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What was the purpose of the sit ins that began in Greensboro North Carolina in 1960?
Greensboro sit-in, act of nonviolent protest against a segregated lunch counter in Greensboro, North Carolina, that began on February 1, 1960. Its success led to a wider sit-in movement, organized primarily by the Student Nonviolent Coordinating Committee (SNCC), that spread throughout the South.
When did the Greensboro lunch counter sit-in happen?
In 1960 four freshmen from North Carolina Agricultural and Technical College in Greensboro walked into the F. W. Woolworth store and quietly sat down at the lunch counter. They were refused service, but they stayed until closing time.
What did the sit ins accomplish?
The sit-ins demonstrated that mass nonviolent direct action could be successful and brought national media attention to the new era of the civil rights movement. Additionally, the jail-in tactic of not paying bail to protest legal injustice became another important strategy.
What happened at the Greensboro?
The Greensboro massacre was a deadly confrontation which occurred on November 3, 1979, in Greensboro, North Carolina, US, when members of the Ku Klux Klan and the American Nazi Party (ANP) shot and killed five participants of a "Death to the Klan" march organized by the Communist Workers Party (CWP).
What caused the Greensboro sit in?
They were inspired by Martin Luther King Jr. and his practice of nonviolent protest, and specifically wanted to change the segregational policies of F. W. Woolworth Company in Greensboro, North Carolina.
What caused the Greensboro sit-ins?
While not the first sit-in of the civil rights movement, the Greensboro sit-ins were an instrumental action, and also the best-known sit-ins of the civil rights movement….
Greensboro Sit-ins
Caused by "Whites Only" lunch counters at F. W. Woolworth Company Racial segregation in public accommodations
Are any of the Greensboro Four still alive?
McCain's death left Ezell Blair (now Jibreel Khazan) and Joseph McNeil as the two surviving members of the Greensboro Four. David Richmond, the fourth member and McCain's freshman college roommate, died in 1990.
Why did the Greensboro Four sit-in?
On February 1, 1960, four friends sat down at a lunch counter in Greensboro. That may not sound like a legendary moment, but it was. The four people were African American, and they sat where African Americans weren't allowed to sit. They did this to take a stand against segregation.
What is the most famous sit-in?
The Greensboro sit-in was a civil rights protest that started in 1960, when young African American students staged a sit-in at a segregated Woolworth's lunch counter in Greensboro, North Carolina, and refused to leave after being denied service. The sit-in movement soon spread to college towns throughout the South.
Was sind gute Abgangsgruppen?
What is the highest paying psychiatry job?


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You asked, they answered. Hear youth grantmaking experts talk about strategies and approaches that help them create change.
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Showing posts tagged with youth leadership
Memo to Foundation CEOs: Get a Youth Council
By Robert K. Ross
Seven years ago, we launched a President's Youth Council (PYC) at the California Endowment, and it seems like a good time to tell you that the young people who've served on the council over those seven years have significantly influenced our programming as a private foundation, been a source of reality-checking and ground-truthing on how our work "shows up" at the community level, and have substantially increased my own "woke-ness" as a foundation executive.
community foundation, leadership, philanthropy, youth, youth empowerment, youth leadership
Why Should Young People Fund Environmental Causes?
By Robert Walton
The environmental movement has been steadily gaining ground as people realize how important it is to take action in the face of ever-growing environmental concerns. Organizations across the country have tried to address problems in different ways, from looking into the science behind climate change, to starting grassroots campaigns that shift our behavior towards the earth. While there are countless approaches to helping our environment, rather than choosing one strategy over another, we need a collective effort that includes many tactics.
environment, grantmaking, philanthropy, youth, youth leadership
Youth Philanthropy, Trust Building, and Sharing Power
By Sheryl Seller
Despite the growing number of youth philanthropy programs in the United States, a 2002 survey found that "only 48 percent of adults believe it is important to seek young people's opinions when making decisions that affect them." As Katie Richards-Schuster, a professor at University of Michigan stated in 2012, "In general, American society, through its policies and practices, tends to focus on the construction of youth as vulnerable and at risk at best, and as problems at worst." However, we know that through youth philanthropy programs where young people are given decision-making power as well as provided with mentorship, communities thrive.
philanthropy, power, youth empowerment, youth leadership, youth philanthropy
How Do You Create a Youth-Led Grantmaking Program to Support Your Community?
By Brooklyn Youth Fellows
A group of young people sit around a table, each with their own unique lived experiences--from incarceration to homelessness to living undocumented--and each filled with immense passion to change the world, block by block, person by person. At this table, the idea for the Brooklyn Youth Voice Awards was born. The Brooklyn Youth Voice Awards is a youth-led grantmaking program created in 2016 by young people and sponsored by Brooklyn Community Foundation. The Brooklyn Youth Voice Awards sees young people as central players in supporting youth-centered projects.
grant review, youth grantmaking, youth leadership, youth philanthropy, youth-led grantmaking
Why Should I Connect With Others When I'm So Busy?
By Sarah Saltzman & Kylie Semel
Being busy isn't a reason to avoid connecting with other youth philanthropists—it's a reason to do it. We're Kylie and Sarah, and we're both members of the Frieda C. Fox Family Foundation Junior Board and the Youth Philanthropy Connect (YPC) Leadership Team. We've been getting to know lots of other youth philanthropists across the U.S. for over three years through Youth Philanthropy Connect conferences and the YPC Leadership Team, where we have met lots of other youth that are weaving the web that is our network. Here are the top 5 benefits we have found from staying connected to other youth philanthropists.
collaboration, communicating, learning, youth leadership, youth philanthropy
How Do I Start a Youth Grantmaking Program to Ensure Youth Voice? What Are the Benefits of Doing so as a Funder?
By Kelly Davenport Nowlin
In 2000, my family's foundation (Surdna) established the Andrus Family Philanthropy Program to engage future generations in our family in formalized philanthropy. In addition, we created two youth programs, targeting 13-17 and 18-24 year olds, respectively (learn more here!). For years, these youth programs were designed and run by adults with expertise in the field, helping young people define what they cared about and find their identity in philanthropy. I have come across similar youth initiatives where adults get together to develop all aspects of the program, then present it to the young people to experience and implement. If the past sixteen years has taught me anything about youth philanthropy it is this: don't take "youth" out of the development and creation of a youth philanthropy program.
grantmaking, leadership, philanthropy, youth empowerment, youth leadership, youth philanthropy
What Are the SDGs and How Do They Relate to the Youth Giving Movement?
By Arif Ekram
United Nations' Sustainable Development Goals—better known as the SDGs—are a set of 17 universal goals for global economic development, prosperity, human dignity, peace, justice, and partnerships. They have been agreed upon by virtually every nation on earth and will remain in effect until 2030. The SDG framework has managed to find common ground between the countless dissimilar and often opposing interests of various nations and has aligned all of these countries under the same agenda to improve the quality of life for people around the globe. It took a great number of very skilled development professionals more than three years, but they have succeeded in putting together a universal framework – one that fits the U.S. as much as it fits Somalia.
philanthropy, sdgs, youth leadership
What Do I Need to Know About Presenting to a Board? What Skills Can I Learn?
By Katherine Scott
As a young person, I advocated for every cause I cared about. I'd post articles on the wall of our school cafeteria about almost every issue (I was passionate about them all) and fundraise (and eventually recruit an entire team) for our local AIDS walk. I even was a very early volunteer in creating a nonprofit named MotherHouse. Through my work with that nonprofit, I became engaged in youth philanthropy. I applied for a project grant from my local community foundation's youth philanthropy committee on behalf of my school volunteer club (leveraging lots of volunteers and great donations too!). With lots of great donations and helpful volunteers, we were able to use the grant to redo an entire room at MotherHouse. Then, I actually joined my local community foundation, Community Foundation of Northern Illinois's (CFNIL) In Youth We Trust Youth Advisory Council, because I had seen the deep impact that was possible through youth philanthropy.
philanthropy, presentations, public speaking, youth, youth empowerment, youth leadership
What Should I Know About Doing a Community Needs Assessment?
By Danielle LaJoie
As a former member of the Battle Creek Community Foundation's Youth Alliance Committee (YAC) and also the Michigan Community Foundations Youth Project, I've seen community needs assessments from both the view of a participant in the assessment and also as the creator of the assessment. A community needs assessment is a tool through which your program can gather information from those in your community, especially young people, about what needs they have and what is most important to them. The needs assessment is unique to each program and community, but ultimately it can be used to ensure the effectiveness of your giving.
learning, needs assessment, philanthropy, youth empowerment, youth leadership
What Do Adults Need to Do to Really Let Youth Lead?
By Maddie Adkins
As the president of my high school environmental club and the youth leader of The Promise Project, I've learned a few things about how to empower youth to become leaders. (1) Facilitate, don't delegate. How do you keep youth motivated? The answer is simple - true leadership is all about "facilitating", not "delegating". You may think that assigning tasks is the same thing as giving youth a leadership role, but until you actually give youth a real piece of the project, something that they can take ownership of and be creative with, they will always be less motivated to work on the project. Instead of asking them to design you a logo, let them be a part of creating the project behind that logo. You have to give them a reason to care about the project, and the best way to do that is to give them the space to make it their own project.
youth empowerment, youth leadership

redpajama_set_name: RedPajamaCommonCrawl


The tragic deaths of hundreds of construction workers (allegedly) in the course of intensive building work of the stadiums for FIFA's 2022 Qatar World Cup are no doubt an inauspicious starting point for the analysis of the new spaces of normative interaction that are now generally considered to be a feature of the global legal order. The latter offers a complex body of different transnational rules that coexist and conflict, beyond the remit of nation-States – whose collective 'loss of control' is by no means accidental or inevitable. The global labour market is perhaps the best example of a new paradigm of non-state (if not private) normativity. While domestic markets become increasingly flexible – take the new trend of zero-hour contracts practised by companies like Uber or Deliveroo – a new arena emerges in which multinational corporations control various industries all over the globe in accordance with their own corporate codes and soft law. In 2010, the Gulf State of Qatar won the bid to host the 2022 World Cup. Following this, Qatar started carrying out multi-billion construction projects for numerous rail lines, roads, a new international airport, the world's largest green-field project and, of course, several stadiums that will host the World Cup matches. Qatar relies largely on migrant workers from South Asia (India, Sri Lanka, Nepal or Bangladesh) who according to some estimates comprise more than 90% of the country's workforce. They are employed under the controversial kafala system, that puts employees under near total control of their employers.


Once again Zara Shahjahan has inward inside the fashion market with the splendid collection of Eid ul Azha 2017 for women! This collection has been launched out just a few couple of days back and it is simply driving everyone crazy for it. Do you want to know why? This amazing Zara Shahjahan Eid ul Azha collection 2017 for women has been quite an awesome piece of collection which you can try to have in your clothing wardrobe for this Eid ul Azha occasion 2017. This collection has been finished with the designing according to the latest and newest strokes of the fashion style statements. The collection is giving out the taste of the three piece suits where the both stitched and unstitched designing has been done.
Long shirts are part of this collection where the finest pairing has been done with the trousers and duppattas. Women of all age groups would love to style themselves in the suits of this collection line. Plus, the fabric used in the stitching patterns of the collection suits is high quality one. This collection is best to be choosen for the ongoing seasonal happening of the summer season and midsummer. Colors are being shaded in the light and much soft combinations with the bold blends that completely give out the whole collection with the mesmerizing feeling.
The embroidery and lace work resting on top of the shirts, is making the collection look so much incredible. You should try it once! At the end we would be sharing with some pictures related with the beautiful Zara Shahjahan Eid ul Azha collection 2017 for women. All in all, this collection is so fantastic and much appearing out to be finished with the elegance and sophistication. Get ready to grab it first!


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Indra Krishnamurthy Nooyi () (Chennai, India, 28 de octubre de 1955), es una empresaria estadounidense nacida en la India. Fue Presidenta y Directora ejecutiva (CEO) de PepsiCo, segundo mayor negocio de alimentos y bebidas en el mundo por sus ingresos netos. Fue a la vez la primera persona inmigrante y la primera mujer en ocupar el puesto con mayor autoridad en la empresa, la más grande del mundo liderada por una mujer.

Ella ayudó a PepsiCo a convertirse en una de las empresas más exitosas del mundo, cuyas ventas crecieron un 80% durante su mandato de 12 años. Ella encabezó la transición de Pepsi a una empresa más ecológica y más respetuosa con el medio ambiente

Biografía

Primeros años
Nooyi nació en Madrás (ahora conocida como Chennai), Tamil Nadu, India. Es de una familia de habla tamil. Se educó en Holy Angels Anglo Indian School la secundaria más importante en Madrás. Recibió una licenciatura en Física, Química y Matemáticas del Madrás Christian College en 1974 y un Diploma de Postgrado en Gestión (MBA) del Instituto Indio de Gestión de Calcuta en 1976.

Carrera
Comenzando su carrera en la India, Nooyi ocupó cargos como directora del producto en Johnson & Johnson y en la firma textil Mettur Beardsell. Fue admitida en la Escuela de Administración de Yale en 1978 y obtuvo el grado de maestría en gestión pública y privada, mientras que en la Universidad de Yale, completó su internado de verano con Booz Allen Hamilton.

Se graduó en 1980, Nooyi se unió a la Boston Consulting Group (BCG), y después se mantuvo posiciones de estrategia en Motorola y Asea Brown Boveri.

Nooyi se unió a PepsiCo en 1994 y fue nombrada presidente y directora financiera (más no CEO) en 2001. Nooyi ha dirigido la estrategia global de la empresa durante más de una década y condujo a la reestructuración de PepsiCo, incluida la venta de 1997, de sus restaurantes en TriCom, ahora conocida como Yum! Brands. Nooyi también tomó la delantera en la adquisición de Tropicana en 1998, y la fusión con Quaker Oats Company, que también trajo Gatorade de PepsiCo.

Desde que comenzó como directora financiero en 2001, el beneficio neto anual de la compañía ha aumentado de $ 2.7 mil millones a $ 6.5 mil millones. En 2006 se convirtió en el quinto Director ejecutivo en 44 años de historia de PepsiCo.

Mientras era CEO de PepsiCo en 2011, Nooyi obtuvo una compensación total de $17 de millones de dólares que incluyó un salario base de $1,6 millones, un bono en efectivo de $2,5 millones, valor de la pensión y compensación diferida de $3 millones. En 2014, su compensación total había crecido a $19.087.832, incluyendo $5.5 millones de dólares de compensación en acciones.

En agosto de 2018, a los 62 años, anunció su retirada como CEO tras 12 años en el cargo (la media anterior era de 5 años). Durante sus años como máxima directival ogró la adquisición de Quaker Foods y evitó la campaña de Nelson Peltz para desmembrar la compañía. El español Ramón Laguarta le sustituye en el cargo.

Durante su administración, el portafolio de PepsiCo reportó diversos cambios relacionados con la reducción de azúcares añadidos y el sodio en 2017, respectivamente, en medio de impuestos a alimentos calóricos en países como México y cambios en los ámbitos alimenticios.

En 2017, Indra Nooyi, de 62 años y maestra en Administración de Empresas por Yale, ocupó el lugar número 11 de la lista de las mujeres más poderosas del mundo de Forbes, debido a sus iniciativas de llevar a la empresa de alimentos y bebidas hacia ofertas más saludables como parte de su plan para 2025.

Vida personal
Nooyi creció en una familia de clase media en India, cuando ella y su hermana eran jóvenes, su madre las desafiaba en la mesa cada noche para dar discursos sobre lo que harían, si fueran primer ministro u otro líder mundial.

Tiene dos hijos. Su esposo es Raj K. Nooyi. Reside en Greenwich, Connecticut. Es vegetariana. Su hermana mayor, Chandrika Krishnamurthy Tandon, es cantante.

Reconocimientos
Es considerada una de las cien mujeres más influyentes del mundo. En 2014, ocupó el puesto 13 en la lista de las 100 mujeres más poderosas del mundo de Forbes, mientras en 2015 el puesto 15. Fue a la vez la primera persona inmigrante y la primera mujer en ocupar el puesto de más autoridad en PepsiCo, la empresa más grande del mundo liderada por una mujer.

Ha recibido el título de Doctor Honoris Causa de Derecho (Leyes) por el Babson College en 2004, y por la Universidad de Warwick y la Universidad de Miami en 2011; Grado honorífico por la Universidad de Nueva York en 2008, la Universidad de Duke en 2009 y la Universidad Estatal de Carolina del Norte en 2013; Doctorado Honorario en Humanidades por la Universidad Estatal de Pensilvania en 2010, y Universidad Estatal de Nueva York en Purchase en 2015; Doctorado Honorario de Derecho por la Universidad de Miami en 2011.

Pratibha Patil, expresidenta de la India (2007-2012), la condecoro con la Padma Bhushan en 2007. Y recibió la Medalla de Honor de Barnard College en 2009. Fue nombrada como la tercera mujer más poderosa en los negocios por Fortune en el año 2014.

Referencias

Enlaces externos

 PepsiCo corporate biography.
 Forbes Profile: Indra Nooyi.
 The Pepsi Challenge, profile Indra Nooyi (Fortune).
 Reference for Business: Indra Nooho Leadership Biography.
 Video of discussion with Indra Nooyi at the Asia Society, New York, 4/14/2009.

Nacidos en Chennai
Alumnado de la Universidad Yale
Empresarios de India
Empresarios de Estados Unidos
PepsiCo
Graduados honorarios de la Universidad Duke
Empresarias
Indias del siglo XX
Indias del siglo XXI
Premio Padma Bhushan

redpajama_set_name: RedPajamaWikipedia


You're on an airline going from point A to point B and the worst has happened -- unfortunately, one of the pilots on your flight dies, as what happened on an American Airlines flight from Phoenix to Boston. What happens next? In every instance, an emergency is declared and the remaining pilot takes over operations of the flight.
The first thing to remember is that both the captain and the first officer are fully qualified and trained to fly an aircraft alone in case of an emergency. The captain has rank, but both pilots share equally in their flight duties, including take-offs and landings.
But in the case of an emergency that incapacitates a pilot, the remaining pilot would probably want someone in the right seat to help with things like checklists, set tasks that happen during every flight. The flight attendant would make an announcement asking if there is a pilot onboard.
It's likely that a commercial pilot flying as a passenger would be aboard a flight, and he or she would go into the cockpit to help the remaining pilot on duty. If no commercial pilot is available, then there would be a call for anyone with a pilot certificate. If that isn't an option, then a flight attendant would sit in the right seat, having been offered some training to handle an emergency.
The remaining flight attendant crew may prepare for an emergency landing, depending on how far the aircraft is from its final destination.
Federal Aviation Administration (FAA) regulations were amended on January 15, 2002, that would allow a flight attendant to enter the cockpit if one of the pilots become incapacitated. The operational requirements found in § 121.313 were also amended on January 15, 2002, to require each airline to establish methods that enable a flight attendant to enter the cockpit in the event that a pilot becomes incapacitated.
This isn't the first time this has happened. In 2009, the captain flying a Boeing 777 Continental Airlines flight from Newark, New Jersey, to Brussels, Belgium, died of a heart attack in the cockpit and the co-pilots took over the flight after a doctor onboard was unable to revive the captain. The flight continued and landed without incident in Brussels, with the passengers none the wiser until they left the plane.
Back in 2007, another Continental Airlines flight from Houston to Puerto Vallarta, Mexico, made an emergency landing in McAllen, Texas, after the captain died at the controls. In 2012, the captain of a Czech Republic flag carrier CSA Czech Airlines died during a flight on an ATR turboprop from Warsaw, Poland, to Prague, where it landed safely.
And in 2013, a United Airlines Boeing 737 flight flying from Houston to Seattle was diverted to Boise, Idaho after the captain had a heart attack in the cockpit. Doctors on board tried to save him, but he later died in a local hospital.
After the crash of a Colgan Air flight outside of Buffalo, New York, in 2009, the FAA required pilots to have an Airline Transport Pilot (ATP) multi-engine certificate and at least 1,500 flight hours. The agency now also requires pilots to have at least 1,000 as an airline first officer before flying as captain.
In the end, U.S. commercial airline pilots -- whether they are captains or first officers -- have years of training and thousands of hours of experience, so in the rare cases when one dies in the cockpit, they are fully qualified to fly the plane safely and without incident, so passengers should feel safe when flying.


Where It States , And I Quote ; '' And The Woman Was Arrayed In Purple And Scarlet Colour , And Decked With Gold And Precious Stones And Pearls , Having A Golden Cup In Her Hand Full Of Abomination And Filthiness Of Her Fornication ; And Upon Her Forehead Was A Name Written , Mystery , Babylon The Great , The Mother Of Harlots And Abominations Of The Earth .
Not that it is an Evil or Bad colour but the lower emotions of anger , pride and lust are usually reflected by Red . This is the reason why whenever they show depictions of the Devil , you always see a little Red Man With Horns , A Pitchfork That Are Thorns And A Pointed Tail , Shown On Things That Are Hot Or Red , Like Spicy Or Hot Foods Such As A Favorite Bottle Of Hot Sauce . Saul , Shaool , Paul , 13th Self-Appointed Apostle took on the attributes of his name .
We first learn about Saul , Shaool , Paul , 13th Self-Appointed Apostle in the book of Acts , ( Acts 7 ; 58 -59 ) one of the seven chosen deacons to suffer for preaching the name of Isa , Yashu'a , Jesus ( Acts 6 ; 5 ) . Saul , Shaool , Paul , 13th Self-Appointed Apostle not only witnessed and approved the murder of Stephen , one of . Saul , Shaool , Paul , 13th Self-Appointed Apostle ' most loyal deacons , but he also held the raiment ( clothing ) of the murderers ( Acts 22 ; 20 ) while they violated Elohyeem God's second commandment '' Thou Shalt Not Kill '' ( Exodus 20 ; 14 , Deuteronomy 5 ; 17 , Matthew 5 ; 21 , Romans 13 ; 9 ) .
Saul , Shaool , Paul , 13th Self-Appointed Apostle was referred to as a young man who spoke against the teaching of . Isa , Yashu'a , Jesus . Saul , Shaool , Paul , 13th Self-Appointed Apostle even caused Havoc in the Church ( Acts 8 ; 3 ) sending any believer of the word of God into prison . In fact , he set out to Damascus breathing out threatening and slaughter against the disciples of Isa , Yashu'a , Jesus ( Acts 9 ; 1 ) .
Suhuf of Adam Verses 9 - 22 , Where It States , And I Quote ; For We Have Knowldge That The Law Is Of The Spirit . ( 10 ) . But I Am Of The Body , One Sold Under Sin . ( 11 ) . For That Which I Do I Allow Not ; For What I Would , That I Do Not . ( 12 ) . But What I Hate , That I Do , If Then I Do That Which I Would Not , I Consent Unto The Law That It Is Good . ( 13 ) . Now Then It Is No More I That Do It , But Sin That Dwelieth In Me . ( 14 ) . For I Have Knowldge That In Me , Dwelleth No Good Thing ; For To Will Is Present With Me . ( 15 . But How To Do That Which Is Good I Find Not .
( 16 ) . For The Good That I Would Do I Do Not , But The Evil Which I Would Not , That I Do . ( 17 ) . Now Of I Do That I Would Not , It Is No More I That Do It . ( 18 ) . But Sin Dwelleth In Me . I find Then A Law , That , When I Would Do Good . ( 19 ) . Evil Is Present With Me . ( 20 ) . For I Delight In The Law Of Allah Most Glorified And Exalted , After The Inward Man . ( 21 ) . But I See Another Law In My Body , Warring Against The Law Of My Mind . ( 22 ) . And Brining Me Into The Level Of The Law Of Sin Which Is In My Body .
This same testament is stated in the Letters , The Epistle of Saul , Shaool , Paul , 13th Self-Appointed Apostle Romans Chapter 7 , Verses 14 - 24 . In this book the Devil is speaking through Saul , Shaool , Paul , 13th Self-Appointed Apostle Romans and saying the exact same statement as he statted in the Suhuf of Adam . The Suhuf of Adam is an ancient scriptures that was revealed to Adam and also means '' Pure Pages '' , The only way the Devil could speak through him is if he possessed Saul , Shaool , Paul , 13th Self-Appointed Apostle , at that moment .
Of Nuwaupian World Wide Masonic Lodges .
Still The Master Teacher In This Day And Time .
Chapter 2 ~ Saul , Shaool , Paul , 13th Self-Appointed Apostle ,Conversion .
John 13 ; 2 , 27 , And supper being ended , the devil having now put into the heart of Judas Iscariot , Simon's son , to betray him . 27 . And after the sop Satan entered into him . Then said Jesus unto him , that thou doest , do quickly .
However , on his journey to Damascus Saul , Shaool , Paul , 13th Self-Appointed Apostle claimed to have received a message from Yashu'a , Isa , Jesus , Shaool , Paul , 13th Self-Appointed Apostle makes record of this journey on three separate accounts . Shaool , Paul , 13th Self-Appointed Apostle acclaimed vision is the only evidence Shaool , Paul , 13th Self-Appointed Apostle could produce for his bid for the leadership of the new Church he would raise .
No wonder the Judeans ( Jews ) were highly skeptical about this claim and would not listen to him ( Acts 13 ; 44 46 ) . Let's take a look in The Holy Bible where Shaool , Paul , 13th Self-Appointed Apostle contradicts himself three times . This is the behavior of a liar . He eventually admits that he was a liar ( Romans 3 ; 7 ; Romans 7 ; 14 - 25 ) . This is something that he was tying to hide all along .
The American Heritage Dictionary defines Lie as ; lie ( 1 ) n . 1. A false statement deliberately presented as being true ; a falsehood . 2 . Something meant to deceive or give a wrong impression .
Contradiction One ; The Holy Bible -Acts 9 ; 3-9 , ( With Greek Script ) , Where It States ; And as he journeyed , he came near Daamasus ; and suddenly there shined round about him a light from heave . And he fell down on that planet earth and heard a voice saying to him , Saul why did you persceute me and he said who are you master ; And the master said I am Yashu'a whom you persecuted it is hard for you to kick against the pricks . And he trembling and astonished said the master what will you have me to do ? And the master said to him arise and go into the city and it shall be told to you what you must do .And the men who journeyed with him stood speechless hearing a voice but seen no man . And Saul arose from the earth ; and when his eyes were opened , he saw no man ; But they led him by the hand. and brought him into Damassus . And he was three days without sight , and neither did eat nor drink .
In the above verse , Shaool , Paul , 13th Self-Appointed Apostle first says that he alone fell to the ground ( Earth ) and then he proceeds to say that the men who journeyed with him stood speechless , hearing a voice , but seeing no man . We all see in Acts Chapter 22 that Shaool , Paul , 13th Self-Appointed Apostle was about to be killed by the people of the city of Caesarea for preaching to the Judeans ( Jews ) amongst the Gentiles that they should forsake Moshen , Musa , Moses and not their children or their customs . Shaool , Paul , 13th Self-Appointed Apostle was saved by the soldiers and centurions who took him to the castle unto the chief Priest . At the castle Shaool , Paul , 13th Self-Appointed Apostle says .
Contradiction Two ; The Holy Bible -Acts 22; 6 - 9 , ( With Greek Script ) , Where It States ; And it came to pass , that , as I made my journey , and was come night unto Damascus about noon , suddely there shone from heaven a great light round about me . And I fell onto the ground and heard a voice saying to me Saul Saul why are you persecuting me ? And I answer who are you Master and he said to me , I'am Jesus of Nazareth whom you persecute .And they that were with me saw surely the force of light , . And were afraid but did not hear the voice of him that spoke to me .
Now , In this verse Shaool , Paul , 13th Self-Appointed Apostle says ( He Alone Fell To The Ground ) He proceeds to say that the men who were with him , ( Saw The Light ) , But heard not the voice of him who spoke . However , Shaool , Paul , 13th Self-Appointed Apostle had just said in Acts 9 ; 3-7 , '' Those who journeyed with him , heard a voice , but saw not a man !
Contradiction Three ; The Holy Bible -Acts 26 ; 12-14 ( With Greek Script ) , Where It States ; Whereupon as I went to Damascus with authority and commission from the chief priest , At midday O ruler I saw in the way a force of light from the sky above the brightness of the halo shining around me and them which were traveling with me . And when we were all falled down on that part of the planet earth I heard a voice speaking to me and saying in a Hebrew Dialect Saul , Saul , Why did you persceute me ? It's hard for you to kick against the pricks .
Saul , Shaool , Paul , 13th Self-Appointed Apostle claims that Yashu'a , Isa , Jesus himself will appear to him and not Ananias as mentioned in Acts 22 ; 12-13 . It doesn't stop there ! When examining Saul , Shaool , Paul , 13th Self-Appointed Apostle claims of seeing Yashu'a , Isa , Jesus in a vision in order to authenticate himself , it is recognized that Saul , Shaool , Paul , 13th Self-Appointed Apostle had three entirely different versions of this vision . Each story contradicted the other . Aside from the contradiction in the book of Acts concerning Saul , Shaool , Paul , 13th Self-Appointed Apostle vision ; there is also an intersting point to be made which will be shown below .
Ques ; What could looking directly into the sun do to your eyes ? At midday or noon the sun was at it zenith ( highest point ) and unbearable to look at for long before causing damage to the eyes , Shaool , Paul , 13th Self-Appointed Apostle claims that the light was above the brightness of the sun . Here the Greek word for above -greek - huper hoop-er is being used which means ; beyond , more and exceedingly . Therefore this light being beyond the brightness of the sun , rendered Shaool , Paul , 13th Self-Appointed Apostle blind and he had to be led into Damascus by hand .
And upon reaching Damascus he was blind for 3days ( Acts 9 ; 8-9 ) . '' And Saul arose from the earth ; and when his eyes were opened , he saw no man ; but they led him by the hand , and brought him into Damascus. 9 , And was three day without sight , and neither did eat nor drink . So , because of this light that was exceedingly brighter than the sun while at its highest and brightest point of the day , Shaool , Paul , 13th Self-Appointed Apostle was blinded and those who journeyed with him had to lead him by hand .
However Shaool , Paul , 13th Self-Appointed Apostle also mentioned that the light had surrounded him as well as all of those who journeyed with him ( Acts 26 ; 16 ) . He claimed that those who journeyed with him also saw this light above the brightness of the sun and it was atound about them and they also fell to the ground . So , according to Shaool , Paul , 13th Self-Appointed Apostle , The men with him saw the same light that he saw ( Accts 22 ; 9 , Acts 26;13 ) and had the same reaction that Shaool , Paul , 13th Self-Appointed Apostle had as they all fell to the Earth while the light shined round about them .
Therefore , in like accord They Should Have All Be Blind for 3 days in which no one would have been able to lead the other by hand because no one would have been able to see due to the brightness of the light . Daniel 2 ; 31 , '' Thou , O king , sawest , and behold a gtreat image . This great image , whose brightness was excellent , stood before thee ; and the form thereof was terrible .
Still The [ Master Teacher] In This Day And Time .


text:
Right-side versus left-side hepatectomy for the treatment of hilar cholangiocarcinoma: a comparative study
Hye-Sung Jo1,
Dong-Sik Kim ORCID: orcid.org/0000-0002-0608-15801,
Young-Dong Yu1,
Woo-Hyoung Kang1 &
Kyung Chul Yoon1
World Journal of Surgical Oncology volume 18, Article number: 3 (2020) Cite this article
Radical resection is the only curative treatment for patients with hilar cholangiocarcinoma. While left-side hepatectomy (LH) may have an oncological disadvantage over right-side hepatectomy (RH) owing to the contiguous anatomical relationship between right hepatic inflow and biliary confluence, a small future liver remnant after RH could cause worse surgical morbidity and mortality. We retrospectively compared surgical morbidity and long-term outcome between RH and LH to determine the optimal surgical strategy for the treatment of hilar cholangiocarcinoma.
This study considered 83 patients who underwent surgical resection for hilar cholangiocarcinoma between 2010 and 2017. Among them, 57 patients undergoing curative-intent surgery including liver resection were enrolled for analysis—33 in the RH group and 27 in the LH group. Prospectively collected clinicopathologic characteristics, perioperative outcomes, and long-term survival were evaluated.
Portal vein embolization was more frequently performed in the RH group than in the LH group (18.2% vs. 0%, P = 0.034). The proportion of R0 resection was comparable in both groups (75.8% vs. 75.0%, P = 0.948). The 5-year overall and recurrence-free survival rates did not differ between the groups (37.7% vs. 41.9%, P = 0.500, and 26.3% vs. 33.9%, P = 0.580, respectively). The side of liver resection did not affect long-term survival. In multivariate analysis, transfusion (odds ratio, 3.12 [1.42–6.87], P = 0.005) and post-hepatectomy liver failure (≥ grade B, 4.62 [1.86–11.49], P = 0.001) were independent risk factors for overall survival.
We recommend deciding the side of liver resection according to the possibility of achieving radical resection considering the anatomical differences between RH and LH.
Complete surgical resection with a negative margin is the only curative treatment for hilar cholangiocarcinoma [1,2,3]. However, R0 resection is always technically demanding owing to the complex contiguity of the hilar structures and longitudinal spread of the tumor. Surgical morbidity and mortality are relatively high since surgical resection for hilar cholangiocarcinoma usually consists of extensive resection including major hepatectomy [4, 5].
Regarding the extent of liver resection, inclusion of the caudate lobe has been a standard procedure as the bile ducts of the caudate lobe originate in the hilar bile ducts [6, 7]. Right-side or left-side hepatectomy (RH or LH, respectively) is also mandatory to achieve a negative margin for hilar cholangiocarcinoma above Bismuth type II [1, 8]. Which side of the liver to resect is determined according to the following considerations: (1) side and level of intrahepatic bile duct invaded by the tumor, (2) vascular invasion to the hepatic artery or portal vein, and (3) adequate future liver remnant (FLR) volume.
Tumors often invade the right hepatic artery because the right hepatic artery usually courses close behind the biliary confluence. When performing LH in such cases, aggressive vascular reconstruction is required to achieve radical resection [9, 10]. Hence, some have argued that LH is considered to have an oncological disadvantage over RH [11]. However, a small FLR after RH could lead to post-hepatectomy liver failure (PHLF) and relatively high morbidity and mortality [12]. There have been few studies about the comparative analysis between RH and LH in hilar cholangiocarcinoma, and the impact of the side of liver resection has not yet been fully determined [12, 13].
Therefore, the aim of this study was to compare surgical morbidity and long-term outcomes between RH and LH in patients undergoing curative-intent resection for hilar cholangiocarcinoma.
All 83 consecutive patients who underwent surgical resection for hilar cholangiocarcinoma between 2010 and 2017 were considered for this study. The following exclusion criteria were applied: (1) non-curative-intent surgery such as bypass surgery, (2) surgery without liver resection, and (3) R2 resection (macroscopic residual tumor). The resulting study cohort comprised 57 patients: 33 in the RH group and 27 in the LH group (Fig. 1). Prospectively collected data were retrospectively reviewed. This study was approved by the Institutional Review Board of Korea University Anam Hospital (2019AN0411).
Patient flow chart depicting the cohort selection
Contrast-enhanced multidetector computed tomography (CT) and magnetic resonance (MR) cholangiography were routinely performed to assess the tumor extent and resectability as well as anatomical variation. In addition, positron emission tomography (PET)-CT was performed to rule out potential distant metastases.
In patients with obstructive jaundice, preoperative biliary drainage, consisting of endoscopic nasobiliary drainage (ENBD), through endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD) were aggressively performed not only to obtain a histological diagnosis but also to decrease the bilirubin level. The indocyanine green (ICG) test was performed to assess the functional status of the liver after the total bilirubin level decreased to below 2.0 mg/dL. Achievement of radical resection was the most important consideration in determining the surgical strategy. The longitudinal and radial extent of the tumor was assessed comprehensively through various imaging studies during an inter-department conference. Preoperative portal vein embolization (PVE) was considered for patients who had planned RH if the FLR volume was less than 35% of the total liver volume, as assessed by CT volumetry.
The surgical procedures are detailed as follows. After making an upper midline incision, the entire abdominal cavity was explored to detect unexpected peritoneal seeding or metastasis. If there was no obvious distant metastasis, a transverse extension to the right side was made to just below the right subcostal margin. A Kocher maneuver was routinely performed for resection of the aortocaval and retropancreatic lymph nodes. The hepatic artery and portal vein to the FLR were isolated to evaluate tumor resectability. Thereafter, the distal common bile duct was isolated and divided at the level of the intrapancreatic portion to retain a negative distal resection margin, and the remainder was sent for frozen biopsy. Subsequently, skeletonization of the hepatoduodenal ligament was performed. The hepatic artery and portal vein of the side to be resected were suture-tied and divided, being careful not to disturb the vascular inflow to the FLR. If the tumor invaded the portal vein confluence, segmental resection and anastomosis were performed before liver transection. After the liver was mobilized by dividing all ligamentous attachments, it was transected using a Cavitron Ultrasonic Surgical Aspirator (Valleylab, Boulder, Colorado, USA) along the demarcation line marked by the ischemic color change of the liver surface. The caudate lobe was involved in all cases. The left intrahepatic bile duct was resected at the origin of the umbilical portion in RH, while the right intrahepatic bile duct was resected at the highest achievable level in LH. The hepatic vein was then resected.
Multiple bile duct openings usually remained to be reconstructed after removal of the specimen from the abdominal cavity. The Roux limb was placed up in a retrocolic fashion, and hepaticojejunostomy was performed using a single-layer suture after making the bile duct openings contiguous whenever possible. After completing the posterior wall suture, a trans-anastomotic internal plastic stent was inserted into each opening. Thereafter, jejunojejunostomy was performed. Two drainage catheters were placed around the resection plane of the liver and the hepaticojejunostomy. Abdominal closure was performed after hemostasis was achieved.
Postoperative follow-up
Patients underwent clinical follow-up every 3 months for the first year and every 6 months thereafter. The follow-up visits comprised a physical exam, laboratory tests including tumor markers, and CT scan. Postoperative adjuvant treatment was performed based on the final pathologic report. All patients who had lymph node metastasis were attempted to receive adjuvant chemotherapy with gemcitabine plus cisplatin, except for patients who refused. Patients with positive resection margin (R1 resection) received 5-FU-based concurrent chemoradiotherapy. No postoperative treatment was performed for patients who had no lymph node metastasis after R0 resection.
The Bismuth–Corlette classification was used to categorize the type of hilar cholangiocarcinoma, as assessed by various imaging studies [14]. Preoperative cholangitis was defined as fever with increased bilirubin and white blood cell count with antibiotic administration. PHLF was defined according to the International Study Group of Liver Surgery [15], and complications were graded according to Clavien–Dindo classifications [16]. T and N staging was based on the American Joint Committee on Cancer 7th edition.
Continuous variables are presented as median and range and categorical variables as numbers with percentages. Comparison of continuous variables between groups was performed using Student's t and Mann–Whitney U tests. Categorical variables were compared using χ2 or Fisher's exact tests, as appropriate. Overall and recurrence-free survival (OS and RFS, respectively) were calculated using Kaplan–Meier analysis and compared using log-rank tests. Cox proportional hazards regression analysis was used to assess the prognostic significance of variables for survival. Multivariate analysis was performed on factors with P values ≤ 0.1 by univariate analysis. P values < 0.05 denoted statistical significance. IBM SPSS Statistics for Windows version 20.0 was used for all statistical analyses (IBM Corp., Armonk, NY, USA).
Baseline characteristics
Baseline characteristics for all patients are shown in Table 1. These included 37 male and 20 female patients, with a median age of 66 (42–83) years. The median follow-up was 19 (1–97) months. Only one patient had an underlying hepatitis B virus infection in the LH group (0 % vs. 4.2%, P = 0.421), and no patient in both groups had hepatitis C virus infection. Among patients who received preoperative biliary drainage, ENBD was performed for 20 patients (68.9%) in the RH group and 14 patients (63.6%) in the LH group (P = 0.856); the remaining patients underwent PTBD. Initial total bilirubin upon hospital referral was higher in the RH group than that in the LH group, with borderline significance (5.36 [0.35–24.96] vs. 1.51 [0.48–21.88], P = 0.093). However, there was no difference in total bilirubin prior to surgery (1.30 [0.37–3.47] vs. 0.90 [0.47–2.76], P = 0.281) and the duration jaundice relief between groups (18 [3–49] days vs. 11 [6–29] days, P = 0.218). Six patients in the RH group underwent portal vein embolization because of a small FLR volume, compared to no patients in the LH group (18.2% vs. 0%, P = 0.034). The baseline characteristics, besides portal vein embolization, did not differ between groups.
Table 1 Baseline characteristics
Subgroup analyses of the RH group showed no differences in the occurrence of PHLF (≥ grade B) and postoperative complications (≥ grade IIIA) between the PVE and non-PVE groups (16.7% vs. 18.5%, P = 0.705, and 33.3% vs. 44.4%, P = 1.000, respectively). In terms of mortality, none of the patients in the PVE group died before postoperative day 90, compared to three patients in the non-PVE group (0% vs. 11.1%, P = 0.614).
Ninety-day mortality
In this study, four patients died within 90 days after surgery (7.0%), including three and one patient in the RH and LH group (9.1% vs. 4.2%, P = 0.631), respectively. One patient in the RH group died due to grade C PHLF. Although the FLR was over 35% and preoperative liver function was preserved, the total bilirubin and ammonia levels gradually increased after surgery. With a combined intra-abdominal infection, hepatic failure progressed and the patient died at postoperative day 25. Two patients in the RH group died due to pneumonia-induced sepsis. One patient in the LH group developed a pseudoaneurysm of the hepatic artery after biliary leakage for which a stent graft was inserted successfully. However, liver abscess and pneumonia-induced sepsis occurred subsequently.
Survival analyses
The 1-, 3-, and 5-year OS rates for all patients were 75.2%, 49.9%, and 39.4%, respectively, and the 1-, 3-, and 5-year RFS rates were 68.3%, 43.1%, and 24.4%, respectively. The 1-, 3-, and 5-year OS rates of the RH group were 69.3%, 48.5%, and 37.7%, respectively, and those of the LH group were 82.6%, 50.6%, and 40.5% (P = 0.485, Fig. 2). In addition, the 1-, 3-, and 5-year RFS rates of the RH group were 76.5%, 53.8%, and 27.7%, respectively, and those of the LH group were 69.6%, 30.6%, and 15.3% (P = 0.637, Fig. 3).
Kaplan–Meier curves showing overall survival between the RH and LH groups. RH, right-side hepatectomy; LH, left-side hepatectomy
Kaplan–Meier curves showing recurrence-free survival between the RH and LH groups. RH, right-side hepatectomy; LH, left-side hepatectomy
In univariate analysis, transfusion (odds ratio, 3.48 [1.60–7.54], P = 0.002), PHLF (≥ grade B, 4.45 [1.83–10.82], P = 0.001), and N stage (≥ N1, 2.18 [1.01–4.71], P = 0.046) were significantly associated with OS. Multivariate analysis revealed that transfusion (3.12 [1.42–6.87], P = 0.005) and PHLF (≥ grade B, 4.62 [1.86–11.49], P = 0.001) were independent risk factors for OS (Table 2). On the other hand, transfusion (2.81 [1.30–6.05], P = 0.008) and LVI (3.22 [1.35–7.63], P = 0.008) were significantly associated with RFS; the same variables were independent risk factors in multivariate analysis (2.82 [1.28–6.20], P = 0.01, and 3.33 [1.34–8.23], P = 0.009, respectively, Table 3).
Table 2 Univariate and multivariate analysis of 57 patients for risk factors related to overall survival
Table 3 Univariate and multivariate analysis of 57 patients for risk factors related to recurrence-free survival
Subgroup analysis was performed for 21 patients who had lymph node metastasis: 15 in the RH group and 6 in the LH group. Among them, 11 patients (52.4%) received adjuvant chemotherapy with gemcitabine plus cisplatin. There were no significant differences in 5-year OS and RFS rates between adjuvant and non-adjuvant treatment group (18.7% vs. 30.5%, P = 0.552, and 33.2% vs. 26.2%, P = 0.576, respectively).
Considering its prognostic effects on the long-term outcome, radical resection plays a major role in the treatment of hilar cholangiocarcinoma [17]. Therefore, many surgeons have made considerable efforts to adopt an aggressive surgical approach, despite technical difficulty [9, 18]. There are many considerations in determining which side of the liver to resect. The Bismuth–Corlette classification has been widely used to assess the hilar cholangiocarcinoma preoperatively [14]. It is a simple but useful method for classifying the type of tumor and deciding the surgical plan. In most cases of type IIIa or IIIb tumor, the surgical procedure is determined according to the side of the tumor. However, surgeons must choose between RH and LH for tumors extending to both sides of the bile duct to a similar level or invading hepatic inflow to the FLR. Once a surgeon decides the surgical plan, it is hard to change during surgery. Hence, clarifying the surgical outcome and long-term survival between RH and LH can be instrumental in deciding the surgical strategy for hilar cholangiocarcinoma.
Few reports have compared RH and LH in hilar cholangiocarcinoma, and the impact of the side of the liver resection has not yet been established [12, 13]. It could be considered that RH has an advantage over LH for achieving R0 resection. The tumor tends to invade the right hepatic artery or portal vein because biliary confluence leans to the right side of the vascular confluence [9, 11, 19]. This could lead surgeons performing LH to choose whether to stop further resection or to conduct aggressive vascular reconstruction. Various studies have demonstrated a high incidence of vascular invasion leading to reconstruction in LH [20, 21]. Nagino et al. reported acceptable mortality and better long-term survival rates following major hepatectomy with simultaneous vascular reconstruction for hilar cholangiocarcinoma consisting of predominantly LH [10]. However, although combined portal vein resection and reconstruction are considered to be a certain option to increase resectability with acceptable morbidity [22], hepatic artery reconstruction could still be technically difficult and cause serious complications.
Furthermore, achieving a negative proximal ductal margin is another reason that makes R0 resection difficult. Some authors have asserted that a negative proximal ductal margin can be more easily achieved in RH because the left extrahepatic bile duct to the bifurcation is longer than that of the right liver and there is less variation in the segmental anatomy of the left liver [23]. However, estimation of longitudinal tumor extent along the bile ducts should be performed before determination of side of liver resection and there was no difference in the proportion of R0 resections (approximately 75%) between groups in the present study which was comparable to those reported previously [8, 24, 25]. In this study, the extent of tumor was the most important consideration in determining the side of liver resection. Then, the tumor invasion of portal vein or hepatic artery and possibility of reconstruction were evaluated with various imaging studies. However, in case in which R0 resection was possible only with one of both sides and vascular invasion to FLR was reconstructible, the side of resection was determined depending on the tumor extent. In case that either side of resection can be considered to achieve a R0 resection, we do not recommend right-side resection with concerns of PHLF based on our results. In terms of achieving a negative proximal ductal margin, we did not routinely perform a frozen biopsy because the proximal bile duct was resected at the highest achievable level [26]. As a result, we reconstructed each segmental bile duct with more than three openings in almost all cases. Therefore, the authors assume that achieving R0 resection depends more on expertise to acquire and reconstruct the proximal bile duct margin as high level as possible, despite several anatomical issues.
Surgical resection for hilar cholangiocarcinoma has higher morbidity and mortality than those of any other operation in hepatobiliary pancreatic surgery [27]. A previous study reported that postoperative complications, including PHLF, occur more frequently in RH than LH [28]. In this study, a postoperative complication rate above Clavien–Dindo grade IIIA was reported in about 40% of both groups, while the hospital stay and 90-day mortality rates did not differ between the groups. PHLF tended to occur more frequently in the RH group than in the LH group (21.2% vs. 8.3%) but the difference was not statistically significant. A small FLR volume associated with severe PHLF is one of the essential considerations in planning surgical strategy [29, 30]. We focused on two ways to prevent PHLF in RH for hilar cholangiocarcinoma, namely, the aggressive use of preoperative biliary drainage for FLR, and PVE. Resection of the jaundiced liver could lead to severe morbidity and mortality [31, 32]. Although there is controversy regarding preoperative biliary drainage, it could relieve preoperative cholangitis and prevent PHLF by resolving obstructive jaundice [33, 34].
Furthermore, maximizing FLR by PVE has allowed better postoperative recovery and reduced the occurrence of PHLF [35]. In this study, six patients (18.2%) in the RH group underwent PVE, with the criteria of performing PVE for FLR of less than 35% as assessed through CT volumetry. A subgroup analysis of the RH group showed no differences in the occurrence of PHLF (≥ grade B) between the PVE and non-PVE groups, suggesting the preventive effect of PVE for the occurrence of PHLF. Although multivariate analysis revealed that PVE was not a significant risk factor for survival, it should be encouraged for patients who are likely to develop PHLF considering that PHLF was an independent risk factor for overall survival. Some groups use PVE more actively, with the criteria of performing right hemihepatectomy or FLR of less than 40% [35]. However, it could be excessive criteria considering a relatively well-preserved liver function in patients with hilar cholangiocarcinoma and a similar proportion of the occurrence of PHLF in both PVE and non-PVE groups in this study. Besides, this invasive procedure has a disadvantage of delaying operation by several weeks for patients without jaundice. Therefore, PVE should be performed on selected patients, considering the underlying liver function and extent of liver resection.
The 5-year OS and RFS were 39.4% and 24.4%, respectively, and no significant difference was observed in OS and RFS between the RH and LH groups. This finding may be due to the similar proportions of R0 resection and pathologic characteristics in both groups. As described above, there were several differences in anatomy and extent of liver resection between RH and LH. However, there were no differences in long-term outcomes following radical resection between groups with similar invasiveness. Multivariate analysis revealed that transfusion was a common risk factor for OS and RFS. Aside from technical aspects, it could be inferred that patients receiving transfusion had worse underlying liver function or aggressive tumor characteristics. It has been reported that transfusion negatively affects not only perioperative outcomes with poor immune modulation but also cancer-related mortality [36]. Although extensive resection is mandatory for the surgical resection of hilar cholangiocarcinoma, we should strive to reduce unnecessary transfusion and optimize patient condition preoperatively. Furthermore, subgroup analysis for patients who had lymph node metastasis revealed that there were no significant differences in long-term outcomes between adjuvant and non-adjuvant treatment group. Although this result could imply the superiority of surgical resection as curative treatment and the limited role of adjuvant chemotherapy, it is hard to conclude owing to the small sample size of each group.
A limitation of this study was its retrospective design with relatively small sample size. Although hilar cholangiocarcinoma accounts for 60–70% of extrahepatic cholangiocarcinoma, the number of cases in a single center is limited. We hope that future multi-center studies involving larger sample sizes will produce more concrete results.
This study suggests that the side of the liver resection did not impact perioperative and long-term outcomes in patients undergoing curative-intent resection for hilar cholangiocarcinoma. We recommend planning a surgical strategy based on the possibility of achieving radical resection with efforts to reduce morbidity and mortality considering the anatomical differences between RH and LH.
All data generated or analyzed during this study are included in this published article.
ENBD:
Endoscopic nasobiliary drainage
ERCP:
FLR:
Future liver remnant
ICG:
Indocyanine green
LH:
Left-side hepatectomy
MR:
Overall survival
PHLF:
Post-hepatectomy liver failure
PTBD:
Percutaneous transhepatic biliary drainage
PVE:
Portal vein embolization
RFS:
Recurrence-free survival
RH:
Right-side hepatectomy
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We have received no funding for this study.
Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, 73, Goryedae-ro, Seongbuk-gu, Seoul, 02841, Korea
Hye-Sung Jo
, Dong-Sik Kim
, Young-Dong Yu
, Woo-Hyoung Kang
& Kyung Chul Yoon
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HSJ contributed to the study design, analysis, and writing of the manuscript. DSK contributed to the study design, interpretation of data, and revising of the article. YDY contributed to the analysis and interpretation of data. WHK and KCY participated in the statistical analysis and in writing the manuscript. All authors read and approved the final manuscript.
Correspondence to Dong-Sik Kim.
This study was performed in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Korea University Anam Hospital (No.2019AN0411).
Jo, H., Kim, D., Yu, Y. et al. Right-side versus left-side hepatectomy for the treatment of hilar cholangiocarcinoma: a comparative study. World J Surg Onc 18, 3 (2020) doi:10.1186/s12957-019-1779-1
Hilar cholangiocarcinoma
Radical resection


text:
Home Columns Feel Good Story The Bike That Keeps On Giving
The Bike That Keeps On Giving
Ally Gravina
Author: Ally Gravina
It's no secret that mountain bikes are expensive, especially for a teenage boy who grows like a weed. For Luca Robillard, 14, and his mom Annie, who live in Truckee, a June trip to Coffeebar turned into the opportunity of a lifetime when the single mom and her son ran into professional mountain biker Katerina Nash.
Annie had worked on the Mountain Bike World Cup Tour for more than 10 years, so she and Nash had mutual friends. At Coffeebar in Truckee, the three got to talking about, what else, mountain biking. Luca, who was riding his mom's old bike at the time, had been bit by the biking bug last year when he first started competing in the National Interscholastic Cycling Association (NICA) mountain bike league for Truckee. Like teenage boys do, Luca grew out of his bike in just one season and was in desperate need for a new one as he was already signed up for the 2017 season. Nash, a decorated athlete who has competed in the Olympics five times, twice as a Nordic skier and three times as a mountain biker, had a solution — the $10,000 Orbea Oiz she raced on in the 2016 Rio Olympics, on which she placed fifth.
"I wanted this super fancy bike to be used and not sit in the garage or hang in a bike shop," Nash said of the bicycle collecting dust in her Truckee garage. "I had a great ride on that bike in Rio and wanted to hold on to it. Since I'm still a sponsored athlete and under contract, I wasn't really able to ride my Olympic bike due to some new sponsorship. So my Olympic bike was sadly sitting in the garage and not being used."
Luca gladly accepted the bike — which boasts electronic shifting and suspension that can be locked out remotely, and weighs only 23 pounds thanks to its carbon frame — and so began his second season competing in mountain biking, this year on a much fancier steed.
"She gave me the bike and said 'No pressure, just have fun with it,'" Luca shared.
As fate would have it, at the first race of Luca's season he saw Nash, who was a special guest at the competition, just before he started the pre-ride. The two were able to scope the course together and Luca explained that Nash gave him suggestions about how to approach the course, and more importantly, about how to approach the course on his new bike, which he nicknamed "The Beast."
In his first season racing, Luca didn't do well. This year, however, with the help of The Beast, he placed third in every race he has competed in. His last race is Oct. 15 and he hopes to end the season with a first place finish."The bike not only makes me faster, but it makes me more excited to get out on the trail and be competitive," he said.
To complement his summer of mountain biking, Luca worked at Paco's Bike and Ski, an outdoor retailer and repair shop in Truckee. He was mainly cleaning bikes and occasionally helping out with repair work, but he says he learned a lot about bikes and was able to do minor maintenance on his Orbea Oiz.
In the end, Nash believes that mountain biking should, first and foremost, be about having fun.
"I'm very happy to hear Luca rode my bike and got to enjoy it," Nash said. "He can even do a wheelie. I can't, so my fancy bike gets to do more things, and, most importantly, gets to ride around Tahoe instead of hanging on some kind of display."
Since Luca is still a growing boy he will outgrow Nash's bike by next season. But thankfully, she is ready and willing to pass The Beast on to another deserving kid.
"I think Luca will be too tall for it next year, but I would like to offer my bike to another NICA racer," Nash said. "Maybe a girl this time around."
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Associate Editor Ally Gravina has been drinking Moonshine for just over a year. While she loves her daily carpool with the other Tahoe City 'shiners, she dreams of one day traveling the commute from her home on the West Shore to the office in Truckee on a motorcycle with a French bulldog in the sidecar.
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Saint-Eusèbe – miejscowość i gmina we Francji, w regionie Owernia-Rodan-Alpy, w departamencie Górna Sabaudia.

Według danych na rok 1990 gminę zamieszkiwało 298 osób, a gęstość zaludnienia wynosiła 43 osób/km² (wśród 2880 gmin regionu Rodan-Alpy Saint-Eusèbe plasuje się na 1331. miejscu pod względem liczby ludności, natomiast pod względem powierzchni na miejscu 1363.).

Bibliografia

Miejscowości w departamencie Górna Sabaudia


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Общие сведения
Пещера, обнаруженная в верховьях реки Бедык, около села Бедык, Эльбрусского района Кабардино-Балкарской республики. Открыта местным жителем Зурабом.
Пещера имеет карстовую природу.
Наличие как горизонтальных так и вертикальных ходов, а также колодцев характеризуют пещеру как многоуровневую.
Разведанная длина пещеры ≈260 метрам.

В пещере найдены останки нескольких человек, предположительно детей.

История исследований
Исследование Бедыкской пещеры проводилось в ходе спелеологической экспедиции Космопоиска в августе 2014 года.

Примечания

Пещеры Кабардино-Балкарии


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