Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort

background current evidence concerning bowel preparation before elective colorectal surgery is still controversial. this study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any adverse event, OM) after elective colorectal surgery using four different types of bowel preparation. methods a prospective database gathered among 78 Italian surgical centers in two prospective studies, including 6241 patients who underwent elective colorectal resection with anastomosis for malignant or benign disease, was re-analyzed through a multi-treatment machine-learning model considering no bowel preparation (NBP; No. = 3742; 60.0%) as the reference treatment arm, compared to oral antibiotics alone (oA; No. = 406; 6.5%), mechanical bowel preparation alone (MBP; No. = 1486; 23.8%), or in combination with oAB (MoABP; No. = 607; 9.7%). twenty covariates related to biometric data, surgical procedures, perioperative management, and hospital/center data potentially affecting outcomes were included and balanced into the model. the primary endpoints were AL, SSIs, and OM. all the results were reported as odds ratio (OR) with 95% confidence intervals (95% CI). results compared to NBP, MBP showed significantly higher AL risk (OR 1.82; 95% CI 1.23-2.71; p = .003) and OM risk (OR 1.38; 95% CI 1.10-1.72; p = .005), no significant differences for all the endpoints were recorded in the oA group, whereas MoABP showed a significantly reduced SSI risk (OR 0.45; 95% CI 0.25-0.79; p = .008). conclusions MoABP significantly reduced the SSI risk after elective colorectal surgery, therefore representing a valid alternative to NBP

Real-time biological early-warning system based on freshwater mussels’ valvometry data

<jats:p>Abstract. Quantifying the effects of external climatic and anthropogenic stressors on aquatic ecosystems is an important task for scientific purposes and management progress in the field of water resources. In this study, we propose an innovative use of biotic communities as real-time indicators, which offers a promising solution to directly quantify the impact of these external stressors on the aquatic ecosystem health. Specifically, we investigated the influence of natural river floods on riverine biotic communities using freshwater mussels (FMs) as reliable biosensors. Using the valvometry technique, we monitored the valve gaping of FMs and analysed both the amplitude and frequency. The valve movement of the FMs was tracked by installing a magnet on one valve and a Hall effect sensor on the other valve. The magnetic field between the magnet and the sensor was recorded using an Arduino board, and its changes over time were normalised to give the opening percentage of the FMs (how open the mussels were). The recorded data were then analysed using continuous wavelet transform (CWT) analysis to study the time-dependent frequency of the signals. The experiments were carried out both in a laboratory flume and in the Paglia River (Italy). The laboratory experiments were conducted with FMs in two configurations: freely moving on the bed and immobilised on vertical rods. Testing of the immobilised configuration was necessary because the same configuration was used in the field in order to prevent FMs from packing against the downstream wall of the protection cage during floods or from breaking their connection wires. These experiments allowed us to verify that immobilised mussels show similar responses to abrupt changes in flow conditions as free mussels. Moreover, immobilised mussels produced more neat and interpretable signals than free-moving mussels due to the reduced number of features resulting from movement constraints. We then analysed the response of 13 immobilised mussels under real river conditions during a flood on 31 March 2022. The FMs in the field showed a rapid and significant change in valve gap frequency as the flood escalated, confirming the general behaviour observed in the laboratory in the presence of an abrupt increase in the flow. These results highlight the effectiveness of using FMs as biosensors for the timely detection of environmental stressors related to natural floods and emphasise the utility of CWT as a powerful signal-processing tool for the analysis of valvometry data. The study proposes the integration of FM valvometry and CWT for the development of operational real-time biological early-warning systems (BEWSs) with the aim of monitoring and protecting aquatic ecosystems. Future research should focus on extending the investigation of the responsiveness of FMs to specific stressors (e.g. turbidity, temperature, and chemicals) and on testing the applications of the proposed BEWSs to quantify the impact of both natural stressors (e.g. heat waves and droughts) and anthropogenic stressors (e.g. hydropeaking, reservoir flushing, and chemical contamination). </jats:p&gt

Commento agli articoli 75-81 c.p.c., Delle parti, in Codice di procedura civile. Commentario diretto da Claudio Consolo. Vol. 1

Commento sistematico agli articoli da 75 a 81 del c.p.c. alla luce delle interpretazioni dottrinali e degli orientamenti giurisprudenzial

Commento agli articoli 90-98 c.p.c., Delle responsabilità delle parti per le spese e per i danni processuali

Commento sistematico agli articoli da 90 a 98 del c.p.c. alla luce delle interpretazioni dottrinali e degli orientamenti giurisprudenzial

Commento agli articoli 88-89 c.p.c., Dei doveri delle parti e dei difensori,

Commento sistematico agli articoli 88 e 89 del c.p.c. alla luce delle interpretazioni dottrinali e degli orientamenti giurisprudenzial

Commento agli articoli 90-98 c.p.c., Delle responsabilità delle parti per le spese e per i danni processuali

Commento sistematico agli articoli da 90 a 98 del c.p.c. alla luce delle interpretazioni dottrinali e degli orientamenti giurisprudenzial

Commento agli articoli 267-272 c.p.c., Dell’intervento di terzi

Commento sistematico agli articoli da 267-272 del c.p.c. alla luce delle interpretazioni dottrinali e degli orientamenti giurisprudenzial