Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

The histology of ovarian cancer: worldwide distribution and implications for international survival comparisons (CONCORD-2)

Objective Ovarian cancers comprise several histologically distinct tumour groups with widely different prognosis. We aimed to describe the worldwide distribution of ovarian cancer histology and to understand what role this may play in international variation in survival. Methods The CONCORD programme is the largest population-based study of global trends in cancer survival. Data on 681,759 women diagnosed during 1995â\u80\u932009 with cancer of the ovary, fallopian tube, peritoneum and retroperitonum in 51 countries were included. We categorised ovarian tumours into six histological groups, and explored the worldwide distribution of histology. Results During 2005â\u80\u932009, type II epithelial tumours were the most common. The proportion was much higher in Oceania (73.1%), North America (73.0%) and Europe (72.6%) than in Central and South America (65.7%) and Asia (56.1%). By contrast, type I epithelial tumours were more common in Asia (32.5%), compared with only 19.4% in North America. From 1995 to 2009, the proportion of type II epithelial tumours increased from 68.6% to 71.1%, while the proportion of type I epithelial tumours fell from 23.8% to 21.2%. The proportions of germ cell tumours, sex cord-stromal tumours, other specific non-epithelial tumours and tumours of non-specific morphology all remained stable over time. Conclusions The distribution of ovarian cancer histology varies widely worldwide. Type I epithelial, germ cell and sex cord-stromal tumours are generally associated with higher survival than type II tumours, so the proportion of these tumours may influence survival estimates for all ovarian cancers combined. The distribution of histological groups should be considered when comparing survival between countries and regions

Introduzione a Formazione e fortuna del Tasso nella cultura della Serenissima

Presentazione degli argomenti trattati nei contributi presenti nel volume (Atti del Convegno tassiano Padova-Venezia, 10-11 novembre 1995)

Formazione e fortuna del Tasso nella cultura della Serenissima. Atti del Convegno di Studi nel IV centenario della morte di Torquato Tasso (1595-1995)

Il volume, introdotto dalla scrivente e da Bianca Maria Da Rif (p. 9-14), pubblica gli Atti del convegno tassiano promosso nel novembre 1995 sotto l'egida dell'Universit\ue0 di Padova, del Comune di Padova, dell'Accademia patavina di Scienze, Lettere ed Arti (ora Accademia Galileiana), dell'Accademia Olimpica, dell'Accademia dei Concordi, della Biblioteca Nazionale Marciana e dello stesso Istituto Veneto. Il volume si compone di saggi di Gian Vito Resta (Formazione e noviziato del Tassino); Vittorio Zaccaria (Le Accademie padane cnquecentesche e il Tasso); Maria Teresa Girardi (Tasso, Speroni e la cultura padovana); Maria Luisa Doglio (Tasso "principe della moderna poesia" nei Discorsi accademici di Paolo Beni; Ginetta Auzzas (La "raccolta" dell "Rime de gli Academici Eterei"; Manlio Pastore Stocchi, La poetica degli Eterei; MariellaMagliani, Stampatori veneti del Tasso; Antonio Daniele, Sul Rinald; Daniele Rota, I Tasso a Bergamo, citt\ue0 della Serenissima; Giovani Da Pozzo, La memoria tassiana dell'esperienza veneta; Adriano Mariuz, Gli amori di Rinaldo e Armida nell'interpretazione di Giambattista Tiepolo; Paolo Preto, Tasso, Venezia e i Turchi; Paolo Fabbri, Tasso e la sua fortuna musicale a Venezia; Pier Mario Vescovo, "Una fatica bizzarra e studiosa": El Goffredo del Tasso cant\ue0 alla barcariola del dottor Tomaso Mondini; Georges Guntert, "De' miei secreti sono signore": reticenze e chiarimenti nelle Lettere poetiche del Tasso; Giorgio Ronconi, Nota sull'impresa del Tasso fra gli Eterei; Giovanni Scianatico, Tasso neoclassico. Dal Pindemonte al Foscolo

Snowball Earth ocean chemistry driven by extensive ridge volcanism during Rodinia breakup

During Neoproterozoic Snowball Earth glaciations, the oceans gained massive amounts of alkalinity, culminating in the deposition of massive cap carbonates on deglaciation. Changes in terrestrial runoff associated with both breakup of the Rodinia supercontinent and deglaciation can explain some, but not all of the requisite changes in ocean chemistry. Submarine volcanism along shallow ridges formed during supercontinent breakup results in the formation of large volumes of glassy hyaloclastite, which readily alters to palagonite. Here we estimate fluxes of calcium, magnesium, phosphorus, silica and bicarbonate associated with these shallow-ridge processes, and argue that extensive submarine volcanism during the breakup of Rodinia made an important contribution to changes in ocean chemistry during Snowball Earth glaciations. We use Monte Carlo simulations to show that widespread hyaloclastite alteration under near-global sea-ice cover could lead to Ca2+ and Mg2+ supersaturation over the course of the glaciation that is sufficient to explain the volume of cap carbonates deposited. Furthermore, our conservative estimates of phosphorus release are sufficient to explain the observed P:Fe ratios in sedimentary iron formations from this time. This large phosphorus release may have fuelled primary productivity, which in turn would have contributed to atmospheric O2 rises that followed Snowball Earth episodes

Addiction and Entertainment Products

Technological forms of entertainment have become increasingly popular amongboth adults and adolescents. However, there have been a growing number ofreports about excessive use of entertainment technology and potentially addictive use (e.g., to video games, mobile phones, the Internet, etc.). The presentchapter briefly overviews addiction to these entertainment products (i.e., “technological addictions”) by defining addiction and arguing that technologicaladdictions are a type of behavioral addiction. The chapter also reviews theempirical literature concerning online gaming addiction and social networkingaddiction, as well as examining the differences between Internet gaming addiction and Internet addiction. The chapter demonstrates that issues encountered bycontemporary researchers and clinicians regarding the assessment of onlineaddictions appear complex and include several factors. It is concluded thatthere is a clear need to distinguish between addictions to the Internet andaddictions on the Internet. Gambling or gaming addicts who chooses to engagein online gambling and gaming are not Internet addicts – the Internet is just the place where they conduct their chosen (addictive) behavior. Based on empiricalresearch, it is evident that excessive entertainment technology use appears to beat least potentially addictive. Further research is needed on whether activitiessuch as video game addiction and Internet addictions such as social networkingaddiction are distinct clinical entities