Robotic Approach to Colon Resection

Robotic surgical techniques are being increasingly adopted as a tool in the minimally invasive armamentarium of the colorectal surgeon. These platforms present numerous potential advantages in visualization, precise dissection, and tissue manipulation while potentially reducing operator fatigue. They may also reduce the learning curve and rate of conversion, though the short- and long-term benefits of this approach in non-pelvic colorectal surgery, and the cost–benefit balance remain an ongoing debate. Adherence to established principles of laparoscopic colon surgery, a robust understanding of the operative anatomy, and proper patient preparation and setup are critical for the efficient and effective utilization of a robotic approach for colon resection

Infarct-like myocarditis with coronary vasculitis and aneurysm formation caused by epstein–barr virus infection

Myocardial infection by Epstein–Barr virus (EBV) may manifest with inflammatory cardiomyopathy, coronary syndrome X, and rarely with infarct-like myocarditis. The aim of the report is to describe a case of myocardial EBV infection causing acute myocarditis with heart failure, necrotizing coronary vasculitis, and multiple left ventricular (LV) aneurysms. A 67-year-old woman presented with fever, chest pain, and heart failure. She underwent non-invasive cardiac studies including electrocardiography, 2D-echocardiography, cardiac magnetic resonance, hematochemical exams with Troponin T determination, and invasive studies including cardiac catheterization, coronary angiography, and LV endomyocardial biopsy. Five endomyocardial samples were processed for histology and immunohistochemistry for inflammatory cells characterization and detection of viral antigens. Two additional frozen samples were evaluated by real-time polymerase chain reaction for the presence of cardiotropic viral genomes. Routine laboratory tests revealed the presence of elevated white blood cells (17 000 103/μL) and increased Troponin T. Electrocardiogram showed sinus tachycardia with ST elevation in V2–V5. Two-dimensional echocardiography showed normal LV dimension with reduced LV contractility (LVEF = 40%) with mild pericardial effusion. Cardiac magnetic resonance revealed the presence of a micro-aneurism in the inferior LV wall, a diffuse oedematous imbibition of LV myocardium suggested by hyper-intensity of T2 mapping, and increased fibrosis as suggested by areas of late gadolinium enhancement signals. Coronary arteries were normal while several micro-aneurysms were observed at LV angiography. At histology, a lymphocytic myocarditis with necrotizing coronary vasculitis sustained by a positive real-time polymerase chain reaction for EBV, detectable in cardiomyocytes and inflamed intramural vessels by positive immunohistochemistry for EBV latent membrane protein 1 antigen, was observed. Myocardial EBV infection is an unusual cause of acute heart failure and cardiac aneurysms, increasing the risk of electrical instability, cardiac perforation, and sudden death

The current landscape of imaging recommendations in cardiovascular clinical guidelines: toward an imaging-guided precision medicine

The purpose of this article is to provide an overview on the role of CT scan and MRI according to selected guidelines by the European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association (ACC/AHA). ESC and ACC/AHA guidelines were systematically reviewed for recommendations to CT and MRI use in specific cardiovascular (CV) clinical categories. All recommendations were collected in a dataset, including the class of recommendation, the level of evidence (LOE), the specific imaging technique, the clinical purpose of the recommendation and the recommending Society. Among the 43 included guidelines (ESC: n = 18, ACC/AHA: n = 25), 26 (60.4%) contained recommendations for CT scan or MRI (146 recommendations: 62 for CT and 84 for MRI). Class of recommendation IIa (32.9%) was the most represented, followed by I (28.1%), IIb (24%) and III (11.9%). MRI recommendations more frequently being of higher class (I: 36.9%, IIa: 29.8%, IIb: 21.4%, III: 11.9%) as compared to CT (I: 16.1%, IIa: 37.1%, IIb: 27.4%, III: 19.4%). Most of recommendation (55.5%) were based on expert opinion (LOE C). The use of cardiac CT and cardiac MR in the risk assessment, diagnosis, therapeutic and procedural planning is in continuous development, driven by an increasing need to evolve toward an imaging-guided precision medicine, combined with cost-effectiveness and healthcare sustainability. These developments must be accompanied by an increased availability of high-performance scanners in healthcare facilities and should emphasize the need of increasing the number of radiologists fully trained in cardiac imaging

Early myocardial damage and microvascular dysfunction in asymptomatic patients with systemic sclerosis: A cardiovascular magnetic resonance study with cold pressor test

Purpose: Cardiac involvement in Systemic Sclerosis (SSc) is increasingly recognized as a mayor cause of morbidity and mortality. The aim of present study is to investigate the early stages of cardiac involvement in SSc by Cardiovascular magnetic resonance (CMR), combining the non-invasive detection of myocardial inflammation and fibrosis using T2 and T1 mapping techniques and the assessment of microcirculatory impairment through perfusion response to cold pressor test (CPT). Methods: 40 SSc patients (30 females, mean age: 42.1 years) without cardiac symptoms and 10 controls underwent CMR at 1.5 T unit. CMR protocol included: native and contrast-enhanced T1 mapping, T2 mapping, T2-weighted, cineMR and late gadolinium enhancement (LGE) imaging. Microvascular function was evaluated by comparing myocardial blood flow (MBF) on perfusion imaging acquired at rest and after CPT. Native myocardial T1 and T2 relaxation times, extracellular volume fraction (ECV), T2 signal intensity ratio, biventricular volumes and LGE were assessed in each patient. Results: SSc patients had significantly higher mean myocardial T1 (1029±32ms vs. 985±18ms, p<0.01), ECV (30.1±4.3% vs. 26.7±2.4%, p<0.05) and T2 (50.1±2.8ms vs. 47±1.5ms, p<0.01) values compared with controls. No significant differences were found between absolute MBF values at rest and after CPT; whereas lower MBF variation after CPT was observed in SSc patients (+33 ± 14% vs. +44 ± 12%, p<0.01). MBF variation had inverse correlation with native T1 values (r: -0.32, p<0.05), but not with ECV. Conclusions: Myocardial involvement in SSc at preclinical stage increases native T1, T2 and ECV values, reflecting inflammation and fibrosis, and reduces vasodilatory response to CPT, as expression of microvascular dysfunction

Cardiovascular magnetic resonance (CMR) and positron emission tomography (PET) imaging in the diagnosis and follow-up of patients with acute myocarditis and chronic inflammatory cardiomyopathy : A review paper with practical recommendations on behalf of the European Society of Cardiovascular Radiology (ESCR).

Advanced cardiac imaging techniques such as cardiovascular magnetic resonance (CMR) and positron emission tomography (PET) are widely used in clinical practice in patients with acute myocarditis and chronic inflammatory cardiomyopathies (I-CMP). We aimed to provide a review article with practical recommendations from the European Society of Cardiovascular Radiology (ESCR), in order to guide physicians in the use and interpretation of CMR and PET in clinical practice both for acute myocarditis and follow-up in chronic forms of I-CMP

Prediction of Shoreline Evolution. Reliability of a General Model for the Mixed Beach Case

In the present paper, after a sensitivity analysis, the calibration and verification of a novel morphodynamic model have been conducted based on a high-quality field experiment data base. The morphodynamic model includes a general formula to predict longshore transport and associated coastal morphology over short- and long-term time scales. With respect to the majority of the existing one-line models, which address sandy coastline evolution, the proposed General Shoreline beach model (GSb) is suitable for estimation of shoreline change at a coastal mound made of non-cohesive sediment grains/units as sand, gravel, cobbles, shingle and rock. In order to verify the reliability of the GSb model, a comparison between observed and calculated shorelines in the presence of a temporary groyne deployed at a mixed beach has been performed. The results show that GSb gives a good agreement between observations and predictions, well reproducing the coastal evolution.</jats:p

Plaque imaging volume analysis: technique and application

The prevention and management of atherosclerosis poses a tough challenge to public health organizations worldwide. Together with myocardial infarction, stroke represents its main manifestation, with up to 25% of all ischemic strokes being caused by thromboembolism arising from the carotid arteries. Therefore, a vast number of publications have focused on the characterization of the culprit lesion, the atherosclerotic plaque. A paradigm shift appears to be taking place at the current state of research, as the attention is gradually moving from the classically defined degree of stenosis to the identification of features of plaque vulnerability, which appear to be more reliable predictors of recurrent cerebrovascular events. The present review will offer a perspective on the present state of research in the field of carotid atherosclerotic disease, focusing on the imaging modalities currently used in the study of the carotid plaque and the impact that such diagnostic means are having in the clinical setting

Recent improvements for estimation of longshore transport

Sempre pi\uf9 frequentemente, la preservazione dei paesaggi costieri, di centri urbani, di infrastrutture per la viabilit\ue0 o dell'industria del turismo balneare pone la necessit\ue0 di ricorrere ad interventi di ripascimento delle spiagge soggette ad erosione. La longevit\ue0 degli interventi talvolta non risulta adeguatamente commisurata al costo sostenuto per la loro attuazione: non \ue8 raro che interventi di ripascimento, protetti o non, si depauperino in un breve lasso di tempo seguente alla esecuzione del lavoro, vanificando cos\uec l'investimento. Pertanto, negli ultimi anni, il progettista di un intervento di difesa della spiaggia dall'erosione tende a valutare la possibilit\ue0 di effettuare il ripascimento artificiale di spiagge soggette ad erosione mediante l'impiego di materiali pi\uf9 grossolani rispetto alla sabbia nativa; tanto al fine di ottenere una spiaggia composta da elementi dotati di una maggiore stabilit\ue0 idraulica rispetto a quelli della spiaggia originaria, a parit\ue0 di condizioni di moto ondoso presenti nell'area di interesse. Tra gli altri, anche le Linee Guida per la difesa delle coste basse della Regione Puglia denominate "Individuazione di strutture di mitigazione del rischio per ciascuna unit\ue0 fisiografica" invitano il progettista all'utilizzo di ghiaie o ciottoli per il ripascimento di arenili, tanto allo scopo di incrementare la longevit\ue0 degli assai dispendiosi interventi a mare. Tuttavia, a tale condivisibile indicazione che giunge dagli Enti regolatori non corrisponde una adeguata risposta da parte del tecnico professionista. Ed infatti, mentre per il caso delle spiagge in sabbia esiste una ragguardevole conoscenza, la comunit\ue0 scientifica e professionale avverte l'assenza di criteri e metodi in grado di valutare i volumi di materiale che vengono mobilizzati dall'azione del moto ondoso che interagisce con una spiaggia, anche se questa \ue8 formata da materiali che non siano sabbia; in particolare, la necessit\ue0 di poter disporre di mezzi di calcolo che non siano limitati al solo caso delle spiagge in sabbia \ue8 maggiormente avvertita per la determinazione del trasporto litoraneo di ghiaie, ciottoli e spiagge miste (sabbia, ghiaie e ciottoli). Il presente studio intende dare un contributo al tema del calcolo del trasporto litoraneo per spiagge composte da materiali pi\uf9 grossolani rispetto alla sabbia. In particolare, \ue8 stata condotta la verifica delle capacit\ue0 del modello GLT (Tomasicchio et alii, 2013) nella stima del trasporto litoraneo per spiagge in ciottoli e spiagge miste. Il modello GLT adotta un approccio del tipo a flusso di energia, combinato con una relazione di tipo empirico/statistico tra la forzante, rappresentata dal moto ondoso incidente, e il numero di elementi che subiscono lo spostamento; GLT assume l'ipotesi che gli elementi che compongono la spiaggia si muovono, durante le fasi di risalita e discesa dell'onda lungo la battigia, con obliquit\ue0 pari a quella delle onde frangenti e riflesse in corrispondenza della profondit\ue0 di frangimento. Allo scopo \ue8 stata verificata la appropriatezza del modello GLT nella quantificazione del trasporto litoraneo per il caso di spiagge in ciottoli. In particolare, la verifica \ue8 stata condotta, evitando qualsiasi tipo di taratura preventiva, mediante il confronto tra i risultati del modello e i dati osservati in campo (Chadwick, 1989; Nicholls &amp; Wright, 1991); il confronto tra il dato osservato e il dato calcolato ha mostrato che il modello GLT \ue8 in grado di predire i dati del trasporto osservati con un'approssimazione limitata ad un fattore 2. Al fine di introdurre ulteriori termini di raffronto per il modello GLT, la sua capacit\ue0 di calcolo \ue8 stata verificata favorevolmente anche rispetto ad un'altra formula generale per la stima del trasporto lungo spiagge composte da ciottoli (Van Rijn, 2014). Infine, passando ad un caso non raro in natura, ma anzi assai diffuso lungo le coste della Nuova Zelanda, dell'Inghilterra, dell'Iran, della Russia o della Calabria, l'affidabilit\ue0 del modello GLT \ue8 stata accertata anche per il caso delle spiagge composte da sabbie, ghiaie e ciottoli (miste); tale seconda verifica \ue8 stata resa possibile dalla disponibilit\ue0 di dati di letteratura osservati in campo per spiaggia mista e spiaggia in ghiaia nella baia di Hawke's Bay, lungo la costa est della Nuova Zelanda (Komar, 2010). A seguito della verifica favorevole del modello GLT condotta per il caso di spiagge in ciottoli e miste, \ue8 possibile sostenerne la possibilit\ue0 di impiego per il caso di progettazione di interventi di ripascimento per i quali si intenda utilizzare materiali pi\uf9 grossolani rispetto alla sabbia. E' anche possibile ipotizzare l'utilizzo del modello nello sviluppo di modelli di previsione della evoluzione nel tempo della linea di riva per spiagge composte da ciottoli o di tipo misto.In the present study, the accuracy of the GLT model (Tomasicchio et alii, 2013) has been verified for the estimation of the Longshore Transport (LT) at shingle and mixed beaches. In order to verify the suitability of the GLT model in determining LT estimates at shingle beaches, without any further calibration, the comparison between the LT predictions and observations from two field data sets (Chadwick, 1989; Nicholls &amp; Wright, 1991) has been considered. The comparison showed that the GLT predicted LT rates within a factor of 2 of the observed values. The predictive capability of the GLT has been also verified against an alternative general formula for the LT estimation at shingle beaches (Van Rijn, 2014). In addition, the suitability of the GLT model, even for the mixed beach case, has been assessed by means of the comparison between the LT prediction and the observation from a field experiment on a mixed sand and gravel beach at Hawke's Bay, on the east coast of New Zealand (Komar, 2010)

Role of computed tomography in predicting critical disease in patients with covid-19 pneumonia: a retrospective study using a semiautomatic quantitative method

Background: So far, only a few studies evaluated the correlation between CT features and clinical outcome in patients with COVID-19 pneumonia. Purpose: To evaluate CT ability in differentiating critically ill patients requiring invasive ventilation from patients with less severe disease. Methods: We retrospectively collected data from patients admitted to our institution for COVID-19 pneumonia between March 5th-24th. Patients were considered critically ill or non-critically ill, depending on the need for mechanical ventilation. CT images from both groups were analyzed for the assessment of qualitative features and disease extension, using a quantitative semiautomatic method. We evaluated the differences between the two groups for clinical, laboratory and CT data. Analyses were conducted on a per-protocol basis. Results: 189 patients were analyzed. PaO2/FIO2 ratio and oxygen saturation (SaO2) were decreased in critically ill patients. At CT, mixed pattern (ground glass opacities (GGO) and consolidation) and GGO alone were more frequent respectively in critically ill and in non-critically ill patients (p &lt; 0.05). Lung volume involvement was significantly higher in critically ill patients (38.5 % vs. 5.8 %, p &lt; 0.05). A cut-off of 23.0 % of lung involvement showed 96 % sensitivity and 96 % specificity in distinguishing critically ill patients from patients with less severe disease. The fraction of involved lung was related to lactate dehydrogenase (LDH) levels, PaO2/FIO2 ratio and SaO2 (p &lt; 0.05). Conclusion: Lung disease extension, assessed using quantitative CT, has a significant relationship with clinical severity and may predict the need for invasive ventilation in patients with COVID-19

Impact of surface topography on the bacterial attachment to micro- and nano-patterned polymer films

The development of antimicrobial surfaces has become a high priority in recent times. There are two ongoing worldwide health crises: the COVID-19 pandemic provoked by the SARS-CoV-2 virus and the antibiotic-resistant diseases provoked by bacteria resistant to antibiotic-based treatments. The need for antimicrobial surfaces against bacteria and virus is a common factor to both crises. Most extended strategies to prevent bacterial associated infections rely on chemical based-approaches based on surface coatings or biocide encapsulated agents that release chemical agents. A critical limitation of these chemistry-based strategies is their limited effectiveness in time while grows the concerns about the long-term toxicity on human beings and environment pollution. An alternative strategy to prevent bacterial attachment consists in the introduction of physical modification to the surface. Pursuing this chemistry-independent strategy, we present a fabrication process of surface topographies [one-level (micro, nano) and hierarchical (micro+nano) structures] in polypropylene (PP) substrates and discuss how wettability, topography and patterns size influence on its antibacterial properties. Using nanoimprint lithography as patterning technique, we report as best results 82 and 86% reduction in the bacterial attachment of E. coli and S. aureus for hierarchically patterned samples compared to unpatterned reference surfaces. Furthermore, we benchmark the mechanical properties of the patterned PP surfaces against commercially available antimicrobial films and provide evidence for the patterned PP films to be suitable candidates for use as antibacterial functional surfaces in a hospital environment.This work is funded by the European Commission, under the project FLEXPOL (H2020-NMBPPILOT-2016-721062). The present study was carried out as part of a European project called “Antimicrobial FLEXible POLymers for its use in hospital environments” (FLEXPOL grant agreement No. 721062) funded by Horizon 2020 Framework Programme for Research and Innovation (2014-2020)