Long-term results of randomized studies on the use of a gentamicin-collagen sponge in rectal cancer – depending on the length of time between the completion of radiotherapy and the surgery

Introduction. Two randomized studies on the use of a gentamicin-collagen sponge (GRM01/1997 and GRM02/2007) in rectal cancer surgery showed a statistically significant decrease in the rate of distant metastases in the experimental group and a similar rate of local recurrences. The objective of the presented study was a retrospective evaluation of the effect of the GRM use on the observed rate of generalized recurrences, disease-free survival (DFS), overall survival (OS) and cancer-specific survival (CSS) – depending on the length of the interval between radiotherapy and surgery. Materials and methods. The study comprised 239 patients, included previously into randomized studies, in whom the 5 x 5 Gy radiotherapy was used. In 204 people, the surgery was made within 7 days of the completion of radiotherapy (group A). The remaining group of 35 patients were operated on after 4–8 weeks (group B). The follow-up period was 5 years. The statistical analysis was made with the Kaplan-Meier test. The value of α = 0.05 was degfined as the threshold of statistical significance. Results. In both groups, there were no statistical differences between the patients operated on with the use of GRM and those operated on without the use of GRM. The analysis took into consideration the most significant parameters, which could affect the oncological results, (ypTNM, lympho-vascular invasion (LVI), blood vessel invasion (BVI). In group A, the use of GRM was connected with a lower rate of metachronic distant metastases (p = 0.002; RR 0.41; 95% CI [0.24–0.72]), the prolongation of DFS (p = 0.008; HR 2.16; 95% CI [1.20–3.83]) and of CSS (p = 0.010; HR 2.37; 95% CI [1.20–4. 67]). No such relationships were observed in group B. Conclusions. The use of GRM decreases the risk of distant metastases and has an influence on the prolongation of recurrence free survival, but only when surgery is carried out within 7 days of the completion of irradiation.Cel: W dwóch randomizowanych badaniach nad zastosowaniem gąbki kolagenowej z gentamycyną (GRM) w chirurgii raka odbytnicy wykazano istotne statystycznie zmniejszenie odsetka przerzutów odległych w grupie eksperymentalnej i podobny odsetek wznów miejscowych. Celem prezentowanego badania była retrospektywna ocena wpływu zastosowania GRM na obserwowany odsetek nawrotów uogólnionych, czas przeżycia wolnego od nawrotu (DFS), przeżycia całkowitego (OS) i zależnego od choroby (CSS), w zależności od długości przerwy pomiędzy radioterapią a operacją. Metoda: Do badania włączono 239 chorych włączonych uprzednio do badań randomizowanych, u których zastosowano radioterapię 5x5Gy. U 204 chorych operacje wykonano w okresie do 7 dni od zakończenia radioterapii (Grupa A), Pozostałych 35 chorych operowanych było po upływie 4-8 tygodni (Grupa B). Czas obserwacji wynosił 5 lat. W analizie statystycznej użyto test Kaplan-Meier’a. Za poziom istotności statystycznej uznawano wartość α=0.05. Wyniki: W obu grupach nie było istotnie statystycznie różnic pomiędzy chorymi operowanymi z użyciem GRM bądź bez, biorąc pod uwagę najistotniejsze parametry mogące rzutować na wyniki onkologiczne (ypTNM, inwazja naczyń chłonnych -LVI, inwazja naczyń krwionośnych). W grupie A zastosowanie GRM wiązało się z mniejszym odsetkiem metachronicznych przerzutów odległych (p=0,002 RR 0,41 (95%CI [0,24-0,72]), wydłużeniem DFS (p=0,008 HR 2,16; 95%CI [1,20-3,83]) i CSS (p=0,010 HR 2,37; 95%CI [1,20-4,67]). Podobnych zależności nie stwierdzono w grupie B. Wnioski: Zastosowanie preparatu GRM przynosi korzyść w postaci zmniejszenia ryzyka przerzutów odległych i wydłużenia czasu wolnego od nawrotu choroby tylko w przypadku, gdy zabieg operacyjny wykonywany jest do 7 dni od zakończenia napromieniania

Metastatic tumors of pancreas — whether and when surgical intervention is gainful for diseased people. Retrospective analysis of data from three surgery centers

Introduction. Metastatic tumors in the pancreas constitute a small (2–5%), but steadily growing percentage of all neoplasms of this organ. The aim of the study was to analyze the surgical treatment of metastases in the pancreas, in particular its effectiveness and the risk of surgical complications. Material and methods. The retrospective analysis was performed on 21 patients treated surgically in three surgical centers. This group included 16 women (76%) and 5 men (24%). The median age at the time of diagnosis of the underlying disease was 55.5 years (41–71). We analyzed the location of secondary lesions, their size, number, type and radicality of surgical intervention, histopathological diagnosis of the disease, as well as the occurrence of postoperative complications. Results. The starting point for metastatic lesions in 16 patients (76%) was renal cell carcinoma (RCC), in other cases — skin melanoma, eyeball melanoma, adenocarcinoma of the rectum, non-small-cell bronchi carcinoma. R0 radical surgery was performed in 15 patients (74%) and perioperative mortality was 5% (1 patient died). The median total survival time was 151 months (10–342), with 168 months for RCC (25–344) and 62 months for the remaining cancers (10–241). Conclusions. The main factor that determines the patient’s future fate is the type of primary neoplasm and surgical treatment of metastatic tumors in the pancreas is the best solution for selected RCC cases

Guzy przerzutowe trzustki — czy i kiedy leczenie operacyjne jest korzystne dla chorego. Analiza retrospektywna materiału trzech ośrodków chirurgicznych

Wstęp. Guzy przerzutowe trzustki stanowią niewielki (2–5%), ale stale rosnący, odsetek wszystkich nowotworów tego narządu. Celem pracy była analiza leczenia operacyjnego przerzutów nowotworowych do trzustki, w szczególności jego skuteczności i ryzyka powikłań chirurgicznych. Materiał i metody. Analizie retrospektywnej poddano 21 chorych leczonych operacyjnie w trzech ośrodkach chirurgicznych. W tej grupie znajdowało się 16 kobiet (76%) i 5 mężczyzn (24%). Mediana wieku chorych w chwili rozpoznania choroby podstawowej wyniosła 55,5 roku (41–71). Przeanalizowano lokalizację zmian wtórnych, ich wielkość, liczbę, typ oraz radykalność interwencji chirurgicznej, rozpoznanie histopatologiczne choroby, a także wystąpienie powikłań pooperacyjnych. Wyniki. Punktem wyjścia zmian przerzutowych u 16 chorych (76%) był rak nerkowokomórkowy nerki (renal cel carcinoma, RCC), w pozostałych przypadkach — czerniak skóry, czerniak gałki ocznej, rak gruczołowy odbytnicy, rak niedrobnokomórkowy oskrzela. Operację o radykalności R0 udało się wykonać u 15 chorych (74%), a śmiertelność okołooperacyjna wynosiła 5% (zmarł 1 chory). Mediana całkowitego czasu przeżycia wynosiła 151 miesięcy (10–342), przy czym dla RCC było to 168 miesięcy (25–344), a dla pozostałych nowotworów 62 miesiące (10–241). Wnioski. Głównym czynnikiem, który determinuje dalszy los chorego, jest rodzaj nowotworu pierwotnego, a leczenie operacyjne guzów przerzutowych trzustki jest najlepszym rozwiązaniem dla wyselekcjonowanych przypadków RCC

AVONET: morphological, ecological and geographical data for all birds

Functional traits offer a rich quantitative framework for developing and testing theories in evolutionary biology, ecology and ecosystem science. However, the potential of functional traits to drive theoretical advances and refine models of global change can only be fully realised when species‐level information is complete. Here we present the AVONET dataset containing comprehensive functional trait data for all birds, including six ecological variables, 11 continuous morphological traits, and information on range size and location. Raw morphological measurements are presented from 90,020 individuals of 11,009 extant bird species sampled from 181 countries. These data are also summarised as species averages in three taxonomic formats, allowing integration with a global phylogeny, geographical range maps, IUCN Red List data and the eBird citizen science database. The AVONET dataset provides the most detailed picture of continuous trait variation for any major radiation of organisms, offering a global template for testing hypotheses and exploring the evolutionary origins, structure and functioning of biodiversity

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Méthodes et modèles pour l'évaluation des conséquences de la rupture d'une structure en béton armé sous l'action d'un souffle

Ce travail est consacré à l'étude des différentes étapes du processus engendré par l'explosion et les effets mécaniques qu'elle produit. Pour ce faire, on caractérise : l'onde de pression issue d'une détonation en milieu aérien, l'espace d'expansion du champ de pression et son interaction avec une structure, les lois de comportement des matériaux et leur représentation dans les codes numériques. Des équations empiriques conçues pour prévoir les charges issues de détonations dans un milieu libre et confiné sont validées. La pertinence d'une hypothèse concernant les valeurs de la pression réfléchie d'un mur rigide lors d'une explosion est analysée. En outre, on propose un modèle simplifié du comportement de béton basé sur des contraintes équivalentes prenant en compte des modifications des propriétés mécaniques au cours des déformations. La comparaison des résultats numériques de calcul d'une plaque en béton armé soumise à une onde de choc est présentée via différents modèles constitutifs du béton.ORLEANS-BU Sciences (452342104) / SudocSudocFranceF

Validation de logiciels de calcul de couplage structure-explosion

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