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Background Appropriate perioperative fluid management is of pivotal importance to reduce postoperative complications, which impact on early and long-term patient outcome. The so-called perioperative goal-directed therapy (GDT) approach aims at customizing perioperative fluid management on the individual patients’ hemodynamic response. Whether or not the overall amount of perioperative volume infused in the context of GDT could influence postoperative surgical outcomes is unclear. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the efficacy of GDT approach between study population and control group in reducing postoperative complications and perioperative mortality, using MEDLINE, EMBASE and the Cochrane Controlled Clinical trials register. The enrolled studies were grouped considering the amount infused intraoperatively and during the first 24 h after the admission in the critical care unit (perioperative fluid). Results The metanalysis included 21 RCTs enrolling 2729 patients with a median amount of perioperative fluid infusion of 4500 ml. In the studies reporting an overall amount below or above this threshold, the differences in postoperative complications were not statically significant between controls and GDT subgroup [43.4% vs. 34.2%, p value = 0.23 and 54.8% vs. 39.8%; p value = 0.09, respectively]. Overall, GDT reduced the overall rate of postoperative complications, as compared to controls [pooled risk difference (95% CI) = − 0.10 (− 0.14, − 0.07); Chi 2  = 30.97; p value < 0.0001], but not to a reduction of perioperative mortality [pooled risk difference (95%CI) = − 0.016 (− 0.0334; 0.0014); p value = 0.07]. Considering the rate of organ-related postoperative events, GDT did not reduce neither renal ( p value = 0.52) nor cardiovascular ( p value = 0.86) or pulmonary ( p value = 0.14) or neurological ( p value = 0.44) or infective ( p value = 0.12) complications. Conclusions Irrespectively to the amount of perioperative fluid administered, GDT strategy reduces postoperative complications, but not perioperative mortality. Trial Registration CRD42020168866; Registration: February 2020 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=168866

Background Postoperative complications impact on early and long-term patients’ outcome. Appropriate perioperative fluid management is pivotal in this context; however, the most effective perioperative fluid management is still unclear. The enhanced recovery after surgery pathways recommend a perioperative zero-balance, whereas recent findings suggest a more liberal approach could be beneficial. We conducted this trial to address the impact of restrictive vs. liberal fluid approaches on overall postoperative complications and mortality. Methods Systematic review and meta-analysis, including randomised controlled trials (RCTs). We performed a systematic literature search using MEDLINE (via Ovid), EMBASE (via Ovid) and the Cochrane Controlled Clinical trials register databases, published from 1 January 2000 to 31 December 2019. We included RCTs enrolling adult patients undergoing elective abdominal surgery and comparing the use of restrictive/liberal approaches enrolling at least 15 patients in each subgroup. Studies involving cardiac, non-elective surgery, paediatric or obstetric surgeries were excluded. Results After full-text examination, the metanalysis finally included 18 studies and 5567 patients randomised to restrictive (2786 patients; 50.0%) or liberal approaches (2780 patients; 50.0%). We found no difference in the occurrence of severe postoperative complications between restrictive and liberal subgroups [risk difference (95% CI) = 0.009 (− 0.02; 0.04); p value = 0.62; I 2 (95% CI) = 38.6% (0–66.9%)]. This result was confirmed also in the subgroup of five studies having a low overall risk of bias. The liberal approach was associated with lower overall renal major events, as compared to the restrictive [risk difference (95% CI) = 0.06 (0.02–0.09); p value  = 0.001]. We found no difference in either early ( p value  = 0.33) or late ( p value  = 0.22) postoperative mortality between restrictive and liberal subgroups Conclusions In major abdominal elective surgery perioperative, the choice between liberal or restrictive approach did not affect overall major postoperative complications or mortality. In a subgroup analysis, a liberal as compared to a restrictive perioperative fluid policy was associated with lower overall complication renal major events, as compared to the restrictive. Trial Registration CRD42020218059; Registration: February 2020, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=218059 .

I am from Turin, so you will not be surprised to learn that I support Juventus. I am like every other football fan, and am looking forward to the coming season. We have had a tough time of it recently and are building a new team, but I have high hopes that in the year ahead we can finish in the top three in Serie A and qualify for the Champions League - a club like Juventus needs to be playing at the top level in Europe. It would have been perfectly understandable had they decided to stay at home; instead, thousands upon thousands of them sat for hours in the rain and got drenched, but it did not dampen their enthusiasm in the least. I know that I wouldn't have sat there on Saturday like they did. Their enthusiasm and their knowledge of the game are second to none. I have played all over the world and nowhere do the galleries have a better appreciation of what it takes to play good golf.

Then came the 14th and 15th. The 16th is the 163-yard par three and again I played a super shot, 12 feet to the left of the hole, but missed the putt again. A routine par followed at the 17th and I had a good up-and-down at the last for a par. It all added up to a round of 74, and a 36-hole total of 143, three over par. I then had to spend the rest of the day waiting to find out whether or not I had made the cut - luckily in the end I did make it. I didn't get off to the best of starts, dropping a shot at the first, but then I birdied the second and seventh to get to the turn in one under par, at which point I was two under for the tournament, and in good shape. But the back nine was frustrating. I missed the green with my second to the 10th and dropped a shot. At the par-three 11th, I struck a lovely iron shot that finished maybe 15 feet from the hole but the putt shaved the hole. It was the same story at the 12th, where once again I was within 15 feet in two but just missed the putt.

I put my second drive (my third shot) in the rough, too, and was only able to move the ball about 100 yards up the fairway in four, from where I missed the green on the left. I hit a good chip but failed to hole the putt and suddenly I had dropped three shots on one hole and walked off with an eight. And all because of one poor tee shot. It was my only bad swing in 36 holes of golf, so you can imagine how frustrated I felt by it. I didn't get off to the best of starts, dropping a shot at the first, but then I birdied the second and seventh to get to the turn in one under par, at which point I was two under for the tournament, and in good shape. But the back nine was frustrating. I missed the green with my second to the 10th and dropped a shot. At the par-three 11th, I struck a lovely iron shot that finished maybe 15 feet from the hole but the putt shaved the hole. It was the same story at the 12th, where once again I was within 15 feet in two but just missed the putt. Then came the 14th and 15th. The 16th is the 163-yard par three and again I played a super shot, 12 feet to the left of the hole, but missed the putt again. A routine par followed at the 17th and I had a good up-and-down at the last for a par. It all added up to a round of 74, and a 36-hole total of 143, three over par. I then had to spend the rest of the day waiting to find out whether or not I had made the cut.

I hit a six iron at the par three 16th and this time holed a putt of around 20 feet for another birdie. The best way to finish a round of golf is with a birdie at the last. I hit a drive and a five iron, probably my best two shots of the day, and held that for another birdie. I also left one or two shots out there, but all in all I am absolutely delighted. I dropped shots at the seventh and ninth but, in the conditions, that was always going to happen. I am delighted to get round in 69, especially after having two bogeys on the back nine. I missed the green with my second shot at the 12th, and then misjudged the amount of sand in the greenside bunker at the 13th. At the par-five 14th, I pulled my second shot, hit a decent pitch but missed the birdie putt.

This paper shows a detailed, advanced procedure to implement cost–benefit analyses (CBAs) in order to assess the effectiveness of flood mitigation measures. The town of Lodi (North of Italy) has been selected as a case study for the research work, as it was hit by a large flood in 2002 for which several data are available. In order to compute the benefits, in terms of avoided damage with the mitigation measure in place, micro-scale damage models developed within the Flood-IMPAT + project were used. The great amount of input data for such models comes from results of a two-dimensional river modelling, for what concern the hazard parameters, and from open-source database, to evaluate the vulnerability and the exposure of the hit area. The research highlights that technological-advanced, high-performance hydraulic models allow taking into account a variety of hazard scenarios, with reasonable computational time, supporting the proper accounting of the probabilistic nature of risk in CBAs. Nonetheless, such high-resolution tools support the implementation of micro-scale damage assessment models, which can provide information on the distribution of benefits in the investigated area, increasing the effectiveness of CBAs for policy making.

Endoscopic ear surgery has gained increasing popularity starting from the early 2000s, introducing new anatomical, physiological and surgical concepts in ear and lateral skull base surgery. Its development has brought new scientific knowledge, thus improving surgical technique with a minimally invasive attitude. The aim of this perspective is to review and summarize all the steps that brought endoscopic ear surgery from a surgery practiced by a few teams to a worldwide recognized advancement in otology.

The financial sector is a critical component of any economic system, as it delivers key qualitative asset transformation services in terms of liquidity, maturity and volume. Although these functions could in principle be carried out separately by specialized actors, in the end it is their systemic co-evolution that determines how the aggregate economy performs and withstands disruptions. In this paper we argue that a functional perspective on financial intermediation can be usefully employed to investigate the functioning of financial networks. We do this in two steps. First, we use previously unreleased data to show that focusing on the economic functions performed over time by the different institutions exchanging funds in an interbank market can be informative, even if the underlying topological structure of their relations remains constant. Second, a set of alternative artificial histories are generated and stress-tested by using real data as a calibration base, with the aim of performing counterfactual welfare comparisons among different topological structures.

: The aberrant subclavian artery (ASA) represents the most common congenital anomaly of the aortic arch, and is frequently associated with a Kommerell diverticulum, an aneurysmal dilation at the anomalous vessel origin. This condition carries a significant risk of rupture and dissection, and growing evidence indicates that local hemodynamic alterations may contribute to its development and progression. Computational Fluid Dynamics (CFD) provides a valuable non-invasive modality to assess biomechanical stresses and elucidate the pathophysiological mechanisms underlying these vascular abnormalities. : In this study, twelve thoracic CT angiography scans were analyzed: six from patients with ASA and six from individuals with normal aortic anatomy. CFD simulations were performed using OpenFOAM, with standardized boundary conditions applied across all cases to isolate the influence of anatomical differences in flow behavior. Four key hemodynamic metrics were evaluated-Wall Shear Stress (WSS), Oscillatory Shear Index (OSI), Drag Forces (DF), and Turbulent Viscosity Ratio (TVR). The aortic arch was subdivided into Ishimaru zones 0-3, with an adapted definition accounting for ASA anatomy. For each region, time- and space-averaged quantities were computed to characterize mean values and oscillatory behavior. : The findings demonstrate that patients with ASA exhibit markedly altered hemodynamics in zones 1-3 compared to controls, with consistently elevated WSS, OSI, DF, and TVR. The most pronounced abnormalities occurred in zones 2-3 near the origin of the aberrant vessel, where disturbed flow patterns and off-axis mechanical forces were observed. These features may promote chronic wall stress, endothelial dysfunction, and localized aneurysmal degeneration. Notably, two patients (M1 and M6) displayed particularly elevated drag forces and TVR in the distal arch, correlating with the presence of a distal aneurysm and right-sided arch configuration, respectively. Overall, this work supports the hypothesis that aberrant hemodynamics contribute to Kommerell diverticulum formation and progression, and highlights the CFD's feasibility for clarifying disease mechanisms, characterizing flow patterns, and informing endovascular planning by identifying hemodynamically favorable landing zones.