101,968 research outputs found
Semplificazione funzionale ed individualità degli schemi occlusali in protesi fissa: ipotesi nel paziente disfunzionale
No full textPerioperative Management
No full textThe ERAS method (Enhanced Recovery After Surgery) is a multimodal protocol of perioperative care aimed at ensuring a rapid postoperative recovery. It takes into account the latest available scientific evidences in the various disciplines that operate around the patients requiring major surgery, leading to positively change the response and preserving the physiological functional reserve. In fact it protects patients’ autonomy limiting stress, significantly reducing the length of hospital stay and also the rate of complications and readmission. In the ERAS protocol, the surgical process is totally redesigned, taking into account some important items in the preoperative, intraoperative and postoperative time. As known, elderly patients have specific and different features, multiple diseases, cognitive-behavioral and psychological problems, and a high risk of complications, representing their typical fragility. The ERAS pathway is capable of responding to the needs of the elderly patients, in order to respect the complexity of their multiple health conditions
Bowel preparation before elective right colectomy: Multitreatment machine-learning analysis on 2,617 patients
No full textbackground: in the worldwide, real-life setting, some candidates for right colectomy still receive no bowel preparation, some receive oral antibiotics alone, some receive mechanical bowel preparation alone, and some receive mechanical bowel preparation with oral antibiotics, with varying degrees of compliance to preoperative intravenous antibiotic prophylaxis. previous studies mainly focused on left-sided colorectal anastomoses while less attention has been devoted to right-sided ileocolic anastomoses. when high-level evidence from randomized clinical trials is lacking, multiple-treatment propensity score weighting analysis of prospective data on the basis of generalized boosted model is superior to a simple propensity score-matching analysis and to an inverse probability weighting in terms of external validity and bias reduction. methods: this is an analysis on the basis of machine-learning procedures of 2,617 patients who underwent elective right colectomies. results: the risk of surgical-site infections (5.0% after no bowel preparation) was significantly lower after mechanical bowel preparation with oral antibiotics (4.0%, P = .017), significantly greater after mechanical bowel preparation alone (8.6%, P = .019), and comparable after oral antibiotics alone (3.9%). the risk of anastomotic leakage (3.2% after no bowel preparation) was significantly greater after oral antibiotics alone (4.8%, P = .013). concerning secondary outcomes, no significant differences were recorded for the risk of overall morbidity and reoperation. the risk of readmission (3.0% after no bowel preparation) was significantly reduced after mechanical bowel preparation with oral antibiotics (1.5%, P = .046), and the risk of major morbidity (5.1% after no bowel preparation) was significantly greater after oral antibiotics alone (6.7%, P = .007). conclusion: this multitreatment machine-learning analysis, despite some limitations, showed that mechanical bowel preparation with oral antibiotics is associated with a decrease in surgical-site infections after elective right colectomy compared with no bowel preparation
Three-row versus two-row circular staplers for left-sided colorectal anastomosis: a propensity score-matched analysis of the iCral 2 and 3 prospective cohorts
No full textBACKGROUND: Since most anastomoses after left-sided colorectal resections are performed with a circular stapler, any technological change in stapling devices may influence the incidence of anastomotic adverse events. The aim of the present study was to analyze the effect of a three-row circular stapler on anastomotic leakage and related morbidity after left-sided colorectal resections. MATERIALS AND METHODS: A circular stapled anastomosis was performed in 4255 (50.9%) out of 8359 patients enrolled in two prospective multicenter studies in Italy, and, after exclusion criteria to reduce heterogeneity, 2799 (65.8%) cases were retrospectively analyzed through a 1:1 propensity score-matching model including 20 covariates relative to patient characteristics, to surgery and to perioperative management. Two well-balanced groups of 425 patients each were obtained: group (A) - true population of interest, anastomosis performed with a three-row circular stapler; group (B) - control population, anastomosis performed with a two-row circular stapler. The target of inferences was the average treatment effect in the treated (ATT). The primary endpoints were overall and major anastomotic leakage and overall anastomotic bleeding; the secondary endpoints were overall and major morbidity and mortality rates. The results of multiple logistic regression analyses for the outcomes, including the 20 covariates selected for matching, were presented as odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: Group A versus group B showed a significantly lower risk of overall anastomotic leakage (2.1 vs. 6.1%; OR 0.33; 95% CI 0.15-0.73; P =0.006), major anastomotic leakage (2.1 vs. 5.2%; OR 0.39; 95% CI 0.17-0.87; P =0.022), and major morbidity (3.5 vs. 6.6% events; OR 0.47; 95% CI 0.24-0.91; P =0.026). CONCLUSION: The use of three-row circular staplers independently reduced the risk of anastomotic leakage and related morbidity after left-sided colorectal resection. Twenty-five patients were required to avoid one leakage
Bibliographie Hilarion G. Petzold 1958 – 2009 mit Anhang als Einführung
No full textDieses Archiv enthält die Gesamtbibliographie der Werke des Autors nebst einiger Texte „Über H. G. Petzold“ im Schlussteil der Bibliographie sowie einen Anhang mit einer Einführung in die Architektur des Werkes in seinem wissenslogischen Aufbau als Ausarbeitung seines „Tree of Science Modells“ (2007).This archive contains the complete bibliography of the author and some texts about H. G. Petzold, moreover an epilogue with an introduction to the architecture of the works in its epistemological structure and composition and as an elaborations of Petzold’s „Tree of Science Modell (2007).https://www.fpi-publikation.de/polyloge/01-2009-petzold-h-g-gesamtbibliographie-h-g-petzold-1958-2009-updating-november2009/peerReviewedpublishedVersio
N(6) or N(9) Substituted 2-Phenyl-8-Azaadenines: Affinity for A1 Adenosine Receptors. VII
No full textThe A1 activities shown respectively by N(6) or N(9) substituted 8-azaadenines were compared. At least in some cases, the biological results indicated the ability of the receptor to accept the exogenous molecule in various arrangements, and an attempt to rationalizing these arrangements was made by means of a model with two different molecular orientations
Dispelling the Myths Behind First-author Citation Counts
No full textWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
Total mesorectal excision for mid and low rectal cancer: Laparoscopic vs robotic surgery
No full textAIM: To compare the short- and long-term outcomes of laparoscopic and robotic surgery for middle and low rectal cancer.
METHODS: This is a retrospective study on a prospectively collected database containing 111 patients who underwent minimally invasive rectal resection with total mesorectal excision (TME) with curative intent between January 2008 and December 2014 (robot, n = 53; laparoscopy, n = 58). The patients all had a diagnosis of middle and low rectal adenocarcinoma with stage I-III disease. The median follow-up period was 37.4 mo. Perioperative results, morbidity a pathological data were evaluated and compared. The 3-year overall survival and disease-free survival rates were calculated and compared.
RESULTS: Patients were comparable in terms of preoperative and demographic parameters. The median surgery time was 192 min for laparoscopic TME (L-TME) and 342 min for robotic TME (R-TME) (P < 0.001). There were no differences found in the rates of conversion to open surgery and morbidity. The patients who underwent laparoscopic surgery stayed in the hospital two days longer than the robotic group patients (8 d for L-TME and 6 d for R-TME, P < 0.001). The pathologic evaluation showed a higher number of harvested lymph nodes in the robotic group (18 for R-TME, 11 for L-TME, P < 0.001) and a shorter distal resection margin for laparoscopic patients (1.5 cm for L-TME, 2.5 cm for R-TME, P < 0.001). The three-year overall survival and disease-free survival rates were similar between groups.
CONCLUSION: Both L-TME and R-TME achieved acceptable clinical and oncologic outcomes. The robotic technique showed some advantages in rectal surgery that should be validated by further studies
Enhanced Recovery Independently Lowers Failure to Rescue After Colorectal Surgery
No full textBACKGROUND: High adherence to the enhanced recovery after surgery pathway reduces morbidity and mortality rates after elective colorectal surgery. OBJECTIVE: To evaluate the effect of adherence to the enhanced recovery after surgery pathway on the failure to rescue rates after elective colorectal surgery. DESIGN: Retrospective analysis of a prospective database. PATIENTS: Adults (≥ 18 years old) who underwent elective colorectal resection with anastomosis for benign and malignant disease. SETTINGS: Prospective enrolment in 78 centers in Italy from 2019 to 2021. INTERVENTIONS: All the outcomes were measured at 60 days after surgery. Several patient-, disease-, treatment-, hospital-, and complication-related variables were analyzed for the outcomes. After univariate analyses, independent predictors of the endpoints were identified through logistic regression analyses, presenting odds ratios and 95% confidence intervals. MAIN OUTCOME MEASURES: Failure to rescue after any adverse event, defined as the ratio between the number of deaths and the number of patients showing any adverse event; failure to rescue after any major adverse event, with the denominator represented by the number of patients showing any major adverse event. RESULTS: An adverse event was recorded in 2,321 out of 8,359 patients (27.8%), a major adverse event in 523 patients (6.3%), and death in 88 patients (1.0%). The failure to rescue rates were 3.8% after any adverse event and 16.8% after any major adverse event. Independent predictors of primary endpoints were identified among patient- (age, American Society of Anesthesiologists class, nutritional status), treatment- (type of resection), and complication-related (anastomotic leakage, reoperation) variables. Enhanced recovery pathway adherence > 70% independently reduced failure to rescue rates. LIMITATIONS: Clustering from multicenter data, and unmeasured confounding from observational data. CONCLUSIONS: Following elective colorectal resection, adherence > 70% to the enhanced recovery pathway independently decreased failure to rescue rates, along with other patient- or treatment-related factors. See Video Abstract
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