National variations in perioperative assessment and surgical management of Crohn's disease: a multicentre study

Aim: Crohn's disease (CD) requires a multidisciplinary approach and surgery should be undertaken by dedicated colorectal surgeons with audited outcomes. We present a national, multicentre study, with the aim to collect benchmark data on key performance indicators in CD surgery, to highlight areas where standards of CD surgery excel and to facilitate targeted quality improvement where indicated. Methods: All patients undergoing ileocaecal or redo ileocolic resection in the participating centres for primary and recurrent CD from June 2018 to May 2019 were included. The main objective was to collect national data on hospital volume and practice variations. Postoperative morbidity was the primary outcome. Laparoscopic surgery and stoma rate were the secondary outcomes. Results: In all, 715 patients were included: 457 primary CD and 258 recurrent CD with a postoperative morbidity of 21.6% and 34.7%, respectively. Laparoscopy was used in 83.8% of primary CD compared to 31% of recurrent CD. Twenty-five hospitals participated and the total number of patients per hospital ranged from 2 to 169. Hospitals performing more than 10 primary CD procedures per year showed a higher adoption of laparoscopy and bowel sparing surgery. Conclusions: There is significant heterogeneity in the number of CD surgeries performed per year nationally in Italy. Our data suggest that high-volume hospitals perform more complex procedures, with a higher adoption of bowel sparing surgery. The rate of laparoscopy in high-volume hospitals is higher for primary CD but not for recurrent CD compared with low-volume hospitals

National variations in perioperative assessment and surgical management of Crohn's disease: a multicentre study

Aim Crohn's disease (CD) requires a multidisciplinary approach and surgery should be undertaken by dedicated colorectal surgeons with audited outcomes. We present a national, multicentre study, with the aim to collect benchmark data on key performance indicators in CD surgery, to highlight areas where standards of CD surgery excel and to facilitate targeted quality improvement where indicated. Methods All patients undergoing ileocaecal or redo ileocolic resection in the participating centres for primary and recurrent CD from June 2018 to May 2019 were included. The main objective was to collect national data on hospital volume and practice variations. Postoperative morbidity was the primary outcome. Laparoscopic surgery and stoma rate were the secondary outcomes. Results In all, 715 patients were included: 457 primary CD and 258 recurrent CD with a postoperative morbidity of 21.6% and 34.7%, respectively. Laparoscopy was used in 83.8% of primary CD compared to 31% of recurrent CD. Twenty-five hospitals participated and the total number of patients per hospital ranged from 2 to 169. Hospitals performing more than 10 primary CD procedures per year showed a higher adoption of laparoscopy and bowel sparing surgery. Conclusions There is significant heterogeneity in the number of CD surgeries performed per year nationally in Italy. Our data suggest that high-volume hospitals perform more complex procedures, with a higher adoption of bowel sparing surgery. The rate of laparoscopy in high-volume hospitals is higher for primary CD but not for recurrent CD compared with low-volume hospitals

Annotazioni per la morfologia di una Gozan bunka

Se le periodizzazioni storico-cronologiche Kamakura-Ashikaga hanno una legittimit\ue0 sul piano della scansione politico-istituzionale, non ne hanno sotto il profilo culturale, ancor meno se, nella seconda et\ue0, si ricorre alle sottoclassificazioni Kitayama bunka e Higashiyama bunka. La fase intercorsa all\u2019incirca fra l\u2019inizio del 1200 e la met\ue0 del 1400, infatti, si presenta come omogenea su tutto il territorio nazionale, con un andamento inizialmente concentrico, dato dal nucleo propulsore delle prime sedi monastiche in cui furono impartiti anche precetti del chan cinese (unitamente alle dottrine del tradizionale magistero buddhista). In breve tempo, per\uf2, la fondazione di sedi monastiche esclusive del Rinzai e la ramificazione capillare dell\u2019istituzione Gozan jissatsu, lungi dal rimanere relegata ad un ambito di sola rappresentanza e azione religiosa, invest\uec l\u2019intero clima culturale della societ\ue0 giapponese. L\u2019iter sarebbe stato laborioso, dalle espressioni ritualistiche degli esordi fino a quelle pi\uf9 profane del quotidiano di ogni strato sociale, e avrebbe gettato i semi dell\u2019imprinting culturale del Giappone Tokugawa, fra '600 e '800. Pertanto, il riconosciuto fenomeno Gozan bungaku (che non pu\uf2 dirsi relegato al solo ambito elitario esegetico e poetico) sarebbe un singolo aspetto di un vasto processo istituzionale, politico, economico, artistico che mosse dalle sedi monastiche ma che pervase tutta la storia del Giappone per pi\uf9 di 250 anni e che pu\uf2, a buon diritto, essere titolato Gozan bunka jidai, \u201cEvo della Cultura dei Cinque Monti\u201d

Ikky\u16b S\u14djun e lo zen del \uabsottobosco\ubb

Il saggio analizza il personaggio storico dell'abate Ikky\u16b S\u14djun (1394-1481, confrontando fama letteraria e tradizione popolare con la documentazione storica, nel tentativo di ritagliare un personaggio meno leggendario (protagonista, oggi, anche di tanta editoria per l'infanzia) e pi\uf9 aderente al contesto storico del periodo Ashikaga. In particolare si dedica attenzione all'analisi dei rapporti fra l'abate e il monastero del Daitokuji (della gerarchia detta "Rinka no zenji, \u201csedi zen del sottobosco\u201d), e dei contatti con la classe mercantile della citt\ue0 di Sakai

De seda y de carne : Trabajo femenino y paternalismo en la industria textil japonesa entre siglo XIX y XX

Il saggio esplora gli obiettivi e le strategie ispirate a familismo e paternalismo nel Giappone d\u2019era Meiji e Taish\u14d (1868\u20131912/1912\u20131926) nell\u2019ambito dell\u2019industria del tessile. Come voce portante del repentino processo d\u2019industrializzazione del Paese, l\u2019industria dei filati (in particolare della seta) vide coinvolta in massima misura la manodopera femminile, principalmente di provenienza rurale, e contribu\uec al processo di ridefinizione del ruolo sociale della donna all\u2019ombra del crescente nazionalismo. Riconsiderando gli studi internazionali fino a oggi condotti sul tema, il saggio intende proporre una sintesi plurivalente del contesto socio-economico del tempo, che superi la dicotomia \u2013 gi\ue0 denunciata da Janet Hunter (2003) \u2013 fra ricerche di economia, statistica e scienze tecnologiche da una parte, e ricerche socio\u2013culturali con netta propensione agli studi di genere

Superlight small bipolarons from realistic long-range Coulomb and Fr\"ohlich interactions

We report analytical and numerical results on the two-particle states of the polaronic t-Jp model derived recently with realistic Coulomb and electron-phonon (Frohlich) interactions in doped polar insulators. Eigenstates and eigenvalues are calculated for two different geometries. Our results show that the ground state is a bipolaronic singlet, made up of two polarons. The bipolaron size increases with increasing ratio of the polaron hopping integral t to the exchange interaction Jp but remains small compared to the system size in the whole range 0<t/Jp<1. Furthermore, the model exhibits a phase transition to a superconducting state with a critical temperature well in excess of 100K. In the range t/Jp<1, there are distinct charge and spin gaps opening in the density of states, specific heat, and magnetic susceptibility well above Tc.Comment: Calculation section and discussion of gap have been updated. Revised calculations now enhance the predicted T_c in our model to over 200 K at large hoppin

Letter to the Editor commenting on “Efficacy of serratus anterior plane block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery: a randomized trial”

We have read with very great interest the study published by Arora S et al.: “Efficacy of serratus anterior plane block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery: a randomized trial”, especially for the attention paid to the key points in the management of breast surgery: postoperative analgesia optimization, incidence of postoperative nausea and vomiting reduction, prevention of the onset of chronic pain and functional impotenc

Mesenteric closure with polymer-ligating clips after right colectomy with complete mesocolic excision for cancer&nbsp;and mesentery-based ileocolic resection for Crohn's disease

Mesenteric closure following right colectomy remains controversial and, following the advent of laparoscopic surgery, many surgeons do not routinely close the mesentery after colorectal resection. Nevertheless, especially after the introduction of operations such as right colectomy with complete mesocolic excision and ileocolic resections with extensive mesentery removal for Crohn's disease, the wide mesenteric defect resulting from the dissections can certainly expose the patients to complications such as internal hernias or volvuli. In general, mesenteric closure requires intracorporeal suturing. We describe a simple technique for the closure of the mesentery after surgical resection using polymer-ligating clips. This novel technique seems to minimize the time, effort and risk inherent to the procedure, even after large mesenteric excisions