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Purpose Over the last years, great advances in the repair of abdominal wall hernias have dramatically improved patients' outcomes. Especially for large and other complex ventral hernias, the application of component separation techniques has been a landmark in their successful management. The aim of this study is to present our experience with the posterior component separation with transversus abdominis release (TAR) in patients with these demanding ventral hernias. Methods A retrospective analysis of prospectively collected data of all patients who underwent elective ventral hernia repair with TAR between January 2016 and December 2019 was performed. Preoperative, intraoperative, and postoperative data were analyzed. Results A total of 125 patients with large and other complex ventral hernias were included in the final analysis. More than 80% of patients had one or more comorbidities. Of all patients, 116 (92.8%) had a history of previous abdominal surgery, 27 (21.6%) had a history of SSI and nine (7.2%) had active fistulas. Postoperatively, SSOs were presented in 11 patients (8.8%), including three cases of SSI. Neither mesh infection occurred, nor mesh excision required. With a mean follow-up of 2.5 years, only one recurrence was observed. Conclusions With a wound complication rate of less than 9% and a recurrence rate of less than 1%, our results show that TAR is a reliable, safe and effective technique for the repair of massive and other complex ventral hernias. The combination of knowledge of the abdominal wall anatomy at a proficient level, proper training, and adoption of a strict prehabilitation program are considered prerequisites for the successful management of such demanding hernias.

The present empirical study sheds light on the role of socioeconomic characteristics toward circular economy, resulting in more sustainable production and consumption patterns. Using fixed-effects and instrumental variable fixed-effects panel approaches, we examine the role of social and economic determinants on materials recycling and circularity in the European Union (EU). Empirical results reveal that recycling and circularity rates are positively affected by factors such as economic wealth, fertility rate, the level of environmental taxes and R&D expenditures. Furthermore, urbanization also seems to have a positive, but nonlinear effect on recycling and circularity rates. Our results can be beneficial to decision makers and managers for implementing several policies aiming to increase recycling and circularity across the EU and beyond.

This study investigates the behaviour of residential demand for electricity, employing a pseudo-panel methodology. The case of Greece, over the period 2009–2018, is taken as an example for our empirical investigation. The empirical analysis uses annual household panel data for the construction of 330 cohorts. The specification of cohorts is based on the date of birth, education level and geographical location of the head of the household. The econometric analysis is carried out using static and dynamic specifications and a quantile regression model. The results show that residential demand for electricity is price and income inelastic, both in the short and the long run. Electricity and heating oil appear to be complementary energy sources, while the household size and the education level are important determinants of residential demand for electricity. Income status has a marginal effect on demand for electricity, and the impact of urbanisation is insignificant. The quantile regression results show that, as the level of electricity use increases, demand for electricity becomes less income responsive and more price responsive. Our results show that a mix of structural energy measures along with economic policies could result in a decrease in electricity use and improve energy efficiency.

Transplanting kidneys small for recipient’s size results in inferior graft function. Body surface area (BSA) is related to kidney size. We used the BSA index (BSAi) (Donor BSA/Recipient BSA) to assess whether the renal graft size is sufficient for the recipient. We included 26,223 adult single kidney transplants (01/01/2007–31/12/2019) from the UK Transplant Registry. We divided renal transplants into groups: BSAi ≤ 0.75, 0.75 1.25. We compared delayed graft function rates, primary non-function rates and graft survival among them. (Reference category: BSAi ≤ 0.75). Cases with BSAi ≤ 0.75 had the highest delayed graft function rates in living-donor renal transplants (11.1%) (0.75 1.25: OR = 0.32, 95% CI = 0.13–0.77, p = 0.011) and in renal transplants from donors after brain death (26.2%) (0.75 1.25: OR = 0.65, 95% CI = 0.47–0.9, p = 0.01). There were no significant differences in renal transplants from donors after circulatory death regarding delayed graft function rates (~ 40% in all groups). Graft survival was similar among BSAi groups in renal transplants from living donors and donors after brain death. Renal transplants from donors after circulatory death with BSAi ≤ 0.75 had the shortest graft survival (0.75 1.25: HR = 0.45, 95% CI = 0.31–0.66, p

Pancreatic solid pseudopapillary neoplasms (SPNs) are rare borderline tumours mainly affecting young female patients. The number of patients diagnosed with SPNs has increased significantly in the last decades owing to the increased use of cross-sectional imaging investigating different abdominal symptoms, whilst a significant proportion are incidentally discovered during the process of evaluating other pathologies. We herein present our institutional experience of patients with SPN who underwent curative resection focusing on clinical, pathological features, and the long-term outcomes. All patients undergoing pancreatectomy in our institution for SPN from January 2010 until December 2018 were included. Clinical, perioperative, histological, and long-term outcomes were collected and analysed. During the inclusion period, a total of 19 patients had a pathological diagnosis of SPNs after surgical resection. Sixteen of them were female (84%), while the median patient age was 30 (range 16–66) years. Nine patients (47%) underwent distal pancreatectomy and splenectomy, 2 (11%) underwent spleen preserving distal pancreatectomy, 6 (32%) underwent pancreatoduodenectomy, one (5%) underwent total pancreatectomy, and one (5%) central pancreatectomy. Seventeen patients underwent R0 resection. During a median follow-up of 23 months, no tumour recurrence or death was recorded. In our experience, SPNs are rare tumours with low malignant potentials. Surgical resection remains the gold standard treatment and is associated with good prognosis.

Intrahepatic cholangiocarcinoma (iCCA) is a rare and aggressive hepatic malignancy. An up-to-date systematic review and meta-analysis was conducted aiming to compare outcomes between laparoscopic (LLR) and open liver resection (OLR) for patients with iCCA. A systematic literature search of Medline, Scopus, Google Scholar, and Cochrane databases was performed. A total of 8 studies comprising 2872 patients, who underwent LLR or OLR for iCCA, were included in our meta-analysis. LLR patients had smaller tumors [mean difference (MD): − 1.17 cm, 95% confidence intervals (CI) − 1.77 to − 0.57, p = 0.0001], underwent major resections less frequently [risk ratio (RR): 0.75, 95% CI 0.67–0.83, p

OBJECTIVES: The aim of this study was to investigate the relationship between M1 and M2 macrophage polarization and clinical stage in patients with medication-related osteonecrosis of the jaw (MRONJ) who underwent treatment with bisphosphonates or denosumab. MATERIALS AND METHODS: M1 and M2 macrophage density and expression of interleukin (IL)-6 and IL-10 were assessed on biopsies of mucosal tissues surrounding necrotic bone in 30 MRONJ patients with stages 1–3 and controls. For identification of M1 and M2 macrophages, double CD68/iNOS and CD68/CD206 immunofluorescence staining was conducted, respectively. Computer-assisted immunofluorescence quantification of markers was performed. RESULTS: Early stage 1 MRONJ patients showed a switch toward the M2 phenotype, as indicated by the higher density of M2 macrophages, the decreased M1/M2 ratio and the upregulation of IL-10. MRONJ patients with advanced stages 2 and 3 showed a shift toward M1-polarized macrophages, as suggested by the higher density of M1 macrophages, the increased M1/M2 ratio and the overexpression of IL-6. The macrophage density of both M1 and M2 subsets was significantly enhanced in patients receiving bisphosphonates compared to those receiving denosumab. CONCLUSIONS: The M1–M2 macrophage polarization status in mucosal tissues bordering necrotic bone correlates with clinical stage of MRONJ. Patients with early stage MRONJ show a switch toward M2-polarized macrophages, while MRONJ patients with advanced stage demonstrate a shift toward the M1 phenotype. CLINICAL RELEVANCE: Therapeutic molecules targeting the inflammatory microenvironment via the regulation of either M1 or M2 macrophage polarization may represent a novel strategy for treatment of MRONJ.

Uncertainty arising from sampling is nowadays a controversial issue, if it is necessary to be taken into account in total uncertainty. As in the quantification of analysis uncertainty, there are two principal approaches in order to estimate uncertainty of sampling: the bottom-up and the top-down approach. A novel top-down approach for sampling uncertainty is proposed in this study using nested analysis of variance (ANOVA). Determination of the oxytetracycline (OTC) content in feed was utilized for estimating uncertainty arising from sampling using the new approach. The advantage of nested ANOVA is that the effect of every factor on the total uncertainty can be calculated. In the present study, factors such as physical preparation of sample, lots of production and particle diameter were examined in the experimental design. It was found that the effect of different lots had the highest uncertainty among the factors. Finally, the results of nested ANOVA were compared with the uncertainty calculated using other top-down approaches. Classical ANOVA and robust ANOVA (RANOVA) did not show significant differences in their results. On the other hand, nested ANOVA estimated higher uncertainty of sampling in comparison with the other approaches.

The strategy of cardiac implantable electronic device (CIED) implantations performed as day-case admissions has gained a wider acceptance overtime; however, data on safety are still limited. This study aims to investigate the safety of a same-day discharge protocol introduced in our hospital for the postprocedural management of patients undergoing CIED implantation.Α prospective, non-interventional, non-randomised study performed in a single high-volume implanting centre for a 16-month period (March 2020 to June 2021). At total of 821 of 965 (85.1%) patients scheduled for elective CIED implantation were considered to be eligible for inclusion in the Short-stay Device Management Protocol. These patients were compared with a historical group of 932 patients, meeting the same inclusion criteria.Procedure was successful in 812 patients (98.9%), committed to same-day discharge versus 921 of 932 patients (98.8%) admitted for overnight stay (p = 0.87). Overall, 90-day complication rate was comparable in both groups (4.14% vs 4.07%, p = 0.95), as was major (1.46% vs. 1.82%, p = 0.55) and minor (2.67% vs. 2.25%, p = 0.64) complication rates. The composite early post-procedural complication rates and late post-procedural complication rates were comparable among groups (0.97 vs 1.18%, p = 0.70 and 0.73% vs 0.64%, p = 0.83, respectively). Six hundred sixty-seven patients (84%) preferred the same-day discharge strategy. Finally, a reduction of 792 bed-days was recorded, resulting in possible financial Health System benefits.Same-day discharge is feasible and safe in the majority of patients referred for CIED implantation. Additionally, same-day discharge is preferred by patients and may reduce procedure-related costs due to significant bed-day reductions.

Background Diaphragmatic hernia involves protrusion of abdominal contents into the thorax through a defect in the diaphragm. This defect can be caused either by developmental failure of the posterolateral foramina to fuse properly, or by traumatic injury of the diaphragm. Left-sided diaphragmatic hernias are more common (80–90%) because the right pleuroperitoneal canal closes earlier and the liver protects the right diaphragm. Diaphragmatic hernias in adults are relatively asymptomatic, but in some cases may lead to incarcerated bowel, intraabdominal organ dysfunction, or severe pulmonary disease. The aim of this report is to enlighten clinical doctors about this rare entity that can have fatal consequences for the patient. Case presentation We present a rare case of a right-sided strangulating diaphragmatic hernia in an adult Caucasian patient without history of trauma. Clinical examination revealed bowel sounds in the right hemithorax, which were confirmed by the presence of loops of small intestine into the right part of the thorax through the right diaphragm, as was shown on chest X-ray and computerized tomography. Deterioration of the clinical status of the patient led to an operation, which revealed strangulated necrotic small bowel. Approximately 1 m of bowel was removed, and laterolateral anastomosis was performed. The patient had an uneventful postoperative recovery and was discharged 8 days later. Conclusions Surgery is required to replace emerged organs into the abdomen and to repair diaphragmatic lesion. A delayed approach can have catastrophic complications for a patient.

The distribution, quantification and fluxes of Pb were examined in an evergreen broadleaved forest in western Greece for three hydrological years. More specifically, concentrations and annual fluxes of Pb were determined in bulk and throughfall deposition as well as litterfall. The Pb concentrations were also measured in forest floor and mineral soil up to 80 cm and the isotopic ratios of 206Pb/207Pb were determined in soil layers and the parent rock material. High variability in the fluxes of the metal among the three hydrological years were found, evidence of the variability of Pb deposition in time. Litterfall fractions with a large surface area, like holm oak flowers, had high Pb concentrations. Applying a steady state model and considering the Pb amounts in throughfall and litterfall as inputs on the forest floor, the mean residence time of Pb in the forest floor was 94 years with a coefficient of variation equal to 41%. More observations are needed to lower the variability of the mean residence time. The isotopic ratio in the rock material was defined as the lithogenic ratio. The statistical tests showed that the petrol derived Pb migrated to the depth of 20 cm and its percentages in the soil pedon was in the range of 62% in the L horizon to 11% in the 10–20 cm layer. In higher depths (> 40 cm) preindustrial anthropogenic Pb affected the isotopic ratio. As the forest under consideration is remote from industrial activities, the results can serve as a baseline for future studies on Pb distribution and quantification.

A systematic framework, involving flow simulation and model selection at many fidelity (resolution) levels, is introduced to accurately quantify the impact of geological uncertainty on multiple output quantities of interest (QoIs). The methodology considers large numbers of realizations (O(1000) in the case presented), though very few (O(10)) simulations are performed at the highest resolutions. We proceed from coarser to finer resolution levels, and at each stage simulation results are used to select a subset of realizations to simulate at the next (higher) fidelity level. Models are constructed at all resolution levels through upscaling of the underlying fine-scale realizations. A global transmissibility upscaling procedure is applied for this purpose. Approximate cumulative distribution functions (CDFs) are constructed for all QoIs considered. The QoI values themselves are always computed at the finest scale, but corresponding percentile values are determined using results at a “rank-preserving” (coarser) fidelity level. Detailed results are presented for oil-water flow in a channelized system. Simulations at seven different fidelity levels are used, and eight QoIs are evaluated. Results for the example considered demonstrate accurate reconstruction of fine-scale CDFs for all QoIs, with a speedup factor of about 18 relative to performing all simulations on the fine scale.

Patients with midgut neuroendocrine tumors (MNETs) frequently present with metastatic disease at the time of diagnosis. Although combined resection of the primary MNET and liver metastases (NELM) is usually recommended for appropriate surgical candidates, primary tumor resection (PTR) in the setting of extensive, inoperable metastatic disease remains controversial. A systematic review was performed according to PRISMA guidelines utilizing Medline (PubMed), Embase, and Cochrane library—Cochrane Central Register of Controlled Trials (CENTRAL) databases until September 30, 2018. Among patients with MNET and NELM, 1226 (68.4%; range, 35.5–85.1% per study) underwent PTR, whereas 567 (31.6%; range, 14.9–64.5%) patients did not. Median follow-up ranged from 55 to 90 months. Cytoreductive liver surgery was performed in approximately 15.7% (range, 0–34.8%) of patients. Pooled 5-year overall survival (OS) among the resected group was approximately 73.1% (range, 57–81%) versus 36.6% (range, 21–46%) for the non-resection group. For patients without liver debulking surgery, PTR remained associated with a decreased risk of death at 5 years compared with patients who did not have the primary tumor resected (HR 0.36, 95% CI 0.16 to 0.79, p = 0.01; I2 58%, p = 0.12). For patients undergoing PTR, 30-day postoperative mortality ranged from 1.43 to 2%. PTR was safe with a low peri-operative risk of mortality and was associated with an improved OS for patients with MNET and unresectable NELM. Given the poor quality of evidence, however, strong evidenced-based recommendations cannot be made based on these retrospective single center–derived data. Future well-design randomized controlled trials will be critical in elucidating the optimal treatment strategies for patients with MNET and advanced metastatic disease.

The objective of our systematic review was to evaluate the long-term outcomes of surgical resection as a treatment strategy for liver and pancreatic metastases from thyroid cancer (TC). A systematic search of three electronic databases for articles published up to October 2018 was conducted. All appropriate observational studies and case reports which reported outcomes from patients with TC metastatic to the liver or pancreas were considered eligible for inclusion in the present systematic review. A total of 15 studies, which comprised of 16 patients that underwent hepatic or pancreatic resection for TC metastasis, were included in the present systematic review; among them, 5 presented with metastasis to the liver, whereas 11 had pancreatic metastatic disease. The median time interval between the initial thyroidectomy and the diagnosis of metastases (either hepatic or pancreatic) was 60 months (SE 23.8, 95% CI 13.3–106.7) for the entire cohort and the mean overall survival was 37.6 months (SE 8, 95% CI 22–53.3). Five patients with pancreatic metastases presented with recurrence whereas no recurrences were noted in patients with liver metastases. Surgical resection of liver and pancreatic metastases from TC seems to be a safe and efficient treatment option for selected patients. In that setting, long-term outcomes in patients with resected TCLM are encouraging given the absence of recurrence as reported from the included studies, whereas in the case of TCPM, survival is limited due to advanced disease at diagnosis and recurrence rates.

Laparoscopic liver surgery is currently acknowledged to be a safe and effective approach for the treatment of a variety of benign and malignant hepatic lesions. Its wider adoption was delayed by lack of experience, unavailability of suitable laparoscopic equipment, fear of uncontrollable intraoperative adverse events and the perceived oncological inadequacy of the approach. Over the years all these obstacles were overcome, and increasing numbers of studies documented the safety and efficacy of the procedure, with beneficial short-term results and long-term outcome comparable with that of the traditional open approach. This review presents the current knowledge on the indications, advantages, and short- and long-term outcomes of laparoscopic liver resection for a variety of liver lesions.

The objective of this paper is to examine the Wagner’s law validity, and whether it can explain the U.K. public spending expansion for the period 1850–2010. According to Wagner’s Law, economic development is the key determinant to public sector growth. Accordingly, the public sector grows overproportionally compared to national income when economies develop. We test this hypothesis for the UK. The data covers a period in which the U.K. economy experienced increased economic growth, government spending and met most of the assumption of Wagner’s Law (industrialisation, urbanisation, increased population). Furthermore, the long data set ensures the reliability of our results in terms of statistical and economic conclusions. We apply unit root tests, unit root tests with structural breaks, cointegration techniques and the Granger causality test. Our results indicate a presence of a long run relationship between national income and government spending, while the causality is bi-directional, thus we find support for Wagner’s and Keynesian hypotheses.

White blood cell (WBC) and platelet indices are useful biomarkers in many inflammatory diseases. A study was made of possible WBC and platelet indices in children with acute appendicitis. We reviewed the results of the complete blood count tests made on admission of 150 children with acute appendicitis (94 boys, 56 girls) and those of 74 healthy children (46 boys, 28 girls). We compared the WBC and platelet indices between the children with acute appendicitis and healthy children and between the complicated and uncomplicated cases of appendicitis. The children with acute appendicitis had higher WBC, neutrophil count, neutrophil percentage and neutrophil/ lymphocyte ratio and lower lymphocyte count and lymphocyte percentage than the healthy children. Cases of appendicitis with complications had lower lymphocyte count, lymphocyte percentage and higher neutrophil to lymphocyte ratio than those without complications. In girls WBC, neutrophil count and neutrophil percentage were higher in complicated acute appendicitis. WBC, neutrophil count, neutrophil percentage, lymphocyte percentage and a neutrophil/lymphocyte ratio >2.5 were accurate markers for acute appendicitis in children, but not for detecting complicated cases. Girls with acute appendicitis had lower platelet distribution width than healthy girls, with high sensitivity and positive predictive value at platelet distribution width

The acute and delayed effect of analgesic-range doses of ketamine on neurocognitive and behavioural outcomes is understudied. Using a non-controlled open-labelled design, three (1-h duration) increasing intravenous (IV) ketamine infusions comprising (i) 30 mg bolus of ketamine + 8 mg/h IV infusion, (ii) 12 mg/h IV infusion and (iii) 20 mg/h infusion were administered to 20 participants (15 male, 5 female, mean age = 30.8 years). Whole-blood ketamine and norketamine concentrations were determined at each treatment step and post-infusion. The Cambridge Neuropsychological Test Automated Battery (CANTAB) was used to assess reaction/movement time (RTI, Simple and 5-Choice), visuospatial working memory (SWM), spatial planning (SOC) and subjective effects (visual analogue scale; VAS) during treatment and at post-treatment. Significant main effects were reported for time (dose) on CANTAB RTI 5-Choice reaction (F(4,18) = 3.41, p = 0.029) and movement time (F(4,18) = 4.42, p = 0.011), SWM (F(4,18) = 4.19, p = 0.014) and SOC (F(4,18) = 4.13, p = 0.015), but not RTI Simple reaction or movement time. Post hoc analyses revealed dose-dependent effects for both RTI 5-Choice reaction and movement time (all p

Recent advances in data-acquisition technologies have equipped team coaches and sports analysts with the capability of collecting and analyzing detailed data of team activity in the field. It is now possible to monitor a sports event and record information regarding the position of the players in the field, passing the ball, coordinated moves, and so on. In this paper we propose a new method to analyze such team activity data. Our goal is to segment the overall activity stream into a sequence of potentially recurrent modes, which reflect different strategies adopted by a team, and thus, help to analyze and understand team tactics. We model team activity data as a temporal network, that is, a sequence of time-stamped edges that capture interactions between players. We then formulate the problem of identifying a small number of team modes and segmenting the overall timespan so that each segment can be mapped to one of the team modes; hence the set of modes summarizes the overall team activity. We prove that the resulting optimization problem is $$\mathrm {NP}$$ -hard, and we discuss its properties. We then present a number of different algorithms for solving the problem, including an approximation algorithm that is practical only for one mode, as well as heuristic methods based on iterative and greedy approaches. We benchmark the performance of our algorithms on real and synthetic datasets. Of all methods, the iterative algorithm provides the best combination of performance and running time. We demonstrate practical examples of the insights provided by our algorithms when mining real sports-activity data. In addition, we show the applicability of our algorithms on other types of data, such as social networks.

According to neoclassical perception the growth of private consumption appears to be higher during (or after) fiscal consolidation periods via the fiscal multiplier effect. Therefore, private consumption booms are more likely to be associated with large cuts in deficits by either increasing taxes or by reducing public spending. Simultaneously, only recently shadow economy and corruption have gained scientific attention, and in the studies appear to have mainly negative effects on real economy. This research uses an alternative growth of private consumption approach using dynamic panel data regression analysis of seventeen Eurozone countries over the period 1995–2015. Empirical findings display that corruption and/or shadow economy might be substitutes regarding its effect on individuals’ real consumption growth. Furthermore, consolidation periods experience a marginal lower private growth of consumption, questioning the generality of neoclassical theory implication.

Laparoscopic liver resections (LLR) are widely accepted as safe and effective procedures for the management of hepatocellular carcinoma (HCC) in the hands of experienced surgeons. The efficacy and extent of benefits of pure as well as hand-assisted laparoscopic and laparoscopy-assisted liver resection over open liver resection (OLR) have been investigated by numerous studies during the last 10 years. The aim of our meta-analysis is to investigate the effect of LLR in short- and long-term outcomes compared to OLR in patients operated for HCC. A total of 5203 patients from forty-four studies were included in our meta-analysis reporting for short- and long-term results for both LLR and OLR for HCC. Among them, 1830 underwent pure laparoscopic hepatectomy, 282 underwent pure laparoscopic or hand-assisted laparoscopic or laparoscopy-assisted hepatectomy, and 3091 were operated through open approach. LLRs were found to be significantly associated with lower blood loss, need for blood transfusion, successful achievement of R0 resection as well as wider resection margin, shorter hospital stay, lower morbidity and 30-day mortality rates. Operative time, tumor recurrence, 1-, 3-, and 5-year overall survival as well as 1-, 3-, and 5-year disease-free survival were not found different between the groups. This meta-analysis clearly demonstrates the superiority of laparoscopic resection over the open approach for patients with small HCC.

In several application domains, including sign language, sensor networks, and medicine, events are not necessarily instantaneous but they may have a time duration. Such events build sequences of temporal intervals, which may convey useful domain knowledge; thus, searching and indexing these sequences is crucial. We formulate the problem of comparing sequences of labeled temporal intervals and present a distance measure that can be computed in polynomial time. We prove that the distance measure is metric and satisfies the triangle inequality. For speeding up search in large databases of sequences of temporal intervals, we propose an approximate indexing method that is based on embeddings. The proposed indexing framework is shown to be contractive and can guarantee no false dismissal. The distance measure is tested and benchmarked through rigorous experimentation on real data taken from several application domains, including: American Sign Language annotated video recordings, robot sensor data, and Hepatitis patient data. In addition, the indexing scheme is tested on a large synthetic dataset. Our experiments show that speedups of over an order of magnitude can be achieved while maintaining high levels of accuracy. As a result of our work, it becomes possible to implement recommender systems, search engines and assistive applications for the fields that employ sequences of temporal intervals.

The best adjuvant treatment for hormone receptor-positive breast cancer, especially in the postmenopausal population, is not an unexceptionable decision and depends on several and many times unequal parameters. Apart from the mechanisms of action which are more or less the same among different agents, the two major factors for consideration are the potential side effects and treatment benefits of the selected drug. The last fifteen years have clearly shown that aromatase inhibitors (AIs) are significantly more effective than tamoxifen in preventing recurrence in this group of patients, but they seem to have no beneficial effect on overall survival. The analysis and results of major controlled randomized trials are taken into consideration every time we are called upon to select the best effective adjuvant treatment for well surgically-controlled early breast cancer in a postmenopausal woman. In the present review, we attempt a comprehensive review of the recent English literature in order to unfold the potent aspects for this decision.