Comparing the 14-mm uncovered and 10-mm covered metal stents in patients with distal biliary obstruction caused by unresectable pancreatic cancer: a multicenter retrospective study.

BACKGROUND: Endoscopic biliary drainage using metal stent (MSs) is an established palliative treatment for patients with unresectable malignant distal biliary obstruction (MDBO). However, a major drawback of MS is recurrent biliary obstruction (RBO). Uncovered MSs with a diameter of 14 mm (UMS-14) were developed to overcome this. We aimed to compare the clinical outcomes of UMS-14 with those of conventional covered MSs having a diameter of 10 mm (CMS-10). METHODS: Consecutive patients with MDBO caused by unresectable pancreatic cancer, who underwent UMS-14 or CMS-10 placement at two tertiary-care centers, were retrospectively examined according to the Tokyo Criteria 2014. RESULTS: Two hundred and thirty-eight patients who underwent UMS-14 (the UMS-14 group, n = 80) or CMS-10 (the CMS-10 group, n = 158) over a 62-month period were included. The technical and clinical success rates were similar between the two groups. RBO occurred in 20 (25%) and 59 (37%) patients of the UMS-14 and CMS-10 groups, respectively (p = 0.06). Median time till RBO was significantly longer in the UMS-14 group than in the CMS-10 group (not reached vs. 290 days, p = 0.04). Multivariate analysis revealed that CMS-10 placement was an independent risk factor for RBO (hazard ratio: 1.66, 95% confidence interval: 1.00-2.76). The incidence of early complications, including pancreatitis, and the overall survival (UMS-14 vs. CMS-10: 169 vs. 167 days, p = 0.83) were comparable between the two groups. CONCLUSIONS: UMS-14 stents were safe and effective for treating patients with MDBO secondary to unresectable pancreatic cancer. The insertion of UMS-14 is recommended, because it is less likely to get occluded as compared to CMS-10.

Comprehensive mechanical power analysis in sprint running acceleration.

Sprint running is a common feature of many sport activities. The ability of an athlete to cover a distance in the shortest time relies on his/her power production. The aim of this study was to provide an exhaustive description of the mechanical determinants of power output in sprint running acceleration and to check whether a predictive equation for internal power designed for steady locomotion is applicable to sprint running acceleration. Eighteen subjects performed two 20 m sprints in a gym. A 35-camera motion capture system recorded the 3D motion of the body segments and the body center of mass (BCoM) trajectory was computed. The mechanical power to accelerate and rise BCoM (external power, Pext ) and to accelerate the segments with respect to BCoM (internal power, Pint ) was calculated. In a 20 m sprint, the power to accelerate the body forward accounts for 50% of total power; Pint accounts for 41% and the power to rise BCoM accounts for 9% of total power. All the components of total mechanical power increase linearly with mean sprint velocity. A published equation for Pint prediction in steady locomotion has been adapted (the compound factor q accounting for the limbs' inertia decreases as a function of the distance within the sprint, differently from steady locomotion) and is still able to predict experimental Pint in a 20 m sprint with a bias of 0.70 ± 0.93 W kg-1 . This equation can be used to include Pint also in other methods that estimate external horizontal power only.

Mechanical work in shuttle running as a function of speed and distance: Implications for power and efficiency.

Biomechanics (and energetics) of human locomotion are generally studied at constant, linear, speed whereas less is known about running mechanics when velocity changes (because of accelerations, decelerations or changes of direction). The aim of this study was to calculate mechanical work and power and to estimate mechanical efficiency in shuttle runs (as an example of non-steady locomotion) executed at different speeds and over different distances. A motion capture system was utilised to record the movements of the body segments while 20 athletes performed shuttle runs (with a 180° change of direction) at three paces (slow, moderate and maximal) and over four distances (5, 10, 15 and 20 m). Based on these data the internal, external and total work of shuttle running were calculated as well as mechanical power; mechanical efficiency was then estimated based on values of energy cost reported in the literature. Total mechanical work was larger the faster the velocity and the shorter the distance covered (range: 2.3-3.7 J m-1 kg-1) whereas mechanical efficiency showed an opposite trend (range: 0.20-0.50). At maximal speed, over all distances, braking/negative power (about 21 W kg-1) was twice the positive power. Present results highlight that running humans can exert a larger negative than positive power, in agreement with the fundamental proprieties of skeletal muscles in vivo. A greater relative importance of the constant speed phase, associated to a better exploitation of the elastic energy saving mechanism, is likely responsible of the higher efficiency at the longer shuttle distances.