Incidental Gallbladder Cancer

Gallbladder cancer (GBC) is a rare but fatal disease with an incidence of less than 5000 new cases per year in the United States. Less than 20% of GBC cases are diagnosed preoperatively. The remaining cases are diagnosed either after laparoscopic cholecystectomy or intraoperatively. GBC is discovered incidentally during histopathology following 0.25–3.0% of laparoscopic cholecystectomies; however, this constitutes 74–92% of all GBC. The most pivotal and important step is accurate patient staging. Staging dictates disease management and treatment options and predicts survival. Because of the fatality of GBC and its poor prognosis, attempts of curative surgery are limited to localized resectable disease

Psychophysiological responses to manual lifting of unknown loads.

BackgroundThe handling of unknown weights, which is common in daily routines either at work or during leisure time, is suspected to be highly associated with the incidence of low back pain (LBP).ObjectivesTo investigate the effects of knowledge and magnitude of a load (to be lifted) on brain responses, autonomic nervous activity, and trapezius and erector spinae muscle activity.MethodsA randomized, within-subjects experiment involving manual lifting was conducted, wherein 10 participants lifted three different weights (1.1, 5, and 15 kg) under two conditions: either having or not having prior knowledge of the weight to be lifted.ResultsThe results revealed that the lifting of unknown weights caused increased average heart rate and percentage of maximum voluntary contraction (%MVC) but decreased average inter-beat interval, very-low-frequency power, low-frequency power, and low-frequency/high-frequency ratio. Regardless of the weight magnitude, lifting of unknown weights was associated with smaller theta activities in the power spectrum density (PSD) of the central region, smaller alpha activities in the PSD of the frontal region, and smaller beta activities in the PSDs of both the frontal and central regions. Moreover, smaller alpha and beta activities in the PSD of the parietal region were associated only with lifting of unknown lightweights.ConclusionsUncertainty regarding the weight to be lifted could be considered as a stress-adding variable that may increase the required physical demand to be sustained during manual lifting tasks. The findings of this study stress the importance of eliminating uncertainty associated with handling unknown weights, such as in the cases of handling patients and dispatching luggage. This can be achieved through preliminary self-sensing of the load to be lifted, or the cautious disclosure of the actual weight of manually lifted objects, for example, through clear labeling and/or a coding system

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population