Laparoscopy in the era of enhanced recovery.

Laparoscopy is one of the cornerstones in the surgical revolution and transformed outcome and recovery for various surgical procedures. Even if these changes were widely accepted for basic interventions, like appendectomies and cholecystectomies, laparoscopy still remains challenged for more advanced operations in many aspects. Despite these discussion, there is an overwhelming acceptance in the surgical community that laparoscopy did transform the recovery for several abdominal procedures. The importance of improved peri-operative patient management and its influence on outcome started to become a focus of attention 20 years ago and is now increasingly spreading, as shown by the incoming volume of data on this topic. The enhanced recovery after surgery (ERAS) concept incorporates simple measures of general management, and requires multidisciplinary collaboration from hospital staff as well as the patient and the relatives. Several studies have demonstrated a significant decrease in postoperative complication rate, length of hospital stay and reduced overall cost. The key elements of success are fluid restriction, a functioning epidural and preoperative carbohydrate intake. With the expansion of laparoscopic techniques, ERAS increasingly incorporates laparoscopic patients, especially in colorectal surgery. However, the precise impact of laparoscopy on ERAS is still not clearly defined. Increasing evidence suggests that laparoscopy itself is an additional ERAS item that should be considered as routine where feasible in order to obtain the best surgical outcomes.

Survival of zirconia- and metal-supported fixed dental prostheses: a systematic review

Purpose: The aim of this review was to systematically evaluate and compare the frequency of veneer chipping and core fracture of zirconia fixed dental prostheses (FOPS) and porcelain-fused-to-metal (PFM) FDPs and determine possible influencing factors. Materials and Methods: The SCOPUS database and International Association of Dental Research abstracts were searched for clinical studies involving zirconia and PFM FDPs. Furthermore, studies that were integrated into systematic reviews on PFM FDPs were also evaluated. The principle investigators of any clinical studies on zirconia FDPs were contacted to provide additional information. Based on the available information for each FOP, a data file was constructed. Veneer chipping was divided into three grades (grade 1 = polishing, grade 2 = repair, grade 3 = replacement). To assess the frequency of veneer chipping and possible influencing factors, a piecewise exponential model was used to adjust for a study effect. Results: None of the studies on PFM FDPs (reviews and additional searching) sufficiently satisfied the criteria of this review to be included. Thirteen clinical studies on zirconia FDPs and two studies that investigated both zirconia and PFM FDPs were identified. These studies involved 664 zirconia and 134 PFM FDPs at baseline. Follow-up data were available for 595 zirconia and 127 PFM FDPs. The mean observation period was approximately 3 years for both groups. The frequency of core fracture was less than 1% in the zirconia group and 0% in the PFM group. When all studies were included, 142 veneer chippings were recorded for zirconia FDPs (24%) and 43 for PFM FDPs (34%). However, the studies differed extensively with regard to veneer chipping of zirconia: 85% of all chippings occurred in 4 studies, and 43% of all chippings included zirconia FDPs. If only studies that evaluated both types of core materials were included, the frequency of chipping was 54% for the zirconia-supported FDPs and 34% for PFM FDPs. When adjusting the survival rate for the study effect, the difference between zirconia and PFM FDPs was statistically significant for all grades of chippings (P = .001), as well as for chipping grade 3 (P = .02). If all grades of veneer chippings were taken into account, the survival of PFM FDPs was 97%, while the survival rate of the zirconia FDPs was 90% after 3 years for a typical study. For both PFM and zirconia FDPs, the frequency of grades 1 and 2 veneer chippings was considerably higher than grade 3. Veneer chipping was significantly less frequent in pressed materials than in hand-layered materials, both for zirconia and PFM FDPs (P = .04). Conclusions: Since the frequency of veneer chipping was significantly higher in the zirconia FDPs than PFM FDPs, and as refined processing procedures have started to yield better results in the laboratory, new clinical studies with these new procedures must confirm whether the frequency of veneer chipping can be reduced to the level of PFM. Int J Prosthodont 2010;23:493-502

Treatment deviating from guidelines does not influence status epilepticus prognosis.

Status epilepticus (SE) prognosis is related to nonmodifiable factors (age, etiology), but the exact role of drug treatment is unclear. This study was undertaken to address the prognostic role of treatment adherence to guidelines (TAG). We prospectively studied over 26 months a cohort of adults with incident SE (excluding postanoxic). TAG was assessed in terms of drug doses (± 30 % of recommendations) and medication sequence; its prognostic impact on mortality and return to baseline conditions was adjusted for etiology, SE severity [Status Epilepticus Severity Score (STESS)], and comorbidities. Of 225 patients, 26 (12 %) died and 82 (36 %) were discharged with a new handicap; TAG was observed in 142 (63 %). On univariate analysis, age, etiology, SE severity, and comorbidities were significantly related to outcome, while TAG was associated with neither outcome nor likelihood of SE control. Logistic regression for mortality identified etiology [odds ratio (OR) 18.8, 95 % confidence interval (CI) 4.3-82.8] and SE severity (STESS ≥ 3; OR 1.7, 95 % CI 1.2-2.4) as independent predictors, and for lack of return to baseline, again etiology (OR 7.4, 95 % CI 3.9-14.0) and STESS ≥ 3 (OR 1.7, 95 % CI 1.4-2.2). Similar results were found for the subgroup of 116 patients with generalized-convulsive SE. Receiver operator characteristic (ROC) analyses confirmed that TAG did not improve outcome prediction. This study of a large SE cohort suggests that treatment adherence to recommendations using current medications seems to play a negligible prognostic role (class III), confirming the importance of the biological background. Awaiting further treatment trials, it appears mandatory to apply resources towards identification of new therapeutic approaches.

Can Orthopantomography be used as a tool for screening of carotid atheromatous pathology and thus be used to help reduce the prevalence of ischemic stroke within the population?

Objective: To assess the possibility of Dentists being able to screen patients with higher risk of vascular diseases. Materials: Kodak 8000C Orthopantomographer, eco-Doppler Logiq-500 General Electric at the Lisbon Hospital Particular. Methods: Assessment of orthopantomographies made to 142 patients aged 50 or more, as well as the existing risk factors. Conduction of carotid eco-Doppler to patients who appear to have calcified plaques of the atheroma. Results: Strong dependence between dichotomised age and having the pathology (p = 0.02).Smokers are twice more likely to present plaques (OR= 2). Being hypertensive increases in about 1.4 the likelihood of having a stroke (OR= 1.4). Of the 27 individuals who presented calcifications in the Orthopantomography, they were all submitted to an eco-Doppler and 21 had the pathology confirmed. 27 individuals, who did not show any plaques in the Orthopantomography, were randomly selected to be the control group. They were submitted to an eco-Doppler. And 23 confirmed the non-existence of plaques. Conclusions: Orthopantomography used for assessing the oral cavity reveals more information which should be the object of the Dentist"s attention

Produção de matéria seca e controle de plantas daninhas por leguminosas consorciadas com cana-de-açúcar em cultivo orgânico

Resumo:O objetivo deste trabalho foi avaliar a produção de matéria seca e o controle de plantas daninhas por espécies de leguminosas consorciadas com cana-de-açúcar, em cultivo orgânico. As espécies leguminosas Arachis pintoi, Cajanus cajan, Calopogonium mucunoides, Crotalaria anagyroides, Crotalaria juncea e Stylosanthes 'Campo Grande' foram semeadas em novembro de 2012, nas entrelinhas da cana-de-açúcar. O delineamento experimental em blocos ao acaso foi utilizado com quatro repetições e dois controles - um tratamento capinado e outro sem capinar. A massa de matéria seca das leguminosas foi avaliada aos 142 dias após a semeadura (DAS), e a massa de matéria seca de plantas daninhas, aos 29, 85 e 142 DAS. A massa de matéria seca de plantas daninhas foi inferior à da testemunha em todas as épocas amostradas. A produção de massa de matéria seca das leguminosas no consórcio foi baixa. As espécies Crotalaria juncea, Cajanus cajan e Calopogonium mucunoides produziram massa de matéria seca superior à das espécies Arachis pintoi e Stylosanthes 'Campo Grande'. A produtividade de colmos da cana-de-açúcar não foi afetada pelo consórcio. O consórcio entre cana-de-açúcar orgânica e leguminosas com semeadura tardia, para adubação verde, é eficiente no controle de plantas daninhas.

Insights into the biogeographical history of the Lower Guinea Forest Domain: evidence for the role of refugia in the intraspecific differentiation of Aucoumea klaineana.

Determining the biogeographical histories of rainforests is central to our understanding of the present distribution of tropical biodiversity. Ice age fragmentation of central African rainforests strongly influenced species distributions. Elevated areas characterized by higher species richness and endemism have been postulated to be Pleistocene forest refugia. However, it is often difficult to separate the effects of history and of present-day ecological conditions on diversity patterns at the interspecific level. Intraspecific genetic variation could yield new insights into history, because refugia hypotheses predict patterns not expected on the basis of contemporary environmental dynamics. Here, we test geographically explicit hypotheses of vicariance associated with the presence of putative refugia and provide clues about their location. We intensively sampled populations of Aucoumea klaineana, a forest tree sensitive to forest fragmentation, throughout its geographical range. Characterizing variation at 10 nuclear microsatellite loci, we were able to obtain phylogeographic data of unprecedented detail for this region. Using Bayesian clustering approaches, we demonstrated the presence of four differentiated genetic units. Their distribution matched that of forest refugia postulated from patterns of species richness and endemism. Our data also show differences in diversity dynamics at leading and trailing edges of the species' shifting distribution. Our results confirm predictions based on refugia hypotheses and cannot be explained on the basis of present-day ecological conditions.

Can resistance to trastuzumab be reversed by endocrine therapy? Combination of trastuzumab and letrozole after resistance to sequential trastuzumab and aromatase inhibitor monotherapies in patients with ER-positive, HER-2 positive, advanced breast cancer: a proof-of-concept trial (SAKK 23/03)

Introduction: Trastuzumab (T) is a cornerstone in the treatment of patients with HER2-overexpressing advanced breast cancer and development of resistance to T is a major therapeutic problem. HER-2 is part of a highly interactive signaling network that may impair efficacy of endocrine therapy. A sequential treatment design was chosen in this trial to ensure complete resistance to single agent therapy before receiving both a non-steroidal aromatase inhibitor (AI) and T. Any kind of clinical activity with combined treatment of AI and T after progression of single agent treatments could indicate restoration of sensitivity as a consequence of cross-talking and networking between both pathways. Methods: Key eligibility criteria included postmenopausal patients (pts.) with advanced, measurable, HER-2 positive (assessed by FISH, ratio (≥2)), HR positive disease and progression on prior treatment with a non-steroidal AI, e.g. letrozole or anastrozole, either in an adjuvant or advanced setting. Pts. received standard dose T monotherapy either weekly or three-weekly in step 1 and upon disease progression, continued T in combination with letrozole in step 2. The primary endpoint was clinical benefit response (CBR: CR, PR or SD for at least 24 weeks (+/- 1 week) according to RECIST) in step 2. Results: Thirteen pts. were enrolled in five centers in Switzerland. In step 1, six pts. (46%) achieved CBR. Median time to progression (TTP) was 161 days (Range: 50 - 627). Based on data collected until the end of May 2010, CBR was observed in seven out of the eleven evaluable pts. (64%) in step 2, including one pt. with partial response. Four of the seven pts. within step 2 that achieved CBR also had CBR in step 1. Seven out of eleven pts. have documented tumor progression during step 2 treatment. Median TTP for all eleven pts. was 184 days (range 61 - 471). Mean time on study treatment (TTP in step 1 plus TTP in step 2) for pts. reaching step 2 was 380 days (range 174 - 864). Adverse events were generally mild. Conclusion: Results of this proof-of-principle trial suggest that complete resistance to both AI and T can be overcome in a proportion of pts. by combined treatment of AI and T, as all pts. served as their own control. Our results appear promising for a new treatment strategy which offers a chemotherapy-free and well-tolerated option for at least a subset of the pts. with HR positive, HER-2 positive breast cancer. Further trials will need to corroborate this finding.

Características pós-colheita de frutos de genótipos de bananeira (Musa spp.)

O conhecimento das características pós-colheita de novos híbridos de bananeira é uma importante informação que auxilia o melhorista em sua tomada de decisão. Este trabalho teve como objetivo avaliar genótipos de bananeira com relação às características de pós-colheita e resistência ao desprendimento do fruto. Foram utilizados frutos da segunda penca de 16 híbridos (Calipso, Bucaneiro, Ambrosia, YB42-21, PV42-53, PV42-68, PV42-81, PV42-85, PV42-129, PV42-142, PV42-143, ST12-31, ST42-08, PV03-44, FHIA-03 e SH 3640) e quatro cultivares (Pacovan, Prata Comum, Nam e Figue Pomme Naine), que foram avaliadas quanto ao peso, comprimento, circunferência, relação polpa/casca, resistência ao desprendimento, firmeza, sólidos solúveis totais (SST), acidez total titulável (ATT), relação SST/ATT e tempo de amadurecimento. Empregou-se um delineamento inteiramente casualizado, com cinco repetições para todas as características, exceto para a firmeza do fruto em que se utilizaram dez repetições. A unidade experimental foi constituída de um único fruto. Os dados foram submetidos à analise de variância e as médias comparadas pelo Teste Scott & Knott, a 5% de probabilidade. A cultivar Nam apresentou a menor acidez titulável e a maior relação SST/ATT, enquanto a maior firmeza do fruto foi apresentada pelos híbridos PV42-81 e PV42-53. Os frutos mais pesados foram do híbrido SH 3640, e os mais compridos foram dos híbridos Bucaneiro e PV42-81. Os híbridos PV42-85 e ST42-08 apresentaram maior resistência ao desprendimento, não diferindo da 'Pacovan'. No entanto, superaram a 'Prata Comum', que obteve a menor resistência. Os genótipos 'Nam', PV42-143 e PV42-129 apresentaram maior tempo de maturação após a colheita quando comparados, principalmente, à 'Prata Comum'. A 'Nam' deve ser considerada como uma nova alternativa na produção de banana. O SH3640, híbrido da Prata Anã, pode ser recomendado como nova cultivar. Os híbridos da Prata São Tomé (ST42-08) e Pacovan (PV42-85, PV42-81, PV42-68, PV42-53, PV42-129 e PV42-143) podem substituir as cultivares Prata Comum e Pacovan nos sitemas produção.

Psychiatrie [Psychiatry]

In 2008 there is no major breakthrough in the field of psychopharmacology. Paliperidone, (Invega), or 9-hydroxyrisperidone, the main hydroxylated metabolite of risperidone, is now available in Switzerland. It has the same pharmacodynamic profile and a different pharmacokinetic profile, linked to an extended release preparation. Bupropion, an antidepressant with noradrenergic and dopaminergic activity, is now accepted on the Swiss market for the treatment of depression under the name of Wellbutrin. Until now, its indication was limited to tobacco withdrawal (under the name of Zyban). The article also includes new data issued from the STAR*D study (concerning the efficacy of cognitive behavioural therapy) and a few remarks about the recent debate in the media about the efficacy of antidepressants.

Les mots francoys selon l'ordre des lettres, ainsi qu'il les faut escrire, tournez en latin pour les enfants ([Reprod.])

Collection : Archives de la linguistique française ; 142

Defective nitric oxide synthesis: a link between metabolic insulin resistance, sympathetic overactivity and cardiovascular morbidity.

Epidemiological studies demonstrate an association between insulin resistance, hypertension and cardiovascular morbidity. In addition to its metabolic effects, insulin also has important cardiovascular actions. The sympathetic nervous system and the nitric oxide-l-arginine pathway have emerged as central players in the mediation of these actions. Over the past decade, the underlying mechanisms and the factors that may govern the interaction between insulin and these two major cardiovascular regulatory systems have been studied extensively in healthy people and insulin-resistant individuals. Here we summarize the current understanding and gaps in knowledge on these interactions. We propose that a genetic and/or acquired defect of nitric oxide synthesis could represent a central defect triggering many of the metabolic, vascular and sympathetic abnormalities characteristic of insulin-resistant states, all of which may predispose to cardiovascular disease.

Value added logistical support service: logistiikan palveluiden tarjoajat Suomessa. osa 4

Tämä osatutkimus on VALSSI- tutkimusprojektin (Value Added Logistical Support Service) neljäs osavaihe. VALSSI- tutkimuksen tarkoituksena on ollut selvittää logistiikkapalveluiden vaatimuksia business-to-business (B2B) ympäristössä ja määrittää logistiikkapalveluiden palvelukonsepti, jossa perinteiset logistiikkapalvelut on laajennettu tuotannollisilla ja lisäarvoa tuottavilla palveluilla. Tutkimuksen tarkoituksena on ollut tuottaa ulkoistamista helpottavaa materiaalia erityisesti varastoinnin ja kuljetusten osalta. Edellisistä osavaiheista on saatavilla tutkimusraportit yliopiston Internet-sivuilta(www.lut.fi/tutkimus/valore). Tämän tutkimuksen tarkoituksena oli kartoittaa Suomessa toimivien logistiikkapalveluyritysten palvelutarjonta. Tutkimus on keskittynyt palveluntarjoajiin, jotka tarjoavat erikoistunutta logistiikkaa (mm. tuotannollisia palveluita, hankintoja ja pakkauspalveluita) asiakkailleen. Tutkimukseen osallistuneet yritykset olivat suomalaisia ja kansainvälisiä sekä kuljetuspalveluita tarjoavia että logistiikkapalveluyrityksiä sekä alihankkijoina/tukkureina toimivia palveluntarjoajia. Huomionarvoista onkin, että moni yrityksistä käytti markkinoilta saatavia kuljetuspalveluita eikä toiminut itse kuljetusoperaattorina. Logistiikkapalveluyrityksissä huomattiin eroavaisuuksia asiakaspalvelun laajuudessa, ICT strategioissa, hankintojen ja kotiinkutsujen organisoinnissa, tuotannollisissa palveluissa sekä paluulogistiikassa. Varsinaiset varastointipalvelut ovat homogeenisia ja varastointiin liittyvät pakkaamispalvelut ovat pääasiassasamankaltaisia. Markkinoilla toimivien tukkukauppiaiden logistiikkaprosessit eroavat perinteisistä palveluntarjoajista. Tukkurit hoitavat laajasti mm. asiakaspalvelua, teknistä tukea sekä erikoistuneita tuotannollisia palveluita. Nykypäivänä asiakkaat asettavat enemmän vaatimuksia logistiikkapalveluyrityksen prosesseille ja prosessien johtamiselle. Tulevaisuudessa Suomessa ja maailmalla toimivat logistiikkapalveluyritykset tulevat toimimaan yhteistyöverkoissa Itä- Euroopan maat ovat entistä suuremmassa roolissa uusia jakelukanavia ja palveluita mietittäessä. Jo nyt on huomattavissa, että asiakkaat vaativat logistiikan palvelutarjoajia tarjoamaan entistä monipuolisempia ja tuotteistetumpia palveluita.

Value added logistical support service: logistiikan palveluiden tarjoajat Suomessa. osa 4

Tämä osatutkimus on VALSSI- tutkimusprojektin (Value Added Logistical Support Service) neljäs osavaihe. VALSSI- tutkimuksen tarkoituksena on ollut selvittää logistiikkapalveluiden vaatimuksia business-to-business (B2B) ympäristössä ja määrittää logistiikkapalveluiden palvelukonsepti, jossa perinteiset logistiikkapalvelut on laajennettu tuotannollisilla ja lisäarvoa tuottavilla palveluilla. Tutkimuksen tarkoituksena on ollut tuottaa ulkoistamista helpottavaa materiaalia erityisesti varastoinnin ja kuljetusten osalta. Edellisistä osavaiheista on saatavilla tutkimusraportit yliopiston Internet-sivuilta(www.lut.fi/tutkimus/valore). Tämän tutkimuksen tarkoituksena oli kartoittaa Suomessa toimivien logistiikkapalveluyritysten palvelutarjonta. Tutkimus on keskittynyt palveluntarjoajiin, jotka tarjoavat erikoistunutta logistiikkaa (mm. tuotannollisia palveluita, hankintoja ja pakkauspalveluita) asiakkailleen. Tutkimukseen osallistuneet yritykset olivat suomalaisia ja kansainvälisiä sekä kuljetuspalveluita tarjoavia että logistiikkapalveluyrityksiä sekä alihankkijoina/tukkureina toimivia palveluntarjoajia. Huomionarvoista onkin, että moni yrityksistä käytti markkinoilta saatavia kuljetuspalveluita eikä toiminut itse kuljetusoperaattorina. Logistiikkapalveluyrityksissä huomattiin eroavaisuuksia asiakaspalvelun laajuudessa, ICT strategioissa, hankintojen ja kotiinkutsujen organisoinnissa, tuotannollisissa palveluissa sekä paluulogistiikassa. Varsinaiset varastointipalvelut ovat homogeenisia ja varastointiin liittyvät pakkaamispalvelut ovat pääasiassasamankaltaisia. Markkinoilla toimivien tukkukauppiaiden logistiikkaprosessit eroavat perinteisistä palveluntarjoajista. Tukkurit hoitavat laajasti mm. asiakaspalvelua, teknistä tukea sekä erikoistuneita tuotannollisia palveluita. Nykypäivänä asiakkaat asettavat enemmän vaatimuksia logistiikkapalveluyrityksen prosesseille ja prosessien johtamiselle. Tulevaisuudessa Suomessa ja maailmalla toimivat logistiikkapalveluyritykset tulevat toimimaan yhteistyöverkoissa Itä- Euroopan maat ovat entistä suuremmassa roolissa uusia jakelukanavia ja palveluita mietittäessä. Jo nyt on huomattavissa, että asiakkaat vaativat logistiikan palvelutarjoajia tarjoamaan entistä monipuolisempia ja tuotteistetumpia palveluita.