BACKGROUND： Split liver transplantation increases the number of grafts available for transplantation. Pre-recovery assessment of liver graft volume is essential for selecting suitable recipients. The purpose of this ...BACKGROUND： Split liver transplantation increases the number of grafts available for transplantation. Pre-recovery assessment of liver graft volume is essential for selecting suitable recipients. The purpose of this study was to determine the ability and feasibility of constructing a 3-D model to aid in surgical planning and to predict graft weight prior to an in situ division of the donor liver. METHODS： Over 11 months, 3-D volumetric reconstruction of 4 deceased donors was performed using Pathfinder Scout liver volumetric software. Demographic, laboratory, operative, perioperative and survival data for these patients along with donor demographic data were collected prospectively and analyzed retrospectively. RESULTS： The average predicted weight of the grafts from the adult donors obtained from an in situ split procedure were 1130 g （930-1458 g） for the extended right lobe donors and 312 g （222-396 g） for left lateral segment grafts. Actual adult graft weight was 92% of the predicted weight for both the extended right grafts and the left lateral segment grafts. The predicted and actual graft weights for the pediatric donors were 176 g and 210 g for the left lateral segment grafts and 308 g and 280 g for the extended right lobe grafts,respectively. All grafts were transplanted except for the right lobe from the pediatric donors due to the small graft weight.CONCLUSIONS： On-site volumetric assessment of donors provides useful information for the planning of an in situ split and for selection of recipients. This information may expand the donor pool to recipients previously felt to be unsuitable due to donor and/or recipient weight.展开更多
Obesity is on the rise worldwide. As a result, unprecedented rates of patients are presenting with end stage liver disease in the setting of non-alcoholic fatty liver disease(NAFLD) and are requiring liver transplanta...Obesity is on the rise worldwide. As a result, unprecedented rates of patients are presenting with end stage liver disease in the setting of non-alcoholic fatty liver disease(NAFLD) and are requiring liver transplantation. There are significant concerns that the risk factors associated with obesity and the metabolic syndrome might have a detrimental effect on the long term outcomes following liver transplantation. In general, short term patient and graft outcomes for both obese and morbidly obese patients are comparable with that of non-obese patients, however, several studies report an increase in peri-operative morbidity and increased length of stay. Continued studies documenting the long-term outcomes from liver transplantation are needed to further examine the risk of recurrent disease(NAFLD) and also further define the role risk factors such cardiovascular disease might play long term. Effective weight reduction in the post liver transplant setting may mitigate the risks associated with the metabolic syndrome long-term.展开更多
BACKGROUND As prevalence of nonalcoholic fatty liver disease increases in the population,livers with steatosis will continue to infiltrate the donor pool.Safe utilization of these extended criteria grafts is paramount...BACKGROUND As prevalence of nonalcoholic fatty liver disease increases in the population,livers with steatosis will continue to infiltrate the donor pool.Safe utilization of these extended criteria grafts is paramount given the increased risk associated with their use in transplantation.Prognostic factors that can predict liver dysfunction immediately after transplantation with macrosteatotic grafts are lacking.AIM To understand the relationship between interleukin-33(IL-33)and complement in recipients immediately following liver reperfusion as a marker of liver dysfunction.METHODS Cohort consisted of patients who received a liver transplant from September 2016–September 2019 at our institution.Clinical variables were retrospectively extracted from the electronic medical record.Back-table donor biopsies were obtained with donor steatosis percentage retrospectively determined by a boardcertified pathologist.Blood samples were available immediately following liver transplantation.Quantification of plasma IL-33 and complement proteins,C3a and C5a,were determined by enzyme-linked immunosorbent assay.For mRNA expression,RNA was extracted from donor biopsies and used against a 780 gene panel.RESULTS Cohort consisted of 99 donor and recipients.Donor median age was 45 years and 55%male.Recipients had a median age of 59 years with 62%male.The main etiologies were alcoholic hepatitis,nonalcoholic steatohepatitis,and hepatocellular carcinoma.Median MELD-Na at transplant was 21.Donors were grouped based on moderate macrosteatosis(≥30%).Recipients implanted with moderate macrosteatotic grafts had significantly higher peak alanine aminotransferase/aspartate aminotransferase(P<0.001 and P<0.004),and increased incidence of early allograft dysfunction(60%compared to 18%).Circulating IL-33 levels were significantly elevated in recipients of≥30%macrosteatotic grafts(P<0.05).Recipients with detectable levels of circulating IL-33 immediately following reperfusion had significantly higher alanine aminotransferase/aspartate aminotransferase(P<0.05 and P<0.01).Activated complement(C3a and C5a)were elevated in recipients implanted with moderate macrosteatotic grafts.RNA expression analysis of donor biopsies revealed moderate steatotic grafts upregulated genes inflammatory processes while downregulated hepatocyte-produced complement factors.CONCLUSION Circulating IL-33 and activated complement levels immediately following liver reperfusion in recipients of moderate macrosteatotic grafts may identify which patients are at risk of early allograft dysfunction.展开更多
Groundwater dependent ecosystems(GDEs)are vulnerable to groundwater regime changes.However,their protection is often hampered by challenges in their identification.Within is presented a remote sensing-based GDE potent...Groundwater dependent ecosystems(GDEs)are vulnerable to groundwater regime changes.However,their protection is often hampered by challenges in their identification.Within is presented a remote sensing-based GDE potential mapping approach based on the persistency of relevant vegetation parameters during prolonged dry periods as an indicator of potential‘consistency’of water supply(e.g.groundwater).The study uses a novel approach to characterising persistency for selected vegetation parameters based on a normalised difference measure and an adaptation of the coefficient of variation statistic.Aggregation of parameters was facilitated through the analytic hierarchy process providing a structured weighting approach to minimise parameter bias.The approach is demonstrated in the semi-arid Flinders Ranges of South Australia where new groundwater resources are being sought to support local domestic and industry needs.Variations in GDE potential were mapped to better target areas where exploration of groundwater should be avoided.Mapping results indicated a high-level of agreement of 77%with an independent springs dataset,along with an 87%agreement with areas coinciding with known phreatophyte species and depths to groundwater.The index-based mapping approach has potential applicability across landscapes,as it normalises for variations in vegetation cover,minimises technical overheads,and employs continental-wide remote sensing data-products.展开更多
VIIRS 375 m active fire data(VNP14IMG),the highest spatial resolution available cost-free fire product,were assessed for representing fire in typical degraded tropical peatlands in Indonesia.The results of applying th...VIIRS 375 m active fire data(VNP14IMG),the highest spatial resolution available cost-free fire product,were assessed for representing fire in typical degraded tropical peatlands in Indonesia.The results of applying the Tropical Peatland Combustion Algorithm to Landsat-8(ToPeCAl-L8)daytime imagery were utilised as the fire references.To permit the comparison of non-simultaneous VNP14IMG and ToPeCAl-L8,peatland fire propagation speeds resulting from previous study using TET-1 data in Central Kalimantan’s peatlands were utilised.Most peatland fires were still within 750 m from their source over 15 h under uniform conditions,except for very large fires.The detection rates of nighttime VNP14IMG compared with ToPeCAl-L8 showed about 80%agreement for small fire areas(<14 ha).For fires larger than 14 ha,a dissolved 375 m buffer(cluster buffer)of VNP14IMG active fires with an integration of nighttime and daytime acquisitions,produced a probability of detection up to 90%.These results generated a recommendation for implementing cluster buffer analysis and integration of nighttime and daytime analysis of VNP14IMG data for better accuracy in fire detection for ground fire management.They also demonstrate the utility of the ToPeCAl-L8 algorithm with VIIRS 375 m active fire data.展开更多
文摘BACKGROUND： Split liver transplantation increases the number of grafts available for transplantation. Pre-recovery assessment of liver graft volume is essential for selecting suitable recipients. The purpose of this study was to determine the ability and feasibility of constructing a 3-D model to aid in surgical planning and to predict graft weight prior to an in situ division of the donor liver. METHODS： Over 11 months, 3-D volumetric reconstruction of 4 deceased donors was performed using Pathfinder Scout liver volumetric software. Demographic, laboratory, operative, perioperative and survival data for these patients along with donor demographic data were collected prospectively and analyzed retrospectively. RESULTS： The average predicted weight of the grafts from the adult donors obtained from an in situ split procedure were 1130 g （930-1458 g） for the extended right lobe donors and 312 g （222-396 g） for left lateral segment grafts. Actual adult graft weight was 92% of the predicted weight for both the extended right grafts and the left lateral segment grafts. The predicted and actual graft weights for the pediatric donors were 176 g and 210 g for the left lateral segment grafts and 308 g and 280 g for the extended right lobe grafts,respectively. All grafts were transplanted except for the right lobe from the pediatric donors due to the small graft weight.CONCLUSIONS： On-site volumetric assessment of donors provides useful information for the planning of an in situ split and for selection of recipients. This information may expand the donor pool to recipients previously felt to be unsuitable due to donor and/or recipient weight.
文摘Obesity is on the rise worldwide. As a result, unprecedented rates of patients are presenting with end stage liver disease in the setting of non-alcoholic fatty liver disease(NAFLD) and are requiring liver transplantation. There are significant concerns that the risk factors associated with obesity and the metabolic syndrome might have a detrimental effect on the long term outcomes following liver transplantation. In general, short term patient and graft outcomes for both obese and morbidly obese patients are comparable with that of non-obese patients, however, several studies report an increase in peri-operative morbidity and increased length of stay. Continued studies documenting the long-term outcomes from liver transplantation are needed to further examine the risk of recurrent disease(NAFLD) and also further define the role risk factors such cardiovascular disease might play long term. Effective weight reduction in the post liver transplant setting may mitigate the risks associated with the metabolic syndrome long-term.
文摘BACKGROUND As prevalence of nonalcoholic fatty liver disease increases in the population,livers with steatosis will continue to infiltrate the donor pool.Safe utilization of these extended criteria grafts is paramount given the increased risk associated with their use in transplantation.Prognostic factors that can predict liver dysfunction immediately after transplantation with macrosteatotic grafts are lacking.AIM To understand the relationship between interleukin-33(IL-33)and complement in recipients immediately following liver reperfusion as a marker of liver dysfunction.METHODS Cohort consisted of patients who received a liver transplant from September 2016–September 2019 at our institution.Clinical variables were retrospectively extracted from the electronic medical record.Back-table donor biopsies were obtained with donor steatosis percentage retrospectively determined by a boardcertified pathologist.Blood samples were available immediately following liver transplantation.Quantification of plasma IL-33 and complement proteins,C3a and C5a,were determined by enzyme-linked immunosorbent assay.For mRNA expression,RNA was extracted from donor biopsies and used against a 780 gene panel.RESULTS Cohort consisted of 99 donor and recipients.Donor median age was 45 years and 55%male.Recipients had a median age of 59 years with 62%male.The main etiologies were alcoholic hepatitis,nonalcoholic steatohepatitis,and hepatocellular carcinoma.Median MELD-Na at transplant was 21.Donors were grouped based on moderate macrosteatosis(≥30%).Recipients implanted with moderate macrosteatotic grafts had significantly higher peak alanine aminotransferase/aspartate aminotransferase(P<0.001 and P<0.004),and increased incidence of early allograft dysfunction(60%compared to 18%).Circulating IL-33 levels were significantly elevated in recipients of≥30%macrosteatotic grafts(P<0.05).Recipients with detectable levels of circulating IL-33 immediately following reperfusion had significantly higher alanine aminotransferase/aspartate aminotransferase(P<0.05 and P<0.01).Activated complement(C3a and C5a)were elevated in recipients implanted with moderate macrosteatotic grafts.RNA expression analysis of donor biopsies revealed moderate steatotic grafts upregulated genes inflammatory processes while downregulated hepatocyte-produced complement factors.CONCLUSION Circulating IL-33 and activated complement levels immediately following liver reperfusion in recipients of moderate macrosteatotic grafts may identify which patients are at risk of early allograft dysfunction.
文摘Groundwater dependent ecosystems(GDEs)are vulnerable to groundwater regime changes.However,their protection is often hampered by challenges in their identification.Within is presented a remote sensing-based GDE potential mapping approach based on the persistency of relevant vegetation parameters during prolonged dry periods as an indicator of potential‘consistency’of water supply(e.g.groundwater).The study uses a novel approach to characterising persistency for selected vegetation parameters based on a normalised difference measure and an adaptation of the coefficient of variation statistic.Aggregation of parameters was facilitated through the analytic hierarchy process providing a structured weighting approach to minimise parameter bias.The approach is demonstrated in the semi-arid Flinders Ranges of South Australia where new groundwater resources are being sought to support local domestic and industry needs.Variations in GDE potential were mapped to better target areas where exploration of groundwater should be avoided.Mapping results indicated a high-level of agreement of 77%with an independent springs dataset,along with an 87%agreement with areas coinciding with known phreatophyte species and depths to groundwater.The index-based mapping approach has potential applicability across landscapes,as it normalises for variations in vegetation cover,minimises technical overheads,and employs continental-wide remote sensing data-products.
基金This research was funded by STEM-University of South Australia under scholarship programme of Research and Innovation in Science and Technology Project(RISET-Pro)in Ministry of Research,Technology and Higher Edu-cation of the Republic of Indonesia(Kemenristekdikti)with World Bank Loan No.8245-ID.
文摘VIIRS 375 m active fire data(VNP14IMG),the highest spatial resolution available cost-free fire product,were assessed for representing fire in typical degraded tropical peatlands in Indonesia.The results of applying the Tropical Peatland Combustion Algorithm to Landsat-8(ToPeCAl-L8)daytime imagery were utilised as the fire references.To permit the comparison of non-simultaneous VNP14IMG and ToPeCAl-L8,peatland fire propagation speeds resulting from previous study using TET-1 data in Central Kalimantan’s peatlands were utilised.Most peatland fires were still within 750 m from their source over 15 h under uniform conditions,except for very large fires.The detection rates of nighttime VNP14IMG compared with ToPeCAl-L8 showed about 80%agreement for small fire areas(<14 ha).For fires larger than 14 ha,a dissolved 375 m buffer(cluster buffer)of VNP14IMG active fires with an integration of nighttime and daytime acquisitions,produced a probability of detection up to 90%.These results generated a recommendation for implementing cluster buffer analysis and integration of nighttime and daytime analysis of VNP14IMG data for better accuracy in fire detection for ground fire management.They also demonstrate the utility of the ToPeCAl-L8 algorithm with VIIRS 375 m active fire data.
