Gallstones in Elderly Patients: Impact of Laparoscopic Cholecystectomy

The use of laparoscopic cholecystectomy (LC) in elderly patients may pose problems because of their poor general condition, especially of cardiopulmonary function. Moreover, these patients present with acute cholecystitis and associated common bile duct stones more often than their younger counterparts. From 1990 to 1999, the authors performed 943 LCs; 31 (3.2%) were attempted on elderly patients, 11 (35%) of which were on an emergency basis because of acute cholecystitis, cholangitis or acute biliary pancreatitis. Ten per cent of LCs needed to be converted to an open cholecystectomy, most often because of an increase in the partial pressure of carbon dioxide in the blood produced by excessive operative time. A gasless procedure was used in the last three years of the study on eight cases; the overall rate of conversion from LC to open cholecystectomy in this group was 0%. Associated gallbladder and common bile duct stones were found in five (16%) patients (four preoperative LC endoscopic sphincterotomy and one transcystic approach). The success rate in both of these cases was 100%, overall morbidity was 29% and there was no mortality. These results show that LC is a feasible and safe procedure for use in elderly patients. Gasless LC should be preferred in patients classified as American Society of Anesthesiologists' class III because an excessive duration of operation is the most common reason for converting to an open cholecystectomy

Tritón pirenaico – Calotriton asper (Dugès, 1852)

Anfibios - Orden Caudata - Familia Salamandridae en la Enciclopedia Virtual de Vertebrados Españoles, http://www.vertebradosibericos.org/. Versiones anteriores: 17-03-2008; 12-03-2009; 21-07-2014A comprehensive review of the natural history of the Pyrenean brook newt Calotriton asper in Spain.Peer reviewe

Nationwide analysis of open groin hernia repairs in Italy from 2015 to 2020

Introduction: Inguinal hernia repair is one of the most commonly performed operations in general surgery. A total of 130.000 inguinal hernia repairs are performed yearly in Italy, and approximately 20 million inguinal hernias are treated worldwide annually. This report represents the trend analysis in inguinal hernia repair in Italy from a nationwide dataset for the 6-year period from 2015 to 2020. Materials and methods: Based on regional hospital discharge records, all the inguinal hernia repairs performed in public and private hospitals in Italy between 2015 and 2020 were reviewed based on diagnosis and procedure codes. For the aim of this study, data from the AgeNas (The National Agency for Regional Health Services) data source were analyzed. Results: Elective inguinal hernia repairs outnumbered urgent operations over the 6-year study period, ranging from 122,737 operations in 2015 to 65,780 in 2020 as absolute numbers, and from 87.96 to 83.3% of total procedures in 2019 and 2020 respectively, with an annual change ranging from - 66.58%, between 2020 and 2019, to - 2.49%, between 2019 and 2018 (mean = - 18.74%; CI =- 46.7%-9.22%; p < 0.0001). Conclusions: This large-scale review of groin hernia data from a nationwide Italian dataset provides a unique opportunity to obtain a snapshot of open groin hernia repair activity. More specifically, there is a trend to perform more elective than urgent procedures and there is a steady decrease in the amount of open hernia repairs in favor to laparoscopy

WoTwins: Automatic Digital Twin Generator for the Web of Things

Digital Twins are crucial in Industry 4.0 IoT scenarios, as they replicate physical assets and enable important tasks such as predictive analytics, what-if scenarios and real time monitoring. The heterogeneity of IoT use cases usually makes the development of digital twins extremely application-specific as well as prone to interoperability issues. To overcome these two challenges, we propose WoTwins, a framework that, on one side, leverages the W3C Web of Things (WoT) standard to model data and entities, and, on the other side, generates automatically Digital Twins of existing Web Things by modeling their state space through a Markov Decision Process (MDP) graph and by predicting its behavior though Machine Learning techniques. We conduct experiments on a simulated use cases related to IoT robotics to evaluate our proposa

A Survey on the Web of Things

The Web of Things (WoT) paradigm was proposed first in the late 2000s, with the idea of leveraging Web standards to interconnect all types of embedded devices. More than ten years later, the fragmentation of the IoT landscape has dramatically increased as a consequence of the exponential growth of connected devices, making interoperability one of the key issues for most IoT deployments. Contextually, many studies have demonstrated the applicability of Web technologies on IoT scenarios, while the joint efforts from the academia and the industry have led to the proposals of standard specifications for developing WoT systems. Through a systematic review of the literature, we provide a detailed illustration of the WoT paradigm for both researchers and newcomers, by reconstructing the temporal evolution of key concepts and the historical trends, providing an in-depth taxonomy of software architectures and enabling technologies of WoT deployments and, finally, discussing the maturity of WoT vertical markets. Moreover, we identify some future research directions that may open the way to further innovation on WoT systems

Use of systemic and in situ lactoferrin in MRONJ surgical management: proposal for a therapeutic solution

Aim: Lactoferrin (Lf) is an antimicrobial and iron chelator glycoprotein contained in exocrine secretion, including saliva, and in secondary granules of neutrophil granulocytes. Lf performs its antibacterial and antiviral action through two pathways: the first deprives bacteria of the iron they need for their reproduction and for biofilm formation; the second contributes to restore the inflammatory homeostasis which is essential for tissue health modulating the level of cytokines, like IL-6. The study intends to propose the use of systemic and in situ Lf effectiveness in the healing of oral mucosa and bone tissue affected by medication-related ostenecrosis of the jaw (MRONJ), after surgical excision or spontaneous elimination of necrotic bone

Evaluando los factores que afectan a la tasa de mortalidad en la carretera: el caso de Sapo Común Bufo bufo, cerca de un área de reproducción

The Common Toad Bufo bufo is the amphibian with the highest rates of road mortality in many European countries. This elevated incidence of road kills has frequently been associated with migration to breeding sites. In this study, we analysed the mortality of the Common Toad in the road network in Catalonia (NE Spain), and investigated the related causative factors on four roads near a breeding site in the Pyrenees. Results suggest that the high mortality rate is due to a combination of factors: toad abundance, traffic density and quality of water bodies for breeding. On the road with the highest incidence of road kills we investigated whether deaths occurred at specific spots or in a random manner. The road was divided into 500 m sections and each section was classified according to biotic (type of vegetation) and abiotic (presence of streams, roadside topography) variables. Multiple correspondence analysis showed that sections with streams crossing under the road had the highest mortality rate, suggesting that such water bodies flowing into the breeding pond are the toads’ main migratory pathways for hibernation and breeding. As toads use the same migratory routes each year, it is critical to identify areas with a high potential mortality so that efficient measures can be designed to increase wildlife permeability, and thereby reduce habitat fragmentation. This methodology could be applied in other areas with high amphibian mortality. Key words: Amphibian, Common Toad, Bufo bufo, Landscape fragmentation, Migration, Mortality, Road permeability, Pyrenees.El Sapo Común Bufo bufo, es el anfibio con mayor tasa de mortalidad en la carretera en numerosos países de Europa. Esta elevada mortalidad se debe principalmente a las migraciones que realiza hacia las zonas de reproducción. En este estudio se analiza la mortalidad del Sapo Común en la red de carreteras de Cataluña (NE España) y más específicamente qué factores influyen sobre dicha mortalidad en cuatro carreteras cercanas a un punto de reproducción en los Pirineos. Los resultados sugieren que la alta tasa de mortalidad se debe a la combinación de tres factores: abundancia de sapos, densidad de tráfico y calidad de los puntos de agua para la reproducción. En la carretera con mayor índice de atropellos, se analizó si existía agregación en los animales atropellados o estos se distribuían al azar. Para ello, la carretera se dividió en tramos de 500 m, cada uno de los cuales se caracterizó por el tipo de vegetación circundante, así como otros factores que pudieran influir sobre la migración de los sapos (p.e. inclinación del margen de la carretera, presencia de riachuelos, etc.). El análisis de correspondencias múltiple demostró que los tramos con torrentes cruzando bajo la carretera presentaban mayor mortalidad. Esto sugiere que dichos torrentes son las vías principales usadas por los sapos para acudir a los puntos de reproducción. Dado que los sapos utilizan cada año las mismas vías migratorias, es fundamental identificar dichos puntos para predecir cuáles presentan mayor mortalidad potencial y así diseñar más eficazmente los mecanismos de permeabilidad para la fauna en las vías de comunicación. Esta metodología puede ser aplicada a otras zonas con elevada mortalidad de anfibios en la red de carreteras. Palabras clave: Anfibio, Sapo Común, Bufo bufo, Fragmentación del paisaje, Migración, Mortalidad, Permeabilidad de la carretera, Pirineos

Automotive Communications in LTE: A Simulation-Based Performance Study

2017 IEEE 86th Vehicular Technology Conference (VTC-Fall)The integration of automotive communications in 5G systems must build on a clear understanding of the performance of services for connected vehicles in today's LTE deployments. In this paper, we carry out a simulation-based performance evaluation of automotive communications in LTE, with particular attention to realism: to that end, we investigate the impact of different road traffic models, employ a state-of-the-art commercial LTE tool, and study a practical service use case. Our results demonstrate that unrealistic road traffic datasets can bias network simulations in urban vehicular environments, and provide insights on the limitations of the current radio access architecture, when confronted to connected vehicles.This research has received funding from the People Pro-gramme (Marie Curie Actions) of the European Unions Sev-enth Framework Programme (FP7/2007- 2013) under REA grant agreement n.630211, ReFleX. Also, this work has been performed in the framework of the H2020-ICT-2014-2 project 5G NORMA

Splenic Trauma: WSES Classification and Guidelines for Adult and Pediatric Patients

Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines