Validation of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) Score in Liver Surgery

Background: The estimation of physiologic ability and surgical stress (E-PASS) has been used to produce a numerical estimate of expected mortality and morbidity after elective gastrointestinal surgery. The aim of this study was to validate E-PASS in a selected cohort of patients requiring liver resections (LR). Methods: In this retrospective study, E-PASS predictor equations for morbidity and mortality were applied to the prospective data from 243 patients requiring LR. The observed rates were compared with predicted rates using Fisher's exact test. The discriminative capability of E-PASS was evaluated using receiver-operating characteristic (ROC) curve analysis. Results: The observed and predicted overall mortality rates were both 3.3% and the morbidity rates were 31.3 and 26.9%, respectively. There was a significant difference in the comprehensive risk scores for deceased and surviving patients (p=0.043). However, the scores for patients with or without complications were not significantly different (p=0.120). Subsequent ROC curve analysis revealed a poor predictive accuracy for morbidity. Conclusions: The E-PASS score seems to effectively predict mortality in this specific group of patients but is a poor predictor of complications. A new modified logistic regression might be required for LR in order to better predict the postoperative outcom

Electron microscopy of high pressure frozen samples: bridging the gap between cellular ultrastructure and atomic resolution

Transmission electron microscopy has provided most of what is known about the ultrastructural organization of tissues, cells, and organelles. Due to tremendous advances in crystallography and magnetic resonance imaging, almost any protein can now be modeled at atomic resolution. To fully understand the workings of biological "nanomachines” it is necessary to obtain images of intact macromolecular assemblies in situ. Although the resolution power of electron microscopes is on the atomic scale, in biological samples artifacts introduced by aldehyde fixation, dehydration and staining, but also section thickness reduces it to some nanometers. Cryofixation by high pressure freezing circumvents many of the artifacts since it allows vitrifying biological samples of about 200μm in thickness and immobilizes complex macromolecular assemblies in their native state in situ. To exploit the perfect structural preservation of frozen hydrated sections, sophisticated instruments are needed, e.g., high voltage electron microscopes equipped with precise goniometers that work at low temperature and digital cameras of high sensitivity and pixel number. With them, it is possible to generate high resolution tomograms, i.e., 3D views of subcellular structures. This review describes theory and applications of the high pressure cryofixation methodology and compares its results with those of conventional procedures. Moreover, recent findings will be discussed showing that molecular models of proteins can be fitted into depicted organellar ultrastructure of images of frozen hydrated sections. High pressure freezing of tissue is the base which may lead to precise models of macromolecular assemblies in situ, and thus to a better understanding of the function of complex cellular structure

Long-Term Quality of Life After Hepatic Resection: Health Is not Simply the Absence of Disease

Background: Due to advances in operative methods and perioperative care, mortality and morbidity following major hepatic resection have decreased substantially, making long-term quality of life (QoL) an increasingly prominent issue. We evaluated whether postoperative diagnosis was associated with long-term QoL and health in patients requiring hepatic surgery for benign or malignant disease. Methods: QoL was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 and the liver-specific QLQ-LMC21 module. Results: Between 2002 and 2006, 249 patients underwent hepatic surgery for malignant (76%) and benign (24%) conditions. One hundred thirty-five patients were available for QoL analysis after a mean of 26.5months. There was no statistical difference in global QoL scores between patients with malignant and benign diseases (p=0.367). Neither the extent of the resection (≥2 segments vs. <2 segments; p=0.975; OR=0.988; 95% CI=0.461-2.119) nor patient age had a significant influence on overall QoL (p=0.092). Conclusions: These results indicate that long-term QoL for patients who underwent liver resection for malignant disease is quite good and that a poor clinical prognosis does not seem to correlate with a poor Qo

Employment and well-being after plant closure: Survey evidence from Switzerland on the mid and long run

How does plant closure affect the employment and well-being of displaced workers? This article presents the results of two surveys of workers at five manufacturing plants two and 11 years after mass layoffs. After two years, two-thirds of displaced workers had been re-employed, one in five workers was still unemployed, and one in 10 workers had retired. A decade after the plant closures, unemployment had fallen below 5%. Overall, post-displacement outcomes in Switzerland were more favourable than in other European plant closures. However, age disparities loomed large. Older workers struggled to find new jobs and often had to accept large wage cuts and unstable jobs. In particular, many workers in their late forties and early fifties were hit hard as they were too young to benefit from early retirement, but too old to start over

Evaluation of Ground Source Heat Pump Energy, Demand, and Greenhouse Potential in Colorado Residential Buildings

ABSTRACT This paper summarizes the results of a detailed energy analysis carried out for a typical Colorado residence using three different HVAC systems for 10 distinct locations in Colorado. The HVAC systems considered in the analysis include: 78% efficient furnace with a 13 SEER air conditioner Vertical well ground source heat pump with a heating COP of 3.5 and a cooling EER of 17.1 Slinky ground source heat pump with a heating COP of 3.5 and a cooling EER of 17.

Conservative treatment and outcome of upper cervical spine fractures in young children: A STROBE-compliant case series.

Cervical spine (C-spine) fractures in young children are very rare, and little information on treatment modalities and functional, radiographic, and patient-reported outcome exists. In this 2-center, retrospective case series, we assessed subjective and functional mid-term outcomes in children aged ≤5 years whose C-spine fractures were treated nonoperatively.Between 2000 and 2018, 6 children (median age at injury: 23.5 months; range: 16-31 months) with C1 or C2 injuries were treated with Minerva cast/brace or soft collar brace at 1 of the 2 study centers. Two patients suffered C1 fractures, and 4 patients had lysis of the odontoid synchondrosis. Overall, 3 children had sustained polytrauma. One child died due to the consequences of massive head injury.For the primary outcome parameter, we recorded subjective symptoms such as pain and functional restrictions due to the sequelae of C-spine injuries at follow-up.Based on medical records, we also assessed the causes of injury, diagnostic procedures, treatments and complications, and time to fracture consolidation.Median follow-up of the 5 surviving children was 51 months (range: 36-160 months). At the latest follow-up, 4 of 5 children did not complain of any pain. One child who sustained an open head injury in combination with a subluxation of the odontoid and undisplaced fracture of the massa lateralis reported occasional headache. All patients experienced complete fracture healing and normal range of motion of the cervical spine.Median duration of cast/brace treatment was 8.5 weeks. Fracture healing was confirmed by computed tomography in all patients.All C-spine injuries were managed with either Minerva cast/Halo brace or soft collar brace without complications.In our retrospective case series, nonoperative treatment of atlas fractures and dislocations or subluxations of the odontoid in young children using Minerva casts or prefabricated Halo braces resulted in good subjective and functional outcomes at mid-term. We observed no complications of conservative treatment of C1 and C2 injuries in young children

Indocyanine Green Plasma Disappearance Rate During the Anhepatic Phase of Orthotopic Liver Transplantation

Non-invasive pulse spectrophotometry to measure indocyanine green (ICG) elimination correlates well with the conventional invasive ICG clearance test. Nevertheless, the precision of this method remains unclear for any application, including small-for-size liver remnants. We therefore measured ICG plasma disappearance rate (PDR) during the anhepatic phase of orthotopic liver transplantation using pulse spectrophotometry. Measurements were done in 24 patients. The median PDR after exclusion of two outliers and two patients with inconstant signal was 1.55%/min (95% confidence interval [CI] = 0.8-2.2). No correlation with patient age, gender, body mass, blood loss, administration of fresh frozen plasma, norepinephrine dose, postoperative albumin (serum), or difference in pre and post transplant body weight was detected. In conclusion, we found an ICG-PDR different from zero in the anhepatic phase, an overestimation that may arise in particular from a redistribution into the interstitial space. If ICG pulse spectrophotometry is used to measure functional hepatic reserve, the verified average difference from zero (1.55%/min) determined in our study needs to be taken into accoun

Epidemic outbreak of tegumentary leishmaniasis in Puerto Esperanza, Misiones, 1998

La provincia de Misiones en 1998 notificó 205 casos de leishmaniosis, 98% en la localidad de Puerto Esperanza. El análisis de las fichas clínicas (n:129) de los casos atendidos en Hospital Puerto Esperanza (enero a septiembre 1998) mostró una mayor proporción de lesión cutánea simple (97,2%), localizada en miembros inferiores (72,5%), sin casos de lesión mucosa. Los resultados fueron coherentes con los de la literatura de otros focos epidémicos en Argentina debidos a Leishmania (V.) Braziliensis. No hubo diferencia significativa de incidencia entre sexos, se registró en todos los grupos etarios, y fue susceptible al tratamiento convencional. El foco principal se registró en el Barrio Km1 con un máximo de transmisión en abril de 1998. La intradermoreacción de Montenegro en población general (n:205) no mostró reactividad en asintomáticos. Se capturaron 577 Phlebotominae pertenecientes a 8 especies, las más abundantes fueron Lutzomyia intermedia (79,7%) y Lu. whitmani (10,9%), presentes en peridomicilios de Km1 asociados a selva paranaense residual y vegetación secundaria. Los resultados se discuten en el marco de estrategias posibles de vigilancia y control.The province of Misiones reported 205 leishmaniasis cases during 1998, 98% of them from the locality of Puerto Esperanza. The resports of Puerto Esperanza Hospital (January to September 1998) for leishmanuasis were analysed (n:129). The mainly reported lesion was the single cutaneous ulcer (97,2%), localized in the inferior limbs (72,5%), without any mucosa involvement. The reults are consistent with the knowledge from other Argentinean leishmaniasis foci due to Leishmania (V.) braziliensis. The difference in incidence among sexes was not significant, leishmaniasis was reported in all age groups, and it was suceptible to the convenctional treatment. The main focus was located in Km1 neighbourhood, the transmission peak was during April 1998. The Montenegro skin test among general population (m:205) did not show reactivity among asymptomatic people. The prevalent Phlebotominae species was Lutzomyia intermedia (79,7%) and Lu. whitmani (10,9%), among the 577 individuals belonging to 8 species collected. The Phlebotominae were abundant in periodomestic habitats of Km1 neighbourhoood, close to human dwellings, in places associated with residual primary forest and secondary vegetation. The results are discussed in the fram of surveillance and possible control stategies.Fil: Salomón, Oscar Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Dirección Nacional de Institutos de Investigación. Administración Nacional de Laboratorios e Institutos de Salud. Centro Nacional de Diagnóstico e Investigaciones Endemo-epidémicas; ArgentinaFil: Sosa-estani, Sergio Alejandro. Dirección Nacional de Institutos de Investigación. Administración Nacional de Laboratorios e Institutos de Salud. Centro Nacional de Diagnóstico e Investigaciones Endemo-epidémicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Monzani, Ángel S.. Dirección Nacional de Institutos de Investigación. Administración Nacional de Laboratorios e Institutos de Salud. Centro Nacional de Diagnóstico e Investigaciones Endemo-epidémicas; ArgentinaFil: Studer, Catalina. Dirección Nacional de Institutos de Investigación. Administración Nacional de Laboratorios e Institutos de Salud. Centro Nacional de Diagnóstico e Investigaciones Endemo-epidémicas; Argentin