An Ego Depletion Account of Aging Stereotypes' Effects on Health-Related Variables

Objectives. This study examined whether stereotypes may predict health outcomes independently from their internalization into the self. Specifically, we tested whether endorsement of negative age stereotypes in the physical activity (PA) domain is related to decreased subjective vitality among active older adults, illustrating ego depletion. Method. This longitudinal study included 192 retired individuals aged 60-92 years who regularly participated in organized PA, and who completed the measures on three occasions (9-month period). Results. Multilevel growth models tested whether within-person variation in age stereotypes endorsement across waves predicted subjective vitality, after controlling for self-perceptions of aging and relevant covariates. Results showed that (a) within-person increases in endorsement of age stereotypes of self-efficacy (b = 0.17, p < .01) were associated with increases in subjective vitality, (b) between-person mean difference in endorsement of age stereotypes of PA benefits (b = 0.21, p < .05) positively predicted subjective vitality, and (c) subjective vitality mediated the relationship between endorsement of self-efficacy stereotype and self-rated health. Discussion. This study confirmed that endorsement of age stereotypes of PA predicted subjective vitality among active older adults. These results suggest that stereotypes may be related to health-related outcomes notably through ego depletion effect

Surgical mistake causing an high recto-vaginal fistula. A case report with combined surgical and endoscopic approach: therapeutic considerations

BACKGROUND: Rectovaginal fistulas (RVFs) have multiple causes, size and location on which the surgical treatment depends. DESCRIPTION: The Authors consider different approaches to RVFs and describe a clinical case of recurrent high RVF. CONCLUSIONS: Most RVFs can be successfully repaired, although many interventions may be necessary. A colostomy with delayed repair may improve RVFs outcome. Moreover, several authors indicate Mucosal Advancement Flap and Babcock-Bacon technique as the treatments of choice respectively for low and high RVFs (complex and recurrent) and emphasize the placement of endoscopic prothesis in cases of difficult healing of the anastomosis

Anesthetic management in awake craniotomy

Resection of brain tumors may cause neurological sequelae, according to the site and size of the brain tissue removed. Awake craniotomy has been proposed as a surgical approach to satisfy criteria of radical surgery while minimizing eloquent brain damage.The most critical aspect of awake craniotomy is to maintain adequate patient comfort, analgesia, immobility and cooperation during a long surgical operation, ensuring in the meanwhile the safety, control and maintenance of vital functions. Apart from pharmacological, surgical, technical knowledge and skillfulness, the ability to maintain close psycho-emotionalcontact and support with the patient throughout the operation is a fundamental task that the anesthesiologist has to pursue for the operation to be successfully managed. This review summarizes the current opinion on anesthetic management of patients undergoing awake craniotomy

Low flow, minimal flow and closed circuit system inhalational anesthesia in modern clinical practice

Low, minimal flow and closed circuit anesthesia has been pursued since the beginning of the history of anesthesia. For many decades this form of anesthesia has been restricted to devoted enthusiasts and those very fond of gas kinetics. For most clinicians, selecting a fresh flow gas higher than 3-5 L/min was widely accepted as a routine anesthesia technique. The introduction onto the market of new volatile agents as well as advanced anesthesia machines accompanied by highly reliable monitoring systems, made minimal flow or closed system anesthesia feasible on a daily basis. Clinical, cultural, environmental, pharmacological, technological and economic reasons, force the modern anesthesiologist to reconsider the role of minimal flow and closed circuit volatile anesthesia, in clinical practice. This paper analyses the main advantages offered by these anesthesia techniques

Estimation of the susceptibility of a road network to shallow landslides with the integration of the sediment connectivity

Abstract. Landslides cause severe damage to the road network of the hit zone, in terms of both direct (partial or complete destruction of a road or blockages) and indirect (traffic restriction or the cut-off of a certain area) costs. Thus, the identification of the parts of the road network that are more susceptible to landslides is fundamental to reduce the risk to the population potentially exposed and the financial expense caused by the damage. For these reasons, this paper aimed to develop and test a data-driven model for the identification of road sectors that are susceptible to being hit by shallow landslides triggered in slopes upstream from the infrastructure. This model was based on the Generalized Additive Method, where the function relating predictors and response variable is an empirically fitted smooth function that allows fitting the data in the more likely functional form, considering also non-linear relations. This work also analyzed the importance, on the estimation of the susceptibility, of considering or not the sediment connectivity, which influences the path and the travel distance of the materials mobilized by a slope failure until hitting a potential barrier such as a road. The study was carried out in a catchment of northeastern Oltrepò Pavese (northern Italy), where several shallow landslides affected roads in the last 8 years. The most significant explanatory variables were selected by a random partition of the available dataset in two parts (training and test subsets), 100 times according to a bootstrap procedure. These variables (selected 80 times by the bootstrap procedure) were used to build the final susceptibility model, the accuracy of which was estimated through a 100-fold repetition of the holdout method for regression, based on the training and test sets created through the 100 bootstrap model selection. The presented methodology allows the identification, in a robust and reliable way, of the most susceptible road sectors that could be hit by sediments delivered by landslides. The best predictive capability was obtained using a model in which the index of connectivity was also calculated according to a linear relationship, was considered. Most susceptible road traits resulted to be located below steep slopes with a limited height (lower than 50 m), where sediment connectivity is high. Different land use scenarios were considered in order to estimate possible changes in road susceptibility. Land use classes of the study area were characterized by similar connectivity features. As a consequence, variations on the susceptibility of the road network according to different scenarios of distribution of land cover were limited. The results of this research demonstrate the ability of the developed methodology in the assessment of susceptible roads. This could give the managers of infrastructure information about the criticality of the different road traits, thereby allowing attention and economic budgets to be shifted towards the most critical assets, where structural and non-structural mitigation measures could be implemented

Persistent hypoxemia after an asthma attack

8openopenDeana, Cristian*; Conangla, Laura; Vetrugno, Luigi; Saltarini, Massimiliano; Buttera, Stefania; Bove, Tiziana; Bassi, Flavio; De Monte, AmatoDeana, Cristian; Conangla, Laura; Vetrugno, Luigi; Saltarini, Massimiliano; Buttera, Stefania; Bove, Tiziana; Bassi, Flavio; De Monte, Amat

Sex-specific predictors of PCSK9 levels in a European population:The IMPROVE study

Background and aims: Proprotein convertase subtilisin/kexin type 9 (PCSK9) is one of the key regulators of low-density lipoprotein cholesterol plasma levels and circulating PCSK9, which differs between genders. PCSK9 represents a valid pharmacological target for preventing cardiovascular (CV) events. We aimed to investigate sex-related associations between PCSK9 plasma levels and biochemical and anthropomorphic factors, and familial and personal morbidities, in a large European cohort (n=3,673) of men (47.9%) and women (52.1%). Methods: Individuals (aged 54 to 79 years) free of CV diseases were enrolled in 7 centers of five European countries: Finland, France, Italy, the Netherlands, and Sweden. PCSK9 plasma levels were measured by ELISA. Results: PCSK9 was higher in women than in men. Multiple linear regression analysis showed that latitude, sex, and treatments with statins and fibrates were the strongest predictors of PCSK9 in the whole group. These variables, together with triglycerides and high-density lipoprotein cholesterol, were also associated with PCSK9 in men or women. Mean corpuscular hemoglobin concentration and pack-years were PCSK9 independent predictors in women, whereas hypercholesterolemia and physical activity were independent predictors in men. The associations between PCSK9 and latitude, uric acid, diabetes, hypercholesterolemia and physical activity were significantly different in men and women (pinteraction &lt;0.05 for all). Conclusions: Besides confirming the association with lipids in the whole group, our study revealed previously unknown differences in PCSK9 predictors in men and women. These might be taken into account when defining individual risk for CV events and/or for refining PCSK9 lowering treatments

Molecular portraits of patients with intrahepatic cholangiocarcinoma who diverge as rapid progressors or long survivors on chemotherapy

OBJECTIVE: Cytotoxic agents are the cornerstone of treatment for patients with advanced intrahepatic cholangiocarcinoma (iCCA), despite heterogeneous benefit. We hypothesised that the pretreatment molecular profiles of diagnostic biopsies can predict patient benefit from chemotherapy and define molecular bases of innate chemoresistance. DESIGN: We identified a cohort of advanced iCCA patients with comparable baseline characteristics who diverged as extreme outliers on chemotherapy (survival 23 m in long survivors, LS). Diagnostic biopsies were characterised by digital pathology, then subjected to whole-transcriptome profiling of bulk and geospatially macrodissected tissue regions. Spatial transcriptomics of tumour-infiltrating myeloid cells was performed using targeted digital spatial profiling (GeoMx). Transcriptome signatures were evaluated in multiple cohorts of resected cancers. Signatures were also characterised using in vitro cell lines, in vivo mouse models and single cell RNA-sequencing data. RESULTS: Pretreatment transcriptome profiles differentiated patients who would become RPs or LSs on chemotherapy. Biologically, this signature originated from altered tumour-myeloid dynamics, implicating tumour-induced immune tolerogenicity with poor response to chemotherapy. The central role of the liver microenviroment was confrmed by the association of the RPLS transcriptome signature with clinical outcome in iCCA but not extrahepatic CCA, and in liver metastasis from colorectal cancer, but not in the matched primary bowel tumours. CONCLUSIONS: The RPLS signature could be a novel metric of chemotherapy outcome in iCCA. Further development and validation of this transcriptomic signature is warranted to develop precision chemotherapy strategies in these settings