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Background: To date, the benefit of image guidance during robot-assisted surgery (IGS) is an object of debate. The current study aims to address the quality of the contemporary body of literature concerning IGS in robotic surgery throughout different surgical specialties. Methods: A systematic review of all English-language articles on IGS, from January 2013 to March 2023, was conducted using PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases. Comparative studies that tested performance of IGS vs control were included for the quantitative synthesis, which addressed outcomes analyzed in at least three studies: operative time, length of stay, blood loss, surgical margins, complications, number of nodal retrievals, metastatic nodes, ischemia time, and renal function loss. Bias-corrected ratio of means (ROM) and bias-corrected odds ratio (OR) compared continuous and dichotomous variables, respectively. Subgroup analyses according to guidance type (i.e., 3D virtual reality vs ultrasound vs near-infrared fluoresce) were performed. Results: Twenty-nine studies, based on 11 surgical procedures of three specialties (general surgery, gynecology, urology), were included in the quantitative synthesis. IGS was associated with 12% reduction in length of stay (ROM 0.88; p = 0.03) and 13% reduction in blood loss (ROM 0.87; p = 0.03) but did not affect operative time (ROM 1.00; p = 0.9), or complications (OR 0.93; p = 0.4). IGS was associated with an estimated 44% increase in mean number of removed nodes (ROM 1.44; p < 0.001), and a significantly higher rate of metastatic nodal disease (OR 1.82; p < 0.001), as well as a significantly lower rate of positive surgical margins (OR 0.62; p < 0.001). In nephron sparing surgery, IGS significantly decreased renal function loss (ROM 0.37; p = 0.002). Conclusions: Robot-assisted surgery benefits from image guidance, especially in terms of pathologic outcomes, namely higher detection of metastatic nodes and lower surgical margins. Moreover, IGS enhances renal function preservation and lowers surgical blood loss. [ABSTRACT FROM AUTHOR]

The fluctuation in the consumption of treated water is a situation that distribution networks gradually face. In times of greater demand, this consumption tends to suffer unnecessary impacts due to the lack of water. The uncertainty that occurs in water consumption can be mathematically modeled by a finite set of scenarios generated by a normal distribution and attributed to the network design. This study presents an optimization model to minimize network installation and operation costs under uncertainties in water demands. A Mixed Integer Nonlinear Programming model is proposed, considering the water flow directions in the pipes as unknown. A deterministic approach is used to solve the problem in three steps: First, the problem is solved with a nominal value for each uncertain parameter. In the second stage, the problem is solved for all scenarios, with the independent variables of the scenario being fixed and obtained from the solution reached in the first stage, known as the deterministic solution. Finally, all scenarios are solved without fixing any variable values, in a stochastic approach. Two case studies were used to test the applicability of the model and global optimization techniques were used to solve the problem. The results show that the stochastic solution can lead to optimal solutions for robust and flexible water distribution networks, capable of working under different conditions, considering the uncertainties of node demand and variable pipe directions. [ABSTRACT FROM AUTHOR]

Oncoplastic breast-conserving surgery (OBCS) is increasingly used to treat breast cancer with the dual purpose of performing a radical oncological resection while minimizing the risk of post-operative deformities. The aim of the study was to evaluate the patient outcomes after Level II OBCS as regards oncological safety and patient satisfaction. Between 2015 and 2020, a cohort of 109 women consecutively underwent treatment for breast cancer with bilateral oncoplastic breast-conserving volume displacement surgery; patient satisfaction was measured with BREAST-Q questionnaire. The 5-year overall survival and disease-free survival were 97% (95%CI 92, 100) and 94% (95%CI 90, 99), respectively. In two patients (1.8%), mastectomy was finally performed due to margin involvement. The median patient-reported score for "satisfaction with breast" (BREAST-Q) was 74/100. Factors associated with a lower aesthetic satisfaction index included: location of tumour in central quadrant (p = 0.007); triple negative breast cancer (p = 0.045), and re-intervention (p = 0.044). OBCS represents a valid option in terms of oncological outcomes for patients otherwise candidate to more extensive breast conserving surgery; the high satisfaction index also suggests a superiority in terms of aesthetic outcomes. [ABSTRACT FROM AUTHOR]

Objective: Resonance frequency analysis (RFA) provides an evaluation of implant stability over time. This analysis is a non-invasive, precise, and objective method. Several studies compare the RFA system with other devices. However, few investigations analyze repeatability and reproducibility between different operators. The aim of this study was to evaluate the intra- and inter-operator concordance of the Osstell® ISQ. Material and methods: RFA measurements were performed with Osstell® ISQ in a total of 37 implants placed in 21 patients. At the time of implant placement, 6 measurements per implant were taken by three different experienced operators. Three measurements were carried out consecutively and three by removing and placing the SmartPeg-Osstell® to assess intra-operator and inter-operator agreement. Results: Intra-operator concordance according to the intraclass correlation coefficient (ICC) showed high concordance. The ICC values were higher than 0.9 (p < 0.0001) for consecutive measures and alternative measures, being almost perfect of Landis & Koch classification. For inter-operator concordance The ICC was 0.709 (p < 0.0001) and 0.670 (p < 0.0001) for consecutive and alternative measures, respectively, both estimates being in the substantial category. In torque and ISQ values, no statistically significant differences were observed when operators and measurements were compared. Conclusions: Osstell® ISQ system was stable both in intra-operator and inter-operator measurements. This device has excellent repeatability and reproducibility, demonstrating reliability to measure the stability of dental implants. Clinical relevance: Resonance frequency analysis (RFA) is a non-invasive, objective, and reliable diagnostic method to determine the ideal moment to load the implant, as well as to predict possible failures. [ABSTRACT FROM AUTHOR]

Constraints and limits to adaptation are critical to understanding the extent to which human and natural systems can successfully adapt to climate change. We conduct a systematic review of 1,682 academic studies on human adaptation responses to identify patterns in constraints and limits to adaptation for different regions, sectors, hazards, adaptation response types, and actors. Using definitions of constraints and limits provided by the Intergovernmental Panel on Climate Change (IPCC), we find that most literature identifies constraints to adaptation but that there is limited literature focused on limits to adaptation. Central and South America and Small Islands generally report greater constraints and both hard and soft limits to adaptation. Technological, infrastructural, and ecosystem-based adaptation suggest more evidence of constraints and hard limits than other types of responses. Individuals and households face economic and socio-cultural constraints which also inhibit behavioral adaptation responses and may lead to limits. Finance, governance, institutional, and policy constraints are most prevalent globally. These findings provide early signposts for boundaries of human adaptation and are of high relevance for guiding proactive adaptation financing and governance from local to global scales. [ABSTRACT FROM AUTHOR]

To the Editor, We read with great interest the article by Toshiaki Shichinohe et al. "Guidelines for cadaver dissection in education and research of clinical medicine (The Japan Surgical Society and The Japanese Association of Anatomists)" recently published in I Surgery Today i and commend the authors on exploring this important topic [[1]]. Finally, we believe that cadaver training is a gift for surgeons and scientists and will prove fundamental both for ensuring the best training of young new surgeons and improving patients' outcomes and safety. [Extracted from the article]

The regulator of angiogenesis most extensively studied is VEGF. VEGF mRNA in plasma from patients with colorectal cancer was analyzed as a possible surrogate marker of tumor angiogenesis. VEGF mRNA was measured by quantitative PCR in plasma, tumors and circulating tumor cells from colorectal cancer patients. Circulating VEGF protein was analyzed by ELISA. Microvessel density was determined. Levels of VEGF mRNA and protein in plasma were higher in patients than in controls. VEGF mRNA was overexpressed in tumors with respect to normal tissues. Levels of VEGF protein were associated with VEGF mRNA in plasma, but no associations with tumor samples were found. A trend to statistical significance was shown between high VEGF mRNA and vascular invasion. MVD was not related to VEGF mRNA in plasma. Thus, VEGF mRNA could be a marker similar to VEGF protein in plasma. [ABSTRACT FROM AUTHOR]