Liver transplantation as last-resort treatment for patients with bile duct injuries following cholecystectomy: a multicenter analysis

Background

Liver transplantation (LT) has been used as a last resort in patients with end-stage liver disease due to bile duct injuries (BDI) following cholecystectomy. Our study aimed to identify and evaluate factors that cause or contribute to an extended liver disease that requires LT as ultimate solution, after BDI during cholecystectomy.

Methods

Data from 8 high-volume LT centers relating to patients who underwent LT after suffering BDI during cholecystectomy were prospectively collected and retrospectively analyzed.

Results

Thirty-four patients (16 men, 18 women) with a median age of 45 (range 22-69) years were included in this study. Thirty of them (88.2%) underwent LT because of liver failure, most commonly as a result of secondary biliary cirrhosis. The median time interval between BDI and LT was 63 (range 0-336) months. There were 23 cases (67.6%) of postoperative morbidity, 6 cases (17.6%) of post-transplant 30-day mortality, and 10 deaths (29.4%) in total after LT. There was a higher probability that patients with concomitant vascular injury (hazard ratio 10.69, P=0.039) would be referred sooner for LT. Overall survival following LT at 1, 3, 5 and 10 years was 82.4%, 76.5%, 73.5% and 70.6%, respectively.

Conclusion

LT for selected patients with otherwise unmanageable BDI following cholecystectomy yields acceptable long-term outcomes.

A Upf3b-mutant mouse model with behavioral and neurogenesis defects

Nonsense-mediated RNA decay (NMD) is a highly conserved and selective RNA degradation pathway that acts on RNAs terminating their reading frames in specific contexts. NMD is regulated in a tissue-specific and developmentally controlled manner, raising the possibility that it influences developmental events. Indeed, loss or depletion of NMD factors have been shown to disrupt developmental events in organisms spanning the phylogenetic scale. In humans, mutations in the NMD factor gene, UPF3B, cause intellectual disability (ID) and are strongly associated with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) and schizophrenia (SCZ). Here, we report the generation and characterization of mice harboring a null Upf3b allele. These Upf3b-null mice exhibit deficits in fear-conditioned learning, but not spatial learning. Upf3b-null mice also have a profound defect in prepulse inhibition (PPI), a measure of sensorimotor gating commonly deficient in individuals with SCZ and other brain disorders. Consistent with both their PPI and learning defects, cortical pyramidal neurons from Upf3b-null mice display deficient dendritic spine maturation in vivo. In addition, neural stem cells from Upf3b-null mice have impaired ability to undergo differentiation and require prolonged culture to give rise to functional neurons with electrical activity. RNA sequencing (RNAseq) analysis of the frontal cortex identified UPF3B-regulated RNAs, including direct NMD target transcripts encoding proteins with known functions in neural differentiation, maturation and disease. We suggest Upf3b-null mice serve as a novel model system to decipher cellular and molecular defects underlying ID and neurodevelopmental disorders.

Synchronous Occurrence of Mycosis Fungoides, Diffuse Large B Cell Lymphoma and Acute Myeloid Leukemia

Patients with mycosis fungoides (MF), the most common subtype of primary cutaneous T-cell lymphoma, have an increased risk of developing secondary malignancies. We herein report two rare cases of MF concurring with diffuse large B cell lymphoma (B lymphoid lineage) and acute myeloid leukemia (myeloid lineage) in two otherwise healthy elderly patients. Potential etiologic factors, including the impact of the therapy-associated inflammatory response on the development of secondary tumors in patients with MF, are discussed. Further clinical, experimental and genetic studies are needed to elucidate possible physiopathogenic associations among the three concurrent malignancies occurring in the cases presented here.

Split liver transplantation: Report of right and left graft outcomes from a multicenter Argentinean group

Grafts from split livers (SLs) constitute an accepted approach to expand the donor pool. Over the last 5 years, most Argentinean centers have shown significant interest in increasing the use of this technique. The purpose of this article is to describe and analyze the outcomes of right-side grafts (RSGs) and left-side grafts (LSGs) from a multicenter study. The multicenter retrospective study included data from 111 recipients of SL grafts from between January 1, 2009 and December 31, 2013. Incidence of surgical complications, patient and graft survival, and factors that affected RSG and LSG survival were analyzed. Grafts types were 57 LSG and 54 RSG. Median follow-up times for LSG and RSG were 46 and 42 months, respectively. The 36-month patient and graft survivals for LSG were 83% and 79%, respectively, and for RSG were 78% and 69%, respectively. Retransplantation rates for LSG and RSG were 3.5% and 11%, respectively. Arterial complications were the most common cause of early retransplantation (less than 12 months). Cold ischemia time (CIT) longer than 10 hours and the use of high-risk donors (age ≥ 40 years or body mass index ≥ 30 kg/m2 or ≥ 5 days intensive care unit stay) were independent factors for diminished graft survival in RSG. None of the analyzed variables were associated with worse graft survival in LSG. Biliary complications were the most frequent complications in both groups (57% in LSG and 33% in RSG). Partial grafts obtained from liver splitting are an excellent option for patients in need of liver transplantation and have the potential to alleviate the organ shortage. Adequate donor selection and reducing CIT are crucial for optimizing results.

Effects of calcium soaps of fatty acids on postpartum reproductive activity in beef cows and growth of calves

Beef cows were used to determine the influence of calcium soaps of fatty acids (CSFA) incorporated in a range supplement on postpartum reproductive characteristics and growth of calves. Cows were assigned randomly to receive 0 (C, n = 68) or 125 g/d of CSFA (M, n = 66). Diets were isonitrogenous (23%) and were used during 105 d, beginning at 61 +/- 36 d (range) precalving. Two blood samples were collected monthly (7-d intervals). Weights of calves at 35, 50, and 90 d of age and weaning weight adjusted to 200 d of age were greater in M than in C (46.8 vs 43.8 kg, P < .05; 56.0 vs 50.6 kg, P< .01; 98.8 vs 91.8 kg, P < .01; and 186 vs 173 kg, P < .01, respectively). Body weights at 35 and 50 d postcalving were greater in M than in C cows (334 and 310 kg, P < .01; 329 and 300 kg, P < .01, respectively). A similar tendency was observed in body condition scores in the same postpartum periods (4.1 vs 3.4, P < .01 and 3.6 vs 2.5, P < .01 for M and C, respectively). Concentrations of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol, and triglycerides were greater (P < .01) in M than in C cows. Percentage of cycling (progesterone > 1 ng/mL) cows at 30 to 90 d postpartum was 38% in M and 22% in C (P < .02). Percentage of pregnant cows during the first half of the breeding season was greater (P < .02) in M (62.5%) than in C cows (35.5%). We concluded that CSFA incorporated in a range supplement during pre- and postpartum periods improved reproductive efficiency and growth of calves.

[Treatment of bronchial asthma in winter using controlled-release salbutamol]

This paper presents results about comparative study in winter season, in a statistics design AB and BA on 20 patients that were treated with salbutamol (Group B) and with salbutamol of controlled liberation (Group B) at random. Results showed that patients of Group B had improvement in symptomatology and had less exacerbations than those patients of group A with statistical significance. It was concluded that salbutamol tablets of controlled liberation is a therapeutic method adequate to control chronic phase of asthmatic patients in winter season.