The European trial investigating normothermic ex vivo liver perfusion (NEVLP) as a preservation technique for liver transplantation (LT) uses gelofusine, a non–US Food and Drug ...Administration–approved, bovine‐derived, gelatin‐based perfusion solution. We report a safety and feasibility clinical NEVLP trial with human albumin–based Steen solution. Transplant outcomes of 10 human liver grafts that were perfused on the Metra device at 37 °C with Steen solution, plus 3 units of erythrocytes were compared with a matched historical control group of 30 grafts using cold storage (CS) as the preservation technique. Ten liver grafts were perfused for 480 minutes (340‐580 minutes). All livers cleared lactate (final lactate 1.46 mmol/L; 0.56‐1.74 mmol/L) and produced bile (61 mL; 14‐146 mL) during perfusion. No technical problems occurred during perfusion, and all NEVLP‐preserved grafts functioned well after LT. NEVLP versus CS had lower aspartate aminotransferase and alanine aminotransferase values on postoperative days 1‐3 without reaching significance. No difference in postoperative graft function between NEVLP and CS grafts was detected as measured by day 7 international normalized ratio (1.1 1‐1.56 versus 1.1 1‐1.3; P = 0.5) and bilirubin (1.5; 1‐7.7 mg/dL versus 2.78; 0.4‐15 mg/dL; P = 0.5). No difference was found in the duration of intensive care unit stay (median, 1 versus 2 days; range, 0‐8 versus 0‐23 days; P = 0.5) and posttransplant hospital stay (median, 11 versus 13 days; range, 8‐17 versus 7‐89 days; P = 0.23). Major complications (Dindo‐Clavien ≥ 3b) occurred in 1 patient in the NEVLP group (10%) compared with 7 (23%) patients in the CS group (P = 0.5). No graft loss or patient death was observed in either group. Liver preservation with normothermic ex vivo perfusion with the Metra device using Steen solution is safe and results in comparable outcomes to CS after LT. Using US Food and Drug Administration–approved Steen solution will avoid a potential regulatory barrier in North America. Liver Transplantation 22 1501–1508 2016 AASLD.
To collect voided urine from dogs with clinical signs of lower UTI and determine the diagnostic performance of a commercially available rapid immunoassay (RIA) immediately after urine collection and ...after refrigeration at 4 and 24 hours.
40 client-owned dogs.
Aerobic urine culture was performed on urine collected by cystocentesis. Urine samples were collected by voiding, and the RIA performed in triplicate within 30 minutes (time 0) and again in triplicate after 4 and 24 hours of refrigeration. Test precision and agreement between culture results and RIA results at each time point were determined, and factors possibly associated with false results investigated.
14 of 40 dogs (35%) had UTI verified by aerobic urine culture, and all had positive RIA. Three dogs had false positive RIA results. Sensitivity, specificity, positive predictive value, and negative predictive value of the RIA were 100, 88%, 82%, and 100%, respectively, and results were not different after 4 and 24 hours of refrigeration. Precision was excellent.
This point-of-care RIA, performed on voided urine refrigerated up to 24 hours, rapidly and accurately identifies bacteriuria in dogs with lower urinary tract clinical signs, inexpensively.
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•Most patients with single HCC ≤3 cm treated by RFA will eventually develop recurrent HCC distant to the ablation site.•Many patients treated with HCC will recur beyond the Milan ...criteria despite close post-RFA surveillance.•Patients with tumors >2 cm and higher serum alpha-fetoprotein are at greater risk of recurrence beyond Milan criteria.
Radiofrequency ablation (RFA) is an effective treatment for single hepatocellular carcinoma (HCC) ≤3 cm. Disease recurrence is common, and in some patients will occur outside transplant criteria. We aimed to assess the incidence and risk factors for recurrence beyond Milan criteria in potentially transplantable patients treated with RFA as first-line therapy.
We performed a retrospective cohort study of potentially transplantable patients with new diagnoses of unifocal HCC ≤3 cm that underwent RFA as first-line therapy between 2000-2015. We defined potentially transplantable patients as those aged <70 years without any comorbidities that would preclude transplant surgery. Incidence of recurrence beyond Milan criteria was compared across 2 groups according to HCC diameter at the time of ablation: (HCC ≤2 cm vs. HCC >2 cm). Competing risks Cox regression was used to identify predictors of recurrence beyond Milan criteria.
We included 301 patients (167 HCC ≤2 cm and 134 HCC >2 cm). Recurrence beyond Milan criteria occurred in 36 (21.6%) and 47 (35.1%) patients in the HCC ≤2 cm and the HCC >2 cm groups, respectively (p = 0.01). The 1-, 3- and 5-year actuarial survival rates after RFA were 98.2%, 86.2% and 79.0% in the HCC ≤2 cm group vs. 93.3%, 77.6% and 70.9% in the HCC >2 cm group (p = 0.01). Tumor size >2 cm (hazard ratio 1.94; 95%CI 1.25–3.02) and alpha-fetoprotein levels at the time of ablation (100–1,000 ng/ml: hazard ratio 2.05; 95%CI 1.10–3.83) were found to be predictors of post-RFA recurrence outside Milan criteria.
RFA for single HCC ≤3 cm provides excellent short- to medium-term survival. However, we identified patients at higher risk of recurrence beyond Milan criteria. For these patients, liver transplantation should be considered immediately after the first HCC recurrence following RFA.
Radiofrequency ablation and liver transplantation are treatment options for early stages of hepatocellular carcinoma (HCC). After ablation some patients will experience recurrence or metastatic spread of the initial tumor or may develop new tumors within the liver. Despite close follow-up, these recurrences can progress rapidly and exceed transplant criteria, preventing the patient from receiving a transplant. We identified that patients with HCC >2 cm and higher serum alpha-fetoprotein are at greater risk of recurrence beyond the transplant criteria. These data suggest that liver transplantation should be considered immediately after the first HCC recurrence for these patients.
Purpose
The purpose of this paper is to develop a thorough understanding of the adoption of logistics and supply chain management (SCM) in practice, particularly at a strategic level, through an ...investigation of the four perspectives taxonomy of the relationship between logistics and SCM.
Design/methodology/approach
Based on a comprehensive literature review, three specific research questions are proposed. The empirical work addresses these questions and comprised three phases: focussed interviews, a questionnaire survey and focus groups.
Findings
The findings provide a usage profile of the four perspectives and indicate a divergence between the understanding and adoption of logistics and SCM principles and concepts at a strategic level in firms. The findings also identify the critical success factors (CSFs) and inhibitors to success in addressing this divergence.
Research limitations/implications
The insights generated using the authors’ methodologically pluralist research design could be built upon to include case studies, grounded theory and action research. Replicating the research in other geographical areas could facilitate international comparisons.
Practical implications
The findings allow practitioners to compare their perspectives on the relationship between logistics and SCM with those of their peers. The CSFs and inhibitors to success provide a rational basis for realising the strategic potential of logistics and SCM in practice.
Originality/value
New insights are generated into practitioner perspectives vis-à-vis logistics vs SCM. A fresh understanding of those factors which drive and hinder the adoption of strategic SCM is also developed and presented.
The liver is the largest solid organ in the body and is critical for metabolic and immune functions. However, little is known about the cells that make up the human liver and its immune ...microenvironment. Here we report a map of the cellular landscape of the human liver using single-cell RNA sequencing. We provide the transcriptional profiles of 8444 parenchymal and non-parenchymal cells obtained from the fractionation of fresh hepatic tissue from five human livers. Using gene expression patterns, flow cytometry, and immunohistochemical examinations, we identify 20 discrete cell populations of hepatocytes, endothelial cells, cholangiocytes, hepatic stellate cells, B cells, conventional and non-conventional T cells, NK-like cells, and distinct intrahepatic monocyte/macrophage populations. Together, our study presents a comprehensive view of the human liver at single-cell resolution that outlines the characteristics of resident cells in the liver, and in particular provides a map of the human hepatic immune microenvironment.
Stationed at the U.S. Army's counterintelligence headquarters in Saigon, David Noble was sent north to launch the first covert intelligence-gathering operation in Vietnam's Central Highlands. Living ...among the Montagnard--the region's indigenous tribal people, deemed critical to winning the war--Noble documented their training, as American Green Berets taught them to use rifles rather than crossbows and spears, while confronting his own challenges in the field.Part memoir, part photojournal, his compelling narrative throws light on a little-known corner of the Vietnam War in its early years--before the Tonkin Gulf Resolution and the deployment of combat units--and traces his transformation from novice intelligence agent and believer in the war to political dissenter and active protester.
High-resolution serial-section electron microscopy (ssEM) makes it possible to investigate the dense meshwork of axons, dendrites, and synapses that form neuronal circuits. However, the imaging scale ...required to comprehensively reconstruct these structures is more than ten orders of magnitude smaller than the spatial extents occupied by networks of interconnected neurons, some of which span nearly the entire brain. Difficulties in generating and handling data for large volumes at nanoscale resolution have thus restricted vertebrate studies to fragments of circuits. These efforts were recently transformed by advances in computing, sample handling, and imaging techniques, but high-resolution examination of entire brains remains a challenge. Here, we present ssEM data for the complete brain of a larval zebrafish (Danio rerio) at 5.5 days post-fertilization. Our approach utilizes multiple rounds of targeted imaging at different scales to reduce acquisition time and data management requirements. The resulting dataset can be analysed to reconstruct neuronal processes, permitting us to survey all myelinated axons (the projectome). These reconstructions enable precise investigations of neuronal morphology, which reveal remarkable bilateral symmetry in myelinated reticulospinal and lateral line afferent axons. We further set the stage for whole-brain structure-function comparisons by co-registering functional reference atlases and in vivo two-photon fluorescence microscopy data from the same specimen. All obtained images and reconstructions are provided as an open-access resource.
Purpose
– The purpose of this paper is to investigate the impact of key supplier relationship management (KSRM) – understood as an aggregated supply chain management (SCM) process in the upstream ...direction – on the overall level of the execution of SCM within organizations.
Design/methodology/approach
– A conceptual model is developed from a theoretical framework and proposes the capability to do KSRM as a mediator between internal and external SCM resources and SCM execution. A survey of 174 managers representing different supply chain stages is used to test the model through variance-based structural equation modelling.
Findings
– The findings reveal that external SCM resources directly affect the capability to do KSRM. Nevertheless, internal resources show a considerable indirect impact through external resources and can thus be considered an indirect determinant. The capability to do KSRM in turn impacts upon the level of SCM execution, measured in terms of the integration of business processes, directly and substantially, as well as mediating the effect between SCM resources and the level of SCM execution.
Originality/value
– The main contribution of this paper is to empirically demonstrate the potential of KSRM for enhancing the level of SCM execution within organizations and consequently the level of integration in supply chains, leading to higher customer and shareholder value.
•Highly porous 3D scaffolds were fabricated from chitosan-agarose blends.•Pore sizes for the blended scaffolds were significantly smaller than for agarose and chitosan only.•The blended scaffolds ...showed enhanced mechanical properties.•FTIR analysis suggested a hydrogen bonding interaction between chitosan and agarose.•All wet blend scaffolds showed instant full recovery after near full compression.
This study aimed to explore the correlation between mechanical and structural properties of chitosan-agarose blend (Ch-Agrs) scaffolds. Porosity of Ch-Agrs scaffolds was constant at 93%, whilst pore sizes varied between 150 and 550 μm. Pore sizes of the blend scaffolds (150–300 μm) were significantly smaller than for either agarose or chitosan scaffolds alone (ca. 500 μm). Ch50-Agrs50 blend scaffold showed the highest compressive modulus and strength values (4.5 ± 0.4 and 0.35 ± 0.03 MPa) due to reduction in the pore size. The presence of agarose improved the stability of the blends in aqueous media. The increase in compressive properties and residual weight after the TGA test, combined with the reduction in the swelling percentage of the blend scaffolds suggested an interaction between chitosan and agarose via hydrogen bonding which was confirmed using FTIR analysis. All wet blend scaffolds exhibited instant recovery after full compression. This study shows the potential of Ch-Agrs scaffolds for repairing soft tissue.
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