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.
Acquired supravalvar membranous stenosis of the left atrioventricular valve developed in a nine year old boy with atrioventricular discordance. The supravalvar membrane had not been present when a partial annuloplasty was performed on the left atrioventricular valve eight years before. The stenosis was relieved by operative excision of the membrane. 相似文献
A case is described of a subarachnoid-pleural fistula developing after resection of an intrathoracic benign nerve sheath tumor near the eleventh thoracic vertebra. The fistula was demonstrated by myelography and was corrected surgically. Of 12 previously reported cases, 11 occurred after trauma and one after an operation. 相似文献
Type II collagen (CII) is of immunological interest because of its
repetitive structure and properties as an autoantigen. The mouse gene has
recently been cloned, thus enabling T cell-defined epitopes to be
identified. Multiple novel epitopes on mouse CII are here detected in the
autoreactive T cell response. The major response is directed to an epitope
with residues 707-721 located on the CB10 fragment. Some 25 other epitopes
are also recognized, including the autologous homologue of the 256-270
epitope which dominates in the response to foreign collagen. The cells
reactive with mouse collagen peptides were of Th1 type, as judged by
release of IFN-gamma. No significant reactivity was detected to mouse CII
peptides during ongoing disease. Alignment of the mouse epitopes revealed a
sequence motif with characteristic side chains at residues P1, P4 and P7,
and to a lesser extent at P5, within a nonamer core sequence. Binding of
these epitopes was simulated in a computer model of the I-Aq molecule,
where peptides with anchor residues at P1, P4 and P7 were indeed found to
fit the binding groove best. The spacing of pockets and the fine structure
of the binding surface of the I-Aq molecule meshes with the repetitive
structure of the collagen (X-Y-Gly), thus providing a likely explanation
for the occurrence of multiple epitopes. Comparison with human DR binding
motifs showed that the I-Aq motif resembles most closely that of the DR4
subtypes which predispose for rheumatoid arthritis.
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