Postoperative pancreatic fistula formation according to ISGPF criteria after D2 gastrectomy in Western patients

Background

Limited information is available on the incidence of postoperative pancreatic fistula (POPF) after D2 gastrectomy with the strict use of the International Study Group of Pancreatic Fistula (ISGPF) criteria, particularly so in Western patients.

Methods

All patients who underwent gastrectomy for adenocarcinoma at the Karolinska University Hospital Huddinge from 2006 until June 2012 were identified via hospital records and reviewed for type of surgical procedure, postoperative morbidity, incidence, and risk factors for POPF.

Results

Ninety-two of 107 cases had a D2 gastrectomy eligible for evaluation of POPF, of which 83 (90 %) also underwent bursectomy. Seven patients fulfilled the criteria for POPF grade A (7.6 %), 5 met the criteria for POPF grade B (5.4 %), and 6 the criteria for POPF grade C (6.5 %). The incidence of POPF grade B or C was 4.9 % among the 82 patients for whom no pancreatic resection was performed and 70 % among 10 cases with concomitant pancreatic resection. The latter (OR 156.2, 95 % CI 8.00–3046.93) and age (OR 1.2, 95 % CI 1.02–1.35) were found to be the only risk factors for POPF after gastrectomy upon a multivariate analysis.

Conclusions

In this series of Western patients, POPF grade B or C according to the ISGPF criteria was uncommon after D2 gastrectomy without pancreatic resection. Bursectomy was not a risk factor for POPF.     

Physiological demands of different sailing techniques of the new Olympic windsurfing class

The introduction of the new Olympic class windsurf-board has prompted sailors to develop a new technique of sail “pumping” (rhythmically pulling the sail so that it acts as a wing). Contrary to the old technique that mainly involved upper body activity, the new one requires both upper and lower body muscle activity. Accordingly, the aim of the present study was to compare the performance characteristics of the board (speed and pointing angle ability relative to the direction of the wind) as well as the sailors’ physiological demands during sail pumping with the old and new pumping techniques. Nineteen male, highly-trained (O_2max: 65.1 ± 5.9 ml min⁻¹ kg⁻¹), international level windsurfers from six different countries underwent two testing sessions on-water in a balanced order. Compared to the old pumping technique the mean distance sailed with the new technique (1,872 ± 15 and 1,764 ± 13 m, respectively) and the board speed (3.42 ± 0.49 and 3.81 ± 0.28 m s⁻¹, respectively) were significantly (P < 0.05) shorter and greater, respectively. Consequently, the time taken to sail the testing course was significantly shorter with the new compared to the old technique (390 ± 8 vs. 420 ± 16 s). Despite the finding that the new technique was sustained at a significantly higher fraction of O_2max (80.5 ± 5.2 and 72.7 ± 4.5%, respectively) compared to the old technique, total energy expenditure (130.7 ± 11.3 and 128.1 ± 9.2 Kcal, respectively) and blood lactate concentration 3 min into recovery (9.4 ± 2.2 and 8.5 ± 1.7 mmol l⁻¹, respectively) were not different. It is concluded that application of the new sail pumping technique improves the performance characteristics of the board without increasing the sailors’ total metabolic requirement.     

Cloning and characterization of two clusterin isoforms in rainbow trout

Clusterin is a broadly distributed glycoprotein constitutively expressed by various tissues and cell types and has been shown to be associated with several physiological and pathological functions. In order to study the molecular evolution of clusterin, here we report the cloning and characterization of two clusterin genes in rainbow trout (Oncorhynchus mykiss). The deduced amino acid sequences of clusterin-1 and a partial clusterin-2 clone are 89% identical to each other, showing 45, 42 and 38% identity with chicken, frog and human orthologs, respectively. Most of the putative N-glycosylation sites, as well as all 10 cysteine residues which are involved in disulfide bond formation in the mature trout clusterin-1 protein, are fully conserved when aligned with its orthologs from various species. Although trout clusterin genes exhibit the same exon-intron organization, in line with that of human clusterin, they show a totally different mRNA expression profile among various trout tissues. Phylogenetic analysis indicates an early segregation of the clusterin ancestral gene within the taxon of fish leading to the formation of a separate subgroup.     

Design of a multi-classifier system for discriminating benign from malignant thyroid nodules using routinely H&E-stained cytological images

A multi-classifier diagnostic system was designed for distinguishing between benign and malignant thyroid nodules from routinely taken (FNA, H&E-stained) cytological images. To construct the multi-classifier system, several combination rules and different mixtures of ensemble classifier members, employing morphological and textural nuclear features, were comparatively evaluated. Experimental results illustrated that the classifier combination k-NN/PNN/Bayesian and the majority vote rule enhanced significantly classification accuracy (95.7%) as compared to best single classifier (PNN: 89.6%). The proposed system was designed with purpose to be utilized in daily clinical practice as a second opinion tool to support cytopathologists' decisions, when a definite diagnosis is difficult to be obtained.     

A member of a new genus in the Potyviridae infects Rubus

Blackberry yellow vein disease causes devastating losses on blackberry in the south and southeastern United States. Blackberry yellow vein associated virus (BYVaV) was identified as the putative causal agent of the disease but the identification of latent infections of BYVaV led to the investigation of additional agents being involved in symptomatology. A potyvirus, designated as Blackberry virus Y (BVY), has been identified in plants with blackberry yellow vein disease symptoms also infected with BYVaV. BVY is the largest potyvirus sequenced to date and the first to encode an AlkB domain. The virus shows minimal sequence similarity with known members of the family and should be considered member of a novel genus in the Potyviridae. The relationship of BVY with Bramble yellow mosaic virus, the only other potyvirus known to infect Rubus was investigated. The presence of the BVY was verified in several blackberry plants, but it is not the causal agent of blackberry yellow vein disease since several symptomatic plants were not infected with the virus and BVY was also detected in asymptomatic plants.     

Cortical processing of tactile stimuli applied in quick succession across the fingertips: temporal evolution of dipole sources revealed by magnetoencephalography

We used magnetoencephalography (MEG) in 10 healthy human subjects to study cortical responses to tactile stimuli applied to the fingertips of digits 2–5 of the right hand. Each stimulus lasted 50 ms and was produced by air-driven elastic membranes. Four-hundred stimuli were delivered on each finger in three temporal patterns (conditions). In the “Discrete” condition, stimuli were applied to each finger repetitively with an interstimulus interval (ISI) of 1–2 s. In the “Continuous” condition, stimuli were applied to the fingers sequentially as four-stimulus trains with zero ISI and 1–2 s intervening between trains. Finally, in the “Gap” condition, stimuli were applied as in the Continuous condition but with an ISI of 50 ms. A sensation of tactile motion across fingers (digit 2 → digit 5) was reported by all subjects in the Continuous and Gap conditions. Cortical responses were extracted as single equivalent current dipoles over a period of 1 s following stimulus onset. In all three conditions, initial responses in left primary somatosensory cortex (SI) were observed ~20 to 50 ms after stimulus onset and were followed by additional left SI responses and bilateral responses in the secondary somatosensory cortex (SII). In addition, in the Continuous and Gap conditions, there was an activation of the precentral gyrus, the temporal aspects of which depended on the temporal relation of the administered stimuli, as follows. An ISI of 0 ms led to activation of the precentral gyrus shortly after the second stimulation, whereas an ISI of 50 ms led to activation of the precentral gyrus after the third stimulation. The current findings support results from previous studies on temporal activity patterns in SI and SII, verify the participation of the precentral gyrus during tactile motion perception and, in addition, reveal aspects of integration of sequential sensory stimulations over nonadjacent areas as well as temporal activity patterns in the postcentral and precentral gyri.