Optimizing patient selection for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Carefully selected patients with resectable and limited colorectal peritoneal metastases (PM) can be treated with curative intent by cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS+HIPEC). It remains a serious challenge to weigh the potential survival benefit from this extensive treatment against the risks of substantial treatment−related morbidity, mortality, and potential diminished QoL. We identified some new and promising preoperative factors that can predict postoperative morbidity and survival outcomes after CRS+HIPEC. Performing a diagnostic laparoscopy (DLS) routinely during the preoperative workup for CRS+HIPEC prevents non−therapeutic laparotomies (i.e., open−close procedures). DLS is feasible and safe and we recommend performing this laparoscopic screening in an experienced HIPEC center. The extent of surgery (ES) during cytoreductive surgery is a well−known risk factor for major postoperative morbidity. For the first time, we discovered that experienced HIPEC surgeons in most cases fail to predict the resections that are necessary to achieve a complete cytoreduction, with an underestimation of the ES in almost 40% of the cases. At this moment, two investigations are still ongoing (i.e., SELECT trial and MUSCLE POWER study) to further optimize patient selection for CRS+HIPEC. The SELECT trial aims to improve the staging of colorectal PM during DLS by using the fluorescent tracer bevacizumab−IRDye800CW. The MUSCLE POWER study focusses on (the prevention of) clinically relevant surgery−related muscle loss (SRML) in cancer patients after major abdominal surgery. Ultimately, these new strategies might reduce overtreatment, morbidity, and costs while maintaining the same or better effectiveness with a lower recurrence rate and improved QoL

Beer in advertising : a Comparison of beer commercials in Germany and the USA since 2010

Die vorliegende Bachelorarbeit befasst sich mit der Werbepraxis im Bereich Fernsehwerbung in den USA und Deutschland. Im Fokus steht dabei die Bierwerbung als Beispiel für den Vergleich. Ziel der Arbeit ist es, die Frage zu beantworten, inwiefern sich die deutsche von der US-amerikanischen Werbung unterscheidet. Nach einem kurzen Überblick über die Werbegeschichte beider Länder, erfolgt zunächst eine Darstellung der jeweiligen Stellung auf dem globalen Werbemarkt. Anschließend werden die Hauptmerkmale der Fernsehwerbung in den USA und Deutschland analysiert und Gemeinsamkeiten sowie Unterschiede festgestellt. Es folgt die Analyse verschiedener Bierwerbespots, die von Januar 2010 bis März 2016 ausgestrahlt wurden. Diese werden anhand der Inhaltsanalyse analysiert und bewertet. Anschließend werden mithilfe der Ergebnisse der Inhaltsanalyse die Werbung in den USA und in Deutschland verglichen. Den Schluss der Arbeit bildet das Fazit. Hier wird die Fragestellung noch einmal aufgegriffen und abschließend beantwortet. Die Ergebnisse der Inhaltsanalyse zeigen, dass es bedeutende Unterschiede in den beiden Werbemethoden gibt, jedoch auch einige Gemeinsamkeiten bestehen. Die USA besitzen eine Pionierstellung am globalen Werbemarkt und können als unanfechtbarer Vorreiter der Werbetrends seit Beginn der Fernsehgeschichte angesehen werden

On maximizing safety in stochastic aircraft trajectory planning with uncertain thunderstorm development

Dealing with meteorological uncertainty poses a major challenge in air traffic management (ATM). Convective weather (commonly referred to as storms or thunderstorms) in particular represents a significant safety hazard that is responsible for one quarter of weather-related ATM delays in the US. With commercial air traffic on the rise and the risk of potentially critical capacity bottlenecks looming, it is vital that future trajectory planning tools are able to account for meteorological uncertainty. We propose an approach to model the uncertainty inherent to forecasts of convective weather regions using statistical analysis of state-of-the-art forecast data. The developed stochastic storm model is tailored for use in an optimal control algorithm that maximizes the probability of reaching a waypoint while avoiding hazardous storm regions. Both the aircraft and the thunderstorms are modeled stochastically. The performance of the approach is illustrated and validated through simulated case studies based on recent nowcast data and storm observations

Lower urinary tract dysfunction in Parkinsonian syndromes

Purpose of review: The aim of this review is to outline the clinical presentation, pathophysiology and evaluation of lower urinary tract (LUT) dysfunction in Parkinson’s disease and other parkinsonian syndromes including multiple system atrophy, dementia with Lewy bodies, progressive supranuclear palsy and corticobasal degeneration. // Recent findings: LUT dysfunction commonly occurs in neurological disorders, including patients with parkinsonian syndromes. The pattern of LUT dysfunction and its severity are variable, depending upon the site of lesion within the neural pathways. Parkinsonian syndromes are broadly divided into Parkinson’s disease (PD) and a typical parkinsonian syndromes such as multiple system atrophy (MSA), dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). Different parkinsonian syndromes have distinct clinical features (e.g. dysautonomia, early dementia, supranuclear gaze palsy, higher cortical signs), and the pattern of LUT dysfunction and its severity can differ. // Conclusions: LUT dysfunction is a common feature in patients with parkinsonian syndromes. Recognising the pattern of LUT dysfunction during the assessment of these patients can help management and possibly facilitate an earlier diagnosis

Optimal Aircraft Trajectory Planning in the Presence of Stochastic Convective Weather Cells

The Air Traffic Management system is heavily influenced by meteorological uncertainty, and convective weather cells represent one of the most relevant uncertain meteorological phenomena. They are weather hazards that must be avoided through tactical trajectory modifications. As a consequence of the existence in uncertainty in meteorological forecasts and nowcasts, it is important to consider the convective weather cells to be avoided as a stochastic, time-dependent process. In this paper we present a comparative analysis of two methodologies for handling stochastic storms in trajectory planning: one based on stochastic reachability and a second one, based on robust optimal control. In the former, the thunderstorm avoidance problem is modelled as a stochastic reach-avoid problem, considering the motion of the aircraft as a discrete-time stochastic system and the weather hazards as random set-valued obstacles. Dynamic programming is used to compute a Markov feedback policy that maximizes the probability of reaching the target before entering the unsafe set, i.e., the hazardous weather zones. For the latter, the stochastic dynamics of the storms are modeled in continuous time. We implement an optimal control formulation that allows different possible realizations of the stochastic process to be considered. The resulting problem is then transcribed to a nonlinear programming (NLP) problem through the use of direct numerical methods. A benchmark case study is presented, in which the effectiveness of the two proposed approaches are analyzed.This work has been partially supported by project TBO-MET project (https://tbomet-h2020.com/), which has received funding from the SESAR JU under grant agreement No 699294 under European Union’s Horizon 2020 research and innovation programme. This work is also partially supported by the Spanish Government through Project entitled Analysis and optimisation of aircraft trajectories under the effects of meteorological uncertainty (TRA2014-58413-C2-2-R). The project has been funded under RD&I actions of Programa Estatal de Investigación, Desarrollo e Innovación Orientada a los Retos de la Sociedad (call 2014).European Commissio

Surgical techniques for mesenteric lengthening in ileoanal pouch surgery:a systematic review

Aim: The key to successful construction of an ileal pouch–anal anastomosis (IPAA) following proctocolectomy in patients with ulcerative colitis or familial adenomatous polyposis is the ability of the pouch reservoir to reach the anus well vascularized and without tension. The aim of this systematic review was to provide an overview of previously described different surgical lengthening techniques to achieve adequate length for a tension-free IPAA. Method: Pubmed, Embase and Cochrane Library databases were systematically searched. Two reviewers conducted a systematic search with combinations of keywords for the surgical procedure and surgical lengthening techniques. All publications that reported one or more surgical lengthening techniques during IPAA surgery in adult patients were selected, consisting of reviews, cohort studies, case reports, human cadaver studies and expert opinions. The primary outcomes measured were the different surgical lengthening techniques and the step-by-step approach they involve that can be used during surgery to achieve adequate length for an IPAA. Results: Of 1577 records reviewed, 19 articles were included in this systematic review describing at least 1181 patients (i.e. one review, four retrospective studies, five human cadaver studies, two case reports and seven expert opinions). A total of six different surgical lengthening techniques with various subtechniques were found and described, consisting of pouch folding, construction of different types of pouches, stepladder incisions, skeletonization of vessels, division and ligation of mesenteric vessels and using an interposition vein graft. No prospective or randomized controlled trials were performed regarding this topic. Quality assessment showed a medium quality of the included studies. Conclusion: Different surgical lengthening techniques are described in a step-by-step approach to create adequate mesenteric length during IPAA surgery, in patients in whom the ileal pouch cannot reach the dentate line.</p