Liver transplantation using grafts from donors after circulatory death - the first Czech Republic experience.

INTRODUCTION: Liver transplantation is established as a lifesaving procedure for patients with acute and chronic liver failure, as well as certain selected malignancies. Due to a continuing organ shortage and ever-growing patient waiting lists, donation after cardiac death (DCD) is becoming more frequently utilized in order to close the gap between “supply and demand”. METHODS: A retrospective analysis of DCD and subsequent liver transplantations was performed. RESULTS: From May 2016 to September 2019, a total of 9 DCD liver transplantations were performed in our institution. All cases except one were primary liver transplantations. The recipients comprised 5 (56%) males and 4 (44%) females. The mean DCD donor age was 41±12 (22-57) years, with ventilation duration of 7±1 days and warm ischemia time 19±3 minutes. The average recipient age was 51±22 (4-73) years, with an average cold ischemia 3h:59m±27m and manipulation time of 23±5 minutes. Periprocedural mortality was 1 (11%). Hepatitis C recurrence was documented in 1 (11%) patient. The mean follow-up time was 19±13 (7-37) months. Until now, we have not observed any signs of ischemic cholangiopathy. CONCLUSION: DCD liver transplantation allows us to enlarge the pool of potential liver grafts, thus decreasing the time spent on the liver recipient waiting list. This paper documents the first series of DCD liver transplantations in the Czech Republic.

Assessing forest availability for wood supply in Europe.

The quantification of forests available for wood supply (FAWS) is essential for decision-making with regard to the maintenance and enhancement of forest resources and their contribution to the global carbon cycle. The provision of harmonized forest statistics is necessary for the development of forest associated policies and to support decision-making. Based on the National Forest Inventory (NFI) data from 13 European countries, we quantify and compare the areas and aboveground dry biomass (AGB) of FAWS and forest not available for wood supply (FNAWS) according to national and reference definitions by determining the restrictions and associated thresholds considered at country level to classify forests as FAWS or FNAWS. FAWS represent between 75 and 95 % of forest area and AGB for most of the countries in this study. Economic restrictions are the main factor limiting the availability of forests for wood supply, accounting for 67 % of the total FNAWS area and 56 % of the total FNAWS AGB, followed by environmental restrictions. Profitability, slope and accessibility as economic restrictions, and protected areas as environmental restrictions are the factors most frequently considered to distinguish between FAWS and FNAWS. With respect to the area of FNAWS associated with each type of restriction, an overlap among the restrictions of 13.7 % was identified. For most countries, the differences in the FNAWS areas and AGB estimates between national and reference definitions ranged from 0 to 5 %. These results highlight the applicability and reliability of a FAWS reference definition for most of the European countries studied, thereby facilitating a consistent approach to assess forests available for supply for the purpose of international reporting.

Possibilities and real meaning of assessment of ovarian reserve.

OBJECTIVE: To summarize the posibilities of diagnosis of diminished ovarian reserve. DESIGN: Survey of contemporary knowledge. SETTINGS: PPCHC, Sanus Jihlava; PPCHC, Sanus Hradec Králové; Reprogenesis, Brno. METHODS: Review of literature. CONCLUSION: Voluntary or involuntary motherhood postmonement to the third decade of woman's life needs presice evaluation of the ovarian reserve before the infertility treatment. Contemporary there are: 1 hormonal tests (basal and dynamic), 2 ultrasonographic markers of ovarian reserve. The most perspective markers of ovarian reserve seems AMH a AFC.

Lock-in and pulsed thermography for solar cell testing.

Inspection of solar cells is an important part of their production process because even small defects can cause a significant drop of a whole photovoltaic module performance. LED illuminated lock-in (LEDILIT) and flash-pulse thermographic techniques (FPT) were compared in this study. Lock-in methods are more commonly used for solar cell inspection. The aim of the study was to discover if the FPT is the appropriate method for inspection of defects of multicrystalline solar cells. Experimental setup, inspection results, and advantages/disadvantages of both methods are presented. It is demonstrated that the LEDILIT is the suitable technique for inspection of defects connected with a photovoltaic effect. Local shunts, cracks, and artificial laser-made defects were detected. Only some of the most significant shunts and laser-made defects were identified by the FPT. However, the FPT inspection is much faster than the LEDILIT. The FPT was also able to indicate an inhomogeneity at a bottom layer of a cell, which was not connected with a photovoltaic effect and not revealed by the LEDILIT.

Analysis of short wavelength infrared radiation during laser welding of plastics.

In this paper, a new measurement system and a new approach in calculation for infrared (IR) radiation investigation in quasi-simultaneous transmission laser welding of plastics are presented. The measurement system is based on a MW/SWIR (medium-wave/short-wave IR) camera and optical filters narrowing the spectral region to SWIR. The measured signals contain radiation from the melted zone in between the semitransparent and absorbing polymers, as well as radiation from the surface and interior of the semitransparent polymer. The new calculation approach was developed to distinguish between these signals. It is based on simplification of the process to two places with two temperatures (surface and molten interface) and knowledge of the spectral optical properties of the material, filters, and camera response. The results of measurement and calculation for three different optical filters and polyoxymethylene samples with two thicknesses are shown and discussed. Good agreement is obtained for the calculation variant using normal transmissivity of the semitransparent polymer.

Coupling of equatorial Atlantic surface stratification to glacial shifts in the tropical rainbelt.

The modern state of the Atlantic meridional overturning circulation promotes a northerly maximum of tropical rainfall associated with the Intertropical Convergence Zone (ITCZ). For continental regions, abrupt millennial-scale meridional shifts of this rainbelt are well documented, but the behavior of its oceanic counterpart is unclear due the lack of a robust proxy and high temporal resolution records. Here we show that the Atlantic ITCZ leaves a distinct signature in planktonic foraminifera assemblages. We applied this proxy to investigate the history of the Atlantic ITCZ for the last 30,000 years based on two high temporal resolution records from the western Atlantic Ocean. Our reconstruction indicates that the shallowest mixed layer associated with the Atlantic ITCZ unambiguously shifted meridionally in response to changes in the strength of the Atlantic meridional overturning with a southward displacement during Heinrich Stadials 2-1 and the Younger Dryas. We conclude that the Atlantic ITCZ was located at ca. 1°S (ca. 5° to the south of its modern annual mean position) during Heinrich Stadial 1. This supports a previous hypothesis, which postulates a southern hemisphere position of the oceanic ITCZ during climatic states with substantially reduced or absent cross-equatorial oceanic meridional heat transport.

Thermal effects of laser marking on microstructure and corrosion properties of stainless steel.

Laser marking is an advanced technique used for modification of surface optical properties. This paper presents research on the influence of laser marking on the corrosion properties of stainless steel. Processes during the laser beam-surface interaction cause structure and color changes and can also be responsible for reduction of corrosion resistance of the surface. Corrosion tests, roughness, microscopic, energy dispersive x-ray, grazing incidence x-ray diffraction, and ferrite content analyses were carried out. It was found that increasing heat input is the most crucial parameter regarding the degradation of corrosion resistance of stainless steel. Other relevant parameters include the pulse length and pulse frequency. The authors found a correlation between laser processing parameters, grazing incidence x-ray measurement, ferrite content, and corrosion resistance of the affected surface. Possibilities and limitations of laser marking of stainless steel in the context of the reduction of its corrosion resistance are discussed.

Bile Duct Anastomosis Supplied With Biodegradable Stent in Liver Transplantation: The Initial Experience.

BACKGROUND: The most common biliary complications after orthotopic liver transplantation are bile leaks, anastomotic and intrahepatic strictures, stones, and ampullary dysfunction. These complications can occur in up to 10% to 30% of liver transplant recipients. Leaks occur early in the posttransplant period; the stricture formation typically graduates over time. METHODS: Ten patients underwent transplantation in our preliminary study: 5 were randomized to the group with stent placement and 5 to the control group. We investigated the role of an absorbable biliary stent with the goal of proving patency of duct-to-duct biliary anastomosis. The stents are made of machine-knitted polydioxanone monofilaments. RESULTS: Our initial results show that duct-to-duct biliary reconstruction using an absorbable internal stent had good patency in all 5 patients. There were no signs of biliary leakage accompanying the anastomoses in any of the cases, and there was no stone formation observed after liver transplantation. The biliary stent was completely absorbed, with no adverse effects. CONCLUSIONS: Based on our initial experience and data, we concluded that biodegradable stents can be successfully and safely used in clinical practice. Further large prospective randomized studies are needed to estimate the efficacy of the bioabsorbable stents.

Extremely heat tolerant photo-symbiosis in a shallow marine benthic foraminifera.

Bleaching, the loss of algal symbionts, occurs in marine photosymbiotic organisms at water temperatures minimally exceeding average summer SST (sea surface temperatures). Pre-adaptation allows organisms to persist under warmer conditions, providing the tolerance can be carried to new habitats. Here we provide evidence for the existence of such adaptation in the benthic foraminifera Pararotalia calcariformata. This species occurs at a thermally polluted site in the Mediterranean, where water temperatures reach a maxima daily average of 36 °C during the summer. To test whether this occurrence represents a widespread adaptation, we conducted manipulative experiments exposing this species from an unpolluted site to elevated temperatures (20-42 °C). It was kept in co-culture with the more thermally sensitive foraminifera Amphistegina lobifera in two experiments (20-36 °C). Reduced photosynthetic activity in A. lobifera occurred at 32 °C whereas photochemical stress in P. calcariformata was first observed during exposure to 36 °C. Pararotalia calcariformata survived all treatment conditions and grew under 36 °C. The photosymbiosis in P. calcariformata is unusually thermally tolerant. These observations imply that marine eukaryote-eukaryote photosymbiosis can respond to elevated temperatures by drawing on a pool of naturally occurring pre-adaptations. It also provides a perspective on the massive occurrence of symbiont-bearing foraminifera in the early Cenozoic hothouse climate.

Nanofaceting as a stamp for periodic graphene charge carrier modulations.

The exceptional electronic properties of monatomic thin graphene sheets triggered numerous original transport concepts, pushing quantum physics into the realm of device technology for electronics, optoelectronics and thermoelectrics. At the conceptual pivot point is the particular two-dimensional massless Dirac fermion character of graphene charge carriers and its volitional modification by intrinsic or extrinsic means. Here, interfaces between different electronic and structural graphene modifications promise exciting physics and functionality, in particular when fabricated with atomic precision. In this study we show that quasiperiodic modulations of doping levels can be imprinted down to the nanoscale in monolayer graphene sheets. Vicinal copper surfaces allow to alternate graphene carrier densities by several 10(13) carriers per cm(2) along a specific copper high-symmetry direction. The process is triggered by a self-assembled copper faceting process during high-temperature graphene chemical vapor deposition, which defines interfaces between different graphene doping levels at the atomic level.

Pancreatic islet autotransplantation after completion pancreatectomy for pancreatic fistula after hemipancreatoduodenectomy for carcinoma.

OBJECTIVE: Pancreatic islet autotransplantation (IAT) has a potential to prevent brittle diabetes in patients after total pancreatectomy. Because of the fear of tumor spread, IAT has rarely been used in case of malignancy. We report our experience with patients who underwent hemipancreatoduodenectomy for carcinoma and later completion pancreatectomy for pancreatic fistula with islet autotransplantation at our institution. METHODS: From August 2007 to December 2012, 5 patients underwent IAT after completion pancreatectomy for pancreatic fistula after hemipancreatoduodenectomy for carcinoma. Islets were isolated from the pancreatic tail with the use of digestion with collagenase. Nonpurified islet suspension was infused into the portal vein during surgery. RESULTS: The median number of islets transplanted was 175,000 islet equivalents (range, 70,000-365,000). One patient died after surgery for reasons unrelated to IAT. Another 3 patients had stable diabetes with partial graft function (fasting C-peptide levels 0.23, 0.41, and 0.61 nmol/L and HbA1c 4.8%, 4.6%, and 6.9% at 24, 24 and 9 months after IAT, respectively). The 1st patient, with pancreatic head carcinoma, was alive 28 months after IAT with lymph node and liver recurrence since 18 months after IAT. The 2nd patient, with gall bladder and distal bile duct carcinoma, died 47 months after IAT with tumor recurrence. The 3rd patient, with ampullary carcinoma, died 12 months after IAT with local recurrence and solitary liver metastasis. The last patient had been off insulin 9 months after IAT without tumor recurrence (fasting C-peptide, 0.89 nmol/L; HbA1c, 4.2%). CONCLUSIONS: Autotransplantation of pancreatic islets isolated from the residual pancreatic tissue in patients who previously underwent hemipancreatoduodenectomy for cancer may provide stable glucose control and thus improve quality of life. In this small series we did not observe early development of multiple liver metastases caused by islet suspension contamination with malignant cells. Oncologic outcome of the patients was not worse than what would be expected without IAT.

Atherogenic versus non-atherogenic lipoprotein profiles in healthy individuals. is there a need to change our approach to diagnosing dyslipidemia?

The electrophoretic separation of lipoproteins on polyacrylamide gels enables the quantification of nonatherogenic and atherogenic plasma lipoproteins including small dense low density lipoprotein (sdLDL) particles, which represent the atherogenic lipoprotein subpopulations in plasma. This methodology could help distinguish between nonatherogenic hyperlipidemia, normolipidemia with an atherogenic lipoprotein profile, non-atherogenic normolipidemia, and atherogenic hyperlipidemia. According to our pilot research of a normolipidemic population, the atherogenic lipoprotein profile might be present in about 6% of normolipidemic young healthy individuals. Therefore, if confirmed by other studies, it will be necessary to consider a different diagnostic approach and risk stratification for patients with atherogenic normolipidemia (as well as non-atherogenic hypercholesterolemia).

Randomized double-blind study: wound-healing effects of a Symphytum herb extract cream (Symphytum×uplandicum Nyman) in children.

The wound healing effects of the topically applied preparation Traumaplant® containing a concentrate (10% active ingredient) from the aerial parts of medicinal comfrey (Symphytum × uplandicum Nyman) were examined in a randomized, controlled, clinical double-blind study. An otherwise identical low-dose preparation (1% active ingredient) was used as a control. The study population consisted of 108 children aged 3-12 years (n=54/group) with fresh abrasions. A 50% healing rate was reached 0.9 days earlier with the higher than with the lower concentration cream. The difference in the healing rate (0.38±0.18/day [95% CI 0.33-0.4] vs. 0.26±0.14/day [95% CI 0.222-0.297]) was statistically significant (p=0.0002). Physicians and children/parents both rated the efficacy of the 10% cream as significantly better than that of the control preparation (physicians' assessment after 2-3 and 7-9 days for verum vs. control: 90.7 and 92.6% vs. 55.6 and 74.0% of the healing rates were rated as "good" or "very good", respectively; p=0.0004 and 0.01). In subgroup analyses, there was no significant influence on the healing rate of the time elapsed between the accident and the first consultation, the wound surface, the affected body part, the origin of the injury and gender. There were no reported adverse effects or problems with tolerability such as local skin irritations. The results justify application of the Symphytum herb extract cream in children with blunt traumata with or without abrasions.

[Liver transplantation in patients with portal vein thrombosis]. / Transplantace jater u pacientu s trombózou portální zíly.

AIM: The aim of the study was to perform a retrospective assessment in a group of patients with portal vein thromboses who underwent consecutive liver transplantation. MATERIAL AND METHODS: PVT was preoperatively diagnosed with ultrasound and CT portography. The follow up period was 1 to 6 years. Postoperative immunosuppressive medication was administered in combination with cyclosporin A, prednison and imuran upon initiation of the transplantation programme (8 patients). During the follow up period, the treatment protocol was replaced with FK 506, Cell Cept and prednisone. Liver biopsy was indicated when rejection was suspected. RESULTS: During 1996-2009, the team of authors performed a total of 740 liver transplantations in 303 female and 437 male subjects. The procedures included 703 primary procedures, 33 retransplantations and four second retransplantations. Out of the total, 57 recipients (7.7%) had portal vein obliteration. These subjects included 42 male and 15 females, their mean age was 52 (9-67) years. 62 liver transplantations were performed in these 57 patients. The following complications were recorded in the patient group: graft dysfunction in 10.5%, revisions for bleeding in 28%, hepatic artery thrombosis in 10.5%, portal vein rethrombosis in 1.8%, biliary complications in 17.5%, acute rejections in 19.3%. Perioperative mortality rate was 15.8%.The mean blood derivates requirement was 17.1 (0-425) erythrocyte transfusion units, 27.1 (0-132) frozen plasma transfusion units and 2.6 (0-20) thrombocyte transfusion units. CONCLUSION: The results of out retrospective study indicate that portal thrombosis is not a contraindication for liver transplantation. Current surgical techniques make liver transplantations in patients with complete splanchnic venous thrombosis possible.

[Early biliary complications following liver transplantation]. / Casné biliární komplikace po transplantaci jater.

INTRODUCTION: Biliary complications (BC) after liver transplantation (LTx) are serious problems with an incidence rate of 6-35%. There are two types of BC, early and late. Early BC is observed for 30 days post LTx or during the entire period of the patient's first hospital stay after LTx. The main causes of early BC are ischemia of the biliary tree (the bile duct of the transplanted liver is supplied only from the right hepatic artery descendingly; the supply from the gastroduodenal artery is lacking) as well as implementation of the biliary anastomosis surgical technique. Treatment of BC is administered by a surgeon, a gastroenterologist and a radiologist. AIM: To evaluate early biliary complications after LTx PATIENTS AND METHODS: We reviewed patients with early BC after LTx from 4/2004 - 12/2009. We defined early BC as a complication that is present during the first 30 days post LTx or during the entire period of the patient's first hospital stay after LTx. RESULTS: We performed 384 LTx during the above-mentioned period. We carried out reconstruction of the biliary tree in the form of a choledochocholedochostomy (CDD) in 312 cases and in the form of a choledochojejunostomy (CDJ) in 72 cases. Sixty-eight patients had early BC (17.7%), 25 patients experienced biliary leak (6.5%), 40 patients had anastomotic stenosis (10.4%) and 3 patients (0.8%) experienced both complications (biliary leak and stenosis). Most complications were eliminated by ERCP with a papilosfincterotomy, a balloon dilatation of stenosis, and a biliary stent implant with repeated stent replacements (45 cases in total- all patients with biliary stenosis). Twenty-two patients were reoperated on (16x CDJ, 3x re-CDD, 2x suture of aberrant bile duct, 1x suture common bile duct) and 1 patient was treated by percutaneous transhepatic bilary drainage (PTD). The mortality rate was zero. CONCLUSION: BC after LTx continue to pose a serious surgical problem. The treatment of choice when dealing with BC is ERCP, which has more than a 70% success rate. If ERCP or PTD are not successful, or when biliary peritonitis is present, we perform a reanastomosis of the bile duct. The combined effort of the surgeon, gastroenterologist and radiologist is the most important factor for successful treatment. The incidence of BC after LTx at IKEM is similar to that of treatment centers all over the world.

Contribution of the atherogenic lipoprotein profile to the development of arterial hypertension.

OBJECTIVES: Determination of non-atherogenic and atherogenic plasma lipoproteins, including small dense LDL, in patients with newly diagnosed arterial hypertension and identification of the phenotype of lipoprotein profile: non-atherogenic phenotype A vs. atherogenic lipoprotein phenotype B, in plasma of examined subjects. BACKGROUND: Atherogenic lipoproteins play an important role in the pathogenesis of arterial hypertension. Impaired lipoprotein metabolism results in overproduction of triglyceride-rich particles and LDL 3-7 subfractions - small dense LDL - a strongly atherogenic LDL subpopulation accelerating the development of arterial hypertension. METHODS: Total cholesterol and triglycerides were analyzed by enzymatic CHOD-PAP method, Roche Diagnostics, Germany. Lipoprotein profiles of plasma described as atherogenic lipoprotein phenotype B or a nonaterogenic lipoprotein phenotype A were examined by a new method of lipoprotein separation by means of electrophoresis on polyacrylamide gel (Lipoprint LDL system). Prostacyclin and thromboxane A2 in plasma were analysed by ELISA method. Score of Atherogenic Risk was determined as a ratio of atherogenic and non-atherogenic plasma lipoproteins. RESULTS: 1) High percentage of atherogenic hypertriacylglycerolemia (93%) and atherogenic mixed hyperlipemia (86 %) in subjects with arterial hypertension. 2) Low percentage of atherogenic hypercholesterolemia (52 %) in subjects with arterial hypertension. 3) Atherogenic normolipemia (7%) in control group of healthy subject. CONCLUSION: Contribution of this method lies in benefits as follows: A) Quantification of non-atherogenic and atherogenic plasma lipoproteins. B) Identification of high percentage of atherogenic dyslipoproteinemia (86-93%) in subjects with arterial hypertension. C) Presence of small dense LDL in plasma is decisive for declaring the atherogenic lipoprotein profile in both hyperlipemia and normolipemia (Tab. 5, Ref. 24).

[Serum lipoprotein profile in newly recognized arterial hypertension. The role of atherogenic lipoproteins in the pathogenesis of disease]. / Lipoproteínový profil séra pri novozistenej artériovej hypertenzii. Uloha aterogénnych lipoproteínov v patogenéze ochorenia.

New examination approaches in biochemical analysis of lipoproteins can identify and quantify atherogenic plasma lipoproteins, including small dense LDL and characterise a lipoprotein spectrum as a non-atherogenic lipoprotein profile phenotype A, respectively as an atherogenic lipoprotein profile phenotype B. Identification of a non-aterogenic hypercholesterolemia (48%), atherogenic hypertriglyceridemia (93%), atherogenic normolipemia (13%) in patients with arterial hypertension and an atherogenic normolipemia in control group of healthy subjects (7%), is an essential contribution of this new laboratory diagnostics.

[Liver transplantations in children using reduced grafts]. / Transplantace jater u detí redukovaným stepem.

AIM: Liver transplantation is a life-saving procedure in patients with end stage liver disease. Five-year survival in patients indicated for transplantation based on standard indication criteria, has reached a rate over 80%. Shortage of suitable grafts remains the main problem in these procedures. While the situation in adult patients is relatively satisfactory, liver transplantations in children, mainly in the low-weight categories, remain a worldwide problem because of the absolute lack of suitable donors. In order to reduce mortality in the youngest patients on the waiting list, a concept of reduction of the adult graft for pediatric use was introduced in the early 1990s. Recent introduction of novel methods, such as split transplantations or transplantations between relatives, has resulted in lower mortality rates in the youngest recipients on the waiting lists. The author assesses a group of patients below 18 years of age, who underwent reduced liver graft transplantations in the Czech Republic. MATERIAL AND METHODS: From 1995 to 2009, a total of 43 patients below 18 years of age underwent transplantations, using 48 liver grafts. Further 17 children were sent abroad for transplantations, where a total of 23 liver grafts were used. Only patients who underwent transplantations using the liver grafts adjusted in IKEM were assessed in the patient group, i.e. 14 patients, resp. 16 liver grafts. Reduction was performed in 13 subjects. One subjects underwent transplantation between relatives and a liver split was used in two subjects. In the lowest weight category up to 10 kgs, 5 liver reductions were performed. OUTCOMES: Out of the total (n = 16), 4 grafts failed (2 were early postoperative failures, ie. within 2 postoperative days and 2 grafts failed in Month 5). The mean graft survival was 65 months. Within the youngest recipient age group (n = 5), no graft failure was recorded. The mean survival time is 26 months. CONCLUSION: Since 2007, the Czech Republic has been providing a program for all patients, including the lowest weight-category pediatric patients. To date data are satisfactory. No graft failure has been recorded in the category of the smallest (up to 10 kgs) pediatric patients.