Focused open necrosectomy in necrotizing pancreatitis

AbstractBackgroundThe control of sepsis is the primary goal of surgical intervention in patients with infected necrosis. Simple surgical approaches that are easy to reproduce may improve outcomes when specialists in endoscopy are not available. The aim of the present study was to describe the experience with a focused open necrosectomy (FON) in patients with infected necrosis.MethodA prospective pilot study conducted to compare a semi‐open/closed drainage laparotomy and FON with the assistance of peri‐operative ultrasound. The incidence of sepsis, dynamics of C‐reactive protein (CRP), intensive care unit (ICU)/hospital stay, complication rate and mortality were compared and analysed.ResultsFrom a total of 58 patients, 36 patients underwent a conventional open necrosectomy and 22 patients underwent FON. The latter method resulted in a faster resolution of sepsis and a significant decrease in mean CRP on Day 3 after FON, P = 0.001. Post‐operative bleeding was in 1 versus 7 patients and the incidence of intestinal and pancreatic fistula was 2 versus 8 patients when comparing FON to the conventional approach. The median ICU stay was 11.6 versus 23 days and the hospital stay was significantly shorter, 57 versus 72 days, P = 0.024 when comparing FON versus the conventional group. One patient died in the FON group and seven patients died in the laparotomy group, P = 0.139.DiscussionFON can be an alternative method to conventional open necrosectomy in patients with infected necrosis and unresolved sepsis

Ultrasound-Assisted Focused Open Necrosectomy in the Treatment of Necrotizing Pancreatitis

Publisher Copyright: © 2015, JOP. J Pancreas (Online). All rights reserved.Introduction The surgical treatment of necrotizing pancreatitis includes percutaneous drainage of acute necrotic collections and sequestrectomy in the late phase of the disease. The aim of the study was to compare the conventional open necrosectomy (CON) approach with the alternative focused open necrosectomy (FON) approach in patients with infected necrosis and progression of sepsis. Methods Patients with acute necrotizing pancreatitis were included in the study prospectively from January 2004 to July 2014. All patients had been admitted with the first or a new episode of disease. Symptomatic large fluid collections were drained percutaneously. The step-up approach was used in patients with several distant localizations of infected necrosis. The methods were analysed by comparing the individual severity according to the ASA, APACHE II and SOFA scores, infection rate, postoperative complication rate and mortality. Results A total of 31 patients were included in the FON group and 39 in the CON group. The incidence of infection was similar in groups. More ASA III comorbid conditions, a higher APACHE II score, a more frequent need for renal replacement therapy was observed in the CON group. The postoperative complication rate was in the range of 32% to 44%; mortality reached 6.5% in the FON group and 12.8% in the CON group. Conclusions Comorbid conditions, organ failure, and infection are the main risk factors in patients with necrotizing pancreatitis. The step-up approach and perioperative ultrasonography navigation improves the clinical outcome and reduces the extent of invasive surgical intervention in patients unsuited to other minimally invasive procedures.publishersversionPeer reviewe

Deep learning-based fully automatic segmentation of wrist cartilage in MR images

The study objective was to investigate the performance of a dedicated convolutional neural network (CNN) optimized for wrist cartilage segmentation from 2D MR images. CNN utilized a planar architecture and patch-based (PB) training approach that ensured optimal performance in the presence of a limited amount of training data. The CNN was trained and validated in twenty multi-slice MRI datasets acquired with two different coils in eleven subjects (healthy volunteers and patients). The validation included a comparison with the alternative state-of-the-art CNN methods for the segmentation of joints from MR images and the ground-truth manual segmentation. When trained on the limited training data, the CNN outperformed significantly image-based and patch-based U-Net networks. Our PB-CNN also demonstrated a good agreement with manual segmentation (Sorensen-Dice similarity coefficient (DSC) = 0.81) in the representative (central coronal) slices with large amount of cartilage tissue. Reduced performance of the network for slices with a very limited amount of cartilage tissue suggests the need for fully 3D convolutional networks to provide uniform performance across the joint. The study also assessed inter- and intra-observer variability of the manual wrist cartilage segmentation (DSC=0.78-0.88 and 0.9, respectively). The proposed deep-learning-based segmentation of the wrist cartilage from MRI could facilitate research of novel imaging markers of wrist osteoarthritis to characterize its progression and response to therapy

Cultural Cooperation on Space of the CIS

The common cultural space of the CIS countries has appeared as a response of their citizens to destruction of the former Soviet culture. Despite of the controversial goals established by political elites, who led the newly independent states, cooperation has continued to preserve the further interaction and mutual enrichment of the cultures which meet the needs of their peoples. In some cases, cultural cooperation outpaces the progress in political and economic cooperation between states, creating favorable conditions for interaction in other fields. There are new forms of cultural cooperation, which appear and make possible to the CIS members to act together on the international arena. It is important that such trends were noticed by the political elites on time and skillfully used in the common interests of the Community of Independent States

Noncovalent interactions in crowded olefinic radical cations

Peer reviewe

Cortical branched actin determines cell cycle progression

International audienc

Диагностика фемороацетабулярного импинджмент-синдрома: роль магнитно-резонансной томографии

The aim of the study was to determine the role of MRI in diagnostics of femoroacetabular impingement syndrome of the hip. Materials and Methods. MRI-scanning results were analyzed for 142 persons (63 (44.4%) males, 79 (55,6%) females; mean age 34 ± 3.2 y.o.), 122 (85.9%) of them had complaints of pain sensation located in the hip joint. All the patients were divided into two groups: an experimental group (n = 122 (85.9%; 62 (50.8%) males, 60 (49.8%) females; mean age 33 ± 5.7 y.o) and a control group (n = 20 (14.1%); 15 (75.0%) males, 5 (25.0%) females; mean age 30 ± 3.8 y.o.). The enrollment criteria for the control group were: absence of complaints of pain sensation located in the hip joint, under sixty years of age. The age limit was provided the high risk of involutional changes in the hip within the patients of this age. In all patients MRI examination were done by high-field MR-scanners associated to designed protocol. While interpreting the results values of neck-shaft angle, lateral center edge angle, Tonnis angle and alpha angle were determined. Results. Different types of femoroacetabular impingement syndrome were determined in 35 (28.7%) patients. In all patients pathologic parameters were observed: abnormal (39 degrees) lateral center edge angle (n = 17; 48.6%), abnormal (55 degrees) alpha angle (n = 17; 48.6%) were determined. Conclusion. MRI allowed to determine abnormality of configuration of the femoral bone and acetabulum, to characterize the pathological conditions of the labrum and subchondral bone. The main symptoms of femoroacetabular impingement syndrome are pathologic configuration of the femoral head and acetabulum. The degeneration and tear of the labrum could be observed in the early stage of disease.Цель: оценить роль высокопольной МРТ в диагностике импинджмент-синдрома тазобедренного сустава. Материал и методы. Проанализированы результаты клинического и лучевого обследования 142 пациентов (63 (44,4%) мужчины и 79 (55,6%) женщин; средний возраст 34 ± 3,2 года), 122 (85,9%) из них предъявляли жалобы на боли и нарушение функции тазобедренного сустава (62 (50,8%) мужчины и 60 (49,8%) женщин; средний возраст 33 ± 5,7 года) и составили основную группу наблюдения (1-я). Остальные 20 (14,1%) обследованных (15 (75,0%) мужчин и 5 (25,0%) женщин; средний возраст 30 ± 3,8 года) составили контрольную группу (2-я). Критерии отбора пациентов в контрольную группу: отсутствие жалоб на боль и ограничение движений в тазобедренном суставе, возраст моложе 60 лет. Возрастные ограничения были обусловлены высокой долей инволютивных изменений структур тазобедренного сустава у таких пациентов. Всем больным выполняли рентгенографию и МРТ тазобедренных суставов по разработанной методике на аппаратах с индукцией магнитного поля 1,5 Тл. По результатам МРТ производили вычисление шеечно-диафизарного угла (ШДУ), угла Виберга, ацетабулярного индекса, угла альфа. Результаты. Фемороацетабулярный импинджмент-синдром был выявлен у 35 (28,7%) обследованных. У всех пациентов отмечали отклонения морфометрических параметров сустава: уменьшение ШДУ (n = 11; 31,5%), увеличение угла альфа (n = 17; 48,6%) и угла Виберга (n = 14; 40,0%), уменьшение ацетабулярного индекса (n = 12; 34,3%). Дегенеративные изменения суставной губы различной степени были обнаружены у всех пациентов. Выводы. Выполнение МРТ обеспечивает получение комплексной характеристики всех патологических признаков импинджмент-синдрома тазобедренного сустава. Основными МР-признаками фемороацетабулярного импинджмент-синдрома являются нарушения конфигурации головки проксимального отдела бедренной кости и формы вертлужной впадины. Дегенеративные изменения и повреждения суставной губы возникают уже на ранних сроках от момента появления болевого синдрома

IUPUI Center for Mathematical Biosciences

poster abstractAt-Large Mission: “to serve as an umbrella center for spearheading research and programmatic activities in the general bio-mathematics area” • promote and facilitate faculty excellence in mathematical and Computational research in the biosciences; • provide a mechanism and an environment that fosters collaborative research activities across the mathematical sciences and the life and health sciences schools at IUPUI— specifically with the IUSOM; • provide foundations and resources for further strategic development in targeted areas of mathematical and computational biosciences research; and • create greater opportunities and increase competitiveness in seeking and procuring extramural funding