The Laparoscopic Cholecystectomy and Common Bile Duct Exploration: A Single-Step Treatment of Pediatric Cholelithiasis and Choledocholithiasis.

BACKGROUND: In recent years, complicated biliary tract diseases are increasingly diagnosed in children. Laparoscopic exploration of the common bile duct (LCBDE) followed by laparoscopic cholecystectomy has gained popularity in children. The aim of this study was to investigate the outcomes of LCBDE in children and compare them with the treatment outcomes of previously used endoscopic retrograde cholangiopancreatography (ERCP). METHODS: From January 2000 to January 2022, a total of 84 children (78.5% female) underwent laparoscopic cholecystectomy with a median follow-up of 11.4 (IQR 8, 14) years. Of these, 6 children underwent laparoscopic cholecystectomy (LC) + ERCP and 14 children underwent LCBDE for choledochiothiasis. The primary end point of the study was the success of treatment in terms of the incidence of complications, recurrence rate, and rate of reoperation. Secondary endpoints were stone characteristics, presenting symptoms, duration of surgery, and length of hospital stay. RESULTS: The majority of patients were female in both groups (83.5% vs. 85.7%), mostly overweight with a median BMI of 27.9 kg/m2 and 27.4 kg/m2, respectively. Obstructive jaundice, colicky pain, acute pancreatitis, and obstruction of the papilla were the most common symptoms in both groups. The majority of patients (68%) had one stone, whereas two or more stones were found in 32% of patients. The median diameter of the common bile duct was 9 mm in both groups. The procedure was successfully completed in all patients in the ERCP group. In the group of patients treated with LCBDE, endoscopic extraction of the stone with a Dormia basket was successfully performed in ten patients (71.4%), while in the remaining four patients (28.6%) the stones were fragmented with a laser because extraction with the Dormia basket was not possible. The median operative time was 79 min in the LCBDE group (IQR 68, 98), while it was slightly longer in the ERCP group, 85 min (IQR 74, 105) (p = 0.125). The length of hospital stay was significantly shorter in the LCBDE group (2 vs. 4 days, p = 0.011). No complications occurred in the LCBDE group, while two (40%) complications occurred in the ERCP group: pancreatitis and cholangitis (p = 0.078). During the follow-up period, no conversions, papillotomies, or recurrences were recorded in either group. CONCLUSIONS: Exploration of the common bile duct and removal of stones by LCBDE is safe and feasible in pediatric patients for the treatment of choledocholithiasis. Through this procedure, choledocholithiasis and cholelithiasis can be treated in a single procedure without papillotomy or fluoroscopy. Compared with LC + ERCP, LCBDE is associated with a shorter hospital stay. The incidence of complications was rather low but not statistically significant.

Governance Innovations for forest ecosystem service provision - Insights from an EU-wide survey.

This paper analyses the occurrence of governance innovations for forest ecosystem service (FES) provision in the forestry sector in Europe and the factors that influence innovation development. Based on a European-wide online survey, public and private forest owners and managers representing different property sizes indicate what type of governance innovation activities they engage in, and why. To investigate forestry innovations as systems, the analysis focuses on biophysical, social and technical factors influencing innovation development. The results of our exploratory quantitative analysis show that most innovation activities identified are largely oriented towards biomass production. Accordingly, most forest owners implement efficiency-driven optimisation strategies for forest management and technological improvement for provisioning service supply, to generate income. In contrast, the provision of regulating and cultural services is not yet a prominent part of forestry innovation activities.Reasons are rooted in a market-oriented economic rationale focusing on timber production, a lack of financial resources to compensate for other FES provisions or institutions to provide backup and security to forest owners and managers for engaging in innovation development. Given that the provision of a wide range of FES is a politically well-established objective for forest management in Europe, a strategy is needed that helps to align actors and sectors for supporting and co-financing related forest management approaches and business models. The current revision of the forest related policy framework on EU level under the EU Green deal poses a window of opportunity for better fostering novel governance approaches for more sustainable FES provision.

The effect of high-fat diet and 13-cis retinoic acid application on lipid profile, glycemic response and oxidative stress in female Lewis rats.

Vitamin A and its metabolites are key regulators of the development of adipose tissue and associated metabolic complications. The aim of this study was to determine the effect of high fat diet and 13-cis retinoic acid (13 cRA) application on metabolic parameters, adipogenic and inflammatory indicators in female Lewis rats. Female rats of Lewis strain were fed standard laboratory diet (STD) and high fat diet (HFD, 45% of saturated fatty acids) during 30 days. The groups were divided into additional 3 groups (6 rats each): two experimental groups that received 13 cRA orally on a daily basis during 30 days (7.5 mg/kg and 15 mg/kg, respectively) and the control group that was given sunflower oil. Animals were sacrificed after 60 days. Feeding of Lewis rats with chronic HFD diet with 13 cRA supplementation increased weight gain, adiposity index, dyslipidaemia, hyperleptinaemia, insulin resistance, VLDL concentrations, oxidative stress and atherogenic indices. Administration of 13 cRA in Lewis rats fed STD did not change the weight of the animals, but it slightly increased the atherogenic parameters. 13 cRA and HFD affect metabolic parameters, glucose and lipid metabolism in Lewis rats and its administration has a completely different effect on metabolism in rats fed STD, highlighting the complex role of vitamin A supplementation in obesity. Other factors, such as genetics, age, sex, adipose tissue distribution, also must be taken into consideration.

Faithful solid state optical memory with dynamically decoupled spin wave storage.

We report a high fidelity optical memory in which dynamical decoupling is used to extend the storage time. This is demonstrated in a rare-earth doped crystal in which optical coherences were transferred to nuclear spin coherences and then protected against environmental noise by dynamical decoupling, leading to storage times of up to 4.2 ms. An interference experiment shows that relative phases of input pulses are preserved through the whole storage and retrieval process with a visibility ≈1, demonstrating the usefulness of dynamical decoupling for extending the storage time of quantum memories. We also show that dynamical decoupling sequences insensitive to initial spin coherence increase retrieval efficiency.

Assessment of stress level of forestry experts with academic education.

This paper provides the results of an applied research of forests engineers connected to their risk of mental stress occurrence in everyday work. This paper also has a component of a basic research, in which the adequacy and reliability of applied methodology in this kind of researches is examined. The mental stress induced risk is tested by usage of an e-mail survey which consists out of 23-part ERI (Effort-Reward Imbalance) questionnaire. For the assessment of mental stress exposure level following indicators have been used: 1) ERI--ratio of devoted effort and achieved reward, and 2) overcommitment. These indicators have been analyzed in comparison to the demographic parameters (gender, age) and the complexity of assigned jobs of the interviewees. The interview was applied on a randomly sampled forestry experts employed in public and private sector. The analysis of reliability of the three components of ERI questionnaire has showed satisfactory internal consistency. Descriptive statistics has been done regarding gender and the complexity of assigned jobs. The testing of the "devoted effort/achieved reward" variable (E/R index) has shown a statistically significant difference of the index value between male interviewees on managerial and standard expert positions. The value of E/R index was x > or = 1 at 18.97% of the sampled interviewees, which indicates a divergence between devoted effort and achieved reward, and also points to a possibility of mental stress occurrence risk. Multiple response tables have shown that female interviewees with less than 20 years of professional experience manifest stress related symptoms earlier than their male colleagues with similar professional experience do. Regression analysis has shown a significant correlation of E/R index to gender, internship and overcommitment. This research also assesses the viability of the applied method as an instrument of forestry experts' mental stress level determination.