Banning psychoactive substances is not enough, we need education too.

© 2016 The Conversation Trust (UK) Limite

Flap fixation in preventing seroma formation after mastectomy: an updated meta-analysis

Seroma formation following mastectomy is one of the most experienced complications, with a very variable incidence ranging from 3 to 90%. In recent years, many publications have been realized to define an effective technique to prevent its formation and several approaches have been proposed. Given the potential of flap fixation in reducing seroma formation, we performed a meta-analysis of the literature to investigate the role of this approach as definitive gold standard in mastectomy surgery. Inclusion criteria regarded all studies reporting on breast cancer patients undergoing mastectomy with or without axillary lymph node dissection; studies that compared mastectomy with flap fixation to mastectomy without flap fixation were selected. Papers were eligible for inclusion if outcome was described in terms of seroma formation. As secondary outcome, also surgical site infection (SSI) was evaluated. The included studies were 12, involving 1887 female patients: 221/986 (22.41%) patients experienced seroma formation after flap fixation and 393/901 (43.61%) patients had this complication not receiving flap fixation, with a significant statistical difference between the two groups (OR = 0.267, p = 0.001, 95% CI 0.153, 0.464). About, SSI 59/686 (8.6%) in flap fixation group and 67/686 (9.7%) in patients without flap fixation, with no statistical differences between groups (OR = 0.59, p = 0.056, 95% CI 0.344, 1.013). The heterogeneity between included studies does not allow us to reach definitive conclusions but only to suggest the strong evaluation of this approach after mastectomy in seroma preventing and SSI reduction

Sentinel node biopsy and radical lymph node dissection for advanced melanoma in the elderly

Articolo presente su PubMed Central. Sourcerecord Id Scopus: 28558 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194399/ Background.The majority of indications for surgery in melanoma are for the treatment of primary tumor and lymph node metastases. During the last decade, the Sentinel Node Biopsy (SNB), from a research procedure, has become standard of care in most institutions. SNB is normally considered for patients with melanoma > 1 mm and generally about 20% are positive; however, the risk of a positive SNB in a melanoma < 1 mm is still 5%. Usually when SNB is positive a complete lymphadenectomy is performed. Materials and methods.In the period 2004-2009, 18 elderly patients (median age 68 years) affected by cutaneous melanoma (mean Breslow’s thickness = 3.77 mm), after SNB histologically confirmed regional lymph node involvement, underwent complete lymph node dissection (CLND). We treated 11 of them with groin dissection, in 3 cases bilateral; 4 patients underwent axillar dissection, in one case bilateral; 2 patients underwent neck dissection and another patient underwent groin-axillar dissection. We treated bilateral groin involvement with laparoscopic access for dissection of lumbar-aortic, iliac and obturator lymph nodes. Results.Disagreeing with literature, 12/18 (67%) of these patients had positive lymph nodes, a high percentage if compared with younger patients’ data. Currently the average follow-up is 25 months. In our sample CLND has a crucial prognostic role (16% vs 41% of deceased in CLND – and CLND + patients respectively). Conclusions.Elderly melanoma patients are characterized by a higher tumor stage and, in patients with nodal metastases, the prognosis is independently affected by older age. In case of positive SNB the CLND plays a notable prognostic role and a presumable therapeutic role

Une nouvelle condition d'independance pour le theoreme de la limite centrale

We prove a central limit theorem with aassumptions which are many weak than classical condition

Men’s health – the impact of stroke

Stroke is a leading cause of adult death and the most common cause of complex disability in the UK. This article discusses the incidence and impact of stroke, focusing on a range of issues from a male perspective, including stroke prevention, psychological needs, sexuality and return to work. There are some gender differences in modifiable risk factors for stroke, and women have better knowledge of stroke symptomatology. For men, the development of post-stroke depression is associated with greater physical disability. (c) Sherborne Gibbs Limite

Entanglement Entropy In Excited States

Negli ultimi anni l’entropia di entaglement è stata ampiamente studiata nel campo dell‘integrabilità. Con l‘introduzione del modello a replica è stato possibile portare alla luce le proprietà universali dell’ entropia di entanglement di un sistema bipartito nello stato di vuoto. In questa tesi si è investigato il problema dell’entropia di entanglement di un sistema bipartito in uno stato eccitato di singola particella. In particolare, si è considerata una teoria bosonica libera in un volume finito, in modo da sfruttare al meglio le tecniche dell‘integrabilità. Nel corso di questa analisi, è stato possibile rielaborare il modello a replica in un volume finito grazie ad un raddoppiamento della teoria bosonica che ha indotto una simmetria U(1) su ogni copia del modello. Tale tecnica, nota in letter- atura come doubling trick ha permesso di ricondurre il calcolo dell’entropia di Renyi a un’opportuna espansione in form factors dei campi U(1) implementanti tale simmetria e valutarne il contributo dominante nel limite in cui il volume è grande. I risultati ottenuti per la Second Rènyi entropy mostrano che in tale limite, l’eccesso di entanglement dovuto allo stato eccitato rispetto a quello di vuoto è indipendente dall’energia dello stato stesso e può essere interpretato come quantità che misura l’incertezza sulla localizzazione dell’eccitazione nelle due parti di cui è composto il sistema