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In the scanning transmission electron microscope, fast-scanning and frame-averaging are two widely used approaches for reducing electron-beam damage and increasing image signal noise ratio which require no additional specialized hardware. Unfortunately, for scans with short pixel dwell-times (less than 5 μs), line flyback time represents an increasingly wasteful overhead. Although beam exposure during flyback causes damage while yielding no useful information, scan coil hysteresis means that eliminating it entirely leads to unacceptably distorted images. In this work, we reduce this flyback to an absolute minimum by calibrating and correcting for this hysteresis in postprocessing. Substantial improvements in dose efficiency can be realized (up to 20%), while crystallographic and spatial fidelity is maintained for displacement/strain measurement.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
Infections are among the most common complications after transplantation and greatly increase the morbidity and mortality of transplantation and decrease graft survival. This chapter describes a timeline of infection after transplantation. Post-transplant infections can be mitigated by preventative methods, routine vaccinations, intake of clean food and water, preventative measures during times of outbreaks visits with travel medicine specialists prior to visiting high risk regions, safer sexual practices for non-monogamous recipients, and guidance on better tattoo acquisition. Hepatitis viruses are common causes for liver transplantation and also common complications after transplant, predominantly as reactivation of latent infections. Molecular diagnostics are emerging as a diagnostic methodology for bacterial infections. Invasive fungal diseases, particularly aspergillosis, are significant causes of morbidity and mortality in transplant recipients. Treatment of individual parasitic infections can involve medications that may interact with transplant medications, or have significant side effects, and should be used carefully.
The preoperative evaluation of kidney transplant candidates involves transplant surgeons, nephrologists, mental health professionals, social workers, dieticians, financial coordinators, and transplant coordinators. There are several absolute and relative contraindications to kidney transplantation. Immunologic evaluation begins with a thorough history of potential antigen exposure, including prior transplantation of any kind, blood product transfusion, and, in female candidates, prior pregnancy. Cardiovascular disease is the leading cause of death, and therefore graft loss, in the first year post transplant. Depending on the malignancy, a disease-free period of between 2 and 5 years is generally accepted as adequate. As the transplanted kidney usually drains into the native lower urinary tract, underlying urologic disease can affect the transplant outcome. In the future, diabetes management via islet cell transplantation, coupled with kidney transplantation, may be considered. A multi-disciplinary approach considering cognitive and other psychosocial factors is necessary to ensure successful transplantation.
The most common surgical approach used for cadaveric donor nephrectomy is the en bloc technique through a large abdominal incision. Transplantation using organs from cadaveric donors is always performed with the over-riding need to minimize the cold ischemic time of the organ. There are a number of techniques for anastomosing the ureter to the bladder. These include the Leadbetter-Politano or a direct vesico-ureteric anastomosis. Many patients with renal failure have significant atherosclerosis, with calcification resulting in noncompressible solid arteries that cannot be clamped. Careful preoperative assessment by computed tomography scanning should allow identification of calcified arteries before listing for transplantation. The preferred donor procedure is a laparoscopic nephrectomy, with mobilization of the kidney assisted by the use of a hand port, usually through a small infra-umbilical midline incision through which the kidney is removed. Late vascular complications are usually stenosis of the arterial anastomosis.
A stringent process of selection of appropriate candidates for liver transplantation is necessary for a number of reasons. This chapter discusses deceased organ transplantation in adults. In liver transplant practice, a distinction needs to be made between the process of selection of appropriate candidates for transplant, which is the main focus of the chapter, and that of organ allocation for those candidates who have been placed on the waiting list for the procedure. Both of these processes are underpinned by similar considerations with respect to the relevant clinical end points and ethical standpoints. The practice of candidate selection and organ allocation is predicated on two fundamental ethical principles: justice (or equity) and utility. Most liver transplant programs have adopted the Milan criteria for selecting patients with hepatocellular carcinoma (HCC) for transplantation. Rarely, patients with heart and liver failure will be considered for combined heart-liver or heart-lung-liver transplant.
Organ Transplantation: A Clinical Guide covers all aspects of transplantation in both adult and pediatric patients. Cardiac, lung, liver, kidney, pancreas and small bowel transplantation are discussed in detail, as well as emerging areas such as face and pancreatic islet cell transplantation. For each organ, chapters cover basic science of transplantation, recipient selection, the transplant procedure, anesthetic and post-operative care, and long-term follow-up and management of complications. Important issues in donor selection and management are also discussed, including recruitment and allocation of potential donor organs and expanding the donor pool. Summary tables and illustrations enhance the text, and long-term outcome data are provided where available. Written by expert transplant surgeons, anesthetists and physicians, Organ Transplantation: A Clinical Guide is an invaluable multidisciplinary resource for any clinician involved in transplantation, providing in-depth knowledge of specialist areas of transplantation and covering the full range of management strategies.
In recent years, face transplantation has become a clinical reality and in the future may become a standard procedure. Composite tissue allotransplantation (CTA) is a new developing field of modern plastic and reconstructive surgery. A series of cadaver dissections were performed in preparation for face transplantation. Using computer-based models, the face looks neither like the donor nor the recipient prior to injury, but carries more of the characteristics of the recipient skeleton than of the donor soft tissues. Imaging is required to analyze the details of the facial defect and determine necessary structures for allotransplantation. To date there have been two scalp transplants and 14 facial allotransplantation cases reported in the literature and in media. Functional MRI, electromyography studies, and volumetric analysis are objective measures of motor recovery of facial units, whereas temperature testing and Semmes-Weinstein monofilament tests are used to monitor the sensory recovery of the facial allograft.
A successful pancreas transplant produces a normoglycemic and insulin-independent state virtually immediately after revascularization. There are important considerations of pancreas transplantation that currently precludes it as therapy for all patients with type 1 diabetes mellitus (DM1). Vascular thrombosis is a very early complication typically occurring within 48 hours. Transplant pancreatitis occurs to some degree in all patients. Bleeding from the vascular anastomotic site or cut surfaces of the pancreatic graft will result in an intra-abdominal hematoma. Peri-pancreatic infections can result in development of a mycotic aneurysm at the arterial anastomosis, which may rupture, and requires allograft pancreatectomy. The outcome of pancreas transplantation with respect to graft survival and rejection rates is dependent on the choice of immunosuppression agents used. The durability of the transplanted endocrine pancreas has been established with the demonstration that normalization of HbA1c is maintained for as long as the allograft functions.