Knowledge and Attitudes toward First Aid among Medical and Nursing Students at Taibah University in Madinah City, Saudi Arabia: A Cross-Sectional Study.

OBJECTIVE: The objective of this study is to evaluate the first aid (FA) knowledge, practice, and attitude of medical and nursing students at Taibah University in Madinah. METHODS: The study involved a cross-sectional online survey of 359 students from different academic years, using a revised and validated questionnaire on FA procedures, which were assessed utilizing a revised iteration of a questionnaire that had been previously validated. RESULTS: Regarding the knowledge score outcomes, the median score was 4, with an interquartile range of (3,5). Approximately 32.3% of participants demonstrated an excellent level of knowledge in first aid. Age exhibited a substantial and positive correlation with knowledge scores (p < 0.001), no significant correlation was observed between age and practice scores (p = 0.782), whereas age exhibited a significant and positive relationship with attitude scores (p < 0.001). Switching to the practice score results, the median practice score was 3, with an interquartile range of 2 to 3. A considerable 39.6% of participants displayed a good level of practice, representing the highest percentage among students. In the context of attitude score findings, the median attitude score was 4, and the interquartile range was 3 to 4, this suggests that the majority of the participants had a positive attitude towards first aid and its importance. Around 27.6% of participants portrayed a good attitude level, followed by 27% who demonstrated an acceptable attitude level. In addition, gender emerged as a differentiating factor in the three primary outcomes, as females achieved superior results across all aspects. CONCLUSION: A significant proportion of medical and nursing students at Taibah University have solid FA knowledge, practice, and attitude. Age and education level reflect the impact of FA training and certification, which should be mandatory for all medical students. Further studies are needed to generalize the findings to other contexts.

Application of Virtual Reality-Assisted Exergaming on the Rehabilitation of Children with Cerebral Palsy: A Systematic Review and Meta-Analysis.

BACKGROUND: Rehabilitation programs for children with cerebral palsy (CP) aim to improve their motor and cognitive skills through repeated and progressively challenging exercises. However, these exercises can be tedious and demotivating, which can affect the effectiveness and feasibility of the programs. To overcome this problem, virtual reality VR-assisted exergaming has emerged as a novel modality of physiotherapy that combines fun and motivation with physical activity. VR exergaming allows children with CP to perform complex movements in a secure and immersive environment, where they can interact with virtual objects and scenarios. This enhances their active engagement and learning, as well as their self-confidence and enjoyment. We aim to provide a comprehensive overview of the current state of research on VR exergaming for CP rehabilitation. The specific objectives are: To identify and describe the existing studies that have investigated the effects of VR exergaming on motor function and participation outcomes in children with CP. In addition, we aim to identify and discuss the main gaps, challenges, and limitations in the current research on VR exergaming for CP rehabilitation. Finally, we aim to provide recommendations and suggestions for future research and practice in this field. METHODS: In June 2023, we conducted a systematic search on Scopus, Web of Science, PubMed, Cochrane, and Embase for randomized trials and cohort studies that applied VR-assisted exergaming to rehabilitating patients with CP. The inclusion criteria encompassed the following: (1) Randomized controlled trials (RCTs) and cohort studies involving the rehabilitation of children with CP; (2) the application of VR-based exergaming on the rehabilitation; (3) in comparison with conventional rehabilitation/usual care. The quality of the selected RCTs was evaluated using Cochrane's tool for risk of bias assessment bias includes. Whereas the quality of cohort studies was assessed using the National Institutes of Health (NIH) tool. RESULTS: The systematic search of databases retrieved a total of 2576 studies. After removing 863 duplicates, 1713 studies underwent title and abstract screening, and 68 studies were then selected as eligible for full-text screening. Finally, 45 studies were involved in this review (n = 1580), and 24 of those were included in the quantitative analysis. The majority of the included RCTs had a low risk of bias regarding study reporting, participants' attrition, and generating a random sequence. Nearly half of the RCTs ensured good blinding of outcomes assessors. However, almost all the RCTs were unclear regarding the blinding of the participants and the study personnel. The 2020 retrospective cohort study conducted at Samsung Changwon Hospital, investigating the effects of virtual reality-based rehabilitation on upper extremity function in children with cerebral palsy, demonstrated fair quality in its methodology and findings. VR-assisted exergaming was more effective than conventional physiotherapy in improving the Gross Motor Function Measurement (GMFM)-88 score (MD = 0.81; 95% CI [0.15, 1.47], p-value = 0.02) and the GMFM walking and standing dimensions (MD = 1.45; 95% CI [0.48, 2.24], p-value = 0.003 and MD = 3.15; 95% CI [0.87, 5.42], p-value = 0.007), respectively. The mobility and cognitive domains of the Pediatric Evaluation of Disability Inventory score (MD = 1.32; 95% CI [1.11, 1.52], p-value < 0.001) and (MD = 0.81; 95% CI [0.50, 1.13], p-value < 0.0001) were also improved. The Canadian Occupational Performance Measure performance domain (MD = 1.30; 95% CI [1.04, 1.56], p-value < 0.001), the WeeFunctional Independence Measure total score (MD = 6.67; 95% CI [6.36, 6.99], p-value < 0.0001), and the Melbourne Assessment of Unilateral Upper Limb Function-2 score (p-value < 0.001) improved as well. This new intervention is similarly beneficial as conventional therapy in improving other efficacy measures. CONCLUSIONS: Our findings suggest that VR-assisted exergaming may have some advantages over conventional rehabilitation in improving CP children's functioning and performance in daily life activities, upper and lower limb mobility, and cognition. VR-assisted exergaming seems to be as effective as conventional physiotherapy in the other studied function measures. With its potential efficacy, better feasibility, no reported side effects, and entertaining experience, VR-assisted exergaming may be a viable complementary approach to conventional physiotherapy in rehabilitating children with CP.

Systematic Review on the Efficacy, Effectiveness, Safety, and Immunogenicity of Monkeypox Vaccine.

BACKGROUND: The variation in the reported vaccine safety and effectiveness could contribute to the high rates of vaccine hesitancy among the general population and healthcare workers in areas where monkeypox (mpox) is circulating. In this review, our objective was to evaluate the safety, immunogenicity, effectiveness, and efficacy of the mpox vaccines. METHODS: An extensive search for articles across multiple databases was performed, including searching six databases (PubMed Central, PubMed Medline, Scopus, Web of Science, Cochrane, ProQuest), two pre-print databases (European PMC Preprint and MedRxiv), and Google Scholar. RESULTS: A total of 4290 citations were retrieved from the included databases. Following the removal of duplicates and the initial screening of records, a total of 36 studies were included into the analysis. Additionally, we identified five more studies through manual searches, resulting in a total of 41 eligible articles for qualitative synthesis. The study findings revealed that mpox vaccines demonstrate the ability to generate adequate antibodies; however, their effectiveness may decrease over time, exhibiting varying safety profiles. Most of the included studies consistently reported substantial levels of effectiveness and efficacy against mpox. Interestingly, the number of vaccine doses administered was found to influence the degree of immunogenicity, subsequently impacting the overall effectiveness and efficacy of the vaccines. Furthermore, we found that smallpox vaccines exhibited a form of cross-protection against mpox. CONCLUSIONS: Vaccines can be used to prevent mpox and effectively control its spread.

Serum LINC00152 and UCA1 in HCV-Induced Hepatocellular Carcinoma: Clinical Significance and Prognostic Value.

Background: Despite significant advancements in the molecular characterization of hepatocellular carcinoma (HCC), no oncogene addiction has been discovered. Long noncoding RNAs (lncRNAs) have a lot of promise as cancer biomarkers. LINC00152 and UCA1 have shown potential as diagnostic, prognostic, and therapeutic targets for human cancers. Aim: To investigate the diagnostic and prognostic potential of serum LINC00152 and UCA1 in hepatocellular carcinoma (HCC). Methods: The expression levels of LINC00152 and UCA1 in blood samples from 120 patients (60 with HCC, 60 with liver cirrhosis) and 40 healthy subjects were assessed using real-time qRT-PCR. Results: Serum LINC00152 and UCA1 expression were considerably higher in HCC patients compared to patients with liver cirrhosis and the healthy controls (p<0.001 and p<0.001 respectively). And their expressions in the liver cirrhosis group were significantly higher than in healthy controls. Both lncRNAs performed well in the ROC analysis, distinguishing HCC patients from patients with liver cirrhosis. Higher levels of LINC00152 expression were linked to lesions in both lobes of the liver (p=0.02), while higher levels of UCA1 expression were linked to vascular invasion and the late stage (p=0.01, p=0.03 respectively). The multivariate analysis showed that a high level of LINC00152 in the blood was an independent indicator of a bad outcome for HCC patients (HR=2.23, 95% CI= 1.30-5.29, p=0.03). Conclusion: Serum LINC00152 and UCA1 expression were upregulated in patients with HCC, suggesting their use as non-invasive biomarkers for HCC. Furthermore, LINC00152 has the potential to serve as a prognostic indicator.

Isolation and characterization of a plant growth­promoting rhizobacterium strain MD36 that promotes barley seedlings and growth under heavy metals stress.

Plant growth, promoting, bacteria, (PGPB) can improve plant germination and growth in heavy metal-contaminated land and enhance heavy metal removal efficiency. In this study, we isolated PGPR bacterial strains which can withstand heavy metal pollution and tested their ability to improve barley germination under heavy metal stress. Out of 16 multi-resistant heavy metal isolates, strain MD36 was identified by 16S rRNA sequencing and shared close relation to different species of the genus Glutamicibacter. The new isolated strain showed other important PGPR activities, mainly IAA production and salt tolerance. The effect of adding the strain MD36 to barley grains under heavy metal stress enhanced their germination up to 100%, while the percentage of germination ranged between 0 and 20% for non-inoculated grains. In addition, in these conditions, MD36 can significantly enhance barley growth by reducing the heavy metal effect. This study strongly recommends the use of MD36 as seed coatings trials in the field to enhance growth and yield in soils contaminated with heavy metals, as well as in bioremediation of HM-contaminated salt-containing soils and water.

Post-cholecystectomy major bile duct injury: ideal time to repair based on a multicentre randomized controlled trial with promising results.

BACKGROUND: Bile duct injury (BDI) is one of the serious complications of cholecystectomy procedures, which has a disastrous impact on long-term survival, health-related quality of life (QoL), healthcare costs as well as high rates of litigation. The standard treatment of major BDI is hepaticojejunostomy (HJ). Surgical outcomes depend on many factors, including the severity of the injury, the surgeons' experiences, the patient's condition, and the reconstruction time. The authors aimed to assess the impact of reconstruction time and abdominal sepsis control on the reconstruction success rate. METHODS: This is a multicenter, multi-arm, parallel-group, randomized trial that included all consecutive patients treated with HJ for major post-cholecystectomy BDI from February 2014 to January 2022. Patients were randomized according to the time of reconstruction by HJ and abdominal sepsis control into group A (early reconstruction without sepsis control), group B (early reconstruction with sepsis control), and group C (delayed reconstruction). The primary outcome was successful reconstruction rate, while blood loss, HJ diameter, operative time, drainage amount, drain and stent duration, postoperative liver function tests, morbidity and mortality, number of admissions and interventions, hospital stay, total cost, and patient QoL were considered secondary outcomes. RESULTS: Three hundred twenty one patients from three centres were randomized into three groups. Forty-four patients were excluded from the analysis, leaving 277 patients for intention to treat analysis. With univariate analysis, older age, male gender, laparoscopic cholecystectomy, conversion to open cholecystectomy, failure of intraoperative BDI recognition, Strasberg E4 classification, uncontrolled abdominal sepsis, secondary repair, end-to-side anastomosis, diameter of HJ (< 8 mm), non-stented anastomosis, and major complications were risk factors for successful reconstruction. With multivariate analysis, conversion to open cholecystectomy, uncontrolled sepsis, secondary repair, the small diameter of HJ, and non-stented anastomosis were the independent risk factors for the successful reconstruction. Also, group B patients showed decreased admission and intervention rates, decreased hospital stay, decreased total cost, and early improved patient QoL. CONCLUSION: Early reconstruction after abdominal sepsis control can be done safely at any time with comparable results for delayed reconstruction in addition to decreased total cost and improved patient QoL.

Effects of Sacubitril/Valsartan Treatment on Left Ventricular Myocardial Torsion Mechanics in Patients with Heart Failure Reduced Ejection Fraction 2D Speckle Tracking Echocardiography.

BACKGROUND: Left ventricular ejection fraction (LVEF) is calculated from volumetric change without representing true myocardial properties. Strain echocardiography has been used to objectively measure myocardial deformation. Myocardial strain can give accurate information about intrinsic myocardial function, and it can be used to detect early-stage cardiovascular diseases, monitor myocardial changes with specific therapies, differentiate cardiomyopathies, and predict the prognosis of several cardiovascular diseases. Sacubitril/valsartan has been shown to improve mortality and reduce hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF). The effect of sacubitril/valsartan angiotensin receptor neprilysin inhibitor (ARNI) on left ventricular (LV) ejection fraction (EF) and torsion dynamics in HFrEF patients has not been previously described. METHODS: The study involved 73 patients with HFrEF, for all patients Full history was taken, full clinical examination was done. Baseline vital signs, ECG, NYHA classification, conventional echocardiography and STE were done at baseline study and after 6 and 11 months.Basal and apical LV short-axis images were acquired for further off-line analysis. Using commercially available two-dimensional strain software, apical, basal rotation, and LV torsion were calculated. RESULTS: ARNI group of patients showed improvement of symptoms, LV global longitudinal strain (LVGLS)% and diastolic parameters including, E/A, E/e', TV, untwist onset and rate after 6 months of therapy in comparison to the traditionally treated patients. The improvement continued for 11 months with in additional significant improvement of systolic parameters in the form of LVGLS%, EF%, Twist, Apical and basal rotations, main dependent parameters for improvement of EF% was LVGLS% and Apical rotation. CONCLUSION: To the best of our knowledge, this is the first study to demonstrate that therapy with sacubitril/valsartan in HFrEF patients could create a state of gradual and chronic LV deloading which cause relieving of myocardial wall tensions and decreasing the LV end diastolic pressure this state could cause cardiac reverse remodeling and reestablishment of starling forces proprieties of LV myocardium, which lead to increase of LV EF.

Highly Conductive Polyelectrolyte Membranes Poly(vinyl alcohol)/Poly(2-acrylamido-2-methyl propane sulfonic acid) (PVA/PAMPS) for Fuel Cell Application.

In this study, chemically cross-linked PVA/PAMPS membranes have been prepared to be used in direct methanol fuel cells (DMFCs). The structural properties of the resultant membrane were characterized by use FTIR and SEM. Additionally, their thermal stability was assessed using TGA. Moreover, the mechanical properties and methanol and water uptake of membrane was studied. The obtained FTIR of PVA/PAMPS membranes revealed a noticeable increase in the intensity of adsorption peaks appearing at 1062 and 1220 cm-1, which correspond to sulfonic groups with the increasing proportion of PAMPS. The thermograms of these polyelectrolyte membranes showed that their thermal stability was lower than that of PVA membrane, and total weight loss gradually decreased with increasing the PAMPS. Additionally, the functional properties and efficiency of these polyelectrolyte membranes were significantly improved with increasing PAMPS proportion in these blends. The IEC of polymer blend membrane prepared using PVA/PAMPS ratio of 1:1 was 2.64 meq/g. The same membrane recorded also a methanol permeability coefficient of 2.5 × 10-8 cm2/s and thus, its efficiency factor was 4 × 105 greater than that previously reported for the commercial polyelectrolyte membrane, Nafion® (2.6 × 105). No significant increase in this efficiency factor was observed with a further amount of PAMPS. These results proved that the PVA:PAMPS ratio of 1:1 represents the optimum mass ratio to develop the cost-effective and efficient PVA/PAMPS blend membranes for DMFCs applications.

Association between latent tuberculosis and ischemic heart disease: a hospital-based cross-sectional study from Saudi Arabia.

INTRODUCTION: atherosclerosis could be a sequela of long-term activation of cell-mediated immunity as the case of latent tuberculosis infection. Atherosclerosis is the main pathological event in ischemic heart disease. The present study aimed to assess the prevalence of Latent tuberculosis infection (LTBI) among patients with ischemic heart disease (IHD) and to detect the association between both diseases. METHODS: this cross-sectional study included 98 patients with a history of previously diagnosed ischemic heart disease who did a multi-detector computed tomography coronary angiogram (MDCTCA). Detailed clinical examination and investigations as chest X-ray and sputum examination were done for those with positive QuantiFERON-TB Gold test (QFT) to exclude active tuberculosis (TB). Participants having positive QFT results but with no evidence of active TB were considered as LTBI positive. RESULTS: the prevalence of LTBI in patients with IHD was 19.3% as only nineteen of the ninety-eight patients were diagnosed with latent tuberculosis infection using the QuantiFERON serum test. Eighty-four percent (84.2%) of patients with LTBI had coronary artery atherosclerosis (CAA) compared to only 55.6% in patients without LTBI with a statistically significant difference. In multivariable analysis, Diabetes Mellitus (DM) (AOR 0.179, 95% C.I.: 0.03-0.967), and LTBI (AOR 1.024, 95% C.I.: 1.002-1.736) were significantly associated with coronary artery atherosclerosis (p=0.0001, and p= 0.003 respectively). CONCLUSION: the prevalence of latent tuberculosis infection among patients with ischemic heart diseases is high. Among different factors that are already well known to precipitate ischemic heart disease, latent tuberculosis should be considered.

Role of interferon gamma in SARS-CoV-2-positive patients with parasitic infections.

BACKGROUND: By 27 June 2020, almost half a million people had died due to COVID-19 infections. The susceptibility and severity of infection vary significantly across nations. The contribution of chronic viral and parasitic infections to immune homeostasis remains a concern. By investigating the role of interferon (IFN)-γ, we conducted this study to understand the connection between the decrease in numbers and severity of COVID-19 cases within parasitic endemic regions. Our research included 375 patients referred to hospitals for diagnosis of COVID-19 infection. Patients were subjected to full investigations, in particular severe acute respiratory syndrome coronavirus-2 nucleic acid and Toxoplasma IgM and IgG antibody detection, stool examination, and quantitative IFN-γ measurement. RESULTS: The majority of the studied cases had chest manifestation either alone (54.7%) or in association with gastrointestinal (GIT) manifestations (19.7%), whereas 25.6% had GIT symptoms. We reported parasitic infections in 72.8% of mild COVID-19 cases and 20.7% of severe cases. Toxoplasma gondii, Cryptosporidium, Blastocyst, and Giardia were the most common parasitic infections among the COVID-19 cases studied. CONCLUSION: The remarkable adaptation of human immune response to COVID-19 infection by parasitic infections with high levels of IFN-γ was observed in moderate cases compared with low levels in extreme cases. The potential therapeutic efforts aimed at the role of parasitic infection in immune system modulation are needed if this hypothesis is confirmed.

Impact of choledochotomy techniques during laparoscopic CBD exploration on short- and long-term clinical outcomes: Time to change concepts (a retrospective cohort study).

BACKGROUND: complications after laparoscopic common bile duct exploration (LCBDE) regarding choledochotomy techniques have not been adequately studied in the literature. Therefore, this study aimed to retrospectively analyze and compare the impact of choledochotomy techniques during LCBDE among patients with choledocholithiasis during the early and late postoperative periods. METHODS: From March 2014 to February 2018, 85 patients with choledocholithiasis (52 females and 33 males) were enrolled in this study. These patients were treated by LCBDE using various choledochotomy techniques, including scalpel or scissor (28 patients, 33%) in group I, diathermy hook (35 patients, 41%) in group II, or an ultrasonic device (22 patients, 26%) in group III. Postoperative follow-up was done for assessment of all possible complications, either early (within the first six months postoperatively) or late (2-6 years postoperatively), with meticulous observation and study of any relevant postoperative events. RESULTS: No statistical difference was detected among the three groups regarding the short- and long-term clinical outcomes, including biliary fistula, biliary stricture, cholangitis, recurrent stones, peritoneal sepsis, wound sepsis, or wound dehiscence. CONCLUSION: The long-lasting concepts of avoidance of using energy machines such as diathermy and ultrasonic devices with biliary structures should be changed. However, a statistical type I error cannot be excluded because of the small sample size. Therefore, further analysis of prospective randomized studies with a larger number of participants is strongly recommended.

Cereal weeds variation in middle Egypt: Role of crop family in weed composition.

Cereals occupies a major part in the diet of humans globally, participating more to our daily protein and calorie intake than any other crop. The present study highlight the weed flora of cereal crops compared to other crops in middle Egypt and their distribution. Ninety-two weed species were recorded in the all studied crops, cereal and other crops; in the studied area belong to 67 genera and 20 families. Egyptian clover; showed the highest numbers of both weed species and genera followed by wheat, on contrast the lowest weed species and genera numbers were recorded associated with Solanaceous crops tomato and pepper. Wheat crops exhibited the highest number of weed species, among cereals, followed by maize crop, while the lowest weed species number was detected in barley crop. Chenopodium murale, Cynodon dactylon, Convolvulus arvensis and Malva parviflora were the most frequent species in winter cereals, while Echinochloa colona, P. oleraceae were the most frequent weeds in summer cereals. Chorological analysis of the recorded weed species showed that cosmopolitan elements showed the highest numbers in total weed flora Differences in weed species compositions were fundamentally influenced by seasonal priority. Based on TWINSPAN and Ward classifications, crop family showed slightly effect as a factor affecting weed composition.

Development and validation of the autotransplanted maxillary canine radiological index.

The purpose of this study was to propose and validate an index evaluating 2D and 3D radiographic variables of autotransplanted maxillary canines. Setting and sample population are from the Department of Oral and Maxillofacial Surgery at University Hospitals Leuven. Eight oral-maxillofacial surgeons rated 12 autotransplanted maxillary canines and adjacent bone using 11 rating variables. A new autotransplanted maxillary canine radiological index (AMCRI) was proposed. It consisted of 11 variables. These variables were based on 2D (intraoral) and 3D Cone Beam Computed Tomography (CBCT) radiographs. Intraclass correlation coefficient (ICC) and Fleiss's kappa statistics were performed to analyze intrarater and interrater agreement. Considering cumulative assessment of the AMCRI, the mean ICC value for the interrater agreement of the eight examiners was 0.94, representing an excellent agreement. Intrarater agreement was 0.91. The AMCRI is an objective tool in rating radiological outcome of autotransplanted canines and adjacent bone, when compared with the contralateral canine.

Development and validation of the Maxillary Canine Aesthetic Index.

Aesthetic appraisal is rarely included in the objective assessment of outcome studies of impacted maxillary canines treatment. The present study aimed to validate a new index for assessing the aesthetic appearance of maxillary canines and adjacent soft tissues. The Department of Oral and Maxillofacial Surgery at University Hospitals Leuven. Four oral-maxillofacial surgeons, two orthodontists, two prosthodontists, and two lay persons rated 11 maxillary canines and adjacent soft tissues according to the new index. Each of the examiners repeated the examination three times with a 2-week interval. Twelve relevant aesthetic variables were selected on the basis of the anatomic form, color, and surface characteristics of the canine crown and on the basis of the anatomic form, color, and surface characteristics of the adjacent soft tissues. Intraclass correlation (ICC) coefficient and Fleiss' kappa statistics were performed to analyze the intrarater and interrater agreement. The index proofed to be a reliable assessment tool. Considering the cumulative assessment of the Maxillary Canine Aesthetic Index (MCAI), the mean ICC value for the interrater agreement of the 10 examiners was 0.71, representing a good agreement. Intrarater agreement ranged from 0.10 to 0.91. Interrater agreement (Fleiss' kappa statistics) calculated for each variable ranged from 0.08 to 0.98. The MCAI is a tool in rating aesthetic outcome of impacted canine treatment and adjacent soft tissues. The MCAI can be used to evaluate the aesthetic outcome after surgical exposure or transalveolar transplantation of maxillary canines.

Impact of Graft Steatosis on Postoperative Complications after Liver Transplantation.

Background Steatotic grafts are more susceptible to ischemia-reperfusion injury than are normal grafts. Therefore, using steatotic grafts for liver transplantation (LT) is associated with high primary dysfunction and decreased survival rates. The aim of this study is to evaluate the impact of graft steatosis on post LT outcomes. Methods A retrospective cohort analysis of 271 LT recipients from 2005 to 2016 was performed and patients were classified based on two types of steatosis, macrosteatosis (MaS), and microsteatosis (MiS). Each category was subdivided into three groups according to the degree of steatosis: no (< 5%), mild (≥5 to < 30%), and moderate (≥30 to ≤60%). The primary hospital stays and 6-month postoperative complications were analyzed by the Clavien-Dindo classification system. Additionally, patient and graft survivals were studied. Results Significant differences were observed in grade III MaS ( p -value = 0.019) and grade V MiS ( p -value = 0.020). A high trend of early graft dysfunction was found in the moderate MaS and MiS groups; however, they were not statistically significant ( p -value = 0.199 and 0.282, respectively). Interestingly, the acute cellular rejection (ACR) rate was found to be inversely proportional to the degree of steatosis in both categories but it did not reach a significant level ( p -value = 0.161 and 0.111, respectively). Conclusion Excellent post LT long-term outcomes using grafts with mild and moderate steatosis were determined. Further studies are needed to evaluate the newly proposed relationship between ACR and steatosis.

Impact of aberrant left hepatic artery ligation on the outcome of liver transplantation.

The preservation of a graft's aberrant left hepatic artery (LHA) during liver transplantation (LT) ensures optimal vascularization of the left liver but can also be considered a risk factor for hepatic artery thrombosis (HAT). In contrast, ligation of an aberrant LHA may lead to hepatic ischemia with the potential risk of graft dysfunction and biliary complications. The aim of this study was to prospectively analyze the impact on the surgical strategy for LT of 5 tests performed to establish whether an aberrant LHA was an accessory or a replaced artery, thus leading to the design of a decisional algorithm. From August 2005 to December 2016, 395 whole LTs were performed in 376 patients. Five parameters were evaluated to determine whether an aberrant LHA was an accessory or a replaced artery. On the basis of our decision algorithm, an aberrant LHA was ligated during surgery when assessed as accessory and preserved when assessed as replaced. A total of 138 anatomical variants of hepatic arterial vascularization occurred in 120/395 (30.4%) grafts. Overall, the incidence of an aberrant LHA was 63/395 (15.9%). The LHA was ligated in 33 (52.4%) patients and preserved in 30 (47.6%) patients. After a mean follow-up period of 50.9 ± 39.7 months, the incidence of HAT, primary nonfunction, early allograft dysfunction, biliary stricture or leaks, and overall survival was similar in the 2 groups. In conclusion, once shown to be an accessory, an LHA can be safely ligated without clinical consequences on the outcome of LT. Liver Transplantation 24 204-213 2018 AASLD.

Fast track program in liver resection: a PRISMA-compliant systematic review and meta-analysis.

BACKGROUND: FT program (FT) is a multimodal approach used to enhance postoperative rehabilitation and accelerate recovery. It was 1st described in open heart surgery, then modified and applied successfully in colorectal surgery. FT program was described in liver resection for the 1st time in 2008. Although the program has become widely accepted, it has not yet been considered the standard of care in liver surgery. OBJECTIVES: we performed this systematic review and meta-analysis to evaluate the impact of using the FT program compared to the traditional care (TC), on the main clinical and surgical outcomes for patients who underwent elective liver resection. METHODS: PubMed/Medline, Scopus, and Cochran databases were searched to identify eligible articles that compared FT with TC in elective liver resection to be included in this study. Subgroup meta-analysis between laparoscopic and open surgical approaches to liver resection was also conducted. Quality assessment was performed for all the included studies. Odds ratios (ORs) and mean differences (MDs) were considered as a summary measure of evaluating the association in this meta-analysis for dichotomous and continuous data, respectively. A 95% confidence interval (CI) was reported for both measures. I was used to assess the heterogeneity across studies. RESULTS: From 2008 to 2015, 3 randomized controlled trials (RCTs) and 5 cohort studies were identified, including 394 and 416 patients in the FT and TC groups, respectively. The length of hospital stay (LoS) was markedly shortened in both the open and laparoscopic approaches within the FT program (P < 0.00001). The reduced LoS was accompanied by accelerated functional recovery (P = 0.0008) and decreased hospital costs, with no increase in readmission, morbidity, or mortality rates. Moreover, significant results were found within the FT group such as reduced operative time (P = 0.03), lower intensive care unit admission rate (P < 0.00001), early bowel opening (P ≤ 0.00001), and rapid normal diet restoration (P ≤ 0.00001). CONCLUSION: FT program is safe, feasible, and can be applied successfully in liver resection. Future RCTs on controversial issues such as multimodal analgesia and adherence rate are needed. Specific FT guidelines should be developed for liver resection.

ALPPS Procedure for Extended Liver Resections: A Single Centre Experience and a Systematic Review.

AIM: To report a single-centre experience with the novel Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) technique and systematically review the related literature. METHODS: Since January 2013, patients with extended primary or secondary liver tumors whose future liver remnant (FLR) was considered too small to allow hepatic resection were prospectively assessed for the ALPPS procedure. A systematic literature search was performed using PubMed, Scopus and the Cochrane Library Central. RESULTS: Until July 2014 ALPPS was completed in 9 patients whose mean age was 60 ± 8 years. Indications for surgical resection were metastases from colorectal cancer in 3 cases, perihilar cholangiocarcinoma in 3 cases, intrahepatic cholangiocarcinoma in 2 cases and hepatocellular carcinoma without chronic liver disease in 1 case. The calculated FLR volume was 289 ± 122 mL (21.1 ± 5.5%) before ALPPS-1 and 528 ± 121 mL (32.2 ± 5.7%) before ALLPS-2 (p < 0.001). The increase in FLR between the two procedures was 96 ± 47% (range: 24-160%, p < 0.001). Additional interventions were performed in 4 cases: 3 patients underwent Roux-en-Y hepaticojejunostomy, and one case underwent wedge resection of a residual tumor in the FLR. The average time between the first and second step of the procedure was 10.8 ± 2.9 days. The average hospital stay was 24.1 ± 13.3 days. There was 1 postoperative death due to hepatic failure in the oldest patient of this series who had a perihilar cholangiocarcinoma and concomitant liver fibrosis; 11 complications occurred in 6 patients, 4 of whom had grade III or above disease. After a mean follow-up of 17.1 ± 8.5 months, the overall survival was 89% at 3-6 and 12 months. The recurrence-free survival was 100%, 87.5% and 75% at 3-6-12 months respectively. The literature search yielded 148 articles, of which 22 articles published between 2012 and 2015 were included in this systematic review. CONCLUSION: The ALPPS technique effectively increased the resectability of otherwise inoperable liver tumors. The postoperative morbidity in our series was high in accordance with the data from the systematic review. Age, liver fibrosis and presence of biliary stenting were predisposing factors for postoperative morbidity and mortality.