Studies analyzing the impact of visceral fat excess on surgical outcomes after resection for colorectal cancer (CRC) have yielded conflicting results. Visceral obesity (VO) and sarcobesity (SO) have ...been recently addressed as risk factors for poor short-term results while no data are available for recovery goals after surgery. No data are available on the protective effect of ERAS in VO and SO patients. The aim of this study was to assess clinical implications of computed tomography (CT) assessed VO and SO on surgical and recovery outcomes after minimally invasive resection for CRC before and after ERAS protocol implementation.
Visceral adipose tissue (VAT) and skeletal muscle area (SMA) were retrospectively assessed using pre-operative CT studies of 261 patients who underwent laparoscopic resection for CRC between January 2012 and April 2019; ERAS protocol was adopted in 160 patients operated on after March 2014. Patients’ surgical and recovery outcomes were compared according to BMI categories, VO and SO which was defined using the VAT/SMA ratio (Sarcobesity Index). Predictive factors for poor surgical and recovery outcomes were evaluated by univariate and multivariate analyses.
Of the 261 patients, 12.6% were BMI obese while 68.6% presented visceral obesity. BMI was not associated to any of the outcomes considered. No differences in intra-operative results were found except for a lower number of retrieved lymph nodes both in VO and SO patients. While VO showed no impact on post-operative course, SO resulted an independent risk factor for cardiac complications and prolonged post-operative ileus (PPOI) at logistic regression analysis. Furthermore, sarcobese patients showed delayed recovery after surgery. Patients enrolled in the ERAS protocol showed improved recovery outcomes for both VO and SO groups, although ERAS did not result to be a protective factor for cardiac complications and PPOI.
A high Sarcobesity Index is a risk factor for developing cardiac complications and PPOI after laparoscopic resection for CRC. A reduced number of lymph nodes retrieved is associated to VO and SO. These conditions should then be considered in clinical practice for the risk of down staging the N stage. Effect of VO and SO on recovery items after surgery should be further investigated. ERAS protocol application should be implemented to improve recovery outcomes in VO and SO patients undergoing laparoscopic colorectal resection.
Interpretation of the Omori law Guglielmi, A. V.
Izvestiya. Physics of the solid earth,
09/2016, Letnik:
52, Številka:
5
Journal Article
Recenzirano
Odprti dostop
The well-known Omori law is represented in the form of the differential equation describing the evolution of the aftershock activity. The interpretation of the evolution equation is suggested. It is ...based on the idea of deactivation of the faults in the vicinity of the main shock of the earthquake. The generalization of the Omori law with the allowance for the nonstationarity of the medium in the source, which is cooling after the main shock, is presented.
Background
Central pancreatectomy (CP) is a parenchyma‐sparing surgical procedure that enables the removal of benign and/or low‐grade malignant lesions from the neck and proximal body of the ...pancreas. The aim of this review was to evaluate the short‐ and long‐term surgical results of CP from all published studies, and the results of comparative studies of CP versus distal pancreatectomy (DP).
Methods
Eligible studies published between 1988 and 2010 were reviewed systematically. Comparisons between CP and DP were pooled and analysed by meta‐analytical techniques using random‐ or fixed‐effects models, as appropriate.
Results
Ninety‐four studies, involving 963 patients undergoing CP, were identified. Postoperative morbidity and pancreatic fistula rates were 45·3 and 40·9 per cent respectively. Endocrine and exocrine pancreatic insufficiency was reported in 5·0 and 9·9 per cent of patients. The overall mortality rate was 0·8 per cent. Compared with DP, CP had a higher postoperative morbidity rate and a higher incidence of pancreatic fistula, but a lower risk of endocrine insufficiency (relative risk (RR) 0·22, 95 per cent confidence interval 0·14 to 0·35; P < 0·001). The risk of exocrine failure was also lower after CP, although this was not significant (RR 0·59, 0·32 to 1·07; P = 0·082).
Conclusion
CP is a safe procedure with good long‐term functional reserve. In situations where DP represents an alternative, CP is associated with a slightly higher risk of early complications.
Works well in properly selected patients
Background
Although the Barcelona Clinic Liver Cancer (BCLC) staging system has been largely adopted in clinical practice, recent studies have emphasized the need for further refinement and ...subclassification of this system.
Methods
Patients who underwent hepatectomy with curative intent for BCLC‐0, ‐A or ‐B hepatocellular carcinoma (HCC) between 2000 and 2017 were identified using a multi‐institutional database. The tumour burden score (TBS) was calculated, and overall survival (OS) was examined in relation to TBS and BCLC stage.
Results
Among 1053 patients, 63 (6·0 per cent) had BCLC‐0, 826 (78·4 per cent) BCLC‐A and 164 (15·6 per cent) had BCLC‐B HCC. OS worsened incrementally with higher TBS (5‐year OS 77·9, 61 and 39 per cent for low, medium and high TBS respectively; P < 0·001). No differences in OS were noted among patients with similar TBS, irrespective of BCLC stage (61·6 versus 58·9 per cent for BCLC‐A/medium TBS versus BCLC‐B/medium TBS, P = 0·930; 45 versus 13 per cent for BCLC‐A/high TBS versus BCLC‐B/high TBS, P = 0·175). Patients with BCLC‐B HCC and a medium TBS had better OS than those with BCLC‐A disease and a high TBS (58·9 versus 45 per cent; P = 0·005). On multivariable analysis, TBS remained associated with OS among patients with BCLC‐A (medium TBS: hazard ratio (HR) 2·07, 95 per cent c.i. 1·42 to 3·02, P < 0·001; high TBS: HR 4·05, 2·40 to 6·82, P < 0·001) and BCLC‐B (high TBS: HR 3·85, 2·03 to 7·30; P < 0·001) HCC. TBS could also stratify prognosis among patients in an external validation cohort (5‐year OS 79, 51·2 and 28 per cent for low, medium and high TBS respectively; P = 0·010).
Conclusion
The prognosis of patients with HCC varied according to the BCLC stage but was largely dependent on the TBS.
Antecedentes
Aunque el sistema de estadificación del Barcelona Clinic Liver Cancer (BCLC) ha sido adoptado en gran medida en la práctica clínica, estudios recientes han enfatizado la necesidad de un mayor refinamiento y subclasificación del sistema BCLC.
Métodos
Los pacientes con carcinoma hepatocelular (hepatocellular cancer, HCC) BCLC‐0, A y B que se sometieron a una hepatectomía con intención curativa entre 2000 y 2017 fueron identificados utilizando una base de datos multi‐institucional. Se calculó la puntuación de carga tumoral (tumour burden score, TBS) y se examinó la supervivencia global (overall survival, OS) en relación con la TBS y los estadios BCLC.
Resultados
En la serie de 1.053 pacientes, 63 (6%) tenían HCC BCLC‐0, 826 (78,4%) HCC BCLC‐A y 164 (15,6%) HCC BCLC‐B. La OS disminuyó de forma incremental en función de la mayor TBS (OS a 5 años; TBS baja: 77,9% versus TBS media: 61% versus TBS alta: 39%, P < 0,001). No se observaron diferencias en la OS entre pacientes con una puntuación TBS similar, independientemente del estadio BCLC (BCLC‐A/TBS media: 61,6% versus BCLC‐B/TBS media: 58,9%, P = 0,93; BCLC‐A/TBS alta: 45,1% versus BCLC‐B/TBS alta: 12,8%, P = 0,175). Los pacientes con BCLC‐B/TBS media tuvieron una mejor OS que los pacientes con BCLC‐A/TBS alta (58,9% versus 45,1%, P = 0,005). En el análisis multivariable, la TBS se mantuvo asociada a la OS en el caso de BCLC‐A (TBS media: cociente de riesgos instantáneos, hazard ratio, HR = 2,07, i.c. del 95%: 1,42‐3,02, P < 0,001; TBS alta: HR = 4,05, i.c. del 95%: 2,40‐6,82, P < 0,001) y BCLC‐B pacientes (TBS alta: HR = 3,85, i.c. del 95%: 2,03‐7,30, P < 0,001). La TBS también pudo estratificar el pronóstico entre pacientes en una cohorte de validación externa (OS a 5 años; TBS baja: 78,7% versus TBS media: 51,2% versus TBS alta: 27,6%, P = 0,01).
Conclusión
El pronóstico de los pacientes con HCC varió según el estadio BCLC, pero dependió en gran medida de la TBS.
The prognosis of patients with hepatocellular carcinoma varied according to the Barcelona Clinic Liver Cancer (BCLC) stage; yet, it was largely dependent on the tumour burden score (TBS). Following resection, patients with similar TBS had comparable long‐term outcomes, regardless of BCLC status, suggesting the need for further subclassification of the current BCLC guidelines and refinement of the proposed treatment algorithm using an assessment of total tumour burden.
Added value
Abstract Background Few papers deal with pathologic characteristics and outcome of the 3 different cholangiocarcinomas based on location (intrahepatic, peri-hilar, distal). There is little evidence ...regarding similarity and differences. Patients and Methods From two tertiary referral Italian Centers (in Bologna and Verona), 479 patients with cholangiocarcinoma were evaluated between 1980 and 2011. Several pathologic characteristics and their impact on survival were analyzed among resected patients for cholangiocarcinomas depending on the site of origin. Results Tumour location was intrahepatic in 172 cases (36%), peri-hilar in 243 (51) and distal in 64(13%). Curative resection was performed in 339 (70%) patients. Intrahepatic cholangiocarcinoma showed higher probability to achieve R0 resection (81%), but was more frequently associated with presence of microvascular invasion (71%). Distal cholangiocarcinoma presented less R0 resections (58%), higher lymphnode involvement (60%) and lower microvascular invasion (49%). Hilar cholangiocarcinoma had intermediate characteristics (R0: 65% of cases). Median follow up was 30.2 ± 38 months; the 5 years overall survival was 31% in the resected population. Overall survival curves were similar among the three groups. At univariate analysis surgical margins, lymphnode status, perineural invasion, T category, TNM stage, microvascular invasion, tumour grading had significant impact on survival. At multivariate analysis, only microvascular invasion was significantly related to long term results (HR = 1,7; 95% CI = 1,0–2,5)”. Conclusion Micro-vascular invasion has the strongest impact on survival in all three types of cholangiocarcinoma. In case of comparable pathologic characteristics and stage, the three tumors show similar outcome; depending on location, it shows a different tendency to invade bordering structures which affect the outcome.
Background
This study aimed to assess the best achievable outcomes in laparoscopic liver resection (LLR) after risk adjustment based on surgical technical difficulty using a national registry.
...Methods
LLRs registered in the Italian Group of Minimally Invasive Liver Surgery registry from November 2014 to March 2018 were considered. Benchmarks were calculated according to the Achievable Benchmark of Care (ABC™). LLRs at each centre were divided into three clusters (groups I, II and III) based on the Kawaguchi classification. ABCs for overall and major morbidity were calculated in each cluster. Multivariable analysis was used to identify independent risk factors for overall and major morbidity. Significant variables were used in further risk adjustment.
Results
A total of 1752 of 2263 patients fulfilled the inclusion criteria: 1096 (62·6 per cent) in group I, 435 (24·8 per cent) in group II and 221 (12·6 per cent) in group III. The ABCs for overall morbidity (7·8, 14·2 and 26·4 per cent for grades I, II and II respectively) and major morbidity (1·4, 2·2 and 5·7 per cent) increased with the difficulty of LLR. Multivariable analysis showed an increased risk of overall morbidity associated with multiple LLRs (odds ratio (OR) 1·35), simultaneous intestinal resection (OR 3·76) and cirrhosis (OR 1·83), and an increased risk of major morbidity with intestinal resection (OR 4·61). ABCs for overall and major morbidity were 14·4 and 3·2 per cent respectively for multiple LLRs, 30 and 11·1 per cent for intestinal resection, and 14·9 and 4·8 per cent for cirrhosis.
Conclusion
Overall morbidity benchmarks for LLR ranged from 7·8 to 26·4 per cent, and those for major morbidity from 1·4 to 5·7 per cent, depending on complexity. Benchmark values should be adjusted according to multiple LLRs or simultaneous intestinal resection and cirrhosis.
Antecedentes
Este estudio tuvo como objetivo evaluar los mejores resultados que se pueden conseguir en la resección hepática laparoscópica (laparoscopic liver resection, LLR) después del ajuste por riesgos basado en la dificultad de la técnica quirúrgica utilizando un registro nacional.
Métodos
Se consideraron las LLRs incluidas en el Registro del Grupo Italiano de Cirugía Hepática Mínimamente Invasiva desde 11/2014 a 03/2018. Los resultados de referencia (benchmarks) se calcularon de acuerdo con el Achievable Benchmark of Care (ABC™). Las LLRs de cada uno de los centros se dividieron en 3 grupos (Grupo I, II y III) en base a la clasificación de Kawaguchi. Se calculó el ABC de la morbilidad global y de la morbilidad mayor para cada grupo. Se realizó un análisis multivariable para identificar los factores independientes de riesgos para la morbilidad global y morbilidad mayor. Se utilizaron variables significativas para realizar ajustes de riesgo adicionales.
Resultados
Un total de 1.752 pacientes de los 2.263 cumplían los criterios de inclusión, de los cuales 1.096 (62,6%) se incluyeron en el Grupo I, 435 (24,8%) en el Grupo II y 221 (12,6%) en el Grupo III. El ABC de la morbilidad global (7,8%, 14,2%, 26,4%) y de la morbilidad mayor (1,4%, 2,2%, 5,7%) aumentó del Grupo I al Grupo III. El análisis multivariable mostró un incremento del riesgo para la morbilidad global asociada con múltiples LLRs (razón de oportunidades, odds ratio, OR 1,349), resección intestinal simultánea (OR 3,760) y cirrosis (OR 1,825), y para la morbilidad mayor con la resección intestinal (OR 4,606). Los ABC de la morbilidad global y morbilidad mayor fueron 14,4% y 3,2% para las LLR múltiples, 30% y 11% para la resección intestinal, y 14,9% y 4,8% para la cirrosis, respectivamente.
Conclusión
Los resultados de referencia (benchmark) para la morbilidad global y morbilidad mayor en la LLR variaron entre un 8% y un 26% y entre un 1,4% y un 5,7%, dependiendo de la complejidad. Los valores de referencia deberían ajustarse de acuerdo con la práctica de LLRs múltiples o resección intestinal simultánea y cirrosis.
Data from the I Go MILS registry were used to calculate the benchmarks for outcomes in laparoscopic liver resection (LLR). Depending on the technical complexity of LLR, the benchmarks ranged between 7·8 and 26·4 per cent for overall morbidity, and 1·4 and 5·7 per cent for major morbidity. Multiple LLRs, simultaneous intestinal resection and cirrhosis worsened benchmark values.
Benchmarks may be useful
Background
Atraumatic restorative treatment (ART) has demonstrated good longevity when used for single‐surface restorations, but lower success rates are reported for occlusoproximal surfaces.
Aim
...This systematic review and meta‐analysis aimed to verify the pooled success rate of occlusoproximal ART restorations in primary teeth considering the outcomes: longevity, pulp damage, or caries lesion progression.
Design
Literature searching was carried out on the studies reporting clinical trials indexed in PubMed and in English language, comprising the outcomes. A meta‐analysis was undertaken considering the results from reviewed studies.
Results
An initial search resulted in 126 articles, and three of them were finally selected. The main reasons for excluding articles were the absence of control group, as amalgam, composite resin, or compomer restorations to be compared with ART (hand excavation + high‐viscous GIC). The pooled estimate (odds ratio; 95% confidence interval) for ART approach success was 1.04 (0.65–1.66).
Conclusion
Atraumatic restorative treatment restorations performed with high‐viscous GIC present similar survival/success rates to conventional approach using composite resin or amalgam for occlusoproximal restorations in primary teeth and can be suggested as a good option for occlusoproximal cavities in primary molars. In addition, further randomized controlled clinical investigations concerning occlusoproximal restorations in primary teeth are still necessary.
Background
The role of routine lymph node dissection (LND) in the surgical treatment of intrahepatic cholangiocarcinoma (ICC) remains controversial. The objective of this study was to investigate the ...trends of LND use in the surgical treatment of ICC.
Methods
Patients undergoing curative intent resection for ICC in 2000–2015 were identified from an international multi‐institutional database. Use of lymphadenectomy was evaluated over time and by geographical region (West versus East); LND use and final nodal status were analysed relative to AJCC T categories.
Results
Among the 1084 patients identified, half (535, 49·4 per cent) underwent concomitant hepatic resection and LND. Between 2000 and 2015, the proportion of patients undergoing LND for ICC nearly doubled: 44·4 per cent in 2000 versus 81·5 per cent in 2015 (P < 0·001). Use of LND increased over time among both Eastern and Western centres. The odds of LND was associated with the time period of surgery and the extent of the tumour/T status (referent T1a: OR 2·43 for T2, P = 0·001; OR 2·13 for T3, P = 0·016). Among the 535 patients who had LND, lymph node metastasis (LNM) was noted in 209 (39·1 per cent). Specifically, the incidence of LNM was 24 per cent in T1a disease, 22 per cent in T1b, 42·9 per cent in T2, 48 per cent in T3 and 66 per cent in T4 (P < 0·001). AJCC T3 and T4 categories, harvesting of six or more lymph nodes, and presence of satellite lesions were independently associated with LNM.
Conclusion
The rate of LNM was high across all T categories, with one in five patients with T1 disease having nodal metastasis. The trend in increased use of LND suggests a growing adoption of AJCC recommendations in the treatment of ICC.
Lymphadenectomy is important
•A systematic literature review on the adoption of near miss management systems (NMS) is performed.•A standard method to design and manage NMS is not present in literature yet.•NMS diffusion is ...growing, mostly in a few industrial sectors so far.•The involvement of top management and the employees’ training are crucial for effective NMSs.•Research gaps and possible future developments are highlighted.
The concept of near miss is quickly wide spreading from pioneer sectors - such as the aviation and the chemical industries- to other ones, like construction and manufacturing. A near miss usually outlines an adverse event that could have caused major harm to someone (i.e. a worker), but did not result in any damage. This diffusion is mainly due to the intrinsic value provided by near miss analysis, as they currently represent a relevant source of information for preventing accidents at the workplace. Although international standards and technical reports have outlined its effectiveness in identifying possible causes of accidents, only a few companies currently apply structured near miss management systems. A near miss management system (NMS) is composed of several processes: from collection to analysis and, finally, dissemination of knowledge to all stakeholders. A standard method to design and manage NMS is not proposed in the international literature; a critical analysis about current near miss management systems is still lacking. The aim of this work is to review scientific literature on this topic, aiming at highlighting best practices and criticalities in its application, thus providing guidelines for developing more effective NMSs. The obtained results outline the state of the art of the application of near miss management systems in industry; positive aspects, limits and further developments are outlined to provide structured information to researchers in addressing current critical issues in NMSs, but also technicians in developing their own effective NMS.
This paper is devoted to the 80th anniversary of the discovery of Alfven waves, which play an important role in physics, radiophysics, astrophysics, and Earth physics. The emphasis is on the ...ponderomotive redistribution of plasma in the Earth’s magnetosphere under the action of Alfven and ion-cyclotron waves. At relatively small distances from the Earth, the ponderomotive force is buoyant, i.e., is directed upwards, regardless of whether an Alfven wave propagates towards the Earth or away from it. In the near-equatorial zone of the central regions of magnetosphere, waves in the Pc 1 range push the plasma to the minimum of geomagnetic field, so that a maximum of plasma density arises on the equator at sufficiently high wave intensity. A bifurcation occurs at the magnetosphere’s periphery, and the maximum is split into two maxima, the distance between which increases while moving away from the Earth. The polar wind, acceleration of heavy ions, and fictitious nonlinearity of the surface impedance of the Earth’s crust are also briefly discussed.
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