المؤلفون: Steele, Scott

الوصف: The developing of questions of Outer Space has only been greatly enhanced by the increase of technology and greater involvement by states, private actors and people seeking to use space above the typical uses i.e., satellites. Such an approach has carried on the original views of space delivered by the Apollo programme, which has inspired entrepreneurs, scientists, politicians, and lawyers to challenge and develop hypothetical opinions and business strategy. Nevertheless, outer space is a free for all without jurisdiction. This thesis will consider both the future of space governance and the Committee on Space Research (COSPAR) planetary protection policy. The uptake of scientific missions through the solar system has formed an enhanced interest as more than ever space exploration is pushing the boundaries are political and legal certainty. The Outer Space Treaty presents a number of fundamental and core elements within space and promotes cooperation through the United Nations Committee on the Peaceful Uses of Outer Space (UNCOPUOS). As such the future of space governance will be considered as to whether the current practice is “fit for purpose”, or whether a new governance regime should be considered for the benefit of space cooperation. Moreover, appropriate discussions around the understanding of astrobiology and how such a road map sets out the need for a planetary protection resource during exploration of space will be examined in detail. COSPARs planetary protection policy will be examined in order to be able to justify whether there is any legal basis for such an implementation or whether the policy remains a recommendation.

الوصول الحر: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.886619Test

المؤلفون: Steele, Scott, Bilchik, Anton, Eberhardt, John, Kalina, Philip, Nissan, Aviram, Johnson, Eric, Avital, Itzhak, Stojadinovic, Alexander

المصدر: Interactive Journal of Medical Research, Vol 1, Iss 2, p e6 (2012)

مصطلحات موضوعية: Computer applications to medicine. Medical informatics, R858-859.7, Medical technology, R855-855.5

الوصف: BackgroundClostridium difficile (C-Diff) infection following colorectal resection is an increasing source of morbidity and mortality. ObjectiveWe sought to determine if machine-learned Bayesian belief networks (ml-BBNs) could preoperatively provide clinicians with postoperative estimates of C-Diff risk. MethodsWe performed a retrospective modeling of the Nationwide Inpatient Sample (NIS) national registry dataset with independent set validation. The NIS registries for 2005 and 2006 were used for initial model training, and the data from 2007 were used for testing and validation. International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes were used to identify subjects undergoing colon resection and postoperative C-Diff development. The ml-BBNs were trained using a stepwise process. Receiver operating characteristic (ROC) curve analysis was conducted and area under the curve (AUC), positive predictive value (PPV), and negative predictive value (NPV) were calculated. ResultsFrom over 24 million admissions, 170,363 undergoing colon resection met the inclusion criteria. Overall, 1.7% developed postoperative C-Diff. Using the ml-BBN to estimate C-Diff risk, model AUC is 0.75. Using only known a priori features, AUC is 0.74. The model has two configurations: a high sensitivity and a high specificity configuration. Sensitivity, specificity, PPV, and NPV are 81.0%, 50.1%, 2.6%, and 99.4% for high sensitivity and 55.4%, 81.3%, 3.5%, and 99.1% for high specificity. C-Diff has 4 first-degree associates that influence the probability of C-Diff development: weight loss, tumor metastases, inflammation/infections, and disease severity. ConclusionsMachine-learned BBNs can produce robust estimates of postoperative C-Diff infection, allowing clinicians to identify high-risk patients and potentially implement measures to reduce its incidence or morbidity.

وصف الملف: electronic resource

العلاقة: http://www.jmir.org/2012/2/e6Test/; https://doaj.org/toc/1929-073XTest

الوصول الحر: https://doaj.org/article/baf63df176804193966d15f04bcf3aaeTest

المؤلفون: Cure, Pablo, Fessel, Joshua P., Hartshorn, Christopher M., Steele, Scott J.

المصدر: Journal of Clinical and Translational Science ; volume 8, issue 1 ; ISSN 2059-8661

الإتاحة: https://doi.org/10.1017/cts.2024.501Test
https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S2059866124005016Test

المؤلفون: Avellaneda, Nicolas, Pellino, Gianluca, Maroli, Annalisa, Tottrup, Anders, Bislenghi, Gabriele, Colpaert, Jan, D'Hoore, Andre, Carvello, Michele, Giorgi, Lorenzo, Juachon, Patrizia, Harsløf, Sanne, de Buck Van Overstraeten, Anthony, Olivera, Pablo A., Gomez, Javier, Holubar, Stefan D., Naranjo, Eddy Lincango, Steele, Scott R., Merchea, Amit, Shaker, Andrew, Gallostra, Marc Marti, Kraft, Miquel, Kotze, Paulo Gustavo, Maruyama, Beatriz Yuki, Wexner, Steven D., Garoufalia, Zoe, Chen, Zhihui, Hahnloser, Dieter, Rrupa, Djana, Buskens, Christianne, Haanappel, Anouck, Warusavitarne, Janindra, Williams, Katherine J., Christensen, Peter, Wolthuis, Albert, Potolicchio, Analia, Spinelli, Antonino

المصدر: Colorectal Disease ; ISSN 1462-8910 1463-1318

الوصف: Aim Recent evidence challenges the current standard of offering surgery to patients with ileocaecal Crohn's disease (CD) only when they present complications of the disease. The aim of this study was to compare short‐term results of patients who underwent primary ileocaecal resection for either inflammatory (luminal disease, earlier in the disease course) or complicated phenotypes, hypothesizing that the latter would be associated with worse postoperative outcomes. Method A retrospective, multicentre comparative analysis was performed including patients operated on for primary ileocaecal CD at 12 referral centres. Patients were divided into two groups according to indication of surgery for inflammatory (ICD) or complicated (CCD) phenotype. Short‐term results were compared. Results A total of 2013 patients were included, with 291 (14.5%) in the ICD group. No differences were found between the groups in time from diagnosis to surgery. CCD patients had higher rates of low body mass index, anaemia (40.9% vs. 27%, p < 0.001) and low albumin (11.3% vs. 2.6%, p < 0.001). CCD patients had longer operations, lower rates of laparoscopic approach (84.3% vs. 93.1%, p = 0.001) and higher conversion rates (9.3% vs. 1.9%, p < 0.001). CCD patients had a longer hospital stay and higher postoperative complication rates (26.1% vs. 21.3%, p = 0.083). Anastomotic leakage and reoperations were also more frequent in this group. More patients in the CCD group required an extended bowel resection (14.1% vs. 8.3%, p : 0.017). In multivariate analysis, CCD was associated with prolonged surgery (OR 3.44, p = 0.001) and the requirement for multiple intraoperative procedures (OR 8.39, p = 0.030). Conclusion Indication for surgery in patients who present with an inflammatory phenotype of CD was associated with better outcomes compared with patients operated on for complications of the disease. There was no difference between groups in time from diagnosis to surgery.

الإتاحة: https://doi.org/10.1111/codi.17056Test

المؤلفون: Schabl, Lukas, Hull, Tracy, Erozkan, Kamil, Alipouriani, Ali, Ban, Kristen A., Steele, Scott R., Spivak, Anna R.

المساهمون: Austrian Surgical Society

المصدر: Langenbeck's Archives of Surgery ; volume 409, issue 1 ; ISSN 1435-2451

مصطلحات موضوعية: Surgery

الوصف: Purpose Recurrence of rectal prolapse following the Altemeier procedure is reported with rates up to 40%. The optimal surgical management of recurrences has limited data available. Ventral mesh rectopexy (VMR) is a favored procedure for primary rectal prolapse, but its role in managing recurrences after Altemeier is unclear. VMR for recurrent prolapse involves implanting the mesh on the colon, which has a thinner wall, more active peristalsis, no mesorectum, less peritoneum available for covering the mesh, and potential diverticula. These factors can affect mesh-related complications such as erosion, migration, or infection. This study assessed the feasibility and perioperative outcomes of VMR for recurrent rectal prolapse after the Altemeier procedure. Methods We queried our prospectively maintained database between 01/01/2008 and 06/30/2022 for patients who had experienced a recurrence of full-thickness rectal prolapse following Altemeier’s perineal proctosigmoidectomy and subsequently underwent ventral mesh rectopexy. Results Ten women with a median age of 67 years (range 61) and a median BMI of 27.8 kg/m 2 (range 9) were included. Five (50%) had only one Altemeier, and five (50%) had multiple rectal prolapse surgeries, including Altemeier before VMR. No mesh-related complications occurred during a 65-month (range 165) median follow-up period. Three patients (30%) experienced minor postoperative complications unrelated to the mesh. Long-term complications were chronic abdominal pain and incisional hernia in one patient, respectively. One out of five (20%) patients with only one previous prolapse repair had a recurrence, while all patients (100%) with multiple prior repairs recurred. Conclusion Mesh implantation on the colon is possible without adverse reactions. However, high recurrence rates in patients with multiple previous surgeries raise doubts about using VMR for secondary or tertiary recurrences.

الإتاحة: https://doi.org/10.1007/s00423-024-03227-wTest

المؤلفون: Otero-Piñerio, Ana M., Aykun, N., Maspero, M., Holubar, Stefan, Hull, Tracy, Lipman, Jeremy, Steele, Scott R., Lightner, Amy L.

المصدر: BMC Gastroenterology ; volume 24, issue 1 ; ISSN 1471-230X

مصطلحات موضوعية: Gastroenterology, General Medicine

الوصف: Introduction Perianal disease occurs in up to 34% of inflammatory bowel disease (IBD) patients. An estimated 25% of women will become pregnant after the initial diagnosis, thus introducing the dilemma of whether mode of delivery affects perianal disease. The aim of our study was to analyze whether a cesarean section (C-section) or vaginal delivery influence perianal involvement. We hypothesized the delivery route would not alter post-partum perianal manifestations in the setting of previously healed perianal disease. Methods All consecutive eligible IBD female patients between 1997 and 2022 who delivered were included. Prior perianal involvement, perianal flare after delivery and delivery method were noted. Results We identified 190 patients with IBD who had a total of 322 deliveries; 169 (52%) were vaginal and 153 (48%) were by C-section. Nineteen women (10%) experienced 21/322 (6%) post-partum perianal flares. Independent predictors were previous abdominal surgery for IBD (OR, 2.7; 95% CI, 1–7.2; p = 0.042), ileocolonic involvement (OR, 3.3; 95% CI, 1.1–9.4; p = 0.030), previous perianal disease (OR, 22; 95% CI, 7–69; p < 0.001), active perianal disease (OR, 96; 95% CI, 21–446; p < 0.001) and biologic (OR, 4.4; 95% CI,1.4–13.6; p < 0.011) or antibiotic (OR, 19.6; 95% CI, 7–54; p < 0.001) treatment. Negative association was found for vaginal delivery (OR, 0.19; 95% CI, 0.06–0.61; p < 0.005). Number of post-partum flares was higher in the C-section group [17 (11%) vs. 4 (2%), p = 0.002]. Conclusions Delivery by C-section section was not protective of ongoing perianal disease activity post-delivery, but should be recommended for women with active perianal involvement.

الإتاحة: https://doi.org/10.1186/s12876-023-03018-5Test

المؤلفون: Hernandez Dominguez, Oscar, Lincango, Eddy P., Spivak, Rebecca, Almonacid-Cardenas, Federico, Prien, Christopher, Uchino, Tairin, Spivak, Anna, Hull, Tracy L., Steele, Scott R., Holubar, Stefan D.

المصدر: International Journal of Surgery ; volume 110, issue 4, page 2381-2388 ; ISSN 1743-9159

الوصف: Background: A colosplenic fistula (CsF) is an extremely rare complication. Its diagnosis and management remain poorly understood, owing to its infrequent incidence. Our objective was to systematically review the etiology, clinical features, diagnosis, management, and prognosis to help clinicians gain a better understanding of this unusual complication and provide aid if it is to be encountered. Methods: A systematic review of studies reporting CsF diagnosis in Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, and Wiley Cochrane Library from 1946 to June 2022. Additionally, a retrospective review of four cases at our institution were included. Cases were evaluated for patient characteristics (age, sex, and comorbidities), CsF characteristics including causes, symptoms at presentation, diagnosis approach, management approach, pathology findings, intraoperative complications, postoperative complications, 30-day mortality, and prognosis were collected. Results: Thirty patients with CsFs were analyzed, including four cases at our institution and 26 single-case reports. Most of the patients were male (70%), with a median age of 56 years. The most common etiologies were colonic lymphoma (30%) and colorectal carcinoma (17%). Computed tomography (CT) was commonly used for diagnosis (90%). Approximately 87% of patients underwent a surgical intervention, most commonly segmental resection (81%) of the affected colon and splenectomy (77%). Nineteen patients were initially managed surgically, and 12 patients were initially managed nonoperatively. However, 11 of the nonoperative patients ultimately required surgery due to unresolved symptoms. The rate of postoperative complications was (17%). Symptoms resolved with surgical intervention in 25 (83%) patients. Only one patient (3%) had had postoperative mortality. Conclusions: Our review of 30 cases worldwide is the largest in literature. CsFs are predominantly complications of neoplastic processes. CsF may be successfully and safely treated with splenectomy and resection of ...

الإتاحة: https://doi.org/10.1097/js9.0000000000001128Test

المؤلفون: Jafari, Mehraneh D, Pigazzi, Alessio, McLemore, Elisabeth C, Mutch, Matthew G, Haas, Eric, Rasheid, Sowsan H, Wait, Alyssa D, Paquette, Ian M, Bardakcioglu, Ovunc, Safar, Bashar, Landmann, Ron G, Varma, Madhulika G, Maron, David J, Martz, Joseph, Bauer, Joel J, George, Virgilio V, Fleshman, James W, Steele, Scott R, Stamos, Michael J

المصدر: Diseases of the colon and rectum. 64(8)

مصطلحات موضوعية: Colon, Rectum, Humans, Rectal Neoplasms, Indocyanine Green, Fluoroscopy, Intraoperative Care, Anastomosis, Surgical, Middle Aged, Female, Male, Anastomotic Leak, Optical Imaging, Anastomotic leak, Angiography, Colorectal anastomosis, Indocyanine green, Perfusion, Clinical Research, Prevention, Clinical Trials and Supportive Activities, Clinical Sciences, Surgery

الوصف: BackgroundIndocyanine green fluoroscopy has been shown to improve anastomotic leak rates in early phase trials.ObjectiveWe hypothesized that the use of fluoroscopy to ensure anastomotic perfusion may decrease anastomotic leak after low anterior resection.DesignWe performed a 1:1 randomized controlled parallel study. Recruitment of 450 to 1000 patients was planned over 2 years.SettingsThis was a multicenter trial.PatientsIncluded patients were those undergoing resection defined as anastomosis within 10 cm of the anal verge.InterventionPatients underwent standard evaluation of tissue perfusion versus standard in conjunction with perfusion evaluation using indocyanine green fluoroscopy.Main outcome measuresPrimary outcome was anastomotic leak, with secondary outcomes of perfusion assessment and the rate of postoperative abscess requiring intervention.ResultsThis study was concluded early because of decreasing accrual rates. A total of 25 centers recruited 347 patients, of whom 178 were randomly assigned to perfusion and 169 to standard. The groups had comparable tumor-specific and patient-specific demographics. Neoadjuvant chemoradiation was performed in 63.5% of perfusion and 65.7% of standard (p > 0.05). Mean level of anastomosis was 5.2 ± 3.1 cm in perfusion compared with 5.2 ± 3.3 cm in standard (p > 0.05). Sufficient visualization of perfusion was reported in 95.4% of patients in the perfusion group. Postoperative abscess requiring surgical management was reported in 5.7% of perfusion and 4.2% of standard (p = 0.75). Anastomotic leak was reported in 9.0% of perfusion compared with 9.6% of standard (p = 0.37). On multivariate regression analysis, there was no difference in anastomotic leak rates between perfusion and standard (OR = 0.845 (95% CI, 0.375-1.905); p = 0.34).LimitationsThe predetermined sample size to adequately reduce the risk of type II error was not achieved.ConclusionsSuccessful visualization of perfusion can be achieved with indocyanine green fluoroscopy. However, no difference in anastomotic leak rates was observed between patients who underwent perfusion assessment versus standard surgical technique. In experienced hands, the addition of routine indocyanine green fluoroscopy to standard practice adds no evident clinical benefit. See Video Abstract at http://links.lww.com/DCR/B560.ValoracinTest de la irrigacin de lado izquierdo/reseccin anterior baja pilar iii un estudio aleatorizado, controlado, paralelo y multicntrico que evala los resultados de la irrigacin con pinpoint imgenes de fluorescencia cercana al infrarrojo en la reseccin anterior bajaANTECEDENTES:Se ha demostrado que la fluoroscopia con verde de indocianina mejora las tasas de fuga anastomótica en ensayos en fases iniciales.OBJETIVO:Nuestra hipótesis es que la utilización de fluoroscopia para asegurar la irrigación anastomótica puede disminuir la fuga anastomótica luego de una resección anterior baja.DISEÑO:Realizamos un estudio paralelo, controlado, aleatorizado 1:1. Se planificó el reclutamiento de 450-1000 pacientes durante 2 años.AMBITO:Multicéntrico.PACIENTES:Pacientes sometidos a resección definida como una anastomosis dentro de los 10cm del margen anal.INTERVENCIÓN:Pacientes que se sometieron a la evaluación estándar de la irrigación tisular contra la estándar en conjunto con la valoración de la irrigación mediante fluoroscopia con verde indocianina.PRINCIPALES VARIABLES EVALUADAS:El principal resultado fue la fuga anastomótica, y los resultados secundarios fueron la evaluación de la perfusión y la tasa de absceso posoperatorio que requirió intervención.RESULTADOS:Este estudio se cerró anticipadamente debido a la disminución de las tasas de acumulación. Un total de 25 centros reclutaron a 347 pacientes, de los cuales 178 fueron, de manera aleatoria, asignados a perfusión y 169 a estándar. Los grupos tenían datos demográficos específicos del tumor y del paciente similares. Recibieron quimio-radioterapia neoadyuvante el 63,5% de la perfusión y el 65,7% del estándar (p> 0,05). La anastomosis estuvo en un nivel promedio de 5,2 + 3,1 cm en perfusión en comparación con 5,2 + 3,3 cm en estándar (p> 0,05). Se reportó una visualización suficiente de la perfusión en el 95,4% de los pacientes del grupo de perfusión. El absceso posoperatorio que requirió tratamiento quirúrgico fue de 5,7% de los perfusion y en el 4,2% del estándar (p = 0,75). Se informó fuga anastomótica en el 9,0% de la perfusión en comparación con el 9,6% del estándar (p = 0,37). En el análisis de regresión multivariante, no hubo diferencias en las tasas de fuga anastomótica entre la perfusión y el estándar (OR 0,845; IC del 95% (0,375; 1,905); p = 0,34).LIMITACIONES:No se logró el tamaño de muestra predeterminado para reducir satisfactoriamente el riesgo de error tipo II.CONCLUSIÓN:Se puede obtener una visualización adecuada de la perfusión con ICG-F. Sin embargo, no se observaron diferencias en las tasas de fuga anastomótica entre los pacientes que se sometieron a evaluación de la perfusión versus la técnica quirúrgica estándar. En manos expertas, agregar ICG-F a la rutina de la práctica estándar no agrega ningún beneficio clínico evidente. Consulte Video Resumen en http://links.lww.com/DCR/B560Test. (Traducción-Dr Juan Antonio Villanueva-Herrero).

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/5z89c0rhTest

المؤلفون: Sobrado, Lucas Faraco, Foley, Niamh, Lincango, Eddy P, Duraes, Leonardo de Castro, Gorgun, Emre, Steele, Scott R, Holubar, Stefan D

المصدر: Journal of Coloproctology ; 71° Congresso Brasileiro de Coloproctologia ; ISSN 2317-6423

الإتاحة: https://doi.org/10.1055/s-0044-1781280Test

المؤلفون: Sobrado, Lucas Faraco, Duraes, Leonardo de Castro, Steele, Scott R, Gorgun, Emre

المصدر: Journal of Coloproctology ; 71° Congresso Brasileiro de Coloproctologia ; ISSN 2317-6423

الإتاحة: https://doi.org/10.1055/s-0044-1780818Test