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A comparison of laparoscopic to open pancreaticoduodenectomy for pancreatic adenocarcinoma by propensity score matching analysis

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Laparoscopic, Endoscopic, and Robotic Surgery 2024年第4期7卷 141-146页

作者： Mount j. Mount B. Poruk K. Tice M. stauffer j.a. Department of Surgery Mayo Clinic Jacksonville FL United States Medical Education Heritage College of Osteopathic Medicine Ohio University Athens OH United States Medical Education The University of Toledo College of Medicine and Life Sciences Toledo OH United States

Objective: In previous studies, laparoscopic pancreaticoduodenectomy (LPD) has demonstrated safety and potential benefits over open pancreaticoduodenectomy (OPD) for pancreatic adenocarcinoma (PDAC). After performing both LPD and OPD procedures interchangeably in routine practice for a decade, the outcomes of LPD versus OPD for PDAC were analyzed and compared at a single institution. Our primary aim was to compare features of LPD and OPD in PDAC patients so that the suitable surgical approach may be chosen for each individual. Methods: From january 2010 through December 2020, all patients undergoing pancreaticoduodenectomy (PD) were identified, and information was collected prospectively. At a single institution, PD was performed on 589 patients, of whom 347 were OPD patients and 242 were LPD patients. After excluding those who underwent pancreatectomy for indications other than PDAC, total pancreatectomy, major vascular or concomitant organ resection, there were 237 patients (OPD = 157, LPD = 80). Then propensity score matching was completed to analyze 77 OPD patients versus 77 LPD patients to create a similar group of patients who underwent either LPD or OPD for PDAC. A comparison of perioperative data and 90-day outcomes with subsequent statistical analysis was performed. Results: Operative time (491 min vs. 281 min, p j.a.g University

关键词： Laparoscopy Pancreatic ductal adenocarcinoma Pancreatic fistula Pancreaticoduodenectomy Whipple

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Hydromechanical characterization of gas transport amidst uncertainty for underground nuclear explosion detection

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journal of Rock Mechanics and Geotechnical Engineering 2024年第6期16卷 2019-2032页

作者： Wenfeng Li Chelsea W.Neil j William Carey Meng Meng Luke P.Frash Philip H.stauffer Earth and Environmental Sciences Los Alamos National LaboratoryLos AlamosNM87544USA Department of Mineral Engineering New Mexico TechSocorroNM87801USA

Given the challenge of definitively discriminating between chemical and nuclear explosions using seismic methods alone,surface detection of signature noble gas radioisotopes is considered a positive identification of underground nuclear explosions(UNEs).However,the migration of signature radionuclide gases between the nuclear cavity and surface is not well understood because complex processes are involved,including the generation of complex fracture networks,reactivation of natural fractures and faults,and thermo-hydro-mechanical-chemical(THMC)coupling of radionuclide gas transport in the *** this study,we provide an experimental investigation of hydro-mechanical(HM)coupling among gas flow,stress states,rock deformation,and rock damage using a unique multi-physics triaxial direct shear rock testing *** testing system also features redundant gas pressure and flow rate measurements,well suited for parameter uncertainty *** porous tuff and tight granite samples that are relevant to historic UNE tests,we measured the Biot effective stress coefficient,rock matrix gas permeability,and fracture gas permeability at a range of pore pressure and stress *** Biot effective stress coefficient varies from 0.69 to 1 for the tuff,whose porosity averages 35.3%±0.7%,while this coefficient varies from 0.51 to 0.78 for the tight granite(porosity<1%,perhaps an underestimate).Matrix gas permeability is strongly correlated to effective stress for the granite,but not for the porous *** experiments reveal the following key engineering implications on transport of radionuclide gases post a UNE event:(1)The porous tuff shows apparent fracture dilation or compression upon stress changes,which does not necessarily change the gas permeability;(2)The granite fracture permeability shows strong stress sensitivity and is positively related to shear displacement;and(3)Hydromechanical coupling among stress states,rock damage,and gas flow appears to be

关键词： Underground nuclear explosion uncertainty quantification Radionuclide transport Biot effective stress coefficient Fracture permeability Matrix permeability

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Birth,Survival and Death of Languages by Monte Carlo Simulation

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Communications in Computational Physics 2008年第2期3卷 271-294页

作者： C.Schulze D.stauffer S.Wichmann Institute for Theoretical Physics Cologne UniversityD-50923 KolnEuroland Department of Linguistics Max Planck Institute for Evolutionary AnthropologyDeutscher Platz 6D-04103 LeipzigGermany.

Simulations mostly by physicists of the competition between adult languagessince 2003 are reviewed. The Viviane and Schulze models give good and reasonableagreement, respectively, with the empirical histogram of language sizes. Alsothe numbers of different languages within one language family is modeled reasonablyin an intermediate range. Bilingualism is now incorporated into the Schulze *** the rate at which the majority shifts from one language to another is found tobe nearly independent of the population size, or to depend strongly on it, accordingto details of the Schulze model. Other simulations, like Nettle-Culicover-Nowak, arereviewed more briefly.

关键词： Language competition Schulze model Viviane model agent-based modeling.

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Modeling Arctic Boundary Layer Cloud Streets at Grey-zone Resolutions

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Advances in Atmospheric Sciences 2020年第1期37卷 42-56页

作者： Hui-Wen LAI Fuqing ZHANG Eugene E.CLOTHIAUX David R.stauffer Brian j.GAUDET johannes VERLINDE Deliang CHEN Department of Meteorology and Atmospheric Science and Center for Advanced Data Assimilation and Predictability TechniquesThe Pennsylvania State UniversityUniversity ParkPennsylvania 16802USA Department of Earth Sciences University of GothenburgGothenburg 40530Sweden Earth Systems Analysis and Modeling Pacific Northwest National LaboratoryRichlandWashington 99354USA

To better understand how model resolution affects the formation of Arctic boundary layer clouds,we investigated the influence of grid spacing on simulating cloud streets that occurred near Utqiaġvik(formerly Barrow),Alaska,on 2 May 2013 and were observed by MODIS(the Moderate Resolution Imaging Spectroradiometer).The Weather Research and Forecasting model was used to simulate the clouds using nested domains with increasingly fine resolution ranging from a horizontal grid spacing of 27 km in the boundary-layer-parameterized mesoscale domain to a grid spacing of 0.111 km in the large-eddy-permitting *** investigated the model-simulated mesoscale environment,horizontal and vertical cloud structures,boundary layer stability,and cloud properties,all of which were subsequently used to interpret the observed roll-cloud *** model resolution led to a transition from a more buoyant boundary layer to a more shear-driven turbulent boundary *** clouds were stratiform-like in the mesoscale domain,but as the model resolution increased,roll-like structures,aligned along the wind field,appeared with ever smaller wavelengths.A stronger vertical water vapor gradient occurred above the cloud layers with decreasing grid *** fixed model grid spacing at 0.333 km,changing the model configuration from a boundary layer parameterization to a large-eddy-permitting scheme produced a more shear-driven and less unstable environment,a stronger vertical water vapor gradient below the cloud layers,and the wavelengths of the rolls decreased *** this study,only the large-eddy-permitting simulation with gird spacing of 0.111 km was sufficient to model the observed roll clouds.

关键词： cloud streets large eddy simulation grey zone Arctic clouds model resolution

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Updated outcomes using clockwise technique for laparoscopic distal pancreatectomy:Optimal treatment of benign and malignant disease of the left pancreas

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Laparoscopic, Endoscopic and Robotic Surgery 2021年第1期4卷 9-13页

作者： jordan S.Dutcher Domenech Asbun Mary P.Tice Horacio j.a.bun john A.stauffer Mayo Clinic Alix School of Medicine JacksonvilleFLUSA Department of General Surgery Mayo Clinic FloridaJacksonvilleFLUSA Hepatobiliary and Pancreas Surgery Miami Cancer InstituteMiamiFLUSA

Background:Laparoscopic distal pancreatectomy(LDP)has become the preferred approach for surgical management of left sided pancreas *** institution previously published its experience with distal pancreatectomies using a clockwise technique with good *** now reexamine our outcomes across a longer time ***:From August 2008 to November 2020,364 patients underwent LDP by hepatobiliary surgeons(HA and jS).All procedures were performed using the same clockwise approach,which includes the stepwise slow compression *** descriptive analysis of patient demographic,clinical,operative,and pathologic data was ***:Of the 364 patients who underwent LDP using this technique,clinically significant postoperative pancreatic fistula(POPF)was noted in 26(7.1%)patients,while major morbidity and mortality were reported in 9.9%and 0.3%,***-assisted method was required for 18(4.9%)patients and unplanned conversion in 20(5.5%)*** a subset analysis of patients with pancreatic adenocarcinoma(n¼90),POPF was noted in 13(14.4%),with minor complications occurring in 34.4%and major morbidity in 14.4%.Conclusion:LDP with a clockwise approach for dissection,combined with the stepwise slow compression technique results in excellent outcomes,with even lower POPF rates than originally *** analysis of patients with pancreatic adenocarcinoma shows acceptable perioperative outcomes with this technique.

关键词： Laparoscopic distal pancreatectomy Pancreatic ductal adenocarcinoma Outcomes

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Feasibility of pancreatectomy following high-dose proton therapy for unresectable pancreatic cancer

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World journal of Gastrointestinal Surgery 2017年第4期9卷 103-108页

作者： Kathryn E Hitchcock R Charles Nichols Christopher G Morris Debashish Bose Steven j Hughes john A stauffer Scott A Celinski Elizabeth A johnson Robert A Zaiden Nancy P Mendenhall Michael S Rutenberg Department of Radiation Oncology University of Florida Department of Surgical Oncology UF Health Cancer Center-Orlando Health Department of Surgery University of Florida Department of Surgery Mayo Clinic Department of Surgery Baylor University Medical Center at Dallas Department of Hematology/Oncology Mayo Clinic Department of Hematology/Oncology Baptist Health

AIM To review surgical outcomes for patients undergoing pancreatectomy after proton therapy with concomitant capecitabine for initially unresectable pancreatic *** From April 2010 to September 2013,15 patients with initially unresectable pancreatic cancer were treated withproton therapy with concomitant capecitabine at 1000 mg orally twice daily. All patients received 59.40 Gy(RBE) to the gross disease and 1 patient received 50.40 Gy(RBE) to high-risk nodal targets. There were no treatment interruptions and no chemotherapy dose reductions. Six patients achieved a radiographic response sufficient to justify surgical exploration,of whom 1 was identified as having intraperitoneal dissemination at the time of surgery and the planned pancreatectomy was aborted. Five patients underwent resection. Procedures included:Laparoscopic standard pancreaticoduodenectomy(n = 3),open pyloris-sparing pancreaticoduodenectomy(n = 1),and open distal pancreatectomy with irreversible electroporation(IRE) of a pancreatic head mass(n = 1). RESULTS The median patient age was 60 years(range,51-67). The median duration of surgery was 419 min(range,290-484),with a median estimated blood loss of 850 cm^3(range,300-2000),median ICU stay of 1 d(range,0-2),and median hospital stay of 10 d(range,5-14). Three patients were re-admitted to a hospital within 30 d after discharge for wound infection(n = 1),delayed gastric emptying(n = 1),and ischemic gastritis(n = 1). Two patients underwent R0 resections and demonstrated minimal residual disease in the final pathology specimen. One patient,after negative pancreatic head biopsies,underwent IRE followed by distal pancreatectomy with no tumor seen in the specimen. Two patients underwent R2 resections. Only 1 patient demonstrated ultimate local progression at the primary site. Median survival for the 5 resected patients was 24 mo(range,10-30).CONCLUSION Pancreatic resection for patients with initially unresectable cancers is feasible after

关键词： Pancreatic cancer Pancreatectomy Pancreas Proton therapy Radiotherapy

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National trends in resection of the distal pancreas

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World journal of Gastroenterology 2012年第32期18卷 4342-4349页

作者： Armando Rosales-Velderrain Steven P Bowers Ross F Goldberg Tatyan M Clarke Mauricia A Buchanan john A stauffer Horacio j.a.bun Department of General Surgery Mayo Clinic FloridaJacksonvilleFL 32225United States

AIM:To investigate national trends in distal pancreatectomy(DP) through query of three national patient care ***:From the Nationwide Inpatient Sample(NIS,2003-2009),the National Surgical Quality Improvement Project(NSQIP,2005-2010),and the Surveillance Epidemiology and End Results(SEER,2003-2009) databases using appropriate diagnostic and procedural codes we identified all patients with a diagnosis of a benign or malignant lesion of the body and/or tail of the pancreas that had undergone a partial or distal *** of laparoscopy was defined in NIS by the International Classification of Diseases,Ninth Revision correspondent procedure code;and in NSQIP by the exploratory laparoscopy or unlisted procedure current procedural terminology *** SEER,patients were identified by the International Classification of Diseases for Oncology,Third Edition diagnosis codes and the SEER Program Code Manual,third edition procedure *** analyzed the databases with respect to trends of inpatient outcome metrics,oncologic outcomes,and hospital volumes in patients with lesions of the neck and body of the pancreas that underwent operative ***:NIS,NSQIP and SEER identified 4242,2681 and 11 082 DP resections,***,laparoscopy was utilized in 15%(NIS) and 27%(NSQIP).No significant increase was seen over the course of the *** was performed for malignancy in 59%(NIS) and 66%(NSQIP).Neither patient Body mass index nor comorbidities were associated with operative approach(P = 0.95 and P = 0.96,respectively).Mortality(3% vs 2%,P = 0.05) and reoperation(4% vs 4%,P = 1.0) was not different between laparoscopy and open *** complications(10% vs 15%,P < 0.001),hospital costs [44 741 dollars,interquartile range(IQR) 28 347-74 114 dollars vs 49 792 dollars,IQR 13 299-73 463,P = 0.02] and hospital length of stay(7 d,IQR 4-11 d vs 7 d,IQR 6-10,P < 0.001) were less when laparoscopy was *** and two year sur

关键词： Laparoscopic distal pancreatectomy Trends Nationwide Inpatient Sample National Surgical Quality Improvement Project Surveillance epidemiology and end results

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Total pancreatectomy: Short- and long-term outcomes at a high-volume pancreas center

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World journal of Gastrointestinal Surgery 2016年第9期8卷 634-642页

作者： Hazem M Zakaria john A stauffer Massimo Raimondo Timothy A Woodward Michael B Wallace Horacio j.a.bun Department of Hepatopancreatobiliary and Liver Transplantation Surgery National Liver Institute Menoufia University Al-Minufya 22732 Egypt Department of Surgery Mayo Clinic Jacksonville FL 32224 United States Department of Gastroenterology Mayo Clinic Jacksonville FL 32224 United States

AIM To identify the current indications and outcomes of total pancreatectomy at a high-volume center. METHODS A single institutional retrospective study of patients undergoing total pancreatectomy from 1995 to 2014 was *** One hundred and three patients underwent totalpancreatectomy for indications including: Pancreatic ductal adenocarcinoma(n = 42, 40.8%), intraductal papillary mucinous neoplasms(n = 40, 38.8%), chronic pancreatitis(n = 8, 7.8%), pancreatic neuroendocrine tumors(n = 7, 6.8%), and miscellaneous(n = 6, 5.8%). The mean age was 66.2 years, and 59(57.3%) were female. Twenty-four patients(23.3%) underwent a laparoscopic total pancreatectomy. Splenic preservation and portal vein resection and reconstruction were performed in 24(23.3%) and 18 patients(17.5%), respectively. The 90 d major complications, readmission, and mortality rates were 32%, 17.5%, and 6.8% respectively. The 1-, 3-, 5-, and 7-year survival for patients with benign indications were 84%, 82%, 79.5%, and 75.9%, and for malignant indications were 64%, 40.4%, 34.7% and 30.9%, *** Total pancreatectomy, including laparoscopic total pancreatectomy, appears to be an appropriate option for selected patients when treated at a high-volume pancreatic center and through a multispecialty approach.

关键词： Intraductal papillary mucinous neoplasms Laparoscopic total pancreatectomy Pancreatic ductal adenocarcinoma Laparoscopy Pancreas cyst Pancreas cancer

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Capitalizing on multi-element interactions through bal-anced nutrition——A pathway to improve nitrogen use efficiency in China,India and North America

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Science China(Life Sciences) 2005年第z2期48卷 780-790页

作者： Paul E.Fixen K.N.Tiwari Mark D.stauffer Potash & Phosphate Institute Brookings SD 57006USA Potash & Phosphate Institute of Canada Midtown Plaza SK S7K 1J5Canada

A viable option for increasing nitrogen (N) use efficiency and mitigation of negative impacts of N on the environment is to capitalize on multi-element interactions through implementation of nutrient management programs that provide balanced nutrition. Numerous studies have demonstrated the immediate efficacy of this approach in the developing regions like China and India as well as developed countries in North America. Based on 241 site-years of experiments in these countries, the first-year N recovery efficiency (RE) for the conventional or check treatments averaged 21% while the balanced treatments averaged 54% RE, for an average increase of 33% in RE due to balanced nutrition. Effective policies to promote adoption are most likely those that enable site-specific approaches to nutrient management decisions rather than sweeping, nation-wide incentives supporting one nutrient over another. Local farmers, advisers and officials need to be empowered with tools and information to help them define necessary changes in practices to create more balanced nutrient management.

关键词： capitalizing, balanced nutrition, nitrogen use efficiency.

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地震预报——正变得有可能

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世界地震译丛 2002年第5期33卷 86-88,F003页

作者： A.Michael P.Reasenberg P.H.stauffer j.W.HendleyⅡ 杨一飞中国地震局地球物理研究所

地球科学家们已经在加利福尼亚开始预报破坏性地震。虽然地震预报仍不成熟, 但现在做出可信的官方地震警报是可能的。这些警报帮助政府。

关键词：地震预报余震预报地震前兆地震警报

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