The role of haptic feedback in video-Assisted thoracic surgery simulation training

technological advances on haptic devices, together with further studies focused on haptic feedback, be useful to develop efficient and effective training curricula and for establishing the value of simulators with haptic feedback in training and assessing thoracic surgical skills

Cervico-mediastinal schwannoma of the vagus nerve: resection with intraoperative nerve monitoring.

Schwannomas are usually benign, single, encapsulated, slow-growing tumours originating from cranial or spinal nerve sheaths. The vagus nerve involvement at the mediastinal inlet is very uncommon. For anatomical reasons, the resection of cervical and mediastinal schwannoma of the vagus nerve has a high risk of vocal fold paralysis. We describe the case of a 67-year-old female with a cervico-mediastinal schwannoma of the vagus nerve that we removed using the intraoperative neuromonitoring technique. The patient presented with mild hoarseness and complained of discomfort behind the jugular notch. Neck and chest computerized tomography described a 35 9 30 mm solid lesion behind the left clavi-sternal junction; preoperative fine needle aspiration cytology revealed schwannoma. Resection of the mass was performed with a cervical approach and the vagus nerve tumour was completely removed under continuous neuromonitoring (NIM-3 System), preserving the vagus and the recurrent laryngeal nerve function. Pathology on the resected mass documented A-type schwannoma with \u2018\u2018ancient schwannoma\u2019\u2019 areas. The intraoperative neurostimulation and neuromonitoring approach for the resection of vagus schwannoma are recommended because it may reduce the risk of injury to the vagus and to the recurrent laryngeal nerve

Nature reappraisers, benefits for the environment: A model linking cognitive reappraisal, the “being away” dimension of restorativeness and eco-friendly behavior

In the last decades, an increasingly prominent role has been given to the motivational factors that can promote pro-environmental behavior. In this contribution, we focus on the role of the individual’s ability to shape the emotions originating from nature in engaging in pro-environmental behavior. In particular, we expect that an emotion regulation strategy as cognitive reappraisal should positively predict pro-environmental behavior, through enhanced perceived restorativeness attributed to the natural environment in terms of the experience of “being away.” One-hundred and fifteen visitors to an urban park (Parco Nord Milano) filled out a questionnaire including measures of cognitive reappraisal, the experience of “being away,” and pro-environmental behaviour while in the park. Results confirmed that cognitive reappraisal was positively and significantly related to pro-environmental behavior. Importantly, the indirect effect of cognitive reappraisal on pro-environmental behavior through the experience of “being away” was significant. Findings suggest the importance of implementing interventions aimed at promoting the habitual use of cognitive reappraisal to enhance the experience of “being away” and, thus, sustain pro-environmental behavior

Cinema in the training of psychiatry residents: focus on helping relationships

Background: Medical schools are currently charged with a lack of education as far as empathic/relational skills and the meaning of being a health-care provider are concerned, thus leading to increased interest in medical humanities. Discussion. Medical humanities can offer an insight into human illness and in a broader outlook into human condition, understanding of one self, responsibility. An empathic relation to patients might be fostered by a matching approach to humanities and sciences, which should be considered as subjects of equal relevance, complementary to one another. Recently, movies have been used in medical - especially psychiatric - trainees education, but mainly within the limits of teaching a variety of disorders. A different approach dealing with the use of cinema in the training of psychiatry residents is proposed, based on Jung and Hillman's considerations about the relation between images and archetypes, archetypal experience and learning. Summary. Selected full-length movies or clips can offer a priceless opportunity to face with the meaning of being involved in a care-providing, helping profession

Self-selection effects in smokers attending lung cancer screening: a 9.5-year population-based cohort study in Varese, Italy.

BACKGROUND:: We hypothesize that mortality risk profile of participants and nonparticipants in nonrandomized lung cancer (LC) screening of smokers may be different. METHODS:: In 1997, a population-based cohort of 5815 smokers of Varese Province was invited to nonrandomized LC screening by annual chest x-ray examination for 4 years. LC risk factors and screening participation rate were recorded. Except for screening, the whole cohort received usual care. After 9.5-year observation, we compared mortality of participants versus nonparticipants by assessing age-standardized all-cause mortality rate ratio (MRR) and disease group-specific MRR with 95% confidence intervals (95% CI). RESULTS:: Self-selected screening participants were 21% of cohort. Participants were younger (p < 0.001), were more frequently current smokers (p = 0.019), had more pack-years of smoking (p < 0.0001), and had higher rate of LC family history (p < 0.0001) and of occupational LC risk (p < 0.0001) relative to nonparticipants. In logistic regression analysis familial LC, occupational risk and pack-years smoked were significant predictors of participation in screening and of developing LC. Participants displayed a healthy effect, as shown by all-cause MRR = 0.67 (95% CI, 0.53-0.84), all cancers except LC MRR = 0.61 (95% CI, 0.41-0.91), cardiovascular diseases MRR = 0.38 (95% CI, 0.22-0.63), and noncancer disease other than cardiovascular or respiratory MRR = 0.57 (95% CI, 0.34-0.92). The LC mortality (MRR = 1.40; 95% CI, 1.03-1.91) was higher in participants relative to nonparticipants (p = 0.031). CONCLUSION:: The selection effect in LC screening participants was dual: healthy effect and higher LC mortality. In assessing the overall effectiveness of LC screening on a population level, a higher LC mortality risk in participants should be considered

Cost of a population-based programme of chest x-ray screening for lung cancer.

Background. After the implementation of a population- based programme of chest x-ray (CXR) screening on smokers in Varese, Italy, lung cancer (LC) mortality was significantly reduced. Analysis of the incremental costs due to this type of screening programme is needed to evaluate its economic impact on the healthcare system. Methods. In July 1997 a population-based cohort, consisting of all high-risk smokers (n=5,815) identified among 60,000 adult residents from the Varese province, was invited to a LC screening programme (an annual CXR for five years) in a general practice setting, and was observed through 2006. Invitees received National Health Service (NHS) usual care, with the addition of CXRs in screening participants. At the end of observation, among the 245 LCs diagnosed in the entire screening-invited cohort the observed LC deaths were 38 fewer than expected. To estimate the incremental direct cost due to screening in the invited cohort for the period July 1997-2006, we compared the direct cost of screening administration, CXR screens and LC management in the invited cohort and in the uninvited and unscreened controls in NHS usual care setting. Results. Over the 9.5 years, the total incremental direct healthcare costs (including screening organization/administration, CXR screens, additional procedures prompted by false-positive tests, overdiagnosed LCs) were estimated to range from \u20ac 607,440 to \u20ac 618,370 (in euros as of 2012), equating to between \u20ac 15,985- \u20ac 16,273 per patient out of the 38 LC deaths averted. Conclusions. In a general practice setting, the incremental cost for a CXR screening programme targeted at all high-risk smokers in a population of 60,000 adults was estimated to be about \u20ac65,000 per annum, approx. \u20ac16,000 for each LC death averted

Farnesyltransferase inhibitors and human malignant pleural mesothelioma: a first-step comparative translational study.

It is known that the potential clinical use of farnesyltransferase inhibitors (FTI) could be expanded to include cancers harboring activated receptor tyrosine kinases. Approximately 70% of malignant pleural mesotheliomas (MPM) overexpress epidermal growth factor receptors (EGFR) and a subset express both EGFR and transforming growth factor A (TGF-A), suggesting an autocrine role for EGFR in MPM. We checked on MPM cells (10 human cell lines, 11 primary cultures obtained by human biopsies, and 7 short-term normal mesothelial cell cultures) concerning the following: (a) the relative overexpression of EGFR (Western blotting, flow cytometry, immunohistochemistry), (b) the relative expression of EGFR ligands (EGF, amphiregulin, TGF-A, ELISA), (c) the relative increase of the activated form of Ras (Ras-bound GTP) after EGF stimulation (Ras activation assay), (d) the efficacy of five different FTIs (HDJ2 prenylation, cell cytotoxicity, and apoptosis using ApopTag and gel ladder). EGFR was overexpressed in MPM cells compared with normal pleural mesothelial cells in equivalent levels as in non\u2013small cell lung cancer cells A549. MPM cells constitutively expressed EGFR ligands; however, Ras activation was attenuated at high EGF concentrations (100 ng/mL). Growth of MPM cells was substantially not affected by treatment with different FTIs (SCH66336, BMS- 214662, R115777, RPR-115135, and Manumycin). Among these, BMS-214662 was the only one moderately active. BMS-214662 triggered apoptosis in a small fraction of cells (not higher than 30%) that was paralleled by a slight decrease in the levels of TGF-A secreted by treated MPM cells. Our data highlighted the concept that the same signaling pathway can be regulated in different ways and these regulations can differ between different cells of different origin