Integrating Genomic Knowledge Sources through an Anatomy Ontology

Modern genomic research has access to a plethora of knowledge sources. Often, it is imperative that researchers combine and integrate knowledge from multiple perspectives. Although some technology exists for connecting data and knowledge bases, these methods are only just begin-ning to be successfully applied to research in modern cell biology. In this paper, we argue that one way to integrate multiple knowledge sources is through anatomy—both generic cellular anatomy, as well as anatomic knowledge about the tissues and organs that may be studied via microarray gene expression experiments. We present two examples where we have combined a large ontology of human anatomy (the FMA) with other genomic knowledge sources: the gene ontology (GO) and the mouse genomic databases (MGD) of the Jackson Labs. These two initial examples of knowledge integration provide a proof of concept that anatomy can act as a hub through which we can usefully combine a variety of genomic knowledge and data

Sequential drain amylase to guide drain removal following pancreatectomy

BACKGROUND: Although used as criterion for early drain removal, postoperative day (POD) 1 drain fluid amylase (DFA) ≤ 5000 U/L has low negative predictive value for clinically relevant postoperative pancreatic fistula (CR-POPF). It was hypothesized that POD3 DFA ≤ 350 could provide further information to guide early drain removal. METHODS: Data from a pancreas surgery consortium database for pancreatoduodenectomy and distal pancreatectomy patients were analyzed retrospectively. Those patients without drains or POD 1 and 3 DFA data were excluded. Patients with POD1 DFA ≤ 5000 were divided into groups based on POD3 DFA: Group A (≤350) and Group B (>350). Operative characteristics and 60-day outcomes were compared using chi-square test. RESULTS: Among 687 patients in the database, all data were available for 380. Fifty-five (14.5%) had a POD1 DFA > 5000. Among 325 with POD1 DFA ≤ 5000, 254 (78.2%) were in Group A and 71 (21.8%) in Group B. Complications (35 (49.3%) vs 87 (34.4%); p = 0.021) and CR-POPF (13 (18.3%) vs 10 (3.9%); p < 0.001) were more frequent in Group B. CONCLUSIONS: In patients with POD1 DFA ≤ 5000, POD3 DFA ≤ 350 may be a practical test to guide safe early drain removal. Further prospective testing may be useful

Evidence Vs. Practice in Early Drain Removal Following Pancreatectomy

Background: Early drain removal when postoperative day (POD) 1 drain fluid amylase (DFA) was ≤ 5000 U/L reduced complications in a previous randomized controlled trial. We hypothesized that most surgeons continue to remove drains late and this is associated with inferior outcomes. Methods: We assessed the practice of surgeons in a prospectively maintained pancreas surgery registry to determine the association between timing of drain removal with demographics, co-morbidities, and complications. We selected patients with POD1 DFA ≤ 5000 U/L and excluded those without drains, and subjects without data on POD1 DFA or timing of drain removal. Early drain removal was defined as ≤ POD5. Results: 244 patients met inclusion criteria. Only 90 (37%) had drains removed early. Estimated blood loss was greater in the late removal group (190 mL vs 100 mL, p = 0.005) and pathological findings associated with soft gland texture were more frequent (97(63%) vs 35(39%), p < 0.0001). Patients in the late drain removal group had more complications (84(55%) vs 30(33%), p = 0.001) including pancreatic fistula (55(36%) vs 4(4%), p < 0.0001), delayed gastric emptying (27(18%) vs 3(3%), p = 0.002), and longer length of stay (7 days vs 5 days, p < 0.0001). In subset analysis for procedure type, complications and pancreatic fistula remained significant for both pancreatoduodenectomy and distal pancreatectomy. Conclusion: Despite level 1 data suggesting improved outcomes with early removal when POD1 DFA is ≤ 5000 U/L, experienced pancreas surgeons more frequently removed drains late. This practice was associated with known risk factors (EBL, soft pancreas) and may be associated with inferior outcomes suggesting potential for improvement

The extractive industries, mineral sector reform and post-conflict reconstruction in developing countries

This paper introduces a Special Section on the extractive industries, mineral sector reform and post-conflict reconstruction in developing countries. The collection of papers presented reflects on a wide range of post-conflict natural resource management scenarios across a variety of geographical settings in sub-Saharan Africa, Latin America and Melanesia. The contributions suggest that although natural resource wealth provides the potential for post-conflict countries to stimulate reconstruction, generate employment and achieve unprecedented economic growth, it also has the ability to de-rail post-conflict peacebuilding and development. Strategies to harness the benefits of extractive industry investment for post-conflict societies will therefore not only require attention to ‘better’ resource management, but also a deeper understanding of local contextual political struggles and how they are embedded within broader causal factors