40 research outputs found
Do some patients receive unnecessary parenteral nutrition after pancreatoduodenectomy? Results from an international multicentre study
No full textBACKGROUNDS/AIMS: After pancreatoduodenectomy (PD), an early oral diet is recommended; however, the postoperative nutritional management of PD patients is known to be highly variable, with some centers still routinely providing parenteral nutrition (PN). Some patients who receive PN experience clinically significant complications, underscoring its judicious use. Using a large cohort, this study aimed to determine the proportion of PD patients who received postoperative nutritional support (NS), describe the nature of this support, and investigate whether receiving PN correlated with adverse perioperative outcomes. METHODS: Data were extracted from the Recurrence After Whipple's study, a retrospective multicenter study of PD outcomes. RESULTS: In total, 1,323 patients (89%) had data on their postoperative NS status available. Of these, 45% received postoperative NS, which was "enteral only," "parenteral only," and "enteral and parenteral" in 44%, 35%, and 21% of cases, respectively. Body mass index < 18.5 kg/m2 (p = 0.03), absence of preoperative biliary stenting (p = 0.009), and serum albumin < 36 g/L (p = 0.009) all correlated with receiving postoperative NS. Among those who did not develop a serious postoperative complication, i.e., those who had a relatively uneventful recovery, 20% received PN. CONCLUSIONS: A considerable number of patients who had an uneventful recovery received PN. PN is not without risk, and should be reserved for those who are unable to take an oral diet. PD patients should undergo pre- and postoperative assessment by nutrition professionals to ensure they are managed appropriately, and to optimize perioperative outcomes
Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple's (RAW) study
No full textBackground: Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for consenting and benchmarking purposes. Furthermore, preoperative identification of high-risk patients can guide patient selection and potentially allow for targeted prehabilitation and/or individualized treatment regimens. Using a large multicentre cohort, this study aimed to calculate the incidence of all PD complications and identify risk factors. Method: Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, 2012–2015). The incidence and severity of all complications was recorded and potential risk factors for morbidity, major morbidity (Clavien–Dindo grade > IIIa), postoperative pancreatic fistula (POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were investigated. Results: Among the 1348 included patients, overall morbidity, major morbidity, POPF, PPH and perioperative death affected 53 per cent (n = 720), 17 per cent (n = 228), 8 per cent (n = 108), 6 per cent (n = 84) and 4 per cent (n = 53), respectively. Following multivariable tests, a high BMI (P = 0.007), an ASA grade > II (P < 0.0001) and a classic Whipple approach (P = 0.005) were all associated with increased overall morbidity. In addition, ASA grade > II patients were at increased risk of major morbidity (P < 0.0001), and a raised BMI correlated with a greater risk of POPF (P = 0.001). Conclusion: In this multicentre study of PD outcomes, an ASA grade > II was a risk factor for major morbidity and a high BMI was a risk factor for POPF. Patients who are preoperatively identified to be high risk may benefit from targeted prehabilitation or individualized treatment regimens.</p
Does an extensive diagnostic workup for upfront resectable pancreatic cancer result in a delay which affects survival? Results from an international multicentre study
No full textBackgrounds/aims: pancreatoduodenectomy (PD) is recommended in fit patients with a carcinoma (PDAC) of the pancreatic head, and a delayed resection may affect survival. This study aimed to correlate the time from staging to PD with long-term survival, and study the impact of preoperative investigations (if any) on the timing of surgery.Methods: data were extracted from the Recurrence After Whipple's (RAW) study, a multicentre retrospective study of PD outcomes. Only PDAC patients who underwent an upfront resection were included. Patients who received neoadjuvant chemo-/radiotherapy were excluded. Group A (PD within 28 days of most recent preoperative computed tomography [CT]) was compared to group B (> 28 days).Results: a total of 595 patents were included. Compared to group A (median CT-PD time: 12.5 days, interquartile range: 6-21), group B (49 days, 39-64.5) had similar one-year survival (73% vs. 75%, p = 0.6), five-year survival (23% vs. 21%, p = 0.6) and median time-todeath (17 vs. 18 months, p = 0.8). Staging laparoscopy (43 vs. 29.5 days, p = 0.009) and preoperative biliary stenting (39 vs. 20 days, p < 0.001) were associated with a delay to PD, but magnetic resonance imaging (32 vs. 32 days, p = 0.5), positron emission tomography (40 vs. 31 days, p > 0.99) and endoscopic ultrasonography (28 vs. 32 days, p > 0.99) were not.Conclusions: although a treatment delay may give rise to patient anxiety, our findings would suggest this does not correlate with worse survival. A delay may be necessary to obtain further information and minimize the number of PD patients diagnosed with early disease recurrence.</p
Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy: results from the recurrence after Whipple's (RAW) study
No full textIntroduction: Adjuvant chemotherapy (AC) can prolong overall survival (OS) after pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). However, fitness for AC may be influenced by postoperative recovery. We aimed to investigate if serious (Clavien-Dindo grade ≥ IIIa) postoperative complications affected AC rates, disease recurrence and OS. Materials and methods: Data were extracted from the Recurrence After Whipple's (RAW) study (n = 1484), a retrospective study of PD outcomes (29 centres from eight countries). Patients who died within 90-days of PD were excluded. The Kaplan-Meier method was used to compare OS in those receiving or not receiving AC, and those with and without serious postoperative complications. The groups were then compared using univariable and multivariable tests. Results: Patients who commenced AC (vs no AC) had improved OS (median difference: (MD): 201 days), as did those who completed their planned course of AC (MD: 291 days, p < 0.0001). Those who commenced AC were younger (mean difference: 2.7 years, p = 0.0002), more often (preoperative) American Society of Anesthesiologists (ASA) grade I-II (74% vs 63%, p = 0.004) and had less often experienced a serious postoperative complication (10% vs 18%, p = 0.002). Patients who developed a serious postoperative complication were less often ASA grade I-II (52% vs 73%, p = 0.0004) and less often commenced AC (58% vs 74%, p = 0.002). Conclusion: In our multicentre study of PD outcomes, PDAC patients who received AC had improved OS, and those who experienced a serious postoperative complication commenced AC less frequently. Selected high-risk patients may benefit from targeted preoperative optimisation and/or neoadjuvant chemotherapy.</p
Predictors of actual five-year survival and recurrence after pancreatoduodenectomy for ampullary adenocarcinoma: results from an international multicentre retrospective cohort study
No full textBackground: pancreatoduodenectomy (PD) is recommended in fit patients with a resectable ampullary adenocarcinoma (AA). We aimed to identify predictors of five-year recurrence/survival.Methods: data were extracted from the Recurrence After Whipple's (RAW) study, a multicentre retrospective study of PD patients with a confirmed head of pancreas or periampullary malignancy (June 1st, 2012-May 31st, 2015). Patients with AA who developed recurrence/died within five-years were compared to those who did not.Results: 394 patients were included and actual five-year survival was 54%. Recurrence affected 45% and the median time-to-recurrence was 14 months. Local only, local and distant, and distant only recurrence affected 34, 41 and 94 patients, respectively (site unknown: 7). Among those with recurrence, the most common sites were the liver (32%), local lymph nodes (14%) and lung/pleura (13%). Following multivariable tests, number of resected nodes, histological T stage > II, lymphatic invasion, perineural invasion (PNI), peripancreatic fat invasion (PPFI) and ≥1 positive resection margin correlated with increased recurrence and reduced survival. Furthermore, ≥1 positive margin, PPFI and PNI were all associated with reduced time-to-recurrence.Conclusions: this multicentre retrospective study of PD outcomes identified numerous histopathological predictors of AA recurrence. Patients with these high-risk features might benefit from adjuvant therapy.</p
Sensory and quality parameters of raw and processed Chicory-Hindbeh, a commonly consumed dark leafy green in Lebanon (Cichorium intybus L.) during frozen storage
No full textThis work aimed at assessing the effect of heat treatment and frozen storage on the sensory and chemical properties of chicory with the goal of optimizing the heat pretreatment-storage condition to best preserve the chemical and sensory properties of chicory. Raw, boiled (10min), blanched (90°C for 60s) and steamed (for 20s) chicory samples were produced and stored at-6°C,-12°C or-18°C for 4 months. Chemical analyses (moisture, ash, vitamin C, peroxidase activity, chlorophyll and color) and sensory evaluation (QDA and hedonic evaluation) were conducted. Treatment significantly influenced all chemical variables (p0.001), except for moisture; and so did freezing temperatures for a-value (p0.001), chlorophyll-a, peroxidase activity, vitamin C and ash (p0.01), total chlorophyll, moisture and b-value (p0.05). Differences were obtained for age for all chemical variables (p0.001). Treatments affected consumers' acceptability of chicory and QDA showed that boiled chicory was significantly more tender, less chewy and crunchy and needed less time to disintegrate than other samples. PCA showed that PC1 and PC2 separated attributes based on type and intensity of treatments, respectively. It is recommended to use blanching at 90°C for 60s and freezing at-12°C or-18°C to best preserve the quality of chicory. © 2014 Elsevier Ltd.Aguero MV, 2005, LWT-FOOD SCI TECHNOL, V38, P772, DOI 10.1016-j.lwt.2004.07.018; Ahmed B, 2003, J ETHNOPHARMACOL, V87, P237, DOI 10.1016-S0378-8741(03)00145-4; Allende A, 2006, TRENDS FOOD SCI TECH, V17, P513, DOI 10.1016-j.tifs.2006.04.005; AOAC, 2000, OFFICIAL METHODS ANA, VII, P33; AOAC, 2006, OFFICIAL METHODS ANA; Bais HP, 2001, J SCI FOOD AGR, V81, P467, DOI 10.1002-jsfa.817.abs; Barbosa-Canovas G. V., 2005, FREEZING FRUITS VEGE; Batal M, 2008, HLTH KITCHEN RECIPES; Batal M, 2007, FOOD NUTR BULL, V28, pS303; Bevilacqua M, 2004, J FOOD ENG, V63, P253, DOI 10.1016-j.jfoodeng.2003.07.007; Cruz RMS, 2009, J FOOD ENG, V94, P90, DOI 10.1016-j.jfoodeng.2009.03.006; Cruz RMS, 2007, INNOV FOOD SCI EMERG, V8, P244, DOI 10.1016-j.ifset.2007.01.003; FRANCIS FJ, 1995, FOOD QUAL PREFER, V6, P149, DOI 10.1016-0950-3293(94)00026-R; Funamoto Y, 2002, POSTHARVEST BIOL TEC, V24, P163, DOI 10.1016-S0925-5214(01)00135-1; Giannakourou MC, 2003, FOOD CHEM, V83, P33, DOI 10.1016-S0308-8146(03)00033-5; Gokmen V, 2005, LWT-FOOD SCI TECHNOL, V38, P903, DOI 10.1016-j.lwt.2004.06.018; Goncalves EM, 2009, J FOOD ENG, V93, P32, DOI 10.1016-j.jfoodeng.2008.12.027; Heaton JW, 1996, TRENDS FOOD SCI TECH, V7, P8, DOI 10.1016-0924-2244(96)81352-5; Huyskens-Keil S, 2008, INT S TOM TROP, V821, P209; Jaiswal AK, 2012, FOOD CHEM, V131, P63, DOI 10.1016-j.foodchem.2011.08.032; Jeambey Z, 2005, USE CONSUMPTION HLTH; Jeambey Z, 2009, PUBLIC HEALTH NUTR, V12, P1902, DOI 10.1017-S1368980009004832; Labib AAS, 1997, PLANT FOOD HUM NUTR, V50, P333, DOI 10.1007-BF02436080; Lawless H. T., 2010, SENSORY EVALUATION F; Lteif L, 2009, J DAIRY SCI, V92, P4135, DOI 10.3168-jds.2009-2070; Ma LF, 1999, PHYTOCHEMISTRY, V50, P195, DOI 10.1016-S0031-9422(98)00584-6; Martin G, 2000, FLAIR FLOW EUROPE A, P6; Martins RC, 2002, INT J REFRIG, V25, P966, DOI 10.1016-S0140-7007(01)00050-0; Martins RC, 2004, J FOOD ENG, V64, P481, DOI 10.1016-j.jfoodeng.2003.11.015; Mazzeo T, 2011, FOOD CHEM, V128, P627, DOI 10.1016-j.foodchem.2011.03.070; Nandagopal S., 2007, ADV BIOL RES, V1, P17; Peters AM, 1998, J AM SOC HORTIC SCI, V123, P326; Pushparaj PN, 2007, J ETHNOPHARMACOL, V111, P430, DOI 10.1016-j.jep.2006.11.028; Rico D, 2007, TRENDS FOOD SCI TECH, V18, P373, DOI 10.1016-j.tifs.2007.03.011; Sanchez-Mata MC, 2012, GENET RESOUR CROP EV, V59, P431, DOI 10.1007-s10722-011-9693-6; Song JY, 2003, FOOD CHEM, V83, P69, DOI 10.1016-S0308-8146(03)00049-9; Tousch D, 2008, BIOCHEM BIOPH RES CO, V377, P131, DOI 10.1016-j.bbrc.2008.09.088; Zafar R, 1998, J ETHNOPHARMACOL, V63, P227, DOI 10.1016-S0378-8741(98)00087-70
Islamic marketing : insights from a critical perspective
No full textThis paper seeks to encourage a critical dialogue within the realm of Journal of Islamic Marketing. It invites marketing scholars and practitioners working on various topics related to Islam and Muslim societies to adopt fresh theoretical and methodological positions that would enhance our understanding of multiple marketing and market dynamics in Muslim societies. The author suggests that the advancement of knowledge in the area of Islamic marketing requires reflexivity and self-critique. The paper highlights the constructive value of critical approach to the development of marketing theory and practice. This paper reflects the author’s personal viewpoint on the production of knowledge and improving practice in the realm of Islamic marketing
Shams al-dim al-Sakhawi as a historian of the 9th/15th century : with an edition of that section of his chronicles (Wajiz al-kalam) covering the period 800-849 / 1397-1445
No full textAlthough a prolific writer of history, Sakhawi is, primarily, a
traditionist. As such, accuracy both in utterance and writing would,
by the very nature of his training, be his first objective.
Modern writers appear to have neglected the importance of his
contribution to the understanding of the history of his century.
accept for a few articles, comparatively little has been written. It
is, therefore, strange that such a mine of information as Sakhawi's
writing presents has remained so long in oblivion.
In this thesis an attempt has been made to evaluate that contribution
together with an edition of part of his work.
The study has been divided into three sections, the first dealing
with Sakhawi’s life and times. This part of the study is based largely
on his autobiography which was written but a few months before he died.
During research no reference was discovered to this most informative
work.
The section falls into three chapters, the first of which endeavours
to show the political and educational aspects of Cairo during the early
part of Sakhawi's lifetime. Cairo was his native city and, as such,
made great impact on his early life.
In the second chapter the position of his family, his Shaykhs, the
academic journeys he made, his residence in Hijaz and the last phase of
his life are portrayed.
The third chapter deals with his activities as an adult, his reputation
as a traditionist together with a survey of his works as presented in
his autobiography.
In the second part, the study deals exclusively with Sakhawi as
a historian of the 9th/15th century. This part also is divided into
two chapters, the first of which considers the following aspects: -
I Sakawi's works on the century;
II His motives, methods and literary style and
III His treatment of the history of the century.
The second chapter collates Sakhawi's methods of selecting his
information and the painstaking efforts he made to verify them, together
with his historical achievements, while the last two topics endeavour to
evaluate his task as a historian in that century.
Section three presents the hitherto unedited part of Wajiz al-Kalam...
which deals with the history of the 9th/15th century. This section
also falls into the three divisions of preface, text and annotations.
The last divides again into two groups one of which deals with the
textual variants mentioned in the footnotes and the other attempts to
deal with the interpretation of most of the idiom, colloquial expressions
and the names of places and personalities mentioned in the supplement to
the text
Venous Resection During Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma—A Multicentre Propensity Score Matching Analysis of the Recurrence After Whipple’s (RAW) Study
No full textBackground: Pancreatoduodenectomy with venous resection (PDVR) may be performed to achieve tumour clearance in patients with a pancreatic ductal adenocarcinoma (PDAC) with venous involvement. This study aimed to evaluate the impact of PDVR on PDAC outcomes. Methods: In total, 435 PDAC patients with either R0 status (n = 322) or R1 status within the superior mesenteric vein groove (n = 113) were extracted from the Recurrence After Whipple’s (RAW) study dataset. PDVR patients were matched in a 1:2 ratio with standard PD patients. Comparisons were then made between the two groups (surgical radicality and survival). Results: A total of 81 PDVRs were matched with 162 PDs. Neoadjuvant chemotherapy (5.7% vs. 13.6%, p = 0.032) and R1 resection rates (17.9% vs. 42%, p < 0.001) were higher in the PDVR group. Risk factors for R1 resection included venous resection (p < 0.001 for sleeve and p = 0.034 for segmental resection), pT3 (p = 0.007), and pN1 stage (p = 0.045). PDVR patients had lower median overall survival (OS, 21 vs. 30 months (m), p = 0.023) and disease-free survival (DFS, 17 m vs. 24 m, p = 0.043). Among PDVR patients, R status did not impact on OS (R0: 23 m, R1: 21 m, p = 0.928) or DFS (R0: 18 m, R1: 17 m, p = 0.558). Irrespective of R status, systemic recurrence was higher in the PDVR group (p = 0.034). Conclusions: Independent of R status, the PDVR group had lower overall survival and higher systemic recurrence rates
