ABSTRACT
BACKGROUND: Near-infrared fluorescence imaging using intravenous indocyanine green (ICG) facilitates intraoperative identification of biliary anatomy. We hypothesize that a much lower dose of ICG than the standard decreases hepatic and background fluorescence and improves bile duct visualization. STUDY DESIGN: In this multicenter randomized controlled trial, 55 adult patients undergoing laparoscopic cholecystectomy were randomized to low-dose (0.05 mg) or standard-dose (2.5 mg) ICG preoperatively on the day of surgery. A quantitative assessment was performed on recorded videos from the operation using ImageJ software to quantify the fluorescence intensity of the bile duct, liver, and surrounding/background fat. Operating surgeons blinded to ICG dose provided a qualitative assessment of various aspects of the visualization of the extrahepatic biliary tree comparing near-infrared fluorescence to standard visible light imaging using a scale of 1 to 5 (1, unsatisfactory; 5, excellent). Quantitative and qualitative scores were compared between the groups to determine any significant differences between the doses. RESULTS: The bile duct-to-liver and bile duct-to-background fat fluorescence intensity ratios were significantly higher for the low-dose group compared with the standard-dose group (3.6 vs 0.68, p < 0.0001; and 7.5 vs 3.3, p < 0.0001, respectively). Low-dose ICG had a slightly higher (ie better) mean score on the qualitative assessment compared to the standard dose, although the differences were not statistically significant. CONCLUSIONS: Low-dose ICG leads to quantitative improvement of biliary visualization using near-infrared fluorescence imaging by minimizing liver fluorescence; this further facilitates routine use during hepatobiliary operations.
Subject(s)
Bile Ducts, Extrahepatic , Biliary Tract , Cholecystectomy, Laparoscopic , Adult , Humans , Indocyanine Green , Cholangiography/methods , Coloring Agents , Biliary Tract/diagnostic imaging , Cholecystectomy, Laparoscopic/methods , Optical Imaging/methodsABSTRACT
The diagnosis of graft-versus-host-disease (GVHD) after solid organ transplantation is made difficult by its variable clinical presentation and lack of sensitive and specific biomarkers to evaluate the immune state of transplant recipients. Emerging noninvasive diagnostic techniques like the quantification of donor-derived cell-free DNA (dd-cfDNA) for surveillance may improve the current standard-of-care. Herein, we report the use of this methodology in a patient with GVHD and corresponding levels of dd-cfDNA without any evidence of graft injury. Correlation of dd-cfDNA levels with the clinical course and its novel application here could lead to improvements in the rapid diagnosis of GVHD and in monitoring of response to treatment.
Subject(s)
Cell-Free Nucleic Acids , Graft vs Host Disease , Liver Transplantation , Cell-Free Nucleic Acids/genetics , Graft Rejection/diagnosis , Graft vs Host Disease/diagnosis , Graft vs Host Disease/etiology , Humans , Liver Transplantation/adverse effects , Tissue DonorsABSTRACT
The review explores key issues associated with discrimination and hostility faced by Lesbian, Gay, Bisexual and Transgender (LGBT) people at work and organizational responses to it. Starting from a description of the main challenges facing LGBT workers' identity management, the review examines manifestations of negative attitudes towards gender and sexual minority groups, highlighting processes of subtle discrimination and exclusion. It presents and critiques dominant organizational responses to LGBT stigmatization, highlighting the need for holistic, intersectional approaches, and pointing out issues requiring further research.
