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Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that is characterized by the formation of comedones, papules, nodules, abscesses and sinus tracts in the axillary, inframammary, groin, and gluteal areas. Up to 3.8% of the Canadian population has HS, though due to a lack of awareness of HS, many patients are initially misdiagnosed and do not receive adequate treatment early on in the disease course. Once a diagnosis of HS is made, developing an effective management plan can be a dilemma for many providers. There is significant variability in response to any given therapy within the HS patient population and many HS patients have other medical comorbidities which must be taken into consideration. The aim of this review is to provide a practical approach for all healthcare providers to diagnose and manage HS and its associated comorbidities. A sample electronic medical record template for HS management was developed by the Canadian Hidradenitis Suppurativa Foundation Executive Board and is intended for use in clinical settings. This will help to increase collaboration between primary healthcare providers, dermatologists, and other medical specialists and ultimately improve the quality of care that HS patients receive.

Children’s vegetable intake remains inadequate and school canteens may provide opportunities to address this public health concern. This study aimed to determine the effectiveness of an 8-week multi-strategy behavioral intervention that included vegetable provisioning and online menu architecture on vegetable sales in primary school canteens. A randomized controlled trial was undertaken in 16 Australian primary schools (n = 4302 students). The control arm kept their regular canteen menu. The primary outcome was vegetable sales measured by assessing vegetable content (in grams) from all menu items and using canteen sales (ordered online and over-the-counter) to calculate vegetable sales (in grams/week) at baseline (3 weeks) and during intervention implementation (8 weeks). Secondary outcomes were vegetable sales in subcategories, intervention acceptability among canteen managers and vegetable waste (four schools). Linear mixed model analysis showed that from baseline to follow-up, the intervention group had significantly higher weekly vegetable sales overall compared with the control group (2707 g/week, 95% CI 1276 to 4137 g/week; p < 0.001), with increased vegetable sales in the subcategories of burgers, hot foods and snacks, but not in sandwiches and pasta/rice dishes. The intervention did not lead to more vegetable waste, nor to a decrease in canteen revenue. The canteen managers found the intervention easy to implement and felt children responded favorably to three of the seven strategies. In conclusion, a multi-strategy behavioral canteen intervention increased vegetable sales amongst primary school students.

Aim Minimally invasive colorectal surgery reduces surgical trauma with better preservation of abdominal wall integrity, but the extraction site is still at risk of incisional hernia (IH). This study aimed to determine pooled incidence of IH for each type of extraction site, and to compare IH rates after midline, non-midline and Pfannenstiel extraction. Methods A systematic review and meta-analysis was conducted using PRISMA guidelines. Single-armed and multiple-armed cohort studies, and randomized controlled trials regarding minimally invasive colorectal surgery were queried from five databases. Outcomes were pooled and compared with random-effects, inverse-variance models. Risk of bias was assessed using the Cochrane ROBINS-I and RoB 2 tools. Results Thirty-six studies were included, totalling 11,788 patients. Pooled extraction site incisional hernia (ESIH) rate was 16.0% for midline (n=4081), 9.3% for umbilical (n=2425), 5.2% for transverse (n=3213), 9.4% for paramedian (n=134) and 2.1% for Pfannenstiel (n=1449). ESIH occurred significantly more with midline extraction in comparison to Pfannenstiel (Odds Ratio (OR) 8.4 [3.5;20.0]). Non-midline extraction (transverse and paramedian) showed a significantly lower OR for IH compared to midline extraction (midline and umbilical). Pfannenstiel extraction resulted in significantly lower OR for ESIH compared to midline (OR 0.12 [0.050;0.30]), transverse (OR 0.25 [0.13;0.50]) and umbilical (OR 0.072 [0.033;0.16]) extraction sites. The risks of surgical site infection and surgical site occurrence were not significantly different in any analyses. Conclusions Specimen extraction through a Pfannenstiel incision is the preferred method in minimally invasive colorectal surgery. In cases where Pfannenstiel extraction is not possible, surgeons should avoid midline specimen extraction.

Aim: Minimally invasive colorectal surgery reduces surgical trauma with better preservation of abdominal wall integrity, but the extraction site is still at risk of incisional hernia (IH). The aim of this study was to determine pooled incidence of IH for each type of extraction site and to compare rates of IH after midline, nonmidline and Pfannenstiel extraction. Method: A systematic review and meta-analysis was conducted using the PRISMA guidelines. Single-armed and multiple-armed cohort studies and randomized controlled trials regarding minimally invasive colorectal surgery were searched from five databases. Outcomes were pooled and compared with random-effects, inverse-variance models. Risk of bias within the studies was assessed using the Cochrane ROBINS-I and RoB 2 tool. Results: Thirty six studies were included, with a total 11,788 patients. The pooled extraction site IH rate was 16.0% for midline (n = 4081), 9.3% for umbilical (n = 2425), 5.2% for transverse (n = 3213), 9.4% for paramedian (n = 134) and 2.1% for Pfannenstiel (n = 1449). Nonmidline extraction (transverse and paramedian) showed significantly lower odds ratios (ORs) for IH when compared with midline extraction (including umbilical). Pfannenstiel extraction resulted in a significantly lower OR for IH compared with midline [OR 0.12 (0.50–0.30)], transverse [OR 0.25 (0.13–0.50)] and umbilical (OR 0.072 [0.033–0.16]) extraction sites. The risks of surgical site infection, seroma/haematoma or wound dehiscence were not significantly different in any of the analyses. Conclusion: Pfannenstiel extraction is the preferred method in minimally invasive colorectal surgery. In cases where Pfannenstiel extraction is not possible, surgeons should avoid specimen extraction in the midline.

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The paradigm for treating inflammatory diseases has shifted dramatically in the past 10 to 20 years with the discovery of targeted therapeutics or “biologic” agents. Patients with rheumatoid arthritis, inflammatory bowel disease, psoriatic arthritis, and psoriasis, among others, are reaping the benefits of decades of bench to bedside research, allowing them to live more productive lives with less side effects than traditional systemic therapies. Despite these advances, many physicians unfamiliar with biologics are left to care for the basic needs of these patients and may be unaware of the multisystem comorbidities associated with psoriasis and the screening, monitoring, and other special considerations required of biologics patients. This can be overwhelming to primary care physicians and inadvertently expose patients to undue risks. The aim of this review is to provide a practical approach for all health care providers caring for patients with psoriasis being treated with biologics to facilitate communication with their treating dermatologist and ultimately provide patients with more comprehensive care.

Highlights • Fish mortalities due to harmful algae cause substantial economic and social costs for the fish farming industry in the northeastern Atlantic, North Sea and adjacent European waters • Toxin syndromes associated with Diarrhetic Shellfish Toxins and Paralytic Shellfish Toxins and their regulation have the most profound effect on the bivalve aquaculture industry in the northeastern Atlantic region • Cyanobacteria and cyanotoxins are mainly problems in brackish water areas, particularly in the Baltic Sea • Emerging threats to the shellfish and finfish industries include the known presence of the phycotoxins azaspiracids and goniodomins • The IOC-ICES-PICESHAEDAT contains time-series baseline information on harmful algal events in Europe Harmful algal blooms (HAB) are recurrent phenomena in northern Europe along the coasts of the Baltic Sea, Kattegat-Skagerrak, eastern North Sea, Norwegian Sea and the Barents Sea. These HABs have caused occasional massive losses for the aquaculture industry and have chronically affected socioeconomic interests in several ways. This status review gives an overview of historical HAB events and summarises reports to the Harmful Algae Event Database from 1986 to the end of year 2019 and observations made in long term monitoring programmes of potentially harmful phytoplankton and of phycotoxins in bivalve shellfish. Major HAB taxa causing fish mortalities in the region include blooms of the prymnesiophyte Chrysochromulina leadbeateri in northern Norway in 1991 and 2019, resulting in huge economic losses for fish farmers. A bloom of the prymesiophyte Prymnesium polylepis (syn. Chrysochromulina polylepis) in the Kattegat-Skagerrak in 1988 was ecosystem disruptive. Blooms of the prymnesiophyte Phaeocystis spp. have caused accumulations of foam on beaches in the southwestern North Sea and Wadden Sea coasts and shellfish mortality has been linked to their occurrence. Mortality of shellfish linked to HAB events has been observed in estuarine waters associated with influx of water from the southern North Sea. The first bloom of the dictyochophyte genus Pseudochattonella was observed in 1998, and since then such blooms have been observed in high cell densities in spring causing fish mortalities some years. Dinoflagellates, primarily Dinophysis spp., intermittently yield concentrations of Diarrhetic Shellfish Toxins (DST) in blue mussels, Mytilus edulis, above regulatory limits along the coasts of Norway, Denmark and the Swedish west coast. On average, DST levels in shellfish have decreased along the Swedish and Norwegian Skagerrak coasts since approximately 2006, coinciding with a decrease in the cell abundance of D. acuta. Among dinoflagellates, Alexandrium species are the major source of Paralytic Shellfish Toxins (PST) in the region. PST concentrations above regulatory levels were rare in the Skagerrak-Kattegat during the three decadal review period, but frequent and often abundant findings of Alexandrium resting cysts in surface sediments indicate a high potential risk for blooms. PST levels often above regulatory limits along the west coast of Norway are associated with A. catenella (ribotype Group 1) as the main toxin producer. Other Alexandrium species, such as A. ostenfeldii and A. minutum, are capable of producing PST among some populations but are usually not associated with PSP events in the region. The cell abundance of A. pseudogonyaulax, a producer of the ichthyotoxin goniodomin (GD), has increased in the Skagerrak-Kattegat since 2010, and may constitute an emerging threat. The dinoflagellate Azadinium spp. have been unequivocally linked to the presence of azaspiracid toxins (AZT) responsible for Azaspiracid Shellfish Poisoning (AZP) in northern Europe. These toxins were detected in bivalve shellfish at concentrations above regulatory limits for the first time in Norway in blue mussels in 2005 and in Sweden in blue mussels and oysters (Ostrea edulis and Crassostrea gigas) in 2018. Certain members of the diatom genus Pseudo-nitzschia produce the neurotoxin domoic acid and analogs known as Amnesic Shellfish Toxins (AST). Blooms of Pseudo-nitzschia were common in the North Sea and the Skagerrak-Kattegat, but levels of AST in bivalve shellfish were rarely above regulatory limits during the review period. Summer cyanobacteria blooms in the Baltic Sea are a concern mainly for tourism by causing massive fouling of bathing water and beaches. Some of the cyanobacteria produce toxins, e.g. Nodularia spumigena, producer of nodularin, which may be a human health problem and cause occasional dog mortalities. Coastal and shelf sea regions in northern Europe provide a key supply of seafood, socioeconomic well-being and ecosystem services. Increasing anthropogenic influence and climate change create environmental stressors causing shifts in the biogeography and intensity of HABs. Continued monitoring of HAB and phycotoxins and the operation of historical databases such as HAEDAT provide not only an ongoing status report but also provide a way to interpret causes and mechanisms of HABs.

De ambities voor het gebruik van zeewier als duurzame bron van voedsel in het circulaire voedsel systeem van de toekomst is groot. Echter moet er wel realistisch gekeken worden naar de draagkracht van een gebied als de Noordzee dat vele mede gebruikers heeft. Zowel de fysieke ruimte als de ecologische draagkracht zijn in het geding bij de ambitie voor een grote zeewier productie op zee. Dit rapport maakt een eerste aanzet om mogelijke indices te identificeren om te bepalen of een beoogde productie binnen de draagkracht van een gebied valt.

Grootschalige zeewierproductie in Europa heeft de potentie om in de toekomst deels als benodigde voedselbron te dienen, op voorwaarde dat dit op een duurzame wijze gebeurt. Hoewel zeewierteelt in Nederland op het moment nog kleinschalig is en voornamelijk in Zeeland plaatsvindt, biedt de opschaling van offshore windparken in de Noordzee en de intentie tot medegebruik van deze parken kansen voor grootschalige uitbreiding van zeewierproductie. Maar hoeveel zeewier kan er eigenlijk op een verantwoorde manier gekweekt worden in de Noordzee? De effecten van zeewierproductie op het mariene ecosysteem zijn grotendeels onbekend en een gestandaardiseerde aanpak voor kwantificering van deze verwachte effecten en gevolgen om ecosysteemdiensten te leveren ontbreken. Het doel van deze deskstudie is een conceptueel framework te ontwikkelen dat eventuele impacts op het ecosysteem als gevolg van zeewierboerderijen in kaart brengt. Dit framework moet toepasbaar zijn op een breed scala aan kweekmethoden en locaties in zowel offshore, als kustgebieden, met name de Nederlandse kustzone en de Deltawateren. Deze aanpak fungeert als een eerste screening om potentiële bedreigingen te identificeren en prioriteren. Deze aanpak zal een solide basis bieden voor het sturen van onderzoek- en adviesbeleid met inachtneming dat de ontwikkeling van de methode zelf een dynamisch proces is dat verder aangepast zal worden. Het uiteindelijke doel is bij te dragen aan de ontwikkeling van zeewierproductiesystemen waarbij de balans tussen voedselproductie en natuurbehoud gehandhaafd wordt.

Mangroves of tropical and subtropical shores and deltas contribute to ecosystem functioning and human wellbeing in numerous ways but continue to be lost or degraded worldwide at a rapid pace. Overexploitation driven by poverty is often the root cause of mangrove destruction and degradation. The negative feedback cycle between destruction and poverty can only be broken by justly valuing current or introducing new sustainable livelihood options to foster long-lasting local support for mangroves. The large array of non-timber forest products (NTFPs) that mangroves offer have rarely been developed beyond the subsistence level and remain undervalued as &ldquo, products of the poor&rdquo, In light of the global trends towards sustainability and bio-economy, today they represent a major business opportunity for forest communities to produce high value-added end-user products. Even though mangrove NTFPs have been recognized to have high potential toward inclusive development and poverty alleviation and to be highly gender-equal, the development of mangrove NTFPs has continued to attract very little funding or research interest. Several ecological characteristics make commercialization of mangrove NTFPs particularly challenging. Production at economies of scale, including quality standards, as well as marketing and value chain management are all essential in order to develop these products beyond their subsistence role. To be most effective, a systems perspective on NTFP development is needed, whereby product-market development occurs in unison and based on a participative, inclusive and fair development approach. The species/product of choice for value-added product-market development in any specific community or area will depend on several factors. To address many of the typical constraints and maximize the chances of success, we suggest that the use of village or district-level cooperatives may be particularly useful. A better use of the untapped potential of mangroves for local livelihoods may form a most convincing advocate for local protection and restoration of mangrove forests. Therefore, funding agencies, governments and researchers alike are called to invest in mangrove NTFP development as a way to locally incentivize sustainable mangrove protection and restoration.

In de Nederlandse Exclusieve Economische Zone (EEZ) zijn windparken gepland op diverse locaties. Door de windparken ontstaan nieuwe kansen voor multifunctioneel gebruik zoals maricultuur en niet-bodemberoerende visserij met passieve vistuigen. Deze studie brengt de potentiële - kwantitatieve - productiviteit van het kweken of vissen (passief vistuig) binnen bestaande, geplande en mogelijke toekomstige windparklocaties op de Noordzee in kaart voor een aantal vormen van medegebruik; kweek van bepaalde soorten zeewier en schelpdieren en de niet-bodemberoerende vangst van bepaalde soorten vissen, schaaldieren en inktvissen. Dit project is een vervolg op een voorgaand project waarbij een kwalitatieve beoordeling gegeven is van de kansrijkheid van de gebieden. In de huidige studie is voor een selectie van kansrijke soorten een berekening voor oogst of productie uitgevoerd. Daarnaast is dit rapport bedoeld om op basis van de huidige stand van kennis een inschatting te geven van de orde van grootte van het ruimtebeslag van zeewierproductie binnen toekomstige windparken. Met een aantal berekeningen wordt inzicht gegeven in de orde van grootte van opbrengsten, beschikbare/benodigde oppervlakten en benodigde nutriënten in de Noordzee. Op basis van deze analyse lijkt een areaal van enkele honderden km2 zeewierproductie realistisch, hierbij is uitgegaan van een grove indicatieve berekening, met diverse aannames. Op basis van de beschikbare voedingsstoffen voor mosselen zou tussen ca. 50 en 100 ton drooggewicht mosselen per km2 per jaar kunnen worden geproduceerd, waarbij de bronnen van onzekerheid in acht genomen dienen te worden. Om een indruk te krijgen van het (relatieve) voorkomen van vissen, weekdieren en schaaldieren is gebruik gemaakt van VMS- en logboekgegevens samen met gegevens van twee jaarlijkse surveys (BTS en IBTS). Het is echter niet mogelijk gebleken om voor alle geselecteerde soorten een kwantitatieve inschatting te maken, aangezien er nog weinig bekend is over ruimtelijke verdeling van deze soorten. Daarom is voor deze soorten een overzicht gegeven van wat er in de literatuur over bekend is.

The European Blue Growth strategy aims to expand the new maritime sectors of aquaculture, energy, biotechnology, coastal tourism and mineral mining. Growth of these sectors will increases pressure on the seas, particularly on those areas that are densely used by traditional sectors such as fisheries and transport. This has triggered interest in developing multiuse of space and multiuse platforms at sea. This paper assesses the feasibility of offshore mussel production project in wind farms by design and ex-ante evaluation of a mussel aquaculture system in the North Sea. A system for mussel cultivation in the Dutch Borssele offshore wind farm was designed, producing both mussel seed and consumption-sized mussels with semi-submerged longlines. Based on the economic model and the risk assessment, this paper concludes that mussel aquaculture is an appealing commercial model for increased returns in offshore wind farms. The economic models shows that the internal rate of return and net present value are positive and based on the sensitivity analysis, it can be concluded that these results are robust.

Purpose Although vaginal dilator use after combined pelvic radiation therapy and brachytherapy (RT/BT) is recommended to prevent vaginal shortening and stenosis, women fail to use them and experience sexual problems. A nurse-led sexual rehabilitation intervention targeting sexual recovery and vaginal dilatation was developed. Its feasibility was investigated during a prospective, longitudinal, observational pilot study. Methods Four oncology nurses were specifically trained to conduct the intervention. Gynecologic cancer patients treated with RT/BT were assessed using (i) questionnaires on frequency of dilator use (monthly), sexual functioning, and sexual distress (at baseline and 1, 6, and 12 months) and psychological and relational distress (at 1, 6, and 12 months); (ii) semi-structured interviews (between 6 and 12 months); and (iii) consultation recordings (a random selection of 21 % of all consults). Results Twenty participants were 26–71 years old (mean = 40). Eight participants discontinued participation after 3 to 9 months. At 6 months after RT, 14 out of 16 (88 %), and at 12 months 9 out of 12 (75 %), participants dilated regularly, either by having sexual intercourse or by using dilators. Sexual functioning improved between 1 and 6 months after RT, with further improvement at 12 months. Most participants reported that the intervention was helpful and the nurses reported having sufficient expertise and counseling skills. Conclusions According to the pilot results, the intervention was feasible and promising for sexual rehabilitation and regular dilator use after RT. Its (cost-)effectiveness will be investigated in a randomized controlled trial. Electronic supplementary material The online version of this article (doi:10.1007/s00520-016-3453-2) contains supplementary material, which is available to authorized users.

Acute abdominal pain is a common symptom in young women. We describe a patient with acute illness and severe lower abdominal pain. Laboratory tests were normal except for mildly deranged inflammatory markers. No abnormalities were reported on abdominal ultrasonography and MRI, whereas diagnostic laparoscopy revealed a tumour located dorsally from the uterus. We resected the tumour and pathology results showed a well-differentiated papillary mesothelioma of the peritoneum (WDPMP). Microscopy showed evidence of acute ischaemia in the resected lesion, which was likely the cause of the acute abdominal pain. WDPMP is a rare disease that arises from the serous membranes which does not seem to have a relation to asbestos exposure. Generally, WDPMP has a mild clinical course and good long-term prognosis.

In de Nederlandse Exclusieve Economische Zone (EEZ) zijn windparken gepland op diverse locaties. Door de windparken ontstaan nieuwe kansen voor multifunctioneel gebruik zoals maricultuur en nietbodemberoerende visserij met passieve vistuigen. Deze studie heeft de relatieve geschiktheid van bestaande, geplande en mogelijke toekomstige windparklocaties op de Noordzee in beeld gebracht voor een aantal vormen van medegebruik met betrekking tot een kweek van een aantal soorten schelpdieren en zeewier en niet-bodemberoerende vangst van een aantal soorten vissen, schaaldieren en weekdieren. Om de relatieve geschiktheid te beoordelen is eerst inzicht nodig waar de verschillende soorten voorkomen en welke condities voor een optimale leefsituatie zorgen. Dit leidt tot een kwalitatieve beoordeling van geschiktheid van (potentiële) windparklocaties voor voedselproductie (i.e. kweek of vangst van de betreffende soorten). De resultaten zijn weergegeven in kaarten per soort waardoor een inschatting gemaakt is van de geschiktheid van de verschillende locaties.

Following the Blue Growth ambition of the European Commission, the interest in the potential of offshore is growing. This paper aimed to contribute to the discussion on the feasibility of offshore aquaculture development and its potential for multi-use with other maritime activities. A review of national and international projects forms the basis of the paper, where the Dutch North Sea is used as a case-study area. Analysis of technical, economic and ecological boundaries indicated that the potential of fish culture is limited, that seaweed cultivation is likely to gain potential when challenges related to processing will be overcome and that mussel culture has the highest potential in the near future. The North Sea is an area where many stakeholders claim space, which might set boundaries to the number of sites available for mussel culture. Competing claims are a potential source of conflict but may also lead to mutual benefits when smart combinations are sought, e.g. with wind parks, fisheries and nature conservation; especially, the possibility of combining mussel culture in or around wind parks is worthwhile to be further explored. A spatial distribution model adapted for the Dutch North Sea conditions demonstrated that offshore mussel production in wind farms can be profitable. Yet, the commercial interest for offshore development of mussel culture is still limited. Actions required to stimulate further development of the offshore mussel industry are presented for the government, the private sector, research institutes and civil society organizations.

Today, fish farming faces an increasing demand in fish products, but also various environmental challenges. Genetic improvement in growth rate and feed conversion ratio is known to be an efficient way to increase production and increase efficiency in fish farming. The environmental consequences of genetic improvement in growth rate and feed conversion ratio, however, are unknown. In this study, we investigated the environmental consequences of genetic improvement in growth rate and feed conversion ratio in an African catfish farm, using Recirculating Aquaculture System (RAS). In RAS, total fish production of the farm is limited by rearing density or by the capacity to treat dissolved nitrogen. To evaluate the environmental consequences of genetic improvement in growth rate and feed conversion ratio, we combined life cycle assessment and bioeconomic modelling of genetic response to selection. We explored different impact categories, such as climate change, eutrophication, acidification and energy use, and we expressed impacts per ton of fish produced. Results show that the environmental impact of genetic improvement in growth rate and feed conversion ratio varies among impact categories and depends on the factor limiting production at farm level (i.e. rearing density or nitrogen treatment capacity). Genetic improvement of feed conversion ratio reduces environmental impacts in each scenario tested, while improving growth rate reduces environmental impacts only when rearing density limits farm production. Environmental responses to genetic selection were generally positive and show similar trends as previously determined economic responses to genetic improvement in growth rate and feed conversion ratio in RAS. These results suggest that genetic improvement of growth rate and feed conversion ratio for species kept in RAS will benefit both the environmental impacts and the economics of the production system.

Laparoscopic cholecystectomy is a commonly performed surgical procedure. The postoperative course is often uncomplicated; however, complications like infection, biliary leakage, and bleeding and bile duct injury can occur. Here we report on a patient with common bile duct obstruction and haemobilia due to a false aneurysm of the right hepatic artery after laparoscopic cholecystectomy, masked by biliary pancreatitis, complicated by an infarction of the liver after embolisation. The aetiology of upper gastrointestinal bleeding greatly varies. This case is an uncommon case of gastrointestinal bleeding due to a false aneurysm of the right hepatic artery, which was successfully treated.

Background Tranexamic acid reduces blood loss associated with various surgical procedures. Postoperative bleeding caused by dissection or bleeding of the enteric staple lines is a well-known complication following bariatric surgery. Reoperation in order to restore hemostasis is frequently necessary (up to 2.5% in literature). The effect of conservative therapy using tranexamic acid for postoperative hemorrhage after bariatric surgery is still very much a novel technique. The aim is to present our results (reoperation rate and thrombo-embolic complication rate) of tranexamic acid therapy for postoperative bleeding after bariatric surgery in comparison to those in existing literature. Methods We retrospectively reviewed 1388 patients who underwent bariatric surgery (laparoscopic gastric bypass or laparoscopic gastric sleeve). Use of tranexamic acid, reoperation rate, transfusion rate and rate of thrombo-embolic complications were reviewed. Results Forty-five of 1388 (3.2%) total patients experienced significant hemorrhage after bariatric surgery. Tranexamic acid was administered in 44 of these patients. A failure of the treatment with tranexamic acid was observed in four patients. The incidence of reoperation was 0.4% for the entire population. No thrombo-embolic complications were registered for patients receiving tranexamic acid. Conclusion These findings suggest that the administration of tranexamic acid appears to be safe in reducing the reoperation rate for bleeding after bariatric surgery.

The &ldquo, Dutch Energy Agreement&rdquo, motivates governments and industries to invest in renewable energy sources, of which offshore wind energy is one of the solutions to meet the agreed target of 16% of the total energy budget from renewable resources by 2023. An option for the multi-use of wind farms is nature-inclusive building, in which the design and construction of wind farms make use of the potential for co-design with oyster bed restoration. This can support the government&rsquo, s ambitions, for the Dutch North Sea, to achieve biodiversity goals, restore ecosystem functions, and enhance ecosystem services, including future seafood production. For the recovery of flat oyster (Ostrea edulis) beds, knowledge is required about the conditions under which active restoration of this species in the North Sea can be successfully implemented. This paper gives a framework and presents results to determine suitability of wind farms for flat oyster restoration, and provides recommendations for pilot studies. Our analysis showed that a number of wind farms in the Dutch section of the North Sea are suitable locations for development of flat oyster beds. Combining oyster restoration and oyster culture, as a protein source, is a viable option worth investigating.

The study deals with the investigation of a sol–gel/nanoclay composite coating as a protective layer for the corrosion protection of hot dip galvanized (HDG) steel. Sol–gel coatings prepared from glycidoxypropyltrimethoxysilane, tetraethoxysilane and methyltriethoxysilane with 2 wt.% of sodium montmorillonite were investigated. The effect of different curing times (2, 5, 10, 15 min) and different curing temperatures (90 °C, 150 °C, 180 °C) on the protection properties of the hybrid layer was investigated. ToF-SIMS analyses and FT-IR measurements highlighted that the higher is the curing temperature, the higher is the densification of the sol–gel network. FT-IR spectroscopy measurements underlined that the Si O Si/Si OH ratio rises by increasing curing time or temperature. ToF-SIMS analyses indicate a lessening in the coating thickness by increasing the curing temperature. The densification of the network through formation of siloxane bonds was found to be responsible for the improved protection offered by the sol–gel layer which leads to a remarkable drop of the cathodic current density and an increase of the resistance associated to the sol–gel film.

This work deals with the investigation of a sol–gel/nanoclay composite coating as a protective layer for the corrosion protection of hot-dip galvanized (HDG) steel. Sol–gel coatings prepared from glycidoxypropyltrimethoxysilane, tetraethoxysilane and methyltriethoxysilane with 2 wt.% of sodium montmorillonite were investigated. As the first part of a complete study, this paper investigates the effect of the formulation parameters on the performance of the composite layer. In particular, the parameters affecting sol preparation and the hydrolysis conditions (such as pH, ultrasonication time,…) were studied as well as their effects on the final corrosion protection properties of the composite layer. The experimental findings highlighted that modifying the pH has a direct impact on the nanoclay dispersion. The investigation of the rheological behavior of the suspension evidenced significant interactions between the particles. In particular, specific interactions between the silanol groups and the nanoclays were observed from FT-IR and indirectly confirmed by the study of the influence of the delay between pH adjustment and addition of the precursors on the properties of the coating. These interactions were correlated to the corrosion protection efficiency of the composite layers.

The present study aims at investigating the elaboration of a ZnO/sol–gel nanocomposite coating, which can provide a number of properties such as UV-absorption, mechanical and barrier effects, etc. depending on targeted applications. The sol–gel coating formulation is an inorganic–organic hybrid based on tetraethoxysilane (TEOS) and glycidyloxypropyltrimethoxysilane (GPTMS). In order to ensure good dispersion in the sol–gel matrix, ZnO nanoparticles were surface-modified with a silane coupling agent. The functionalization was confirmed by Fourier transform infrared (FTIR) and thermogravimetric (TGA) analyses. Field emission gun-scanning electron microscopy (FEG-SEM) characterization of the nanocomposite film reveals a homogeneous distribution and dispersion of the ZnO nanoparticles throughout the film. Glow discharge optical emission spectrometry (GDOES) analysis allows evaluating the thickness of coatings and getting a depth composition profile. Some properties such as UV-absorption and barrier effect are highlighted using a UV–visible spectrometer and electrochemical impedance spectroscopy (EIS), respectively. The effect of ZnO concentration is also presented.

TiO2 nanotubes have demonstrated perspective applications in the photovoltaic field. They can reduce both the transport dimensionality and the recombination of the photoinjected electrons. In this paper, arrays of TiO2 nanotubes were fabricated by anodization of Ti foils in an ethylene glycol solution containing hydrofluoric acid (HF) under a constant voltage. From field emission scanning electron microscopy (FE-SEM) images, we observed the microstructure of titania nanotubes. Images show that, as-anodized, the surface of the nanotubes is covered with a precipitate. Ultrasonic treatment was used to remove this precipitate. X-ray diffraction (XRD) results show that the as-anodized amorphous TiO2 nanotubes are converted to crystalline anatase after the samples have been annealed at 500 °C during 2 h. Electrochemical behaviour (in terms of charge transfer resistance) was investigated by electrochemical impedance spectroscopy (EIS). The annealed samples were characterized by electrochemical tests. A schematic representation of the TiO2 nanotubes consisting of two layers (i.e. dense and nanoporous) is proposed to explain the obtained results.

In fish farming, economic values (EV) of breeding goal traits are lacking, even though they are key parameters when defining selection objectives. The aim of this study was to develop a bioeconomic model to estimate EV of 2 traits representing production performances in fish farming: the thermal growth coefficient (TGC) and the feed conversion ratio (FCR). This approach was applied to a farm producing African catfish (Clarias gariepinus) in a recirculating aquaculture system (RAS). In the RAS, 2 factors could limit production level: the nitrogen treatment capacity of the biofilter or the fish density in rearing tanks at harvest. Profit calculation includes revenue from fish sales, cost of juveniles, cost of feed, cost of waste water treatment, and fixed costs. In the reference scenario, profit was modeled to zero. EV were calculated as the difference in profit per kilogram of fish between the current population mean for both traits (µt) and the next generation of selective breeding (µt+Δt) for either TGC or FCR. EV of TGC and FCR were calculated for three generations of hypothetical selection on either TGC or FCR (respectively 6.8% and 7.6% improvement per generation). The results show that changes in TGC and FCR can affect both the number of fish that can be stocked (number of batches per year and number of fish per batch) and the factor limiting production. The EV of TGC and FCR vary and depend on the limiting factors. When dissolved NH3-N is the limiting factor for both µt and µt+Δt, increasing TGC decreases the number of fish that can be stocked but increases the number of batches that can be grown. As a result, profit remains constant and EVTGC is zero. Increasing FCR, however, increases the number of fish stocked and the ratio of fish produced per kilogram of feed consumed ("economic efficiency"). The EVFCR is 0.14 €/kg of fish, and profit per kilogram of fish increases by about 10%. When density is the limiting factor for both µt and µt+Δt, the number of fish stocked per batch is fixed; therefore, extra profit is obtained by increasing either TGC, which increases the annual number of batches, or by decreasing FCR, which decreases annual feed consumption. EVTGC is 0.03 €/kg of fish and EVFCR is 0.05-0.06 €/kg of fish. These results emphasize the importance of calculating economic values in the right context to develop efficient future breeding programs in aquaculture.

This work deals with the effect of the sonication treatment applied to an aqueous suspension of sodium montmorillonite nanoparticles used to prepare hybrid clay-organosilane derived sol-gel films. The sol-gel films were obtained from a mixture of 3-glycidoxypropyltrimethoxysilane (GPTMS), tetraethoxysilane (TEOS) and methyltriethoxysilane (MTES) adding 2 wt% of sodium montmorillonite suspension after sonication. The sol-gel layers were applied onto hot dip galvanized (HDG) steel plates. The influence of the duration of the sonication treatment (i.e. 0, 1, 3 and 12 hours) on both the structure as well as on the electrochemical properties of the sol-gel films was analyzed in details. The effect of different sonication times on the structure of the sol-gel film was investigated by means of solid state Nuclear Magnetic Resonance (NMR), X-Ray diffraction (XRD) and Infra-Red (FT-IR) spectroscopy. The corrosion protection properties of the different sol-gel layers were investigated mainly by means of electrochemical techniques. The structural characterization (NMR, XRD, FT-IR) of the coating proved that interactions between the montmorillonite plates and the silica-based sol-gel network take place, with changing the local environment of Al sites in the clay. The potentiodynamic measurements as well as the EIS confirmed the beneficial effects of the presence of the Na-MMT and of the sonication treatment.

Clad AA2024 T3 specimens were anodized in a tartaric-sulfuric acid bath (TSA) and subsequently protected either by classical Cr-free water sealing treatment or by application of a hybrid sol–gel coating. The sol–gel coating was prepared using a solution with high water content (58 %v/v) and obtained by the hydrolysis and condensation of tetraethoxysilane (TEOS) and 3-glycidoxypropyltrimethoxysilane (GPTMS). The morphology of the sealed anodic films and their thicknesses were evaluated by scanning electron microscopy (SEM), field emission scanning electron microscopy (FE-SEM) and glow discharge optical emission spectrometry (GDOES). The corrosion resistance of the samples was evaluated by electrochemical impedance spectroscopy (EIS) and salt-spray test. The results showed that the treatment with the hybrid sol–gel increased the resistive properties of the pores compared to the classical water sealing, delaying the access of aggressive species to the barrier layer.

As an alternative to chromate based coatings cerium oxide thin films were deposited by magnetron sputtering on Al clad 2024 alloy in order to evaluate their corrosion protection potential. Varying plasma properties by modifying O2 content during deposition allowed to affect the chemistry and microstructure of the synthesized films. The electrochemical characterization showed that specific self-healing mechanisms are suspected for the samples deposited with the highest amount of oxygen. Those mechanisms, leading to the reinforcement of barrier properties versus immersion time in NaCl solution, are associated with the interaction between alumina and cerium oxide film in the presence of electrolyte.

The synergistic effect of incorporation of nanoclay along with cerium nitrate as a corrosion inhibitor into an eco-friendly silane layer consisting of glycidyl–oxypropyl–trimethoxysilane (GPS), tetraethoxysilane (TEOS) and methyltriethoxysilane (MTES) applied on pure Al was studied in the present work. At first, the most effective concentration of cerium nitrate and the mechanism in which the cerium component could improve performance of silane layer were determined through a combination of electrochemical techniques and surface analysis methods as well. Based on the impedance spectra as well as polarization curves the superiority of silane film in the presence of cerium could be linked to deposition of a film on the cathodic zones, restricting access of the aggressive species to the surface. Moreover, FTIR spectra revealed impact of the inhibitor on the film structure. Furthermore, EIS data revealed that the nanoparticles enriched silane coating in the presence of cerium nitrate could provide superior corrosion protection compared to the sol–gel film which is solely incorporated with nanoclay.

Seaweeds are increasingly seen as an alternative to land-grown products in food and feed applications. Interest in production of seaweeds in temperate waters is rising, in particular in combination with offshore wind energy generation. This article reports an investigation of the economic feasibility of seaweed production in the North Sea using economic modelling. Often, an overly positive picture of the costs and benefits of seaweed production is sketched. Based on current available information, offshore seaweed production in the North Sea is not economically feasible. Sensitivity analysis shows that revenues would have to increase by roughly 300%, all other things equal, to make a profit. A number of opportunities to improve the economic feasibility of a North Sea seaweed value chain are identified. Technical innovation and the design of systems that enable multiple harvests per year can reduce production costs. Successful marketing of seaweed as human food, and the development of biorefinery concepts can increase the value of the produced seaweed.

The efficiency of dicarboxylate corrosion inhibitors for mild steel in near neutral NaCl solution was studied using electrochemical methods as open circuit potential, potentiodynamic polarisation curves and electrochemical impedance spectroscopy. Surface analysis was carried out to determine the kind of protection afforded by these inhibitors and to establish the inhibition mechanism. The results show that adipate and sebacate are good inhibitors, and their effectiveness is strongly dependent on chloride concentration. In the case of sebacate, the concentration required for inhibition was determined, and it was found that full protection strongly depends on the chloride concentration. Furthermore, it was shown that the mixture of benzotriazole with these dicarboxylates significantly improves the inhibition performance. The combination of these inhibitors exhibits a synergistic protective effect as it leads to higher efficiencies compared to those obtained when used individually.

C athodic electrodeposition is currently used to protect the totality of the world automotive production against corrosion. Although this technology is highly competitive, some aspects, as the coverage of salient edges, could still be improved. Special paints containing flow modifiers have consequently been developed. Salt fog exposure on steel knife blades is the most frequently performed test to characterize the protection afforded by cataphoretic coatings against edge corrosion. In this study, a method based on electrochemical techniques, among which cathodic polarization and electrochemical impedance spectroscopy (EIS), is proposed for the special characterization of edge coverage in a faster and less restrictive way in comparison with salt fog spray. The combination of dc and ac measurements is also employed to accelerate the degradation process and to improve the fitting of EIS spectra. In order to validate these testing methods, different kinds of pretreatments and coatings were selected. The influence on edge corrosion of different parameters as the coating thickness and the amount of flow modifier were determined.

Silane sol–gel based films are very promising alternatives to the traditional chromate pre-treatments. However, the protection offered by the silane films strongly decreases when the coating is damaged. Some previous studies showed that the barrier properties of the silane layer can be improved by incorporation of clay nanoparticles. Moreover, inhibitive metallic cations can be incorporated in the nanoclays by ion exchange, providing a way to prepare cheap corrosion inhibitors nanoreservoirs offering self-healing properties. Rare earth (RE) metal salts have been shown to be effective corrosion inhibitors on a wide range of metals, including hot dip galvanized (HDG) steel. For this study, montmorillonite clay is modified to obtain a Ce(III) montmorillonite clay (Ce-MMT). The amount of incorporated Ce(III) is characterized by means of XRF measurements. X-ray diffraction showed that the Ce(III) is located in the interlayer space. The influence of the ionic strength and of the nature of the counter ion on the kinetic of Ce(III) release is investigated in NaCl and ZnCl 2 solutions. Either unmodified MMT or Ce-MMT nanoreservoirs are incorporated in a silane sol–gel treatment consisting in a combination of 3 different silanes (GPS, TEOS and MTES). The corrosion protection offered to HDG substrate by the modified silane layer was evaluated by means of electrochemical impedance spectroscopy in 0.1 M NaCl.

The corrosion protection properties offered to galvanized steel by an aqueous based silane layer are studied after incorporation of different amounts of sodium montmorillonite nanoclays (Na MMT). The rheological behaviour of Na + nanoclays in aqueous suspensions was determined in order to select the appropriate sonication time and concentration for incorporation in the silane matrix. The effect of sonication on the disaggregation/exfoliation of platelets was evaluated by using different characterization methods such as using the methylene blue (MB) dye as a spectrophotometric probe (UV–vis), zeta potential and hydrodynamic diameter measurements. The corrosion protection conferred to galvanized steel substrate by the modified silane layer was evaluated by electrochemical impedance spectroscopy (EIS) in 0.1 M aerated sodium chloride solution. The barrier properties of the silane layer are significantly increased by addition of 2 wt.% of clay sonicated for 1 and 2 h.

The compatibility between a cataphoretic electro-coating and a silane layer applied on galvanized steel was evaluated by performing electrochemical impedance measurements on coated and uncoated samples. During electro-deposition, the water electrolysis induces hydrogen production. This process can induce degradation or destruction of the silane layer. This process was simulated by reproducing the application conditions of electro-coating in an aqueous solution of same pH (6) and conductivity (1600 μS) than the electro-coating bath, but without any pigments and binder. A current of 2 mA/cm2 was applied between the sample and the counter-electrode during 10 and 20 s. These conditions are representative of the mean real application conditions just before the coating formation. The loss of the barrier effect offered by the silane layer was evaluated by EIS before and after simulation. This simulation shows whether it is possible to conveniently design the properties of the silane layer to maintain its protection and adhesion promotion properties after polarization. The barrier properties and the water uptake of the electro-coated samples were evaluated by EIS as a function of immersion time in a sodium chloride solution (0.1 M). The coated silane pre-treated samples show a good behaviour compared to the samples coated without pre-treatment. By properly managing the deposition conditions of sol–gel films it is possible to obtain cataphoretic coating with improved corrosion resistance. Silane sol–gel films of different thicknesses and curing temperature were produced. It was demonstrated that a 120 nm thick silane sol gel film cured at 180 °C ensures a very good compatibility with the electro-coat. In fact, this system shows a very high corrosion resistance even after 50 days of immersion in a sodium chloride solution. Also the resistance in the salt spray chamber of the electro-coated thin silane layer cured at 180 °C is remarkable. The results confirm that, if conveniently designed, silane sol–gel film properties, the silane layer is a good adhesion promoter of the cataphoretic coating on galvanized steel and this property is maintained for long exposure times.

Electroless nickel–boron (Ni–B) was synthesized on mild steel. Coating thickness was approximately 30 μm. Some of the coatings were submitted to a hardening heat treatment at 400 °C for 1 h in an atmosphere containing 95% Ar and 5% H 2 to improve their mechanical performance. Heat treated and untreated samples were submitted to the Taber abrasion test to assess their wear resistance. The wear track was then examined by SEM and roughness measurement. The Taber Wear Index of untreated samples was slightly better than that of steel but heat treated samples attained TWI as small as 13. The corrosion resistance of the Ni–B coatings was investigated by potentiodynamic polarization and electrochemical impedance spectroscopy. The EIS results showed diffusion phenomena in 0.1 M NaCl solution. Electroless Ni–B coating increases the corrosion resistance of steel and heat treatments allow a further enhancement. Wear decreases that resistance but the worn product keeps a better behaviour than uncoated parts.

Silane based products are becoming an interesting material for pre-treatment deposition, because, for the environmental compatibility, they can be used as substitutes of traditional pre-treatments like chromates. Silanes have been studied as new pre-treatments before organic coating deposition for many different metals, including aluminium, copper and zinc. In this work, some results concerning the properties of water-based silane pre-treatments on galvanized steel will be presented. Galvanized sheets obtained by continuous hot dip process were considered. A silane based bath containing a mixture of three different silanes were used for the pre-treatment deposition (Glycidoxypropiltrimethoxysilane, Tetraethoxysilane and Methyltriethoxysilane). The obtained pre-treatments were characterized by SEM observations, FT-IR and ToF-Sims analysis. The corrosion protection properties of the pre-treated galvanized samples were studied using industrial accelerated tests (like salt spray exposure) and electrochemical measurements (polarization curves and electrochemical impedance spectroscopy (EIS) measurements), as a function of the different curing conditions. The pre-treated galvanized sheets were further coated with an epoxy-polyester powder coating, in order to verify the adhesion promotion properties and the corrosion protection performances of the complete protective system. The coated samples were characterized by EIS measurements with artificial defect in order to study the interfacial stability (adhesion) in wet conditions and monitor the coating delamination. The electrochemical data were compared with adhesion measurements obtained by cathodic delamination tests. The electrochemical tests showed that the silane layer acts not only as a coupling agent between the inorganic substrate and the organic coating, but it also ensures a good barrier effect against water and oxygen.

The introduction of new tailor-made (meth)acrylated oligomers has extended the potential use of the radiation curing technology to metal coating applications where adhesion, flexibility and corrosion resistance are of prime importance. In this paper, we discuss the properties of three fairly simple clearcoat systems spanning a range of glass transition temperatures between ≈10 and 70 °C. The systems were obtained by combination of two original urethane acrylate resins and two reactive diluents. Practical performance tests typically used to establish coating profiles in the metal industry (i.e., mechanical testing, adhesion, salt-spray test, etc.) were performed on ultraviolet (UV)-coated galvanised steel. In addition, the barrier properties of coated steel panels were systematically investigated at different coating thicknesses using electrochemical impedance spectroscopy. These results are analysed in terms of relevant physico-chemical characteristics such as conversion, volume contraction, swelling, viscoelastic and tensile behaviour determined on free-standing coating layers of the three formulations.

The ageing of organic coatings is generally associated with an increase of stresses leading to a coating degradation: loss of adherence, increase of the porosity and irreversible changes during exposure to climatic parameters such as humidity and temperature. In this work, electrochemical impedance spectroscopy (EIS) and the cantilever method (stressmeter) were used to establish a correlation between the loss of barrier properties and the increase of the stress of electrocoated paints. The stress was generated during hygrothermal ageing cycles in a climatic chamber (20 h at 55 °C–84% RH and 4 h at 23 °C–40% RH). Phosphatised steel plates were used for the electrochemical measurements and calibrated steel strips for the stress measurements. Two electrocoated paints differing by their composition were tested. For both electrocoatings, the plates and the calibrated steel strips were submitted to 0, 1, 2 and 4 hygrothermal cycles in the climatic chamber. The generated stress was determined after each cycle. The strong influence of humidity on the stress was underlined during humidity cycles at ambient temperature. The sensitivity of the organic coatings to humidity increases with the number of humidity cycles and finally induces an irreversibility of the system. The barrier properties were evaluated after the different hygrothermal cycles and after 0, 2, 7, 14 and 21 days of immersion in 0.5 M NaCl electrolyte solution by EIS on the electrocoated steel samples. The stress generated during ageing increases with the number of cycles and at the same time a decrease of the barrier properties is observed. For the electrocoating whose stress evolution is more sensitive to humidity, a good correlation is observed between the increase of the internal stress and the increase of the coating capacitance due to water uptake by the coating.

It has been observed that UV weathering and corrosion resistance tests are often performed separately, without taking into consideration their reciprocal influence. This is the case in the field of prepainted steel, where the European norm considers either UV durability or corrosion resistance. There is therefore no real evaluation of the global durability of the system. The aim of the present study is to show the influence of the photo-oxidation of painted layers on their barrier effect. This can lead to the formation of small blisters during field exposure. The blistering observed in natural exposure is never observed in individual accelerated corrosion tests. The depth of degradation from the surface of prepainted panels has been determined with infrared spectroscopy. Successive abrasions and FTIR analysis in ATR mode (attenuated total reflectance) allow us to determine oxidation profiles that can be well correlated with the decrease of barrier properties of painted systems measured with electrochemical impedance spectroscopy (EIS). The blistering has then been reproduced by exposing UV-weathered samples in a salt spray device.

Background:Pancreatic panniculitis is a rare entity, occurring in less than 2% of patients with pancreatic disorders. Skin manifestations may precede the diagnosis of a pancreatic disease by many months. When treatable, correction of the underlying pancreatic disorder may lead to prompt resolution of the panniculitis.Objective:We present the case of a 74-year-old-man with a history of chronic pancreatitis who presented with an acute onset of tender, nonulcerating nodules. The clinical and histologic features of pancreatic panniculitis are discussed, with a brief review of the differential diagnosis and clinical approach to panniculitis.Conclusions:Pancreatic panniculitis is a recognizable clinical entity with characteristic histologic features that may resolve with treatment of the underlying pancreatic disorder. The algorithm-based clinical approach to panniculitis presented in this study is a practical tool designed to guide clinicians in ordering investigations and determining the appropriate management for patients presenting with subcutaneous nodules.

The introduction of laparoscopy as a surgical technique provided a method which allows for preventing major abdominal wall incisions and improving recovery of the patient after surgery. In abdominal wall surgery, laparoscopic ventral hernia repair has proven to be at least as safe as open repair. However, the technique of laparoscopic ventral hernia repair has not been standardized. Despite all the research that has been conducted and all the articles that have been published, there still seems to be a lack of consensus about the best method to repair a ventral hernia. The aim of this paper is to review knowledge on incisional hernias and discuss several controversies regarding the laparoscopic management of ventral hernias. A review of the literature was undertaken, and a search identified twenty records: six RCTs on incisional hernias, five RCTs on ventral hernias, and nine reviews or meta-analyses. Interpretation of the scientific data was difficult because the outcomes in literature were often based on pooled data of primary ventral hernias and incisional ventral hernias. Controversy remains regarding the optimal laparoscopic management of ventral hernias in terms of selection of patients for laparoscopic repair, optimal technique, outcomes and cost-efficacy. Lack of evidence allows persisting controversies in laparoscopic ventral hernia repair. RCTs and registries are necessary to document efficacy, morbidity, quality of life and costs during a sufficient period of time to provide clinicians with the evidence required to make the right choice for the best surgical technique.