Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Consumers’ perceptions on complexity and prospects of ethical luxury: qualitative insights from Taiwan

This qualitative study explores ethical luxury in Taiwan, a country that represents a significant demographic in the luxury market. The study utilized the ZMET technique and focus groups. A total of 28 heavy users of luxury brands were interviewed. Results indicate that luxury brands are chiefly defined by such constructs as price, quality and aesthetical attributes, whereas ethicality is centrally demarcated by human wellbeing, the environment and animal welfare, amongst other elements. The fusion of these two concepts implies several encouraging outlooks and certain deterring factors. Results denote that there is potential for ethical luxury's inception in the Taiwanese market, but with considerable forethought in the process. This study extends the body of knowledge in how consumers perceive the prospect of ethical luxury, especially from a non-western perspective

Detection of adulteration of olive oil with seed oils by a combination of column and gas liquid chromatography

Samples of virgin olive oil and refined seed oils, as well as mixtures of olive oil with 10 and 5% seed oils were fractionated by column chromatography on silicic acid impregnated with ammoniacal silver nitrate. It was possible to isolate a characteristic fraction enriched in polyunsaturated triglycerides. Its linoleic acid content in pure olive oil never exceeds 9.3%, whereas in pure seed oils, it varies between 38.1 and 70.1%; in mixtures of olive oil with 10 and 5% of seed oils, the respective values are 22.3-38.2% and 15.6-32.1%. The oleic-to-linoleic acid ratios of the same fraction are more than 7.6 (olive oil), 0.2-0.8 (seed oils), 1.1-2.0 (olive oil with 10% seed oils) and 1.4-3.6 (olive oil with 5% seed oils). These analytical values may be used as a safe criterion for the eventual adulteration of olive oil with seed oils. © 1981 American Oil Chemists' Society

Isolation and complete separation of lipids from natural sources

A method of isolation and complete separation of lipids from natural sources into classes and species is reported which combines our previously published techniques with new techniques described in this article for the first time. Pigments are separated from crude total lipid extracts with two successive TLC systems: a) petroleum ether/benzene/glacial acetic acid (30:70:2) and b) acetone/methanol/water (40:20:1). Pigment-free total lipids are separated on a silicic acid column into neutral, glyco- and phospholipids. Neutral, glyco- and phospholipids are separated into classes and species by suitable HPLC methods