Search

Copyright of Bautechnik is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The design of composite compression members can be realized based on the General Method in accordance with Eurocode 4. This method represents a more sophisticated design based on advanced numerical analysis. It may be applied for any type of composite column. The General Method contains two steps; the first step is defined as the global nonlinear finite element analysis (GMNIA) accounting for all geometrical and physical nonlinear effect and considering geometrical and structural imperfection; while the second step represents the analysis on the cross‐section level, by N‐M interaction diagram to determine the overall safety factor γ0. EN1994‐1‐1 requires the N‐M‐Interaction based on the plastic resistance. However, often the General Method is provided for those section, where the plastic resistance is not representing the real behavior. Therefore, the question is discussed why the N‐M‐Interaction should not be developed based on the strain‐limited resistance considering the approaches for concrete stress‐strain curve in accordance with EN 1992‐1‐1 and for structural steel in accordance with prEN1993‐1‐14. In this paper, the application of general method is investigated for different type of composite columns with N‐M interaction diagram evaluated with plastic and strain‐limited resistance. Results are compared and discussed in terms of overall safety factor γ0. Conclusions are provided for the further development of the General Method in Eurocode 4. [ABSTRACT FROM AUTHOR]

The effectiveness of headed studs for shear transfer in the steel‐concrete interface of composite columns is questionable when important load needs to be transferred. Circular reinforced composite dowel (CRCD) connectors are known for their high initial stiffness and significant load‐bearing capacity. This paper presents the different types of CRCD connectors and the available analytical equations to determine their shear resistance, as well as a database of 52 experimental specimens to study their performance. The results show that the equations developed by Wang et al. 2014, He et al. 2016 and Zhao et al. 2016 provided the best performance, with 76% of the predictions falling within the error bounds of +/−15%. Further research is recommended to understand the behaviour of CRCD connectors on H‐shaped steel profiles and to develop analytical equations to calculate their resistance. [ABSTRACT FROM AUTHOR]

This paper presents the results of an experimental testing campaign performed to determine slip‐factor between the faying surfaces of shot‐blasted steel plates and state‐of‐the‐art friction shims. In total five experimental tests were performed as consistent with the provisions of EN1090‐2 Annex G to determine the slip‐factor between the faying surfaces. The results of the experimental test campaign showed that the surface roughness of the steel plates needs to be suitable for the selected type of the friction shims to enrich the slip‐resistance of the bolted‐connections. The test procedure was simulated with a commercial finite‐element analysis software, Abaqus, to compare the empirically determined slip‐factor and the penalty friction formulation of the software. It is shown that the slip‐factor definition of EN1090 – 2 Annex G fits in a very good agreement to the penalty friction formulation of the software to estimate the slip‐resistance of the bolted connections. The differences between the test results and the outputs of the finite element analysis are discussed in detail with a novel representation of non‐linear stick‐slip transition path for the slip‐resistant bolted connections. A further parametric study was performed to understand the impact of the geometric parameters on the slip‐resistance and the load‐slip behaviour of the faying surfaces. [ABSTRACT FROM AUTHOR]

In order to provide sustainable structural solution for the steel‐concrete downstand composite beams in buildings by providing modularity and reusability, new demountable shear connector device based on frictional behaviour is devised. The mechanical behaviour of the newly developed connector is investigated both experimentally and numerically and its applicability in aforementioned application is assessed. [ABSTRACT FROM AUTHOR]

The imperfections stemming from manufacturing or construction practices have effects on capacities of structural columns. Bow imperfections or residual stresses are commonly investigated and well known examples of these imperfections. Since the composite construction generally has different stages than reinforced concrete or steel construction, there are other sources of imperfections for this field. Different approaches to consider geometrical imperfections are studied for this paper. These are namely the approach of EN‐1992‐1‐1 [1],EN 1994‐1‐1 [2] and EN 13670 [3]. Eurocode 2 and Eurocode 4 specify geometric imperfection for columns differently. Former introduces them as load eccentricity and latter introduces them as bow imperfections. EN 13670 giving the construction tolerances for reinforced concrete structures, has different methods to limit geometrical imperfections. For the purpose of comparing different approaches and their effect on capacity calculations, several composite columns were simulated using physical and geometrical non‐linear analysis, their load‐deflection relationships were monitored and capacities compared. An outlook of the ongoing investigation for the adaptation of geometrical imperfection for composite columns is further discussed. [ABSTRACT FROM AUTHOR]

Composite column design in accordance with EN 1994‐1‐1 can be computed by the general method or by simplified methods. For the general method, EN 1994‐1‐1 refers to a 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 do it. Additional information may be found as non‐contradictory complementary information (NCI) in National Annexes (NA). This paper points out the procedure for the general method and refers to the changes and additional information provided by the draft of prEN 1994‐1‐1:2021. Furthermore, the modelling and computation by FE‐Analysis for several software applications are presented by implementing specified initial bow imperfections and predefined residual stresses for the steel section. The results obtained with the general method's approach are compared with that calculated by simplified method by the European buckling curves. In addition, the impact of different stress‐strain curves for concrete and strain limits introduced by Codes are investigated. [ABSTRACT FROM AUTHOR]

The second generation of Eurocode 4 has been developed through several project teams that report to CEN TC250 Subcommittee 4 (CEN/TC250/SC4) 'Design of composite steel and concrete structures', which is chaired by Dr Graham Couchman. Given that work on the revised version of Eurocode 4 is nearing completion, this paper presents a selection of the changes that will be included, together with some of the technical challenges that needed to be overcome. Finally, further enhancements that might be considered worthy for inclusion within future editions of this standard are presented. [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]

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]

Buckling is a complex phenomenon, influenced by the non‐linear material properties, as yielding of steel, cracking of concrete as well as, slenderness, geometrical imperfection and residual stresses. The design codes provide essential rules for mechanical resistance, stability and safety aspects. However, the current Eurocodes essentially stipulates engineering models that can easily be transferred to classical structural analysis, but often do not guide sufficiently the application and evaluation of advanced numerical analysis. The present study investigates the buckling analysis of steel and partial encased composite columns. Different definitions for geometrical imperfections and residual stresses are considered. The geometrical imperfections are taken into account in accordance with prEN1993‐1‐14 [2]and EN1090‐2 alternatively. The residual stresses are based on prEN1993‐1‐14 [2] and ECCS – Pub. No.33. In addition, analysis without the consideration of residual stresses are investigated. The scope is to assess the non‐linear finite element analysis (GMNIA), comparing the behavior of hot‐rolled and welded steel cross‐section as well as the impact of additional reinforced concrete encasement. Guidance for the numerical analysis for steel and composite columns is developed. [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]

Background: Enhanced recovery programs (ERP) demonstrated decreased postoperative complication rate and reduced length of stay (LOS). Recently, data on the financial impact revealed cost reduction for colorectal, liver and pancreatic surgery. The present study aimed to assess the cost-effectiveness of ERP in gastric surgery. Methods: ERP based on enhanced recovery after surgery (ERAS®) society guidelines was implemented in our institution, in June 2014. Consecutive patients undergoing gastric surgery after ERP implementation (n = 71) were compared to a control group of consecutive patients operated before ERP implementation (n = 58). Primary endpoint was cost-effectiveness including detailed perioperative costs. Secondary endpoints were postoperative complications and LOS. Standard statistical testing (means, Mann–Whitney Fisher's exact T test or Pearson Chi-square test) was used. Results: Both groups were comparable regarding demographic details. Mean (SD) overall costs per patient were lower in the ERP group (€33,418 (17,901) vs €39,804 (27,288), P = 0.027). Lower costs were found for anesthesia and operating room (−€2 356), intensive or intermediate care (−€8 629), medication (−€1 196)), physiotherapy (−€611), laboratory (−€1 625)) and blood transfusion (−€977). Overall complication rates in ERP and control group (51% vs 62%, P = 0.176) were similar. Mean length of stay (SD) (14(13) days vs 17(11) days, P = 0.037) was shorter in the ERP group. Conclusion: ERP significantly reduces overall, preoperative and postoperative costs in patients undergoing major gastric surgery. [ABSTRACT FROM AUTHOR]

In order to improve sustainability of composite structures and promote the principles of circular economy in construction industry, novel demountable shear connector based on the frictional behavior was developed within the framework of Work package 2 of parent project ECON4SD (Eco Construction for Sustainable Development) at the University of Luxembourg. The demountable composite floor system is composed out of modular concrete one‐way solid slabs with equidistantly embedded Halfen HTA‐CE rail channels, double symmetric steel I section and demountable connector device assembly based on HV high strength structural bolts for preloading that provides the demountable shear connection. In this paper trilinear behavior model is proposed for the force‐slip behavior of aforementioned connector device complying to the results of the push test experimental campaign and the results of FEA simulations. Afterwards, parametric study is performed on the range of simply supported composite beams in propped and unpropped condition under uniformly distributed load applying the aforementioned shear connection validating the predictability of the composite beam bending behavior in accordance with the rules of EN 1994‐1‐1. [ABSTRACT FROM AUTHOR]

Composite columns provide many advantages for the application in multi‐story and high‐rise buildings. However, EN 1994‐1‐1 does not provide rules for the design of circular concrete sections with fully encased steel profiles according to the simplified methods. Normally, the simplified method for the design of composite columns is based on a normal force‐moment interaction diagram which assumes plastic cross‐section resistance. However, the moment resistance is to be reduced by a reduction factor αM, considering among other the difference between strain‐limited and plastic moment resistance. This reduction factor is developed and calibrated for composite compression members with concrete encased sections, partially encased sections and concrete filled rectangular and circular tubes. Comparison of plastic moment resistance to results based on strain limitation show that the application for circular section with encased steel section but without a steel tube may lead to unsafe results. The paper discusses different approaches for the determination of the N‐M Interaction curve and the design on cross‐section level. The results obtained from these methods are then compared to each other for different dimensions of cross‐sections of circular columns; and for different ratios of reinforcements, various steel grades and for normal and high strength concretes. Furthermore, the investigation focuses on the validation of the reduction factor αM and shows for which section types the values according to Eurocode 4 cannot be applied. [ABSTRACT FROM AUTHOR]

Slim‐floor beams which have the steel sections fully or partially integrated into the concrete slab lead to a significant reduction of the construction height. Due to its flat lower surface, it provides favourable solution for technical installation. According to EN1994‐1‐1, for composite beams plastic moment resistance is assumed. In the case of slim‐floor sections, due to the reduced construction height by the integration of the steel beam in the concrete and its extended bottom flange, a large compression zone height may be expected, thus concrete failure in the compression zone may happen before reaching the plastic moment resistance Mpl,Rd. Here, strain limit resistance becomes decisive. For design with partial shear connection, EN1994‐1‐1 provides the partial shear diagram based on the plastic bending resistance Mpl,Rd which is not always suitable for slim‐floor beams. Based on strain limited method, the more suitable partial shear diagram of different slim‐floor beams can be developed. From parametric studies of different types of slim‐floor beams, the impacts of critical parameters on the design are highlighted, and the limitations of the current plastic resistance based partial shear diagram are suggested. A simplified calculation method for situation beyond the limitation are also proposed to guarantee an economical design of those beams. [ABSTRACT FROM AUTHOR]

Advanced design methods are becoming more important for the structural analysis. However, their results depend strongly on the quality of the numerical model and its underlying assumptions. Current Eurocode 4 does not provide clear guidance for this analysis type. A literature review on the compression tests conducted on concrete encased steel composite columns is presented. It was found out that there is a lack in the literature when it comes to the testing of slender composite columns as opposed to numerous tests done on stub columns. A selection of existing specimen tests are then simulated using finite element analysis software ABAQUS. Nonlinearity in the model was defined through materials and geometry. The interface modelling between steel and concrete as well as the modelling of load introduction are discussed. The finite element model was intended to be as generic as possible so that it can be taken as a basis for future parameter studies. Moreover, the column resistance check using interaction curves was discussed. Different approaches to form interaction curves namely strain limitation and plastic section capacity were compared. [ABSTRACT FROM AUTHOR]

10.1007/s00268-022-06725-4. 36520177 2 Kuligowska A, O'Connor-Manson M, Perin G. Letter to the Editor: drain versus no drain in open mesh repair for incisional hernia results of a prospective randomized controlled trial. Size will influence the way the repair will be performed: IPOM for small hernia (< 5 cm), eTEP for larger hernia and TAR - Transversus Abdominis Release for large hernia requiring component separation. [Extracted from the article]

This study investigates moment redistribution phenomenon for pin ended double‐span steel‐concrete continuous composite beams and arise a question about moment redistribution for the continuous beams subjected to partially distributed or concentrated loading conditions. The overall objective of the study is to propose a methodology to fulfil the technical gaps adopted by Eurocode‐4, which considers the redistribution for only uniformly load condition. A robust iterative algorithm is developed to obtain moment‐curvature relations of the standard composite cross‐sections. Flexural stiffness‐curvature relations of the cross‐sections are predicted through the moment‐curvature relations. Flexural stiffness distribution along the composite beams is determined with curvature compatibility. Fourth order differential load‐deflection equation is evaluated with finite difference solution scheme for continuous beam conditions and variable flexural stiffness along the beam length. A non‐iterative incremental load‐deflection algorithm is developed to calculate moment distribution in continuous beams with variable flexural stiffness. A benchmark example is solved with Eurocode‐4 provisions to validate the developed algorithms. Moment redistribution from hogging (negative) zone to sagging (positive) zone of uniformly loaded double‐span continuous composite beam is illustrated considering the degree of flexural stiffness degradation in the composite medium. A question is arisen for moment redistribution in the continuous beams subjected to partially distributed or concentrated loading conditions. [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]

Background: Standardized quality indicators assessing avoidable readmission become increasingly important in health care. They can identify improvements area and contribute to enhance the care delivered. However, the way of using them in practice was rarely described.Methods: Retrospective study uses prospective inpatients' information. Thirty-day readmissions were deemed potentially avoidable or non-avoidable by a computerized algorithm, and annual rate was reported between 2010 and 2014. Observed rate was compared to expected rate, and medical record review of potentially avoidable readmissions was conducted on data between January and June 2014.Results: During a period of ten semesters, 11,011 stays were screened by the algorithm and a potentially avoidable readmission rate (PAR) of 7% was measured. Despite stable expected rate of 5 ± 0.5%, an increase was noted concerning the observed rate since 2012, with a highest value of 9.4% during the first semester 2014. Medical chart review assessed the 109 patients screened positive for PAR during this period and measured a real rate of 7.8%. The delta was in part due to an underestimated case mix owing to sub-coded comorbidities and not to health care issue.Conclusions: The present study suggests a methodology for practical use of data, allowing a validated quality of care indicator. The trend of the observed PAR rate showed a clear increase, while the expected PAR rate was stable. The analysis emphasized the importance of adequate "coding chain" when such an algorithm is applied. Moreover, additional medical chart review is needed when results deviate from the norm. [ABSTRACT FROM AUTHOR]

Background: Tumor recurrence during the first year after oncological esophagectomy has been reported in up to 17-66% of patients. However, little is known as to the risk factors potentially associated with this adverse outcome. The aim of this retrospective observational study was to identify clinically relevant parameters associated with early recurrence.Methods: All patients with squamous cell cancer or adenocarcinoma of the esophagus or gastroesophageal junction, operated with curative intent in our center from 2000 to 2014, were screened for this study. Univariate analysis was conducted to identify variables potentially associated with early recurrence, and clinically relevant parameters with P < 0.1 were included in multiple logistic regression. Survival analyses were conducted with the Kaplan-Meier method. Significance threshold was set at P < 0.05.Results: Among the 164 included patients, 46 (28%) presented early recurrence. Eight patients (17.4%) had locoregional and 38 patients (82.6%) metastatic recurrence. Advanced T and N stages, lymph node capsular effraction, a high positive-to-resected lymph node ratio, positive resection margins, poor response to neoadjuvant treatment, preoperative active smoking, malnutrition and dysphagia were associated with early recurrence on a univariate level. In multivariable analysis, preoperative smoking (OR 2.76, 95% CI 1.28-6.17), pT stage (OR 1.72, 95% CI 1.18-2.58) and an increased positive-to-resected lymph node ratio (OR 6.72, 95% CI 1.08-48.51) remained independently associated with ER.Conclusion: Our study identified both patient- and tumor-related parameters as risk factors for early recurrence after oncological esophagectomy. Of particular interest, active smoking was significantly associated with this adverse outcome, highlighting the importance of preoperative smoking cessation. [ABSTRACT FROM AUTHOR]

Abstract: In this article, the design of composite beams in steel and concrete based on EN1994‐1‐1 and Chinese JGJ138‐2016 is compared. In general, design according to Eurocode 4 is more detailed. Differences of effective width between both codes are explained in theory and through parameter studies. Allowance for moment redistribution is also compared. For bending moment resistance, the comparison is carried out with a parameter study on single span beams. For longitudinal shear design, the resistance of shear studs, minimum shear connection degree, the arrangement of shear studs, longitudinal shear resistance in concrete slabs based on both codes are compared. [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]

Background: Enhanced recovery after surgery (ERAS) programs have been shown to ease the postoperative recovery and improve clinical outcomes for various surgery types. ERAS cost-effectiveness was demonstrated for colorectal surgery but not for liver surgery. The present study aim was to analyze the implementation costs and benefits of a specific ERAS program in liver surgery. Methods: A dedicated ERAS protocol for liver surgery was implemented in our department in July 2013. The subsequent year all consecutive patients undergoing liver surgery were treated according to this protocol (ERAS group). They were compared in terms of real in-hospital costs with a patient series before ERAS implementation (pre-ERAS group). Mean costs per patient were compared with a bootstrap T test. A cost-minimization analysis was performed. Results: Seventy-four ERAS patients were compared with 100 pre-ERAS patients. There were no significant pre- and intraoperative differences between the two groups, except for the laparoscopy number ( n = 18 ERAS, n = 9 pre-ERAS, p = 0.010). Overall postoperative complications were observed in 36 (49 %) and 64 patients (64 %) in the ERAS and pre-ERAS groups, respectively ( p = 0.046). The median length of stay was significantly shorter for the ERAS group (8 vs. 10 days, p = 0.006). The total mean costs per patient were €38,726 and €42,356 for ERAS and pre-ERAS ( p = 0.467). The cost-minimization analysis showed a total mean cost reduction of €3080 per patient after ERAS implementation. Conclusions: ERAS implementation for liver surgery induced a non-significant decrease in cost compared to standard care. Significant decreased complication rate and hospital stay were observed in the ERAS group. [ABSTRACT FROM AUTHOR]

Background: To study the 'metabolic profile' of different surgical procedures and correlate it with pertinent surgical details and postoperative complications. Methods: We conducted a prospective pilot study of 70 patients, ten for each of the seven following groups: (1) laparoscopic cholecystectomy, (2) incisional hernia repair, (3) laparoscopic and (4) open colon surgery, (5) upper gastrointestinal, (6) hepatic, and (7) pancreatic resections. Biochemical assessment included white blood cell count (WBC), C-reactive protein (CRP), glucose, triglycerides (TG), albumin (Alb), and pre-albumin (Pre-Alb), from the day before surgery until 5 days thereafter. Biological markers were compared for major versus minor surgery groups, which were defined on a clinical basis. Univariable analysis was used to identify risk factors for postoperative complications and p < 0.05 was the significance threshold. Results: Common findings in all surgery groups were the acute inflammatory response (↑: WBC, CRP, ↓: TG, Alb, pre-Alb). Using cut-off values of 240 min operative (OR) time and 300 ml estimated blood loss (EBL), laparoscopic cholecystectomy, incisional hernia repair, and laparoscopic colectomy could be distinguished from open colectomy, upper gastrointestinal, liver, and pancreas resections. In a biochemical level, increased CRP and reduced postoperative Alb levels were highly discriminative of all types of 'major surgery.' Significant risk factors for postoperative complications were age, male gender, malignancy, longer OR time, higher blood loss, high CRP, and low Alb levels. Conclusions: Biochemically, CRP and Alb levels can help quantify the magnitude of the surgical trauma, which is correlated with adverse outcomes. [ABSTRACT FROM AUTHOR]

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]

Background: Despite progress in multidisciplinary treatment of esophageal cancer, oncologic esophagectomy is still the cornerstone of therapeutic strategies. Several scoring systems are used to predict postoperative morbidity, but in most cases they identify nonmodifiable parameters. The aim of this study was to identify potentially modifiable risk factors associated with complications after oncologic esophagectomy. Methods: All consecutive patients with complete data sets undergoing oncologic esophagectomy in our department during 2001-2011 were included in this study. As potentially modifiable risk factors we assessed nutritional status depicted by body mass index (BMI) and preoperative serum albumin levels, excessive alcohol consumption, and active smoking. Postoperative complications were graded according to a validated 5-grade system. Univariate and multivariate analyses were used to identify preoperative risk factors associated with the occurrence and severity of complications. Results: Our series included 93 patients. Overall morbidity rate was 81 % ( n = 75), with 56 % ( n = 52) minor complications and 18 % ( n = 17) major complications. Active smoking and excessive alcohol consumption were associated with the occurrence of severe complications, whereas BMI and low preoperative albumin levels were not. The simultaneous presence of two or more of these risk factors significantly increased the risk of postoperative complications. Conclusions: A combination of malnutrition, active smoking and alcohol consumption were found to have a negative impact on postoperative morbidity rates. Therefore, preoperative smoking and alcohol cessation counseling and monitoring and improving the nutritional status are strongly recommended. [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]

Background: Survival after pancreatic head adenocarcinoma surgery is determined by tumor characteristics, resection margins, and adjuvant chemotherapy. Few studies have analyzed the long-term impact of postoperative morbidity. The aim of the present study was to assess the impact of postoperative complications on long-term survival after pancreaticoduodenectomy for cancer. Methods: Of 294 consecutive pancreatectomies performed between January 2000 and July 2011, a total of 101 pancreatic head resections for pancreatic ductal adenocarcinoma were retrospectively analyzed. Postoperative complications were classified on a five-grade validated scale and were correlated with long-term survival. Grade IIIb to IVb complications were defined as severe. Results: Postoperative mortality and morbidity were 5 and 57 %, respectively. Severe postoperative complications occurred in 16 patients (16 %). Median overall survival was 1.4 years. Significant prognostic factors of survival were the N-stage of the tumor (median survival 3.4 years for N0 vs. 1.3 years for N1, p = 0.018) and R status of the resection (median survival 1.6 years for R0 vs. 1.2 years for R1, p = 0.038). Median survival after severe postoperative complications was decreased from 1.9 to 1.2 years ( p = 0.06). Median survival for N0 or N1 tumor or after R0 resection was not influenced by the occurrence and severity of complications, but patients with a R1 resection and severe complications showed a worsened median survival of 0.6 vs. 2.0 years without severe complications ( p = 0.0005). Conclusions: Postoperative severe morbidity per se had no impact on long-term survival except in patients with R1 tumor resection. These results suggest that severe complications after R1 resection predict poor outcome. [ABSTRACT FROM AUTHOR]

Background: Protocols for enhanced recovery provide comprehensive and evidence-based guidelines for best perioperative care. Protocol implementation may reduce complication rates and enhance functional recovery and, as a result of this, also reduce length-of-stay in hospital. There is no comprehensive framework available for pancreaticoduodenectomy. Methods: An international working group constructed within the Enhanced Recovery After Surgery (ERAS) Society constructed a comprehensive and evidence-based framework for best perioperative care for pancreaticoduodenectomy patients. Data were retrieved from standard databases and personal archives. Evidence and recommendations were classified according to the GRADE system and reached through consensus in the group. The quality of evidence was rated 'high', 'moderate', 'low' or 'very low'. Recommendations were graded as 'strong' or 'weak'. Results: Comprehensive guidelines are presented. Available evidence is summarised and recommendations given for 27 care items. The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations. Conclusions: The present evidence-based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy. A unified protocol allows for comparison between centres and across national borders. It facilitates multi-institutional prospective cohort registries and adequately powered randomised trials. [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]

The article presents a study which evaluated the role of CCL18 as a biomarker of disease activity in idiopathic interstitial pneumonias (IIPs) and systemic sclerosis (SSc) with lung involvement. The results of a study suggest that CCL18 production by BAL cells and serum CCL18 concentrations reflect pulmonary fibrotic activity in patients with IIPs and those with SSc.

Background: Patients with alcoholic liver cirrhosis have reduced hepatic glycogen stores but the mechanisms leading to this finding are not clear. Methods: We therefore determined the hepatic glycogen content in patients with alcoholic (n = 9) or biliary cirrhosis (n = 8), and in control patients undergoing liver surgery (n = 14). All patients were in the postabsorptive state. In addition, we performed a morphometric analysis of the livers, and measured activities and mRNA expression of several enzymes involved in glycogen metabolism. Cirrhotic and control patients were similar regarding age and body weight. Results: Cirrhotic patients had a reduced glycogen content per gram liver wet weight (17 ± 11 versus 45 ± 17 mg/g, P < 0.05), per milliliter hepatocytes (28 ± 16 versus 52 ± 21 mg/ml, P < 0.05) and per liver (28 ± 17 versus 64 ± 22 g, P < 0.05), the reduction being observed in both patients with alcoholic or biliary cirrhosis. Liver histology confirmed these findings and revealed that the decrease in liver glycogen in cirrhotic patients was not homogenous across cirrhotic lobules. Activities of glycogen synthase and phosphorylase (total activity and active form) were not different between cirrhotic and control patients, whereas hepatic mRNA expression was decreased in cirrhotics by approximately 50%. The activity of glucokinase was decreased in cirrhotic as compared in control patients (0.06 ± 0.30 versus 0.42 ± 0.21 U/ml hepatocytes, P < 0.05), the reduction being observed in both patients with alcoholic or biliary cirrhosis. Conclusions: We conclude that patients with alcoholic or biliary cirrhosis have decreased hepatic glycogen stores per volume of hepatocytes and per liver. Decreased activity of glucokinase may represent an important mechanism leading to this finding. [ABSTRACT FROM AUTHOR]

Bile duct injury (BDI) during laparoscopic cholecystectomy (LC) which may result in patient disability or death are reported to occur more frequently when compared to open surgery. The aim of this nationwide prospective study beyond the laparoscopic learning curve was to analyze the incidence, risk factors, and management of major BDI. During a 3-year period (1995–1997) 130 items of all LC data were collected on a central computer system from 84 surgical institutions in Switzerland by the Swiss Association of Laparoscopic and Thoracoscopic Surgery and evaluated for major BDIs. Simple biliary leakage was excluded from analysis. There were 12,111 patients with a mean age of 55 years (3–98 years) enrolled in the study. The overall BDI incidence was 0.3%, 0.18% for symptomatic gallstones, and 0.36% for acute cholecystitis. In cases of severe chronic cholecystitis with shrunken gallbladder, the incidence was as high as 3%. Morbidity and mortality rates were significantly increased in BDIs. BDI was recognized intraoperatively in 80.6%, in 64% of cases by help of intraoperative cholangiography. Immediate surgical repair was performed laparoscopically (suture or T-drainage) in 21%; in 79%, open repair (34% simple suture, 66% Roux-en-Y reconstruction) was needed. The BDI incidence did not decrease during the last 7 years. In 47%, BDIs were caused by experienced laparoscopic surgeons, perhaps because they tend to operate on more difficult patients. In conclusion, the incidence of major BDIs remains constant in Switzerland at a level of 0.3%, which is still higher when compared to open surgery. However, most cases are now detected intraoperatively and immediately repaired which ensures a good long-term outcome. For preventing such injuries, exact anatomical knowledge with its variants and a meticulous surgical dissecting technique especially in case of acute inflammation or shrunken gallbladder are mandatory. [ABSTRACT FROM AUTHOR]

Ribosomal proteins L2, L3 and L4, together with the 23S RNA, are the main candidates for catalyzing peptide bond formation on the 50S subunit. That L2 is evolutionarily highly conserved led us to perform a thorough functional analysis with reconstituted 50S particles either lacking L2 or harboring a mutated L2. L2 does not play a dominant role in the assembly of the 50S subunit or in the fixation of the 3′-ends of the tRNAs at the peptidyl-transferase center. However, it is absolutely required for the association of 30S and 50S subunits and is strongly involved in tRNA binding to both A and P sites, possibly at the elbow region of the tRNAs. Furthermore, while the conserved histidyl residue 229 is extremely important for peptidyl-transferase activity, it is apparently not involved in other measured functions. None of the other mutagenized amino acids (H14, D83, S177, D228, H231) showed this strong and exclusive participation in peptide bond formation. These results are used to examine critically the proposed direct involvement of His229 in catalysis of peptide synthesis. [ABSTRACT FROM AUTHOR]

A reply by authors on comments made on their article on assessing the implementation costs of an Enhanced Recovery After Surgery (ERAS) program in liver surgery is presented.

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.