1,721,223 research outputs found
Management strategies for patients with advanced rectal cancer and liver metastases using modified Delphi methodology: results from the PelvEx collaborative
No full textBACKGROUND:
A total of 15-20% of patients with rectal cancer patients have liver metastases on presentation. The management of these patients is controversial. Heterogeneity in management strategies is considerable, and often dependent on local resources and available expertise.
METHODS:
members of the PelvEx Collaborative were invited to participate in the generation of a consensus statement on the optimal management of patients with advanced rectal cancer with liver involvement. Fifteen statements were created for topical discussion on diagnostic and management issues. Panellists were asked to vote on statements and anonymous feedback was given. A collaborative meeting was used to discuss any nuances and clarify any obscurity. Consensus was considered when >85% agreement on a statement was achieved.
RESULTS:
a total of 135 participants were involved in the final round of the Delphi questionnaire. Nine of the fifteen statements reached consensus regarding the management of patients with advanced rectal cancer and oligometastatic liver disease. Routine use of MRI Liver was not recommended for patients with locally advanced rectal cancer, unless there was concern for metastatic disease on initial Computed Tomography staging scan. Induction chemotherapy was advocated as first-line treatment in those with synchronous liver metastases in locally advanced rectal cancer. In the presence of symptomatic primary disease, a diverting stoma may be required to facilitate induction chemotherapy. Overall, only one-quarter of the panelists would consider simultaneous pelvic exenteration and liver resection.
CONCLUSION:
this Delphi highlights the diverse treatment of advanced rectal cancer with liver metastases and provides recommendations from an experienced international group regarding the multidisciplinary management approach
TAMIS-Flap Technique: Full-thickness Advancement Rectal Flap for High Perianal Fistulae Performed through Transanal Minimally Invasive Surgery
No full textThe formation of an advancement rectal flap could be technically demanding in the presence of high perianal of rectovaginal fistula, and the outcomes could be frustrated by the inadequate view, bleeding and a poor exposure through the standard transanal approach. The application of the transanal minimally invasive surgery (TAMIS) to the advancement rectal flap procedure could overcome these difficulties. In the lithotomy position, a partial fistulectomy was performed and the internal opening was closed. A full-thickness flap was mobilized initially through the classic transanal approach. Subsequently, the TAMIS port was inserted and the mobilization of the flap was carried on proximally for as long as required. The laparoscopic visualization allowed a perfect view, a proper orientation of the flap and accurate hemostasis. The TAMIS-flap procedure seems a promising technique to perform a long advancement rectal flap to treat high perianal or rectovaginal fistulae (Video, Supplemental Digital Content 1, http://links.lww.com/SLE/A208)
Grazio e le ginestre altinati
No full textIl contributo studia gli impieghi della ginestra nel territorio altinate e la testimonianza in proposito del poeta Grazio
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Ancient extractive metallurgy of copper in the Aosta Valley (Western Alps, Italy): new evidence from pre-Roman slags from the Misérègne site
No full textMany metallurgical sites are scattered across the Aosta Valley territory (e.g. Tumiati et al., 2005). The age of some
of them is unknown and often the slag heaps are the sole vestiges of metallurgical activities. Such is the case of
Miséregne (Fénis), where the village is built on an enormous slag deposit.
We performed radiocarbon dating on charcoal fragments included in the slags and obtained ages comprised between
the 4th and 1st century BC. So far, these are the most ancient ages for early mining activity in the Aosta Valley, probably
carried out by the local population of the Salassi.
We studied the slags following a petrologic approach. The occurrence of matte inclusions in the slags indicates that
the processed raw minerals were Cu-Fe sulfides. Relying on morphologic and micro-textural features, we classified the
slags into three categories, i.e., coarse, massive and flat, as suggested by Addis (2013). In all the slag classes the most
abundant phase is olivine. Other common phases are spinel group minerals and sulfides, mainly pyrrhotite and bornite
solid solutions. The olivine crystal shapes allowed us to qualitatively estimate the degree of undercooling (ΔT) and the
rate of cooling of the slags: the coarse slags show a high ΔT; the massive slags seem to record an initial, long-lasting
low-ΔT stage, followed by an increase in the cooling rate; the flat slags underwent a brief low-ΔT stage, followed by a
sudden marked increase in ΔT. Combining this information with the slag bulk chemistry, the sulfide compositions, the
slag morphology and the presence of inclusions of charcoal, quartz and other slag fragments, we hypothesize that the
massive and coarse slags come from the lower and, respectively, the upper portion of the same slag contained in the
furnace, while the flat ones were tapped slags. Minimum furnace working temperatures estimated by means of olivinespinel
geothermometry are in the ranges 932-964°C, 968-1037°C, 1202-1239°C for the coarse, massive and flat slags,
respectively. According to the above observations, the flat slags should record conditions that are the closest to the
actual furnace working temperature
The role of carbon capture and storage electricity in attaining 1.5 and 2 °C
Full text linkThe climate targets defined under the Paris agreement of limiting global temperature increase below 1.5 or 2 °C require massive deployment of low-carbon options in the energy mix, which is currently dominated by fossil fuels. Scenarios suggest that Carbon Capture and Storage (CCS) might play a central role in this transformation, but CCS deployment is stagnating and doubts remain about its techno-economic feasibility. In this article, we carry out a throughout assessment of the role of CCS electricity for a variety of temperature targets, from 1.5 to above 4 °C, with particular attention to the lower end of this range. We collect the latest data on CCS economic and technological future prospects to accurately represent several types of CCS plants in the WITCH energy-economy model, We capture uncertainties by means of extensive sensitivity analysis in parameters regarding plants technical aspects, as well as costs and technological progress. Our research suggests that stringent temperature scenarios constrain fossil fuel CCS based deployment, which is maximum for medium policy targets. On the other hand, Biomass CCS, along with renewables, increases with the temperature stringency. Moreover, the relative importance of cost and performance parameters change with the climate target. Cost uncertainty matters in less stringent policy cases, whereas performance matters for lower temperature targets
The global cost of pelvic exenteration: in-hospital perioperative costs
No full textNo abstract availabl
Surgical treatment of colonic Crohn's disease: a national snapshot study
Full text linkAIM: The different surgical options for patients with colonic Crohn's disease (CD) include segmental colectomy, subtotal colectomy or proctocolectomy with end ileostomy. We present a national, multicentre study, promoted by the Italian Society of Colorectal Surgery with the aim to collect benchmark data and national variations on multidisciplinary management and postoperative outcomes of patients undergoing surgery for colonic CD.METHODS: All adult patients having elective surgery for colonic CD from June 2018 to May 2019 were eligible for participation in this retrospective study. The primary outcome measure was postoperative morbidity within 30days of surgery.RESULTS: One hundred twenty-two patients were included: 55 subtotal colectomy, 30 segmental colectomy, 25 proctectomy and 12 proctocolectomy. Eighty-six patients (70.4%) were discussed at the inflammatory bowel disease (IBD) multidisciplinary team meeting (MDT) prior to surgery. This ranged from 76.6% for segmental colectomy to 60% for subtotal colectomy, 66.6% for proctocolectomy and 48% for proctectomy. The proportion of patients counselled by a stoma nurse preoperatively was 50%. Laparoscopy was associated with reduced postoperative morbidity (p=0.017) and shorter length of hospital stay (p<0.001), whilst pre-operative anti-TNF was associated with Dindo-Clavien ≥3 complications (p=0.023) and longer in-hospital stay (p=0.007). The main procedure performed (segmental colectomy, subtotal colectomy, proctocolectomy or proctectomy) was not associated with postoperative morbidity (p=0.626).CONCLUSIONS: Surgery for colonic CD has a high rate of postoperative complications. Almost a third of the patients were not preoperatively discussed at the IBD MDT, whilst the use of minimally invasive surgery for surgical treatment of colonic CD ranges from 40 to 66%
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