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Introduction: Robotic colorectal surgery is being increasingly adopted. Our objective was to compare early postoperative outcomes between robotic and laparoscopic colectomy in a nationally representative sample.Methods: The American College of Surgeons National Surgical Quality Improvement Project Colectomy Targeted Dataset from 2012 to 2014 was used for this study. Adult patients undergoing elective colectomy with an anastomosis were included. Patients were stratified based on location of colorectal resection (low anterior resection (LAR), left-sided resection, or right-sided resection). Bivariate data analysis was performed, and logistic regression modeling was conducted to calculate risk-adjusted 30-day outcomes.Results: There were a total of 25,998 laparoscopic colectomies (30 % LAR's, 45 % left-sided, and 25 % right-sided) and 1484 robotic colectomies (54 % LAR's, 28 % left-sided, and 18 % right-sided). The risk-adjusted overall morbidity, serious morbidity, and mortality were similar between laparoscopic and robotic approaches in all anastomotic groups. Patients undergoing robotic LAR had a lower conversion rate (OR 0.47, 95 % CI 1.20-1.76) and postoperative sepsis rate (OR 0.49, 95 % CI 0.29-0.85) but a higher rate of diverting ostomies (OR 1.45, 95 % CI 1.20-1.76). Robotic right-sided colectomies had significantly lower conversion rates (OR 0.58, 95 % CI 0.34-0.96). Robotic colectomy in all groups was associated with a longer operative time (by 40 min) and a decreased length of stay (by 0.5 days).Conclusions: In a nationally representative sample comparing laparoscopic and robotic colectomies, the overall morbidity, serious morbidity, and mortality between groups are similar while length of stay was shorter by 0.5 days in the robotic colectomy group. Robotic LAR was associated with lower conversion rates and lower septic complications. However, robotic LAR is also associated with a significantly higher rate of diverting ostomy. The reason for this relationship is unclear. Surgeon factors, patient factors, and technical factors should be considered in future studies. [ABSTRACT FROM AUTHOR]

Cellulose and silk blended biomaterial films were regenerated from ionic liquid solution and investigated to characterize and understand the effect of inter- and intra-molecular interactions upon the morphology and thermal properties. The blended films were dissolved in 1-allyl-3-methylimidazolium chloride ionic liquid, coagulated and regenerated with water. Various characterization techniques were implemented to characterize structural, morphological and thermal properties: FTIR, SEM, TGA, DSC and X-ray scattering. The results showed that the cellulose microcrystalline structure and β-sheets from the silk can be disrupted by inter- and intra-molecular hydrogen bonds forming intermediate semicrystalline or amorphous structures. The SEM showed morphological effects of such interactions that cause varying thermal degradation and glass transition temperature. The X-ray scattering confirms such findings at the molecular level, demonstrating that the cellulose microfibril diameter decreases as the silk content increases. It also shows that the β-sheets size increases as the cellulose content increases. These various techniques provide evidence that suggest the hydrogen bonds between the β-sheets and the glucose units in the cellulose chains control the thermal and structural properties of the blended films, changing the morphology and physicochemical properties. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Langerhans cell histiocytosis with anorectal involvement: a rare manifestation of adult disease" in the October 16, 2014 issue.