A meta-analysis for the effect of prophylactic GTN on the incidence of post-ERCP pancreatitis and on the successful rate of cannulation of bile ducts

<p>Abstract</p> <p>Background</p> <p>Glyceryl trinitrate (GTN) has been shown to be able to relax the sphincter of Oddi (SO) both in animals and humans. Theoretically, the use of these compounds during and after endoscopic retrograde cholangiopancreatgraphy (ERCP) could relax the biliary and pancreatic sphincters, facilitating cannulation of common bile duct (CBD) during the procedure, or minimizing potential pancreatic outflow obstruction after the procedure. However, clinical trials evaluating the protective effect of GTN on the post-endoscopic retrograde cholangiopancreatgraphy pancreatitis (PEP) have yielded inconclusive results. This meta-analysis is to systematically assess the effect of prophylactic administration of glyceryl trinitrate (GTN) on the prevention of PEP and the effect on the cannulation of bile ducts.</p> <p>Methods</p> <p>By searching PubMed (1966 to September 2009), CENTRAL (Cochrane Controlled trials Register; issue 3, 2009) and EMBASE.com (1984 to September 2009), two independent reviewers systematically identified prospective randomized controlled trials (RCTs) detecting the effect of prophylactic GTN on the incidence of PEP and on the cannulation of bile ducts. A meta-analysis of these clinical trials was then performed.</p> <p>Results</p> <p>There are 55/899(6.1%) patients suffering PEP in the treatment group versus 95/915(10.4%) patients in the placebo group. The overall pooled risk of PEP was significantly lower in the GTN group than in the placebo group (OR 0.56, 95% CI: 0.40 to 0.79, p = 0.001). Subgroup analyses suggested that GTN administered by the sublingual form (OR 0.34,95% CI:0.16 to 0.75, p = 0.007) is more effective than transdermal route(OR 0.64,95% CI:0.40 to 1.01, p = 0.05), and the protective effect of GTN was far more obvious in the centers with high incidence of PEP (OR 0.40, 95% CI:0.24 to 0.67, p = 0.0006) than those centers with a low incidence of PEP (OR 0.75, 95% CI: 0.47 to 1.20, p = 0.22). Additionally, the meta-analysis suggests that GTN was not helpful for the cannulation of bile ducts.</p> <p>Conclusion</p> <p>We concluded that prophylactic administration of GTN may significantly reduce the incidence of PEP and not be helpful for the cannulation of bile ducts.</p

Local supplier firms in Madagascar’s apparel export industry : Upgrading paths, transnational social relations and regional production networks

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The Hand-bot, a Robot Design for Simultaneous Climbing and Manipulation

We present a novel approach to mobile object manipulation for service in indoor environments. Current research in service robotics focus on single robots able to move, manipulate objects, and transport them to various locations. Our approach differs by taking a collective robotics perspective: different types of small robots perform different tasks and exploit complementarity by collaborating together. We propose a robot design to solve one of these tasks: climbing vertical structures and manipulating objects. Our robot embeds two manipulators that can grasp both objects or structures. To help climbing, it uses a rope to compensate for the gravity force. This allows it to free one of its manipulators to interact with an object while the other grasps a part of a structure for stabilization. Our robot can launch and retrieve the rope autonomously, allowing multiple ascents. We show the design and the implementation of our robot and demonstrate the successful autonomous retrieval of a book from a shelf

Workers’ Agency and Re-Working Power Relations in Cambodia's Garment Industry

This paper explores Cambodian garment factory workers’ collective voice and ability to negotiate a living wage. Workers’ agency is examined through a case study of a large-scale strike in September 2010 over national minimum wage negotiations, led by two Cambodian trade union federations. Analysis is centred on four structural impediments to workers’ wage demands. First, the Cambodian People’s Party (CPP) consolidated power in 2008. As a result, space for independent trade unions and civil society is decreasing. Second, Cambodia is not deemed ‘competitive’ as a global sourcing option in terms of price, quality and speed to market. As a result, low wages and a proliferation of unmonitored subcontract factories are increasingly becoming the industry’s competitive advantage vis-à-vis Bangladesh and Vietnam. Third, the proliferation of fixed-duration contracts in Cambodia means work is less secure, with attendant impacts on workers and unions’ negotiating strength. And fourth, the unusually high number of plant-level and national trade union federations makes it difficult for ‘genuine’ unions to promote the rights of their members, and workers’ agency potential is marginalized. The intersection of these four structural forces circumscribes workers and independent trade unions’ ability to rework power relations with the employers association, the Garment Manufacturers Association in Cambodia (GMAC). Despite the challenges, workers and independent unions recognize themselves as the agents who must shape key demands, including on wages

Manufacturing urbanism: Improvising the urban–industrial nexus through Chinese economic zones in Africa

The relationship between industrialisation and urban development is subject to assumptions based on experiences in the global North, with little research on how it plays out in countries undergoing urbanisation and industrialisation today. In the context of recent excitement about China’s role in stimulating an ‘industrial revolution’ in Africa, we examine how Chinese zones in Ethiopia and Uganda are influencing the urban–industrial nexus. We argue that Chinese zones are key sites of urban–industrial encounter, but these dynamics are not primarily driven by the government officials that dominate the ‘policy mobilities’ literature, nor by the State-Owned Enterprises usually associated with Chinese activity overseas. Rather, they are emerging through the activities of inexperienced private Chinese actors who do not even operate in the worlds of urban policy. Faced with government histories and capacities that vastly differ from China’s, directly replicating the Chinese experience is virtually impossible; yet the tentative and improvisational relationships between Chinese firms, African government authorities and other local actors are gradually moulding new urbanisms into shape. The piecemeal bargaining and negotiation that unfolds through these relationships bridges some of the gaps between industrialisation and planning, but this cannot compensate for the governance of the urban–industrial nexus at higher scales