Despite design enhancements in endocutters, key challenges related to limited surgical access and space can impact stapling and, potentially, surgical outcomes.
This study aimed to develop consensus ...statements outlining the clinical value of precise articulation and greater anatomical access in minimally invasive surgery performed by bariatric, colorectal, and thoracic surgeons.
Colorectal, bariatric, and thoracic surgeons from Japan, the United States, United Kingdom, and France participated in a 2-round modified Delphi panel. Round 1 included binary, Likert scale-type, multiple-response, and open-ended questions. These were converted to affirmative statements for round 2 if sufficient agreement was reached. Consensus was set at a predefined threshold of at least 90% of panelists across all surgical specialties and regions selecting the same option ("agree" or "disagree") for the affirmative statements.
Of the 49 statements in the round 2 questionnaire, panelists (n=135) reached consensus that (1) tissue slippage outside stapler jaws can occur due to limited access and space; (2) greater jaw aperture could help to manipulate thick or fragile tissue more easily; (3) articulation of an endocutter is clinically important in laparoscopic surgeries; (4) improved access to hard-to-reach targets and in limited space would improve safety; and (5) an endocutter with improved access through greater articulation would become common use.
By understanding user-specific challenges and needs from both specialty- and region-wide perspectives, endoscopic stapling devices can continue to be refined. In this study, improved articulation and greater jaw aperture were the key design features examined. Improved articulation and greater jaw aperture were key stapler design features identified in this study that may mitigate the risk of instrument clashes and intraoperative complications such as anastomotic leaks.
This study gained insights into surgeons' perspective across a variety of specialties and from 3 distinct geographies. Participating surgeons reached consensus that an endocutter with greater jaw aperture and articulation may improve surgical access and has potential to improve surgical outcomes.
The number of total knee arthroplasties (TKA) carried out globally is expected to substantially rise in the coming decades. Consequently, focus has been increasing on improving surgical techniques ...and minimizing expenses. Robotic arm-assisted knee arthroplasty has garnered interest to reduce surgical errors and improve precision.
Our primary aim was to compare the episode-of-care cost up to 90 days for unicompartmental knee arthroplasty (UKA) and TKA performed before and after the introduction of robotic arm-assisted technology. The secondary aim was to compare the volume of UKA vs TKA.
This was a retrospective study design at a single healthcare system. For the cost analysis, we excluded patients with bilateral knee arthroplasty, body mass index >40, postoperative infection, or noninstitutional health plan insurance. Costs were obtained through an integrated billing system and affiliated institutional insurance company.
Knee arthroplasty volume increased 28% after the introduction of robotic-assisted technology. The TKA volume increased by 17%, while the UKA volume increased 190%. Post introduction, 97% of UKA cases used robotic arm-assisted technology. The cost analysis included 178 patients (manual UKA, n = 6; robotic UKA, n = 19; manual TKA, n = 58, robotic TKA, n = 85). Robotic arm-assisted TKA and UKA were less costly in terms of patient room and operating room costs but had higher imaging, recovery room, anesthesia, and supply costs. Overall, the perioperative costs were higher for robotic UKA and TKA. Postoperative costs were lower for robotic arm-assisted surgeries, and patients used less home health and home rehabilitation.
Surgeons performed higher volumes of UKA, and UKA comprised a greater percentage of total surgical volume after the introduction of this technology. The selective cost analysis indicated robotic arm-assisted technology is less expensive in several cost categories but overall more expensive by up to $550 due to higher cost categories including supplies and recovery room.
Our findings show a change in surgeons' practice to include increased incidence and volume of UKA procedures and highlights several cost-saving categories through the use of robotic arm-assisted technology. Overall, robotic arm-assisted knee arthroplasty cost more than manual techniques at our institution. This analysis will help optimize costs in the future.
High-protein enteral nutrition is advised for patients who are critically ill. Options include immunonutrition formulas of various compositions and standard high-protein formulas (StdHP). Additional ...research is needed on the health economic value of immunonutrition in a broad cohort of severely ill hospitalized patients.
The study goal was to compare healthcare resource utilization (HCRU) and cost between immunonutrition and StdHP using real-world evidence from a large US administrative database.
A retrospective cohort study was designed using the PINC AI™ Healthcare Database from 2015 to 2019. IMPACT® Peptide 1.5 (IP) was compared with Pivot® 1.5 (PC), and StdHP formulas. Inclusion criteria comprised patients age 18+ with at least 1 day's stay in the intensive care unit (ICU) and at least 3 out of 5 consecutive days of enteral nutrition. Pairwise comparisons of demographics, clinical characteristics, HCRU, and costs were conducted between groups. Multivariable regression was used to assess total hospital cost per day associated with enteral nutrition cohort.
A total of 5752 patients were identified across 27 hospitals. Overall, a median 7 days of enteral nutrition was received over a 16-day hospital and 10-day ICU stay. Median total and daily hospital costs were lower for IP vs PC ($71 196 vs $80 696,
<.001) and ($4208 vs $4373,
=.019), with each higher than StdHP. However, after controlling for covariates such as mortality risk, surgery, and discharge disposition, average total hospital cost per day associated with IP use was 24% lower than PC, and 12% lower than StdHP (
<.001). Readmissions within 30 days were less frequent for patients receiving IP compared with PC (
<.02) and StdHP (
<.001).
Choice of high-protein enteral nutrition for patients in the ICU has implications for HCRU and daily hospital costs. Considering these correlations is important when comparing formula ingredients and per unit costs. Among the enteral nutrition products studied, IP emerged as the most cost-saving option, with lower adjusted hospital cost per day than PC or StdHP.
Using a select immunonutrition formula for critically ill patients may provide overall cost savings for the healthcare system.
ABSTRACT
Objectives:
Current practice during pediatric colonoscopy is to obtain random colonic biopsies, even from normal appearing tissue. The majority of literature published on colonic biopsy ...practice analyzes adults; however, limited data examines the pediatric population. The lack of standardization regarding tissue sampling during pediatric colonoscopy reinforces the necessity to study this question objectively. The aim of the present study was to assess the value of obtaining mucosal biopsies from grossly normal colonic tissue.
Methods:
A retrospective study was performed to examine the utility of obtaining colonic biopsies from normal appearing tissue. Subjects included patients who underwent colonoscopy during a 2‐year period. Descriptive analyses and logistic regression models were used to determine endoscopic and histologic agreement and to characterize predictors of agreement.
Results:
The predictive value of agreement between normal appearing colonoscopies (n = 237) and histopathology was 81%. Excluding patients with inflammatory bowel disease (IBD) increased the predictive value to 85%. Two and a half percent of grossly normal colonoscopies had histological findings consistent with newly diagnosed IBD. Predictors of normal histology included abdominal pain (odds ratio OR 3.68, 95% CI 1.84–7.37), whereas a known diagnosis of IBD was predictive of abnormal histology (OR 0.22, 95% CI 0.08–0.67). Among the full sample, elevated inflammatory markers (OR 2.02, 95% CI 1.06–3.86) or fatigue (OR 2.60, 95% CI 1.13–5.94) were predictive of abnormal histology.
Conclusions:
Results suggest that colonic biopsies may not need to be routinely obtained from all pediatric colonoscopies, particularly in those patients with complaints of abdominal pain. Biopsies should continue to be obtained from patients with a known diagnosis of IBD, elevated inflammatory markers, or fatigue. Further studies are needed to standardize protocols for biopsy practice in pediatric colonoscopy.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Background: Mechanical ventilation is the technique through which gas is moved toward and from the lungs through an external device connected directly to the patient. Information about the mortality ...if patients requiring mechanical ventilation is important because it allows for better counseling of patients and their families. Objectives: To study the outcome in patients receiving mechanical ventilation for specific indications. Methodology: Patients on mechanical ventilation in Government Wenlock Hospital. It is a retrospective record-based study—a semi-structured questionnaire including all complete information from pre-recorded case sheets prepared after an extensive review of the literature. Data was analyzed using SPSS version 29. Results: The mean age was 45 years. Other details of patients suffering from Chronic kidney disease, Acute Kidney Injury, Multiple organ dysfunction syndrome, Head injuries, shock, pulmonary edema, and Pneumothorax mainly. The majority of the patients who received mechanical ventilation were below 40 years of age (37.7%). A major reason for the initiation of mechanical ventilation was pneumonia (22.3%), Sepsis (25.4%), and ARDS (16.9%). AKI (N= 12), CKD (N=9), Shock (N=7), and MODS (N=6) were the major under ‘others. The type of ventilation used in the majority of the cases was invasive (87.7%) The type of ventilation used in most cases was of invasive type (87.7%). Conclusion: Even after providing mechanical ventilation, high number of patients succumbed to the complications.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK, VSZLJ
According to the statistics, hysterectomy is the most common procedure done in South India with the highest rates in Andhra Pradesh and Telangana. The present study was carried out to analyze patient ...characteristics, common causes and route of procedure, rate of concurrent oophorectomy, and complication rates. A retrospective study was conducted using medical records. The patient characteristics who had undergone hysterectomy for benign conditions were noted in a questionnaire along with the indication for surgery, operative findings, comorbidities, and complications. Overall, 243 patients were recruited of whom the majority (62%) had undergone total abdominal hysterectomy. The mean age was 43.4 ± 9.6 years. The most common cause for the procedure was abnormal uterine bleeding (78%). Twenty percentage had associated comorbidities during admission. The complication rate was 13.5%, and postoperative fever was the most common. Concurrent oophorectomy was done in 46% of cases. Increased age and parity were in more favor of vaginal hysterectomy (P = 0.00). The mean length of stay (LOS) in the hospital was 6.4 ± 2.9 days and was influenced by surgical procedure (P = 0.016), occurrence of complications (P = 0.00), and concurrent oophorectomy (P = 0.00). We conclude that the route of the procedure, the presence of complications, and concurrent oophorectomy influenced the LOS in the hospital.
Coenzyme Q10 Therapy Garrido-Maraver, Juan; Cordero, Mario D.; Oropesa-Ávila, Manuel ...
Molecular syndromology
5, Issue:
3-4
Journal Article
Peer reviewed
For a number of years, coenzyme Q10 (CoQ10) was known for its key role in mitochondrial bioenergetics; later studies demonstrated its presence in other subcellular fractions and in blood plasma, and ...extensively investigated its antioxidant role. These 2 functions constitute the basis for supporting the clinical use of CoQ10. Also, at the inner mitochondrial membrane level, CoQ10 is recognized as an obligatory cofactor for the function of uncoupling proteins and a modulator of the mitochondrial transition pore. Furthermore, recent data indicate that CoQ10 affects the expression of genes involved in human cell signaling, metabolism and transport, and some of the effects of CoQ10 supplementation may be due to this property. CoQ10 deficiencies are due to autosomal recessive mutations, mitochondrial diseases, aging-related oxidative stress and carcinogenesis processes, and also statin treatment. Many neurodegenerative disorders, diabetes, cancer, and muscular and cardiovascular diseases have been associated with low CoQ10 levels as well as different ataxias and encephalomyopathies. CoQ10 treatment does not cause serious adverse effects in humans and new formulations have been developed that increase CoQ10 absorption and tissue distribution. Oral administration of CoQ10 is a frequent antioxidant strategy in many diseases that may provide a significant symptomatic benefit.
Defined as signs denoting products linked to discrete characteristics of an area, geographical indications (GIs) acquired prominence in the economic development agenda. Gains from GIs triggered ...processes of redefinition and extension of the underlying territorial boundaries. Extensions increased the number of beneficiaries of the returns from GIs but also ignited tensions that deserve to be observed to distil theoretical insights on the evolution of indications and actionable guidelines for practitioners and policymakers. This study investigates the processes governing the settlement of tensions after the extension of a GI and attempts at understanding how contestations among incumbents and newcomers can be managed. Through a retrospective longitudinal analysis of the Prosecco extension, we find that incumbents and newcomers clashed based on different visions of the GI. Three elements allowed the management of tensions: political agency, the design of governance mechanisms, and a territorial portfolio strategy.
•The paper sheds light on the tensions ensuing from the enlargement of a GI.•How tensions can be managed is studied in the context of the Prosecco GI.•Incumbents and newcomers engage in contests and mobilize opposing cognitive frames.•The paper systematizes the determinants of two opposing frames in the Prosecco GI.•Political agency, governance, a portfolio strategy ensure the stability of the GI.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Polygonum multiflorum has been traditionally processed with black bean juice to reduce toxicity and enhance efficacy. The efficacy of KIOM processed P. multiflorum in osteoporosis treatment has been ...validated in previous research. The metabolites change in KIOM processed P. multiflorum by steaming with black bean juice has not been elucidated. In this study, metabolite differences between dried KIOM P. multiflorum and KIOM processed P. multiflorum were statistically verified. The efficacy improvement based on metabolite changes was identified through tyrosinase and elastase inhibition experiments. The analysis revealed significant differences in compound content between KIOM P-PM and KIOM D-PM, with higher levels of THSG, emodin, and physcion as efficacious compounds. In contrast, 5-hydroxymethylfurfural as toxic substance was decreased. KIOM P-PM exhibited strong inhibitory effects against tyrosinase and elastase, due to increase of THSG and emodin concentrations. This is the first report on systematic evaluation for metabolites change in P. multiflorum root tubers subjected to co-steam processing with additive and their chemical-specified efficacy. The KIOM P-PM, which has increased major compounds and efficacy through a co-steaming process from KIOM D-PM, is expected to have higher economic value compared to the general commercial P. multiflorum as industrial/in vitro cultivated medicinal products.
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•The main components of P. multiflorum were increased and toxic chemicals were decreased by co-steaming with black bean juice extract.•In the enzyme inhibition analysis base on the increased compounds, enzyme activity inhibition effect was increased.•A metabolite-based efficacy evaluation system for co-steaming process has been established as first scientific attempt, and verified as statistically.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Context: Hysterectomy is a major surgical procedure that is performed worldwide for several indications ranging from benign to malignant conditions. It may be life-saving especially in certain ...obstetric situations.
Objective: The aim was to determine the incidence, indications and complications of hysterectomy in Delta State University Teaching Hospital (DELSUTH), Oghara.
Materials and methods: This was a retrospective descriptive study of hysterectomy performed in DELSUTH, Oghara from January 1st, 2012 to December 31st 2016. Every patient that had hysterectomy was included.
Results: During the period, there were there 468 major gynaecological surgeries. Eighty-five patients had hysterectomy accounting for 18.2%. The mean age of the patients was 47.9±10.6 years. Majority (46.6%) of the patients were para 5 and above. The mean parity was 3.2±0.83. Uterine fibroid accounted for majority (30.0%) of the cases. Total abdominal hysterectomy accounted for 78.75% while 8.75% had sub-total abdominal hysterectomy and 12.5% had vaginal hysterectomy. Fifty-two percent of the patients had bilateral salpingo-oophorectomy while 6.25% had unilateral salpingo-oophorectomy. Anaemia and wound sepsis were the most common complications. One patient (1.25%) ended as a mortality during the period under review.
Conclusion: The indications for, and surgical outcome following hysterectomy are comparable to that from other public hospitals across the country.
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