29 research outputs found
Development of a new, minimally invasive, full thickness excision technique for early colonic neoplasia
No full textIntroduction of bowel cancer screening programmes internationally has resulted in a significant shift in diagnosis towards early stage disease. In addition, the number of patients diagnosed with complex benign colorectal polyps is increasing.
Advanced endoscopic techniques including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) as well as transanal endoscopic microsurgery (TEMS) are being increasingly utilised for excision of early rectal neoplasia. An equivalent surgical technique is currently not available for colonic lesions, and endoscopic techniques are associated with a high risk of complications such as bleeding, perforation and recurrence than in the rectum. Hemicolectomy with en bloc mesenteric excision remains the gold standard treatment for patients with early, node negative colon cancer and large colonic polyps. Even when performed laparoscopically within an enhanced recovery protocol, problems such as death, anastomotic leakage and other complications occurring in up to 40% of patients make colectomy a morbid intervention.
The introduction to this thesis reviews the literature on the development and staging of colorectal cancer as well as currently available endoscopic and surgical techniques. In order to improve our understanding of the morbidity associated with hemicolectomy for the treatment of benign colonic polyps, two studies examined short term outcomes after surgery. The results suggest similar 30-day outcomes to those after cancer resection. In addition, a two-part study was designed to assess bowel function and related quality of life in patients who underwent hemicolectomy for colonic neoplasia, a subject that is poorly documented in the literature. As an introduction to the laboratory work, a systematic review of endoscopic full thickness excision techniques is presented. The final three chapters of the thesis describe ex-vivo development and outcome data after a porcine survival study of a laparo-endoscopic excision technique for colonic lesions as a potential alternative to hemicolectomy.Open Acces
Motorway proximity affects spatial dynamics of orthopteran assemblages in a grassland ecosystem
No full textRebrina F, Reinhold K, Tvrtkovic N, Brigic A. Motorway proximity affects spatial dynamics of orthopteran assemblages in a grassland ecosystem. Insect Conservation and Diversity . 2021;15(2):213-225.Major roads have become significant components of environmental change but their impacts on invertebrate assemblages are insufficiently understood, and therefore rarely considered in road-planning and management. In the current study, we test (i) whether and how orthopteran assemblages change with distance from a motorway, and (ii) how road-induced changes in noise level, vegetation height and microclimate affect assemblage metrics and spatial distribution of orthopteran species. In 2018, we sampled orthopterans at five distances from a motorway: 10, 25, 50, 100 and 500 m, in eight locations within homogeneous portions of a grassland habitat in Lika region, Croatia, using two sampling methods: pitfall trapping and sweep-netting. Orthopteran abundance, species richness, true diversity and conservation value decreased at the sites closest to the motorway in the pitfall dataset, primarily due to negative responses of species with low-frequency acoustic signals. Road-influenced vegetation height had a stronger overall impact on orthopteran assemblages than traffic noise and/or microclimate; increased diversity and conservation value at 25 m from the motorway suggest an effect similar to early stages of vegetation succession. This study shows, for the first time, that a major road can induce changes in adjacent orthopteran assemblages, but negative impacts are confined to a narrow zone. Our results indicate that road-induced changes in orthopteran assemblages could be more efficiently assessed using pitfall trapping than sweep-netting. Increasing heterogeneity of roadside habitats by appropriate vegetation management could help mitigating negative road impacts on Orthoptera in the study area, while contributing to higher diversity of their assemblages
Endoscopic full thickness resection (EFTR) of colonic lesions
No full textBackground: The introduction of bowel cancer screening programs has led to an increasing incidence of complex colonic polyps and early colonic cancer requiring colectomy. Traditional radical colonic resection risks substantial morbidity and there is a need for alternative approaches. This review summarizes the published methods of colonic endoscopic full-thickness resection (EFTR), examining data on feasibility and safety. Preclinical research reported on three EFTR techniques using endoscopic stapling devices, T-tags or compression device closure for defect closure before or after specimen resection. A total of 103 procedures were performed in 99 porcine models, with an overall success rate of 87% (90/103 procedures). The intraoperative complication rate was 19% (19/90 procedures). When bowel closure was performed after resection, rather than before it, it more commonly resulted in failure to close the defect and a high incidence of abnormal findings at post-mortem examination. Clinical experience involved five studies reporting EFTR in 38 patients, with three of these using compression device pre-resection closure and one, post-resection closure. EFTR was completed in 33/38 without assistance. Only three patients had complications reported. Lateral margin clearance was variably reported and complete full-thickness resection was achieved in only 12/17 patients. The technique of EFTR is evolving, with only limited clinical evidence to date, but currently pre-resection closure methods seem advisable. Significant technological challenges remain, including reproducible lateral margin clearance. before colonic EFTR can be recommended
QuaRRi: a new methodology for rock-fall risk analysis and management in quarry exploitation
No full textRockfall is one of the most critical geological events that can affect quarrying activities. Nevertheless, few tools are currently available to help designers and managers correctly define the risk conditions and quantify the advantages, in terms of workers' safety and quarry management, that can be obtained using suitable prevention devices. For this reason it is necessary to evaluate the various parameters that are involved, and to define the most important and which have the greatest influence on rock-fall phenomena, taking into account the Prevention through Design approach. A risk evaluation systemwhich is able to support decision makers in the critical rockfall risk assessment phase, and offer decision makers the updated information that is necessary for a continuous and dynamic operation design during exploitation activities is here presented and discusse
Technical considerations in laparoscopic near‐infrared sentinel lymph node mapping in early colonic neoplasia – a video vignette
No full textOptimising methods for communicating survival data to patients undergoing cancer surgery
No full textBACKGROUND: Patients undergoing cancer surgery require outcome data to inform decisions, but communication of numerical risk is difficult. This study assessed patient understanding of survival data presented in different formats. METHODS: Semi-structured interviews in which patients interpreted four presentation formats of survival data (three graphical and one narrative) were audio-recorded. The interviewer and a blinded observer (listening to the audio-recordings) scored patients' understanding of each format. Logistic regression examined associations between understanding and clinical and socio-demographic details. RESULTS: Seventy participants with colorectal cancer were interviewed and 67 [95.7%, 95% confidence intervals (CIs) 90.9-100%] correctly interpreted a simplified Kaplan-Meier survival curve. A high proportion accurately understood data presented as a bar chart or pictograph (94.3%, 95% CIs 88.7-99.9% and 92.9%, 95% CIs 86.7-99.0% respectively). Standard narrative alone was least well understood (n=53, 75.7%, 95% CIs 65.4-86.0%). Multivariable analyses demonstrated that older and female patients had poorer overall understanding (OR 0.93 per year, 95% CIs 0.87-0.98, p=0.01 and OR 0.24, 95% CIs 0.07-0.86, p=0.03). CONCLUSION: Patient understanding of survival data was higher when presented with graphs compared to narrative alone. Further work examining understanding in the clinical context and before surgery is recommended before this can be used routinely.BACKGROUND: Patients undergoing cancer surgery require outcome data to inform decisions, but communication of numerical risk is difficult. This study assessed patient understanding of survival data presented in different formats. METHODS: Semi-structured interviews in which patients interpreted four presentation formats of survival data (three graphical and one narrative) were audio-recorded. The interviewer and a blinded observer (listening to the audio-recordings) scored patients' understanding of each format. Logistic regression examined associations between understanding and clinical and socio-demographic details. RESULTS: Seventy participants with colorectal cancer were interviewed and 67 [95.7%, 95% confidence intervals (CIs) 90.9-100%] correctly interpreted a simplified Kaplan-Meier survival curve. A high proportion accurately understood data presented as a bar chart or pictograph (94.3%, 95% CIs 88.7-99.9% and 92.9%, 95% CIs 86.7-99.0% respectively). Standard narrative alone was least well understood (n=53, 75.7%, 95% CIs 65.4-86.0%). Multivariable analyses demonstrated that older and female patients had poorer overall understanding (OR 0.93 per year, 95% CIs 0.87-0.98, p=0.01 and OR 0.24, 95% CIs 0.07-0.86, p=0.03). CONCLUSION: Patient understanding of survival data was higher when presented with graphs compared to narrative alone. Further work examining understanding in the clinical context and before surgery is recommended before this can be used routinely
Systematic review of surgical innovation reporting in laparoendoscopic colonic polyp resection.
No full textBACKGROUND:The IDEAL framework (Idea, Development, Exploration, Assessment, Long-term study) proposes a staged assessment of surgical innovation, but whether it can be used in practice is uncertain. This study aimed to review the reporting of a surgical innovation according to the IDEAL framework.METHODS:Systematic literature searches identified articles reporting laparoendoscopic excision for benign colonic polyps. Using the IDEAL stage recommendations, data were collected on: patient selection, surgeon and unit expertise, description of the intervention and modifications, outcome reporting, and research governance. Studies were categorized by IDEAL stages: 0/1, simple technical preclinical/clinical reports; 2a, technique modifications with rationale and safety data; 2b, expanded patient selection and reporting of both innovation and standard care outcomes; 3, formal randomized controlled trials; and 4, long-term audit and registry studies. Each stage has specific requirements for reporting of surgeon expertise, governance details and outcome reporting.RESULTS:Of 615 abstracts screened, 16 papers reporting outcomes of 550 patients were included. Only two studies could be put into IDEAL categories. One animal study was classified as stage 0 and one clinical study as stage 2a through prospective ethical approval, protocol registration and data collection. Studies could not be classified according to IDEAL for insufficient reporting details of patient selection, relevant surgeon expertise, and how and why the technique was modified or adapted
