87%), power (+8.52%), force (+11%) resulting in a higher jump height (+1.12%). These changes were inversely correlated with sea days (Pearson r of -0.81, -0.96 and -0.90, respectively, p less then 0.01). CONCLUSIONS Changes in body weight and composition are consistent with previous data indicating a probable negative energy balance. The main finding demonstrates a difference in muscular conditioning between upper and lower limbs that might be explained by differential workload related to boat architecture (trampolines) or handling.BACKGROUND Little has been reported about mortality among crews in passenger shipping. The aim of the study was to determine the detailed causes and circumstances of deaths from unnatural causes among crews employed in United Kingdom (UK) and Bermudan registered passenger shipping, their trends, how they relate to the type of passenger ship and crew rank and to discuss preventative measures. MATERIALS AND METHODS A longitudinal study from 1976 to 2018, based on reviews of marine accident investigation reports, death inquiry files, cruise shipping websites and online searches. RESULTS One hundred and forty crew fatalities in UK (127) and Bermudan (13) passenger ships were identified from accidents and drowning (91), suicides and disappearances at sea (38), homicide, other and unexplained causes (11). Over the 43-year study period, a reduction in mortality (per 1000 ship-years) from accidents and drowning was identified (mean annual reduction 4.3%; 95% confidence interval 2.1-6.5%) but no significant reduction for suicides and disappearances at sea (annual reduction 1.2% confidence interval -1.3% to +3.7%). Most suicides and disappearances (70%) were among customer service Staff and, of 19 employed on large cruise ships, most (79%) were non-Europeans. CONCLUSIONS The number of suicides and probable suicides is a cause for concern, especially among customer service staff on cruise ships. These findings indicate the need for interventions to reduce suicide risks. Further studies are needed to improve the targeting of interventions. These will need both to analyse the circumstances of individual deaths and derive suicide rates according to rank, department and nationality, based on reliable population denominators.Not applicable for Editorials.BACKGROUND Chronic pain still occurs in 10-12% of patients who undergo surgical groin hernia repair. Considering the high prevalence of this pathology, we performed a single-center prospective study comparing the laparoscopic trans-abdominal pre-peritoneal (TAPP) approach to the standard surgical open technique for primary uncomplicated hernia repair. METHODS A prospective cohort of 278 patients was extracted from our dataset 121 received a laparoscopic TAPP approach, and 157 were treated by the Lichtenstein technique in case of inguinal hernia or by the deployment of a polypropylene plug in case of femoral hernia. Both groups were followed-up for 3 years. RESULTS A significant difference in haematoma/seroma collection was found (P=0.001) among the groups. Wound infection (P=0.001) and pain perception in the perioperative and early post-operative period were significantly reduced in the TAPP group (P=0.0023 and P less then 0.0021, respectively). Chronic discomfort at 3-year follow-up was higher in the open approach (P=0.0044), while operative time was marginally shorter compared to TAPP (P =0.002). CONCLUSION The incidence of chronic pain and the overall complication rate were significantly lower with the TAPP approach. Based on our findings, the TAPP approach deserves to be considered as the treatment of choice for uncomplicated single-site primary hernia surgery. Further studies with a larger sample will be needed to confirm these preliminary data.Pneumocystis jirovecii, formerly known as Pneumocystis carinii, is an atypical fungal pathogen best known for causing Pneumocystis jirovecii pneumonia (PCP). The epidemiology of PCP is changing such that patients without HIV infection now comprise the largest subset of individuals diagnosed with PCP. Selleck GSK 2837808A While those with hematologic malignancies and organ transplants are at greatest risk for non-HIV-related PCP, this review will focus on PCP in patients with solid tumors. They are at risk for PCP due to their chemotherapy regimens and use of steroids in the management of various complications of treatment, and possibly because of the immunosuppressive effect of the cancer itself. In particular, patients with solid tumors being treated for metastatic spinal cord compression are at great risk for PCP. Patients with solid tumors and PCP face greater mortality than those with HIV infection. Multiple reviews have attempted to describe the ideal regimen of corticosteroids for metastatic spinal cord compression, but there is little consensus. We present 2 cases of patients with metastatic spinal cord compression due to prostate cancer undergoing radiation therapy and treatment with corticosteroids. These cases highlight the difficulties in predicting the length of corticosteroid therapy and the dangers that patients face without appropriate prophylaxis. This article will also provide a review of the current guidelines for PCP prophylaxis in patients undergoing treatment for metastatic spinal cord compression. We recommend empiric treatment with trimethoprim-sulfamethoxazole or dapsone in those patients with a sulfa allergy in all patients with solid tumors when any high-dose steroids are started for the treatment of metastatic spinal cord compression. Further research is needed to assess the epidemiology of PCP in patients with solid tumors and additional trials are necessary to refine PCP prophylaxis.Key Points • Recurrent HCC after OLT management is challenging and notoriously difficult. • High oncologic-risk patient identification and close follow-up are essential. • Recurrences diagnosed within the first 2 years after OLT can be classified as early-onset and are associated with poor prognosis. • Surgical resection should be the first curative attempt when it is technically feasible. • TACE in patients who have undergone OLT appears to be effective and safe. • Sorafenib can be used as systemic therapy in cases with multi-organ recurrence; newer therapies are emerging. • The benefit of immunosuppression with an mTOR inhibitor has not been established. • In the posttransplant setting, a combination treatment approach is warranted.