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Aim: To assess the added value of Near InfraRed Fluorescence (NIRF) imaging during laparoscopic cholecystectomy. Methods: This international multicentre randomized controlled trial included participants with an indication for elective laparoscopic cholecystectomy. Participants were randomised into a NIRF imaging assisted laparoscopic cholecystectomy (NIRF-LC) group and a conventional laparoscopic cholecystectomy (CLC) group. Primary end point was time to ‘Critical View of Safety’ (CVS). The follow-up period of this study was 90 postoperative days. An expert panel analysed the video recordings after surgery to confirm designated surgical time points. Results: A total of 294 patients were included, of which 143 were randomized in the NIRF-LC and 151 in the CLC group. Baseline characteristics were equally distributed. Time to CVS was on average 19 min and 14 s for the NIRF-LC group and 23 min and 9 s for the CLC group (p 0.032). Time to identification of the CD was 6 min and 47 s and 13 min for NIRF-LC and CLC respectively (p < 0.001). Transition of the CD in the gallbladder was identified after an average of 9 min and 39 s with NIRF-LC, compared to 18 min and 7 s with CLC (p < 0.001). No difference in postoperative length of hospital stay nor occurrence of postoperative complications was found. ICG related complications were limited to one patient who developed a rash after injection of ICG. Conclusion: Use of NIRF imaging in laparoscopic cholecystectomy provides earlier identification of relevant extrahepatic biliary anatomy: earlier achievement of CVS, cystic duct visualisation and visualisation of both cystic duct and cystic artery transition into the gallbladder.

Aims: To investigate whether different calculation methods to express fluorescence intensity (FI) as target-to-background (BG) ratio are comparable and which method(s) match with human perception. Materials and Methods: Comparison of three calculation methods from current literature (OsiriX (R), ImageJ (R), and Photoshop (R)) to objectify FI during laparoscopic cholecystectomy measured at the exact same locations within recorded images of two categories: ex vivo and in vivo. Currently applied formulas to present FI in relation to the BG signal are compared with the subjective assessment by the human observers. These three formulas are Signal contrast = (FI in fluorescence regions-FI in BG)/255; Target-to-background ratio = (FI of target-FI of BG)/FI of BG; Signal-to-background ratio = FI of cystic duct/FI of liver and Target-to-background ratio = (FI of target-noise)/(FI of BG-noise). Results: In our evaluation OsiriX and ImageJ provided similar results, whereas OsiriX values were structurally slightly lower compared with ImageJ. Values obtained through Photoshop were less evidently related to those obtained with OsiriX and ImageJ. The formula Target-to-background ratio = (FI of target-noise)/(FI of BG-noise) was less corresponding with human perception compared with the other used formulas. Conclusions: FI results based on measurements using the programs OsiriX and ImageJ are similar, allowing for comparison of results between these programs. Results using Photoshop differ significantly, making direct comparison impossible. This is an important finding when interpreting study results. We propose to report both target and BG FI in articles, so that proper interpretation between articles can be made.

Purpose: The lumbar abdominal wall hernia is a rare hernia in which abdominal contents protrude through a defect in the dorsal abdominal wall, which can be of iatrogenic, congenital, or traumatic origin. Two anatomical locations are known: the superior and the inferior lumbar triangle. The aim of this systematic review is to provide a clear overview of the existing literature and make practical clinical recommendations for proper diagnosis and treatment of the primary lumbar hernia. Methods: The systematic review was conducted according to the PRISMA guidelines. A systematic search in PubMed, MEDLINE, and EMBASE was performed, and all studies reporting on primary lumbar hernias were included. No exclusion based on study design was performed. Data regarding incarceration, recurrence, complications, and surgical management were extracted. Results: Out of 670 eligible articles, 14 were included and additional single case reports were analysed separately. The average quality of the included articles was 4.7 on the MINORS index (0–16). Risk factors are related to increased intra-abdominal pressure. CT scanning should be performed during pre-operative workup. Available evidence favours laparoscopic mesh reinforcement, saving open repair for larger defects. Incarceration was observed in 30.8% of the cases and 2.0% had a recurrence after surgical repair. Hematomas and seromas are common complications, but surgical site infections are relatively rare. Conclusion: The high risks of incarceration in lumbar hernias demand a relatively fast elective repair. The use of a mesh is recommended, but the surgical approach should be tailored to individual patient characteristics and risk factors.

A more detailed understanding of porous flow inside a rubble-mound structure may have potential benefits in breakwater design. Numerical models are expected to be a useful additional research tool in this field, provided that their calculation results can be validated against measurements. This paper presents the results of a systematic effort to validate a set of different numerical models for a strongly simplified model set-up. The results of this effort will be used to select models for a next stage in which the complexity of the model set-up is increased. By means of this step-by-step approach a good insight in the capabilities and limitations of the various models is achieved., Hydraulic Engineering, Civil Engineering and Geosciences

A more detailed understanding of porous flow inside a rubble-mound structure may have potential benefits in breakwater design. Numerical models are expected to be a useful additional research tool in this field, provided that their calculation results can be validated against measurements. This paper presents the results of a systematic effort to validate a set of different numerical models for a strongly simplified model set-up. The results of this effort will be used to select models for a next stage in which the complexity of the model set-up is increased. By means of this step-by-step approach a good insight in the capabilities and limitations of the various models is achieved., Hydraulic Engineering, Civil Engineering and Geosciences

Chapter 1: the environmental conditions in greenhouses differ in many respects from those in the open field. Both the climate and the crops are different. A free exchange between the fauna of the greenhouses and the open air is hampered by the glass walls and roofs. The isolating effect of greenhouses on arthropod pests contributes to the effectiveness of control measures, but also to the development and maintenance of pesticide resistance in greenhouses. Because of the special conditions a specific fauna exists in greenhouses, and the use of exotic predators and parasites for biological control is possible. The greenhouse environment acts as a "sieve" only allowing such species to thrive that are adapted to these special conditions. These are sometimes exotic species that cannot thrive in the open in the Dutch climate. Native species may penetrate into greenhouse cultures, but to pass the "sieve" they have to adapt to greenhouse conditions.The leaf-roller Clepsis spectrana Tr. is native in the Netherlands. It gives an example of the development of a greenhouse-adapted biotype. In Dutch greenhouses, especially on roses, it causes much damage. In heated greenhouses, where artificial illumination is not given, growth and reproduction of C. spectrana continue without diapause during winter, which is advantageous for the species in this environment, where the difference between summer and winter temperatures does not exceed a few degrees and suitable food is available all the year round.Chapter 2 deals with the morphology, bionomics, host plant range, and distribution area of C. spectrana. Chapter 3 describes the materials and methods.Chapter 4: the number of larval instars from egg hatching to pupation varied between 4 and 8 in both field and greenhouse strains. Each larval growth type had its own specific progression of head capsule width. The difference in head capsule width between the 4- and 5-instar type was already evident in the 1st instar, between the Sand 6-in, Beschrijving van het aan de omstandigheden van Nederlandse kassen aangepaste biotype van de bladroller (Clepsis spectrana) wat betreft morfologie, fenologie, reactie op daglengte, samenstelling van geslachtsferomonen en kruisbaarheid met veldpopulaties