Immune Function in Alcoholism: A Controlled Study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66331/1/j.1530-0277.1993.tb00763.x.pd

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

A New Approach to Design Glove-Like Wearable Hand Exoskeletons for Rehabilitation

The synthesis of hand exoskeletons for rehabilitation is a challenging theoretical and technical task. A huge number of solutions have been proposed in the literature. Most of them are based on the concept to consider the phalanges of the finger as fixed to some links of the exoskeleton mechanism. This approach makes the exoskeleton synthesis a difficult problem that compels the designer to devise approximate technical solutions which, frequently, reduce the efficiency of the rehabilitation system and are rather bulky. This paper proposes a different approach. Namely, the phalanges are not fixed to some links of the exoskeleton, but they can have a relative motion, with one or two degrees of freedom when planar systems are considered. An example is presented to show the potentiality of this approach, which makes it possible: (i) to design glove-like exoskeletons that only approximate the human finger motion; (ii) to leave the fingers have their natural motion; (iii) to adapt a wider range of patient hand sizes to a given hand exoskeleton