The Role of Laparoscopy and Ultrasonography in Pancreatic Head Carcinoma

Objective: The authors performed a prospective evaluation of staging laparoscopy with laparoscopic ultrasonography in predicting surgical resectability in patients with carcinomas of the pancreatic head and periampullary region

Improved Method for the Determination of Phospholipase A2 Catalytic Activity Concentration in Human Serum and Ascites

Peer Reviewe

Using resilience assessments to inform the management and conservation of coral reef ecosystems

Climate change is causing the decline of coral reef ecosystems globally. Recent research highlights the importance of reducing CO2 emissions in combination with implementing local management actions to support reef health and recovery, particularly actions that protect sites which are more resilient to extreme events. Resilience assessments quantify the ecological, social, and environmental context of reefs through the lens of resilience, i.e., the capacity of a system to absorb or withstand stressors such that the system maintains its structure and functions and has the capacity to adapt to future disturbances and changes. Resilience assessments are an important tool to help marine managers and decision makers anticipate changes, identify areas with high survival prospects, and prioritize management actions to support resilience. While being widely implemented, however, there has not yet been an evaluation of whether resilience assessments have informed coral reef management. Here, we assess the primary and gray literature and input from coral reef managers to map where resilience assessments have been conducted. We explore if and how they have been used to inform management actions and provide recommendations for improving the likelihood that resilience assessments will result in management actions and positive conservation outcomes. These recommendations are applicable to other ecosystems in which resilience assessments are applied and will become increasingly important as climate impacts intensify and reduce the window of opportunity for protecting natural ecosystems

Дуоденум-сохраняющая резекция головки поджелудочной железы при хроническом панкреатите, доброкачественных и предраковых опухолях поджелудочной железы

ПОДЖЕЛУДОЧНАЯ ЖЕЛЕЗА /ПАТОЛОГ /ХИРНОВООБРАЗОВАНИЯ КИСТОЗНЫЕ, СЛИЗИСТЫЕ И СЕРОЗНЫЕНЕЙРОЭНДОКРИННЫЕ НОВООБРАЗОВАНИЯНЕЙРОЭНДОКРИННЫЕ ОПУХОЛИПАНКРЕАТИТХРОНИЧЕСКИЙ ПАНКРЕАТИТПАНКРЕАТОДУОДЕНЭКТОМИЯДУОДЕНОПАНКРЕАТЭКТОМИЯПАНКРИАТИКОДУОДЕНЭКТОМИЯОПЕРАЦИЯ УИПЛАДУОДЕНУМ-СОХРАНЯЮЩАЯ РЕЗЕКЦИЯ ГОЛОВКИ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫПОСЛЕОПЕРАЦИОННЫЕ ОСЛОЖНЕНИЯЦель. Сообщить об опыте применения в клинике дуоденум-сохраняющей резекции головки поджелудочной железы (ДСРГПЖ) как метода хирургического лечения хронического панкреатита с воспалительным инфильтратом, доброкачественных и предраковых новообразований, а также нейроэндокринных опухолей головки поджелудочной железы. Материал и методы. ДСРГПЖ является операцией, при которой сохраняется антральный отдел желудка, общий желчный проток и двенадцатиперстная кишка, в то время как операция Уиппла относится к мультивисцеральной операции, включающей в себя дуоденэктомию. Дуоденум-сохраняющая резекция головки поджелудочной железы была впервые применена в нашей клинике в Берлине в 1969 году. Результаты. При хроническом панкреатите (ХП) с воспалительным инфильтратом в головке ПЖ ДСРГПЖ стала стандартным хирургическим вмешательством, принятым во всем мире. В группе из 603 пациентов с ХП, перенесших ДСРГПЖ, частота панкреатических свищей была 3,3%, внутрибрюшных абсцессов – 2,8%, кровотечения – 2,8%, повторных операций – 5,6%, летальности – 0,82% и повторной госпитализации в течение 90 дней – 8%. ДСРГПЖ при доброкачественных и предраковых кистозных новообразованиях головки ПЖ в основном используется для IPNM (инвазивный внутрипротоковый папиллярный рак), MCN (муцинозная киста) и SPN (серозная киста). В обзоре иностранных публикаций, включающих 503 пациентов, частота общих осложнений была 38,2%, тяжелых послеоперационных осложнений – 12,7%. из них панкреатические свищи В+С (по классификации ISGPF) наблюдались у 13,6%, повторные операции – у 2,7% и летальность в течение 90 дней – у 0,4%. При использовании ДСРГПЖ при нейроэндокринных опухолях головки ПЖ рекомендуется дополнительная локальная лимфодиссекция. Отдаленные осложнения ДСРГПЖ, такие как сахарный диабет и экзокринная дисфункция, наблюдаются только у 5-7% пациентов. Заключение. Операция Уиппла сопровождается значительным количеством метаболических осложнений. ДСРГПЖ при воспалительных опухолях, доброкачественных и предраковых новообразованиях, нейроэндокринных опухолях головки поджелудочной железы имеет преимущества в сохранении двенадцатиперстной кишки и поддержании эндокринной и экзокринной функции ПЖ.Objective. To report the institutional experience of the evolution of duodenum-preserving pancreatic head resection (DPPHR) as a surgical treatment for chronic pancreatitis with an inflammatory tumor as well as cystic and benign, premalignant neoplasms and neuroendocrine tumors of the pancreatic head. Methods. DPPHR is associated with preservation of gastric antrum, common bile duct and duodenum/upper jejunal loop, contrary to Kausch-Whipple resection, which is a multivisceral procedure, including duodenectomy. Duodenum-preserving pancreatic head resection was first established in clinical setting in Berlin in 1969. Results. For chronic pancreatitis with an inflammatory infiltrat in the pancreatic head, duodenum-preserving pancreatic head resection has become a standard surgical treatment with worldwide acceptance. In a series of 603 patients with chronic pancreatitis following DPPHR, the frequency of pancreatic fistula was 3.3 %, intra-abdominal abscess 2.8 %, hemorrhage 2.8 %, frequency of reoperation 5.6%, in-hospital mortality 0.82 % and 90-day rehospitalisation 8 %. DPPHR for benign and premalignant cystic neoplasms of the pancreatic head is used predominantly for IPMN, MCN and SPN tumors. In a review of international publications comprising 503 patients, the general morbidity was 38.2 %, severe surgery-related complications 12.7% of them pancreatic fistula B+C 13.6 %, resurgery 2.7 % and 90-day mortality 0.4 %. When pancreatic neuroendocrine tumors of pancreatic head are treated with DPPHR, a local lymph node dissection is additionally recommended. The long-term morbidity following DPPHR revealed new onset of diabetes mellitus and exocrine dysfunctions in only 5-7 % of patients. Conclusion. Kausch-Whipple resection is associated with considerable high metabolic complications. Duodenum-sparing pancreatic head resection for inflammatory tumor, benign and premalignant neoplasms, and neuroendocrine tumors of the pancreatic head has the advantage of the duodenum preservation and maintenance of the pancreatic endocrine and exocrine functions

Über die Stickstoffbestimmung nach Kjeldahl im Kreatin.

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High-latitude marginal reefs support fewer but bigger corals than their tropical counterparts

Anthropogenic impacts are typically detrimental to tropical coral reefs, but the effect of increasing environmental stress and variability on the size structure of coral communities remains poorly understood. This limits our ability to effectively conserve coral reef ecosystems because size specific dynamics are rarely incorporated. Our aim is to quantify variation in the size structure of coral populations across 20 sites along a tropical-to-subtropical environmental gradient on the east coast of Australia (~ 23 to 30°S), to determine how size structure changes with a gradient of sea surface temperature, turbidity, productivity and light levels. We use two approaches: 1) linear regression with summary statistics (such as median size) as response variables, a method frequently favoured by ecologists and 2) compositional functional regression, a novel method using entire size–frequency distributions as response variables. We then predict coral population size structure with increasing environmental stress and variability. Together, we find fewer but larger coral colonies in marginal reefs, where conditions are typically more variable and stressful, than in tropical reefs. Our model predicts that coral populations may become gradually dominated by larger colonies (> 148 cm2) with increasing environmental stress. Fewer but bigger corals suggest low survival of smaller corals, slow growth, and/or poor recruitment. This finding is concerning for the future of coral reefs, as it implies that current marginal populations, or future reefs in increasingly stressful environmental conditions may have low recovery potential. We highlight the importance of continuously monitoring changes to population structure over biogeographic scales