Quality Performance Indicators for the Surgical Management of Oesophageal Cancer: A Systematic Literature Review.

BACKGROUND: The objective of this systematic review was to identify pre-existing quality performance indicators (QPIs) for the surgical management of oesophageal cancer (OC). These QPIs can be used to objectively measure and compare the performance of individual units and capture key elements of patient care to improve patient outcomes. METHODS: A systematic literature search of PubMed, MEDLINE, Scopus and Embase was conducted. Articles reporting on the quality of healthcare in relation to oesophageal neoplasm or cancer and the surgical treatment of OC available until the 1st of March 2022 were included. RESULTS: The final list of articles included retrospective reviews (n = 13), prospective reviews (n = 8), expert guidelines (n = 1) and consensus (n = 1). The final list of QPIs was categorized as process, outcome or structural measures. Process measures included multidisciplinary involvement, availability of multimodality diagnostic and treatment pathways and surgical metrics. Outcome measures included reoperation and readmission rates, the achievement of RO resection and length of hospital stay. Structural measures include multidisciplinary meetings. CONCLUSIONS: This systematic review summarizes QPIs for the surgical treatment of OC. The data will serve as an introduction to establishing a quality initiative project for OC resections.

Value of contrast-enhanced ultrasound in diagnosis and differential diagnosis of polypoid lesions of gallbladder ≥ 1 cm.

OBJECTIVES: To evaluate the usefulness of Contrast-enhanced ultrasound (CEUS) in the diagnosis and differential diagnosis of Polypoid lesions of gallbladder (PLGs) ≥ 1 cm. METHODS: A prospective analysis was performed on 180 patients with PLGs ≥ 1 cm. 175 cases were confirmed by pathological diagnosis and the remaining were confirmed by other imaging findings. The characteristics of lesions on conventional Ultrasonography (US) and CEUS were recorded. RESULTS: Significant differences were observed in enhancement patterns between benign and malignant PLGs during both arterial (P < 0.001) and venous phases (P < 0.001). The malignant lesions typically yielded a "fast-in and fast-out" enhancement pattern. There was no significant difference in Arrival time (AT) between malignant and benign PLGs. If we consider wash-out time ≤ 40 s as a diagnostic standard for malignant lesions, the sensitivity, specificity, and accuracy were 88.24%, 85.62%, and 86.11%, respectively. Destruction of the Gallbladder (GB) wall was a particularly important indication of malignant PLGs, and the sensitivity, specificity, and accuracy were 93.33%, 92.12%, and 92.22%, respectively. The accuracy of CEUS in the diagnosis of PLGs, as well as malignant and benign lesions, was 92.22%, 92.47%, and 91.17%, respectively. CONCLUSIONS: The "fast-in and fast-out" enhancement pattern, hyper-enhancement in comparison to the GB wall in the arterial phase, wash-out time ≤ 40 s, GB wall destruction, and hepatic parenchymal infiltration are the characteristic findings of malignant PLGs. Besides, CEUS provides a valuable reference to classify some of the benign lesions.

Effect of preparation methods on the performance of CuFe-SSZ-13 catalysts for selective catalytic reduction of NOx with NH3.

CuFe-SSZ-13 catalyst showed excellent performance in the selective catalytic reduction of NOx with NH3 (NH3-SCR) for diesel engine exhaust purification. To investigate the effect of preparation methods on NH3-SCR performance, Fe was loaded into one-pot synthesized Cu-SSZ-13 catalysts through solid-state ion-exchange (SSIE), homogeneous deposition precipitation (HDP) and liquid ion-exchange (IE), respectively. Three CuFe-SSZ-13 catalysts showed similar SO2 resistance, which was better than that of Cu-SSZ-13. The improvement was attributed to the protection of Fe species. Hydrothermal stability of three CuFe-SSZ-13 catalysts was significantly different, which was attributed to the state of active species caused by different preparation methods. Compared with the other two catalysts, more active species existed inside the zeolite pores of CuFe-SSZ-13SSIE. During hydrothermal aging, the aggregation of these active species in the pores caused the collapse of catalyst structure, ultimately leading to the deactivation of CuFe-SSZ-13SSIE. In contrast, Fe species was dispersed better on the surface over CuFe-SSZ-13IE, enhancing the hydrothermal stability of catalysts. Consequently, Fe loading effectively improved the resistance of SO2 and H2O over Cu-SSZ-13. For CuFe-SSZ-13, large amounts of active species located inside the zeolite pores are not beneficial for the hydrothermal stability.

Contrast-enhanced ultrasonography diagnosis of fundal localized type of gallbladder adenomyomatosis.

BACKGROUND: Adenomyomatosis of gallbladder is an acquired hyperplastic lesion, characterized by focal or diffuse thickening of the gallbladder with intramural cysts or echogenic areas with comet tail on ultrasonography. But in some cases, especially in the localized fundal type of adenomyomatosis, the intramural anechoic cystic spaces are uncertainty which causes difficult to differential adenomyomatosis from GB cancer. The purpose of this study was to determine the accuracy of real-time contrast-enhanced ultrasonography(CEUS) in the diagnosis of the fundal localized type of gallbladder adenomyomatosis. METHODS: We performed a retrospective study of 21 patients with pathologically proven fundal localized type of gallbladder (GB) adenomyomatosis. All patients underwent preoperative grayscale ultrasound (US) and real-time CEUS examination. The study's reviewers made the diagnosis of adenomyomatosis according to the presence of the focal thickening of the fundal gallbladder wall with intramural cyst or intramural echogenic foci on grayscale US or CEUS. The diagnostic accuracy of US and CEUS was compared. The enhanced pattern and degree of intactness of the GB wall were also recorded. RESULTS: The fundal portion of the GB wall showed localized thickness in all 21 patients. Small anechoic spaces or intramural echogenic foci were detected in 14 (66.7%) and 21 (100 %) of cases respectively, and the intactness of the GB wall's outer hyper-echoic layer was demonstrated in 17 (81%) and 20 (95%) on grayscale US and CEUS, respectively. The accuracy rate of the above two examination modalities was significantly different (p < 0.05). In the arterial phase of the CEUS, areas of focal thickened GB wall were iso-enhanced in 18 cases and hyper-enhanced in 3 cases. All 21 cases appeared to show heterogeneous enhancement with small non-enhancement spaces. The mucosal and serosal layers of the GB wall surrounding the lesions were enhanced, which presented as two "hyper-echoic lines" in the arterial phase of CEUS. In the venous phase of the CEUS, 19 lesions were iso-enhanced and 2 lesions were hypo-enhanced. The small non-enhancement spaces were more clearly during the venous phase. CONCLUSION: The small non-enhancement space is a characteristic finding of the fundal localized type of gallbladder adenomyomatosis on CEUS. CEUS could increase the degree of visualization of Rokitansky-Aschoff sinuses (RAS) and intactness of the GB wall, which play an important role in differential diagnosis.

The increasing use of minimally invasive surgery in acute general surgical conditions: A decade of results from a national data set.

BACKGROUND: To assess the rate of uptake of acute laparoscopic surgery for common general surgical conditions using national-level data. METHODS: The use of laparoscopic surgery in the acute management of appendicitis, cholecystitis, adhesive small bowel obstruction, and inguinal hernias was assessed between 2013 and 2022 at a national level in New Zealand. RESULTS: Laparoscopic appendicectomy increased from 83% to 95% (P = .0002). Laparoscopic cholecystectomy increased from 94% to 96% (P = .001). Laparoscopic adhesiolysis increased from 42% to 60% (P = .001). Laparoscopic inguinal hernia repair increased from 3% to 18% (P = .004). The rate of laparoscopic conversion demonstrated a decrease for appendicectomy (1.9% to 0.24%), cholecystectomy (0.77% to 0.39%), and adhesiolysis (9% to 2.4%) across this time. The laparoscopic cohorts were all associated with a shorter and less expensive length of stay compared to the open cohort. Maori and Pacific Island patients had largely equitable or superior rates of laparoscopic use compared to the rest of the population. No changes in laparoscopic use were detected during the COVID-19 pandemic. Rates of laparoscopic cholecystectomy and appendicectomy are similar throughout the regions. The largest difference in rates detected was for adhesiolysis, which was more common in the northern region. CONCLUSION: There has been a statistically significant rise in the use of acute laparoscopic surgery for acute general surgical procedures. This rise is likely clinically and economically significant, particularly in appendicectomy and adhesiolysis, with rises of 12% and 17% across the 10 years, with the known associated patient and health care system benefits.

Gastrointestinal stromal tumours: incidence, recurrence and mortality. A decade of patients from a New Zealand tertiary surgical centre.

BACKGROUND: Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. The New Zealand (NZ) population incidence has not previously been documented nor has the potential effect of ethnicity been reviewed. We furthermore wanted to assess the difference between those undergoing a wedge resection versus a more extensive operation which we hypothesised would correlate with recurrence and mortality. METHODS: All patients (n = 103) with a GIST diagnosed and treated at Te Whatu Ora Waitemata (Auckland, New Zealand) between 2012 and 2021 are presented. Patient demographics, method of GIST detection, management approach, index surgery, histological features, use of adjuvant and neoadjuvant imatinib, follow-up, recurrence and mortality rates were analysed. RESULTS: This paper reports the largest NZ GIST cohort to date and estimates an incidence of 17 cases per million per year. Eighty-four patients underwent surgical resection, 58 received a wedge resection and 17 received a more extensive operation. Five-year disease-free survival rates were 100% in the low/very low risk, 90% in the intermediate and 59% in the high risk groups as determined by the modified NIH criteria. Our overall 5-year GIST-specific survival rate was 83%; it was 91% in those who underwent a wedge resection and 60% in the extensive operation group. There is evidence that Maori have higher rates of GIST recurrence compared to non-Maori and are more likely to require an extensive surgical resection.

Quality performance indicators for oesophageal and gastric cancer: ANZ expert Delphi consensus.

BACKGROUND: Quality performance indicators for the management of oesophagogastric cancer can be used to objectively measure and compare the performance of individual units and capture key elements of patient care to improve patient outcomes. METHODS: Two systematic reviews were completed to identify evidence-based quality performance indicators for the surgical management of oesophagogastric cancer. Based on the indicators identified, a two-round modified Delphi process with invitations was sent to all members of the Australia and Aotearoa New Zealand Gastric and Oesophageal Surgery Association. The expert working group discussed each suggested indicator and either removed, added, or adjusted the list of indicators of oesophagogastric cancer. RESULTS: The final list of both OG cancer indicators included Specialized Multi-disciplinary team discussion, Endoscopy documentation, Staging Contrast CT Chest/Abdomen and Pelvis, Neoadjuvant or Adjuvant chemo/radiotherapy administered in accordance with the Local multi-disciplinary team, Pathological margin clearance (R0 Resection), Lymphadenectomy retrieving 15 or more nodes, Formal review of pathological findings and documentation, Postoperative complications, 30-day and 90-day postoperative mortality, clinical surveillance and Specialized Dietetic guidance. Indicators specific to gastric cancer included Preoperative biopsy for pathological diagnosis and Staging Laparoscopy. Indicators specific to oesophageal cancer include positron emission tomography scan if CT negative for metastasis, Perioperative Oesophagectomy Care Pathway, length of stay of 21 days or more, and Unplanned readmission within 30 days. CONCLUSIONS: The results of this study present a core set of indicators for the surgical management of oesophagogastric cancer that can be used to measure quality and compare performance between different units.

Contrast-enhanced ultrasonography to diagnose gallbladder perforation.

AIM: The purpose of this study was to evaluate contrast-enhanced ultrasonography (CEUS) as a modality for diagnosing perforation of the gallbladder (GB) and pericholecystic hepatic abscess. METHODS: This retrospective study comprised 6 patients with acute cholecystitis and GB perforation plus pericholecystic hepatic abscess who underwent conventional US and CEUS imaging. The following sonographic features were examined: GB contour, defect in the GB wall, and pericholecystic hepatic mass. The findings of conventional US and CEUS were compared. RESULTS: Conventional US revealed a defect in the GB wall in 2 patients and partially obscured GB wall in 4 patients. Pericholecystic masses were visualized as isohypoechoic masses in 3 and mixed cystic-solid masses in 3 patients. Contrast-enhanced US revealed hyperenhancement of the GB wall during the early arterial phase, and a defect was seen in every patient. The pericholecystic masses showed heterogeneous enhancement with a honeycomb-like appearance during the arterial phase-interpreted abscesses. CONCLUSION: Contrast-enhanced US clearly visualized defects in the GB wall and pericholecystic abscesses in patients with GB perforation. The results indicate that CEUS is a useful modality for the diagnosis of GB perforation.

Selective use of radiological staging in node-positive stage II breast cancer patients may have a role in treatment.

BACKGROUND: Advanced-staging radiography is used inconsistently for patients with early-stage (stage I + II) breast cancer. However, accurate and appropriate staging of newly diagnosed breast cancer may significantly impact treatment decisions. METHODS: Four hundred and ninety-nine patients with stages II and III breast cancer were seen in the breast service at Waitemata DHB, New Zealand from 2013 to 2018 were enrolled in the study and audited for radiological staging. RESULTS: One hundred and two stage II patients had computed tomography (CT) at baseline; 88 of 102 (86%) of stage II patients were node-positive (≥N1) with six patients (6.8%) having distant metastatic disease, and were upstaged to stage IV. Fifty-two stage III patients out of 72 (72%) had baseline staging CTs. Nine out of 52 patients (17%) of stage III patients were upstaged to stage IV. Despite guideline recommendations, baseline staging for T4 disease (stage IIIB) was poor, with only 7 out of 13 patients with stage IIIB disease radiologically staged. CONCLUSION: Consideration for baseline radiological staging should be given to stages II and III, cN1 breast cancer patients, in which diagnosis of distant metastatic disease would change the treatment plan. Regional guidelines for baseline radiological staging for breast cancer patients may have an impact on patient management in breast cancer patients.

Quality performance indicator compliance for the treatment of gastric adenocarcinoma.

BACKGROUND: Quality performance indicators (QPI) are objective measurements of aspects of patient care that affect clinical outcome. This study investigates the compliance rate to published QPIs of gastric adenocarcinoma (GA) management, in a single institution, to determine areas of strong performance and those requiring improvement. METHODS: All patients with GA treated from 2010 to 2015, and 2020 to 2021 were included. Electronic data in the form of clinic letters, operation notes, and histology and radiology reports were reviewed with ethics approval. QPI adherence was collected in binary form. RESULTS: QPIs with high compliance rate include preoperative radiological staging and histological diagnosis, subspecialty surgeon training and pathology report documentation. QPIs with low compliance include perioperative chemotherapy (31.6%), postoperative radiological surveillance (32.5%) and minimally invasive approaches to surgical resection (12.5%). CONCLUSIONS: QPIs from the systematic review are variably implemented in clinical practice, thus informing on their relevance to real world clinical practice whilst also identifying the areas requiring focus for improvement.

Contrast-enhanced sonographic appearance of malignant fibrous histiocytoma in the sigmoid colon: a case report.

Malignant fibrous histiocytoma (MFH) of the sigmoid colon is extremely rare and imaging characteristics of MFH during contrast-enhanced sonography have not been described yet. Here we report the case of a 55-year-old man suffering from MFH in the sigmoid colon, with an emphasis on contrast-enhanced sonography findings.

The impacts of improvements in the unified economic and environmental efficiency of transportation infrastructure on industrial structure transformation and upgrade from the perspective of resource factors.

As an important part of a modern economic system, a modern industrial system is the key to promoting high-quality economic development. China's modern industrial system construction focuses on industrial restructuring. At present, in order to strengthen the support and leading role of transportation in the modern economic system, China is actively promoting the construction of a competitive transportation power. Therefore, it is necessary to study whether large-scale investment in transportation infrastructure can promote industrial structure transformation and upgrade. This paper takes China as the research background. Firstly, a RAM model was employed to evaluate the unified economic and environmental efficiency of transportation infrastructure that measures the level of transportation infrastructure investment. Secondly, a PVAR model was built to evaluate the dynamic effects of transportation infrastructure investment on industrial structure transformation and upgrade. Finally, from the perspective of rational flow and optimal allocation of resource factors, the paper points out that transportation infrastructure investment can indirectly promote industrial structure transformation and upgrade through three paths, namely expanding market demand, reducing resource misallocation and increasing technological innovation, and the first half of these paths are positively regulated by policies. Then, an empirical test was done with the moderated mediation model. Research findings suggest that: first, improvements in the unified economic and environmental efficiency of transportation infrastructure can only promote industrial structure supererogation in a short time, but have no significant effect on promoting industrial structure rationalization in the short or long term. Second, in actual situation, transportation infrastructure investment can promote industrial structure transformation and upgrade only by expanding market demand and technological innovation, but not by reducing resource misallocation. Third, the first half of these paths through which transportation infrastructure investment promotes industrial structure transformation and upgrade are positively regulated by policies. This paper provided some theoretical reference for promoting industrial structure transformation and upgrade by virtue of the sustainable development of transportation.

Combined analysis of whole-exome sequencing and RNA sequencing in type 2 diabetes mellitus patients with thirst and fatigue.

BACKGROUND: The principal objective of this study was to gain a better understanding of the mechanisms of type 2 diabetes mellitus (T2DM) patients with fatigue (D-T2DM) through exome and transcriptome sequencing. METHODS: After whole-exome sequencing on peripheral blood of 6 D-T2DM patients, the consensus mutations were screen out and analyzed by a series of bioinformatics analyses. Then, we combined whole-exome sequencing and transcriptome sequencing results to find the important genes that changed at both the DNA and RNA levels. RESULTS: The results showed that a total of 265,393 mutation sites were found in D-T2DM patients compared with normal individuals, 235 of which were consensus mutations shared with D-T2DM patients. These genes significantly enriched in HIF-1 signaling pathway and sphingolipid signaling pathway. At the RNA level, a total of 375 genes were identified to be differentially expressed. After the DNA-RNA joint analysis, eight genes were screened that changed at both DNA and RNA levels. Among these genes, FUS and LMNA were related to carbohydrate metabolism, energy metabolism, and mitochondrial function. Subsequently, we predicted the herbs, including Qin Pi and Hei Zhi Ma, that might play a therapeutic role in D-T2DM through the SymMap database. CONCLUSION: These findings have significant implications for understanding the mechanisms of D-T2DM and provide potential targets for D-T2DM diagnosis and treatment.

Correction to: Attrition after Acceptance onto a Publicly Funded Bariatric Surgery Program.

Unfortunately, the original version of this article contained an error. The Methods section's first sentence and Table 1 both mistakenly contained the letters XXXX in place of the district health board and hospital city names.

Attrition after Acceptance onto a Publicly Funded Bariatric Surgery Program.

BACKGROUND: Factors such as ethnicity, gender, and socioeconomic status may play a role in both access to and attrition from bariatric programs before surgery is undertaken. New Zealand (NZ) has high rates of obesity in its Pacific population and the indigenous Maori. These groups also experience poorer health outcomes and therefore have the greatest need for surgery. METHODOLOGY: A retrospective cross-sectional study of 704 people referred for and accepted onto a publicly funded bariatric surgery from 2007 to 2016. The demographic and clinical features of two groups were compared: those that completed surgery successfully (n = 326) and those that dropped out of the program before surgery (n = 378). We also attempted to identify factors associated with attrition. RESULTS: The attrition rate was high (54%), with a significant difference according to gender (men 66% vs 45% women, p < 0.001) and ethnicity (39% in NZ Europeans, 50% in Maori, and 73% in Pacific patients, p < 0.001). Two out of three European women proceeded to surgery, but fewer than one in seven Pacific men. Attrition was associated with having a higher mean BMI and being a smoker. Logistic regression modeling showed that while employment seemed to be protective against attrition for NZ Europeans (p < 0.004), it was not for Pacific patients. CONCLUSIONS: While there was no obvious bias in rates of referral, there is clearly a need for better ways to support Maori and Pacific people, and men in particular, to complete bariatric surgery. Further research is needed to clarify the socio-economic and cultural barriers that underlie this phenomenon.

A Conjugated Polyelectrolyte with Pendant High Dense Short-Alkyl-Chain-Bridged Cationic Ions: Analyte-Induced Light-Up and Label-Free Fluorescent Sensing of Tumor Markers.

A novel cationic water-soluble conjugated polyelectrolyte (CPE) of polyfluorene that contains 15% fraction of 2,1,3-benzothiadiazole (BT) units (PFC3NBT) has been obtained. PFC3NBT demonstrates intramolecular energy transfer from the fluorene segments to BT sites when negatively charged species (SDS or DNAs) are added, following by a shift in emission color from blue to green, has been developed. The high density of positive charges and pendent short alkyl chains of N-propyltrimethylammoniums endow PFC3NBT with high solubility and high fluorescence quantum efficiency of 33.6% in water. The fluorescence emission properties were investigated in the presence of adverse buffer solutions, different surfactants and DNA strands. Interesting fluorescence emission quenching at short wavelength and fluorescence resonance energy transfer (FRET) induced light-on at BT sites were observed and discussed in detail. Very different from previous reports, the fluorescence emission spectra transition happens with an enhancement of integrated fluorescent intensity. The analytes induced a light-up sensing system was studied with a PFC3NBT/SDS complex mode and confirmed with DNA/DNA-FAM sensing systems. More exciting preliminary results on label-free sensing of tumor markers were also reported by investigating the unique fluorescence response to 11 kinds of proteins. These results provide a new insight view for designing CPEs with light-up and label-free features for biomolecular sensing.

DNA barcoding, species-specific PCR and real-time PCR techniques for the identification of six Tribolium pests of stored products.

Flour beetles of the genus Tribolium Macleay (Coleoptera: Tenebrionidae) are important stored product pests in China and worldwide. They are often found or are intercepted in grain depots, flour mills, and entry-exit ports, etc. Traditionally, Tribolium species are identified according to the morphological characteristics of the adult. However, it is almost impossible to rapidly identify adult fragments and non-adult stages based on external morphological characteristics. Molecular techniques for the rapid and accurate identification of Tribolium species are required, particularly for pest monitoring and the quarantine of stored products pests. Here, we establish DNA barcoding, species-specific PCR, and real-time PCR techniques for the identification of six stored-product pest Tribolium species including T. castaneum, T. confusum, T. destructor, T. madens, T. freemani and T. brevicornis. We detected the mitochondrial DNA cytochrome oxidase subunit I (COI) barcodes for Tribolium from 18 geographic populations and 101 individuals, built a Tribolium DNA barcode library, and designed species-specific primers and TaqMan probes for the above six Tribolium species. The three techniques were applied to identify Tribolium collected from stored samples and samples captured from quarantine ports. The results demonstrated that three techniques were all able to identify the six species of Tribolium both rapidly and accurately.

[Effects of different removal disturbance intensity on plant diversity of Bursaphelenchus xylophilus-invaded Masson pine community].

The study on the plant diversity of Bursaphelenchus xylophilus-invaded Masson pine community under effects of different removal disturbance intensity showed that the species diversity indices (richness, Shannon-Wiener index and evenness) of arbor layer decreased in the sequence of broad-leaved stand after the removal of all infected pine trees in the pure pine stand in Fuyang > lightly infected Masson pine - Schima superba mixed stand in Fuyang > uninfected stand mixture of Masson pine and Castanopsis fargessi as the control > lightly infected pure Masson pine stand in Fuyang > Quercus variables stand formed after selective removal of infected pine trees from a mixed Masson pine and Q. variables stand in Zhoushan Islands > pure young Masson pine stand formed after the removal of all infected pine trees from a pure Masson pine stand > pure Liquidambar formosana stand after the removal of infected pine trees from a pure pine stand in Zhoushan Islands > mixed stand consisted of Pinus thunbergii and the Masson pine in Zhoushan Islands > moderately infected Masson pine stand in Zhoushan Islands. All the three indices of shrub layer did not show any significant differences among different communities, except for the pure pine stand in Zhoushan Island, which were the lowest. The three indices of herb layer were higher in pure young Masson pine, Q. variables stand, and L. formosana stand than in other stands. The Masson pine forest at different geographical situation and with different harm extent had distinct disparity, as well as that in different disturbance degree and restoring manner. The "Index of Disturbing Intensity of Stump and Fallen Woods" or IDISF was created to represent the disturbance degree of tree removal on plant diversity. It was found that for both less and more removal disturbing degree, the relationship between species diversity indices and IDISF followed the "Mid-altitude bulge" theory. Specifically, both excessive and insufficient removal of infected trees would cause the decline of plant species diversity in certain degree. Covariance analysis of IDISF indicated that different IDISF had no significant effects on the species diversity of arbor layer, but had different effects on that of shrub and herb layers, which could be used to assess the changes in species diversity of different Masson pine communities after the invasion of pine wood nematode.