Effectiveness and Safety of Non-Invasive Neuromodulation for Vision Restoration: A Systematic Review and Meta-Analysis.

We carried out a systematic review and meta-analysis to determine the effectiveness and safety of non-invasive electrical stimulation (NES) for vision restoration. We systematically searched for randomised controlled trials (RCTs) comparing NES with sham stimulation, for vision restoration between 2000 and 2022 in CENTRAL, MEDLINE, EMBASE, and LILACS. The main outcomes were as follows: visual acuity (VA); detection accuracy; foveal threshold; mean sensitivity as the parameter for the visual field; reading performance; contrast sensitivity (CS); electroencephalogram; quality of life (QoL), and safety. Two reviewers independently selected studies, extracted data, and evaluated the risk of bias using the Cochrane risk of bias 2.0 tool. The certainty in the evidence was determined using the GRADE framework. Protocol registration: CRD42022329342. Thirteen RCTs involving 441 patients with vision impairment indicate that NES may improve VA in the immediate post-intervention period (mean difference [MD] = -0.02 logMAR, 95% confidence intervals [CI] -0.08 to 0.04; low certainty), and probably increases QoL and detection accuracy (MD = 0.08, 95% CI -0.25 to 0.42 and standardised MD [SMD] = 0.09, 95% CI -0.58 to 0.77, respectively; both moderate certainty). NES likely results in little or no difference in mean sensitivity (SMD = -0.03, 95% CI -0.53 to 0.48). Compared with sham stimulation, NES increases the risk of minor adverse effects (risk ratio = 1.24, 95% CI 0.99 to 1.54; moderate certainty). The effect of NES on CS, reading performance, and electroencephalogram was uncertain. Our study suggests that although NES may slightly improve VA, detection accuracy, and QoL, the clinical relevance of these findings remains uncertain. Future research should focus on improving the available evidence's precision and consistency.

A Comparative Study of Shade-Matching Reproducibility Using an Intraoral Scanner and a Spectrophotometer.

BACKGROUND: We compared the repeatability of the shade determination of resin composite restorations and acrylic teeth in light and darker shades at baseline and after an aging process through two digital tooth color-matching methods: using a Trios 3Shape intraoral scanner and using a Vita Easyshade Compact spectrophotometer. MATERIAL AND METHODS: Forty upper central incisor acrylic teeth in the shade A1 (n = 10) and A3 (n = 10) were randomly assigned to be restored with Filtek Bulk Fill in the shade A1 (n = 10) or A3 (n = 10). Subsequently, 20 Class V cavities were prepared in a standardized manner (mesio-distal = 3.0 mm, cervical-occlusal = 2.0 mm, depth = 1.5 mm). Cavities were restored using an universal adhesive system and resin composite in two increments and were light-cured. The shade difference between the resin composite Class V restorations in acrylic teeth of the A1 and A3 shades was evaluated at baseline and after aging. Aging was simulated using ultraviolet light for 120 h. An Easyshade device and an intraoral scanner were used under D65 illumination. Measurements were taken five times, on top of the restoration and on the acrylic teeth, in a randomized manner. RESULTS: Data analysis was on the calculation of the arithmetic mean for the percentage of repeatability conducted by the Trios scanner and the Easyshade device. There was no statistically significant comparison between the shade measurement devices (p > 0.05). At baseline, the repeatability for both the Trios intraoral scanner and the Vita Easyshade Compact device for artificial teeth in the shades A1 and A3 was 100%. After aging, the trueness recorded by the intraoral scanner and the Easyshade device for artificial teeth in the shade A1 was 80%. For Class V restoration with shade A1, the intraoral scanner recorded 80% trueness and the Easyshade device recorded 60% trueness at baseline. For shade A3, the intraoral scanner recorded 60% trueness and the Easyshade device recorded 60% trueness. CONCLUSIONS: The intraoral scanner and Easyshade device are reliable for baseline shade selection, but their accuracy decreases after aging, particularly for darker shades.

Ultrathin Feldspathic Ceramic Veneers: A Pilot SEM Evaluation of Etched Intaglio Surfaces.

Ultrathin ceramic veneers are a viable therapeutic option to manage esthetic challenges in the anterior zone. Proper conditioning of the intaglio surface of porcelain veneers is essential to achieve an adequate bonding. In clinical practice, this is typically done with chemical etching using an acid-containing agent, such as hydrofluoric acid. While it is well established that the etching effect is dependent on etching time and the acid concentration, little is known about the impact of etching time and the veneer fabrication method. The purpose of this pilot study was to evaluate, using scanning electron microscopy (SEM), the effect that different etching-time protocols have on the intaglio surface characteristics of ultrathin ceramic veneers fabricated with either the platinum foil technique or the refractory die technique. Several replicas of an ultrathin feldspathic ceramic veneer for a maxillary central incisor were fabricated. Individual specimens were processed according to different intaglio surface-etching protocols: no etching, etching for 90 seconds, etching for 120 seconds, and etching for 150 seconds (9.6% hydrofluoric acid used for all etching groups). It was observed that the 120-second etching protocol resulted in a favorable microroughness surface pattern in the platinum foil group. This pattern was comparable to that obtained by etching for 90 seconds with hydrofluoric acid the intaglio surface of veneers fabricated with the refractory die technique. Increasing the etching time to 150 seconds did not result in a more favorable roughness pattern.

Patient satisfaction in three advanced hybrid closed-loop systems at 6 months of treatment in adults with type 1 diabetes mellitus: a follow-up study.

INTRODUCTION: Advanced hybrid closed-loop (AHCL) systems have demonstrated improved glycemic control in individuals with Type 1 Diabetes Mellitus. The aim of this study is to compare patient satisfaction among three available AHCL systems (Medtronic Minimed780 G, Roche Diabeloop DBLG1, and Tandem t:slim X2 Control IQ) after six months of treatment and to determine if it is related to glycemic control. METHODS: The data of 75 individuals were analyzed, including 15 using the DBLG1 system, 9 using Control IQ, and 51 using MM780 G. Patient satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire for Diabetes Mellitus (DTSQc), a validated instrument. RESULTS: All systems demonstrated treatment satisfaction. The DBLG-1 system scored 14 (-15-21) points, while Control IQ scored 21 (9-24) and M780 G scored 19 (11-24) (p = 0.004). The multivariate analysis revealed that the DBLG-1 system is associated with a lower DTSQc score (OR 0.19, p = 0.019) independent of glycemic control, sex, age, duration of diabetes, duration as an insulin pump user, and daily insulin dose. CONCLUSION: AHCL systems are satisfactory treatments for users, with potential variations observed between each system regardless of the achieved glycemic control.

A practical, predictable, and reliable method to select shades for direct resin composite restorations.

OBJECTIVE: This article describes a practical, predictable, and reliable method to select shades for direct composite restorations using custom shade guides made of resin composite at hand using a process of elimination CLINICAL CONSIDERATIONS: Esthetics in direct resin composite restorations depends on the clinician's ability to reproduce the shape and shade of natural teeth, thus appropriate shade selection is a must. This method presented in this article simplifies the process of shade selection for direct resin composite restorations. The use of custom shades tabs made of commecially available resin composites, its arrangment and a process of elimination of tabs during shade selection allows the practitioner to obtain the best possible resin composite shade available for every case. CONCLUSIONS: The use of custom shade guide tabs and an elimination protocol facilitates and expedites the process of shade selection for direct resin composites CLINICAL SIGNIFICANCE: The article presents a practical, predictable, and reliable method to select shades for direct resin composite restorations for daily practice.

Fracture resistance of defective amalgam restorations repaired with a resin-based composite material.

BACKGROUND: Repair is used to increase the longevity of defective restorations, such as large amalgams. The aim of this study was to investigate the fracture resistance and fracture modes of mesio-occlusodistal (MOD) amalgam molar restorations with extensive cuspal fracture repaired or replaced using a bulk-fill resin-based composite material. METHODS: Amalgam restorations were placed in 84 permanent extracted molars and randomly assigned (n = 14) to groups: (1) MOD amalgam, (2) composite repair of 1-cusp fracture and adjacent proximal box, (3) composite repair of 1-cusp fracture, (4) composite repair of 2-cusp fracture, (5) replacement of 1-cusp defect and existing MOD amalgam, (6) replacement of 2-cusp defect and MOD amalgam. Each molar was prepared to simulate the assigned fracture and either repaired or replaced. Specimens were aged and then loaded to fracture. Fracture resistance and fracture modes were recorded. RESULTS: The authors found significant differences (P < .001) between group 4 (1,652.3 N) and groups 5 (3,095.0 N), 1 (2,669.8 N), 6 (2,658.6 N), and 2 (2,442.9 N) as well as between group 3 (2,133.5 N) and group 5 (3,095.0 N). The results of the Fisher exact test showed differences among groups (P < .001), with group 5 having the highest number of nonrestorable fractures as well as higher fracture resistance on average. CONCLUSIONS: Composite material is a viable option for the repair and replacement of cuspal defects, especially in the case of a 1-cusp fracture and 1-cusp fracture involving the adjacent proximal box. PRACTICAL IMPLICATIONS: Within the limitations of this study, the repair of cusp fractures in existing MOD amalgam-restored molars is an appropriate treatment option, although replacement of the defect and existing restoration with resin-based composite will withstand higher forces.

Risk factors for nonunion following open reduction and internal fixation for proximal humerus fractures.

PURPOSE: The incidence of proximal humerus fractures (PHF) is rising and surgical intervention carries risk for fracture nonunion. The purpose was (1) to compare patient demographics of those that developed nonunion and (2) identify patient risk factors that predispose to nonunion following open reduction and internal fixation (ORIF) for PHF. METHODS: A retrospective review of the Medicare Claims Database from 2005 to 2014 for patients who underwent primary ORIF for PHFs. Patients who developed nonunion were identified as the study group (n = 1020) and compared to a control group (n = 51,209). Primary endpoints were to compare demographics of the study group and the comparison cohorts and to identify patient-related risk factors associated with nonunion within 6-months following the index procedure. A logistic regression model was constructed to determine the association of comorbid conditions on developing a nonunion. A p value of 0.001 was the significance threshold. RESULTS: Patients who developed nonunion were younger, more likely to be male, and had higher Elixhauser-Comorbidity Index scores (7 vs. 5; p < 0.0001) when compared with controls. Iron deficiency anemia (OR: 1.32; p = 0.0001), tobacco use (OR: 1.32; p = 0.0004), rheumatoid arthritis (OR: 1.29; p = 0.0001), depression (OR: 1.28; p = 0.0002), and BMI range from 30-39 kg/m2 (OR: 1.21; p = 0.001) were significant risk factors for nonunion. CONCLUSIONS: Certain patient risk factors including tobacco use, iron deficiency anemia, rheumatoid arthritis, depression, and a BMI in the range of 30-39 were associated with nonunion within 6 months of ORIF for PHF. This study may help in the risk stratification of these patients.

Comparison of patient-demographics, causes, and costs of 90-day readmissions following primary total shoulder arthroplasty for glenohumeral osteoarthritis.

Introduction: Readmissions following orthopaedic surgery are associated with worse outcomes and increased healthcare costs. Studies investigating trends, causes, and costs of readmissions following primary total shoulder arthroplasty (TSA) for the indication of glenohumeral osteoarthritis (OA) are limited. The objective was to compare: 1) patient-demographics of those readmitted and not readmitted within 90-days following primary TSA for OA; 2) causes of readmissions and 3) associated costs. Methods: A retrospective query from 2005 to 2014 was performed using a nationwide administrative claims database. The study group consisted of patients readmitted within 90-days following primary TSA for glenohumeral OA, whereas patients not readmitted served as controls. Causes of readmission were stratified into the following groups: cardiovascular, hematological, endocrine, gastrointestinal (GI), musculoskeletal (MSK), neoplastic, neurological, pulmonary, infectious, renal, and miscellaneous causes. Patient demographics were compared, in addition to the frequency of the causes of readmissions, and their associated costs. Chi-square analyses compared demographics between groups. Analysis of variance was utilized to determine differences in 90-day costs for the causes of readmission. A p-value less than 0.001 was significant. Results: The overall 90-day readmission rate was 2.4% (3432/143,878). Patients readmitted following primary TSA were more likely to be over the age of 75, female, and higher prevalence of comorbid conditions, including psychiatric and medical conditions. Readmitted patients had a higher overall comorbidity burden per mean Elixhauser-Comorbidity Index (ECI) scores (10 vs. 7,p < .0001). The leading cause of readmissions were due to MSK (17.34%), cardiac (16.28%), infectious (16.26%), and gastrointestinal (11.64%) etiologies. There were differences in the mean 90-day costs of care for the various causes of readmissions, with the leading cost of readmissions being cardiac causes ($10,913.70) and MSK ($10,590.50) etiologies. Conclusion: Patients with greater comorbidities experienced increased incidence of readmission following TSA for glenohumeral OA. Cardiac and MSK etiologies were the primary cause of readmissions. Level of evidence: III.

Dentin adhesives application deviations: Effects on permeability and nanoleakage.

The purpose was to evaluate the effect that deviations from the recommended protocol of a two-step etch-and-rinse adhesive system has on permeability and nanoleakage. One hundred and twenty dentin disks were treated with a two-step etch-and-rinse adhesive system, according to the manufacturer's instructions, or using five simulated deviations from the recommended protocol: applying potassium oxalate, reducing the application time of the adhesive, avoiding adhesive drying, aggressively drying the adhesive, and double application of adhesive. Kruskal-Wallis and Tukey's post hoc comparisons were used to evaluate the permeability reduction (α=0.05). Twelve additional dentin disks were prepared for transmission electron microscope (TEM) analysis of nanoleakage. Aggressive drying, adding additional layers of adhesive or using oxalate reduced dentin permeability and yielded a better infiltration of the hybrid layer, whereas reducing the application time or less drying the adhesive did not to reduce dentin permeability, caused extensive nanoleakage, showing immediate compromised dentin sealing.

A systematic approach to contouring and polishing anterior resin composite restorations: A checklist manifesto.

PURPOSE: This article presents a systematic, step-by-step checklist approach to be used for contouring and polishing anterior resin composite restorations to achieve maximum esthetics efficiently. CLINICAL CONSIDERATIONS: This checklist is intended to be used to take the guesswork out and streamline the process to predictably, practically, and repeatedly contour and polish anterior resin composite restorations. The practitioner's knowledge of basic dental anatomy combined with this step-by-step checklist facilitates identifying and modifying the final restoration to an anatomically correct form, thus satisfying the most esthetically demanding patients. This approach is demonstrated with case presentation of direct resin veneers in a young female, which resulted in an improved smile that satisfied her esthetic desires. CONCLUSIONS: The use of standardized protocols facilitates and expedites daily procedures in dentistry. Specifically, this checklist protocol, which is geared towards contouring and polishing anterior direct resin composite restorations. CLINICAL SIGNIFICANCE: The clinical technique presented in this article shows the advantages of using a step-by-step checklist approach to predictably and efficiently obtain ideal esthetics when performing anterior resin composite restorations.

Bio-additive and enameloplasty technique for restoring anterior esthetics: 54-month clinical follow-up.

Teeth with altered size and shape, incisal wear, and inadequate position affect the smile and dentofacial harmony. The aim of this article was to describe a simple and safe protocol for an additive technique with composite resin and cosmetic enameloplasty to improve a patient's smile. A 24-year-old man complained about the appearance of his smile regarding color, shape, and position of the maxillary anterior teeth. Relevant dental history included previous orthodontic treatment with inadequate completion. The clinical examination revealed a disharmony of the smile caused by size and shape alterations of the incisors, a white spot on the right central incisor, incisal wear of the canines, and uneven incisal edges between the maxillary anterior teeth. Treatment with direct composite restoration and enameloplasty was performed in line with the current conservative approach in dentistry. The patient was recalled for 54 months. The use of appropriate techniques in enameloplasty allowed the desired outcome to be observed over the 54 months of follow-up. With this method, it is possible to perform future repair and/or modification, and it may increase the longevity of the restoration. Esthetic and functional results were achieved by careful planning and execution as well as periodic recalls. This conservative approach is a useful alternative to conventional restorations, reducing invasive treatments, chairside time, and costs.

Microtensile bond strength to dentin and enamel of self-etch vs. etch-and-rinse modes of universal adhesives.

PURPOSE: To compare the immediate microtensile bond strengths (µTBSs) of four mild self-etch universal adhesives applied to dentin and enamel with self-etch and etch-and-rinse techniques. METHODS: Flat middle dentin surfaces from 104 human teeth and two enamel fragments from another 104 human teeth were randomly distributed into eight groups according to the various adhesive systems used: Scotchbond Universal (SBU) [etch-and-rinse mode vs. self-etch mode]; Optibond XTR (OPT) [ etch-and-rinse mode vs. self-etch mode]; Clearfil Universal Bond Quick (CL) [ etch-and-rinse mode vs. self-etch mode]; and Adhese Universal (ADH) [etch-and-rinse mode vs. self-etch mode]. After 24 hours of water storage, the bonded sticks were tested for µTBS. The differences in the pre-test failure and fracture-failure modes were tested by a two-way ANOVA and GEE model analysis. Bond-strength data were analyzed with a two-way ANOVA and mixed-model analysis. RESULTS: : For dentin, the mean µTBS was statistically different among the four adhesives, but not different between the self-etch and etch-and-rinse modes. For enamel, the mean µTBS was statistically different among the four adhesives, as was the application mode. GEE model analysis revealed a statistically significant adhesive failure rate proportion among the four types of adhesives for both enamel and dentin. CLINICAL SIGNIFICANCE: Etching enamel prior to the application of a universal adhesive can be recommended as an approach to enhance bond strength.

Masking and Penetration Ability of Various Sealants and ICON in Artificial Initial Caries Lesions In Vitro.

PURPOSE: The purpose of the present in vitro study and survey was to compare the masking ability and the penetration capacity of three resin composite sealers as well as a resin infiltrant in shallow artificial caries lesions. MATERIALS AND METHODS: Panels of artificial initial caries lesion with an average depth of 200 µm were created on buccal and lingual surfaces of 75 extracted human molars. Specimens were randomly assigned to 5 groups: ICON (DMG America), Biscover LV (Bisco), Optiguard (Kerr Hawe), Permaseal (Ultradent), and control (no treatment). Teeth were hemi-sectioned yielding two halves, each with a panel of artificial caries lesion. Lesions on one hemi-section were used to assess the esthetic improvement following caries lesion penetration with the 4 resins based on photographs evaluated using a 100-mm visual analogue scale (VAS) by 17 raters. Lesions on opposite hemi-sections were used to measure the resin penetration area percentage (PA%) and the resin penetration depth percentage (PD%) visualized using a confocal laser scanning microscope (CLSM, Leica). RESULTS: ICON, Optiguard, and Permaseal yielded significantly greater average VAS scores compared to Biscover. The mean PA% and PD% were significantly higher for ICON, intermediate for Optibond and Permaseal, and significantly lower for Biscover. A moderately large positive correlation was noticed between the average VAS scores and the penetration measures. CONCLUSION: All the resin sealers (Biscover, Optiguard, and Permaseal) penetrated the artificial initial caries lesions. However, ICON resulted in the deepest penetration and the largest penetration area percentages. The masking ability of Optiguard and Permaseal of the artificial caries lesions was similar to ICON.

BTEX adsorption on TiO2 anatase and rutile surfaces: DFT functionals.

Benzene, toluene, ethylbenzene, and xylenes are volatile hydrocarbons known as BTEX, which present concerns about environmental problems. Density functional theory (DFT) functionals were used for the BTEX gas phase adsorption on TiO2 (110) of rutile and (101) of anatase surfaces. Dispersion terms have shown the importance to treat weak interactions and were used to study these adsorptions using plane wave DFT calculations. All BTEX molecules have the same trend for the adsorption on rutile and anatase surfaces. The inclusion of dispersion terms has a significant contribution for the interaction energy. Density of states results suggest the hybridization between the d state of pentacoordinated titanium atoms (Ti5C) and carbon p states of benzene. The adsorption energy values indicate an effective interaction between the BTEX and surfaces, mainly due to the aromatic π interaction, which is present in all adsorbates. However, for p-xylene the methyl hydrogen directs the second major influence. Graphical abstract Charge difference showing the system with the smallest interaction and the one with the largest interaction.

Pulsed Radiofrequency Versus Continuous Radiofrequency for Facet Joint Low Back Pain: A Systematic Review.

OBJECTIVE: To compare pulsed radiofrequency (PRF) treatment with continuous radiofrequency (CRF) to improve pain, functionality, and safety profile in patients with facet joint chronic low back pain. METHODS: A systematic, critical review of recent literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Cochrane, Clinical Trials, and LILACS databases were searched. Medical Subject Heading terms were "low back pain," "zygapophyseal joint," and "pulsed radiofrequency treatment." Original research articles in peer-reviewed journals were included in the review. The articles were thoroughly examined and compared on the basis of study design and outcomes. Only studies that met the eligibility criteria were included. RESULTS: Three randomized clinical trials comprising 103 patients (39 in PRF group, 44 in CRF group, and 20 in control group) were included in the final analysis. Two trials compared PRF with CRF, and 1 trial compared 3 groups: PRF, CRF, and control with intervention as conventional treatment. The studies reported greater pain control and better functionality with CRF compared with PRF. PRF showed a decrease in visual analog scale and Oswestry Disability Index in 2 studies, and 1 study reported increased pain and disability after the intervention. No side effects were reported. CONCLUSIONS: PRF treatment is less effective than CRF regarding pain control and return of functionality in patients with facet joint chronic low back pain. We recommend CRF with a large safety profile after conventional treatment.

Lipases as Biocatalyst for Biodiesel Production.

Global shortages of fossil fuels, significant rise in the price of crude oil, and increased environmental concerns have stimulated the rapid growth of biodiesel production. Biodiesel is generally produced through transesterification reaction catalyzed either chemically or enzymatically. Enzymatic transesterification is of interest since it shows advantages over the chemical process and, in addition, is considered a "green" process. This chapter reviews the current status of biodiesel production with a lipase biocatalysis approach, including sources of lipases, kinetics, lipase immobilization techniques, and lipase reaction mechanism for biodiesel production. Factors affecting biodiesel production and the economic feasibility of lipase biodiesel production are also covered.

Rendimiento del sistema Bethesda en el diagnóstico citopatológico del nódulo tiroideo / Efficiency of the Bethesda System for Thyroid Cytopathology

INTRODUCCIÓN: La punción-aspiración con aguja fina es una pieza clave en la evaluación preoperatoria del nódulo tiroideo y el sistema Bethesda es el más aceptado para categorizar el análisis citológico. El objetivo del estudio es evaluar la validez del sistema Bethesda en la enfermedad nodular tiroidea para diagnosticar malignidad. MÉTODOS: Se incluye a los pacientes intervenidos de tiroides consecutivamente entre junio de 2010 y junio de 2017. Se realizó el análisis de la punción preoperatoria según el sistema Bethesda, correlacionando este dato con la histología definitiva para cada nódulo biopsiado. Los parámetros de prueba diagnóstica se calcularon como prueba de screening (verdadero positivo: categorías IV, V, VI) y como método para identificar malignidad (verdadero positivo: categorías V, VI). RESULTADOS: Se incluyó a 522 pacientes, de los que 184 (35,2%) presentaron un carcinoma en la histología definitiva; siendo el carcinoma papilar el más frecuente (84,2%). Los porcentajes de malignidad en el nódulo biopsiado para cada categoría Bethesda fueron: I, 0%; II, 1,5%; III, 6,4%; IV, 31%; V, 86,5% y VI, 100%. En el análisis como prueba de screening, se identificó una sensibilidad del 98,9%, especificidad del 84,4%, valor predictivo positivo del 69,6%, valor predictivo negativo del 99,5% y precisión diagnóstica global del 88,2%. En el análisis para detectar malignidad, los parámetros fueron: sensibilidad 98,6%, especificidad 97,6%, valor predictivo positivo 93,5%, valor predictivo negativo 99,5% y precisión diagnóstica global 97,9%. CONCLUSIONES: El sistema Bethesda es un método sencillo y reproducible en la categorización citológica del nódulo tiroideo, una herramienta útil en el manejo y eficaz para identificar el riesgo de malignidad

INTRODUCTION: To establish quality standards in oncologic surgery is a complex but necessary challenge to improve surgical outcomes. Unlike other tumors, there are no well-defined quality standards in pancreatic cancer. The aim of this study is to identify quality indicators in pancreatic oncologic surgery in Spain as well as their acceptable limits of variability. METHODS: Quality indicators were selected based on clinical practice guidelines, consensus conferences, reviews and national publications on oncologic pancreatic surgery between the years 2000 and 2016. Variability margins for each indicator have been determined by statistical process control techniques and graphically represented with the 99.8 and 95% confidence intervals above and below the weighted average according to sample size. RESULTS: The following indicators have been determined with their weighted average and acceptable quality limits: resectability rate 71% (> 58%), morbidity 58% (< 73%), mortality 4% (< 10%), biliary leak 6% (< 14%), pancreatic fistula rate 18% (< 29%), hemorrhage 11% (< 21%), reoperation rate 11% (< 20%) and mean hospital stay (< 21 days). CONCLUSIONS: To date, few related series have been published, and they present important methodological limitations. Among the selected indicators, the morbidity and mortality quality limits have come out higher than those obtained in international standards. It is necessary for Spanish pancreatic surgeons to adopt homogeneous criteria regarding indicators and their definitions to allow for the comparison of their results