14 research outputs found
Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study
Background
Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for consenting and benchmarking purposes. Furthermore, preoperative identification of high-risk patients can guide patient selection and potentially allow for targeted prehabilitation and/or individualized treatment regimens. Using a large multicentre cohort, this study aimed to calculate the incidence of all PD complications and identify risk factors.
Method
Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, 2012–2015). The incidence and severity of all complications was recorded and potential risk factors for morbidity, major morbidity (Clavien–Dindo grade > IIIa), postoperative pancreatic fistula (POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were investigated.
Results
Among the 1348 included patients, overall morbidity, major morbidity, POPF, PPH and perioperative death affected 53 per cent (n = 720), 17 per cent (n = 228), 8 per cent (n = 108), 6 per cent (n = 84) and 4 per cent (n = 53), respectively. Following multivariable tests, a high BMI (P = 0.007), an ASA grade > II (P II patients were at increased risk of major morbidity (P < 0.0001), and a raised BMI correlated with a greater risk of POPF (P = 0.001).
Conclusion
In this multicentre study of PD outcomes, an ASA grade > II was a risk factor for major morbidity and a high BMI was a risk factor for POPF. Patients who are preoperatively identified to be high risk may benefit from targeted prehabilitation or individualized treatment regimens
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CONVERGENCE OF A RANDOM PARTICLE METHOD TO SOLUTIONS OF THE KOLMOGOROV EQUATION ut =xX + U (l - u)
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Non-convex profile evolution in two dimensions using volume of fluids
A new Volume of Fluid (VoF) method is applied to the problem of surface evolution in two dimensions (2D). The VoF technique is applied to problems that are representative of those that arise in semiconductor manufacturing, specifically photolithography and ion-milling. The types of surface motion considered are those whose etch rates vary as a function of both surface position and orientation. Functionality is demonstrated for etch rates that are non-convex in regard to surface orientation. A new method of computing surface curvature using divided differences of the volume fractions is also introduced, and applied to the advancement of surfaces as a vanishing diffusive term
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Convergence and accuracy of kernel-based continuum surface tension models
Numerical models for flows of immiscible fluids bounded by topologically complex interfaces possessing surface tension inevitably start with an Eulerian formulation. Here the interface is represented as a color function that abruptly varies from one constant value to another through the interface. This transition region, where the color function varies, is a thin O(h) band along the interface where surface tension forces are applied in continuum surface tension models. Although these models have been widely used since the introduction of the popular CSF method [BKZ92], properties such as absolute accuracy and uniform convergence are often not exhibited in interfacial flow simulations. These properties are necessary if surface tension-driven flows are to be reliably modeled, especially in three dimensions. Accuracy and convergence remain elusive because of difficulties in estimating first and second order spatial derivatives of color functions with abrupt transition regions. These derivatives are needed to approximate interface topology such as the unit normal and mean curvature. Modeling challenges are also presented when formulating the actual surface tension force and its local variation using numerical delta functions. In the following they introduce and incorporate kernels and convolution theory into continuum surface tension models. Here they convolve the discontinuous color function into a mollified function that can support accurate first and second order spatial derivatives. Design requirements for the convolution kernel and a new hybrid mix of convolution and discretization are discussed. The resulting improved estimates for interface topology, numerical delta functions, and surface force distribution are evidenced in an equilibrium static drop simulation where numerically-induced artificial parasitic currents are greatly mitigated
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Two new methods for simulating photolithography development in 3D
Two methods are presented for simulating the development of photolithographic profiles during the resist dissolution phase. These algorithms are the volume-of-fluid algorithm, and the steady level-set algorithm. They are compared with the ray-trace, cell, and level-set techniques employed in SAMPLE-3D. The volume-of-fluid algorithm employs an Euclidean Grid with volume fractions. At each time step, the surface is reconstructed by computing an approximation of the tangent plane of the surface in each cell that contains a value between 0 and 1. The geometry constructed in this manner is used to determine flow velocity vectors and the flux across each edge. The material is then advanced by a split advection scheme. The steady Level Set algorithm is an extension of the Iterative Level Set algorithm. The steady Level Set algorithm combines Fast Level Set concepts and a technique for finding zero residual solutions to the ( ) function. The etch time for each cell is calculated in a time ordered manner. Use of heap sorting data structures allows the algorithm to execute extremely quickly. Comparisons of the methods have been performed and results shown