Notes

DecoPath: a web software for deciphering walkway enrichment analysis.
The spring indices, models that represent the onset of spring season biological activity, were developed using a long-term observational record from the mid-to-late twentieth century of three species of lilacs and honeysuckles contributed by volunteer observers across the nation. The USA National Phenology Network (USA-NPN) produces and freely delivers maps of spring index onset dates at fine spatial scale for the USA. These maps are used widely in natural resource planning and management applications. The extent to which the models represent activity in a broad suite of plant species is not well documented. In this study, we used a rich record of observational plant phenology data (37,819 onset records) collected in recent years (1981-2017) to evaluate how well gridded maps of the spring index models predict leaf and flowering onset dates in (a) 19 species of ecologically important, broadly distributed deciduous trees and shrubs, and (b) the lilac and honeysuckle species used to construct the models. The extent to which the spring indices predicted vegetative and reproductive phenology varied by species and with latitude, with stronger relationships revealed for shrubs than trees and with the Bloom Index compared to the Leaf Index, and reduced concordance between the indices at higher latitudes. These results allow us to use the indices as indicators of when to expect activity across widely distributed species and can serve as a yardstick to assess how future changes in the timing of spring will impact a broad array of trees and shrubs across the USA.BACKGROUND There is no clear consensus over the optimal width of resection margin for colorectal liver metastases (CRLM), with evolving definitions alongside the advances on the management of the disease. In addition, data on the impact of resection margin after laparoscopic liver resection are still scarce. METHODS Prospectively maintained databases of patients undergoing open or laparoscopic CRLM resection in 7 European tertiary hepatobiliary referral centres were reviewed. After propensity score matching (PSM), the influence of 1 mm and wider margins on OS and DFS were evaluated in open and laparoscopic cohorts. RESULTS After PSM, 648 patients were comparable in each group. The incidence of positive margins ( less then  1 mm) was similar in open and laparoscopic groups (17% vs 13%, p = 0,142). Margins  less then  1 mm were associated with shorter RFS in open (12 vs 26 months, p = 0.042) and in laparoscopic group (13 vs 23, p = 0,002). Margins  less then  1 mm were associated with shorter OS in open (36 vs 57 months, p = 0.027), but not in laparoscopic group (49 vs 60, p = 0,177). Subgroups with margins ≥ 1 mm (1-4 mm, 5-9 mm, ≥ 10 mm) presented similar RFS in open (p = 0,251) or laparoscopic cohorts (p = 0.117), as well as similar OS in open (p = 0.295) or laparoscopic cohorts (p = 0.908). In the presence of liver recurrence, repeat liver resection was performed in 70 (30%) patients in the open group and 88 (48%) in the laparoscopic group (p  less then  0.001). CONCLUSIONS Our study suggests that a positive resection margin (less than 1 mm) width does not impact OS after laparoscopic resection of CRLMs as it does in open liver resection. However, a positive margin continues to affect RFS in open and laparoscopic resection. Wider margins than 1 mm do not seem to improve oncological results in open or laparoscopic surgery.BACKGROUND Endoscopic techniques have become the first-line therapy in bariatric surgery-related complications such as leaks and fistulas. We performed a systematic review and meta-analysis on the effectiveness of self-expandable stents, clipping, and tissue sealants in closing of post-bariatric surgery leak/fistula. METHODS A systematic literature search of the Medline/Scopus databases was performed to identify full-text articles published up to February 2019 on the use of self-expandable stents, clipping, or tissue sealants as primary endoscopic strategies used for leak/fistula closure. Meta-analysis of studies reporting stents was performed with the PRISMA guidelines. JH-X-119-01 RESULTS Data concerning the efficacy of self-expanding stents in the treatment of leaks/fistulas after bariatric surgery were extracted from 40 studies (493 patients). The overall proportion of successful leak/fistula closure was 92% (95% CI, 90-95%). The overall proportion of stent migration was 23% (95% CI, 19-28%). Seventeen papers (98 patients) reported the use of clipping the over-the-scope clips (OTSC) system was used in 85 patients with a successful closure rate of 67.1% and a few complications (migration, stenosis, tear). The successful fistula/leak closure using other than OTSC types was achieved in 69.2% of patients. In 10 case series (63 patients), fibrin glue alone was used with a 92.8-100% success rate of fistula closure that usually required repeated sessions at scheduled intervals. The complications of fibrin glue applications were reported in only one study and included pain and fever in 12.5% of patients. CONCLUSIONS Endoscopic techniques are effective for management of post-bariatric leaks and fistulas in properly selected patients.BACKGROUND Post-cholecystectomy bile leak is relatively a well-known surgical complication. Several potential treatment modalities for such leaks are used. The early use of ERCP to exclude significant bile duct injury and to treat the leak by various endoscopic means is supported by a large bulk of data. However, there is no consensus as to the optimal endoscopic intervention. METHODS A retrospective review of ERCP database was done to identify all cases of bile leak related to cholecystectomy. Patient records including surgical and endoscopic reports were reviewed, and telephone interviews were conducted to collect data. RESULTS During the period 2004-2016, 100 patients (53 men, 47 women; mean age, 55 years) with post-cholecystectomy bile leak were referred for ERCP. Cholecystectomy was done laparoscopically in 82 patients (with an open conversion rate of 13%). In the majority of cases (77%), the leak was diagnosed by ongoing bile flow from the drains. The most common symptoms were pain (17%) and fever (4%).
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