LIVIVO - The Search Portal for Life Sciences

zur deutschen Oberfläche wechseln
Advanced search

Search results

Result 1 - 10 of total 24

Search options

  1. Article ; Online: Value-Based Healthcare and Enhanced Recovery After Surgery Implementation in a High-Volume Bariatric Center in Italy.

    Goretti, Giulia / Marinari, Giuseppe M / Vanni, Elena / Ferrari, Chiara

    Obesity surgery

    2020  Volume 30, Issue 7, Page(s) 2519–2527

    Abstract: Background: Bariatric surgery is the most effective treatment for patients affected by morbid obesity. The Enhanced Recovery After Surgery (ERAS) protocol increases clinical outcomes, but the most recent literature shows incomplete patients' adherence. ... ...

    Abstract Background: Bariatric surgery is the most effective treatment for patients affected by morbid obesity. The Enhanced Recovery After Surgery (ERAS) protocol increases clinical outcomes, but the most recent literature shows incomplete patients' adherence. This study aims to demonstrate the feasibility of applying a Value-Based Healthcare (VBHC) strategy associated with ERAS to increase patients' engagement and outcomes.
    Method: A multiprofessional team redesigned the process considering ERAS recommendations and patients' feedbacks. Outcomes that matter to patients were defined with structured patients' interviews and collected in the electronic clinical record. Adherence to the pathway and the cost of the cycle of care were measured to demonstrate sustainability. A model was developed to grant its replicability.
    Results: A total of 2.122 patients were included. The lowest adherence to the protocol for a single item was 82%. 74% of excess weight loss; 90% better comorbidities control; 77.5% had no pain after surgery; 61% no postoperative nausea and vomiting. Zero mortality; 1.8% overall morbidity; 0.4% readmission and reoperation rate within 30 days. The average length of stay is 2.1 days. Patient-Reported Outcome Measures (PROMs) documented increased productivity and quality of life.
    Conclusion: Building a caring relationship by a multidisciplinary team, adding patient wellness in a VBHC framework on top of ERAS as a patient-centered approach, increases patients' engagement and adherence to the pathway of care, resulting in better health outcomes (clinical and PROMs). The Value-Based Model is sustainable and replicable; it represents the prototype for redesigning other pathways and may become a model for other organizations.
    MeSH term(s) Bariatric Surgery ; Delivery of Health Care ; Enhanced Recovery After Surgery ; Humans ; Italy/epidemiology ; Length of Stay ; Obesity, Morbid/surgery ; Postoperative Complications/epidemiology ; Quality of Life
    Language English
    Publishing date 2020-02-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1070827-3
    ISSN 1708-0428 ; 0960-8923
    ISSN (online) 1708-0428
    ISSN 0960-8923
    DOI 10.1007/s11695-020-04464-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

    Full text online

    More links

    Kategorien

    In stock of ZB MED Cologne/Königswinter

    Zs.A 3381: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

  2. Article ; Online: Trends and safety of bariatric revisional surgery in Italy: multicenter, prospective, observational study.

    Boru, Cristian E / Marinari, Giuseppe M / Olmi, Stefano / Gentileschi, Paolo / Morino, Mario / Anselmino, Marco / Foletto, Mirto / Bernante, Paolo / Piazza, Luigi / Perrotta, Nicola / Morganti, Riccardo / Silecchia, Gianfranco

    Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

    2023  Volume 19, Issue 11, Page(s) 1270–1280

    Abstract: Background: Revisional bariatric surgery (RBS) represents a further solution for patients who experience inadequate weight loss (IWL) following primary bariatric surgery (BS) or significant weight regain (WR) following initial satisfactory response. RBS ...

    Abstract Background: Revisional bariatric surgery (RBS) represents a further solution for patients who experience inadequate weight loss (IWL) following primary bariatric surgery (BS) or significant weight regain (WR) following initial satisfactory response. RBS guidelines are lacking; however, an increased trend in further BS offerings has been reported recently.
    Objective: Analyze trend, mortality, complication, readmission, and reoperation rates for any reason at 30 days after RBS in Italy.
    Setting: Ten Italian high-volume BS centers (university hospitals and private centers).
    Methods: Prospective, observational, multicenter study enrolling patients undergoing RBS between October 1, 2021, and March 31, 2022, registering reasons for RBS, technique, mortality, intraoperative and perioperative complications, readmissions, and reinterventions for any reason. Patients undergoing RBS during the same calendar interval in 2016-2020 were considered control patients.
    Results: A total of 220 patients were enrolled and compared with 560 control-group patients. Mortality was .45% versus .35% (n.s), with an overall mortality of .25%, while open surgery or conversion to open surgery was registered in 1%. No difference was found for mortality, morbidity, complications, readmission (1.3%), and reoperation rates (2.2%). IWL/WR was the most frequent cause, followed by gastroesophageal reflux disease; Roux-en-Y gastric bypass was the most used revisional procedure (56%). Sleeve gastrectomy was the most revised procedure in the study group, while gastric banding was the most revised in the control group. RBS represents up to 9% of the total BS in the Italian participating centers.
    Conclusions: Laparoscopy represents the standard approach for RBS, which appears safe. Current Italian trends show a shift toward sleeve gastrectomy being the most revised procedure and Roux-en-Y gastric bypass being the most frequent revisional procedure.
    Language English
    Publishing date 2023-05-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2274243-8
    ISSN 1878-7533 ; 1550-7289
    ISSN (online) 1878-7533
    ISSN 1550-7289
    DOI 10.1016/j.soard.2023.05.009
    Database MEDical Literature Analysis and Retrieval System OnLINE

    Full text online

    More links

    Kategorien

    In stock of ZB MED Cologne/Königswinter

    Zs.A 6572: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

  3. Article ; Online: Sleeve gastrectomy leads to easy management of hormone replacement therapy and good weight loss in patients treated for craniopharyngioma.

    Trotta, Manuela / Da Broi, Joël / Salerno, Angelo / Testa, Rosa M / Marinari, Giuseppe M

    Updates in surgery

    2017  Volume 69, Issue 1, Page(s) 95–99

    Abstract: The aim of this study is to investigate the effects of sleeve gastrectomy on hormone replacement therapy and on hypothalamic obesity in patients affected by craniopharyngioma with post-surgical pan-hypopituitarism. A retrospective review of three ... ...

    Abstract The aim of this study is to investigate the effects of sleeve gastrectomy on hormone replacement therapy and on hypothalamic obesity in patients affected by craniopharyngioma with post-surgical pan-hypopituitarism. A retrospective review of three patients, treated for hypothalamic obesity with laparoscopic sleeve gastrectomy, who have previously undergone surgery for craniopharyngioma in their childhood, was done. Patients' mean age and BMI were 22.3 years (range 21-24) and 49.2 kg/m
    Language English
    Publishing date 2017-03
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-017-0425-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

    Full text online

    More links

    Kategorien

    In stock of ZB MED Cologne/Königswinter

    Zs.B 101: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

  4. Article ; Online: Bariatric and metabolic surgery during COVID-19 outbreak phase 2 in Italy: why, when and how to restart.

    Marinari, Giuseppe M / Anselmino, Marco / Tascini, Carlo / Bernante, Paolo / Foletto, Mirto / Gentileschi, Paolo / Morino, Mario / Olmi, Stefano / Toppino, Mauro / Silecchia, Gianfranco

    Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

    2020  Volume 16, Issue 10, Page(s) 1614–1618

    Abstract: In Italy elective bariatric and metabolic surgery was cancelled on February 21,2020 at the beginning of the so-called phase 1 of the SARS-CoV-2 outbreak. Gradually it was restarted on May 4,2020 at the beginning of the so-called phase 2, when ... ...

    Abstract In Italy elective bariatric and metabolic surgery was cancelled on February 21,2020 at the beginning of the so-called phase 1 of the SARS-CoV-2 outbreak. Gradually it was restarted on May 4,2020 at the beginning of the so-called phase 2, when epidemiological data showed containment of the infection. Before the outbreak in eight high-volume bariatric centers 840 patients were surgically treated developing a Covid-19 infection, during phase 1, in only 5 cases (0.6%) without mortality. The post-operative complication rate was similar when compared to the 836 subjects submitted to bariatric surgery the year before. Since the high prevalence of infection in subjects with BMI > 30, it was argued that early intervention on obesity during phase 2 could help to minimize the effects of the disease in the event of a possible reversion to a SARS-CoV-2 outbreak phase 1. At the same time a prospective observational study from July 1 till the WHO declaration of the end of the pandemic has started in the eight high volume centers to monitor the post-operative outcome and its effect on SARS-CoV-2 infection.
    MeSH term(s) Bariatric Surgery/statistics & numerical data ; Betacoronavirus ; COVID-19 ; Comorbidity ; Coronavirus Infections/epidemiology ; Coronavirus Infections/transmission ; Disease Transmission, Infectious/prevention & control ; Humans ; Obesity/epidemiology ; Obesity/surgery ; Pandemics ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/transmission ; SARS-CoV-2 ; Time Factors
    Keywords covid19
    Language English
    Publishing date 2020-06-24
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2274243-8
    ISSN 1878-7533 ; 1550-7289
    ISSN (online) 1878-7533
    ISSN 1550-7289
    DOI 10.1016/j.soard.2020.06.025
    Database MEDical Literature Analysis and Retrieval System OnLINE

    More links

    Kategorien

    In stock of ZB MED Cologne/Königswinter

    Zs.A 6572: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

  5. Article ; Online: Dietary habits and body weight at long-term following biliopancreatic diversion.

    Cornicelli, Miriam / Noli, Gloria / Marinari, Giuseppe M / Adami, Gian Franco

    Obesity surgery

    2010  Volume 20, Issue 9, Page(s) 1278–1280

    Abstract: Aim: This study aims to evaluate the role of simple carbohydrates and alcohol intake in determining weight of stabilization at long-term following malabsorptive bariatric surgery.: Material and methods: Sixty patients at more than 2 years following ... ...

    Abstract Aim: This study aims to evaluate the role of simple carbohydrates and alcohol intake in determining weight of stabilization at long-term following malabsorptive bariatric surgery.
    Material and methods: Sixty patients at more than 2 years following biliopancreatic diversion (BPD) were submitted to an alimentary interview for evaluating the daily consumption of simple sugar, fruits, ice-cream, sweets, and caloric and alcoholic beverages. Eating behavior was assessed by Three Factors Eating Questionnaire.
    Results: The mean estimated daily energy consumption intake was 2,852 kcal, with a mean daily intake of simple carbohydrates of 89 g that represented 12% of the total energy intake. The current body weight was positively and independently related to the preoperative body weight and to simple carbohydrate and alcohol intake and negatively related to physical activity, while no association with total energy consumption and eating behavior was found.
    Discussion: These findings confirm that following BPD the body weight is independent of energy intake and eating behavior. Furthermore, these data suggest that in post-BPD subjects the simple carbohydrates and alcohol absorption is fully preserved, and that the operated subjects could regulate their body weight by reducing simple carbohydrates and alcoholic intake and increasing physical activity.
    MeSH term(s) Alcohol Drinking ; Biliopancreatic Diversion ; Body Mass Index ; Body Weight ; Dietary Carbohydrates/administration & dosage ; Energy Intake ; Feeding Behavior ; Female ; Humans ; Male ; Motor Activity ; Obesity, Morbid/physiopathology ; Obesity, Morbid/surgery ; Weight Loss
    Chemical Substances Dietary Carbohydrates
    Language English
    Publishing date 2010-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1070827-3
    ISSN 1708-0428 ; 0960-8923
    ISSN (online) 1708-0428
    ISSN 0960-8923
    DOI 10.1007/s11695-010-0111-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

    Full text online

    More links

    Kategorien

    In stock of ZB MED Cologne/Königswinter

    Zs.A 3381: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

  6. Article: Bariatric and metabolic surgery during COVID-19 outbreak phase 2 in Italy: why, when and how to restart

    Marinari, Giuseppe M / Anselmino, Marco / Tascini, Carlo / Bernante, Paolo / Foletto, Mirto / Gentileschi, Paolo / Morino, Mario / Olmi, Stefano / Toppino, Mauro / Silecchia, Gianfranco

    Surg Obes Relat Dis

    Abstract: In Italy elective bariatric and metabolic surgery was cancelled on February 21,2020 at the beginning of the so-called phase 1 of the SARS-CoV-2 outbreak. Gradually it was restarted on May 4,2020 at the beginning of the so-called phase 2, when ... ...

    Abstract In Italy elective bariatric and metabolic surgery was cancelled on February 21,2020 at the beginning of the so-called phase 1 of the SARS-CoV-2 outbreak. Gradually it was restarted on May 4,2020 at the beginning of the so-called phase 2, when epidemiological data showed containment of the infection. Before the outbreak in eight high-volume bariatric centers 840 patients were surgically treated developing a Covid-19 infection, during phase 1, in only 5 cases (0.6%) without mortality. The post-operative complication rate was similar when compared to the 836 subjects submitted to bariatric surgery the year before. Since the high prevalence of infection in subjects with BMI > 30, it was argued that early intervention on obesity during phase 2 could help to minimize the effects of the disease in the event of a possible reversion to a SARS-CoV-2 outbreak phase 1. At the same time a prospective observational study from July 1 till the WHO declaration of the end of the pandemic has started in the eight high volume centers to monitor the post-operative outcome and its effect on SARS-CoV-2 infection.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #613421
    Database COVID19

    Kategorien

    Inter-library loan at ZB MED

    Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

  7. Article ; Online: Bariatric and metabolic surgery during COVID-19 outbreak phase 2 in Italy

    Marinari, Giuseppe M. / Anselmino, Marco / Tascini, Carlo / Bernante, Paolo / Foletto, Mirto / Gentileschi, Paolo / Morino, Mario / Olmi, Stefano / Toppino, Mauro / Silecchia, Gianfranco

    Surgery for Obesity and Related Diseases

    why, when and how to restart

    2020  Volume 16, Issue 10, Page(s) 1614–1618

    Keywords Surgery ; covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ZDB-ID 2274243-8
    ISSN 1878-7533 ; 1550-7289
    ISSN (online) 1878-7533
    ISSN 1550-7289
    DOI 10.1016/j.soard.2020.06.025
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

    Full text online

    More links

    Kategorien

    In stock of ZB MED Cologne/Königswinter

    Zs.A 6572: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

  8. Article: Histological alterations following bariatric surgery: pilot study.

    Migliori, Franco Carlo / Robello, Giacomo / Ravetti, Jean L / Marinari, Giuseppe M

    Obesity surgery

    2008  Volume 18, Issue 10, Page(s) 1305–1307

    Abstract: Background: Macroscopic clinical evidence of tissue damaging following bariatric surgery pushed plastic surgeons to presume microscopic alterations as well.: Methods: Five preliminary cases studied randomly, and compared with healthy tissues, ... ...

    Abstract Background: Macroscopic clinical evidence of tissue damaging following bariatric surgery pushed plastic surgeons to presume microscopic alterations as well.
    Methods: Five preliminary cases studied randomly, and compared with healthy tissues, confirmed these initial suspects. A deeper and wider study has then been structured.
    Results: Preliminary results are so evident to encourage us to carry on an estimated 2-3 years multidisciplinary study.
    Conclusions: What we want to study is if histological post-bariatric alterations are confirmed, and if these can be considered responsible for higher complication rate in body contouring following bariatric surgery.
    MeSH term(s) Abdominal Fat/pathology ; Abdominal Fat/surgery ; Abdominal Wall/pathology ; Abdominal Wall/surgery ; Adult ; Bariatric Surgery ; Biliopancreatic Diversion ; Case-Control Studies ; Dermis/pathology ; Dermis/surgery ; Female ; Humans ; Male ; Obesity, Morbid/pathology ; Obesity, Morbid/surgery ; Pilot Projects ; Reconstructive Surgical Procedures ; Time Factors
    Language English
    Publishing date 2008-04-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1070827-3
    ISSN 1708-0428 ; 0960-8923
    ISSN (online) 1708-0428
    ISSN 0960-8923
    DOI 10.1007/s11695-008-9503-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

    Full text online

    More links

    Kategorien

    In stock of ZB MED Cologne/Königswinter

    Zs.A 3381: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

  9. Article: A new approach to the fashioning of the gastroenteroanastomosis in laparoscopic standard biliopancreatic diversion.

    Camerini, Giovanni / Marinari, Giuseppe M / Scopinaro, Nicola

    Surgical laparoscopy, endoscopy & percutaneous techniques

    2003  Volume 13, Issue 3, Page(s) 165–167

    Abstract: A retrocolic submesocolic approach was used for creating the gastroenteroanastomosis in 42 consecutive patients who underwent laparoscopic biliopancreatic diversion for obesity. The surgical technique is described in detail. The laparoscopic ... ...

    Abstract A retrocolic submesocolic approach was used for creating the gastroenteroanastomosis in 42 consecutive patients who underwent laparoscopic biliopancreatic diversion for obesity. The surgical technique is described in detail. The laparoscopic gastroenteroanastomosis was successfully performed on all the operated patients, with no intraoperative complications requiring conversion to open surgery and no immediate or late postoperative morbidity related to the anastomosis.
    MeSH term(s) Adult ; Biliopancreatic Diversion/methods ; Female ; Gastroenterostomy/methods ; Humans ; Laparoscopy/methods ; Male ; Middle Aged ; Obesity/surgery ; Outcome Assessment (Health Care)
    Language English
    Publishing date 2003-06-10
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1475108-2
    ISSN 1534-4908 ; 1530-4515 ; 1051-7200
    ISSN (online) 1534-4908
    ISSN 1530-4515 ; 1051-7200
    DOI 10.1097/00129689-200306000-00005
    Database MEDical Literature Analysis and Retrieval System OnLINE

    More links

    Kategorien

    In stock of ZB MED Cologne/Königswinter

    Zs.A 3200: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

  10. Article: Laparoscopic standard biliopancreatic diversion: technique and preliminary results.

    Scopinaro, Nicola / Marinari, Giuseppe M / Camerini, Giovanni

    Obesity surgery

    2002  Volume 12, Issue 2, Page(s) 241–244

    Abstract: Background: A technique for standard laparoscopic BPD was developed.: Methods: Standard laparoscopic BPD was performed in 26 morbidly obese patients with mean BMI 43. Details of the technique, using 6 trocars, and instrumentation are described. ... ...

    Abstract Background: A technique for standard laparoscopic BPD was developed.
    Methods: Standard laparoscopic BPD was performed in 26 morbidly obese patients with mean BMI 43. Details of the technique, using 6 trocars, and instrumentation are described. Intestinal limb lengths were measured fully stretched, and the gastric remnant volume was also measured. Both enteroenteral and gastrointestinal anastomoses were fashioned with a side-to-side technique using the endoGIA, the conjoined defect being closed with a manual running seromuscular suture.
    Results: 6 and 12 month weight loss results were similar to those obtained in open BPD.
    Conclusion: Laparoscopic standard BPD is a feasible alternative to the open operative procedure, the major advantage being the likely near total avoidance of wound hernia.
    MeSH term(s) Adult ; Biliopancreatic Diversion/standards ; Body Mass Index ; Female ; Humans ; Laparoscopy/standards ; Male ; Middle Aged ; Obesity, Morbid/surgery ; Treatment Outcome
    Language English
    Publishing date 2002-04
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1070827-3
    ISSN 1708-0428 ; 0960-8923
    ISSN (online) 1708-0428
    ISSN 0960-8923
    DOI 10.1381/096089202762552692
    Database MEDical Literature Analysis and Retrieval System OnLINE

    Full text online

    More links

    Kategorien

    In stock of ZB MED Cologne/Königswinter

    Zs.A 3381: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

To top