229 research outputs found
Refractory distal ulcerative colitis: is proctocolectomy always necessary?
No full textRefractory distal ulcerative colitis (RDUC) is defined as persistence of symptoms caused by endoscopically proven colonic inflammation located at the rectum or left colon despite oral/topical steroids and 5-ASA. RDUC affects a small subset of patients and is associated with chronic disabling symptoms and increased social/medical costs. Moreover, patients with long-standing ulcerative colitis (UC) carry an elevated risk of developing colorectal cancer and colonic mucosa high-grade dysplasia. Alternative medical strategies in steroid refractory disease are unlikely to provide durable remission in all patients, carry potential severe side effects and, as immunosuppressants, the risk of other neoplasms, and may increase the short-term complication rate when surgery is finally required. Restorative proctocolectomy with ileal pouch-anal anastomosis (RP-IPAA) allows the complete removal of the diseased rectum and colon, virtually eliminating the risk of malignant transformation and reestablishing intestinal continuity with continence preservation. Since the introduction of this surgical procedure, morbidity and mortality rates have been drastically reduced. Despite the still notable rate of surgical complications, long-term quality of life assessment has shown excellent results in nearly all patients who have undergone RP-IPAA, comparing well with the general population. Furthermore, when performed for distal UC, RP-IPAA produces similar surgical outcomes with respect to pancolitis. In conclusion, RP-IPAA should always be considered in patients with RDUC, and multidisciplinary counseling should provide patients clear information about the advantages of surgery and possible complications as well as the chance to achieve disease remission with medical therapy
Psychological Perspectives of Inflammatory Bowel Disease Patients Undergoing Surgery: Rightful Concerns and Preconceptions
No full textSurgery has been associated with variable effect on the quality of life of IBD (Inflammatory Bowel Disease) patients, depending on clinical patterns and baseline disease characteristics. However, surgical treatment is often conceived by these patients with distress and considered as the failure of their therapies. Lack of control, risk of complications, defacement of the body image, need for ostomy and hospitalization may be triggering concerns leading to anguish and anxiety. Even though the quality of life in most cases generally improves after surgery, some particular aspects such as sexual activity, bowel movements and the ability to deal with a possible stoma may present a slower amelioration trend. These problems represent common causes of distress and may lead to an heightened risk of depression and anxiety with respect to background population. The psychological impact and apprehension surrounding surgery will be discussed in this review. Pros and cons of the surgical treatment in various IBD populations and its long-term sequelae in terms of quality of life and psychological well-being will be highlighted. Furthermore the tools to encompass these issues such as complete patient information, gastroenterologist/surgeon synergy and psychological counseling will be explored analyzing their respective roles
With adequate precautions colorectal cancer surgery can be safely continued during COVID-19 pandemic
No full textIntriguing Role of the Mesentery in Ileocolic Crohn's Disease
No full textCrohn's disease (CD) is a chronic relapsing inflammatory bowel disease with unknown etiology. Up to 80% of patients will eventually require surgery throughout their lifetime, and often repeated resections are required for disease recurrence. Observations of “creeping fat” surrounding the diseased intestine renewed interest in the mesentery, recently defined as an organ with endocrine and immune functions. According to the inside-out model, the mesentery may be primarily affected in CD and subsequent cause alterations in the mucosa. Recently, lower surgical recurrence rates have been reported with en-bloc excision of the mesentery adjoining the diseased intestine. Results of ongoing randomized controlled trials may clarify the role of the mesentery in CD and possibly lead to its adoption as standard during surgery for Crohn's disease
Distributed Risk Management in a Virtual Enterprise Environment
No full textRisk management models and techniques are mature enough to handle risk in the context of a single enterprise. However, the problem of risk management in the setting of an organization of organizations is quite difficult to manage and to deal with. The model proposed in this paper arises from an approach to risk management based on the definition of risk ontology in the context of software development. We will discuss a multi-agent architecture in which risk monitoring agents collect data about several possible risk typologies, perform risk analysis, and decide how to react to risks according to a rule based specification logic
Physical assessment techniques performed by Italian registered nurses: a quantitative survey
No full textAim and objectives: The aims of the study were to describe which of the core techniques of the physical assessment are regularly performed by a sample of Italian nurses, and to investigate the potential predictors of a more complete examination. Background: Physical examination is among the essential tasks of nursing professionals, who are requested to perform a correct and complete physical assessment. Design: Cross-sectional survey. Methods: The study was performed between August 2013 and January 2014 in 17 Italian regions. A total of 1182 questionnaires were collected. Results: Most participants were females (age range 41-50 years), and worked in Internal Medicine, Intensive Care, and Surgical hospital units. Of the 30 core techniques that are currently taught and performed according to the Italian Baccalaureate degree requirements, 20 were routinely performed, six were seldom used, and four were learnt but almost never performed (auscultation of lung, heart and bowel sounds, and spine inspection). Graduate and postgraduate nurses, working in Intensive Care Units and Nursing Homes, were more prone than the others to carry out a more complete physical assessment. Conclusions: The skills to perform a physical assessment are suboptimal among this sample of Italian nurses. Health and educational providers should pose more attention and efforts to provide nurses with an acceptable training in physical examination practice. Relevance to clinical practice: This study describes the specific physical techniques performed by nurses in real practice and provides information on which skills require more attention in nursing educational programs
Text mining techniques for the management of predictive maintenance.
No full textThe advent of Industry 4.0 provides new opportunities to improve the maintenance of production equipment from both the technical and managerial perspective. In this paper, we propose a contribution in the direction of predictive maintenance of machine tools based on the integration of a text mining algorithm with the cyber-physical system of a manufacturing industry. The system performs its analysis starting from data stored in log files maintained by a machine tool returning an alert about a future potential machine failure. Log files, produced by part programs running on the machine control system, record the status of execution parameters taken by key sensors or derived by the control system during the part program execution. Historical data are collected by means of Digital Twin technologies and then analyzed using computational linguistic techniques so that we can predict a machine failure in the imminent future starting from data collected in the past. The paper first describes a new scheme for the classification of maintenance approaches. Then, starting from the proposed cyber-physical system model, an algorithm for predictive maintenance based on text mining technology is integrated in it.
The implemented tool supports the maintenance manager in making the most appropriate decisions about the scheduling of maintenance activities when there is an alert about a possible machine failure
Laparoscopic right colectomy after previous colonic resection - the importance of three-dimensional CT angiography reconstruction and indocyanine green fluorescence - a video vignette
No full textStrategies to Reverse Endothelial Progenitor Cell Dysfunction in Diabetes
No full textBone-marrow-derived cells-mediated postnatal vasculogenesis has been reported as the main responsible for the regulation of vascular homeostasis in adults. Since their discovery, endothelial progenitor cells have been depicted as mediators of postnatal vasculogenesis for their peculiar phenotype (partially staminal and partially endothelial), their ability to differentiate in endothelial cell line and to be incorporated into the vessels wall during ischemia/damage. Diabetes mellitus, a condition characterized by cardiovascular disease, nephropathy, and micro- and macroangiopathy, showed a dysfunction of endothelial progenitor cells. Herein, we review the mechanisms involved in diabetes-related dysfunction of endothelial progenitor cells, highlighting how hyperglycemia affects the different steps of endothelial progenitor cells lifetime (i.e., bone marrow mobilization, trafficking into the bloodstream, differentiation in endothelial cells, and homing in damaged tissues/organs). Finally, we review preclinical and clinical strategies that aim to revert diabetes-induced dysfunction of endothelial progenitor cells as a means of finding new strategies to prevent diabetic complications.Version of Recor
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