Partial ALPPS with a longer wait between procedures is safe and yields adequate future liver remnant hypertrophy

Nagappan Kumar,Trish Duncan,David O’Reilly,Zsolt Kaposztas,Craig Parry,John Rees,Sameer Junnarkar 한국간담췌외과학회 2019 Annals of hepato-biliary-pancreatic surgery Vol.23 No.1

Backgrounds/Aims: Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) has generated controversy due to high morbidity and mortality. We present our series of patients with 30-40% parenchymal transection and minimal hilar dissection. Methods: Patients who had partial ALPPS between April 2015 and April 2016 were included. Patients with colorectal liver metastases (CRLM) had their future liver remnants (FLR) cleared with metastasectomies. The liver was divided along the future line of transection to 30-40%, right portal vein was stapled and divided without extensive hilar dissection, with minimal handling of right liver, which was not mobilised. We preserved the middle hepatic vein. Data were collected prospectively for hypertrophy of the FLR, morbidity and mortality. Results: Among the 8 patients (age 25-68) investigated, one patient with cholangiocarcinoma had portal vein embolization prior to partial ALPPS. All patients completed two stages with adequate FLR hypertrophy at a median of 28 days. No mortality was found. The median length of stay after stages 1 and 2 was 9 and 9.6 days, respectively. The median increase in FLR was 38%. Conclusions: A limited transection of 30-40%, minimal hilar dissection and longer wait between stages yielded adequate FLR hypertrophy with low morbidity and no mortality.

Performance and emissions analysis on diesel engine fuelled with cashew nut shell biodiesel and pentanol blends

Yuvarajan Devarajan,Beem Kumar Nagappan,Dinesh Babu Munuswamy 한국화학공학회 2017 Korean Journal of Chemical Engineering Vol.34 No.4

We studied the impact of blending pentanol, a next generation biofuel, with cashew nut shell biodiesel on its performance and emissions characteristics in a constant speed compression ignition engine. Our main objective was to reduce CO, HC, NOX and smoke emission when fueled with neat cashew nut shell biodiesel and the pentanol blends. Cashew nut shell oil is a byproduct from cashew nut industry. Since it is nonedible, it can be used as a promising alternative. Conventional transesterification process was used to convert the cashew nut shell oil into cashew nut shell biodiesel. Pentanol with 98.4% purity was used as an oxygenated additive. The experiment involved three test fuels: neat cashew nut shell biodiesel (C100), Pentanol blended with cashew nut shell biodiesel by 10% volume (C90P10) and Pentanol blended with cashew nut shell biodiesel by 20% volume (C80P20). The feasibility of using neat biofuel (without adding diesel) was also investigated. Experimental work concluded that the test fuels used in this study does not require any modification in engines. In addition, the combustion of fuels was smooth and there was no physical and visible damage in the engine components when fueled with cashew nut shell biodiesel and the pentanol blends. By adding 10% and 20% of pentanol to cashew nut shell biodiesel, significant reduction in CO, HC, NOX and smoke emission was observed. In addition, brake thermal efficiency increased marginally with slight reduction in brake specific fuel consumption.

Hepatocellular carcinoma in body builders; an emerging rare but serious complication of androgenic anabolic steroid use

Christopher Woodward,Josie Smith,Dean Acreman,Nagappan Kumar 한국간담췌외과학회 2019 Annals of hepato-biliary-pancreatic surgery Vol.23 No.2

Illicit use of androgenic anabolic steroids (AAS) is a known problem amongst certain groups including body builders and other athletes. Use of these drugs is thought to be high in some areas of South Wales. A number of adverse effects have been associated with use of AAS including the development of hepatic adenomas. There have been a handful of rare cases of the development of hepatocellular carcinoma following AAS use. We report two such cases presenting to the same surgical centre in South Wales within six months. We do this with reference to data from Public Health Wales, including the Harm Reduction Wales Needle and Syringe provision report, which indicate a particularly high rate of use of AAS in the surrounding area. We believe these cases are important from the public health point of view. They demonstrate a rare and not widely known about, but potentially fatal adverse effect of AAS, now becoming prevalent with the high use of these drugs. This is important for doctors to be aware of, but also could form the focus of a public health campaign targeted at AAS users.

Recent developments in air-trapped superhydrophobic and liquid-infused slippery surfaces for anti-icing application

Latthe, Sanjay S.,Sutar, Rajaram S.,Bhosale, Appasaheb K.,Nagappan, Saravanan,Ha, Chang-Sik,Sadasivuni, Kishor Kumar,Liu, Shanhu,Xing, Ruimin Elsevier 2019 Progress in organic coatings Vol.137 No.-

<P><B>Abstract</B></P> <P>Anti-icing coating is one of the recent hot topics in industrial applications as well as from the academic viewpoint. Icing is one of the major problem on various substrates such as glass windows in buildings as well as vehicles, solar panels, wind turbine blades, airplanes, transmission lines, power towers, traffic signals, off-shore oil platforms, telecommunication antennas, and many others. Ice accumulation can significantly reduce the performance of the substrates and results in poor visibility. Recently, considerable attention is being paid on the naturally inspired superhydrophobic/icephobic surfaces by mimicking its surface property for the development of artificial self-cleaning superhydrophobic and ice-phobic surfaces. A good example is the lotus leaf surface where hierarchical micro and nano-scale rough structure covered by low surface energy coating layer on the leaf can repel water droplets and prevent ice accumulation. On superhydrophobic surfaces, impacting and condensed water droplets rolled off before freezing at subzero temperature. On the other hand, in slippery liquid-infused porous surface (SLIPS), the air pockets are replaced by immiscible lubricant film which can easily remove the accumulated ice without any damage to the surface. In this review article, we describe the recent progress in passive anti-icing coating materials and methodologies. Metal substrates, polymers, and nanoparticles/polymer composites are playing the major role in the development of anti-icing surface. So, the main goal of this review articles deals with the development of various synthetic routes of superhydrophobic anti-icing coating materials from metal substrates, polymers, and nanoparticles/polymer composites. In addition, the role of SLIPS in anti-icing coating and their use are also discussed.</P> <P><B>Highlights</B></P> <P> <UL> <LI> This review article explores the recent developments done in fabricating the anti-icing surfaces. </LI> <LI> Various new ideas, materials, fabrication techniques and prospects are thoroughly discussed. </LI> <LI> The merit/demerits of various anti-icing surfaces were identified and discussed. </LI> <LI> This review article is beneficial for graduate, post-graduate students and experts in this research field. </LI> </UL> </P>

How successful is liver resection for colorectal cancer liver metastases in patients over 75 years old?

Nicholas George Mowbray,Carven Chin,Patricia Duncan,David O’Reilly,Zsolt Kaposztas,Sameer Junnarkar,Nagappan Kumar 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.1

Backgrounds/Aims: As populations age, an increased incidence of colorectal cancer will generate an increase in colorectal cancer liver metastases (CRLM). In order to guide treatment decisions, this study aimed to identify the contemporary complication rates of elderly patients undergoing liver resection for CRLM in a, centralised, UK centre. Methods: All patients undergoing operative procedures for CRLM between January 2013 and January 2019 were included. Patient, tumour and operative data were analysed, including the prognostic marker; tumour burden score. Results: 339 operations were performed on 289 consecutive patients with CRLM (272 patients <75 years old, 67 patients ≥75 years old). Median age was 66 years (range 20-93). There was no difference in major complication rates between the two age cohorts (6.65 vs. 6.0%, p=0.847) or operative mortality (1.1% vs. 1.4%, p=0.794). Younger patients had higher R1 resection rates (20.4% vs. 4.5%, p=0.002) and post-operative chemotherapy rates (60.3% vs. 35.8%, p< 0.001). The 1, 3 and 5-year OS was 90.2%, 70.5% and 52.3% respectively, median 70 months, with no difference between age cohorts (p=0.772). Tumour Burden score and operation type were independent predictors of overall survival. Conclusions: Liver resection for CRLM in patients 75 years and older is feasible, safe and confers a similar 5-year survival rate to younger patients. The current outcomes from surgery are better than historical datasets.