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BackgroundLaparoscopic liver resection (LLR) of posterosuperior segments (PSS) is still technically demanding procedure for highly selective patients. There is no long-term survival comparative estimation after LLR and open liver resection (OLR) for colorectal liver metastases (CRLM) located in PSS. We aimed to compare long-term overall (OS) and disease-free survival (DFS) after parenchyma-sparing LLR with expanding indications and open liver resection (OLR) of liver PSS in patients with CRLM.MethodsTwo Russian centers took part in the study. Patients with missing data, hemihepatectomy and extrahepatic tumors were excluded. One of contraindications for LLR was suspicion for tumor invasion in large hepatic vessels. Logistic regression was used for 1:1 propensity score matching (PSM).ResultsPSS were resected in 77 patients, which accounted for 42% of the total number of liver resections for CRLM. LLR were performed in 51 (66%) patients. Before and after matching, no differences were found between groups in the following factors: median size of the largest metastatic tumor; proximity to the large liver vessels; the rate of anatomical parenchyma sparing resection of PSS; a positive response to chemotherapy before and after surgery. Regardless of matching, the size of the largest metastases was above 50 mm in more than one-third of patients who received LLR. Before matching, intraoperative blood loss, ICU stay and hospital stay were significantly greater in the group of OLR. No 90-day mortality was observed within both groups. There were no differences in long-term oncological outcomes: 5-year OS after PSM was 78% and 63% after LLR and OLR, respectively; 4-year DFS after PSM was 27% in both groups.ConclusionLaparoscopic parenchyma-sparing resection of PSS for CRLM are justified in majority of patients who have an indication for OLR if performed in high volume specialized centers expertized in laparoscopic liver surgery.

In the commercial insurance industry, the commercial general liability (CGL) policy is the most common form of liability insurance purchased by both public and private sectors in the United States and is perhaps the most litigated insurance product in the marketplace. CGL policies provide the insured with a broad spectrum of protection against unintentional and unexpected risk arising out of the conduct of the insured's business.The Reference Handbook on the Commercial General Liability Policy, Third Edition, provides concise overviews of the most salient points of insurance litigation over CGL policies. The Third Edition tracks the standard ISO CGL form and includes general updates on a host of coverage issues, such as the insurer's duty to defend and indemnify, the policyholder's duty to comply with policy conditions, \"occurrence\" triggers, covered injuries, damages, insured status, exclusions, loss allocation, and issues beyond the four corners of the policy, like bad faith and jurisdictional concerns. The Third Edition adds new chapters on Coverage C and Supplementary Payments, and weaves in emerging issues such as computer-related liability and opioid litigation.This collaborative work is written by experienced counsel representing both policyholders and insurers. The handbook offers seasoned practitioners with foundational material and leading case law to jump start their research, while guiding newer practitioners through the complexities of CGL policies.

In the commercial insurance industry, the commercial general liability (CGL) policy is the most common form of liability insurance purchased by both public and private sectors in the United States and is perhaps the most litigated insurance product in the marketplace. CGL policies provide the insured with a broad spectrum of protection against unintentional and unexpected risk arising out of the conduct of the insured's business.The Reference Handbook on the Commercial General Liability Policy, Third Edition, provides concise overviews of the most salient points of insurance litigation over CGL policies. The Third Edition tracks the standard ISO CGL form and includes general updates on a host of coverage issues, such as the insurer's duty to defend and indemnify, the policyholder's duty to comply with policy conditions, occurrence triggers, covered injuries, damages, insured status, exclusions, loss allocation, and issues beyond the four corners of the policy, like bad faith and jurisdictional concerns. The Third Edition adds new chapters on Coverage C and Supplementary Payments, and weaves in emerging issues such as computer-related liability and opioid litigation.This collaborative work is written by experienced counsel representing both policyholders and insurers. The handbook offers seasoned practitioners with foundational material and leading case law to jump start their research, while guiding newer practitioners through the complexities of CGL policies.

Astrology is a complex, multifold and long-lived subject that has been approached from many different perspectives in a broad range of scholarly disciplines. In order to understand its many roles within the history of science, theology, and culture, one needs a well-articulated historically and conceptually sound interpretive framework. In this article, a framework is proposed based on the curricular structures at medieval universities by which fundamental conceptual patterns and practices were passed down from generation to generation. It is argued that this will be helpful both for framing answerable questions, and for approaching their solutions. This goes particularly for the complex long-term patterns of astrology’s marginalization from the domain of legitimate knowledge and practice during the Scientific Revolution and the Enlightenment.

Although there has been an immense amount of scholarship on Marsilio Ficino, his life and writings, much of it excellent, an area that I would argue is fundamental for understanding both him and his work – astrology – has received much more problematic attention. In this essay, I will indicate some of my first and still coalescing thoughts on one central facet of this issue by asking whether Ficino’s astrology in De vita has a significant theurgical dimension, and by exploring what this might mean.

Objectives. The purpose of this study was to compare the efficacy and safety of the Evolut PRO to the Evolut R valve in a real-world setting. Background. The next-generation self-expanding transcatheter aortic valve replacement (TAVR) system, the CoreValve Evolut PRO was designed with an outer pericardial skirt to improve valve-sealing performance. Safety and efficacy of this valve have not previously been compared to its predecessor, the Evolut R valve. Methods. We retrospectively studied 134 patients who underwent TAVR with the Evolut PRO or Evolut R valve over one year at a tertiary center. Endpoints, defined by the Valve Academic Research Consortium-2 criteria, included device success, paravalvular leak (PVL), and a composite safety endpoint including mortality, stroke, major vascular complications, life-threatening bleeding, acute kidney injury, coronary artery obstruction, and repeat procedure for valve-related dysfunction. Results. 60 Evolut PRO and 56 Evolut R patients met the study criteria. Both groups had similar device success rates (90 vs. 89%, p=0.44). Incidence of moderate PVL was similar on discharge (5 vs. 11%, p=0.68) and at 30 days (11 vs. 13%, p=0.79), with nil incidence of severe PVL. There were no mortalities, and the VARC-2 safety endpoint at 30 days was comparable. Conclusion. Despite the additional pericardial skirt and larger sheath size of Evolut PRO, outcomes were comparable between the two Evolut systems, supporting adoption of the newest generation valve in the management of severe aortic stenosis as well as continued use of the Evolut R in patients with smaller vasculature warranting a lower profile device.

The presence of concomitant aortic insufficiency (AI) and mitral regurgitation (MR) is common and may further accelerate cardiac dysfunction. However, there exists no US regulatory–approved transcatheter device for the treatment of AI. The effectiveness of isolated transcatheter mitral therapy in this population is not well-understood; thus, we aimed to evaluate outcomes for patients with combined AI and MR compared with isolated MR who underwent mitral transcatheter edge-to-edge repair (m-TEER). Retrospective data were obtained from the Northwell m-TEER registry. A total of 587 patients who underwent m-TEER at 4 high-volume transcatheter aortic valve replacement/transcatheter edge-to-edge repair centers within the Northwell Health system were included. All patients had severe MR and were divided into 2 groups: group 1 with ≥3+ AI (AI+) and the group 2 with <3+ AI (AI−). Echocardiographic outcomes were evaluated at 1 month. Clinical outcomes were evaluated at 1 month and 1 year. The primary end point was death or rehospitalization at 1 year. A total of 587 patients were included in the study, with 92 in the AI+ group. Baseline characteristics were similar in both groups. Approximately 2/3 of patients in the AI+ group demonstrated an improvement in AI severity after isolated mitral therapy. There was no difference in the primary outcome at 1 month or 1 year. There was also no significant difference in New York Heart Association functional class at 1 month between the groups. In conclusion, patients who underwent m-TEER with combined MR and AI (AI+ group) fared well compared with those with isolated mitral valve dysfunction (AI− group), with no discernible differences in survival, New York Heart Association class, or rehospitalization rates at 1 month or 1 year. Hence, isolated m-TEER is a reasonable treatment approach in patients with a high surgical risk with combined AI and MR.

Introduction. Requirement of permanent pacemaker (PPM) implantation is a known and common postoperative consequence of transcatheter aortic valve replacement (TAVR). The Emory risk score has been recently developed to help risk stratify the need for PPM insertion in patients undergoing TAVR with SAPIEN 3 valves. Our aim was to assess the validity of this risk score in our patient population, as well as its applicability to patients receiving self-expanding valves. Methods. We conducted a retrospective review of 479 TAVR patients without preoperative pacemakers from November 2016 through December 2018. Preoperative risk factors included in the Emory risk score were collected for each patient: preoperative QRS, preoperative right bundle branch block (RBBB), preoperative syncope, and degree of valve oversizing. Multivariable analysis of the individual variables within the scoring system to identify predictors of PPM placement was performed. The predictive discrimination of the risk score for the risk of PPM placement after TAVR was assessed with the area under the receiver operating characteristic curve (AUC). Results. Our results demonstrated that, of the 479 patients analyzed, 236 (49.3%) received balloon-expandable valves and 243 (50.7%) received self-expanding valves. Pacemaker rates were higher in patients receiving self-expanding valves than those receiving balloon-expandable valves (25.1% versus 16.1%, p=0.018). The Emory risk score showed a moderate correlation with pacemaker requirement in patients receiving each valve type, with AUC for balloon-expandable and self-expanding valves of 0.657 and 0.645, respectively. Of the four risk score components, preoperative RBBB was the only predictor of pacemaker requirement with an AUC of 0.615 for both balloon-expandable and self-expanding valves. Conclusion. In our cohort, the Emory risk score had modest predictive utility for PPM insertion after balloon-expandable and self-expanding TAVR. The risk score did not offer better discriminatory utility than that of preoperative RBBB alone. Understanding the determinants of PPM insertion after TAVR can better guide patient education and postoperative management.