BACKGROUND Thromboembolic complications are relatively common causes of increased morbidity and mortality in the perioperative period in liver transplant patients.Early postoperative portal vein thrombosis(PVT,inciden...BACKGROUND Thromboembolic complications are relatively common causes of increased morbidity and mortality in the perioperative period in liver transplant patients.Early postoperative portal vein thrombosis(PVT,incidence 2%-2.6%)and early hepatic artery thrombosis(HAT,incidence 3%-5%)have a poor prognosis in transplant patients,having impacts on graft and patient survival.In the present study,we attempted to identify the predictive factors of these complications for early detection and therefore monitor more closely the patients most at risk of thrombotic complications.AIM To investigate whether intraoperative thromboelastography(TEG)is useful in detecting the risk of early postoperative HAT and PVT in patients undergoing liver transplantation(LT).METHODS We retrospectively collected thromboelastographic traces,in addition to known risk factors(cold ischemic time,intraoperative requirement for red blood cells and fresh-frozen plasma transfusion,prolonged operating time),in 27 patients,selected among 530 patients(≥18 years old),who underwent their first LT from January 2002 to January 2015 at the Liver University Transplant Center and developed an early PVT or HAT(case group).Analyses of the TEG traces were performed before anesthesia and 120 min after reperfusion.We retrospectively compared these patients with the same number of nonconsecutive control patients who underwent LT in the same study period without developing these complications(1:1 match)(control group).The chosen matching parameters were:Patient graft and donor characteristics[age,sex,body mass index(BMI)],indication for transplantation,procedure details,United Network for Organ Sharing classification,BMI,warm ischemia time(WIT),cold ischemia time(CIT),the volume of blood products transfused,and conventional laboratory coagulation analysis.Normally distributed continuous data are reported as the mean±SD and compared using one-way Analysis of Variance(ANOVA).Nonnormally distributed continuous data are reported as the median(interquartile range)and compared using the Mann-Whitney test.Categorical variables were analyzed with Chi-square tests with Yates correction or Fisher’s exact test depending on best applicability.IBM SPSS Statistics version 24(SPSS Inc.,Chicago,IL,United States)was employed for statistical analysis.Statistical significance was set at P<0.05.RESULTS Postoperative thrombotic events were identified as early if they occurred within 21 d postoperatively.The incidence of early hepatic artery occlusion was 3.02%,whereas the incidence of PVT was 2.07%.A comparison between the case and control groups showed some differences in the duration of surgery,which was longer in the case group(P=0.032),whereas transfusion of blood products,red blood cells,fresh frozen plasma,and platelets,was similar between the two study groups.Thromboelastographic parameters did not show any statistically significant difference between the two groups,except for the G value measured at basal and 120’postreperfusion time.It was higher,although within the reference range,in the case group than in the control group(P=0.001 and P<0.001,respectively).In addition,clot lysis at 60 min(LY60)measured at 120’postreperfusion time was lower in the case group than in the control group(P=0.035).This parameter is representative of a fibrinolysis shutdown(LY60=0%-0.80%)in 85%of patients who experienced a thrombotic complication,resulting in a statistical correlation with HAT and PVT.CONCLUSION The end of surgery LY60 and G value may identify those recipients at greater risk of developing early HAT or PVT,suggesting that they may benefit from intense surveillance and eventually anticoagulation prophylaxis in order to prevent these serious complications after LT.展开更多
AIM:To describe our single-centre experience in liver transplantation(LT)with the infusion of high perioperative thymoglobulin doses.The optimal dosage and timing of thymoglobulin[antithymocyte globulin(ATG)]administr...AIM:To describe our single-centre experience in liver transplantation(LT)with the infusion of high perioperative thymoglobulin doses.The optimal dosage and timing of thymoglobulin[antithymocyte globulin(ATG)]administration during LT remains controversial.Cytokine release syndrome,haemolytic anaemia,thrombocytopenia,neutropenia,fever and serum sickness are potential adverse effects associated with ATG infusion.METHODS:Between December 2009 and December 2010,16 adult non-randomized patients(ATG group),receiving a liver graft from a deceased donor,received an intraoperative infusion(4-6 h infusion)of thymoglobulin(3 mg/kg,ATG:Thymoglobuline).These patients were compared(case control approach)with 16 patients who had a liver transplant without ATG treatment(control group)to evaluate the possible effects of intraoperative ATG infusion.The matching parameters were:Sex,recipient age(±5 years),LT indication including viral status,MELD score(±5 points),international normalized ratio and platelet count(as close as possible).The exclusion criteria for both groups included the following:Multi-organ or living donor transplant,immunosuppressive therapy before transplantation,contraindications to the administration of any thymocyte globulin,human immunodeficiency virus seropositivity,thrombocytopenia[platelet<50000/μL]or leukopenia[white blood cells<1000/μL].The perioperative side effects(haemodynamic alterations,core temperature variations,colloids and crystalloids requirements,and surgical time)possibly related to ATG infusion and the thromboelastographic(TEG)evaluation of the ATG effects on coagulation,blood loss and blood product transfusion were analysed during the operation and the first three postoperative days.RESULTS:Intraoperative ATG administration was associated with longer surgical procedures[560±88 min vs 480±83 min(control group),P=0.013],an intraoperative core temperature more than 37℃(50%of ATG patients vs 6.2%of control patients,P=0.015),major intraoperative blood loss[3953±3126 mL vs 1419±940 mL(control group),P=0.05],higher red blood cell[2092±1856 mL ATG group vs 472±632 mL(control group),P=0.02],fresh frozen plasma[671±1125 mL vs 143±349 mL(control group),P=0.015],and platelet[374±537 mL vs 15.6±62.5 mL(control group),P=0.017]transfusion,and a higher requirement for catecholamines(0.08±0.07μg/kg per minutes vs 0.01±0.38μg/kg per minutes,respectively,in the ATG and control groups)for haemodynamic support.The TEG tracings changed to a straight line during ATG infusion(preanhepatic and anhepatic phases)in 81%of the patients from the ATG group compared to 6.25%from the control group(P<0.001).Patients from the ATG group compared to controls had higher post-op core temperatures(38℃±1.0℃vs 37.3℃±0.5℃;P=0.02),an increased need of noradrenaline(43.7%vs 6.25%,P=0.037),received more platelet transfusions(31.5%vs 0%,P=0.04)and required continuous renal replacement therapy(4 ATG patients vs none in the control group;P=0.10).ATG infusion was considered the cause of a fatal anaphylactic shock and of a suspected adverse reaction that led to intravascular haemolysis and acute renal failure.CONCLUSION:The side effects and the coagulation imbalance observed in patients receiving a high dosage of ATG suggest caution in the use of thymoglobulin during LT.展开更多
Two populations of the kentrurostylid ciliate Pseudokeronopsis erythrina Chen et al.,2011 were isolated from a brackish wastewater treatment plant,Pisa,Italy and from a nutrient-rich freshwater body,the East Lake,Wuha...Two populations of the kentrurostylid ciliate Pseudokeronopsis erythrina Chen et al.,2011 were isolated from a brackish wastewater treatment plant,Pisa,Italy and from a nutrient-rich freshwater body,the East Lake,Wuhan,China.The populations were thoroughly investigated for their morphology,focusing on cell body plasticity.The study was supplemented with 18S rDNA phylogenetic analysis and mitogenome sequencing,following the integrative taxonomy approach.The Italian population possesses a great variation in terms of the frontal area,and the numbers of left marginal rows,and dorsal kineties.Additionally,the number of left marginal anlagen and dorsal kineties anlagen varied.For instance,additional small anlagen appeared in the left marginal rows,and two dorsal kineties anlagen derived from a single dorsal kinety.The Wuhan population resembled the type population(originally isolated from Guangzhou,China),differing only by the presence of an extra dorsal kinety.The existence of giant individuals characterized both new populations of P.erythrina although with some differences in their respective frequency and features.The 18S rDNA sequences of the Italian,Wuhan,and type populations were identical.Phylogenetic analyses showed that these three populations formed a distinct cluster within the clade containing P.songi,P.parasongi,and P.flava.The structure of the P.erythrina mitochondrial genome is also provided.The content of this genome closely resembled Pseudourostyla cristata,except for the absence of genes nadh3 and nadh6.Our findings suggest that the Wuhan population represents an intermediate form between the type and Italian populations.The greater morphological plasticity observed in the Italian population underscores the importance of molecular data and integrative analyses in species identification.展开更多
The key role of the building envelope in achieving building energy efficiency and indoor comfort for the user has been long established.The most promising-and innovative-strategy for the building envelope of the futur...The key role of the building envelope in achieving building energy efficiency and indoor comfort for the user has been long established.The most promising-and innovative-strategy for the building envelope of the future is based on a dynamic,active and integrated solution,that is able to optimize the thermal performance,integrate the active elements and systems,and exploit energy from renewable sources.This paper illustrates the most relevant results of a decade-long research activity carried out on active and integrated building envelopes at the Politecnico di Torino,in which numerical analyses and experimental campaigns,involving test cells and field monitoring,have been performed.The overall performances of different façade modules and the thermo-physical behaviour of various components,under different operating strategies,are presented and discussed.The analysis provides information on the contribution of each subsystem,e.g.glazing,sun-shading devices,natural and mechanical ventilation,...to the achieved energy efficiency and the overall performances of different typologies of Double-Skin Façades(DSFs)and Advanced Integrated Façades(AIFs).展开更多
文摘BACKGROUND Thromboembolic complications are relatively common causes of increased morbidity and mortality in the perioperative period in liver transplant patients.Early postoperative portal vein thrombosis(PVT,incidence 2%-2.6%)and early hepatic artery thrombosis(HAT,incidence 3%-5%)have a poor prognosis in transplant patients,having impacts on graft and patient survival.In the present study,we attempted to identify the predictive factors of these complications for early detection and therefore monitor more closely the patients most at risk of thrombotic complications.AIM To investigate whether intraoperative thromboelastography(TEG)is useful in detecting the risk of early postoperative HAT and PVT in patients undergoing liver transplantation(LT).METHODS We retrospectively collected thromboelastographic traces,in addition to known risk factors(cold ischemic time,intraoperative requirement for red blood cells and fresh-frozen plasma transfusion,prolonged operating time),in 27 patients,selected among 530 patients(≥18 years old),who underwent their first LT from January 2002 to January 2015 at the Liver University Transplant Center and developed an early PVT or HAT(case group).Analyses of the TEG traces were performed before anesthesia and 120 min after reperfusion.We retrospectively compared these patients with the same number of nonconsecutive control patients who underwent LT in the same study period without developing these complications(1:1 match)(control group).The chosen matching parameters were:Patient graft and donor characteristics[age,sex,body mass index(BMI)],indication for transplantation,procedure details,United Network for Organ Sharing classification,BMI,warm ischemia time(WIT),cold ischemia time(CIT),the volume of blood products transfused,and conventional laboratory coagulation analysis.Normally distributed continuous data are reported as the mean±SD and compared using one-way Analysis of Variance(ANOVA).Nonnormally distributed continuous data are reported as the median(interquartile range)and compared using the Mann-Whitney test.Categorical variables were analyzed with Chi-square tests with Yates correction or Fisher’s exact test depending on best applicability.IBM SPSS Statistics version 24(SPSS Inc.,Chicago,IL,United States)was employed for statistical analysis.Statistical significance was set at P<0.05.RESULTS Postoperative thrombotic events were identified as early if they occurred within 21 d postoperatively.The incidence of early hepatic artery occlusion was 3.02%,whereas the incidence of PVT was 2.07%.A comparison between the case and control groups showed some differences in the duration of surgery,which was longer in the case group(P=0.032),whereas transfusion of blood products,red blood cells,fresh frozen plasma,and platelets,was similar between the two study groups.Thromboelastographic parameters did not show any statistically significant difference between the two groups,except for the G value measured at basal and 120’postreperfusion time.It was higher,although within the reference range,in the case group than in the control group(P=0.001 and P<0.001,respectively).In addition,clot lysis at 60 min(LY60)measured at 120’postreperfusion time was lower in the case group than in the control group(P=0.035).This parameter is representative of a fibrinolysis shutdown(LY60=0%-0.80%)in 85%of patients who experienced a thrombotic complication,resulting in a statistical correlation with HAT and PVT.CONCLUSION The end of surgery LY60 and G value may identify those recipients at greater risk of developing early HAT or PVT,suggesting that they may benefit from intense surveillance and eventually anticoagulation prophylaxis in order to prevent these serious complications after LT.
文摘AIM:To describe our single-centre experience in liver transplantation(LT)with the infusion of high perioperative thymoglobulin doses.The optimal dosage and timing of thymoglobulin[antithymocyte globulin(ATG)]administration during LT remains controversial.Cytokine release syndrome,haemolytic anaemia,thrombocytopenia,neutropenia,fever and serum sickness are potential adverse effects associated with ATG infusion.METHODS:Between December 2009 and December 2010,16 adult non-randomized patients(ATG group),receiving a liver graft from a deceased donor,received an intraoperative infusion(4-6 h infusion)of thymoglobulin(3 mg/kg,ATG:Thymoglobuline).These patients were compared(case control approach)with 16 patients who had a liver transplant without ATG treatment(control group)to evaluate the possible effects of intraoperative ATG infusion.The matching parameters were:Sex,recipient age(±5 years),LT indication including viral status,MELD score(±5 points),international normalized ratio and platelet count(as close as possible).The exclusion criteria for both groups included the following:Multi-organ or living donor transplant,immunosuppressive therapy before transplantation,contraindications to the administration of any thymocyte globulin,human immunodeficiency virus seropositivity,thrombocytopenia[platelet<50000/μL]or leukopenia[white blood cells<1000/μL].The perioperative side effects(haemodynamic alterations,core temperature variations,colloids and crystalloids requirements,and surgical time)possibly related to ATG infusion and the thromboelastographic(TEG)evaluation of the ATG effects on coagulation,blood loss and blood product transfusion were analysed during the operation and the first three postoperative days.RESULTS:Intraoperative ATG administration was associated with longer surgical procedures[560±88 min vs 480±83 min(control group),P=0.013],an intraoperative core temperature more than 37℃(50%of ATG patients vs 6.2%of control patients,P=0.015),major intraoperative blood loss[3953±3126 mL vs 1419±940 mL(control group),P=0.05],higher red blood cell[2092±1856 mL ATG group vs 472±632 mL(control group),P=0.02],fresh frozen plasma[671±1125 mL vs 143±349 mL(control group),P=0.015],and platelet[374±537 mL vs 15.6±62.5 mL(control group),P=0.017]transfusion,and a higher requirement for catecholamines(0.08±0.07μg/kg per minutes vs 0.01±0.38μg/kg per minutes,respectively,in the ATG and control groups)for haemodynamic support.The TEG tracings changed to a straight line during ATG infusion(preanhepatic and anhepatic phases)in 81%of the patients from the ATG group compared to 6.25%from the control group(P<0.001).Patients from the ATG group compared to controls had higher post-op core temperatures(38℃±1.0℃vs 37.3℃±0.5℃;P=0.02),an increased need of noradrenaline(43.7%vs 6.25%,P=0.037),received more platelet transfusions(31.5%vs 0%,P=0.04)and required continuous renal replacement therapy(4 ATG patients vs none in the control group;P=0.10).ATG infusion was considered the cause of a fatal anaphylactic shock and of a suspected adverse reaction that led to intravascular haemolysis and acute renal failure.CONCLUSION:The side effects and the coagulation imbalance observed in patients receiving a high dosage of ATG suggest caution in the use of thymoglobulin during LT.
基金supported by the European Commission H2020-MSCA-RISE 2019(872767)the National Natural Science Foundation of China(32370475)+1 种基金the Biological taxonomist,Chinese Academy of Sciences(CAS-TAX-24-037)by the University of Pisa,PRA_2018_63 project.
文摘Two populations of the kentrurostylid ciliate Pseudokeronopsis erythrina Chen et al.,2011 were isolated from a brackish wastewater treatment plant,Pisa,Italy and from a nutrient-rich freshwater body,the East Lake,Wuhan,China.The populations were thoroughly investigated for their morphology,focusing on cell body plasticity.The study was supplemented with 18S rDNA phylogenetic analysis and mitogenome sequencing,following the integrative taxonomy approach.The Italian population possesses a great variation in terms of the frontal area,and the numbers of left marginal rows,and dorsal kineties.Additionally,the number of left marginal anlagen and dorsal kineties anlagen varied.For instance,additional small anlagen appeared in the left marginal rows,and two dorsal kineties anlagen derived from a single dorsal kinety.The Wuhan population resembled the type population(originally isolated from Guangzhou,China),differing only by the presence of an extra dorsal kinety.The existence of giant individuals characterized both new populations of P.erythrina although with some differences in their respective frequency and features.The 18S rDNA sequences of the Italian,Wuhan,and type populations were identical.Phylogenetic analyses showed that these three populations formed a distinct cluster within the clade containing P.songi,P.parasongi,and P.flava.The structure of the P.erythrina mitochondrial genome is also provided.The content of this genome closely resembled Pseudourostyla cristata,except for the absence of genes nadh3 and nadh6.Our findings suggest that the Wuhan population represents an intermediate form between the type and Italian populations.The greater morphological plasticity observed in the Italian population underscores the importance of molecular data and integrative analyses in species identification.
文摘The key role of the building envelope in achieving building energy efficiency and indoor comfort for the user has been long established.The most promising-and innovative-strategy for the building envelope of the future is based on a dynamic,active and integrated solution,that is able to optimize the thermal performance,integrate the active elements and systems,and exploit energy from renewable sources.This paper illustrates the most relevant results of a decade-long research activity carried out on active and integrated building envelopes at the Politecnico di Torino,in which numerical analyses and experimental campaigns,involving test cells and field monitoring,have been performed.The overall performances of different façade modules and the thermo-physical behaviour of various components,under different operating strategies,are presented and discussed.The analysis provides information on the contribution of each subsystem,e.g.glazing,sun-shading devices,natural and mechanical ventilation,...to the achieved energy efficiency and the overall performances of different typologies of Double-Skin Façades(DSFs)and Advanced Integrated Façades(AIFs).
