Graft thrombosis is a devastating complication after renal transplantation. We recently described the association of anti-beta-2-glycoprotein-I (IgA-ab2GP1) antibodies with early graft loss mainly caused by thrombosis in a monocenter study.Multicenter prospective observational cohort study.Seven hundred forty patients from five hospitals of the Spanish Forum Renal Group transplanted from 2000 to 2002 were prospectively followed-up for 10 years.Early graft loss and graft loss by thrombosis.The presence of IgA anti-B2GP1 antibodies in pretransplant serum was examined using the same methodology in all the patients.p < 0.001), vessel thrombosis being the most frequent cause of early graft loss, especially in Group-1 (6.9 vs. 0.4% p < 0.001). IgA-aB2GP1 was the most important independent risk factor for graft thrombosis . Furthermore, the, presence of IgA-aB2GP1 was associated with early graft loss and delayed graft function. At 10 years, survival figures were also lower in Group-1: graft survival was lower compared with Group-2 . Mortality was significantly higher in Group-1 .At transplantation, 288 patients were positive for IgA-B2GP1  and the remaining were negative (Group-2). Graft loss at 6 months was higher in Group-1 (12.5 vs. 4.2% Patients were obtained during a 3-year period (1 January 2000–31 December 2002) and kidneys were only transplanted from brain-dead donors. Nowadays, the patients are older and the percentage of sensitized and retransplants is high.In a prospective observational multicenter study, we were able to corroborate that pretransplant presence of IgA-aB2GP1 was the main risk factor for graft thrombosis and early graft loss. Therefore, a prospective study is needed to evaluate the efficacy and safety of prophylactic anticoagulation to avoid this severe complication. The introduction of modern immunosuppression, advances in the control of infections, better methodologies, and improvement in histocompatibility tests in recent decades have substantially increased short- and long-term results after renal transplantation. However, the percentage of patients who suffer graft loss in the first months posttransplant (mainly by thrombosis) has remained unchanged (5–8%) .2 glycoprotein I (B2GP1)  . It has  (B2GP1) .Antiphospholipid antibodies (aPL) are a group of autoantibodies directed against phospholipid-binding plasma proteins, including both those circulating in the blood and/or located in the plasma membrane of blood vessel cells. Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by the presence of circulating aPL associated with vessels thrombosis or adverse pregnancy outcome .B2GP1 is a protein that is mainly synthesized not only in the liver but also in kidney and heart. It is localized in plasma and in the membrane of endothelial cells, the platelets being the most frequent antigen recognized by pathogenic aPL , 10. TheWe recently described the association of a variety of IgA anti-beta-2 glycoprotein-I (aB2GP1) antibodies with early loss of kidney grafts, mainly from thrombosis . This obOur work has aimed to corroborate the association of IgA aB2GP1 with early graft thrombosis after renal transplantation in a prospective multicenter study.N = 2,600).We performed an observational, “non-interventional” follow-up study that included patients transplanted in five hospitals of the Spanish Forum Renal Group cohort. The original series  included all transplanted patients, without exclusions, during 2000–2002 in 14 renal transplant units in Spain  were evaluated in a 10-year prospective follow-up study. Presence of aPL was examined in pretransplant serum samples used for donor–recipient crossmatch : “Hospital 12 de Octubre” (Madrid); Unit-2 (N = 86): “Hospital Ramon y Cajal” (Madrid); Unit-3 (N = 63): “Hospital Marques de Valdecilla” (Santander); Unit-4 (N = 282): “Hospital de Cruces” (Bilbao); and Unit-5 (N = 20): “Hospital la Paz” (Madrid).The centers and number of patients in each center included in the study were as follows: Unit-1  early graft loss and (B) graft loss by thrombosis. Secondary endpoint: delayed graft function (DGF).The secondary aims are to perform a Replication Study comparing the results from the hospitals 2 to 5 with the results from hospital 1 that had previously described such a prevalence. Secondary endpoints: prevalence of IgA-aB2GP1 antibodies, graft and patient survival, and causes of graft loss and death.The “Forum renal” study  was approved by all the Ethics Committees and Nephrology Departments of the 14 hospitals, assuring data confidentiality , 16. TheIn addition, prior to centralizing the laboratory and database work, the study was submitted for approval to the Hospital 12 de Octubre Ethics Committee for Clinical Research and it received a favorable report (Reference Number CEIC-14/021).Seven hundred forty patients (99.1% Caucasian) received a kidney transplant from heart-beating (brain dead) donors. Although an exhaustive coagulation study was not performed, all patients were negative for Factor V Leiden , smoking, and pretransplant cardiovascular disease were recorded. Immunosuppressive drug treatment was also included.After surgery, incidence of thrombotic events, cardiovascular events, neoplasia, DGF, and acute rejection (AR) episodes were recorded. Patient and graft survival (GS), and causes of mortality and graft loss were also recorded.The most frequently used immunosuppressive protocol (88.5% of patients) was based on triple therapy with calcineurin inhibitors, mainly tacrolimus, associated with steroids and MMF with or without induction. In patients older than 60 years who received kidneys from donors older than 60 years, immunosuppression regimen was based on Cyclosporine (CsA), steroids, and MMF with or without induction. Immunosuppressive treatments in all the patients are described in Table S1 in Supplementary Material.Thrombotic events were defined as venous thrombosis, arterial thrombosis, graft thrombosis, pulmonary thromboembolism acute stroke, or transient ischemic attack. Thrombotic episodes were diagnosed by imaging techniques or by histological study .Graft thrombosis was diagnosed with imaging techniques. Furthermore, most of the patients who suffered graft thrombosis underwent a transplactectomy. Immediately after the surgery, the kidneys were studied in the Pathology Department, the results of macroscopic and histopathology analysis confirmed the presence of graft thrombosis.Death of the patient or loss of kidney function that requires the beginning of permanent renal replacement therapy. It is considered early graft loss if it occurs in the first 6 months after the transplant. Censored graft loss is graft loss excluding death of the patient.-function that requires hemodialysis during the first week after surgery. DFG was diagnosed once discarded hyperacute rejection, vascular complications, and urinary tract obstruction.Delayed graft function is a form of posttransplantation acute renal failure defined as a temporary graft nonArterial hypertension was defined as blood pressure greater than 140/90 mm Hg.Primary non-function was considered to exist in grafts with good perfusion that never functioned in which a biopsy study had excluded other causes of graft dysfunction as AR.Cardiovascular event was considered if at least one of the following was present: heart failure, angina, coronary revascularization, myocardial infarction, stroke, or peripheral bypass.Acute rejection was applied to acute deterioration in allograft function associated with specific histopathologic changes in the graft.Clinically suspected AR is defined as patients with AR clinical criteria lacking histological data that confirmed the diagnostic.Panel Reactive Antibody Score was defined as the percentage of the general population to which the patient reacts by preformed antibodies. PRA was studied by complement-mediated cytotoxicity using pooled lymphocyte panel with at least 35 unrelated genotypes. Patients were considered as “sensitized” with PRA values ≥50%.Hyperlipidemia was defined as when hypertriglyceridemia (>150 mg/dL) or hypercholesterolemia (>200 mg/dL) were seen./L).Diabetes mellitus was diagnosed in patients with fasting plasma glucose greater than 126 mg/dL  using the QUANTA Lite B2 GPI IgA . A unique assay lot was used for the analysis of the samples from centers 2, 3, 4, and 5.The anti-cardiolipin (aCL) and aBGPI antibodies of IgG and IgM isotypes in patients from center 1 were measured with QUANTA Lite aCL IgG, QUANTA Lite B2 GPI IgG, QUANTA Lite aCL IgM, and QUANTA Lite B2 GPI IgM (INOVA Diagnostics Inc.). In patients from centers 2, 3, 4 and 5, these were measured using BioPLex 2200 multiplex immunoassay system APLS IgG and IgM .Antibody levels higher than 18 U/mL were considered positive for aPL of IgG and IgM isotypes and higher than 20 U/mL were considered positive for IgA-aB2GP1. The cutoff values were those recommended by the manufacturer, which coincided with those determined in the healthy population in our country , 18.U test in scaled variables with two categories. Probabilities less than 0.05 were considered significant.Results were expressed as mean ± SE, or absolute frequency and percentage. Association between qualitative variables was determined with Pearson’s Chi-square test or Fisher’s exact test, when appropriate. Comparisons were performed using the Mann–Whitney Survival was calculated using the Kaplan–Meier Method and differences between the distributions of survival were assessed with the log-rank test.Multivariate analyzes of graft loss and graft thrombosis-associated variables were performed using Cox regression . The relative measure of an effect was expressed as hazard ratio (HR).Multivariate analysis of DGF (dichotomous outcome concentrated in a very short period of time) was performed using logistic regression model . ProbabiThe policy regarding donor–recipient selection was based on trying to match recipients and donors with similar ages. Therefore, donor age is a recipient age-dependent variable. Donor age was not included as a statistical analysis variable except when studying DGF because it is more associated with donor age than recipient age in the literature .Data were processed and analyzed using Medcalc for Windows version 16.1 .The average pretransplant levels of aCL antibodies were IgM 5.4 U/mL ± 0.7 and IgG 4.0 U/mL ± 0.4. Mean levels of aB2GP1 antibodies were as follows: IgM 4.3 U/mL ± 0.8, IgG were 4.1 U/mL ± 0.5, and IgA were 32.4 U/mL ± 1.8 . Patients whose antibody levels were above the cutoff were considered positive. Prevalence of aCL positive patients was 1.1% for IgM and 1.2% for IgG. Prevalence of aB2GP1 antibodies patients was 1.6% for IgM and 1.2% for IgG.p = 0.017) and less hyperimmunized patients . The prevalence of dyslipidemia and hypertension was slightly higher in Group-1. The remaining pretransplant characteristics did not differ between both groups .Two hundred eighty-eight (38.9%) patients were positive for IgA-aB2GP1 antibodies (Group-1) and 452 were negative (Group-2). Patients in Group-1, were immunologically less complex and there were fewer retransplanted patients . At 3 months, the percentage of patients with graft loss in the Group-1 was also significantly higher than in Group-2  (Table p < 0.001), presence of DGF , positivity for IgA-aB2GP1 antibodies , and a higher proportion of patients with nephroangiosclerosis as cause of end-stage renal disease (ESRD)  (Table Thirty-six patients in Group-1 12.5%) lost their graft during the first semester after transplantation vs. 19 in the Group-2  Table  showing p < 0.001, Figure p < 0.001, Figure A Kaplan–Meier survival analysis showed significantly lower 6-month GS rates in Group-1 . There were no differences regarding AR episodes in both groups ].Early graft loss-associated factors that were significant in the univariate analysis Table  were incp = 0.002). Recipient age, presence of DGF, and nephroangiosclerosis as cause of ESRD were also independent risk factors for early graft loss [Table Presence of IgA-aB2GP1 antibodies continued to be an independent and significant risk factor for graft loss after adjusting for other risk factors  were identified as independent risk factors for graft thrombosis [Table IgA-aB2GP1, cold ischemia time, and age were identified in univariate analysis as significant and associated factors for graft thrombosis . In a Cox proportional regression multivariate analysis, cold ischemia time, DGF, and especially IgA-aB2GP1-ab , hypertension , type 2 diabetes , and BMI .No significant differences were observed between the group I patients who suffered graft loss due to thrombosis and the remaining patients of this same group who had cardiovascular risk factors: dyslipidemia  were analyzed in a logistic regression univariate analysis. Those that continued to be significant were studied in a multivariate analysis: donor age, BMI, hypertension, and especially IgA-aB2GP1 antibodies [odds ratio (OR): 2.08, 95% CI: 1.47–2.95; p = 0.002) and death-censored GS .Graft survival Figure  was signp = 0.042).Causes of graft loss in this period were similar in both groups except for death with a functioning kidney that was more frequent in Group-1 patients  showed that graft loss was higher in Group-1 vs. Group-2: survival was 60.4 vs. 76.8%; HR: 1.91; 95% CI: 1.45–2.52; p < 0.001  was lower in Group-1 than Group-2: 76.1 vs. 86.5%; HR: 2.34; 95% CI: 1.61–3.39; p = 0.005; Table p = 0.015, Figure Global mortality in the follow-up was 15.1%, this being significantly higher in Group-1  and at 10 years .When patients from centers 2, 3, 4, and 5 were considered alone with the exclusion of center 1, GS  were significantly more frequent in patients in Group-1 than observed in Group-2 patients.Notably, graft thrombosis  and graft thrombosis . Likewise, IgA-aB2GP1 continued to be an independent risk factor for DGF in a multivariate logistic regression analysis .Remarkably, in a Cox proportional regression multivariate analysis , IgA-aB2GP1 antibodies continued to be an independent and significant risk factor associated with early graft-loss .Mortality was also higher on Group-1  of renal transplant patients suffered early loss in the first 6 posttransplant months and 22 of them (40%) due to graft thrombosis. Therefore, graft thrombosis was the main cause of early graft loss, representing 3% of the total group, a percentage almost similar to the other series . However, a different diagnostic system was used to quantify aPL of IgG and IgM isotype for center 1 (ELISA) than in rest of the centers (multiplex immunoassay). This change of methodology is irrelevant because the efficiency in determination of aPL of IgG and IgM isotypes using ELISA and multiplex diagnostic systems is very similar , 36. FurThe need to include the determination of aB2GP1 IgA in diagnostic protocols has been suggested recently. Currently, the IgA isotype is not included among the APS classification criteria of the APS, so that very few centers perform the IgA determination aB2GP1. For this reason, cases of IgA-mediated thrombosis are clearly underdiagnosed .In summary, for the first time, we have been able to corroborate in a large cohort of patients from five hospitals that the presence of pretransplant IgA-aB2GP1 is an independent risk factor for graft thrombosis after renal transplantation, a devastating condition without available prevention and treatment. This finding can be the rationale for a prospective study to demonstrate if prophylactic anticoagulation can be useful to improve this early complication.The study was submitted to the Ethics Committee for Clinical Research (ECCR) of Hospital “12 de Octubre” and received a favorable report (Reference Number CEIC-14/021).AS and JM conceived the project, designed the research, discussed the results, and wrote the manuscript. AS, MS, and JM-F performed the antiphospholipid determinations and were responsible for the database and the statistical analysis. JM, JG, MA, RM, FE, AA, NM, and EA were responsible for the patients’ care and clinical data collection. AS, MS, JM-F, JC, and ML-H were responsible for coordination of the Organ Transplant Waiting List Serum Bank. MM evaluated the histopathology. All authors contributed to the data interpretation, reviewed the manuscript, and agreed with the final version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer KK and handling editor declared their shared affiliation.


The Scientific World Journal has retracted the article titled “The Design and Implementation of Postprocessing for Depth Map on Real-Time Extraction System” . The pee


Journal of Educational Evaluation for Health Professions adopted an open data policy [In April 2016, a policy . When anhttps://dataverse.harvard.edu/dataverse/jeehp. Therefore, starting in April 2017, all data began to be deposited in the Harvard Dataverse. Data can be deposited at this depository site at no cost. Because the Harvard Dataverse provides a digital object identifier (DOI) for each dataset, it is very convenient to present the URL for the site where data have been deposited. A simple DOI address suffices to direct a reader to the data site . Through the end of 2017, 111 journals have created a deposit space in the Harvard Dataverse. The number of journals registered in the Harvard Dataverse has increased year by year [Revista Brasileira de Educação do Campo published by the Universidade Federal do Tocantins are the 2 journals that deal with education. I am not sure how many other journals in the field of education have announced an open data policy. There is another data repository, Figshare (https://figshare.com/), which is used by many international publishers; however, it is difficult to find information regarding open data policies on the journal level. I would guess that this journal is 1 of only 2 education journals with an open data policy at the present. Submitters to the journal understand this policy very well, and they are therefore eager to provide raw or processed data. In 2017, only 1 submitter refused to provide raw data. That article was withdrawn before the review process. I hope that many researchers access the data of the studies that we have published, replicate the results, and develop novel ideas from the data.The authors of all articles published since April 2016 have included their raw data, which have been deposited on the journal website and PubMed Central. In March 2017, the editorial office requested Harvard Dataverse to create a journal-specific space for depositing the journal’s data. This space was created on April 11, 2017, and is available at:  by year  Fig. 1)https://dThis year, it was possible to publish many invaluable articles due to the voluntary work of invited reviewers. I appreciate their devotion to the journal. The list of reviewers for the 2017 issue is as follows:Su-Jin Chae, Ara Cho, Jody Chu, Kevin Chui, Chad Cook, Upreet Dhaliwal, Christian Ezeala, Jorge Riquelme Galindo, Diana Galindo, Mitra Hanani, Maureen Hardy, Jianhui He, Kyaw Ko Ko Htet, Yera Hur, Kun Hwang, Ki-Taeg Jang, Eun Young Jeon, Geum Hee Jeong, Amir Maroof Khan, Saval Khanal, Hyunjung Kim, Ki-Song Kim, Nam-Hee Kim, Kyung-Nyun Kim, Sue Kim, Shin Jeong Kim, Hyunjung Kim, Tetsuo Kimura, Oh Young Kwon, Young Hwan Lee, Kyoungsin Lee, Sang-Kyu Lee, Eunyoung Lim, Woo-Taek Lim, Christianne Micallef, Victor Mogre, Barbara O’Donell, Younjae Oh, Young Guk Park, Sonja Raaum, Jennifer Reneker, Saara Repo, Hye-Rin Roh, Dong Gi Seo, Jeong-Tak Seo, Ravi Shankar, Ramzi Sha-wahna., Jae-Hoon Shim, Sujin Shin, Dong Whan Sohn, Hohee Son, Pascal Staccini, Mohan Sunkad, Gideon Victor, Adam Wilson, Shi-geo Yamamura, Hon Yuen.Additionally, Tom Huh has worked on a volunteer basis to make audio recordings of the abstracts.Before closing this issue, I wish to express my regret for not accepting more articles from throughout the world. Some submissions were not accepted for a variety of reasons. I believe that all research data are worthy of being published; however, published research should fit not only the aims and scope of the journal, but also its style and formatting requirements. After verifying that submissions met those criteria, I screened them for scientific soundness. Most of the manuscripts were from medical/health educators, and I believe that their research and experiences are meaningful and helpful to other educators, not only in their country, but throughout the world. The editorial team and I are always happy when we receive well-formatted manuscripts. We have done our best to edit those manuscripts after evaluating their scientific merit. I hope to publish brilliant articles from all over the world next year as well. I close this editorial by expressing my appreciation once more to the authors, reviewers, and readers of this journal, all of whom I wish a productive and fulfilling new year.


Different lesions affecting the midfacial regions require surgical reconstruction. The aim of this study was to assess the different methods used in midfacial reconstruction after maxillectomy procedures. The various reported surgical reconstructive techniques focusing on the esthetic and functional outcomes are to be reviewed in this article.A thorough PUBMED and hand-search of journals of relevance was performed on related terms and yielded 772 titles of which 45 abstracts were selected and obtained as full articles for further evaluation while the rest were excluded by title/abstract. According to the inclusion criteria; 14 of these studies were used to complete this article.In this review we showed that fibular and radial vascularized grafts were the most commonly reported methods in literature with a few other options. Computer aided design and surgical planning has been also reviewed and seems to be a rapidly evolving option for maxillofacial reconstruction. Lack of RCTs  and large scale case series was noticed in this review making the evidence of poor quality.Methods of evaluation of reconstruction options mainly qualitative and subjective made the evaluation of the techniques in this review difficult. Benign and malignant lesions commonly affecting the maxillary/midface regions require surgical ablation. The surgical removal of such lesions leaves behind a defect of esthetic and functional components. The esthetic component of the defect is caused by the loss of facial support of the soft tissues related to the region especially the cheek prominence resulting in facial asymmetry. In cases where the defect extended to the orbital region causing orbital exenteration the esthetic disfigurement is paramount. The functional problems are caused by the loss of the maxillary alveolar process with subsequent loss of the masticatory function. Moreover, the speech and cosmetic problems they cause; make their reconstruction very difficult .Another functional issue encountered is the oro-nasal/antral communication which occurs in cases of lesions perforating the antral / nasal floor. Palatal defects may be covered by acrylic obturators and sparing the patient the sequelae of oro-antral communication . ObturatOn the other hand, microvascular procedures are complex procedures requiring special training. The donor site needed to harvest the graft adds to the surgical morbidity, increases the intraoperative time and may require more than one surgical reconstructive procedure , 6. The The various surgical reconstructive techniques used focusing on the esthetic and functional outcomes are to be reviewed in this systematic review.This review aimed to study the different reported techniques of midfacial reconstruction.A search in MEDLINE (Pub Med) was performed using the following search query:#1 midface#2 rehabilitation OR reconstruction.A hand search of international journals in the scope of maxillofacial surgery was also performed to identify any skipped relevant articles , International journal of OMFS, Journal of OMFS, Journal of craniofacial surgery, Journal of craniomaxillofacial surgery, Journal of plastic and reconstructive surgery, Journal of aesthetic plastic surgery, Journal of clinical oral investigation, Journal of clinical otorhinolaryngeology, Journal of craniomaxillofacial trauma and reconstruction, Head & neck journal, Annals of plastic surgery, Journal of prosthetic dentistry, Journal of oral surgery-pathology-radiology-endodontics).The results of this search yielded 772 titles that were screened by the authors. Forty five of the resulting titles were chosen for abstract evaluation. Clinical trials reporting different techniques of maxillary reconstruction of pathologic defects were selected and after screening 29 articles were obtained as full articles and studied thoroughly and those not fulfilling the inclusion criteria were excluded.The 14 publications fulfilling the inclusion criteria were selected to perform this review. Author disagreements were negotiated till satisfactory results reached .Clinical trials reporting different techniques of maxillary reconstruction of pathologic defects were selected and after screening at each level studies were excluded according to the following exclusion criteria.Traumatic fractures of the face (non-pathologic defects)Cosmetic / plastic surgeriesAnimal studiesStudies evaluating surgical approach rather than reconstruction techniqueSoft tissue defects without a bony componentIn languages other than EnglishNon clinical trials / review articlesData collection forms were custom designed for the selected articles including the following items:Authors & study dateStudy typeNumber of patientsAge of patientsTreatment providedFollow up durationPatient satisfactionHistopathological assessmentThe selected articles were studied according to the method of reconstruction used and outcome accomplished. The different methods of reconstruction reported included; iliac grafts, fibular grafts, radial forearm free flap, scapular, calvarial, computer guided procedures, distraction ostoegenesis or a combination of two of these techniques together.Risk of bias was assessed according to study design, randomized selection, specification of the inclusion/exclusion criteria, reporting of lost follow-up and complications, objective evaluation and statistical analysis of the results.Of the 14 articles selected none were randomized controlled trial; the study design was either retrospective (6 studies), case report (5 studies) or case series (3 studies) and so no meta- analysis was possible and the results will be presented in a descriptive manner. Data was collected from the selected articles in customized forms and tabulated  and the The articles were published in the period from 1998 to 2015. The outcome in all of them was a subjective assessment of esthetic and functional patient satisfaction and so no numerical evaluation of the different reconstruction techniques was possible. Histopathologic assessment of the lesions in most cases reported a malignant pathology; and in some cases adjunctive chemotherapy and/or radiotherapy was necessary. Risk of bias in all selected articles was substantially high due to the study design which was either retrospective studies or prospective non-controlled case series/reports. This literature review will therefore only present the studies narrative without any meta-analysis.A total of 55 cases of reconstruction using fibular grafts were found in the search of which 3 were associated with an anterolateral thigh soft tissue flap. Moreno et al. reported the use of an osteocutaneous fibular graft in 11 patients with total loss of the graft in one patient; and partial flap loss of less than 10 % in 2 cases A combination of an ALT and an osteocutaneous fibular graft was reported in 3 of these cases with reported uneventful healing and successful grafting . An osteThe patients reported excellent (14/27), good (8/27), fair (4/27) and poor (1/27) esthetics. Regarding function, the study reported regaining of normal diet in 14 patients while 13 others only followed a soft diet regimen. The speech of all patients in this retrospective study was reported to be intelligible over the phone. The feasibility of elongating the vascular pedicle when necessary as applied in several cases in this study is another advantage of the fibular graft . A singlAnother study used fibular osteocutaneous reconstruction for 27 cases with midfacial defects. Dental implants were placed 3-6 months after the initial surgery and 6 months later the maxillary prosthesis was placed. The study reported a single case of flap failure, while 5 other required intervention to salvage the flap.Three cases of reconstruction using iliac grafting were found in the selected articles. The use of iliac bone accompanied by the insertion of implants into simultaneously harvested anterolateral thigh flaps was reported in Mueller et al’ s study. The final prosthesis was installed after an average of 13 months postoperatively. Patients wore the prosthesis and were satisfied to an extent although only 3 of the patients wore the prosthesis publicly . OsteomyIn reviewing the literature, 40 cases of reconstruction using RFFF as the primary reconstruction graft were found; of which 3 cases were accompanied by ALT soft tissue flap. A case series reported the reconstruction of 23 midfacial defects using osteocutaneous radial forearm free flap (OCRFFF). Recipient site complications ranging from hematoma formation to wound dehiscence was noted in 10 cases. Oronasal fistulas occurred in 3 cases and were locally treated by advancement flaps. While donor site complications occurred in 7 cases with radial bone fracture in 1 case and skin graft loss in 6 others. Although none of the patients received dental rehabilitation, a normal diet was regained except for 2 patients. Smaller defect size understandably showed a lower rate of recipient site complications and showed better esthetic results than larger defects . AnotherScapular flaps were used in 13 maxillary reconstruction cases in the included articles. A case series published in 1998 reported the use of the scapular grafts to reconstruct midface defects. This was reported in 8 cases; 7 carcinomas and 1 hemangioma. 4 out of the 8 cases required a second procedure due to flap loss or volume correction . The useA retrospective study of 6 patients reported the reconstruction of the midface using calvarial bone grafts along with a temporoparietal local vascularized graft. The follow-up period extended to a range of 3-36 months with 1 patient complaining of a moderate facial deformity postoperatively due TPF loss and requiring a revision surgery. The authors concluded that the use of calvarial bone grafts in this manner should only be confined to small defects not necessitating further soft tissue grafting . AnotherA case series studied the use of temporoparietal osteofascial flap in maxillofacial reconstruction including 2 cases of midface reconstruction. Both cases were reported to show good uneventful healing and successful results along the follow-up periods which lasted 24 and 30 months. The authors concluded that the TOF has the obvious advantage of the absence of a second surgical donor site and so less morbidity. On the other hand, alopecia and dural tears have been reported so extreme care intraoperatively is essential .The rapidly evolving advancements in the scope of computer software has allowed for the introduction of virtual surgical planning techniques and the fabrication of patient specific implants and/or stereolithographic models.A single case of the use of a specifically fabricated titanium mesh in conjunction with a latissimus dorsi flap was reported. Mesh exposure was reported requiring secondary surgical intervention with another soft tissue graft. The latissimus dorsi flap provides an abundance of soft tissue which was advantageous in this case to cover the titanium prosthesis. The same amount of soft tissue from another donor site would be accompanied by significant donor-site morbidity .Another case report of a single case with a secondary midfacial depression was treated using a computer guided prefabricated MEDPOR implant. The preoperative CT scans of the patient were used to make a model of the patient’s facial skeleton. The model was then used intraoperatively to adapt the MEDPOR implant. After 9 months of follow-up, both the patient and clinician reported good esthetics and function. The use of MEDPOR in this case avoided a secondary surgical site with its morbidity. On the other hand, the main disadvantage of MEDPOR is the risk of infection and the added cost of the implant .In 2013 a published case report introduced the use of a patient specific implant along with a scapular osteomyocutaneous flap. The patient had an ablative surgery earlier and the CTs were imported into the computer software where a virtual surgery was performed by designing the components of the defect to be reconstructed with the scapular graft . A patient specific titanium implant was also designed by mirror imaging the normal side to obtain a structure of the midface as close to normal as possible. The zygomatic and orbital components of the defect were reconstructed using the PSI. Intraoperatively the scapular flap was harvested and microvascular anastomosis achieved by using the facial artery and vein as recipient vessels. Proper insertion and fixation of the device were detected intraoperatively using intraoperative navigation systems. The myocutaneous component of the flap was used to better support the soft tissue of the cheek. Healing was uneventful with good epithelialization of the recipient mucosa and good contour and symmetry. Later on due to the poor vascularity of the radiated recipient bed, as reported by the authors, part of the titanium implant was exposed at the lower eyelid necessitating a secondary rotation cheek flap to cover it. Three months postoperatively complete healing and epithelialization was reported. Although this is a costy technique; it provides superior esthetics and requiring less graft harvesting .Maxillectomy defects have been reported to be treated by prosthetic appliances; obturators; as early as the 1950s aiming to provide adequate esthetics and function after surgical ablation. The advantages of the obturator at that time was to restore functions, reduce bleeding and maintain a clean wound. Obturators have been reported to restore the drinking ability of the patient by closing the oro-antral/nasal caused by the resection , 23. On Complications of obturators were overcomed with the introduction of microvascular techniques which has become the internationally accepted method of maxillary/midface reconstruction. Donor sites have varied according to the size and type of the defect with pros and cons to each of the reported donor sites in literature.Fibular grafts are a common option in cases requiring a bony component in the graft. The use of osteocutaneous flaps in midface defects has been reported to be highly reliable and providing acceptable esthetics in cases other than those requiring restoration of bony parts of the orbit. Authors commented that the use of an osteocutaneous fibular graft for midfacial reconstruction is beneficial especially in the freely movable soft tissue component which is not the case in other composite grafts . It has nd donor site. Authors of this trial reported uneventful healing in all 29 cases included with only a single case of seroma formation which was treated locally and eventually healed as well [Radial forearm free flap is another commonly used option. It may supply a wide variety of tissue components; skin, muscle and/or bone according to the defect characteristics and clinician’s preference. Flap harvesting is quite a simple technique with a thin, long reliable pedicle. Osseocutaneous radial forearm grafts have been used to reconstruct midface defects and restoring the infraorbital rim using the bony component of the graft. High success rates in terms of graft incorporation; function restoration  and esthetic outcomes  have been reported . Moreove as well .Scapular flaps have also been discussed vastly in the literature with several different applications with/without other tissue grafts. Combination with the latissimus dorsi muscle and harvesting a part of the scapular bone has been reported to provide sufficient bone and soft tissue components to reconstruct maxillectomy defects. Some authors considered it to be the first reconstructive option in cases of maxillectomy with orbital exenteration defects  while otIliac grafts: the iliac region may provide bone with or without accompanying soft tissue components for maxillofacial reconstruction. The outstanding advantage of iliac grafts is the abundant bone stock available with its vascular pedicle. The cutaneous tissue of the groin has the advantage of being hairless and so mimicking the recipient area but the skin tone unfortunately does not match that of the face. The hairless nature of the groin skin is advantageous although the non-matching skin tone may cause an esthetic concern .Despite the obvious advantage of autogenous tissue grafting, reconstruction of the maxilla/midface has higher morbidity rates and is a complex procedure. Prolonged surgical time complications, donor site morbidity, technique sensitivity and expensive equipment complicate the use of microvascular surgery. With the introduction of computer-guided surgeries, preoperative surgical planning and fabrication of patient specific implants were reported and aimed at overcoming such drawbacks , 21.The technique of computer-assisted planning and mirror-imaging of the same patient’s normal side was used by Mertens et al to fabricate a patient specific titanium implant (PSI) to act as a scaffold for an osteomyocutaneous scapular flap to reconstruct an oncologic midface defect. Postoperative CT was ordered at the end of the 4 month followup period to enable the fabrication of implant-retained rehabilitation was used. The authors considered it to be a promising technique combining advantages of several reconstructive techniques yet no further details on the postoperative period have been provided . The maiIn conclusion, the articles included in this review were chosen to target methods used to overcome facial asymmetry/deformity caused by pathologic defects. The lack of controlled/ RCTs and a fixed postoperative evaluation scale made the comparison of the results impossible. It was noted however that outcomes were directly affected by the extent of the defect with larger defects usually accompanied by poorer outcomes. The computer-guided novel techniques are yet to be researched to allow for further assessment but the show great potential for esthetically satisfactory simple midface reconstruction. The risk of bias in all assessed articles was substantially high making the proper evaluation of the reported techniques impossible. Outcomes in the selected articles were vague reports of patients’ satisfaction as regards function and esthetics. Properly arranged RCTs with fixed postoperative assessment measures are highly recommended to enable further analysis of the results to come up with guidelines for midface/maxillary reconstruction.


Impaired ability to make inferences about what another person might think or feel  is recognised as a core feature of schizophrenia and a key determinant of the poor social functioning that characterizes this illness. The development of treatments to target social cognitive impairments as a causal factor of impaired functioning in schizophrenia is of high priority. In this study, we investigated the acceptability, feasibility, and limited efficacy of 2 programs targeted at specific domains of social cognition in schizophrenia: “SoCog” Mental-State Reasoning Training (SoCog-MSRT) and “SoCog” Emotion Recognition Training (SoCog-ERT).n = 19) or SoCog-ERT (n = 12). Treatment comprised 12 twice-weekly sessions for 6 weeks. Participants underwent assessments of social cognition, neurocognition and symptoms at baseline, post-training and 3-months after completing training.Thirty-one participants with schizophrenia or schizoaffective disorder were allocated to either SoCog-MSRT (Attendance at training sessions was high with an average of 89.29 % attendance in the SoCog-MSRT groups and 85.42 % in the SoCog-ERT groups. Participants also reported the 2 programs as enjoyable and beneficial. Both SoCog-MSRT and SoCog-ERT groups showed increased scores on a false belief reasoning task and the Reading the Mind in the Eyes test. The SoCog-MSRT group also showed reduced personalising attributional biases in a small number of participants, while the SoCog-ERT group showed improved emotion recognition.The results are promising and support the feasibility and acceptability of the 2 SoCog programs as well as limited efficacy to improve social cognitive abilities in schizophrenia. There is also some evidence that skills for the recognition of basic facial expressions need specific training.ACTRN12613000978763. Retrospectively registered 3/09/2013.Australian New Zealand Clinical Trials Registry  Impaired social cognition is a core feature of schizophrenia . Social Treatments for social cognitive impairments in schizophrenia tend to be dichotomised into ‘targeted’ treatments focusing on specific impairments , 7 or ‘cKern et al.  concludehttp://www.paulekman.com/micro-expressions/) and found improved emotion recognition in people with schizophrenia that was durable 1 month after testing. The METT uses a series of videos showing facial expressions with verbal commentary to direct attention to relevant facial features of commonly confused emotional expressions . Following from this we piloted a novel 6-week “SoCog-MSRT” program that targets ToM and attribution style, with no specific reference to emotion recognition  dunb = -.24, see Fig. p = .025, CI , dunb = -.85, see Fig. p = .078, CI , dunb = .68, see Fig. p = .025, CI , dunb = .54).Figures p = .18, 95 % CI , dunb = .394, see Fig. p = .001, dunb =1.26, CI , see Fig. p = .349, CI , dunb = .246, see Fig. p = .01, CI , dunb = .63, see Fig. Figure p = .01, dunb = .49, 95 % CI , see Fig. p = .003, CI , dunb = -.38, see Fig. p = .015, CI , dunb = .71, see Fig. p = .137, CI , dunb = -.37, see Fig. Figures p = .14, 95 % CI , dunb = .28, see Fig. p = .94, CI , dunb = -.02, see Fig. p = .078, dunb = .53, see Fig. p = .60, CI , dunb = .28, see Fig. Figures p = .11, dunb = -.83, see results in Fig. p = .01, CI , dunb = -1.9, see Fig. Figures The aim of this study was to explore the feasibility, acceptance, and limited efficacy of 2 novel social-cognitive remediation (SoCog) programs to improve social cognition in schizophrenia. We predicted that participants would accept the program and find it enjoyable and beneficial and they would be motivated to attend training sessions. We further predicted that following training, the SoCog-ERT group would show enhanced recognition of basic facial expressions of emotion whereas the SoCog-MSRT group would show improved mental-state decoding and mental-state reasoning.Attendance rates were better than in similar studies . There was a trend toward improvements immediately after training. Although only 6 participants remained in SoCog-ERT at T3, 5 of these 6 individuals showed moderate increases in accuracy  3 months after training. This is consistent with the results of our previous brief emotion recognition training studies where we also found delayed improvements 1-month post-training and speculated that was due to participants using newly learned skills in their everyday life such that practice over time led to improvements that were not immediately apparent . CIs shoAs predicted, the SoCog-MSRT group did not show improvements in emotion recognition accuracy for basic emotions and indeed this group showed a decrease in accuracy at 3-month follow-up. As this type of training did not provide explicit training about how to recognise basic facial expressions this finding might indicate that it is important to provide specific ERT in order to improve these more basic perceptual aspects of social cognition. However, further investigation in a larger study would be needed to draw any definitive conclusions.Both the ERT and MSRT groups showed an increased ability to recognise complex emotions from static photos of the eyes (RMET) at 3-month follow-up. With the exception of 2 participants in MSRT, all participants showed delayed improvement at 3 months. CIs showed comparable changes for both groups between 1.87 and 5.2 for MSRT and from 1.12 to 5.2 for ERT with large and moderate effect sizes, respectively.Both training groups showed immediate post-training improvements on false-belief reasoning (PSTFB). These improvements were not durable for the SoCog-MSRT group at 3-months but were for SoCog-ERT. Nevertheless, inspection of the paired data and the width of the CIs for this ERT group contrast suggest the result might be imprecise as most participants showed decreased scores, and only 1 showed no change. This imprecision is most likely due to the small sample size but might also have been influenced by task difficulty. Participants were sometimes reluctant, or refused, to do this task a second and third time because they found it too challenging, therefore follow-up results might also be confounded by tolerability and/or missing data .unb = 2.26) however the CI was wide indicating the need for replication in a larger sample before strong conclusions can be drawn. Nevertheless, this outcome is encouraging, because the evidence to date that attributional biases can be successfully remediated is variable with few studies showing success in remediating these complex cognitive processes [The SoCog-MSRT group showed reduced biases in a small subset of participants who showed a personalising bias  at baserocesses , 47.An important issue that we cannot address directly in this study is whether the results have clinical significance. Whilst the limited efficacy found in this study is encouraging, we experienced some significant challenges in conducting the study that prevent us from drawing any firm conclusions about clinical significance. These challenges related to working with some of the treating staff who were reluctant to have their patients randomised to a control group, the rejection of the initial active control treatment by the participants randomised to that arm of the study and drop-out. All of these contributed to the small sample size that restricted analyses and also precludes us from ruling out practice effects on some of our dependent variables. Our assessing staff were not blind to the allocation of the subjects, which may also have led to an overestimation of treatment effects . The stuOur results also highlight the difficulties inherent in conducting randomised controlled trials within real-world clinical settings. We found that both consumers and clinicians were often not responsive to randomisation into a control group. This is because most services encourage active engagement in a range of rehabilitation programs. Thus, clinicians and consumers alike can see 3−12 months (or more) of participation in the control group of a longitudinal RCT as a potential impediment to the rehabilitation process.RCTs are considered the gold standard test for new treatments ; howeverDespite the above limitations, the results of this acceptability and feasibility study are encouraging and are consistent with studies testing similar programs. Importantly, participants reported being motivated to participate, enjoying the program and perceiving it as valuable thus supporting the acceptability and feasibility of SoCog. Limited efficacy was observed despite the significant chronicity of many of the participants. Perhaps most promising was that we were able to work closely over several years with hospital staff to implement SoCog within an existing inpatient rehabilitation program. As such, the difficulties that we encountered arguably resemble more closely clinical practice, thus, our results are likely similar to what a clinical team might expect using SoCog. Moreover, SoCog is now run as part of standard care  in several mental health services across Australia by clinicians who continue to provide feedback for further development and refinement of the program. The results also suggest that basic emotion recognition might not improve without specific training.


We have obtained nanocellulose from OSP through acid hydrolysis with lower consumption of sulfuric acid and followed by ultrasound treatment. The structural change and crystallinity degree of OSP and nanocellulose were studied by means of SEM and XRD techniques. It has been established that nanocellulose has a density up to 1.3 g/cm3, transparency up to 70%, crystallinity degree 72.5%. The TEM and AFM methods shown that nanocellulose have diameter of particles in the range from 10 to 40 nm. Thermogravimetric analysis confirmed that nanocellulose films have more dense structure and smaller mass loss in the temperature range 220–260 °C compared with OSP. The obtained nanocellulose films had high Young’s modulus up to 11.45 GPa and tensile strength up to 42.3 MPa. The properties of obtained nanocellulose from OSP exhibit great potential in its application for the preparation of new nanocomposite materials.The object of this work is to present a study of nanocellulose preparation from organosolv straw pulp (OSP) and its properties. OSP was obtained through thermal treatment in the system of isobutyl alcohol–H Nanocellulose is steadily gaining attention since this material is a renewable alternative to artificial polymers . ResearcNanocellulose belongs to a group of nanomaterials consisting of the nanosized cellulose particles. Characteristics of nanocellulose particles depend on the properties of plant raw materials and methods used for their production . NanocelIn world practice, there are methods of obtaining nanocellulose from kanaf , oat husIn the global practice of pulp and paper industry, the dominating technologies to obtain cellulose are sulfate and sulfite methods, which lead to environmental pollution. Increased environmental requirements to the quality of wastewater and gas emissions of industrial enterprises requires the development of new technologies for processing of plant raw materials with the use of organic solvents , 25. For2O–KOH–hydrazine, which makes it possible to reuse the organic component and waste cooking liquor without regeneration [We have already demonstrated the possibility of obtaining straw pulp by means of organosolv delignification in the system of isobutyl alcohol–Hneration . At the neration . MechanoWe investigated the possibility of obtaining nanocellulose from never-dried OSP using only sulfuric acid hydrolysis and ultrasound treatment, and we defined the mechanical and thermal properties of nanocellulose.In order to obtain pulp, stalks of wheat straw from Kiev region harvested in 2015 were used. Averaged chemical composition relative to absolutely dry raw material (a.d.r.m.) was 44.2% of cellulose, 18.6% of lignin, 25.2% of pentosans, 4.2% of ash, 4.9% of resin, fats and waxes, and 71.8% of holocellulose. Chemical composition of wheat straw stalks was identified according to standard methods . For eac2O–KOH–hydrazine was carried out according to the procedure described in [Cooking of straw stalks in the system isobutyl alcohol–Hribed in . The recIn order to remove residual lignin and carried out partial hydrolysis of hemicellulose, we additionally carried out thermochemical treatment of OSP using acetic acid and hydrogen peroxide in a volume ratio of 70:30% with the catalyst–sulfuric acid which was 15% to a.d.r.m mass. Treatment with the mixture was carried out 180 min at a temperature of 95 ± 2 °C. We received the bleached OSP with ash content of 0.2%, lignin—less than 0.2%, degree of polymerization—460, whiteness—83%, and used it for preparation of nanocellulose.Hydrolysis of never-dried bleached OSP was carried out by means of sulfuric acid with concentration of 43%, at the liquid to solid ratio 10:1, at temperature 20 and 60 °C during 30 and 60 min. The hydrolyzed cellulose was rinsed with distilled water three times by means of centrifugation at 8000 rev/min and subsequent dialysis until reaching neutral pH. Ultrasound treatment of hydrolyzed cellulose was performed using ultrasound disintegrator UZDN-A  with 22 kGz for 30 min. The cellulose dispersion was placed in an ice bath to prevent overheating during treatment. Eventually, the suspension had the form of a homogenous gel-like dispersion.The prepared suspensions were poured into Petri dishes and dried in air at a room temperature to obtain nanocellulose films. Their density was determined according to the ISO 534:1988. The degree of polymerization was determined according to ISO 5351 by the viscosity of the samples dissolved in copper ethylene-diamine solution. Scanning electron microscope (SEM) analysis was performed with PEM–106I  microscope to observe the morphology of OSP and CNF films. Transparency of the nanocellulose films was determined by electron absorption spectra, which were registered in regions from 200 to 1100 nm. Electron absorption spectra of the nanocellulose films in UV and in visible and near infrared regions were registered on two-beam spectrophotometer 4802  with resolution of 1 nm.2, respectively. Before AFM investigation, dilute nanocellulose suspensions with the concentration of 0.01 wt% were ultrasonically treated for 10 min. Subsequently, one drop of CNF dispersion for sample was injected onto a freshly cleaned glass-ceramic and air dried at room temperature.Transmission electron microscopy (TEM) images were obtained using electron microscope TEM125K  operating at a potential of 100 kV. A dilute CNF suspension (0.1 wt%) was dropped onto a thin scaffoldings Lacey Formvar/Carbon, 400 mesh, copper approx. grid hole size 42 μm . Topographical characterization of nanocellulose samples was investigated using atomic force microscopy (AFM), and the measurements were accomplished with Si cantilever, operating in the tapping mode on the device Solver Pro M, NT-MDT, Russia. The scanning speed and area were 0.6 line/s and 2 × 2 μmI200 − Iam)/I200 × 100%, where I200 is an intensity of (200) reflex about 22.5°, and Iam is an intensity of amorphous scattering at 18.5°.X-ray diffraction patterns of different cellulose samples were obtained by Ultima IV diffractometer . The method proposed in  was usedThe thermal degradation behavior of cellulose and CNF samples was explored by heating using Netzsch STA-409 thermoanalyzer. The samples were heated at a rate of 5 °C/min, from 25 to 450 °C.Tensile properties of the nanocellulose films were measured at controlled temperature (23 ± 1 °C) and humidity (50 ± 2%) according to ISO 527-1. Tension tests were performed at a crosshead speed of 0.5 mm/min on the TIRAtest-2151 (Germany) instrument equipment with a 2-N load stress. For testing, test strips with 10 ± 2 mm width and 25 ± 5 mm long were used. The data reported are tensile strength and Young’s modulus. Each composition was tested with a minimum of five specimens to extract an average and standard deviation for each property.Morphology of initial OSP and obtained nanocellulose films were studied by means of SEM. Figure Changes in the look of organosolv pulp and CNF films according to the stages of treatment are presented in Fig. Nanocellulose prepared after hydrolysis and ultrasound treatment of OSP had homogeneous and stable nanocellulose suspension. The nature of stabilization of the colloidal suspension is explained by the presence of charged groups on the surface of nanocellulose, which are formed by the interaction of cellulose with sulfate acid due to the esterification reaction. As proof of the stability nanocellulose suspensions, we give its images immediately after the preparation and after a prolonged storage time Fig. . There wThe decrease of the cellulose particles size and the increase of its dispersity were assessed by measuring the changes in the degree of polymerization (DP). Thus, DP of the initial organosolv straw pulp was 460; DP of OSP after sonication was 390; DP of nanocellulose after hydrolysis with 43% sulfuric acid was 210; DP of nanocellulose after hydrolysis and sonication was 105. From the date, it can be see that hydrolysis of OSP reduces the degree of polymerization more intensively than ultrasound. The joint action of sulfuric acid and sonication leads to a substantial reduction of the cellulose macromolecules.In order to assess the changes in the particles size after hydrolysis and sonication, we examined the morphology of nanocellulose samples with the use of TEM and AFM Figs.  and 6. AWe have also investigated the change in the ratio of amorphous and crystalline parts of OSP during its chemical and physical treatment. The analysis of X-ray diffraction patterns of initial OSP Fig. , after sThe increase of crystallinity parts after treatment of the initial OSP is confirmed by the thermogravimetric analysis (TGA) of OSP and nanocellulose films Fig. . Figure In this research, mechanical parameters of initial OSP and nanocellulose films prepared after hydrolysis of OSP at different temperature and duration and additional sonication during 30 min were measured Table . The ave2O–KOH–hydrazine solution, which is an effective system for removal of lignin and hemicellulose components. Thermochemical treatment of organosolv pulp using acetic acid and hydrogen peroxide was carried out for remove residual lignin and partial hydrolysis of hemicellulose. Organosolv pulp is an interesting low-cost starting material for nanocellulose production with using of sulfuric acid and sonication. The advantages of this method of nanocellulose preparation consist in using low concentration of sulfuric acid (43%) before ultrasonic treatment of organosolv wheat straw pulp. To form the idea about the structure and properties of OSP nanocellulose, a wide variety of measurement methods  were used. It was found out that by using the method of acid hydrolysis and ultrasound treatment of OSP it is possible to obtain nanocellulose with density up to 1.3 g/cm3, transparency up to 70%, crystallinity degree 72.5%. The TEM and AFM methods show that nanocellulose have diameter of particles in the range from 10 to 40 nm. Thermogravimetric analysis confirmed that nanocellulose films have more dense structure and smaller mass loss in the temperature range 220–260 °C compared with OSP. The obtained nanocellulose films had high Young’s modulus up to 11.45 GPa and tensile strength up to 42.3 MPa. The properties of obtained nanocellulose from OSP exhibit great potential in its application for the preparation of new nanocomposite materials, for example for production of biocomposites, which are applied in optoelectronic devices, packaging, and building.In this research work, the organosolv pulp and nanocellulose were prepared from the wheat straw, one of the most abundant sources of cellulose for countries with limited supply of wood. Organosolv pulp was obtained from stalks of wheat straw by delignification in isobutanol–H


Romanian Journal of Ophthalmology has changed its name from Oftalmologia and begun being published in English. At that time, the aim was to obtain a better visibility and quotation, which has been partly achieved. Three years have passed since all the articles up to date have been indexed in PMC and PubMed. PubMed Central (PMC) is a free digital repository that archives publicly accessible full-text scholarly articles that have been published within the biomedical and life sciences journal literature . PubMed is a free search engine accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics (source: https:// en.wikipedia.org/ wiki/ PubMed). In other words, we managed to fulfill our desideratum of making our journal popular and increase its visibility. Of course, this change has brought more value to our journal, now being indexed in an international database. In addition, we welcome scientists, academic personalities, etc., from Romania and the whole world to send their articles to be published in Romanian Journal of Ophthalmology. Starting 2017, a contract has been signed with The National Library of Medicine (NLM), thus, indexing of the abstracts of the articles in MEDLINE, continuing with the conversion of all the articles in a specific format (XML) and their uploading on PMC platform and in PubMed database. The process of indexing was a lengthy one, starting with the MEDLINE indexers describe the content of biomedical articles by assigning subject terms to them. These subject terms are selected from the controlled vocabulary, Medical Subject Headings (MeSH). The MeSH terms assigned to an article appear on the bibliographic citation in PUBMED. They can be used in PUBMED searches and retrieval (source: https:// www.nlm.nih.gov/ bsd/ indexing/ training/ INT_010.html).Regarding process of indexing, MeSH controlled vocabulary, developed at NLM , contains over 27,000 terms covering life sciences, medicine, as well as many other areas. MeSH vocabulary reflects the progress in biomedical sciences. Every year, several hundred new terms are added to the MeSH vocabulary, and some existing terms are modified. In addition to the MeSH descriptors, MEDLINE indexers also use 79 topical subheadings or qualifiers (source: https:// www.nlm.nih.gov/ bsd/ indexing/ training/ INT_010.html).The https:// onlinelibrary.wiley.com/ doi/ pdf/ 10.1002/ rth2.12047).For the full participation in PMC, which is a full text archive, a journal must meet the scientific quality standards established by the National Institutes of Health (NIH) and National Library of Medicine. The members of the latter will decide if the scientific and editorial scope and quality of a journal merit its inclusion in PMC. Moreover, the opinions of expert consultants will also count in the final evaluation of the journal (source: https:// onlinelibrary.wiley.com/ doi/ pdf/ 10.1002/ rth2.12047). The journal must also meet the technical standards of the database by providing high-quality digital files (full text articles in XML format) (source: https:// onlinelibrary.wiley.com/ doi/ pdf/ 10.1002/ rth2.12047). The PMC application requires that a journal publish at least 25 peer-reviewed research articles before being indexed (source: https:// onlinelibrary.wiley.com/ doi/ pdf/ 10.1002/ rth2.12047).Regarding the inclusion of a journal in MEDLINE, there is a condition that a journal has been publishing for 12 months and has published at least 40 articles. The more content the journal has published, the stronger the application. The journal needs to appear sustainable by publishing quality content at a regular rate. Other elements taken into consideration include scope and coverage of the journal, quality of content and editorial work, production quality, and audience (source: https:// onlinelibrary.wiley.com/ doi/ pdf/ 10.1002/ rth2.12047). MEDLINE requires that all published articles include declarations of conflict of interest by authors, confirmation that informed consent was sought from research subjects, and that animal welfare was taken into consideration (source: Bookshelf. MEDLINE is the largest subset of PubMed (source: https://www.nlm.nih.gov/pubs/factsheets/dif_med_pub.html).What sets MEDLINE apart from the rest of PubMed is the added value of using the NLM controlled vocabulary, Medical Subject Headings (MeSH®), to index citations. PubMed has been available since 1996. Its more than 27 million references include the MEDLINE database plus different types of citations. PubMed citations often include links to the full-text article on the publishers’ Web sites and/ or in PMC and the we intend to index the journal in many other international databases, including Thomson Reuters (ISI). This indexing has been greatly appreciated so far by the academic community and we hope that this will result into more articles of Romanian and international authors being published in the future, taking into account that before submitting, an author should be well acquainted with the editorial recommendations for writing an article . In addition, when writing an article the authors should properly mention the complete name and surname, address of the corresponding author, etc., and they should also comply with the IMRAD form: introduction, methods, results, discussion and conclusion, including acknowledgements, disclosures and all the references, which should be all cited with no exception and at all times. However, in order to succeed, we need the help and collaboration of all the authors who send their articles to be published in the journal. In addition, It was a tremendous effort for us to get where we are, but we must continue, improve, be better, and the rewards will surely be the ones expected. We have managed to publish an issue at every three months, which means that on one hand, we have kept our promise and on the other, the ophthalmology field is still interesting for many authors. We are very confident that together with the Romanian Society of Ophthalmology and the ophthalmological academic community, Romanian Journal of Ophthalmology can be the best journal in this field in Romania and abroad.The steps taken so far have required and are still requiring the further improving of the quality of the published articles. Our recommendation to the authors, readers, members of the academic community, etc., is to get more involved in the effort of promoting the journal both in Romania and in the whole world and to encourage their peers to write and send articles to be published in our journal, to achieve visibility.Assist. Prof. Gheorghe Consuela-Mădălina, PhD,Philologist, Authorized translator


Carbohydrates represent an important fraction of labile and semi-labile marine organic matter that is mainly comprised of exopolymeric substances derived from phytoplankton exudation and decay. This study investigates the composition of total combined carbohydrates  and the community development of free-living (0.2–3 μm) and particle-associated (PA) (3–10 μm) bacterioplankton during a spring phytoplankton bloom in the southern North Sea. Furthermore, rates were determined for the extracellular enzymatic hydrolysis that catalyzes the initial step in bacterial organic matter remineralization. Concentrations of tCCHO greatly increased during bloom development, while the composition showed only minor changes over time. The combined concentration of glucose, galactose, fucose, rhamnose, galactosamine, glucosamine, and glucuronic acid in tCCHO was a significant factor shaping the community composition of the PA bacteria. The richness of PA bacteria greatly increased in the post-bloom phase. At the same time, the increase in extracellular β-glucosidase activity was sufficient to explain the observed decrease in tCCHO, indicating the efficient utilization of carbohydrates by the bacterioplankton community during the post-bloom phase. Our results suggest that carbohydrate concentration and composition are important factors in the multifactorial environmental control of bacterioplankton succession and the enzymatic hydrolysis of organic matter during phytoplankton blooms. In seasonal seas, phytoplankton development and temperature have repeatedly been reported to structure bacterioplankton communities  composition is only poorly resolved. Numerous compounds in the vast pool of marine OM may support species-rich bacterioplankton communities, which are, in turn, able to efficiently remineralize large portions of the OM. In laboratory experiments, bacterioplankton exhibit specific OM uptake at a class and clade level . Single bacteria .While large portions of marine OM are still chemically uncharacterized, carbohydrates have been identified as the largest fraction of characterized marine OM . Recent Bacteria can take up LMW compounds as large as 0.6–0.8 kDa through porins and slightly larger compounds via TonB-dependent transporters  to meet Understanding the interaction between bacterioplankton and diverse OM is important for our understanding of biogeochemistry . It is ain situ meta-transcriptomics. It investigates the influence of carbohydrate composition and concentration in seawater on the community structure of free-living (FL) and particle-associated (PA) bacteria by combining, for the first time, a detailed analysis of the composition of total combined carbohydrates  using high-performance anion-exchange chromatography coupled with pulsed amperometric detection (HPAEC-PAD) and bacterial community analysis using Automated Ribosomal Intergenic Spacer Analysis (ARISA) and Catalyzed Reporter Deposition-Fluorescence In Situ Hybridization (CARD-FISH). Furthermore, it investigates the extracellular enzymatic activity of the bacterial community in relation to carbohydrates and the wide range of physicochemical and biological factors at the transition from winter to spring in the temperate North Sea.This field study aims to fill the gap between laboratory studies of single bacterial groups or carbohydrates and results inferred from Surface water (∼1 m depth) was collected in a 10-L plastic carboy in the morning twice a week from February 2nd to May 18th 2010 from a research vessel at the long-term North Sea monitoring station “Helgoland Roads” between the islands of Helgoland  in the German Bight, North Sea see .After pre-filtration through 10 μm-pore size filters, PA bacteria were collected by filtering 2 L of seawater through 3-μm filters . To collect FL bacteria, 500 mL of the resulting filtrate was filtered through a 0.2-μm filter . All filters were cut into three equal pieces using sterilized pincers and scalpel and stored in a 2 mL-reaction tube at -20°C until processing.The DNA from all three filter pieces was extracted simultaneously using lysozyme followed by phenol-chloroform-isoamylalcohol purification , was applied. The wells were loaded with 0.25 or 0.5 μL of samples, depending on the amount needed to visualize bands clearly. Values obtained from the application of a 0.5 μL sample were divided by two prior to data analysis. The volume of applied sample was confirmed to have no significant effect on Sørensen-similarities in the PA-  and FL-  fractions. The software package BioNumerics  was used to analyze the gel images. The bands with a length between 300 and 1500 bp were binned into size classes (termed “ARISA-band-classes”) to correct for minor length variations of the IGS regions between lineages with almost identical 16S rDNA-sequences. Bins of 3 bp were used for fragments up to 700 bp in length, bins of 5 bp were used for fragments between 700 and 1,000 bp, and bins of 10 bp were used for fragments larger than 1,000 bp , as described in 1,000 bp . In thisIn Situ Hybridization (CARD-FISH) of non-prefiltered samples on 0.2-μm filters were taken from Values for Catalyzed Reporter Deposition Fluorescence 1  as part of the Helgoland Roads LTER time series, which is also accessible via the open database PANGEA1 . Surface1 . Salinit1 . A fluortrations . Inorgantmeasured is the temperature in °C, measured simultaneously with pH using a combined electrode  calibrated with standard buffer solutions .where Particulate carbon was collected on pre-combusted GF/F filters , which were stored at -20°C until analysis. The filtration volume (80–380 mL) was adjusted to the particle loading of the seawater. Filters were treated with 200 μL of carbon-free HCl (0.2 N) to remove inorganic carbon and dried at 60°C for approximately 48 h. After drying, filters were packed into small Zn-cartridges and analyzed using an elemental analyzer .For analysis of DOC concentration, seawater was filtered through combusted  GF/F filters , and 15 mL was sealed in combusted glass ampoules. Samples were stored at -80°C in the dark. Some of the ampoules were damaged during transport to the mainland, resulting in reduced temporal resolution. Acidified samples  were analyzed using high-temperature catalytic oxidation  on a ShiTotal organic carbon (TOC) was calculated as the sum of particulate organic carbon (POC) and DOC.2), were analyzed on a Dionex ICS3000 system combining high performance anion exchange chromatography (HPAEC) and pulsed amperometric detection (PAD) using a Dionex CarboPac PA10 analytical column (2 × 250 mm) coupled to a Dionex CarboPac PA10 guard column (2 × 50 mm). The autosampler (Dionex AS50) was maintained at 8°C, and 17.5μL of sample was injected for each analysis. After every second sample, 17.5 μL of a mixed sugar solution was injected for standardization. Blanks  were analyzed using the same procedure used for the samples and subtracted from sample concentration. We identified 12 carbohydrate monomers (Supplementary Table S1). The neutral sugars arabinose (Ara), fucose (Fuc), galactose , glucose (Glc), and rhamnose (Rha) were investigated, as well as the co-eluting sugars mannose and xylose (Man/Xyl). The acidic sugars galacturonic acid , gluconic acid (GlcA), glucuronic acid (GlcUA) and muramic acid (Mur) were measured. In addition, the concentrations of the two amino sugars galactosamine  and glucosamine (GlcN) were determined. The detection limit for the method was 1 nmol L-1. Values for all sugar components and standard deviations can be found in Supplementary Table S2.Analysis of total combined carbohydrates , which are a portion of high molecular weight organic matter (HMW-OM), was performed according to L-leucyl-4-methylcoum-arinylamid-hydrochlorid and 4-methylumbelliferyl-phosphate, respectively. The substrate analogs were added to seawater samples at final concentrations of 1, 5, 10, 20, 50, 80, 100, and 200 μmol L-1 to determine enzyme kinetics. To measure fluorescence, the infinite M200 plate reader  was used. The fluorescence emitted by 4-methylumbelliferone (MUF) was detected at 365 nm excitation and 440 nm emission wavelengths, and that of 7-amino-4-methyl-coumarine (AMC) was detected at 380 nm excitation and 440 nm emission wavelengths. Fluorescence units were converted into concentrations of MUF or AMC after calibration with standard solutions. Enzymatic rates were calculated from the increase in MUF or AMC concentration, over time. An initial fluorescence measurement was conducted immediately after the addition of the substrate analog, followed by two measurements within 4 h of incubation in the dark at the approximate in situ temperature for the sampling day (1–8°C). The initial fluorescence was subtracted as background fluorescence from the fluorescence measured at each time point. The slope of the linear regression between incubation time and the concentration of the fluorescent marker was applied for rate calculations. Experimental data were fitted using the Michaelis–Menten equation to determine the maximum velocity (Vmax) of the enzymatic reactions. To estimate the amount of substrate hydrolyzed by β-glucosidase (β-Glcase) during the post-bloom phase, we calculated the enzymatic rate for each day using a mean post-bloom concentration of 2.13 μmol L-1 Glc. The resulting mean rate (83.05 nmol L-1 d-1) was multiplied by the number of days (26) in the post-bloom phase.The activity of extracellular enzymes was determined by the use of fluorogenic substrate analogs . The ratr > 0.8) Fuc, Rha, Gal, Glc, GalN, GlcN, and GlcUA were pooled.For multivariate statistical analyses, the software package PRIMER v.6 and the add-on PERMANOVA+  were used. The analyses were performed using Sørensen-similarity-matrices generated from square-root transformed ARISA-band-class data. To test for community assemblage differences between phytoplankton bloom phases, permutational multivariate analysis of variance (PERMANOVA) was applied. Distance-based multivariate multiple regression (DistLM) was used to calculate correlations of community composition to environmental factors, and distance-based redundancy analysis (dbRDA) was used to visualize these correlations. For this analysis, the highly collinear combined carbohydrates  was used to determine the state of the phytoplankton bloom. After low Chl a concentrations (<1 μg L-1) in February, a diatom-dominated spring phytoplankton bloom developed at the long-term monitoring station “Helgoland Roads” . Bloom development started in mid-March and reached Chl a values of up to 12 μg L-1 in April . The onset of the bloom coincided with a strong peak in dissolved inorganic phosphate (DIP) concentration and a slight increase in sea surface temperature . The bloom development was accompanied by rising seawater pH. Salinity decreased from approximately 34 in February to approximately 31 at the end of April . The phytoplankton bloom terminated in late April, likely due to the depletion of DIP and silicate (SiO2) .Chlorophyll -1 , while DOC showed a maximum value of 151 μmol L-1 at the peak of the bloom. TOC values were calculated as the sum of POC and DOC and reached maximum values of 135 and 187 μmol L-1 before and after the phytoplankton bloom, respectively. Bloom development resulted in the accumulation of tCCHO, which contributed up to 14% of TOC in the post-bloom phase . The subsequent decline in tCCHO and POC lagged behind the decrease in diatom cell numbers and Chl a . The carbon contribution of tCCHO to TOC strongly increased during the bloom . Several carbohydrates in HMW-OM showed very similar temporal dynamics (Pearson r > 0.8) during spring 2010. Therefore, for the statistical analysis, glucose, galactose, fucose, rhamnose, galactosamine, glucosamine, and glucuronic acid were pooled into a single factor and designated as collinear CHO (colCHO). Its concentration strongly increased toward the end of the phytoplankton boom and maintained high values during the early post-bloom phase . In contrast, Ara showed concentrations near the detection limit during the entire study, while GalUA revealed strong dynamics unrelated to the phytoplankton bloom. Throughout the bloom, the composition of tCCHO was dominated by neutral sugars (60–90 mol%). Glc alone contributed an average 53 mol%, with maximum concentrations of 3 μmol monomer equivalent L-1 in the late bloom and post-bloom phase . Concentrations of Man/Xyl, Fuc and Gal increased with the onset of the phytoplankton bloom and maintained high values during the post-bloom phase, though maximum concentrations of 0.2–0.4 μmol L-1 were approximately an order of magnitude lower than that of Glc . Man/Xyl and Fuc showed similar mean concentrations of 0.13 and 0.16 μmol monomer equivalent L-1, respectively. In the late post-bloom period, Man/Xyl strongly increased, while Fuc decreased rapidly. Rha and Ara showed comparatively low concentrations ≤ 0.1 μmol L-1 throughout the investigation period.During the bloom, POC increased with diatom abundance, reaching a maximum of 54 μmol LFigure 2C). Concentrations increased again until the end of the phytoplankton bloom, reaching values of 0.2–0.3 μmol L-1, comparable to the concentrations of most neutral sugars, in April . The other acidic sugars GlcA, Mur, and GlcUA were only present in very low concentrations (below 0.02 μmol L-1). Of those, only GlcUA increased slightly in concentration toward the end of the bloom and maintained an elevated level during the post-bloom. Amino sugars were only present at low concentrations (below 0.1 μmol L-1) . However, both, GalN and GlcN concentrations increased toward the end of the bloom, with GlcN reaching values of up to 0.07–0.08 μmol L-1, higher than the concentrations of most acidic sugars during the late bloom and post-bloom phases.The acidic sugar GalUA was a major component of tCCHO before the onset of the bloom in February, followed by strongly declining concentrations in March  but were similar during the pre-bloom  and bloom phases . Both, PA and FL bacterial community significantly changed between phytoplankton bloom phases , revealing distinct temporal successions. DistLM shows that the development of PA communities is significantly related to three environmental variables. Apart from an abrupt change along a POC gradient  at the onset of the phytoplankton bloom, PA bacteria showed the strongest community development during the post-bloom phase, following a gradient of temperature (explaining ∼20%) and carbohydrates  . The FL bacterial community composition strongly changed during the ongoing phytoplankton bloom and during the post-bloom phase, mainly tracking with diatom abundance (∼14%) and temperature (∼34%), respectively . In total, significant environmental factors explained ∼60 and ∼48% of the variability in PA and FL communities, respectively. The richness of PA bacteria increased with rising Chl a and tCCHO concentrations, revealing a linear correlation  between colCHO concentration and PA bacterial richness . The PA richness reached a maximum approximately 1.5 weeks after the breakdown of the bloom at persistently high concentrations of tCCHO and was followed by a steep decrease in both richness and tCCHO thereafter . In contrast, the richness of FL bacteria did not resemble the temporal development of Chl a or diatom cell numbers during the bloom .Particle-associated and FL bacterial communities were significantly different during the post-bloom phase  showed a direct positive correlation to colCHO and to GalUA (Supplementary Table S3). Notably, these also correlated to temperature and pH, as well as POC and Chl a. Furthermore, they were correlated positively to all investigated extracellular enzymes. Although in total, Roseobacter did not correlate to any investigated parameter, the SAR11 subgroup correlated to pH and silicate. Bacteroidetes correlated to Chl a.Of the investigated microbial clades (CARD-FISH), only GAM42 . With the onset of the phytoplankton bloom, leucine-aminopeptidase (LAPase) activity increased and maintained high levels during the bloom, reaching a maximum of 0.95 μmol L-1 h-1 in the post-bloom phase. The activity of β-glucosidase (β-Glcase) increased toward the end of the bloom, concurrent with a strong increase in tCCHO concentrations . A maximum rate of 0.08 μmol L-1 h-1 was determined on May 11th. The amount of substrate hydrolyzed by β-Glcase during the post-bloom phase was estimated as approximately 2.16 μmol L-1, equivalent to approximately 72% of the total combined glucose that accumulated during the bloom . The rates of extracellular phosphatase (phos), increased rapidly after phosphate depletion  at the end of the bloom, indicating the enhanced use of organic phosphorous by bacteria and phosphatase-releasing phytoplankton groups. The co-incidence of phosphate depletion with a pronounced increase in phosphatase activity correlates well with the increase in phosphate transporters, as reported in The activity of extracellular enzymes was near the detection limit from February to mid-March (Table 2). Phos was positively correlated to DOC. In general, all neutral tCCHO except Ara and Man/Xyl showed strong (rs > 0.7) to very strong (rs > 0.9) positive correlations with LAPase, Glcase, and phos. Furthermore, amino sugars correlated well with enzyme activities. β-Glcase and LAPase activity were very strongly (rs > 0.9) correlated with Fuc, while LAPase was correlated very strongly (rs > 0.9) with Gal. Man/Xyl correlated with only amino-peptidase and phos, but not β-Glcase. The amino-sugars correlated well with enzyme activities. Glc-URA was the only acidic sugar showing a significant correlation with enzyme activities.All enzyme activities were positively correlated with seawater pH, temperature and POC but were negatively correlated to nutrients  were positively correlated to colCHO and showed higher abundances toward the end of the bloom. Further correlations of Gammaproteobacteria with POC and Chl a underline the importance of fresh OM derived from phytoplankton production for the growth of this group, which is a prominent member of bacterial communities associated with marine particles . In addition, approximately 75% of PA ARISA band classes did not correlate with the development of carbohydrate concentrations in any bloom phase. This might be explained by the fact that carbohydrates analyzed in this study are >1 kDa and thus part of the HMW-OM. The most labile fraction of freshly produced OM includes LMW compounds, which were shown to strongly affect bacterial community composition in in vitro experiments . In addition, the high activity of extracellular β-Glcase was observed well after the Chl a and tCCHO peaks, when PA bacterial richness was high. This indicates that for β-Glcase, high PA bacterial richness facilitates the enzymatic turnover of tCCHO. It is likely that the richer PA bacterial community produces not only high amounts of β-Glcase but also a high diversity of β-Glcase iso-enzymes  for laminarin and alginate that comprised genes of surface-exposed proteins such as oligomer transporters, substrate-binding proteins, and carbohydrate-active enzymes .The present study shows a correlation between the concentration of combined carbohydrates in HMW-OM and the diversity of PA bacteria during the development of a spring bloom, suggesting that the availability of carbohydrates contributes to the multifactorial control of marine bacterioplankton communities. Our study is in line with earlier findings demonstrating the importance of PA bacteria for total community activity . This himunities . In the es (pCO2 . Increaslability . CombiniMS developed the study concept and conducted the sampling as well as most of the sample- and data analysis. He also wrote the manuscript. JP helped develop the study concept, provided methodological support, especially with acquisition and analysis of extracellular enzyme data, and contributed to the manuscript. AE and AW provided lab space and financial and methodological support, helped develop the study concept and contributed to the manuscript. KW provided phytoplankton- and physicochemical data and contributed to the manuscript. JN provided data on dissolved organic carbon and contributed to the manuscript. GG provided lab space and financial and methodological support, helped develop the study concept, supported the statistical analysis and contributed to the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The role of hepatectomy for malignant liver tumors has expanded during the past decades, and vascular reconstruction during liver resection is sometimes necessary to achieve curative surgery.We report a case of liver resection in a 54-year-old male who had liver metastasis that invaded the right hepatic vein. He had undergone laparoscopic low anterior resection for rectal cancer. Six months later, liver metastasis was detected. After the reduction of the tumor by preoperative chemotherapy, liver resection with right hepatic vein reconstruction using his own internal jugular vein graft was performed. The postoperative course was uneventful, and the patient was discharged 8 days after the surgery.Internal jugular vein grafts are superior to other types of vascular grafts for vascular reconstruction in liver surgery. Liver resection is the best treatment for most malignant liver tumors. However, vascular involvement of the inferior vena cava, hepatocaval confluence, portal vein, or hepatic artery has been a contraindication to hepatic resection . RecentlThe patient was a 54-year-old man who had undergone laparoscopic low anterior resection for rectal cancer  6 months previously. Liver metastasis (5 cm in diameter) was detected, with invasion of the right hepatic vein (RHV) and attachment to the middle hepatic vein. He was started on preoperative chemotherapy with mFOLFOX6 plus bevacizumab (Bmab). After seven courses of chemotherapy, the tumor size had decreased to 4 cm in diameter, and the tumor was no longer attached to the middle hepatic vein (Fig. An approximately 6-cm-long horizontal skin incision 2 cm above the left clavicle or diagonal skin incision along the medial border of the sternocleidomastoid muscle was made. The anterior surface of the IJV was exposed by dissecting the connective tissue behind the sternocleidomastoid muscle. The omohyoid muscle was divided and the IJV was free from the surrounding tissue by dividing the small inflow branches from the level of the facial vein tributary to the level of the upper border of the clavicle. Two vascular clamps were applied on the upper and the lower portions of the dissected IJV, and the IJV graft was taken. The IJV graft was 3 cm in length and 1 cm in diameter. Then, partial hepatic resection of segments 7 and 8, including the root of the RHV, was performed. There were no tributaries of the RHV in the resected site, and the RHV was reconstructed using an IJV graft by running suture Fig. . The posRecently, the indications for surgery have evolved, shifting from oncological criteria to surgical criteria, predominantly resectability. The technical feasibility of hepatectomy has to fulfill two mandatory conditions. First, it has to achieve a completely clear macroscopic resection margin , and secVascular resection combined with liver resection is the latest step. Recently, various methods have been reported for liver resection with vascular reconstruction, such as synthetic artificial grafts, cryopreserved vein, and IJV grafts. Each graft type has its own merits and demerits. The merits of synthetic vascular grafts are their universal availability and products having various lengths and diameters, while the demerits are the relatively rigid vascular walls and tendency to become infected . InfectiThe merits of using IJV grafts are not only the best flexibility but also the most viable vessel wall among the various vascular graft types . AlthougIn selecting the graft for hepatic vein reconstruction, the patency of the reconstructing vein is important, because the obstruction of the graft can lead to severe congestion of the remaining liver tissue, deteriorating liver function, and accumulating ascites. We believe that the IJV graft is the most useful for hepatic vein reconstruction to maintain function .