Robotic approaches have been steadily replacing laparoscopic approaches in metabolic and bariatric surgeries (MBS); however, their superiority has not been rigorously evaluated. The main goal of the study was to evaluate the 5-year utilization trends of robotic MBS and to compare to laparoscopic outcomes.
Methods
Retrospective analysis of 2015–2019 MBSAQIP data. Kruskal-Wallis test/Wilcoxon and Fisher’s exact/chi-square were used to compare continuous and categorical variables, respectively. Generalized linear models were used to compare surgery outcomes.
Results
The use of robotic MBS increased from 6.2% in 2015 to 13.5% in 2019 (N= 775,258). Robotic MBS patients had significantly higher age, BMI, and likelihood of 12 diseases compared to laparoscopic patients. After adjustment, robotic MBS patients showed higher 30-day interventions and 30-day readmissions alongside longer surgery time (26–38 min).
Conclusion
Robotic MBS shows higher intervention and readmission even after controlling for cofounding variables.
BACKGROUND CONTEXT: Methylprednisolone has evolved during the 1990s, through the results obtained from the National Acute Spinal Cord Injury Studies NASCIS II and III, as a standard treatment in acute spinal injury. PURPOSE: To evaluate the scientific basic for the use of methylprednisolone in acute spinal cord injury. STUDY DESIGN: Systematic review of the accumulated literature. METHODS: Critical evaluation of the data obtained in the NASCIS II and III studies plus other accumulated literature. RESULTS: Analyses have been made on subgroups of the study populations, and the results were based on statistical artefacts. Furthermore, improved functional recovery shown by these studies was not clinically significant. CONCLUSION: There is insufficient evidence to support the use of methylprednisolone as a standard treatment in acute spinal cord injury. 相似文献
Journal of Public Health - Depression is a major morbidity and the most common mental disorder among the medical students in medical schools globally. Undergraduate students suffer stress more due... 相似文献
BackgroundRisk of nephrotoxicity in liver transplant patients on calcineurin inhibitors (CnIs) is a concern. Several controlled trials reported benefit of everolimus (EVR) in minimizing this risk when combined with a reduced CnI dose.BackgroundTo systematically review the efficacy and safety of EVR, alone or with reduced CnI dose, as compared to CnI alone post-liver transplantation.MethodsWe searched MEDLINE, Scopus, and the Cochrane Library for randomized controlled trials comparing EVR- and CnI-based regimens post-liver transplantation. Assessment of studies and data extraction were undertaken independently.ResultsEight studies were selected, describing 769 patients. Cockcroft-Gault GFR was higher at one (P = .05), 3, and 5 years (P = .030) in patients on EVR compared to those receiving CnI therapy. The composite endpoint of efficacy failure was similar between the 2 arms after 1, 3, and 5 years of study. More patients discontinued EVR due to adverse effects in 1 year; however, no difference was noted after 3 or 5 years. A higher rates of proteinuria, peripheral edema, and incisional hernia occurred in patients on EVR.ConclusionsThe analysis confirms noninferiority of EVR and reduced CnI combination. Combination regimen resulted in better renal function compared to standard CnI therapy. 相似文献
This study aimed to determine the seroprevalence and determinants of hepatitis B virus (HBV) infection among university students in Bangladesh. This cross-sectional study was conducted among 614 students from five universities in central Bangladesh. Data were collected on demographic information, immunization history, medical and blood transfusion history through the face-to-face interview. Blood samples were collected and screened for anti-HBsAg using ELISA, HBsAg Rapid Test-cassette, and immune chromatographic test. The overall seroprevalence of HBV infection was 5.0%, and vaccination coverage was 19.2% among the participants. Students having a history of surgery (OR 11.004, 95% CI 3.211–37.707), blood transfusion (OR 5.651, 95% CI 0.965–33.068), being married (OR 4.776, 95% CI 1.508–15.127), and not being vaccinated (OR 9.825, 95% CI 1.130–85.367) were at higher risk of being infected by HBV. This study showed the endemicity of HBV infection among the Bangladeshi population. Marriage, surgical or blood transfusion history, not being vaccinated were the determinants of HBV infection within the study population. Public health initiatives for preventing HBV infection at the university levels should be envisaged.
Choriocarcinoma arising in the placenta, or intraplacental choriocarcinoma, has seldom been reported, particularly in the
absence of maternal metastases. Reluctance to diagnose choriocarcinoma in the presence of chorionic villi can delay diagnosis;
however, timely diagnosis of choriocarcinoma is prognostically important, both for the mother and infant. We report the clinicopathologic
findings in five mothers and infants in whom choriocarcinoma was identified in the placenta. None of the mothers had a history
of gestational trophoblastic disease in previous pregnancies. Three placentas were similar with a single small lesion grossly
suggesting a small infarct; microscopically these consisted of infarcted areas surrounded by choriocarcinoma. These three
mothers were unusual in that none had metastatic choriocarcinoma; two were treated with chemotherapy and remained disease-free;
the third was lost to follow-up shortly following delivery. The remaining two mothers had known pulmonary metastases at time
of delivery. One of these latter two placentas contained a large marginal lesion microscopically identified as choriocarcinoma.
The fifth placenta had rare microscopic foci of choriocarcinoma, and sheets of necrotic choriocarcinoma were identified in
“blood clot” submitted with the placenta. In four of the five cases the choriocarcinoma appeared to be arising from otherwise
normal chorionic villi, and in no case was there invasion of the villous stroma. All of the infants survived, and none had
evidence of choriocarcinoma. These cases support the concept that choriocarcinoma associated with otherwise normal pregnancy
arises in the placenta and may be more common than reported.
Received August 11, 1997; accepted December 8, 1997. 相似文献