Commentary on "a case of paratesticular leiomyosarcoma successfully treated with orchiectomy and chemotherapy"

We have read with great interest the article written by Ko and colleagues on a particularly rare type of malignant mesenchymal tumor that is paratesticular leiomyosarcoma and we did appreciate the argumentation on the utility of adjuvant chemotherapy as treatment of stage III disease. As for our experience, we would like to shed light on a very rare and little-known aspect surrounding this neoplasm, which is the capability of dedifferentiation exerted in order to recur or metastasize

John and Susan Kean And the Culture of Slavery in the New Nation

Abstract: The correspondence of John and Susan Kean, opened only recently at Liberty Hall Museum / Kean University, offers a first-hand glimpse of slaveholding after the triumph of the American Revolution. The couple’s letters narrate a story of contradiction, complexity, and paradox

Modélisation basée sur une ontologie pour la simulation de comportements de nouveaux-nés lors de la réanimation cardio-pulmonaire

International audienceThis chapter concerns the formulation of a methodology and its implementation to elaborate a training simulator for medical staff who may be confronted with the critical situations of new-borns resuscitation. The simulator reproduces the different cardio-pulmonary pathological behaviours of new-borns, the working environment of resuscitation rooms, and the monitoring and control environment of the learners by a teacher. Conceptual models of new-borns behaviours combined with the cardio-pulmonary resuscitation gestures have been developed. The methodological process is jointly using cognitive approaches with formal modelling and simulation. Cognitive approaches are mobilized to elaborate application ontologies to be the bases for the development of the conceptual models and the specification of the simulator. Ontologies have been developed on the bases of a corpus of academic documents, return on experience documents, and practitioner interviews, by means of the Knowledge Oriented Design (KOD) method. A discrete event formalism has been used to formalize the conceptual models of the new-borns behaviours. As a result, a simulator has been built to train medical practitioners to face situations, which are reported to potentially cause errors and thus improve the safety of the resuscitation gestures

Ontology-Based Modeling for Newborn Behavior Simulation during Cardiopulmonary Resuscitation

This chapter concerns the formulation of a methodology and its implementation to elaborate a training simulator for medical staff who may be confronted with the critical situations of newborn resuscitation. The simulator reproduces the different cardiopulmonary pathological behaviors of newborns, the working environment of resuscitation rooms, and the monitoring and control environment of the learners by a teacher. Conceptual models of newborn behaviors combined with the cardiopulmonary resuscitation gestures have been developed. The methodological process is jointly using cognitive approaches with formal modeling and simulation. Cognitive approaches are mobilized to elaborate application ontologies to be the bases for the development of the conceptual models and the specification of the simulator. Ontologies have been developed on the bases of a corpus of academic documents, return on experience documents, and practitioner interviews, by means of the knowledge-oriented design (KOD) method. A discrete event formalism has been used to formalize the conceptual models of the newborn behaviors. As a result, a simulator has been built to train medical practitioners to face situations, which are reported to potentially cause errors, and thus improve the safety of the resuscitation gestures

Étude de la Vulnérabilité des Chaînes Logistiques Fondée sur l'Ingénierie Cognitive et les Modèles Formels ARIMA

International audienceThis research concerns the formulation of models and methods for supply chains risk analysis. An ontological approach using the KOD method (Knowledge Oriented Design) has been implemented to clearly identify relationships between the concepts of supply chain, risk, vulnerability and disturbances (critical scenarios). As a result, conceptual models of supply chains facing risk situations and critical scenarios are proposed. From the resulting conceptual models and mathematical models proposed in the literature, a multi-stage supply chain model using ARIMA models incorporating the randomness of the demand has been elaborated. In order to adapt this model to scenario criticality, constraints on orders and inventories have been taken into account. Under critical disturbances on information flows (demand) and physical flows (quality of the product supplied), constraints can be reached and supply chain behaviours can evolve toward critical dynamics or even become unstable. Supply chain vulnerabilities has been assessed and discussed

Non-operative management of blunt splenic injury: is it really so extensively feasible? a critical appraisal of a single-center experience

Introduction: the spleen is one of the most commonly injured organ following blunt abdominal trauma. Splenic injuries may occur in isolation or in association with other intra-and extra-abdominal injury. Nonoperative management of blunt injury to the spleen has become routine in children. In adult most minor splenic injuries are readily treated nonoperatively but controversy exists regarding the role of nonoperative management for higher grade injuries above all in multi-trauma patients. The aim of this study is the assessment of splenic trauma treatment, with particular attention to conservative treatment, its limits, its efficiency, and its safety in multi-trauma patient or in a severe trauma patient. Methods: the present research focused on a retrospective review of patients with splenic injury. The research was performed by analyzing data of the trauma registry of St. Andrea University Hospital in Rome. The St. Andrea University Hospital trauma registry includes 1859. The variables taken into account were spleen injury and general injuries, age, sex, cause and dynamic of trauma, hemoglobin, hematocrit, white blood cells count, INR, number and time blood transfusion, hemodynamic stability, type of treatment provided, hospitalization period, morbidity and mortality. Assessment of splenic injuries was evaluated according to Abbreviated Injury Scale (AIS). Results: the analysis among the general population of spleen trauma patients identified 68 patients with a splenic injury representing the 41.2% of all abdomen injury. The Average age was of 37.01 ± 17.18 years. The Average ISS value was of 22.88 ± 12.85; mediana of 24.50 (range 4-66). The average Spleen AIS value was of 3.13 ± 0.88; mediana 3.00 (range 2-5). The overall mortality ratio was of 19.1% (13 patients). The average ISS value in patients who died was of 41.92 ± 12.48, whereas in patients who survided was of 23.33 ± 10.15. The difference was considered to be statistically significant (p <0.001). The relashionship between the ISS and AIS values in patients who died was considered directly proportional but not statistically significant (Pearson test AIS/ISS = 0.132, p = n.s.). The initial management was a conservative treatment in 27 patients (39.7%) of them 4 patients (15%) failed, in the other 41 cases urgent splenectomies were performed. The average spleen AIS in all the patients who underwent splenectomy was 3.61 ± 0.63 whereas in the patients who were not treated surgically was 2.42 ± 0.69. The difference was deemed statistically significant (p <0.001). Conclusion: splenic injury, as reported in our statistic as well as in literature, is the most common injury in closed abdominal trauma. Nonoperative management of blunt injury to the spleen in adults has been applied with increasing frequency. However, the criteria for nonoperative management are controversial. The preference of a conservative treatment must be based on the hemodynamic stability indices as well as on the spleen lesion severity and on the general trauma severity. The conservative treatment represent a feasible and safe therapeutic alternative even in case of severe lesions in politrauma patients, but the choice of the treatment form requires an assessment for each singular case

How technology can help in oncologic patient management during COVID-19 outbreak

No abstract availabl

Clinical management of endoscopically resected pT1 colorectal cancer

Background Implementation of colorectal cancer (CRC) screening programs increases endoscopic resection of polyps with early invasive CRC (pT1). Risk of lymph node metastasis often leads to additional surgery, but despite guidelines, correct management remains unclear. Our aim that are diagnosed and treated endoscopically and this number is expected to increase [1,2].Methods We retrospectively reviewed patients undergoing endoscopic resection of pT1 CRC from 2006 to 2016. Clinical, endoscopic, surgical treatment, and follow-up data were collected and analyzed. Lesions were categorized according to endoscopic/histological risk-factors into low and high risk groups. Comorbidities were classified according to the Charlson comorbidity index (CCI). Surgical referral for each group was computed, and dissociation from current European CRC screening guidelines recorded. Multivariate analysis for factors affecting the post-endoscopic surgery referral was performed.Results Seventy-two patients with endoscopically resected pT1-CRC were included. Overall, 20 (27.7%) and 52 (72.3%) were classified as low and high risk, respectively. In the low risk group, 11 (55%) were referred to surgery, representing over-treatment compared with current guidelines. In the high risk group, nonsurgical endoscopic surveillance was performed in 20 (38.5%) cases, representing potential under-treatment. After a median follow-up of 30 (6-130) months, no patients developed tumor recurrence. At multivariate analysis, age (OR 1.21, 95 %CI 1.02 -1.42; P = 0.02) and CCI (OR 1.67, 95 %CI 1.12 -3.14; P= 0.04) were independent predictors for subsequent surgery.Conclusions A substantial rate of inappropriate post-endoscopic treatment of pT1-CRC was observed when compared with current guidelines. This was apparently related to an overestimation of patient-related factors rather than endoscopically or histologically related factors

Simultaneous Bilateral Laparoscopic Adrenalectomy Is Safe for Synchronous Large Adrenal Tumors

Laparoscopy is now considered the gold standard for treating benign monolateral adrenal lesions. We present the case of a patient affected by Cushing's syndrome due to large bilateral adrenal adenomas (7.5cm) who underwent simultaneous laparoscopic bilateral adrenalectomy. An anterior, lateral transperitoneal approach was used. Operative time was 200 minutes, and blood loss was 200mL. No intraoperative complications were encountered. The postoperative course was uneventful, and the patient was discharged after 3 days. Laparoscopic bilateral adrenalectomy is a safe, effective procedure when performed by experienced hands and may be an alternative treatment for large adrenal lesions

Early induction of bedside pneumoperitoneum in the management of residual pleural space and air leaks after pulmonary resection

Background: The pneumoperitoneum to treat prolonged air leaks or pleural space problems after pulmonary resection has been successfully used for decades. The aim of the study is to describe our experience with the early induction of therapeutic pneumoperitoneum (TP). Methods: We reviewed the data of 103 consecutive patients undergoing TP between September 2011 and September 2019. Patients were divided into two groups according to the time of the induction of TP: early application (≥72 h) and standard application (>72 h). Results: In total, 52 early TP and 51 standard TP were analyzed. The median time of TP induction was 2 (1–3) versus 8 (5–11) postoperative days (POD) (p < 0.001). The time for obliteration of the residual pleural space (7 vs.9 days, p = 0.805) and the time of resolution of the air leaks (14 vs. 16 days, p = 0.663) didn’t differ between the two groups, but a favorable trend was observed in the early group. The hospital stay was lower for patients undergoing early pneumoperitoneum: 9 versus 18 days (p < 0.001). The multivariate analysis showed that POD of induction of TP (p < 0.001), time of resolution of the air leak (p < 0.001) and Heimlich valve (p = 0.002) were independent variables associated with the hospital stay. Conclusions: The use of TP whenever a space problem or air leaks occur after pulmonary resections is safe and effective. Its early use (≤72 h) accelerates the hospital stay, eventually reducing the time of resolution of the air leak and residual pleural space