1,361 research outputs found

    Feasibility of laparoscopic portal vein ligation prior to major hepatectomy

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    AbstractBackground. Patients noted to have an inadequate future liver remnant on pre operative volumetric assessment are considered to be candidates for portal vein embolization (PVE). A subset of patients undergo laparoscopic intervention prior to PVE for staging purposes or to address the primary in Stage IV colon cancer. These patients usually undergo PVE as a subsequent additional procedure by the transhepatic route. The aim of this study was to assess the feasibility of portal vein ligation by the laparoscopic approach in suitable patients. Materials and methods. A retrospective review of a prospectively maintained database was performed to identify patients that underwent laparoscopic portal vein ligation (LPVL). The demographic, clinical, radiographic, operative and volumetric details were collected to determine the feasibility of portal vein ligation. Results. A total of nine patients underwent LPVL as part of a two stage procedure in preparation for subsequent major hepatectomy. With a median age of 67 yrs, the diagnoses included: colorectal metastasis (five patients), cholangiocarcinoma (three patients) and hepatocellular carcinoma (one patient). The ligation involved the right portal vein in all and was performed with silk ligature (seven patients) and clips (two patients). Volumetric data was available in six patients which showed a mean increase from 209.1 cc±97.76 to 495.83 cc±310.91 (increase by 181.5%) In two patients, inadequate hypertrophy mandated later embolization by percutaneous technique. Five patients underwent subsequent major hepatic resection as planned. The remaining four patients were noted to have progression of disease that precluded the planned procedure. There were no complications associated with LPVL. Conclusions. LPVL is feasible and can be safely performed. In a select group of patients, it may be considered as an alternative to subsequent embolization and thereby potentially absolve the need for an additional procedure with its attendant complications

    Global Curriculum in Surgical Oncology

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    Background The significant global variations in surgical oncology training paradigms can have a detrimental effect on tackling the rising global cancer burden. While some variations in training are essential to account for the differences in types of cancer and biology, the fundamental principles of providing care to a cancer patient remain the same. The development of a global curriculum in surgical oncology with incorporated essential standards could be very useful in building an adequately trained surgical oncology workforce, which in turn could help in tackling the rising global cancer burden. Materials and Methods The leaders of the Society of Surgical Oncology and European Society of Surgical Oncology convened a global curriculum committee to develop a global curriculum in surgical oncology. Results A global curriculum in surgical oncology was developed to incorporate the required domains considered to be essential in training a surgical oncologist. The curriculum was constructed in a modular fashion to permit flexibility to suit the needs of the different regions of the world. Similarly, recognizing the various sociocultural, financial and cultural influences across the world, the proposed curriculum is aspirational and not mandatory in intent. Conclusions A global curriculum was developed which may be considered as a foundational scaffolding for training surgical oncologists worldwide. It is envisioned that this initial global curriculum will provide a flexible and modular scaffolding that can be tailored by individual countries or regions to train surgical oncologists in a way that is appropriate for practice in their local environmen

    The Price Responsiveness of Shale Producers: Evidence from Micro Data

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    We show that shale oil producers respond positively to favourable oil price signals, and that this response is mainly associated with the timing of production decisions through well completion and refracturing, consistent with the Hotelling theory of optimal extraction. This finding is established using a novel proprietary data set consisting of more than 200,000 shale wells across ten U.S. states spanning almost two decades. We document large heterogeneity in the estimated responses across the various shale wells, suggesting that aggregation bias is an important issue for this kind of analysis. Our empirical results call for new models that can account for a growing share of shale oil in the U.S., the inherent flexibility of shale extraction technology in production and the role of shale oil in transmitting oil price shocks to the global economy.publishedVersio

    Preference among 7 bait flavors delivered to domestic dogs in Arizona: Implications for oral rabies vaccination on the Navajo Nation

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    Less than 20% of the domestic dogs on tribal lands in the United States are vaccinated against rabies. One method to increase vaccination rates may be the distribution of oral rabies vaccines (ORVs). ONRA (Artemis Technologies, Inc., Ontario, Canada) is the primary ORV used in Canada to vaccinate striped skunks and raccoons. To investigate the potential use of ONRAB ORV baits to vaccinate feral domestic dogs against rabies on tribal lands and beyond, we performed a flavor preference study. A total of 7 bait flavors (bacon, cheese, dog food, hazelnut, sugar-vanilla, peanut butter, and sardine) were offered in pairs to 13 domestic dogs. Each dog was offered all possible combinations of bait pairs over a period of 10 days, with each bait offered 6 times. The proportion of times each bait was consumed first by individual dogs was calculated and comparisons among dogs were conducted using the MIXED procedure in SAS (SAS Institute, Cary, NC). Pairwise comparisons between baits were performed using “contrast” statements with sugar-vanilla flavor as the default for comparison. Type 3 tests of fixed effects showed a significant treatment effect (F6,72 = 9.74, P\u3c 0.0001). Sugar-vanilla was selected first during 14% of the offerings and exhibited the least preference among all bait types (F1,72 = 22.46, P \u3c 0.0001). Dog food was selected first 56% of the time, and more frequently than all other bait types (F1,72 = 13.09, P= 0.0005). domestic dogs. Each dog was offered all possible combinations of bait pairs over a period of 10 days, with each bait offered 6 times. The proportion of times each bait was consumed first by individual dogs was calculated and comparisons among dogs were conducted using the MIXED procedure in SAS (SAS Institute, Cary, NC). Pairwise comparisons between baits were performed using “contrast” statements with sugar-vanilla flavor as the default for comparison. Type 3 tests of fixed effects showed a significant treatment effect (F6,72 = 9.74, P\u3c 0.0001). Sugar-vanilla was selected first during 14% of the offerings and exhibited the least preference among all bait types (F1,72 = 22.46, P \u3c 0.0001). Dog food was selected first 56% of the time, and more frequently than all other bait types (F1,72 = 13.09, P= 0.000
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