Geriatric approach to the treatment of senile patients with colorectal cancer

Introduction. The lack of consensus guidelines for the treatment of colorectal cancer (CRC) in senile patients, the high incidence of early postoperative complications after radical surgery caused the search for the most optimal approach to the management of this category of patients.The aim is to introduce a geriatric approach to the treatment of colorectal cancer in senile patients, reduce the incidence of Clavien–Dindo grade 4 early postoperative complications.Materials and methods. 190 senile patients who underwent radical surgery with D3 lymphadenectomy with stage II and III colorectal cancer were enrolled in the study. They were divided into two groups: the control group included 100 patients who underwent standard treatment, the study group included 90 patients, to whom the geriatric approach with a comprehensive geriatric assessment (CGA) and subsequent pre-rehabilitation was applied. A comparative intergroup analysis was performed on the basis of obtained data.Results. The study group differed from the control group in higher polymorbidity and high operational and anesthetic risk (p <0.001). Implementation of geriatric pre-rehabilitation with due account for CGA results and correction of polymorbidity improved chances of providing surgical care using laparoscopic and robotic technologies. The frequency of intraoperative blood transfusion and prolonged mechanical ventilation in the study group was reduced (p <0.001 and p = 0.009, respectively). Predictors that increase the chances of developing acute postoperative myocardial infarction were identified. They included the patient’s male gender (p = 0.004), redo surgery after development of early postoperative complications (p = 0.043), prolonged mechanical ventilation (p = 0.052), increased length of stay in the intensive care unit (p = 0.011), and comorbidity (p = 0.022). The introduction of the geriatric approach made it possible to reduce the risk of postoperative myocardial infarction by 17.86 times (p = 0.007).Conclusion. The geriatric approach to the senile patients with colorectal cancer makes it possible to expand the indications for radical treatment in severe polymorbidity and senile asthenia, as well as to reduce the incidence of early postoperative complications

Outcomes of surgery for high transsphincteric anal fistulas: prospective randomized trial

Background. Reliable data on the efficacy and safety of fistulectomy with primary sphincter repair for the treatment of high transsphincteric anal fistulas are deficient.The aim. To compare the efficacy and safety of fistulectomy with advancement muco-muscular flap (F) and fistulectomy with primary sphincter reconstruction (SR) for the treatment of high anorectal fistulas.Methods. A cohort of 92 consecutive patients with transsphincteric anal fistula involving 1/3 to 2/3 of the sphincteric complex were included in prospective randomized study. The primary endpoint was the recurrence rate. The duration of surgery, blood loss, pain intensity, postoperative complications, the duration of wound healing, incontinence, quality of life were registered.Results. Forty-six patients were randomized in each group. A statistically significant difference was obtained for operative time (Group “F” – 45 (20–160) min, Group “SR” – 33 (10–55) min). The blood loss was 3 (1–20) and 2 (1–10) ml in Groups “F” and “SR”, respectively (p = 0.482). The return to work in Groups “SR” and “F” occurred after 7 (2–14) and 8 (4–20) days, respectively (p = 0.005). The pain syndrome was significantly greater in Group “F” (p < 0.05) on days 1 and 7. Recurrence rate was in 23.9 % (11 cases) in Group “F” and in 6.5 % (3 cases) in Group “SR” (p = 0.042). Incontinence was in 7 (15.2 %) people in Group “F”, in 10 patients (21.7 %) – in Group “SR” (p = 0.591). There was no statistically significant difference in postoperative complications.Conclusion. Findings can expand the indications for the treatment of high transsphincteric anorectal fistulas involving from 1/3 to 2/3 of the sphincter complex without statistically significant risk for functional results

Long-term results of treatment of right-sided colon cancer with mesocolic excision and D3-lymph node dissection

Aim of investigation. To estimate efficacy of D3-lymph node dissection with mesocolic excision in comparison to standard surgical technique of right hemicolectomy for right colon cancer in long-term terms.Methods. Comparative analysis of the long-term results of treatment of right colon cancer at I–III stages with D2- and D3-lymph node dissections was carried out. Traditional right hemicolectomy with D2-lymph node dissection was applied in 132 patients (control group). Patients after right hemicolectomy with D3-lymph node dissection, mesocolic excision with «notouch» principles have been included to the main group (n=64). Groups were comparable by demographic and clinical features, and also by stage of local neoplastic spread.Results. Significant differences in general cumulative 5-years survival rate (69 and 86% respectively, р=0,043) and 5-years cancer-specific survival rate (91 and 71% respectively, р=0,014) have been revealed between control and main groups. Among patients with involved lymph nodes (III stage) overall 5-years survival rate after standard surgery (58%) was worse, than after right hemicolectomy with D3-lymph node dissection (83%, p=0,042). In patients with D2-lymph node dissection the involvement of regional lymph nodes was significant prognostic factor deteriorating overall 5-years survival rate (p=0,039) while at D3-lymph node dissection this factor had no effect on the prognosis (p=0,535).Conclusion. At right colon cancer of I–III stages D3-lymph node dissection is the major factor significantly improving overall 5-years survival rate. Extended lymph node dissection is the factor levelling negative prognostic effect of metastatic lymph node involvement which can be accomplished by prevention of local lymphogenic relapse of tumor

Diagnosis and Treatment of Elderly and Senile Chronic Constipation: an Expert Consensus

Aim. An appraisal of practitioners with chronic constipation management details in older and senile adults.Key points. Chronic constipation is a common issue in geriatrics. Aside to age-related physiological bowel disfunction, a higher constipation incidence is conditioned by declined physical activity and frailty, polypharmacy and a series of secondary constipation-developing chronic states and diseases. Chronic constipation is associated with a higher risk of cardiovascular disease and complications, impaired general perception of health and pain, growing alarm and depression, and reduced quality of life. The treatment tactics in chronic constipation is cause-conditioned and should account for the patient’s history and therapy line, overall clinical condition, cognitive status and functional activity level. An essential baseline aspect of constipation management is apprising the patient and his family of the underlying factors and methods for non-drug and drug correction. An higher-fibre diet is recommended as first measure, with osmotic laxatives added and titrated to clinical response if none observed towards the non-drug and high-fibre regimens. Stimulant laxatives and prokinetics should be recommended in patients reluctant to fibre supplements and osmotic laxatives. Subsidiary correction includes biofeedback, transanal irrigation, acupuncture, foot reflexology and percutaneous tibial nerve stimulation.Conclusion. Elderly and senile chronic constipation is a prevalent multifactorial state requiring an efficient management via assessment and correction of total risk factors and consistent use of non-medication and drug therapies

Follicular Occlusion Syndrome — a Possible Option of Follicular-Retension Origin of Pilonidal Sinus

Аim: to analyze and evaluate the clinical and morphological manifestations of pilonidal sinus disease (PSD) as a part of follicular occlusion syndrome (FOS).Materials and methods. In the Clinic of Coloproctology and Minimally Invasive Surgery, 80 patients with PSD underwent surgeries from November 2018 to December 2019: 62 (77.5 %) patients — with primary PSD, 18 (22.5 %) — with recurrence of the disease.Results. There were 80 patients, 6 patients (9.7 %) with primary and one (5.6 %) patient with recurrent cyst had concomitant manifestations of follicular occlusion syndrome. Thus, the frequency of combination of PSD with other variants of FOS course amounted to 8.8 %. Hidradenitis suppurativa of axillary and inguinal areas was found in 5 out of 7 patients. Acne conglobata, as one of the components of FOS, was noted in three patients. Dissecting cellulitis of the scalp was diagnosed in one patient. Follicular occlusion triad was observed in two patients. Follicular occlusion tetrad was not noted in any observation. All patients were treated with excision of the pilonidal sinus disease with local tissue-plasty of the defect. At present, no recurrences have been noted in any of the cases, and the mean follow-up time was 14 ± 5.6 months (6–27 months). PSD as a manifestation of follicular occlusion syndrome is characterized by a more cranial and more superficial location of the cavity in the sacrococcygeal region. According to the data of histologic examination of patients with FOS, the morphologic picture is identical with patients with isolated PSD. All patients with confirmed FOS have received pathogenetic local and conservative therapy. After the therapy remission of combined diseases is noted.Conclusion. Deroofing of the lining of the cavity, often used in dermatologic practice, along with complex treatment within the framework of multidisciplinary (together with a dermatologist) management of patients with FOS, looks promising

Использование интраоперационного нейромониторинга для определения вегетативных нервов малого таза при хирургическом лечении рака прямой кишки: обзор литературы и первичный опыт клиники

Introduction. Urogenital and anorectal functional disturbances associated with the pelvic autonomic nerve damage are common complications of rectal cancer surgery. the search for methods of intraoperative identification of the autonomic nerve plexus is currently one of the key tasks in modern surgery of rectal cancer. the purpose of our study is to evaluate the role of intraoperative neuromonitoring in rectal cancer surgery.Material and methods. In 2017 we performed intraoperative neuromonitoring during rectal cancer surgery in two cases. the superior hypogastric plexus and the inferior hypogastric plexus were identified and the pelvic autonomic nerve was preserved in both patients. urogenital and anorectal functional outcomes were assessed in the postoperative period.Results. Satisfactory functional outcomes in the late postoperative period and at the 12-month follow-up suggest that intraoperative neuromonitoring may be useful in identification and prevention of the pelvic autonomic nerve damage in patients with rectal cancer.Conclusion. This method would be difficult to use routinely for intraoperative identification of the autonomic nerve plexus but could be especially useful for the study of pelvic physiology. With further development, the method of intraoperative neuromonitoring could help discover a technique that will improve the surgical treatment of rectal cancer. Further research using intraoperative neuromonitoring is needed to more precisely determine its value in the preservation of urinary, anorectal and sexual function.Введение. Расстройство мочеполовых функций и анальная инконтиненция – частые осложнения хирургического лечения рака прямой кишки, которые связаны с повреждением вегетативных нервных стволов малого таза. Поиск методов интраоперационной идентификации вегетативных нервных сплетений – одна из задач современной хирургии рака прямой кишки.Цель исследования – оценить возможности интраоперационного нейромониторинга при хирургическом лечении рака прямой кишки.Материал и методы. В 2017 г. на базе клиники проведены 2 операции по поводу рака прямой кишки с интраоперационным нейромониторингом. Во время операций идентифицированы поясничные внутренностные нервы, гипогастральные нервы, нижние гипогастральные сплетения, выполнен запланированный объем оперативного лечения с сохранением элементов вегетативной нервной системы. В послеоперационном периоде проводилась оценка функционального состояния мочеполовой сферы, анальной континенции, пациентам проводились периодические исследования в соответствии с программой мониторинга колоректального рака.Результаты. Удовлетворительные функциональные результаты в позднем послеоперационном периоде и через 12 мес наблюдения позволяют говорить о том, что интраоперационный нейромониторинг при резекциях прямой кишки может быть использован для идентификации и предотвращения повреждения вегетативных нервных сплетений малого таза у пациентов с диагностированным раком прямой кишки.Заключение. В качестве интраоперационного метода определения вегетативных нервных сплетений данный метод в настоящее время сложно рассматривать как основной, но он имеет перспективы с точки зрения изучения физиологии малого таза. При дальнейшем развитии интраоперационного нейромониторинга можно будет получить методику, совершенствующую технические приемы оперативного лечения рака прямой кишки. Необходимо продолжить исследования с использованием интраоперационного нейромониторинга и определить его значение для сохранения мочевой, аноректальной и половой функций

General Terminology Induction in OWL

Abstract. Automated acquisition, or learning, of ontologies has attracted re-search attention because it can help ontology engineers build ontologies and give domain experts new insights into their data. However, existing approaches to on-tology learning are considerably limited, e.g. focus on learning descriptions for given classes, require intense supervision and human involvement, make assump-tions about data, do not fully respect background knowledge. We investigate the problem of general terminology induction, i.e. learning sets of general class in-clusions, GCIs, from data and background knowledge. We introduce measures that evaluate logical and statistical quality of a set of GCIs. We present methods to compute these measures and an anytime algorithm that induces sets of GCIs. Our experiments show that we can acquire interesting sets of GCIs and provide insights into the structure of the search space.

Ontology Design Patterns for bio-ontologies: a case study on the Cell Cycle Ontology

<p>Abstract</p> <p>Background</p> <p>Bio-ontologies are key elements of knowledge management in bioinformatics. Rich and rigorous bio-ontologies should represent biological knowledge with high fidelity and robustness. The richness in bio-ontologies is a prior condition for diverse and efficient reasoning, and hence querying and hypothesis validation. Rigour allows a more consistent maintenance. Modelling such bio-ontologies is, however, a difficult task for bio-ontologists, because the necessary richness and rigour is difficult to achieve without extensive training.</p> <p>Results</p> <p>Analogous to design patterns in software engineering, Ontology Design Patterns are solutions to typical modelling problems that bio-ontologists can use when building bio-ontologies. They offer a means of creating rich and rigorous bio-ontologies with reduced effort. The concept of Ontology Design Patterns is described and documentation and application methodologies for Ontology Design Patterns are presented. Some real-world use cases of Ontology Design Patterns are provided and tested in the Cell Cycle Ontology. Ontology Design Patterns, including those tested in the Cell Cycle Ontology, can be explored in the Ontology Design Patterns public catalogue that has been created based on the documentation system presented (<url>http://odps.sourceforge.net/</url>).</p> <p>Conclusions</p> <p>Ontology Design Patterns provide a method for rich and rigorous modelling in bio-ontologies. They also offer advantages at different development levels (such as design, implementation and communication) enabling, if used, a more modular, well-founded and richer representation of the biological knowledge. This representation will produce a more efficient knowledge management in the long term.</p

A Goal-Directed Decision Procedure for Hybrid PDL

We present the first goal-directed decision procedure for hybrid PDL. The procedure is based on a modular approach that scales from basic modal logic with eventualities to hybrid PDL. The approach is designed so that nominals and eventualities are treated orthogonally. To deal with the complex programs of PDL, the approach employs a novel disjunctive program decomposition. In arguing the correctness of our approach, we employ the novel notion of support generalizing the standard notion of Hintikka sets

Perioperative management and anaesthetic considerations in pelvic exenterations using Delphi methodology: Results from the PelvEx Collaborative

Background: The multidisciplinary perioperative and anaesthetic management of patients undergoing pelvic exenteration is essential for good surgical outcomes. No clear guidelines have been established, and there is wide variation in clinical practice internationally. This consensus statement consolidates clinical experience and best practice collectively, and systematically addresses key domains in the perioperative and anaesthetic management. Methods: The modified Delphi methodology was used to achieve consensus from the PelvEx Collaborative. The process included one round of online questionnaire involving controlled feedback and structured participant response, two rounds of editing, and one round of web-based voting. It was held from December 2019 to February 2020. Consensus was defined as more than 80 per cent agreement, whereas less than 80 per cent agreement indicated low consensus. Results: The final consensus document contained 47 voted statements, across six key domains of perioperative and anaesthetic management in pelvic exenteration, comprising preoperative assessment and preparation, anaesthetic considerations, perioperative management, anticipating possible massive haemorrhage, stress response and postoperative critical care, and pain management. Consensus recommendations were developed, based on consensus agreement achieved on 34 statements. Conclusion: The perioperative and anaesthetic management of patients undergoing pelvic exenteration is best accomplished by a dedicated multidisciplinary team with relevant domain expertise in the setting of a specialized tertiary unit. This consensus statement has addressed key domains within the framework of current perioperative and anaesthetic management among patients undergoing pelvic exenteration, with an international perspective, to guide clinical practice, and has outlined areas for future clinical research