Drain amylase value as an early predictor of pancreatic fistula after cephalic duodenopancreatectomy

AIM:To determine predictors of clinically relevant pancreatic fistulas(CRPF)by measuring drain fluid amylase(DFA)in the early postoperative period.METHODS:This prospective clinical study included382 patients with periampullary tumors that were surgically resected at our department between March 2005and October 2012.A cephalic duodenopancreatectomy (DP)was performed on all patients.Two closed suction drains were placed at the end of the surgery.The highest postoperative DFA value was recorded and analyzed during the first three postoperative days and on subsequent days if the drains were kept longer.Pancreatic fistula(PF)was classified according to the International Study Group of Pancreatic Fistula(ISGPF)criteria.Postoperative complications were defined according to the Dindo-Clavien classification.All data were statistically analyzed.The optimal thresholds of DFA levels on the first,second and third postoperative days were estimated by constructing receiver operating curves,generated by calculating the sensitivities and specificities of the DFA levels.The DFA level limits were used to differentiate between the group without PF and the groups with biochemical pancreatic fistula(BPF)and CRPF.RESULTS:Pylorus-preserving duodenopancreatectomy was performed on 289(75.6%)patients,while the remaining patients underwent a classic Whipple procedure(CW).The total incidence of PF was 37.7%(grade A22.8%,grade B 11.0%and grade C 3.9%).Soft pancreatic texture(SPT)was present in 58.3%of patients who developed PF.Mortality was 4.2%.The median DFA value on the first postoperative day(DFA1)in patients who developed PF was 4520 U/L(range 350-99000 U/L)for grade A fistula(BPF)with a SPT and a diameter of the main pancreatic duct(MPD)of≤3 mm.For grade B/C(CRPF),the median DFA1 value was 8501 U/L(range377-92060 U/L)with a SPT and MPD of≤3 mm.These values were significantly higher when compared to the patients who did not have PF(122;range 5-37875 U/L).The upper limit of DFA values for the first 3 postoperative days in the examined stages of PF were:DFA1 1200U/L for the BPF and CRPF;DFA3 350 U/L for BPF and DFA3 800 U/L for CRPF.The determined values were highly significant and demonstrated a reliable diagnostic test for both BPF and CRPF.CONCLUSION:DFA1≥1200 U/L is an important predictive factor for PF of any degree.The trend of DFA3(decrease of<50%)compared to DFA1 is a significant factor in the differentiation of CRPF from transient BPF.

Computed Tomography Assessment of Cephalic Index and Sella Turcica Dimensions and Morphology in a Nigerian Population

Cephalic index(CI)is the percentage of biparietal diameter to the occipitofrontal diameter of the skull and can be used in forensic investigations in cases of disputed identity where only fragments of the head/skull are available.The sella turcica houses the pituitary gland whose hormones regulate the functions of many other glands and systems of the body.Abnormal sizes of sella turcica could indicate sella/pituitary pathology with health implications.This study aimed to assess CI,head shapes and sella turcica dimensions and morphology of the Yoruba tribe of Nigeria.The objectives are:to relate CI and head shapes with sella turcica dimensions and morphology,to use CI and head shape to identify and distinguish the Yoruba tribe from other tribes,to use CI and head shape to distinguish between genders.Skull/head and sella turcica dimensions were measured on 321 retrospectively enlisted normal cranial Computed Tomography(CT)images of Yoruba subjects,mean age 55(SD±17)years,in a Tertiary Hospital in South-West Nigeria between January 2020 and April 2021,and then CI calculated.Data was analyzed using IBM SPSS 27(IBM Corp.Armonk,NY,USA,2019).Predominant head shape of the studied group was dolichocephalic.Mean CI was 70.0±3.7 and showed no statistically significant difference between gender(P=0.097).Mean sella length,depth;and anteroposterior diameter was 1.22±0.24 cm,0.80±0.15 cm,1.34±0.25 cm respectively.Mean sella length and depth showed significant difference between gender(P=0.0001;P=0.032)respectively.Head shape has no association with sella dimensions and morphology.Head shape and CI may stratify populations in forensic practice and surgical planning.

Effect of Stimulating the BL67 Point on Fetal Correction from Breech to Cephalic Presentation and Natural Delivery after the 36 Weeks of Pregnancy: A Randomized Clinical Trial

Objective:Various techniques are proposed for changing fetal presentation.We aimed to assess the effect of BL67 point stimulation on correcting breech presentation and natural delivery in women at 36-38 gestational weeks.Methods:A parallel single blinded randomized clinical trial was conducted on 72 eligible pregnant women with breech presentation at the 36 weeks of pregnancy.The subjects were divided into two groups-intervention(n=36)and control groups(n=36)by block randomization method.The intervention group stimulated the BL67 point by self-administration for 20 min once a day for 2 weeks.Finally,the appearance of cephalic presentation and rate of vaginal delivery was compared between the groups(n1=n2=32)using the Chi-square test and multivariate logistic regression.Results:The correction of breech to cephalic presentation occurred in 53.1% of patients in the intervention group.The adjusted relative risk(RR)for fetal correction from breech to cephalic was 1.80(RR=1.80,95%confidence interval[CI],1.13-5.17).It was shown that the stimulation of the BL67 point increased the correction of breech to cephalic presentation.In addition,the rate of vaginal delivery increased by>4-fold(RR=4.16,95%CI,2.54-6.82)by correction to cephalic presentation.Moreover,65.6%of mothers in intervention group and 90.6%in the control group underwent cesarean section.Conclusions:The stimulation of the BL67 point is a safe,inexpensive,and effective method that can be self-administered at home for fetal correction from breech to cephalic presentation in women with breech presentations during 36-38 gestational weeks.This promotes uncomplicated natural childbirth.

The cephalic labial gland secretions of two socially parasitic bumblebees Bombus hyperboreus （Alpinobombus） and Bombus inexspectatus （ Thoracobombus） question their inquiline strategy

Social parasitic Hymenopterans have evolved morphological, chemical, and behavioral adaptations to overcome the sophisticated recognition and defense systems of their social host to invade host nests and exploit their worker force. In bumblebees, so- cial parasitism appeared in at least 3 subgenera independently： in the subgenus Psithyrus consisting entirely of parasitic species, in the subgenus Alpinobombus with Bombus hy- perboreus, and in the subgenus Thoracobombus with B. inexspectatus. Cuckoo bumblebee males utilize species-specific cephalic labial gland secretions for mating purposes that can impact their inquiline strategy. We performed cephalic labial gland secretions in B. hyperboreus, B. inexspectatus and their hosts. Males of both parasitic species exhibited high species specific levels of cephalic gland secretions, including different main com- pounds. Our results showed no chemical mimicry in the cephalic gland secretions between inquilines and their host and we did not identify the repellent compounds already known in other cuckoo bumblebees.

What to do when it is breech? A state-of-the-art review on management of breech presentation

Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification of risk factors and a proper physical examination are beneficial;however,ultrasound is the gold standard for the diagnosis of malpresentations.External cephalic version(ECV)refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation.This procedure is performed manually through the mother’s abdomen by a trained health care provider,to reduce the likelihood of a cesarean section.Studies have reported a version success rate of above 50%by ECV.The main objective of this review is to present a broad perspective on fetal malpresentation,ECV,and delivery of a breech fetus.The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them.After discussing breech prevalence,risk factors,diagnosis,and management,an updated review of ECV is presented.Moreover,ECV indications/contraindications,alternatives,clinical techniques on how to perform ECV and breech vaginal delivery,and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.

An early Cambrian Sidneyia(Arthropoda) resolves the century-long debate of its head organization

We report the extraordinarily preserved euarthropod Sidneyia minor sp.nov.from the Cambrian Stage 3 Xiaoshiba Lagerst?tte in Yunnan,South China.So far this is the earliest occurrence of the genus.As with other species of Sidneyia,the new taxon shares similar features such as a crescent-shaped head shield with paired lateral notches for stalked eyes,but more significantly and new,is the presence of three pairs of post-antennal appendages beneath the head shield identified by micro-CT methods.We conclude that Sidneyia is a sister group to other members of Vicissicaudata within the diverse radiation of Artiopoda.

Neurological disorder

13.1.Infection2005419 Clinical characteristics of unidentified en-cephalitis with tumor-like symptoms.XU Ping-yi(徐评议),et al.Dept Neurol,Affili Hosp 1,Sun