Liver transplantation (LT) in human immunodeficiency virus (HIV)‐positive individuals is considered to be an experimental therapy with limited reported worldwide experience, and little long‐term ...survival data. Published data suggest that the short‐term outcome is encouraging in selected patients. Here, we report our experience in 14 HIV‐infected liver allograft recipients, and compare outcomes between those coinfected with hepatitis C virus (HCV) and the non‐HCV group. A total of 14 HIV‐infected patients (12 male, 2 female, age range 26‐59 years) underwent LT between January 1995 and April 2003. Indications for LT were HCV (n = 7), hepatitis B virus (HBV; n = 4), alcohol‐induced liver disease (n = 2), and seronegative hepatitis (n = 1); 3 patients presented with acute liver failure. At LT, CD4 cell counts (T‐helper cells that are targets for HIV) ranged from 124 to 500 cells/μL (mean 264), and HIV viral loads from <50 to 197,000 copies/mL. Nine of 12 patients were exposed to highly active antiretroviral therapy (HAART) before LT. In the non‐HCV group (n = 7), all patients are alive, all surviving more than 365 days (range 668‐2,661 days). No patient has experienced HBV recurrence, and graft function is normal in all 7 patients. However, 5 of 7 HCV‐infected patients died after LT at 95‐784 days (median 161 days). A total of 4 patients died of complications due to recurrent HCV infection and sepsis, despite antiviral therapy in 3 of them. A total of 3 patients experienced complications relating to HAART therapy. In conclusion, outcome of LT in HIV‐infected patients with HBV or other causes of chronic liver disease indicates that LT is an acceptable therapeutic option in selected patients. However, longer follow‐up in larger series is required before a conclusive directive can be provided for HCV / HIV coinfected patients requiring LT. (Liver Transpl 2004;10:1271–1278.)
Heart failure is a progressive disease with limited treatment options. The C-Pulse Heart Assist System (Eden Prairie, MN) is an extravascular, diastolic counterpulsation circulatory support device ...for patients with refractory NHYA Class III/ambulatory class IV heart failure. It comprises a balloon-cuff which is implanted around the ascending aorta that is synchronised to inflate during ventricular diastole. The system eliminates the need for systemic anticoagulation and significantly reduces the risk of bleeding and overcomes the problem of device thrombosis. However, clinical efficacy is dependent on maintenance of residual myocardial function. We describe a case of a patient who presented with ischemic cardiomyopathy in end-stage heart failure and received the C-Pulse System. Due to deterioration in cardiac function, the system had to be upgraded to a full-support left ventricular assist device (LVAD) after 4 months. However, the aorta ascendens was short and the outflow graft of the HeartWare LVAD had to be anastomosed to the cuff balloon region of the aorta. Our experience showed in this case that the inflatable cuff action did not compromise the structural integrity of the aortic wall.
This theoretical investigation of steady fluid flow through a rigid three-dimensional branching geometry is motivated by applications to haemodynamics in the brain especially, while the flow through ...a tube with a blockage or through a collapsed tube provides another motivation with a biomedical background. Three-dimensional motion without symmetry is addressed through one mother vessel to two or several daughters. A comparatively long axial length scale of the geometry leads to a longitudinal vortex system providing a slender-flow model for the complete mother-and-daughters flow response. Computational studies and subsequent analysis, along with comparisons, are presented. The relative flow rate varies in terms of an effective Reynolds number dependence, allowing a wide range of flow rates to be examined theoretically; also any rigid cross-sectional shape and ratio of cross-sectional area expansion or contraction from the mother vessel to the daughters can be accommodated in principle in both the computations and the analysis. Swirl production with substantial crossflows is found. The analysis shows that close to any carina (the ridge separating daughter vessels) or carinas at a branch junction either forward or reversed motion can be observed locally at the saddle point even though the bulk of the motion is driven forward into the daughters. The local forward or reversed motion is controlled, however, by global properties of the geometry and incident conditions, a feature which applies to any of the flow rates examined.
Adult orthotopic liver transplantation is associated with significant use of allogenic blood products, which places considerable demands on finite resources. This could be reduced by autologous red ...cell salvage use, and we evaluated its cost effectiveness in this prospective study.
Intraoperative autotransfusion was used in 660 adult liver transplant patients between January 1997 and July 2002. These included 134 with acute liver failure, 62 retransplants, 90 alcohol-related, 183 viral, 98 cholestatic chronic liver diseases, and 93 with other etiologies.
The total volume of red blood cells transfused was 3641+/-315 ml, 2805+/-234 ml, 2603+/-443 ml, and 2785+/-337 ml for alcohol-related, viral, cholestatic, and others, respectively. Low preoperative hemoglobin was significantly associated with higher intraoperative transfusion requirements. Blood volumes transfused at retransplantation were significantly higher (7077+/-1110 ml vs. 2864+/-138 ml; P<0.001) than for acute liver failure and chronic liver disease. Autologous blood volumes transfused were similar in all diagnostic groups, but were significantly greater in retransplantation (2754+/-541 ml vs. 1524+/-77 ml; P<0.01). Venovenous bypass was significantly associated with higher transfusion requirements. Total savings per case were similar for all diagnostic groups but were greater in cases of retransplantation (864+/-222 pounds (1235+/-317 US dollars) vs. 238+/-24 pounds (340+/-34 US dollars; P<0.001). With the use of autologous transfusion over the study period, a cost saving of 131,901 pounds (188,618 US dollars) was achieved.
Intraoperative red blood cell salvage and autologous transfusion is cost effective in adult liver transplantation. Currently, where optimum resource utilization and fiscal constraint are paramount in healthcare delivery, autologous transfusion is an important adjunct in liver transplantation.
Valid measurement of physical activity is important for studying the risks for morbidity and mortality. The purpose of this study was to examine evidence of construct validity of two similar ...single-response items assessing physical activity via self-report. Both items are based on the stages of change model. The sample was 687 participants (men = 504, women = 183) who completed an 8-response (PA8) or 5-response (PA5) single-response item about current level of physical activity. Responses were categorized as meeting or not meeting guidelines for sufficient physical activity to achieve a health benefit. Maximal cardiorespiratory fitness (CRF) and health markers were obtained during a clinical examination. Partial correlation, multivariate analysis of covariance, and logistic regression were used to identify the relations between self-reported physical activity, CRF, and health markers when controlling for gender and age. Single-response items were compared to a detailed measure of physical activity. Single-response items correlated significantly with CRF determined with a maximal exercise test on a treadmill (PA8 = .53; PA5 = .57). Differences in percentage of body fat and cholesterol were in the desired direction, with those self-reporting sufficient physical activity for a health benefit having the lower values. The single-response items demonstrated evidence of construct validity and may provide feasible, cost-effective, and efficient methods to assess physical activity in large-scale studies.
During the recent COVID-19 pandemic, in common with educators across the Higher Education sector, the School of Dentistry at the University of Liverpool reimagined the learning and assessment ...strategy by moving from proctored closed-book assessment to largely unmonitored open-book examinations (OBE). This article discusses understandings from an educator perspective following our implementation of OBE. The educator perspective discussed here indicates that OBE have the potential to be an authentic and acceptable form of assessment, but that some reframing of attitudes towards assessment from all stakeholders and their approaches to assessment is necessary when developing these innovative types of assessment.
This article was published open access under a CC BY licence: https://creativecommons.org/licences/by/4.0.
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