The laparoscopic treatment of perforated duodenal ulcer in Romania – a multicentric study

Clinica Chirurgie 2, Timișoara, România, Clinica Chirurgie, Spitalul de Urgență, București, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Aims. This retrospective study was evaluated the results of laparoscopic treatment of the perforated duodenal ulcer (PDU) in 6 Romanian centres with an important experience in laparoscopic surgery.Methods. Between 2000 and 2010, 221 patients (38 females and 183 men) aged from 18 to 78 years, were operated laparoscopicaly for PDU, by using 3 (66.0%), 4 (27%) or 5 (7.0%) trocars. Forty six (20.8%) of them had a weak, 143(64.7%) an important and 32(14.5%) a grave peritonitis. Procedures performed were: simple suture 84(38.1%) patients, suture with epiplonoplasty 135(61.1%) patients, only epiplonoplasty 1(0.4%) patients, excision with suture 1(0.4%) patients. All patients had abundant peritoneal cavity washing and tub drainage (1-3 tubs).Results. The interventions lasted between 30 and 120 min, with an average of 63 min. No mortality was reported. Postoperative oral nutrition began after 24 hours for 114(51.6%) patients and after intestinal transit has restarted for 107(48.4%) patients. The intestinal transit has restarted after 1-6 days (average 3.5 days), depending of the gravity of peritonitis. Complications were: parietal infections 3 (1.3%), duodenal fistula 1 (0.4%), abdominal abcesses 1(0.4%), digestive haemorrhage 1(0.4%) and duodenal stenosis 1 (0.4%). Hospitalization lasted between 2 and 13 days (average 5.5 days). In comparison with open techniques, patients had the same intravenous perfusions, less pain, less antibiotics, less dressings, less complications during postoperative evolution. Conclusion. Laparoscopic treatment of PDU is safe even in case of severe peritonitis, with faster patient’s recovery. with less complications and with less postoperative medical care than open procedures. Aims. This retrospective study was evaluated the results of laparoscopic treatment of the perforated duodenal ulcer (PDU) in 6 Romanian centres with an important experience in laparoscopic surgery.Methods. Between 2000 and 2010, 221 patients (38 females and 183 men) aged from 18 to 78 years, were operated laparoscopicaly for PDU, by using 3 (66.0%), 4 (27%) or 5 (7.0%) trocars. Forty six (20.8%) of them had a weak, 143(64.7%) an important and 32(14.5%) a grave peritonitis. Procedures performed were: simple suture 84(38.1%) patients, suture with epiplonoplasty 135(61.1%) patients, only epiplonoplasty 1(0.4%) patients, excision with suture 1(0.4%) patients. All patients had abundant peritoneal cavity washing and tub drainage (1-3 tubs). Results. The interventions lasted between 30 and 120 min, with an average of 63 min. No mortality was reported. Postoperative oral nutrition began after 24 hours for 114(51.6%) patients and after intestinal transit has restarted for 107(48.4%) patients. The intestinal transit has restarted after 1-6 days (average 3.5 days), depending of the gravity of peritonitis. Complications were: parietal infections 3 (1.3%), duodenal fistula 1 (0.4%), abdominal abcesses 1(0.4%), digestive haemorrhage 1(0.4%) and duodenal stenosis 1 (0.4%). Hospitalization lasted between 2 and 13 days (average 5.5 days). In comparison with open techniques, patients had the same intravenous perfusions, less pain, less antibiotics, less dressings, less complications during postoperative evolution. Conclusion. Laparoscopic treatment of PDU is safe even in case of severe peritonitis, with faster patient’s recovery. with less complications and with less postoperative medical care than open procedures

Mapping and assessment of ecosystems and their services. Urban ecosystems

Action 5 of the EU Biodiversity Strategy to 2020 requires member states to Map and Assess the state of Ecosystems and their Services (MAES). This report provides guidance for mapping and assessment of urban ecosystems. The MAES urban pilot is a collaboration between the European Commission, the European Environment Agency, volunteering Member States and cities, and stakeholders. Its ultimate goal is to deliver a knowledge base for policy and management of urban ecosystems by analysing urban green infrastructure, condition of urban ecosystems and ecosystem services. This report presents guidance for mapping urban ecosystems and includes an indicator framework to assess the condition of urban ecosystems and urban ecosystem services. The scientific framework of mapping and assessment is designed to support in particular urban planning policy and policy on green infrastructure at urban, metropolitan and regional scales. The results are based on the following different sources of information: a literature survey of 54 scientific articles, an online-survey (on urban ecosystems, related policies and planning instruments and with participation of 42 cities), ten case studies (Portugal: Cascais, Oeiras, Lisbon; Italy: Padua, Trento, Rome; The Netherlands: Utrecht; Poland: Poznań; Spain: Barcelona; Norway: Oslo), and a two-day expert workshop. The case studies constituted the core of the MAES urban pilot. They provided real examples and applications of how mapping and assessment can be organized to support policy; on top, they provided the necessary expertise to select a set of final indicators for condition and ecosystem services. Urban ecosystems or cities are defined here as socio-ecological systems which are composed of green infrastructure and built infrastructure. Urban green infrastructure (GI) is understood in this report as the multi-functional network of urban green spaces situated within the boundary of the urban ecosystem. Urban green spaces are the structural components of urban GI. This study has shown that there is a large scope for urban ecosystem assessments. Firstly, urban policies increasingly use urban green infrastructure and nature-based solutions in their planning process. Secondly, an increasing amount of data at multiple spatial scales is becoming available to support these policies, to provide a baseline, and to compare or benchmark cities with respect to the extent and management of the urban ecosystem. Concrete examples are given on how to delineate urban ecosystems, how to choose an appropriate spatial scale, and how to map urban ecosystems based on a combination of national or European datasets (including Urban Atlas) and locally collected information (e.g., location of trees). Also examples of typologies for urban green spaces are presented. This report presents an indicator framework which is composed of indicators to assess for urban ecosystem condition and for urban ecosystem services. These are the result of a rigorous selection process and ensure consistent mapping and assessment across Europe. The MAES urban pilot will continue with work on the interface between research and policy. The framework presented in this report needs to be tested and validated across Europe, e.g. on its applicability at city scale, on how far the methodology for measuring ecosystem condition and ecosystem service delivery in urban areas can be used to assess urban green infrastructure and nature-based solutions

A MULTICENTER, OBSERVATIONAL, AMBISPECTIVE STUDY EVALUATING EFFICACY AND SAFETY OF GENERIC IMATINIB COMPARED TO GLEEVEC IN CHRONIC MYELOGENOUS LEUKEMIA IN CHRONIC PHASE-3 MONTHS RESPONSE ANALYSIS

Univ Estadual Campinas, Hematol & Hemotherapy Ctr, Campinas, SP, BrazilUniv Fed Minas Gerais, Hosp Clin, Belo Horizonte, MG, BrazilInst Nacl Cancer, Rio De Janeiro, BrazilFac Med, Sao Paulo, BrazilUniv Sao Paulo, Sao Paulo, BrazilHemorio, Rio De Janeiro, BrazilHosp Clin Porto Alegre, Porto Alegre, RS, BrazilCtr Pesquisa Oncol Santa Catarina, Florianopolis, SC, BrazilUniv Fed Bahia, Salvador, BA, BrazilUniv Fed Sao Paulo, Sao Paulo, BrazilInst Estudos & Pesquisas Sao Lucas, Sao Paulo, BrazilUniv Estadual Campinas, Campinas, SP, BrazilUniv Fed Sao Paulo, Sao Paulo, BrazilWeb of Scienc

Expert Consensus Recommendations for the Suspicion and Diagnosis of Transthyretin Cardiac Amyloidosis

Cardiomyopathy is a manifestation of transthyretin amyloidosis (ATTR), which is an underrecognized systemic disease whereby the transthyretin protein misfolds to form fibrils that deposit in various tissues and organs. ATTR amyloidosis is debilitating and associated with poor life expectancy, especially in those with cardiac dysfunction, but a variety of treatment options have recently become available. Considered a rare disease, ATTR amyloidosis may be more prevalent than thought, particularly in older persons. Diagnosis is often delayed because of a lack of disease awareness and the heterogeneity of symptoms at presentation. Given the recent availability of effective treatments, early recognition and diagnosis are especially critical because treatment is likely more effective earlier in the disease course. The Amyloidosis Research Consortium recently convened a group of experts in ATTR amyloidosis who, through an iterative process, agreed on best practices for suspicion, diagnosis, and characterization of disease. This review describes these consensus recommendations for ATTR associated with cardiomyopathy as a resource to aid cardiologists and others in the recognition and diagnosis of ATTR associated with cardiomyopathy. Included in this review is an overview of red flag signs and symptoms and a recommended diagnostic approach, including testing for monoclonal protein, scintigraphy, or biopsy and, if ATTR associated with cardiomyopathy is identified, TTR genotyping

Management of KPC-Producing Klebsiella pneumoniae Infections

Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) has become one of the most important contemporary pathogens, especially in endemic areas

Measurement of the atmospheric muon depth intensity relation with the NEMO Phase-2 tower

The results of the analysis of the data collected with the NEMO Phase-2 tower, deployed at 3500 m depth about 80 km off-shore Capo Passero (Italy), are presented. Cherenkov photons detected with the photomultipliers tubes were used to reconstruct the tracks of atmospheric muons. Their zenith-angle distribution was measured and the results compared with Monte Carlo simulations. An evaluation of the systematic effects due to uncertainties on environmental and detector parameters is also included. The associated depth intensity relation was evaluated and compared with previous measurements and theoretical predictions. With the present analysis, the muon depth intensity relation has been measured up to 13 km of water equivalent.Comment: submitted to Astroparticle Physic

NEMO: A Project for a km3^3 Underwater Detector for Astrophysical Neutrinos in the Mediterranean Sea

The status of the project is described: the activity on long term characterization of water optical and oceanographic parameters at the Capo Passero site candidate for the Mediterranean km$^3$ neutrino telescope; the feasibility study; the physics performances and underwater technology for the km$^3$; the activity on NEMO Phase 1, a technological demonstrator that has been deployed at 2000 m depth 25 km offshore Catania; the realization of an underwater infrastructure at 3500 m depth at the candidate site (NEMO Phase 2).Comment: Proceeding of ISCRA 2006, Erice 20-27 June 200

Modelos de crecimiento y producción en España: historia, ejemplos contemporáneos y perspectivas

En el presente trabajo se presenta una revisión sobre los modelos forestales desarrollados en España durante los últimos años, tanto para la producción maderable como no maderable y, para la dinámica de los bosques (regeneración, mortalidad). Se presentan modelos tanto de rodal completo como de clases diamétricas y de árbol individual. Los modelos desarrollados hasta la fecha se han desarrollado a partir de datos procedentes de parcelas permanentes, ensayos y el Inventario Forestal Nacional. En el trabajo se muestran los diferentes submodelos desarrollados hasta la fecha, así como las plataformas informáticas que permiten utilizar dichos modelos. Se incluyen las principales perspectivas de desarrollo de la modelización forestal en España.In this paper we present a review of forest models developed in Spain in recent years for both timber and non timber production and forest dynamics (regeneration, mortality). Models developed are whole stand, size (diameter) class and individual-tree. The models developed to date have been developed using data from permanent plots, experimental sites and the National Forest Inventory. In this paper we show the different sub-models developed so far and the friendly use software. Main perspectives of forest modeling in Spain are presented.The models described in this paper were funded by different regional, national and European projects, and some of them were elaborated by the authors. This work was funded by the Spanish Government by the SELVIRED network (code AGL2008-03740) and the strategic project «Restauración y Gestión Forestal» (code PSE-310000-2009-4)

Improving the content validity of the mixed methods appraisal tool: a modified e-Delphi study

Objective The mixed methods appraisal tool (MMAT) was developed for critically appraising different study designs. This study aimed to improve the content validity of three of the five categories of studies in the MMAT by identifying relevant methodological criteria for appraising the quality of qualitative, survey, and mixed methods studies. Study Design and Setting First, we performed a literature review to identify critical appraisal tools and extract methodological criteria. Second, we conducted a two-round modified e-Delphi technique. We asked three method-specific panels of experts to rate the relevance of each criterion on a five-point Likert scale. Results A total of 383 criteria were extracted from 18 critical appraisal tools and a literature review on the quality of mixed methods studies, and 60 were retained. In the first and second rounds of the e-Delphi, 73 and 56 experts participated, respectively. Consensus was reached for six qualitative criteria, eight survey criteria, and seven mixed methods criteria. These results led to modifications of eight of the 11 MMAT (version 2011) criteria. Specifically, we reformulated two criteria, replaced four, and removed two. Moreover, we added six new criteria. Conclusion Results of this study led to improve the content validity of this tool, revise it, and propose a new version (MMAT version 2018)