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Current Urology Reports Mar 2016Pelvic organ prolapse repair with mesh remains the gold standard for advanced prolapse. There are several surgical approaches available to the pelvic reconstructive... (Review)
Review
Pelvic organ prolapse repair with mesh remains the gold standard for advanced prolapse. There are several surgical approaches available to the pelvic reconstructive surgeon. Prolapse repair can be performed vaginally or abdominally using native tissue or may be augmented with a biologic or mesh patch. In this article, we will review the different approaches to prolapse repair, the role of mesh, and the risks and benefits of each option. Patient selection, surgical technique, and the rationale for using mesh will be explored. Complications from prolapse repair with mesh including dyspareunia, pelvic pain, mesh exposure, and reoperation will be discussed.
Topics: Animals; Humans; Laparoscopy; Pelvic Organ Prolapse; Pelvic Pain; Reoperation; Robotic Surgical Procedures; Surgical Mesh
PubMed: 26874532
DOI: 10.1007/s11934-016-0580-8 -
Transportation Research... Jun 2021Supply chains in general and last-mile logistics in particular, have been disrupted due to COVID-19. Though several innovative last-mile logistics solutions have been...
Supply chains in general and last-mile logistics in particular, have been disrupted due to COVID-19. Though several innovative last-mile logistics solutions have been proposed in the past, they possess certain limitations, especially during COVID-19 motivating the need for an alternative last-mile logistics solution. We present a review of literature related to last-mile logistics and supply chain disruptions to identify the limitations of existing last-mile delivery practices during COVID-19. Using a stylized analytical model, we then propose that "mobile warehouse" can be an effective solution to last-mile logistics issues faced during COVID-19 and beyond under certain conditions. A mobile warehouse is a truck dedicated to a particular geographical location and carries the inventory of various products based on the estimated demand requirements for these products in that geographical location. We provide the condition under which the B2C e-commerce providers find it profitable to adopt a truck as a mobile warehouse to sell high demand items quickly.
PubMed: 36844004
DOI: 10.1016/j.trip.2021.100339 -
Sustainable Cities and Society Dec 2021Recent events such as Covid-19 vaccine distribution issues and the blockage of the Ever Given ship in the Suez Canal raised concerns about how fragile the traditional...
Recent events such as Covid-19 vaccine distribution issues and the blockage of the Ever Given ship in the Suez Canal raised concerns about how fragile the traditional supply chain is. Last-mile personalized fulfillment can have a catalyst role in the proliferation of the Industry 4.0. This growing trend will reduce standard production, bringing manufacturing closer to the client and, ultimately, boiling down the supply chain to the last mile. However, the literature is not clear about the breakdown of the supply chain to enhance cities' sustainability and reducing the number of transports and circulating vehicles. Stemming from an empirical study to simulate the existing gap in the market and the development of a case study through structured interviews with privileged interlocutors complemented by the document analysis, this paper highlights how the integration of local stakeholders can efficiently enhance a personalized service based on dynamic collaborations to set up the supply chain, by introducing the Last-Mile-as-a-Service (LMaaS) concept. This concept relies on a revenue-sharing framework based on an open marketplace composed by last-mile manufacturing, transport, and storage assets and stakeholders to disrupt the supply chain, enabling any company to provide personalized products in almost real-time to any location.
PubMed: 36568532
DOI: 10.1016/j.scs.2021.103310 -
Open Heart Mar 2022Decreased proximal aortic distensibility (AD) is known to significantly predict all-cause mortality and cardiovascular events among individuals without overt...
OBJECTIVE
Decreased proximal aortic distensibility (AD) is known to significantly predict all-cause mortality and cardiovascular events among individuals without overt cardiovascular disease. This cross-sectional study investigated the association of endurance training (ET) parameters, namely, ET starting age, ET years and yearly ET volume with AD in non-elite endurance athletes.
METHODS
Healthy, normotensive, male Caucasian participants of a 10-mile race were assessed with a 2D echocardiogram and comprehensive interview. Ascending aortic diameters were measured simultaneously with pulse pressure. Aortic strain, AD and aortic stiffness index were calculated. Predictors of AD were investigated among training parameters by linear regression models corrected for age, resting heart rate, stroke volume index and mean blood pressure.
RESULTS
Ninety-two of 121 athletes (aged 42±8 years) had sufficient echocardiogram quality and were used for analysis. ET starting age (range 6-52 years) and years of ET (range 2-46 years) were highly collinear and used in two separate models for AD. Significant factors for AD were ET starting age, 10-mile race time and resting heart rate in model I, and age, years of ET, 10-mile race time and heart rate in model II (all p<0.01).
CONCLUSIONS
In our cohort of healthy, non-elite, middle-aged runners, AD was significantly higher in athletes with younger ET starting age or more years of ET (in the model adjusted for confounders). In the model with years of ET, age had a negative contribution to AD, suggesting that with older age, the benefit of more years of ET on AD decreased. Future studies assessing the effect of exercise training on arterial properties should include training starting age.
Topics: Aorta; Athletes; Child; Cross-Sectional Studies; Echocardiography; Endurance Training; Humans; Male; Middle Aged
PubMed: 35264414
DOI: 10.1136/openhrt-2021-001771 -
Indian Journal of Ophthalmology Feb 2020
Topics: Delivery of Health Care; Eye Diseases; Government Programs; Humans; India; Ophthalmology
PubMed: 31937718
DOI: 10.4103/ijo.IJO_2367_19 -
International Journal of Environmental... Nov 2021The aims of the current study were to compare the pacing patterns of all-time 800 m, 1500 m and mile running world records (WRs) and to determine whether differences...
The aims of the current study were to compare the pacing patterns of all-time 800 m, 1500 m and mile running world records (WRs) and to determine whether differences exist between sexes, and if 800 m and 1500 m WRs were broken during championship or meet races. Overall and lap times for men and women's 800 m, 1500 m, and mile WRs from World Athletics were collected when available and subsequently compared. A fast initial 200 m segment and a decrease in speed throughout was found during 800 m WRs. Accordingly, the first 200 m and 400 m were faster than the last 200 m and 400 m, respectively ( < 0.001, 0.77 ≤ ES ≤ 1.86). The first 400 m and 409 m for 1500 m and mile WRs, respectively, were faster than the second lap ( < 0.001, 0.74 ≤ ES ≤ 1.46). The third 400 m lap was slower than the last 300 m lap and 400 m lap for 1500 m and mile WRs, respectively ( < 0.001, 0.48 ≤ ES ≤ 1.09). No relevant sex-based differences in pacing strategy were found in any event. However, the first 409 m lap was faster than the last 400 m lap for men but not for women during mile WRs. Women achieved a greater % of WRs than men during championships (80% vs. 45.83% in the 800 m, and 63.63% vs. 31.58% in the 1500 m, respectively). In conclusion, positive, reverse J-shaped and U-shaped pacing profiles were used to break 800 m, men's mile and 1500 m, and women's mile WRs, respectively. WRs are more prone to be broken during championships by women than men.
Topics: Athletic Performance; Competitive Behavior; Female; Humans; Male; Running; Time
PubMed: 34886317
DOI: 10.3390/ijerph182312589 -
Minimally Invasive Ivor Lewis Esophagectomy (MILE): technique and outcomes of 100 consecutive cases.Surgical Endoscopy Jul 2020Esophagectomy is the mainstay of therapy for esophageal cancer but is a complex operation that is associated with significantly high morbidity and mortality rates. The...
BACKGROUND
Esophagectomy is the mainstay of therapy for esophageal cancer but is a complex operation that is associated with significantly high morbidity and mortality rates. The primary aim of this study is to report our perioperative outcomes, and long-term survival of Minimally Invasive Ivor Lewis Esophagectomy (MILE).
METHODS
IRB approved retrospective study of 100 consecutive patients who underwent elective MILE from September 2013 to November 2017 at University of Florida, Jacksonville.
RESULTS
Primary diagnosis was esophageal cancer (n = 96) and benign esophageal disease (n = 4). Anastomotic leak rate was observed in 6%; 30- and 90-day mortality rates were 2% and 3%, respectively. The mean length of hospital stay was 10.3 days; 87 patients were discharged to home, while 12 patients were discharged to rehabilitation facility, and there was one in-hospital mortality secondary to graft necrosis. At a mean follow-up was 37 months (2-74), the 3- and 5-year overall survivals are 63.9 ± 5.0% (95% CI 53.3-72.7%) and 60.5 ± 5.3% (95% CI 49.4-69.9%), respectively. The 3- and 5-year disease-free survival is 75.0 ± 4.8% (95% CI 64.2-83.0%) and 70.4 ± 5.5% (95% CI 58.0-80.0%).
CONCLUSION
MILE can be performed with low perioperative mortality, and favorable long-term overall and disease-free survival.
Topics: Aged; Anastomosis, Surgical; Anastomotic Leak; Disease-Free Survival; Esophageal Neoplasms; Esophagectomy; Female; Hospital Mortality; Humans; Length of Stay; Male; Middle Aged; Minimally Invasive Surgical Procedures; Postoperative Complications; Retrospective Studies; Survival Rate; Treatment Outcome
PubMed: 32253561
DOI: 10.1007/s00464-020-07529-0 -
OncoTargets and Therapy 2018Minimally invasive esophagectomy is increasingly performed for esophageal or gastroesophageal junctional cancer, with advantages of improved perioperative outcomes in... (Review)
Review
Comparison of short-term outcomes between minimally invasive McKeown and Ivor Lewis esophagectomy for esophageal or junctional cancer: a systematic review and meta-analysis.
PURPOSE
Minimally invasive esophagectomy is increasingly performed for esophageal or gastroesophageal junctional cancer, with advantages of improved perioperative outcomes in comparison with open esophagectomy. McKeown and Ivor Lewis are widely used procedures of minimally invasive esophagectomy, and there have been controversies on which one is preferred for patients with resectable esophageal or junctional cancer.
PATIENTS AND METHODS
This review was registered at the International Prospective Register of Systematic Reviews (number CRD42017075989). Studies in PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov were thoroughly investigated. Eligible studies included prospective and retrospective studies evaluating short-term outcomes of minimally invasive McKeown esophagectomy (MIME) vs minimally invasive Ivor Lewis esophagectomy (MILE) in patients with resectable esophageal or junctional tumors. Main parameters included anastomotic leak and 30-day/in-hospital mortality. Overall incidence rates (ORs)/weighted mean difference (WMD) with 95% confidence intervals (CIs) were calculated by employing random-effects models.
RESULTS
Fourteen studies containing 3,468 cases were included in this meta-analysis. Age, male sex, and American Joint Committee on Cancer (AJCC) stage between the 2 groups were not statistically different. MIME led to more blood loss, longer operating time, and longer hospital stay than MILE. MIME was associated with higher incidence of pulmonary complications (OR =1.96, 95% CI =1.28-3.00) as well as total anastomotic leak (OR =2.55, 95% CI =1.40-4.63), stricture (OR =2.07, 95% CI =1.05-4.07), and vocal cord injury/palsy (OR =5.62, 95% CI =3.46-9.14). In addition, the differences of R0 resection rate, number of lymph modes retrieved, blood transfusion rate, length of intensive care unit stay, incidence of cardiac arrhythmia, and Chyle leak between MIME and MILE were not statistically significant. Notably, incidence of severe anastomotic leak (OR =1.28, 95% CI =0.73-2.24) and 30-day/in-hospital mortality (OR =1.76, 95% CI =0.92-3.36) as well as 90-day mortality (OR =2.22, 95% CI =0.71-6.98) between the 2 procedures were also not significantly different.
CONCLUSION
This study suggests that MIME and MILE are comparable with respect to clinical safety. MILE may be a better option when oncologically and clinically suitable. MIME is still a safe alternative procedure when clinically indicated. However, this evidence is at risk for bias; randomized controlled trials are needed to validate or correct our results.
PubMed: 30275710
DOI: 10.2147/OTT.S169488 -
PloS One 2018Emerging evidence indicates that proximity to unconventional oil and gas development (UOGD) is associated with health outcomes. There is intense debate about "How close...
Emerging evidence indicates that proximity to unconventional oil and gas development (UOGD) is associated with health outcomes. There is intense debate about "How close is too close?" for maintaining public health and safety. The goal of this Delphi study was to elicit expert consensus on appropriate setback distances for UOGD from human activity. Three rounds were used to identify and seek consensus on recommended setback distances. The 18 panelists were health care providers, public health practitioners, environmental advocates, and researchers/scientists. Consensus was defined as agreement of ≥70% of panelists. Content analysis of responses to Round 1 questions revealed four categories: recommend setback distances; do not recommend setback distances; recommend additional setback distances for vulnerable populations; do not recommend additional setback distances for vulnerable populations. In Round 2, panelists indicated their level of agreement with the statements in each category using a five-point Likert scale. Based on emerging consensus, statements within each category were collapsed into seven statements for Round 3: recommend set back distances of <¼ mile; ¼-½ mile; 1-1 ¼ mile; and ≥ 2 mile; not feasible to recommend setback distances; recommend additional setbacks for vulnerable groups; not feasible to recommend additional setbacks for vulnerable groups. The panel reached consensus that setbacks of < ¼ mile should not be recommended and additional setbacks for vulnerable populations should be recommended. The panel did not reach consensus on recommendations for setbacks between ¼ and 2 miles. The results suggest that if setbacks are used the distances should be greater than ¼ of a mile from human activity, and that additional setbacks should be used for settings where vulnerable groups are found, including schools, daycare centers, and hospitals. The lack of consensus on setback distances between 1/4 and 2 miles reflects the limited health and exposure studies and need to better define exposures and track health.
Topics: Consensus; Delphi Technique; Health Personnel; Humans; Oil and Gas Industry; Public Health; Research Personnel; Surveys and Questionnaires
PubMed: 30114206
DOI: 10.1371/journal.pone.0202462 -
Surgical Endoscopy Feb 2022Anastomotic leak is a serious complication following esophagectomy. The aim of the study was to report our experience with indocyanine green fluorescence angiography...
BACKGROUND
Anastomotic leak is a serious complication following esophagectomy. The aim of the study was to report our experience with indocyanine green fluorescence angiography (ICG-FA)-PINPOINT® assisted minimally invasive Ivor Lewis esophagectomy (MILE) and assess factors associated with anastomotic leak.
METHODS
We reviewed consecutive patients undergoing MILE from 2013 to 2018. Intraoperative real-time assessment of gastric conduit was performed using ICG-FA with PINPOINT®. Perfusion was categorized as good perfusion (brisk ICG visualization to conduit tip) or non-perfusion (any demarcation along the conduit).
RESULTS
100 patients (81 males, median age 68 [60-72]) underwent MILE for malignancy in 96 patients and benign disease in 4 patients. There were six anastomotic leaks all managed with endoscopic stent placement. There was no intraoperative mortality and no 30-day mortality in leak patients. Patients with a leak were more likely to be overweight with BMI > 25 (100% versus 53%, p = 0.03), have pre-existing diabetes (50% versus 13%, p = 0.04), and have higher intraoperative estimated blood loss (260 mL [95-463] versus 75 mL [48-150], p = 0.03). Anastomotic leaks occurred more frequently in the non-perfusion (67%) versus the good perfusion category (33%, p = 0.03). By multivariable analysis, diabetes (odds ratio [OR] 6.42; p = 0.04) and non-perfusion (OR 6.60; p = 0.04) were independently associated with leak.
CONCLUSION
Intraoperative use of ICG-FA may be a useful adjunct to assess perfusion of the gastric conduit with non-perfusion being independently associated with a leak. While perfusion plays an important role in anastomotic integrity, development of a leak is multifactorial, and ICG-FA should be used in conjunction with the optimization of patient and procedural components to minimize leak rates. Prospective, randomized studies are required to validate the interpretation, efficacy, and application of this novel technology in minimally invasive esophagectomies.
Topics: Aged; Anastomosis, Surgical; Anastomotic Leak; Esophageal Neoplasms; Esophagectomy; Humans; Indocyanine Green; Male; Perfusion; Prospective Studies; Stomach
PubMed: 33580319
DOI: 10.1007/s00464-021-08346-9