Robotic versus laparoscopic left colectomy: a systematic review and meta-analysis

Background: This study aimed to review the new evidence to understand whether the robotic approach could find some clear indication also in left colectomy. Methods: A systematic review of studies published from 2004 to 2022 in the Web of Science, PubMed, and Scopus databases and comparing laparoscopic (LLC) and robotic left colectomy (RLC) was performed. All comparative studies evaluating robotic left colectomy (RLC) versus laparoscopic (LLC) left colectomy with at least 20 patients in the robotic arm were included. Abstract, editorials, and reviews were excluded. The Newcastle–Ottawa Scale for cohort studies was used to assess the methodological quality. The random-effect model was used to calculate pooled effect estimates. Results: Among the 139 articles identified, 11 were eligible, with a total of 52,589 patients (RLC, n = 13,506 versus LLC, n = 39,083). The rate of conversion to open surgery was lower for robotic procedures (RR 0.5, 0.5–0.6; p < 0.001). Operative time was longer for the robotic procedures in the pooled analysis (WMD 39.1, 17.3–60.9, p = 0.002). Overall complications (RR 0.9, 0.8–0.9, p < 0.001), anastomotic leaks (RR 0.7, 0.7–0.8; p < 0.001), and superficial wound infection (RR 3.1, 2.8–3.4; p < 0.001) were less common after RLC. There were no significant differences in mortality (RR 1.1; 0.8–1.6, p = 0.124). There were no differences between RLC and LLC with regards to postoperative variables in the subgroup analysis on malignancies. Conclusions: Robotic left colectomy requires less conversion to open surgery than the standard laparoscopic approach. Postoperative morbidity rates seemed to be lower during RLC, but this was not confirmed in the procedures performed for malignancies

Morphology control of single-crystal InSb nanostructures by tuning the growth parameters

Research interest in indium antimonide (InSb) has increased significantly in recent years owing to its intrinsic properties and the consequent opportunities to implement next-generation quantum devices. Hence, the precise, reproducible control over morphology and crystalline quality becomes of paramount importance for a practical quantum-device technology. Here, we investigate the growth of InSb nanostructures with different morphologies on InAs stems without pre-growth efforts (patterning). InSb nanostructures such as nanowires (1D), nanoflags (2D) and nanocubes (3D) have been realized by means of Au-assisted chemical beam epitaxy by tailoring the growth parameters like growth temperature, precursor fluxes, sample rotation and substrate orientation. Through morphological and crystallographic characterization, all the as-grown InSb 2D nanostructures are found to be single-crystalline with zinc blende structure, free from any defects such as stacking faults and twin planes. The existence of two families of 2D nanostructures, characterised by an aperture angle at the base of 145 and 160 , is observed and modelled. This study provides useful guidelines for the controlled growth of high-quality InSb nanostructures with different shape

A heterotrimeric G protein, G alpha i-3, on Golgi membranes regulates the secretion of a heparan sulfate proteoglycan in LLC-PK1 epithelial cells

A heterotrimeric G-alpha-i subunit, alpha-i-3, is localized on Golgi membranes in LLC-PK1 and NRK epithelial cells where it colocalizes with mannosidase II by immunofluorescence. The alpha-i-3 was found to be localized on the cytoplasmic face of Golgi cisternae and it was distributed across the whole Golgi stack. The alpha-i-3 subunit is found on isolated rat liver Golgi membranes by Western blotting and G-alpha-i-3 on the Golgi apparatus is ADP ribosylated by pertussis toxin. LLC-PK1 cells were stably transfected with G-alpha-i-3 on an MT-1, inducible promoter in order to overexpress alpha-i-3 on Golgi membranes. The intracellular processing and constitutive secretion of the basement membrane heparan sulfate proteoglycan (HSPG) was measured in LLC-PK1 cells. Overexpression of alpha-i-3 on Golgi membranes in transfected cells retarded the secretion of HSPG and accumulated precursors in the medial-trans-Golgi. This effect was reversed by treatment of cells with pertussis toxin which results in ADP-ribosylation and functional uncoupling of G-alpha-i-3 on Golgi membranes. These results provide evidence for a novel role for the pertussis toxin sensitive G-alpha-i-3 protein in Golgi trafficking of a constitutively secreted protein in epithelial cells

InAs/InP/InSb Nanowires as Low Capacitance n-n Heterojunction Diodes

Nanowire diodes have been realized by employing an axial heterojunction between InAs and InSb semiconductor materials. The broken-gap band alignment (type III) leads to a strong rectification effect when the current-voltage (I-V) characteristic is inspected at room temperature. The additional insertion of a narrow InP barrier reduces the thermionic contribution, which results in a net decrease of leakage current in the reverse bias with a corresponding enhanced rectification in terms of asymmetry in the I-V characteristics. The investigated diodes compare favorably with the ones realized with p-n heterostructured nanowires, making InAs/InP/InSb devices appealing candidates to be used as building blocks for nanowire-based ultrafast electronics and for the realization of photodetectors in the THz spectral range

Conversion Surgery in Gastric Cancer Carcinomatosis

Background: After the REGATTA trial, patients with stage IV gastric cancer could only benefit from chemotherapy (CHT). However, some of these patients may respond extraordinarily to palliative chemotherapy, converting their disease to a radically operable stage. We present a single centre experience in treating peritoneal carcinomatosis from gastric cancer. Methods: All patients with stage IV gastric cancer with peritoneal metastases as a single metastatic site operated at a single centre between 2005 and 2020 were included. Cases were grouped according to the treatment received. Results: A total of 118 patients were considered, 46 were submitted to palliative gastrectomy (11 were considered M1 because of an unsuspected positive peritoneal cytology), and 20 were submitted to Hyperthermic Intraperitoneal Chemotherapy (HIPEC) because of a <6 Peritoneal Cancer Index (PCI). The median overall survival (OS) after surgery plus HIPEC was 46.7 (95% CI 15.8–64.0). Surgery (without HIPEC) after CHT presented a median OS 14.4 (8.2–26.8) and after upfront surgery 14.7 (10.9–21.1). Patients treated with upfront surgery and considered M1 only because of a positive cytology, had a median OS of 29.2 (25.2–29.2). The OS of patients treated with surgery plus HIPEC were 60.4 months (9.2–60.4) in completely regressed cancer after chemotherapy and 31.2 (15.8–64.0) in those partially regressed (p = 0.742). Conclusions: Conversion surgery for peritoneal carcinomatosis from gastric cancer was associated with long survival and it should always be taken into consideration in this group of patients

Near-field terahertz probes with room-temperature nanodetectors for subwavelength resolution imaging

Near-field imaging with terahertz (THz) waves is emerging as a powerful technique for fundamental research in photonics and across physical and life sciences. Spatial resolution beyond the diffraction limit can be achieved by collecting THz waves from an object through a small aperture placed in the near-field. However, light transmission through a sub-wavelength size aperture is fundamentally limited by the wave nature of light. Here, we conceive a novel architecture that exploits inherently strong evanescent THz field arising within the aperture to mitigate the problem of vanishing transmission. The sub-wavelength aperture is originally coupled to asymmetric electrodes, which activate the thermo-electric THz detection mechanism in a transistor channel made of flakes of blackphosphorus or InAs nanowires. The proposed novel THz near-field probes enable room-temperature sub-wavelength resolution coherent imaging with a 3.4 THz quantum cascade laser, paving the way to compact and versatile THz imaging systems and promising to bridge the gap in spatial resolution from the nanoscale to the diffraction limit

Pb/InAs nanowire Josephson junction with high critical current and magnetic flux focusing

We have studied mesoscopic Josephson junctions formed by highly $n$-doped InAs nanowires and superconducting Ti/Pb source and drain leads. The current-voltage properties of the system are investigated by varying temperature and external out-of-plane magnetic field. Superconductivity in the Pb electrodes persists up to $\sim 7$ K and with magnetic field values up to 0.4 T. Josephson coupling at zero backgate voltage is observed up to 4.5 K and the critical current is measured to be as high as 615 nA. The supercurrent suppression as a function of the magnetic field reveals a diffraction pattern that is explained by a strong magnetic flux focusing provided by the superconducting electrodes forming the junction.Comment: 6 pages, 5 color figure

The perceived ability of gastroenterologists, hepatologists and surgeons can bias medical decision making

Medical errors are a troubling issue and physicians should be careful to scrutinize their own decisions, remaining open to the possibility that they may be wrong. Even so, doctors may still be overconfident. A survey was here conducted to test how medical experience and self-confidence can affect physicians working in the specific clinical area. Potential participants were contacted through personalized emails and invited to contribute to the survey. The \u201crisk-intelligence\u201d test consists of 50 statements about general knowledge in which participants were asked to indicate how likely they thought that each statement was true or false. The risk-intelligence quotient (RQ), a measure of self-confidence, varies between 0 and 100. The higher the RQ score, the better the confidence in personal knowledge. To allow for a representation of 1000 physicians, the sample size was calculated as 278 respondents. A total of 1334 individual emails were sent to reach 278 respondents. A control group of 198 medical students were also invited, of them, 54 responded to the survey. The mean RQ (SD)of physicians was 61.1 (11.4) and that of students was 52.6 (9.9). Assuming age as indicator of knowledge, it was observed that physicians 6434 years had a mean RQ of 59.1 (10.1); those of 35\u201342 years had 61.0 (11.0); in those of 43\u201351 years increased to 62.9 (12.2); reached a plateau of 63.0 (11.5) between 52\u201359 years and decreased to 59.6 (12.1) in respondents 6560 years (r2:0.992). Doctors overestimate smaller probabilities and under-estimate higher probabilities. Specialists in gastroenterology and hepato-biliary diseases suffer from some degree of self-confidence bias, potentially leading to medical errors. Approaches aimed at ameliorating the self-judgment should be promoted more widely in medical education