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Laparoscopic retrosternal gastric pull-up for fistulized mediastinal mass

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World Journal of Gastrointestinal Surgery 2017年第3期9卷 92-96页

作者： Benedetto Mungo Arianna Barbetta Anne O Lidor Miloslawa Stem daniela molena Division of Thoracic Surgery Department of Surgery Johns Hopkins University School of Medicine Thoracic Surgery Service Department of Surgery Memorial Sloan Kettering Cancer Center Department of Surgery Johns Hopkins University School of Medicine Baltimore

We describe the case of a patient successfully reconstructed with laparoscopic retrosternal gastric pull-up after esophagectomy for unresectable posterior mediastinal inflammatory myofibroblastic tumor, eroding into the esophagus and compressing the airways. A partial esophagectomy with esophagostomy was performed for treatment of esophageal pleural fistula and empyema, while the airways were managed with the placement of an endobronchial stent. Gastrointestinal reconstruction was performed using a laparoscopic approach to create a retrosternal tunnel for gastric conduit pull-up and cervical anastomosis. The patient was discharged uneventfully after 6 d, and has done very well at home with normal diet.

关键词： Esophageal surgery Minimally invasive surgery Esophageal fistula Laparoscopic retrosternal bypass Gastric conduit

Evidence-based approach to the treatment of esophagogastric junction tumors

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World Journal of Clinical Oncology 2022年第3期13卷 159-167页

作者： Francisco Schlottmann María A Casas daniela molena Department of Surgery Hospital Alemán of Buenos AiresBuenos Aires C1118AATArgentina Department of Surgery Memorial Sloan Kettering Cancer CenterNew YorkNY 10065United States

The incidence of esophagogastric junction(EGJ)adenocarcinoma is increasing in developed nations due to the rising prevalence of obesity and gastroesophageal reflux *** to the peculiar location in a histological transition zone between the esophagus and the stomach,the management of EGJ tumors is *** main surgical approaches exist:total gastrectomy with distal esophagectomy or esophagectomy by either transhiatal or transthoracic *** operations differ significantly in the extent of *** addition,patients with locally advanced disease can receive either preoperative chemoradiation or perioperative *** evidence-based review analyzes current evidence regarding the management of EGJ tumors in order to help defining the best surgical and systemic treatment of these patients.

关键词： Esophagogastric junction tumors Esophagectomy Gastrectomy Esophageal adenocarcinoma Chemotherapy Chemoradiation

Post-discharge complications after esophagectomy account for high readmission rates

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World Journal of Gastroenterology 2016年第22期22卷 5246-5253页

作者： Sophia Y Chen daniela molena Miloslawa Stem Benedetto Mungo Anne O Lidor Department of Surgery Johns Hopkins University School of Medicine Thoracic Surgery Service Department of Surgery Memorial Sloan Kettering Cancer Center Section of Minimally Invasive Foregut and Bariatric Surgery Division of General Surgery University of Wisconsin School of Medicine and Public Health

AIM: To identify rates of post-discharge complications(PDC), associated risk factors, and their influence on early hospital outcomes after ***: We used the 2005-2013 American College of Surgeons National Surgical Quality Improvement Program(ACS-NSQIP) database to identify patients ≥ 18 years of age who underwent an esophagectomy. These procedures were categorized into four operative approaches: transhiatal, Ivor-Lewis, 3-holes, and non-gastric conduit. We selected patient data based on clinical relevance to patients undergoing esophagectomy and compared demographic and clinical characteristics. The primary outcome was PDC, and secondary outcomes were hospital readmission and reoperation. The patients were then divided in 3 groups: no complication(Group 1), only pre-discharge complication(Group 2), and PDC patients(Group 3). A modified Poisson regression analysis was used to identify risk factors associated with developing postdischarge complication, and risk ratios were ***: 4483 total patients were identified, with 8.9% developing PDC within 30-d after esophagectomy. Patients who experienced complications post-discharge had a median initial hospital length of stay(LOS) of 9 d; however, PDC occurred on average 14 d following surgery. Patients with PDC had greater rates of wound infection(41.0% vs 19.3%, P < 0.001), venous thromboembolism(16.3% vs 8.9%, P < 0.001), and organ space surgical site infection(17.1% vs 11.0%, P = 0.001) than patients with pre-discharge complication. The readmission rate in our entire population was 12.8%. PDC patients were overwhelmingly more likely to have a reoperation(39.5% vs 22.4%, P < 0.001) and readmission(66.9% vs 6.6%, P < 0.001). BMI 25-29.9 and BMI ≥ 30 were associated with increased risk of PDC compared to normal BMI(18.5-25).CONCLUSION: PDC after esophagectomy account for significant number of reoperations and readmissions. Efforts should be directed towards optimizing patient's health pre-disch

关键词： Reoperation hospital readmission Post discharge complications esophagectomy Outcomes research

Breaking the brain barrier:cell competition in neural development and disease

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Neural Regeneration Research 2024年第9期19卷 1863-1864页

作者： Patrizia Morciano daniela Grifoni Department of“Life Health and Environmental Sciences”University of L’AquilaItaly “INFN-Laboratori Nazionali del Gran Sasso” AssergiItaly

General information on cell competition:Social behaviors are the basis of biological *** species and populations,cell communities experience Darwinian ecological interactions,and in case space and nutrient availabilit... 详细信息

关键词： neural barrier throughout

Climate change impacts on eutrophication in the Po River(Italy):Temperature-mediated reduction in nitrogen export but no effect on phosphorus

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Journal of Environmental Sciences 2024年第9期143卷 148-163页

作者： Elisa Soana Maria Pia Gervasio Tommaso Granata daniela Colombo Giuseppe Castaldelli Department of Environmental and Prevention Sciences University of FerraraVia Luigi Borsari 4644121 FerraraItaly CESI-Italian Electrical and Technical Experimental Center via Rubattino 5420134MilanoItaly

Rivers worldwide are under stress from eutrophication and nitrate pollution,but the ecological consequences overlap with climate change,and the resulting interactions may be unexpected and still *** Po River basin(northern Italy)is one of the most agriculturally productive and densely populated areas in *** remains unclear whether the climate change impacts on the thermal and hydrological regimes are already affecting nutrient dynamics and transport to coastal *** present work addresses the long-term trends(1992-2020)of nitrogen and phosphorus export by investigating both the annual magnitude and the seasonal patterns and their relationship with water temperature and discharge *** the constant diffuse and point sources in the basin,a marked decrease(-20%)in nitrogen export,mostly as nitrate,was recorded in the last decade compared to the 1990 s,while no significant downward trend was observed for *** water temperature of the Po River has warmed,with the most pronounced signals in summer(+0.13℃/year)and autumn(+0.16℃/year),together with the strongest increase in the number of warm days(+70%-80%).An extended seasonal window of warm temperatures and the persistence of low flow periods are likely to create favorable conditions for permanent nitrate removal via denitrification,resulting in a lower delivery of reactive nitrogen to the *** present results show that climate change-driven warming may enhance nitrogen processing by increasing respiratory river metabolism,thereby reducing export from spring to early autumn,when the risk of eutrophication in coastal zones is higher.

关键词： Nutrient export Eutrophication Climate change Water temperature Denitrification Po River

Hospitalization for esophageal achalasia in the United States

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World Journal of Gastrointestinal Endoscopy 2015年第13期7卷 1096-1102页

作者： daniela molena Benedetto Mungo Miloslawa Stem Anne O Lidor Division of Thoracic Surgery Department of Surgery Johns Hopkins University School of Medicine Department of Surgery Johns Hopkins University School of Medicine

AIM: To assess the outcome of different treatments in patients admitted for esophageal achalasia in the United ***: This is a retrospective analysis using the Nationwide Inpatient Sample over an 8-year period(2003-2010). Patients admitted with a primary diagnosis of achalasia were divided into 3 groups based on their treatment:(1) Group 1: patients who underwent Heller myotomy during their hospital stay;(2) Group 2: patients who underwent esophagectomy; and(3) Group 3: patients not undergoing surgical treatment. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay(LOS), discharge destination and total hospital ***: Among 27141 patients admitted with achalasia, nearly half(48.5%) underwent Heller myotomy, 2.5% underwent esophagectomy and 49.0% had endoscopic or other treatment. Patients in group 1 were younger, healthier, and had the lowest mortality when compared with the other two groups. Group 2 had the highest LOS and hospital charges among all groups. Group 3 had the highest mortality(1.2%, P < 0.001) and the lowest home discharge rate(78.8%) when compared to the other groups. The most frequently performed procedures among group 3 were esophageal dilatation(25.9%) and injection(13.3%). Among patients who died in this group the most common associated morbidities included acute respiratory failure, sepsis and aspiration pneumonia. CONCLUSION: Surgery for achalasia carries exceedingly low mortality in the modern era; however, in complicated patients, even less invasive treatments are burdened bysignificant mortality and morbidity.

关键词： Esophageal achalasia Outcomes Myotomy

Experimental Exclusion of Guanaco Grazing Increases Cover, Diversity, Land Function and Plant Recruitment in Patagonia

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Phyton-International Journal of Experimental Botany 2024年第7期93卷 1383-1401页

作者： Carla Cepeda Gabriel Oliva daniela Ferrante INTA Instituto Nacional de Tecnología Agropecuaria Santa Cruz9400Rio GallegosArgentina Universidad Nacional de la Patagonia Austral Santa Cruz9400Rio GallegosArgentina

Semiarid Patagonia represents 25%of the rangeland area in Argentina,and sheep overgrazing has degraded about a third of it in the *** this century,depleted domestic stocks have mostly stabilized,but Guanaco populations have *** native camelids share habitat and diets with sheep,but their effect on vegetation is poorly understood and has long been *** set up an exclusion experiment in Monte León and Cañadón Vaca,a semiarid shrubland grassland in southern Patagonia,currently grazed only by *** baselines were studied in 2016 in twelve plots,and half of them were protected from guanaco ***-six plots were cleared to study *** was reassessed in 2021,and changes were evaluated using a paired *** protected plots,vegetation cover increased,bare soil diminished,and vegetated patches grew in size,but the density of the patch-interpatch arrangement did not ***,measured by richness and the Shan-non-Wiener(SW)index,grew signiﬁ*** recycling increased,as did the Stability and Inﬁltration Land Function indexes,although these last differences were not signiﬁ*** cover under guanaco grazing also increased,mainly due to the growth of dwarf shrubs,a typical tendency in sheep grazing-induced transitions in the *** patches under grazing fragmented,resulting in smaller patches and denser patch struc-tures,while diversity and land function indexes remained *** plants established in cleared plots without guanacos showed higher cover density and individual *** effects are similar to those observed in numerous experimental sheep *** grazing may thus prevent restoration and contribute to the generalized land degradation processes that overgrazing has been causing in Patagonia for over a century.

关键词： Rangelands herbivory biodiversity overgrazing carrying capacity fauna

High CO_(2)permeation using a new Ce_(0.85)Gd_(0.15)O_(2-δ)-LaNiO_(3)composite ceramic–carbonate dual-phase membrane

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Journal of Environmental Sciences 2024年第6期140卷 219-229页

作者： daniela González-Varela JFrancisco Gómez-García Gustavo Tavizon Heriberto Pfeiffer Instituto de Investigaciones en Materiales Universidad Nacional Autónoma de MéxicoCd.UniversitariaDel.CoyoacánCP 04510Ciudad de MéxicoMéxico Departamento de Física y Química Teórica Facultad de QuímicaUniversidad Nacional Autónoma de MéxicoCd.UniversitariaDel.CoyoacánCP 04510Ciudad de MéxicoMéxico 不详

This work shows the synthesis,characterization and evaluation of dense-ceramic membranes made of Ce_(0.85)Gd_(0.15)O_(2-δ)-LaNiO_(3)(CG-LN)composites,where the fluorite-perovskite ratio(CG:LN)was varied as follows:75:25,80:20 and 85:15 wt.%.Supports were initially characterized by XRD,SEM and electrical conductivity(using vacuum and oxygen atmospheres),to determine the composition,microstructural and ionic-electronic conductivity ***,supports were infiltrated with an eutectic carbonates mixture,producing the corresponding dense dual-phase membranes,in which CO_(2)permeation tests were ***,CO_(2)permeation experiments were performed from 900 to 700℃,in the presence and absence of oxygen(flowed in the sweep membrane side).Results showed that these composites possess high CO_(2)permeation properties,where the O_(2)addition significantly improves the ionic conduction on the sweep membrane ***,the GC80-LN20 composition presented the best results due to the following physicochemical characteristics:high electronic and ionic conductivity,appropriate porosity,interconnected porous channels,as well as thermal and chemical stabilities between the composite support and carbonate phases.

关键词： CO_(2)permeation Doped CeO_(2) LaNiO_(3) Impedance Ceramic carbonate membrane

Litter production and leaf nutrient concentration and remobilization in response to climate seasonality in the central Amazon

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Journal of Forestry Research 2024年第3期35卷 131-141页

作者： Ricardo Antonio Marenco Saul Alfredo Antezana-Vera daniela Pereira Dias Luiz Antonio Candido Instituto Nacional de Pesquisas da Amazonia Coordenagao de Uso da Terra e Mudanca ClimaticaAv.Andre Araujo 2936ManausAM69067-375Brazil Programa de pos-Graduagao em Agricultura no Tropico Umido Instituto Nacional de Pesquisas da Amazonia-INPAManausAMBrazil Unidade Academica de Ciencias Agrarias Universidade Federal de JataiBR 364km 195JataiGO 75801-615Brazil

Litterfall is the largest source of nutrients to for-est soils of tropical ***,variability in lit-terfall production,nutrient remobilization,and changes in leaf nutrient concentration with climate seasonality remain largely unknown for the central *** study meas-ured litterfall production,leaf nutrient remobilization,and leaf area index on a forest plateau in the central *** was measured at monthly intervals during 2014,while nitrogen,phosphorus,potassium,calcium and mag-nesium concentrations of leaf litter and canopy leaves were measured in the dry and rainy seasons,and remobilization rates *** area index was also recorded in the dry and rainy *** litterfall varied from 33.2(in the rainy season)to 87.6 g m^(-2) in the dry season,while leaf area index increased slightly in the rainy *** seasonality had no effect on concentrations of nitrogen,calcium,and magnesium,whereas phosphorous and potassium responded to rainfall seasonality *** phosphorous increased,potassium decreased during the dry *** seasons,nitrogen,potassium,and phosphorous decreased in leaf litter;calcium increased in leaf litter,while magnesium remained unaffected with leaf ***,the five nutrients had similar remobilization rates over the *** absence of climate seasonality on nutrient remobilization suggests that the current length of the dry season does not alter nutrient remobilization rates but this may change as dry periods become more prolonged in the future due to climate change.

关键词： Throughfall Nutrient cycling Climatic seasonality Leaf mass per area