Anastomotic leak (AL) after bilioenteric reconstruction (BR) is a feared complication after bile duct resection, especially in combination with liver resection. Literature on surgical outcome is ...sparse. This study aimed to determine the incidence and risk factors for AL after combined liver and bile duct resection with a focus on operative or endoscopic reinterventions.
Data from consecutive patients who underwent liver resection and BR between 2004 and 2018 in 11 academic institutions in Europe were collected from prospectively maintained databases.
Within 921 patients, AL rate was 5.4% with a 30d mortality of 9.6%. Pringle maneuver (p<0.001),postoperative external biliary (p=0.007) and abdominal drainage (p<0.001) were risk factors for clinically relevant AL. Preoperative biliary drainage (p<0.001) was not associated with a higher rate of AL. AL was more frequent in stented patients (76.5%) compared to PTCD (17.6%) or PTCD+stent (5.9%,p=0.017). AL correlated with increased incidence of postoperative liver failure (p=0.036), cholangitis, hemorrhage and sepsis (all p<0.001).
This multicenter data provides the largest series to date of LR with BR and could help in the management of these patients which are often challenging and hampering the patients’ postoperative course negatively.
Background
Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system that is increasingly recognized worldwide in children and adolescents. The current study aimed at ...identifying the clinical characteristics of MS with onset under 18 years of age.
Methods
This cross-sectional study was conducted in the Multiple Sclerosis Center archive system in Baghdad Teaching Hospital during the period from March 1 to May 15, 2008. The records of 1125 MS patients from 2000 to 2008 were reviewed. Among them 77 patients had the onset of MS under 18 years of age.
Results
Two thirds of the patients were female (a female/male ratio of 1.6:1). The mean age of the patients at the onset of the disease was 14.95±3.21 years, and the mean time between the first and second attacks was 3.06±4.09 years. Seventy patients (90.9%) had an initial course of relapse remitting MS. Among them 9 (12.9%) progressed to secondary progressive MS after a mean duration of 9.87±4.14 years. The remaining 7 patients had primary progressive MS associated with optic neuritis and brain stem lesion. Fifty-nine (76.6%) patients had monofocal signs and 18 (23.4%) had polyfocal signs. The mean extended disability status scale score was 4.15±2.17 and the mean progression index was 1.44±2.31. There was a strong inversed correlation between the progression index and interval between the first and second attacks (
P
=0.0001).
Conclusions
The results of the present study show that the course of MS in Iraqi children and adolescents is more aggressive than in children from other countries. This finding needs to be evaluated by further studies.
Rheumatoid arthritis is a multifactorial autoimmune disease affecting 1–2% of
the population worldwide. It is more common in women than men, predominately aged 40-60. This study aims to identify the ...association of the polymorphism in
the MIR146A gene with RA susceptibility in a sample of Iraqi patients and to examine whether these polymorphisms can influence the severity and activity of the
disease. The case-control study was conducted in the period between December
2021 and February 2022. A total of 120 blood samples were collected, including
60 patients with rheumatic arthritic disease who most regularly visit the chronic
arthritis diseases department of Baghdad Teaching Hospital-Medical City in Iraq
and 60 healthy controls. Polymorphisms were genotyped by using HRM realtime PCR for genotyping assay. Significant differences in the frequency of miRNA-146a rs2910164 alleles and genotypes were observed between RA patients
and controls. The CC genotype of the MIR146A Gene in the (rs2910164 SNP)
shows a risk for rheumatoid arthritis (50% versus 23.33% in healthy individuals),
the (χ2 =5.81; O.R.= 1 and the P-value = 0.0159) respectively especially in females than males the CC genotype seems the only risk factor among the other
genotypes (CG and GG) with (P-value ≤ 0.05) in (31.46%), while the other genotypes (CG and GG) show no risk for rheumatoid arthritis in the studied samples
of Iraqi population.
Keywords: MIR146a gene, polymorphism, rs2910164, HRM, RA, Iraq.
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•30% Reclaimed Asphalt Pavement (RAP) utilization: enhancing sustainability in asphalt practices.•Hybridized rejuvenating agent: exploring the synergy of vacuum residue (VR) and waste ...engine oil (WEO) as hybridized rejuvenating agent.•Thorough analysis: comprehensive examination of asphalt properties, encompassing physical, rheological, and performance attributes.•Enhanced performance for RAP mixtures: encouraging results with VR/WEO blend, signifying improved performance for rap mixtures.
In recent years, there has been a noticeable increase in the production of Reclaimed Asphalt Pavement (RAP) resulting from the maintenance and rehabilitation activities conducted on asphalt pavements. However, the presence of aged binder in RAP gives rise to asphalt mixtures with unfavourable characteristics. To address this concern, the use of rejuvenating agents has been examined as a viable solution to restore the properties of aged asphalt. In this study, an investigation was undertaken to assess the efficacy of incorporating waste engine oil (WEO) and vacuum residue (VR) as hybridized rejuvenating agents for RAP. Various characteristics including penetration, softening point, ductility, viscosity, and stiffness were measured to ascertain the optimal dosage of the hybridized rejuvenating agent. Subsequently, the performance of the rejuvenated asphalt was evaluated through Marshall tests, indirect tensile strength (ITS), moisture damage, and Kim tests, comparing it with different samples. Moreover, the Creep compliance, semi-circular bending (SCB), and Cantabro loss measurements were employed in the evaluation. The findings of the study indicate that a 6.5% hybrid rejuvenator composed of WEO and VR effectively rejuvenates asphalt mixtures containing 30% RAP material by softening the aged binder. Furthermore, the rejuvenated mixture exhibited significant improvements when compared to both the virgin asphalt and RAP mixtures. In conclusion, the incorporation of WEO and VR as a hybridized rejuvenating agent showcases promising results in enhancing the performance of RAP mixtures. This, in turn, contributes to sustainable and efficient pavement practices.
This research addresses the significant challenge posed by early water damage in highway asphalt pavement, a critical concern affecting pavement service performance. To counteract this issue, the ...utilization of anti-stripping agents in asphalt is explored as a highly effective technical intervention. In this investigation, a carefully selected amine-free additive was employed to modify the asphalt binder. A comprehensive array of physical and rheological tests, covering aspects such as storage stability, penetration, softening point, ductility, elastic recovery, rolling thin-film oven, retained penetration, the ductility of residue, and rotational viscometer assessments, were conducted to examine the multifaceted impact of the anti-stripping agent on the asphalt binder. Additionally, we assessed the asphalt mixture’s sensitivity to moisture through Marshall stability tests after conditioning for 40 min and 24 h, followed by an enhanced immersion test and moisture susceptibility measurement. The results reveal a nuanced interplay of chemical and physical mechanisms influencing the behavior of the asphalt binder. Notably, the incorporation of an anti-stripping agent at a concentration of 0.25–0.5% (by weight of asphalt binder) led to a substantial improvement in the tensile strength ratio (TSR) to 94.9%, a noteworthy enhancement compared to the 80.6% observed with virgin asphalt mixture. Furthermore, the retained stability index (RSI) exhibited a remarkable increase to 98.1%, surpassing the 87.6% recorded for virgin asphalt. This study not only provides crucial insights into the intricate dynamics of asphalt binder performance but also emphasizes the pivotal role of anti-stripping agents in augmenting the structural integrity and resilience of asphalt pavement.
The use of polymers to modify asphalt binders has become a widely accepted practice in modern pavement construction, offering a promising solution to address key factors contributing to asphalt ...pavement deficiencies. These factors include issues such as rutting, moisture-induced deterioration, and fatigue-related wear. The copolymer referred to as PGXpand was utilized as the modifying additive for the virgin binder in this study. It demonstrates exceptional performance in terms of high-temperature resilience and resistance to rutting. The impact of incorporating the PGXpand on asphalt properties was investigated. A comprehensive series of tests were conducted, covering storage stability, penetration, softening point, ductility, viscosity, and elastic recovery. Further analyses involved calculations of stiffness modulus, complex modulus, and phase angle. Mechanical and performance evaluations were also carried out, including Marshall properties, moisture susceptibility, creep compliance, and Kim tests. The results demonstrate the effectiveness of the PGXpand in enhancing asphalt performance, with modified mixtures exhibiting significant improvements compared to their unmodified counterparts. Consequently, integrating the PGXpand into asphalt technology emerges as a highly promising approach for optimizing road infrastructure, especially in regions with high-temperature conditions. Ultimately, such integration contributes substantially to the development of sustainable and resilient transportation networks.
•A copolymer ranging from 0% to 3% has been introduced into pure asphalt as a modifier.•Physical, rheological, and performance assessments of the modified asphalt have been carried out.•The PGXpand copolymer shows promise as a potential modifier for asphalt binder.
Primary aortoduodenal fistula is a rare condition caused mainly by a bulging infra-renal aortic aneurysm with subsequent erosion of the duodenum and formation of a fistula. We present a patient who ...suffered from a herald upper gastrointestinal bleeding followed by circulo-respiratory collapse only hours after, due to bleeding from the fistula. The mortality is reported to be 100 %, requiring emergency EVAR or open aortic graft repair to control any further bleeding.
