Outcome of elderly patients after acute biliary pancreatitis

Background and aim: The data regarding the differences in outcome after acute biliary pancreatitis in elderly patients are scarce. This study aims to evaluate the outcome and radiological presentation in patients over 70 years after acute biliary pancreatitis. Methods: Between January 2006 and December 2012, a retrospective analysis was performed on all consecutive patients with acute biliary pancreatitis admitted to the university hospital (CHUV) in Lausanne (Switzerland). Patients were divided into 2 groups: >70 years (elderly group) and <70 years (control group). The severity of patients' comorbidities was assessed according to the Charlson score. Data analysed included clinical (Atlanta classification) and radiological severity (Baltazar score, computed tomography severity index) of the acute pancreatitis. Results: A total of 214 patients (n=77 elderly group, n=137 control group) were included. The elderly group had a mean age of 80 years (control group 45 years, p<0.001). The elderly had a higher Charlson score at admission (p<0.001). According to the Atlanta classification, there was no difference in the clinical severity of the pancreatitis between young and elderly patients, and the majority had a mild acute pancreatitis (66% vs. 64%, p=0.857). The elderly required more ERCP (39% vs. 20%, p=0.004) and percutaneous/endoscopic drainage of infected collection (12% vs. 4%, p=0.039). The rate of portal vein thrombosis was higher in the elderly (10% vs. 2%, p=0.005). The elderly had a longer hospital stay (10 vs. 7 days, p<0.001), while the ICU length of stay was similar in both groups. The 90-day mortality was similar in both groups. Conclusions: Despite higher comorbidities at admission, elderly patients have similar clinical severity and mortality as young patients after acute biliary pancreatitis. However, the natural history of the disease seems different in the elderly with higher rates of infected collections requiring invasive procedures, and a higher rate of portal vein thrombosis

Discrete-row growth of xenon adsorbed on the vicinal Pt(997) surface: Comparison between theory and experiment

Xe exhibits a discrete-row growth mode on the vicinal Pt(997) surface by sequential attachment to the substrate steps. In order to interpret experimental results obtained by grazing incidence helium scattering, potential calculations are performed. A mean-field Hamiltonian within the two-dimensional Ising model is shown to explain the sequential-row growth observed in helium-atom diffraction studies. More specifically, the calculated temperatures for the occurrence of each row depend mainly on the shape of the potential increment due to the steps and countersteps. They are in good agreement with the experimental values associated with maxima in the scattered He intensity versus coverage curves

Stone consolidation: a critical discussion of theoretical insights and field practice

Stone consolidants have been extensively used for the preservation of historical structures since the 19th century. However, their true effectiveness in practice is often a source of debate, largely because of known cases where badly chosen treatments were unsuccessful, or even caused an accelerated degradation of the substrate. Researchers have therefore strived to better understand, and possibly predict, the behavior of consolidants on-site, in order to assist practitioners in their decision making. Despite the large number of publications available on the subject, however, the contribution of scientific research for practical applications remains scarce. Reasons for this include the limited accessibility of scientific publications and the lack of documentation or preparatory studies from the field. This unfortunately compromises the knowledge exchange between researchers and practitioners, which we consider to be a main challenge that this field must overcome. The target of this letter is to reconnect the critical problems identified on-site through practical experience with the conceptual research outcomes that could help solve them. For this, we present an informed evaluation of the most needed research, along with a synthetic overview of the insights that scientific research can offer in terms of consolidant selection, application and monitoring

Direct Observation of Dimerization between Different CREB1 Isoforms in a Living Cell

Cyclic AMP-responsive element binding protein 1 (CREB1) plays multiple functions as a transcription factor in gene regulation. CREB1 proteins are also known to be expressed in several spliced isoforms that act as transcriptional activators or repressors. The activator isoforms, possessing the functional domains for kinase induction and for interaction with other transcriptional regulators, act as transcriptional activators. On the other hand, some isoforms, lacking those functional domains, are reported to be repressors that make heterodimers with activator isoforms. The complex and ingenious function for CREB1 arises in part from the variation in their spliced isoforms, which allows them to interact with each other. To date, however, the dimerization between the activator and repressor isoforms has not yet been proved directly in living cells. In this study, we applied fluorescence cross-correlation spectroscopy (FCCS) to demonstrate direct observation of dimerization between CREB1 activator and repressor. The FCCS is a well established spectroscopic method to determine the interaction between the different fluorescent molecules in the aqueous condition. Using differently labeled CREB1 isoforms, we successfully observed the interaction of CREB1 activator and repressor via dimerization in the nuclei of cultured cells. As a result, we confirmed the formation of heterodimer between CREB1 activator and repressor isoforms in living cells

Green Urbanism and its Application to Singapore

Green urbanism has been applied to cities but not in Asia. Seven characteristics of green urbanism are outlined and then applied to Singapore. The Renewable City is not yet a concept for Singapore. The Carbon Neutral City is being developed for an island Palau Ubin and by some firms but not to significant sectors or parts of urban Singapore. The Distributed City is being developed around Singapore’s polycentric model but needs specific infrastructure plans similar to ones developed by Singapore for Tianjin Eco-City. The Biophillic City is being developed as a world first through its Skyrise Greenery initiative and urban landscaping. The Eco-Efficient City is also being demonstrated through Singapore closing the loop on their water and solid waste systems. The Place Based City is very evident in all its 22 sub centres. And the Sustainable Transport City is an Asian leader in integrated transport planning though there are signs of this becoming harder to achieve

Sustainability of an HIV PEP Program for Sexual Assault Survivors: “Lessons Learned” from Health Care Providers

This study explored challenges to continuing an HIV post-exposure prophylaxis (PEP) program of care provided to sexual assault survivors in the province of Ontario, Canada. Data were collected as part of an implementation and evaluation of a universal offering of HIV PEP (known as the HIV PEP Program) at 24 of 34 provincial hospital-based sexual assault treatment centres. Experienced health care providers were surveyed (n = 132) and interviewed in four focus groups (n = 26) about their perceptions of what, if any, factors threatened their ability to maintain the HIV PEP Program. All focus groups were audio-recorded and the recordings transcribed. The transcriptions and open-ended survey responses were analyzed using content analysis. Administrator, nurse, physician, social worker, and pharmacist respondents perceived important barriers to sustainability of the HIV PEP Program. Eight constructs were identified within four broad themes: resources (inadequate funds, overworked and unacknowledged staff), expertise (insufficient external supports, insufficiently trained and knowledgeable staff), commitment (lack of institutional support, physician resistance to offering HIV PEP), and accommodation (lack of flexibility in addressing specific client and community needs, inaccessibility and lack of clarity of tools). We discuss the implications of these findings and the actions that were taken to address the challenges

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369