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Background Lung sleeve resection is indicated for centrally located lung tumors, especially for patients who cannot tolerate pneumonectomy. With video-assisted thoracoscopic surgery (VATS) being increasingly implemented for a wide variety of thoracic pathologies, this study aims to compare the intraoperative, postoperative, and long-term outcomes of VATS and open bronchial sleeve lobectomy for non-small cell lung cancer (NSCLC). Methods The MEDLINE (via PubMed), Cochrane Library, and Scopus databases were searched. Original clinical studies, comparing VATS and open sleeve lobectomy for NSCLC were included. Evidence was synthesized as odds ratios for categorical and weighted mean difference (WMD) for continuous variables. Results Our analysis included six studies with non-overlapping populations reporting on 655 patients undergoing bronchial sleeve lobectomy for NSCLC (229 VATS and 426 open). VATS sleeve lobectomy was associated with significantly longer operative time ((WMD): 45.85 min, 95% confidence interval (CI): 12.06 to 79.65, p = 0.01) but less intraoperative blood loss ((WMD): −34.57 mL, 95%CI: −58.35 to −10.78, p Conclusions The limitation of our study arises mainly due to the heterogeneity of the included studies. Nevertheless, VATS bronchial sleeve lung resection constitutes a feasible and safe alternative to the open sleeve lung resection surgery for the management of centrally located lung tumors.

Background We compared the outcomes of laparoscopic hepatectomy (LH) vs. open hepatectomy (OH) for intrahepatic cholangiocarcinoma (iCCA). Methods A systematic review of the MEDLINE, EMBASE, Scopus, and Cochrane Library databases was performed using PRISMA guidelines (end-of-search date: 08-June-2020). Individual patient data on overall survival (OS) and recurrence-free survival (RFS) were extracted. Random-effects meta-analyses, and one- and two-stage survival analyses were conducted. Results Eight retrospective cohort studies comparing LH (n = 544) vs. OH (n = 2256) were identified. LH demonstrated lower overall complication (Risk ratio [RR] = 0.64, 95% confidence interval [CI]: 0.46–0.90; p = 0.01), surgical lymphadenectomy (RR = 0.74, 95% CI: 0.58–0.93; p = 0.01) and margin-positive resection (RR = 0.78, 95% CI: 0.62–0.99; p = 0.04) rates, and higher recurrence-free rate (RR = 1.24, 95% CI: 1.01–1.51; p = 0.04) vs. OH. In Cox regression, no difference was observed regarding OS (Hazard Ratio [HR] = 1.11, 95% CI: 0.65–1.91; p = 0.70) and RFS (HR = 1.19, 95% CI: 0.74–1.90; p = 0.47). Conclusion The use of LH should be considered when feasible in well-selected iCCA patients by hepatobiliary surgeons with experience in minimally-invasive surgery.

Simple Summary Cytoreductive nephrectomy (CN) refers to the removal of the primary renal tumor in the setting of metastatic renal cell carcinoma. In the past, the combination of CN with cytokine-based immunotherapy was considered the standard of care. However, CN’s role during the targeted treatment era remains controversial. We attempted to address this issue by performing a systematic review and meta-analysis of the literature. We synthesized data from 15 studies comparing CN and targeted therapy to targeted therapy alone. Our results show that CN combined with targeted therapy was associated with increased survival compared to targeted therapy only. Careful patient selection is required to take full advantage of any survival benefit that CN may offer. Future research endeavors should focus on developing appropriate prognostic models to guide appropriate patient selection for CN. Abstract The role of cytoreductive nephrectomy (CN) in the treatment of metastatic renal cell carcinoma (mRCC) remains controversial during the targeted therapy era. To reconcile the current literature, we analyzed the reported survival data at the individual patient level and compared the long-term survival outcomes of CN combined with targeted therapy vs. targeted therapy alone in patients with mRCC. We performed a systematic review of the literature using the MEDLINE, Scopus, and Cochrane Library databases (end-of-search date: 21 July 2020). We recuperated individual patient data from the Kaplan–Meier curves for overall (OS), progression-free (PFS), and cancer-specific survival (CSS) from each study. We subsequently performed one-stage frequentist and Bayesian random-effects meta-analyses using both Cox proportional hazards and restricted mean survival time (RMST) models. Two-stage random-effects meta-analyses were also performed as sensitivity analyses. A subgroup analysis was also performed to determine the effect of CN timing. Fifteen studies fulfilling our inclusion criteria were identified, including fourteen retrospective cohort studies and one randomized controlled trial. In the one-stage frequentist meta-analysis, the CN group had superior OS (hazard ratio [HR]: 0.58, 95% confidence interval [CI]: 0.54–0.62, p < 0.0001) and CSS (HR: 0.63, 95% CI: 0.53–0.75, p < 0.0001). No meaningful clinical difference was observed in PFS (HR: 0.90, 95% CI: 0.80–1.02, p = 0.09). One-stage Bayesian meta-analysis also revealed superior OS (HR: 0.59, 95% credibility interval [CrI]: 0.55–0.63) and CSS (HR: 0.63, 95% CrI: 0.53–0.75) in the CN group, while no meaningful clinical difference was detected in PFS (HR: 0.91, 95% CrI: 0.80–1.02). Similar results were obtained with the RMST models. The OS benefit was also noted in the two-stage meta-analyses models, and in the subgroup of patients who received upfront CN. The combination of CN and targeted therapy for mRCC may lead to superior long-term survival outcomes compared to targeted therapy alone. Careful patient selection based on prognostic factors is required to optimize outcomes.

Introduction: Values are the cornerstone of routine nursing practice. Yet, there is lack of clarity and controversies over the content of the term and its application in contemporary nursing practice. Aim : The main aim of this discussion paper to explore the concept of ‘values’ in nursing, provide insights into their application with specific relevance to nursing and contemplate on its consequences on contemporary nursing practice. Methodology : For this paper’s needs a critical literature search was undertaken within the past two decades whereby key terms and corresponding contexts were critically appraised with regards to the concepts involved. Search terms used included: nursing, values, deontology, caring, in both Pubmed and Greek databases. The Cohen's Kappa coefficient was used in order to assess inter-rater reliability. Results & Discussion : After close perusal, the search yielded 55 papers with a distinct content on values in contemporary nursing. These were categorized in 5 distinct subthemes i.e. Ethical and individual values, Professional values and virtues, The development of values, Integrity and Dignity which were subsequently addressed and discussed further. Cohen's Kappa was 0.85 (95% CI:0.776-0.922) reflecting a strong level of agreement among the two authors. Discussion : Professional values can be seen as tools that encourage nurses to become ethically sensitive professionals. Various studies on professional values in different countries have shown that the difference in the adoption and weight given to professional values is mainly due to the priorities given, rather than their nature per se. Ethical values significantly influence the scope of nursing practice, the way nurses think and act and consequently the care they provide with integrity and dignity being at the core of their practice delivery. Conclusions : Values in nursing science should be developed primarily by direct learning in basic education through raising awareness among nurses regarding ethics and the value of nursing. Integrity and respect for dignity are referred to as two of the most basic values which may affect both nursing practice and care providers. The way nurses behave is a reflection of their knowledge, experience, ability, personality and judgment. This reflects the professionalism of nurses based on agreed common values.

Intensive care electronic registries have been instrumental in quality measurement, improvement, and assurance of intensive care. In this article, the development and pilot implementation of the Intensive Care Unit Quality Management Registry are described, with a particular focus on monitoring the quality and operational cost in an adult ICU at a northern Greek state hospital. A relational database was developed for a hospital ICU so that qualitative and financial data are recorded for further analysis needed for planning quality care improvement and enhanced efficiency. Key features of this database registry were low development cost, user friendliness, maximum data security, and interoperability in existing hospital information systems. The database included patient demographics, nursing and medical parameters, and quality and performance indicators as established in many national registries worldwide. Cost recording was based on a mixed approach: at patient level ("bottom-up" method) and at department level ("top-down" method). During the pilot phase of the database operation, regular monitoring of quality and cost data revealed several fields of quality excellence, while indicating room for improvement for others. Parallel recording and trending of multiple parameters showed that the database can be utilized for optimum ICU quality and cost management and also for further research purposes by nurses, physicians, and administrators.

In this research, the sediment quality of the recently reconstructed Lake Karla (central Greece) was evaluated by monitoring the nutrient loadings and heavy metal concentrations in 16 sites during the initial period of the lake’s rehabilitation. The results indicated that lake sediments exhibited a high nutrient status as manifested by the high loadings of organic carbon (OC), total nitrogen (TN) and available phosphorus (AP). Comparison of metal (Ni, Cr, Co, Zn, Cu and Pb) levels with sediment quality guidelines showed that Ni and Cr were found in concentrations well above the PEL (probable effect level) values. No correlations were found between the nutrients and the measured heavy metals. Multivariate analysis results implied that Ni, Cr, Co, Cu and Zn were controlled by natural geological sources whereas Pb might have an anthropogenic origin. The bioavailability ratios of metals followed a decreasing order of Pb > Cu ~ Co > Zn > Ni > Cr based on results obtained by a single 0.5 M HCl leach. Total and bioavailable concentrations of metals demonstrated significant seasonal variations but trends could not be generalized for all the elements. On the contrary, the nutrients did not show significant seasonal differences indicating that the lake sediments record the history of contamination with regard to nutrient status.

Background/Aims: The hypothesis that dialytic modality affects arterial stiffness was never investigated. This study includes comparative evaluation of hemodiafiltration versus hemodialysis on arterial function during first and second weekly dialysis sessions. Methods: 24 patients receiving hemodiafiltration and another 24 age- and sex-matched controls receiving hemodialysis were included. Patients were evaluated before and after first and second weekly dialysis sessions. Applanation tonometry of peripheral arteries was applied to determine aortic and brachial pulse wave velocity and heart rate-adjusted augmentation index (AIx(75)). Results: Hemodiafiltration and hemodialysis reduced AIx(75), but not aortic and brachial pulse wave velocity. Intradialytic reductions in AIx(75) did not differ between hemodiafiltration and hemodialysis in first and mid-week dialysis. In multivariate linear regression, predictors of intradialytic reduction in AIx(75) were changes in body weight and central aortic systolic blood pressure, but not dialytic modality. Conclusion: This study showed that hemodiafiltration has similar effects with hemodialysis on wave reflections and stiffness.

The KRAS oncogene has been extensively studied for more than three decades, however, it is only recently that it attained a central role in the clinical decision-making process for the practicing oncologist. Recently, based on retrospective analyses of large randomized clinical trials, the use of anti-epidermal growth factor (EGFR) monoclonal antibodies, cetuximab and panitumumab, was restricted to patients with metastatic colorectal cancer that carry the “wild-type” KRAS genotype. Challenges remain in the laboratory implementation of KRAS mutational testing and the clinical application of the test for treatment planning. This review attempts to offer a global view of KRAS biology, its functional role in cell signaling, mechanisms of resistance to anti-EGFR agents and its predictive potential in metastatic colorectal cancer. We also survey the growing list of candidate biomarkers that may shortly supplement KRAS in routine clinical patient stratification. Finally, we discuss practical aspects of KRAS testing that may be useful for those involved in mutational screening in their centers. This general overview of KRAS for clinical oncology practice aims to assist in data interpretation and offer insight into potential pitfalls of mutational testing. KRAS is a prime example of how translational research can fulfill the promises of personalized medicine for tailoring treatment to match the underlying tumor biology. (C) 2010 Elsevier Ltd. All rights reserved.

Background: After the discovery of somatic mutations in the tyrosine kinase domain (exons 18-24) of the epidermal growth factor receptor (EGFR) correlating with responses of non-srnall cell lung cancer (NSCLC) to the tyrosine kinase inhibitors (TKIs) gefitinib and erlotinib, there has been increasing interest in utilizing this molecular marker for treatment selection. We aimed to analytically catalogue the Mutational spectrum of somatic Mutations in EGFR and format a database allowing correlation of specific mutations with clinico-pathologic factors and response to TKIs. Methods: A computerized search of MEDLINE (January I 2004 to,June 30, 2007) was performed to identify articles reporting on NSCLC patients harboring somatic mutations in EGFR. Demographic, clinico-pathologic, Mutational, and response data were extracted and tabulated. Results: A total of 202 eligible articles were identified. We report data on 12,244 patients with 3381 somatic EGFR mutations. The majority Of mutations have been reported on only one occasion (158 of 254, 62.2%), and only nine Mutations occur at a rate of L858R and delE746-A750 account for 32.84% and 24.28% of all mutations, respectively; with 50% of mutations being exon 19 deletions or “deletional-insertions.” There is a clear association between the presence of Mutations and response to TKI. Conclusions: We have generated a free access, nonprofit online analytical database of somatic EGFR mutations in NSCLC. Cumulative information will be made available through a routine update of both database tables and associated graphical representations. Direct updates and Submissions through the online site (www.somaticmutations-EGFR.org) are encouraged, as are comments and suggestions.