Systematic Review and Meta-analysis of Restrictive Perioperative Fluid Management in Pancreaticoduodenectomy.

BACKGROUND: There is significant interest and controversy surrounding the effect of restrictive fluid management on outcomes in major gastrointestinal surgery. This has been most studied in colorectal surgery, although the literature relating to pancreaticoduodenectomy (PD) patients is growing. The aim of this paper was to generate a comprehensive review of the available evidence for restrictive perioperative fluid management strategies and outcomes in PD. METHODS: MEDLINE/PubMed, Embase, and the Cochrane Library were searched from inception to April 2017. A review protocol was utilized and registered with PROSPERO. Primary citations that evaluated perioperative fluid management in PD, including those as part of a clinical pathway, were considered. The primary outcome was postoperative pancreatic fistula (POPF). Secondary outcomes included delayed gastric emptying (DGE), complication rate, length of stay (LOS), mortality, and readmission. RESULTS: A total of six studies involving 846 patients were included (2009-2015), of which four were RCTs. Pooled analysis of RCTs and high-quality observational studies found no effect of restrictive intraoperative fluid management on POPF, DGE, complication rate, LOS, mortality, and readmission. Only one study assessed postoperative fluid management exclusively and found prolonged LOS in patients in the restricted fluid group. CONCLUSION: Based on results of RCTs and high-quality observational studies, intraoperative fluid restriction in PD has not been shown to significantly affect postoperative outcomes. There are too few studies assessing postoperative fluid management to draw conclusions at this time.

Newspaper depictions of mental and physical health.

Aims and method Media portrayals of mental illness have long been recognised as being misleading and stigmatising. Following the campaigns of several advocacy groups to address this issue, we aimed to evaluate the impact on mental health reporting over time. We repeated a survey we did 15 years ago using the same methods. Nine UK daily newspapers were surveyed over a 4-week period and coded with a schema to analyse the reporting of mental health compared with physical health. Results In total, 963 articles - 200 on mental health and 763 on physical health - were identified. Over half of the articles on mental health were negative in tone: 18.5% indicated an association with violence compared with 0.3% of articles on physical health. However, there were more quotes from patients with mental disorders than physical disorders (22.5% v. 19.7%) and an equal mention of treatment and rehabilitation. Clinical implications Mental health in print media remains tainted by themes of violence, however some improvement in reporting in recent years is evident, in particular by providing a voice for people with mental illness.

Complex contributions of fibronectin to initiation and maturation of microfibrils.

Fibrillins constitute the backbone of extracellular multifunctional assemblies present in elastic and non-elastic matrices, termed microfibrils. Assembly of fibrillins into microfibrils and their homoeostasis is poorly understood and is often compromised in connective tissue disorders such as Marfan syndrome and other fibrillinopathies. Using interaction mapping studies, we demonstrate that fibrillins require the complete gelatin-binding region of fibronectin for interaction, which comprises domains FNI6-FNI9. However, the interaction of fibrillin-1 with the gelatin-binding domain of fibronectin is not involved in fibrillin-1 network assembly mediated by human skin fibroblasts. We show further that the fibronectin network is essential for microfibril homoeostasis in early stages. Fibronectin is present in extracted mature microfibrils from tissue and cells as well as in some in situ microfibrils observed at the ultrastructural level, indicating an extended mechanism for the involvement of fibronectin in microfibril assembly and maturation.

"Shall we blick?" Novel words highlight actors' underlying intentions for 14-month-old infants.

By 14 months, infants have become exquisite observers of others' behavior and successful word learners. But do they coordinate their early observational and language capacities to gain insight into the intentions of others? Building upon Gergely, Bekkering, and Király's (2002) classic head-touch phenomenon, we consider the contribution of language to 14-month-old infants' imitation of an unconventional behavior (turning on a light with one's forehead, rather than hand). Providing a novel word ("I'm going to blick the light!") prompted infants to imitate; simply drawing attention to the action ("Look at this!"; "Look at what I'm doing!") did not. Thus, by 14 months, infants gain insight into the intentions of others by considering not only what we do but also what we say.

Individuation of pairs of objects in infancy.

Looking-time studies examined whether 11-month-old infants can individuate two pairs of objects using only shape information. In order to test individuation, the object pairs were presented sequentially. Infants were familiarized either with the sequential pairs, disk-triangle/disk-triangle (XY/XY), whose shapes differed within but not across pairs, or with the sequential pairs, disk-disk/triangle-triangle (XX/YY), whose shapes differed across but not within pairs. The XY/XY presentation looked to adults like a single pair of objects presented repeatedly, whereas the XX/YY presentation looked like different pairs of objects. Following familiarization to these displays, infants were given a series of test trials in which the screen was removed, revealing two pairs of objects in one of two outcomes, XYXY or XXYY. On the first test trial, infants familiarized with the identical pairs (XY/XY) apparently expected a single pair to be revealed because they looked longer than infants familiarized with the distinct pairs (XX/YY). Infants who had seen the distinct pairs apparently expected a double pair outcome. A second experiment showed outcomes of a single XY pair. This outcome is unexpected for XX/YY-familiarized infants but expected for XY/XY-familiarized infants, the reverse of Experiment 1. This time looking times were longer for XX/YY infants. Eleven-month-olds appear to be able to represent not just individual objects but also pairs of objects. These results suggest that if they can group the objects into sets, infants may be able to track more objects than their numerosity limit or available working memory slots would normally allow. We suggest possible small exact numerosity representations that would allow tracking of such sets.