Thermosiphon

As the title implies the article describes the thermosiphon. The proposed invention relates to heat engineering. It can be used as devices for transferring heat energy. It is described in short comparison of the invention with prototypes. Much attention is given to advantages of the invention over similar products. Design sectional drawing is proposed. Conclusions are drawn that the thermosyphon will find wide application in heat engineering.В данной статье рассмотрен термосифон. Предлагаемое изобретение относится к теплотехнике и может быть использовано в устройствах для передачи тепловой энергии. Описаны преимущества изобретения перед аналогами. Представлены схемы различных вариантов конструкции. В заключении сделан вывод о том, что предложенный термосифон найдет широкое применение в теплотехнике для передачи тепловой энергии по протяженным путям

Implementation and outcome of minimally invasive pancreatoduodenectomy in Europe:a registry-based retrospective study A critical appraisal of the first 3 years of the E-MIPS registry

BACKGROUND: International multicenter audit-based studies focusing on the outcome of minimally invasive pancreatoduodenectomy (MIPD) are lacking. The European Registry for Minimally Invasive Pancreatic Surgery (E-MIPS) is the E-AHPBA endorsed registry aimed to monitor and safeguard the introduction of MIPD in Europe. MATERIALS AND METHODS: A planned analysis of outcomes among consecutive patients after MIPD from 45 centers in 14 European countries in the E-MIPS registry (2019-2021). The main outcomes of interest were major morbidity (Clavien-Dindo grade ≥3) and 30-day/in-hospital mortality. RESULTS: Overall, 1336 patients after MIPD were included [835 robot-assisted (R-MIPD) and 501 laparoscopic MIPD (L-MIPD)]. Overall, 20 centers performed R-MIPD, 15 centers L-MIPD, and 10 centers both. Between 2019 and 2021, the rate of centers performing L-MIPD decreased from 46.9 to 25%, whereas for R-MIPD this increased from 46.9 to 65.6%. Overall, the rate of major morbidity was 41.2%, 30-day/in-hospital mortality 4.5%, conversion rate 9.7%, postoperative pancreatic fistula grade B/C 22.7%, and postpancreatectomy hemorrhage grade B/C 10.8%. Median length of hospital stay was 12 days (IQR 8-21). A lower rate of major morbidity, postoperative pancreatic fistula grade B/C, postpancreatectomy hemorrhage grade B/C, delayed gastric emptying grade B/C, percutaneous drainage, and readmission was found after L-MIPD. The number of centers meeting the Miami Guidelines volume cut-off of ≥20 MIPDs annually increased from 9 (28.1%) in 2019 to 12 (37.5%) in 2021 ( P =0.424). Rates of conversion (7.4 vs. 14.8% P &lt;0.001) and reoperation (8.9 vs. 15.1% P &lt;0.001) were lower in centers, which fulfilled the Miami volume cut-off. CONCLUSION: During the first 3 years of the pan-European E-MIPS registry, morbidity and mortality rates after MIPD were acceptable. A shift is ongoing from L-MIPD to R-MIPD. Variations in outcomes between the two minimally invasive approaches and the impact of the volume cut-off should be further evaluated over a longer time period.</p

Implementation and outcome of minimally invasive pancreatoduodenectomy in Europe:a registry-based retrospective study A critical appraisal of the first 3 years of the E-MIPS registry

BACKGROUND: International multicenter audit-based studies focusing on the outcome of minimally invasive pancreatoduodenectomy (MIPD) are lacking. The European Registry for Minimally Invasive Pancreatic Surgery (E-MIPS) is the E-AHPBA endorsed registry aimed to monitor and safeguard the introduction of MIPD in Europe. MATERIALS AND METHODS: A planned analysis of outcomes among consecutive patients after MIPD from 45 centers in 14 European countries in the E-MIPS registry (2019-2021). The main outcomes of interest were major morbidity (Clavien-Dindo grade ≥3) and 30-day/in-hospital mortality. RESULTS: Overall, 1336 patients after MIPD were included [835 robot-assisted (R-MIPD) and 501 laparoscopic MIPD (L-MIPD)]. Overall, 20 centers performed R-MIPD, 15 centers L-MIPD, and 10 centers both. Between 2019 and 2021, the rate of centers performing L-MIPD decreased from 46.9 to 25%, whereas for R-MIPD this increased from 46.9 to 65.6%. Overall, the rate of major morbidity was 41.2%, 30-day/in-hospital mortality 4.5%, conversion rate 9.7%, postoperative pancreatic fistula grade B/C 22.7%, and postpancreatectomy hemorrhage grade B/C 10.8%. Median length of hospital stay was 12 days (IQR 8-21). A lower rate of major morbidity, postoperative pancreatic fistula grade B/C, postpancreatectomy hemorrhage grade B/C, delayed gastric emptying grade B/C, percutaneous drainage, and readmission was found after L-MIPD. The number of centers meeting the Miami Guidelines volume cut-off of ≥20 MIPDs annually increased from 9 (28.1%) in 2019 to 12 (37.5%) in 2021 ( P =0.424). Rates of conversion (7.4 vs. 14.8% P &lt;0.001) and reoperation (8.9 vs. 15.1% P &lt;0.001) were lower in centers, which fulfilled the Miami volume cut-off. CONCLUSION: During the first 3 years of the pan-European E-MIPS registry, morbidity and mortality rates after MIPD were acceptable. A shift is ongoing from L-MIPD to R-MIPD. Variations in outcomes between the two minimally invasive approaches and the impact of the volume cut-off should be further evaluated over a longer time period.</p

Robot-assisted versus laparoscopic pancreatoduodenectomy: a pan-European multicenter propensity-matched study

Background: The use of robot -assisted and laparoscopic pancreatoduodenectomy is increasing, yet large adjusted analyses that can be generalized internationally are lacking. This study aimed to compare outcomes after robot -assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy in a pan-European cohort. Methods: An international multicenter retrospective study including patients after robot -assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy from 50 centers in 12 European countries (2009-2020). Propensity score matching was performed in a 1:1 ratio. The primary outcome was major morbidity (Clavien-Dindo >= III). Results: Among 2,082 patients undergoing minimally invasive pancreatoduodenectomy, 1,006 underwent robot -assisted pancreatoduodenectomy and 1,076 laparoscopic pancreatoduodenectomy. After matching 812 versus 812 patients, the rates of major morbidity (31.9% vs 29.6%; P = .347) and 30-day/inhospital mortality (4.3% vs 4.6%; P = .904) did not differ significantly between robot -assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy, respectively. Robot -assisted pancreatoduodenectomy was associated with a lower conversion rate (6.7% vs 18.0%; P < .001) and higher lymph node retrieval (16 vs 14; P = .003). Laparoscopic pancreatoduodenectomy was associated with shorter operation time (446 minutes versus 400 minutes; P < .001), and lower rates of postoperative pancreatic fistula grade B/C (19.0% vs 11.7%; P < .001), delayed gastric emptying grade B/C (21.4% vs 7.4%; P < .001), and a higher R0 -resection rate (73.2% vs 84.4%; P < .001). Conclusion: This European multicenter study found no differences in overall major morbidity and 30day/in-hospital mortality after robot -assisted pancreatoduodenectomy compared with laparoscopic pancreatoduodenectomy. Further, laparoscopic pancreatoduodenectomy was associated with a lower rate of postoperative pancreatic fistula, delayed gastric emptying, wound infection, shorter length of stay, and a higher R0 resection rate than robot -assisted pancreatoduodenectomy. In contrast, robot -assisted pancreatoduodenectomy was associated with a lower conversion rate and a higher number of retrieved lymph nodes as compared with laparoscopic pancreatoduodenectomy. (c) 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Robot-assisted versus laparoscopic pancreatoduodenectomy:a pan-European multicenter propensity-matched study

Background: The use of robot-assisted and laparoscopic pancreatoduodenectomy is increasing, yet large adjusted analyses that can be generalized internationally are lacking. This study aimed to compare outcomes after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy in a pan-European cohort. Methods: An international multicenter retrospective study including patients after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy from 50 centers in 12 European countries (2009–2020). Propensity score matching was performed in a 1:1 ratio. The primary outcome was major morbidity (Clavien–Dindo ≥III). Results: Among 2,082 patients undergoing minimally invasive pancreatoduodenectomy, 1,006 underwent robot-assisted pancreatoduodenectomy and 1,076 laparoscopic pancreatoduodenectomy. After matching 812 versus 812 patients, the rates of major morbidity (31.9% vs 29.6%; P = .347) and 30-day/in-hospital mortality (4.3% vs 4.6%; P = .904) did not differ significantly between robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy, respectively. Robot-assisted pancreatoduodenectomy was associated with a lower conversion rate (6.7% vs 18.0%; P &lt; .001) and higher lymph node retrieval (16 vs 14; P = .003). Laparoscopic pancreatoduodenectomy was associated with shorter operation time (446 minutes versus 400 minutes; P &lt; .001), and lower rates of postoperative pancreatic fistula grade B/C (19.0% vs 11.7%; P &lt; .001), delayed gastric emptying grade B/C (21.4% vs 7.4%; P &lt; .001), and a higher R0-resection rate (73.2% vs 84.4%; P &lt; .001). Conclusion: This European multicenter study found no differences in overall major morbidity and 30-day/in-hospital mortality after robot-assisted pancreatoduodenectomy compared with laparoscopic pancreatoduodenectomy. Further, laparoscopic pancreatoduodenectomy was associated with a lower rate of postoperative pancreatic fistula, delayed gastric emptying, wound infection, shorter length of stay, and a higher R0 resection rate than robot-assisted pancreatoduodenectomy. In contrast, robot-assisted pancreatoduodenectomy was associated with a lower conversion rate and a higher number of retrieved lymph nodes as compared with laparoscopic pancreatoduodenectomy.</p

Центральная или дистальная резекция при новообразованиях поджелудочной железы: анализ и оценка непосредственных результатов

Objective: to compare short-term and long-term postoperative complications between patients who have undergone central pancreatectomy (CP) and distal pancreatectomy (DP).Materials and methods. This retrospective study included patients who had CP for benign pancreatic tumors and tumors of low malignant potential (cases) and patients who had DP for similar reasons (controls). The controls were randomly selected and matched cases for tumor size, presence of diabetes mellitus (Dm), and ASA physical status. we evaluated the incidence of grade ≥III complications (Clavien–Dindo classification), clinically significant pancreatic fistulas, Dm, and impaired exocrine pancreatic function in the late postoperative period.Results. There were 25 cases and 25 controls. Both groups were matched for the main clinical characteristics. Surgeries were significantly longer in the CP groups compared to the DP group (230 min vs 180 min, р &lt; 0.0001). There was no difference in the overall incidence of postoperative complications (9 (36 %) vs 14 (56 %), р = 0.26); there was a trend towards a higher incidence of postoperative complications in the CP group. Two patients after CP (8 %) required repeated surgeries. none of the study participants died. Clinically significant (B and C) pancreatic fistulas were registered in 8 (32 %) and 11 (44 %) patients, respectively (p = 0.56). Two patients in the DP group (8 %) developed impairments of exocrine pancreatic function that required pharmacotherapy. none of the patients developed Dm postoperatively.Conclusion. Despite the fact that CP and DP outcomes were comparable in terms of the main parameters evaluated, severe post-CP complications indicate that there is a need for careful selection of patients for such interventions and further accumulation of experience. Our findings can be used in the subsequent analysis of the experience of different clinics.Цель исследования – сравнительная оценка ранних и поздних послеоперационных осложнений центральной резекции поджелудочной железы (ЦРПЖЖ) и дистальной субтотальной резекции поджелудочной железы (дсРПЖЖ).Материалы и методы. В ретроспективное исследование включали пациентов, которым выполняли ЦРПЖЖ по поводу доброкачественных новообразований тела поджелудочной железы (ПЖЖ) и новообразований с низким потенциалом злокачественности. В контрольную группу включали пациентов, которым выполняли дсРПЖЖ по схожим показаниям; к каждому случаю в исследуемой группе случайным образом подбирали случай в контрольной группе с сопоставлением по следующим критериям: размер опухоли, наличие сахарного диабета, статус по шкале ASA. Основными оцениваемыми параметрами были частота осложнений III степени и выше по Clavien–Dindo, частота развития клинически значимых панкреатических свищей, частота развития сахарного диабета и нарушения экзокринной функции ПЖЖ в позднем послеоперационном периоде.Результаты. В исследуемую и контрольную группу было включено по 25 пациентов. группы были сопоставимы по всем основным клиническим характеристикам. Продолжительность операции была достоверно выше в группе ЦРПЖЖ (180 и 230 мин, р &lt;0,0001). Общая частота осложнений достоверно не различалась между группами (9 (36 %) и 14 (56 %) случаев, р = 0,26), тенденция к более высокому числу осложнений отмечена в группе ЦРПЖЖ. Также только в этой группе были выполнены повторные операции по поводу осложнений – у 2 (8 %) пациентов. Послеоперационной летальности не было. частота развития клинически значимых (В и с) панкреатических свищей составила 8 (32 %) и 11 (44 %) случаев соответственно (р = 0,56). В группе дсРПЖЖ у 2 (8 %) пациентов отмечено нарушение экзокринной функции ПЖЖ, потребовавшее назначения лекарственной терапии. случаев развития сахарного диабета после операции не отмечено.Выводы. Несмотря на то, что результаты дсРПЖЖ и ЦРПЖЖ были сопоставимы по основным оцениваемым параметрам, отмеченные в группе ЦРПЖЖ тяжелые послеоперационные осложнения говорят о необходимости тщательной селекции пациентов для подобных вмешательств и дальнейшего накопления опыта. Полученные нами данные могут служить для последующего обобщенного анализа опыта различных клиник

The Russian consensus on the diagnosis and treatment of chronic pancreatitis: Enzyme replacement therapy

The Russian consensus on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian Pancreatology Club to clarify and consolidate the opinions of Russian specialists (gastroenterologists, surgeons, and pediatricians) on the most significant problems of diagnosis and treatment of chronic pancreatitis. This article continues a series of publications explaining the most significant interdisciplinary consensus statements and deals with enzyme replacement therapy

Прогнозирование панкреатической фистулы после панкреатодуоденальной резекции с помощью компьютерной томографии

Aim. To reveal and evaluate opportunities of preoperative computer tomography (CT) for pancreatic fistula (PF) prediction after pancreatoduodenectomy.Materials and methods. In 2005 International Study Group on Pancreatic Fistula (ISGPF) developed grading criteria for PF, including asymptomatic biochemical (Grade A), that could be treated conservatively, and clinically relevant (Grade B, Grade C), with consecutive active surgical treatment. For now ISGPF definition of PF is widely accepted. We review the literature since 2005 for original articles in English describing quantitive assessment of the pancreatic parenchyma using CT with histological validation. Low sample trials (&lt;10 cases) were excluded.Results. Three original publications met the inclusion criteria. Fatty and fibrosis infiltration of the pancreatic parenchyma assessed by preoperative CT revealed statistically significant correlation with PF rate.Conclusion. Preoperative CT offers accurate prediction opportunities for postoperative pancreatic fistula and may help caregivers to set up protocols for a strict and early detection of warning clinical signs, to tailor the clinical management of different risk classes, or to select high-risk patients who might be excluded from surgical resection. This would also improve patient selection for relevant research protocols and facilitate a more definitive assessment of collected data related to surgical outcomes, across different institutions and surgeons, and even among different surgeries, in either single-institution or multi-center trials that involve pancreatic surgery.Цель исследования: выявить и оценить возможности прогнозирования панкреатической фистулы после панкреатодуоденальной резекции на основании данных предоперационной компьютерной томографии (КТ).Материал и методы. В 2005 г. Международная рабочая группа по изучению панкреатических фистул (International Study Group on Pancreatic Fistula, ISGPF) разработала критерии градации панкреатических фистул на бессимптомные биохимические (Grade A) и клинически значимые (Grade B и С), требующие терапевтической (Grade A) или хирургической коррекции (Grade B и С). Данная классификация стала общепринятой и широко используется. Проведен анализ литературы, при котором учитывались только оригинальные англоязычные публикации после 2005 г, которые описывали возможности предоперационной количественной оценки плотности поджелудочной железы (ПЖ) с помощью КТ, а данные КТ сопоставлялись с результатами гистологического исследования ткани ПЖ. Работы с малыми выборками (&lt;10 пациентов) были исключены из анализа.Результаты. Критериям включения соответствовали 3 статьи, описывающие возможности КТ для оценки степени фиброза и жировой инфильтрации паренхимы ПЖ, в качестве факторов риска панкреатической фистулы. Выявлена статистически достоверная зависимость данных показателей и риска панкреатической фистулы.Заключение. Современные возможности Кт позволяют объективно судить о риске развития панкреатической фистулы и предоставляют хирургам возможность подобрать наиболее подходящую периоперационную тактику ведения пациента. Прогнозирование риска панкреатической фистулы и формирование гомогенных групп для клинических исследований позволят получать более достоверные результаты при анализе данных даже из разных источников, что, несомненно, повысит качество проводимых исследований

МАЛОИЗВЕСТНЫЕ БАКТЕРИИ, ВЫДЕЛЕННЫЕ ПРИ ЗАБОЛЕВАНИЯХ ЧЕЛОВЕКА

The paper is devoted to the study of little-known and previously unknown bacteria isolated from patients with various diseases. Here we present the data on 22 strains that are little-known or previously unknown as human pathogens and isolated from patients with various diseases. Most of the isolates were found to have multiple antibiotic resistances. Moreover, in many conditions potentially pathogenic spore-forming bacteria were identified. Spore formation provides bacteria for survival in the environment and promotes high resistance to antiseptics and disinfectants. Spore-forming bacteria are high survival and especially dangerous as potential hospital-acquired infections because of its antibiotic resistance but the activity of this antibiotic therapy doesn’t concern microbial spores.Работа посвящена изучению малоизвестных и ранее не известных бактерий, изолированных у больных с патологиями различной локализации. Выделенные и изученные 22 штамма малоизвестных бактерий или вообще не описаны ранее как возбудители заболеваний человека, или обнаружены при патологии другой локализации. Большинство полученных бактерий обладает множественной  устойчивостью к различным  антибиотикам. При  разных  заболеваниях в материале обнаружено много потенциально-патогенных спорообразующих   бактерий. Спорообразование   обеспечивает бактериям  сохранение  жизнеспособности в окружающей среде и повышенную устойчивость к антисептикам и дезинфектантам. Спорообразующие бактерии хорошо   сохраняются   и особенно  опасны  в качестве потенциальных  возбудителей внутрибольничных   инфекций,   поскольку резистентны к антибиотикотерапии, активность которой не распространяется на микробные споры

Russian consensus on exoand endocrine pancreatic insufficiency after surgical treatment

The Russian consensus on exo - and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian "Pancreatic Club" on the Delphi method. His goal was to clarify and consolidate the opinions of specialists on the most relevant issues of diagnosis and treatment of exo - and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is provided by the participation of leading gastroenterologists and surgeons