Robotic rectal resection preserves anorectal function: Systematic review and meta-analysis.

AbstractBackgroundImproving survival rates in rectal cancer patients has generated a growing interest in functional outcomes after total mesorectal excision (TME). The well‐established low anterior resection syndrome (LARS) score assesses postoperative anorectal impairment after TME. Our meta‐analysis is the first to compare bowel function after open, laparoscopic, transanal, and robotic TME.MethodsAll studies reporting functional outcomes after rectal cancer surgery (LARS score) were included, and were compared with a consecutive series of robotic TME (n = 48).ResultsThirty‐two publications were identified, including 5 565 patients. Anorectal function recovered significantly better within one year after robotic TME (3.8 [95%CI –9.709–17.309]) versus laparoscopic TME (26.4 [95%CI 19.524–33.286]), p = 0.006), open TME (26.0 [95%CI 24.338–29.702], p = 0.002) and transanal TME (27.9 [95%CI 22.127–33.669], p = 0.003).ConclusionsRobotic TME enables better recovery of anorectal function compared to other techniques. Further prospective, high‐quality studies are needed to confirm the benefits of robotic surgery

Association of Neuroretinal Thinning and Microvascular Changes with Hypertension in an Older Population in Southern Italy.

Retinal microvasculature assessment at capillary level may potentially aid the evaluation of early microvascular changes due to hypertension. We aimed to investigate associations between the measures obtained using optical coherence tomography (OCT) and OCT-angiography (OCT-A) and hypertension, in a southern Italian older population. We performed a cross-sectional analysis from a population-based study on 731 participants aged 65 years+ subdivided into two groups according to the presence or absence of blood hypertension without hypertensive retinopathy. The average thickness of the ganglion cell complex (GCC) and the retinal nerve fiber layer (RNFL) were measured. The foveal avascular zone area, vascular density (VD) at the macular site and of the optic nerve head (ONH) and radial peripapillary capillary (RPC) plexi were evaluated. Logistic regression was applied to assess the association of ocular measurements with hypertension. GCC thickness was inversely associated with hypertension (odds ratio (OR): 0.98, 95% confidence interval (CI): 0.97-1). A rarefaction of VD of the ONH plexus at the inferior temporal sector (OR: 0.95, 95% CI: 0.91-0.99) and, conversely, a higher VD of the ONH and RPC plexi inside optic disc (OR: 1.07, 95% CI: 1.04-1.10; OR: 1.04, 95% CI: 1.02-1.06, respectively) were significantly associated with hypertension. A neuroretinal thinning involving GCC and a change in capillary density at the peripapillary network were related to the hypertension in older patients without hypertensive retinopathy. Assessing peripapillary retinal microvasculature using OCT-A may be a useful non-invasive approach to detect early microvascular changes due to hypertension

Idiopathic macular hole: post-operative morpho-functional assessment and prognostic factors for recovery of visual acuity

INTRODUCTION: Idiopathic macular hole (MH) is a full-thickness retinal damage typical of the advanced age with a high social impact because, as it affects the macula, it produces severe loss of vision. AIM: This study aims to evaluate the therapeutic efficacy of surgery and to determine prognostic factors, considering how hypovision weighs on individual quality of life and on public health. METHODS: All patients affected by MH were evaluated with an ophthalmic visit, measurement of visual acuity and Optical Coherence Tomography (OCT) documentation before surgical intervention. Surgical treatment followed and, subsequently, all the patients were examined with the same documentation at 7 days, 1 month, 3 months, 6 months and 12 months. RESULTS: Surgical therapy, with the modern techniques available, demonstrated the efficacy of anatomical recovery and retinal function. Furthermore, the quantitative characteristics of the MH in the OCT scanning revealed an important prognostic function

Laparoscopic cholecystectomy with indocyanine green fluorescence in patient with situs inversus totalis

Situs Viscerum Inversus (SVI) is a rare autosomal recessive disease. Because of this particular anatomy, it could be challenging for the surgeon to perform any abdominal procedure, including laparoscopic cholecystectomy. In these situations, indocyanine green fluorescence cholangiography can be essential. A 29-year-old female with documented situs viscerum inversus totalis underwent laparoscopic cholecystectomy with a four-trocar technique. Switching the vision to the near-infrared camera, which elicited the indocyanine green molecules, the surgeon could easily identify the common bile duct and the cystic duct. Switching back to the normal vision, the operator completed the dissection. The described procedure is still challenging due to the “mirror effect” and the uncommon position of the surgical instruments, especially for right-handed surgeons. Indocyanine green fluorescence angiography can help the surgeon identify the structures in cases of non-regular anatomy such as this

The Way Forward for Indirect Structural Health Monitoring (iSHM) Using Connected and Automated Vehicles in Europe

Europe’s aging transportation infrastructure requires optimized maintenance programs. However, data and monitoring systems may not be readily available to support strategic decisions or they may require costly installations in terms of time and labor requirements. In recent years, the possibility of monitoring bridges by indirectly sensing relevant parameters from traveling vehicles has emerged—an approach that would allow for the elimination of the costly installation of sensors and monitoring campaigns. The advantages of cooperative, connected, and automated mobility (CCAM), which is expected to become a reality in Europe towards the end of this decade, should therefore be considered for the future development of iSHM strategies. A critical review of methods and strategies for CCAM, including Intelligent Transportation Systems, is a prerequisite for moving towards the goal of identifying the synergies between CCAM and civil infrastructures, in line with future developments in vehicle automation. This study presents the policy framework of CCAM in Europe and discusses the policy enablers and bottlenecks of using CCAM in the drive-by monitoring of transport infrastructure. It also highlights the current direction of research within the iSHM paradigm towards the identification of technologies and methods that could benefit from the use of connected and automated vehicles (CAVs)

Data Fusion Analysis of Sentinel-4 and Sentinel-5 Simulated Ozone Data

AbstractThe complete data fusion method, generalized to the case of fusing profiles of atmospheric variables retrieved on different vertical grids and referred to different true values, is applied to ozone profiles retrieved from simulated measurements in the ultraviolet, visible, and thermal infrared spectral ranges for the Sentinel-4 and Sentinel-5 missions of the Copernicus program. In this study, the production and characterization of combined low Earth orbit (Sentinel-5) and geostationary Earth orbit (Sentinel-4) fused ozone data is performed. Fused and standard products have been compared and a performance assessment of the generalized complete data fusion is presented. The analysis of the output products of the complete data fusion algorithm and of the standard processing using quality quantifiers demonstrates that the generalized complete data fusion algorithm provides products of better quality when compared with standard products

Set up of a dedicated COVID-19 surgical pathway and operating room for surgical emergencies

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Application of the Complete Data Fusion algorithm to the ozone profiles measured by geostationary and low-Earth-orbit satellites:A feasibility study

The new platforms for Earth observation from space are characterized by measurements made at great spatial and temporal resolutions. While this abundance of information makes it possible to detect and study localized phenomena, it may be difficult to manage this large amount of data for the study of global and large-scale phenomena. A particularly significant example is the use by assimilation systems of Level 2 products that represent gas profiles in the atmosphere. The models on which assimilation systems are based are discretized on spatial grids with horizontal dimensions of the order of tens of kilometres in which tens or hundreds of measurements may fall in the future. A simple procedure to overcome this problem is to extract a subset of the original measurements, but this involves a loss of information. Another option is the use of simple averages of the profiles, but this approach also has some limitations that we will discuss in the paper. A more advanced solution is to resort to the so-called fusion algorithms, capable of compressing the size of the dataset while limiting the information loss. A novel data fusion method, the Complete Data Fusion algorithm, was recently developed to merge a set of retrieved products in a single product a posteriori. In the present paper, we apply the Complete Data Fusion method to ozone profile measurements simulated in the thermal infrared and ultraviolet bands in a realistic scenario. Following this, the fused products are compared with the input profiles; comparisons show that the output products of data fusion have smaller total errors and higher information contents in general. The comparisons of the fused products with the fusing products are presented both at single fusion grid box scale and with a statistical analysis of the results obtained on large sets of fusion grid boxes of the same size. We also evaluate the grid box size impact, showing that the Complete Data Fusion method can be used with different grid box sizes even if this possibility is connected to the natural variability of the considered atmospheric molecule

A Distributed Modular Data Processing Chain Applied to Simulated Satellite Ozone Observations

Remote sensing of the atmospheric composition from current and future satellites, such as the Sentinel missions of the Copernicus programme, yields an unprecedented amount of data to monitor air quality, ozone, UV radiation and other climate variables. Hence, full exploitation of the growing wealth of information delivered by spaceborne observing systems requires addressing the technological challenges for developing new strategies and tools that are capable to deal with these huge data volumes. The H2020 AURORA (Advanced Ultraviolet Radiation and Ozone Retrieval for Applications) project investigated a novel approach for synergistic use of ozone profile measurements acquired at different frequencies (ultraviolet, visible, thermal infrared) by sensors onboard Geostationary Equatorial Orbit (GEO) and Low Earth Orbit (LEO) satellites in the framework of the Copernicus Sentinel-4 and Sentinel-5 missions. This paper outlines the main features of the technological infrastructure, designed and developed to support the AURORA data processing chain as a distributed data processing and describes in detail the key components of the infrastructure and the software prototype. The latter demonstrates the technical feasibility of the automatic execution of the full processing chain with simulated data. The Data Processing Chain (DPC) presented in this work thus replicates a processing system that, starting from the operational satellite retrievals, carries out their fusion and results in the assimilation of the fused products. These consist in ozone vertical profiles from which further modules of the chain deliver tropospheric ozone and UV radiation at the Earth’s surface. The conclusions highlight the relevance of this novel approach to the synergistic use of operational satellite data and underline that the infrastructure uses general-purpose technologies and is open for applications in different contexts

Enhanced Recovery Program for Colorectal Surgery: a Focus on Elderly Patients Over 75 Years Old

Background: An enhanced recovery after surgery (ERAS) protocol can effectively improve perioperative outcomes in surgical patients by reducing complication rates and hospital stay. However, its application in elderly patients has yielded contradictory results. The aim of this study was to evaluate surgical outcomes in a cohort of elderly patients undergoing colorectal resection in our unit before and after the introduction of ERAS. Methods: From 328 patients undergoing colorectal surgery in our unit over a 2-year period (2015\u20132016), 114 patients 65 75 years of age were selected. The patients were categorized according to perioperative treatment as pre-ERAS and ERAS patients (respectively, 53 vs 61 patients), and the groups were compared for statistical purposes. Outcome measures included length of hospital stay, recovery of bowel functions, oral feeding, postoperative complications, and readmissions. Compliance with the ERAS protocol was also measured. Results: Groups were homogeneous for all the clinical-surgical variables, with the sole exception of the Charlson index, which was more severe in the ERAS group (p = 0.012). Compared with control patients, ERAS patients reported improved functional recovery (time to first flatus, stool, and oral feeding; p < 0.001). Hospital stay was reduced in ERAS patients overall and by side of resection, excluding rectal procedures. No differences were observed regarding postoperative complications. Of note, an optimal adherence to the protocol was reported, with 79% of items respected. Conclusions: ERAS can be considered safe in elderly patients undergoing colorectal surgery with a high comorbidity index, providing a reduction in hospital stay and improving short-term postoperative outcomes. Finally, the protocol application was feasible, with a high adherence to the items in this subset of patients