Diagnosis and treatment of pancreatic duct disruption or disconnection: an international expert survey and case vignette study

Background: Pancreatic duct disruption or disconnection is a potentially severe complication of necrotizing pancreatitis. With no existing treatment guidelines, it is unclear whether there is any consensus among experts in clinical practice. We evaluated current expert opinion regarding the diagnosis and treatment of pancreatic duct disruption and disconnection in an international case vignette study. Methods: An online case vignette survey was sent to 110 international expert pancreatologists. Expert selection was based on publications in the last 5 years and/or participation in development of IAP/APA and ESGE guidelines on acute pancreatitis. Consensus was defined as agreement by at least 75% of the experts. Results: The response rate was 51% (n = 56). Forty-four experts (79%) obtained a MRI/MRCP and 52 experts (93%) measured amylase levels in percutaneous drain fluid to evaluate pancreatic duct integrity. The majority of experts favored endoscopic transluminal drainage for infected (peri)pancreatic necrosis and pancreatic duct disruption (84%, n = 45) or disconnection (88%, n = 43). Consensus was lacking regarding the treatment of patients with persistent percutaneous drain production, and with persistent sterile necrosis. Conclusion: This international survey of experts demonstrates that there are many areas for which no consensus existed, providing clear focus for future investigation

Isolated photochemical reaction centers from bacteriochlorophyll b - containing organisms

Optical, ESR and pulsed laser spectroscopic examination of isolated bacteriochlorophyll (BChl) b-containing reaction centers (RCs) demonstrates that their composition (1 P960 : 2 bacteriopheophytin (BPh) b : 2 cyt c 558 : 2 cyt c 553 : BChl/BPh = 2) and their mechanism for charge separation are very similar to those in BChl a-containing RCs; however, P960/sup +/, the oxidized form of the primary electron donor, is apparently not a symmetrical dimer of BChl b. The ''primary'' electron acceptor (X) is a quinone-iron complex, and I, the intermediary electron carrier between P960 and X, is BPh which interact(s) strongly with one or more of the other components in the RC. Comparison of the optical spectra of isolated RCs of the BChl b-containing bacteria, Rhodopseudomonas viridis and Thiocapsa pfennigii, with those of their intact cells shows that the BPh in the RC is not generated during the isolation procedure

Elastoplastic deformation of 316 stainless steel under tensile loading at elevated temperatures

The response of 316 stainless steel has been examined under uniaxial tensile loading during a range of tests carried out between 20 °C and 650 °C. In-situ neutron diffraction was used to measure internal elastic strain in subsets of differently oriented crystallites within the polycrystal aggregate. This allowed the determination of diffraction elastic constants. Further, results have been compared with predictions from a slip-based elasto-plastic self-consistent model. Good agreement is obtained during both conventional slip and when dynamic strain aging (DSA) is evidenced. The quality of agreement was reduced in the higher temperature regime, where it is expected that other mechanisms become active