12 research outputs found

    Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

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    : The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

    Laparoscopic Surgical Skills programme: preliminary evaluation of Grade I Level 1 courses by trainees

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    Introduction: New training models are needed to maintain safety and quality of surgical performance. A simulated setting using virtual reality, synthetic, and/or organic models should precede traditional supervised training in the operating room. Aim: The aim of the paper is to describe the Laparoscopic Surgical Skills (LSS) programme and to provide information about preliminary evaluation of Grade! Level 1 courses, including overall quality, applicability of the course content in practice and the balance between theory and hands-on training modules, by participating trainees. Material and methods: During 5 accredited LSS Grade I Level I courses held in Eindhoven (the Netherlands), Kosice (Slovak Republic), and Lisbon (Portugal) between April 2011 and January 2012, demographic data and pre-course surgical experience in laparoscopic surgery of the participants were recorded. The final course evaluation form was completed by each participant after the course (anonymous) to evaluate course progress, course materials, assessment, staff location and overall impression of the course on a 1-10 scale to obtain feedback information. Results: Forty-seven surgeons of 5 different nationalities were enrolled in an LSS Grade I Level I programme. Most participants were first or second year residents (n = 25), but also already established surgeons took part (n = 6). The mean age of the participants was 31.2 years (SD = 2.86), the male/female ratio was 32/15, and previous experience with laparoscopic surgery was limited. Overall impression of the course was rated with 8.7 points (SD = 0.78). The applicability of the course content in practice and the balance between theory and hands-on training were also rated very well mean 8.8 (SD = 1.01) and 8.1 points (SD = 0.80) respectively Conclusions: Laparoscopic Surgical Skills Grade I Level 1 courses are evaluated as well balanced, with content applicable in clinical practice, meeting the expectations of individual participants. International interest in the programme suggests that LSS might become the future European standard in surgical education in laparoscopic surgery. Further conclusions concerning success of the programme may be drawn after the completion of clinical assessment of enrolled participants

    Umbilical Cord Blood Cells CD133+/CD133− Cultivation in Neural Proliferation Media Differentiates Towards Neural Cell Lineages

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    Umbilical cord blood (UCB) has been identified as a good source of hematopoietic and nonhematopoietic stem cells that can be easily isolated. In the present study we investigated the possibility of whether stem cells in mononuclear UCB grown under defined conditions can produce progeny with neural phenotype. A combination of antigen-driven magnetic cell sorting (MACs) method and defined culture conditions specific for cells of neural lineages were used for isolation, expansion and differentiation of CD133+/− cells from UCB. Both UCB-derived fractions were expanded by exposure to growth factors (EGF, bFGF). Differentiation was induced by replacing them with fetal bovine serum. Using immunocytochemistry, the cell markers for neural (MAP2, GFAP, RIP) and non-neural lineages (S-100, von Willebrand factor) were detected. The analysis revealed occurrence of fully mature neural and non-neural lineages, which showed qualitative and quantitative differences between population of CD133+ and CD133− cells. The expression levels of MAP2 and RIP in CD133+ were significantly higher than in CD133−, more GFAP positive cells were found in the CD133−. At the same time, S-100 was expressed by 32.47 ± 6.24% of CD133− cells and 29.42 ± 1.32% of CD133− cell expressed a von Willebrand factor antigen. Our results indicate that stem cells derived from umbilical cord blood are easy to obtain, proliferate and are able to differentiate towards the cells of neural lineages, which represents a promising way for their utilization in cell-based therapies for CNS injuries and diseases

    Conservative Management in Three Cases of Prenatally Recognized Splenic Cyst Using 2D, 3D, Multi-Slice and Doppler Ultrasonography

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    The aetiology, differential diagnosis and management strategies of the foetal spleen affected with a cystic lesion are discussed. In the current literature, there are very few reports that relate to antenatally diagnosed splenic cyst. Our study presents 3 case reports that were first suspected due to anisoechogenic structures detected during routine ultrasonographic examination at the 27th, 31st and 34th weeks of gestation. All 3 cases were further characterized by the lack of pathological power Doppler findings inside and around the lesions, and were morphologically refined by prenatal 3D ultrasound imaging. All findings were reconfirmed postnatally. No complications such as cyst expansion, subcapsular bleeding or acute abdomen have developed, and all 3 cystic lesions have regressed spontaneously after birth
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