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Non-alcoholic fatty liver disease (NAFLD) currently affects more than 25% of the world population and is rising. NAFLD can progress to non-alcoholic steatohepatitis that is associated with hepatic inflammation and fibrosis and can result in cirrhosis with subsequent liver failure. Non-alcoholic steatohepatitis (NASH) has now emerged as one of the leading etiologies for a liver transplant among adults in the United States. Given the rising incidence of liver transplants in patients with NASH-related cirrhosis, it is essential for anesthesiologists to be familiar with this condition as well as with NASH-related comorbidities and perioperative complications. Not only is NASH linked to metabolic syndrome, but it also is independently associated with cardiovascular disease, renal and thyroid dysfunction, obstructive sleep apnea (OSA), and a hypercoagulable state. The association with these conditions can affect the perioperative outcome of these patients, particularly because of increased mortality from major adverse cardiovascular events and sepsis. In order to decrease the perioperative morbidity and mortality of patients with NASH undergoing a liver transplant, a multidisciplinary approach to their perioperative management is essential, along with careful preoperative evaluation and aggressive intraoperative and postoperative monitoring. The focus of this review article is to provide a comprehensive overview of challenges associated with liver transplants in patients with NASH and to provide suggestions for appropriate patient selection and perioperative management. [ABSTRACT FROM AUTHOR]

Hyponatremia is a common electrolyte disorder in patients with end-stage liver disease (ESLD) and is associated with increased mortality on the liver transplantation (LT) waiting list. The impact of hyponatremia on outcomes after LT is unclear. Ninety-day and one-year mortality may be increased, but the data are conflicting. Hyponatremic patients have an increased rate of complications and longer hospital stays after transplant. Although rare, osmotic demyelination syndrome (ODS) is a feared complication after LT in the hyponatremic patient. The condition may occur when the serum sodium (sNa) concentration increases excessively during or after LT. This increase in sNa concentration correlates with the degree of preoperative hyponatremia, the amount of intraoperative blood loss, and the volume of intravenous fluid administration. The risk of developing ODS after LT can be mitigated by avoiding large perioperative increases in sNa concentration. This can be achieved through measures such as carefully increasing the sNa pretransplant, and by limiting the intravenous intra- and postoperative amounts of sodium infused. SNa concentrations should be monitored regularly throughout the entire perioperative period. [ABSTRACT FROM AUTHOR]

The increasing evidence base and public concern on the health effects of exposure to high levels of air pollution, combined with stricter environmental legislation, are forcing local governments to take drastic measures. One of the policy instruments, the low emission zone (LEZ), specifically targets a reduction in emissions from vehicles, a key source in urban environments. It is a contested instrument, with supporters who think it is a fair "polluter pays" instrument that especially benefits more deprived communities, while opponents fear an unequal social impact on people's accessibility and finances. This study wants to add a data-driven perspective to the discussion by simultaneously analysing the unequal exposure to air pollution and the unequal accessibility impact, in a comparative study of the LEZs in London and Brussels. The analysis combines a conventional multivariate regression analysis with a geographically weighted regression (GWR) modelling to define the local spatial variation in the relationships, which is of particular concern when considering an explicitly spatial problem and solution. The study shows that GWR is a promising method in distributional environmental justice research through identifying parts of the city where effects are more unequal, as such facilitating customized policy instruments and targeted support. • Low emission zones aim for improved air quality but can also affect accessibility. • Supporters and opponents of low emission zones use social justice arguments. • Comparative data analysis of two implementations: London and Brussels. • Application of a complementary environmental and transport justice perspective. • Geographically weighted regression helps identify where impact is more unequal. [ABSTRACT FROM AUTHOR]