Intra-operative gallbladder scoring predicts conversion of laparoscopic to open cholecystectomy: a WSES prospective collaborative study

Abstract Introduction Laparoscopic cholecystectomy, the gold-standard approach for cholecystectomy, has surprisingly variable outcomes and conversion rates. Only recently has operative grading been reported to define disease severity and few have been validated. This multicentre, multinational study assessed an operative scoring system to assess its ability to predict the need for conversion from laparoscopic to open cholecystectomy. Methods A prospective, web-based, ethically approved study was established by WSES with a 10-point gallbladder operative scoring system; enrolling patients undergoing elective or emergency laparoscopic cholecystectomy between January 2016 and December 2017. Gallbladder surgery was considered easy if the G10 score < 2, moderate (2 ≦ 4), difficult (5 ≦ 7) and extreme (8 ≦ 10). Demographics about the patients, surgeons and operative procedures, use of cholangiography and conversion rates were recorded. Results Five hundred four patients, mean age 53.5 (range 18–89), were enrolled by 55 surgeons in 16 countries. Surgery was performed by consultants in 70% and was elective in (56%) with a mean operative time of 78.7 min (range 15-400). The mean G10 score was 3.21, with 22% deemed to have difficult or extreme surgical gallbladders, and 71/504 patients were converted. The G10 score was 2.98 in those completed laparoscopically and 4.65 in the 71/504 (14%) converted. (p <  0.0001; AUC 0.772 (CI 0.719–0.825). The optimal cut-off point of 0.067 (score of 3) was identified in G10 vs conversion to open cholecystectomy. Conversion occurred in 33% of patients with G10 scores of ≥ 5. The four variables statistically predictive of conversion were GB appearance—completely buried GB, impacted stone, bile or pus outside GB and fistula. Conclusion The G10 operative scores provide simple grading of operative cholecystectomy and are predictive of the need to convert to open cholecystectomy. Broader adaptation and validation may provide a benchmark to understand and improve care and afford more standardisation in global comparisons of care for cholecystectomy

Correlation of mRNA expression of KLK13 gene with the clinical expression of gastric adenocarcinoma

Objectives Gastric cancer is a fatal human malignancy with poor prognosis. Several modifications in gene expression, including those of the kallikrein-related peptidase family, have been shown to take place in gastric carcinogenesis. Given KLK13 involvement in human malignancies, we aimed to uncover its prognostic strength in stomach cancer.Design and methods Quantitative analysis of KLK13 profiles was accomplished in human gastric cancer cells and in a statistically significant sample size of stomach tissue specimens, with the development of the highly sensitive real-time PCR methodology.Results Decreased KLK13 expression was demonstrated in cancerous compared with their matching nonmalignant pairs (p=0.002) and in poorly differentiated gastric tumors (p=0.029). KLK13-positive patients were shown to live considerably longer (p=0.014) and with low risk of disease recurrences (p=0.043).Conclusions This is the first study disclosing the possible clinical utility of KLK13 as a new tumor biomarker capable of predicting a favorable outcome for gastric cancer patients.Σκοπός Ο καρκίνος του στομάχου έχει υψηλά ποσοστά νοσηρότητας και αποτελεί μία από τις συχνότερες αιτίες θανάτου από καρκίνο. Αρκετές γονιδιακές μεταλλάξεις έχει βρεθεί ότι εμπλέκονται στην καρκινογένεση στο στόμαχο και τα γονίδια των καλλικρεϊνών αποτελούν πηγή μοριακών δεικτών. Στην παρούσα μελέτη εξετάστηκε η δυνητική προγνωστική σημασία του KLK13 στο γαστρικό αδενοκαρκίνωμα.Υλικά και ΜέθοδοςΚαρκινική σειρά γαστρικού αδενοκαρκινώματος (AGS) και ιστικά δείγματα στομάχου χρησιμοποιήθηκαν στην παρούσα μελέτη. Έγινε απομόνωση του ολικού RNA, σύνθεση cDNA και εν συνεχεία ενίσχυση αυτού με qRT-PCR ώστε να προσδιοριστεί η mRNA έκφραση του KLK13.ΑποτελέσματαΣτατιστικώς σημαντικά (p=0.002) μειωμένη έκφραση του KLK13 βρέθηκε στους καρκινικούς σε σχέση με τους φυσιολογικούς ιστούς στομάχου, καθώς επίσης και στους όγκους χαμηλής διαφοροποίησης (p=0.029). Διαπιστώθηκε επιπλέον στατιστικώς σημαντική (p=0.038), αντιστρόφως ανάλογη σχέση μεταξύ της mRNA έκφρασης του KLK13 και του μεγέθους του όγκου. Τέλος παρατηρήθηκε μακρότερη επιβίωση (p=0.014), χωρίς υποτροπές (p=0.043), σε όσους ήταν KLK13- θετικοί σε σχέση με όσους ήταν KLK13-αρνητικοί.Συμπεράσματα Συμπερασματικά, τα ευρήματα της παρούσας μελέτης δίνουν για πρώτη φορά ενδείξεις για την προγνωστική σημασία του KLK13 στον καρκίνο του στομάχου, καθώς και για την ικανότητα διάκρισης ιστικών δειγμάτων αδενοκαρκινώματος του στομάχου από δείγματα φυσιολογικού γαστρικού βλεννογόνου

Συσχέτιση της mRNA έκφρασης του γονιδίου της καλλικρεΐνης-13 (KLK13) με την κλινική έκφραση του αδενοκαρκινώματος του στομάχου

Ο καρκίνος του στομάχου έχει υψηλά ποσοστά νοσηρότητας και αποτελεί μία από τις συχνότερες αιτίες θανάτου από καρκίνο. Αρκετές γονιδιακές μεταλλάξεις έχει βρεθεί ότι εμπλέκονται στην καρκινογένεση στο στόμαχο και τα γονίδια των καλλικρεϊνών αποτελούν πηγή μοριακών δεικτών. Στην παρούσα μελέτη εξετάστηκε η δυνητική προγνωστική σημασία του KLK13 στο γαστρικό αδενοκαρκίνωμα. Υλικά και Μέθοδος Καρκινική σειρά γαστρικού αδενοκαρκινώματος (AGS) και ιστικά δείγματα στομάχου χρησιμοποιήθηκαν στην παρούσα μελέτη. Έγινε απομόνωση του ολικού RNA, σύνθεση cDNA και εν συνεχεία ενίσχυση αυτού με qRT-PCR ώστε να προσδιοριστεί η mRNA έκφραση του KLK13. Αποτελέσματα Στατιστικώς σημαντικά (p=0.002) μειωμένη έκφραση του KLK13 βρέθηκε στους καρκινικούς σε σχέση με τους φυσιολογικούς ιστούς στομάχου, καθώς επίσης και στους όγκους χαμηλής διαφοροποίησης (p=0.029). Διαπιστώθηκε επιπλέον στατιστικώς σημαντική (p=0.038), αντιστρόφως ανάλογη σχέση μεταξύ της mRNA έκφρασης του KLK13 και του μεγέθους του όγκου. Τέλος παρατηρήθηκε μακρότερη επιβίωση (p=0.014), χωρίς υποτροπές (p=0.043), σε όσους ήταν KLK13- θετικοί σε σχέση με όσους ήταν KLK13-αρνητικοί. Συμπεράσματα Συμπερασματικά, τα ευρήματα της παρούσας μελέτης δίνουν για πρώτη φορά ενδείξεις για την προγνωστική σημασία του KLK13 στον καρκίνο του στομάχου, καθώς και για την ικανότητα διάκρισης ιστικών δειγμάτων αδενοκαρκινώματος του στομάχου από δείγματα φυσιολογικού γαστρικού βλεννογόνου.Objectives Gastric cancer is a fatal human malignancy with poor prognosis. Several modifications in gene expression, including those of the kallikrein-related peptidase family, have been shown to take place in gastric carcinogenesis. Given KLK13 involvement in human malignancies, we aimed to uncover its prognostic strength in stomach cancer. Design and methods Quantitative analysis of KLK13 profiles was accomplished in human gastric cancer cells and in a statistically significant sample size of stomach tissue specimens, with the development of the highly sensitive real-time PCR methodology. Results Decreased KLK13 expression was demonstrated in cancerous compared with their matching nonmalignant pairs (p=0.002) and in poorly differentiated gastric tumors (p=0.029). KLK13-positive patients were shown to live considerably longer (p=0.014) and with low risk of disease recurrences (p=0.043). Conclusions This is the first study disclosing the possible clinical utility of KLK13 as a new tumor biomarker capable of predicting a favorable outcome for gastric cancer patients

Drone Control in AR: An Intuitive System for Single-Handed Gesture Control, Drone Tracking, and Contextualized Camera Feed Visualization in Augmented Reality

Traditional drone handheld remote controllers, although well-established and widely used, are not a particularly intuitive control method. At the same time, drone pilots normally watch the drone video feed on a smartphone or another small screen attached to the remote. This forces them to constantly shift their visual focus from the drone to the screen and vice-versa. This can be an eye-and-mind-tiring and stressful experience, as the eyes constantly change focus and the mind struggles to merge two different points of view. This paper presents a solution based on Microsoft’s HoloLens 2 headset that leverages augmented reality and gesture recognition to make drone piloting easier, more comfortable, and more intuitive. It describes a system for single-handed gesture control that can achieve all maneuvers possible with a traditional remote, including complex motions; a method for tracking a real drone in AR to improve flying beyond line of sight or at distances where the physical drone is hard to see; and the option to display the drone’s live video feed in AR, either in first-person-view mode or in context with the environment

Drone Control in AR: An Intuitive System for Single-Handed Gesture Control, Drone Tracking, and Contextualized Camera Feed Visualization in Augmented Reality

Traditional drone handheld remote controllers, although well-established and widely used, are not a particularly intuitive control method. At the same time, drone pilots normally watch the drone video feed on a smartphone or another small screen attached to the remote. This forces them to constantly shift their visual focus from the drone to the screen and vice-versa. This can be an eye-and-mind-tiring and stressful experience, as the eyes constantly change focus and the mind struggles to merge two different points of view. This paper presents a solution based on Microsoft’s HoloLens 2 headset that leverages augmented reality and gesture recognition to make drone piloting easier, more comfortable, and more intuitive. It describes a system for single-handed gesture control that can achieve all maneuvers possible with a traditional remote, including complex motions; a method for tracking a real drone in AR to improve flying beyond line of sight or at distances where the physical drone is hard to see; and the option to display the drone’s live video feed in AR, either in first-person-view mode or in context with the environment

Femoral fractures are an indicator of increased severity of injury for road traffic collision victims: an autopsy-based case-control study on 4895 fatalities

Introduction The course of road traffic collision (RTC) victims with femoral fractures (FFx) from injury to death was reviewed. We sought to correlate the presence of femoral fractures with the overall severity of injury from RTCs using objective indices and to identify statistically significant associations with injuries in other organs. Patients and methods A case- control study based on forensic material from 4895 consecutive RTC-induced fatalities, between 1996 and 2005. Injuries were coded according to the Abbreviated Injury Scale-1990 Revision (AIS-90), and the Injury Severity Score (ISS) was calculated. Victims were divided according to the presence of femoral fractures in all possible anatomic locations or not. Univariate comparisons and logistic regression analysis for probabilities of association as odds ratios (OR) were performed. Results The FFx group comprised 788 (16.1%) victims. The remaining 4107 victims constituted the controls. The FFx group demonstrated higher ISS (median 48 vs 36, p &lt; 0.001) and shorter post-injury survival times (median 60 vs 85 min, p &lt; 0.001). Presence of bilateral fractures (15.5%) potentiated this effect (median ISS 50 vs 43, p = 0.006; median survival time 40 vs 65, p = 0.0025; compared to unilateral fractures). Statistically significant associations of FFx were identified with AIS2-5 thoracic trauma (OR 1.43), AIS2-5 abdominal visceral injuries (OR 1.89), AIS1-3 skeletal injuries of the upper (OR 2.7) and lower limbs (OR 3.99) and AIS2-5 of the pelvis (OR 2.75) (p &lt; 0.001). In the FFx group, 218 (27.7%) victims survived past the emergency department and 116 (53.2%) underwent at least one surgical procedure. Complications occurred in 45.4% of hospitalized victims, the most common being pneumonia (34.8%). Conclusion This study has documented that femoral fractures are associated with increased severity of injury, shorter survival times and higher incidence of associated thoracic, abdominal and skeletal extremity injuries, compared to controls. These findings should be considered for an evidence-based upgrading of trauma care