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Preoperative diagnosis for suspected gallbladder cancers is challenging, with a risk of overtreating benign disease, for example, xanthogranulomatous cholecystitis, with radical cholecystectomies. We retrospectively evaluated the surgeon's intraoperative assessment alone, and with the addition of intraoperative frozen sections, for suspected gallbladder cancers from a tertiary hepatobiliary multidisciplinary team (MDT).MDT patients with complex gallbladder disease were included. Collated data included demographics, MDT discussion, operative details, and patient outcomes.A total of 454 patients with complex gallbladder disease were reviewed, 48 (10.6%) were offered radical surgery for suspected cancer. Twenty-five underwent frozen section that led to radical surgery in 6 (25%). All frozen sections were congruent with final histopathology but doubled the operating time (p 0.0001). Both the surgeon's subjective and additional frozen section's objective assessment, allowed for de-escalation of unnecessary radical surgery, comparing favourably to a 13.0% cancer diagnosis among radical surgery historically.The MDT process was highly sensitive in identifying gallbladder cancers but lacked specificity. The surgeon's intraoperative assessment is paramount in suspected cancers, and deescalated unnecessary radical surgery. Intraoperative frozen section was a safe and viable adjunct at a cost of resources and operative time.

The spread of the COVID‐19 pandemic, commonly called coronavirus, has caused serious problems in society leading to the deaths of many people, affecting businesses, jobs, and education all over the globe. Social distancing, and avoiding group gathering and physical contact are the potential solutions to reduce the spread of the virus. In this chapter, we exploit the benefits of unmanned aerial vehicles (UAVs) deployed as aerial base stations (ABSs) or relays for terrestrial communication, crowd surveillance, and monitoring as the key aspect to enable social distancing restrictions.

There is an abundant expansion in the race of technology, specifically in the production of data, because of the smart devices, such as mobile phones, smart cards, sensors, and Internet of Things (IoT). Smart phones and devices have undergone an enormous evolution in a way that they can be used. More and more new applications, such as face recognition, augmented reality, online interactive gaming, and natural language processing are emerging and attracting the users. Such applications are generally data intensive or compute intensive, which demands high resource and energy consumption. Mobile devices are known for the resource scarcity, having limited computational power and battery life. The tension between compute/data intensive application and resource constrained mobile devices hinders the successful adaption of emerging paradigms. In the said perspective, the objective of this paper is to study the role of computation offloading in mobile cloud computing to supplement mobile platforms ability in executing complex applications. This paper proposes a systematic approach (EFFORT) for offload communication in the cloud. The proposed approach provides a promising solution to partially solve energy consumption issue for communication-intensive applications in a smartphone. The experimental study shows that our proposed approach outperforms its counterparts in terms of energy consumption and fast processing of smartphone devices. The battery consumption was reduced to 19% and the data usage was reduced to 16%.

Fog computing is a promising technique to reduce the latency and power consumption issues of the Internet of Things (IoT) ecosystem by enabling storage and computational resource close to the end-user devices with additional benefits such as improved execution time and processing. However, with an increase in IoT devices, the resource allocation and job scheduling became a complicated and cumbersome task due to limited and heterogeneous resources along with the locality restriction in such computing environment. Therefore, this paper proposes a cache-based approach for efficient resource allocation in fog computing environment, while maintaining the quality of service. The proposed algorithm is realized using iFogSim simulator and a comprehensive comparison is presented with the traditional First Come First Served and Shortest Job First policies. The performance evaluation revealed that with the proposed scheme the execution time, latency, processing delays and power consumption decreased by 38%, 11.1%, 6%, and 17.8%, respectively, as compared to those of the traditional schemes.

This chapter presents an insight into the narrowband Internet of Things (NB‐IoT), a cellular technology for enabling massive machine type communications such as automation in Industry. It provides an overview of NB‐IoT with respect to industrial automation. The chapter highlights the design of NB‐IoT to fulfil the intended objective, namely flexible deployment, extended coverage, long battery life, low device complexity, ultra‐low device cost, small data transmission, and massive device connectivity. The chapter provides a detailed overview of both downlink and uplink radio frames and transmission schemes along with the physical control channels. It includes the specific requirements of industrial automation use cases to highlight the feasibility of NB‐IoT for such scenarios. The chapter concludes the key features of NB‐IoT that can act as a key enabler for industrial automation. Mapping IoT applications in industrial automation with the recent development in communication technologies is essential for exploring future research directions and challenges.

Background Scoring systems were developed to stratify patients with colorectal liver metastases considered for liver resection into different risk groups. Such scores have never been evaluated in recurrent liver metastases. The aim of this study was to evaluate whether these scores are applicable to patients with recurrent colorectal liver metastases and treated with curative intent. Methods We retrospectively analyzed data from 375 consecutive patients who underwent liver surgery for colorectal liver metastases between June 2010 and August 2015. Seventy-three patients developed liver-limited recurrence treated with curative intent. The predictive value of 6 scores (Fong, Sofocleous, Nagashima, Nordlinger, Konopke, and the Basingstoke index) was assessed in this set of patients. Results Median follow-up was 36.2 months. Overall survival and progression-free survival were 33.6 and 5.6 months, respectively. When scores were applied for OS, none showed a significant stratification between patients, although Nagashima's score showed a significant difference in overall survival between patients from the low-risk group and those from the intermediate- and high-risk groups (40.8 vs 30.5 months, P = 0.039). For PFS, only Fong's score showed a statistically significant stratification (6.6 vs 4.7 months, P = 0.027). Conclusion Scoring systems are of limited-value in stratifying patients operated on for recurrent colorectal liver metastases.

Background Cardiopulmonary exercise testing (CPET) assessed “poorer” fitness correlates with poorer outcomes in blinded studies. Whether this correlation will persist when CPET is utilized to stratify care as part of a multi-modal enhanced recovery after surgery (ERAS) program is unclear. This study examined whether CPET variables were associated with postoperative morbidity in patients undergoing hepatectomy within an ERAS program. Objectives and Methods Data were prospectively collected on patients undergoing elective hepatectomy between October 2009 and April 2011. The relationships between CPET derived variables; postoperative complications and length of stay were investigated. Results Of 267 patients undergoing surgery, 197 had undergone standard cycle ergometer CPET. The relative oxygen uptake [ (ml kg−1 min−1)] and ventilatory equivalent of CO2 at the anaerobic threshold (AT) were not associated with complications or length of stay. Greater absolute oxygen uptake at AT [ at AT (L min−1)] was associated with early hospital discharge [OR 2.16 (95% CI 1.18–3.96), P = 0.013] on multivariable analysis. Conclusions When CPET is used to delineate perioperative management a low relative oxygen uptake [ (ml kg−1 min−1)] at the AT does not place patients at significantly higher risk of postoperative complications. This suggests CPET assessed “poor” fitness should not be used as a barrier to surgical intervention. J. Surg. Oncol. 2014; 110:439–444. © 2014 Wiley Periodicals, Inc.

Background There is limited evidence for the use of enhanced recovery after surgery (ERAS) in patients undergoing hepatectomy, and the impact of the evolution of ERAS over time has not been examined. This study sought to evaluate the effect of an evolving ERAS program in patients undergoing hepatectomy for colorectal liver metastases (CRLM). Methods A multimodal ERAS program was introduced in 2/2008. Consecutive patients undergoing hepatectomy for CRLM between 2/2008 and 9/2012 were included in the study. Data were collected prospectively. Retrospective analysis compared an early ERAS cohort (2/2008–4/2010) with a later cohort with a matured ERAS program (5/2010–8/2012). Results Length of stay reduced as experience of ERAS increased (Log-rank χ2 = 10.43, P = 0.001). Although median length of stay remained unchanged (6 days), the probability of hospitalization beyond 10 days was 25% in the early cohort compared with 7% in the later cohort. Critical care utilization reduced over time (75.5% vs. 54.7%, P

Background:Todate,thereislimiteddataontheliver‐firstapproachinthemanagementofcolorectallivermetastases(CRLM).Theaimofthestudy was to assess the outcomes of the liver‐first approach for patients with synchronous CRLM in two tertiary referral centers. Methods: Patients with stage IV colorectal cancer selected for the liver‐first approach from January 2009 to December 2012 in two tertiary referral centers were included. Data collated included demographics, chemotherapy, operative findings, histo‐pathological features, and survival. Results: Thirty‐seven patients with synchronous CRLM were considered for the liver‐first approach. Twenty‐five patients had rectal cancer. All patients underwent induction chemotherapy. Thirty patients underwent hepatic resections with no post‐operative deaths. Following liver resection, five patients failed toproceed tocolorectal resection and one patient had completeresponse tochemo‐radiotherapy. Ofthe25 patientsthat completed the liver‐first approach, 13 patients had recurrent disease, of which 12 patients died. The overall 1‐ and 3‐year survival rates were 65.9% and 30.4%, respectively. Conclusion: The liver‐first approach is a feasible strategy for patients with synchronous CRLM and may improve survival in selected patients. The selection of patients should be incorporated in a multidisciplinary approach to achieve the best possible outcomes. J. Surg. Oncol. 2013;108:444–449. 2013 Wiley Periodicals, Inc.

Aim The standard treatment for colorectal liver metastases (CRLM) is surgical resection. Only 20–30% of patients are deemed suitable for surgery. Recently, much attention has focused on ablative therapies either to treat unresectable CRLM or to extend the margins of resectability. This review aims to assess the long-term outcome and complication rates of various ablative therapies used in the management of CRLM. Method A literature search was performed of electronic databases including Medline, Cochrane Collaboration Library and the National Library of Medicine’s ClinicalTrials.gov. Inclusion criteria were ablation for CRLM with minimum 1 year follow-up and > 10 patients, published between January 1994 and January 2010. Results In all, 226 potentially relevant studies were identified, of which 75 met the inclusion criteria. Cryotherapy (26 studies) had local recurrence rates of 12–39%, with mean 1-, 3- and 5-year survival rates of 84%, 37% and 17%. The major complication rate ranged from 7% to 66%. Microwave ablation (13 studies) had a local recurrence rate of 5–13%, with a mean 1-, 3- and 5-year survival of 73%, 30% and 16%, and a major complication rate ranging from 3% to 16%. Radiofrequency ablation (36 studies) had a local recurrence rate of 10–31%, with a mean 1-, 3- and 5-year survival of 85%, 36% and 24%, with major complication rate ranging from 0% to 33%. Conclusion Ablative therapies offer significantly improved survival compared with palliative chemotherapy alone with 5-year survival rates of 17–24%. Complication rates amongst commonly used techniques are low.