711 research outputs found
ASO Author Reflections: Vascular Resection in Perihilar Cholangiocarcinoma Surgery
No full textvascular resection in hilar cholangiocarcinom
PACE Solver Description: OCMu64, a Solver for One-Sided Crossing Minimization
Full text linkGiven a bipartite graph (A,B), the one-sided crossing minimization (OCM) problem is to find an ordering of the vertices of B that minimizes the number of edge crossings when drawn in the plane.
We introduce the novel strongly fixed, practically fixed, and practically glued reductions that maximally generalize some existing reductions. We apply these in our exact solver OCMu64, that directly uses branch-and-bound on the ordering of the vertices of B and does not depend on ILP or SAT solvers
sj-docx-1-tam-10.1177_17588359211033704 – Supplemental material for Circulating TP53 mutations are associated with early tumor progression and poor survival in pancreatic cancer patients treated with FOLFIRINOX
No full textSupplemental material, sj-docx-1-tam-10.1177_17588359211033704 for Circulating TP53 mutations are associated with early tumor progression and poor survival in pancreatic cancer patients treated with FOLFIRINOX by Fleur van der Sijde, Zakia Azmani, Marc G. Besselink, Bert A. Bonsing, Jan Willem B. de Groot, Bas Groot Koerkamp, Brigitte C. M. Haberkorn, Marjolein Y. V. Homs, Wilfred F. J. van IJcken, Quisette P. Janssen, Martijn P. Lolkema, Saskia A. C. Luelmo, Leonie J. M. Mekenkamp, Dana A. M. Mustafa, Ron H. N. van Schaik, Johanna W. Wilmink, Eveline E. Vietsch and Casper H. J. van Eijck in Therapeutic Advances in Medical Oncology</p
Detection of airborne Campylobacter with three bioaerosol samplers for alarming bacteria transmission in broilers.
No full textIn an airborne transmission experiment, Campylobacter in the air was sampled by three types of bioaerosol samplers (all-glass impinger AGI-30, Andersen six-stage impactor, and OMNI-3000) in four broiler rooms. In each room, five 14-day- old broilers inoculated with Campylobacter jejuni were kept in a central cage located in the middle of the room. Another ten broilers, as susceptible animals, were kept individually in ten cages surrounding the central cage at a distance of approximately 75 cm. Air samples were taken on eight days: the day before inoculation (BI) as a negative control, and 1, 3, 6, 9, 14, 21, and 29 days post-inoculation (PI). Presence of C. jejuni was investigated with the culture method for culturable bacteria and with the PCR test for bacterial DNA. Results showed that Campylobacter infection of susceptible broilers occurred in all four rooms; however, no culturable C. jejuni could be detected in any of the air samples. This might have been the result of the low number of broilers in the room and the unfavorable conditions for Campylobacter survival, leading to Campylobacter concentrations below the detection limits of the bioaerosol samplers. The PCR test showed that DNA of C. jejuni was detected in the air samples on the first day PI, but no bacterial DNA was detected on the following days. It is concluded that the three samplers used in this study are not able to alarm Campylobacter outbreaks through an airborne route when low bacterial concentrations are present. Developments of new sampling techniques with low detection limits are required for biosecurity assessment
High mortality after ALPPS for perihilar cholangiocarcinoma: case-control analysis including the first series from the international ALPPS registry.
No full textINTRODUCTION:
Resection of perihilar cholangiocarcinoma (PHC) entails high-risk surgery with postoperative mortality reported up to 18%, even in specialized centers. The aim of this study was to compare outcomes of PHC patients who underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to patients who underwent resection without ALPPS.
METHODS:
All patients who underwent ALPPS for PHC were identified from the international ALPPS registry and matched controls were selected from a standard resection cohort from two centers based on future remnant liver size. Outcomes included morbidity, mortality, and overall survival.
RESULTS:
ALPPS for PHC was associated with 48% (14/29) 90-day mortality. 90-day mortality was 13% in 257 patients who underwent major liver resection for PHC without ALPPS. The 29 ALPPS patients were matched to 29 patients resected without ALPPS, with similar future liver remnant volume (P = 0.480). Mortality in the matched control group was 24% (P = 0.100) and median OS was 27 months, comparted to 6 months after ALPPS (P = 0.064).
DISCUSSION:
Outcomes of ALPPS for PHC appear inferior compared to standard extended resections in high-risk patients. Therefore, portal vein embolization should remain the preferred method to increase future remnant liver volume in patients with PHC. ALPPS is not recommended for PHC
Potential of LCA for designing technological innovations – the case of organic eggs
No full textEcological sustainability in agriculture is a concept that contains various environmental problems, which are caused by emission of pollutants and unsustainable use of limited resources, during different processes along the food chain. Technological innovations may help to improve ecological sustainability of food products. Preceding to the development of ecological sustainable technological innovations three questions need to be answered; 1) how ecological sustainable is the current production process, 2) which processes in the chain causes the highest ecological impact and 3) which production parameters significantly affect the ecological impact of these processes? The aim of this research is to demonstrate Life Cycle Assessment to the designers of technological innovations Life Cycle Assessment as a method to answer these questions, by means of a case study of the organic egg. In this study the LCA of organic eggs was calculated and compared to equivalent egg products. Ecological hotspots within the production chain were identified and the effectiveness of production parameters from the laying hen farm were identified on the LCA using sensitivity analysis. This LCA case study showed that organic eggs score worse than equivalent eggs on acidification, eutrophication and land use. Technological innovators should focus on ammonia emission from the laying hen farm to reduce the impact of acidification. Another focus should be nitrate leaching during concentrate production to reduce eutrophication. Innovative organic laying hen farmers may focus on a high feed conversion to improve the LCA of organic eggs in a broader sense. A shift from single tiered housing of laying hens to multi tiered housing with manure drying on manure belts, can reduce acidification 53% and eutrophication with 18%, almost enough to level out the 60% higher acidification and the 25% higher eutrophication of organic eggs compared to equivalent egg products
Timing of Initiation of Palliative Chemotherapy in Asymptomatic Patients with Metastatic Pancreatic Cancer:An International Expert Survey and Case-Vignette Study
Full text linkBackground: The use of imaging, in general, and during follow-up after resection of pancreatic cancer, is increasing. Consequently, the number of asymptomatic patients diagnosed with metastatic pancreatic cancer (mPDAC) is increasing. In these patients, palliative systemic therapy is the only tumor-directed treatment option; hence, it is often immediately initiated. However, delaying therapy in asymptomatic palliative patients may preserve quality of life and avoid therapy-related toxicity, but the impact on survival is unknown. This study aimed to gain insight into the current perspectives and clinical decision=making of experts regarding the timing of treatment initiation of patients with asymptomatic mPDAC. Methods: An online survey (13 questions, 9 case-vignettes) was sent to all first and last authors of published clinical trials on mPDAC over the past 10 years and medical oncologists of the Dutch Pancreatic Cancer Group. Inter-rater variability was determined using the Kappa Light test. Differences in the preferred timing of treatment initiation among countries, continents, and years of experience were analyzed using Fisher’s exact test.Results: Overall, 78 of 291 (27%) medical oncologists from 15 countries responded (62% from Europe, 23% from North America, and 15% from Asia–Pacific). The majority of respondents (63%) preferred the immediate initiation of chemotherapy following diagnosis. In 3/9 case-vignettes, delayed treatment was favored in specific clinical contexts (i.e., patient with only one small lung metastasis, significant comorbidities, and higher age). A significant degree of inter-rater variability was present within 7/9 case-vignettes. The recommended timing of treatment initiation differed between continents for 2/9 case-vignettes (22%), in 7/9 (77.9%) comparing the Netherlands with other countries, and based on years of experience for 5/9 (56%). Conclusions: Although the response rate was limited, in asymptomatic patients with mPDAC, immediate treatment is most often preferred. Delaying treatment until symptoms occur is considered in patients with limited metastatic disease, more comorbidities, and higher age.</p
Uncertainty in Medical Decision Making: knowing how little you know
Full text linkMaking decisions about the care of individual patients is fundamental to health care. For
each patient, many decisions have to be made. In the emergency room, for example, a
doctor should decide which patient to see first, decide whether an x-ray should be made of
an injured ankle, and decide how this specific ankle fracture of this specific patient should
be treated. Medical training is focused on acquiring the knowledge and experience to make
such decisions. Other factors that are essential for patient care, including empathy and
technical abilities, also involve decision making. For example, in the outpatient clinic, a
trade-off is needed when one patient needs more time and empathy, but the waiting room
is packed and the physician is an hour behind schedule. In the operating room, a surgeon
must decide whether to proceed with a complicated laparoscopic procedure to remove a
gall bladder, to convert to an open procedure, or to ask a more experienced surgeon for
help
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