Laparoscopic mesogastrium excision for gastric cancer. Only the beginning

Background: Surgery, with the aid of chemotherapy and radiotherapy, is the only curative chance for gastric cancer. Unfortunately, gastric cancer had an elevated recurrence rate, primarily locally. Mesogastrium excision (MGE) during D2 lymphadenectomy has the aim to remove all possible contaminated tissue around the stomach. Methods: PubMed, EMBASE, and the Web of Science (WOS) were systematically searched for MGE reports in gastric cancer up to March 2020. The outcome reported were the number of lymph nodes retrieved, operative time (OT), overall morbidity, intra- and postoperative complications, conversion rate, and length of hospital stay. Results: A total of six studies, including 518 patients, were considered eligible for this analysis. All the studies reported laparoscopic cases. The mean number of lymph nodes retrieved was 36.7 ± 10.1. Mean OT was 240.7 ± 10.1 minutes. One case of conversion is reported. Overall morbidity was 6%. Medium estimated blood loss was 50.2 ± 39.6 mL. Overall length of stay was 10.7 ± 0.7 days. Mean follow-up was 11 ± 1.4 months. Conclusions: Only few studies evaluated this item, and according to the available evidence, MGE is a feasible technique that could be performed, also laparoscopically, in all surgical resections for gastric cancer with curative intent. Further studies are essential to establish the clear indication of this invasive procedure

Evidence on postoperative abdominal binding. A systematic review with meta-analysis of randomized controlled trials

Background: Midline laparotomy is an unavoidable approach to many surgical procedures. Many surgeons prescript the use of postoperative abdominal binder during the first mobilization after surgery. The use and the cost effective of this device is still debated by many surgeons. Methods: PubMed, EMBASE and the CENTRAL were systematically searched for randomized controlled trials (RCT) comparing patients who wore abdominal binder ("binder") and patient who did not wear any abdominal binder ("non-binder") up to March 2020. The primary outcomes measured in the comparison were postoperative pain, pulmonary functions, the entity of physical activity, the comfort. A meta-analysis of relevant studies was performed using RevMan 5.3. Results: wearing an abdominal binder after midline laparotomy seems to reduce postoperative pain on first and third postoperative day, to improve the physical activity on third postoperative day, and not affect pulmonary functions. Generally, an elastic abdominal binder is well tolerated during postoperative. Conclusions: the use of elastic abdominal binder permits a comfortable early postoperative mobilization reducing pain, increases physical activity and seems to not affect pulmonary functions

Minilaparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy. An endless debate

Background: Our systematic review and meta-analysis examine the impact of minilaparoscopic cholecystectomy (MLC) versus conventional laparoscopic cholecystectomy (CLC). Some authors previously compared these surgical approaches without reaching any clear conclusion, since then, further trials have been performed, but an update was needed. Materials and Methods: PubMed, EMBASE, and the CENTRAL were systematically searched for randomized controlled trials comparing MLC versus CLC up to August 2019. The outcome measures used for comparison were operative time (OT), overall morbidity, intra- and postoperative complications, conversion and reintervention rate, length of hospital stay (LOS), postoperative pain (POP), and cosmetic results. A meta-analysis of relevant studies was performed using RevMan 5.3. Results: Fifteen studies, including 863 patients, were considered eligible to collect data and entered the meta-analysis. A total of 415 patients in the MLC group versus 448 in the CLC group were compared. No statistical difference as for overall morbidity, intra- and postoperative complications, conversion and reintervention rate, LOS, and cosmetic results were retrieved among the groups. CLC results faster and MLC shows to be the least painful. Conclusions: According to the available high-level evidence, both surgical approaches resulted substantially equivalent to perform LC, with some advantages of CLC as for OT and of MLC concerning POP. As a consequence, we can conclude that either procedure is superior or inferior to the other one; actually, we are not able to suggest the adoption of any of the two on a routine basis

Genome-wide Analyses Identify KIF5A as a Novel ALS Gene

To identify novel genes associated with ALS, we undertook two lines of investigation. We carried out a genome-wide association study comparing 20,806 ALS cases and 59,804 controls. Independently, we performed a rare variant burden analysis comparing 1,138 index familial ALS cases and 19,494 controls. Through both approaches, we identified kinesin family member 5A (KIF5A) as a novel gene associated with ALS. Interestingly, mutations predominantly in the N-terminal motor domain of KIF5A are causative for two neurodegenerative diseases: hereditary spastic paraplegia (SPG10) and Charcot-Marie-Tooth type 2 (CMT2). In contrast, ALS-associated mutations are primarily located at the C-terminal cargo-binding tail domain and patients harboring loss-of-function mutations displayed an extended survival relative to typical ALS cases. Taken together, these results broaden the phenotype spectrum resulting from mutations in KIF5A and strengthen the role of cytoskeletal defects in the pathogenesis of ALS.Peer reviewe

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Relaciones de consumo y factor de atribución de la responsabilidad del proveedor: un debate que sigue abierto

El factor de atribución en la responsabilidad por daños sigue siendo un tema en constante movimiento y discusión. La ideología de la responsabilidad civil es la que subyace en el problema y la movilidad de la realidad subyacente genera contrapuntos, readecuaciones, cambios y polémicas. El terreno de las relaciones de consumo no es ajeno al fenómeno. Si bien en nuestro país la gran mayoría postula una responsabilidad objetiva, no solo existen discusiones en orden al fundamento de dicha tipología, sino que autorizadas voces se han pronunciado por la existencia de parcelas de responsabilidad subjetiva. En otros sistemas, conviven factores subjetivos y objetivos y existen similares disputas. En estas breves líneas expondremos nuestra mirada sobre ello..

La denominada "firma digital" en el marco del Código Civil Argentino

El impacto de la tecnología digital en las relaciones jurídicas. Las respuestas que brinda el derecho a esta nueva realidad. Emplazamiento de la cuestión en el campo de la fenomenología: el "mundo digital" como nueva forma de comunicación entre las personas. El documento electrónico. Documentos e instrumentos. Documento electrónico. Proyectos de reforma. La firma en el Código Civil. Firma electrónica y firma digital. La firma digital y su inserción en el ordenamiento argentino. El Código Civil y la ley 25.506

El contratante débil (determinación de la categoría jurídica)

Origen de la expresión "contratante débil". Sentido de la expresión. Aclaraciones preliminares. Parte débil: ¿Categoría objetiva o apreciación in concreto? Conclusiones

Les enjeux d’une pratique de l’activité physique en psychiatrie face au COVID-19

Le confinement de près de deux mois que connait la France pendant la pandémie mondiale à COVID-19, se traduit par une réorganisation majeure des soins en psychiatrie de l’adulte. Dans ce contexte de crise, le Pôle Clamart du GHT Paul Guiraud a considéré essentiel de maintenir un accès aux activités physiques, reconnues pour leurs bénéfices sur la santé et bien-être psychosocial. L’analyse de l’activité de son Centre d’Activités Physiques et Sportives (CAPS) éclaire sur les possibilités d’une pratique physique malgré des mesures sanitaires strictes. De plus elle révèle le développement de pratique d’auto-santé par les patients, en lien étroit avec les propositions des soignants. Cette situation inédite révèle ainsi une nouvelle manière d’envisager le soin et les relations entre soignants et soignés et donne au corps une place centrale dans le soin.During two months, France population had experienced lockdown because of COVID-19 pandemic. In this context, psychiatric hospitals reorganized adult psychiatric cares. During this crisis, the Clamart Unit of the GHT Paul Guiraud considered essential to maintain access to physical activities, because of their benefits on health and psychosocial well-being. The analysis of the activity of its Physical and Sports Activities Center (CAPS) sheds light on the possibilities of physical practice despite strict health measures. Moreover, it reveals the development of self-care practices by patients, in close connection with the proposals of the caregivers. Finally, this situation reveals a new way of looking at care and the relationship between carers and patients and gives to the body a central place in care