Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery

Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available. The International Study Group on Pancreatic Surgery, an international panel of pancreatic surgeons working in well-known, high-volume centers, reviewed the literature and worked together to establish a consensus on the definition and classification of chyle leak after pancreatic operation. Chyle leak was defined as output of milky-colored fluid from a drain, drain site, or wound on or after postoperative day 3, with a triglyceride content ≥110 mg/dL (≥1.2 mmol/L). Three different grades of severity were defined according to the management needed: grade A, no specific intervention other than oral dietary restrictions; grade B, prolongation of hospital stay, nasoenteral nutrition with dietary restriction, total parenteral nutrition, octreotide, maintenance of surgical drains, or placement of new percutaneous drains; and grade C, need for other more invasive in-hospital treatment, intensive care unit admission, or mortality. This classification and grading system for chyle leak after pancreatic resection allows for comparison of outcomes between series. As with the other the International Study Group on Pancreatic Surgery consensus statements, this classification should facilitate communication and evaluation of different approaches to the prevention and treatment of this complicatio

Evidence Map of Pancreatic Surgery-A living systematic review with meta-analyses by the International Study Group of Pancreatic Surgery (ISGPS)

Background: Pancreatic surgery is associated with considerable morbidity and, consequently, offers a large and complex field for research. To prioritize relevant future scientific projects, it is of utmost importance to identify existing evidence and uncover research gaps. Thus, the aim of this project was to create a systematic and living Evidence Map of Pancreatic Surgery. Methods: PubMed, the Cochrane Central Register of Controlled Trials, and Web of Science were systematically searched for all randomized controlled trials and systematic reviews on pancreatic surgery. Outcomes from every existing randomized controlled trial were extracted, and trial quality was assessed. Systematic reviews were used to identify an absence of randomized controlled trials. Randomized controlled trials and systematic reviews on identical subjects were grouped according to research topics. A web-based evidence map modeled after a mind map was created to visualize existing evidence. Meta-analyses of specific outcomes of pancreatic surgery were performed for all research topics with more than 3 randomized controlled trials. For partial pancreatoduodenectomy and distal pancreatectomy, pooled benchmarks for outcomes were calculated with a 99% confidence interval. The evidence map undergoes regular updates. Results: Out of 30,860 articles reviewed, 328 randomized controlled trials on 35,600 patients and 332 systematic reviews were included and grouped into 76 research topics. Most randomized controlled trials were from Europe (46%) and most systematic reviews were from Asia (51%). A living meta-analysis of 21 out of 76 research topics (28%) was performed and included in the web-based evidence map. Evidence gaps were identified in 11 out of 76 research topics (14%). The benchmark for mortality was 2% (99% confidence interval: 1%–2%) for partial pancreatoduodenectomy and <1% (99% confidence interval: 0%–1%) for distal pancreatectomy. The benchmark for overall complications was 53% (99%confidence interval: 46%–61%) for partial pancreatoduodenectomy and 59% (99% confidence interval: 44%–80%) for distal pancreatectomy. Conclusion: The International Study Group of Pancreatic Surgery Evidence Map of Pancreatic Surgery, which is freely accessible via www.evidencemap.surgery and as a mobile phone app, provides a regularly updated overview of the available literature displayed in an intuitive fashion. Clinical decision making and evidence-based patient information are supported by the primary data provided, as well as by living meta-analyses. Researchers can use the systematic literature search and processed data for their own projects, and funding bodies can base their research priorities on evidence gaps that the map uncovers

Connecting the sustainable development goals by their energy inter-linkages

The United Nations' Sustainable Development Goals (SDGs) provide guide-posts to society as it attempts to respond to an array of pressing challenges. One of these challenges is energy; thus, the SDGs have become paramount for energy policy-making. Yet, while governments throughout the world have already declared the SDGs to be 'integrated and indivisible', there are still knowledge gaps surrounding how the interactions between the energy SDG targets and those of the non-energy-focused SDGs might play out in different contexts. In this review, we report on a large-scale assessment of the relevant energy literature, which we conducted to better our understanding of key energy-related interactions between SDGs, as well as their context-dependencies (relating to time, geography, governance, technology, and directionality). By (i) evaluating the nature and strength of the interactions identified, (ii) indicating the robustness of the evidence base, the agreement of that evidence, and our confidence in it, and (iii) highlighting critical areas where better understanding is needed or context dependencies should be considered, our review points to potential ways forward for both the policy making and scientific communities. First, we find that positive interactions between the SDGs outweigh the negative ones, both in number and magnitude. Second, of relevance for the scientific community, in order to fill knowledge gaps in critical areas, there is an urgent need for interdisciplinary research geared toward developing new data, scientific tools, and fresh perspectives. Third, of relevance for policy-making, wider efforts to promote policy coherence and integrated assessments are required to address potential policy spillovers across sectors, sustainability domains, and geographic and temporal boundaries. The task of conducting comprehensive science-to-policy assessments covering all SDGs, such as for the UN's Global Sustainable Development Report, remains manageable pending the availability of systematic reviews focusing on a limited number of SDG dimensions in each case

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

MitoRibo-Tag mice – a novel tool to study the composition of the mitochondrial ribosome in vivo

Mitochondria, semi-autonomous organelles of eukaryotic cells derived from an α-proteobacterium, are essential for synthesis of iron-sulfur clusters, amino acids, lipids and for maintaining the cellular ATP levels by the oxidative phosphorylation (OXPHOS). During evolution, mitochondria retained a compact double stranded circular mitochondrial DNA (mtDNA) genome, which harbors organelle-specific rRNA, tRNA and mRNA genes. The mitochondrial mRNAs encode highly hydrophobic protein constituents of the OXPHOS system and are translated by mitochondrial ribosomes (mitoribosomes). The coordinated synthesis of mtDNA- and nuclear- encoded OXPHOS proteins is required for mitochondrial integrity and cell survival. Mitoribosomes are structurally and functionally adapted as they have acquired 36 specific proteins, different from bacterial ribosomal proteins, and putatively interact with inner mitochondrial membrane. The regulation of translation and mitoribosome assembly in mitochondria is well studied in Saccharomyces cerevisiae but remains largely unexplored in mammals due to the limited number of available animal models. To obtain new insights into regulatory mechanisms underlying the process of mitochondrial translation, we generated a knock-in mouse model, denoted MitoRibo-Tag mice, expressing a FLAG-tagged mitoribosome protein. We used MitoRibo-Tag mice to determine the mitoribosome interactome across various mouse tissues by proteomics. This mitoribosome protein catalog unravels several novel mitoribosome-interacting proteins (MIPs) and demonstrates intriguing tissue-specific compositional differences. Moreover, the proteomic definition of a biogenesis intermediate, formed in the absence of the mitoribosome assembly factor MTERF4, unveils PUSL1 as a novel MIP. We find that PUSL1 is peripherally associated with the mitochondrial inner membrane from the matrix side and part of a yet unknown mitoribosome biogenesis intermediate. Additionally, depletion of PUSL1 reveals that the protein is required for efficient de novo synthesis of mtDNA-encoded proteins. In summary, this PhD thesis establishes MitoRibo-Tag mice as a novel tool to study mitoribosomes in vivo, enabling future studies on translation and dynamics during different physiological states, including ageing, exercise and fasting or disease

Novel lymphocyte-independent mechanisms to initiate inflammatory arthritis via bone marrow-derived cells of Ali18 mutant mice.

In a large-scale ENU (N-ethyl-N-nitrosourea) mouse mutagenesis programme, we previously have identified and characterized a novel mutation Ali18 that causes inflammatory arthritis like lesions in peripheral joints. In this study, we analysed the immune system of Ali18 mice to understand mechanisms underlying the spontaneous inflammation. METHODS: Humoral and cellular components of the immune system were phenotyped by ELISA and flow cytometry. The contribution of the immune system for phenotype expression was analysed in disease transfer experiments. The involvement of the adaptive immune system was investigated in Ali18;Rag1 double mutants and the influence of environmental factors was analysed in Ali18 mice reared under germ-free conditions. RESULTS: Bone marrow cells from Ali18 mice were able to transfer the disease phenotype to na&iuml;ve wild-type recipients suggesting that cellular components of the reconstituted immune system were sufficient to induce arthritis. Ali18 mice revealed abnormal leucocyte populations including lymphocytes and granulocytes, as well as increased plasma IL-5 and IgE levels. Ali18;Rag1 double homozygous mutants, which lack mature lymphocytes, still developed arthritis, suggesting that the phenotype is independent of the adaptive immune system. In addition, the arthritis phenotype appeared to be independent from environmental conditions as demonstrated in mice reared under germ-free conditions. CONCLUSIONS: The Ali18 mutation induces inflammatory arthritis through bone marrow-derived cells. However, non-pro-inflammatory cytokine cascades and mature lymphocyte independent-mechanisms are crucial for initiation and progression of the phenotype. Ali18 mice may thus represent a model to study mechanisms involved in seronegative arthritis induced by cells of the innate immune system