Surgeons have hesitated early cholecystectomy because of cardiovascular comorbidities during adoption of guidelines

The introduction of the guidelines has resulted in an increase of laparoscopic surgeries performed, but the rate of early surgery was still low. Here, the initial effect of the introduction of the guideline was confirmed in single center, and factors disturbing early cholecystectomy were analyzed. This study included 141 patients who were treated for acute cholecystitis from January 2010 to October 2014 at Kanazawa Medical Center. Each patient was assigned into a group according to when they received treatment. Patients in Group A were treated before the Tokyo Guidelines were introduced (n = 48 cases), those in Group B were treated after the introduction of the guidelines (93 cases). After the introduction of the guidelines, early laparoscopic cholecystectomy was significantly increased (P < 0.001), however, the rate of early operations was still 38.7% only. There are many cases with cardiovascular disease in delayed group, the prevalence had reached 50% as compared with early group of 24% (P < 0.01). Approximately 25% of patients continued antiplatelet or anticoagulant therapy. In the early days of guidelines introduction, the factor which most disturbed early surgery was the coexistence of cardiovascular disease. These contents could be described in the next revision of the guidelines.

”Fulminant” acute pancreatitis: diagnosis, prognosis, treatment

Aim: improving the results treatment of patients with severe acute pancreatitis by early diagnosis fulminant course of the disease and development of individualized treatment tactics based on early surgical interventions with perioperative extracorporeal detoxificationMaterials and methods: In research analyzed the treatment of 232 patients with severe acute pancreatitis: 175 patients were evaluated retrospectively (control group), 57 were included in a prospective study (main group). The severity of the disease was studied using integral scales, necrosis of the pancreas (its localization, depth) and the prevalence of parapancreatitis (gradations according to Ishikawa et al.) - according to CT data. The tactics of treatment at the retrospective stage of the study was based on the current Clinical Recommendations, at the prospective stage - on the developed signs of a "fulminant" course of the disease and included early operations with perioperative extracorporeal detoxification.Results: Criteria for a fulminant course of severe acute pancreatitis were found in 41 (23%) of 175 and 24 (42%) of 57 patients. According to the scale values (APACHE II ≥ 16 Ranson ≥ 8, SOFA ≥ 7 points) in the first 48 hours from the onset of the disease, the presence of aseptic enzymatic peritonitis, the depth of necrosis in the region of the head and body of the pancreas ≥50%, intra-abdominal hypertension of the III-IV degree, significant differences with similar indicators in 134 and 33 patients with severe acute pancreatitis. With fulminant course in the control and main groups, all 5 patients who received only conservative treatment died, 33 (86.8%) and 9 (40.9%) after operations, χ2 = 13.32, p<0.001. Mortality in severe acute pancreatitis, excluding patients with fulminant course, was comparable in the groups, being 15.7% and 15.2%, χ2 = 0.450, p> 0.05.Conclusion: Patients with severe acute pancreatitis represent a heterogeneous group. The morphological substrate of "fulminant" pancreatitis is deep (more than 50%) necrosis with localization in the head and body of the pancreas and widespread parapancreatitis. The developed individualized approach to treatment allows predicting an unfavorable course in the first 48 hours after the onset of the disease. Early operations in the nature of detoxification, decompression and drainage interventions, with perioperative use of extracorporeal detoxification methods allowed to reduce mortality from 86.8% to 40.9%.

Negotiating Care

This article explores the creation of the Over 60 Health Clinic in Berkeley, California, during the mid-1970s. Developed by a local network of the activist group Gray Panthers, the clinic offered screening and preventive care to elderly clients and was intended to serve as a catalyst for broader health reform. Drawing on the proposals, contracts, and reports that structured the clinic’s early operations, the article traces the clinic’s efforts to imagine new modes of care, even within the constraints of collaboration with bureaucratic public agencies. In so doing, the East Bay Gray Panthers articulated a distinct understanding of “healthy aging” as relational and contingent on the maintenance of existing intergenerational communities.

How Start-up Businesses View and Use Accounting in Early Year Operations

This research analyzes how start-up companies implement accounting in their early operations and if that use of accounting (or lack thereof) has played a role in acquiring funding. Prior research shows that the quality of financial statements positively affects investing efficiency for companies in emerging markets (Chen et al., 2011). In this paper, we evaluate the hypothesis that start-ups using financial statements more extensively receive more outside funding than their counterparts. This was tested with a 27-question survey broken into three sections: demographic, accounting use, and financial information. There were 44 participants. The typical start-up profile is 5-6 years old, employs ten people, and identifies in the technology industry. Approximately 75% of participants reported using financial statements. While mostly viewed positively, some participants feel strongly against using standard accounting practices. Results showed companies who use financial statements more often reported a higher percentage of debt and investment funding received than those who used financial statements less frequently or not at all. In conclusion, accounting helps start-ups communicate higher quality information to investors, thus leading to a better chance of receiving capital investment/debt financing. This sample selection was not chosen randomly and is not a statistical depiction of the entire population.

Surgical Emotions: How TV and Newspaper Coverage Furthered the Cause of Heart Transplantation in France (1968–1973)

This paper shows the influence of media coverage for the fate of heart transplantation in France. It argues that the media’s support not only reinforced the graft’s medical legitimacy, but also sustained the practice by mobilizing public support. Our study focuses on two peaks in media coverage. The first took place in 1968/69, as the first grafts in the world and in France were performed. The second occurred in 1973, when surgeries resumed in France following a four-year hiatus due to the mixed results of the early operations. French transplants were then largely covered on TV and in newspapers. We examine the reasons for these peaks in coverage and the underlying rationales of the alliance between French surgeons and journalists. Cross-analysis of TV and print productions sheds light on the media devices used to enlist the general public’s moral support. It shows that state television proved an effective platform for doctors, allowing for a different kind of storytelling than in newspapers.

Study of the Galactic radio sources in the SCORPIO survey resolved by ATCA at 2.1 GHz

We present a catalogue of a large sample of extended radio sources in the SCORPIO field, observed and resolved by the Australia Telescope Compact Array. SCORPIO, a pathfinder project for addressing the early operations of the Australia SKA Pathfinder, is a survey of ∼5 square degrees between 1.4 and 3.1 GHz, centered at l = 343.5○, b = 0.75○ and with an angular resolution of about 10 arcsec. It is aimed at understanding the scientific and technical challenges to be faced by future Galactic surveys. With a mean sensitivity around $100\ \mu \mathrm{Jy\ beam}^{-1}$ and the possibility to recover angular scales at least up to 4 arcmin, we extracted 99 extended sources, 35 of them detected for the first time. Among the 64 known sources 55 had at least a tentative classification in literature. Studying the radio morphology and comparing the radio emission with infrared we propose as candidates 6 new H ii regions, 2 new planetary nebulae, 2 new luminous blue variable or Wolf–Rayet stars and 3 new supernova remnants. This study provides an overview of the potentiality of future radio surveys in terms of Galactic source extraction and characterization and a discussion on the difficulty to reduce and analyze interferometric data on the Galactic plane.