Central Duct Research Articles

Development and validation of a novel pancreaticojejunostomy strategy based on the anatomical location of the main pancreatic duct that can reduce the risk of postoperative pancreatic fistula after pancreatoduodenectomy.

Postoperative pancreatic fistula (POPF) is a common complication after pancreaticoduodenectomy (PD). The effect of the location of the main pancreatic duct on POPF development is not completely elucidated. This study aimed to investigate the association between the location of the main pancreatic duct and POPF, and the effect of pancreaticojejunostomy based on the location of the main pancreatic duct on the risk of POPF. This retrospective study enrolled 871 patients who underwent PD between January 2018 and December 2021. Logistic regression analysis was performed to identify the independent risk factors associated with POPF. Predictive performance was evaluated using the receiver operating characteristic curves. In addition, a novel pancreaticojejunostomy strategy that could reduce the risk of POPF was adopted. Based on the multivariate analysis, the pancreatic texture and the location of the main pancreatic duct were the independent risk factors of POPF. A threshold ratio of 0.397 was used to distinguish the central from the eccentric pancreatic ducts. Notably, patients with the central pancreatic duct had a significantly lower incidence rate of POPF than those with the eccentric pancreatic ducts (10.6% vs. 44.8%, P<0.001). The novel group exhibited a significantly lower incidence rate of POPF than the conventional group (13.7% vs. 23.0%, P=0.02), and the incidence rate of other complications was not high. The location of the main pancreatic duct is associated with POPF development. However, implementing the novel pancreaticojejunostomy approach can effectively reduce the risk of POPF while ensuring safety.

Meibomian gland lipid alterations and ocular surface sequela in Awat2 knockout murine model of meibomian gland dysfunction and evaporative dry eye disease

PurposeThere is an urgent need for animal models of meibomian gland dysfunction (MGD) and evaporative dry eye disease (EDED) to understand their pathophysiology and investigate novel therapeutics. This study sought to further define the acyl-CoA: wax alcohol acyltransferase 2 knockout (Awat2 KO) mouse as a model of EDED using a combination of novel clinical, biochemical, and biophysical endpoints. MethodsWildtype and Awat2 KO mice between 1 and 18 months of age were used. Ocular examinations and advanced imaging were performed. The lipidomic composition and in situ melting temperature of meibum were determined. qPCR was performed to define ocular surface gene and pro-inflammatory transcript expression. Dynamic contact angle goniometry was performed to assess the adherence capability of the ocular surface. ResultsAwat2 KO mice have mild, white, hyperreflective corneal opacities of the anterior stroma and significantly enlarged apical epithelial cells (P = 0.0004). In Awat2 KO meibum, wax esters were 9–10 times lower than in wildtype meibum. Additionally, meibum melting temperature increased from 32° to 47 °C (P < 0.0001), leading to impaired meibum secretion and dilation of the central duct. Awat2 KO corneal epithelia had significantly decreased mucin expression (Muc1 and Muc4, P = 0.0043) and increased interferon-γ production (P = 0.0303). Awat2 KO globes have a significantly shortened time of droplet adherence to their ocular surface (P = 0.0053), indicating a decreased tear film adherence capacity. Wildtype corneal epithelia does not express Awat2, indicating that the EDED phenotype is secondary to the loss of Awat2 from the meibomian glands. ConclusionsAwat2 KO mice recapitulate many of features of human MGD and EDED, representing a model to test novel therapeutics.

Elimination of bile leakage in liver injuries

Aim. To study the causes and consequences of bile leakage in liver injury and determine the potential ways for its elimination. Materials and methods. The study involved a retrospective analysis of 204 liver injuries of various types. 26 % of cases were detected with isolated abdominal trauma, 74 % – with concomitant abdominal injury. According to the AAST grading scale, 15.7 % of patients got grade II liver injuries, 44.6 % – grade III, 34.3 % – grade IV, and 5.4 % – grade V. Since concomitant injuries predominated, surgical treatment was initially performed in the overwhelming number of cases. 14 % of cases received non-operative management. Results. The incidence of bile leakage amounted to 28.4 % for all liver injuries and reached 54.9 % for III–V grade injuries (AAST). Small bile leakage prevailed, while active leaking was observed in 36.2 %. Damage to peripheral parts of the biliary tract was noted in most cases (68 %). Conservative management of patients with small bile leakage associated with damage to peripheral parts of the biliary tract appeared successful in 48.5 % of cases. Endoscopic biliary drainage of bile ducts proved effective in case of active bile leakage and (or) injuries of the central bile ducts. Conclusion. Endoscopic biliary drainage of bile ducts is considered the most effective for elimination of active biliary leakage in the absence of biliary peritonitis and communication of biliary tract with pleural cavity.

Assessing MRI Sensitivity and Specificity for Detecting Occult Nipple-Areolar Complex Malignancy in Nipple-Sparing Mastectomy Candidates: A Systematic Review and Meta-Analysis

Background: Approximately 8% of breast cancers originate within the central ducts near the nipple-areolar complex(NAC), which revealed higher rates of occult involvement than previously thought. Precise preoperative imaging to assess NAC and subjacent tumor involvement has become critical to identify candidates for nipple-sparing mastectomy(NSM) while ensuring oncological safety. The aim of our study is to determine whether MRI could be used for the detection of subtle neoplastic infiltration. Method: Electronic databases including PubMed, Scopus, Web of Science, and EMBASE were systematically searched to identify all relevant studies on diagnostic performance of Magnetic Resonance Imaging(MRI) in malignant extension to the nipple published before 2024. The keywords include MRI, NAC, breast cancer, NSM. True Positive(TP), True Negative(TN), False Positive(FP), False Negative(FN) were extracted for analysis. Finally, 5 articles were selected for our meta-analysis. STATA version 15 was used to analysis data. Result: Our meta-analysis showed a pooled sensitivity of 89%(95% CI: 81%-94%)with low heterogeneity(I2 = 17.51%), and a pooled specificity of 89% (95% CI: 71%-96%), with significant heterogeneity(I2 = 95.87%). The pooled positive diagnostic likelihood ratio(pDLR) was 7.81(95% CI: 2.82-21.61, I2 = 92.66%), and the negative diagnostic likelihood ratio(nDLR) was 0.12(95% CI: 0.07-0.22, I2 = 11.94%). Conclusion: Diagnostic MRI characteristics such as NAC enhancement, non-mass enhancement(NME) type, mass size (greater than 20 mm), and tumor-to-nipple distance(TND) were assocaited with the presence of NAC involement. Because of high diagnostic accuracy, MRI imaging can be used as a helpful tool for NAC diagnosis.

HDAC1/2 and HDAC3 play distinct roles in controlling adult Meibomian gland homeostasis

PurposeTo investigate the roles of HDAC1/2 and HDAC3 in adult Meibomian gland (MG) homeostasis. MethodsHDAC1/2 or HDAC3 were inducibly deleted in MG epithelial cells of adult mice. The morphology of MG was examined. Proliferation, apoptosis, and expression of MG acinus and duct marker genes, meibocyte differentiation genes, and HDAC target genes, were analyzed via immunofluorescence, TUNEL assay, and RNA in situ hybridization. ResultsCo-deletion of HDAC1/2 in MG epithelium caused gradual loss of acini and formation of cyst-like structures in the central duct. These phenotypes required homozygous deletion of both HDAC1 and HDAC2, indicating that they function redundantly in the adult MG. Short-term deletion of HDAC1/2 in MG epithelium had little effect on meibocyte maturation but caused decreased proliferation of acinar basal cells, excessive DNA damage, ectopic apoptosis, and increased p53 acetylation and p16 expression in the MG. By contrast, HDAC3 deletion in MG epithelium caused dilation of central duct, atrophy of acini, defective meibocyte maturation, increased acinar basal cell proliferation, and ectopic apoptosis and DNA damage. Levels of p53 acetylation and p21 expression were elevated in HDAC3-deficient MGs, while the expression of the differentiation regulator PPARγ and the differentiation markers PLIN2 and FASN was downregulated. ConclusionsHDAC1 and HDAC2 function redundantly in adult Meibomian gland epithelial progenitor cells and are essential for their proliferation and survival, but not for acinar differentiation, while HDAC3 is required to limit acinar progenitor cell proliferation and permit differentiation. HDAC1/2 and HDAC3 have partially overlapping roles in maintaining survival of MG cells.

Real-Time Evaluation of Absolute, Cytosolic, Free Ca2+ and Corresponding Contractility in Isolated, Pressurized Lymph Vessels.

The lymphatic vasculature, now often referred to as "the third circulation," is located in many vital organ systems. A principal mechanical function of the lymphatic vasculature is to return fluid from extracellular spaces back to the central venous ducts. Lymph transport is mediated by spontaneous rhythmic contractions of lymph vessels (LVs). LV contractions are largely regulated by the cyclic rise and fall of cytosolic, free calcium ([Ca2+]i). This paper presents a method to concurrently calculate changes in absolute concentrations of [Ca2+]i and vessel contractility/rhythmicity in real time in isolated, pressurized LVs. Using isolated rat mesenteric LVs, we studied changes in [Ca2+]i and contractility/rhythmicity in response to drug addition. Isolated LVs were loaded with the ratiometric Ca2+-sensing indicator Fura-2AM, and video microscopy coupled with edge-detection software was used to capture [Ca2+]iand diameter measurements continuously in real time. The Fura-2AM signal from each LV was calibrated to the minimum and maximum signal for each vessel and used to calculate absolute [Ca2+]i. Diameter measurements were used to calculate contractile parameters (amplitude, end diastolic diameter, end systolic diameter, calculated flow) and rhythmicity (frequency, contraction time, relaxation time) and correlated with absolute [Ca2+]i measurements.

Could cigarette smoke be associated with metaplastic type of meibomian gland dysfunction?

Madam, The meibomian glands are located in the tarsal plates of the eyelids. The diseases involving these glands belong to a broad classification. However, the metaplastic diseases of the meibomian gland are the focus of this letter.1 We intend to propose the possible role of cigarette smoke as an active agent in developing metaplastic type of meibomian gland dysfunction (MGD). A meibomian gland is made up of multiple acini that are arranged around a long central duct. Owing to its vigorous function of producing meibum and maintaining tear film stability, the gland requires a constant turnover and differentiation of cells. Consequently, during this intricate cascade of continuous production and differentiation of cells, even a slight deviation from normality can lead to drastic pathological effects.2 We presume that oxidative stress can produce such a pathologic deviation. One of the most common causes of increased oxidative stress in cells is exposure to cigarette smoke. It has also been experimentally established that cigarette smoke is a well-known inducer of metaplastic changes; especially known to cause squamous metaplasia in the bronchial epithelium.3 Therefore, exposure to cigarette smoke may also be a culprit when the meibomian orifice, owing to its superficial location on the eyelid, is exposed to the components of cigarette smoke. Cigarette smoke contains carbon particles and other toxic compounds that begin the cascade of inflammation and during the attempts of phagocytic elimination of these toxic compounds, inflammatory damage to DNA and proteins can occur.4 The aspect of protein damage and hyperkeratinization in response to increased oxidative stress has already been studied and implicated in the pathogenesis of MGD.2 Furthermore, it has been demonstrated that EGF (Epidermal Growth Factor) is produced in epithelial cells in response to smoke and that further increases the possibility of metaplastic as well as hyperplastic changes.5 Therefore, we suggest that there exists a strong relation between exposure to cigarette smoke and the development of metaplastic meibomian gland dysfunction. Further studies in this regard might help in prevention, as well as newer diagnostic approaches towards MGD especially in populations exposed to cigarette smoke on a regular basis.

Mechanical Study of a Solar Central Air Conditioning Duct Cleaning Robot

Mechanical Study of a Solar Central Air Conditioning Duct Cleaning Robot

Extended pancreatic neck transection versus conventional pancreatic neck transection during laparoscopic pancreaticoduodenectomy (LPDEXCEPT): protocol for a multicentre superiority randomised controlled trial

IntroductionPostoperative pancreatic fistula (POPF) remains one of the most severe complications of laparoscopic pancreaticoduodenectomy (LPD). Theoretically, transecting the pancreatic neck more distally has both advantages (more blood supply, and more...

Experience with the new multi-hole self-expandable metallic stent.

Multi-hole self-expandable metallic stent (M.I.Tech/Boston Scientific: MHSEMS) has small holes in the cover part of FCSEMS and has properties between UCSEMS and FCSEMS. The MHSEMS was originally an FCSEMS with holes in all cells. In the distal bile duct, the MHSEMS have the potential to prevent migration by allowing tissue to enter the small holes. In the hilar region, the MHSEMS can potentially prolong the duration of patency of the central bile duct by preventing ingrowth by covering the branches without impeding them. However, because there were reports of cases of inoperable removal due to ingrowth overseas, the model launched in Japan in 2022 had fewer holes, and the cover of the Hanarostent Biliary Full Cover NEO (M.I. Tech/Boston Scientific) had a row of holes in every other row. It was used in 7 cases of malignant biliary obstruction. The primary diseases were gallbladder cancer, cholangiocarcinoma, and pancreatic cancer. The obstruction sites were the hilar region and the distal bile duct. All patients underwent successful implantation with no pancreatitis or cholangitis observed. Five patients continued chemotherapy. One gallbladder cancer patient died after 20 days, one cholangiocarcinoma patient experienced obstruction after 81 days, and the other five cases showed no evidence of obstruction or deviation (ranging from 6 to 119 days after implantation, with an average of 75 days). MHSEMS can be used for malignant biliary obstruction, mainly in the distal bile duct.

Perioperative strategies for patients undergoing subtotal cholecystectomy: a single-center retrospective review of 102 procedures

BackgroundCalculous gall bladder disease is often handled by laparoscopic cholecystectomy. In cases where a safe dissection of the hepatocystic triangle cannot be carried out, a subtotal cholecystectomy (STC) may be performed. The perioperative management of patients undergoing STC is characterized by limited evidence. This large single-center series explores some of the perioperative aspects and outcomes after STC.Materials and methodsThe study population includes all patients who underwent STC at Oslo University Hospital (Ullevål and Aker Hospitals) from 01.01.2014 to 30.09.2020. A STC was defined as a cholecystectomy where there was a failure to control the cystic duct during surgery. Study variables included demographic data, comorbidities, previous biliopancreatic disease, indication for surgery, perioperative information, subsequent interventions and outcome data.ResultsDuring the study period, 2376 cholecystectomies were performed, and 102 (4.3%) were categorized as STC. Of all patients with STC, 48 (47.1%) had an intra- or postoperative ERCP during the index hospital admission. The indication for ERCP was bile leak in 37 (42.6%) of the cases. The bile leak resolution rate was 60.0 % in intraoperative ERCP vs 95.7% in postoperative ERCP. Among the STC patients, there were no injuries to the central bile ducts. Later, one patient has undergone a remnant cholecystectomy, following fenestrating STC.ConclusionSTC was a safe bailout strategy for dissection in the hepatocystic triangle in difficult cholecystectomies. Intraoperative ERCP increased procedure time and was associated with a lower rate of leak resolution, as compared to postoperative ERCP.

Eruptive Sebaceous Hyperplasia A rare adverse effect of systemic corticosteroid use in two immunosuppressed patients

Sebaceous hyperplasia is a benign, not uncommon cutaneous disorder. The disorder is caused by overabundance and proliferation of sebocytes in the sebaceous glands [1]. The proliferation induces enlargement of the sebaceous gland up to several times its regular size, but still keeping the normal anatomical structures. Sebacceous glands have a central duct that may become dilated in sebaceous hyperplasia due to secretion of an oily substance, sebum, which presents flesh- or yellowish coloured [2]. Sebaceous glands are localized everywhere on the skin except for palms and soles of the feet. The highest concentration of the glands is found on the face, the back, and the upper arms, which is also the most common places to encounter sebaceous hyperplasia [3]. Papules that are newly formed often swell during sweating which is pathognomonic for the disorder. Sebaceous glands are commonly associated with hair follicles, though may rarely present in hairless regions of the skin [4].

Preoperative MRCP Can Rule Out Choledocholithiasis in Acute Cholecystitis with a High Negative Predictive Value: Prospective Cohort Study with Intraoperative Cholangiography

BackgroundMagnetic resonance cholangiopancreatography (MRCP) provides a noninvasive and fast modality for imaging the biliary tree when choledocholithiasis is suspected. Guidelines suggest that MRCP is recommended when strong or moderate signs of common bile duct (CBD) stones are present. Well-performed prospective studies are scarce regarding the sensitivity and specificity of preoperative MRCP in patients with acute cholecystitis in comparison with intraoperative cholangiography, ERCP, or choledochoscopy. MethodsWe performed a prospective, observational population-based feasibility study in Central Finland Hospital Nova between January 2019 and December 2019. We examined the diagnostic performance of preoperative MRCP on consecutive patients with acute cholecystitis scheduled for index admission cholecystectomy. The accuracy of MRCP was verified with IOC, choledochoscopy, or ERCP. The interobserver reliability of the image quality of MRCP and the sensitivity and specificity of choledocholithiasis were observed independently by three experienced radiologists. ResultsA total of 180 consecutive patients diagnosed with acute cholecystitis followed by index admission cholecystectomy were identified. MRCP was performed in 113/180 (62.8%) patients, and complementary perioperative imaging of the bile ducts was performed in 72/113 (63.7%) patients. The incidence of choledocholithiasis was high (29.2%). In acute cholecystitis, the sensitivity (76.2–85.7%) and specificity (84.3–92.2%) of MRCP were equally compared to the literature with unselected patient groups. The best visibility was observed in the common hepatic duct, the inferior CBD, and the central hepatic duct. The interobserver reliability was excellent for determining the size and quantity of CBD stones. ConclusionIn acute cholecystitis, MRCP yields high negative predictive value regarding detection of choledocholithiasis. If CBD stones were discovered, the interobserver reliability was excellent when measuring the size and number of CBD stones. The best-visualized area was the distal part of the biliary tract, which provides good preoperative workup if choledocholithiasis is present.

An improved anisotropic continuum model for the flow and heat transfer in grain aeration system

AbstractTo investigate the influence of pore structure distribution on the flow and heat transfer during the aeration process of a grain pile, an anisotropic continuous model (ACM) was developed based on the homogeneous continuous model (HCM). The improved ACM includes spatial resistance factors and effective thermal conductivity correction coefficients. The experimental results were compared with the particle‐resolved computational fluid dynamics (PRCFD) and ACM simulation results to verify the accuracy. At higher inlet velocities, the HCM underestimated the pressure drop in the wheat fixed bed, with an average deviation of 21%. In contrast, the improved ACM incorporates the effect of resistance factors and had an average deviation of less than 10% from the experimental. By simulating the pilot‐scale bin aeration system, the accuracy of the improved ACM applied to the real bin was ensured, considering the change in the porosity of the grain pile along the center of the bin to the bin wall and the grain pile height direction. The range of variable porosity distribution was set at .35–.45, and the total average deviation between the ACM simulation static pressure and the experimental value was 9.7% when the inlet airflow velocity was .019 m/s. The simulated temperature of the ACM matches the measured temperature better compared to the temperature values of the grain pile at different heights in the HCM with a constant porosity of .45. Therefore, the impact of four central air collection duct forms on airflow and temperature was discussed, and it was determined that the pipe with a larger diameter at the top and a smaller diameter at the bottom air collection duct was more advantageous when used in a horizontal aeration system by applying the improved ACM to different scenarios.Practical ApplicationsThis study introduces the resistance factor and effective thermal conductivity in a laboratory‐scale fixed bed of wheat. An improved anisotropic continuous model was established for simulating the flow and heat transfer in the fixed bed during the aeration process. The improved anisotropic continuous model accurately reflected the non‐uniformity of fixed bed flow and temperature transfer in the fixed bed. This model can be employed for simulating flow and heat transfer in large‐scale actual storage systems characterized by heterogeneous pore distribution, while ensuring appropriate computational efficiency and precision.

Copper and mercury exposure alters rectum microbiota in female adult mice

ObjectivesCopper (Cu) and mercury (Hg) are major pollutants worldwide, but the gastrointestinal damage caused by copper and mercury exposure is unclear. We are committed to scientific research on the harm and transformation of copper and mercury exposure to the rectal microbial population of female mice. MethodsKunming mice (n = 24) were randomly divided into four equal groups, i.e., 1) Rectal Colon Control (RCK) group, 0 mg/kg of Cu and Hg), 2) Rectal Copper (RCu group), 5 mg/kg weight of Cu), 3) Rectal Mercury (RHg) group, 2 mg/kg weight of Hg) and 4) Rectal copper-mercury (RCH) group, 2.5 and 1 mg/kg weight of Cu and Hg. On the 90th day, the rectal and intestinal tissues were analyzed for pathophysiology, and quantitative analysis by PCR, then a library was prepared, and sequencing was carried out. ResultsThe rectal tissue of the RCu and RCH group had histopathological and physiological damage, including low weight, low pH value, increased thickness of the outer muscle layer, smooth muscle tissue, widening of the submucosal layer, reduction of goblet cells, blunt intestinal villi and severe aging of the central mammary duct. In addition, Sequencing results of 16S rRNA genes compared with RCK showed that the abundance of the Treponema, Coprococcus, and Dehalobacterium in RCu was more significant than the RCK. Still, the bacillus, Jeotgalicoccus, Salinicoccus, Staphylococcus, and Ignatzschineria was just the opposite. The abundance of Butyricimonas, Streptococcus, Dehalobacterium, Coprococcus, Oscillospira, and Helicobacter in RHg was more significant than in the RCK. Still, Corynebacterium, Bacillus, Jeotgalicoccus, Salinicoccus, Staphylococcus, Lactococcus, and Ignatzschineria were the opposite. We found some similar exciting things. The abundance of the Dehalobacterium, Coprococcus, and Oscillospira was significantly more significant than the RCK. Still, the Corynebacterium, Salinicoccus, Jeotgalicoccus, Staphylococcus, Lactococcus, Sutterella, and Ignatzschineria were the opposite. In addition, the Staphylococcus in RCu was increased than in the RCH, and the Streptococcus in RCu was increased than in the RCH. ConclusionThe results of the present study furnish a source for a more precise validation of the risk of digestive tract diseases driven by Cu and Hg.

ROLE OF INTRAOPERATIVE ULTRASONOGRAPHY IN GUIDING THE DECISION FOR PRIMARY COMMON BILE DUCT CLOSURE

Intraoperative Ultrasonogram (IOUS) has been an valuable adjunct in deciding whether primary cbd closure is feasible or not. The use of intraoperative ultrasound (IOUS) has become increasingly popular in primary central bile duct (CBD) closure procedures. IOUS offers real-time imaging that allows surgeons to precisely identify the anatomy of the CBD, detect any abnormalities or stones, and confirm the success of the closure procedure. IOUS is particularly useful in cases where there is uncertainty about the location or extent of bile duct injury, or when there is a high risk of bile duct injury during the closure procedure or when there is doubt in retained CBD calculus. This abstract brings out series of patients that we have operated at our institution and followed up for a period of 1year from march 2022 to march 2023

Primary cilia control cellular patterning of Meibomian glands during morphogenesis but not lipid composition

Meibomian glands (MGs) are modified sebaceous glands producing the tear film’s lipids. Despite their critical role in maintaining clear vision, the mechanisms underlying MG morphogenesis in development and disease remain obscure. Cilia-mediate signals are critical for the development of skin adnexa, including sebaceous glands. Thus, we investigated the role of cilia in MG morphogenesis during development. Most cells were ciliated during early MG development, followed by cilia disassembly during differentiation. In mature glands, ciliated cells were primarily restricted to the basal layer of the proximal gland central duct. Cilia ablation in keratine14-expressing tissue disrupted the accumulation of proliferative cells at the distal tip but did not affect the overall rate of proliferation or apoptosis. Moreover, impaired cellular patterning during elongation resulted in hypertrophy of mature MGs with increased meibum volume without altering its lipid composition. Thus, cilia signaling networks provide a new platform to design therapeutic treatments for MG dysfunction.

Planning of distributed ventilation systems for energy-efficient buildings by discrete optimisation

The EU's climate targets are increasingly affecting the building sector. Energy-efficient buildings should therefore be built as airtight as possible in order to meet these targets - ventilation systems are necessary to ensure a comfortable indoor climate. In the planning of ventilation systems, the placement, wiring and operation of the fans, among other things, must be considered. If, instead of the conventional planning for the maximum load case, the partial load scenarios are included, oversizing is reduced and energy efficiency is increased. In addition, there are new ventilation approaches that include distributed components in the central duct network and thus offer further opportunities to increase the energy efficiency of the systems. If one now considers multiple load cases and allows distributed components in the design, the number of combinations exceeds any human manageable amount and the human made design decision becomes far from optimal as a result. Therefore, in this paper a method is presented that uses mathematical optimisation techniques to control the complexity and support the design. The planning task is modeled techno-economically as a minimisation problem with respect to life-cycle costs (Mixed-Integer Nonlinear Program) and solved with discrete optimisation methods. The approach is then tested on a case study, with which savings of 22% in life-cycle costs are achieved while reducing energy consumption by 28%. Furthermore, the embedding in the real planning process is considered and shown that the division into several planning phases has a negative impact on the efficiency of the ventilation system. These results show that increasing the complexity of the planning task and modelling and solving it using discrete optimisation methods allows for a huge increase in the efficiency of the ventilation system.

Intranodal dynamic contrast-enhanced CT lymphangiography and dynamic contrast-enhanced MR lymphangiography in microminipig.

To evaluate the feasibility and image quality of intranodal dynamic contrast-enhanced CT lymphangiography (DCCTL) and dynamic contrast-enhanced MR lymphangiography (DCMRL) in microminipigs. Our institution's committee for animal research and welfare provided approval. Three microminipigs underwent DCCTL and DCMRL after inguinal lymph node injection of 0.1mL/kg contrast media. Mean CT values on DCCTL and signal intensity (SI) on DCMRL were measured at the venous angle and thoracic duct (TD). The contrast enhancement index (CEI; increase in CT values pre- to post-contrast) and signal intensity ratio (SIR; SI of lymph divided by SI of muscle) were evaluated. The morphologic legibility, visibility, and continuity of lymphatics were qualitatively evaluated using a 4-point scale. Two microminipigs underwent DCCTL and DCMRL after lymphatic disruption and the detectability of lymphatic leakage was evaluated. The CEI peaked at 5-10min in all microminipigs. The SIR peaked at 2-4min in two microminipigs and at 4-10min in one microminipig. The peak CEI and SIR values were 235.6 HU and 4.8 for venous angle, 239.4 HU and 2.1 for upper TD, and 387.3 HU and 2.1 for middle TD. The visibility and continuity of upper-middle TD scores were 4.0 and 3.3-3.7 for DCCTL, and 4.0 and 4.0 for DCMRL. In the injured lymphatic model, both DCCTL and DCMRL demonstrated lymphatic leakage. DCCTL and DCMRL in a microminipig model enabled excellent visualization of central lymphatic ducts and lymphatic leakage, indicating the research and clinical potential of both modalities. • Intranodal dynamic contrast-enhanced computed tomography lymphangiography showed a contrast enhancement peak at 5-10min in all microminipigs. • Intranodal dynamic contrast-enhanced magnetic resonance lymphangiography showed a contrast enhancement peak at 2-4min in two microminipigs and at 4-10min in one microminipig. • Both intranodal dynamic contrast-enhanced computed tomography lymphangiography and dynamic contrast-enhanced magnetic resonance lymphangiography demonstrated the central lymphatic ducts and lymphatic leakage.

Why are adaptive facades not widely used in practice? Identifying ecological and economical benefits with life cycle assessment

The challenges concerning climate change require innovative approaches. Adaptive façades (AF) represent a promising approach, as making the façade adaptable brings several benefits such as less energy usage or increased comfort. Nevertheless, they are not widely used in practice, since the known advantages/motivators appeal in particular to stakeholders who have little involvement in the decision-making of the design process and entail compromises to stakeholders who do. In this article it is shown that besides the known advantages and compromises of AF, there are further motivators for stakeholders with high decision-making power. In a case study, a building with typical centralized ventilation is compared with a building where an AF with an integrated ventilation system was installed to substitute the centralized ventilation system. This results in a lower building height and corresponding weight of the construction, as the central duct system can be eliminated. 3 m of building height and up to 340 tons of material can be saved, which results in avoided impact on climate change of 110 tons CO2-eqviv. (−7%). During utilization, 615 tons of CO2-eqviv. Can be avoided. The lifecycle costs can be reduced by 485,000 € while the rentable floor space can be increased by 4%.