Cost-benefit analysis of an enhanced recovery protocol for pancreaticoduodenectomy.

BACKGROUND: Enhanced recovery after surgery (ERAS) programmes have been shown to decrease complications and hospital stay. The cost-effectiveness of such programmes has been demonstrated for colorectal surgery. This study aimed to assess the economic outcomes of a standard ERAS programme for pancreaticoduodenectomy. METHODS: ERAS for pancreaticoduodenectomy was implemented in October 2012. All consecutive patients who underwent pancreaticoduodenectomy until October 2014 were recorded. This group was compared in terms of costs with a cohort of consecutive patients who underwent pancreaticoduodenectomy between January 2010 and October 2012, before ERAS implementation. Preoperative, intraoperative and postoperative real costs were collected for each patient via the hospital administration. A bootstrap independent t test was used for comparison. ERAS-specific costs were integrated into the model. RESULTS: The groups were well matched in terms of demographic and surgical details. The overall complication rate was 68 per cent (50 of 74 patients) and 82 per cent (71 of 87 patients) in the ERAS and pre-ERAS groups respectively (P = 0·046). Median hospital stay was lower in the ERAS group (15 versus 19 days; P = 0·029). ERAS-specific costs were euro922 per patient. Mean total costs were euro56 083 per patient in the ERAS group and euro63 821 per patient in the pre-ERAS group (P = 0·273). The mean intensive care unit (ICU) and intermediate care costs were euro9139 and euro13 793 per patient for the ERAS and pre-ERAS groups respectively (P = 0·151). CONCLUSION: ERAS implementation for pancreaticoduodenectomy did not increase the costs in this cohort. Savings were noted in anaesthesia/operating room, medication and laboratory costs. Fewer patients in the ERAS group required an ICU stay.

Aspectos tomográficos da tuberculose pulmonar em pacientes adultos com AIDS

OBJETIVO: Este trabalho tem como finalidade descrever os achados tomográficos da tuberculose pulmonar em pacientes adultos com AIDS atendidos no serviço de radiologia de um hospital de referência em doenças infecciosas, procurar associações desses achados e a contagem de CD4. MATERIAIS E MÉTODOS: Foram estudados 45 pacientes por meio de tomografia computadorizada de tórax durante quatro anos. RESULTADOS: Foram encontrados linfonodomegalia mediastinal e/ou hilar em 31 (68,8%) dos casos, derrame pleural em 29 (64,4%), nódulos centrolobulares de distribuição segmentar em 26 (57,7%), consolidação em 24 (53,3%), confluência de micronódulos em 17 (37,7%), nódulos mal definidos com distribuição centrolobular em 16 (35,5%), padrão de "árvore em brotamento" em 13 (28,9%), espessamento de parede brônquica em 12 (26,6%), cavidade de parede espessa em 10 (22,2%), nódulos miliares em 9 (20%) e bronquiectasias cilíndricas em 6 (13,3%). Dos 45 pacientes, 35 (77,8%) apresentaram CD4 < 200 cel/mm³ e 10 (22,2%) apresentaram CD4 > 200 cel/mm³. CONCLUSÃO: Concluímos que neste estudo, diversamente do descrito na literatura, linfonodomegalia mediastinal e/ou hilar e consolidação foram significativamente mais frequentes em pacientes com CD4 > 200 cel/mm³. No entanto, linfonodos com centro hipodenso foram mais frequentemente observados em pacientes com severa imunodepressão, ou seja, CD4 < 200 cel/mm³.

Flush, de Virginia Woolf, en Català i la carrera literària de Roser Cardús

Flush (1933), de Virginia Woolf, protagonitzada pel gos de la poeta Elisabeth Barrett Browning, es va traduir al català cinc anys després, a Edicions de la Rosa dels Vents, quan encara es podia veure a la cartellera barcelonina la pel·lícula que narrava la història del matrimoni de poetes Browning, The Barrets of Wimpole Street, estrenada l�any 1934 i dirigida per Sidney Franklin. També havia arribat a Catalunya la traducció francesa de Charles Mauron, publicada l�any 1935. Això va fer que l�any 1938, malgrat el conflicte bèl·lic, hi hagués un context de recepció propici a aquesta traducció, encarregada per l�editor Josep Janés i Oliver. En aquest article donem a conèixer qui era la noia de divuit anys que va realitzar la traducció al català a partir de la traducció francesa, Roser Cardús i Malagarriga (1920-1974), i en descrivim la carrera com a escriptora i com a traductora.

Desenvolvimento de um sistema de filtração e titulação para determinação da acidez de ácidos húmicos

The acidity determinations method of humic acids (HA) content was developed by Schnitzer and Gupta and is a very well known procedure. Nevertheless, care is necessary to prevent measure errors due to non-controlled BaCO3 production, during the filtration and titration of HA total acidity. To overcome this problem, we developed in our laboratory a simple filtration and titration system for the determination of HA acidity under inert atmosphere. This system enables a better reproducibility and accuracy of total, carboxylic and phenolic acidity measures than those by Schnitzer and Gupta method.

Coordenação local do Eu(III) em híbridos orgânicos/inorgânicos emissores de luz branca

Eu3+ luminescence and EXAFS (Extended X-ray Absorption Fine Structure) results are presented for organic-inorganic hybrid gel hosts composed of a siliceous network to which small chains of oxyethylene units are covalently grafted by means of urea bridges. Coordination numbers for Eu3+ ions range from 12.8 to 9.7 with increasing Eu3+ concentration while the Eu3+-first neighbours mean distance is found to be constant at 2.48-2.49 Å in the same concentration range. Emission spectra display a broad band in the green/blue spectral region superposed to narrow lines appearing in the yellow/red region in such a way that for the eyes emission appears white. The broad band is assigned to intrinsic NH groups emission and also to electron-hole recombination in the nanosised siliceous domains. The narrow lines are assigned to intra-4f6, 5D0->7F0-4 Eu3+ transitions and from the energy position of the 7F0-4 levels a mean distance could be calculated for the Eu3+-first neighbours. The calculated results are in good agreement with the experimental ones obtained from EXAFS analysis.

Influência da catálise ácida e básica na preparação da sílica funcionalizada pelo método sol-gel

Some aspects of the chemistry involved in the preparation and characterization of functionalized silicon oxide by sol-gel method are considered in this work. The synthesis was performed with different silicon alcoxide precursors and the influence of the acid and basic catalyst was investigated. Characterization was performed by infrared absorption spectroscopy, elemental analysis and 29Si NMR. Infrared data show Si-C and -CH2- vibrational modes at 1250 to 1280 and 2920 to 2940 cm-1, respectively. The elemental analysis confirmed the presence of organic groups in the inorganic silica network. 29Si NMR results show different hydrolisys depending on the acid or base catalysis.

Preparação de LiNbO3 e LiNbO3:Eu3+ pelo método dos precursores poliméricos

The ferroelectric compound LiNbO3 was prepared by the polymeric precursors method in the polycrystalline form containing different concentrations of Eu3+. The compounds were characterized by X-ray diffraction, vibrational and electronic spectroscopy. Electronic spectroscopy was shown to be sensitive to small concentrations of contaminating phases allowing a good control of the compound purity. The presence of Eu3+ ions leads to the formation of the LiNb3O8 phase in the range of 500 to 800 °C. Above this temperature range LiNbO3 and tetragonal (T') EuNbO4 were obtained.

Filmes de titânio-silício preparados por "spin" e "dip-coating"

The conditions for the preparation of luminescent materials, consisting of Eu3+ ions entrapped in a titanium matrix, in the forma of a thin film, using the sol-gel process, are described. The films were obtained from sols prepared with TEOS and TEOT, in the presence of acetylacetone as the hidrolysis-retarding agent, using the dip-coating and spin-coating techniques. The influence of these techniques on the films based on titanium and silicon are presented. The Eu3+ was used as a luminescent probe. The films have been characterized by luminescence, reflection and transmittance. The thickness of the films could be related to the preparation procedure. Transparent thin films have been prepared by dip-coating technique.

Estudo fitoquímico do decocto das folhas de Maytenus truncata Reissek e avaliação das atividades antinociceptiva, antiedematogênica e antiulcerogênica de extratos do decocto

The present paper describes the phytochemical investigation and biological activities of the chloroform, ethyl acetate and methanol extracts of leaf decocts of M. truncata Reiss (Celastraceae). Our studies afforded two flavonoid glycosides, quercetin-3-O-rhamnopyranosyl-O-glucopyranosyl- O-rhamnopyranosyl-O-galactopyranoside (1) and kampferol-3-O-rhamnopyranosyl-O-glucopyranosyl- O-rhamnopyranosyl-O-galactopyranoside (2) from the methanolic extract and dulcitol (3) from the ethyl acetate extract. Ethyl acetate and methanol extracts exhibited considerable antiulcerogenic and analgesic activities. The results of the phytochemical studies suggest that the healing activity of methanol extracts can be related to the presence of glycosyl flavonoids.

Construção de câmara de luz ultravioleta para fotopolimerização de fases estacionárias monolíticas

The assembly of a photochemical reactor with six fluorescent lamps, used for photopolymerizations is described. This chamber presents a mobile support, allowing the placement of samples at different heights and a safety lock that interrupts the radiation, if it is opened during operation. The mirrored internal walls avoid the dispersion and non-uniform distribution of light. There is no high heating because the own character of the used lamps. All parts could be purchased in commerce with less than U$ 150,00. This reactor was successfully used for monolithic stationary phase photopolymerization.

De miraculis

Invocatio: I.S.A: - Ded.: Jonas Bruzelius.

Chemical constituents of Salacia elliptica (Celastraceae)

The chemical investigation of Salacia elliptica allowed to the isolation of 20 constituents: two polyols, one xanthone, a mixture of long chain hydrocarbons, one carboxylic acid, one polymer, two steroidal compounds, one aromatic ester and eleven pentacyclic triterpenes. These triterpenes include 3β-stearyloxy-oleanane, 3β-stearyloxy-ursane, one seco-friedelane, and eight compounds of the friedelane serie. The chemical structure and the relative configuration of a new triterpene 1,3-dioxo-16α-hydroxyfriedelane (15) were established through ¹H and 13C NMR including 2D experiments (HMBC, HMQC, COSY and NOESY) and herein reported for the first time.

Constituintes químicos e efeito ecotoxicológico do óleo volátil de folhas de Eucalyptus urograndis (Mirtaceae)

The volatile oil from the leaves of E. urograndis was analyzed by GC and GC-MS. It was identified 10 compounds in which, orto-cimene (41.4%) and 1,8-cineol (25.8%) were the main constituents. The induction of deleterious effect to aquatic organisms due to the presence of volatile oil lixiviated from E. urograndis leaves was studied using Daphnia laevis and D. similis as bioindicators. Through the results of toxicological tests it was possible to show that the litterbag of E. urograndis represents a risk factor for the aquatic ecosystem of lakes and rivers that are in the surrounding area of large scale Eucalyptus plantations. The method can be used for monitor the quality of these types of aquatic environments.

Theses miscellaneae

Invocatio: I.N.J.A.