Laparoscopic Liver Resection: A South American Experience with 2887 Cases.

BACKGROUND: Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers. METHODS: From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results. RESULTS: Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%. CONCLUSIONS: This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers.

[School assistance for attention deficit hyperactivity disorder in the Spanish autonomous regions]. / Atencion escolar al trastorno por deficit de atencion/hiperactividad en las comunidades españolas.

INTRODUCTION: In recent years different Spanish autonomous regions have presented policies on school assistance for attention deficit hyperactivity disorder (ADHD) or coordination between the educational and healthcare services, which result in protocols, instructions or guidelines of action. AIM: To determine and compare the proposals put forward by the different Spanish regions with respect to school assistance for ADHD. SUBJECTS AND METHODS: After searching for the documents that contain these policies, the information therein was analysed with the aim of being able to compare them in several different areas: document, scope of application, detection of ADHD, diagnosis, school measures, follow-up of the proposals of the Guidelines on clinical practice in attention deficit hyperactivity disorder, grounds and resources offered. RESULTS: The Valencian Region is the only one for which no documents were found. The document for the Balearic Islands was not analysed because it is not public, and in the other regions differences were found in the degree of compliance with the criteria assessed in each area. The policies in Extremadura, Galicia, Catalonia and Navarra are the ones that meet the largest number of criteria. All the regions with policies on ADHD propose some kind of school measures and resources such as bibliographical references, contacts or models of documents or screening tools. All of them, except Madrid, offer information about the detection and diagnosis of ADHD. CONCLUSION: There are differences among the proposals for school assistance for ADHD in Spain, and those of Extremadura, Galicia, Catalonia and Navarra are found to be the most complete.

TITLE: Atencion escolar al trastorno por deficit de atencion/hiperactividad en las comunidades españolas.Introduccion. En los ultimos años, distintas comunidades autonomas españolas han presentado politicas de atencion escolar al trastorno por deficit de atencion/hiperactividad (TDAH) o de coordinacion entre los servicios de educacion y sanidad, que se concretan en protocolos, instrucciones o guias de actuacion. Objetivo. Conocer y comparar las propuestas de las distintas comunidades españolas para la atencion escolar al TDAH. Sujetos y metodos. Tras una busqueda de los documentos que recogen estas politicas, se analizo su informacion para poder compararlos en varias areas: documento, ambito de aplicacion, deteccion del TDAH, diagnostico, medidas escolares, seguimiento de las propuestas de la Guia de practica clinica sobre el trastorno por deficit de atencion/hiperactividad, fundamentacion y recursos ofrecidos. Resultados. La Comunidad Valenciana es la unica de la que no se ha encontrado documento alguno. No se analizo el de Baleares, por no ser publico, y en las comunidades restantes se encuentran diferencias en el cumplimiento de los criterios valorados en cada area. Las politicas de Extremadura, Galicia, Cataluña y Navarra son las que cumplen el mayor numero de criterios. Todas las comunidades con politicas sobre el TDAH proponen algun tipo de medida escolar y recursos como bibliografia, contactos o modelos de documentos o herramientas de deteccion. Todas, menos Madrid, ofrecen informacion sobre la deteccion y el diagnostico del TDAH. Conclusion. Se constatan diferencias entre las propuestas de atencion escolar al TDAH en España, y se identifican las de Extremadura, Galicia, Cataluña y Navarra como las mas completas.

Formalizing an electronic institution for the distribution of human tissues.

The use of multi-agent systems (MAS) in health-care domains is increasing. Such agent-mediated medical systems can manage complex tasks and have the potential to adapt gracefully to unexpected events. However, in these kinds of systems the issues of privacy, security and trust are particularly sensitive in relation to matters such as agents' access to patient records, what is acceptable behaviour for an agent in a particular role and the development of trust both between (heterogeneous) agents and between users and agents. To address these issues we propose a formal normative framework, deriving from and developing the notion of an electronic institution. Such institutions provide a framework to define and police norms that guide, control and regulate the behaviour of the heterogeneous agents that participate in the institution. These norms define the acceptable actions that each agent may perform depending on the role or roles it is playing, and clearly specifies the data it may access and/or modify in playing those roles. In this paper, we present the formalization of Carrel, a virtual organization for the procurement of organs and tissues for transplantation purposes, as an electronic institution using the ISLANDER institution specification language as formalizing languages. We demonstrate aspects of the formalization of such an institution, example fragments in the language used for the textual specification, and how such formalization can be used as a blueprint in the implementation of the final agent architecture, through techniques such as skeleton generation.

External validation of a simplified BCLC staging system for early hepatocellular carcinoma.

BACKGROUND AND AIMS: The aim was to externally validate the capability of a simplified Barcelona Clinic Liver Cancer (s-BCLC) staging system in allocating patients to hepatic resection (HR) and the effect on survival: S-BCLC was defined by only 2 groups: AA included BCLC A1 + A2 classes with alpha-fetoprotein (AFP) ≤ 20 ng/ml and AB included A1 + A2 with AFP > 20 ng/ml plus A3 + A4 subgroups. METHODS: This study compared a training group (TG) with hepatocellular carcinoma (HCC) submitted to hepatic resection (HR) in Milan with another group of patients, the validation group (VG) in Creteil. All patients underwent ultrasound-guided anatomical resection (<3 segments). RESULTS: Overall survival got worse from A1 to A4 (p = 0.0271) in TG (n = 132), as well as in VG (n = 100) (p = 0.0044) with a more important overlapping of each curves. According s-BCLC classification, the survival curves of TG (p = 0.0001) and VG (p = 0.0250) showed a definitive separation in two different staging groups. The s-BCLC provided the best predictive accuracy and it also presented the highest separability index and C-statistics in both TG and VG. On the other hand, in the evaluation of discriminatory ability for death, measured by ROC curve areas, the s-BCLC system gave better results than the others. CONCLUSION: This experience stressed the high value of BCLC system in staging of HCC, but the s-BCLC system seems to be more useful for therapeutic decision making.

Fuzzy K-nearest neighbor classifiers for ventricular arrhythmia detection.

We report a study of the efficiency of 4 classifiers (the K-nearest-neighbor and single-nearest-prototype algorithms, each as parametrized by both Fuzzy C-Means and Fuzzy Covariance clustering) in the detection of ventricular arrhythmias in ECG traces characterized by 4 features derived from 7 spectral parameters. Principal components analysis was used in conjunction with a cardiologist's deterministic classification of 90 ECG traces to fix the number of trace classes to 5 (ventricular fibrillation/flutter, sinus rhythm, ventricular rhythms with aberrant complexes and 2 classes of artefact). Forty of the 90 traces were then defined as a test set; 5 different learning sets (numbering 25, 30, 35, 40 and 45 traces) were randomly selected from the remaining 50 traces; each learning set was used to parametrize both the classification algorithms using both fuzzy clustering algorithms and the parametrized classification algorithms were then applied to the test set. Optimal K for K-nearest-neighbor algorithms and optimal cluster volumes for Fuzzy Covariance algorithms were sought by trial and error to minimize classification differences with respect to the cardiologist's classification. Fuzzy Covariance clustering afforded significantly better perception of cluster structure than the Fuzzy C-Means algorithm, and the classifiers performed correspondingly with an overall empirical error ratio of just 0.10 for the K-nearest-neighbor algorithm parametrized by Fuzzy Covariance.