Pyogenic Liver Abscess Following Pancreaticoduodenectomy: Risk Factors,Treatment, and Long-Term Outcome

Background

Pancreaticoduodenectomy (PD) remains a challenging operation with a 40 % postoperative complication rate. Pyogenic liver abscess (PLA) is an uncommon complication following PD with little information on its incidence or treatment. This study was done to examine the incidence, risk factors, treatment, and long-term outcome of PLA after PD.

Methods

We retrospectively reviewed 1,189 patients undergoing PD (N?=?839) or distal pancreatectomy (DP) (N?=?350) at a single institution over a 14-year period (January 1, 1994–January 1, 2008). Pancreatic databases (PD and DP) were queried for postoperative complications and cross-checked through a hospital-wide database using ICD-9 codes 572.0 (PLA) and 006.3 (amebic liver abscess) as primary or secondary diagnoses. No PLA occurred following DP. Twenty-two patients (2.6 %) developed PLA following PD. These 22 patients were matched (1:3) for age, gender, year of operation, and indication for surgery with 66 patients without PLA following PD.

Results

PLA occurred in 2.6 % (22/839) of patients following PD, with 13 patients (59.1 %) having a solitary abscess and 9 (40.9 %) multiple abscesses. Treatment involved antibiotics and percutaneous drainage (N?=?15, 68.2 %) or antibiotics alone (N?=?7, 31.8 %) with a mean hospital stay of 12 days. No patient required surgical drainage, two abscesses recurred, and all subsequently resolved. Three patients (14 %) died related to PLA. Postoperatively, patients with biliary fistula (13.6 vs. 0 %, p?=?0.014) or who required reoperation (18.2 vs. 1.5 %, p?=?0.013) had a significantly higher rate of PLA than matched controls. Long-term follow-up showed equivalent 1-year (79 vs.74 %), 2-year (50 vs. 57 %), and 3-year (38 vs. 33 %) survival rates and hepatic function between patients with PLA and matched controls.

Conclusions

Postoperative biliary fistula and need for reoperation are risk factors for PLA following PD. Antibiotics and selective percutaneous drainage was effective in 86 % of patients with no adverse effects on long-term hepatic function or survival.     

Collective credit allocation in science

Collaboration among researchers is an essential component of the modern scientific enterprise, playing a particularly important role in multidisciplinary research. However, we continue to wrestle with allocating credit to the coauthors of publications with multiple authors, because the relative contribution of each author is difficult to determine. At the same time, the scientific community runs an informal field-dependent credit allocation process that assigns credit in a collective fashion to each work. Here we develop a credit allocation algorithm that captures the coauthors’ contribution to a publication as perceived by the scientific community, reproducing the informal collective credit allocation of science. We validate the method by identifying the authors of Nobel-winning papers that are credited for the discovery, independent of their positions in the author list. The method can also compare the relative impact of researchers working in the same field, even if they did not publish together. The ability to accurately measure the relative credit of researchers could affect many aspects of credit allocation in science, potentially impacting hiring, funding, and promotion decisions.Reflecting the increasing complexity of modern research, in the last decades, collaboration among researchers became a standard path to discovery (1). Collaboration plays a particularly important role in multidisciplinary research that requires expertise from different scientific fields (2). As the number of coauthors of each publication increases, science’s credit system is under pressure to evolve (3–5). For single-author papers, which were the norm decades ago, credit allocation is simple: the sole author gets all of the credit. This rule, accepted since the birth of science, fails for multiauthor papers (6). The lack of a robust credit allocation system that can account for the discrepancy between researchers’ contribution to a particular body of work and the credit they obtain, has prompted some to state that “multiple authorship endangers the author credit system” (7). This situation is particularly acute in multidisciplinary research (8, 9), when communities with different credit allocation traditions collaborate (10). Furthermore, a detailed understanding of the rules underlying credit allocation is crucial for an accurate assessment of each researcher’s scientific impact, affecting hiring, funding, and promotion decisions.Current approaches to allocating scientific credit fall in three main categories. The first views each author of a multiauthor publication as the sole author (11, 12), resulting in inflated scientific impact for publications with multiple authors. This system is biased toward researchers with multiple collaborations or large teams, customary in experimental particle physics or genomics. The second assumes that all coauthors contribute equally to a publication, allocating fractional credit evenly among them (13, 14). This approach ignores the fact that authors’ contributions are never equal and hence dilutes the credit of the intellectual leader. The third allocates scientific credit according to the order or the role of coauthors, interpreting a message agreed on within the respective discipline (15–17). For example, in biology, typically the first and the last author(s) get the lion’s share of the credit, and in some areas of physical sciences, the author list reflects a decreasing degree of contribution. An extreme case is offered by experimental particle physics, where the author list is alphabetic, making it impossible to interpret the author contributions without exogenous information. Finally, there is an increasing trend to allocate credit based on the specific contribution of each author (18, 19), specified in the contribution declaration required by some journals (20, 21). However, each of these approaches ignores the most important aspect of credit allocation: notwithstanding the agreed on order, credit allocation is a collective process (22–24), which is determined by the scientific community rather than the coauthors or the order of the authors in a paper. This phenomena is clearly illustrated by the 2012 Nobel prize in physics that was awarded based on discoveries reported in publications whose last authors were the laureates (25, 26), whereas the 2007 Nobel prize in physics was awarded to the third author of a nine-author paper (27) and the first author of a five-author publication (28). Clearly the scientific community operates an informal credit allocation system that may not be obvious to those outside of the particular discipline.The leading hypothesis of this work is that the information about the informal credit allocation within science is encoded in the detailed citation pattern of the respective paper and other papers published by the same authors on the same subject. Indeed, each citing paper expresses its perception of the scientific impact of a paper’s coauthors by citing other contributions by them, conveying implicit information about the perceived contribution of each author. Our goal is to design an algorithm that can capture in a discipline-independent fashion the way this informal collective credit allocation mechanism develops.     

S100蛋白检测在脑梗死中的应用研究

目的：探讨S100蛋白检测在脑梗死（CI）中的作用价值。方法分析我院自2012年1月~2013年4月收治的76例CI患者,检测S100蛋白在CI患者发病后第3、7、14天时的水平,以及与神经功能缺损评分、脑梗死病灶面积大小的关系。同时选取我院同期行健康体检患者56例进行对照分析。结果（1）CI组与对照组比较,在术后3d与7d时,S100蛋白水平比较,P＜0.01,P＜0.05。（2）神经功能缺损评分中型、重型组与轻型组S100蛋白水平比较,P＜0.05,P＜0.01。（3）梗死面积中、大组与小梗死面积组比较,P＜0.05, P＜0.01。结论 S100蛋白在CI发病早期为高表达,同时其高表达神经功能缺损严重程度及梗死面积增大有密切关系,表明S100蛋白与CI的病理、生理的过程有一定的相关性。     

Clinical status of Sagliker syndrome: a case report and literature review

In a 53-year-old woman, Sagliker syndrome developed during 22 years of treatment with intermittent hemodialysis as a result of severe secondary hyperparathyroidism (SHPT) complicating end-stage renal disease. She failed medical managements and lost her renal graft just after the kidney transplantation due to acute rejection. Although surgical parathyroidectomy was effective, the parathyroid hormone level became extremely high again due to recurrent hyperparathyroidism. It is possible that such patient could survive long-term with dialysis, but prevention of severe SHPT is the most important.     

导入JCI医院认证评审标准加强医院感染管理

为保证病人安全,提高医疗服务质量,探讨加强医院感染管理的新思路。导入JCI医院认证的思想,介绍JCI认证的内涵以及JCI认证医院感染的标准、特色。结合当前医院感染管理的实际情况发现医院感染管理在制度、监测、暴发调查、干预、个人防护、人员管理和培训、信息管理等方面尚存在一定不足。借鉴发达国家经验,提出加强医院感染管理的策略和启示。     

Concomitant mediastinal and extrarenal retroperitoneal angiomyolipomas in a patient who previously underwent ipsilateral radical nephrectomy

The association of the tuberous sclerosis complex with angiomyolipoma (AML) arising from the retroperitoneum and mediastinum has not been reported in the literature. We present the first case in which a patient presented with a combined retroperitoneal extrarenal and posterior mediastinal AML. Interestingly, the ipsilateral retroperitoneal AML emerged 15 years after radical nephrectomy for the left renal AML.     

心肺运动试验对COPD的评估价值

采用自行车功率计做功，通过体积描记仪和能耗测试系统，监测３８例男性慢性阻塞性肺疾病（ＣＯＰＤ）患者和３０例正常男性对照者的心肺运动试验，发现运动试验指标与年龄呈负相关；ＣＯＰＤ组做功、每分通气量、摄氧量、ＣＯ２产生量的改变与用力肺活量、最大呼气中段流量、第一秒用力呼气量、呼气流量峰值等反映阻塞性通气障碍的肺功能指标显著相关提示心肺运动试验主要指标的改变可反映阻塞性通气功能障碍，有助于ＣＯＰＤ的评估