Hiatal hernia surgery: laparoscopic versus robotic approach?

Aim. Evaluate the advantages and disadvantages of laparoscopic and robot-assisted anti-reflux operations.General findings. Reflux esophagitis in the association with hiatal hernia on the third place in the structure of gastroenterological diseases. The development of minimally invasive surgical technologies has led to an increase in the number of laparoscopic and robot-assisted anti-reflux operations. The literature review includes 12 studies, the results of which were published from 2002 to 2020, with a total number of patients 1633. In most of them, when comparing laparoscopic and robot-assisted anti-reflux operations, the advantages of one or another technique were not revealed. In some studies, the high cost and duration of the operation were noted when using the da Vinci robotic surgical complex. Other studies have reported possible improvements in the treatment outcomes of patients with large or recurrent hiatal hernias due to the high precision of movement and improved visualization characteristic of therobot-assisted surgeries.Conclusion. It is necessary to conduct more researches on this problem to develop indications for the choice of a particular surgical approach, as well as to create a single transparent algorithm for the surgical treatment of patients with reflux esophagitis and hiatal hernia

HIPEC и PIPAC при раке желудка: методика и сравнение эффективности. Обзор литературы

Background: According to the World Health Organization (WHO) data, gastric cancer (GC) was the 5th most common cancer and the 4th leading cause of cancer death worldwide in 2020. Peritoneal metastases (PM) are associated with a poor prognosis and detected in 30 % of patients with locally advanced GC; the median overall survival in patients with PM is 3–6 months without any treatment and 6–12 months with the use of systemic chemotherapy. Delivery of appropriate chemotherapeutic drugs directly into the abdominal cavity increases the effectiveness of treatment without severe systemic side effects. Today, various forms of intra-abdominal chemotherapy of PM are used in the world.Aim: To evaluate the efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) and aerosol intraperitoneal pressure chemotherapy (PIPAC) in the treatment of GC PM.Purposes: To review current domestic and foreign publications on HIPEC and PIPAC, to compare their efficacy.Materials and methods: Articles in PubMed, Scopus, Web of Science databases were studied and analyzed for the key queries: “stomach cancer”, “carcinomatosis”, “peritoneal metastases”, “HIPEC”, “PIPAC”.Conclusions: The best results were achieved when using PIPAC as preoperative chemotherapy, followed by cytoreductive surgery in combination with HIPEC. Both procedures are promising and require further study with multicenter randomized prospective trials to assess their therapeutic potential.Актуальность: По данным Всемирной Организации Здравоохранения (ВОЗ) в 2020 году рак желудка (РЖ) занимал 5‑е место по частоте встречаемости и 4‑е по частоте смертности в мире среди онкологических заболеваний. Перитонеальные метастазы (ПМ) выявляют у 30 % больных местнораспространенным РЖ, а медиана общей выживаемости у пациентов с ПМ составляет 3–6 месяцев без какого‑либо лечения и 6–12 месяцев при использовании системной химиотерапии. Доставка соответствующих химиотерапевтических препаратов напрямую в брюшную полость повышает эффективность лечения без тяжелых системных побочных эффектов. Сегодня в мире применяют разнообразные формы внутрибрюшной химиотерапии РЖ.Цель: Оценить эффективность гипертермической внутрибрюшной химиотерапии (HIPEC) и аэрозольной внутрибрюшной химиотерапии под давлением (PIPAC) в лечении ПМ РЖ.Задачи: Провести обзор актуальных отечественных и зарубежных публикаций, посвященных HIPEC и PIPAC, сравнить их эффективность.Материалы и методы: Были изучены и проанализированы статьи в базах данных PubMed, Scopus, Web of Science по ключевым запросам: «рак желудка», «канцероматоз», «перитонеальные метастазы», “HIPEC”, “PIPAC”.Выводы: Наилучшие результаты были достигнуты при использовании PIPAC в качестве предоперационной химиотерапии с последующим проведением ЦРХ в сочетании с HIPEC. Обе процедуры являются перспективными и требуют дальнейшего изучения с проведением многоцентровых рандомизированных проспективных исследований для оценки их лечебного потенциала

Neutral atoms in ionic lattices: Stability and ground state properties of KCl:Ag(0)

The equilibrium geometry of Ag0 centers formed at cation sites in KCl has been investigated by means of total-energy calculations carried out on clusters of different sizes. Two distinct methods have been employed: First, an ab initio wave-function based method on embedded clusters and second, density-functional theory ~DFT! methods on clusters in vacuo involving up to 117 atoms. In the ab initio calculations the obtained equilibrium Ag0 -Cl2 distance Re is 3.70 Å, implying a large outward relaxation of 18%, along with 7% relaxation for the distance between Ag0 and the first K1 ions in ^100& directions. A very similar result is reached through DFT with a 39-atom cluster. Both approaches lead to a rather shallow minimum of the total-energy surface, the associated force constant of the A1g mode is several times smaller than that found for other impurities in halides. These conclusions are shown to be compatible with available experimental results. The shallow minimum is not clearly seen in DFT calculations with larger clusters. The unpaired electron density on silver and Cl ligands has been calculated as function of the metal-ligand distance and has been compared with values derived from electron-paramagnetic resonance data. The DFT calculations for all cluster sizes indicate that the experimental hyperfine and superhyperfine constants are compatible when Re is close to 3.70 Å. The important relation between the electronic stability of a neutral atom inside an ionic lattice and the local relaxation is established through a simple electrostatic model. As most remarkable features it is shown that ~i! the cationic Ag0 center is not likely to be formed inside AgCl, ~ii! in the Ag0 center encountered in SrCl2, the silver atom is probably located at an anion site, and ~iii! the properties of a center-like KCl:Ag0 would experience significant changes under hydrostatic pressures of the order of 6 GPa