Challenges and controversies in open pancreatoduodenectomies

Duodenopancreatectomia cefalopancreatica este o procedura intricata, ce necesita o inalta precizie datorita proximitatii structurilor vitale, sustinuta prin expertiza. O data cu evolutia chirurgiei si aparitia de instrumente inovatoare, mortalitatea a scazut sub 5%, dar morbiditatea a ramas la 30%, in special datorita fistulelor de anastomoza si a evenimentelor hemoragice. In acest sens, chirurgia deschisa confera rezultate mai bune, cu o curba de invatare rezonabila. Cu atat mai mult, cu cat efectuarea de trialuri clinice este dificila in acest domeniu, atat in chirurgia deschisa, cat si minim invaziva, pentru a obtine evidente valoroase, astfel subiectul ramane unul de dezbatere.Whipple procedure is intricate and demands high precision due to the proximity of critical structures, which requires an achieved expertise. With the innovative instruments and evolution of surgery, the perioperative morbidity still stands at 30% with a mortality lower than 5%, primary because of anastomotic leaks and haemorrhagic events. Therefore open surgery provides better outcomes with a decent learning curve. Furthermore, it is challenging to conduct clinical trials in the field of pancreatic surgery both open or minimally-invasive to obtain high-level evidence, remaining a subject open to debate

Soil fertility in the Central-southern part of Romania expressed by soil reaction and nutrient content: a case study from the Raul Alb catchment, Dambovita County

The field research took place between 2019 and 2020, in the upper river basin of the Raul Alb creek, located in the northwest of Dambovita County, the analysed land area being 4034 ha. Underlying the research of the complex erosion phenomena faced by the analysed territory was the soil survey, which consisted of sampling 46 soil profiles in the representative areas for the analysed territory. For the analysis of the soil fertility, chemical analyses were performed regarding the pH, humus content, reported to the soil texture in the topsoil and the supply of nutrients (nitrogen, phosphorus and potassium), also physical-mechanical analysis (soil texture), interpreted according to the “Methodology for the Development of Pedological Studies, Volumes I, II, III, 1987”. By centralising the obtained results, it found that 59.42% of the total analysed land surface had a weak alkaline pH, at least in the topsoil, due to the CaCO3 content. For the supply of humus, the most significant share is that of the extremely low-supplied soils with this element in the topsoil, i.e. 73.42% of the mapped area, and in terms of the nitrogen supply, 26.67% of the total surface of the river basin shows severe deficiencies in this element. The situation is worrying indeed in the case of the supply of soils with mobile phosphorus, with 3 280.27 ha of the mapped surface having very low or low contents of this element, making up 81.31%. However, for potassium, the soils from the upper sector of the Raul Alb catchment are mostly moderately and well supplied, with only 620.85 ha (15.39%) being extremely poorly supplied with this element

The degree of soil fertility in the drainage basin of Râul Alb stream, Dâmboviţa county, up to the point it meets Bărbuleţu stream, expressed through the soil reaction and the supply of nutrients (organic matter, Nitrogen, Phosphorus and Potassium)

The field research took place in the interval 2019-2020, in the higher drainage basin of Râul Alb stream, located in the north-western part of Dâmboviţa County, the analysis covering an area of 4034 ha. The research into the complex phenomena of erosion in the analyzed area was based on a pedological study, which consisted in performing 46 pedological profiles in representative areas of the analyzed region. After centralizing the results, it was noted that 59.42% of the entire analyzed area display a low alkaline reaction, at least at the level of the upper layer, because of its CaCO3 content, which exacerbates the risk of landslide. From the point of view of the supply of nutrients (humus), most of the soils have a low and extremely low supply of these elements at the level of the upper layer, namely 73.42% of the analyzed area; as for the nitrogen supply, 26,68% of the entire surface of the drainage basin display severe shortages of this element. The situation is really serious in the case of the supply of mobile phosphorus in the soil, 3280.27 ha of the analyzed surface are low and very low in phosphorus, namely 76.20%, while the levels of potassium supply in the soils in the higher drainage basin of Râul Alb stream are mostly moderate and good, only 620.85 ha (14.42%) are extremely low and low in potassium supply

Iatrogenic bile duct injuries – the road to consensus

Scop: Leziunile iatrogene de cale biliară după colecistectomia laparoscopică reprezintă o problemă serioasă care trebuie manageriată corect din punct de vedere diagnostic și al unui tratament prompt. Multiple clasificări au fost dezvoltate și utilizate pentru descrierea acestor leziuni. Material și metode: Studiul nostru este un studiu de tip retrospectiv descriptiv cu scopul de a identifica rolul unei clasificări uniforme și complete, dar și implicarea acesteia în managementul leziunilor de cale biliară. Au fost incluși pacienți referați în centru nostru terțiar, pentru tratamentul leziunilor de cale biliară survenite după colecistectomia laparoscopică, pe o perioadă de 10 ani (2011-2020). Rezultate: O sută de pacienți au fost incluși în studiu; 15% din leziuni au fost întâmpinate la cazuri operate primar în serviciul nostru. În 73% din cazuri, leziunile nu au fost clasificate, în 23% din cazuri s-a utilizat clasificarea Strasberg, în 3% din cazuri clasificarea Bismuth, iar în 1% din cazuri clasificarea ATOM. După reclasificarea retrospectivă a tuturor cazurilor, s-a observat că clasificarea Straberg, dar chiar și clasificarea Hannover suprasimplifică complexitatea leziunii. Tratamentul în majoritatea cazurilor a fost derivația biliodigestivă (60% din cazuri). Concluzii: Clasificarea ATOM realizează o descriere comprehensivă a leziunilor biliare, putând ghida astfel tratamentul corespunzător în funcție de severitatea fiecărei leziuni. O clasificare uniformă ar trebui adoptată la scară largă pentru a asigura un limbaj comun în discuția referitoare la leziunile de cale biliară.Aim: Iatrogenic bile duct injuries after laparoscopic cholecystectomy represent a significant problem, that needs to be addressed correctly in terms of diagnosis and prompt treatment. Several classifications have been developed and used to describe these lesions. Methods: Our study is a retrospective descriptive study that aims to identify the role of an uniform and comprehensive classification and its implication on the consecutive management of the bile duct injury. We have included patients diagnosed with bile duct injury after laparoscopic cholecystectomy, referred to a tertiary centre, in a ten-year period (2011-2020). Results: We included in our study 100 patients; 15% of the BDI occurred in our center. No classification system was used in 73% of patients; 23% of the BDI were classified by the Strasberg system, 3% were classified by the Bismuth classification, 1% being classified by the ATOM classification. After retrospectively classifying all BDI, we observed that especially the Strasberg classification, as well as Hannover, over-simplifies the characteristics of the injury. Most main bile duct injuries underwent a bilio-digestive anastomosis (60%), as a definitive treatment. Conclusions: The ATOM classification performs a comprehensive description of the bile duct injury and subsequent guidance of the correct treatment according to the severity of each lesion. A consistent classification should be adopted, in order to assure a uniform discussion on iatrogenic bile duct injuries

Scientific contributions in order to calculate rainfall erosivity factor (R) from revised universal soil loss equation (rusle) for Valea Tata watershed, Dambovita county, Romania

The research studies on the occurrence of complex soil erosion phenomena in the hydrographic basin of the Valea Tata stream, a right bank tributary of the Ialomita river, were carried out in the period 2017-2021 and aimed to quantify the amount of soil that is lost annually from the surface of the analyzed watershed. The main objective of this study was to calculate the rainfall erosivity factor (R) included in the Revised Universal Soil Erosion Equation (RUSLE) based on the records made in the period 2017-2021 on the experimental field as well as the data recorded at the climate monitoring stations in the proximity of the watershed for a period of 30 years for the calculation of soil loss from the Valea Tata watershed depending on the rain aggressiveness. The average value obtained for the Moroeni climate monitoring station was 289.54 MJ mm ha-1 h -1 year-1 with a minimum value of 83.20 MJ mm ha-1 h -1 year-1 and a maximum value of 964.06 MJ mm ha-1 h -1 year-1 while for Fieni climate monitoring station the values obtained were between 60.99 MJ mm ha-1 h -1 year-1 and 537.22 MJ mm ha-1 h -1 year-1 with an average value of 193.38 MJ mm ha-1 h -1 year-1 . For the experimental field, where the rainfall data, rain intensity and duration of the erosive events were more complex, the results obtained for the erosivity factor (R) has values between 149.50 MJ mm ha-1 h -1 year-1 and 800.80 MJ mm ha-1 h -1 year-1 with an average value of 284.91 MJ mm ha-1 h -1 year-1

Research on soil degradation resulting from sheet and gully erosion processes. Case study – the Raul Alb hydrographic basin, Dambovita county, up to the point it meets Barbuletu stream

The research works focused on the upper hydrographic basin of the Raul Alb creek up to the point it meets Barbuletu stream, covering an area of 4 034 ha and aimed at establishing the degree of soil degradation as a result of the complex action of sheet and gully erosion. Following the pedological study, seven soil types have been identified, each with several subtypes, which fall into five large soil classes. Regosols account for 51.00% of the catchment area, followed by eutric cambisols, 18.70%, rendzic leptosols 11.55% and phaeozems 11.00%. The fluvisol, anthrosol and luvisol total 7.75% of the entire basin. The class of Entisols is present in 56.10% of the area, followed by Mollisols 22.55% and Inceptisols 18.70% of the analysed area. The Entisol class (eroded phases) is to be found in 2.26% of the area, whereas the Alfisols account only for 0.39% of the hydrographic basin. In terms of sheet erosion, slightly eroded lands represent 48.26% of the total of 4 034 ha investigated, followed by the moderately eroded ones, 43.97%, whereas 2.27% of soils are strongly and excessively eroded and only 5.50% are not affected by sheet erosion. Deep water erosion is represented by rills, gullies and ravines. Gullies can be found in 35 of the 43 units of identified soils, ravines are present in 2 soil units and only 5 soil units are not affected by gully erosion

Facile synthesis and characterization of hydroxyapatite particles for high value nanocomposites and biomaterials

Lately Hydroxyapatite has gained a lot of research interest and intense focus due to its structural as well as compositional similarity to the components of human bone mineral. The conversion of calcium-rich precursors to hydroxyapatite could lead to the development of a new sustainable alternative with a valuable environmental and socio-economically impact. Still, current approaches faces lots of challenges in terms of synthesis parameters compatible to a reproducible route for calcium phosphates (hydroxyapatite included) synthesis. The optimization of Rathje synthesis route and characterization of biogenic derived calcium phosphates from dolomitic marble and Mytilus galloprovincialis seashells, constitutes the main goals of this study. The synthesized materials were characterized using FTIR, SEM coupled with EDS, and X-ray diffraction at all synthesis stages. Precursors were also subjected to thermal analysis and differential scanning calorimetry for thermal transformations investigations and dissociation temperature setting. This study suggests that acid quantity and magnetic stirring are the key-factors for Ca/P molar ratio adjustment, hence for the amount of naturally-derived hydroxyapatite. This research also contributes to the development of new strategies for further optimization of the conversion procedure and removal of residual components

Large olfactory groove meningiomas: Clinical outcome considering different surgical approaches

Olfactory groove meningiomas (OGMs) account for 4.5 to 13% of all intracranial meningiomas (1,2). They arise in the anterior cranial fossa at the cribriform plate of the ethmoid bone and the area of the suture adjoining the planum sphenoidale.We performed a large retrospective study of 98 patients (59 females and 39 males) evaluated and operated in the Neurosurgical Department of the National Institute of Neurology and Neurovascular Diseases between 1979 – 2009. This represented 7.93% of all intracranial meningiomas operated in our department (1235 cases). These operations were done by or under the supervision of the senior neurosurgeon (LD). For the surgical removal of the OGMs we used both frontolateral (67 cases) or bifrontal approaches (31 cases). We achieved total removal of the meningioma in most of the cases (93.9%), meaning in 66 patients operated through unilateral frontolateral craniotomy (98.5%), and in 26 patients operated through bifrontal craniotomy (83.9%). As postoperative complications, were encountered: subdural hygroma, postoperative hemorrhage, cerebrospinal fluid (CSF) leak, postoperative seizures, diffuse cerebral edema and local infection. Postoperative mortality was 7.14% (7 patients). Frontolateral approach allowed, even in large OGMs, very good postoperative results, with high rates of total tumor resection and low rates of morbidity and mortality

Numerical analysis of the thermal comfort in a church building

Based on the monitoring campaigns, we have evaluated the indoor microclimate in a church. Most church buildings are characterised by low thermal comfort due primarily to their architecture, heating huge volume of air. The CFD tools was used for thermal comfort evaluation in case of the existing heating system during the winter season. The simulation model was validated with experimental data and it was used for thermal and air velocity profiles in the occupancy zone of churchgoers. The aim of the paper is the study the feasibility of maintaining the heritage values of the churches while achieving the significant improvement of the thermal comfort