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Non-metastatic neuroendocrine carcinoma of the cervix (NECC) is a rare and aggressive disease. Lacking prospective studies, the optimal multimodal treatment approach has not yet been clearly defined. This study aims to assess the clinical outcomes of patients with non-metastatic NECC treated with surgery and (neo)adjuvant chemotherapy, according to pathologic prognostic factors and multimodal treatments received. We retrospectively examined data from patients with non-metastatic NECC candidate to receive surgery and (neo)adjuvant chemotherapy, and discussed at the European Institute of Oncology's Multidisciplinary Neuroendocrine Tumor Board, between January 2003 and December 2021. Primary endpoints were event-free survival and overall survival. A total of 27 consecutive patients were evaluated, 15 with early stage NECC and 12 with a locally advanced NECC. Eight patients received neoadjuvant and 19 adjuvant platinum-based chemotherapy; 14 received adjuvant pelvic radiotherapy, half with external-beam radiation therapy alone, and half combined with brachytherapy. No patients progressed or relapsed during (neo)adjuvant chemotherapy. The median event-free survival was 21.1 months and the median overall survival was 33.0 months. Pathological FIGO stage ≥ IIB, adjuvant external-beam radiation therapy with or without brachytherapy emerged as significant and independent prognostic factors for event-free survival. Brachytherapy was also prognostic for overall survival. Non-metastatic NECC requires a multimodal approach, mainly weighted on the FIGO stage. The addition of brachytherapy should be considered, especially in patients with locally advanced disease. Because of the scarcity of robust clinical data, treatment strategy should be discussed in multidisciplinary board, taking into account patient preferences.

The authors regret that there was a mistake in affiliation b. The correct affiliation can be found above. The authors would like to apologise for any inconvenience caused. DOI of original article: https://doi.org/10.1016/j.ygyno.2019.12.040

Active wheelset steering promises an attractive cost–benefit ratio and is highly likely to be implemented in the future. Previous studies investigated the steering effect simply through a wear index like wear number. However, a wear index cannot predict how much the material removal on wheels can be reduced, and it is unable to reveal the wear pattern. This paper builds an iterative wear model to predict wheel wear evaluation under the presence of an active steering system. Three active steering schemes are proposed, and they are compared in terms of wheel wear evolution. To quantify the steering effectiveness, two factors are created to, respectively, evaluate economic impacts and satisfaction of three steering schemes. Finally, a simplified method based on traditional wear indices is compared with the established iterative wear calculation method to examine the applicability and tolerance of the simplified method., QC 20210309

Objective: To evaluate the role of laparoscopic (LPS) and laparotomic (LPT) re-staging in patients with incompletely surgically staged ovarian granulosa cell tumors (OGCT). Methods: We conducted a medical chart retrospective analysis of all patients with sex cord stromal tumors (SCSTs) who were managed in our division between March 1994 and March 2017. After a complete review of surgical and pathological notes, patients with incomplete staging were restaged according to the FIGO guidelines. Statistical analysis was conducted using Statistical Package version 20.0 for Windows (SPSS, Inc., Chicago, Illinois). Results: Out of a total of 170 patients SCSTs, 84 patients (49,5%) received primary surgery that included a hysterectomy; 86 patients (50,5%) underwent fertility-sparing surgery. Eighty-one patients (48%) with diagnosis of OGCT were incompletely surgically staged at another institution. We evaluated our results in terms of laparoscopic approach (56 patients) and open treatment (25 patients). Among the IA patient's group, 1 was upstaged to IIB stage and 2 to IIIB; among patients with IC stage, 1 was upstaged to IIA, 2 to IIB and 1 to IIIB stage. Adjuvant chemotherapy was given to the upstaged patients with final stage IIB-IIIC. No statistically significant difference between laparoscopy and open-surgery was detected in terms of upstaged patients after second surgery (p = 0,36). Conclusion: According to our series, laparoscopic restaging compared to the open approach seems to be a feasible and efficient technique to complete surgical staging in patients with GCTs incorrectly staged. Surgical restaging seems to upstage a considerable number of OGCT, mainly in the initial stage IC group of patients. However, the impact of restaging on final outcome and survival remains to be demonstrated.

Importance: According to international recommendations, hospitals should use medication reconciliation to prevent medication errors and improve patient safety. Objective: To assess the impact of medication reconciliation at hospital admission on patient-centered health care outcomes. Design, Setting, and Participants: This parallel group, open-label randomized controlled trial used centralized randomization to the intervention group (ie, individuals with medication reconciliation) or control group (ie, individuals with only standard, physician-acquired medication history). Outcome assessors and data analysts were blinded to group allocation. Participants included 1702 patients aged 85 years or older, with more than 10 medications at hospital admission, or meeting both conditions at 2 regional secondary teaching hospitals in southern Switzerland. Study duration was 14.5 months, from November 1, 2018, to January 15, 2020. Data were analyzed from December 2018 through March 2020. Interventions: Medication reconciliation was performed at hospital admission in 3 steps: (1) the pharmacy assistant obtained the list of the patient's current medications (ie, the best possible medication history [BPMH]); (2) the clinical pharmacist led reconciliation of the BPMH with the list of home medications recorded at hospital admission by the attending physician (according to the hospital standard procedure); and (3) medication discrepancies were communicated to the attending physician, and, when necessary, medications prescribed at admission were adapted. Main Outcomes and Measures: The primary outcome was a composite postdischarge health care use variable quantified as the proportion of patients with unplanned all-cause hospital visits (including visits to the emergency department and hospital readmissions) within 30 days after discharge from the hospital when medication reconciliation took place. A time-to-event analysis was performed. Results: Among 1702 patients (median [interquar

The City of Venice and the surrounding lagoonal ecosystem are highly vulnerable to variations in relative sea level. In the past ~150 years, this was characterized by a secular linear trend of about 2.5 mm/year resulting from the combined contributions of vertical land movement and sea-level rise. This literature review reassesses and synthesizes the progress achieved in understanding, estimating and predicting the individual contributions to local relative sea level, with focus on the most recent publications. The current best estimate of historical sea-level rise in Venice, based on tide-gauge data after removal of subsidence effects, is 1.23 ± 0.13 mm/year (period from 1872 to 2019). Subsidence thus contributed to about half of the observed relative sea-level rise over the same period. A higher – yet more uncertain – rate of sea-level rise is observed during recent decades, estimated from tide-gauge data to be about 2.76 ± 1.75 mm/year in the period 1993–2019 for the climatic component alone. An unresolved issue is the contrast between the observational capacity of tide gauges and satellite altimetry, with the latter tool not covering the Venice Lagoon. Water mass exchanges through the Gibraltar Strait currently constitute a source of substantial uncertainty for estimating future deviations of the Mediterranean mean sea-level trend from the global-mean value. Subsidence and regional atmospheric and oceanic circulation mechanisms can deviate Venetian relative sea-level trends from the global mean values for several decades. Regional processes will likely continue to determine significant interannual and interdecadal variability of Venetian sea level with magnitude comparable to that observed in the past, as well as non-negligible differential trends. Our estimate of the likely range of mean sea-level rise in Venice by 2100 due to climate change is presently estimated between 11 and 110 centimetres. An improbable yet possible high-end scenario linked to strong ice