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Development of single-port cholecystectomy : results of a case-control study matched to one surgeon
(2012)
Background: Single-port laparoscopic cholecystectomy is an evolving technique which is now widely established. Up until now, the safety of the procedure and a respective learning curve have not been adequately reported in most studies. The aim of this study was to demonstrate that single-port cholecystectomy is a safe procedure, with a positive learning curve from a case-control study matched to one surgeon.
Methods: One hundred single-port cholecystectomies performed by one surgeon (AB) were retrospectively matched to 100 patients who underwent conventional laparoscopic cholecystectomy carried out by the same surgeon. The two groups were matched in respect of surgical indication, gender, age, and body mass index. The groups were compared with respect to operation time, use of additional trocars, analgesics required in the post anesthesia care unit, postoperative complications, and duration of hospital stay.
Results: No significant difference was found between the two groups with respect to postoperative complications and stay in hospital. The operation time increased slightly in the single-port group. Directly after the operation, the analgesic use required in the post anesthesia care unit was higher in the single-port group. Consumption of analgesics on the surgical ward was very similar in each group. In respect to the learning curve, the operation time and use of additional trocars showed a positive trend, starting with the thirtieth operation.
Conclusion: Single-port cholecystectomy is a feasible and safe procedure in a specialist setting. The procedure can be done under the same safety rules as those for conventional laparoscopic cholecystectomy. Considering the learning curve, starting with the thirtieth operation, a positive trend was seen. Long-term studies will be needed to establish the incidence and rate of incisional hernias.
Minimal invasive Techniken gehören zum chirurgischen Alltag. Sie hinterlassen nur kleine Narben, erfordern aber ein besonderes Geschick des Operateurs. Eine Studie von Ernst Hanisch, Professor an der Goethe-Universität und Chefarzt an der Asklepios Klinik Langen, zur minimal invasiven Entfernung der Gallenblase zeigt: Die Technik ist sicher und verbessert sich mit zunehmender Erfahrung des Chirurgen.
It is proposed to install an experimental setup in the fixed-target hall of the Nuclotron with the final goal to perform a research program focused on the production of strange matter in heavyion collisions at beam energies between 2 and 6 A GeV. The basic setup will comprise a large acceptance dipole magnet with inner tracking detector modules based on double-sided Silicon micro-strip sensors and GEMs. The outer tracking will be based on the drift chambers and straw tube detector. Particle identification will be based on the time-of-flight measurements. This setup will be sufficient perform a comprehensive study of strangeness production in heavy-ion collisions, including multi-strange hyperons, multi-strange hypernuclei, and exotic multi-strange heavy objects. These pioneering measurements would provide the first data on the production of these particles in heavy-ion collisions at Nuclotron beam energies, and would open an avenue to explore the third (strangeness) axis of the nuclear chart. The extension of the experimental program is related with the study of in-medium effects for vector mesons decaying in hadronic modes. The studies of the NN and NA reactions for the reference is assumed.
To compare the development of the auditory system in hearing and completely acoustically deprived animals, naive congenitally deaf white cats (CDCs) and hearing controls (HCs) were investigated at different developmental stages from birth till adulthood. The CDCs had no hearing experience before the acute experiment. In both groups of animals, responses to cochlear implant stimulation were acutely assessed. Electrically evoked auditory brainstem responses (E-ABRs) were recorded with monopolar stimulation at different current levels. CDCs demonstrated extensive development of E-ABRs, from first signs of responses at postnatal (p.n.) day 3 through appearance of all waves of brainstem response at day 8 p.n. to mature responses around day 90 p.n.. Wave I of E-ABRs could not be distinguished from the artifact in majority of CDCs, whereas in HCs, it was clearly separated from the stimulus artifact. Waves II, III, and IV demonstrated higher thresholds in CDCs, whereas this difference was not found for wave V. Amplitudes of wave III were significantly higher in HCs, whereas wave V amplitudes were significantly higher in CDCs. No differences in latencies were observed between the animal groups. These data demonstrate significant postnatal subcortical development in absence of hearing, and also divergent effects of deafness on early waves II–IV and wave V of the E-ABR.
The caption of Figure 1 in the paper at doi:10.1155/2012/182767 has to be corrected as shown here. Also, should be corrected as follows: J. Tillein, S. Heid, E. Lang, R. Hartmann, and A. kral, “Development of brainstem-evoked responses in congenital auditory deprivation,” Neural Plasticity, vol. 2012, Article ID 182767, 11 Pages, 2012. s.a. urn:nbn:de:hebis:30:3-267673
We investigate the decisions of listed firms to go private once again. We start by revealing that while a significant number of firms which go public is VC-backed, an overproportional share of these VC-backed firms go private later on (they stay on the exchange for an average of 8.5 years). We interpret this very robust pattern such that IPOs of VC-backed firms are to a large extent a temporary rather than a permanent feature of the corporate governance of these firms. We investigate various potential hypotheses why VCs actually seem to be able to bring marginal firms to the exchange by relating the going-private decisions to various characteristics of the IPO market as well as to VC characteristics. We find strong support for the certification ability of VCs: more experienced and reputable VCs are more able to bring marginal firms to public exchanges via an IPOs. These marginal firms backed-by more reputable and experienced VCs are more likely to go private later on. Hence, our analysis suggests that IPOs backed by experienced VCs are most likely to be a temporary rather than the final stage in the life of the portfolio firm. We find no support that reputable VCs underprice their IPO-exits more implying that they have no need to leave more money on the table to take the marginal firms public.
Offene Sandvegetation auf Binnendünen zählt zu den am stärksten bedrohten Vegetationstypen Mitteleuropas. Zu den Pionierarten subatlantisch geprägter Sandstandorte gehört das konkurrenzschwache Silbergras (Corynephorus canescens). In Randbereichen von zwei Mäanderschleifen der Hase (Emsland, NW-Deutschland), die früher zum Teil unter intensiver landwirtschaftlicher Nutzung standen, wurden im Rahmen von Restitutionsmaßnahmen Silbergrasfluren (Spergulo vernalis-Corynephoretum canescentis) auf neu geschaffenen, nährstoffarmen Dünenstandorten angesiedelt. Die „Neodünen“ wurden hierzu mit Mahdgut aus einer Leitbildfläche (nahegelegenes Naturschutzgebiet) inokuliert und vorwiegend mit Rindern (selten mit Pferden) extensiv beweidet. Auch zehn Jahre nach den Restitutionsmaßnahmen sind Corynephorus-Horste auf allen einst inokulierten Flächen und in den Altbeständen vorhanden, jedoch kommen sie in unterschiedlicher Vergesellschaftung vor. Nur einmal konnte eine Neuansiedlung von C. canescens auf einer offenen Sandfläche in Flussnähe festgestellt werden. Unterschiede an den Wuchsorten im Offensandanteil, Humusgehalt des Substrates sowie in der Anzahl und Zusammensetzung konkurrierender Pflanzenarten beeinflussen die Vitalität einzelner Corynephorus-Individuen und die Größe ihrer Populationen. Die Horste variieren in Frequenz, Größe, Vitalität und Anzahl ihrer Ausbreitungseinheiten. Die inokulierten Bestände der neu angelegten Dünen unterscheiden sich in diesen Parametern am stärksten von denen der fragmentierten Altdüne und solchen, die sich spontan neu gebildet haben. Die Ergebnisse zeigen, dass die Größe der Horste mit der Anzahl der Blütenstände und damit mit dem Ausbreitungspotenzial von C. canescens korreliert. Die Größe der Horste hängt von den jeweiligen Wuchsbedingungen ab. Eine dauerhafte Etablierung von C. canescens ist von einem komplexen Wirkungsgefüge mehrerer Faktoren abhängig. Über eine erfolgreiche Ausbreitung entscheidet eine möglichst große Phytomasse des Horstes, da diese die Anzahl der Blütenstände und Diasporen positiv beeinflusst. Das längerfristige Bestehen von C. canescens-Populationen ist im Bereich der „Neodünen“ unter den derzeitigen Bedingungen (z. B. Konkurrenz anderer Pflanzenarten, höhere Humus-Akkumulation, Fehlen stärkerer Offenboden-Dynamik) nicht gesichert. Ein höherer Beweidungsdruck sollte eine Re-Dynamisierung fördern.
In this paper, we develop a state-dependent sensitivity value-at-risk (SDSVaR) approach that enables us to quantify the direction, size, and duration of risk spillovers among financial institutions as a function of the state of financial markets (tranquil, normal, and volatile). Within a system of quantile regressions for four sets of major financial institutions (commercial banks, investment banks, hedge funds, and insurance companies) we show that while small during normal times, equivalent shocks lead to considerable spillover effects in volatile market periods. Commercial banks and, especially, hedge funds appear to play a major role in the transmission of shocks to other financial institutions. Using daily data, we can trace out the spillover effects over time in a set of impulse response functions and find that they reach their peak after 10 to 15 days.
Background and Aims: Chronic infection with the hepatitis B virus (HBV) is a major health issue worldwide. Recently, single nucleotide polymorphisms (SNPs) within the human leukocyte antigen (HLA)-DP locus were identified to be associated with HBV infection in Asian populations. Most significant associations were observed for the A alleles of HLA-DPA1 rs3077 and HLA-DPB1 rs9277535, which conferred a decreased risk for HBV infection. We assessed the implications of these variants for HBV infection in Caucasians.
Methods: Two HLA-DP gene variants (rs3077 and rs9277535) were analyzed for associations with persistent HBV infection and with different clinical outcomes, i.e., inactive HBsAg carrier status versus progressive chronic HBV (CHB) infection in Caucasian patients (n = 201) and HBsAg negative controls (n = 235).
Results: The HLA-DPA1 rs3077 C allele was significantly associated with HBV infection (odds ratio, OR = 5.1, 95% confidence interval, CI: 1.9–13.7; p = 0.00093). However, no significant association was seen for rs3077 with progressive CHB infection versus inactive HBsAg carrier status (OR = 2.7, 95% CI: 0.6–11.1; p = 0.31). In contrast, HLA-DPB1 rs9277535 was not associated with HBV infection in Caucasians (OR = 0.8, 95% CI: 0.4–1.9; p = 1).
Conclusions: A highly significant association of HLA-DPA1 rs3077 with HBV infection was observed in Caucasians. However, as a differentiation between different clinical courses of HBV infection was not possible, knowledge of the HLA-DPA1 genotype cannot be translated into personalized anti-HBV therapy approaches.