The outcome of surgical treatment for pancreatic head carcinoma in relation to the extent of lymphadenectomy

Uvod. Ideja ekstenzivne limfadenektomije je zasnovana na ideji da limfni nodusi izvan polja standardne disekcije mogu sadržati metastaze. Studije japanskih autora Ishikawe-a i Manabe-a iz 1988. i 1989. pokazale su značajno duže višegodišnje preživljavanje pacijenata kojima je rađena duodenopankreatektomija (DP) sa radikalnom limfadenektomijom u odnosu na one kod kojih je rađena standardna limfadenektomija. Od tada, benefit od radikalne limfadenektomije bio je predmet brojnih retrospektivnih studija u Japanu i na Zapadu. Višegodišnje preživljavanje u ovim studijama nije bilo značajno duže ali su stope postoperativnih komplikacija bile u nekim studijama značajno veće. Prva randomizirana kontrolisana studija (RCT) koja je poredila rezultate nakon standardne odnosno radikalne limfadenektomije kod DP bila je studija Pedrazzoli-ja. U ovoj studiji pacijenti sa radikalnom limfadenektomijom su imali značajno duže višegodišnje preživljavanje ali se ovo odnosilo samo na podgrupu pacijenata sa metastazama u limfnim nodusima (N1-status). Sledeće tri randomizirane kontrolisane studije nisu uspele da ponove rezultate Pedrazzoli-jeve studije odnosno nisu pokazale benefit u višegodišnjem preživljavanju nakon radikalne limfadenektomije. Ostali rezultati u smisli mortaliteta, morbiditeta i kvaliteta života bili su slični ili lošiji kod pacijenata sa radikalnom disekcijom limfnih nodusa. Ciljevi istraživanja. Primarni cilj istraživanja bio je analiza uticaja vrste hirurške procedure, standardne odnosno radikalne limfadenektomije na dugoročno preživljavanje pacijenata kojima je urađena DP zbog karcinoma glave pankreasa. Drugi ciljevi uključivali su analizu uticaja vrste hirurške procedure, standardne odnosno radikalne limfadenektomije na stope perioperativnog mortaliteta, postoperativnog morbiditeta i analizu prediktora mortaliteta. Materijal i metode. Istraživanje je dizajnirano po tipu prospektivne kohortne studije. U studiju su uključeni pacijenti mlađi od 80 godina sa potencijalno resektabilnim adenokarcinomom glave pankreasa bez pacijenata sa mucinoznim cistadenokarcinomima i intraduktalnim papilarnim mucinoznim karcinomima. Drugi kriterijumi isključenja iz studije bili su udaljenje visceralne metastaze, R2 resekcija, ASA (American Society of Anesthesiologists) skor veći od 3 i adjuvantna terapija. Studija je odobrena od strane etičkog odbora a svi pacijenti su potpisali pristanak za učešće u studiji. Od januara 2007. do decembra 2010., 103 pacijenta sa potencijalno resektabilnim karcinomom glave pankreasa su operisani pilorus-preserving duodenopankreatektomijom (PPDP) na Klinici za digestivnu hirurgiju, Klinički Centar Srbije. Pacijenti su podeljeni u dve grupe. Prva grupa (S=53) je operisana PPDP sa standardnom limfadenektomijom. Druga grupa (R=50) je operisana PPDP sa radikalnom limfadenektomijom. Pacijenti su praćeni na mesec dana prvih 6 meseci, potom na 3 meseca do navršene prve godine od operacije i na 6 meseci nakon toga...Introduction. The idea of extended lymphadenectomy was based on the fact that lymph nodes outside the field of dissection can harbour micrometastases. In the studies by Japanese authors Ishikawa and Manabe from 1988 and 1989, long-term survival was significantly improved in patients who underwent pancreaticoduodenectomy (PD) with extended lymphadenectomy comparing to those with standard lymphadenectomy. Since then, the benefit of extended lymphadenectomy has been evaluated in retrospective studies in Japan and also in Western countries. Long-term survival did not differ significantly in patients with extended lymphadenectomy compared to those with standard lymphadenectomy but some studies showed significantly higher rates of postoperative complications in patients who underwent PD with extended lymphadenectomy. The first RCT (randomized controlled trial) to compare the results of standard versus extended lymphadenectomy in PD, was reported by Pedrazzoli et al. In this trial patients who underwent PD with extended lymphadenectomy had a significantly better long-term survival but this regards only to patients with lymph node metastasis (N1). Three other RCTs failed to repeat Pedrazzoli's results and did not prove benefit in long-term survival in patients who underwent extended lymphadenectomy for pancreatic head carcinoma. Other results concerning mortality, morbidity and quality of life were similar between groups or even worse in patients with extended pancreatoduodenectomy. Aims and objectives. The primary aim of this study was to evaluate the benefit of extended lymphadenectomy in PD and to estimate its impact on long-term survival in patients with pancreatic head carcinoma. Secondary end-points included perioperative mortality, postoperative morbidity and predictors of mortality (survival) in patients undergoing standard versus extended lymphadenectomy for pancreatic head carcinoma. Material and methods. The study was designed as a prospective cohort study. For this trial we enrolled patients younger than 80 years of age with potentially resectable adenocarcinoma of the pancreatic head, excluding mucinous cystadenocarcinoma and intraductal papillary mucinous carcinoma. Other exclusion criteria included distant visceral metastases, R2 resection, ASA (American Society of Anesthesiologists) score higher than 3 and any adjuvant therapy previously received. This study was approved by institutional ethical review board and all patients gave their written consent before they were enrolled in the study. From January 2007 to December 2010, 103 patients with potentially resectable pancreatic head carcinoma were enrolled and resected using pilorus-preserving pancreaticoduodenectomy (PPPD) at Clinic for Digestive Surgery, Clinical Center of Serbia. Patients were divided into two groups. First group (S=53) underwent PPPD with standard lymphadenectomy. Second group (R=50) was operated with PPPD with extended lymphadenectomy. Mortality was defined as any death related to surgery. The patients were followed monthly during first 6 months, every 3 months until one year from surgery and every 6 months since. Minimum follow-up period for each patient was 5 years..

Principal maize viruses in Mediterranean countries

Maize plants with virus-like symptoms were sampled in fields in Greece, Yugoslavia and Italy in 1994. Disease incidence (%) and disease severity (1-6) were assessed. Leaf samples were tested by enzyme-linked immunosorbent assay (ELISA) and electroblot immunoassay (EBIA). Antisera against maize dwarf mosaic virus (MDMV), sugarcane mosaic virus (SCMV) and barley yellow dwarf viruses (BYDVs) (PAV- and RPV-like) were used in these tests. A higher disease incidence occurred in Italy and Greece than in Yugoslavia. MDMV was proved by both ELISA and EBIA in all maize genotypes in Greece, Yugoslavia and Italy. None of the samples reacted with SCMV antibodies. A total of 13.7 and 11% of individual Greek samples were positive for PAV- and RPV- respectively, while, 17.5 and 5% of Yugoslav samples were positive for PAV- and RPV- respectively. Phragmites sp, a perennial maize weed, was also positive for PAV- and RPV- by ELISA

Insulin responses to acute glucose infusions in Buša and Holstein-Friesian cattle breed during the peripartum period: Comparative study

The aim of this study was to compare insulin responsevness to acute glucose infusion in cows of Holstein Friesian (HF) and Buša breeds during the peripartal period. Eight cows per each group (HF and Buša), were chosen. At day 7 prior to calving (ante partum) and day 14 after calving (post partum) animals were subjected to a glucose tolerance test (GTT). Blood samples were taken immediately before infusion and 15, 30, 60, 120 and 180 min thereafter. Glucose and insulin concentrations were measured in each blood sample, while BHBA and NEFA were measured only in samples taken before the infusion. QUICKY an indicator of insulin resistance in cows was calculated. Basal glycemia did not significantly differ between the breeds. Basal insulinemia was significantly higher in Buša than in HF cows in both examined periods (p<0.001, respectively). Basal NEFA levels tended (p=0.06) to be higher in Buša cows compared with those of HF ante partum, and was significantly higher (p<0.001) post partum. Basal BHBA was significantly lower in Buša than HF cows in both examined periods (p<0.01; p<0.001). QUICKI was significantly lower in Buša compared to HF cows both ante partum and post partum periods (p<0.001, respectively). Glycemia determined during GTT were higher in Buša than HF cows, both ante partum and post partum, but significantly starting from minute 15 ante partum i.e. minute 30 post partum. Insulinemia determined during GTT was significantly lower at min 15, and significantly higher starting from min 90 in Buša than HF cows, both ante partum and post partum. Results obtained in this study indicate on difference in insulin responsevness to acute glucose infusion between the examined breeds, which is probably a consequence of the difference in the degree of negative energy balance rather than of selection on high milk production. Namely, decreased insulin tissues sensitivity and decreased insulin responsiveness in Buša compared to HF cows is probably the consequence of inadequate energy intake from alimentary sources which leads to enhanced usage of energy from body reserves. [Projekat Ministarstva nauke Republike Srbije, br. 46002

The application of physicochemical methods for the analysis of radiation processed food products

The aim of this study was to investigate the occurrence and stability of free radicals in freeze-dried samples of cow milk, pineapple and banana after irradiation (10 kGy dose), using the ESR spectroscopy, as well as to assess possible changes in their protein structure by means of electrophoresis.The Conference is dedicated to the 100th Anniversary of the academician Pavle Savić birthday and 20th Anniversary of the Society of Physical Chemists of SerbiaPhysical chemistry 2010 : 10th international conference on fundamental and applied aspects of physical chemistry; September 21-24, Belgrade, 2012

Uloga hepatičnih zvezdastih ćelija (HSCs) u razvoju fibroze jetre mačaka sa policističnim bubrezima (PKD)

Hepatic stellate cells (HSCs) play a significant role in hepatic fibrogenesis. In the following study we described the distribution of cells that express alpha-smooth muscle actin (α-SMA) and desmin in the cat liver with various degrees of fibrosis, as well as the significance of hepatic stellate cells and portal myofibroblasts in the genesis of fibrosis in cats with polycistic kidney disease. Liver samples from 15 necropsied Persian cats were examined microscopically, using H&E and Masson-trichrom methods and immunohistology for α-SMA and desmin. Liver fibrosis was confirmed in cats with terminal stage of chronic cholangiohepatitis and it was characterized by connective tissue septa which divide the liver parenchyma into irregular lobuli. Inflammation in the cat liver is connected with the activation of periductal myofibroblasts. The intensity of immunopositivity of perisinusoidal HSCs to α-SMA and desmin varied depending on the degree of fibrosis and was the strongest in livers of cats with cirrhosis.U ovom radu je opisana distribucija ćelija koje eksprimiraju α-glatkomišićni aktin (α-SMA) i dezmin u jetri mačaka sa različitim stadijumom fibroze, kao i značaj ovih ćelija u razvoju fibroze, kod mačaka sa policističnim bubrezima. Mikroskopski su ispitani uzorci jetre od 15 obdukovanih persijskih mačaka, korišćenjem HE i Mason-trihromnog bojenja i imunohistohemijski na α-SMA i dezmin. Fibroza jetre potvrđena je kod mačaka sa terminalnim stadijumom hroničnog holangiohepatitisa i odlikovala se prisustvom vezivno-tkivnih septi koje dele parenhim na nejednake lobuluse. Inflamacija u jetri mačaka u vezi je sa aktivacijom periduktalnih miofibroblasta. Intenzitet imunohistohemijske reakcije perisinusoidnih HSCs na α-SMA i dezmin razlikovala se od stepena fibroze i bio je najjači u jetri mačaka sa cirozom

Gastric adenomyoma

Bacground. Gastric adenomyoma is a rare, hamartomatous tumor localized most frequently in the gastric antrum. Review of the available literature shows only sporadic reports or smaller series. Case reports. We presented a 72-year-old woman admitted due to epigastric pain with dyspeptic difficulties. Biochemical parameters and tumor markers were within the referential limits. Diagnostic procedures (upper endoscopy, endoscopic ultrasonography and computerized tomography) revealed an intramural tumor prominence with intact mucosa on the posterior wall of gastric antrum, not accessible for biopsy. Surgical treatment was performed with total extirpation of the tumor. Histopathological examination verified adenomyoma with focal low grade epithelial dysplasia. Cytologic immunophenotype was consistent with smooth muscle stromal and epithelial tumor (CK7 and CK20 ++ immunophenotype). Stromal component revealed low proliferative index (Ki-67 protein immunoexpression level 3%), and p53 less than 0.1% in both epithelial and stromal components. Following the operation, the patient remained in good condition. Conclusion. Uncertain malignant potential of the gastric adenomyoma in the presented case indicates that timely diagnostics with adequate surgical treatment is crucial for an adequate treatment

The formation and characterization of nanocrystalline phases by mechanical milling of biphasic calcium phosphate/poly-L-lactide biocomposite

Biphasic calcium phosphate/poly-L-lactide granules of 150-200 mu m sizes were subjected to high-energy mechanical milling in a planetary ball mill for up to 480 minutes. Characterization of the material obtained was carried out using X-ray diffraction (XRD), differential scanning calorimetry (DSC), environmentally scanning electronic microscopy (ESEM), transmission electron microscopy (TEM) and infrared spectroscopy (IR). These techniques confirmed that mechanical milling induced significant changes in the biocomposite structure and properties. The most significant changes are reduction of the HAp crystallites size from 99.8 to 26.7 nm and beta-TCP from 97.3 to 29.6, as well as crystallinity of PLLA phases. Homogeneous phase distribution (arrangement) is obtained by extending the duration of mechanical milling

Nekotorye otnoščenija meždu strukturami, polučennymi pri pomošči transformacii značimyh glavnyh komponentov matricy interkorrjaelcii i značnimyh glavnyh ocej imaž matricy kovariacii

Varimax and oblimin trasformations of significant principal components of complete intercorelation matrixes and significant principal axes of image matrixes of covariances were compared. Varimax poorl approximates simple structure, tending to produce general and poorly defined group factors and sometimes integrating those factors which in oblimin position are highly intercorrelated. Oblimin ususally gives very simple structure with well defined factors, especially if significant principal axes of image matrixes of covariances are transformed. The same analyses using the same tests on 9 subsamples (of which some overlapping from the same population were very similar. Not only that varimax invariance was not higher than direction oblimin invariance, but it was, as a rule, significantly lower. Therefore, ti seems that oblimin transformation of significant iage axes is very suitable method for explorative factor analyses of psychological measurement instruments

Deflection control for reinforced recycled aggregate concrete beams: Experimental database and extension of the fib Model Code 2010 model

Recycled aggregate concrete (RAC) has emerged as a viable solution for solving some of the environmental problems of concrete production. However, design guidelines for deflection control of reinforced RAC members have not yet been proposed. This study presents a comprehensive analysis of the applicability of the fib Model Code 2010 (MC2010) deflection control model to reinforced RAC beams. Three databases of long-term studies on natural aggregate concrete (NAC) and RAC beams were compiled and meta-analyses of deflection predictions by MC2010 were performed. First, the MC2010 deflection control model was tested against a large database of long-term tests on NAC beams. Second, a database of RAC and companion NAC beams was compiled and initial and long-term deflections were calculated using the MC2010 model. It was shown that deflections of RAC beams are significantly underestimated relative to NAC beams. Previously proposed modifications for MC2010 equations for shrinkage strain and creep coefficient were used, and new modifications for the modulus of elasticity and empirical coefficient β were proposed. The improved MC2010 deflection control model on RAC beams was shown to have equal performance to that on companion NAC beams. The proposals presented in this paper can help engineers to more reliably perform deflection control of reinforced RAC members.This is the peer-reviewed version of the article: N. Tošić, S. Marinković, and J. de Brito, ‘Deflection control for reinforced recycled aggregate concrete beams: Experimental database and extension of the fib Model Code 2010 model’, Structural Concrete, vol. 20, no. 6, pp. 2015–2029, 2019 [https://doi.org/10.1002/suco.201900035