Paralytic ileus is a temporary syndrome with impairment of peristalsis and no passage of food through the intestine. Although improvements in supportive measures have been achieved, no therapy useful to specifically reduce or eliminate the motility disorder underlying postoperative ileus has been developed yet. In this paper, we draw a plausible, physiologically fine-tuned scenario, which explains a possible cause of paralytic ileus. To this aim we extend the existing 1D intestinal electrophysiological Aliev-Richards-Wikswo ionic model based on a double-layered structure in two and three dimensions. Thermal coupling is introduced here to study the influence of temperature gradients on intestine tissue which is an important external factor during surgery. Numerical simulations present electrical spiral waves similar to those experimentally observed already in the heart, brain and many other excitable tissues. This fact seems to suggest that such peculiar patterns, here electrically and thermally induced, may play an important role in clinically experienced disorders of the intestine, then requiring future experimental analyses in the search for possible implications for medical and physiological practice and bioengineering.
The role of neoadjuvant chemotherapy (NACT) has been investigated in order to improve prognosis of patients with locally advanced cervical cancer. According to a meta-analysis, NACT followed by radiotherapy may be detrimental with a low dose of cisplatin and longer cycle intervals. Some meta-analyses showed NACT followed by surgery resulted in a reduction in the risk of death by 35% with a gain of 14% in the 5-year survival compared with radiotherapy. In a Cochrane meta-analysis, overall survival and progression-free survival were significantly improved with NACT followed by surgery versus surgery alone (23% reduction in the risk of death). The platinum/paclitaxel combination is now the preferred regimen in the neoadjuvant setting and preliminary data indicate that dose-dense regimens are feasible and effective (overall response rate: 67.8-87%). A weekly regimen with carboplatin/paclitaxel before chemoradiation showed promising results and the INTERLACE ongoing trial will help to confirm whether additional short-course chemotherapy given weekly before chemoradiation will lead to an improvement in overall survival.
This article represents the first observational study that describes the trend in the growth rate of borderline ovarian tumor recurrence in relation to their size detected at the first ultrasound examination. The findings of this study seem to confirm, in selected patients, that a thorough ultrasonographic follow-up of borderline ovarian tumor recurrence has proven to be safe and feasible. The final goal of such management is to maximize the impact on fertility potential of these young women without worsening their prognosis.
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