bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stapler and Nonstapler Closure of the Pancreatic Remnant After Distal Pancreatectomy: Multicenter Retrospective Analysis of 388 Patients
Authors: Ban Daisuke , Shimada Kazuaki , Konishi Masaru , Saiura Akio , Hashimoto Masaji , Uesaka Katsuhiko 
Published: April 2012

AbstractBackgroundThe pancreatic fistula rate following distal pancreatectomy ranges widely, from 13.3 to 64.0 %. The optimal closure method of the pancreatic remnant remains controversial, especially regarding whether to use a stapler.MethodsAll patients who underwent distal pancreatectomy in five Japanese hospitals from January 2001 to June 2009 were included in this study. All relevant, anonymized medical records were entered into an electronic case report form. Complications and pancreatic fistulas were classified according to the Clavien–Dindo classification and the International Study Group of Pancreatic Surgery grading system, respectively.ResultsOf the 388 patients, stapler closure and nonstapler closure were used after distal pancreatectomy in 224 patients (57.7 %) and 164 patients (42.3 %), respectively. Clinically relevant pancreatic fistulas (grades B and C) occurred in 47 patients (21.0 %) treated by stapler closure, which was a significantly lower rate than that for the 83 patients (50.6 %) treated by nonstapler closure. There were no surgical mortalities or in‐hospital deaths. The distribution of postoperative complications was grade 1, 30.7 % (n = 119); grade 2, 40.2 % (n = 156); grade 3a, 0.1 % (n = 5); grade 3b, 0.3 % (n = 1); grade 4a, 0.3 % (n = 1). In the multivariate analysis, diabetes mellitus, previous laparotomy, operating time, and method of stump closure were found to be independently associated with the development of a clinical pancreatic fistula.ConclusionsStapler closure is a safe, efficient alternative to standard suture closure techniques because the clinical fistula rate is significantly lower.
Rate of Clinically Significant Postoperative Pancreatic Fistula in Pancreatic Neuroendocrine Tumors
Authors: Inchauste Suzanne M. , Lanier Brock J. , Libutti Steven K. , Phan Giao Q. , Nilubol Naris , Steinberg Seth M. , Kebebew Electron , Hughes Marybeth S. 
Published: April 2012

AbstractBackgroundIn 2005, the International Study Group of Pancreatic Fistula (ISGPF) developed a definition and grading system for postoperative pancreatic fistula (POPF). The authors sought to determine the rate of POPF after enucleation and/or resection of pancreatic neuroendocrine tumors (PNET) and to identify clinical, surgical, or pathologic factors associated with POPF.MethodsA retrospective analysis of pancreatic enucleations and resections performed from March 1998 to April 2010. We defined a clinically significant POPF as a grade B that required nonoperative intervention and grade C.ResultsOne hundred twenty‐two patients were identified; 62 patients had enucleations and 60 patients had resections of PNET. The rate of clinically significant POPF was 23.7 % (29/122). For pancreatic enucleation, the POPF rate was 27.4 % (17/62, 14 grade B, 3 grade C). The pancreatic resection group had a POPF rate of 20 % (12/60, 10 grade B, 2 grade C). This difference was not significant (p = 0.4). In univariate analyses, patients in the enucleation group with hereditary syndromes (p = 0.02) and non‐insulinoma tumors (p = 0.02) had a higher POPF rate. Patients in the resection group with body mass index (BMI) > 25 (p < 0.01), multiple endocrine neoplasia type 1 (MEN‐1; p < 0.01) and those who underwent simultaneous multiple procedures (p = 0.02) had a higher POPF rate. Multivariate analyses revealed that hereditary syndromes were able to predict POPF in the enucleation group, while having BMI > 25 and increasing lesion size were also associated with POPF in the group undergoing resection.ConclusionsWe found a clinically significant POPF rate after surgery in PNET to be 23.7 % with no difference by the type of operation. Our POPF rate is comparable to that reported in the literature for pancreatic resection for other types of tumors. Certain inherited genetic diseases—von Hippel–Lindau disease (VHL) and MEN‐1—were associated with higher POPF rates.
Patients with Multiple Hepatocellular Carcinomas Within the UCSF Criteria Have Outcomes After Curative Resection Similar to Patients Within the BCLC Early‐Stage Criteria
Authors: Zhao Wen‐Chao , Yang Ning , Zhu Nan , Zhang Hai‐Bin , Fu Yong , Zhou Hua‐Bang , Cai Wen‐Ke , Chen Ben‐Dong , Yang Guang‐Shun 
Published: April 2012

AbstractBackgroundSurgical strategies for the treatment of multiple hepatocellular carcinomas (HCC) remain controversial. This study compared the prognostic power of the University of California, San Francisco (UCSF) criteria with the Barcelona Clinic Liver Cancer (BCLC) early‐stage criteria.MethodsClinical and survival data of 162 multiple‐HCC patients in Child‐Pugh class A who underwent curative resection were retrospectively reviewed. Prognostic risk factors were analyzed using univariate and multivariate analyses.ResultsUCSF criteria were shown to independently predict overall and disease‐free survival. In patients within the UCSF criteria, 3‐year overall and disease‐free survivals were significantly better than in those exceeding the UCSF criteria (68 vs. 34 % and 54 vs. 26 %, respectively; both p < 0.001). There were no significant differences in 3‐year overall and disease‐free survival between patients within the UCSF criteria but exceeding the BCLC early stage and patients with BCLC early‐stage disease (71 vs. 66 %, p = 0.506 and 57 vs. 50 %, p = 0.666, respectively). Tumors within the UCSF criteria were associated with a lower incidence of high‐grade tumor (p = 0.009), microvascular invasion (p = 0.005), 3‐month death (p = 0.046), prolonged Pringle’s maneuver (p = 0.005), and surgical margin <0.5 cm (p < 0.001) than those exceeding the UCSF criteria. Tumors within the UCSF criteria but exceeding the BCLC early stage had invasiveness and surgical difficulty similar to those within the BCLC early‐stage criteria.ConclusionsMultiple HCC patients within the UCSF criteria benefit from curative resection. Expansion of curative treatment is justified.
MicroRNAs: Relevant Tools for a Colorectal Surgeon?
Authors: Peacock Oliver , Lee Andrew C. , Larvin Michael , Tufarelli Cristina , Lund Jonathan N. 
Published: April 2012

AbstractColorectal cancer is the third most common malignancy and cause of cancer‐related deaths worldwide. Approximately half of the patients diagnosed with colorectal cancer ultimately die of the condition. Death from colorectal cancer can be prevented by early detection, but unfortunately presentation is often late, with a worse prognosis. Screening by fecal occult blood testing reduces disease‐specific mortality, but there is a need for sensitive and specific noninvasive biomarkers to facilitate detecting the disease, staging it, and predicting the best therapeutic options. MicroRNAs (miRNAs) are short noncoding RNA sequences that have a crucial role in the regulation of gene expression. They have significant regulatory functions in basic cellular processes, such as cell differentiation, proliferation, and apoptosis. Evidence suggests that miRNAs may function as both tumor suppressors and oncogenes. The main mechanism for changes in the function of miRNAs in cancer cells is due to aberrant gene expression. Accurate discrimination of miRNA profiles between tumor and normal mucosa in colorectal cancer allows definition of specific expression patterns of miRNAs, giving good potential as diagnostic and therapeutic targets. MiRNAs expressed in colorectal cancers are also abundantly present and stable in stool and plasma samples. Their extraction from these three sources is feasible and reproducible. The ease and reliability of determining miRNA profiles in plasma or stool makes them potential molecular markers for colorectal cancer screening. This review summarizes the role miRNAs have in colorectal cancer, highlighting particularly the potential diagnostic, prognostic, and therapeutic implications in the future treatment of the disease.
Clinical Significance of Gastric Cancer Surveillance in Renal Transplant Recipients
Authors: Lee In‐Seob , Kim Tae‐Hwan , Kim Young‐Hoon , Yook Jeong‐Hwan , Kim Byung‐Sik , Han Duck‐Jong 
Published: April 2012

AbstractBackgroundPosttransplant malignancy is one of the major causes inhibiting long‐term graft survival. Gastric adenocarcinoma is the most common malignancy in Korea and occurs more frequently in renal transplant recipients compared to that in Western countries. We aimed to analyze the clinical features of the post‐renal‐transplant gastric cancer and assess factors that can affect the difference in survival.MethodsOf the 2,157 recipients who underwent renal transplantation at Asan Medical Center between January 1992 and April 2008, the 13 patients diagnosed with gastric adenocarcinoma after transplantation were retrospectively reviewed. We analyzed the effects of primary disease causing end‐stage renal disease, type of donor, type of immunosuppressant, induction therapy, and organ rejection on survival after cancer diagnosis. In addition, we evaluated the need for regular gastric cancer screening after transplantation by analyzing the difference in survival between the patients who were and were not screened on a regular basis.ResultsGastric adenocarcinoma occurred 3.44 times more often in men and 8.33 times more often in women than in the same age group of the general population in Korea (176.4/100,000 in men and 67.6/100,000 in women). Except for endoscopic screening, survival had no relation to the primary disease, type of donor, type of immunosuppressive drug, induction therapy, or the presence of rejection. The 5‐year survival rates of recipients who were and were not screened by regular gastroscopic surveillance were 100 and 53.6 %, respectively (p = 0.06).ConclusionsRegular gastric surveillance might be needed for renal transplant recipients with a high risk of gastric malignancy.
Predictors of Missed Appointments in Prospective Hand Surgery Research
Authors: Ootes Daan , Buijze Geert A. , Ring David 
Published: April 2012

Background Missed research appointments may bias the outcome of prospective clinical trials if the participants that miss appointments differ in important ways from those that do not. The purpose of this study was to determine the predictors of missed research appointments in patients enrolled in clinical trials. Methods We retrospectively evaluated 665 participants enrolled in ten prospective clinical trials conducted at our outpatient office between 2001 and 2010. Demographic data (sex, race, date of birth, date of enrollment, age at enrollment, educational level, and work status), study coordinator, and study type were analyzed for association with missed a research appointment in bivariate and multiple logistic regression analyses. Results One hundred and forty-four (21.7 %) participants missed research appointments during their follow-up. There were no statistical differences between those who missed appointments and those who did not, regarding sex, race, and age at enrollment. Educational level and work status were independent predictors of missed appointments. Conclusions This study suggests that educational level and work status are predictors of missed appointments in prospective clinical research.
The Effect of Temperature and Moisture Content of Stored Rapeseed on the Phytosterol Degradation Rate
Authors: Gawrysiak‐Witulska Marzena , Rudzińska Magdalena , Wawrzyniak Jolanta , Siger Aleksander 
Published: April 2012

AbstractThe effect of temperature (25 or 35 °C) and moisture content (10, 12.5, 15.5 %) on rapeseed phytosterol degradation was examined for 18 days. Statistical analysis showed that temperature, moisture and time of storage have a significant effect on phytosterol degradation. After 18 days of seed storage at a temperature of 25 and 30 °C losses of these compounds amounted to 11 and 13 % in seeds with moisture contents of 10, 12 and 16 % in seeds with a moisture content of 12.5 %, while they were 24 and 58 % in seeds with a moisture content of 15.5 %. Among all the identified sterols the greatest degradation rate was observed for stigmasterol and brassicasterol. Losses of stigmasterol and brassicasterol during storage of seeds with a 12.5 % moisture content at a temperature of 30 °C were 17 and 28 %, respectively, while in seeds with a moisture content of 15.5 % these losses increased to 73 and 63 %.
Designing tailorable software systems with the users’ participation
Authors: Neris Vânia Paula de Almeida , Baranauskas M. Cecília C. 
Published: April 2012

AbstractThere are several barriers that prevent Brazilian citizen to access knowledge, including the way in which computational technology is presented considering the diversity of interaction skills in our population. One approach for suiting the diverse and mutable interaction requirements is to tailor interfaces according to the users’ preferences or needs. Although literature regarding tailoring presents results with diverse foci, there has been a lack of works considering methods and techniques to support designers in their practice. This paper presents a practical approach to elicit and formalize the tailorable behavior making interactive systems more flexible. The elicitation of the different possible interfaces is performed with users’ participation and the tailorable behavior is formalized with a norm-based structure. A case study, in the context of an inclusive social network system, is described as well as the evaluation with final users.
The education and examination of actuaries
Authors: Goddard P. R. 
Published: April 2012

Every profession should be concerned with the problem of matching training and working practice. The problem is especially a vital one for the small but powerful actuarial profession seeking to adapt to significant changes.This note gives a brief summary of my Ph.D. thesis, which was based on questionnaires concerning the training of actuaries, and also in § 7 makes reference to a more recent investigation.A survey was designed and questionnaires despatched in 1973, in an attempt to discover the existing relationship between actuarial training and occupational practice, whether there was any shortcoming in this relationship and if so what might be needed to correct it. The response rate from the 236 actuaries who qualified for the Fellowship of the Institute of Actuaries in the four sets of examinations spanning the two calendar years 1972 and 1973 and who formed the test population was 81% (192 replies).
Assessing the solvency and financial strength of a general insurance company
Authors: Daykin C.D. , Bernstein G.D. , Coutts S.M. , Devitt E.R.F. , Hey G.B. , Reynolds D.I.W. , Smith P.D. 
Published: April 2012

AbstractAfter reviewing some general issues concerning solvency and the problems associated with establishing the financial strength of a general insurance company using the traditional balance sheet concept, the authors put forward an emerging costs approach for examining the strength of a company. This enables the true nature of the assets and liabilities to be taken into account, including their essential variability. Simulation is suggested as a powerful tool for use in examining the financial strength of a company and in exploring the impact of alternative scenarios. A particular example of such a simulation model is then presented and used to explore the resilience of a company's financial position to variations in a wide variety of parameters. The model enables the user to quantify the probability that the assets will prove adequate to meet the liabilities with or without an assumption of continuing business. This in turn permits an appropriate asset margin to be assessed individually for any particular company in the light of the strategy that the company intends to follow. Some of the implications of this approach for the management and supervision of general insurance companies are explored. The suggestion is made that the effectiveness of statutory supervision based on the balance sheet and a crude solvency margin requirement is limited, since it cannot have proper regard to the risk profile of individual companies. More responsibility should be placed on an actuary or other suitably qualified professional individual to report on the overall financial strength of the company, both to management and to the supervisory authorities.
Control of unfunded and partially funded systems of payments
Authors: Taylor G. C. 
Published: April 2012

SummaryThe paper considers systems of payments which are not fully funded, i.e partially funded or fully unfunded. Generally, the objective is to be able to establish a premium formula which is consistent with long term planning as to e.g. a target rate of funding, limited variation in premiums from year to year, etc. The premium formulas considered are those which relate premiums to prior years' premiums, claims experience and accumulated funds. These questions are reviewed in Section 1 which suggests the use of control theory. Section 2 formulates and provides a formal solution to the problem.Section 3 provides a couple of results which relate premiums to targeting of accumulated funds.Subsequent sections consider the construction of premium formulas. It is emphasized that the intention is not to supply a definitive set of instructions as to how the premium formula might be constructed, but rather to illustrate some of the principles relevant to it.In particular, two numerical examples are provided in § 6.2. Premium formulas are constructed which appear to respond reasonably satisfactorily to simulated claims experience.It is found that accurate prediction of future claims escalation is crucial to the operation of formulas of the linear control theory type (§ 6.2.1). Brief comment on possible further research aimed at dealing with this aspect of the question is given in Section 7.
Some statistical aspects of the Continuous Mortality Investigation Bureau's mortality investigations
Authors: Scott W. F. 
Published: April 2012

ABSTRACTThis article discusses the formulae for the select and ultimate exposed-to-risk in the CMIB's mortality studies, and certain statistical aspects of these investigations. It is shown that there are difficulties in the traditional binomial approach to the distribution of deaths, particularly for select rates, and the use of the Poisson distribution, rather than the binomial, is advocated.
Reserving for deferred capital gains tax (an application of option pricing theory)
Authors: Sherris M. 
Published: April 2012

AbstractThis paper sets out a framework, based on option pricing theory, that can be used to assess the value of deferred unrealised capital gains tax. In the U.K. and Australia, capital gains tax is paid on realisation of assets and the basis for determining the tax allows for inflation indexation of the cost base of the asset. Capital gains tax payments under these circumstances are shown to resemble those of a complex option. A number of theoretical approaches to the valuation of this option are discussed in the paper.
The developing role of the Government Actuary's Department in the supervision of insurance
Authors: Daykin C. D. 
Published: April 2012

AbstractFollowing a brief outline of the origins of the actuarial profession in the United Kingdom, the paper traces the involvement of actuaries in the supervision of insurance in the U.K., and recalls the origins and early development of actuaries in government. In 1919, the Government Actuary's Department (GAD) was formed, and the paper explores the developing role of GAD in the supervision of insurance and how insurance supervision has evolved into a close partnership between the actuarial profession and the supervisors.
Recent developments in the United Kingdom. National report for the United Kingdom to the 24th International Congress of Actuaries, Montreal, 31 May – 5 June 1992
Authors: McCutcheon J. J. , Shelley P. J. 
Published: April 2012

SummaryThe Report begins by discussing the origins of the actuarial profession in the United Kingdom and the recent growth in its size.The aim of the Report is to describe the more significant recent developments which affect the actuarial profession in the U.K. These developments are discussed under the following headings:Planning,Education,Life assurance,Pensions,General insurance,Relationships with actuaries overseas,Groupe Consultatif,Mortality and sickness insurance statistics,Investment indices.Within each heading there is a discussion of current topics and, where appropriate, of possible future developments.
On the choice of bandwidth for kernel graduation
Authors: Gavin J. B. , Haberman S. , Verrall R. J. 
Published: April 2012

AbstractThis paper considers cross-validation as an objective and risk-based method for selecting the smoothing parameter in a non-parametric graduation. In addition, the relative merits of two kernel estimators are compared in the context of mortality graduation. Finally, it is well known in the statistical literature that the use of theoretically superior kernels is not as important as the choice of bandwidth. Our results support this conclusion, suggesting that the focus on such weights is misguided in the actuarial textbooks on moving weighted averages.
Valuation and corporate management in a non-life insurance company
Authors: Bride M. , Lomax M. W. 
Published: April 2012

AbstractThis paper explores the benefits and limitations of a valuation framework as a management tool within a general insurance operation. Two models are presented, one a model of the firm and the other an option valuation model, which together create a robust framework that enables management to analyse how different decisions would affect both the overall firm value and its distribution amongst investors. The model of the firm assists in understanding how key factors such as the momentum of a general insurance portfolio and the allocation of scarce resources affect the value of the firm. The second model, an option framework for corporate liabilities, highlights the critical distinction between the value of the firm and the value of investors' claims on the firm.
The expectation of life and its relationship to mortality
Authors: Pollard J. H. 
Published: April 2012

SUMMARYThe complete expectation of life at birth ė0 is frequently used as a measure of the level of mortality of a population. It is also used for assessing trends in mortality and trends in mortality differentials. Although the relationship between mortality and expectation of life is essentially reciprocal, the exact connexion is rather more complicated, and becomes important when, for example, trends in differentials are analysed.In this paper, the relationship between mortality and expectation of life is explored in some detail, and formulae are developed for analysing the effects of mortality changes on expectation of life, and trends in mortality differentials on ė0 differentials.Unlike Keyfitz (1977), who concentrates on the proportional change in ė0 corresponding to equal proportional changes in mortality at all ages, we study the relationship between absolute changes in mortality, generally different at different ages, and the corresponding absolute change in ė0.It is demonstrated that two populations may experience diminishing mortality differentials and at the same time widening ė0 differentials. Numerical examples are given using Australian data over the periods 1921–71 and 1971–79.Although the formulae in the paper relate solely to the expectation of life at birth, the methods and formulae are readily adapted to expectations of life at other ages and indeed, temporary expectations.