A Reappraisal of Lymphadenectomy in Common Gynecological Cancers

Objectives: Lymph node dissection (LND) in gynecological malignancies has always been a cornerstone in the diagnosis of metastasis, it is also considered an important prognostic factor, and a reliable guide to management strategies. However, its incidence of complications, namely lymphedema, vascular injuries and other lesions, has led to a reconsideration of its efficacy and a comparison of the role of systematic vs. sentinel lymph node (SLN) dissection. Mechanism: Review of the literature using keywords such as “lymph nodes”, “sentinel lymph nodes”, “morbidity and mortality”, “gynecological cancers”, “endometrial cancer”, “ovarian cancer”, and “cervical cancer”. Findings in Brief: In the case of endometrial cancer, several studies have investigated the efficacy of SLN compared with systematic LND. Most of the results demonstrated the efficacy of SLN dissection in endometrial cancer, with the added benefit of lower morbidity. In patients with ovarian cancer, the mainstay of treatment is debulking with optimal cytoreductive surgery. Recent studies have compared systematic lymphadenectomy to non-lymphadenectomy, with an additional advantage in the cases of lymphadenectomy. However, since its publication, the lymphadenectomy in ovarian cancers (LIONS) trial, has revolutionized the standard of care for patients with advanced ovarian cancer and has called into question the increased morbidity and mortality in systematic lymphadenectomy. In cervical cancers, lymph node status is considered to be the most important prognostic factor. In this case, limiting lymphadenectomy to the borders of the inferior mesenteric artery seems promising, and studies are currently being carried out to investigate the feasibility of SLN dissection instead of systematic lymph node dissection. Conclusions: SLN dissection is associated with lower morbidity and mortality, and has been shown to be superior to systematic lymphadenectomy in several studies. However, more research and specific guidelines are needed to better select either one or the other method in the management of gynecological cancers. Copyright: © 2023 The Author(s)

Practice of laparoscopic prolapse surgery in Europe - ESGE Survey.

peer reviewedSacrocolpopexy is considered as the "gold standard" for management of women with apical prolapse. Numerous technical variants are being practiced. The first aim of this survey was to determine the habits of practice of laparoscopic sacrocolpopexy (LSCP) in Europe. The second aim was to determine whether surgeons who perform laparoscopic pelvic organ prolapse (POP) repair are familiar with the practice of alternative techniques and with mesh-less laparoscopic treatment of prolapse. The questionnaire was designed by the Urogynaecology Special Interest Group of the European Society for Gynaecological Endoscopy (ESGE). All ESGE-members were invited by email to respond to this survey consisting of 54 questions divided in different categories. Following review of ESGE member's responses, we have highlighted the great heterogeneity concerning the practice of LSCP and important variability in performance of concomitant surgeries. Alternative techniques are rarely used in practice. Furthermore, the lack of standardisation of the many surgical steps of a laparoscopic sacrocolpopexy is mainly due to the lack of evidence. There is a need for training and teaching in both standard and newer innovative techniques as well as the reporting of medium and long-term outcomes of both standard laparoscopic sacrocolpopexy and any of its alternatives

Computational investigation of diesel nozzle internal flow during the complete injection event

[EN] Currently, diesel engines are calibrated using more and more complex multiple injection strategies. Under these conditions, the characteristics of the flow exiting the fuel injector are strongly affected by the transient interaction between the needle, the sac volume and the orifices, which are not yet clear. In the current paper, a methodology combining a 1D injector model and 3D-CFD simulations is proposed. First, the characteristics of the nozzle flow have been experimentally assessed in transient conditions by means of injection rate and momentum flux measurements. Later, the 3D-CFD modeling approach has been validated at steady-state fixed lift conditions. Finally, a previously developed 1D injector model has been used to extract the needle lift profiles and transient pressure boundary conditions used for the full-transient 3D-CFD simulations, using adaptive mesh refinement (AMR) strategies to be able to simulate the complete injection rate starting from 1 mu m lift.This work was partly sponsored by "Ministerio de Economia y Competitividad'', of the Spanish Government, in the frame of the Project "Estudio de la interaccion chorro-pared en condiciones realistas de motor'', Reference TRA2015-67679-c2-1-R. The authors would like also to thank the computer resources, technical expertise and assistance provided by Universidad de Valencia in the use of the supercomputer "Tirant''. Mr. Jaramillo's Thesis is funded by "Conselleria d'Educacio, Cultura i Esports'' of Generalitat Valenciana in the frame of the program "Programa VALI + D para investigadores en formacion, Reference ACIF/2015/040.Salvador, FJ.; De La Morena, J.; Bracho Leon, G.; Jaramillo-Císcar, D. (2018). Computational investigation of diesel nozzle internal flow during the complete injection event. Journal of the Brazilian Society of Mechanical Sciences and Engineering. 40(3):153-167. https://doi.org/10.1007/s40430-018-1074-zS153167403Hall CAS, Lambert JG, Balogh SB (2014) EROI of different fuels and the implications for society. Energy Policy 64:141–152. https://doi.org/10.1016/j.enpol.2013.05.049Lujan JM, Tormos B, Salvador FJ, Gargar K (2009) Comparative analysis of a DI diesel engine fuelled with biodiesel blends during the European MVEG-A cycle: preliminary study (I). 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Association between age at disease onset of anti-neutrophil cytoplasmic antibody-associated vasculitis and clinical presentation and short-term outcomes

Objectives: ANCA-associated vasculitis (AAV) can affect all age groups. We aimed to show that differences in disease presentation and 6 month outcome between younger- A nd older-onset patients are still incompletely understood. Methods: We included patients enrolled in the Diagnostic and Classification Criteria for Primary Systemic Vasculitis (DCVAS) study between October 2010 and January 2017 with a diagnosis of AAV. We divided the population according to age at diagnosis: <65 years or ≥65 years. We adjusted associations for the type of AAV and the type of ANCA (anti-MPO, anti-PR3 or negative). Results: A total of 1338 patients with AAV were included: 66% had disease onset at <65 years of age [female 50%; mean age 48.4 years (s.d. 12.6)] and 34% had disease onset at ≥65 years [female 54%; mean age 73.6 years (s.d. 6)]. ANCA (MPO) positivity was more frequent in the older group (48% vs 27%; P = 0.001). Younger patients had higher rates of musculoskeletal, cutaneous and ENT manifestations compared with older patients. Systemic, neurologic,cardiovascular involvement and worsening renal function were more frequent in the older-onset group. Damage accrual, measured with the Vasculitis Damage Index (VDI), was significantly higher in older patients, 12% of whom had a 6 month VDI ≥5, compared with 7% of younger patients (P = 0.01). Older age was an independent risk factor for early death within 6 months from diagnosis [hazard ratio 2.06 (95% CI 1.07, 3.97); P = 0.03]. Conclusion: Within 6 months of diagnosis of AAV, patients >65 years of age display a different pattern of organ involvement and an increased risk of significant damage and mortality compared with younger patients

Zooplankton of <i>Trichodesmium</i> Phenomenon

1-6Zooplankton abundance has a direct relationship with Trichodesmium phenomenon. The main components of zooplankton during Trichodesmium blooms are cladocerans, copepods, decapod larvae, chaetognaths, fish eggs and larvae and appendicularians. There is a periodicity in the appearance of various groups of organisms and this seems to be repeated with the return of Trichodesmium phenomenon each year. There is no food relationship between zooplankton and Trichodesmium but the relationship is through enrichment caused by the bloom which promotes almost concurrently the growth of diatoms and dinoflagellates on which the herbivores feed. The herbivores are followed by carnivores

Production at different trophic levels in the estuarine system of Goa

83-86Primary production in the estuaries of Goa has been measured during the monsoon period. This estuarine system sustains a high production having a maximum average production of 316 mgC m-2d-1 in Cumbarjua canal followed by Zuari (249) and Mandovi (247). The chlorophyll concentration is also maximum in the canal. In zuari only, the production increases linearly with the increase in chlorophyll a. Assimilation number varies at different places and depths. Relation between nutrients and production is poor. The 'transfer coefficient' varies from 1.7 to 39.9% and decreases with increase in production. With these data, the average tertiary production in terms of wet weight is 19 mg m-2d-1, a very close estimate with the corresponding figure of the Indian Ocean