Background
Anastomotic leakage of pancreaticojejunostomy (PJ) remains the single most important source of morbidity after pancreaticoduodenectomy (PD). The primary aim of this randomized clinical ...trial comparing PG with PJ after PD was to test the hypothesis that invaginated PG would result in a lower rate and severity of pancreatic fistula.
Methods
Patients undergoing PD were randomized to receive either a duct‐to‐duct PJ or a double‐layer invaginated PG. The primary endpoint was the rate of pancreatic fistula, using the definition of the International Study Group on Pancreatic Fistula. Secondary endpoints were the evaluation of severe abdominal complications (Clavien–Dindo grade IIIa or above), endocrine and exocrine function.
Results
Of 123 patients randomized, 58 underwent PJ and 65 had PG. The incidence of pancreatic fistula was significantly higher following PJ than for PG (20 of 58 versus 10 of 65 respectively; P = 0·014), as was the severity of pancreatic fistula (grade A: 2 versus 5 per cent; grade B–C: 33 versus 11 per cent; P = 0·006). The hospital readmission rate for complications was significantly lower after PG (6 versus 24 per cent; P = 0·005), weight loss was lower (P = 0·025) and exocrine function better (P = 0·022).
Conclusion
The rate and severity of pancreatic fistula was significantly lower with this PG technique compared with that following PJ. Registration number: ISRCTN58328599 (http://www.controlled-trials.com).
This pancreaticogastrostomy technique is superior
The church of San Nicolas in Gandia (1962), is the posthumous work of Eduardo Torroja Miret, engineer, in collaboration with Gonzalo Echegaray Comba, architect. The temple is characterized by its ...unique structure: two folded sheets of post-tensioned concrete, supported on the side walls, with 29 meters span. In 1996, the detection of cracks in the concrete and spalling, made it advisable an inspection and evaluation of the damages detected in the building, mostly caused by the corrosion of reinforcement concrete, and concluded by recommending repair them. This paper explains the structural system of the temple, describes the identified damages in the structure, exposes the refurbishment project and displays the works executed during the intervention. The work was completed just in time for the 50th anniversary of its construction in 2012.
There is an increasing demand on alternatives methods to animal testing. Numerous health parameters have been already studied using in vitro devices able to mimic the essential functions of the ...organs, being the real-time monitoring and response to stimuli their main limitations. Regarding the health of the gut, the short chain fatty acids, and particularly acetate, have emerged as key biomarkers to evaluate gut healthiness and disease development, although the number of acetate biosensors is still very low. This article presents a microbial biosensor based on fully biocompatible materials which is able to detect acetate in aerobic conditions in the range between 11 and 50 mM, and without compromising the viability and function of either bacteria (>90% viability) or mammalian cells (>80% viability). The detection mechanism is based on the metabolism of acetate by Escherichia coli bacteria immobilized on the transducer surface. Ferricyanide is used as a redox mediator to transfer electrons from the acetate metabolism in the bacterial cells to the transducer. High bacterial concentrations are immobilized in the transducer surface (109 cfu mL−1) by electrodeposition of conductive alginate hydrogels doped with reduced graphene oxide. The results show successful outcomes to exploit bacteria as a biosensing tool, based on the use of inkjet printed transducers, biocompatible materials and cell entrapment technologies.
Display omitted
•Escherichia coli uses acetate as carbon source in aerobic conditions.•Stable, biocompatible, conductive alginate hydrogel is electrodeposited on inkjet printed sensor's working electrode.•Immobilization of high bacterial concentrations of E. coli within alginate hydrogel.•Bacterial metabolism oxidizes acetate, enabling amperometric measurement of electron flow via ferricyanide reduction.•Successful proof-of-concept demonstration of bioelectrochemical acetate detection is performed.
•The only RCT following the widely accepted ORNguideline published by Marx in1983.•HBO seems to have a positive influence on the curation of osteoradionecrosis.•HBO shows a positive trend on quality ...of life, swallowing and ADL in HNC patients.•Only ORN of the mandible, diagnosed according to strict criteria, was included.
Osteoradionecrosis (ORN) of the mandible is a serious complication of head and neck radiotherapy. This study aims to investigate the effect of hyperbaric oxygen (HBO) treatment on ORN in two randomized, controlled multicentre trials.
Patients with ORN with indication for surgical treatment were randomised to either group 1: surgical removal of necrotic mandibular bone supplemented by 30 pre- and 10 postoperative HBO exposures at 243 kPa for 90 min each, or group 2: surgical removal of necrotic bone only. Primary outcome was healing of ORN one year after surgery evaluated by a clinically adjusted version of the Common Toxicity Criteria of Adverse Events (CTCAE) v 3.0. Secondary outcomes included xerostomia, unstimulated and stimulated whole salivation rates, trismus, dysphagia, pain, Activities of Daily Living (ADL) and quality of life according to EORTC. Data were combined from two separate trials. Ninety-seven were enrolled and 65 were eligible for the intent-to-treat analysis. The 33% drop-out was equally distributed between groups.
In group 1, 70% (21/30) healed compared to 51% (18/35) in group 2. HBO was associated with an increased chance of healing independent of baseline ORN grade or smoking status as well as improved xerostomia, unstimulated whole salivary flow rate, and dysphagia. Due to insufficient recruitment, none of the endpoints reached a statistically significant difference between groups. ADL data could only be obtained from 50 patients.
Hyperbaric oxygen did not significantly improve the healing outcome of osteoradionecrosis after surgical removal of necrotic bone as compared to standard care (70% vs. 51%). This effect is not statistically significant due to the fact that the study was underpowered and is therefore prone to type II error.
Es descriu una nova espècie del gènere Leptosalenia(Echinoidea: Saleniidae) de l’Albià de Traiguera (el Baix Maestrat,
Castelló, NE de la península Ibèrica). El registre d’espècies d’aquest gènere a ...la conca del Maestrat, fins ara constituït
per Leptosalenia prestensis(Desor, 1865) i L. grasi(Cotteau, 1861), es veu incrementat per la que constitueix la primera
cita en l’Albià d’Europa d’una espècie de Leptosalenia.
How do you sufficiently progress beyond the status quo when an entire rural community views the status quo as sufficient progress? Educating children in poverty remains the most important educational ...challenge of our time. What few people know is this: the rate of child poverty in our nation’s rural communities is actually higher than it is in our country’s urban centers. Hardball Leadership is a best practices guide for rural school leaders who are passionate about closing the achievement gap and committed to leading their districts to significant academic improvement. Based upon original research that examined the leadership practices of effective rural superintendents who led their districts to dramatic academic improvement, this book’s insights include: • Establishing a strong academic culture where every student can and will be successful • Developing a system for improving teacher instructional performance • Fostering an academically-focused partnership with the board of education • Managing school-based controversy in a productive way • Building and sustaining a financially strong district This leadership handbook will help rural school leaders build an academic pathway that will lead their students towards a happy and prosperous life.
Es completa la descripció de Trapezium nucleus (Coquand, 1865) i se n’estableix una diagnosi. Es realitza un estudi biomètric de les poblacions de la Conca del Maestrat i s’indiquen les diferències ...entre les subconques d’Oliete i de Morella. Es fa una anàlisi ontogenètica i es designa un neotip. Es compara amb l’holotip de Tapes parallela Coquand, 1865 concloent que T. nucleus és una espècie diferent de T. parallela, tot i que les formes juvenils presenten fortes similituds. S’amplia la distribució de T. nucleusa dues noves localitats dins la subconca de Morella: el Forcall i Vallibona (els Ports, Castelló).
To provide evidence-based recommendations for prevention and management of osteoradionecrosis (ORN) of the jaw secondary to head and neck radiation therapy in patients with cancer.
The International ...Society of Oral Oncology-Multinational Association for Supportive Care in Cancer (ISOO-MASCC) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials and observational studies, published between January 1, 2009, and December 1, 2023. The guideline also incorporated systematic reviews conducted by ISOO-MASCC, which included studies published from January 1, 1990, through December 31, 2008.
A total of 1,539 publications were initially identified. There were 487 duplicate publications, resulting in 1,052 studies screened by abstract, 104 screened by full text, and 80 included for systematic review evaluation.
Due to limitations of available evidence, the guideline relied on informal consensus for some recommendations. Recommendations that were deemed evidence-based with strong evidence by the Expert Panel were those pertaining to best practices in prevention of ORN and surgical management. No recommendation was possible for the utilization of leukocyte- and platelet-rich fibrin or photobiomodulation for prevention of ORN. The use of hyperbaric oxygen in prevention and management of ORN remains largely unjustified, with limited evidence to support its practice.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
PDF
