Special lagrangian fibrations on flag variety F3F^3

One constructs lagrangian fibrations on the flag variety $F^3$ and proves that the fibrations are special.Comment: 19 page

Кишечный кольпопоэз

Secţia ginecologie chirurgicală, IMSP Institutul Mamei şi Copilului, Catedra chirurgie generală semiologie nr. 3, IP USMF „Nicolae Testemiţanu”, Laboratorul chirurgie „Hepato-Pancreato-Duodenală” IP USMF „Nicolae Testemiţanu”, IMSP Institutul OncologicIn the article is described one of the surgical procedures for vaginal agenezis – bowel colpopoezis. The authors describe historical data of bowel colpopoezis, indications, principles of surgical techniques, advantages and disadvantages of the method.В статье описан один из методов хирургического лечения агенезии влагалища – кишечный кольпопоэз. Авторы приводят исторические данные о кишечном кольпопоэзе, показания, принципы хирургического лечения, преимущества и недостатки данного метода

The observation of a family with hereditary nonpolyposis colorectal cancer for 30 years

Institutul Oncologic, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Sindroamele ereditare reprezintă de la 5% la 10% cazuri din cancerul colorectal. Unul dintre acestea este sindromul bine definit de cancer colorectal nonpolipozic ereditar (CCNPE). Scopul: De a studia spectrul de incidenţă a tumorilor maligne în rîndul persoanelor de primul și al doilea grad de rudenie a probandului cu sindromul de CCNPE. Material şi metode: Studiul a cuprins 101 persoane cu primul şi al doilea grad de rudenie a probandului cu sindrom de CCNPE. Au fost studiate incidenţa cancerului colorectal printre aceştia, numărul şi localizarea tumorilor, managementul chirurgical. Rezultate: Printre cele 101 rude de primul și al doilea grad tumori maligne au fost depistate în 13 cazuri (12,9%). În familie au fost relevate 30 de tumori maligne, dintre care 23 cu afectarea colonului. La 9 rude (8,9%) au fost neoplasme primare multiple (NPM): cîte 2 tumori – la 4 rude, cîte 3 tumori – la 3 rude, 4 tumori – la 1 rudă şi 5 tumori – la 1 rudă. Din cele 26 tumori depistate la aceştia – 19 cu localizare în colon (8 – hemicolonul drept), altele 7 – în afara intestinului (tumori extracolice). Toate rudele cu cancer au fost supuse tratamentului chirurgical. Trei pacienţi cu cancer colorectal primar multiplu au suportat colectomie subtotală şi 1 – colectomie totală. Concluzii: Se impune monitorizarea activă a rudelor pacienţilor cu CCNPE, cu scopul de a depista posibila apariţie a cancerului colorectal la aceştia şi a tumorilor extracolice asociate la un stadiu precoce, ce ar duce, fără îndoială, la un tratament mai eficient.Introduction: Hereditary syndromes range 5% to 10% of cases of colorectal cancer. One of them is well defined syndrome, hereditary non-polyposis colorectal cancer (HNPCC). Aim: To study the spectrum of accumulation of malignant neoplasms among the first- and second-degree relatives of the proband with the HNPCC syndrome. Material and methods: The study included 101 people with first- and second-degree kinship of the proband with HNPCC syndrome. We studied the incidence of colorectal cancer among these persons, the number and location of the tumors, surgical management. Results: Among the 101 first- and second-degree relatives malignant tumors were found in 13 (12.9%). 30 malignant tumors were revealed in the family, 23 of them with colon impairment. 9 relatives (8.9%) had multiple primary neoplasms (MPN): by 2 tumors were detected in 4 relatives, by 3 tumors – 3 relatives, 4 tumors – 1 person and 1 relative with 5 tumors. Of the 26 tumors detected in them – 19 had colon localization (8 – right hemicolon), 7 others had extra-intestinal location. All relatives with cancer underwent surgical treatment. Three patients with primary multiple colorectal cancer – subtotal colectomy and 1 – total colectomy. Conclusions: A dynamic monitoring of the relatives of patients with HNPCC is recomanded, in order to detect possible occurrence of colorectal cancer and associated extra-intestinal tumors at an early stage, which would undoubtedly lead to more effective treatment

Oncology-led early identification of nutritional risk: a pragmatic, evidence-based protocol (PRONTO)

Simple Summary Early identification of patients on antineoplastic therapy who are at risk for or already malnourished is critical for optimizing treatment success. Malnourished patients are at increased risk for being unable to tolerate the most effective 'level' and 'duration' of treatment, with grave implications for both the short- (during treatment) and long-term outcomes. Herein, we provide a practical PROtocol for NuTritional risk in Oncology (PRONTO) to enable oncologists to identify patients with or at risk of malnutrition for further evaluation and follow-up with members of the multidisciplinary care team (MDT). Additional guidance is included on the oncologist-led provision of nutritional support if referral to a dietary service is not available. Nutritional issues, including malnutrition, low muscle mass, sarcopenia (i.e., low muscle mass and strength), and cachexia (i.e., weight loss characterized by a continuous decline in skeletal muscle mass, with or without fat loss), are commonly experienced by patients with cancer at all stages of disease. Cancer cachexia may be associated with poor nutritional status and can compromise a patient's ability to tolerate antineoplastic therapy, increase the likelihood of post-surgical complications, and impact long-term outcomes including survival, quality of life, and function. One of the primary nutritional problems these patients experience is malnutrition, of which muscle depletion represents a clinically relevant feature. There have been recent calls for nutritional screening, assessment, treatment, and monitoring as a consistent component of care for all patients diagnosed with cancer. To achieve this, there is a need for a standardized approach to enable oncologists to identify patients commencing and undergoing antineoplastic therapy who are or who may be at risk of malnutrition and/or muscle depletion. This approach should not replace existing tools used in the dietitian's role, but rather give the oncologist a simple nutritional protocol for optimization of the patient care pathway where this is needed. Given the considerable time constraints in day-to-day oncology practice, any such approach must be simple and quick to implement so that oncologists can flag individual patients for further evaluation and follow-up with appropriate members of the multidisciplinary care team. To enable the rapid and routine identification of patients with or at risk of malnutrition and/or muscle depletion, an expert panel of nutrition specialists and practicing oncologists developed the PROtocol for NuTritional risk in Oncology (PRONTO). The protocol enables the rapid identification of patients with or at risk of malnutrition and/or muscle depletion and provides guidance on next steps. The protocol is adaptable to multiple settings and countries, which makes implementation feasible by oncologists and may optimize patient outcomes. We advise the use of this protocol in countries/clinical scenarios where a specialized approach to nutrition assessment and care is not available

РАК ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ И НАСЛЕДСТВЕННЫЕ СИНДРОМЫ

The aim of this study is to assess relative risk of prostate cancer (PC) and other tumors in families of patients with multiple primary malignancies (MPM) and the syndrome of hereditary nonpolyposis colorectal cancer (HNPCC). The study is based on data from the cancer register of families that includes information on 560 patients with MPM, 126 families with HNPCC and their first-degree relatives. Incidence of these diseases in population served as the control.Among 560 probands with PPN 217 (38.7%) were male and 343 (61.3%) – female. Only 12 (2.1%) male patients had tumor in the prostate. In these patients 24 tumors were identified. Two patients had synchronous tumors, other ten patients had metachronous. Eight patients with prostate cancer had tumors of other organs: 5 – in rectum, 2 – in colon and 1 – in bladder. As a second tumor prostate cancer was diagnosed in 4 patients, three of them had rectal cancer and one – colon cancer. Only 2 (0.3%) patients had prostate cancer as a primary tumor. Clinical and genealogical information achieved from 543 patients with MPM, including in 206 male probands. Among 3637 first-degree relatives of probands with MPM prostate cancer was diagnosed in 2  (0.11±2.3%) patients that was 1.7 times higher than in population (0.063±0.0019%). The relative risk of prostate cancer for relatives of patients from families with HNPCC syndrome was 0.8 ± 6.3% that was 12/7 times higher than  in the control group (p <0.05). The estimation of the relative risk in families of male probands was perfprmed. Among 1460 male relatives with MPM only 1 (0.14%) case of prostate cancer was diagnosed (son of proband). Among 42 families of male probands with HNPCC syndrome, prostate cancer was detected in 2 (1.3%) brothers that exceeds population risk 20.6 times. Although the molecular mechanisms and pathogenesis of prostate cancer in such families is unknown, its association with a HNPCC-syndrome and possibly MPM-syndrome is obvious.Higher relative risk of developing prostate cancer for male relatives of probands with MPM and HNPCC syndrome presupposes inherited genetically determined predisposition to disease development. Further molecular and genetic studies are needed to determine the genetic basis of predisposition to prostate cancer in these families.Цель исследования — оценить относительный риск рака предстательной  железы (РПЖ) и других (внепростатных)  опухолей в семьях больных с первично-множественными  злокачественными  новообразованиями   (ПМЗН) и с синдромом  наследственного неполипозного колоректального рака (HNPCC). Материалом для исследования  послужили данные регистра раковых семей,  включающий сведения  о 560 больных с ПМЗН, 126 семей с HNPCC и их родственников первой степени родства.  В качестве контроля служили популяционные частоты указанных заболеваний.Среди 560 пробандов с ПМЗН было 217 (38.7%) мужчин и 343 (61.3%)  женщин. Только у 12 (2.1%) пациентов-мужчин одна из опухолей поражала  ПЖ. У них выявлены 24 опухоли. У двух  из них опухоли были синхронными, а у 10 — метахронными. У 8 пациентов с РПЖ вторые опухоли локализовались:  в прямой кишке (5), ободочной кишке (2) и мочевом  пузыре (1). В качестве  второй опухоли РПЖ наблюдали  у 4 пациентов:  у 3 с раком прямой кишки и у 1 — раком ободочной  кишки. Только у 2 (0.3%) пациентов первой опухолью был РПЖ. Клинико-генеалогические  сведения  удалось  получить у 543 пациентов  с ПМЗН, в том числе у 206 пробандов-мужчин.  Среди 3637 родственников первой степени родства пробандов с ПМЗН РПЖ выявлен  у 2 (0.11±2.3%), что в 1.7 раза превышает популяционный риск (0.063±0.0019%). Относительный  риск РПЖ для родственников  пациентов  из семей с синдромом  HNPCC составляет 0.8±6.3% и превышает таковой в контрольной  группе в 12.7 раз (р<0.05).  Проведена оценка относительного риска в семьях пробандов-мужчин. Среди 1460 родственников-мужчин с ПМЗН выявлен 1 (0.14%) случай РПЖ — у сына. В 42 семьях пробандов-мужчин  с синдромом  HNPCC РПЖ был выявлен у 2 (1.3%) братьев,  что превышает популяционный риск в 20.6 раза. Хотя молекулярный  механизм  и патогенез  РПЖ в описанных семьях остается неизвестным, его ассоциация с синдромом  HNPCC и, возможно, с синдромом полинеоплазий, очевидна. Высокий относительный риск заболеть  РПЖ для кровных родственников-мужчин пробандов с ПМЗН и синдромом  HNPCC предполагает наличие унаследованной генетически обусловленной предрасположенности  к развитию болезни.  Необходимы молекулярно-генетические исследования,  чтобы определить  генетическую основу подверженности к раку предстательной  железы в этих семьях. Не исключено, что это может быть связано с общими этиологическими факторами

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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised