Role of ghrelin gene-derived peptides in the control of energy balance and cardiometabolic homeostasis

The human GHRL gene encodes a 117-aminoacid peptide, preproghrelin that is proteolytically processed to yield two peptides: ghrelin and obestatin. Ghrelin is secreted to the bloodstream in two major forms, acylated ghrelin (with an n-octanoylation in the third serine residue) and desacyl ghrelin (the form lacking n-octanoylation). Ghrelin acylation, promoted by ghrelin O-acyltransferase (GOAT), is essential for binding to the growth hormone (GH) secretagogue receptor (GHS-R) 1a and for the main endocrine functions of acylated ghrelin, including the stimulation of GH release, induction of food intake and stimulation of adipogenesis. Although devoid of binding to GHS-R 1a, desacyl ghrelin also displays orexigenic and adipogenic actions, whereas the role of obestatin in the regulation of energy balance remains unclear. The discovery of the widespread distribution of ghrelin and its receptor in the cardiovascular system opened a new research field in the role of ghrelin in the control of blood pressure and myocardial function. Indeed, ghrelin inhibits the apoptosis of cardiomyocytes and endothelial cells, ameliorates left ventricular function and reduces fibrosis after myocardial injury in experimental models. In humans, ghrelin improves endothelial function by increasing nitric oxide (NO) bioavailability, normalizes the altered balance between endothelin-1 and NO in patients with metabolic syndrome and exerts performance-enhancing effects on myocardial function of patients with chronic heart failure. This review focuses on advances in cardiometabolic effects of ghrelin gene-derived products in rodents and humans, and the possible role of ghrelin as a therapeutic molecule for treating cardiometabolic diseases.Adipobiology 2011; 3: 21-30

Silicon photomultiplier arrays - a novel photon detector for a high resolution tracker produced at FBK-irst, Italy

A silicon photomultiplier (SiPM) array has been developed at FBK-irst having 32 channels and a dimension of 8.0 x 1.1 mm^2. Each 250 um wide channel is subdivided into 5 x 22 rectangularly arranged pixels. These sensors are developed to read out a modular high resolution scintillating fiber tracker. Key properties like breakdown voltage, gain and photon detection efficiency (PDE) are found to be homogeneous over all 32 channels of an SiPM array. This could make scintillating fiber trackers with SiPM array readout a promising alternative to available tracker technologies, if noise properties and the PDE are improved

Energy based vessel sealing devices in thyroid surgery: A systematic review to clarify the relationship with recurrent laryngeal nerve injuries

Background and objectives: The principal complications associated with thyroid surgery consist in postoperative recurrent laryngeal nerve (RLN) palsy, hypoparathyroidism, intra-operative and post-operative hemorrhage. In this paper, structured as a literature review, we describe the current knowledge and the technical improvements currently employed in the field of thyroid surgery, focusing on the contribution of energy based devices in relation with the reduction of the operating time and the odds of possible complication. Materials and methods: a relevant systematic literature search on Pubmed was carried out including works from 2004 through 2019, selecting studies providing information on the energy based devices employed in surgeries and statistic data concerning RNL (transient and permanent) injury and operative time. Results: Nineteen studies were reviewed, dealing with 4468 patients in total. The operative variables considered in this study are: employed device, number of patients, pathological conditions affecting the patients, surgical treatment, RNL injury percentage and the operating time, offering an insight on different patient conditions and their relative operative outcomes. A total of 1843 patients, accounting to the 41.2% of the total pool, underwent the traditional technique operation, while 2605 patients (58.3%) were treated employing the energy based devices techniques. Thyroidectomy performed by approaches different from traditional (for example robotic, MIVAT (Mini Invasive Video Assisted thyroidectomy)) were excluded from this study. Conclusions: The energy-based vessel sealing devices in study, represent a safe and efficient alternative to the traditional clamp-and-tie hand technique in the thyroidal surgery scenario, granting a reduction in operating time while not increasing RNL injury rates. According to this information, a preference for energy based devices techniques might be expressed, furthermore, a progressively higher usage rate for these devices is expected in the near future

SiPM and front-end electronics development for Cherenkov light detection

The Italian Institute of Nuclear Physics (INFN) is involved in the development of a demonstrator for a SiPM-based camera for the Cherenkov Telescope Array (CTA) experiment, with a pixel size of 6$\times$6 mm$^2$. The camera houses about two thousands electronics channels and is both light and compact. In this framework, a R&D program for the development of SiPMs suitable for Cherenkov light detection (so called NUV SiPMs) is ongoing. Different photosensors have been produced at Fondazione Bruno Kessler (FBK), with different micro-cell dimensions and fill factors, in different geometrical arrangements. At the same time, INFN is developing front-end electronics based on the waveform sampling technique optimized for the new NUV SiPM. Measurements on 1$\times$1 mm$^2$, 3$\times$3 mm$^2$, and 6$\times$6 mm$^2$ NUV SiPMs coupled to the front-end electronics are presentedComment: In Proceedings of the 34th International Cosmic Ray Conference (ICRC2015), The Hague, The Netherlands. All CTA contributions at arXiv:1508.0589

How emergency surgery has changed during the COVID-19 pandemic: A cohort study

Introduction: Various surgical societies constantly update their recommendations in order to adapt surgical activity on current Pandemic conditions. The aim of this study is to analyze how hospitalizations and emergency operations have changed in our Department of Medical and Surgical Sciences in the Hospital of Foggia during covid-19 pandemic. Methods: Our cohort-study was conducted by analyzing two groups of patients admitted to the Department of Medical and Surgical Sciences of the Hospital of Foggia: those admitted during the no-covid period from March 09th, 2019 to May 09th, 2019 and those during the covid period from March 09th, 2020 to May 09th, 2020. Results: A total of 750 patients admitted during the no-covid period of 2019 and 171 during the covid period of 2020, of these 222 were emergency admission during 2019 and 97 during 2020, 528 were elective admission during 2019 and 74 during 2020. Of the emergency admissions (222 during 2019 and 97 during 2020), 91 were operated during the no covid period in 2019 and 52 during the covid period in 2020. The mean Mannheim Peritonitis Index Score, that is a scoring system used in peritonitis which is simple and cost-effective, were 15.6 during the no covid period of 2019 and 22.2 during the covid period of 2020. We observed 29 post-operative complications during 2019 and 26 during 2020. Conclusions: Contraction of admissions for urgent and emergent conditions in the first period of lockdown has been followed from some positive effects as well as aggravating consequences

miRNA Signatures in Sera of Patients with Active Pulmonary Tuberculosis.

Several studies showed that assessing levels of specific circulating microRNAs (miRNAs) is a non-invasive, rapid, and accurate method for diagnosing diseases or detecting alterations in physiological conditions. We aimed to identify a serum miRNA signature to be used for the diagnosis of tuberculosis (TB). To account for variations due to the genetic makeup, we enrolled adults from two study settings in Europe and Africa. The following categories of subjects were considered: healthy (H), active pulmonary TB (PTB), active pulmonary TB, HIV co-infected (PTB/HIV), latent TB infection (LTBI), other pulmonary infections (OPI), and active extra-pulmonary TB (EPTB). Sera from 10 subjects of the same category were pooled and, after total RNA extraction, screened for miRNA levels by TaqMan low-density arrays. After identification of "relevant miRNAs", we refined the serum miRNA signature discriminating between H and PTB on individual subjects. Signatures were analyzed for their diagnostic performances using a multivariate logistic model and a Relevance Vector Machine (RVM) model. A leave-one-out-cross-validation (LOOCV) approach was adopted for assessing how both models could perform in practice. The analysis on pooled specimens identified selected miRNAs as discriminatory for the categories analyzed. On individual serum samples, we showed that 15 miRNAs serve as signature for H and PTB categories with a diagnostic accuracy of 82% (CI 70.2-90.0), and 77% (CI 64.2-85.9) in a RVM and a logistic classification model, respectively. Considering the different ethnicity, by selecting the specific signature for the European group (10 miRNAs) the diagnostic accuracy increased up to 83% (CI 68.1-92.1), and 81% (65.0-90.3), respectively. The African-specific signature (12 miRNAs) increased the diagnostic accuracy up to 95% (CI 76.4-99.1), and 100% (83.9-100.0), respectively. Serum miRNA signatures represent an interesting source of biomarkers for TB disease with the potential to discriminate between PTB and LTBI, but also among the other categories

A Scintillating Fiber Tracker With SiPM Readout

We present a prototype for the first tracking detector consisting of 250 micron thin scintillating fibers and silicon photomultiplier (SiPM) arrays. The detector has a modular design, each module consists of a mechanical support structure of 10mm Rohacell foam between two 100 micron thin carbon fiber skins. Five layers of scintillating fibers are glued to both top and bottom of the support structure. SiPM arrays with a channel pitch of 250 micron are placed in front of the fibers. We show the results of the first module prototype using multiclad fibers of types Bicron BCF-20 and Kuraray SCSF-81M that were read out by novel 32-channel SiPM arrays from FBK-irst/INFN Perugia as well as 32-channel SiPM arrays produced by Hamamatsu. A spatial resolution of 88 micron +/- 6 micron at an average yield of 10 detected photons per minimal ionizig particle has been achieved.Comment: 5 pages, 7 figures, submitted as proceedings to the 11th Topical Seminar on Innovative Particle and Radiation Detectors (IPRD08

Management of bile duct injuries after cholecystectomy: Therapeutic approach and examination of possible sources of error. Report of 2 cases

Background: Bile duct injuries is the primary concern of general surgeons during and after cholecystectomy, with an incidence ranging from 0.08% to 0.4%. Through the description of two cases we intend to discuss the management of most frequent types of bile duct injuries after cholecystectomy and examine some possible sources of error. Case reports: We have treated 2 cases previously operated by other surgical teams. Case report 1: patient undergoing laparoscopic cholecystectomy with lesion of the main bile duct, treated with its reconstruction with positioning of a T-drainage tube. Case report 2: patient with jaundice previously treated for incarcerated incisional hernia and gallbladder stones. We verified the presence of a stenosis of the main bile duct which was resolved with the positioning of a T-tube drainage Discussion: Many descriptions and classifications regarding iatrogenic lesions of the bile duct after cholecystectomy have been described, although some of them represent a good guide on the surgical approach to be adopted, but the surgical skills possessed by the operator remain the most important variables Conclusions: All possible precautions must be considered in order to avoid the possibility of damaging the biliary tree. In our opinion an anterograde approach during cholecystectomy offers greater safety

Strangulated hiatal hernia remains a challenge in surgical emergency: Literature review and our experience

Introduction. Upside-down stomach (UDS) is the rarest type of hiatal hernia (<5%). It is characterized by herniation of the entire stomach or most gastric portions into the posterior mediastinum. It is a very rare condition and it is associated with a risk of incarceration as well as volvulus development. All of these complications represent true emergencies as life-threatening conditions. Material & methods. Case 1: A 62-year-old woman with an incarcerated and ischemic paraesophageal hiatal hernia with a stomach perforation. A total gastrectomy was performed with a Roux en-Y esophago-jejunostomy. The patient was discharged after 15 days without any complication. Case 2: A 84-year-old woman with the evidence at the computer tomography scan all of her stomach and parts of her jejunum and pancreas were drawn into the hernia sac herniated in her thorax. An exploratory laparotomy was performed which showed edematous intraperitoneal portion of the pyloric antrum, a total gastrectomy was performed and Roux en-Y esophago-jejunostomy was performed. The patient was placed in the intensive care unit, where she was instable and she developed sepsis. She died on 7th postoperative day. Case 3: A 76-year-old man presented in our department as emergency with the diagnosis of an incarcerated and ischemic paraesophageal hiatal hernia. An exploratory laparotomy was performed which showed an incarcerated and strangulated hiatal hernia. A section of the cardias and the body of the stomach was performed. The patient was placed in the intensive care unit, where he was instable and he developed sepsis which caused his death. Discussion. Surgery for incarcerated paraesophageal hernia or upside-down stomach has to be performed emergently as incarceration can become irreversible and severe bleeding can occur due to distension and vascular dilation. Moreover, ischemia and gastric perforation are on the verge. However, there are no clear evidence or existing guidelines on the management of acute paraesophageal hernia or upside-down stomach. In our literature review we analyzed clinical case reports and case series studies of strangulated hiatal hernia published between 2013 and 2019 published in PubMed. Conclusion. Management of strangulated hiatal hernia remains a challenge in general surgery. Open approach is suggested for unstable patients and an emergent laparoscopic reduction and repair is reasonable in stable patients