The Feasibility of Laparoscopic Cholecystectomy in Patients with Previous Abdominal Surgery

A retrospective study was carried in 1500 patients submitted to elective laparoscopic cholecystectomy to ascertain its feasibility in patients with previous abdominal surgery. In 411 patients (27.4%) previous infraumbilical intraperitoneal surgery had been performed, and 106 of them (7.06%) had 2 or more operations. Twenty five patients (1.66%) had previous supraumbilical intraperitoneal operations (colonic resection, hydatid liver cysts, gastrectomies, etc.) One of them had been operated 3 times. In this group of 25 patients the first trocar and pneumoperitoneum were performed by open laparoscopy. In 2 patients a Marlex mesh was present from previous surgery for supraumbilical hernias. Previous infraumbilical intraperitoneal surgery did not interfere with laparoscopic cholecystectomy, even in patients with several operations. There was no morbidity from Verres needle or trocars. In the 25 patients with supraumbilical intraperitoneal operations, laparoscopic cholecystectomy was completed in 22. In 3, adhesions prevented the visualization of the gallbladder and these patients were converted to an open procedure. In the 2 patients Marlex mesh prevented laparoscopic cholecystectomy because of adhesions to abdominal organs. We conclude that in most instances previous abdominal operations are no contraindication to laparoscopic cholecystectomy

A geometrical formulation of the μ-lower bound problem

A new problem formulation for the structured singular value μ in the case of purely real (possibly repeated) uncertainties is presented. The approach is based on a geometrical interpretation of the singularity constraint arising in the μ lower bound problem. An interesting feature of this problem formulation is that the resulting parametric search space is independent of the number of times any parameter is repeated in the structured uncertainty matrix. A corresponding lower bound algorithm combining randomisation and optimisation methods is developed, and some probabilistic performance guarantees are derived. The potential usefulness of the proposed approach is demonstrated on two high-order real μ analysis problems from the aerospace and systems biology literature

Metabolic profiling and biological capacity of Pieris brassicae fed with kale (Brassica oleracea L. Var. Acephala).

Vegetables of the Brassica group are the most commonly grown and consumed worldwide. Food plants with apparent cancer and cardiovascular di sease-preventing properties include several varieties of Brassica oleraceae. The majority of the herbivorous insect species are specialized feeders, for which the behavioral decision to accept a plant as food or oviposition substrate is mainly related with sensory information. Pieris insects (Lepidoptera: Pieridae) are specialist herbivores of cruciferous plants

Workplace burnout and health issues among Colombian correctional officers.

Introduction Correctional employees typically work under adverse conditions that may enhance the occurrence of different negative psychological states. Burnout constitutes a high-risk phenomenon that may affect people's physical/mental health and welfare, especially in vulnerable occupational groups. Objectives The aim of this study was to characterize the burnout profile of correctional officers, and to associate their burnout profile with health issues and lifestyle factors. Methods The full sample was composed of 219 Colombian correctional officers with a mean age of 30.18 years. A questionnaire composed of three sections was employed: demographic data, burnout, and health information. Results A high proportion of participants reported burnout indicators, also significantly correlated to their health indicators and lifestyle factors. Cluster analyses were used in order to characterize the burnout/age (model A) and burnout/age/psychological disturbance (model B) profiles of correctional officers. Furthermore, significant differences were found when comparing frequencies of alcohol consumption and physical exercise (lifestyle indicators) and perceived social support of officers depending on their profile. Conclusions the discussion focused on the negative impact of burnout on health, and on the importance of strengthening occupational programs aimed at reducing the impact of hazardous working conditions that contribute to the development of burnout, and to the arise different mid and long-term health complains among correctional workers

Zero Ripple Current with Coupled Inductors in Continuous Conduction Mode under PWM Signals

This article presents a generalized analysis to explain current ripple of an m windings coupled inductor with a given coupling factor k ij for each pair of windings and then studies more in detail its use in the continuous conduction mode and with pulsewidth modulated signals. To determine the current ripple, a generalized expression of the equivalent inductance of each winding is calculated, including the influence of voltage unbalance. In the ideal case, the equivalent inductance shows that the current ripple can only become m times smaller than that with uncoupled inductors. But in the unbalanced case, some divergences of the equivalent inductance appear that are responsible for zero ripple current. The proposed generalized expressions of the equivalent inductance also describe the current ripple of the new appearing intervals due to out-of-phase signals. An easy to design condition is proposed that achieves zero current ripple in all windings but one. Experimental results are provided that validate the presented theoretical expressions under the given conditions

The 4G/4G genotype of PAI-1 polymorphism is associated with higher plasma PAI-1 concentrations and mortality in patients with severe sepsis

Objective: Two studies have reported that patients with the 4G/4G genotype of the plasminogen activator inhibitor-1 (PAI-1) genetic polymorphism had higher plasma PAI-1 concentrations and higher risk of death than those with the 4G/5G or 5G/5G genotypes; one study involved 175 children with meningococcal disease, and the other included 88 adult patients with septic shock. Thus, the objective of this study was to determine whether there is an association between carriage of the 4G/4G genotype, plasma PAI-1 concentrations and mortality in a large series of adult septic patients. Methods: An observational, prospective, multicenter study was carried out in six Spanish Intensive Care Units including severe septic patients. We determined the PAI-1 4G/5G polymorphism and plasma PAI-1 concentrations in all patients. The end-points of the study were 30-day and 6-month mortality. Results: We included a total of 260 patients, 82 (31.5%) with 4G/4G, 126 (48.5%) with 4G/5G and 52 (20.0%) with 5G/5G genotype. Multivariate logistic regression analysis showed that the 4G/4G genotype was associated with higher mortality at 30 days (Odds Ratio = 1.95; 95% CI = 1.063-3.561; p = 0.03) and at 6 months (Odds Ratio = 2.19; 95% CI = 1.221-3.934; p = 0.01), and that higher plasma PAI-1 concentrations were associated with higher mortality at 30 days (Odds Ratio = 1.01; 95% CI = 1.002-1.022; p = 0.02) at 6 months (Odds Ratio = 1.01; 95% CI = 1.003-1.023; p = 0.01). Multivariate linear regression analysis showed that increased plasma PAI-1 concentrations were associated with the PAI-1 4G/4G genotype (regression coefficient = 4.82; 95% CI = 3.227 to 6.406; p<0.001). Conclusions: The major findings of our study, to our knowledge the largest series reporting data about 4G/5G polymorphism of the PAI-1 gene, plasma PAI-1 concentrations and mortality in septic patients, were that septic patients with the 4G/4G genotype had higher plasma PAI-1 concentrations and higher risk of death than those with 4G/5G or 5G/5G genotypes

Association between interleukin-6 promoter polymorphism (-174 G/C), serum interleukin-6 levels and mortality in severe septic patients

The association between interleukin (IL)-6 promoter polymorphism (-174 G/C), circulating IL-6 levels and mortality in septic patients has scarcely been addressed, and then only in studies of small sample size, and a direct association among them has not been previously reported. Therefore, the purpose of our study was to determine whether this association exists. An observational, prospective and multicenter study including severe septic patients was undertaken and serum IL-6 levels at severe sepsis diagnosis and IL-6 promoter polymorphism (-174 G/C) were determined. The end-point of the study was 30-day mortality. The study included 263 patients with the following genotypes of IL-6 promoter polymorphism (-174 G/C): 123 (46.8%) GG, 110 (41.8%) GC and 30 (11.4%) CC. CC homozygous patients showed lower sepsis-related organ failure assessment (SOFA) score, serum IL-6 levels and mortality at 30 days compared to those with other genotypes (GC or GG). On regression analysis, CC homozygous patients showed lower 30-day mortality than those with genotype GG (odds ratio = 0.21; 95% CI = 0.053-0.838; p = 0.03) or GC (hazard ratio = 0.28; 95% CI = 0.074-1.037; p = 0.06). The most important results of our study were that CC might be a favorable genotype in septic patients showing lower serum IL-6 levels and lower risk of death within 30 days

Gestión del corzo en Zaragoza: de conservación a control poblacional

As it has happened with other wild ungulates in Europe, the roe deer (Capreolus capreolus) population in Aragon has suffered a considerable expansion during the last two decades. In the Iberian Mountains of Zaragoza (SIZ) this process come along with an increasing sporting interest in the species and the raising of conflicts due to crop damage, mainly on fruit trees and vineyards. The Government of Aragon is responsible of managing big game populations and fixes the hunting quotas. During the elaboration of hunting plans it has to consider different and even opposite interests and points of view, so availability of reliable population trends it is essential for the management of these populations. It has been developed a scheme for monitoring roe deer population in Aragon based on strip transect counts of pellet groups. This information is complemented by the sightings of roe deer during a fox and lagomorph monitoring scheme based on spotlight counts from car. In the Iberian Mountain System of Zaragoza, between 2005 and 2009, the survey results point that the roe deer abundance has doubled, and the mean density reaches 5.4 ± 0.33 roe deer/km2. Initially, management plans followed a conservative criterion in order to keep the population growing, with a moderate extraction rate, still hunt and a balanced sex-specific quota. Due to the positive trend of the species and the necessity of reducing damage caused to agriculture, mainly fruit trees, the management goals change to population control and it was decided to increase hunting pressure: hunting season was extended, hunting drives with dogs are authorized and the extraction rate is raised. Although the hunting quota fulfillment is close to 80%, and the number of shot deer has increased from 193 in 2005 to 1.084 in 2009, until now there is no reduction in the population growth.Al igual que ha ocurrido con otros ungulados en el resto de Europa, durante las dos últimas décadas la población de corzo (Capreolus capreolus) ha experimentado una considerable expansión en Aragón. En el Sistema Ibérico zaragozano (SIZ) este proceso se ha visto acompañado por un incremento del interés cinegético hacia la especie y por una creciente conflictividad asociada a los daños en cultivos de leñosas. En Aragón es la Administración la responsable de planificar el aprovechamiento cinegético de la caza, asignando los cupos de captura a los cotos de caza. Durante la elaboración de los planes de caza se debe atender a posiciones e intereses muchas veces contrapuestos, por lo que para gestionar estas poblaciones es imprescindible contar con datos objetivos sobre su estado. Para ello se ha desarrollado un plan de seguimiento del corzo en Aragón basado en la realización periódica de transectos de recuento de grupos fecales sobre recorridos fijos. Esta información se complementa con las observaciones de corzo registradas en una red de fareos nocturnos diseñada originalmente para el seguimiento de lagomorfos y zorro. Los datos obtenidos en el SIZ indican que entre 2005 y 2009 la abundancia media de corzo se ha duplicado y que su densidad media alcanza 5,4 ± 0,33 corzos/km2. Inicialmente los planes de caza seguían criterios conservadores que permitiesen mantener la población en crecimiento, con una tasa de extracción moderada, un cupo equilibrado entre machos y hembras y una caza selectiva a rececho. Ante la evolución positiva de la especie y la necesidad de atenuar las protestas por daños en cultivos, fundamentalmente frutales, se ha cambiado a una estrategia de control poblacional con un notable incremento de la presión cinegética: se amplía el periodo hábil de caza, se autoriza la caza en batidas y se aumenta la tasa de extracción, aunque se ha mantenido la sex-ratio equilibrada en los cupos. A pesar de que el cumplimiento del cupo se sitúa en torno al 80%, y se ha pasado de 193 capturas en 2005 a 1.084 en 2009, hasta ahora no se ha conseguido frenar el crecimiento poblacional

Serum levels of caspase-cleaved cytokeratin-18 and mortality are associated in severe septic patients: Pilot study

Objective: Apoptosis is increased in sepsis. Cytokeratin 18 (CK-18), a protein of the intermediate filament group present in most epithelial and parenchymal cells, is cleaved by the action of caspases and released into the blood as caspase-cleaved CK (CCCK)-18 during apoptosis. Circulating levels of CCCK-18 have scarcely been explored in septic patients. In one study with 101 severe septic patients, the authors reported higher serum CCCK-18 levels in non-survivors than in survivors; however, the sample size was too small to demonstrate an association between serum CCCK-18 levels and early mortality and whether they could be used as a biomarker to predict outcomes in septic patients. Thus, these were the objectives of this study with a large series of patients. Methods: We performed a prospective, multicenter, observational study in six Spanish Intensive Care Units with 224 severe septic patients. Blood samples were collected at the time that severe sepsis was diagnosed to determine serum levels of CCCK-18, tumor necrosis factor (TNF)-alpha, interleukin (IL)-6 and IL-10. The end point was 30-day mortality. Results: Non-surviving patients (n = 80) showed higher serum CCCK-18 levels (P391 u/L were associated with 30-day survival (Odds ratio = 2.687; 95% confidence interval = 1.449-4.983; P = 0.002), controlling for SOFA score, serum lactic acid levels and age. Kaplan-Meier survival analysis showed that the risk of death in septic patients with serum CCCK-18 levels >391 u/L was higher than in patients with lower values (Hazard Ratio = 3.1; 95% CI = 1.96-4.84; P<0.001). Serum CCCK-18 levels were positively associated with serum levels of IL-6 and lactic acid, and with SOFA and APACHE scores. Conclusions: The major novel finding of our study, the largest cohort of septic patients providing data on circulating CCCK-18 levels, was that serum CCCK-18 levels are associated with mortality in severe septic patients