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Steel‐fibre reinforced concrete is a well‐known material used for decades for industrial floorings, shotcrete, or other specific applications. Its use is now spreading in structural applications as a complement or a substitute for conventional bar‐reinforced concrete since the normative framework is ready to provide design approaches for several concrete applications. Nevertheless, some adaptations are needed for implementing steel‐fibre reinforced concrete in the design approach for steel‐concrete composite structures whereby complementary aspects need to be considered. In this field, besides the increase of tensile properties and durability of the concrete member, a very important contribution may be given by the increase of the concrete ductility in compression. This property is conferred by the steel fibres which provide a confinement effect increasing the plastic damage that the concrete matrix can absorb. If this property is widely accepted, its benefits are limited for the design of conventional concrete sections. Conversely, for composite sections, the possibility to reach higher strains in compression means ensuring full exploitation of the strength capacity of structural steel. Besides reaching an optimisation of already in‐use cross‐sections, this new material combination enhances the use of higher structural steel strengths in composite structures. [ABSTRACT FROM AUTHOR]

Vaccination hesitancy has been a major challenge for health authorities and societies during the COVID-19 pandemic. The general determinants of vaccination intentions and behavior include sociodemographic and health-related, psychological, and communication-related factors, with varying relevance for different types of vaccinations, countries, and target groups. The predictors of university students' COVID-19 vaccination behavior have not been sufficiently studied. Using a German university as an example and based on an online survey of 1398 university students, we investigated factors related to (a) the likelihood of vaccination against COVID-19 and (b) vaccination intention among those who had not been vaccinated by summer of 2021. Psychological factors showed high relevance. Field of study, trust in, and use of certain media and information channels were found to be important determinants of students' vaccination decision. Our findings can help better understand university students' vaccination behavior to develop and implement tailored strategies and campaigns. [ABSTRACT FROM AUTHOR]

Design of composite columns in steel and concrete – update prEN 1994‐1‐1 The design of composite columns follows the rules in accordance to EN 1994‐1‐1 providing simplified design methods and the general method. Whereby the general method requires an advanced comprehensive FE‐Analysis. However, the recent Eurocode 4 does not provide sufficient guidance for the application of the general method and there is not a harmony in the literature on how to conduct it. This often leads to uncertainty among users and discussions on the validation and assessment of the analysis results. Actually, the draft of the second generation of Eurocode 4 (prEN 1994‐1‐1) is available, including more guidance but also introduces additional safety parameters and extends the application scope in regard to the martial strengths. This paper points out the procedure for the design of composite column with focus on the general method and changes provided by the draft of prEN 1994‐1‐1:2021. [ABSTRACT FROM AUTHOR]

Strain limited moment resistance for composite shallow‐floor beams Due to the demand for sustainable buildings and slim constructions, composite slim‐floor systems become more important. The present European Codes do not include complete design rules for shallow‐floor beams. For the design, additional regulations have to be considered for bending design and the classification of the cross‐section. This article points out the limits for plastic bending design and its particularities. [ABSTRACT FROM AUTHOR]

Development of slim‐floor construction in Europe Slim‐floor or also called shallow floor construction represents innovative composite beam systems for multi‐storey buildings. These are rolled or welded steel profiles fully or partially integrated into the concrete slab. This construction method constitutes one of the most recent developments in steel‐concrete composite construction and has become increasingly important in the last two decades. In this article, the construction method is explained as well as its development. [ABSTRACT FROM AUTHOR]

Finally, exclusion of severely ill patients may be challenged, but patients with Clavien grade IIIb and IV complications were not excluded, as mentioned in the manuscript. Author's Reply: Cost-Benefit Analysis of an Enhanced Recovery Program for Gastrectomy: A Retrospective Controlled Analysis In addition, the positive effect of ERP programs may be reduced in patients with multiple complications because the active patient's participation is required. [Extracted from the article]

Das Immobilienprojekt KONS sieht innerhalb von zweieinhalb Jahren den Abriss und die neue Überbauung eines großen Areals gegenüber des Hauptbahnhofs in zentraler, innerstädtischer Lage der Stadt Luxemburg vor. Die Anforderungen der Investoren wie auch die Auflagen der Verwaltung konnten nur durch einen integrativen und intelligenten Planungsprozess erfüllt werden. Die komplexen Verflechtungen zwischen logistischen und baubetrieblichen Abläufen, konstruktiven Detailfragen und wirtschaftlicher Gesamtbetrachtung fanden ihre Lösung in einer in jeder Hinsicht leistungsfähigen Stahlverbundkonzeption. Symbiosis of steel and stone - An innovative solution realized by a composite structure in steel and concrete for complex intra-urban projects. The real estate project KONS encountered a two and a half year process of demolition of an existing building and construction of a new building complex in a central, urban location of Luxembourg City opposite of the main railway station. Thereby the ambitious specifications of the investor as well as the requirements of the local authorities could be met only through a comprehensive and intelligent planning process. The complex interrelation between logistics and construction management processes, detailing and overall economic assessmentfound the solution of steel-composite design highly performant and efficient in every aspect. [ABSTRACT FROM AUTHOR]

The existence of the so-called “Werther effect” is well confirmed, and there are several recommendations on how the media should (not) report suicide to minimize the risk of copycat behavior. Unfortunately, very little is known about how suicide is actually reported. The article examines the German press coverage of six celebrity suicides with respect to compliance with guidelines on suicide reporting and analyzes changes in suicides in the wake of the reporting. It concludes that German media do not respect the recommendations in a substantial number of their articles. In addition, a significant increase in suicides and similar suicides is found. [ABSTRACT FROM PUBLISHER]

Background: Due to the underlying diseases and the need for immunosuppression, patients after lung transplantation are particularly at risk for gastrointestinal (GI) complications that may negatively influence long-term outcome. The present study assessed the incidences and impact of GI complications after lung transplantation and aimed to identify risk factors. Methods: Retrospective analysis of all 227 consecutively performed single- and double-lung transplantations at the University hospitals of Lausanne and Geneva was performed between January 1993 and December 2010. Logistic regressions were used to test the effect of potentially influencing variables on the binary outcomes overall, severe, and surgery-requiring complications, followed by a multiple logistic regression model. Results: Final analysis included 205 patients for the purpose of the present study, and 22 patients were excluded due to re-transplantation, multiorgan transplantation, or incomplete datasets. GI complications were observed in 127 patients (62 %). Gastro-esophageal reflux disease was the most commonly observed complication (22.9 %), followed by inflammatory or infectious colitis (20.5 %) and gastroparesis (10.7 %). Major GI complications (Dindo/Clavien III-V) were observed in 83 (40.5 %) patients and were fatal in 4 patients (2.0 %). Multivariate analysis identified double-lung transplantation ( p = 0.012) and early (1993-1998) transplantation period ( p = 0.008) as independent risk factors for developing major GI complications. Forty-three (21 %) patients required surgery such as colectomy, cholecystectomy, and fundoplication in 6.8, 6.3, and 3.9 % of the patients, respectively. Multivariate analysis identified Charlson comorbidity index of ≥3 as an independent risk factor for developing GI complications requiring surgery ( p = 0.015). Conclusion: GI complications after lung transplantation are common. Outcome was rather encouraging in the setting of our transplant center. [ABSTRACT FROM AUTHOR]

Flachdecken mit integrierten Stahlprofilen in Verbundbauweise zeichnen sich vor allem durch die schlanke Bauweise mit geringen Deckenhöhen aus. In den letzten Jahren haben sich neben den typischen Querschnitten aus gewalzten Profilen mit untergeschweißter Gurtplatte immer mehr hohlkastenähnliche Profilformen durchgesetzt. Bei diesen Systemen kann zur Steigerung der Querkrafttragfähigkeit ein hybrides Fachwerkmodell abgeleitet werden, bei dem neben der Querkrafttragfähigkeit des Stahlprofils auch die Tragfähigkeit des Betons angerechnet wird. Aufgrund der daraus resultierenden zusätzlichen Spannungen im Stahlprofil muss die Momenten-Querkraft-Interaktionsbeziehung erweitert werden. Shear resistance and M-V-Interaction of Slim-Floor-systems with integrated steel-box sections - Approach of a hybrid truss model for the shear design. Shallow-floor slabs with integrated steel profiles in composite behavior are mainly characterized by the slim design. Parallel to the traditional sections consisting of rolled profiles with an additional bottom plate also floor-slabs with integrated steel-box sections have gained widespread adoption in practice in the recent years. Because of the sheathing of the concrete by the steel section a hybrid truss model with a compression strut in the concrete section is developed, increasing the shear resistance of these sections. Due to the additional steel stresses resulting by the truss model, the relationship for the interaction between moment and vertical shear forces is to expand. [ABSTRACT FROM AUTHOR]

Due to the demand for sustainable buildings and slim constructions, composite slim-floor systems become more important. The present European Codes do not include complete design rules for shallow-floor beams. In the design, additional regulations have to be considered for ultimate limit state, serviceability limit state and fire design. In this paper the characteristics in erection state, for the cross section classification, the plastic moment resistance and the influence of transverse bending moments are presented. Apart from traditional sections consisting of rolled profiles also floor slabs with integrated steel box-sections have been considered. [ABSTRACT FROM AUTHOR]

Die Verkehrspolitik in Luxemburg sieht das Erstellen eines möglichst dichten Netzes an öffentlichen Verkehrsmitteln vor. Autofahrer, vor allem die Vielzahl der Grenzgänger aus dem angrenzenden Ausland, sollen bereits grenznah auf die Bahn umsteigen, um somit das Straßennetz über die Grenzen von Luxemburg hinaus zu entlasten. Im Jahr 2013 wurde mit der Eröffnung das Parkhauses Belval-Université das erste einer Reihe geplanter Park Parking Belval-Université - A Park and Rail project is defining new boarders in Europe. Transport policy in Luxembourg provides the realization of a dense network of public transport. Motorists, especially the large number of commuters from the neighbor countries, should already change close to the borders to public traffic - especially to train. By that it is possible to relieve the national highways and also those in bordering regions. With the start into service of the new multi-storey car park Belval-Université in 2013, the first of a series of planned Park [ABSTRACT FROM AUTHOR]

Background: The relationship between physicians and patients has undergone important changes, and the current emancipation of patients has led to a real partnership in medical decision making. The present study aimed to assess patients' preferences on different aspects of decision making during treatment and potential complications, as well as the amount and type of preoperative information wanted before visceral surgery. Methods: This was a prospective non-randomized study based on a questionnaire given to 253 consecutive patients scheduled for elective gastrointestinal surgery. Results: In considering surgical complications or treatment in the intensive care unit, 64 % of patients wished to take an active role in any medical decisions. The respective figures for cardiac resuscitation and treatment limitations were 89 and 60 %. As for information, 73, 77, and 47 % of patients wish detailed information, information on a potential ICU hospitalization, and knowledge of cardiac resuscitation, respectively. Elderly and low-educated patients were significantly less interested in shared medical decision making ( p = 0.003 and 0.015), and in receiving information ( p = 0.03 and 0.05). Similarly, involvement of the family in decision making was significantly less important to elderly and male patients ( p = 0.05 and 0.03, respectively). Neither the type of operation (minor or major) nor the severity of disease (malignancies versus non-malignancies) was a significant factor for shared decision making, information, or family involvement. Conclusions: The vast majority of surgical patients clearly want to get adequate preoperative information about their disease and the planned treatment. They also consider it crucial to be involved in any kind of decision making for treatment and complications. For most patients, the family role is limited to supporting the treating physicians if the patient is unable to participate in decision making. [ABSTRACT FROM AUTHOR]

Tristetraprolin (TTP) is a critical negative immune regulator. It binds AU-rich elements in the untranslated-regions of many mRNAs encoding pro-inflammatory mediators, thereby accelerating their decay. A key but poorly understood mechanism of TTP regulation is its timely proteolytic removal: TTP is degraded by the proteasome through yet unidentified phosphorylation-controlled drivers. In this study, we set out to identify factors controlling TTP stability. Cellular assays showed that TTP is strongly lysine-ubiquitinated, which is required for its turnover. A genetic screen identified the ubiquitin E3 ligase HUWE1 as a strong regulator of TTP proteasomal degradation, which we found to control TTP stability indirectly by regulating its phosphorylation. Pharmacological assessment of multiple kinases revealed that HUWE1-regulated TTP phosphorylation and stability was independent of the previously characterized effects of MAPK-mediated S52/S178 phosphorylation. HUWE1 function was dependent on phosphatase and E3 ligase binding sites identified in the TTP C-terminus. Our findings indicate that while phosphorylation of S52/S178 is critical for TTP stabilization at earlier times after pro-inflammatory stimulation, phosphorylation of the TTP C-terminus controls its stability at later stages. [ABSTRACT FROM AUTHOR]

Background and Objective: Key factors of Fast Track (FT) programs are fluid restriction and epidural analgesia (EDA). We aimed to challenge the preconception that the combination of fluid restriction and EDA might induce hypotension and renal dysfunction. Methods: A recent randomized trial (NCT00556790) showed reduced complications after colectomy in FT patients compared with standard care (SC). Patients with an effective EDA were compared with regard to hemodynamics and renal function. Results: 61/76 FT patients and 59/75 patients in the SC group had an effective EDA. Both groups were comparable regarding demographics and surgery-related characteristics. FT patients received significantly less i.v. fluids intraoperatively (1900 mL [range 1100–4100] versus 2900 mL [1600–5900], P < 0.0001) and postoperatively (700 mL [400–1500] versus 2300 mL [1800–3800], P < 0.0001). Intraoperatively, 30 FT compared with 19 SC patients needed colloids or vasopressors, but this was statistically not significant (P = 0.066). Postoperative requirements were low in both groups (3 versus 5 patients; P = 0.487). Pre- and postoperative values for creatinine, hematocrit, sodium, and potassium were similar, and no patient developed renal dysfunction in either group. Only one of 82 patients having an EDA without a bladder catheter had urinary retention. Overall, FT patients had fewer postoperative complications (6 versus 20 patients; P = 0.002) and a shorter median hospital stay (5 [2–30] versus 9 d [6-30]; P< 0.0001) compared with the SC group. Conclusions: Fluid restriction and EDA in FT programs are not associated with clinically relevant hemodynamic instability or renal dysfunction. [Copyright &y& Elsevier]

Purpose: A patent processus vaginalis peritonei (PPV) presents typically as an indirect hernia with an intact inguinal canal floor during childhood. Little is known however about PPV in adults and its best treatment. Methods: A cohort study included all consecutive patients admitted for ambulatory open hernia repair. In patients with a PPV, demographics, hernia characteristics, and outcome were prospectively assessed. Annulorrhaphy was the treatment of choice in patients with an internal inguinal ring diameter of <30 mm. Results: Between 1998 and 2006, 92 PPVs (two bilateral) were diagnosed in 676 open hernia repairs (incidence of 14%). Eighty nine of the 90 patients were males, the median age was 34 years (range: 17-85). A PPV was right-sided in 67% and partially obliterated in 66%. Forty-one patients had an annulorrhaphy and 51 patients had a tension-free mesh repair. The median operation time was significantly shorter in the annulorrhaphy group (38 vs. 48 min, P<.0001). In a median follow-up period of 56 months (27-128), both groups did not differ concerning recurrence (1/41 vs. 2/51), chronic pain (3/41 vs. 4/51), and hypoesthesia (5/41 vs. 9/51). There was however a clear trend to less neuropathic symptoms in favor of annulorrhaphy (0/41 vs. 5/51, P < 0.066). Conclusions: PPV occurs in 14% of adults undergoing hernia repair. In selected patients, annulorrhaphy takes less time and is associated with equally low recurrence but less potential for neuropathic symptoms. [ABSTRACT FROM AUTHOR]

Objectives: Postoperative bleeding represents a life-threatening complication after pancreatic surgery. Recent developments in interventional radiology have challenged the role of surgery in bleeding control. This study aimed to assess the management of major haemorrhagic complications after pancreatic surgery at a tertiary referral centre. Methods: Between August 1998 and June 2009, 18 patients with major bleeding after pancreatic surgery were admitted to the University Hospital of Zurich, Zurich, Switzerland. We retrospectively analysed their medical charts, focusing on diagnosis, therapy and outcome. Results: Major arterial bleeding occurred after a median postoperative interval of 21.5 days (range: 9-259 days). Seventeen patients demonstrated various symptoms, such as repeated upper gastrointestinal bleeding or haemorrhagic shock. Diagnosis was usually made by contrast-enhanced computed tomography (CT). Leakage of the pancreaticojejunostomy caused the formation of a pseudoaneurysm in 78% of patients. Haemostasis was achieved in 10 patients by interventional radiology. Two patients died of massive re-bleeding. Six patients underwent primary emergency surgery, which five did not survive. Conclusions: Delayed bleeding after pancreatic surgery is suspicious for a pseudoaneurysm. Contrast-enhanced CT followed by early angiography provides accurate diagnosis and treatment. Interventional radiological treatment should be preferred over primary surgery because it is currently the most life-saving approach. [ABSTRACT FROM AUTHOR]

Laparoscopic splenectomy (LS) is the standard procedure for normal size or moderately enlarged spleens; open splenectomy (OS) is preferred in cases of splenomegaly. In this study, indications for and complications of open and laparoscopic splenectomy were analyzed, with the aim to identify patients who will benefit from either technique. A consecutive series of 52 patients undergoing elective open or laparoscopic splenectomy between January 2001 and December 2006 was analyzed. Spleen volume was calculated as length × width × depth from the pathologist’s measurements. LS was performed in 25 patients with a median age of 41 years (range = 24–65). OS was performed in 27 patients with a median age of 60 years (range = 24–86) ( p < 0.001). Conversion to OS was necessary in two patients (8%). Operation time was significantly shorter in LS ( p < 0.05). Spleen volume was significantly greater in patients who underwent open (median = 2520 ml, range = 150–16,800 ml) versus laparoscopic (median = 648 ml, range = 150–4860 ml) splenectomy ( p = 0.001). In 36% of all laparoscopic procedures, spleen volume exceeded 1000 ml. The underlying disease was mainly immunothrombocytopenia in LS patients and lymphoma and osteomyelofibrosis in OS patients. Five patients died after OS. Significantly more patients were hospitalized longer than 7 days following OS than following LS ( p < 0.05). Overall complication rate was higher after OS (LS, 8; OS, 13 patients; p < 0.05). LS was preferred in younger patients with moderate splenomegaly, while massive splenomegaly mostly led to OS. In view of the absence of technique-related differences, LS can primarily be attempted in all patients. [ABSTRACT FROM AUTHOR]

Background/Aims: To study the effect of short-term cholestasis on glycogen metabolism.Methods: Rats were bile duct ligated (BDL) for 4 or 8 days and compared to sham-operated control rats pair-fed to BDL (pair-fed CON) or fed ad libitum (ad libitum-fed CON).Results: Four days after surgery, the hepatic glycogen content was 21.6±7.6 mg/g in BDL, 21.2±8.5 mg/g in pair-fed CON and 72.9±7.7 mg/g in ad libitum-fed CON, respectively. Eight days after surgery, the hepatic glycogen content was reduced in BDL as compared to pair-fed (31.2±8.9 vs. 59.1±5.4 mg/g) or ad libitum-fed CON (58.3±4.7 mg/g). Similar findings were obtained with the glycogen content expressed per ml hepatocytes or per liver. Histological analysis of BDL livers showed that most hepatocytes were affected. As compared to CON, activities and mRNA levels of glycogen synthase and phosphorylase were reduced in BDL, whereas plasma glucagon and endotoxin levels were increased at both time points. In contrast to liver, skeletal muscle glycogen metabolism remained unaffected.Conclusions: While reduced intake of food explains the decrease in the hepatic glycogen stores in BDL and pair-fed CON 4 days after surgery, reduced glycogen synthesis, possibly related to endotoxinemia, is the most probable cause of the decrease in the hepatic glycogen content in BDL 8 days after surgery. [Copyright &y& Elsevier]

BIM modeling of existing buildings – a study on effort and efficiency In the project "FHprofUnt 2018: BIM Bauen im Bestand (BIM‐BiB)", funded by the Federal Ministry of Education and Research, the campus of Trier University of Applied Sciences was surveyed using terrestrial laser scanners and the data obtained was transferred to BIM models of the campus buildings. Here, the efficiency of as‐is surveys using 3D scanners, point cloud generation and post‐processing, as well as BIM modeling of existing buildings is examined on the basis of the effort values obtained. The results show that the use of terrestrial laser scanners for as‐is surveys is an efficient method, but the processing and creation of high‐quality point clouds is still very time‐consuming and the actual BIM modeling greatly exceeds the two first‐mentioned work areas in terms of effort. To explain the results presented, the current state of the art and the project‐specific problems are discussed. The data obtained and its evaluation reveal weaknesses in the efficiency of the methods available today and shed light on research opportunities to make the process of modeling existing buildings more economical. [ABSTRACT FROM AUTHOR]

Due to the demand for sustainable constructions, composite structures have become more important and lead to slim and economic solutions with a low structural self-weight. EN 1994-1-1 distinguishes between four different cross-section classes for the determination of moment resistance. For the plastic moment resistance, it is assumed, that each cross-sectional fibre can plastify without any limit on the strain. For standard composite beams with sagging moments and a high plastic neutral axis, plastic resistance and strain-limited resistance give similar results. For sections with a large compression zone height x pl and limited rotation capacity, concrete failure in the compression zone can occur before the plastic moment resistance M pl,Rd , is reached. The strain limit design becomes critical. This paper points out the impact of the concrete part on the design of composite beams. A parametric study comparing plastic and strain limited moment resistance of a considerable variety of cross-sections has been carried out to develop the beam design methods considering compression zone height for the next generation of Eurocodes. [Display omitted] • Point out limitations for plastic bending resistance • Comparing plastic and strain-limited bending resistance • Parametric studies of more than 200,000 cross-sections • Considering both conventional and slim-floor composite beams\ [ABSTRACT FROM AUTHOR]

αVβ3 integrin can bind to multiple extracellular matrix proteins, including vitronectin (Vn) and fibronectin (Fn), which are often presented to cells in culture as homogenous substrates. However, in tissues, cells experience highly complex and changing environments. To better understand integrin ligand selection in such complex environments, we employed binary-choice substrates of Fn and Vn to dissect αVβ3 integrin-mediated binding to different ligands on the subcellular scale. Super-resolution imaging revealed that αVβ3 integrin preferred binding to Vn under various conditions. In contrast, binding to Fn required higher mechanical load on αVβ3 integrin. Integrin mutations, structural analysis and chemical inhibition experiments indicated that the degree of hybrid domain swing-out is relevant for the selection between Fn and Vn; only a force-mediated, full hybrid domain swing-out facilitated αVβ3-Fn binding. Thus, force-dependent conformational changes in αVβ3 integrin increased the diversity of available ligands for binding and therefore enhanced the ligand promiscuity of this integrin. [ABSTRACT FROM AUTHOR]

Background: Postoperative complications are frequent after gastrointestinal surgery and early prediction remains an unmet need. Serum albumin shows a rapid decrease after surgery, and this decline (ΔAlb) may reflect the intensity of the surgical stress response and thereby be a predictor of postoperative complications. This study aimed to comprehensively review the available data on ΔAlb in gastrointestinal surgery. Methods: PRISMA guidelines were followed to conduct a systematic review of the literature in MEDLINE and Embase. Studies assessing the role of ΔAlb to predict complications after gastrointestinal surgery were included. Results: A total of 1256 articles were screened, and 16 studies were included in the final analysis: 7 prospective and 9 retrospective trials. Sensitivity of ΔAlb to predict postoperative complications ranged from 63 to 84%, whereas specificity ranged from 61 to 86%. Nine out of the 16 included studies established a threshold of ΔAlb to predict morbidity (range: 5–11 g/l or 14–27%). Conclusion: ΔAlb appeared as a valuable and promising biomarker to anticipate complications after gastrointestinal surgery. Future efforts are needed to determine whether and how ΔAlb may be integrated in clinical practice to guide clinicians in the perioperative management of patients. [ABSTRACT FROM AUTHOR]

Purpose: Perioperative chemotherapy combined with surgical resection represent the gold standard in the treatment of locally advanced gastric cancer. The Mandard tumor regression score (TRG) is widely used to evaluate pathological response to neoadjuvant treatment. The aim of this study was to assess the prognostic value of TRG in terms of overall survival (OS) and disease-free (DFS). Methods: Retrospective analysis of all consecutive patients who underwent oncological gastrectomy after neoadjuvant chemotherapy from January 2007 to December 2019 for gastric adenocarcinoma was performed. Based on their TRG status they were categorized into two groups: good responders (TRG 1–2) and poor responders (TRG 3–5). Subsequent multivariable analyses were conducted. Results: Seventy-four patients were included, whereby 15 (20.3%) were TRG 1–2. Neoadjuvant regimens for TRG 1–2 vs. TRG 3–5 were similar: MAGIC (53% vs. 39%), FLOT (40% vs. 36%), FOLFOX (7% vs. 15%, p = 0.462). Histologic types according to Lauren classification for TRG 1–2 vs. TRG 3–5 were: 13% vs. 29% intestinal, 53% vs. 44% diffuse and 34% vs. 27% indeterminate (p = 0.326). TRG 1–2 group exhibited significantly less advanced ypT (46% vs. 10%, p = 0.001) and ypN stages (66% vs. 37%, p = 0.008), alongside a diminished recurrence rate (20% vs. 42%, p = 0.111). The 3-year DFS was significantly better in this group (81% vs. 47%, p = 0.041) whereas the disparity in three-year OS (92% vs. 55%, p = 0.054) did not attain statistical significance. Conclusions: TRG 1–2 was associated with less advanced ypT and ypN stage and better DFS compared to TRG 3–5 patients, without a significant impact on OS. [ABSTRACT FROM AUTHOR]

Purpose: Paraoesophageal hernias (PEH) are associated with a high complication rate and often occur in elderly and fragile patients. Surgical gastropexy without fundoplication is an accepted alternative procedure; however, outcomes and functional results are rarely described. Our study aims to evaluate short-term outcomes and the long-term quality of life after gastropexy as treatment for PEH. Methods: Single center cohort analysis of all consecutive patients who underwent gastropexy for PEH without fundoplication. Postoperative outcomes and functional results were retrospectively collected. Reflux symptoms developed postoperatively were reported using the validated quality of life questionnaire: GERD-Health Related Quality of Life Qestionnaire (GERD-HRQL). Results: Thirty patients (median age: 72 years (65–80)) were included, 40% classified as ASA III. Main PEH symptoms were reflux (63%), abdominal/thoracic pain (47%), pyrosis (33%), anorexia (30%), and food blockage (26%). Twenty-six laparoscopies were performed (86%). Major complications (III-IVb) occurred in 9 patients (30%). Seven patients (23%) had PEH recurrence, all re-operated, performing a new gastropexy. Median follow-up was 38 (17–50) months. Twenty-two patients (75%) reported symptoms resolution with median GERD-HRQL scale of 4 (1–6). 72% (n = 21) reported operation satisfaction. GERD-HRQL was comparable between patients who were re-operated for recurrence and others: 5 (2–19) versus 3 (0–6), p = 0.100. Conclusion: Gastropexy without fundoplication was performed by laparoscopy in most cases with acceptable complications rates. Two-thirds of patients reported symptoms resolution, and long-term quality-of-live associated to reflux symptoms is good. Although the rate of PEH recurrence requiring a new re-intervention remained increased (23%), it does not seem to affect long-term functional results. [ABSTRACT FROM AUTHOR]

University students worldwide are facing increasing mental health challenges. Traditional stress models, like the Job/Study Demand-Resources Model, link stressors directly to strain. Yet, recent studies suggest the influence of strain on stressors may be even stronger. Our research explored these reciprocal dynamics among university students, considering social support and mindfulness as potential moderators. We conducted a two-wave panel study with 264 university students. We ran separate cross-lagged panel structural equation analyses for three key health outcomes—emotional exhaustion, depression, and well-being—each paired with perceived study stressors, specifically workload and work complexity. Findings revealed significant stressor and strain effects, with social support notably moderating the impact of emotional exhaustion on workload. These insights challenge traditional stress theories and underscore the importance of mental health support and effective stress management strategies for students, emphasizing the need for proactive mental health initiatives in academic environments. [ABSTRACT FROM AUTHOR]

Patient’s first pregnancy was complicated by mild thrombocytopenia caused by a 13-cm splenic cyst, who delivered vaginally without complication. Risks and management of maternal splenic cysts in pregnancy and delivery are reviewed here. [ABSTRACT FROM PUBLISHER]

Purpose: Statin treatment has been shown in certain population studies and meta-analyses to improve survival of patients with pancreatic ductal adenocarcinoma (PDAC). This study assessed if patients with statin treatment had better overall survival (OS) and disease-free survival (DFS) after upfront pancreatoduodenectomy for PDAC. Methods: Consecutive PDAC patients were retrospectively collected from three centers in Europe and USA (study period: 2000–2017). Adult patients who underwent upfront pancreatoduodenectomy and survived the first 90 postoperative days were included. Patients with metastasis at diagnosis or with macroscopic incomplete resection were excluded. Patients were considered under statin if started at least one month before pancreatoduodenectomy. Survival rates were calculated using Kaplan–Meier method and compared with log-rank test. Results: A total of 496 patients were included. Median age was 67 years (IQR 59–75), 48% (n = 236) were women, and 141 patients (28%) received statin treatment already preoperatively. Patients with and without statin treatment were comparable in terms of demographics and pre-/intraoperative characteristics, except for age and pre-existing diabetes. Median OS and DFS were similar in patients with and without statin treatment (OS: 29, 95% CI 22–36 vs. 27 months, 95% CI 22–32, p = 0.370, DFS: 18, 95% CI 14–22 vs. 16 months, 95% CI 14–18, p = 0.430). On multivariable Cox regression, lymph node involvement (HR 1.9, 95% CI 1.6–2.2, p < 0.001), tumor differentiation (HR 1.3, 95% CI 1.1–1.6, p = 0.003), and postoperative chemotherapy (HR 0.5, 95% CI 0.4–0.7, p < 0.001) were predictors of OS, whereas statin treatment was not a prognostic factor (HR 0.9, 95% CI 0.7–1.2, p = 0.376). Conclusion: In this international cohort of PDAC patients, statin treatment did not influence survival after upfront pancreatoduodenectomy. Nodal involvement, tumor differentiation, and postoperative chemotherapy were independent predictors of OS. [ABSTRACT FROM AUTHOR]

Introduction: Diffuse-type gastric cancer (DTGC) is associated with poor outcome. Surgical resection margin status (R) is an important prognostic factor, but its exact impact on DTGC patients remains unknown. The aim of this study was to assess the prognostic value of microscopically positive margins (R1) after gastrectomy on survival and tumour recurrence in DTGC patients. Methods: All consecutive DTGC patients from two tertiary centers who underwent curative oncologic gastrectomy from 2005 to 2018 were analyzed. The primary endpoint was overall survival (OS) for R0 versus R1 patients. Secondary endpoints included disease-free survival (DFS), recurrence patterns as well as the overall survival benefit of chemotherapy in this DTGC patient cohort. Results: Overall, 108 patients were analysed, 88 with R0 and 20 with R1 resection. Patients with negative lymph nodes and negative margins (pN0R0) had the best OS (median 102 months, 95% CI 1–207), whereas pN + R0 patients had better median OS than pN + R1 patients (36 months 95% CI 13–59, versus 7 months, 95% CI 1–13, p < 0.001). Similar findings were observed for DFS. Perioperative chemotherapy offered a median OS of 46 months (95% CI 24–68) versus 9 months (95% CI 1–25) after upfront surgery (p = 0.022). R1 patients presented more often early recurrence (< 12 postoperative months, 30% vs 8%, p = 0.002), however, no differences were observed in recurrence location. Conclusion: DTGC patients with microscopically positive margins (R1) presented poorer OS and DFS, and early tumour recurrence in the present series. R0 resection should be obtained whenever possible, even if other adverse biological features are present. [ABSTRACT FROM AUTHOR]

Load‐bearing behaviour of CoSFB‐Dowels Slim‐floor or shallow floor construction is characterized by the integration of a steel beam into a slab. The activation of a composite action between the steel section and the concrete slab leads to a significant increase of the bending capacity and the stiffness of the beam, allowing for larger beam spans. This paper presents a fundamentally new method for assessing the load‐bearing capacity of CoSFB‐Dowels, which ensures a composite action of a composite slim‐floor beam (CoSFB). Based on detailed analysis of push‐out tests, extensive numerical simulations were performed in order to identify the contribution of various parameters on the load‐bearing capacity. Finally, an analytical formulation of the load‐bearing capacity is presented, which has been derived by applying a simple second order plasticity approach. [ABSTRACT FROM AUTHOR]

The article offers the author's insights regarding the clinical study by Skawran and colleagues on the risk of infertility after bilateral endoscopic total extraperitoneal (TEP) inguinal. He mentions that local interaction of normal body tissue and mesh is assumed to be the pathophysiological basis for complications related to mesh. He notes that the study offers a good evidence that the male infertility problem due to spermatic cord obstruction has no clinical importance.

The article discusses the inguinal hernia repair and the pain after the surgery. 5-10 percent patients suffer from chronic pain after the surgery. The neuropathic pain represents the persistent pain and nerve damage is the cause of it. It is alleged that the current literatures dealing with chronic pain lacks clear definitions, pain assessment methods, follow-up strategy and improper study design. Future studies are set to include six new domains to improve its quality and reliability.

The authors discuss aspects of meta-analysis in randomized controlled trials in evaluating the prophylactic use of ceftriaxone. They admit that prophylatic antibiotics is generally accepted therapy for infectious complications following a surgery. However, the authors think that many surgeons still lack the required infectiological knowledge and updated information on wounds and injuries.

The article presents views on a study on preventing parastomal hernia with a prosthetic mesh. It is noted that patients with parastomal hernia often need additional ostomy devices. It is commented that the results clearly showed a benefit for the mesh group and that parastomal hernia formation was an ongoing process, showing an increasing incidence over the years.

Postoperative enteral nutrition is a widely accepted route of application for nutrition formulas due to a low complication rate, a good acceptance by patients. and a favorable cost-effectiveness. We report three cases of bezoar ileus after early postoperative enteral nutrition, using a fine needle jejunostomy (FNJ) in two cases and a nasoduodenal tube in one case. A male patient who underwent gastric resection for a gastrointestinal stroma tumor and was nourished through an fine needle jejunostomy developed an acute abdomen on the seventh postoperative day. Surgical exploration revealed a mechanical ileus caused by denaturated nutrition formula distal to the catheter tip. The second case, a female patient, underwent gastric resection for a gastric cancer and on the fourth postoperative day developed acute onset of abdominal pain. Intraoperative findings were the same as described in the first case. The third case, a male patient with necrotizing cholecystitis, underwent open cholecystectomy. Postoperative enteral feeding was performed using a nasoduodenal tube. He developed a small bowel obstruction on the 17th postoperative day that was caused by an intraluminal bezoar. In conclusion, bezoar formation represents an underestimated complication of postoperative enteral feeding. Acute onset of abdominal pain and the development of small bowel obstruction are the main clinical symptoms of this severe complication. The pathogenesis of bezoar formation remains unclear. [ABSTRACT FROM AUTHOR]

Suicide is a global public health problem. Media impact on suicide is well confirmed and there are several recommendations on how media should and should not report on suicide to minimize the risk of copycat behavior. Those media guidelines have been developed to improve responsible reporting on suicide (RRS). Although such guidelines are used in several countries, we lack empirical evidence on their causal effect on actual journalistic news writing. We conducted an experiment with journalism students (N = 78) in Germany in which we tested whether exposure to awareness material promoting RRS influences news writing. As a supplement to the widely used text-based material, we tested the impact of a video in which a suicide expert presents the guidelines. A video was used as a supplement to text partly due to its potential benefit for prevention efforts over the Internet. We chose a low-budget production process allowing easy reproduction in different countries by local suicide experts. In the experiment, participants were either exposed to written, audio-visual, or no awareness material. Afterwards, participants read numerous facts of an ostensible suicide event and were asked to write a factual suicide news story based on these facts. Analyses indicate that awareness material exposure helped to improve RRS with the awareness video showing the strongest effects. We recommend that suicide prevention should use instructive awareness videos about RRS complementary to text-based awareness material. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has disrupted educational systems worldwide, and various alarming effects of this crisis on university students' mental health have been reported. This study aimed to identify which factors, existing prior to the pandemic (summer term 2019), might be related to resilience when dealing with academic demands during the pandemic (summer term 2020). A sample of 443 university students took part in a longitudinal survey study at a large university in Germany. Resilience, defined as the level of adaptation to a stressor, was operationalized by modeling latent change scores of emotional exhaustion, depression, and somatization in the face of study stress. Multiple regression analyses were performed to analyze how potential facilitating and hindering factors were related to resilience demonstration while controlling for study stressors (workload, work complexity, and change in time spent studying). Academic self-efficacy was positively related to various forms of resilience demonstration, while competition was negatively related. Performance pressure was negatively related to only one form of resilience demonstration. No evidence was found for social support (from lecturers or fellow students) being positively related to the demonstration of resilience. This study confirms previous findings regarding relevant resilience factors such as self-efficacy. It also reveals unexpected aspects such as social support, and it indicates new constructs in resilience research in a university setting such as competition and performance pressure. Practical implications can be drawn fromthis research to benefit resilience promotion among students in preparation for challenging times. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Evaluation of complex, acquired, non-malignant tracheo/broncho-oesophageal fistulas (TEF) repaired by extrathoracic pedicled muscle flaps that were, in addition to their interposition between the airways and the gastro-intestinal tract, patched into gastrointestinal or airway defects if primary closure seemed risky. METHODS: A single institution experience of patients treated between 2003 and 2015. Twenty-two patients required TEF repair following oesophageal surgery (18), Boerhaave syndrome (1), chemotherapy for mediastinal lymphoma (1), carinal resection and irradiation (1) and laryngectomy (1); 64% of them underwent prior radio- or chemotherapy and 50% prior airway or oesophageal stenting. RESULTS: Airway defects were closed by muscle flap patch (n = 12), lobectomy (n = 4), airway resection/anastomosis (n = 2), pneumonectomy (n = 1), segmentectomy (n = 2) or primary suture (n = 1). Gastro-intestinal defects were repaired by oesophageal diversion (n = 9), muscle flap patch (n = 8) or primary suture (n = 5). A muscle flap patch was used to close airway and gastro-intestinal defects in 55% and 36% of cases, respectively. The 90-day postoperative mortality and TEF recurrence rates were 18% and 4.5%. Airway healing and breathing without tracheal appliance was obtained in 95% of patients and gastro-intestinal healing in 77% of those without oesophageal diversion. Five of nine patients with oesophageal diversion underwent intestinal restoration by retrosternal colon transplants. CONCLUSIONS: Complex TEF arising after oesophageal surgery, radio-chemotherapy or failed stenting can be successfully closed using extrathoracic muscle flaps that can, in addition to their interposition between the airway and the gastro-intestinal tract, also be patched into gastro-oesophageal or airway defects if primary closure seems hazardous. [ABSTRACT FROM AUTHOR]

Background: Lower endoscopy (LE) is the standard diagnostic modality for lower gastrointestinal bleeding (LGIB). Conversely, computed tomographic angiography (CTA) offers an immediate non-invasive diagnosis visualizing the entire gastrointestinal tract. The aim of this study was to compare these 2 modalities with regards to diagnostic value and bleeding control. Methods: Tertiary center retrospective analysis of consecutive patients admitted for LGIB between 2006 and 2012. Comparison of patients with LE vs. CTA as first exam, respectively, with emphasis on diagnostic accuracy and bleeding control. Results: Final analysis included 183 patients; 122 (66.7%) had LE first, while 32 (17.5%) had CTA; 29 (15.8%) had neither of both exams. Median time to CTA was shorter compared to LE (3 (IQR = 8.2) vs. 22 (IQR = 36.9) hours, P <0 . 0 0 1 ) . Active bleeding was identified in 31% with CTA vs. 15% with LE (P = 0.031); a non-actively bleeding source was found by CTA and LE in 22 vs. 31%, respectively (P = 0.305). Bleeding control required endoscopy in 19%, surgery in 14% and embolization in 1.6%, while 66% were treated conservatively. Post-interventional bleeding was mostly controlled by endoscopic therapy (57%). 80% of patients with active bleeding on CTA required surgery. Conclusions: Post-interventional LGIB was effectively addressed by LE. For other causes of LGIB, CTA was efficient, and more available than colonoscopy. Treatment was conservative for most patients. In case of active bleeding, CTA could localize the bleeding source and predict the need for surgery. [ABSTRACT FROM AUTHOR]

Simple Summary: Gastric adenocarcinoma remains associated with a poor prognosis despite recent therapeutical advances. As diagnosis is frequently made at an advanced stage, long-term outcome is dismal. Individualized identification of factors associated with poor prognosis allows more precise survival prediction and, in some cases, to propose targeted treatment through individualized precision medicine. This review aims to highlight the prognosis determinants of these tumors and potential therapeutical impact from the available literature. Gastric adenocarcinoma remains associated with a poor long-term survival, despite recent therapeutical advances. In most parts of the world where systematic screening programs do not exist, diagnosis is often made at advanced stages, affecting long-term prognosis. In recent years, there is increasing evidence that a large bundle of factors, ranging from the tumor microenvironment to patient ethnicity and variations in therapeutic strategy, play an important role in patient outcome. A more thorough understanding of these multi-faceted parameters is needed in order to provide a better assessment of long-term prognosis in these patients, which probably also require the refinement of current staging systems. This study aims to review existing knowledge on the clinical, biomolecular and treatment-related parameters that have some prognostic value in patients with gastric adenocarcinoma. [ABSTRACT FROM AUTHOR]

Background: Open mesh repair of incisional hernia is associated with different local complications, particularly bleeding and seroma formation. Traditionally, drains have been placed perioperatively to prevent these complications, despite the lack of scientific evidence or expert consensus. We formulated the hypothesis that the absence of drainage would reduce number of patients presenting collections or complications. The present study aimed to compare postoperative complication rates after open mesh repair for incisional hernia with or without prophylactic wound drainage. Methods: Prospective randomized study using standardized surgical technique and drain placement. The primary endpoint was the evaluation of residual fluid collection with ultrasound on postoperative day 30. Other complications, subdivided into medical and surgical, were analyzed as secondary endpoints. Results: There were 144 patients randomized (70 with drain, 74 without drain). No difference was identified between both groups for fluid collection at 30 days (60.3% vs. 62%, p = 0.844). However, less surgical complications were identified in the drain group (21.7% vs. 42.7%, p = 0.007), with a lower wound dehiscence rate (1.5% vs. 9.3%, p = 0.041). Conclusions: Prophylactic drainage in open incisional hernia repair does not objectively reduce the rate of postoperative fluid collections. Therefore, our results do not support the use of routine drainage in incisional hernia repair. Trial registration: Trial registration on clinicaltrials.gov (NCT00478348). [ABSTRACT FROM AUTHOR]

Background: Serum albumin has been shown to be predictive of complications after various gastrointestinal operations. The present study aimed to assess whether preoperative serum albumin and serum albumin drop on postoperative day 1 are associated with postoperative complications after pancreatic surgery. Methods: A single-center cross-sectional study was performed. All patients who underwent pancreatectomy between January 2010 and June 2019 and had preoperative serum albumin value and serum albumin value on postoperative day 1 were included. ΔAlb was defined as the difference between preoperative serum albumin and serum albumin on postoperative day 1. Binary logistic regressions were performed to determine independent predictors of postoperative complications. Results. A total of 185 patients were included. Pancreatoduodenectomies were performed in 133 cases, left pancreatectomies in 36, and other pancreas operations in 16. The preoperative serum albumin value was found to be an independent predictor of complications (OR 0.9, 95%CI 0.9–1.0, p = 0.041), whereas ΔAlb was not significantly associated with postoperative complications (OR 1.0, 95%CI 0.9–1.1, p = 0.787). The threshold of 44.5 g/L for preoperative albumin level was found to have the highest combined sensitivity and specificity based on the maximum Youden index. Patients with preoperative albumin < 44.5 g/L had a higher incidence of postoperative complications and higher median comprehensive complication index than patients with preoperative albumin ≥   44.5 g/L. Conclusions: This study highlighted that preoperative serum albumin is an independent predictor of postoperative complications after pancreas surgery. [ABSTRACT FROM AUTHOR]

A response by Markus Schäfer to a letter to the editor about his article on parastomal hernia.

Simple Summary: The optimal neoadjuvant treatment modality for locally advanced gastroesophageal junction (GEJ) adenocarcinoma is still debated. Although chemoradiotherapy is set as the standard of treatment for squamous cell cancer, offering high rates of complete clinical and histologic response, the optimal treatment for adenocarcinoma remains a matter of debate. This study retrospectively compared 94 patients with locally advanced adenocarcinoma of the esophago-gastric junction treated with neoadjuvant chemoradiotherapy (n = 27) versus chemotherapy (n = 67) followed by curative surgery. Chemoradiotherapy offered better histological response of the primary tumor, but no benefit in terms of negative resection margins or long-term survival or recurrence. Patients undergoing chemoradiation were shown to have higher rates of cardiovascular complications after surgery. Based on these findings, the added benefit of external beam radiation in the neoadjuvant treatment of locally advanced esophageal adenocarcinoma remains unclear. Background: Locally advanced gastroesophageal junction adenocarcinoma (GEJ) is treated with either perioperative chemotherapy (CT) or preoperative radiochemotherapy (RCT) followed by surgery. The aim of this study was to compare pathologic response and long-term outcomes in junction adenocarcinoma treated with neoadjuvant RCT versus CT. Methods: All patients with locally advanced GEJ adenocarcinoma treated with neoadjuvant treatment (NAT) followed by surgery between 2009 and 2018 were retrospectively analyzed. Results: A total of 94 patients were included, 67 (71.2%) RCT and 27 (28.8%) CT. Complete pathologic response was more frequent in RCT patients (13.4% vs. 7.4%, p = 0.009) with a trend to better lymph node control (ypN0) (55.2% vs. 33.3%; p = 0.057). RCT offered no benefit in R0 resection (66.7% vs. 72.1% CT, p = 0.628) and was related to higher postoperative cardiovascular complications (35.8% vs. 11.1%; p = 0.017). Long-term overall and disease-free survival were similar (5-year OS 61.1% RCT vs. 75.7% CT, p = 0.259; 5-year DFS 33.5% RCT vs. 22.8% CT; p = 0.763). NAT type was neither independently associated with pathologic response nor long-term survival. Discussion: Patients with locally advanced GEJ adenocarcinoma treated with RCT had more postoperative cardiovascular complications but higher rates of complete pathologic response and a trend to superior locoregional lymph node control. This did not translate in a survival or recurrence benefit. [ABSTRACT FROM AUTHOR]

Background: Perioperative decrease of albumin (ΔAlb) appeared as a promising predictor of complications after digestive surgery, but its role after liver surgery remains unclear. This study aimed to analyze whether and how ΔAlb can be used to predict complications after liver surgery. Methods: A bicentric retrospective analysis of patients undergoing liver surgery (2010–2016) was performed, following TRIPOD guidelines. The preoperative and postoperative difference of albumin was calculated on POD 0 and defined as ΔAlb. Patients with any missing variable were excluded. The primary endpoint was overall complications according to the Clavien classification. A multiparametric algorithm based on ΔAlb was generated to optimize prediction performance. Results: A total of 110 patients were analyzed. At least one complication occurred in 66 (60%) patients. Patients with and without complication showed a ΔAlb of 15.8 vs. 9.5 g/L (p<0.001). Area under ROC curve (AUC) of ΔAlb was 0.75 (p<0.01.). The ΔAlb-based algorithm showed an AUC of 0.84 (p<0.01), significantly improving performance (p=0.03). Multivariable analysis identified ΔAlb as independent predictor of complications (HR, 1.12; 95% CI, 1.01–1.07; p = 0.002). Conclusions: ΔAlb appeared as a promising predictor independently associated with the risk of complication after liver surgery. The study presents a novel decision-tree based on ΔAlb to anticipate complications. [ABSTRACT FROM AUTHOR]

Background: The aim of the current study was to assess whether widely used nutritional parameters are correlated with the nutritional risk score (NRS-2002) to identify postoperative morbidity and to evaluate the role of nutritionists in nutritional assessment. Methods: A randomized trial on preoperative nutritional interventions (NCT00512213) provided the study cohort of 152 patients at nutritional risk (NRS-2002 ≥3) with a comprehensive phenotyping including diverse nutritional parameters (n=17), elaborated by nutritional specialists, and potential demographic and surgical (n=5) confounders. Risk factors for overall, severe (Dindo-Clavien 3-5) and infectious complications were identified by univariate analysis; parameters with P<0.20 were then entered in a multiple logistic regression model. Results: Final analysis included 140 patients with complete datasets. Of these, 61 patients (43.6%) were overweight, and 72 patients (51.4%) experienced at least one complication of any degree of severity. Univariate analysis identified a correlation between few (≤3) active co-morbidities (OR=4.94; 95% CI: 1.47-16.56, p=0.01) and overall complications. Patients screened as being malnourished by nutritional specialists presented less overall complications compared to the not malnourished (OR=0.47; 95% CI: 0.22-0.97, p=0.043). Severe postoperative complications occurred more often in patients with low lean body mass (OR=1.06; 95% CI: 1-1.12, p=0.028). Few (≤3) active co-morbidities (OR=8.8; 95% CI: 1.12-68.99, p=0.008) were related with postoperative infections. Patients screened as being malnourished by nutritional specialists presented less infectious complications (OR=0.28; 95% CI: 0.1-0.78), p=0.014) as compared to the not malnourished. Multivariate analysis identified few co-morbidities (OR=6.33; 95% CI: 1.75-22.84, p=0.005), low weight loss (OR=1.08; 95% CI: 1.02-1.14, p=0.006) and low hemoglobin concentration (OR=2.84; 95% CI: 1.22-6.59, p=0.021) as independent risk factors for overall postoperative complications. Compliance with nutritional supplements (OR=0.37; 95% CI: 0.14-0.97, p=0.041) and supplementation of malnourished patients as assessed by nutritional specialists (OR=0.24; 95% CI: 0.08-0.69, p=0.009) were independently associated with decreased infectious complications. Conclusions: Nutritional support based upon NRS-2002 screening might result in overnutrition, with potentially deleterious clinical consequences. We emphasize the importance of detailed assessment of the nutritional status by a dedicated specialist before deciding on early nutritional intervention for patients with an initial NRS-2002 score of ≥3. [ABSTRACT FROM AUTHOR]

Background As the long-term survival of pancreatic head malignancies remains dismal, efforts have been made for a better patient selection and a tailored treatment. Tumour size could also be used for patient stratification. Methods One hundred and fourteen patients underwent a pancreaticoduodenectomy for pancreatic adenocarcinoma, peri-ampullary and biliary cancer stratified according to: ≤20 mm, 21-34 mm, 35-45 mm and >45 mm tumour size. Results Patients with tumour sizes of ≤20 mm had a N1 rate of 41% and a R1/2 rate of 7%. The median survival was 3.4 years. N1 and R1/2 rates increased to 84% and 31% for tumour sizes of 21-34 mm ( P = 0.0002 for N, P = 0.02 for R). The median survival decreased to 1.6 years ( P = 0.0003). A further increase in tumour size of 35-45 mm revealed a further increase of N1 and R1/2 rates of 93% ( P < 0.0001) and 33%, respectively. The median survival was 1.2 years ( P = 0.004). Tumour sizes >45 mm were related to a further decreased median survival of 1.1 years ( P = 0.2), whereas N1 and R1/2 rates were 87% and 20%, respectively. Discussion Tumour size is an important feature of pancreatic head malignancies. A tumour diameter of 20 mm seems to be the cut-off above which an increased rate of incomplete resections and metastatic lymph nodes must be encountered and the median survival is reduced. [ABSTRACT FROM AUTHOR]

Aiming to develop and implement intervention strategies targeting pharmacological neuroenhancement (PN) among university students more specifically, we (1) assessed the prevalence of PN among German university students, (2) identified potential sociodemographic and study-related risk groups, and (3) investigated sociodemographic, psychological, study-related psychosocial, general psychosocial and health behavior related factors predicting the 12-month prevalence of PN. Therefore, a cross-sectional online survey was administered to students of the University of Mainz, Germany. A binary logistic regression with stepwise inclusion of the five variable groups was performed to predict PN. A total number of 4351 students out of 31,213 registered students (13.9%) participated in the survey, of which N = 3984 answered the question concerning PN. Of these, 10.4% had used one substance for PN at least once in the past 12 months. The regression analysis revealed 13 variables that were significantly related to the 12-month prevalence of PN. Specifically, the group of health behavior related variables showed the strongest relationship with PN. Therefore, an approach to the prevention of PN should be multifactorial so that it addresses social conditions, as well as education on substance use and healthy behaviors in terms of non-pharmacological strategies as alternatives of PN. [ABSTRACT FROM AUTHOR]