1,721,033 research outputs found
LAPAROSCOPIC LIVER RESECTIONS VERSUS OPEN APPROACH: A PROSPECTIVE INTRAOPERATIVE COST-EFFECTIVENESS ANALYSIS
No full textBackground. The long learning curve and the common opinion that laparoscopic liver resections (LLRs) have higher costs are limiting the widespread utilization of this technique. Aim of the present study was to perform a cost-effectiveness analysis of LLR vs liver resections with standard approach. Material and methods. From August 2011 to November 2011, 25 liver resections were performed, 18 of them (72%) with a laparoscopic approach and 7 (28%) with an open approach. Hepatic resections requiring bile duct or vascular reconstruction or focal lesions not amenable to a parenchyma-sparing technique were not considered for laparoscopic approach. CUSA-Excel© was utilized as liver transecting device in open approach whereas Sonosurg© was utilized for LLRs. We prospectively collected the number and type of disposable materials used for surgery such as: trocars, vascular staplers and refills, clips, stitches, sutures, irrigation suction, disposable materials for CUSA and Sonosurg, argon beamer, endobags. Results. The mean operation time was 356±123 min vs 186±75 min (p<0.001) whereas the mean postoperative stay was 3.7±2.6 days vs 8.7±2.1 days for laparoscopic and open approach, respectively (p=0.001). Type of resections in LLR vs open patients were respectively: 0 vs 3 right hepatectomy, 3 vs 1 left hepatectomy, 7 vs 2 segmentectomy, 8 vs 1 wedge resection. According to the actual marketing price for Belgium, LLRs resulted in an average intraoperative per/operation surplus costs of 310€ (1406±96€ vs 1096±86€ for LLR and open approach respectively, p<0.001). The main costs for LLR were vascular stapler and refills (391€), trocars (351€), and clips (301€). The main costs for open approach were the disposable CUSA materials (426€) and sutures/stiches (202€). The cost of a day in hospital stay is 600 €, consequently the overall cost saving was 2690€. Conclusions. LLRs require significant higher intraoperative costs and longer operation time compared to the open approach. However the higher intraoperative costs are entirely compensated and overcome by the inferior costs of the shorter postoperative stay. A randomized prospective comparative study is necessary to avoid operation selection bias
The complete nucleotide sequence of hepatitis B virus in 9 patients with fulminant hepatitis B infection
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Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
Prospective evaluation of intraoperative hemodynamics in liver transplantation with whole, partial and DCD grafts.
No full textThe interaction of systemic hemodynamics with hepatic flows at the time of liver transplantation (LT) has not been studied in a prospective uniform way for different types of grafts. We prospectively evaluated intraoperative hemodynamics of 103 whole and partial LT. Liver graft hemodynamics were measured using the ultrasound transit time method to obtain portal (PVF) and arterial (HAF) hepatic flow. Measurements were recorded on the native liver, the portocaval shunt, following reperfusion and after biliary anastomosis. After LT HAF and PVF do not immediately return to normal values. Increased PVF was observed after graft implantation. Living donor LT showed the highest compliance to portal hyperperfusion. The amount of liver perfusion seemed to be related to the quality of the graft. A positive correlation for HAF, PVF and total hepatic blood flow with cardiac output was found (p = 0.001). Portal hypertension, macrosteatosis > 30%, warm ischemia time and cardiac output, independently influence the hepatic flows. These results highlight the role of systemic hemodynamic management in LT to optimize hepatic perfusion, particularly in LDLT and split LT, where the highest flows were registered
Pure laparoscopic full-left living donor hepatectomy for calculated small-for-size LDLT in adults: Proof of concept
No full textAdult-to-adult living donor liver transplantation (A2ALDLT) is an accepted mode of treatment for end-stage liver disease. Right-lobe grafts have usually been preferred in view of the higher graft volume, which lowers the risk of a small-for-size syndrome. However, donor left hepatectomy is associated with less morbidity than when it is compared to right hepatectomy. Laparoscopic donor hepatectomy (LDH) has been considered almost exclusively in pediatric transplantation. The results of laparoscopic left-liver graft procurement for calculated small-for-size A2ALDLT in four donors are presented. The graft-to-recipient body weight ratio was <0.8 in all recipients. The mean portal vein flow and the pressure and hepatic artery flows were measured at 190 ± 56 mL/min/100 g, 13 ± 1.4 mm/Hg and 109 ± 19 mL/min, respectively. No early postoperative donor complications were recorded. One graft was lost due to intrahepatic abscesses. Asymptomatic stenosis of a right posterior duct was treated with a Roux-en-Y loop 4 months later in one donor. We show that LDH of the full-left lobe is feasible. LDH is a very demanding operation, potentially decreasing donor morbidity. Standardization of this procedure, making it accessible to the growing number of experienced laparoscopic liver surgeons, could help renewing the interest for A2ALDLT in the Western world. This report of laparoscopic procurement of full-left liver grafts for small-for-size adult-to-adult living donor liver transplants shows that this operation is technically feasible and has the potential to diminish donor morbidity. See editorial by Akoad and Pomfret on page 2243 and case reports on pages 2462 and 2467. © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons
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