This paper presents a projection-based augmented-reality system (MARVIS) that supports the visualization of internal structures on the surface of a liver phantom. MARVIS is endowed with three key features: tracking of spatial relationship between the phantom and the operator’s head in real time, monoscopic projection of internal liver structures onto the phantom surface for 3D perception without additional head-mounted devices, and phantom internal electronic circuit to assess the accuracy of a syringe guidance system. An initial validation was carried out by 25 medical students (12 males and 13 females; mean age, 23.12 years; SD, 1.27 years) and 3 male surgeons (mean age, 43.66 years; SD, 7.57 years). The validation results show that the ratio of failed syringe insertions was reduced from 50% to 30% by adopting the MARVIS projection. The proposed system suitably enhances a surgeon’s spatial perception of a phantom internal structure.
Post-transplantation lymphoproliferative disorder (PTLD) is a life-threatening complication of solid organ transplantation (SOT). Its development risk varies among organ graft recipients. In this study, retrospective data were analyzed to compare PTLD’s risk and prognostic factors between adult kidney and liver transplant recipients (KTRs and LTRs, respectively). Over 15 years, 2598 KTRs and 1378 LTRs were under observation at our center. Sixteen KTRs (0.62%) and twenty-three LTRs (1.67%) were diagnosed with PTLD. PTLD developed earlier in LTRs (p < 0.001), SOT patients > 45 years old (p = 0.002), and patients receiving tacrolimus (p < 0.001) or not receiving cyclosporin (p = 0.03) at diagnosis. Tacrolimus use, male sex, and age > 45 years old significantly affected the time of PTLD onset in KTRs (hazard ratio (HR) = 18.6, 7.9 and 5.2, respectively). Survival was longer in LTRs < 45 years old (p < 0.009). LTRs were more likely than KTRs to achieve complete remission (p = 0.039). Factors affecting PTLD development and outcome differ between KTRs and LTRs; thus, these populations should be separately evaluated in future studies.
Introduction
Early prognostic markers that identify high-risk patients could lead to increased surveillance, personalized immunosuppression, and improved outcomes. The vigilance and rapid detection of allograft injury is what would result in the identification of patients who will require more intensive monitoring to ensure that their new allografts function well for the longest possible time.
The aim of the study was to assess whether urine levels of CCL2 and CXCL10 can be valuable, noninvasive source of information about inflammation, tubular injury, progression of fibrosis and other damage features in the kidney allograft.
Materials and methods
In this prospective study 40 patients who underwent a protocolar biopsy within 1 year post kidney transplant were included. The levels of chemokines CCL2 and CXCL10 with reference to creatinine in urine were assayed in all patients. Based on biopsy results research group (N=25) with diagnosis of BKV nephropathy, IFTA II–III, peritubular capillaritisis, C4d or rejection was selected. Patients with normal biopsy results were included as control group (N=15).
Results
Median urinary CCL2-to-creatinine (Cr) ratio [ng/mmol] was significantly elevated in research group compared to control group (21.76 ± 18.57 vs 8.99 ±5.12, p=0.003). There was no statistical difference between groups regarding CXCL10/Cr ratio (7.96 ± 9.08 vs 5.58 ±5.7 p=0.32). Patients with BKV nephropathy (N=3) had much higher level of CCL2 [ng/l] than control group but the difference did not reach statistical significance (429.69 ± 166.49 vs 78.04 ±53.61, p=0.06).
Conclusion
CCL2/Cr may be used as a non-ivasive tool useful for monitoring graft condition and predicting recipients with high risk of transplant kidney loss.
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