Proctocolectomia totale ibrida laparoscopica hand-assisted/robotica con ileo pouch-ano anastomosi: tecnica chirurgica ed esperienza preliminare

Introduzione: esistono pochi studi descriventi interventi chirurgici di proctocolecotomia totale effettuata con tecnica mini-invasiva e con confezionamento di anastomosi ileo pouch-anale (AIPA) per retto-colite ulcerosa (RCU) e poliposi adenomatosa familiare (FAP). Materiali e metodi: tra il Febbraio 2010 ed il Luglio 2013, quattro pazienti sono stati sottoposti a proctocolecotomia totale effettuata con tecnica mini-invasiva e con confezionamento di AIPA. In tutti gli interventi la colectomia è stata eseguita con tecnica laparoscopica hand-assisted attraverso incisione trasversa sovrapubica, che è stata utilizzata anche per confezionare il pouch ileale; la proctectomia è stata eseguita con il Sistema Robotico da Vinci ®; l’AIPA è stata effettuata con approccio transanale ed è stata confezionata una ileostomia di protezione. Risultati: il tempo operatorio medio è stato di 473 minuti (range 360–565 min). In tutti i casi è stata eseguita una proctectomia nerve-sparing e nessun intervento è stato convertito a laparotomia tradizionale. La durata media della degenza post-operatoria è stata 17 giorni (range 11–24). Non sono state osservate deiscenze anastomotiche. Ad oggi, non sono stati osservati disturbi autonomici, con una media di 3,8 evacuazioni quotidiane. Conclusioni: l’approccio ibrido laparoscopico hand-assisted – robotico per la proctocolectomia totale con AIPA non è mai stato descritto in letteratura. La nostra esperienza mostra la fattibilità di questa tecnica, che supera molte delle limitazioni delle tecniche puramente laparoscopiche o robotiche. È comunque necessaria una maggiore esperienza per raffinare la tecnica e dimostrare i suoi potenziali vantaggi. Background: Few studies have reported minimally invasive total proctocolectomy with ileal pouch–anal anastomosis (IPAA) for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). We herein report a novel hand-assisted hybrid laparoscopic–robotic technique for patients with FAP and UC. Methods: Between February 2010 and July 2013, four patients underwent hand-assisted hybrid laparoscopic–robotic total proctocolectomy with IPAA. The abdominal colectomy was performed laparoscopically with hand assistance through a transverse supra-pubic incision, also used to fashion the ileal pouch. The proctectomy was carried out with the da Vinci Surgical System. The IPAA was handsewn through a transanal approach. The procedure was complemented by a temporary diverting loop ileostomy. Results: The mean operative time was 473 min (range, 360–565 min). In all cases, a nerve-sparing proctectomy was performed and no conversion to traditional laparotomy was required. The mean postoperative hospital stay was 17 days (range, 11–24 days). No anastomotic leakage was observed. To date, no autonomic neurological disorders have been observed with an average of 3.8 bowel movements per day. Conclusions: The hand-assisted hybrid laparoscopic–robotic approach to total proctocolectomy with IPAA has not been previously described. Our report shows the feasibility of this hybrid approach, which surpasses most of the limitations of pure laparoscopic and robotic techniques. Further experience is necessary to refine the technique and fully assess its potential advantages

Burden of Persuasion in Meta-argumentation

This work defines a burden of persuasion meta-argumentation model interpreting the burden as a set of meta-arguments. Bimodal graphs are exploited to define a meta level (dealing with the burden) and an object level (dealing with standard arguments). Finally, an example in the law domain addressing the problem of burden inversion is discussed in detail

A Mechanism for Reasoning over Defeasible Preferences in Arg2P

This paper introduces argumentation over defeasible preferences in Arg2P, an argumentation framework based on logic programming. A computational mechanism is first implemented in Arg2P according to Dung’s defeasible preference model, then generalised to enable arbitrary preference relations over arguments

Neuro-symbolic Computation for XAI: Towards a Unified Model

The idea of integrating symbolic and sub-symbolic approaches to make intelligent systems (IS) understandable and explainable is at the core of new fields such as neuro-symbolic computing (NSC). This work lays under the umbrella of NSC, and aims at a twofold objective. First, we present a set of guidelines aimed at building explainable IS, which leverage on logic induction and constraints to integrate symbolic and sub-symbolic approaches. Then, we reify the proposed guidelines into a case study to show their effectiveness and potential, presenting a prototype built on the top of some NSC technologies

Burden of Persuasion: A Meta-argumentation Approach

This work defines a burden of persuasion meta-argumentation model interpreting burden as a set of meta-arguments. Bimodal graphs are exploited to define a meta level (dealing with the burden) and an object level (dealing with standard arguments). A novel technological reification of the model supporting the burden inversion mechanism is presented and discussed

Burden of persuasion in argumentation: A meta-argumentation approach

This paper examines the view of the burden of persuasion as meta argument and elaborates the meta-argumentative aspects of a burden-of-persuasion semantics in argumentation. An argumentation framework composed of a meta level (dealing with the burden) and an object level (dealing with standard arguments) is proposed and discussed, and its equivalence with the burden-of-persuasion model in argumentation is proved. Finally, a computationally-feasible implementation of the meta-argumentation approach is presented

Arg-tuProlog: A tuProlog-based argumentation framework

Over the last decades, argumentation has become increasingly central as a frontier research within artificial intelligence (AI), especially around the notions of interpretability and explainability, which are more and more required within AI applications. In this paper we present the first prototype of Arg-tuProlog, a logic-based argumentation tool built on top of the tuProlog system. In particular, Arg-tuProlog enables defeasible reasoning and argumentation, and deals with priorities over rules. It also includes a formal method for dealing with burden of proof (burden of persuasion). Being lightweight and compliant to the requirements for micro-intelligence, Arg-tuProlog is perfectly suited for injecting argumentation into distributed pervasive systems

Hepatic abscess caused by trans-gastric migration of a fishbone

Background Stomach or duodenal perforation due to foreign body are usually associated with the development of a walled-off abdominal mass or abscess, and are less prone to cause systemic signs of infection. Methods and Case presentation A 65-year-old man with no comorbidities was admitted for rapid onset of abdominal discomfort, fever, and chills. An abdominal computed tomography (CT) showed an 8 cm abscess in the left lobe of the liver. The lesion was aspirated under ultrasound guidance; cultures from the abscess grew Streptococcus constellatus. Chest CT scan, colonoscopy, esophagogastroduodenoscopy, and blood cultures were negative. The patient’s clinical status rapidly improved with antibiotic therapy, but a follow-up CT scan revealed the presence of a thin, 3 cm-long radiopaque object at the site of the previous abscess. A few months later, due to symptomatic cholelithiasis, the patient underwent elective laparoscopic cholecystectomy and concurrent removal of a 3 cm-long fishbone, which was embedded into the wall of the gastric antrum and the third segment of the liver, the latter which was partially resected. Results The small gastrotomy was reapproximated with a single resorbable stitch. The post-operative course was uneventful and at 6 month follow up, the patient was asymptomatic without evidence of residual abdominal pathology. Conclusions Asymptomatic perforation of the gastric wall by an ingested foreign body can occur and be subsequently complicated by a liver abscess. A contained perforation can be successfully managed conservatively

Antilisterial Activity of Nisin-Like Bacteriocin-Producing Lactococcus lactis subsp. lactis Isolated from Traditional Sardinian Dairy Products

With the aim of selecting LAB strains with antilisterial activity to be used as protective cultures to enhance the safety of dairy products, the antimicrobial properties of 117 Lactococcus lactis subsp. lactis isolated from artisanal Sardinian dairy products were evaluated, and six strains were found to produce bacteriocin-like substances. The capacity of these strains to antagonize Listeria monocytogenes during cocultivation in skimmed milk was evaluated, showing a reduction of L. monocytogenes counts of approximately 4 log units compared to the positive control after 24 h of incubation. In order for a strain to be used as bioprotective culture, it should be carefully evaluated for the presence of virulence factors, to determine what potential risks might be involved in its use. None of the strains tested was found to produce biogenic amines or to possess haemolytic activity. In addition, all strains were sensitive to clinically important antibiotics such as ampicillin, tetracycline, and vancomycin. Our results suggest that these bac+ strains could be potentially applied in cheese manufacturing to control the growth of L. monocytogenes

Argumentation and Defeasible Reasoning in the Law

Different formalisms for defeasible reasoning have been used to represent knowledge and reason in the legal field. In this work, we provide an overview of the following logic-based approaches to defeasible reasoning: defeasible logic, Answer Set Programming, ABA+, ASPIC+, and DeLP. We compare features of these approaches under three perspectives: the logical model (knowledge representation), the method (computational mechanisms), and the technology (available software resources). On top of that, two real examples in the legal domain are designed and implemented in ASPIC+ to showcase the benefit of an argumentation approach in real-world domains. The CrossJustice and Interlex projects are taken as a testbed, and experiments are conducted with the Arg2P technology