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This paper describes a novel method for trimming a low noise, differential micro-electromechanical system (MEMS) microphone with a state of the art signal to noise ratio (SNR) of 66 dB(A) and a sensitivity of -38 dBV/Pa @ 1 kHz after completing the fabrication process. The method allows compensating the electroacoustic variations caused by process tolerances and reducing specification limits of the microphone sensitivity from ±3 dB to ±0.5 dB. Trimming is done by programming the bias supply voltage of the capacitive membrane-backplate-system and the gain factor of the output pre-amplifier. Microphone sensitivity can be modified within a range of 11.2 dB. Thus the standard deviation of the sensitivity of a production batch could be reduced from 0.97 dB to 0.11 dB. Furthermore the SNR could be increased to 66.5 dB(A). [ABSTRACT FROM AUTHOR]

Although sheep are widely used as an experimental model for various surgical procedures there is a paucity of data on the pharmacokinetics and efficacy of analgesic drugs in this species. The aims of this study were to investigate the pharmacokinetics of intravenously (IV) administered tramadol and its active metabolite O-desmethyltramadol (M1) and to assess the mechanical antinociceptive effects in sheep. In a prospective, randomized, blinded study, six healthy adult sheep were given 4 and 6 mg/kg tramadol and saline IV in a cross-over design with a 2-week wash-out period. At predetermined time points blood samples were collected and physiological parameters and mechanical nociceptive threshold (MNT) values were recorded. The analytical determination of tramadol and M1 was performed using high performance liquid chromatography. Pharmacokinetic parameters fitted a two- and a non-compartmental model for tramadol and M1, respectively. Normally distributed data were analysed by a repeated mixed linear model. Plasma concentration vs. time profiles of tramadol and M1 were similar after the two doses. Tramadol and M1 plasma levels decreased rapidly in the systemic circulation, with both undetectable after 6 h following drug administration. Physiological parameters did not differ between groups; MNT values were not statistically significant between groups at any time point. It was concluded that although tramadol and M1 concentrations in plasma were above the human minimum analgesic concentration after both treatments, no mechanical antinociceptive effects of tramadol were reported. Further studies are warranted to assess the analgesic efficacy of tramadol in sheep. [ABSTRACT FROM AUTHOR]

Introduction Multilevel cervical myelopathy without surgical treatment is generally poor in the neurological deficit without surgical decompression. The two main surgical strategies used for the treatment of multilevel cervical myelopathy are anterior decompression via anterior corpectomy or posterior decompression via laminctomy/laminoplasty. Presentation of case We present the case of a 62 year-old lady, harboring rheumatoid artritis (RA) with gait disturbances, pain, and weakness in both arms. A C5 and C6 somatectomy, C4–C7 discectomy and, instrumentation and fusion with telescopic distractor “piston like”, anterior plate and expandable screws were performed. Two days later the patient complained dysfagia, and a cervical X-ray showed hardware dislocation. So a C4 somatectomy, telescopic extension of the construct up to C3 with expandible screws was performed. After one week the patient complained again soft dysfagia. New cervical X-ray showed the pull out of the cranial screws (C3). So the third surgery “one stage combined” an anterior decompression with fusion along with posterior instrumentation, and fusion was performed. Discussion There is a considerable controversy over which surgical approach will receive the best clinical outcome for the minimum cost in the compressive cervical myelopathy. However, the most important factors in patient selection for a particular procedure are the clinical symptoms and the radiographic alignment of the spine. the goals of surgery for cervical multilevel stenosis include the restoration of height, alignment, and stability. Conclusion We stress the importance of a careful patients selection, and invocated still the importance for 360° cervical fixation. [ABSTRACT FROM AUTHOR]

It is well-known that old animals show physiologic and/or pathologic variation that could modify the pharmacokinetics of drugs and the related pharmacodynamic response. In order to define the most appropriate therapeutic protocol in old horses, pharmacokinetic profile and safety of naproxen were investigated in horses aged over 18 years after oral administration for 5 days at the dose of 10 mg/ kg b.w./day. After the first administration, the maximum concentration (Cmax 44.21 ± 9.21 μg/mL) was reached at 2.5 ± 0.58 h post-treatment, the harmonic mean terminal half-life was 6.96 ± 1.73 h, AUC0-24h was 459.71 ± 69.95 h μg/mL, MRT was 7.44 ± 0.74 h and protein binding was 98.47 ± 2.72%. No drug accumulation occurred with repeated administrations. No clinical and laboratory changes were detected after administration of naproxen. Gastric endoscopies performed after the treatment did not show pathological changes of the gastric mucosa. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents the development of an advanced, quasi-analytical method for aircraft wing weight estimation and its detailed technical implementation. Similar to other quasi-analytical methods, it makes use of elementary wing box sizing techniques to compute the amount and distribution of material required to resist the applied loads, in combination with empirical methods to estimate all the other weight contributions. However, a new analytical derivation of the so-called airfoil effective distance parameter and a new advanced load estimation approach have been developed, which allow achieving a higher level of accuracy and design sensitivity than any other similar method found in literature. The proposed wing weight prediction method has been validated using data of various airplanes of different size, category and manufacturer. The computational time is dramatically lower than any finite element based sizing tool, while the achieved level of accuracy is comparable or even higher. Each weight prediction takes few seconds on a standard PC, while the average error on the total wing weight is consistently lower than 2%. The high level of design sensitivity allows the designers to assess the effect of design choices such as different airfoils and planform shapes, different structural layouts and materials, including both metal and composites, etc. The resulting combination of speed, accuracy and high level of design sensitivity makes of the proposed tool also a suitable asset for multidisciplinary design optimization studies. [Copyright &y& Elsevier]

We report a case of dyspnea in a 71-year-old man who underwent heterotopic heart transplantation in 2003. At presentation, electrocardiography showed ventricular fibrillation of the native heart and then a progression to both donor and recipient hearts. Synchronized electrical cardioversion restored sinus rhythm and relieved the patient from his symptoms. [ABSTRACT FROM AUTHOR]

Abstract: Patients scheduled for orthotopic liver transplantation (OLT) may have coexisting diseases and more likely receive grafts of poorer quality than in the past. Perioperative mortality and morbidity are usually due to a combination of factors related to the patient, graft, surgery, anesthesia, and intensive care management. Anesthesia and intensive care are the areas with the highest frequency and severity of errors. Error and accident risks are always present in this context where a human component is unavoidable. The matter of medical errors is becoming noteworthy worldwide. Nevertheless, data concerning medical errors during OLT are not available in Italy. There are only hypothetical evaluations. The number of adverse events may be high, but so far no specific programs have been developed to increase patient safety. To improve patient safety, anesthesia and intensive care units must use a proactive approach dedicated to an OLT program. We have presented herein a prevention policy to detect errors before they happen through incident reporting, anonymous and voluntary reports of adverse events or near misses, operating room checklists (patient, drugs, devices, equipment), improved training, safer facilities, equipment function, and adequate drug supplies for an OLT program. [ABSTRACT FROM AUTHOR]

Growing interest in unconventional aircraft designs coupled with miniaturization of electronics and advancements in manufacturing techniques have revived the interest in the use of Sub-scale Flight Testing (SFT) to study the flight behaviour of full-scale aircraft in the early stages of design process by means of free-flying sub-scale models. SFT is particularly useful in the study of unconventional aircraft configurations as their behaviour cannot be reliably predicted based on legacy aircraft designs. In this paper, we survey the evolution of various design approaches (from 1848 to 2021) used to ensure similitude between a sub-scale model and its full-scale counterpart, which is an essential requirement to effectively perform SFT. Next, we present an exhaustive list of existing sub-scale models used in SFT and analyse the key trends in their design approaches, test-objectives, and applications. From this review, we conclude that the state-of-the-art sub-scale model design methods available in literature have not been used extensively in practice. Furthermore, we argue that one sub-scale model is not sufficient to predict the complete flight behaviour of a full-scale aircraft, but a catalog of tailored sub-scale models is needed to predict full-scale behaviour. An introduction to the development of such a catalog is presented in this paper, but the development of a formal methodology remains an open challenge. Establishing an approach to develop and use a SFT catalog of models to predict full-scale aircraft behaviour will help engineers enhance confidence on their designs and make SFT a viable and attractive testing method in the early stages of design. [ABSTRACT FROM AUTHOR]

Abstract: Photosynthetic stimulation and stomatal conductance (Gs) depression in Quercus ilex leaves at a CO2 spring suggested no down-regulation. The insensitivity of Gs to a CO2 increase (from ambient 1500 to 2000μmolmol−1) suggested stomatal acclimation. Both responses are likely adaptations to the special environment of CO2 springs. At the CO2-enriched site, not at the control site, photosynthesis decreased 9% in leaves exposed to 2× ambient O3 concentrations in branch enclosures, compared to controls in charcoal-filtered air. The stomatal density reduction at high CO2 was one-third lower than the concomitant Gs reduction, so that the O3 uptake per single stoma was lower than at ambient CO2. No significant variation in monoterpene emission was measured. Higher trichome and mesophyll density were recorded at the CO2-enriched site, accounting for lower O3 sensitivity. A long-term exposure to H2S, reflected by higher foliar S-content, and CO2 might depress the antioxidant capacity of leaves close to the vent and increase their O3 sensitivity. [Copyright &y& Elsevier]

Abstract: Liver transplantation is a stressful condition for the cardiovascular system of patients with advanced hepatic disease. The underlying hemodynamic and cardiac status of patients with cirrhosis is crucial to determine which patients should became recipients. Generally preoperative cardiovascular testing is performed on potential candidates who are more than 45 years old, or have diabetes mellitus, or peripheral vascular disease, or more than two standard cardiac risk factors. Recent data suggest that the prevalence of coronary artery disease among patients with cirrhosis is much greater than previously believed; it likely mirrors or exceeds the prevalence rate in the healthy population. The morbidity and mortality of patients with coronary artery disease who undergo orthotopic liver transplantation (OLT) without treatment are unacceptably high. In conclusion, accurate preoperative cardiac evaluation according to the new American Heart Association & American College of Cardiology should lead to detect and treat coronary artery disease before liver transplantation. In case of alcohol-related cardiomyopathy, portopulmonary hypertension, and hypertrophic cardiomyopathy, there should be a case-by-case discussion by the hepatologist and cardiologist to consider the patient for liver transplantation. No robust data are available on the impact of decompensated dilated heart failure in this setting. If a recipient with cardiac disease is scheduled for OLT, we strongly suggest advanced intra- and postoperative hemodynamic monitoring plus transesophogcal echocardiography. [Copyright &y& Elsevier]

• The fragmentation of Afro-Mediterranean Cupressus gene pools dates back to the Pliocene • The history of C. dupreziana as relic species started in the Pleistocene. • Cupressus sempervirens var. numidica is endemic of Tunisia and belongs to the central Mediterranean gene pool since the Pleistocene. Only few woody species of North Africa have been the subject of biogeographical studies, despite the importance of this region, in the Mediterranean area, for the presence of hotspots of endemism and biodiversity, and of refugia. Here, we present research on the Afro-Mediterranean Cupressus spp., which have a discontinuous and fragmented distribution, resulting from population dynamics experienced during their life history. We aim to retrace their demographic history, by combining Bayesian clustering and approximate Bayesian computation (ABC) methods. The fragmentation of the cypress gene pool dates back to Pliocene, when the Mediterranean and the North African lineages separated from a common ancestor. The separation of C. atlantica and C. dupreziana dates back to the Pleistocene, when the history of C. dupreziana as relic species started. Finally, C. sempervirens var. numidica is likely endemic of Tunisia, belonging to the cypress gene pool of the central Mediterranean since the Pleistocene. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the safety of intra-articular (IA) lidocaine plus adrenaline for improving peri-operative analgesia in anaesthetized dogs undergoing arthroscopy of the elbow. A solution of lidocaine (L) 1.98% plus adrenaline 1:100.000 was administered via the IA route and its safety evaluated in terms of cardio-, neuro-, and chondro-toxicity. No bradycardia or hypotension was recorded from induction to the last observational time point. Signs of toxicity of the nervous system could have been masked by the general anaesthesia but lidocaine concentrations detected in the blood were lower than those thought to be capable of producing toxicity. The assessment of in vitro chondrotoxicity showed a dose- and time-dependent effect of lidocaine on the viability of articular cells. Adrenaline appeared to reduce the chondrotoxicity of 1% lidocaine, following an exposure of up to 30 min. [ABSTRACT FROM AUTHOR]

Abstract: Assessing the optimal volemia in the perioperative course of liver transplantation is a challenge for the anesthesiologist. Traditional estimates of intravascular volume status, such as pulmonary artery occlusion pressure (PAOP), have been widely shown to poorly correlate with changes in cardiac output among critically ill patients. Hence, there has been recent interest in alternative, catheter-related, bedside device volume estimates using thermodilution. Continuous end diastolic volume (CEDVI) showed better correlations with cardiac performance than cardiac filling pressures in studies performed in critically ill patients. When compared with conventional pressure-derived data, preload monitoring estimated as intrathoracic blood volume index (ITBVI) with the PiCCO system based on an integrated transpulmonary thermodilution technique better reflected left ventricular filling both in critically ill patients and those who underwent liver transplantation. Moreover, in liver transplantation, the use of transoesophageal echocardiography (TEE) has been increasing for it provides rapid visualization of the dimension and function of heart chambers as well as the left ventricular end diastolic area index (EDAI) that seem to correlate with graded acute hypovolemia, although its validity as on preload index is still under discussion. [Copyright &y& Elsevier]

Background: Anaemia is associated with poor postoperative outcomes, but few studies have described the impact of preoperative anaemia in low- and middle- (LMICs), and high-income countries (HICs).Methods: This was a planned analysis of data collected during an international 7 day cohort study of adults undergoing elective inpatient surgery. The primary outcome was in-hospital death, and the secondary outcomes were in-hospital complications. Anaemia was defined as haemoglobin <12 g dl-1 for females and <13 g dl-1 for males. Hierarchical three-level mixed-effect logistic regression models were constructed to examine the associations between preoperative anaemia and outcomes.Results: We included 38 770 patients from 474 hospitals in 27 countries of whom 11 675 (30.1%) were anaemic. Of these, 6886 (17.8%) patients suffered a complication and 198 (0.5%) died. Patients from LMICs were younger with lower ASA physical status scores, but a similar prevalence of anaemia [LMIC: 5072 (32.5%) of 15 585 vs HIC: 6603 (28.5%) of 23 185]. Patients with moderate [odds ratio (OR): 2.70; 95% confidence interval (CI): 1.88-3.87] and severe anaemia (OR: 4.09; 95% CI: 1.90-8.81) were at an increased risk of death in both HIC and LMICs. Complication rates increased with the severity of anaemia. Compared with patients in LMICs, those in HICs experienced fewer complications after an interaction term analysis [LMIC (OR: 0.92; 95% CI: 0.87-0.97) vs HIC (OR: 0.86; 95% CI: 0.84-0.87); P<0.01].Conclusions: One-third of patients undergoing elective surgery are anaemic. These patients have an increased risk of complications and death. The prevalence of anaemia is similar amongst patients in LMICs despite their younger age and lower risk profile.Clinical Trial Registration: ISRCTN51817007. [ABSTRACT FROM AUTHOR]

Abstract: Critically ill patients who require intensive care need effective analgesia and sedation to control potentially unpleasant symptoms, such as pain and anxiety. Analgesics and sedatives are also used to allow patients to tolerate nursing procedures and tracheal intubation as well as to aid mechanical ventilation. Metabolism of traditional opioids is dependent on organ function, which is abnormal among critically ill patients. The use of a score system to ensure sufficient but not excessive sedation should be mandatory. Sufentanil and remifentanil are more predictable opioids that are suitable for either sedation or analgesia in critically ill patients to achieve an adequate Ramsay score from 2 to 4. [Copyright &y& Elsevier]

Abstract: Assessing adequate volemia to avoid fluid overload and pulmonary edema perioperatively in liver transplantation (LT) is a challenge both for the anesthetist and the intensivist. Volumetric preload indices, such as intrathoracic blood volume index (ITBVI), measured by transpulmonary thermodilution, and continuous end-diastolic volume index (EDVI), measured by pulmonary artery thermodilution, were shown to better reflect preload than central venous pressure (CVP) or pulmonary artery occlusion pressure (PAOP). An ITBVI increase soon after the graft reperfusion influenced pulmonary perfusion without an alteration of extravascular lung water index (EVLWI) and without impaired oxygenation. This study was designed to evaluate relationships between CVP, PAOP, ITBVI, EDVI, and stroke volume index (SVI) within 48 hours after LT. We also investigated the relationship between EVLWI and arterial partial pressure of oxygen and inspired oxigen fraction ratio (PaO2/FiO2). Methods: We enrolled 125 patients (103 men and 22 women) undergoing LT. All patients were monitored with the PiCCO system (Pulsion Medical System) and with advanced pulmonary artery catheter connected to the Vigilance System. Hemodynamic-volumetric data were collected upon intensive care unit admission and every 8 hours up to 48 hours. Univariate and multivariate regression models were fitted to assess associations between SVI and EDVI, ITBVI, and filling pressures after adjusting for the right ventricular ejection fraction (RVEF, categorized as ≤30, 31–40, or >40) and the phase of the observation period. We also assessed associations between PaO2/FiO2 and EVLWI. Results: SVI was associated with EDVI, ITBVI, and RVEF. The models showing the best fit to the data were those including EDVI and ITBVI. Neither CVP nor PAOP showed correlation with SVI. EVLWI inversely correlated with PaO2/FiO2. Conclusions: In the first 48 hours after LT, ITBVI and EDVI were associated with SVI assessment, whereas CVP and PAOP were not related. EVLWI significantly inversely correlated with PaO2/FiO2. [Copyright &y& Elsevier]

Abstract: The introduction of highly active antiretroviral therapy (HAART) has improved survival in HIV patients, allowing them to undergo liver transplantation (OLT) in cases of end-stage liver disease. HIV patients show a higher incidence of pulmonary hypertension. The aim of this study was to evaluate pulmonary and systemic hemodynamic changes in HIV-infected patients compared with a non–HIV-infected group of patients undergoing OLT. Methods: We analyzed 20 HIV-infected patients and 20 non–HIV-infected patients who underwent OLT. We analyzed preoperative cardiovascular status, as well as intra- and postoperative hemodynamic data. Hemodynamic data were recorded at 4 predefined phases during OLT and at 24, 48, and 72 hours after intensive care unit (ICU) admission. We also evaluated the following perioperative aspects: transfusion requirements, postoperative mechanical ventilation time, ventilation time, and length of ICU and of hospital stay. Results: HIV-positive patients were younger than controls with a greater incidence of coinfection with hepatotropic viruses. One HIV-infected patient died in the ICU. Hemodynamic data showed a higher cardiac index and higher pulmonary vascular resistance index among HIV-infected patients, but without any clinical impact. No significant difference in blood unit transfusions, postoperative time on mechanical ventilation, or length of ICU or hospital stay was observed between the groups. Conclusions: Although the number of patients studied is limited, we concluded that HIV-infected patients undergoing OLT showed similar perioperative courses as non–HIV-infected patients. [Copyright &y& Elsevier]

Rickettsia slovaca is a tick-borne zoonotic bacterium and is the etiological agent of SENLAT, Scalp Eschar and Neck Lymph-Adenopathy after Tick bite. Despite many human cases reported in Europe, its epidemiology is not completely understood. To further understand this neglected tick-borne pathogen, we collected ticks and wild boar blood samples in 2017 to evaluate R. slovaca prevalence. Due to the high prevalence detected in Dermacentor marginatus , we investigated archive tick and blood samples collected previously in 2010 monitoring activities. The research was conducted in Euganean Hills Regional Park, North-Eastern Italy. Sampling was performed in 2010 and 2017 and regarded both blood and ticks collected from wild boars at culling. In 2010, ticks were sampled from animals and from the vegetation using the dragging method. Ticks were identified using identification keys and processed for DNA extraction. Biological samples were screened by real-time PCR targeting Rickettsia gltA gene and positive samples were tested by classical PCR targeting gltA and ompB genes for species identification. Overall, 89 wild boar blood samples were collected, 75 in 2010 and 14 in 2017. All samples tested negative. In addition, 254 tick samples were analysed, 233 sampled in 2010 and 21 in 2017. Four different tick species were identified: Dermacentor marginatus (n=190), Ixodes ricinus (n=58), Rhipicephalus sanguineus (n=5), and Hyalomma marginatum (n=1). A difference in R. slovaca prevalence was recorded among tick species, i.e, 23.68±6.05% in D. marginatus and 3.45±4.70% in I. ricinus while R. sanguineus and H. marginatum tested negative. In addition, ticks collected by dragging were negative, while a prevalence of 18.68%±5.66 and 61.90±20.77 was detected in ticks from wild boars sampled in 2010 and 2017, respectively. D. marginatus showed the highest prevalence of R. slovaca , revealing its important vectorial role. Comparing the tick sampling methods, dragging seems less informative than tick collection from wild boars. Since wild boars tested negative, their role in R. slovaca epidemiological cycle needs more investigations, while they act as a maintenance host of D. marginatus populations. [ABSTRACT FROM AUTHOR]

Three Mediterranean shrubs, Phillyrea latifolia L. (phillyrea), Arbutus unedo L. (strawberry tree), and Laurus nobilis L. (laurel), differing in their morphological and ecological response to water shortage, were exposed for 90 days to 0 or 110 ppb of ozone (O3), 5 h each day. This yielded an accumulated exposure over of a threshold of 40 ppb (AOT40) of 31.5 ppm h over the 3 months experiment. These species showed differing responses to O3: laurel and phillyrea developed foliar chlorotic mottles on the adaxial surface of leaves, whereas strawberry tree leaves showed reddish interveinal stipple-like necrotic lesions. In all cases, however, foliar injury did not exceed 8% of the sampled leaf area. At the end of the exposure period, O3-induced stomatal limitation caused significant decreases of net photosynthesis in strawberry tree and laurel, but not in phillyrea. The relative water content of the leaves was significantly decreased by O3, especially in laurel and strawberry tree, suggesting the occurrence of drought stress. Electrical conductivity of leachates from foliar discs increased in response to the treatment, much more strongly in laurel and in strawberry tree than in phillyrea, suggesting an O3-dependent alteration of the membrane retention capacity. At the end of the experimental period, the activity of superoxide dismutase and the content of reduced glutathione, but not that of reduced ascorbate, were significantly increased in the ozonated leaves of strawberry tree and phillyrea, but not in laurel. The evergreen broadleaves studied here maybe relatively tolerant to realistic O3 levels, at least in terms of visible injury and gas exchange. Such tolerance might overlap with their level of tolerance to drought stress. High constitutive levels, and/or O3-induced increases in antioxidants, might contribute to O3 tolerance in these Mediterranean evergreen broadleaf species. [Copyright &y& Elsevier]

Abstract: Although sequential portal and arterial revascularization (SPAr) is the most common method of graft reperfusion at liver transplantation (OLT), contemporaneous portal and hepatic artery revascularization (CPAr) has been used to reduce arterial ischemia to the bile ducts. The aim of this study was to prospectively compare SPAr (group 1; n = 19) versus CPAr (group 2; n = 21) among 40 consecutive OLT from heart-beating donors. There were no differences in the demographics characteristics, Model for End-stage Liver Disease scores, indication for OLT and donor parameters between the groups. OLT was performed using the piggyback technique. The biliary anastomosis was performed in all cases by a duct-to-duct technique with a T-tube in 32% versus 29% of cases without a T tube (P = .83). In the CPAr group, the liver was reperfused simultaneously via the portal vein and hepatic artery. CPAr showed a longer warm ischemia (66 ± 8 vs 37 ± 7 minutes; P < .001), while SPAr had a longer arterial ischemia 103 ± 42 vs 66 ± 8 minutes (P = .0004). Recovery of graft function was similar. There was no primary nonfunction and delayed graft function occurred among 10% versus 9%. Liver function tests were similar between the two groups up to 90 days case of follow-up- One-year graft and patient survivals were, respectively, 89% and 95% versus 94% and 100% (P = .29). At a median follow-up of 13 ± 6 versus 14 ± 7 months, biliary complications included anastomotic stenoses in 15% versus 19% (P = .78) and intrahepatic non-anastomotic biliary strictures in 26% versus none (P = .01) for SPAr and CPAr, respectively. CPAr was safe and feasible, reducing the incidence of intrahepatic biliary strictures by decreasing the duration of arterial ischemia to the intrahepatic bile ducts. [Copyright &y& Elsevier]

Abstract: Background: Split-liver transplantation (SLT) offers immediate expansion of the cadaver donor pool. The principal beneficiaries have been adult and pediatric recipients with excellent outcomes. This study analyzed a single-center experience of adult to adult in situ SLT in adult recipients. Patients and methods: Fourteen consecutive adult-to-adult in situ SLT have been performed at our institution since 1998. The extended right lobe comprising segment 1 was transplanted in to adult patients, the left lateral segment, for pediatric transplants. Results: Donors of SLT were significantly younger (P = .03) than those of whole liver transplants. Survival rates of patients receiving a split liver were 83%, 73%, and 73% at 1, 3, and 5 years after the transplant respectively and grafts of 73%, 73%, and 73% for SLT and 76%, 70%, and 66% for whole liver transplants (P = .44). The rate of biliary complication after SLT was 21%, which was comparable to that after whole organ transplantation (17%). The incidence of hepatic artery thrombosis and primary nonfunction was not significantly different between split liver and whole organ transplantation performed during the same time period (7% versus 4.6% P = .67 and 7% versus 2.6% P = .32, respectively). Conclusion: This limited single-center experience confirmed that both early and long-term results of SLT are comparable to those of traditional whole liver organ transplantation. [Copyright &y& Elsevier]

The strategies currently used to monitor concentrations of cyclosporine (CsA) in transplanted patients include whole blood trough (C0), total or abbreviated area under the curve (AUC) concentration and population pharmacokinetic approaches. Recently, a single blood concentration measurement at 2 hours (C2) after CsA administration has been shown to be helpful to predict clinical effects during the first weeks after transplantation of liver and kidney grafts. However, this approach has raised multiple questions about pharmacokinetic variability, analytical methods, and organizational requirements. From a pharmacokinetic point of view, the variability of CsA blood concentrations may relate to circadian variations. The present study sought to characterize the circadian variation in C0 and C2 CsA levels among 20 liver transplant recipients during the first 2 weeks posttransplant. All patients received two equal oral doses of CsA microemulsion formulation every 12 hours. Blood samples were collected before and 2 hours after CsA administration in the morning (am) and in the evening (pm). Whole blood concentrations of CsA were assayed using the monoclonal fluorescence polarization immunoassay system. During the first 2 weeks posttransplant, C2 am mean levels were significantly higher than C2 pm levels (542 ± 241 vs 383 ± 182 ng/mL, P = .005), while the C0 am mean level was not statistically different from the C0 pm (285 ± 174 vs 223 ± 124 ng/mL, P = .367). Our results suggest that morning CsA blood samples may afford a better approach to optimize the CsA dosage, especially based on C2 values. [Copyright &y& Elsevier]

Abstract: Liver retransplantation is considered to carry a higher risk than primary transplantation. However, there are an increasing number of retransplant candidates, especially owing to late graft failure. The aim of this study was to analyze a single-center experience in late liver retransplantation. The overall rate of primary retransplantation was 11.4% (28 re-OLT out of 245 primary OLT); the 14 (52%) who underwent retransplantation at more than 3 months after the first transplant were analyzed by a medical record review. Causes of primary graft failure leading to retransplantation were chronic hepatic artery thombosis in five cases (36%); recurrent HCV cirrhosis in four cases (29%); chronic rejection in two cases (14%); veno-occlusive disease; hepatic vein thrombosis or idiopathic graft failure in one case each (7%). UNOS status at re-OLT was always 2A, all patients were hospitalized; three were intensive care unit bound. ICU and total hospital stay had been 7 ± 5 and 28 ± 16 days, respectively. One- and 2-year patient and graft survivals were 84% and 62% and 67% and 67%, respectively. Death occurred in four patients. Two out of the three recovered in ICU at the time of retransplantation, at a median interval of 15 ± 9 days after retransplantation. The survival rate after late retransplantation is improving, and this option should be considered to be a efficient way to save lives, especially by defining the optimal timing for retransplantation. [Copyright &y& Elsevier]