The routine use of laparoscopic common bile duct exploration (LCBDE) for common bile duct (CBD) stones discovered during cholecystectomy would be further supported if the long-term outcomes were ...similar to those for endoscopic retrograde cholangiopancreatography with endoscopic papillotomy (ERCP/EP).
A retrospective review was completed of 151 patients who had a positive intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy (LC). A "positive" IOC was defined as a filling defect or lack of contrast flow into the duodenum. A "successful" CBDE was defined as a negative IOC after completion of CBDE. Long-term follow-up was obtained using a standardized questionnaire to determine the incidence of recurrent biliary pain or need for subsequent ERCP/EP.
CBD exploration was attempted in 142 patients (transcystic LCBDE 126 and open CBDE 16) and was successful in 107 of 142 (75%). Transcystic LCBDE was successful in 90 of 126 (71%). ERCP/EP was used in 41 patients; 35 of these cases were for failed LCBDE. Pancreatitis was not observed in any patient after CBDE but was observed in 3 of 41 patients (7.3%) after ERCP/EP. Long-term follow-up of the LCBDE versus ERCP/EP patients revealed no difference in the incidence of recurrent biliary pain or need for subsequent ERCP (mean follow-up time of 61 months).
LCBDE is safe and effective in the majority of cases when an attempt at transcystic LCBDE was made. In addition, after long-term follow-up of >5 years, the outcomes were similar if the stones were removed by intraoperative laparoscopic methods versus postoperative ERCP. LCBDE seems worthy of pursuing when an intraoperative CBD stone is discovered.
Despite substantial improvements in perioperative mortality, complications, and specifically the development of a pancreatic fistula, remain a common occurrence after pancreaticoduodenectomy. It was ...the objective of this study to evaluate the role of fibrin glue sealant as an adjunct to decrease the rate of pancreatic fistula after pancreaticoduodenectomy. One hundred twenty-five patients were randomized after pancreaticoduodenal resection only if, in the opinion of the surgeon, the pancreaticojejunal anastomosis was at high risk for development of a pancreatic anastomotic leak. After completion of the pancreaticojejunal anastomosis, the patients were randomized to topical application of fibrin glue sealant to the surface of the anastomosis or no such application. The primary postoperative end points in this study were pancreatic fistula, total complications, death, and length of hospital stay. A total of 59 patients were randomized to the fibrin glue arm, whereas 66 patients were randomized to the control arm and did not receive fibrin glue application. The pancreatic fistula rate in the fibrin glue arm of the study was 26% vs. 30% in the control group (
p
=
not significant NS). The mean length of postoperative stay for all patients randomized was similar (fibrin glue
=
12.2 days, control
=
13.6 days) and the mean length of stay for patients in whom pancreatic fistula developed was also not different (fibrin glue
=
18.9 days, control
=
21.7 days). There were no differences with respect to total complications or specific complications such as postoperative bleeding, infection, or delayed gastric emptying. These data demonstrate that the topical application of fibrin glue sealant to the surface of the pancreatic anastomosis in this patient population undergoing high-risk pancreaticojejunal anastomosis did not reduce the incidence of pancreatic fistula or total complications after pancreaticodudodenectomy. There seems to be no benefit regarding the use of this substance in this setting.
Triticale y tricepiro son especies que posibilitan obtener grano forrajero de buena calidad en ambientes con limitaciones edáfoclimáticas. El objetivo del trabajo fue identificar líneas de aceptable ...producción de grano en dos fechas de siembra: marzo y junio. Se desarrollaron ensayos comparativos durante cinco ciclos (2013-2017) con DBCA y tres repeticiones. Los caracteres observados fueron: rendimiento en grano, sus componentes (espigas/m2, granos/espiga y peso de 1.000 granos) y tres caracteres para medir el esfuerzo reproductivo de las líneas (macollos fértiles, índice de fertilidad de la espiga e índice de cosecha). Los rendimientos medios de las 26 líneas experimentales y los 10 testigos ensayados fueron 124,76 ± 119,94 g/ m2 para la siembra de marzo y 334,08 ± 204,24 g/m2 para la siembra de junio (diferencia de 209,32 g/m2). Los ANOVA revelaron interacción genotipo x ambiente significativa para la mayoría de los caracteres. Los biplots GGA permitieron identificar ocho genotipos de buen comportamiento en ambas fechas, las cuales fueron utilizadas para analizar la estabilidad de las diferencias de rendimiento. Las líneas de triticale 16 y 19 y el tricepiro 21 presentaron las menores diferencias de rendimiento (159,19, 163,80 y 165,60 g/m2, respectivamente); sin embargo, sólo la línea 16 presentó estabilidad a través de los años de ensayo. Al analizar los componentes del rendimiento, dicha línea tuvo las menores diferencias en macollos fértiles, número de granos por espiga, índice de cosecha y peso de 1.000 granos. Los resultados demuestran la importancia de seleccionar genotipos de alta estabilidad en ambientes de alta variación interanual.
This article proposes a reflexion on the analysis of "long sequences" in interaction and presents a conversational analytic methodology to study the way in which participants organize them. This ...methodology is implemented on an extract of video-recorded meeting. The analysis takes into account several dimensions seldom integrated in the description of this level of the interaction: the number of participants and the construction of participative frameworks that are continuously reconfigured, and the multimodal resources used by the participants, including, in addition to gaze and gestural and postural orientations, the notes that are taken during the meeting. Cet article propose une réflexion sur l'analyse des « longues séquences » dans l'interaction et présente une méthodologie relevant de l'analyse conversationnelle pour étudier la façon dont les participants les organisent. Cette méthodologie est mise en œuvre sur un extrait de réunion. L'analyse prend en compte plusieurs dimensions rarement intégrées dans la description de ce niveau de l'interaction : le nombre de participants et la construction de cadres participatifs en perpétuelle reconfiguration et la multimodalité des ressources mises en œuvre, faisant intervenir, outre les regards et les orientations gestuelles et posturales, la prise de notes effectuée de ce qui se passe.
L'article met en perspective les évolutions dans le champ des analyses interactionnelles en français / sur le français au cours des 40 dernières années.
Post-COVID oncology Rossi, M.; Bellotti, G.; Blengio, F. ...
Working paper of public health,
06/2020, Letnik:
8, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Objectives: To analyse the organisational changes adopted by the Oncology SC during the Covid-19 emergency in order to identify their future applicability as an ordinary model of oncology patient ...management. Methodology: Application of ministerial recommendations, of the Piedmont and Aosta Valley Oncology Network and of the main scientific societies on the management of oncological patients during the pandemic and in phase 2. Results: During the pandemic, organisational models and pathways were adopted that ensured continuity of care and patient safety and can also be applied in the post-Covid phase. Conclusions: The reorganisation model of Oncology during the Covid-19 emergency was effective and some of the pathways adopted may constitute an ordinary tool of activity.
Background: The presence of enterohepatic Helicobacter species (EHS) is commonly noted in mouse colonies. These infections often remain unrecognized but can cause severe health complications or more ...subtle host immune perturbations and therefore can confound the results of animal experiments. The aim of this study was to isolate and characterize a putative novel EHS that has previously been detected by PCR screening of specific‐pathogen‐free mice.
Materials and Methods: Biochemical analysis of enzyme activities (API campy), morphologic investigation (Gram‐staining and electron microscopy) and genetic analyses (16SrRNA and 23SrRNA analyses, DNA fingerprinting, restriction fragment polymorphisms, and pulsed‐field gel electrophoresis) were used to characterize isolated EHS. Genomic DNA fragments were sequenced to develop a species‐specific PCR detection assay.
Results: Scanning electron microscopy revealed the presence of spiral‐shaped EHS, which varied in length (2.5–6 μm) and contained single monopolar or single bipolar sheathed flagella. The bacteria were grown under anaerobic conditions, preferably on agar plates containing serum or blood. The 16SrRNA, genetic, and biochemical analyses indicated the identification of a novel EHS species, named Helicobacter magdeburgensis. We also examined the genome content using pulsed‐field gel electrophoresis. Based on the pattern produced by two restriction enzymes, BamIII and KspI, the genome size was determined to be about 1.7–1.8 Mbp.
Conclusion: We isolated and characterized a novel EHS species, H. magdeburgensis, morphologically, biochemically, and genetically. These results are important for future studies on the prevalence and pathophysiologic relevance of such infections. Our PCR assay can be used to detect and discriminate H. magdeburgensis from other Helicobacter species.
This work presents a 14-band low-complexity and high-performance synthesizer architecture for multiband orthogonal frequency-division multiplexing operating in the range of 3.1 to 10.6 GHz. The ...synthesizer uses a single phase-locked loop with trivial divide-by-2 circuits, single side band mixers, low-complexity filters, and multiplexers. Specifications of the synthesizer components are chosen in order to minimize the total spurs power and respect the IEEE802.15.3a recommendations.
Abstract Liver transplantation success is limited by the availability of donors. To overcome this limitation, anti-core-positive donors are increasingly being accepted, but underutilization of this ...resource still occurs. We performed the current study to determine the prevalence of anti-core-positive donors in our region and to describe the management of these donors and their recipients. Between January 2005 and July 2011, the national transplant database included 2,262 registered liver donors among whom 106 (4.7%) were anti-core-positive including 59 (56%) discarded and 47 (44%) implanted organs. A median of 14.5 offers (range 4–60) were rejected before harvesting and implanting the accepted grafts. The only difference between the implanted and the discarded grafts was found for the alanine aminotransferase level, which was higher among the discarded ones (50 ± 59 UI/L vs 25 ± 16, P < .05). Among 40 recipients included in the study, 5 (12.5%) did not receive any prophylaxis; 18 (45%) a nucleos(t)ide analog 11 (25.5%), heptitis B immunoglobulin and nucleos(t)ide analogs and 6 (15%) pretransplant hepatitis B vaccination. Over a mean follow-up of 871 ± 585 days, 4 de novo hepatitis B cases were identified at 545, 720, 748, and 1,080 days posttransplantation. None of these patients had received any prophylaxis. In all cases entecavir successfully controlled viral replication. We believe that better utilization of these donors and careful management of their recipients represent safe strategies to expand the liver donor pool in Argentina.
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