Multimodality treatment for esophageal adenocarcinoma: Multi-center propensity-score matched study

Background: The primary aim of this study was to compare survival from neoadjuvant chemoradiotherapy plus surgery (NCRS) versus neoadjuvant chemotherapy plus surgery (NCS) for the treatment of esophageal or junctional adenocarcinoma. The secondary aims were to compare pathological effects, short-term mortality and morbidity, and to evaluate the effect of lymph node harvest upon survival in both treatment groups. Methods: Data were collected from 10 European centers from 2001 to 2012. Six hundred and eight patients with stage II or III oesophageal or oesophago-gastric junctional adenocarcinoma were included; 301 in the NCRS group and 307 in the NCS group. Propensity score matching and Cox regression analyses were used to compensate for

Definition, diagnosis and treatment of oligometastatic oesophagogastric cancer: A Delphi consensus study in Europe.

Local treatment improves the outcomes for oligometastatic disease (OMD, i.e. an intermediate state between locoregional and widespread disseminated disease). However, consensus about the definition, diagnosis and treatment of oligometastatic oesophagogastric cancer is lacking. The aim of this study was to develop a multidisciplinary European consensus statement on the definition, diagnosis and treatment of oligometastatic oesophagogastric cancer. In total, 65 specialists in the multidisciplinary treatment for oesophagogastric cancer from 49 expert centres across 16 European countries were requested to participate in this Delphi study. The consensus finding process consisted of a starting meeting, 2 online Delphi questionnaire rounds and an online consensus meeting. Input for Delphi questionnaires consisted of (1) a systematic review on definitions of oligometastatic oesophagogastric cancer and (2) a discussion of real-life clinical cases by multidisciplinary teams. Experts were asked to score each statement on a 5-point Likert scale. The agreement was scored to be either absent/poor (<50%), fair (50%-75%) or consensus (≥75%). A total of 48 experts participated in the starting meeting, both Delphi rounds, and the consensus meeting (overall response rate: 71%). OMD was considered in patients with metastatic oesophagogastric cancer limited to 1 organ with ≤3 metastases or 1 extra-regional lymph node station (consensus). In addition, OMD was considered in patients without progression at restaging after systemic therapy (consensus). For patients with synchronous or metachronous OMD with a disease-free interval ≤2 years, systemic therapy followed by restaging to consider local treatment was considered as treatment (consensus). For metachronous OMD with a disease-free interval >2 years, either upfront local treatment or systemic treatment followed by restaging was considered as treatment (fair agreement). The OMEC project has resulted in a multidisciplinary European consensus statement for the definition, diagnosis and treatment of oligometastatic oesophagogastric adenocarcinoma and squamous cell cancer. This can be used to standardise inclusion criteria for future clinical trials

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

International audienceOesophageal cancer is the seventh most common cause of cancer-related death in the developed world and the incidence of oesophageal adenocarcinoma is now the fastest growing of any gastrointestinal cancer. Lymph node involvement is the single most important prognostic factor in oesophageal cancer. Imaging to determine the extent of lymph node involvement and plan treatment often requires a combination of modalities to avoid under-staging. The seventh edition of the staging system released by the International Union Against Cancer (IUCC) has stratified lymph node involvement according to the number of lymph nodes involved and redefined its groupings for location of metastatic lymph node involvement. This review discusses the prognostic and treatment implications of these modifications and explores micrometastatic lymph node involvement, capsular infiltration and lymph node ratio as possible additions to the staging system

Social Inequality as Global Challenge

Доступ до книги на сайті видавництва (copyright) https://www.riverpublishers.com/book_details.php?book_id=922У цій книзі обговорюються чинники нерівності, закладеної в наші соціальні, економічні та політичні системи. Соціальна нерівність особливо проявляється в секторах послуг у відмінності в доступі до охорони здоров’я, освіти, соціального захисту, системи житла, догляду за дітьми, догляду за літніми тощо. соціальним статусом певної групи, мовою, релігією, звичаями та нормами є ще одна поширена проблема. Ця книга намагається представити точну картину цих проблем на прикладах з різних країн. Здебільшого, коли ми говоримо про нерівність, акцент робиться на економічній нерівності; однак зберігається значна нерівність, особливо дискримінація за статтю, віком, походженням, етнічною приналежністю, інвалідністю, сексуальною орієнтацією, класом та релігією. Щоб покласти край цій ситуації, необхідно провести соціальні, економічні та політичні реформи. Поки маргіналізовані групи не отримають повноваження, проблему нерівності неможливо вирішити чи навіть мінімізувати. На основі різних тематичних досліджень ця книга заохочує нас переосмислити розвиток суспільства через призму зростаючої нерівності та диспропорції. У книзі представлені нові ідеї для оцінки прогресу соціального розвитку. Книга висвітлює сучасні проблеми соціальної нерівності. У сукупності ця збірка відредагованих статей дає комплексне розуміння питання «чому суспільство нерівне»? Ця книга націлена на тих зацікавлених сторін, які хочуть змінити та побудувати нерозділене, соціально інклюзивне суспільство або внести свій внесок у них, а також для тих, хто хоче зробити свій внесок у розширення прав і можливостей суспільства у ХХІ столітті.В этой книге обсуждаются факторы, лежащие в основе неравенства, присущего нашим социальным, экономическим и политическим системам. Социальное неравенство особенно заметно в секторах услуг - в различиях в доступе к здравоохранению, образованию, социальной защите, жилищным системам, уходу за детьми, уходу за престарелыми и т. д. Другой широко распространенной проблемой является социальный статус конкретных групп, их язык, религия, обычаи и нормы. В этой книге делается попытка представить точную картину этих проблем на примерах из разных стран. На основе различных тематических исследований эта книга побуждает нас переосмыслить социальное развитие через призму растущего неравенства и неравенства. В книге представлены новые идеи для оценки прогресса в социальном развитии. В книге освещаются современные проблемы социального неравенства. В совокупности этот сборник отредактированных статей дает комплексное понимание вопроса «почему общество неравно»? Эта книга адресована тем заинтересованным сторонам, которые хотят внести свой вклад в изменения и построить неразделенное, социально инклюзивное общество, а также тем, кто хочет внести свой вклад в расширение прав и возможностей общества в XXI веке.This book discusses the factors behind the inequalities embedded within our social, economic and political systems. Social inequalities are especially seen in the service sectors â  in the differences of access to healthcare, education, social protection, housing systems, childcare, elderly care etc. Cultural inequality, which segregates people from the mainstream based on recognition problems with a specific groups' social status, language, religion, customs and norms, is another widespread issue. This book tries to present an accurate picture of these issues with cases studies from various countries. Mostly, when we talk about inequality, the focus is on economic inequality; however, much inequality persists, especially discrimination due to gender, age, origin, ethnicity, disability, sexual orientation, class, and religion. To end this situation there is a need for social, economic, and political reform. Until or unless the marginalized groups are empowered, the inequality issue cannot be solved or even minimized. On the basis of various case studies, this book encourages us to rethink societal development through the lens of growing inequalities and disparities. The book presents new insights for evaluating the progress on social development. The book highlights the current challenges of social inequality. In combination this collection of edited papers gives an integrated understanding of the question of “why is society unequal”? This book is aimed at those stakeholders, who want to make or contribute to change and build an undivided, socially inclusive society, and to those who want to contribute to empowering society in the Twenty-First century

Partitioning the Heritability of Tourette Syndrome and Obsessive Compulsive Disorder Reveals Differences in Genetic Architecture

The direct estimation of heritability from genome-wide common variant data as implemented in the program Genome-wide Complex Trait Analysis (GCTA) has provided a means to quantify heritability attributable to all interrogated variants. We have quantified the variance in liability to disease explained

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings: The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. Interpretation: Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. Funding: Bill & Melinda Gates Foundation

The effect of stress and coping on surgical performance during simulations

Objective: This study investigates the effects of surgeons' stress levels and coping strategies on surgical performance during simulated operations. Methods: Thirty surgeons carried out each a non-crisis and a crisis scenario of a simulated operation. Surgeons' stress levels were assessed by several measures: self-assessments and observer ratings of stress, heart rate, heart rate variability, and salivary cortisol. Coping strategies were explored qualitatively and quantified to a coping score. Experience in surgery was included as an additional predictor. Outcome measures consisted of technical surgical skills using Objective Structured Assessment of Technical Skill (OSATS), nontechnical surgical skills using Observational Teamwork Assessment for Surgery (OTAS), and the quality of the operative end product using End Product Assessment (EPA). Uni- and multivariate linear regression were used to assess the independent effects of predictor variables on each performance measure. Results: During the non-crisis simulation, a high coping score and experience significantly enhanced EPA (β1, 0.279; 0.009–0.460; P= 0.04; β2, 0.571; 4.328–12.669, P< 0.001; respectively). During the crisis simulation, a significant beneficial effect of the interaction of high experience and low stress on all performance measures was found (EPA: β, 0.537; 2.079–8.543; OSATS: β, 0.707; 8.708–17.860; OTAS: β, 0.654; 13.090–30.483; P< 0.01). Coping significantly enhanced nontechnical skills (β, 0.302; 0.117–1.624, P= 0.03). Conclusions: Clinicians' stress and coping influenced surgical performance during simulated operations. Hence, these are critical factors for the quality of health care

Stress Management Training for Surgeons - a randomised controlled intervention study

Background: Stress and coping influence performance. In this study, we evaluate a novel stress management intervention for surgeons. Methods: A randomized control group design was used. Sixteen surgeons were allocated to either the intervention or control group. The intervention group received training on coping strategies, mental rehearsal, and relaxation. Performance measures were obtained during simulated operations and included objective-structured assessment of technical skill, observational teamwork assessment for surgery, and end product assessment rated by experts. Stress was assessed using the state-trait-anxiety-inventory, observer rating, coefficient of heart rate variability (C_HRV), and salivary cortisol. The number of applied surgical coping strategies (number of coping strategies [NC]) was assessed using a questionnaire. A t test for paired samples investigated any within-subject changes, and multiple linear regression analysis explored between-subject effects. Interviews explored surgeons' perceptions of the intervention. Results: The intervention group showed enhanced observational teamwork assessment for surgery performance (t = –2.767, P < 0.05), and increased coping skills (t = –4.690, P < 0.01), and reduced stress reflected inheart rate variability (t = –4.008, P < 0.01). No significant changes were identified in the control group. Linear regression analysis confirmed a significant effect on NC (β = –0.739, P < 0.01). Qualitative data analysis revealed improved technical skills, decision making, and confidence. Conclusions: The intervention had beneficial effects on coping, stress, and nontechnical skills during simulated surgery

Clinical evaluation of intraoperative near misses in laparoscopic rectal cancer surgery

OBJECTIVE:To investigate the frequency, nature, and severity of intraoperative adverse near miss events within advanced laparoscopic surgery and report any associated clinical impact. BACKGROUND:Despite implementation of surgical safety initiatives, the intraoperative period is poorly documented with evidence of underreporting. Near miss analyses are undertaken in high-risk industries but not in surgical practice. METHODS:Case video and data from 2 laparoscopic total mesorectal excision randomized controlled trials were analyzed (ALaCaRT ACTRN12609000663257, 2D3D ISRCTN59485808). Intraoperative adverse events were identified and categorized using the observational clinical human reliability analysis technique. The EAES classification was applied by 2 blinded assessors. EAES grade 1 events (nonconsequential error, no damage, or need for correction) were considered near misses. Associated clinical impact was assessed with early morbidity and histopathology outcomes. RESULTS:One hundred seventy-five cases contained 1113 error events. Six hundred ninety-eight (62.7%) were near misses (median 3, IQR 2-5, range 0-15) with excellent inter-rater and test-retest reliability (κ=0.86, 95% CI 0.83-0.89, P < 0.001 and κ=0.88, 95% CI 0.85-0.9, P < 0.001 respectively). Significantly more near misses were seen in patients who developed early complications (4 (3-6) vs. 3 (2-4), P < 0.001). Higher numbers of near misses were seen in patients with more numerous (P = 0.002) and more serious early complications (P = 0.003). Cases containing major intraoperative adverse events contained significantly more near misses (5 (3-7) vs. 3 (2-5), P < 0.001) with a major event observed for every 19.4 near misses. CONCLUSION:Intraoperative adverse events and near misses can be reliably and objectively captured in advanced laparoscopic surgery. Near misses are commonplace and closely associated with morbidity outcomes.Nathan J. Curtis, Godwin Dennison, Chris S. B. Brown, Peter J. Hewett, George B. Hanna, Andrew R. L. Stevenson … et al