Western Series Research Articles

“There Is No Heaven to Go to, Because We’re in It Already. We’re in Hell, Too. They Coexist”

This article explores the idea and articulation of place in Taylor Sheridan’s western series 1883 and Yellowstone. Through narrative and genre analysis, we critically compare these two series to demonstrate that genre semantics combine in a particular series-specific syntax to articulate place differently. Our thinking on place and adjacent concepts of trails and knots, inhabiting and occupation, as well as the differentiation between place as object and place as event, is primarily informed by the scholarship of Tim Ingold. We argue that these series’ specific and gendered articulations of place are meaningfully linked to each series’ protagonist, Elsa Dutton and John Dutton respectively. Finally, we suggest that the two series generate an additional western-genre binary that we base on Ingold’s work: occupation (particular to Yellowstone) vs. inhabiting (specifically in 1883). The Yellowstone character Beth Dutton notably reifies this binary. Yellowstone, here framed as post-heydey western, postwestern and post-Western, articulates place as nostalgic and static compared to 1883’s more expansionist and dynamic iteration of place.

Попавшие в „мышеловку”: анализ отношения местного населения к Чернобыльской Зоне Отчуждения в кино- и телепродукции (1990–2021 гг.)

The release of the television series Chernobyl (HBO, Sky Atlantic 2019) drew renewed attention to the tragedy, its locations, and the affected population, generating new productions in Russia, such as the film Chernobyl: Abyss (Danila Kozlovskij, 2021), explicitly made in response to the Western series, signalling a desire to re-appropriate the narrative of the disaster and its territories. Indeed, a recurrent characteristic of the film and television productions of the countries most affected by the 1986 nuclear disaster (Ukraine, Belarus, and Russia) has been the representation of the land and the inhabitants’ relationship with it (Lindbladh 2019). This is also a central theme in Svetlana Alexievich’s renowned 1997 work Voices from Chernobyl: Chronicle of the future, whose stories inspired some episodes of the Anglo-American series. This article analyzes the representation of the relationship between the inhabitants of the Chornobyl/Chernobyl Exclusion Zone and their homeland in film and television productions dedicated to the nuclear disaster, beginning with Eastern European films made in the early 1990s, moving on to the representation in the Western series, and culminating with an analysis of Kozlovskij’s Chernobyl: Abyss. Features considered include the development of romantic narratives within the contaminated zone, the visual representation of radiation, and the depiction of the local institutions’ response to the disaster.

Risk Factors for Lymph Node Metastasis in a Western Series of Patients with Distal Early Gastric Cancer.

Background: Assessment of potential lymph node metastasis is mandatory in the appropriate treatment of early gastric cancers. This study analysed factors associated with lymph node metastasis to identify differences between node-negative and node-positive patients and between T1a and T1b cancers. Methods: The clinicopathological features of 129 early gastric cancer patients who had undergone radical gastrectomy were analysed to identify predictive factors for lymph node metastasis. Results: Lymph node metastasis was detected in 76 (59.0%) patients. Node-positive patients were younger (58.1 ± 11.3 years) than those without metastasis (61.9 ± 9.6 years, p = 0.02). Greater tumour sizes were observed in patients with lymph node metastasis (3.6 ± 1.0 cm) compared to node-negative patients (1.9 ± 0.5 cm, p = 0.00001). Depressed form, ulceration, diffuse histological type, and undifferentiated lesions were more frequent in node-positive patients than in the node-negative group. Tumour size > 3.0 cm showed a correlation with lymph node metastasis in both T1a (p = 0.0001) and T1b (p = 0.006) cancer. The male sex (p = 0.006) had a significant correlation with lymph node metastasis in T1a cancer. Depressed appearance (p = 0.02), ulceration (p = 0.03), differentiation (p = 0.0001), diffuse type (p = 0.0002), and lower third location (p = 0.005) were associated with lymph node metastasis in T1b cancer. Conclusions: Tumour size > 3 cm, undifferentiated lesions, ulceration, diffuse type, lower third location, and submucosal invasion are risk factors for lymph node metastasis in early gastric cancer.

Clinical Manifestations of Wegener Granulomatosis in Iranian Ethnicities Using the K-Means Algorithm: A Descriptive Study.

Introduction Wegener granulomatosis (WG) appears with clinical symptoms, including recurrent respiratory infection, renal manifestations, and nonspecific systemic symptoms. Objective To study the clinical manifestations of WG in Iranian ethnicities, and data on 164 patients were recorded from 2013 to 2018. Methods The data included demographics, symptoms, and the Birmingham Vasculitis Activity Score (BVAS). The symptoms involved the following sites: the nose, sinus, glottis, ears, lungs, kidneys, eyes, central nervous system, mucous membranes, skin, heart, stomach, intestine, as well as general symptoms. The clinical manifestations of nine ethnicities were analyzed. Results In total, 48% of the patients were male and 51% were female, with a median age of 51 years. The BVAS was of 15.4, the sites most involved were the sinus ( n = 155), nose ( n = 126), lungs ( n = 125), and ears ( n = 107). Gastrointestinal ( n = 14) and cardiac ( n = 7) involvement were less common. Among the patients, 48.17% were Persian, 13.41% were Azari, 11.17% were Gilaki, 11.17% were Kurd, and 10.9% were Lor. Conclusion Our findings indicated that the sinus, nose, lungs, and ears were the sites most involved, and gastrointestinal and cardiac involvement were less common. In the present study, involvement of the upper and lower respiratory tract was higher than that reported in Western and Asian case series. Moreover, we report for the first time that, in all patients with ear involvement, the left ear was the first to be affected. The clinical manifestations among Iranian ethnicities were not different, and the Gilaki ethnicity had the highest BVAS, mostly because the weather was humid; therefore, in Iran, in areas with humidity, the rate of the disease was higher.

Gastric Polyps in Familial Adenomatous Polyposis Portuguese Patients: The First Western Cohort with Asian Features

Introduction: Chronic atrophic gastritis may contribute to gastric polyps (GP) phenotype in familial adenomatous polyposis (FAP). Considering the high prevalence of Helicobacter pylori (HP) infection in Portugal, we aim to characterize GP in a series of Portuguese patients. Methods: In a retrospectively selected series of 53 FAP patients, clinical data and histopathological features of GP and background gastric mucosa were studied. SPSS (27.0) was used for statistical analysis. Results: Thirteen patients (24.5%) developed fundic gland polyps (FGP), seven (13.2%) gastric adenomas (GA), and ten (18.9%) both FGP and GA. Out of 100 GP, four were hyperplastic polyps, 58 FGP (24 with dysplasia), 35 intestinal-type GA (intGA), and three foveolar-type GA (fovGA). IntGA were larger (60% >7 mm, p = 0.03), occurred predominantly in the distal stomach (66.7%, p = 0.024), in patients harboring gastric intestinal metaplasia (IM) (86.7%, p < 0.001), and duodenal adenomas (86.7%, p < 0.001). Conclusion: This is the first Western series showing high prevalence of intGA in FAP patients, comparable to Asian cohorts. HP infection and chronic atrophic gastritis/intestinal metaplasia are likely responsible for this difference, with risk of neoplastic transformation and management implications. Biopsy/excision of GP >7 mm in the distal stomach and in patients harboring gastric intestinal metaplasia/duodenal adenomas should be considered.

Accretion and subduction mass transfer processes: Zircon SHRIMP and geochemical insights from the Carboniferous Western Series, Central Chile

ABSTRACT In the region of Pichilemu (Central Chile), the exhumed roots of the Carboniferous paleo-accretionary wedge developed during subduction of an oceanic realm underneath the western Gondwana margin are exposed. We focus on the areas of Infiernillo beach and Punta de Lobos: the former representing a well-characterized transitional blueschist-facies coherent stack of metabasitic lithologies interlayered at the centimetre- to metre-scale within metasedimentary rocks and glaucophanites, whereas the latter corresponds to a massive, up to hundreds of metres thick, strained metapillow lavas edifice surrounded (not interlayered) by metasedimentary rocks. We provide new field, geochemical, Raman thermometry and zircon SHRIMP U-Th-Pb geochronology on the lithologies forming the Infiernillo-Punta de Lobos complex aiming at characterizing the sedimentary sources and the extent of mechanical mixing. Field observations suggest that the Infiernillo-Punta de Lobos complex can be considered as part of the same successions, subducted and basally accreted almost coherently at high pressure-low temperature (HP-LT) conditions. The geochemistry signal in metasedimentary rocks and maximum deposition ages point to a marked forearc source for all the metasedimentary and glaucophanite lithologies, whereas massive metapillow lavas and greenschists might represent volcanic products and oceanic roughnesses erupted near the trench when the oceanic material approached the Gondwana margin at c. 329 Ma. It is suggested that the interlayering now observed in the field is mostly the consequence of sedimentary and/or volcanic processes close to the trench environment, with minor tectonic reworking of the pre-subduction structures (e.g. lithological contacts). Our results suggest that the Punta de Lobos edifice is closely related to the subduction of large volumes of continent-derived, trench-filling sediments towards HP-LT conditions. Thus, in line with previous experimental and numerical simulations, we emphasize the potential role of oceanic roughness as stress perturbations that could contribute to the subduction of thick sedimentary sequences, and discuss their implications for seismogenesis.

Paleozoic Gondwanan structure along the Maule river valley between Toconey and Constitución (35.4°S, Chilean Pacific Coast)

During the late Carboniferous–middle Permian, the basement of the Chilean Coastal Cordillera was deformed by the Gondwanan Orogeny, developed by the subduction of the Paleo-Pacific plate under Gondwana from the early Carboniferous. In the Maule sector (35.4°S), the following metamorphic rock units are distinguished: (i) Western Series, formed by metapelites, metabasites, metacherts, metaconglomerates, and marbles, mixed in a subduction channel, with probably ages between the Cambrian and the Carboniferous; (ii) Eastern Series, consisting of metasediments of a fore-arc basin, Carboniferous in age. In the Eastern Series two units are recognized in terms of lithology and deformation style: the Eastern Pelitic Series and the Eastern Sandy Series. Three Gondwanan deformation episodes have been distinguished, affecting both series unequaly. In the Western Series, D1 structures consist of a foliation (S1) developed under high-pressure and low-temperature conditions, while in the Eastern Series it comprise tight east-verging folds, with the associated S1 developed under low PT metamorphic conditions (greenschist facies). D2 structures are only present in the Western Series and Eastern Pelitic Series and represent the exhumation of the accretionary prism and its emplacement to the east over the fore-arc basin, with the development of east-verging recumbent folds and a thick shear-zone. Difficulties in the propagation of the deformation by the presence of the Coastal Batholith to the east led to the development of the D3 deformation event, only well developed in the Eastern Sandy Series, and represented by the Los Tablones Back-thrust and associated folds, as well as N–S open right folds formed under low PT metamorphic conditions.

The Psychological Impact of Western Web Series on India High-Schoolers

This study aims to understand the depth of the influence of western web series on young impressionable minds of school-going teenagers. These teenagers are studying in both residential and non-residential schools, in tier 1 and tier 2 cities. The feedback that was received was encouraging enough to indicate that drugs, alcohol, smoking, and violence were not what they wanted to replicate, but they were enamoured by the education system as well as the academic life that students in these series depicted. This was a source of attraction for Indian high schoolers to the extent that it did make them consider pursuing these countries for higher education. The next step of my study would be to extend the survey to a wider reach of students in different cities in rural and urban areas.

Craniological data on migrations from the West to Eastern Europe in the Post-Catacomb period

In the article the craniology of the post-Catacomb and Middle Volga Abashevo populations in the context of cranial metric characteristics of Neolithic and Bronze Age groups of continental Europe is discussed. The data on 2100 male skulls belonging to 95 samples was analyzed by means of Mahalanobis distances (D²) matrix. The results reveal high level of similarity between the post-Catacomb series and Catacomb East-Manych, Eastern Caucasus (Gintchi) and Fatyanovo-Balanovo samples. Basically these results are in line with archaeological reconstructions of cultural processes in Middle and Late Bronze Age. The most western series, which displays morphologic similarity with the Babino sample, is the Globular Amphora series, while the Corded Ware sample from the Baltic region is similar to the Lolino culture sample. We suggest that the series of skulls from the Pepkino kurgan may be unrepresentative for the Middle Volga Abashevo population, since analogies to its cranial metric profile can be traced only in the late Fatyanovo and Balanovo samples and in one local Yamnaya sample, but are absent in other European populations, including Bell Beaker sample, which is in contradiction with archaeological data.

Translation and the acquisition of symbolic capital: The Blueberry Western series in the field of American comic books

ABSTRACT One of the best Western comic book series in the field of Franco-Belgian comics, the Blueberry series is widely acclaimed and has generated considerable symbolic capital. Mirroring its success in France and Belgium, this series has also been extensively (re)translated and (re)printed in several countries, such as Spain and Italy. In Anglophone countries, however, this editorial success has not been replicated. The Blueberry series has never been published in its entirety in English, nor has it acquired the symbolic capital that it enjoys in the Franco-Belgian comics field. This article focuses on the American editions of the Blueberry series. By adopting a translational framework based on Jean-Marc Gouanvic’s works on the sociology of translation, this paper shifts the traditional focus of Translation Studies from the texts to the critical and often overlooked role of translators and other agents in the international circulation of (graphic) narratives. Based primarily on the analysis of interviews with the American translators and editors of the Blueberry series, coupled with close paratextual examination of selected comics samples, this article investigates the context behind the reception of this iconic Western series in the field of American comic books.

ASO Visual Abstract: Impact of Surgical Margins on Overall Survival After Gastrectomy for Gastric Cancer: A Validation of Japanese Gastric Cancer Association Guidelines on a Western Series

ASO Visual Abstract: Impact of Surgical Margins on Overall Survival After Gastrectomy for Gastric Cancer: A Validation of Japanese Gastric Cancer Association Guidelines on a Western Series

Impact of Surgical Margins on Overall Survival after Gastrectomy for Gastric Cancer: A Validation of Japanese Gastric Cancer Association Guidelines on a Western Series

PurposeNo consensus exists on the resection extent needed to ensure oncological safety in gastrectomy for gastric adenocarcinoma (GAC). This study aims to assess the impact of margin adequacy according to Japanese Gastric Cancer Association (JGCA) guidelines on overall survival (OS).Patients and MethodsPatients who underwent surgery for stage I–III GAC at our institution between 2010 and 2017 were included. Margin adequacy according to JGCA, National Comprehensive Cancer Network (NCCN), and European Society for Medical Oncology (ESMO) guidelines was assessed, and their predictive value on OS was evaluated with Harrell’s C-index. Patients were analyzed according to their margins’ adherence to JGCA guidelines, and a propensity score matching (PSM) was run. Indication to either total gastrectomy (TG) or distal gastrectomy (DG) according to each guideline was also assessed.ResultsA total of 279 patients were included, of whom 220 (79%) underwent DG. Adequate margins according to JGCA were obtained in 209 patients (75%). On multivariate analysis, JGCA margin adequacy was independently associated with OS, together with American Society of Anesthesiologist class, neoadjuvant chemotherapy, lymphadenectomy extent, R0 resection, and postoperative N stage. After PSM, patients with JGCA adequate margins showed better OS, recurrence-free survival (RFS), and local RFS than patients with JGCA inadequate margins. For 220 DG, JGCA guidelines would have recommended TG in 25 patients (11%), NCCN in 30 (14%), and ESMO in 90 (41%) (p < 0.001).ConclusionAdequacy of surgical resection margins to JGCA guidelines leads to improved survival outcomes and allows for a more organ-preserving approach than Western guidelines.

Posterior Quadrant Disconnection for Childhood Onset Sub-Hemispheric Posterior Head Region Epilepsy: Indications in an Indian Cohort and Outcome

Background: Posterior quadrant disconnection (PQD) is an under-utilized surgical technique in the management of refractory epilepsy. There is a dearth of data pertinent to post-PQD seizure outcomes. Methods: This retrospective study analyzed patients with drug-resistant childhood-onset epilepsy who underwent PQD at our center from 2009 to 2018. The clinical, imaging, and electrophysiological data were reviewed. The seizure outcome was noted from the latest follow-up in all patients. Results: Fifteen patients underwent PQD, with a mean age at onset of epilepsy of 3.3 ± 4.6 years. All patients had seizure onset in childhood with focal onset of seizures, and in addition, 5 had multiple seizure types. All cases underwent presurgical workup with MRI, video-EEG, psychometry, while PET/MEG was done if required. Engel Ia and ILAE I outcomes were considered to be favorable. The histology of the specimen showed 9 patients (60%) had gliosis, 4 (26.7%) had focal cortical dysplasia (FCD), while 1 patient had nodular heterotopia and another had polymicrogyria-pachygyria complex. Postoperative follow-up was available in 14 cases. One patient was lost to follow-up. Mean follow-up duration for the cohort was 45 + 24 months. At last, follow-up (n = 14), 66.7% (10 cases) had favorable outcome (Engel Ia). At the end of 1-year follow-up, up to 73% (n = 11) of the patients were seizure-free. Four patients developed transient hemiparesis after surgery which improved completely by 3–6 months. Conclusions: Gliosis was more common etiology requiring PQD in our series than Western series, where FCD was more common. PQD is a safe and effective surgical modality in childhood-onset epilepsy with posterior head region epileptogenic focus.

Uni-, Bi- or Trifocal Hepatocellular Carcinoma in Western Patients: Recurrence and Survival after Percutaneous Thermal Ablation.

Simple SummaryPercutaneous thermal ablation (PTA) is a validated treatment for small (<3 cm) hepatocellular carcinoma (HCC). Multifocality is usually reported as a strong pejorative factor. Yet, the current literature lacks data on the influence in Western patients of HCC nodule numbers on recurrence and survival after PTA. From a prospective cohort of patients who underwent PTA for <3 cm HCC, we retrospectively compared recurrence and survival, according to the number of nodules. We found that bi- and trifocal HCC significantly increased the risk of distant recurrence, especially very early (<6 months) distant recurrence. Overall survival after PTA of trifocal HCC proved to be significantly below what was expected after a curative treatment, ranging between that of BCLC A and of BCLC B patients. Liver transplantation should certainly be considered earlier in this sub-population. Reasonable hopes come from adjuvant/neoadjuvant trials based on immunotherapies alone or in combination.Multifocality is usually reported as a pejorative factor after percutaneous thermal ablation (PTA) of HCC but little is known in Western series. Recurrence and survival were extracted from a prospective database of all patients who underwent PTA for ≤3 cm HCC. From January 2015 to April 2020, we analyzed 281 patients with unifocal (n = 216), bifocal (n = 46) and trifocal (n = 16) HCC. PTA of bi- and trifocal HCC resulted in a high risk of very early (<6 months) distant recurrence (38.8% and 50%, respectively). Median RFS was 23.3 months (95% CI:18.6–30.4), 7.7 months (95% CI:5.1–11.43, p = 0.002) and 5.2 months (95% CI:3–12.3, p = 0.015), respectively, for uni-, bi- and trifocal HCC groups. In a multivariate analysis, both bifocal (HR = 2.46, p < 0.001) and trifocal (HR = 2.70, p = 0.021) vs. unifocal HCC independently predicted shorter RFS. Median OS in trifocal HCC group was 30.3 months (95 CI:19.3-not reached). Trifocal vs. unifocal HCC independently predicted shorter OS (HR = 3.30, p = 0.008), whereas bifocal vs. unifocal HCC did not (p = 0.27). Naïve patient (HR = 0.42, p = 0.007), AFP > 100 ng/mL (HR = 3.03, p = 0.008), MELD > 9 (HR = 2.84, p = 0.001) and steatotic HCC (HR = 0.12, p = 0.038) were also independent predictors of OS. In conclusion, multifocal HCCs in a Western population have a dramatically increased risk of distant recurrence. OS after PTA of trifocal HCC is significantly below what was expected after a curative treatment.

Feasibility and safety of robotic-assisted total pancreatectomy: a pilot western series

This study was designed to demonstrate non-inferiority of robot-assisted total pancreatectomy (RATP) to open total pancreatectomy (OPT) based on an intention-to-treat analysis, having occurrence of severe post-operative complications (SPC) as primary study endpoint. The two groups were matched (2:1) by propensity scores. Assuming a rate of SPC of 22.5% (non-inferiority margin: 15%; α: 0.05; β: 0.20; power: 80%), a total of 25 patients were required per group. During the study period (October 2008–December 2019), 209 patients received a total pancreatectomy. After application of exclusion and inclusion criteria, matched groups were extracted from an overall cohort of 132 patients (OPT: 107; RATP: 25). Before matching, the two groups were different with respect to prevalence of cardiac disease (24.3% versus 4.0%; p = 0.03), presence of jaundice (45.8% versus 12.0%; p = 0.002), presence of a biliary drainage (23.4% versus 0; p = 0.004), history of weight loss (28.0% versus 8.0%; p = 0.04), and vein involvement (55.1% versus 28.0%) (p = 0.03). After matching, the two groups (OTP: 50; RATP: 25) were well balanced. Regarding primary study endpoint, SPC developed in 13 patients (26.0%) after OTP and in 6 patients (24.0%) after RATP (p = 0.85). Regarding secondary study endpoints, RATP was associated with longer median operating times [475 (408.8–582.5) versus 585 min (525–637.5) p = 0.003]. After a median follow-up time of 23.7 months (10.4–71), overall survival time [22.6 (11.2–81.2) versus NA (27.3–NA) p = 0.006] and cancer-specific survival [22.6 (11.2–NA) versus NA (27.3–NA) p = 0.02] were improved in patients undergoing RATP. In carefully selected patients, robot-assisted total pancreatectomy is non-inferior to open total pancreatectomy regarding occurrence of severe post-operative complications.

Surgery for Bismuth-Corlette Type 4 Perihilar Cholangiocarcinoma: Results from a Western Multicenter Collaborative Group

BackgroundAlthough Bismuth-Corlette (BC) type 4 perihilar cholangiocarcinoma (pCCA) is no longer considered a contraindication for curative surgery, few data are available from Western series to indicate the outcomes for these patients. This study aimed to compare the short- and long-term outcomes for patients with BC type 4 versus BC types 2 and 3 pCCA undergoing surgical resection using a multi-institutional international database.MethodsUni- and multivariable analyses of patients undergoing surgery at 20 Western centers for BC types 2 and 3 pCCA and BC type 4 pCCA.ResultsAmong 1138 pCCA patients included in the study, 826 (73%) had BC type 2 or 3 disease and 312 (27%) had type 4 disease. The two groups demonstrated significant differences in terms of clinicopathologic characteristics (i.e., portal vein embolization, extended hepatectomy, and positive margin). The incidence of severe complications was 46% for the BC types 2 and 3 patients and 51% for the BC type 4 patients (p = 0.1). Moreover, the 90-day mortality was 13% for the BC types 2 and 3 patients and 12% for the BC type 4 patients (p = 0.57). Lymph-node metastasis (N1; hazard-ratio [HR], 1.62), positive margins (R1; HR, 1.36), perineural invasion (HR, 1.53), and poor grade of differentiation (HR, 1.25) were predictors of survival (all p ≤0.004), but BC type was not associated with prognosis. Among the N0 and R0 patients, the 5-year overall survival was 43% for the patients with BC types 2 and 3 pCCA and 41% for those with BC type 4 pCCA (p = 0.60).ConclusionsIn this analysis of a large Western multi-institutional cohort, resection was shown to be an acceptable curative treatment option for selected patients with BC type 4 pCCA although a more technically challenging surgical approach was required.

Comparison of Short-term Results after Laparoscopic Complete Mesocolic Excision and Standard Colectomy for Right-Sided Colon Cancer: Analysis of a Western Center Cohort.

PurposeLaparoscopic complete mesocolic excision (CME) right colectomy is a technically demanding procedure infrequently employed in Western centers. This retrospective cohort study aims to analyze the safety of laparoscopic CME colectomy compared to standard colectomy for right-sided colon cancer in a Western series.MethodsProspectively collected data from 60 patients who underwent laparoscopic CME right colectomy were compared to the ones of 55 patients who underwent laparoscopic standard right colectomy.ResultsNo differences in clinical characteristics were observed between the CME and standard right colectomy groups. No differences were demonstrated in terms of blood loss (P = 0.060), intraoperative complications (P = 1), conversion rate (P = 0.102), and operative time (P = 0.473). No deaths were observed in either group, while complication rate was 40.0% in the CME and 49.1% in the standard group (P = 0.353). Severe complications occurred in 10.0% vs. 9.1% (P = 0.842), redo surgery in 5.0% vs. 7.3% (P = 0.708), and unplanned readmission in 5.0% vs. 5.5% (P = 1) after CME and standard colectomy, respectively. A significant difference in favor of CME was observed in the total length of specimen (P < 0.001), proximal (P = 0.018), and distal margins (P = 0.037). The number of lymph nodes harvested was significantly higher in the CME group (27 vs. 22, P = 0.037).ConclusionIn Western series, where patients have less favorable clinical characteristics, laparoscopic CME allows to obtain better quality surgical specimens and comparable short-term outcomes compared to standard right colectomy.

Microbiology of Liver Abscesses and Its Correlation with Hospital Stay

Pyogenic liver abscess (LA) is a rare disease associated with high morbidity and mortality rates, and prolonged hospital stay. Certain microbiological agents have assumed a predominant role in Asian series, however, few studies have been published in Europe regarding the microbiological agents involved in liver abscesses and their relationship with prognosis and length of hospital stay. The aim of this study was to characterize the main microbiological agents involved in LA in a European hospital, to assess resistance patterns and to relate them to patient prognosis and length of hospital stay. A retrospective analysis was conducted on all LA-diagnosed adult patients, admitted to a northern Portuguese hospital between 2013 and 2018. Clinical, laboratory, imaging, and microbiological data were collected for descriptive and statistical analysis. A total of 63 LA diagnosed patients were admitted to the General Surgery Unit between January 2013 and December 2018. Patients´ mean age at diagnosis was 71.4 years. Abdominal pain and fever were the most common symptoms on admission (73.0 and 61.9%, respectively). Fifty-eight percent of patients were female. Leukocytosis and increased C-reactive protein were the most observed analytical changes. The most frequently isolated microbiological agents were <i>Escherichia coli</i> (36.5%), <i>Streptococcus species</i> (27.8%), <i>Klebsiella pneumoniae</i> (11.4%), and anaerobic agents (10.1%). Of the isolated species, 12.5% proved multi-resistant. A higher LA frequency caused by <i>Klebsiella pneumoniae</i> was identified in relation to other Western series. <i>Klebsiella pneumoniae</i> was associated with a longer hospital stay (25.67 vs 16.50 days, p=0.07) when compared to other agents. There were 4 mortality cases in our series (6.3%). Microbiological agents, namely <i>Klebsiella pneumoniae</i> and multidrug-resistant agents have a predominant role in LA management, negatively affecting prognosis and length of hospital stay. Despite advances in LA treatment, more studies are required to determine the appropriate therapy owing to the absence of internationally defined guidelines. Our results provide important information for the proper management of these patients.

Treatment and outcomes in patients with left ventricular thrombus - experiences from the Aga Khan University Hospital, Nairobi - Kenya.

Introductionleft ventricular thrombus (LVT) may lead to thromboembolism and has been associated with increased morbidity and mortality. Little is known about the incidence, etiology and outcomes in patients with LVT in Africa. The objective was to determine the etiology, treatment practices, rate of resolution and clinical outcomes in patients with LVT in the region.Methodsa review of all echocardiograms performed in 2017 and 2018 at the Aga Khan University Hospital, Nairobi was carried out and patients with LVT identified. Physician review of charts was performed to document clinical characteristics and outcomes.Resultsduring the study period 100 patients with LVT were identified (1.3% of adult echoes). The mean LVEF was 28.5% (±11.0%) and 88 (88%) patients had an LVEF of less than 40%. Underlying etiology of LV dysfunction was post myocardial infarction (MI) in 28 (28%), chronic ischemic cardiomyopathy in 42(42%) and non-ischemic cardiomyopathy in 30 (30%) patients. In 15 (15%) patients a stroke or TIA predated the diagnosis of LVT. Long term anticoagulation was given to 92 (92%) patients. Among these, 34 (37%) received warfarin while 58 (63%) were treated with a DOAC. In the 64 patients who had reassessment imaging (median duration 177 days), complete thrombus resolution was noted in 38 (59.4%). One-year clinical outcome data was available for 85 patients: 13 (15.3%) patients had died, 4 (4.7%) had suffered a stroke, and 8(9.4%) had had a bleeding episode. Rates of thrombus resolution (warfarin 64%, DOAC 55.6%, p=0.51), stroke (warfarin 2.9%, DOAC 1.7%, p=1.0) and bleeding (warfarin 5.9%, DOAC 5.2%, p = 1.00 were not significantly different among patients treated with warfarin and DOAC.Conclusionwe noted a high incidence of LVT compared to contemporary Western series. The majority of our patients were treated with DOACs. There were no significant differences in outcomes between patients treated with a DOAC and those receiving warfarin. Prospective evaluation on the efficacy and safety of DOACs for this indication is needed.

Abstract 15792: Etiology, Treatment and Outcomes in Patients With Left Ventricular Thrombus - Experiences From an African Center

Introduction: Left ventricular thrombus (LVT) may lead to thromboembolism and has been associated with increased morbidity and mortality. Little is known about the incidence, etiology and outcomes in patients with LVT in Africa. Objectives: To determine the etiology, treatment practices, rate of resolution and outcomes in patients with LVT in the region. Methods: A review of all echocardiograms performed in 2017 and 2018 at the Aga Khan University Hospital, Nairobi was carried out and patients with LVT identified. Physician review of charts was performed to document clinical characteristics and outcomes. Results: During the study period 100 patients with LVT were identified (1.3% of adult echoes). The mean LVEF was 28.5% (±11.0%) and 88% of the patients had an LVEF of less than 40%. Underlying etiology of LV dysfunction was post MI in 28%, chronic ischemic cardiomyopathy in 42% and non ischemic cardiomyopathy in 30%. In 15% of the patients a stroke or TIA predated the diagnosis of LVT. Long term anticoagulation was given to 92 patients. Among these, 37% received warfarin while 63% were treated with a DOAC (rivaroxaban (50%), dabigatran(7.6%) and apixaban(5.4%)). In 60% of the patients, anticoagulation was continued beyond a year. In patients with reassessment imaging (64%, median time 177 days), complete thrombus resolution was noted in 59.4%. One year follow-up data was available for 85 patients: 13 (15.3%) patients had died, 4 (4.7%) had suffered a stroke, and 8(9.4%) had a bleeding episode. Rates of thrombus resolution, stroke and bleeding were not significantly different among patients treated with warfarin and DOAC (Figure 1). Conclusions: We noted a high incidence of LVT compared to contemporary Western series. The majority of our patients were treated with DOACs. There were no significant differences in outcomes between patients treated with a DOAC and those receiving warfarin. Prospective evaluation on the efficacy and safety of DOACs for this indication is needed.