Abdominal versus perineal approach for external rectal prolapse: systematic review with meta-analysis

BACKGROUND: External rectal prolapse (ERP) is a debilitating condition in which surgery plays an important role. The aim of this study was to evaluate the outcomes of abdominal approaches (AA) and perineal approaches (PA) to ERP. METHODS: This was a PRISMA-compliant systematic review with meta-analysis. Studies published between 1990 and 2021 were retrieved. The primary endpoint was recurrence at the last available follow-up. Secondary endpoints included factors associated with recurrence and function. All studies were assessed for bias using the Newcastle-Ottawa Scale and Cochrane tool. RESULTS: Fifteen studies involving 1611 patients (AA = 817; PA = 794) treated for ERP were included, three of which were randomized controlled trials (RCTs; 114 patients (AA = 54; PA = 60)). Duration of follow-up ranged from 12 to 82 months. Recurrence in non-randomized studies was 7.7 per cent in AA versus 20.1 per cent in PA (odds ratio (OR) 0.29, 95 per cent confidence interval (c.i.) 0.17 to 0.50; P < 0.001, I2 = 45 per cent). In RCTs, there was no significant difference (9.8 per cent versus 16.3 per cent, AA versus PA (OR 0.82, 95 per cent c.i. 0.29 to 2.37; P = 0.72, I2 = 0.0 per cent)). Age at surgery and duration of follow-up were risk factors for recurrence. Following AA, the recurrence rates were 10.1 per cent and 6.2 per cent in patients aged 65 years and older and less than 65 years of age, respectively (effect size [e.s.] 7.7, 95 per cent c.i. 4.5 to 11.5). Following PA, rates were 27 per cent and 16.3 per cent (e.s. 20.1, 95 per cent c.i. 13 to 28.2). Extending follow-up to at least 40 months increased the likelihood of recurrence. The median duration of hospital stay was 4.9 days after PA versus 7.2 days after AA. Overall, incontinence was less likely after AA (OR 0.32), but constipation occurred more frequently (OR 1.68). Most studies were retrospective, and several outcomes from RCTs were not consistent with those observed in non-RCTs. CONCLUSION: The overall risk of recurrence of ERP appears to be higher with PA versus AA. Incontinence is less frequent after AA but at the cost of increased constipation. Age at surgery and duration of follow-up are associated with increased risk of recurrence, which warrants adequate reporting of future studies on this topic

Shifting paradigms in two common abdominal surgical emergencies during the pandemic

During the pandemic there was a reduction in access to the hospital and surgical treatment of appendicitis and cholecystitis at a global level. Some strategies adopted during this challenging time could be applied even after the emergency has been controlled

Anti-laminin-1 antibodies in sera and follicular fluid of women with endometriosis undergoing in vitro fertilization.

There is increasing evidence that autoimmune phenomena, including auto-antibody production, may affect fertility in women with endometriosis. The aims of this study are to evaluate anti-laminin-1 antibody (aLN-1) presence in sera and in follicular fluids (FF) of women with endometriosis undergoing IVF and its impact on oocyte maturation and IVF outcome. aLN-1 were measured by a home-made enzyme linked immunosorbent assay in sera and FF obtained from 35 infertile women with endometriosis and in sera from 50 fertile controls and 27 infertile women without endometriosis (IWWE). aLN-1 serum levels were significantly higher in women with endometriosis in comparison with both fertile controls and IWWE (P<0.001 and P <0.05, respectively) and a positive correlation was found between serum-and FF- aLN-1 (r = 0.47, P = 0.004). According to the cut-off (mean+3 SD of fertile controls), 31% of women with endometriosis were aLN-1 positive. Metaphase II oocyte counts showed inverse correlation with FF-aLN-1 levels (r = −0.549, P = 0.0006). Ongoing pregnancy (i.e pregnancy progressing beyond the 12th week of gestation) occurred in 4/11 aLN-1 positive patients and in 7/24 aLN-1 negative with no significant difference (P= 0.7). In conclusion, our results highlight that aLN-1 are increased in women with endometriosis and their presence in FF may affect oocyte maturation leading to a reduced fertility. However, aLN-1 seem to have no effect on IVF outcome

Messina 1908-2008: understanding crust dynamics and subduction in Southern Italy

To mark the centennial anniversary of the 1908 earthquake that shook Messina, Italy, the Istituto Nazionale di Geofisica e Vulcanologia (INGV) has begun the "Messina 1908- 2008" research project. The aim is to clarify the extension deformation processes that occur in the Messina Strait and to understand relationships between subduction and crustal deformation there by merging existing data and studies, and by collecting new and more detailed seismological, geodetic, historical, and satellite observations. More than 20 permanent seismic stations and about 15 temporary stations are located in the study region. A dense permanent geodetic network also operates in the region, several campaign surveys are newly available, and new geodetic campaign measurements were performed in March 2008. In addition, during July 2008, five ocean bottom seismometers (OBS) were deployed to better monitor the area largely covered by the sea. Records of historical earthquakes that struck the Strait of Messina will be analyzed, and synthetic aperture radar images will help define surface deformation of the region. The Messina 1908-2008 project's assemblage of a database and integration of innovative technologies could transform our understanding of the crust and mantle structure of the active tectonics and seismic hazards of the Strait of Messina

Clinical efficacy of minimally invasive surgical (MIS) and non-surgical (MINST) treatments of periodontal intra-bony defect. A systematic review and network meta-analysis of RCT's

Objective: The aim of this systematic review was to explore the efficacy of different minimal invasive surgical (MIS) and non-surgical (MINST) approaches for the treatment of intra-bony defect in terms of clinical attachment level (CAL) gain and periodontal pocket depth (PPD) reduction. / Methods: A detailed review protocol was designed according to PRISMA guideline. Online search was conducted on PubMed, Cochrane library and Embase. Only randomized clinical trials (RCTs) testing MIS or MINST procedure, with or without the application of a regenerative tool for the treatment of intra-bony defect, were included. Cochrane checklist for risk of bias assessment was used. Network meta-Analysis (NMAs) was used to rank the treatment efficacy. / Results: Nine RCTs accounting for 244 patients and a total of 244 defects were included. Only two studies were at low risk of bias. CAL gain for included treatment ranged from 2.58 ± 1.13 mm to 4.7 ± 2.5 mm while PPD reduction ranged from 3.19 ± 0.71 mm to 5.3 ± 1.5 mm. On the basis of the ranking curve, MINST showed the lowest probability to be the best treatment option for CAL gain. Pairwise comparisons and treatment rankings suggest superiority for regenerative approaches (CAL difference 0.78 mm, (0.14–1.41); P < 0.05) and surgical treatment elevating only the buccal or palatal flap (CAL difference: 0.95 mm, (0.33–1.57); P < 0.05). / Conclusions: Minimally invasive surgical (MIS) and non-surgical (MINST) periodontal therapy show promising results in the treatment of residual pocket with intra-bony defect. / Clinical relevance: MIS procedures represent a reliable treatment for isolated intra-bony defect

Efficacy and safety of first-line treatment strategies for anaplastic lymphoma kinase-positive non-small cell lung cancer: a Bayesian network meta-analysis.

Background: Targeted therapies have led to significant improvement in the management and prognosis of anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC). We performed a network meta-analysis of frontline treatment options of ALK-positive NSCLC to provide clinical guidance. Methods: PubMed, Embase, ClinicalTrials.gov, and international conference databases were searched to identify relevant trials from inception to June 30, 2021. Phase III randomized controlled trials (RCTs) comparing treatments for patients with ALK-positive advanced NSCLC in the first-line setting were included in a Bayesian network meta-analysis. Eligible studies reported at least one of the following clinical outcomes: progression-free survival (PFS), overall survival (OS), risk of the central nervous system (CNS) progression, adverse events (AEs) of grade (G) 3 or higher (G3 AEs), or serious AEs (SAEs). Hazard ratios (HRs) and CI for primary outcome of PFS and secondary outcome of OS and risk of CNS progression were obtained. A multivariate, consistency model, fixed-effects analysis was used in the network meta-analysis. Data on G3 AEs and SAEs were abstracted and meta-analyzed. Risk of bias (RoB) was assessed using the Cochrane Collaboration's tool. Results: Nine RCTs comprising 2,484 patients were included with seven treatments: alectinib, brigatinib, ceritinib, crizotinib, ensartinib, lorlatinib, and chemotherapy. Compared with chemotherapy, ALK-tyrosine kinase inhibitors (TKIs) significantly prolong PFS and reduced risk of CNS progression except for ceritinib. Lorlatinib appears superior at reducing risk of CNS progression. None of the ALK-TKIs have a significantly prolonged OS as compared with chemotherapy. Lorlatinib increases the risk of G3 AEs as compared with alectinib (odds ratio 4.26 [95% CrI 1.22 to 15.53]), while alectinib caused the fewest G3 AEs. Conclusions: Lorlatinib is associated with the highest PFS benefit and lowest risk of CNS progression benefits for patients with advanced ALK-positive NSCLC, compared with other first-line treatments, but with higher toxicity. The implementation of a newer generation of ALK-TKIs in the first-line treatment of ALK-positive NSCLC into current clinical practice is evolving rapidly

Camelina sativa (L. Crantz) Fresh Forage Productive Performance and Quality at Different Vegetative Stages: Effects of Dietary Supplementation in Ionica Goats on Milk Quality

The research meant to study the productive performances of Camelina sativa and the effects of feeding Camelina fresh forage harvested during five phenological stages (I: main stem elongation; II: maximum stem elongation: III: inflorescence appearance; IV: flowering; V: fruit set visible) on the yield, chemical composition and fatty acid profile of milk from autochthonous Ionica goats. Goats were randomly assigned to two groups (n = 15) that received a traditional forage mixture (Control) or Camelina forage harvested at different stages (CAM). The field experiment was conducted in two years; no significant differences between years were recorded for any of the Camelina production traits. The total biomass increased (p &lt; 0.05) from phase I (1.4 t/ha) to phase V (5.2 t/ha). The distribution of stem, leaves and pod also changed during growth, showing a significant increase of stem from 40.8 to 45.6% and of pod from 0 to 19.4%, whereas leaves decreased from 59.2 to 35.1%. The milk yield and chemical composition were unaffected by the diet, while supplementation with Camelina forage increased milk CLA content (on average 1.14 vs. 0.78%). A markedly higher concentration of PUFAs was found in milk from goats fed Camelina harvested during the last three phenological stages. The index of thrombogenicity of milk from the CAM fed goats was significantly lower compared to the control group. In conclusion, Camelina sativa is a multi-purpose crop that may be successfully cultivated in Southern Italy regions and used as fresh forage for goat feeding. Milk obtained from Camelina fed goats showed satisfactory chemical and fatty acid composition, with potential benefits for human health

Dietary supplementation with camelina sativa (L. crantz) forage in autochthonous ionica goats: Effects on milk and caciotta cheese chemical, fatty acid composition and sensory properties

The research studied the effects of dietary supplementation with Camelina sativa fresh forage on the chemical and fatty acid composition of milk and Caciotta cheese, and its sensory properties. Twenty Ionica goats were randomly assigned to the following two groups (n = 10): the control received a traditional forage mixture (Avena sativa, 70%; Vicia sativa, 20%; Trifolium spp., 10%), while the experimental group was given Camelina sativa fresh forage (CAM). All of the dams grazed on pasture and received a commercial feed (500 g/head/day) at housing. The milk from the CAM group showed a higher (p &lt; 0.05) content of dry matter, fat, lactose and concentrations of C6:0, C11:0, C14:0, C18:2 n-6, CLA and PUFA, while lower (p &lt; 0.05) amounts of C12:0, C18:0 and saturated long chain FA (SLCFA). The Caciotta cheese from the CAM group showed a greater (p &lt; 0.05) content of n-6 FA and n-6/n-3 ratio, although close to four, thus resulting adequate under the nutritional point of view. The overall liking, odour, taste, hardness, solubility and “goaty” flavour were better (p &lt; 0.05) in the CAM cheeses. Further investigation would be advisable in order to evaluate the effect of feeding Camelina forage obtained from different phenological stages, and the application of ensiling techniques