Effects of catastrophic financial loss on suicide risk: evidence from Korean stock market crash in October 2008

Social Psychiatry and Psychiatric Epidemiology - The negative effect of catastrophic financial loss on suicide risk is widely perceived but hardly studied in-depth because of various difficulties...     

Amylase level after pancreaticoduodenectomy in predicting postoperative pancreatic fistula

BackgroundIt is new clinical interest higher serum amylase level with pancreatitis after pancreaticoduodenectomy (PD) correlates with postoperative pancreatic fistula (POPF). Nevertheless, its evidence and study were scarce. We aimed to investigate correlation of serum amylase level immediate after PD and POPF occurrence.MethodsOf 163 patients who underwent PD at between January 2009 and December 2019, retrospective analysis was conducted to identify risk factors including serum amylase level immediate after PD for POPF occurrence.ResultsOverall incidence of POPF (25/163) was 15.3%. The patients occurred a POPF had significantly higher level of serum amylase on POD0 compared to in whom without a POPF (414 vs 253, p < 0.001). In univariate analysis, ASA classification, post pancreatectomy acute pancreatitis (POAP, serum amylase on POD0 >285IU/L) and Fistula Risk Grade were correlated with POPF occurrence. In multivariable analysis, Fistula risk grade and POAP were significantly associated with developing POPF.ConclusionIn patients with higher serum amylase (>285IU/L) on POD0 with higher fistula risk grade, comprehensive management to achieve mitigation of POPF is important.     

Tropical countries may be willing to pay more to protect their forests

Inadequate funding from developed countries has hampered international efforts to conserve biodiversity in tropical forests. We present two complementary research approaches that reveal a significant increase in public demand for conservation within tropical developing countries as those countries reach upper-middle-income (UMI) status. We highlight UMI tropical countries because they contain nearly four-fifths of tropical primary forests, which are rich in biodiversity and stored carbon. The first approach is a set of statistical analyses of various cross-country conservation indicators, which suggests that protective government policies have lagged behind the increase in public demand in these countries. The second approach is a case study from Malaysia, which reveals in a more integrated fashion the linkages from rising household income to increased household willingness to pay for conservation, nongovernmental organization activity, and delayed government action. Our findings suggest that domestic funding in UMI tropical countries can play a larger role in (i) closing the funding gap for tropical forest conservation, and (ii) paying for supplementary conservation actions linked to international payments for reduced greenhouse gas emissions from deforestation and forest degradation in tropical countries.Primary forests—“forests of native species in which there are no clearly visible signs of past or present human activity” (ref. 1, p. 11)—are globally significant repositories of biodiversity (2) and carbon (3). The global area of these forests is declining at an annual percentage rate that is nearly triple the rate for total global forest area (ref. 1, tables 2.4 and 3.3). Virtually all of the loss is occurring in tropical countries (SI Text, section 1). Logging is the main cause of the loss (ref. 1, p. 27), but hunting threatens biodiversity even in primary forests with intact tree cover (4, 5).Protecting primary tropical forests is a core mission of several international institutions created since the early 1990s, including the Convention on Biological Diversity (CBD), the Global Environment Facility (GEF), and the UN Collaborative Program on Reducing Emissions from Deforestation and Forest Degradation in Developing Countries (REDD). However, the CBD failed to achieve its goal of significantly reducing biodiversity loss by 2010 (6); international funding for biodiversity protection through the GEF and other mechanisms is below commitments made at the 1992 Earth Summit (7) and the amounts required to achieve the CBD’s 2020 protection targets (8); and REDD has not advanced beyond a readiness phase (www.un-redd.org). Relying on international mechanisms to fund protection of primary tropical forests does not look like a winning strategy.Here, we argue that economic development during the past 20–25 y has raised public demand for forest protection within tropical countries, but the level of protection supplied by tropical country governments has not kept pace. We focus on the dynamics of conservation and development within relatively wealthier developing countries: The group that is classified by the World Bank as upper-middle income (UMI). As we will show, the majority of primary forest area in tropical countries is found in these countries. We hypothesize that public willingness to pay (WTP) to protect forests has reached a relatively high level in UMI countries, leading to greater support for local conservation nongovernmental organizations (NGOs) and prompting governments to boost forest protection efforts—but not as much as the public would like. This gap between domestic demand and domestic supply of forest protection has two important implications: Domestic funding might be sufficient to cover the costs of additional protection in some, and perhaps many, tropical countries; and international funding might be able to leverage more domestic funding than it currently does.Although many cross-country studies in the environmental Kuznets curve (EKC) literature have investigated the effect of rising national income on deforestation (9), none has considered the effect on primary forests. This gap matters because deforestation, unlike primary forest loss, results mainly from agricultural conversion, not logging (1, 10). A few cross-country studies have considered the effect of national income on creation of protected areas (11–16), but with mixed findings on the significance of the effect. A second and larger group of studies has used surveys to measure WTP for biodiversity conservation by domestic populations within particular countries. Most of these studies have failed to detect a significant income effect (P < 0.05) (17, 18). Metaanalyses of these studies estimate income effects that are generally positive (protection increases with income) but not necessarily statistically significant (17, 18).We extended this prior work by coupling two research approaches: a broad-brush statistical analysis of the association between a standard measure of economic development, i.e., per capita gross national income (GNI), and a large set of cross-country conservation indicators (CIs); and a focused investigation of forest protection in a particular UMI country, Malaysia. The statistical analysis spanned 12 indicators from 10 diverse sources (Materials and Methods and SI Text, section 1). The indicators pertained to public environmental preferences, conservation NGOs, and government action (conservation spending, protected area establishment). These indicators relate more directly to our hypothesis about domestic demand and domestic supply of forest protection than do the deforestation rates analyzed by EKC studies. We limited the samples to countries classified as tropical by the UN Food and Agriculture Organization Forestry Department (ref. 19, data table 2) and paid special attention to differences between tropical countries in the UMI group and ones in lower income groups.The Malaysian case study allowed us to examine more closely the linkages from rising household income to increased household WTP, NGO engagement, and government protective action, and thereby uncover reasons for the underprovision of forest protection relative to household preferences. The case concerned Belum–Temengor, a 300,000-ha forested region in the state of Perak (Fig. 1). This region contains the largest area of primary forest in Peninsular Malaysia outside a national park. Our research included a population-representative survey of 1,261 rural and urban households in the Malaysian state of Selangor and the federal territory of Kuala Lumpur during 2010 (Materials and Methods). We used choice experiments (20, 21) to estimate household WTP to protect Belum–Temengor against logging and poaching (SI Text, section 2). Information from the case study enabled us to compare the public’s aggregate WTP for protection to current protection expenditures and to discuss why there is a gap between the two.Open in a separate windowFig. 1.Locations of Belum–Temengor (site of forest protection plans in choice experiments) and Selangor and Kuala Lumpur (site of household survey; the black dot is Kuala Lumpur) within Peninsular Malaysia (light gray). Lines show Malaysian state boundaries. Sources: base map, GADM database (www.gadm.org); Belum–Temengor boundaries, Forest Research Institute Malaysia.     

Argon plasma coagulation is safe and effective for treating smaller gastric lesions with low-grade dysplasia: a comparison with endoscopic submucosal dissection

Background and aims

The best therapeutic modality has not been established for gastric low-grade adenomas or dysplasia (LGD), which can progress to invasive carcinoma despite a low risk. This study aims to investigate the clinical efficacy, safety, and local recurrence after argon plasma coagulation (APC) treatment of gastric LGD compared with endoscopic submucosal dissection (ESD).

Patients and methods

A total of 320 patients with gastric LGD ≤2.0 cm treated with APC or ESD between 2004 and 2011 were retrospectively analyzed. We compared local recurrence rate, complication rate, procedure time, and admission to hospital between APC and ESD groups.

Results

Of the 320 patients, 116 patients were treated with APC and 204 with ESD. During follow-up, local recurrence was more common in the APC group (3.8 %, 4/106) than the ESD group (0.5 %, 1/188; log-rank test P = 0.036). However, all patients with local recurrence (n = 5) were treated by additional APC, and followed up without further recurrences. ESD was complicated by two perforations (1.0 %, 2/204) compared with no perforations in the APC group (0 %, 0/116). Bleeding complications were not different between the APC (1.7 %, 2/116) and ESD (2.0 %, 4/204) groups. Procedure time was shorter in the APC (7.8 ± 5.1 min) than the ESD (53.1 ± 38.1 min) group (P < 0.001). The proportion of hospitalization was less in the APC group (31.0 %, 36/116) than the ESD group (100.0 %, 204/204) (P < 0.001).

Conclusions

APC can be a good treatment option for patients with LGD ≤2.0 cm.     

Value of contrast-enhanced power Doppler sonography using a microbubble echo-enhancing agent in evaluation of small breast lesions

PURPOSE: The purpose of this study was to prospectively evaluate the usefulness of contrast-enhanced power Doppler sonography (PDUS) using a microbubble echo-enhancing agent in differentiating between malignant and benign small breast lesions. PATIENTS AND METHODS: Between July 1, 2000, and September 30, 2001, we performed gray-scale sonographic examination of patients in whom diagnostic sonography or screening mammography had revealed solid breast lesions measuring less than 2 cm in the largest dimension. The patients were then examined on PDUS before and after injection of a microbubble contrast agent. The sonographic findings for all 3 techniques, as well as the morphologic features of the Doppler signals for each patient before and after injection of the contrast agent on PDUS, were independently assessed. Each lesion was classified as "benign" or "malignant" on the basis of specific criteria for sonographic interpretation. A hemodynamic study was performed in which time-transit profiles of the Doppler signals on contrast-enhanced PDUS were generated using a computer-assisted program, and the results for each patient were compared with the findings of a histopathologic examination of surgical specimens. RESULTS: Thirty-six patients (35 women and 1 man) with a mean age of 43.5 years (range, 18-69 years) were evaluated. The tumors ranged from 4 to 19 mm in the largest dimension. Histopathologic examination revealed that 19 tumors were benign and 17 were malignant. For morphologic diagnosis of the malignant lesions, the sensitivity of gray-scale sonography was 100%, compared with 29% for PDUS without contrast enhancement. The specificity of gray-scale sonography was 47%, compared with 74% for PDUS without contrast enhancement. Contrast-enhanced PDUS had a sensitivity of 71% and a specificity of 58%. The diagnostic accuracy was 72% for gray-scale sonography, 53% for PDUS without contrast enhancement, and 64% for contrast-enhanced PDUS. The time-transit profiles of the hemodynamic study did not reveal a statistically significant difference in the accuracy rates of contrast-enhanced PDUS between benign and malignant breast lesions. CONCLUSIONS: Compared with PDUS without contrast enhancement, contrast-enhanced PDUS provides better visualization of the morphology of vascular Doppler signals that is characteristic of malignancy and therefore has a higher sensitivity and diagnostic accuracy, albeit a lower specificity. In differentiating between benign and malignant small breast lesions, contrast-enhanced PDUS can be helpful when used with gray-scale sonography and PDUS without contrast enhancement.