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Special operations

Hanlu Zhang, Longqi Chen, Yingcai Geng, Yu Zheng, Yun Wang
Thoracoscopic intrathoracic esophagogastrostomy is a technically demanding operation; these technical requirements restrict the extensive application of minimally invasive Ivor Lewis esophagectomy. In an attempt to reduce the difficulty of this surgical procedure, we developed a modified anastomotic technique for thoracolaparoscopic Ivor Lewis esophagectomy. During the entirety of this modified approach, neither technically challenging operations such as intrathoracic suturing, or knotting, nor special instruments such as an OrVil system or a reverse-puncture head are required...
October 21, 2016: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
Yu Sun, Jesper Østergaard
Efficient drug delivery is dependent on the drug substance dissolving in the body fluids, being released from dosage forms and transported to the site of action. A fundamental understanding of the interplay between the physicochemical properties of the active compound and pharmaceutical excipients defining formulation behavior after exposure to the aqueous environments and pharmaceutical performance is critical in pharmaceutical development, manufacturing and quality control of drugs. UV imaging has been explored as a tool for qualitative and quantitative characterization of drug dissolution and release with the characteristic feature of providing real-time visualization of the solution phase drug transport in the vicinity of the formulation...
October 20, 2016: Pharmaceutical Research
Ryan C Shelstad, Justin G Reeves, Katsuhiro Yamanaka, T Brett Reece
We review the operative techniques of aortic arch replacement. Aortic arch replacement presents several formidable challenges, as it requires arresting the circulation to the body and replacement of the brachiocephalic vessels with special consideration for protecting the central nervous system. Perfusion strategies, selective antegrade cerebral perfusion, and operative graft selection are key elements in aortic arch replacement surgery. Standard approaches include the island technique, the branched graft technique, and the "Spielvogel" trifurcated graft technique-each having its own advantages...
October 7, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
S L Lu
Experienced over twenty years of theoretical accumulation and ten years of clinical exploration, wound repair speciality in our country is in the phase of enhancing comprehensive ability. Our wound healing experts team has successfully carried out treatment of suspected bacterial weapon related chronic wounds, which lasted up to more than 70 years, through multilateral cooperation. We summarized the surgical program of wound fibrous tissue removal and scalp as donor sites for long-term non-healing wounds in the elderly...
October 20, 2016: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
Carlos F Cáceres, Annick Borquez, Jeffrey D Klausner, Rachel Baggaley, Chris Beyrer
BACKGROUND: In this article, we present recent evidence from studies focused on the implementation, effectiveness and cost-effectiveness of pre-exposure prophylaxis (PrEP) for HIV infection; discuss PrEP scale-up to date, including the observed levels of access and policy development; and elaborate on key emerging policy and research issues to consider for further scale-up, with a special focus on lower-middle income countries. DISCUSSION: The 2015 WHO Early Release Guidelines for HIV Treatment and Prevention reflect both scientific evidence and new policy perspectives...
2016: Journal of the International AIDS Society
Jordi Gratacos-Masmitja, Jesus Luelmo-Aguilar, Pedro Zarco-Montejo, Rafael Botella-Estrada, Ana Maria Carrizosa-Esquivel, Maria Luz Garcia-Vivar, Silvia Perez-Barrio, Jose Antonio Roman-Ivorra, Maria Dolores Ruiz-Montesino, Jose Luis Lopez-Estebaranz
INTRODUCTION: In numerous clinical practice guidelines, emphasis is placed on the need for coordinated care of psoriatic arthritis (PsA) between rheumatologists and the objective was to develop experience-based points to consider facilitating the implementation of multidisciplinary units (Dermatology/Rheumatology) for the management of patients with PsA. METHODS: A scientific committee of rheumatology and dermatology experts in the management of PsA, and with experience in joint care, discussed the critical aspects of multidisciplinary PsA Units...
October 18, 2016: Advances in Therapy
J Labenz
Barrett's esophagus is an endoscopically visible metaplasia of the columnar epithelium in the esophagus with histological detection of a specialized intestinal metaplasia. The circumferential and longitudinal extent are described endoscopically using the Prague classification. Barrett's esophagus mostly occurs as the result of gastroesophageal reflux disease. The risk of developing esophageal adenocarcinoma is increased but the absolute risk is low with 0.10-0.15 % per year. According to guideline recommendations, screening for Barrett's esophagus as well as endoscopic and biopsy surveillance should be limited to high risk groups...
October 18, 2016: Der Internist
Marie-Josée Fleury, Guy Grenier, Catherine Vallée, Denise Aubé, Lambert Farand, Jean-Marie Bamvita, Geneviève Cyr
BACKGROUND: This study evaluates implementation of the Quebec Mental Health (MH) Reform (2005-2015) which aimed to improve accessibility, quality and continuity of care by developing primary care and optimizing integrated service networks. Implementation of MH primary care teams, clinical strategies for consolidating primary care, integration strategies to improve collaboration between primary care and specialized services, and facilitators and barriers related to these measures were examined...
October 18, 2016: BMC Health Services Research
Ning Ma, Yang Qun Li, Yong Tang, Wen Chen, Zhe Yang, Mu Xin Zhao, Wei Xin Wang, Li Si Xu, Jun Feng
Resurfacing large facial defect is a continuing challenge for plastic surgeons. Skin graft or free flap is hard to obtain satisfactory results or is beyond the skill of most surgeons. The authors performed 13 expended submental island flaps to resurface middle and lower facial defects and achieved satisfactory results. In the first stage operation, the authors implanted one soft tissue expander in the anterior neck region which was expanded over an average of 3 months. In the second stage operation, the authors elevated the expanded submental island flap to resurface facial defect...
October 14, 2016: Journal of Craniofacial Surgery
Levon Kocharyan, Lilit Baghdasaryan
OBJECTIVE: About 40% of adult population suffers from arterial hypertension and its complications are in the leading places among overall and cerebrovascular mortality. Despite the broad range of available medications and its combinations, less than half of the patients have adequately controlled blood pressure worldwide. And arterial hypertension has a great social and economic impact. Our goal was to create a program which will give an opportunity for long term control of arterial hypertension and closer follow up...
September 2016: Journal of Hypertension
Lucas Brien Chartier, Licinia Simoes, Meredith Kuipers, Barb McGovern
Over the last decade, patient volumes in the emergency department (ED) have grown disproportionately compared to the increase in staffing and resources at the Toronto Western Hospital, an academic tertiary care centre in Toronto, Canada. The resultant congestion has spilled over to the ED waiting room, where medically undifferentiated and potentially unstable patients must wait until a bed becomes available. The aim of this quality improvement project was to decrease the 90th percentile of wait time between triage and bed assignment (time-to-bed) by half, from 120 to 60 minutes, for our highest acuity patients...
2016: BMJ Quality Improvement Reports
Shunji Morita, Kimimasa Ikeda, Takamichi Komori, Tsukasa Tanida, Hisanori Hatano, Yoshito Tomimaru, Hiroshi Imamura, Keizo Dono
BACKGROUND: Emergency surgery for obstructing colorectal cancer is associated with high mortality and morbidity rates. OBJECTIVE: The purpose of this study was to assess outcomes of emergency surgery for obstructing colorectal cancer in a single hospital, where care was primarily provided by colorectal surgeons. DESIGN: This was a retrospective cohort study. SETTINGS: The study was conducted at the Toyonaka Municipal Hospital...
November 2016: Diseases of the Colon and Rectum
A Hennigs, F Riedel, F Marmé, P Sinn, K Lindel, A Gondos, K Smetanay, M Golatta, C Sohn, F Schuetz, J Heil, A Schneeweiss
BACKGROUND: During the last decade, neoadjuvant chemotherapy (NACT) of early breast cancer (EBC) evolved from a therapy intended to enable operability to a standard treatment option aiming for increasing cure rates equivalent to adjuvant chemotherapy (ACT). In parallel, improvements in the quality control of breast cancer care have been established in specialized breast care units. PATIENTS AND METHODS: This study analyzed chemotherapy usage in patients with EBC treated at the Heidelberg University Breast Unit between January 2003 and December 2014...
October 15, 2016: Breast Cancer Research and Treatment
Congbo Cai, Xi Chen, Weijun Liu, Shuhui Cai, Delu Zeng, Xinghao Ding
Quantitative susceptibility mapping (QSM) reconstruction is a well-known ill-posed problem. Various regularization techniques have been proposed for solving this problem. In this paper, a rapid method is proposed that uses ℓ0 norm minimization in a gradient domain. Because ℓ0 minimization is an NP-hard problem, a special alternating optimization strategy is employed to simplify the reconstruction algorithm. The proposed algorithm uses only simple point-wise multiplications and thresholding operations, and significantly speeds up the calculation...
October 4, 2016: Computers in Biology and Medicine
C Isbert
The Contour® Transtar™ operation represents a further methodological development of conventional transanal stapled rectal resection (STARR) for the treatment of obstructed defecation syndrome (ODS) and/or full thickness rectal prolapse. In contrast to the conventional STARR technique a specially designed single curved stapler is used with which the rectal wall is incised in a circular fashion and anastomosed. This results in a monoblock resection with almost unlimited extent of resection. In multicenter studies the procedure has generally been shown to be effective for treatment of ODS with intussusception and rectocele...
October 14, 2016: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
Jody M Kaban, Anand Dayama, Srinivas H Reddy, Sheldon Teperman, Melvin E Stone
OBJECTIVE: Our institution began Advanced Trauma Operative Management (ATOM) simulation course in 2007 for senior residents with the aim of increasing opportunities for surgical trainees to gain operative trauma experience. The aim of our study was to evaluate the effect of the ATOM simulation course on residents' choice of trauma as a career as demonstrated by entrance into surgical critical care (SCC) fellowships. DESIGN: Retrospective study of institutional data on graduating residents from 2002 to 2015...
October 11, 2016: International Journal of Surgery
Jianjun Liu, Mingxue Su, Jing Wang, Gan Zhang, Jing Zhou, Anqing Zhang, Zixue Ren, Xucai Zheng, Shikai Hong, Shengying Wang, Rongxin Zhang
Although local advanced gastric cancer (AGC) could benefit from neoadjuvant radiotherapy (NRT), there are few studies evaluating patients' survival after NRT. In current study, we aimed to investigate the value of prognostic factors in AGC patients after NRT and to evaluate whether post-therapy pathological characteristics were predictive factors in these patients. We retrospectively analyzed AGC patients who underwent NRT from Surveillance, Epidemiology, and End Results (SEER) Database. The patients' clinical and post-therapy pathological characteristics were analyzed...
October 11, 2016: Oncotarget
Jennifer Fang, Kelley Lee, Nidhi Sejpal
The China National Tobacco Corporation (CNTC), which produces one-third of the world's cigarettes, is the largest tobacco company in the world. Over the past 60 years, the CNTC has been focused on supplying a huge domestic market. As the market has become increasingly saturated, and potential foreign competition looms, the company has turned to expansion abroad. This paper examines the ambitions and prospects of the CNTC to 'go global'. Using Chinese and English language sources, this paper describes the globalisation ambitions of the CNTC, and its global business strategy focused on internal restructuring, brand development and expansion of overseas operations in selected markets...
October 13, 2016: Global Public Health
P S Sidhu
In these days of political vagueness, to use a kinder term, although many would describe the situation as turmoil, in Europe, there are success stories to be lauded. Notwithstanding the direction individual countries choose in relation to closer or not so close co-operation in Europe and the direction the political agenda will travel over the next few years, I believe science and in particular medicine has benefited enormously form close co-operation across the European Union and with colleagues outside this political and trading block of nations...
October 2016: Ultraschall in der Medizin
Paula Villa Martín, Jorge Hidalgo, Rafael Rubio de Casas, Miguel A Muñoz
Evolutionary and ecosystem dynamics are often treated as different processes -operating at separate timescales- even if evidence reveals that rapid evolutionary changes can feed back into ecological interactions. A recent long-term field experiment has explicitly shown that communities of competing plant species can experience very fast phenotypic diversification, and that this gives rise to enhanced complementarity in resource exploitation and to enlarged ecosystem-level productivity. Here, we build on progress made in recent years in the integration of eco-evolutionary dynamics, and present a computational approach aimed at describing these empirical findings in detail...
October 2016: PLoS Computational Biology
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