Laparoscopic radical 'no-touch' left pancreatosplenectomy for pancreatic ductal adenocarcinoma: technique and results

Background Laparoscopic left pancreatectomy has been well described for benign pancreatic lesions, but its role in pancreatic adenocarcinoma remains open to debate. We report our results adopting a laparoscopic technique that obeys established oncologic principles of open distal pancreatosplenectomy. Methods This is a post hoc analysis of a prospectively kept database of 135 consecutive patients undergoing laparoscopic left pancreatectomy, performed across two sites in the UK and the Netherlands (07/2007–07/2015 Southampton and 10/2013–07/2015 Amsterdam). Primary outcomes were resection margin and lymph node retrieval. Secondary endpoints were other perioperative outcomes, including post-operative pancreatic fistula. Definition of radical resection was distance tumour to resection margin >1 mm. All patients underwent ‘laparoscopic radical left pancreatosplenectomy’ (LRLP) which involves ‘hanging’ the pancreas including Gerota’s fascia, followed by clockwise dissection, including formal lymphadenectomy. Results LRLP for pancreatic adenocarcinoma was performed in 25 patients. Seven of the 25 patients (28 %) had extended resections, including the adrenal gland (n = 3), duodenojejunal flexure (n = 2) or transverse mesocolon (n = 3). Mean age was 68 years (54–81). Conversion rate was 0 %, mean operative time 240 min and mean blood loss 340 ml. Median intensive/high care and hospital stay were 1 and 5 days, respectively. Clavien–Dindo score 3+ complication rate was 12 % and ISGPF grade B/C pancreatic fistula rate 28 %; 90-day (or in-hospital) mortality was 0 %. The pancreatic resection margin was clear in all patients, and the posterior margin was involved (<1 mm) in 6 patients, meaning an overall R0 resection rate of 76 %. No resection margin was microscopically involved. Median nodal sample was 15 nodes (3–26). With an average follow-up of 17.2 months, 1-year survival was 88 %. Conclusions A standardised laparoscopic approach to pancreatic adenocarcinoma in the left pancreas can be adopted safely. Our study shows that these results can be reproduced across multiple sites using the same technique

Native Speaker Perceptions of Accented Speech: The English Pronunciation of Macedonian EFL Learners

The paper reports on the results of a study that aimed to describe the vocalic and consonantal features of the English pronunciation of Macedonian EFL learners as perceived by native speakers of English and to find out whether native speakers who speak different standard variants of English perceive the same segments as non-native. A specially designed computer web application was employed to gather two types of data: a) quantitative (frequency of segment variables and global foreign accent ratings on a 5-point scale), and b) qualitative (open-ended questions). The result analysis points out to three most frequent markers of foreign accent in the English speech of Macedonian EFL learners: final obstruent devoicing, vowel shortening and substitution of English dental fricatives with Macedonian dental plosives. It also reflects additional phonetic aspects poorly explained in the available reference literature such as allophonic distributional differences between the two languages and intonational mismatch

The Variability of Fruit Characteristics of Traditional Pear Karamanka in Different Ecological Conditions

In this paper, we present the results of the phenological characteristics (flowering and ripening time), fruit characteristics (fruit mass, fruit length, fruit width, fruit hardness, length of fruit stalk and number of seeds in fruit) and chemical characteristics of fruits (soluble dry matter, total sugar and total acids) of a traditional pear variety ‘Karamanka’. For this study, a survey was undertaken in different ecological regions of Macedonia i.e. Skopje, Kumanovo, Kratovo, Kriva Palanka and Resen. The ‘Karamanka’ pear flowers in the first half of April. The period of fruit ripening starts in the second half of August and lasts until the first half of September. The earliest time of flowering and ripening was found to be in the regions of Skopje and Kumanovo. The pear ‘Karamanka’ has medium-sized fruits and the largest fruits were detected in the regions of Kumanovo and Resen. These differences in reference to the fruit mass were statistically significant. It was found that fruits contained 14.2% of soluble dry matter, 13.5% of total sugar and 0.13% of total acids. The highest values of soluble dry matter and total sugar were found in the fruits from the Kriva Palanka region. These values were statistically significant. The fruits from the regions of Skopje and Kratovo were characterized with poor quality and with the highest amount of stone cells

Citizens' Perception and Concerns on Chemical Exposures and Human Biomonitoring-Results from a Harmonized Qualitative Study in Seven European Countries.

Funding Information: Funding: This research was done within the HBM4EU project and funded by the European Union’s Horizon 2020 research and innovation program under grant agreement No 733032. The organization and collection of Danish data (including Norstat) was financed by the University of Copenhagen. Funding Information: This research was done within the HBM4EU project and funded by the European Union’s Horizon 2020 research and innovation program under grant agreement No 733032. The organization and collection of Danish data (including Norstat) was financed by the University of Copenhagen. Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Exposure to different chemicals is an inevitable part of our everyday lives. Within HBM4EU, focus group discussions were conducted to gather data on citizens' perceptions of chemical exposure and human biomonitoring. These discussions were hosted in Cyprus, Denmark, Hungary, Israel, Latvia, the Netherlands, and North Macedonia following a protocol developed in the first round of discussions. Results indicate the very high concern of European citizens regarding food safety and the environment. Focus group participants were well aware of potential uptake of chemicals through food consumption (e.g., preservatives, flavor enhancers, coloring agents, pesticides, fertilizers, metals), drinking water, or from polluted air and water. One of the positive aspects identified here, is the high interest of citizens in awareness and education on personal measures to control exposure. The promotion of personal behavioral changes requires active involvement of society (e.g., commuting habits, energy choices, waste disposal, dietary habits). Activities should focus on raising awareness of the general public, implementation of policy measures, and mainstreaming of related topics into the education system. Raising awareness of the general public may promote engagement of citizens, which in turn may empower them to put pressure on politicians to take effective actions. There is also a need for further research which might focus on the impact of country-specific situations and of the COVID-19 pandemic on the exposure of citizens to chemicals.publishersversionPeer reviewe