Handling of hilar vasculature in living donor right hepatectomy using extrahepatic Glissonean approach

Donor hepatectomy is one of the most important procedures in LDLT because it affects the safety of donors and the outcome of the recipients. We standardized a method of securing the important vessels at the hepatic hilum while advancing the dissection toward the central direction. This research introduces our technique of handling hilar vasculature in living donor hepatectomy, using the extrahepatic Glissonean approach, and discusses its efficacy. At first, after the extrahepatic right Glissonean approach, the resected hepatic artery and portal vein are secured on the same line as with the secured the glisson. The resected hepatic artery and portal vein are followed in the central direction, and the surrounding area is dissected. The dissection is continued up to the main brunch of hepatic artery and portal vein. The bile duct can be secured by subtracting the hepatic artery and portal vein from the tape that secured the Glissonean pedicle. The bile duct, hepatic artery, and the portal vein are dissected in this order, before dissecting the right hepatic vein, completing the surgery. This method of dissection approaching the extrahepatic Glisson is carried out towards the central direction suggest to acquire minimal tissue removal and to shorten operative time. This could result in adequate perfusion to the remaining liver and donor safety, taken together effective results on recipient.

Radially patterned transplantable biodegradable scaffolds as topographically defined contact guidance platforms for accelerating bone regeneration

Background The healing of large critical-sized bone defects remains a clinical challenge in modern orthopedic medicine. The current gold standard for treating critical-sized bone defects is autologous bone graft; however, it has critical limitations. Bone tissue engineering has been proposed as a viable alternative, not only for replacing the current standard treatment, but also for producing complete regeneration of bone tissue without complex surgical treatments or tissue transplantation. In this study, we proposed a transplantable radially patterned scaffold for bone regeneration that was defined by capillary force lithography technology using biodegradable polycaprolactone polymer. Results The radially patterned transplantable biodegradable scaffolds had a radial structure aligned in a central direction. The radially aligned pattern significantly promoted the recruitment of host cells and migration of osteoblasts into the defect site. Furthermore, the transplantable scaffolds promoted regeneration of critical-sized bone defects by inducing cell migration and differentiation. Conclusions Our findings demonstrated that topographically defined radially patterned transplantable biodegradable scaffolds may have great potential for clinical application of bone tissue regeneration.

The Issue Of The Central Asian Northern Pilgrimage Route In The Russian-Bukhara Diplomatic Relations In The XVIII Century (On The Example Of The Activities Of Ambassador Ernazar Maqsud Oglu)

In the Middle Ages, Central Asian pilgrims traveled to Mecca in three directions: the North direction ‒ through the Russian Empire, the central direction‒ through the territory of Persia, and the south direction ‒ along roads through India and the Arabian Sea. Therefore, the question of the directions of the Hajj was reflected in the diplomatic correspondence of the Central Asian khanates with Persia, India, the Russian and Ottoman empires тоо. Depending on the political, economic and ideological interests of these states, sometimes pilgrims were given permits to be sent to Mecca through their territories, and sometimes not. The degree of intensity of pilgrimage movements, in most cases, depended on the activities of interstate ambassadors. On the issue of eliminating various prohibitions and obstacles in the movements of pilgrimage roads, the Central Asian ambassadors were active and historical documents reveal these data to us. In this period the Central Asian ambassadors, who were sent to the reception of the governors those neighbor states on other issues, in most cases negotiated precisely on the direction of the Hajj of the Central Asian pilgrims also. One of such far-sighted ambassadors was a rich merchant from Bukhara, who lived in the XVIII c. Ernazar Maksud ogli officially sent several times by the Central Asian rulers to the Russian Empire. In this article analyzes the question of how the problems of the Hajj road were solved at the international diplomatic level by the example of the activities this ambassador. The history of negotiations between Ernazar and the Russian emperors on matters of the northern direction of the Hajj road and their results illuminated on base documents on this issue, which stored in the fund of the Archive of Foreign Policy of the Russian Empire (AFPRE). The scientific conclusions of this article serve for an extensive study of the issues of diplomatic and economic relations between the Central Asian khanates and the Russian Empire in the XVIII century, revealing the history of the embassy relations of the khanates and the history of the pilgrimage of the Hajj of the Central Asian people and the features of the directions of roads from Central Asia to Mecca.

Impacts in the Respiratory Mechanics of the Ventilator Hyperinsuflation in the Flow Bias Concept: a Narrative Review

Patients who require invasive ventilatory support are subject to the deleterious effects of this, mainly ventilator-associated pneumonia (VAP). The physiotherapist, a member of the multiprofessional team, assists the patient with the purpose of promoting the recovery and preservation of the functionality, being able to minimize / avoid secondary complications. This study aims to identify the repercussions of mechanical ventilation hyperinflation (MVH) in the flow bias concept in respiratory mechanics. This study is a narrative review. MVH is an important resource commonly used in clinical practice that involves the manipulation of mechanical ventilator configurations to provide larger pulmonary volumes, and the generated airflow gradient may play a relevant role in mucus transport, with the concept of flow bias the main factor responsible for its direction. For the mobilization of the mucus towards the cephalic direction to occur, there must be a predominant expiratory flow, guaranteeing the peak ratio of expiratory flow / inspiratory flow peak (EFP / IFP) greater than 1.11. Maintenance of mechanical ventilation assures the patient to maintain the positive end expiratory pressure (PEEP) and the oxygen inspired fraction, avoiding the deleterious effects of the mechanical ventilator disconnection. MVH is able to improve lung compliance without, however, increasing airway resistance. MVH in the cephalic flow bias concept is effective for the mucus mobilization in the central direction, being able to improve pulmonary compliance and peripheral oxygen saturation.Keywords: Respiration, Artificial. Intensive Care Units. Physical Therapy Department, Hospital.ResumoOs pacientes internados que necessitam de suporte ventilatório invasivo estão sujeitos aos efeitos deletérios deste, principalmente a pneumonia associada à ventilação mecânica (PAV). O fisioterapeuta, integrante da equipe multiprofissional, assiste o paciente com a finalidade de promover a recuperação e preservação da funcionalidade, podendo minimizar/evitar complicações secundárias. Este estudo consiste em identificar as repercussões da hiperinsuflação com ventilador mecânico (HVM) no conceito flow bias na mecânica respiratória. O presente estudo trata-se de uma revisão narrativa. A HVM é um importante recurso comumente utilizado na prática clínica que envolve a manipulação das configurações do ventilador mecânico para fornecer maiores volumes pulmonares, e o gradiente de fluxo de ar gerado pode desempenhar um papel relevante no transporte do muco, sendo o conceito de flow bias cefálico o principal fator responsável pelo direcionamento deste. Para que a mobilização do muco em direção cefálica ocorra, deve existir um fluxo expiratório predominante, garantindo a razão pico de fluxo expiratório/pico de fluxo inspiratório (PFE/PFI) maior do que 1,11. A manutenção da assistência ventilatória mecânica assegura ao paciente a manutenção da pressão positiva ao final da expiração (PEEP) e a fração inspirada de oxigênio (FiO2), evitando os efeitos deletérios da desconexão do ventilador mecânico. A HVM é capaz de melhorar a complacência pulmonar sem, no entanto, aumentar a resistência das vias aéreas. A HVM no conceito flow bias cefálico é eficaz para a mobilização do muco em direção central, sendo capaz de melhorar a complacência pulmonar e saturação periférica de oxigênio (SpO2).Palavras-chave: Respiração Artificial. Unidades de Terapia Intensiva. Serviço Hospitalar de Fisioterapia.

The Relationship between Current Ground Stress and Permeability of Coal in Superimposed Zones of Multistage Tectonic Movement

According to the characteristics of the paleostress field and tectonic features at the key moments during tectonic movement after the formation of the no. 3 coal seam, the superimposed areas of different folding zones in the southern section of Shizhuang in central and southern Qinshui Basin were divided. The reservoir permeability of the coal in different superimposed areas was obtained by integrating a laboratory in situ measurement technique, geological strength indices, and multiple parameter fitting of acoustic logging data. The maximum and minimum horizontal principal stresses in different superimposed areas were gained through analysis of the fracturing curve and acoustic logging data. Thus, the relationships between ground stress and permeability in different superimposed areas were revealed. The results show that the relationships between different stresses and permeability were not obvious without considering multistage tectonic superposition. The relationships between the varying stresses and permeability in the same superimposed areas were exponential. The deformation of coal seams in the superimposed areas on the wings of fold belts striking north-central direction was relatively weak, and its permeability was the highest. The permeability in the superimposed areas of the wings of different fold belts in a southeasterly direction was lower than that in the superimposed areas of the wings and the cores of folds. The permeability is the worst in the superimposed areas by the cores and wings of the folds. The results can provide a reference for the study of the heterogeneous deformation of coal reservoirs.

Conclusion: Revolutions, Settlements and Scotland’s Political Development

THE REVOLUTION SETTLEMENT OF 1689–90 repudiated many of the principles and policies of royal government in the Restoration period. But while their responses were different, James VII and the makers of the settlement sought solutions to the same fundamental problems. By studying the upheavals of the 1685–90 period, we have focused on two sets of challenges confronting the rulers of seventeenth-century Scotland. The first concerned the character of the established Church. How was it to be constituted and what was the appropriate role for the monarch in its government? How should the civil magistrate deal with religious dissent? A second cluster of problems involved the crown’s power and authority. Was the king ‘absolute’ and what did this mean in practice? To what extent was local government in Scotland autonomous, and how far was it amenable to central direction?...

Reweaving the rainbow: qualitative color in business education

Purpose This study aims to reflect on the dominance of a narrowly focused analytical approach within business schools, which provides an artificially fractured and disjointed understanding of the contextual complexities and interconnectedness that students will encounter in the future. This approach unnecessarily constrains sensemaking and inhibits creative response to future social and organizational complexity. As business schools and their graduates come under sustained scrutiny and criticism, it perhaps appropriate to reexamine and reframe their analytical bias. Design/methodology/approach The central direction taken in this study is that of critical reflection on the present author’s practice and experience in teaching undergraduate economics and accounting. Although the analysis may have limited generalizability, it is hoped that it may prove of interest and value to business school educators. Findings The preferential business school reliance on analytical perspectives suggest that they fail to appreciate the nature of business, its embeddedness in broader society and the competencies required by undergraduates and graduates. This study argues that an emphasis on holistic systems, synthetic fusion and an appreciation of complexity – rather than a reductive analytical agenda – might benefit business schools, their graduates and society at large. Originality/value This study provides an original, albeit personal, insight into a significant problem in business education. It offers original perspectives on the problem and presents faculty-centered suggestions on how business students might be encouraged and empowered to see quality as well as quantitative perspectives in their first-year courses.