This largest single institution experience with OLT for HCC demonstrates prolonged survival after liver transplantation for tumors beyond Milan criteria but within UCSF criteria, both when classified by preoperative imaging and by explant pathology. Measured expansion of OLT criteria is justified for tumors not exceeding the UCSF criteria.

Epidemiologic/prognostic study, level III.

BACKGROUND:The COVID-19 pandemic has affected the entire global health care system. In California, because of a high burden of cases, a lockdown order was announced on March 19, 2020. This study investigated the impact of the lockdown on the epidemiology and outcomes of trauma admissions at the largest trauma center in Los Angeles. METHODS:A retrospective study comparing epidemiological and clinical characteristics and outcomes of trauma admissions during the lockdown period (March 20, 2020, to June 30, 2020 to a similar period in the previous year (March 20, 2019, to June 30, 2019) was performed. Data collection included demographics, mechanism of injury, prehospital transportation, substance use, injury severity, resource utilization, and outcomes. FINDINGS:There were 1,202 admissions during the lockdown period in 2020 and 1,143 during the same calendar period in 2019. Following the lockdown, there was a reduction in the automobile versus pedestrian admissions by 42.5%, motorcycle injuries by 38.7%, and bicycle accidents by 28.4% but no significant effect on the number of motor vehicle accident admissions. There was an increase in ground level falls by 32.5%, especially in the elderly group. The absolute number of gunshot wounds increased by 6.2% and knife injuries by 39.3%. Suicides increased by 38.5%. Positive testing for substance use increased by 20.9%. During the lockdown, patients suffered less severe trauma, with Injury Severity Score of <9 (p < 0.001), as well as less severe head (p = 0.001) and severe chest trauma (p < 0.001). Trauma deaths were reduced by 27.9%, and the crude overall mortality was significantly lower during the lockdown period (4.1% vs. 5.9%, p = 0.046). Intensive care unit admission rates, mechanical ventilation, and intensive care unit length of stay were all reduced. CONCLUSION:The COVID-19 lockdown in 2020 had a significant effect on the epidemiology, clinical characteristics, and critical care resource utilization of trauma admissions in a large academic trauma center. These findings may help in planning and optimization of hospital resources during the pandemic.

The T cell immunoglobulin and mucin domain-containing molecules (TIM) protein family, which is expressed by T cells, plays a crucial role in regulating host adaptive immunity and tolerance. However, its role in local inflammation, such as innate immunity-dominated organ ischemia-reperfusion injury (IRI), remains unknown. Liver IRI occurs frequently after major hepatic resection or liver transplantation. Using an antagonistic anti-TIM-1 antibody (Ab), we studied the role of TIM-1 signaling in the model of partial warm liver ischemia followed by reperfusion. Anti-TIM-1 Ab monotherapy ameliorated the hepatocellular damage and improved liver function due to IR, as compared with controls. Histological examination has revealed that anti-TIM-1 Ab treatment decreased local neutrophil infiltration, inhibited sequestration of T lymphocytes, macrophages, TIM-1 ligand-expressing TIM-4 ؉ cells, and reduced liver cell apoptosis. Intrahepatic neutrophil activity and induction of proinflammatory cytokines/ chemokines were also reduced in the treatment group. In parallel in vitro studies, anti-TIM-1 Ab suppressed interferon-␥ (IFN-␥) production in concanavalin A (conA)-stimulated spleen T cells, and diminished tumor necrosis factor ␣ (TNF-␣)/interleukin (IL)-6 expression in a macrophage/spleen T cell coculture system. This is the first study to provide evidence for the novel role of TIM-1 signaling in the mechanism of liver IRI. TIM-1 regulates not only T for the role of cell activation but may also affect macrophage function in the local inflammation response. These results provide compelling data for further investigation of TIM-1 pathway in the mechanism of IRI, to improve liver function, expand the organ donor pool, and improve the overall success of liver transplantation. (HEPATOLOGY 2010;51:1363-1372 T he T cell immunoglobulin mucin (TIM) family of cell surface proteins has attracted much attention as potential regulators of the immune system. The TIM family is located on chromosome 11B1.1 in mice and consists of four identified members (TIM-1, -2, -3, and -4) and four putative members . In humans, the TIM family is located on chromosome 5q33.2 and consists of three members, TIM-1, TIM-3, and TIM-4. All are predicted to be type I membrane proteins that share a characteristic immunoglobulin

Compliance with the BTF guidelines for ICP monitoring is poor. ICP monitoring does not have any survival benefit in patients with isolated severe blunt TBI and is associated with more complications and increased utilization of hospital resources.

Prognostic study, level III.

Therapeutic/care management, level IV.

Prognostic study, level III; therapeutic study, level IV.