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

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

Evolving coral reef conservation with genetic information

Targeted conservation and management programs are crucial for mitigating anthropogenic threats to declining biodiversity. Although evolutionary processes underpin extant patterns of biodiversity, it is uncommon for resource managers to explicitly consider genetic data in conservation prioritization. Genetic information is inherently relevant to management because it describes genetic diversity, population connectedness, and evolutionary history; thereby typifying their behavioral traits, physiological climate tolerance, evolutionary potential, and dispersal ability. Incorporating genetic information into spatial conservation prioritization starts with reconciling the terminology and techniques used in genetics and conservation science. Genetic data vary widely in analyses and their interpretations can be challenging even for experienced geneticists. Therefore, identifying objectives, decision rules, and implementations in decision support tools specifically for management using genetic data is challenging. Here, we outline a framework for eight genetic system characteristics, their measurement, and how they could be incorporated in spatial conservation prioritization for two contrasting objectives: biodiversity preservation vs maintaining ecological function and sustainable use. We illustrate this framework with an example using data from Tridacna crocea (Lamarck, 1819) (boring giant clam) in the Coral Triangle. We find that many reefs highlighted as conservation priorities with genetic data based on genetic subregions, genetic diversity, genetic distinctness, and connectivity are not prioritized using standard practices. Moreover, different characteristics calculated from the same samples resulted in different spatial conservation priorities. Our results highlight that omitting genetic information from conservation decisions may fail to adequately represent processes regulating biodiversity, but that conservation objectives related to the choice of genetic system characteristics require careful consideration

Methods for calculating Protection Equality for conservation planning

Protected Areas (PAs) are a central part of biodiversity conservation strategies around the world. Today, PAs cover c15% of the Earth’s land mass and c3% of the global oceans. These numbers are expected to grow rapidly to meet the Convention on Biological Diversity’s Aichi Biodiversity target 11, which aims to see 17% and 10% of terrestrial and marine biomes protected, respectively, by 2020. This target also requires countries to ensure that PAs protect an “ecologically representative” sample of their biodiversity. At present, there is no clear definition of what desirable ecological representation looks like, or guidelines of how to standardize its assessment as the PA estate grows. We propose a systematic approach to measure ecological representation in PA networks using the Protection Equality (PE) metric, which measures how equally ecological features, such as habitats, within a country’s borders are protected. Extending research in Barr et al. (2011), we present an R package and two Protection Equality (PE) measures; proportional to area PE, and fixed area PE, which measure the representativeness of a country’s PA network. We illustrate the PE metrics with two case studies: coral reef protection across countries and ecoregions in the Coral Triangle, and representation of ecoregions of six of the largest countries in the world. Our results provide repeatable transparency to the issue of representation in PA networks and provide a starting point for further discussion, evaluation and testing of representation metrics. They also highlight clear shortcomings in current PA networks, particularly where they are biased towards certain assemblage types or habitats. Our proposed metrics should be used to report on measuring progress towards the representation component of Aichi Target 11. The PE metrics can be used to measure the representation of any kind of ecological feature including: species, ecoregions, processes or habitats