Perioperative management of patients undergoing pancreaticoduodenectomies (PD). Surgical clinic no. III Cluj expertise

Clinica Chirurgie III, Institutul Regional de Gastroenterologie si Hepatologie, UMF “Iuliu Hatieganu” Cluj-Napoca, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: În 2009, în Clinica Chirurgie III Cluj-Napoca a fost introdus un protocol care cuprinde aspecte legate de pregătirea preoperatorie a pacienților pentru DPC, de tactica și tehnica intraoperatorie, și tratament postoperator. Material si metode: Studiul înrolează 444 pacienti cu DPC operați în clinica între 2009-2018, împărțiți în două loturi: 2009-2015 și 2016-2018. Au fost urmăriți factorii incriminați în apariția principalelor complicații postoperatorii, rezultatele fiind comparate cu cele obținute înainte de 2009. Informaţiile s-au colectat utilizând Excel 2009, analiza statistică efectuandu-se cu software-ul R v3.2.4. Rezultate: Nu am obtinut reducerea semnificativă a morbidității (53% înainte de 2009, 45,6% între 2009-2015 și 42% între 2016- 2018), însă a scăzut rata de apariție a fistulei pancreatice (de la 10% la 9,06%, respectiv 7,5%) și a stazei gastrice (de la 43% la 20,47%, respectiv 12,8%). Hemoragia bontului pancreatic a apărut mai frecvent (de la 2%, la 6,71%, respectiv 7,2%). Mortalitatea s-a redus semnificativ (de la 11,9%, la 6,04%, respectiv 3,99%), datorită scăderii fistulelor pancreatice grad C. Concluzie: Implementarea protocolului de pregătire a DPC și-a dovedit utilitatea, iar preocuparea de îmbunătațire a acestuia, prin adaptarea la literatură și la propria experiență rămâne o prioritate.Introduction: In 2009, a protocol was introduced at the Surgical Clinic III Cluj-Napoca, which included aspects related to preoperative preparation of patients for PD, intraoperative tactics and technique, and postoperative treatment. Material and Method: The study includes 444 patients with PD operated in the clinic between 2009-2018, divided into two batches: 2009-2015 and 2016-2018. We followed the factors involved in the occurrence of the main postoperative complications and the results were compared with those we obtained before 2009. The information was collected using Excel 2009, the statistical analysis being performed with the software R v3.2.4. Results: We have not achieved a significant decrease in morbidity (53% before 2009, 45.6% between 2009-2015 and 42% between 2016-2018), but decreased the rate of pancreatic fistula (from 10% to 9, 06% and 7.5% respectively) and gastric stasis (from 43% to 20.47% and 12.8% respectively). Pancreas bleeding occurred more frequently (from 2% to 6.71% and 7.2%, respectively). Mortality was significantly reduced (from 11.9% to 6.04% and 3.99%, respectively) due to the reduce rate of grade C pancreatic fistulae. Conclusion: Implementation of the protocol has proven useful and the concern for improvement by adapting it to literature and our experience remains a priority

Classic vs laparoscopic approach in colorectal cancer. Experience of a tertiary center, Surgery No 3 Clinic, Cluj-Napoca

Clinica Chirurgie 3, Cluj-Napoca, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Cancerul colorectal este unul dintre cele mai frecvente cancere și cu tendință în creștere la nivel global. Majoritatea studiilor recente au demonstrat non inferioritatea și chiar o ușoară superioritate în abordul laparoscopic prin prisma rezultatelor obținute și a supraviețuirii la distanță. Material și metode: Au fost selectate retrospectiv 2186 de cazuri din baza de date completată prospectiv a Clinicii Chirurgie 3 pentru perioada ian 2013-dec 2018 (6 ani). Din acestea s-au exclus 76 cazuri laparoscopie/laparotomie exploratorie, 154 cazuri colostomii, 51 derivații interne; în final au fost analizate 1905 cazuri de cancer colorectal. Rezultate: Din 1905 cazuri s-au efectuat rezecții laparoscopice la un număr de 310 (16.27%) și clasice la un număr de 1595 cazuri (83.73%). Au fost analizați între cele două loturi următorii parametri: pregătire preoperatorie, durata operației, pierderi sangvine, complicații postoperatorii (fistulă, abces, hemoragie, ocluzie, complicații generale), supurații de plagă, zile spitalizare, necesar antibiotic, mobilizare postoperatorie, mortalitate. Concuzii: Abordul laparoscopic prezintă avantaje privind recuperarea postoperatorie, pierderi sangvine, zile spitalizare, necesar antialgice/antibiotic, lipsa supurațiilor de plagă. Dezavantajele sunt curba de învățare, aparatura specifică și dificultatea păstrării principiilor oncologice.Introduction: Colorectal cancer remains one of the most frequently diagnosed malignant pathologies with a continuously increasing rate worldwide. Most of the recent studies have shown the non-inferiority and slight superiority in the laparoscopic approach through obtained results. Material and methods: 2186 cases were selected retrospectively from a prospectively completed database of the Surgical no 3 Clinic in Cluj-Napoca over the course of 6 years (ian 2013 – dec 2018). Out of these cases, 76 cases were excluded for exploratory laparoscopy/laparotomy, 154 which underwent only colostomy, and 51 which underwent internal derivation. At the end of the study, 1905 cases were eligible. Results: Out of 1905 cases, 310 underwent a laparoscopic approach (16.27%) and 1595 cases underwent a classic approach (83.73%). Between the two approaches, a series of parameters were analyzed: preoperative care, duration of the surgery, intraoperative blood loss, postoperative complications (fistula, abscess, hemorrhage, occlusion, general complications), antibiotic necessity, postoperative mobilization, mortality, prevalence of surgical site infection. Conclusions: The laparoscopic approach proves many advantages regarding postoperative care, blood loss, hospitalization care, necessity of antibiotics and painkillers, and surgical site infection, cosmetic advantages. Disadvantages are the learning curve, specific instruments requirements, difficulty of maintaining the oncology principles

Effect of Nuclear Quadrupole Interaction on the Relaxation in Amorphous Solids

Recently it has been experimentally demonstrated that certain glasses display an unexpected magnetic field dependence of the dielectric constant. In particular, the echo technique experiments have shown that the echo amplitude depends on the magnetic field. The analysis of these experiments results in the conclusion that the effect seems to be related to the nuclear degrees of freedom of tunneling systems. The interactions of a nuclear quadrupole electrical moment with the crystal field and of a nuclear magnetic moment with magnetic field transform the two-level tunneling systems inherent in amorphous dielectrics into many-level tunneling systems. The fact that these features show up at temperatures $T<100mK$, where the properties of amorphous materials are governed by the long-range $R^{-3}$ interaction between tunneling systems, suggests that this interaction is responsible for the magnetic field dependent relaxation. We have developed a theory of many-body relaxation in an ensemble of interacting many-level tunneling systems and show that the relaxation rate is controlled by the magnetic field. The results obtained correlate with the available experimental data. Our approach strongly supports the idea that the nuclear quadrupole interaction is just the key for understanding the unusual behavior of glasses in a magnetic field.Comment: 18 pages, 9 figure

Resection margin in liver metastasectomy secondary colorectal cancer

Clinica Chirurgie 3, Cluj-Napoca, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Rezectia hepatică este gold standardul în tratamentul metastazelor hepatice. Marginea de rezectie hepatica în cazul metastazelor hepatice a fost si este un subiect des dezbătut. Unii chirurgi considerau marginea de siguranță oncologică de 1 cm, în timp ce în ultima vreme se acceptă tot mai des marginea de rezecție de 1 mm. Materiale și metode: În studiul prezent au fost analizați 140 de pacienți internați din 01.01.2011 pana in 30.06.2018 si s-au comparat rezultatele obținute în funcție de marginile de rezecție R0 si R1. Rezultate și concluzii: Concluziile acestui studiu sunt că lipsa tratamentului neoadjuvant se corelează cu apariția mai frecventă marginii de rezecție microscopic pozitive, nu sunt diferențe semnificativ statistice de supraviețuire între pacienții cu R0 și R1, supraviețuirea acestora la 5 ani fiind de 45% vs. 33%, pe termen scurt și mediu, supraviețuirea estimată este mai mică în grupul pacienților cu metastaze mai mari de 5 cm, metastazele din hemificatul stang prezic un prognostic mai lung al supraviețuirii, iar supraviețuirea este influențată de gradul de diferențiere tumoral - biologia tumorală.Introduction: Liver resection is the gold standard in the treatment of liver metastases. The hepatic resection margin for liver metastases has been and is a frequently debated topic. Some surgeons considered the 1 cm margin of oncology safety, whereas lately, the 1 mm resection margin is increasingly accepted. Material and methods: In the current study, 140 patients were admitted from January 01, 2011 to June 30, 2018 and the results obtained according to the resection edges R0 and R1 were compared. Results and conclusion: The conclusion of this study is that the lack of neoadjuvant treatment correlates with the more frequent occurrence of the positive microscopic resection margin, there are no statistically significant survival differences between patients with R0 and R1, their survival at 5 years being 45% vs. 33%, in the short and medium term, the estimated survival is lower in the patients with metastases greater than 5 cm, the left hemi-liver metastases predict a longer prognosis of survival, and survival is influenced by the degree of tumor differentiation - tumor biology

R1 incidence in pancreatoduodenectomy for pancreatic ductal adenocarcinoma of the pancreatic head

Universitatea de Medicină și Farmacie “Iuliu Hațieganu”, Institultul Regional de Gastroenterologie și Hepatologie “Prof. O. Fodor”, Institutul Regional de Gastroenterologie și Hepatologie “Prof. O. Fodor,” Departamentul de Anatomie Patologică, Cluj-Napoca, Romănia, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Gold standardul duodenopancreatectomiei cefalice (DPC) este obținerea unor margini de rezecție tumorală negative (R0). Având în vedere datele din literatură, în care unii autori au demonstrat ca incidența marginilor R1 crește după folosirea unor protocoale histopatologice standardizate de colorare și preparare a piesei de duodenopancreatectomie cefalica (DPC), am considerat necesar efectuarea unui studiu, în acest sens, în Institutul nostru. Material și metode: Au fost studiate 116 cazuri de adenocarcinom ductal pancreatic cefalic la care s-a efectuat DPC cu intenție de radicalitate. Cele 116 cazuri au fost împarțite în două loturi: un lot de 59 de cazuri (retrospectiv) la care marginile de rezecție nu au fost preparate și un lot de 57 de cazuri (prospectiv) la care piesele au fost preparate și colorate conform unui protocol standardizat. Astfel dacă în cazul lotului retrospectiv marginea circumferențiala nu a fost detaliată, în cazul lotului prospectiv această margine a fost imparțită în: medială, anterioară, superioară și posterioară. Rezultate: Incidența marginii R1 în lotul retrospectiv a fost de 39%, iar în lotul prospectiv a fost de 68.6% (p-value=0.0016). Marginea de rezecție cea mai des R1 a fost marginea circumferențială (87%) în cazul lotului retrospectiv, iar marginea mediala (mezopancreasul) (74.35%) în lotul prospectiv. Marginile R1 au fost multifocale în 13.04% în grupul retrospectiv vs 51.28% în grupul prospectiv (p-value=0.003). Supraviețuirea generală nu a fost influențată de tipul margini de rezecție (R0/R1). Concluzii: Folosirea unor protocoale standardizate de preparare și colorare a pieselor de DPC duce la creșterea incidenței marginilor R1. Mezopancreasul reprezintă locul de elecție pentru apariția marginilor R1 în DPC.Utilizarea unor protocoale standardizate pentru colorarea marginilor de rezecție în DPC crește incidența marginilor R1 multifocale. Supraviețuirea generală este influențată de tipul margini de rezecție (R0/R1).Introduction: Obtaining "clear" margins (R0) in pancreatoduodenectomy is the gold standard for this surgery. We sought to determine whether a standardized histopathological protocol (SHP) would increase the R1 rate. Material and methods: We analyzed 116 cases who had received surgery to treat pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head. We separated the cases into two groups: the first group included 59 cases (retrospective) with no standardized histopathological protocol (NSHP), while the second one included 57 cases (prospective), for which we used an SHP for the tumor margins. The circumferential margins were not defined in detail in the NSHP group, while SHP margins were defined as medial (mesopancreas), anterior, superior and posterior. R1 was defined as the distance between the tumor and the resection margin of ≤1 mm. Results: The R1 rate increased significantly from 39% in the NSHP group to 68.6% in the SHP group (p-value=0.0016). The circumferential margin was closest to the R1 definition in the NSHP group (87%); the closest to R1 in the SHP group was a medial margin (74.35%). The margin positivity was multifocal (13.04% retrospective vs 51.28% prospective, p-value=0.003) in the SHP group. There was no significant difference in overall survival (OS) between R0 and R1 resections (p-value=0.348). Conclusions: The R1 incidence rate in PD for PDAC of the pancreatic head is influenced by SHP, but OS is not influenced by margin positivity when R1 is defined as 1 mm. The mesopancreas represents the primary site for positive resection margins. SHP can determine multifocal margin positivity

Variants in STXBP3 are Associated with Very Early Onset Inflammatory Bowel Disease, Bilateral Sensorineural Hearing Loss and Immune Dysregulation

Background and aims: Very early onset inflammatory bowel disease [VEOIBD] is characterized by intestinal inflammation affecting infants and children less than 6 years of age. To date, over 60 monogenic aetiologies of VEOIBD have been identified, many characterized by highly penetrant recessive or dominant variants in underlying immune and/or epithelial pathways. We sought to identify the genetic cause of VEOIBD in a subset of patients with a unique clinical presentation. Methods: Whole exome sequencing was performed on five families with ten patients who presented with a similar constellation of symptoms including medically refractory infantile-onset IBD, bilateral sensorineural hearing loss and, in the majority, recurrent infections. Genetic aetiologies of VEOIBD were assessed and Sanger sequencing was performed to confirm novel genetic findings. Western analysis on peripheral blood mononuclear cells and functional studies with epithelial cell lines were employed. Results: In each of the ten patients, we identified damaging heterozygous or biallelic variants in the Syntaxin-Binding Protein 3 gene [STXBP3], a protein known to regulate intracellular vesicular trafficking in the syntaxin-binding protein family of molecules, but not associated to date with either VEOIBD or sensorineural hearing loss. These mutations interfere with either intron splicing or protein stability and lead to reduced STXBP3 protein expression. Knock-down of STXBP3 in CaCo2 cells resulted in defects in cell polarity. Conclusion: Overall, we describe a novel genetic syndrome and identify a critical role for STXBP3 in VEOIBD, sensorineural hearing loss and immune dysregulation.info:eu-repo/semantics/publishedVersio

How values and perceptions shape farmers' biodiversity management: insights from ten European countries

Farmers play a pivotal role in addressing biodiversity loss whilst maintaining food production. To rethink conservation in agricultural landscapes, it is crucial to understand their decisions regarding biodiversity and its management on the farms. In this study, we conducted 48 semi-structured interviews across ten European countries in 2021/22 to explore how farmers’ perceptions and valuations relate to their biodiversity management. Employing reflexive thematic analysis, we identified recurring patterns of shared meanings. Our findings underscore the profound influence of farmers’ biodiversity perceptions on their biodiversity management practices: 1) Narrow and targeted interventions were closely tied to instrumental values of biodiversity, whereas holistic management strategies were linked with recognising an inherent value of nature. 2) Targeted approaches were related to farmers’ interpretations of biodiversity as specific taxa and functions, relying on easily assessable and emotionally connoted indicators. 3) Holistic approaches aligned with a broader biodiversity concept and an emphasis on intricate functional relationships within ecosystems. 4) Actual decisions to implement measures were significantly constrained by perceived dependencies, namely production pathways, social dependencies, and landscape conditions. These findings raise a critical question about the prioritisation of ecocentric intrinsic versus anthropocentric instrumental values in conservation strategies. We propose an approach of ethical pluralism, acknowledging that instrumental values may provide practical solutions for certain challenges, while intrinsic values hold ethical significance, particularly in the context of complex or large-scale biodiversity conservation initiatives. Engaging in dialogue that accounts for diverse values will be essential for shaping effective and socially meaningful biodiversity conservation

A Method to Exploit the Structure of Genetic Ancestry Space to Enhance Case-Control Studies

A. Palotie on työryhmän Int IBD Genetics Consortium jäsen.One goal of human genetics is to understand the genetic basis of disease, a challenge for diseases of complex inheritance because risk alleles are few relative to the vast set of benign variants. Risk variants are often sought by association studies in which allele frequencies in case subjects are contrasted with those from population-based samples used as control subjects. In an ideal world we would know population-level allele frequencies, releasing researchers to focus on case subjects. We argue this ideal is possible, at least theoretically, and we outline a path to achieving it in reality. If such a resource were to exist, it would yield ample savings and would facilitate the effective use of data repositories by removing administrative and technical barriers. We call this concept the Universal Control Repository Network (UNICORN), a means to perform association analyses without necessitating direct access to individual-level control data. Our approach to UNICORN uses existing genetic resources and various statistical tools to analyze these data, including hierarchical clustering with spectral analysis of ancestry; and empirical Bayesian analysis along with Gaussian spatial processes to estimate ancestry-specific allele frequencies. We demonstrate our approach using tens of thousands of control subjects from studies of Crohn disease, showing how it controls false positives, provides power similar to that achieved when all control data are directly accessible, and enhances power when control data are limiting or even imperfectly matched ancestrally. These results highlight how UNICORN can enable reliable, powerful, and convenient genetic association analyses without access to the individual-level data.Peer reviewe