| 1. |
- Abbassi, Fariba, et al.
(författare)
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Novel Benchmark Values for Redo Liver Transplantation Does the Outcome Justify the Effort?
- 2022
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Ingår i: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 276:5, s. 860-867
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To define benchmark cutoffs for redo liver transplantation (redo-LT). Background: In the era of organ shortage, redo-LT is frequently discussed in terms of expected poor outcome and wasteful resources. However, there is a lack of benchmark data to reliably evaluate outcomes after redo-LT. Methods: We collected data on redo-LT between January 2010 and December 2018 from 22 high-volume transplant centers. Benchmark cases were defined as recipients with model of end stage liver disease (MELD) score <= 25, absence of portal vein thrombosis, no mechanical ventilation at the time of surgery, receiving a graft from a donor after brain death. Also, high-urgent priority and early redo-LT including those for primary nonfunction (PNF) or hepatic artery thrombosis were excluded. Benchmark cutoffs were derived from the 75th percentile of the medians of all benchmark centers. Results: Of 1110 redo-LT, 373 (34%) cases qualified as benchmark cases. Among these cases, the rate of postoperative complications until discharge was 76%, and increased up to 87% at 1-year, respectively. One-year overall survival rate was excellent with 90%. Benchmark cutoffs included Comprehensive Complication Index CCI (R) at 1-year of <= 72, and in-hospital and 1-year mortality rates of <= 13% and <= 15%, respectively. In contrast, patients who received a redo-LT for PNF showed worse outcomes with some values dramatically outside the redoLT benchmarks. Conclusion: This study shows that redo-LT achieves good outcome when looking at benchmark scenarios. However, this figure changes in high-risk redo-LT, as for example in PNF. This analysis objectifies for the first-time results and efforts for redo-LT and can serve as a basis for discussion about the use of scarce resources.
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| 2. |
- Gero, Daniel, et al.
(författare)
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Defining Global Benchmarks in Bariatric Surgery A Retrospective Multicenter Analysis of Minimally Invasive Roux-en-Y Gastric Bypass and Sleeve Gastrectomy
- 2019
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Ingår i: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 270:5, s. 859-867
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To define “best possible” outcomes for bariatric surgery (BS)(Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG]).Background: Reference values for optimal surgical outcomes in well-defined low-risk bariatric patients have not been established so far. Consequently, outcome comparison across centers and over time is impeded by heterogeneity in case-mix.Methods: Out of 39,424 elective BS performed in 19 high-volume academic centers from 3 continents between June 2012 and May 2017, we identified 4120 RYGB and 1457 SG low-risk cases defined by absence of previous abdominal surgery, concomitant procedures, diabetes mellitus, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, anticoagulation, BMI>50 kg/m2 and age>65 years. We chose clinically relevant endpoints covering the intra- and postoperative course. Complications were graded by severity using the comprehensive complication index. Benchmark values were defined as the 75th percentile of the participating centers’ median values for respective quality indicators.Results: Patients were mainly females (78%), aged 38±11 years, with a baseline BMI 40.8 ± 5.8 kg/m2. Over 90 days, 7.2% of RYGB and 6.2% of SG patients presented at least 1 complication and no patients died (mortality in nonbenchmark cases: 0.06%). The most frequent reasons for readmission after 90-days following both procedures were symptomatic cholelithiasis and abdominal pain of unknown origin. Benchmark values for both RYGB and SG at 90-days postoperatively were 5.5% Clavien-Dindo grade ≥IIIa complication rate, 5.5% readmission rate, and comprehensive complication index ≤33.73 in the subgroup of patients presenting at least 1 grade ≥II complication.Conclusion: Benchmark cutoffs targeting perioperative outcomes in BS offer a new tool in surgical quality-metrics and may be implemented in quality-improvement cycle.ClinicalTrials.gov Identifier NCT03440138
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| 3. |
- Ingason, Haukur, et al.
(författare)
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The Metro Project : Final report
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This report compiles the results from the METRO project. The different parts of theproject – design fires, evacuation, integrated fire control, smoke control, extraordinarystrain onconstructions and fire- and rescue operations – are presented separately.The most complicated and expensive part of the project was the performance of thelarge scale fire and explosion tests in the Brunsberg tunnel, where the maximum heatrelease rates measured from the metro wagon was 77 MW.The main results from the project are new recommendations regarding design firesin mass transport systems, identification of key factors for fire and smoke spread in tunnelsand at stations as well as regarding the difficulties for disabled persons to evacuatefrom trains in tunnels, new recommended types of way guiding systems, safer design incase of explosions in trains and evaluation of the fire and rescue services’ possibilitiesand limitations in underground mass transport systems.
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| 4. |
- Ingason, Haukur, et al.
(författare)
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The Metro Project: Final Report
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The report compiles the results from the METRO-project. The different parts of the project; design fires, evacuation, integrated fire control, smoke control, extraordinary strain on constructions and fire- and rescue operations are presented separately. The most complicated and expensive part of the project was the performance of the large scale fire and explosion tests in the Brunsberg tunnel. The maximum heat release rates measured from the metro carriage was 77 MW. The maximum ceiling gas temperatures was 1118 °C. These values are high, and should be put into a perspective of the situation and the type of carriages used. The project is not recommending the highest values as the design fire, but values reflected in conditions. The egress study confirm that one of the major issues related to fire evacuation in underground transportation systems is that people often are reluctant to initiate an evacuation. New data show that participants moved with an average of 0.9 meters per second in the smoke filled environment (average visibility of 1.5–3.5 meters). A way-finding installation at the emergency exit, which consisted of a loudspeaker, was found to perform particularly well in terms of attracting people to the door. Two smoke control systems were simulated for a single exit metro station. The systems consisted of a pressurizing supply air system and mechanical exhaust ventilation system with and without platform screen doors. The results show that both the pressurizing supply air system and the mechanical exhaust air system provide effective smoke control for one exit metro station. The significance of the platform screen doors was shown to be important in relation to smoke control. Experiments and simulations have provided increased confidence in ability to simulate explosion scenarios to determine the pressure inside and outside a carriage and to be able to study variations of conditions such as carriage geometry and window designs. The explosion test performed show that an explosion with a relatively minor charge can significantly change the conditions for both evacuees and the rescue service. The results show that the conditions for evacuation and rescue operations can change dramatically as a result of a relatively minor explosion. Evaluation of methods and fire and rescue tactics in metros is given. Mapping of IR imaging as a tactical resource at tunnel fires was presented.
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| 5. |
- Klapper, Yvonne, et al.
(författare)
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Mediation of a non-proteolytic activation of complement component C3 by phospholipid vesicles
- 2014
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Ingår i: Biomaterials. - : Elsevier BV. - 0142-9612 .- 1878-5905. ; 35:11, s. 3688-3696
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Tidskriftsartikel (refereegranskat)abstract
- Liposomes are becoming increasingly important as drug delivery systems, to target a drug to specific cells and tissues and thereby protecting the recipient from toxic effects of the contained drug. Liposome preparations have been described to activate complement. In this study, we have investigated complement activation triggered by neutral dimyristoyl-phosphocholine (DMPC) liposomes in human plasma and whole-blood systems. Incubation in plasma led to the generation of complement activation products (C3a and sC5b-9). Unexpectedly, investigations of surface-bound C3 revealed contact activated, conformationally changed C3 molecules on the liposomes. These changes were characterized by Western blotting with C3 monoclonal antibodies, and by incubating liposomes with purified native C3 and factors I and H. Quartz crystal microbalance analysis confirmed binding of C3 to planar DMPC surfaces. In addition, we demonstrated that DMPC liposomes bound to or were phagocytized by granulocytes in a complement-dependent manner, as evidenced by the use of complement inhibitors. In summary, we have shown that C3 is activated both by convertase-dependent cleavage, preferentially in the fluid phase, by mechanisms which are not well elucidated, and also by contact activation into C3(H2O) on the DMPC surface. In particular, this contact activation has implications for the therapeutic regulation of complement activation during liposome treatment. (C) 2013 Elsevier Ltd. All rights reserved.
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