Retrospective Study Minimally Invasive Management of Postoperative Lithiasis of the Common Bile Duct

Rezumat Studiu retrospectiv asupra managementului miniinvaziv al litiazei postoperatorii a cãii biliare principale Introducere: Litiaza postoperatorie a cãii biliare principale (CBP) ocupã un loc însemnat în patologia bilio-pancreaticã, atât prin frecvenåa mare, cât şi prin problemele de diagnostic şi tratament pe care le ridicã. Material aei metodã: Bazându-ne pe o experienåã, care s-a desfãşurat într-o perioadã de cinci ani (2008)(2009)(2010)(2011)(2012), evaluatã retrospectiv, totalizând 51 de pacienåi cu litiazã postoperatorie a CBP, am încercat sã formulãm câteva recomandãri în tratamentul acestei patologii. Acestea au fost ghidate de opåiunile terapeutice alternative existente şi de ideile vehiculate în literatura de specialitate, privind rezultatele înregistrate de fiecare manierã de tratament. Rezultate: Rata de clearence a CBP a fost de 93,6%, morbiditatea de 10,65% şi mortalitatea de 0%, acestea îndreptãåindu-ne sã apreciem eficienåa tratamentului miniinvaziv, ca fiind maximã în tratamentul acestei patologii. Concluzii: Tratamentul endoscopic al litiazei postoperatorii a CBP s-a dovedit a fi posibil, eficient şi credem cã este bine a se folosi de principiu, chirurgia deschisã rãmânând rezervatã doar eşecurilor sau contraindicaåiilor tratamentului miniinvaziv. Cuvinte cheie: litiazã coledocianã, ERCP, sfincterotomie endoscopicã Abstract Introduction: Postoperative common bile duct (CBD) lithiasis holdsa significant place in the bilio-pancreatic pathology, both due to its high frequency as well as to the diagnostic and treatment issues it triggers. Material and Methods: Based on a 5-year experience (2008)(2009)(2010)(2011)(2012), assessed retrospectively, totalling 51 patients with postoperative lithiasis of CBD, we tried to elaborate on several recommendations for the treatment of this pathology. The recommendations were guided by the existing alternative therapeutic options and by the ideas in the literature regarding the results achieved by every manner of treatment. Results: The rate of clearance of the CBD was of 93.6%, themorbidity rate was of 10.65% and the mortality rate was of 0%, which entitles us to deem the effectiveness of the minimally invasive treatment as maximum in the treatment of this pathology. Conclusions: The endoscopic treatment of postoperative lithiasis of the CBD proved to be possible, efficient and we believe it good to be used as a principle; open surgery should be the solution in case of failures or of contraindications to minimally invasive treatmen

On the interaction of vortices with mixing layers

We describe the perturbations introduced by two counter-rotating vortices - in a two-dimensional configuration - or by a vortex ring - in an axisymmetric configuration - to the mixing layer between two counterflowing gaseous fuel and air streams of the same density. The analysis is confined to the near stagnation point region, where the strain rate of the unperturbed velocity field, A0, is uniform. We restrict our attention to cases where the typical distance 2r0 between the vortices - or the characteristic vortex ring radius r0 - is large compared to both the thickness, δv, of the vorticity core and the thickness, δm∼(ν/A0)1/2, of the mixing layer. In addition, we consider that the ratio, Γ/ν, of the vortex circulation, Γ, to the kinematic viscosity, ν, is large compared to unity. Then, during the interaction time, A0,-1, the viscous and diffusion effects are confined to the thin vorticity core and the thin mixing layer, which, when seen with the scale r0, appears as a passive interface between the two counterflowing streams when they have the same density. In this case, the analysis provides a simple procedure to describe the displacement and distortion of the interface, as well as the time evolution of the strain rate imposed on the mixing layer, which are needed to calculate the inner structure of the reacting mixing layer as well as the conditions for diffusion flame extinction and edge-flame propagation along the mixing layer. Although in the reacting case variable density effects due to heat release play an important role inside the mixing layer, in this paper the analysis of the inner structure is carried out using the constant density model, which provides good qualitative understanding of the mixing layer response

An integrated view of theiInfluence of temperature, pressure, and humidity on the stability of trimorphic cysteamine hydrochloride

Understanding the phase behavior of pharmaceuticals is important for dosage form development and regulatory requirements, in particular after the incident with ritonavir. In the present paper, a comprehensive study of the solid-state phase behavior of cysteamine hydrochloride used in the treatment of nephropathic cystinosis and recently granted orphan designation by the European Commission is presented employing (high-pressure) calorimetry, water vapor sorption, and X-ray diffraction as a function of temperature. A new crystal form (I2/a, form III) has been discovered, and its structure has been solved by X-ray powder diffraction, while two other crystalline forms are already known. The relative thermodynamic stabilities of the commercial form I and of the newly discovered form III have been established; they possess an overall enantiotropic phase relationship, with form I stable at room temperature and form III stable above 37 degrees C. Its melting temperature was found at 67.3 +/- 0.5 degrees C. Cysteamine hydrochloride is hygroscopic and immediately forms a concentrated saturated solution in water with a surprisingly high concentration of 47.5 mol % above a relative humidity of 35%. No hydrate has been observed. A temperature composition phase diagram is presented that has been obtained with the unary pressure temperature phase diagram, measurements, and calculations. For development, form I would be the best form to use in any solid dosage form, which should be thoroughly protected against humidity.Postprint (author's final draft

Соціальні аптеки та їх роль у системі охорони здоров’я

The aim of this study is to know the pharmacists’ opinion about the work of social pharmacies and the social activity of community pharmacies, as well as to develop recommendations on improvement of the social activity of the pharmacy network in the Republic of Moldova. The survey of pharmacists (specialists with higher pharmaceutical education) has been conducted. The advanced working experience of the social pharmacies on the example of the Rumanian pharmacies has been analyzed. The absence of social pharmacies in the Republic of Moldova has been found. The majority of respondents supports the need for social pharmacies (94%) and considers the presence of such pharmacies in the Republic of Moldova to be possible (72.4%). The social activity of community pharmacies (78.8% of the respondents) has been also supported. The provision of social pharmaceutical services for the population of the Republic of Moldova through the pharmaceutical network is mentioned only by 46.6% of the respondents working in these pharmacies. The causes of the absence of social pharmacies in the Republic of Moldova, including, first of all, their unprofitable activity (100%) and the lack of regulations (57.3%), have been determined. The methodological recommendations for improving the social activity of pharmacies in the Republic of Moldova have been developed.Целью исследования является выявление мнений фармацевтических работников по поводу работы социальных аптек и социальный деятельности коммунитарных аптек, а также разработка рекомендаций по совершенствованию социальной деятельности аптечной сети Республики Молдова. Исследование проведено путём анкетирования фармацевтов (специалистов с высшим фармацевтическим образованием). Изучен передовой опыт работы социальных аптек на примере отдельных аптек Румынии. Выявлено отсутствие социальных аптек в Республике Молдова. Большинство респондентов поддерживают необходимость существования социальных аптек (94,0%) и считают возможным наличие таких аптек в Республике Молдове (72,4%). Поддерживается также социальная деятельность коммунитарных аптек (78,8% респондентов). Оказание фармацевтических социальных услуг для населения Республики Молдова через сеть коммунитарных аптек отметили только 46,4% респондентов, работающих в таких аптеках. Выявлены причины отсутствия социальных аптек в Республике Молдова, среди которых главные – их нерентабельная деятельность (100,0%), отсутствие регламентаций (57,3%). Разработаны методические рекомендации, направленные на улучшение социальной деятельности аптек Республики Молдова, которые могут быть использованы в качестве основы для дальнейших, более углубленных исследований по обоснованию деятельности социальных аптек и будут способствовать их внедрению соответствующими государственными органами.Метою дослідження є виявлення думок фармацевтичних працівників із приводу роботи соціальних аптек і соціальної діяльності комунітарних аптек, а також розробка рекомендацій щодо удосконалення соціальної діяльності аптечної мережі Республіки Молдова. Дослідження проведено шляхом анкетування фармацевтів (фахівців із вищою фармацевтичною освітою). Вивчено передовий досвід роботи соціальних аптек на прикладі окремих аптек Румунії. Виявлено відсутність соціальних аптек у Республіці Молдова. Основні результати. Більшість респондентів підтримують необхідність існування соціальних аптек (94,0%) і вважають за можливе наявність таких аптек в Республіці Молдова (72,4%). Підтримується також соціальна діяльність комунітарних аптек (78,8% респондентів). Надання фармацевтичних соціальних послуг для населення Республіки Молдова через мережу комунітарних аптек відзначили лише 46,4% респондентів, які працюють у таких аптеках. Виявлено причини відсутності соціальних аптек у Республіці Молдова, серед яких головні – їх нерентабельна діяльність (100,0%), відсутність регламентацій (57,3%). Розроблено методичні рекомендації щодо поліпшення соціальної діяльності аптек Республіки Молдова, які можуть бути використані як основа для подальших, більш глибоких досліджень з обґрунтування діяльності соціальних аптек і сприятимуть їх упровадженню відповідними державними органами

Mucosal Associated Invariant T cells in the human gastric mucosa and blood: Role in Helicobacter pylori infection

Mucosal-associated invariant T (MAIT) cells represent a class of antimicrobial innate-like T cells that have been characterized in human blood, liver, lungs and intestine. Here, we investigated, for the first time, the presence of MAIT cells in the stomach of children, adults and the elderly undergoing routine endoscopy and assessed their reactivity to Helicobacter pylori (H. pylori-Hp), a major gastric pathogen. We observed that MAIT cells are present in the lamina propria compartment of the stomach and display a similar memory phenotype to blood MAIT cells. We then demonstrated that gastric and blood MAIT cells are able to recognize H. pylori. We found that CD8+ and CD4-CD8- (DN) MAIT cell subsets respond to H. pylori-infected macrophages stimulation in a MR-1 restrictive manner by producing cytokines (IFNg, TNFa, IL-17A) and exhibiting cytotoxic activity. Interestingly, we observed that blood MAIT cell frequency in Hp+ve individuals was significantly lower than in Hp-ve individuals. However, gastric MAIT cell frequency was not significantly different between Hp+ve and Hp-ve individuals, demonstrating a dichotomy between blood and gastric tissues. Further, we observed that the majority of gastric MAIT cells (>80%) expressed tissue-resident markers (CD69+ CD103+), which were only marginally present on PBMC MAIT cells (<3%), suggesting that gastric MAIT cells are readily available to respond quickly to pathogens. These results contribute important new information to the understanding of MAIT cells function on peripheral and mucosal tissues and its possible implications in the host response to H. pylori