Should we encourage the use of robotic technologies in complicated diverticulitis? Results of systematic review and meta-analysis.

Introduction: Complicated diverticulitis is a common abdominal emergency that often requires a surgical intervention. The systematic review and meta-analysis below compare the benefits and harms of robotic vs. laparoscopic surgery in patients with complicated colonic diverticular disease. Methods: The following databases were searched before 1 March 2023: Cochrane Library, PubMed, Embase, CINAHL, and ClinicalTrials.gov. The internal validity of the selected non-randomized studies was assessed using the ROBINS-I tool. The meta-analysis and trial sequential analysis were performed using RevMan 5.4 (Cochrane Collaboration, London, United Kingdom) and Copenhagen Trial Unit Trial Sequential Analysis (TSA) software (Copenhagen Trial Unit, Center for Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark), respectively. Results: We found no relevant randomized controlled trials in the searched databases. Therefore, we analyzed 5 non-randomized studies with satisfactory internal validity and similar designs comprising a total of 442 patients (184 (41.6%) robotic and 258 (58.4%) laparoscopic interventions). The analysis revealed that robotic surgery for complicated diverticulitis (CD) took longer than laparoscopy (MD = 42 min; 95% CI: [-16, 101]). No statistically significant differences were detected between the groups regarding intraoperative blood loss (MD = -9 mL; 95% CI: [-26, 8]) and the rate of conversion to open surgery (2.17% or 4/184 for robotic surgery vs. 6.59% or 17/258 for laparoscopy; RR = 0.63; 95% CI: [0.10, 4.00]). The type of surgery did not affect the length of in-hospital stay (MD = 0.18; 95% CI: [-0.60, 0.97]) or the rate of postoperative complications (14.1% or 26/184 for robotic surgery vs. 19.8% or 51/258 for laparoscopy; RR = 0.81; 95% CI: [0.52, 1.26]). No deaths were reported in either group. Discussion: The meta-analysis suggests that robotic surgery is an appropriate option for managing complicated diverticulitis. It is associated with a trend toward a lower rate of conversion to open surgery and fewer postoperative complications; however, this trend does not reach the level of statistical significance. Since no high quality RCTs were available, this meta-analysis isnot able to provide reliable conclusion, but only a remarkable lack of proper evidence supporting robotic technology. The need for further evidence-based trials is important.

[In-hospital mortality in acute abdominal diseases in the Central Federal District of Russia depending on availability of laparoscopic procedures]. / Dinamika gospital'noi letal'nosti pri ostrykh abdominal'nykh zabolevaniyakh v Tsentral'nom federal'nom okruge Rossii v zavisimosti ot chastoty primeneniya laparoskopicheskikh operatsii.

OBJECTIVE: To study in-hospital mortality in acute abdominal diseases in the Central Federal District and compared effectiveness of laparoscopic and open surgeries. MATERIAL AND METHODS: The study was based on the previous data for 2017-2021. The odds ratio (OR) was used to assess significance of between-group differences. RESULTS: The absolute number of deceased patients with acute abdominal diseases increased significantly and exceeded 23 thousand in the Central Federal District between 2019 and 2021. This value approached 4% for the first time over the last 10 years. In-hospital mortality from acute abdominal diseases in the Central Federal District increased for 5 years and reached maximum value in 2021. The greatest changes occurred in perforated ulcers (mortality increased from 8.69% in 2017 to 14.01% in 2021), acute intestinal obstruction (from 4.7% to 9.0%) and ulcerative gastroduodenal bleeding (from 4.5% to 5.5%). In other diseases, in-hospital mortality is lower, but trends are similar. Laparoscopic surgeries are common in acute cholecystitis (71-81%). At the same time, in-hospital mortality is significantly lower in regions with more active use of laparoscopy (0.64% and 1.25% in 2020; 0.52% and 1.16% in 2021). Laparoscopic surgeries are significantly less actively used for other acute abdominal diseases. We analyzed availability of laparoscopic surgeries using the «Hype Cycle¼. Percentage range of introduction reached conditional «productivity plateau¼ only in acute cholecystitis. CONCLUSION: Most regions are stagnating in laparoscopic technologies for acute appendicitis and perforated ulcers. Laparoscopic operations are actively used for acute cholecystitis in most regions of the Central Federal District. Annual increase in the number of laparoscopic operations and their technical improvement are promising in reducing in-hospital mortality associated with acute appendicitis, perforated ulcers and acute cholecystitis.

[Impact of staffing on the results of treatment among surgical patients. Statistical study]. / Vliyanie kadrovoi ukomplektovannosti na rezul'taty lecheniya khirurgicheskikh bol'nykh. Statisticheskoe issledovanie.

OBJECTIVE: To study the influence of staffing index on the results of surgical treatment. MATERIAL AND METHODS: The study was based on the data of surgical service in the Russian Federation upon 2018 (A.Sh. Revishvili et al., 2019). Correlation and regression analysis was carried out using the Microsoft Excel 2019 software. To assess between-group differences, we analyzed odds ratio (OR) and contingency table using χ2 test. RESULTS: Correlation and regression analysis revealed strong direct functional relationships (r=0.889) between the staffing of surgical service and in-hospital mortality rates. We distinguished 3 formalized levels of surgical staffing (high, medium and low). Gradation of these categories depends on the annual average reference indicator of staffing (88.4% in 2018). In high level of surgical staffing (≥88.4%), in-hospital mortality was 2.19%. Low level of surgical staffing (<88.4%) is accompanied by in-hospital mortality of 2.65% (OR 0.83; 95% CI 0.81-0.84; p<0.05). CONCLUSION: We confirmed the hypothesis about correlation of in-hospital mortality and staffing of surgical personnel. Validation of scientific data requires further studies with multivariate analysis of various covariates. Long-term prospects of surgical personnel policy in Russia are associated with formulation of specific tasks for surgical services at each level of surgical care.

[Comparison of robot-assisted and conventional endoscopic surgeries in the Russian Federation. (A systematic review and meta-analysis)]. / Sravnenie robot-assistirovannykh i traditsionnykh videoendoskopicheskikh operatsii v RF. (Rezul'taty sistematicheskogo obzora i metaanaliza).

OBJECTIVE: Comparative assessment of immediate and long-term results of robot-assisted and conventional endoscopic technologies in the Russian Federation. MATERIAL AND METHODS: Searching for primary trials devoted to robot-assisted (RAE) and traditional video endoscopic (TVE) surgeries in the Russian Federation was carried out in the e-library and CENTRAL Cochrane databases. We used the recommendations of the Center for Expertise and Quality Control of Medical Care (2017, 2019) and the current version of the Cochrane Community Guidelines (2021). These guidelines define the features of meta-analysis of non-randomized comparative studies. Review Manager 5.4 software was used for statistical analysis. RESULTS: We enrolled 26 Russian-language primary sources (3111 patients) including 1174 (38%) ones in the RAE group and 1937 (62%) patients in the TVE group. There were no randomized controlled trials in the Russian Federation, and all primary studies were non-randomized. We found no significant between-group differences in surgery time, incidence of intraoperative complications, intraoperative blood loss in thoracic surgery, urology and gynecology, conversion rate, postoperative hospital-stay, postoperative morbidity (in abdominal surgery, urology and gynecology), postoperative mortality. We observed slightly lower intraoperative blood loss for RAE in abdominal surgery and lower incidence of postoperative complications in robot-assisted thoracic surgery. These results can be compromised by methodological quality of comparative studies, significant heterogeneity and systematic errors. CONCLUSION: Currently, we cannot confirm the benefits of robot-assisted technologies, since this approach does not worsen or improve treatment outcomes. Further high-quality studies are needed.

[Central Aortic Pressure: Reference and Diagnostic Values].

OBJECTIVE: Practical application of central aortic pressure (CAP) parameters is limited by the absence of generally recognized reference and threshold diagnostic indices. The purpose of this work is to establish their values in the general population of Novosibirsk. Materials and Methods. A total of 327 people were examined: 155 men and 172 women aged 25-44 years from a representative sample from the general population of Novosibirsk. Applanation tonometry of the radial artery was performed by the SphygmoCor system. The reference values of CAP parameters were obtained by a nonparametric method according to the Clinical and Laboratory Standards Institute (CLSI) recommendations (95 % percentile interval with 2.5 % and 97.5 % cut-off points and their 90 % confidence intervals). Diagnostic thresholds and categories of CAP were determined as mean values depending on the categories of brachial arterial pressure (BP) and on the basis of risk estimates, as well as sensitivity and specificity values for left ventricular hypertrophy similar to risk and sensitivity and specificity values of threshold levels (categories) of brachial BP. RESULTS: The reference values of the parameters of the CAP were: 18-43 mm Hg for pulse pressure; 5-24 mm Hg for the amplification of pulse pressure; - 8.8-40 % for the augmentation index. Diagnostic categories of CAP were determined to be: optimal - less than 110 / 80, normal - 110 / 80-114 / 84, high normal - 115 / 85-124 / 89, hypertension - more than 125 / 90 mm Hg. CONCLUSION: The reference values, diagnostic thresholds and categories of parameters of CAP in the general population of Novosibirsk aged 25-44 years have been determined. It is expedient to further study them.

[Use of topical haemostatic agents in cardiovascular surgery]. / Ispol'zovanie mestnykh gemostaticheskikh sredstv v serdechno-sosudistoi khirurgii.

The problem of haemostasis in cardiovascular surgery is of current concern. Recent trends are towards increased use of topical haemostatic agents. Tachocomb has been used for more than 30 years in abdominal surgery and oncology. The purpose of the present publication is to analyse the literature data and formulate the indications for the use of Tachocomb in cardiovascular surgery. Multicenter randomized and local studies have demonstrated efficacy of Tachocomb in treatment of surgical haemorrhage in operations on the heart, thoracic aorta, carotid arteries and lower-limb arteries, resulting in significantly decreased time to achieve haemostasis, decreased volume of blood loss and haemotrasfusion, as well as reduced frequency of complications. Also shown was economic efficacy, including a shortened length of patients' hospital stay. This is followed by describing a wide spectrum of examples of alternative use of Tachocomb, including its use for seamless closure of defects of cardiac chamber walls, aero- and lymphostasis, prevention of formation of commissures. Convincing experimental and clinical results make it possible to formulate a series of indications for the use of Tachocomb in cardiovascular surgery.

Publisher Correction: Imaging spectroscopy of solar radio burst fine structures.

The original version of this article contained errors in Refs 15, 27, 32, 33 and 43, which were incorrectly given with the wrong journal name "Solid Phys." rather than the correct "Sol. Phys.". This has now been corrected in the PDF and HTML versions of the article.

Imaging spectroscopy of solar radio burst fine structures.

Solar radio observations provide a unique diagnostic of the outer solar atmosphere. However, the inhomogeneous turbulent corona strongly affects the propagation of the emitted radio waves, so decoupling the intrinsic properties of the emitting source from the effects of radio wave propagation has long been a major challenge in solar physics. Here we report quantitative spatial and frequency characterization of solar radio burst fine structures observed with the Low Frequency Array, an instrument with high-time resolution that also permits imaging at scales much shorter than those corresponding to radio wave propagation in the corona. The observations demonstrate that radio wave propagation effects, and not the properties of the intrinsic emission source, dominate the observed spatial characteristics of radio burst images. These results permit more accurate estimates of source brightness temperatures, and open opportunities for quantitative study of the mechanisms that create the turbulent coronal medium through which the emitted radiation propagates.

Turbulent Kinetic Energy in the Energy Balance of a Solar Flare.

The energy released in solar flares derives from a reconfiguration of magnetic fields to a lower energy state, and is manifested in several forms, including bulk kinetic energy of the coronal mass ejection, acceleration of electrons and ions, and enhanced thermal energy that is ultimately radiated away across the electromagnetic spectrum from optical to x rays. Using an unprecedented set of coordinated observations, from a suite of instruments, we here report on a hitherto largely overlooked energy component-the kinetic energy associated with small-scale turbulent mass motions. We show that the spatial location of, and timing of the peak in, turbulent kinetic energy together provide persuasive evidence that turbulent energy may play a key role in the transfer of energy in solar flares. Although the kinetic energy of turbulent motions accounts, at any given time, for only ∼(0.5-1)% of the energy released, its relatively rapid (∼1-10 s) energization and dissipation causes the associated throughput of energy (i.e., power) to rival that of major components of the released energy in solar flares, and thus presumably in other astrophysical acceleration sites.

A New Approach To the Diagnosis of Point Mutations in Native DNA Using Graphene Oxide.

Development of new methods for the diagnosis of point mutations is a pressing issue. We have developed a new approach to the design of graphene oxide-based test systems for the diagnosis of point mutations in native DNA. This new approach is based on the use of graphene oxide for the adsorption and quenching of fluorescently labeled primers in a post-amplification PCR mixture followed by detection of fluorescently labeled PCR products. It is possible to detect fluorescently labelled amplicons in the presence of an excess of primers in a PCR product solution due to the different affinities of single-stranded and double-stranded DNA molecules to graphene oxide, as well as the ability of graphene oxide to act as a quencher of the fluorophores adsorbed on its surface. The new approach was tested by designing a graphene oxide-based test system for the DNA diagnosis of the point mutation associated with the development of the 3M syndrome in Yakuts. The developed approach enables one to design graphene oxide-based test systems suitable for the diagnosis of any point mutations in native DNA.

[Immediate results of surgical correction of combined pathology of the aortic valve and coronary arteries].

The authors analyzed an experience of surgical treatment in patients with aortic valve failure and ischemic heart disease. All patients have been operated in clinic of hospital surgery No 2 of State Pavlov Medical University. The work presented basic approaches to the management and strategy choice of the treatment of these patients. On the basis of given research, the authors suggested to perform a reconstruction of aortic valve by using original method in combination with coronary bypass surgery, which allowed avoiding a prosthetic-patient inadequacy. At the same time, it could improve an intracardiac haemodynamics and postoperative course.

[Clinical electroencephalographic aspects of outcome prognosis of acute period of ischemic supratentorial stroke].

Clinical computed electroencephalographic examination of 120 patients in acute period of ischemic supratentorial stroke was made with the aim of outcome prognosis optimization. Prognostic value of stroke subtype evaluation using the Oxfordshire Community Stroke Project classification and the degree of initial neurological deficit (by NIHSS) in acute period of the stroke was clarified. Statistical significant correlations between parameters of electroencephalographic pattern in the onset of ischemic supratentorial stroke and stroke acute period outcome were established. Using logistic regression it was proved that combined specification of clinical stroke subtype by Oxfordshire Community Stroke Project classification and DAR coefficient of affected hemisphere in the onset of disease improves prediction of stroke acute period outcome.

[Capabilities of a Multivox hardware-software system in the radiodiagnosis of facial skeleton injury].

The authors evaluated the efficiency of a Multivox RIS hardware-software system in optimizing the radiodiagnosis of facial skeleton injury. An attempt was undertaken to systematize an approach to the comprehensive radiographic examination of patients with craniofacial polytrauma. It is shown that an image can be postprocessed using the Multivox RIS hardware-software system, which contributes to the comprehensive analysis of obtained images, by applying different radiographic studies; moreover, digital X-ray study has the most diagnostic value and rationality for isolated maxillofacial trauma and multislice spiral computed tomography has them for mixed, concurrent, and multiple injuries. The developed algorithm for examining the patients with facial skeleton trauma unifies and optimizes the diagnosis of craniofascial injuries at different sites.

[Formation of focus of West Nile fever on the territory of Saratov Region].

AIM: Detection of circulation of West Nile virus (WNV) on the territory of Saratov Region and prerequisites for formation of natural focus of West Nile fever (WNF), determination of the role of WNV in infectious pathology on the territory of the region. MATERIALS AND METHODS: of organs of small mammals, birds, blood-sucking arthropods for the presence of WNV markers (antigens and/or RNA) were studied. Clinical material from patients with symptoms not excluding WNF was studied. Donor blood sera samples were analyzed with the aim of detection of immune layer against WNV in population of Saratov Region. RESULTS: In 2010 WNV antigens were detected by EIA in 12 samples (7.1%) of mammal organ suspensions. In 2012 by using RT-PCR and EIA, markers of WNV were detected in 6 samples of bird brain suspensions (6.3%) and 1 sample of mammal organ suspension. Immune layer of population against WNV was 4% in 2011, 2.8% in 2012. In 2012 in 11 of 27 examined patients IgM against WNV in diagnostic titers and/or serconversion of IgG in paired sera were detected. In addition in 5 individuals virus RNA was detected in blood. Based on clinical, laboratory data and epidemiologic anamnesis 11 patients were diagnosed with WNF. CONCLUSION: The results obtained give evidence on the circulation of WNV on the territory of Saratov Region in 2010 - 2012. With the development of complications of WNF epidemiologic situation in 2012 an expansion of WNV areal onto the territory of the region took place and the process of formation of WNF natural foci is ongoing.

[24-Hour arterial pressure variability and 24-hour variability of pulse carries unidirectional character and is not associated with left ventricular hypertrophy (results of population study)].

Alternative prognostic interpretation of variability of arterial pressure (AP) and pulse seems contradictory if one considers classical conceptions of close physiological connection between AP and pulse. It is logical to expect that elevated variability of AP should be associated with elevated variability of pulse and vice versa. Within framework of the project EPOCH we examined a populational sample of inhabitants of Novosibirsk (129 men and 170 women) formed according to the family principle. Ambulatory 24-hour registration of AP and pulse was carried out with 15-30 minutes interval. Variability of AP turned out to be unidirectionally interconnected with variability of pulse and was not an independent marker of hypertrophy of the left ventricle but was associated with it at the account of concealed dependence on mean 24-hour AP. Cornell voltage index in persons with normal AP, "white coat" arterial hypertension (AH), "masked" AH was comparable and significantly lower than in subjects with sustained AH.

[State of cardiac activity in patients with varicose disease of the lower extremity veins].

The intracardiac characteristics were studied in 100 patients prior to a removal of varicose veins by surgical or screrotherapeutic methods using US methods. An analysis of these characteristics has shown that investigation of the diastolic function of the heart ventricles is the most demonstrative one. The function of one or two ventricles was shown to worsen with age having negative influence on the venous system of lower extremities which can cause the appearance of varicose veins or their progression thus increasing the stage of chronic venous insufficiency, the appearance of recurrent varicosity after its removal.

[Pathomorphology of shock-related changes as a criterion for age dating of injury].

The necessity of integrated approach to age dating of injuries implies the search for new diagnostic criteria. Shock may be one of them. Analysis of shock-related morphological changes in the affected and intact tissues along with concomitant inflammatory reactions permits to more accurately determine the length of the post-trauma period.

[Distribution of fleas in rodent colonies in the northwestern Precaspian region].

Distribution of fleas by their rodents hosts was investigated by field experiments using the method of individual labeling both the parasites and the hosts. The experimental site was situated in sand landscapes of the northwestern Precaspian region. Pattern of the contacts between rodents leading to the exchange of their ectoparasites was established. Average distance of the rodent migration from the site of its previous record was 54 m, while the distance of flea transfer for the same period was 142 m. The probability of host exchange by a flea under under its periodic attacks on host amounted to the value 0.500-0.889. The parameters of flea spreading in the northwestern Precaspian region and in the sand landscapes between Volga and Ural were shown to be similar. The ability of the flea Xenopsylla conformis to parasitizing on social vole without a significant decrease of its abundance was revealed.

[Ultraminiature electrochemical and photoelectric current sources and their possible use for controlled induction of immune system activity and in other medical applications].

The possibility of producing microparticles (10-1000 nm) suitable for the introduction into biological cells and tissues and producing the electrical field and electrical currents around them due to electrochemical and photoelectric processes is discussed. A number of phenomena related to antitumor immunity are discussed, and several hypotheses to explain them are invoked. Among them is the hypothesis that the antitumor activity of the immune system may be associated with some agents that are phagocytized by the cells of the macrophage series and promote their activation. Presumably, cell activation is triggered by the damage to phagosomes caused by the phagocytized agent. It is suggested to use for cell activation an artificial agent consisting of the above-mentioned electrically active microscopic particles. For example, it may consist of microscopic particles of semiconductor with zones of n- and p-type conductivity. Such particles act as microscopic photoelectric cells: when exposed to optical radiation, they generate a potential difference, which causes disruption and damage of phagosome membranes and results in the activation of immune cells.