Hemorrhagic Cysts in the Pancreas: Risk Factors, Treatment, and Outcomes - Insights from a Single-Center Study.

BACKGROUND Hemorrhagic cysts are rarely discussed subtypes of pancreatic pseudocysts that occur in about 10% of these cases. They are caused by erosion of the walls of neighboring vessels by extravasated proteolytic pancreatic enzymes. A retrospective analysis was performed to clinically characterize risk factors, treatment, and outcome in patients with hemorrhagic cysts of the pancreas. MATERIAL AND METHODS The retrospective study included patients from the Department of Digestive Tract Surgery in Katowice, Poland, who were treated surgically for a pancreatic hemorrhagic cyst from January 2016 to November 2022. We gathered and assessed data on cyst etiology, symptoms, imaging examinations, risk factors, time, type, and complications of surgery. RESULTS The main symptom was abdominal pain, noted in 5 (62.5%) patients. The most common etiology of cyst was acute pancreatitis, which occurred in 5 patients (62.5%). The most common localization was the tail of pancreas, found in 3 patients (36.5%). The largest dimension of the cyst was 98±68 (30-200) mm. Every patient needed surgical intervention. Patients underwent distal pancreatectomy (n=3) or marsupialization (n=5). One (12.5%) postoperative complication was observed, while mortality was 0%. CONCLUSIONS Hemorrhagic cyst is a life-threatening complication of pancreatitis requiring immediate treatment. In most cases, open surgery is the treatment of choice. Despite the continuous development of minimally invasive techniques, surgical treatment remains the only effective treatment method. Depending on the cyst localization and technical possibilities, pancreatectomy or marsupialization can be applied, and both of them have low complication and mortality rates.

Are the estimated needs for mental health care among adolescents from different socioeconomic backgrounds met equally in Sweden? A longitudinal survey-registry linkage study.

Evidence of inequality in the utilisation of mental health care (MHC) by adolescents in Nordic countries is mixed. This study aims to investigate if there are socioeconomic differences in the utilisation of MHC, while accounting for adolescents' mental health status. We analysed a cohort of 3517 adolescents, followed from 7 to 9th grade (ages 13-16), to examine the association between parental socioeconomic position (SEP: education and disposable income), adolescents' estimated needs, and the utilisation of MHC (defined as visits to secondary psychiatric care or receipt of psychotropic medication). Logistic and negative binomial regression models, with mental health status as moderator, were used to predict utilisation during each grade. Lower SEP predicted higher odds of utilising MHC in adolescents with no/mild symptoms (e.g., odds ratio, OR = 1.33, 95% CI 1.04-1.72, lower vs highest education), but not in those with moderate-to-severe symptoms (estimates close to one and non-significant). This pattern was largely explained by treatment of attention deficit hyperactivity disorder/autism spectrum disorders (ADHD/ASD) in boys. For girls with severe symptoms, lower SEP predicted reduced odds of utilising MHC for other mental disorders (OR = 0.48, 95% CI 0.25-0.92, lower education), and fewer outpatient visits when in contact with such care, although non-significant (incidence rate ratio, IRR = 0.51, 95% CI 0.25-1.05, lowest vs highest income). Our findings suggest a more equitable use of MHC for treating ADHD/ASD, but not other mental disorders such as depression and anxiety, particularly among girls.

Comparison of Postoperative Outcomes of Hand-Sewn Versus Stapled Esophago-jejunal Anastomosis During Total Gastrectomy for Gastric Cancer in 72 Patients: A Retrospective, Single-Center Study in Poland.

BACKGROUND Mechanical stapling is a commonly used alternative to hand-sewn technique for esophago-jejunal anastomosis in total gastrectomy (TG). Some studies report reduction in postoperative complications in the stapler group. This retrospective study aimed to compare short- and long-term surgical outcomes between the groups with stapled and hand-sewn esophago-jejunal anastomosis (EJA) during open TG for gastric cancer. MATERIAL AND METHODS The study included 72 adult patients with gastric cancer who underwent TG in the Department of Digestive Tract Surgery in Katowice between May 2018 and December 2021. The patients were divided into 2 groups according to the technique of EJA: stapled (44 cases) or hand-sewn (28 cases). We compared the groups in terms of the duration of the surgery, length of hospital stay, and occurrence of complications (focusing on anastomotic leakage, stricture and abdominal abscess). RESULTS There were no significant differences in duration of the surgery (P=0.6), blood loss (P=0.7), or length of postoperative hospital stay (P=0.2) among the groups. Early postoperative complications rates were 9.1% (4/44) in the stapler group and 17.9% (5/28) in the hand-sewn group (P=0.27). The most frequent complication was anastomotic leakage, with 2 cases in each group (P=0.76). The mean follow-up time was 1.8±0.9 (0.3-3.6) years. During this period the anastomotic stricture occurred in 7 (15.9%) cases with stapled anastomosis and in 5 (17.9%) cases with hand-sewn anastomosis (P=0.52). CONCLUSIONS In this study there were no significant differences in mortality, morbidity, and surgery duration between stapled and hand-sewn esophago-jejunal anastomosis in total gastrectomy.

Surgical Outcomes in 62 Patients with Ulcerative Colitis: A Retrospective, Single-Center Study from Poland.

BACKGROUND Surgery continues to play an important role in the treatment of ulcerative colitis (UC), which is one of the most common inflammatory diseases of the colon and rectum. This retrospective study from a single center in Poland aimed to evaluate surgical outcomes in 62 patients with ulcerative colitis. MATERIAL AND METHODS The study enrolled 62 patients (36 men [58.1%], 26 women [41.9%]), mean age 52.69±16.84 (range, 19-96) years who underwent surgical treatment of UC during the period 2001-2020. The mandatory inclusion criteria were patients with UC, who underwent total intra-abdominal colectomy (n=22, 46.8%), proctocolectomy (n=25, 53.2%), or left-sided hemicolectomy (n=8, 12.9%). The primary endpoint was postoperative death, and secondary endpoints were long hospitalization (>15 days), complications, and relaparotomy. RESULTS Postoperative mortality was observed in 8 (12.9%) patients. Older age and low albumin level were associated with longer hospitalization time (P=0.004 and P<0.001, respectively). High C-reactive protein (CRP) level (P=0.003), high CRP/albumin ratio (P=0.023), and malnourishment (P=0.026) were risk factors for complications. Malnutrition (P=0.026), older age (P=0.031), high CRP level (p<0.001), high CRP/albumin ratio (P=0.014), arterial hypertension (P=0.012), and urgent surgeries (P=0.021) were associated with higher risk of postoperative death. Patients who had undergone previous surgeries were more likely to need relaparotomy (P=0.022). CONCLUSIONS Preoperative nutritional status was an important factor associated with postoperative outcomes in patients with ulcerative colitis. Correction of malnutrition seems to be a vital part of preoperative preparation.

Intraoperative Hypotension and Its Association with Postoperative Acute Kidney Injury in Patients Undergoing Pancreaticoduodenectomy: A 5-Year, Single-Center, Retrospective Cohort Study.

BACKGROUND Intraoperative hypotension (IOH) is a common phenomenon in high-risk surgery and is often linked to postoperative acute kidney injury (AKI). Pancreaticoduodenectomy (PD), or Whipple's procedure, is a lengthy and complex surgical procedure to remove the head of the pancreas, gallbladder and bile duct, and the first part of the duodenum. This retrospective 5-year study from a single center in Poland included 303 patients who underwent PD and evaluated IOH as a factor associated with AKI. MATERIAL AND METHODS We analyzed perioperative data to assess how various IOH thresholds can predict AKI (according to KDIGO criteria). Several IOH definitions were applied, including absolute and relative thresholds, based on the mean arterial pressure (MAP). Statistically significant IOH thresholds were inserted into multivariable logistic regression models with previously established independent variables. RESULTS We included 303 patients over a 5-year period (2016-2021). There were 58 (19.1%) cases of postoperative AKI. MAP <55 mmHg and a maximal% drop from preinduction MAP were the only IOH definitions associated with AKI. Multivariable analysis revealed that max% drop from preinduction MAP (per 10%, OR=1.65; AUROC=0.70) was the IOH definition best suited for AKI prediction in patients undergoing PD. CONCLUSIONS In patients undergoing PD, it is important to prevent excessive blood pressure drops in regards to preinduction blood pressure values. In this cohort, relative IOH thresholds were better suited for prediction of AKI than the absolute IOH thresholds.

A chronicle of the pancreatoduodenectomy technique development - from the surgeon's hand to the robotic arm.

BACKGROUND: Pancreatoduodenectomy (PD) remains one of the most challenging abdominal surgical procedures. METHODS: A review of the literature regarding the history of PD, starting from the pioneers, Walter Kausch and Alan Whipple, through the great surgeons of the last century, up to the present day. RESULTS: The greatest development of the PD technique took place at the end of the twentieth century. Over the last 40 years, there have been huge technological advances in medicine, which have resulted in the introduction of laparoscopic and robotic techniques for abdominal surgery. However, it turns out that PD is still performed as it used to be "by the surgeon's hand" via laparotomy rather than using the most modern robot or laparoscope and is currently recommended by experts for treatment of pancreatic head cancer (PHC). This is mainly caused by not many data comparing these three PD methods. Moreover, increasingly the results achieved by surgeons advanced in minimally invasive pancreatic resections are comparable to or even better than those achieved by the open method in reference centres. Robot-assisted PD appears to be gaining an advantage over laparoscopic technique in the efficacy of PHC treatment. The obstacles most inhibiting the use of surgical robotics are the high cost of the device and procedure, and the long learning curve. A bright future lies ahead for both methods, with the robotic technique in the forefront. CONCLUSIONS: Despite significant advances in access and surgical technique, PD remains a challenging surgical procedure requiring a big surgeon's experience.

Pancreatic Cystic Tumors: A Single-Center Observational Study.

Background and Objectives: The aim of the study was to analyze the prevalence and characteristics of pancreatic cystic tumors (PCTs). Material and Methods: A retrospective analysis of the medical records of 124 patients, 102 (69%) women and 46 (31%) men, who had undergone surgery for pancreatic cystic tumors in 2014-2018. Among 148 pancreatic cysts, 24 (16%) were non-neoplasmatic and 124 (84%) were neoplasmatic. The neoplasmatic cysts (n = 124) were included in our analysis. There were five main types of PCTs: IPMN (intraductal papillary mucinous neoplasm) (n = 45), MCN (mucinous cystic neoplasm) (n = 30), SCN (serous cystic neoplasm) (n = 28), SPN (solid pseudopapillary neoplasm) (n = 8), and CPEN (cystic pancreatic endocrine neoplasm) (n = 8), as well as mixed-type tumors (n = 5). Results: A statistically significant dependency between PCT type and age was proven (p= 0.0001): IPMNs were observed in the older group of patients with an average age of 66.12 (40-79) years while SPNs were noted in the youngest group of patients with an average age of 36.22 (22-55) years. A statistically significant association between PCT type and gender (p = 0.0001) was found: IPMNs occurred among 24 (53.33%) men and 21 (46.6%) women. In the MCN and SPN groups, all patients were female (100%). Among the SCN group, the majority were women (27 (96.43%)), and there was only 1 (3.57%) man. A statistically significant dependency between PCT type and size was proven (p = 0.0007). The mean size of IPMNs was the smallest 2.95 (0.6-10 cm) and the mean size of MCNs was the largest 6.78 (1.5-19 cm). A statistically significant dependency between PCT type and tumor location was proven (p = 0.000238). The most frequent location of IPMN was the pancreatic head: 27 (60%). MCN was most frequently located in the pancreatic tail (18 (60%)). Most (10/28) SCNs were found in the pancreatic tail (10 (35.71%)). CPENs were most frequently located in the pancreatic tail (three (37.5%)) and pancreatic body and tail (three (37.5%)). SPNs were located commonly in the pancreatic head (five (62.5%)). The type of surgery depended on the tumor location. The most frequent surgery for IPMNs was pancreatoduodenectomy (44.4%), while for MCNs and SCNs, it was distal pancreatectomy (81%). The postoperative morbidity and mortality were 34.68% and 1.61%, respectively. Postoperative pancreatic fistula (POPF) was the most frequent (29%) complication. Conclusions: IPMN was the most frequent resected PCT in our material. A statistically significant association between the type of cyst and location within the pancreas, size, local lymph node involvement, and patient's age and sex was proved. POPF was the most frequent postoperative complication. In patients with PCTs, due to substantial postoperative morbidity, adequate patient selection, considering both the surgical risk as well as the long-term risk of malignant transformation, is very important during qualification for surgery.

Retrospective Study of Surgical Outcomes in 60 Patients with Crohn Disease from a Single Center in Poland.

BACKGROUND In Crohn disease (CD), pharmacotherapy with nutritional support is the treatment of choice. However, complications and a lack of response to drugs are indications for surgery. The aim of this study was to present indications for surgery and methods of surgical treatment of CD and to analyze the postoperative morbidity and mortality risk factors. MATERIAL AND METHODS This was a retrospective analysis of adult patients who underwent surgery for CD between January 2015 and January 2019. Sixty of 457 patients (13%) hospitalized for CD required surgical treatment. The parameters age, sex, body mass index, duration, behavior and location of the disease, pharmacotherapy, indications for surgery, type and duration of surgery, perioperative complications, and laboratory tests results were analyzed. RESULTS Most procedures (90%) were elective. The most common indications for surgery were fistulae and strictures. The most frequently performed procedure was right hemicolectomy (60%). Thirty-two percent of patients had postoperative complications. Perianal disease (P=0.002) and penetrating behavior (P=0.01) were associated with more surgeries. Stricturing and penetrating behavior was more frequent in patients with ileal/ileocecal involvement than in those with CD affecting the colon (P=0.039). Patients with smoking history had a significantly lower age at first surgery (P=0.02). The use of anti-TNF medications appeared to extend time between diagnosis and first surgery (P=0.014). CONCLUSIONS Although the analysis did not reveal any risk factors for perioperative complications, perianal manifestations, penetrating disease type, ileal/ileocecal involvement, and smoking may be associated with risk of earlier surgery or multiple surgeries.

A Retrospective Study of Postoperative Outcomes in 98 Patients Diagnosed with Gastrointestinal Stromal Tumor (GIST) of the Upper, Middle, and Lower Gastrointestinal Tract Between 2009 and 2019 at a Single Center in Poland.

BACKGROUND Gastrointestinal stromal tumors (GISTs) arise in the smooth muscle pacemaker interstitial cells of Cajal, or similar cells. The aim of this retrospective study between 2009 and 2019 from a single center in Poland was to assess the selected prognostic factors (location, tumor size, mitotic index, body mass index (BMI), length of hospital stay, age, sex, and coexistent neoplasm) and to investigate postoperative outcomes in 98 patients with GIST of the upper, middle, and lower gastrointestinal tract. MATERIAL AND METHODS Between 2009 and 2019, 98 patients (50 women and 48 men) with an average age of 63.8 years (range from 38 to 90 years) were operated on for GIST in the Department of Gastrointestinal Surgery in Katowice, Poland. Based on the intraoperative and postoperative investigations, the tumor size and mitotic index were determined in each case. RESULTS A statistically significant correlation between age and mitotic index (MI) was found (p=0.02). The higher the MI, the younger the age of the patients. However, regardless of sex, younger patients had a tendency to survive longer. A >60-year-old male patient's probability of survival was around 65% after 40 months. Higher mitotic index was also associated with larger tumor size (p<0.0001). Female patients had a tendency to survive longer than males. CONCLUSIONS The findings from this small retrospective study support the importance of preoperative evaluation and frequent postoperative follow-up for patients with GIST of the gastrointestinal tract, particularly in older male patients, and patients with malignant comorbidities, which are associated with increased mortality.

Absence of the celiac trunk and anomalous very low origin of the common hepatic artery arising independently from the abdominal aorta just above aortic bifurcation in patient undergoing radical pancreaticoduodenectomy.

PURPOSE: Knowledge of anomalies of the celiac trunk is very important during various surgical procedures (such as pancreatic and gastric resections including Appleby operation, liver resections and liver transplantations) and as well as radiologic procedures (such as chemoembolization of pancreatic and hepatic tumors). METHODS: A 77-years-old woman was admitted to our department for surgical treatment of ampullary adenocarcinoma G2 confirmed in endoscopic retrograde cholangiopancreatography (ERCP) with papillotomy and ampullary biopsy. In the contrast-enhanced computed tomography, the ampullary tumor was not visible, but the main pancreatic duct within pancreatic head and isthmus was dilated (indirect radiological tumor signs). An absence of the celiac trunk (CT) was established via computed tomography. Therefore, computed tomography-based angiography (angio-CT) of the abdominal aorta (AA) was performed before operation. RESULTS: Angio-CT confirmed an extremely rare vascular anomaly: an absence of CT. The left gastric (LGA), splenic (SA), and common hepatic (CHA) arteries connected above origin of the superior mesenteric artery (SMA) from the AA. Pylorus-preserving pancreaticoduodenectomy (PD) was performed. This anomaly was also confirmed intraoperatively. The postoperative course was uneventful and the patient was discharged on postoperative day 10. There were no signs of recurrence of the tumor during the 6 months follow-up. CONCLUSION: The proper preoperative identification of anomalies within major abdominal vessels and its relationship to the tumor is very important to avoid intraoperative vascular injury and major postoperative complications.

Intranasal epidermal growth factor treatment rescues neonatal brain injury.

There are no clinically relevant treatments available that improve function in the growing population of very preterm infants (less than 32 weeks' gestation) with neonatal brain injury. Diffuse white matter injury (DWMI) is a common finding in these children and results in chronic neurodevelopmental impairments. As shown recently, failure in oligodendrocyte progenitor cell maturation contributes to DWMI. We demonstrated previously that the epidermal growth factor receptor (EGFR) has an important role in oligodendrocyte development. Here we examine whether enhanced EGFR signalling stimulates the endogenous response of EGFR-expressing progenitor cells during a critical period after brain injury, and promotes cellular and behavioural recovery in the developing brain. Using an established mouse model of very preterm brain injury, we demonstrate that selective overexpression of human EGFR in oligodendrocyte lineage cells or the administration of intranasal heparin-binding EGF immediately after injury decreases oligodendroglia death, enhances generation of new oligodendrocytes from progenitor cells and promotes functional recovery. Furthermore, these interventions diminish ultrastructural abnormalities and alleviate behavioural deficits on white-matter-specific paradigms. Inhibition of EGFR signalling with a molecularly targeted agent used for cancer therapy demonstrates that EGFR activation is an important contributor to oligodendrocyte regeneration and functional recovery after DWMI. Thus, our study provides direct evidence that targeting EGFR in oligodendrocyte progenitor cells at a specific time after injury is clinically feasible and potentially applicable to the treatment of premature children with white matter injury.

Has the association between low school performance and the risk of disability benefit due to mental disorders become stronger over time?

BACKGROUND: The proportion of young adults on disability benefits due to mental disorders has increased in Europe since the early 2000's. Poor educational achievement is a risk factor for disability benefits due to mental disorders in early adulthood, yet no study has examined whether this association has become stronger over time. METHODS: All residents of Stockholm County at the time of graduation from compulsory education between 2000 and 2007 (N = 169,125) were followed prospectively for recipient of disability benefits due to a mental disorder from 2003 to 2011. Information about the study participants was obtained by linkage of national registers. Low school performance in the last year of compulsory school was defined as having a merit rating corresponding to the lowest quintile. The association between school performance and disability benefits was examined using Cox proportional hazards models. RESULTS: Low school performers had a greater risk of disability benefits due to mental disorders during early adulthood, as compared to their better performing counterparts, and this association was more pronounced for the more recent graduation cohorts (OR = 1.12, 95% CI 1.08-1.16). CONCLUSIONS: The association between low school performance and the risk of disability benefits due to mental disorders seems to become stronger during the first decade of the twenty-first century. It is plausible that this trend indicates an increased vulnerability of poor school performers to exclusion from the labor market. Prevention of school failure and adjustment of the labour market to individual variability in academic performance appear to be critical approaches to counteract this trend.

Water consumption management in polyethylene terephthalate (PET) bottles washing process via wastewater pretreatment and reuse.

The increasing recycling of polyethylene terephthalate (PET) bottles requires more and more fresh water during washing the bottles. The post-washing wastewater is often treated as effluent, whereas it could be reused in the technological process after appropriate pretreatment. In this paper, coagulation together with flocculation is proposed for use in the pretreatment of the wastewater arising during PET bottles washing. Five flocculants and six coagulants were tested. The turbidity and total organic carbon (TOC) were reduced by up to 98% and 69%, respectively. Out of the tested flocculants, Praestol 611 BC at a dose of 2 mg/dm3 had the best performances. The best coagulant in TOC reduction was PIX-123. As for turbidity reduction, ALS was the best, but PIX-123 was comparable, and therefore, PIX-123 was indicated as most suitable in simultaneous reduction of TOC and turbidity. The coagulation and flocculation together reduced the amount of pollutants and contaminants in the post-washing wastewater to the levels allowing the water to be reused in the washing process, which could bring both economical and ecological benefits.

Associations Between Nutritional Parameters and Clinicopathologic Factors in Patients with Gastric Cancer: A Comprehensive Study.

The aim of this study was to assess and analyze the nutritional status of gastric cancer (GC) patients. The analysis included 207 patients with GC treated in a large center of oncology. Patients were divided into two groups according to the cutoff value of the mean prognostic nutritional index (PNI): those with a PNI < 52.78 and those with a PNI ≥ 52.78. The higher PNI was associated with lower age and higher total protein and hemoglobin levels (P < 0.01). The total lymphocyte count (P = 0.02), albumin, total protein and PNI (P < 0.01) were significantly higher in stable-weight patients and lower in the group with weight loss > 10% (P = 0.000031). Body mass index (BMI) after disease recognition, albumin and total protein (0.003) levels, total lymphocyte count, and PNI were significantly lower in patients with nutritional risk. Significantly lower BMI before disease and BMI after disease recognition were noted in smoking patients. Significantly higher total lymphocyte count was observed in smoking patients (P < 0.01). Significantly lower PNI was noted in tumors with lymph node metastasis (N+). G3 tumors were associated with the lowest total lymphocyte count (P = 0.01). Assessment of nutritional status using PNI calculation should be the standard management of patients with GC before treatment.

The structural and surface properties of natural and modified coal gangue.

A novel application of coal gangue as inexpensive adsorbents is considered in this study. The structural and surface properties of natural and modified gangue were studied via nitrogen adsorption. Four types of samples were studied: natural, modified with H2NO3 and H2O2 and calcined at 250 °C and 600 °C. The specific surface area and porosity of the samples were determined using various methods. The raw material is mainly mesoporous with relatively small specific surface area. The chemical modification enlarged the total pore volume and the specific surface area. The calcination at 250 °C enlarged slightly the pore volume and lowered the specific surface area, but did not cause significant changes in the structural properties. The calcination at 600 °C resulted in a significant increase in pore volume and a decrease in specific surface area. These results suggest that the coal gangue studied here could be used as inexpensive adsorbent in industrial wastewater pretreatment.

E2F1 coregulates cell cycle genes and chromatin components during the transition of oligodendrocyte progenitors from proliferation to differentiation.

Cell cycle exit is an obligatory step for the differentiation of oligodendrocyte progenitor cells (OPCs) into myelinating cells. A key regulator of the transition from proliferation to quiescence is the E2F/Rb pathway, whose activity is highly regulated in physiological conditions and deregulated in tumors. In this paper we report a lineage-specific decline of nuclear E2F1 during differentiation of rodent OPC into oligodendrocytes (OLs) in developing white matter tracts and in cultured cells. Using chromatin immunoprecipitation (ChIP) and deep-sequencing in mouse and rat OPCs, we identified cell cycle genes (i.e., Cdc2) and chromatin components (i.e., Hmgn1, Hmgn2), including those modulating DNA methylation (i.e., Uhrf1), as E2F1 targets. Binding of E2F1 to chromatin on the gene targets was validated and their expression assessed in developing white matter tracts and cultured OPCs. Increased expression of E2F1 gene targets was also detected in mouse gliomas (that were induced by retroviral transformation of OPCs) compared with normal brain. Together, these data identify E2F1 as a key transcription factor modulating the expression of chromatin components in OPC during the transition from proliferation to differentiation.

Removing heavy metals from wastewaters with use of shales accompanying the coal beds.

A possibility of using clay waste rocks (shales) from coal mines in the removal of heavy metals from industrial wastewaters is considered in this paper. Raw and calcined (600 °C) shales accompanying the coal beds in two Polish coal mines were examined with respect to their adsorptive capabilities for Pb, Ni and Cu ions. The mineralogical composition of the shales was determined and the TG/DTG analysis was carried out. The granulometric compositions of raw and calcined shales were compared. Tests of adsorption for various Pb(II), Ni(II) and Cu(II) concentrations were conducted and the pH before and after adsorption was analyzed. The results indicate that the shales from both coal mines differ in adsorptive capabilities for particular metal ions. The calcination improved the adsorptive capabilities for lead, but worsened them for nickel. The examined shales have good adsorptive capabilities, and could be used as inexpensive adsorbents of heavy metal ions, especially in the regions where resources of shale are easy accessible in the form of spoil tips.

School effects on risk of non-fatal suicidal behaviour: a national multilevel cohort study.

OBJECTIVE: Research has demonstrated school effects on health, over and above the effects of students' individual characteristics. This approach has however been uncommon in mental health research. The aim of the study was to assess whether there are any school-contextual effects related to socioeconomic characteristics and academic performance, on the risk of hospitalization from non-fatal suicidal behaviour (NFSB). METHODS: A Swedish national cohort of 447,929 subjects was followed prospectively in the National Patient Discharge Register from the completion of compulsory school in 1989-93 (≈16 years) until 2001. Multilevel logistic regression was used to assess the association between school-level characteristics and NFSB. RESULTS: A small but significant share of variation in NFSB was accounted for by the school context (variance partition coefficient <1%, median odds ratio = 1.26). The risk of NFSB was positively associated with the school's proportion of students from low socioeconomic status (SES), single parent household, and the school's average academic performance. School effects varied, in part, by school location. CONCLUSION: NFSB seems to be explained mainly by individual-level characteristics. Nevertheless, a concentration of children from disadvantaged backgrounds in schools appears to negatively affect mental health, regardless of whether or not they are exposed to such problems themselves. Thus, school SES should be considered when planning prevention of mental health problems in children and adolescents.

End-to-end ductal anastomosis in biliary reconstruction: indications and limitations.

End-to-end ductal anastomosis is a physiologic biliary reconstruction that is commonly used in liver transplantation and less frequently in the surgical treatment of iatrogenic bile duct injuries. Currently, end-to-end ductal anastomosis is the biliary reconstruction of choice for liver transplantation in most adult patients. In recent years, it has also been performed for liver transplantation in children and in select patients with primary sclerosing cholangitis. The procedure is also performed in some patients with iatrogenic bile duct injuries, as it establishes physiologic bile flow. Proper digestion and absorption as well as postoperative endoscopic access are possible in patients who undergo end-to-end ductal anastomosis. It allows endoscopic diagnostic and therapeutic procedures in patients following surgery. This anastomosis is technically simple and associated with fewer early postoperative complications than the Roux-en-Y hepaticojejunostomy; however, end-to-end ductal anastomosis is not possible to perform in all patients. This review discusses the indications for and limitations of this biliary reconstruction, the technique used in liver transplantation and surgical repair of injured bile ducts, suture types and use of a T-tube.

L'anastomose termino-terminale du canal biliaire est la technique de reconstruction biliaire physiologique la plus couramment utilisée lors de la greffe du foie; elle est moins souvent utilisée pour le traitement chirurgical des blessures iatrogènes affectant le canal biliaire. À l'heure actuelle, l'anastomose termino-terminale est la reconstruction biliaire privilégiée lors d'une transplantation hépatique chez la plupart des patients adultes. Ces dernières années, on y a également eu recours pour la greffe hépatique chez les enfants et dans certains cas de cholangite sclérosante. L'intervention est également effectuée chez certains patients présentant des traumatismes iatrogènes affectant le canal biliaire, puisqu'elle permet la circulation physiologique de la bile. Une digestion et une absorption adéquates, de même qu'un accès endoscopique postopératoire sont donc possibles chez les patients qui subissent une anastomose termino-terminale. Elle facilite les interventions diagnostiques et thérapeutiques endoscopiques chez les patients après la chirurgie. Cette anastomose est simple au plan technique et associée à moins de complications durant la période postopératoire immédiate comparativement à l'hépaticojéjunostomie Roux en Y. Toutefois, l'anastomose termino-terminale n'est pas réalisable chez tous les patients. La présente analyse aborde les indications et les limites de cette reconstruction biliaire, la technique utilisée lors de la greffe hépatique et lors de la réparation chirurgicale des canaux biliaires lésés, les types de sutures et l'utilisation d'un tube en T.

Endovascular Treatment of Hepatic Artery Pseudoaneurysm after Pancreaticoduodenectomy: A Literature Review.

Pancreaticoduodenectomy (PD) is a complex surgical procedure performed in patients with periampullary tumors located within the pancreatic head, the papilla of Vater, the distal common bile duct, and the duodenum. In advanced tumors, the operative technique involves the need for dissection and divestment of the arteries located within the pancreaticoduodenal field, including the common hepatic artery (CHA) and the proper hepatic artery (PHA) and its branches. The second most important cause of post-PD visceral aneurysms is irritation of the peri-pancreatic arterial wall by pancreatic juice in a postoperative pancreatic fistula (POPF). Hepatic artery pseudoaneurysm (HAP) is a very dangerous condition because it is usually asymptomatic, but it is a rare and potentially lethal pathology because of the high risk of its rupture. Therefore, HAP requires treatment. Currently, selective celiac angiography is the gold-standard diagnostic and therapeutic management for postoperative bleeding and pseudoaneurysm in patients following PD. Open surgery and less invasive endovascular treatment are performed in patients with HAP. Endovascular treatment involves transarterial embolization (TAE) and stent graft implantation. The choice of treatment method depends on the general and local conditions, such as the patient's hemodynamic stability and arterial anatomy. In patients in whom preservation of the flow within the hepatic artery (to prevent hepatic ischemia complications such as liver infarction, abscess, or failure) is needed, stent graft implantation is the treatment of choice. This article focuses on a review of two common methods for endovascular HAP treatment. In addition, risk factors and diagnostic tools have been described.