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Aims: Outcomes for patients with oesophago-gastric cancer are variable across Europe. The reasons for this variability are not clear. The aim of this study was to describe and analyse clinical pathways to understand differences in service provision for oesophageal and gastric cancer in the countries participating in the EURECCA Upper GI group., Methods: A questionnaire was devised to assess clinical presentation, diagnosis, staging, treatment, pathology, follow-up and service frameworks across Europe for patients with oesophageal and gastric cancer. The questionnaire was issued to experts from 14 countries. The responses were analysed quantitatively and qualitatively and compared., Results: The response rate was (10/14) 71.4%. The approach to diagnosis was similar. Most countries established a diagnosis within 3 weeks of presentation. However, there were different approaches to staging with variable use of endoscopic ultrasound reflecting availability. There has been centralisation of treatments in most countries for oesophageal surgery. The most consistent area was the approach to pathology. There were variations in access to specialist nurse and dietitian support. Although most countries have multidisciplinary teams, their composition and frequency of meetings varied. The two main areas of significant difference were research and audit and overall service provision. Observations on service framework indicated that limited resources restricted many of the services., Conclusion: The principle approaches to diagnosis, treatment and pathology were similar. Factors affecting the quality of patient experience were variable. This may reflect availability of resources. Standard pathways of care may enhance both the quality of treatment and patient experience., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Purpose: This study explores the applicability of registry data as a proxy for perceived stress by examining the association between perceived stress measured in health surveys and registry data., Methods: Of 35,700 randomly invited participants from the 2010 Health Survey in the North Denmark Region (age 16-99 years), 21,842 answered 10 items from Cohen's Perceived Stress Scale. Respondents were divided into quartiles based on their stress score. Survey information was individually linked to national registries containing information on prescribed psychiatric medication and consultations with psychologists or psychiatrists from 2009 to 2011., Results: The percentage of persons with prescriptions or consultations was higher (37.6%) in the highest stress score group, compared with the lowest stress score group (7.7%). Odds ratio (95% confidence interval) for the highest score compared with the lowest score was 7.3 (6.5-8.1). Different combinations of treatment showed low sensitivity (8.7%-37.6%), positive predictive value (49.4%-56.8%), and positive agreement (16.2%-42.7%) were found, whereas specificity (88.5%-98.0%) and negative agreement (85.5%-87.2%) were higher. Kappa measure showed slight to fair agreement (0.104-0.285)., Conclusions: Participants reporting high perceived stress were more often prescribed medications and referred for consultations with psychologists or psychiatrists. However, due to low predictive values, registry data may not be suitable as a proxy for perceived stress., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Previous studies found that thermally dried biosolids contained more mineralisable organic nitrogen (N) than the raw or anaerobically digested (AD) biosolids they were derived from. However, the effect of thermal drying temperature on biosolid N availability is not well understood. This will be of importance for the value of the biosolids when used to fertilise crops. We sourced AD biosolids from a Danish waste water treatment plant (WWTP) and dried it in the laboratory at 70, 130, 190 or 250 °C to >95 % dry matter content. Also, we sourced biosolids from the WWTP dried using its in-house thermal drying process (input temperature 95 °C, thermal fluid circuit temperature 200 °C, 95 % dry matter content). The drying process reduced the ammonium content of the biosolids and reduced it further at higher drying temperatures. These findings were attributed to ammonia volatilisation. The percentage of mineralisable organic N fraction (min-N) in the biosolids, and nitrous oxide (N2O) and carbon dioxide (CO2) production were analysed 120 days after addition to soil. When incubated at soil field capacity (pF 2), none of the dried biosolids had a greater min-N than the AD biosolids (46.4 %). Min-N was lowest in biosolids dried at higher temperatures (e.g. 19.3 % at 250 °C vs 35.4 % at 70 °C). Considering only the dried biosolids, min-N was greater in WWTP-dried biosolids (50.5 %) than all of the laboratory-dried biosolids with the exception of the 70 °C-dried biosolids. Biosolid carbon mineralisation (CO2 release) and N2O production was also the lowest in treatments of the highest drying temperature, suggesting that this material was more recalcitrant. Overall, thermal drying temperature had a significant influence on N availability from the AD biosolids, but drying did not improve the N availability of these biosolids in any case.

A number of root and root hair traits have been proposed as important for nutrient acquisition. However, there is still a need for knowledge on which traits are most important in determining macro- and micronutrient uptake at low soil fertility. This study investigated the variations in root growth vigor and root hair length (RHL) and density (RHD) among spring wheat genotypes and their relationship to nutrient concentrations and uptake during early growth. Six spring wheat genotypes were grown in a soil with low nutrient availability. The root and root hair traits as well as the concentration and content of macro- and micronutrients were identified. A significant genetic variability in root and root hair traits as well as nutrient uptake was found. Fast and early root proliferation and long and dense root hairs enhanced uptake of macro- and micronutrients under low soil nutrient availability. Vigorous root growth, however, was a better indicator of early nutrient acquisition than RHL and RHD. Vigorous root growth and long and dense root hairs ensured efficient acquisition of macro- and micronutrients during early growth and a high root length to shoot dry matter ratio favored high macronutrient concentrations in the shoots, which is assumed to be important for later plant development.

Organic fertilisation inevitably leads to heterogeneous distribution of organic matter and nutrients in soil, i.e. due to uneven surface spreading or inhomogeneous incorporation. The resulting localised hotspots of nutrient application will induce various biotic and abiotic nutrient turnover processes and fixation in the residue sphere, giving rise to distinct differences in nutrient availability, soil oxygen content and greenhouse gas (GHG) production. In this study we investigated the spatiotemporal dynamics of the reaction of manure solids and manure solids char with soil, focusing on their phosphorus (P) availability, as current emphasis on improving societal P efficiency through recycling waste or bio-based fertilisers necessitates a sound understanding of their behaviour. Soil layers amended at a constant P application rate with either pig manure solids or char made from pig manure solids were incubated for three weeks between layers of non-amended, P-depleted soil. Spatial and temporal changes in and around the amendment layers were simultaneously investigated in this study using a sandwich sensor consisting of a planar oxygen optode and multi-element diffusive gradients in thin films (DGT) gels, combined with GHG emission measurements. After three weeks of incubation, the soil containing a layer amended with manure solids had a lower overall O2 content and had emitted significantly more CO2 than the non-amended control or the char-amended soil. The P availability from manure solids was initially higher than that from the char, but decreased over time, whereas from the char-amended layer P availability increased in the same period. In both treatments, increases in P availability were confined to the amended soil layer and did not greatly affect P availability in the directly adjacent soil layers during the three-week incubation. These results highlight the importance of placing organic P fertilisers close to where the plant roots will grow in order to facilitate optimal fertiliser use efficiency., (Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.)

The combined effects of pig slurry acidification, subsequent separation techniques and biochar production from the solid fraction on N mineralisation and N2O and CO2 emissions in soil were investigated in an incubation experiment. Acidification of pig slurry increased N availability from the separated solid fractions in soil, but did not affect N2O and CO2 emissions. However acidification reduced soil N and C turnover from the liquid fraction. The use of more advanced separation techniques (flocculation and drainage > decanting centrifuge > screw press) increased N mineralisation from acidified solid fractions, but also increased N2O and CO2 emissions in soil amended with the liquid fraction. Finally, the biochar production from the solid fraction of pig slurry resulted in a very recalcitrant material, which reduced N and C mineralisation in soil compared to the raw solid fractions., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background and Aim: Gastroesophageal junction cancer is one of the leading causes to cancer-related death and the prognosis is poor. However, progress has been made over the last couple of decades with the introduction of multimodality treatment and optimized surgery. Three-year survival rates have improved to 50% in patients receiving neoadjuvant therapy. Only a few studies have focused on the difference of postoperative complications in patients receiving neoadjuvant therapy in relation to a comparative surgery-only group. The aim of this study was to compare the prevalence of postoperative complications of patients with cancer at the gastroesophageal junction treated with either neoadjuvant chemotherapy or surgery alone in patients from "The Danish Clinical Registry of Carcinomas of the Esophagus, the Gastro-Esophageal Junction and the Stomach.", Materials and Methods: A historical follow-up study, comparing postoperative complications between two cohorts before and after implementation of chemotherapy was completed., Results: In all, 180 consecutive patients treated with perioperative chemotherapy and a comparative surgery-only group of patients were identified from The Danish Clinical Registry of Carcinomas of the Esophagus, the Gastro-Esophageal Junction and the Stomach. No difference was found in demographics between the two groups, except for alcohol consumption and a lower T and N stage in the surgery-only group, and no difference in complication rates was found. Furthermore, no variable in the multivariate analysis was significantly associated with anastomotic leakage which was considered the most severe complication., Conclusion: Since perioperative chemotherapy does not appear to increase surgical complications, the future challenges include defining the optimal combination of chemo- and/or radiotherapy, but more importantly also to select the patients who will benefit the most from the different neoadjuvant strategies., (© The Finnish Surgical Society 2015.)

Drying of solids produced from digestate is prone to N losses through NH3 volatilisation. The applicability of acidification as an NH3 emission mitigation technique during the drying of solids from digestate was assessed in a drying experiment. Operating conditions comprised four drying temperatures (70-160°C), two air ventilation rates (natural, 420ml/min) and three pH levels (9.2, 6.5 and 5.5) of the solids, modified by the addition of concentrated sulphuric acid. Acidification of the solids from digestate significantly decreased the NH3 emission during drying, irrespective of the drying conditions. A parallel decrease in the organic nitrogen content and an increase in the ammonium content of the solids was observed after acidification of the solids. It was confirmed that acidification before thermal concentration of solids from digestate, minimised NH3 losses under a wide range of drying conditions., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Biochemical methane potential (BMP) is a very important characteristic of a given feedstock for optimisation of its use in biogas production. However, the long digestion time needed to determine BMP is the main limitation for the use of this assay during the operation of anaerobic digesters to produce biogas. Fourier transform mid-infrared photoacoustic spectroscopy (FTIR-PAS) was used to predict the BMP of 87 plant biomasses. The developed calibration model was able to explain 81% of the variance in the measured BMP of a selected test set with a root mean square error (RMSE) of 40NLCH4kg(-1) of volatile solids (VS) and a ratio of performance to deviation (RPD) of 2.38. The interpretation of the regression coefficients used in the calibration revealed a positive correlation of BMP with easily degradable compounds (amorphous cellulose, hemicellulose and aliphatic compounds) and a negative correlation with inhibitors of cellulose hydrolysis (lignin, hemicellulose)., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Industrial use of aniline is increasing worldwide with production estimated to surpass 5.6 million metric tons in 2016. Exposure to aniline occurs via air, diet, and water augmenting the risk of exposing a large number of individuals. Early observations suggest that aniline is metabolized to paracetamol/acetaminophen, likely explaining the omnipresence of low concentrations of paracetamol in European populations. This is of concern as recent studies implicate paracetamol as a disrupter of reproduction. Here, we show through steroidogenic profiling that exposure to aniline led to increased levels of the Δ4 steroids, suggesting that the activity of CYP21 was decreased. By contrast, paracetamol decreased levels of androgens likely through inhibition of CYP17A1 activity. We confirm that aniline in vivo is rapidly converted to paracetamol by the liver. Intrauterine exposure to aniline and paracetamol in environmental and pharmaceutical relevant doses resulted in shortening of the anogenital distance in mice, a sensitive marker of fetal androgen levels that in humans is associated with reproductive malformations and later life reproductive disorders. In conclusion, our results provide evidence for a scenario where aniline, through its conversion into antiandrogenic paracetamol, impairs male reproductive development., (© The Author 2015. Published by Oxford University Press on behalf of the Society of Toxicology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Background: Fast-track TKA has significantly shortened the time available for physiotherapists to optimize knee ROM before discharge. Safety aspects concerning knee stiffness and the need for manipulation in a fast-track setting need to be illuminated. The study aims were to analyze if fast-track TKA can be considered safe considering rates of knee manipulation and if there is an association between knee ROM at time of discharge and the need for later manipulation., Methods: Primary TKAs operated in 2011 at our institution were eligible for inclusion. The study group consisted of 359 TKAs., Results: Manipulation of the knee was performed in 21 of 359 TKAs (5.8%). Seventy-one percent were discharged with a flexion ≥70° combined with an extension deficit of ≤10°. The occurrence of MUA for these patients was 4.3%. The prevalence of knee manipulation showed a statistically significant association with the achieved knee flexion at discharge (p=0.02). Median length of stay was two days., Conclusion: Compared with literature findings fast-track TKA surgery may be considered safe based on the acceptable rate of knee manipulations after TKA (5.8%). We suggest ROM of ≥70° flexion combined with an extension deficit of ≤10° as an "optimal-zone" for ROM at discharge. The reason for this is the low occurrence of MUA (4.3%) in relation to the large amount of TKAs it represents (71%). The indication for MUA is multifactorial and ROM at discharge serves only as an indicator of later MUA risk., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objective: Intrathoracic anastomotic leakage after intended curative resection for cancer in the esophagus or gastroesophageal junction has a negative impact on long-term survival. The aim of this study was to investigate whether an anastomotic leakage was associated with an increased recurrence rate., Methods: This nationwide study included consecutively collected data on patients undergoing curative surgical resection with intrathoracic anastomosis, alive 8 weeks postoperatively, between 2003 and 2011. Patients with incomplete resection, or metastatic disease intraoperatively, were excluded. Only biopsy-proven recurrences were accepted., Results: In total, 1085 patients were included. The frequency of anastomotic leakage was 8.6%. The median follow-up time was 29 months (interquartile range [IQR]: 13-58 months). Overall, 369 (34%) patients had disease recurrence, of which 346 patients died of recurrent gastroesophageal carcinoma. Twenty-three patients were alive with recurrence at the censoring date. In the study period, 333 patients died without signs of recurrent disease. The overall median time to recurrence was 66 weeks (IQR: 38-109 weeks). Distant metastases were found in 267 (25%), and local disease recurrence in 102 (9%) patients. Overall, 5-year disease-free survival in patients with leakage was 27%, versus 39% in those without leakage (P = .017). Anastomotic leakage was independently associated with higher risk of recurrence (hazard ratio [HR] = 1.63; 95% confidence interval [CI]: 1.17-2.29, P = .004) and all-cause mortality (HR = 1.57; 95% CI: 1.23-2.05, P < .0001)., Conclusions: Intrathoracic anastomotic leakage increased the risk of recurrence in patients who underwent curative gastroesophageal cancer resection., (Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Small-scale household digesters have been promoted across Asia as a sustainable way of handling manure. The major advantages are that they produce biogas and reduce odor. However their disadvantages include the low recycling of nutrients, because digestate is dilute and therefore difficult to transport, and the loss of biogas as a result of cracks and the intentional release of excess biogas. In this study, life cycle assessment (LCA) methodology was used to assess the environmental impacts associated with biogas digesters in Vietnam. Handling 1,000 kg of liquid manure and 100 kg of solid manure in a system with a biogas digester reduced the impact potential from 4.4 kg carbon dioxide (CO2) equivalents to 3.2 kg CO2 equivalents compared with traditional manure management. However, this advantage could easily be compromised if digester construction is considered in the LCA or in situations where there is an excess of biogas which is intentionally released. A sensitivity analysis showed that biogas digesters could be a means of reducing global warming if methane emissions can be kept low. In terms of eutrophication, farms with biogas digesters had 3 to 4 times greater impacts. In order to make biogas digesters sustainable, methods for recycling digestates are urgently required.

Context: Atomoxetine (ATX) is the treatment of choice for attention deficit hyperactivity disorders with co-morbid risk of drug abuse, although its abuse potential needs to be qualified. The purpose of this study is to analyse ATX misuse in relation to therapeutic use and compare our results with that of methylphenidate (MPH)., Methods and Materials: Data on enquiries were extracted from the Danish Poison Information Centre database (January 2006 to June 2012), while data on therapeutic use were provided by the Danish State Serum Institute (2007-2011)., Results: The study included 28 ATX and 394 MPH enquiries. Frequency of ATX enquiries did not show a significant correlation to either sale or number of treated patients but for MPH, both correlations were significant (p = 0.001 and p = 0.0008, respectively). The enquiries/number of treated patients relationship differed significantly between ATX and MPH (p = 0.018), but not the enquiries/sale relationship. The proportion of exposures motivated by recreational drug use was significantly lower for ATX (19%) than that for MPH (40%) (p = 0.038)., Discussion and Conclusion: These results suggest that ATX is used by adults for non-medical purposes including recreational use, but to a lesser extent than MPH.

Fourier transform infrared (FT-IR) spectroscopy has been used for several years as a fast, low-cost, reliable technique for characterising a large variety of materials. However, the strong influence of sample particle size and the inability to measure the absorption of very dark and opaque samples have made FTIR unsuitable for many waste materials. FTIR-photoacoustic spectroscopy (FTIR-PAS) can eliminate some of the shortcomings of traditional FTIR caused by scattering effects and reflection issues, and recent advances in PAS technology have made commercial instruments available. In this study, FTIR-PAS was used to characterise a wide range of organic waste products and predict their labile carbon fraction, which is normally determined from time-consuming assays. FTIR-PAS was found to be capable of predicting the labile fraction of carbon as efficiently as near infrared spectroscopy (NIR) and furthermore of identifying the compounds that are correlated with the predicted parameter, thus facilitating a more mechanistic interpretation., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

This study investigated the effects of different mixing ratios of crop residues and biochar with liquid digestate from anaerobically treated pig manure on CH₄, CO₂, and N₂O emissions over 84 days in a system of passive aeration composting, resembling typical Vietnamese solid manure storage conditions. Two treatments with solid manure were included for comparison. The results showed that C losses through CH4 and CO₂emissions accounted for 0.06-0.28% and 1.9-26.7%, respectively, of initial total C. CH4 losses accounted for just 0.4-4.0% of total C losses. Total N losses accounted for 27.1-40% of initial total N in which N₂O emissions corresponded to 0.01-0.57% of initial total N, and hence accounted for only 0.1-1.8% of total N losses. It is assumed that the remainder was either the result of denitrification losses to N₂or ammonia volatilization. The composting of biochar (B) or crop residue with digestate (D) showed significantly lower CH4 and N₂O emissions compared with composting manure (M) (p < .05). The composting of digestate with biochar showed significantly lower CO₂and CH₄emissions and significantly higher N₂O emissions compared to the composting of digestate with rice straw (RS) (p < .05). The combined composting of digestate with biochar and rice straw (D + B + RS5:0.3:1) showed significantly reduced N₂O emissions compared with composting digestate with biochar with alone (p < .05). Composting sugar cane bagasse (SC) with digestate (D + SC) significantly reduced CH₄and N₂O emissions compared with the composting of rice straw with digestate (D + RS3.5:1 and D + RS5:1) (p < .05).

The alteration of easily available phosphorus (P) from the separated solid fraction of pig slurry by composting and thermal processing (pyrolysis or combustion at 300-1000 °C) was investigated by water and acidic extractions and the diffusive gradients in thin films (DGT) technique. Temporal changes in P availability were monitored by repeated DGT application in three amended temperate soils over 16 weeks. P availability was found to decrease in the order: drying>composting>pyrolysis>combustion with increasing degree of processing. Water extractions suggested that no P would be available after pyrolysis above 700 °C or combustion above 400 °C, respectively, but during soil incubation, even char and ash, processed at 800 °C, increased P availability. Low-temperature pyrolysis vs. combustion was found to favor P availability as did application to acidic vs. neutral soil. Composting and thermal treatment produced a slow-release P fertilizer, with P availability being governed by abiotic and biotic mechanisms., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: Direct measurement of chemical constituents in complex biologic matrices without the use of analyte specific reagents could be a step forward toward the simplification of clinical biochemistry. Problems related to reagents such as production errors, improper handling, and lot-to-lot variations would be eliminated as well as errors occurring during assay execution. We describe and validate a reagent free method for direct measurement of six analytes in human plasma based on Fourier-transform infrared spectroscopy (FTIR)., Design and Methods: Blood plasma is analyzed without any sample preparation. FTIR spectrum of the raw plasma is recorded in a sampling cuvette specially designed for measurement of aqueous solutions. For each analyte, a mathematical calibration process is performed by a stepwise selection of wavelengths giving the optimal least-squares correlation between the measured FTIR signal and the analyte concentration measured by conventional clinical reference methods. The developed calibration algorithms are subsequently evaluated for their capability to predict the concentration of the six analytes in blinded patient samples., Results: The correlation between the six FTIR methods and corresponding reference methods were 0.87

The availability and spatial distribution of oxygen (O) in agricultural soil are controlling factors in the production and emission of nitrous oxide (NO) to the atmosphere, but most experiments investigating the effects of various factors on NO emissions in soil have been conducted without determining the content and distribution of O. This complicates data interpretation and leads to speculative conclusions about which nitrogen transformation processes are responsible for NO production. Using an O-specific planar optode, this paper shows how spatiotemporal O dynamics can be used to interpret data on NO emissions following a uniform or layered amendment of manure to agricultural soil. The spatial distribution of O and gas emission rates were monitored for 12 h. An anoxic layer formed rapidly around the layered manure, whereas the uniformly distributed manure led to a more widespread anoxia. Nitrous oxide emissions increased immediately after depletion of O in the manure-amended treatments. Greater understanding and improved knowledge of the spatial distribution of O is clearly beneficial and can be used to devise improved application strategies for mitigating NO emissions from manure and other fertilizers., (Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.)

Introduction: Telemedicine is often seen as the solution to the challenge of providing health care for an increasing number of people with chronic conditions. Projects are often organised locally and based on the involvement of stakeholders with a wide range of backgrounds. It can be challenging to ensure that projects are based on previous experience and that they do not repeat previous studies. To better understand these challenges and current practice, we examined telemedicine projects funded in the 2008-2010 period to explore where, how and to what extent results from the projects were documented and disseminated., Material and Methods: Public and private funds were contacted for information about telemedicine studies focusing on people residing in their homes. After an initial screening of titles and abstracts, 19 projects were identified. The managers of the projects were contacted and information about project results and dissemination were obtained., Results: More than half of all projects were disseminated to professionals as well as to the public and used two-way communication. However, it was generally difficult to obtain an overview of the projects due to dynamic changes in names and scopes., Conclusion: We propose that the funding authorities require designs comprising proper evaluation models that will subsequently allow the investigators to publish their findings. Furthermore, a dissemination plan comprising both peers and other professions should be made mandatory. The investigators should ensure proper documentation and dissemination of changes both during and after the projects in order to ensure transparency, and national or international organisations should establish a database with relevant data fields., Funding: not relevant., Trial Registration: not relevant.

Aeration is an important factor influencing CO2, CH4, N2O and NH3 emissions from the composting process. Both CH4 and N2O are potent greenhouse gases (GHG) of high importance. Here, we examined the effects of high and low aeration rates together with addition of barley straw with and without bio-char on GHG and NH3 emissions from composting cattle slurry and hen manure in small-scale laboratory composters. Depending on treatment, cumulative C losses via CO2 and CH4 emissions accounted for 11.4-22.5% and 0.004-0.2% of initial total carbon, while N losses as N2O and NH3 emissions comprised 0.05-0.1% and 0.8-26.5% of initial total nitrogen, respectively. Decreasing the flow rate reduced cumulative NH3 losses non-significantly (by 88%) but significantly increased CH4 losses (by 51%) from composting of cattle slurry with barley straw. Among the hen manure treatments evaluated, bio-char addition to composting hen manure and barley straw at low flow rates proved most effective in reducing cumulative NH3 and CH4 losses. Addition of bio-char in combination with barley straw to hen manure at both high and low flow rates reduced total GHG emissions (as CO2-equivalents) by 27-32% compared with barley straw addition alone. Comparisons of flow rates showed that low flow could be an alternative strategy for reducing NH3 losses without any significant change in N2O emissions, pointing to the need for well-controlled composting conditions if gaseous emissions are to be minimised., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Foreign body ingestion occurs commonly. In 80-90% of cases, the ingested foreign body passes uneventfully through the gastrointestinal tract; endoscopy is performed in 20% of cases, and surgery in less than 1%. Complications usually occur when the ingested foreign body is sharp, large, a button battery or multiple magnets. We present a potential algorithm for the management of swallowed foreign bodies. Most patients can be treated conservatively by observation alone, but often it is convenient to proceed to endoscopic retrieval. Surgery is reserved for complicated cases.

Background: Most likely because of low statistical power, no previous studies have shown any significant association between long-term survival and anastomotic leakage in patients who have undergone gastroesophageal cancer resection., Material and Methods: The present study included, prospectively and consecutively, nationwide collected patients who underwent gastroesophageal cancer resection between 2003 and 2011 in Denmark. The operation was carried out as an Ivor Lewis procedure. Only patients with intrathoracic anastomosis were included in the analysis., Results: From 2003 to 2011, 1,296 patients underwent gastroesophageal resection, and 128 (9.9 %) of these experienced anastomotic leakage. The overall 5-year survival rates in patients with and without anastomotic leakage were 20 and 35 % (P < 0.0001), respectively. After exclusion of 4 weeks mortality, the 5-year survival rate in patients with leakage was 22 % compared to 36 % in patients without anastomotic leakage (P < 0.001). After exclusion of 8 weeks mortality, the 5-year survival rate was 23 % in patients with leakage and 36 % in those without (P = 0.009). The corresponding median time of survival was 74 versus 128, 87 versus 138, and 95 versus 138 weeks, respectively. The overall hazard ratios of death after anastomotic leakage, unadjusted, and after adjusting for potentially confounding factors, were 1.59 (1.27-1.99) and 1.45 (1.14-1.84). The unadjusted and adjusted odds ratios after exclusion of 4 weeks mortality were 1.51 (1.19-1.90) and 1.41 (1.10-1.81). After exclusion of 8 weeks mortality the odds ratios were 1.38 (1.08-1.77) and 1.32 (1.02-1.71)., Conclusions: This nationwide study confirms that patients experiencing anastomotic leakage after gastroesophageal cancer resection have a significantly lower long-term survival, even following full recovery after the leakage.

Solid-liquid separation of animal slurry, with solid fractions used for composting, has gained interest recently. However, efficient composting of separated animal slurry solid fractions (SSFs) requires a better understanding of the process dynamics in terms of important physical parameters and their interacting physical relationships in the composting matrix. Here we monitored moisture content, bulk density, particle density and air-filled porosity (AFP) during composting of SSF collected from four commercially available solid-liquid separators. Composting was performed in laboratory-scale reactors for 30 days (d) under forced aeration and measurements were conducted on the solid samples at the beginning of composting and at 10-d intervals during composting. The results suggest that differences in initial physical properties of SSF influence the development of compost maximum temperatures (40-70 degreeC). Depending on SSF, total wet mass and volume losses (expressed as % of initial value) were up to 37% and 34%, respectively. After 30 d of composting, relative losses of total solids varied from 17.9% to 21.7% and of volatile solids (VS) from 21.3% to 27.5%, depending on SSF. VS losses in all composts showed different dynamics as described by the first-order kinetic equation. The estimated component particle density of 1441 kg m-3 for VS and 2625 kg m-3 for fixed solids can be used to improve estimates of AFP for SSF within the range tested. The linear relationship between wet bulk density and AFP reported by previous researchers held true for SSF.

Animal slurry management is associated with a range of impacts on fossil resource use and the environment. The impacts are greatest when large amounts of nutrient-rich slurry from livestock production cannot be adequately utilised on adjacent land. To facilitate nutrient redistribution, a range of different technologies are available. This study comprised a life cycle assessment of the environmental impacts from handling 1000 kg of pig slurry ex-animal. Application of untreated pig slurry onto adjacent land was compared with using four different treatment technologies to enable nutrient redistribution before land application: (a) separation by mechanical screw press, (b) screw press separation with composting of the solid fraction, (c) separation by decanter centrifuge, and (d) decanter centrifuge separation with ammonia stripping of the liquid fraction. Emissions were determined based on a combination of values derived from the literature and simulations with the Farm-N model for Danish agricultural and climatic conditions. The environmental impact categories assessed were climate change, freshwater eutrophication, marine eutrophication, terrestrial acidification, natural resource use, and soil carbon, nitrogen and phosphorus storage. In all separation scenarios, the liquid fraction was applied to land on the pig-producing (donor) farm and the solid fraction transported to a recipient farm and utilised for crop production. Separation, especially by centrifuge, was found to result in a lower environmental impact potential than application of untreated slurry to adjacent land. Composting and ammonia stripping either slightly increased or slightly decreased the environmental impact potential, depending on the impact category considered. The relative ranking of scenarios did not change after a sensitivity analysis in which coefficients for field emissions of nitrous oxide, ammonia and phosphorus were varied within the range cited in the literature. Therefore, the best technology to implement in a given situation depends on the environmental problem in question, local policy, cost and practicality., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Introduction: Complications to oesophageal and junctional cancer surgery are common and have not diminished much during the past ten years. An unusually high occurrence of anastomotic dehiscence occurred in Denmark in 2009 and 2010 as seen in the national database for oesophagus, cardiac and gastric (ECV) cancer., Material and Methods: In accordance with national guidelines, all patients resected for oesophageal and junctional cancer in Denmark from 2003 were prospectively entered into a national database. Data concerning anaesthesia, peri- and post-operative course, complications, re-operations and time spent in intensive care unit were obtained retrospectively from hospital records. An in-depth analysis of data from two high-volume centres performing ECV cancer surgery according to national guidelines was performed., Results: A total of 881 patients (Centre 1: 438; Centre 2: 443) were resected for oesophageal and junctional cancer. A total of 79 patients with anastomotic insufficiency (AI) were detected (Centre 1: 36; Centre 2: 43). By using a grading system, it was shown that AI was more severe and occurred earlier in one centre than in the other. Possible factors of influence are discussed, including neoadjuvant oncological therapy, use of thoracoscopically performed anastomosis and perioperative inotrophic drugs., Conclusion: Thanks to the establishment of a nationwide database in pursuance of national guidelines, it was possible to detect variations in quality of surgery over time, evaluate serious complications early and undertake an in-depth analysis of possible aetiological factors. Particularly, comparison was facilitated by the use of a standardised grading system for complications., Funding: not relevant., Trial Registration: not relevant.

Energy recovery from pig manure offers an opportunity for waste utilisation and financial benefit. Samples of the solid fraction of separated pig manure and samples which had undergone chemical or biological pretreatment prior to separation were pyrolysed. A beech wood sample was pyrolysed for comparison. The chemically pre-treated and anaerobically digested materials had similar properties and showed similar behaviour during thermogravimetric analysis. However, the energy content of the gas arising from pyrolysis in a batch reactor at 600 °C comprises about 30% of the original energy of the feedstock in the case of the anaerobically digested materials and double that of the chemically pre-treated material. Therefore, the overall energy balance showed a loss of 595.9 MJ/t for the pyrolysis of the chemically pre-treated manure, while very small positive values of 351.7 MJ/t, 817.3 MJ/t and a significant value of 8935 MJ/t were found for anaerobically digested sample, un-pretreated solid and for wood, respectively., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: In several European countries, centralization of oesophagogastric cancer surgery has been realized and clinical audits initiated. The present study was designed to evaluate differences in resection rates, outcomes and annual hospital volumes between these countries, and to analyse the relationship between hospital volume and outcomes., Methods: National data were obtained from cancer registries or clinical audits in the Netherlands, Sweden, Denmark and England. Differences in outcomes were analysed between countries and between hospital volume categories, adjusting for available case-mix factors., Results: Between 2004 and 2009, 10 854 oesophagectomies and 9010 gastrectomies were registered. Resection rates in England were 18·2 and 21·6 per cent for oesophageal and gastric cancer respectively, compared with 28·5-29·9 and 41·4-41·9 per cent in the Netherlands and Denmark (P < 0·001). The adjusted 30-day mortality rate after oesophagectomy was lowest in Sweden (1·9 per cent). After gastrectomy, the adjusted 30-day mortality rate was significantly higher in the Netherlands (6·9 per cent) than in Sweden (3·5 per cent; P = 0·017) and Denmark (4·3 per cent; P = 0·029). Increasing hospital volume was associated with a lower 30-day mortality rate after oesophagectomy (odds ratio 0·55 (95 per cent confidence interval 0·42 to 0·72) for at least 41 versus 1-10 procedures per year) and gastrectomy (odds ratio 0·64 (0·41 to 0·99) for at least 21 versus 1-10 procedures per year)., Conclusion: Hospitals performing larger numbers of oesophagogastric cancer resections had a lower 30-day mortality rate. Differences in outcomes between several European countries could not be explained by differences in hospital volumes. To understand these differences in outcomes and resection rates, with reliable case-mix adjustments, a uniform European upper gastrointestinal cancer audit with recording of standardized data is warranted., (Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.)

Milk proteins are often used by the food industry because of their good emulsifying properties. In addition, they can also provide oxidative stability to foods. However, different milk proteins or protein components have been shown to differ in their antioxidative properties, and their localisation in emulsions has been shown to be affected by the emulsification conditions. The objective of this study was to investigate the influence of homogenisation equipment (microfluidizer vs. two-stage valve homogeniser) on lipid oxidation in 10% fish oil-in-water emulsions prepared with two different milk proteins. Emulsions were prepared at pH 7 with similar droplet sizes. Results showed that the oxidative stability of emulsions prepared with sodium caseinate was not influenced by the type of homogeniser used. In contrast, the type of homogenisation equipment significantly influenced lipid oxidation when whey protein was used as emulsifier, with the microfluidizer resulting in lower levels of oxidation., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Pig slurry separation is a slurry treatment technique that can reduce excess loads of P, Cu and Zn to the arable land. This study investigated the effects of different commercial and laboratory separation treatments for pig slurry on P, Cu and Zn distribution into solid and liquid fractions. Solid and liquid separation fractions were collected from two commercial separators installed on the farm. Five different separation treatments were performed (polymer flocculation and drainage; coagulation with iron sulphate addition and polymer flocculation and drainage; ozonation and centrifugation; centrifugation only; and natural sedimentation) on sow and suckling piglet raw slurry. Particle size fractionation was performed on raw slurry and all separation fractions by sequential wet sieving and P, Cu and Zn concentrations were then measured in the particle size classes. Dry matter and total P, Cu and Zn were separated with higher efficiency when chemical pretreatments with flocculants and coagulants were introduced before mechanical separation at both commercial and laboratory scale. When solid fractions are utilized as crop fertilizer (primarily as P fertilizer), the loads of Cu and Zn to the soils are not markedly different than the loads applied with raw slurry. When liquid fractions are used as crop fertilizer (primarily as N fertilizer), the loads of Cu and Zn are markedly lower than those supplied with raw slurry. The loads of Cu and Zn introduced to the soil were lowest on application of the liquid fraction produced by optimized separation treatments that included flocculation and coagulation.

Chemical-mechanical separation of pig slurry into a solid fraction rich in dry matter, P, Cu and Zn and a liquid fraction rich in inorganic N but poor in dry matter may allow farmers to manage surplus slurry by exporting the solid fraction to regions with no nutrient surplus. Pig slurry can be applied to arable land only in certain periods during the year, so it is commonly stored prior to field application. This study investigated the effect of storage duration and temperature on chemical characteristics and P, Cu and Zn distribution between particle size classes of raw slurry and its liquid separation fraction. Dry matter, VFA, total N and ammonium content of both slurry products decreased during storage and were affected by temperature, showing higher losses at higher storage temperatures. In both products, total P, Cu and Zn concentrations were not significantly affected by storage duration or temperature. Particle size distribution was affected by slurry separation, storage duration and temperature. In raw slurry, particles larger than 1 mm decreased, whereas particles 250 μm-1 mm increased. The liquid fraction produced was free of particles >500 μm, with the highest proportions of P, Cu and Zn in the smallest particle size class (<25 μm). The proportion of particles <25 μm increased when the liquid fraction was stored at 5 °C, but decreased at 25 °C. Regardless of temperature, distribution of P, Cu and Zn over particle size classes followed a similar pattern to dry matter., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Introduction: Lichen sclerosus (LS) is a chronic skin disorder with a predilection for the anogenital area. The disease is mostly seen in prepubertal and postmenopausal females. The lesions present as sharply demarcated white plaques encircling the vagina and anus. The atrophic form can lead to scarring of the affected area., Material and Methods: Retrospective analysis of hospital records of children (aged 1-18 years) seen at the Department of Dermatology and Allergy Centre in Odense from October 1998 to November 2010 with a definite clinical diagnosis of anogenital LS with/without a confirming biopsy., Results: A total of 35 girls and one boy were diagnosed with anogenital LS. The diagnostic delay was 17 months. Pruritus, dysuria, bleeding and constipation were the dominant complaints, while one patient was asymptomatic. Referral was made by general practitioners, private dermatologists and paediatricians. Sexual abuse was suspected in five cases. Ten patients underwent biopsy confirming LS. Before a definite diagnosis was given, many children were extensively treated with various topical and oral agents. In our outpatient clinic, 30 children were treated with potent/ultra-potent corticosteroids and five patients were treated with calcineurin inhibitors., Conclusion: General practitioners may overlook this disorder despite characteristic clinical features and effective symptomatic treatment. Diagnostic delay is a significant problem for both patient and family, and the lesions may mimic the findings of sexual abuse. Potent corticosteroids are very effective in symptomatic treatment., Funding: not relevant., Trial Registration: not relevant.

eIF4A is a key component in eukaryotic translation initiation; however, it has not been clear how auxiliary factors like eIF4B and eIF4G stimulate eIF4A and how this contributes to the initiation process. Based on results from isothermal titration calorimetry, we propose a two-site model for eIF4A binding to an 83.5 kDa eIF4G fragment (eIF4G-MC), with a high- and a low-affinity site, having binding constants KD of ∼50 and ∼1000 nM, respectively. Small angle X-ray scattering analysis shows that the eIF4G-MC fragment adopts an elongated, well-defined structure with a maximum dimension of 220 Å, able to span the width of the 40S ribosomal subunit. We establish a stable eIF4A-eIF4B complex requiring RNA, nucleotide and the eIF4G-MC fragment, using an in vitro RNA pull-down assay. The eIF4G-MC fragment does not stably associate with the eIF4A-eIF4B-RNA-nucleotide complex but acts catalytically in its formation. Furthermore, we demonstrate that eIF4B and eIF4G-MC act synergistically in stimulating the ATPase activity of eIF4A.

Background: We previously reported that both leukoreduced (LR) and buffy coat-depleted (BCD) blood transfusions had a detrimental effect on long-term overall survival in patients who underwent elective surgery for colorectal disease. This analysis investigates long-term cause-specific mortality in trial participants diagnosed with colorectal cancer (CRC)., Study Design and Methods: We used the Danish Civil Registration System to follow 448 trial participants with CRC, from their enrollment in 1992 to 1995 until January 2007. A total of 108 patients were transfused with BCD blood, 94 with LR blood, and 246 did not receive a transfusion (NT). We reviewed death certificates for study patients who died during follow-up. Cause-of-death data were coded according to the International Classification of Diseases (ICD-8 and -10). The Charlson Comorbidity Index was used for risk adjustment., Results: A total of 43% of NT, 28% of BCD, and 27% of LR transfused patients were alive after 15 years of follow-up (p = 0.001 for transfused vs. NT patients). For LR-transfused versus NT patients the adjusted mortality ratio for death from rectal cancer was 1.81 (95% confidence interval [CI], 0.97-3.38), and for death from cardiovascular disease 2.12 (95% CI, 1.23-3.62). For BCD versus NT patients the adjusted mortality ratio for death from rectal cancer was 1.19 (95% CI, 0.61-2.33) and for cardiovascular disease it was 1.68 (95% CI, 0.97-2.91)., Conclusion: LR transfusion is associated with decreased long-term survival due to death from cardiovascular disease. A similar but weaker tendency was observed for BCD transfusion., (© 2010 American Association of Blood Banks.)

Solid liquid separation of animal slurry is a method to reduce the excess nutrient loads from intensive livestock production. Five different separation technologies (sedimentation, centrifugation, pressurized filtration, polymer flocculation and drainage, and iron chloride addition + polymer flocculation and drainage) were applied to pig and cattle slurry in a laboratory study. Separation efficiencies of mass, dry matter (DM), N, and P were measured. Particle size fractionation of the solid fractions was performed by subjecting them to wet fractionation and C, organic N (N(org)), and P contents were subsequently measured. Chemical pretreatment with polymer before gravity drainage separated DM, total N, and P from raw pig and cattle slurry with the highest efficiencies. Sedimentation and centrifugation separated P from pig and cattle slurries with higher simple separation efficiencies (0.77 and 0.70, respectively) compared with pressurized filtration (0.15 and 0.37). Pressurized filtration transferred the lowest masses (14 and 18%) to the solid fractions. Solid fractions from pig slurry generally contained higher concentrations of P and C compared with cattle slurry solid fractions. The majority of C in solid fractions was present in particles > 25 microm, whereas N and P were present in larger proportions in particles < 25 microm. Chemical pretreatment increased the capture of smaller N(org)- and P-rich particles into larger particles between 25 and 1000 microm.

Plasma concentrations after administration of peptide drugs are often low due to the high potency often seen with this class of compounds. In this work a bioanalytical method based on coupled column liquid chromatography-tandem mass spectrometry (LC-MS/MS) is presented for quantification of a peptide drug, FE 202158, under clinical development. A volume of 0.5 ml human plasma is solid phase extracted on a weak cationic exchanger. After evaporation of the solvent to dryness, the reconstituted sample is injected into a coupled column liquid chromatography system. A heart-cut from the initial column, a cyano column, is trapped on a C(4) column and thereafter injected into a microbore C(18) column. For the detection a triple quadrupole mass spectrometer, equipped with a TurboIonSpray interface working in positive ion mode, is used. The design of the system is described and the gain in sensitivity and selectivity, compared to a conventional system, is discussed. Data from validation of the bioanalytical method are presented. For human plasma samples a lower limit of quantification (LLOQ) of 5.00 pg/ml (=4.77 pmol/l) was achieved. The inter-assay precision was less than 11% and bias was within +/-4% over the whole validated range of 5.00-860 pg/ml., (Copyright (c) 2010 Elsevier B.V. All rights reserved.)

Background: Population-based data on the early postoperative outcome after surgery for gastric cancer are very sparse. We examined the development in the quality of surgery and early postoperative outcomes in Denmark following centralization of gastric cancer surgery and implementation of national clinical guidelines., Methods: All patients in Denmark who underwent resection with curative intent for gastric cancer between 1st July 2003 and 31st December 2008 in one of five university hospitals were registered in a national database. Data on surgical quality and mortality were obtained from the database and compared with the results from the period before centralization (1999-2003)., Results: A total of 416 patients underwent resection in the study period. The risk of anastomotic leakages for the whole period was 5.0% (95%CI; 3.2-7.7) compared to 6.1% (95%CI; 4.3-8.6) before centralization, whereas the 30-days hospital mortality was 2.4% (95%CI; 1.2-4.4) compared to 8.2% (95%CI; 6.0-10.4) before centralization. In addition, the percentage of patients with at least 15 lymph nodes removed increased during the study period from 19 in 2003 to 76 in 2008., Conclusions: Centralization of gastric cancer surgery in Denmark and implementation of national clinical guidelines monitored by a national database was associated with improvements in surgical quality and substantially lower in-hospital mortality., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

Introduction: Pancreaticoduodenectomy (PD) is associated with high mortality and morbidity. Results can be optimised through centralisation and adjustment of perioperative care. The aim of this study was to describe organisation, postoperative stay, readmission and hospital mortality in the period 2005-2008 and to evaluate postoperative care and treatment after PD in 2007-2008., Material and Methods: The study is based on data from the National Patient Registry for the period 2005-2008 and medical records for 2007-2008 from PD patients., Results: The median duration of postoperative stay in hospital 2005-2008 was 17 days (range 2-649). The readmission rate was 11%, and hospital mortality was 6%. In 2007-2008, both wound infections and intraabdominal abscesses were seen in 12% of cases, and anastomotic leakage of the hepaticojejunostomy and pancreaticojejunostomy occurred in 9% and 12% of cases, respectively. Four percent had no wound-related complications. Nasogastric and nasojejunal tubes were removed postoperatively on median day five and day six, respectively. Clear fluid intake began from median day five and solid food from day seven. The epidural catheter was removed on median day five and abdominal drains on day seven., Conclusion: Mortality and postoperative hospital stay after PD were reduced in Denmark from the period 1996-2004 to 2005-2008, but the morbidity remains high. The results suggest a need for adjustment of perioperative care to current evidence-based care standards.

Introduction: Mallory-Weiss syndrome (MW) has been know since 1929. Only few studies exist which focus on the prognosis of the lesion. No Danish MW data are available. The purpose of the study was to describe the demographics of patients admitted with an MW to a Danish surgical unit during a 5-year period and to investigate the prognosis of these patients., Material and Methods: Data from the patient records of 49 patients with endoscopically verified MW admitted through a five-year period were analysed. At follow-up, 35 patients were alive and contacted. A total of 29 responded. The mean time to follow-up from admittance was 42.7 months (range: 10.1-77.1)., Results: Haemostasis was achieved in all 49 patients. Sixteen received active therapy during the endoscopic procedure. Haemoglobin at admittance was lower (p = 0.008), the presence of bleeding stigmata higher (p < 0.0001) and the number of patients receiving blood transfusion higher (p = 0.01) among those receiving active therapy than among the group receiving no therapy at the time of their endoscopy. At follow-up, 50% of those receiving active therapy were dead (eight of 16) compared with 18% (six of 33) in the no-therapy group (p = 0.02). In the follow-up period, 10% of the patients admitted with an MW were re-admitted for a new gastrointestinal bleeding., Conclusion: Our data suggests that an attitude change is needed toward MW with bleeding stigmata. The course of the disease may not be as benign as generally believed. Further prospective studies designed to resolve this matter are needed.

Growth retardation is an important breeding aim and an essential part of horticultural plant production. Here, the potential of transferring the Arabidopsis short internode (shi) mutant phenotype was explored by expressing the AtSHI gene in the popular ornamental plant Kalanchoë. A 35S-AtSHI construct was produced and transferred into eight genetically different cultivars of Kalanchoë by Agrobacterium tumefaciens. The resulting transgenic plants showed dwarfing phenotypes like reduced plant height and diameter, and also more compact inflorescences, as a result of increased vegetative height. The shi phenotype was stable over more than five vegetative subcultivations. Compared with Arabidopsis, the ectopic expression of AtSHI in Kalanchoë showed several differences. None of the Kalanchoë SHI-lines exhibited alterations in leaf colour or morphology, and most lines were not delayed in flowering. Moreover, continuous treatment of lines delayed in flowering with low concentrations of gibberellins completely restored the time of flowering. These features are very important as a delay in flowering would increase plant production costs significantly. The effect of expression controlled by the native Arabidopsis SHI promoter was also investigated in transgenic Kalanchoë and resulted in plants with a longer flowering period. Two AtSHI like genes were identified in Kalanchoë indicating a widespread presence of this transcription factor. These findings are important because they suggest that transformation with the AtSHI gene could be applied to several species as a tool for growth retardation, and that this approach could substitute the use of conventional chemical growth regulation in plant production.

The distribution of phosphorus (P) (water-soluble inorganic P [P(i)], acid-soluble P(i), and residual P) was determined in 40 samples of solids from solid-liquid separated slurry. These were collected from separation plants using different technologies, separating by simple mechanical means, by flocculation as pre-treatment before mechanical separation or by anaerobic digestion followed by separation and centrifugation. Simple mechanical separation yielded a low solid TP content (8-9 g P kg(-1) dry matter [DM]) compared with separation by flocculation (26 g P kg(-1) DM) or by anaerobic digestion-centrifugation (33.4 g P kg(-1) DM). Acid-soluble P(i) predominated in the high P-yielding solids, whereas organic-bound or residual P was a minor component in all slurry solids. Acid-soluble P(i) and residual P were significantly correlated with total phosphorus (TP) content (R(2) = 0.855 and R(2) = 0.584), but water-soluble P(i) was uncorrelated (R(2) = 0.077). The relative distribution of P(i) to TP in the solids showed a high proportion of water-soluble P(i) in solids from simple mechanical separation, whereas the absolute concentrations were highest in solids from separation by flocculation and anaerobic digestion-centrifugation. Three solid fractions, representing the range of solids variability produced by the separation techniques, were composted for 30 d, and the P distribution was compared before and after composting. Total mass of P was conserved during composting, but water-soluble P(i) as a proportion of TP decreased in most cases. The most pronounced decrease in water-soluble P(i) was observed during composting of the solids separated using flocculation. However, changes in short- to medium-term bioavailability of P were modest, and thus the potential benefits of composting regarding storage and handling can presumably be realized without seriously compromising the P fertilization quality.

Chemical and biochemical properties were investigated in 47 solids collected from commercial solids separation plants separating liquid manure into a nutrient-rich solid fraction and a nutrient-poor liquid fraction. The samples originated from five different types of separation technologies, separating primarily swine manure and anaerobically digested manure. The largest variations in measured chemical and biochemical characteristics between samples from the five different separation technologies were found for ash, total P, total C, DM and C distribution in the biochemical fractions (neutral detergent solubles (NDS), hemicellulose, cellulose and lignin). Principal component analysis (PCA) of the data obtained showed that the chemical and biochemical characteristics of the solids were dependent on the type of technology used for separation.

Introduction: We evaluated the organisation, management and outcome for patients undergoing elective liver resection in Denmark in the period 2002-2007., Material and Methods: Nationwide data based on the National Patient Registry and discharge information from hospital departments in the period 1 January 2002 to 31 December 2007 were analysed., Results: Twenty-three departments performed 818 resections with five departments performing 96% and 18 departments performing 4% of the operations. The amount of non-anatomical resections constituted 30% (248 of 818) of the resections. The median postoperative stay was nine days, and the hospital mortality rate was 3.9%, distributed between 2.4% for non-anatomical resections, 2.9% for segmental resections and 5.2% for right-sided hepatectomy., Conclusion: The number of treated patients was too small as was the number referred to highly specialised liver surgery units. Moreover, the amount of non-anatomical resections was too high as was the average postoperative stay and the hospital mortality rate. In future, we propose that liver resections be centralised in 2-3 hospitals each capable of providing all the following services: surgery, hepatology, oncology and interventional radiology.

Sphincterotomy of the ampulla of Vater--a common diagnostic and therapeutic procedure that is sometimes done during endoscopic retrograde cholangiography (ERC)--allows reflux of intestinal content into the biliary tree. The resulting inflammation may contribute to malignant transformation of the biliary epithelium and therefore increase the risk of cholangiocarcinoma. We used data from population-based Danish health-care registries to examine the incidence of cholangiocarcinoma after ERC for 10 690 ERC patients who underwent sphincterotomy between 1977 and 2003 and 10,690 ERC patients who did not undergo sphincterotomy. Patients with sphincterotomy were matched to patients without sphincterotomy by sex and age at, calendar year of, and indication for ERC. The cholangiocarcinoma incidence rate for sphincterotomy patients was 404 per 100,000 person-years during the first year after ERC and decreased progressively at later times after ERC (79, 42, and 27 per 100,000 person-years during years 2, 3-5, and > 5, respectively). The corresponding rates for patients without sphincterotomy were 458, 12, 10, and 19 per 100,000 person-years, respectively. The gradual decrease in cholangiocarcinoma rate over time after ERC for sphincterotomy patients indicates that some of these patients had a cholangiocarcinoma that was present at the time of ERC but not diagnosed until 2-5 years later. The similar rates at the latest times after ERC suggest the lack of a causal association between sphincterotomy and cholangiocarcinoma.

A series of 4-aryl-5-(4-piperidyl)-3-isoxazolol GABAA antagonists have been synthesized and pharmacologically characterized. The meta-phenyl-substituted compounds 9k and 9m and the para-phenoxy-substituted compound 9l all display high affinities (Ki=10-70 nM) and antagonist potencies in the low nanomolar range (Ki=9-10 nM). These potencies are significantly higher than those of previously reported 4-PIOL antagonists and considerably higher than that of the standard GABAA antagonist SR 95531.

Application of municipal solid waste (MSW) to arable land can be used to close the nutrient cycle between urban and rural areas. The aim of the current study was to quantify net N mineralization and respiration from composted MSW (CMSW) and anaerobically digested MSW (ADMSW) applied to soil, and to test whether a simple relationship between net N mineralization and respiration that was developed for plant materials, was applicable for these types of MSW. In a laboratory experiment, CMSW and ADMSW were incorporated into soil and incubated at 15 degrees C. During the 149-day experiment, netN mineralization and respiration were determined. Cumulative respiration derived from both MSW types was very steep during the first 30 days, after which it levelled off. However, calculated on the basis of applied C, the ADMSW was 10 times more degradable than the CMSW. Both MSW types caused initial net N immobilization followed by re-mineralization. A simple model based on the relationship between net N mineralization and respiration was only applicable for the MSW after significant modifications. If farmers are to recognize CMSW and ADMSW as valuable fertilizers, it is important that they can be produced with higher maturity, in order to avoid initial N immobilization.