Timing of ileocolonic anastomosis in ileocecal resection in Crohn's disease

openABSTRACT Background - Crohn's disease (CD) is a chronic inflammatory disorder affecting the gastrointestinal tract with no current curative treatment. Despite significant improvements in medical treatments, surgery is still necessary in most cases, especially in the management of complications. Intestinal resection of the terminal ileum followed by ileocolonic anastomosis is the most performed surgery for Crohn's disease since it typically affects the terminal ileum. Among different types of anastomoses, the side-to-side anastomosis is currently recommended by European Crohn’s and Colitis Organisation (ECCO) guidelines, and the laparoscopic method appears to be preferred. However, it remains uncertain whether performing the anastomosis intracorporeally or extracorporeally ultimately affects postoperative outcomes, leaving the decision up to the surgeon. Currently, there are no studies in the literature comparing these outcomes in ileocolic anastomoses. Therefore, our study aims to investigate any differences between the two anastomosis types in terms of disease activity, body image, quality of life, operating time, and clinical and surgical recurrence-free survival time. Methods - We performed a retrospective analysis of 50 consecutive patients who underwent ileocecal resection followed by ileocolonic side-to-side anastomosis in our department from 2020 to 2023. For each patient, surgical records, discharge letters, and outpatient follow-up visits were thoroughly analyzed. In July 2023, 48 patients agreed to participate in a telephone interview to assess patients' clinical disease activity (Harvey-Bradshaw), quality of life (Cleveland Global Quality of Life), and body image (Body Image Questionnaire) after surgery. Results – 16 and 34 patients underwent intracorporeal and extracorporeal anastomosis, respectively. The disease activity (Harvey-Bradshaw Index) did not show significant differences in single item or total HBI scores between the two groups. However, patients with extracorporeal anastomosis had slightly higher scores for item HB3 (number of liquid/soft stools per day) (p = 0.0778), moreover patients with extracorporeal anastomosis had a slightly higher HB total score (p = 0.0580). The Body Image Questionnaire (BIQ) results indicated that patients who underwent intracorporeal anastomosis were more satisfied with their bodies (BIQ1, p = 0.0270), felt more attractive (BIQ3, p = 0.0570), and felt more masculine/feminine (BIQ4, p = 0.0814) compared to those with extracorporeal anastomosis although only the first item showed a statistical significance. We performed additional analysis of the results, specifically excluding patients who underwent open surgery. The previously slight differences were no longer observed, except for item BIQ1 (p = 0,0257). No differences were found in quality of life, health, energy level, or postoperative complications between the two groups. However, in terms of operating time, intracorporeal anastomoses showed a slightly shorter operating time, although this did not reach statistical significance. On the other hand, intracorporeal anastomoses appear to be associated with a slight, though not statistically significant, tendency to recur. Conclusions - Our study suggests that intracorporeal anastomosis seems to have slightly functional and aesthetic advantages compared to extracorporeal anastomosis, although these findings did not reach statistical significance. In addition, intracorporeal anastomosis appears to be faster to perform, but it seems to be associated with a higher likelihood of disease recurrence. In terms of postoperative quality of life, no significant differences were observed between the two types of anastomoses, and there were no significant differences in postoperative complications. It's important to note that these results are based on a limited sample size and follow-up period, and further studies are needed for confirmation.ABSTRACT Background - Crohn's disease (CD) is a chronic inflammatory disorder affecting the gastrointestinal tract with no current curative treatment. Despite significant improvements in medical treatments, surgery is still necessary in most cases, especially in the management of complications. Intestinal resection of the terminal ileum followed by ileocolonic anastomosis is the most performed surgery for Crohn's disease since it typically affects the terminal ileum. Among different types of anastomoses, the side-to-side anastomosis is currently recommended by European Crohn’s and Colitis Organisation (ECCO) guidelines, and the laparoscopic method appears to be preferred. However, it remains uncertain whether performing the anastomosis intracorporeally or extracorporeally ultimately affects postoperative outcomes, leaving the decision up to the surgeon. Currently, there are no studies in the literature comparing these outcomes in ileocolic anastomoses. Therefore, our study aims to investigate any differences between the two anastomosis types in terms of disease activity, body image, quality of life, operating time, and clinical and surgical recurrence-free survival time. Methods - We performed a retrospective analysis of 50 consecutive patients who underwent ileocecal resection followed by ileocolonic side-to-side anastomosis in our department from 2020 to 2023. For each patient, surgical records, discharge letters, and outpatient follow-up visits were thoroughly analyzed. In July 2023, 48 patients agreed to participate in a telephone interview to assess patients' clinical disease activity (Harvey-Bradshaw), quality of life (Cleveland Global Quality of Life), and body image (Body Image Questionnaire) after surgery. Results – 16 and 34 patients underwent intracorporeal and extracorporeal anastomosis, respectively. The disease activity (Harvey-Bradshaw Index) did not show significant differences in single item or total HBI scores between the two groups. However, patients with extracorporeal anastomosis had slightly higher scores for item HB3 (number of liquid/soft stools per day) (p = 0.0778), moreover patients with extracorporeal anastomosis had a slightly higher HB total score (p = 0.0580). The Body Image Questionnaire (BIQ) results indicated that patients who underwent intracorporeal anastomosis were more satisfied with their bodies (BIQ1, p = 0.0270), felt more attractive (BIQ3, p = 0.0570), and felt more masculine/feminine (BIQ4, p = 0.0814) compared to those with extracorporeal anastomosis although only the first item showed a statistical significance. We performed additional analysis of the results, specifically excluding patients who underwent open surgery. The previously slight differences were no longer observed, except for item BIQ1 (p = 0,0257). No differences were found in quality of life, health, energy level, or postoperative complications between the two groups. However, in terms of operating time, intracorporeal anastomoses showed a slightly shorter operating time, although this did not reach statistical significance. On the other hand, intracorporeal anastomoses appear to be associated with a slight, though not statistically significant, tendency to recur. Conclusions - Our study suggests that intracorporeal anastomosis seems to have slightly functional and aesthetic advantages compared to extracorporeal anastomosis, although these findings did not reach statistical significance. In addition, intracorporeal anastomosis appears to be faster to perform, but it seems to be associated with a higher likelihood of disease recurrence. In terms of postoperative quality of life, no significant differences were observed between the two types of anastomoses, and there were no significant differences in postoperative complications. It's important to note that these results are based on a limited sample size and follow-up period, and further studies are needed for confirmation

Parametric models for a database of realistic threats to GNSS receivers

Threats to GNSS receivers are becoming increasingly complex and easier to implement due to technological advancement. So, these attacks have become now a serious problem for any user, not only, for example, for military or safety-of-life purposes anymore. In this context, TAM has been created to collect data about these attacks and possible mitigations. This thesis describes how tested threat scenarios to GNSS signals have been parameterized to be inserted in the TAM database.openEmbargo tempraneo per motivi di segretezza e/o di proprietà dei risultati e informazioni di enti esterni o aziende private che hanno partecipato alla realizzazione del lavoro di ricerca relativo alla tes

Estrogen, angiogenesis, immunity and cell metabolism: Solving the puzzle

Estrogen plays an important role in the regulation of cardiovascular physiology and the immune system by inducing direct effects on multiple cell types including immune and vascular cells. Sex steroid hormones are implicated in cardiovascular protection, including endothelial healing in case of arterial injury and collateral vessel formation in ischemic tissue. Estrogen can exert potent modulation effects at all levels of the innate and adaptive immune systems. Their action is mediated by interaction with classical estrogen receptors (ERs), ER\u3b1 and ER\u3b2, as well as the more recently identified G-protein coupled receptor 30/G-protein estrogen receptor 1 (GPER1), via both genomic and non-genomic mechanisms. Emerging data from the literature suggest that estrogen deficiency in menopause is associated with an increased potential for an unresolved inflammatory status. In this review, we provide an overview through the puzzle pieces of how 17\u3b2-estradiol can influence the cardiovascular and immune systems

New treatment guidelines on Cushing's disease

It is important to treat patients with Cushing's disease as rapidly as possible to limit its long-term mortality and morbidity. Selective transphenoidal pituitary adenomectomy remains the treatment of choice but, unfortunately, the rate of cure at long-term follow-up is suboptimal and recurrences are high, even in the hands of expert neurosurgeons. Treatment options for persistent or relapsed disease include repeat trasphenoidal pituitary surgery, radiotherapy or bilateral adrenalectomy. Medical treatment, a second-line treatment option, may have either a primary or adjunctive role if the patient cannot safely undergo surgery, if surgery fails, or if the tumor recurs. Cabergoline and pasireotide (SOM230), two pituitary tumor-directed drugs, are the most exciting news in the human pharmacological approach. However, the use of these drugs in clinical practice and their real impact in the management of patients is yet to be determined. The treatment of patients with Cushing's disease is complex and requires a multidisciplinary and individualized approach to patient management using cost-benefit analyses

Tractor cabin ergonomics analyses by means of Kinect motion capture technology

Kinect is the de facto standard for real-time depth sensing and motion capture cameras. The sensor is here proposed for exploiting body tracking during driving operations. The motion capture system was developed taking advantage of the Microsoft software development kit (SDK), and implemented for real-time monitoring of body movements of a beginner and an expert tractor drivers, on different tracks (straight and with curves) and with different driving conditions (manual and assisted steering). Tests show how analyses can be done not only in terms of absolute movements, but also in terms of relative shifts, allowing for quantification of angular displacements or rotations

Managing Cushing's disease: the state of the art.

Cushing's disease is a rare chronic disease caused by a pituitary adenoma, which leads to excess secretion of adrenocorticotropic hormone (ACTH). The over-production of ACTH leads to hyperstimulation of the adrenal glands and a chronic excess of cortisol, resulting in the signs and symptoms of a severe clinical state (Cushing's syndrome) that leads to significant morbidity, negative impacts on the patient's quality of life, and, if untreated, increased mortality. The management of patients with Cushing's disease is complicated by the heterogeneity of the condition, with signs and symptoms that overlap with those of other diseases, and high subclinical incidence rates. Controversies surrounding the tests used for screening and identifying patients with Cushing's disease add to the challenge of patient management. Surgical intervention to remove the adenoma is the first-line treatment for patients with Cushing's disease, but medical therapies are useful in patients who relapse or are unsuitable for surgery. The recent introduction of pasireotide, the first pituitary-directed medical therapy, expands the number of treatment options available for patients with Cushing's disease. This state-of-the-art review aims to provide an overview of the most recent scientific research and clinical information regarding Cushing's disease. Continuing research into improving the diagnosis and treatment of Cushing's disease will help to optimize patient management