The causal link between circular economy and economic growth in EU-25.

Actively promoting circular economy (CE) is one of the key means of global sustainable development. The purpose of this study is to analyze the causal relationship between CE and economic growth using data from EU-25 countries from 2010 to 2018. The selected CE indicators included municipal waste recycling rate, CE-related investment, municipal waste generation per capita, circularity rate, and trade in recyclable raw materials. Panel cointegration techniques affirmed the long-term equilibrium relationship between CE indicators and GDP. Panel vector error correction model results confirmed that in terms of short-run causality, an increase in material recycling led to a decrease in waste generation, an increase in waste generation led to an increase in CE-related investment, and economic growth led to circular economy growth, but not vice versa. This implies that encouraging CE-related innovation investments and promoting material recycling to stimulate the secondary raw material market can help achieve zero waste goals. Looking at the long-term causality, the GDP and CE indicators constituted a causal loop, which implies that there is co-evolution between them, although the circular economy is still in its infancy. This co-evolutionary sustainable economic growth can bring welfare to future generations.

The dynamic interaction between circular economy and the environment: Evidence on EU countries.

This study examined the causal dynamics between circular economy (CE) and carbon dioxide (CO2) emissions in European Union (EU) countries. The selected CE indicators included the trade in recyclable raw materials (TRM) and the circular material use rate (CMR) in the secondary raw materials area, the generation of municipal waste per capita (GMWp) in the production and consumption area and the recycling rate of municipal waste (RMW) in the area of waste management. The coefficients of the panel cointegration equations showed that for every 1 percentage point increase in RMW, average CO2 emissions decreased by 0.5%, while for every 1 percentage point increase in GMWp and TRM, the average CO2 emissions increased by 0.263% and 0.101%, respectively. It also showed that the recycling volumes and recycling rate had a positive but very limited impact on the CMR. The panel vector error correction model result showed that there were long-run bidirectional causalities between CE indicators and carbon emissions, and the TRM had a short-run negative impact on waste generation. However, the short-run impact of CE indicators on carbon emissions was not significant, which may be because the European CE is still in its infancy. The finding suggests that policymakers should adopt multilateral policies such as reducing carbon emissions, improving the efficiency and productivity of resource management and waste recycling, and increasing investment and innovation in the secondary raw materials market to achieve resource decoupling and impact decoupling. The decoupling of these two types is a necessary condition for sustainable development.

Mummichog gill and operculum exhibit functionally consistent claudin-10 paralog profiles and Claudin-10c hypersaline response.

Claudin (Cldn)-10 tight junction (TJ) proteins are hypothesized to form the paracellular Na+ secretion pathway of hyposmoregulating mummichog (Fundulus heteroclitus) branchial epithelia. Organ-specific expression profiles showed that only branchial organs [the gill and opercular epithelium (OE)] exhibited abundant cldn-10 paralog transcripts, which typically increased following seawater (SW) to hypersaline (2SW) challenge. Post-translational properties, protein abundance, and ionocyte localization of Cldn-10c, were then examined in gill and OE. Western blot analysis revealed two Cldn-10c immunoreactive bands in the mummichog gill and OE at ∼29 kDa and ∼40 kDa. The heavier protein could be eliminated by glycosidase treatment, demonstrating the novel presence of a glycosylated Cldn-10c. Protein abundance of Cldn-10c increased in gill and OE of 2SW-exposed fish. Cldn-10c localized to the sides of gill and OE ionocyte apical crypts and partially colocalized with cystic fibrosis transmembrane conductance regulator and F-actin, consistent with TJ complex localization. Cldn-10c immunofluorescent intensity increased but localization was unaltered by 2SW conditions. In support of our hypothesis, cldn-10/Cldn-10 TJ protein dynamics in gill and OE of mummichogs and TJ localization are functionally consistent with the creation and maintenance of salinity-responsive, cation-selective pores that facilitate Na+ secretion in hyperosmotic environments.

Effects of copper on a reconstructed freshwater rainbow trout gill epithelium: Paracellular and intracellular aspects.

The barrier properties and intracellular responses of a primary cultured trout gill epithelium (containing both mitochondria-rich and pavement cells) were examined over 24 h of copper (Cu) exposure (0, 200 and 1000 µg/L) in apical fresh water. Transepithelial resistance (TER) and mRNA abundance of tight junction proteins zonula occludens-1, occludin, cingulin, claudin-8d and -28b were examined as endpoints of barrier function and the paracellular pathway. Intracellular endpoints analyzed were Cu accumulation, Na+ content, carbonic anhydrase activity and mRNA abundance of carbonic anhydrase (ca-II) and Na+/K+ ATPase (nka α1a and nka α1b isoforms). After a brief initial drop in TER in the 1000 µg Cu/L treatment, Cu at both levels increased TER over the first 6 h of exposure but there were no differences among groups from 12 h onwards. After 24 h of Cu exposure, there were no differences in mRNA abundance of any of the tight junction proteins examined. Cu accumulation occurred at 1000 µg Cu/L (5.5-fold increase), but no depletion of Na+ content. Carbonic anhydrase activity decreased significantly (by 76%), however Cu exposure did not alter the transcript abundance of ca-II, nka α1a, or nka α1b. This study provides a first report of carbonic anhydrase sensitivity to Cu exposure in a cultured model gill epithelium. We conclude that Cu impacts the permeability of this model during the early stages of exposure and that the use of carbonic anhydrase inhibition as an endpoint of metal toxicity in this model preparation may be useful for future mechanistic investigations and environmental monitoring.

Design and Development of a Wearable Exoskeleton System for Stroke Rehabilitation.

For more than a decade, many countries have been actively developing robotic assistive devices to assist in the rehabilitation of individuals with limb disability to regain function in the extremities. The exoskeleton assistive device in this study has been designed primarily for hemiplegic stroke patients to aid in the extension of fingers to open up the palm to simulate the effects of rehabilitation. This exoskeleton was designed as an anterior-support type to achieve palmar extension and acts as a robotic assistive device for rehabilitation in bilateral upper limb task training. Testing results show that this wearable exoskeleton assistive device with human factor consideration using percentile dimensions can provide comfortable wear on patients as well as adequate torque to pull individual fingers into flexion towards the palm for rehabilitation. We hope this exoskeleton device can help stroke patients with loss of function in the upper extremities to resume motor activities in order to maintain activities of daily living.

Decoupling of environmental pressure and economic growth: evidence from high-income and nuclear-dependent countries.

This paper proposes a three-step process, based on the definition of absolute decoupling (AbsDec), to analyze the role of nuclear energy in the absolute decoupling between environmental pressures (including Energy resource use and CO2Emissions) and Economic growth (3-E) during the period 1987-2016. First, we select the top four Nuclear-Dependent Countries (4-NDC), including France, Belgium, Sweden, and Switzerland, from high-income economies and the USA as a sample (i.e., 5-country). Second, we provide compound annual growth rate (CAGR) statistics for all relevant variables in each country. Third, we assess the Carbon Kuznets Curve (CKC) and investigate the dynamic interactions between 3-E by using Lotka-Volterra ecosystem model. For the 5-country, we find that the CAGR of GDP is positive, the CAGRs of CO2 emissions, CO2 intensity, and energy intensity are negative, the panel CKC exists, and the projected CAGRs of CO2 emissions are negative between 2017 and 2025. For the USA, a commensalism of energy-led growth and an amensalism of emissions-limited growth exist. For the 4-NDC, neutralisms between 3-E exist. The aggregated results indicate that the 4-NDC seem to have achieved an AbsDec between 3-E, the USA appears to achieve an AbsDec between economic growth and emissions while undergoing a relative, and perhaps absolute, decoupling between 3-E. The findings can infer that nuclear power is one of the most important energy sources for achieving absolute decoupling and genuinely sustainable development. The policy implication is that measures to reduce energy consumption and control CO2 emissions may not significantly impair economic growth in countries that rely on nuclear power.

Impact of salt-contaminated freshwater on osmoregulation and tracheal gill function in nymphs of the mayfly Hexagenia rigida.

The impact of freshwater (FW) salinization on osmoregulation as well as tracheal gill morphology and function was examined in nymphs of the mayfly Hexagenia rigida following exposure to salt contaminated water (SCW, 7.25 g/l NaCl) for a 7-day period. Ionoregulatory homeostasis was perturbed in SCW exposed H. rigida nymphs as indicated by increased hemolymph Na+, K+ and Cl- levels as well as hemolymph pH and water content. Despite this, SCW did not alter gill Na+-K+-ATPase (NKA) or V-type H+-ATPase (VA) activity. In addition, NKA and VA immunolocalization in gill ionocytes did not show alterations in enzyme location or changes in ionocyte abundance. The latter observation was confirmed using scanning electron microscopy (SEM) to examine exposed tracheal gill ionocyte numbers. Ionocyte surface morphometrics also revealed that SCW did not change individual ionocyte surface area or ionocyte fractional surface area. Nevertheless, analysis of Na+ movement across the tracheal gill of mayfly nymphs using scanning ion-selective electrode technique indicated that FW nymphs acquired Na+ from surrounding water, while tracheal gills of SCW nymphs had the capacity to secrete Na+. Because Na+ secretion across the gill of SCW-exposed animals occurred in the absence of any change in (1) NKA and VA activity or (2) ionocyte numbers/surface exposure, it was reasoned that Na+ movement across the gill of SCW animals may be occurring, at least in part, through the paracellular pathway. The ultrastructure of tracheal gill septate junctions (SJs) supported this idea as they exhibited morphological alterations indicative of a leakier pathway. Data provide a first look at alterations in osmoregulatory mechanisms that allow H. rigida nymphs to tolerate sub-lethal salinization of their surroundings.

Efficacy, tolerability, and safety of oral paliperidone extended release in the treatment of schizophrenia: a 24-week, open-label, prospective switch study in different settings in Taiwan.

PURPOSE: Paliperidone extended release (ER) is an oral psychotropic treatment formulated to release paliperidone at a controlled, gradually ascending rate. We evaluated the efficacy and safety of switching to paliperidone ER in Taiwanese patients with schizophrenia who were unresponsive or intolerant to previous antipsychotic therapy. PATIENTS AND METHODS: This was a 24-week, open-label, single-arm, multicenter, Phase IV trial. Based on consulting psychiatrists' judgment, patients were deemed eligible for the switch to paliperidone ER; the switch was achieved by cross-tapering, using a recommended starting dose of 6 mg. Eligibility considerations included lack of efficacy, tolerability, and/or adherence to previous oral antipsychotic medication. RESULTS: Of the 297 enrolled patients, 178 (59.5%) completed the study. The main reasons for discontinuation included insufficient efficacy (8.7%), patient decision (8.4%), and adverse events (AEs; 6.4%). Improvements in the: Positive and Negative Syndrome Scale total score and Clinical Global Impression-Severity score were observed only in patients treated at medical centers and not in those treated at psychiatric hospitals. The most common AEs were insomnia, headache, constipation, and extrapyramidal syndrome. One or more serious AEs were reported in 11 (3.7%) patients; none resulted in death. No significant changes in body weight, plasma glucose, or lipid levels were observed. CONCLUSION: Switching to paliperidone ER was effective and well tolerated for up to 24 weeks in patients with schizophrenia who were unresponsive or intolerant to previous antipsychotic therapy. The observed differences in treatment between psychiatric hospitals and medical centers with regard to dosage and titration of paliperidone ER warrant further investigation.

Impact of chronic disease on the mid-age employment in Taiwan.

Chronic diseases, also known as non-communicable diseases (NCDs), have become the leading causes of deaths and disability around the world. Cardiovascular disease, cancer, and diabetes are also listed in the top 10 causes of deaths in Taiwan for decades. This study aims to investigate the relationship the chronic diseases and the mid-age employment in Taiwan. We estimate the impact of the chronic diseases on employment using the 2009 NHIS data of Taiwan using 2 kinds of probit model. In addition, we show that a usual probit model can underestimate the negative effect of NCDs on mid-age employment. To reduce the productivity loss from the NCDs, policymakers can increase the awareness of risk of these chronic diseases through media and the adult preventive care services, which is free for the people aged 40 and above in Taiwan.

Nasogastric tube placement with video-guided laryngoscope: A manikin simulator study.

BACKGROUND: This study aimed to investigate video-guided laryngoscopy for nasogastric tube placement. METHODS: This was an observational comparative study performed in a hospital. The participants included volunteers from the medical staff (physicians and nurses) experienced with nasogastric intubation, and non-medical staff (medical students, pharmacists and emergent medical technicians) with knowledge of nasogastric intubation but lacking procedural experience. Medical and non-medical hospital staff performed manual, laryngoscope-assisted and video-guided laryngoscope nasogastric intubation both in the presence and in the absence of an endotracheal tube, using a manikin. Nasogastric intubation times were compared between groups and methods. RESULTS: Using the video-guided laryngoscope resulted in a significantly shorter intubation time compared to the other 2 methods, both with and without an endotracheal tube, for the medical and non-medical staff alike (all p < 0.05). For the medical staff, mean nasogastric intubation time was significantly shorter using video-guided laryngoscope without endotracheal intubation, direct laryngoscope with endotracheal intubation and video-guided laryngoscope with endotracheal intubation compared to manual intubation without endotracheal intubation (0.49, 0.63 and 0.72 vs. 5.63, respectively, p ≤ 0.008). For non-medical staff, nasogastric intubation time was significantly shorter using video-guided laryngoscope without endotracheal intubation, direct laryngoscope with endotracheal intubation and video-guided laryngoscope with endotracheal intubation compared to manual intubation without endotracheal intubation (1.67, 1.58 and 0.95 vs. 6.9, respectively, p ≤ 0.002). And mean nasogastric intubation time for video-guided laryngoscope endotracheal intubation was significantly shorter for medical staff than for non-medical staff (0.49 vs. 1.67 min, respectively, p = 0.041). CONCLUSION: Video-guided laryngoscope reduces nasogastric intubation time compared to manual and direct laryngoscope intubation, which promotes a consistent technique when performed by experienced medical and previously untrained non-medical staff.

Non-traumatic out-of-hospital cardiac arrest in rural Taiwan: A retrospective study.

OBJECTIVE: Out-of-hospital cardiac arrest (OHCA) studies are usually conducted at metropolitan medical centres. Because rural studies are rare, our study aimed to assess non-traumatic OHCA prevalence and resuscitation outcomes in rural Taiwan. DESIGN: A retrospective observational study. SETTING: All seven designated community hospital emergency departments (ED) in Nantou County, Taiwan. PARTICIPANTS: All OHCA patients from May 2011 to March 2013. MAIN OUTCOME MEASURES: Any return of spontaneous circulation (ROSC) and survival for ED discharge. RESULTS: In the 23-month period, 850 OHCA cases were reported; 741 (87.2%) were non-traumatic. The overall ROSC achievement rate was 19.7%, with 16.4% case survival for ED discharge. Logistic regression identified that arrest in public (OR: 2.62, 95% CI: 1.19-5.78), witness when collapsed (OR: 2.14, 95% CI: 1.28-3.60), and cardiopulmonary resuscitation (CPR) by bystander (OR: 2.09, 95% CI: 1.02-4.26) might increase the likelihood of any ROSC; arrest in public (OR: 2.68, 95% CI: 1.10-6.50), witnessed collapse (OR: 2.26, 95% CI: 1.24-4.09) and CPR by bystander (OR: 2.79, 95% CI: 1.28-6.05) might also increase the likelihood of survival. For non-traumatic OHCA patients conveyed to EDs via emergency medical service system (EMS), a shorter response time (OR: 1.09, 95% CI: 1.01-1.18) and travelling time (OR: 1.04, 95% CI: 1.00-1.09) might also increase the chance of survival. CONCLUSION: Compared to previous data from metropolitan areas, ROSC achievement rate was lower in rural Taiwan. Witness presence, response and travelling times affect ROSC achievement in non-traumatic OHCA patients in rural Taiwan.

Laparoendoscopic single-site cholecystectomy and common bile duct exploration using conventional instruments.

BACKGROUND: Optimization of quality of life is an important goal in the advanced surgery. Herein we share our fifteen cases to demonstrate the feasibility of scarless laparoendoscopic single-site common bile duct (CBD) exploration using conventional instruments in the management of CBD stones. METHODS: Fifteen patients (4 male) underwent transumbilical laparoendoscopic single-site cholecystectomy and CBD exploration: the patients were diagnosed with CBD stones. The endoscopic nasobiliary drainage (ENBD), endoscopic retrograde biliary drainage (ERBD) or J-type tube was introduced into the CBD preoperatively or intraoperatively. A 2-cm periumbilical incision was made for the placement of three trocars. Conventional rigid laparoscopic instruments were solely used throughout the procedure, and operative techniques were carried out in the same fashion as for conventional T-tube-free laparoscopic cholecystectomy and CBD exploration. RESULTS: The procedures were completed uneventfully in the mean duration of 125.7 min. Three patients occurred pigtail J-tube displacement and all three were later excreted safely in stool. CONCLUSIONS: Laparoendoscopic single-site cholecystectomy and CBD exploration appears to be a technically feasible alternative to standard laparoscopic procedure, and can be performed using conventional laparoscopic instruments. Laparoscopic primary closure with preoperative ENBD and ERBD tubes and with intraoperative J-tubes is safe and feasible.

The liquorice root derivative glycyrrhetinic acid can ameliorate ionoregulatory disturbance in rainbow trout (Oncorhynchus mykiss) abruptly exposed to ion-poor water.

To consider the idea that a dietary botanical supplement could act as an adaptogen in a teleost fish, the effect of a liquorice root derivative (18ß-glycyrrhetinic acid, 18ßGA) on rainbow trout following an acute ionoregulatory stressor was examined. Freshwater (FW) trout were fed a control or 18ßGA supplemented diet (0, 5, or 50µg 18ßGA/g diet) for 2weeks, then abruptly exposed to ion-poor water (IPW) for 24h. Following IPW exposure, muscle moisture content and serum cortisol levels elevated and serum [Na(+)] and/or [Cl(-)] reduced in control and 50µg/g 18ßGA-fed fish. However, these endpoints were unaltered in 5µg/g 18ßGA-fed fish. Gill tissue was investigated for potential mechanisms of 18ßGA action by examining mRNA abundance of genes encoding corticosteroid receptors (CRs), 11ß-hydroxysteroid dehydrogenase 2 (11ß-hsd2), and tight junction (TJ) proteins, as well as Na(+)-K(+)-ATPase and H(+)-ATPase activity, and mitochondrion-rich cell (MRC) morphometrics. Following IPW exposure, CR and 11ß-hsd2 mRNA, MRC fractional surface, Na(+)-K(+)-ATPase and H(+)-ATPase activity were unaltered or decreased in 50µg 18ßGA fish, as was mRNA encoding select TJ proteins. In contrast, 5µg 18ßGA-fed fish exhibited elevated 11ß-hsd2 and CR mRNA abundance versus 50µg 18ßGA-fed, and reduced MRC apical area as well as some differences in TJ protein mRNA abundance versus control fish. Data suggest that 18ßGA, at low levels, may be adaptogenic in trout and might help to ameliorate ionoregulatory perturbation following IPW exposure. This seems to occur, in part, through 18ßGA-induced alterations in the biochemistry and physiology of the gill.

Economic Stress and Mental Health: The Relationship Between the Stock Market and Neurotic Disorder Doctor Visits.

This paper investigates the relationship between the stock market and the neurotic disorder doctor visits. We use aggregate data, partition the population by age and gender and examine the impact of changes in the stock market on neurotic disorders. Using doctor visits as a proxy measure of morbidity, we find evidence of some relationship between neurotic disorder morbidity and stock market variations. A stock market falling in a single day and the accumulation of daily stock market drops are both associated with more neurotic disorder doctor visits. We also observe more neurotic disorder doctor visits during periods of a low stock index for the elderly, regardless of gender. Copyright © 2016 John Wiley & Sons, Ltd.

Effect of the liquorice root derivatives on salt and water balance in a teleost fish, rainbow trout (Oncorhynchus mykiss).

The effect of liquorice root derivatives (LRDs) glycyrrhizic acid (GL) and glycyrrhetinic acid (18ßGA) on salt and water balance and end points of gill ion transport in a freshwater teleost, (rainbow trout) was examined after feeding fish diets containing GL or 18ßGA (0, 5, 50 or 500 µg/g diet) for a two week period. Serum cortisol levels and gill 11ß-hydroxysteroid dehydrogenase type 2 mRNA abundance decreased in fish fed GL but increased (at select doses) in fish fed 18ßGA. At higher doses of GL, gill Na(+)-K(+)-ATPase and H(+)-ATPase activity increased, while cystic fibrosis transmembrane conductance regulator type II mRNA abundance significantly decreased at the lowest dose of GL. End points of gill transcellular ion transport were not significantly altered in fish fed 18ßGA, except for a reduction in Na(+)-K(+)-ATPase activity at a 50 µg/g dose. In contrast, high doses of GL and 18ßGA increased gill transcript abundance of the tight junction protein claudin-31 (cldn-31). Other end points of gill paracellular transport differed in fishes fed LRDs. Tricellulin mRNA abundance was increased by high dose GL and decreased by high dose 18ßGA, and cldn-23a and cldn-27b mRNA abundance significantly decreased in response to GL irrespective of dose. Despite the above observations, systemic end points of salt and water balance (i.e. serum [Na(+)] and [Cl(-)] as well as muscle moisture) were unaffected by LRDs. Therefore data suggest that LRDs can alter end points of ion transport in fishes but that overall salt and water balance need not be perturbed.

Enantioselective and rapid Rh-catalyzed arylation of N-tosyl- and N-nosylaldimines in methanol.

Enantiomerically enriched tosyl-protected diarylmethylamines were rapidly prepared by the asymmetric addition of arylboronic acids to N-tosylaldimines under mild conditions in the presence of a catalyst prepared in situ from Rh(I) and a chiral diene ligand. This methodology offers access to diarylmethylamines in good yields with excellent chiral purity at room temperature using MeOH as a solvent and NEt3 as a base. Its synthetic utility was demonstrated by the preparation of (S)-1-phenyl-1,2,3,4-tetrahydroisoquinoline (14), an antagonist of the N-methyl-d-aspartate (NMDA) receptor.

Impact of 24-month fluoride tablet program on children with disabilities in a non-fluoridated country.

The aim of this study was to evaluate the caries preventive effects of a school-based fluoride tablet program in children with disabilities. Two hundred and seventeen children with disabilities were divided into two groups: the intervention group (IG) ingested 1.0mg fluoride tablet daily while the control group (CG) ingested a placebo. The initial oral examinations were conducted prior to fluoride intake and 24-month follow-up examinations were conducted to evaluate the effectiveness of fluoride tablet ingestion. The results from this study demonstrated significant reductions in the DMFT index (the sum of decayed, missing, and filled permanent teeth), 0.63, as well as the DMFS index (the sum of decayed, missing, and filled surfaces of the permanent dentition), 1.25, when compared with the CG. A statistically significant reduction in the DMFT index and DMFS index (30.42% and 36.84%, respectively) suggested an anti-cariogenic benefit to fluoride tablet administration. Greater caries reduction occurred on mesio-distal and bucco-lingual surfaces (53.27% and 52.57%, respectively). Fluoride tablets should be considered as a caries preventive strategy in school-based caries prevention programs for children with disabilities in fluoride deficient areas.

Awareness and utilization of preventive care services among the elderly under National Health Insurance.

This empirical study investigates the factors affecting the awareness and the utilization of preventive care among the elderly in Taiwan. We use data obtained from the 2005 National Health Interview Survey. A recursive bivariate probit model is adopted to analyze the factors affecting the awareness and the utilization of preventive care. The probability of awareness of free preventive care under the National Health Insurance is higher for those who are younger, Mainlanders, have received more education, have a spouse, exercise regularly, have better self-rated health status, and have chronic diseases; the probability of awareness is lower for those who are aborigines and who live in the south and the east. Awareness of preventive care services, having a spouse, living alone, having better health status, and the existence of chronic diseases increase the probability of preventive care utilization; working reduces the probability of preventive care utilization. Our result supports the views in Arrow (Am Econ Rev 53(5):941-973, 1963) that health information is an important factor determining the demand for medical care. Policymakers may enhance such preventive care service utilization by increasing the awareness of such services among the elderly.

Stock or stroke? Stock market movement and stroke incidence in Taiwan.

This paper investigates the impact of stock market movement on incidences of stroke utilizing population-based aggregate data in Taiwan. Using the daily data from the Taiwan Stock Exchange Capitalization Weighted Stock Index and from the National Health Insurance Research Database during 2001/1/1-2007/12/31, which consist of 2556 observations, we examine the effects of stock market on stroke incidence - the level effect and the daily change effects. In general, we find that both a low stock index level and a daily fall in the stock index are associated with greater incidences of stroke. We further partition the data on sex and age. The level effect is found to be significant for either gender, in the 45-64 and 65 ≥ age groups. In addition, two daily change effects are found to be significant for males and the elderly. Although stockholdings can increase wealth, they can also increase stroke incidence, thereby representing a cost to health.

Single-incision versus conventional three-incision laparoscopic appendectomy: a single centre experience.

PURPOSE: To compare the short-term outcomes of single-incision and conventional three-incision laparoscopic appendectomy (LA) at a single surgical unit. METHODS: We conducted a retrospective study comparing the operative outcomes of two LA techniques between January 2009 and November 2010. RESULTS: LA was performed successfully in 44 patients: through a single incision in 27 patients and through three incisions in 17 patients. The time taken to resume oral intake was slightly less in the single-incision group than in the three-incision group, at 1.1 versus 1.5 days, respectively (P = 0.0419). However, blood loss and hospital stay were not significantly different, at 7.2 versus 6.4 ml (P = 0.6244) and 3.7 versus 3.8 days (P = 0.8565), respectively. The cosmetic result was better in the single-incision group, because of the well-concealed scar. CONCLUSION: Both single-incision and conventional LA are effective and minimally invasive, and should be performed according to the experience of the surgeon. Single-incision LA results in faster recovery, but larger studies are required to confirm this and to determine if these techniques can be used safely for all indications of appendectomy.