High-pressure balloon dilatation in children: our results in 30 patients with POM and the implications of the cystoscopic evaluation

Primary Obstructive Megaureter (POM) is a common cause of hydronephrosis in children with spontaneous resolution in most cases. High-Pressure Balloon Dilatation (HPBD) has been proposed as a minimally invasive procedure for POM correction in selected patients. The aim of the paper is to review our experience with HPBD in patients with POM. We performed a retrospective study in a single Centre collecting data on patients' demographics, diagnostic modalities, surgical details, results and follow-up. In particular, the endoscopic aspect of the orifice permitted the identification of 3 patterns: adynamic ureteral segment, stenotic ureteric ring and pseudoureterocelic orifice. We performed HPBD in 30 patients over 6 years. We had 23 patients with adynamic distal ureteral segment (type 1), 4 with stenotic ring (type 2) and 3 with ureterocelic orifice (type 3). In 3 patients (10%) the guidewire did not easily pass into the ureter requiring ureteral stenting or papillotomy. Post-operative course was uneventful. Five patients (3 pseudoureterocelic) required open surgery during follow-up. HPBD for the treatment of POM is a safe and feasible procedure and it can be a definitive treatment of POM. Complications are mainly due to double J stent and none of our patients had symptoms related to vescico-ureteral reflux. The aspect of the orifice, identified during cystoscopy, seems to correlate with the efficacy of the dilatation: type 1 and 2 are associated with good and excellent results respectively; type 3 do not permit dilatation in almost all cases requiring papillotomy. HPBD can be performed in selected patients of all paediatric ages as first therapeutic line. The presence of a pseudoureterocelic orifice or long stenosis might interfere with the ureteral stenting and seems associated with worse outcomes

Multi-organ impairment and long COVID: a 1-year prospective, longitudinal cohort study.

ObjectivesTo determine the prevalence of organ impairment in long COVID patients at 6 and 12 months after initial symptoms and to explore links to clinical presentation.DesignProspective cohort study.ParticipantsIndividuals.MethodsIn individuals recovered from acute COVID-19, we assessed symptoms, health status, and multi-organ tissue characterisation and function.SettingTwo non-acute healthcare settings (Oxford and London). Physiological and biochemical investigations were performed at baseline on all individuals, and those with organ impairment were reassessed.Main outcome measuresPrimary outcome was prevalence of single- and multi-organ impairment at 6 and 12 months post COVID-19.ResultsA total of 536 individuals (mean age 45 years, 73% female, 89% white, 32% healthcare workers, 13% acute COVID-19 hospitalisation) completed baseline assessment (median: 6 months post COVID-19); 331 (62%) with organ impairment or incidental findings had follow-up, with reduced symptom burden from baseline (median number of symptoms 10 and 3, at 6 and 12 months, respectively). Extreme breathlessness (38% and 30%), cognitive dysfunction (48% and 38%) and poor health-related quality of life (EQ-5D-5L ConclusionsOrgan impairment persisted in 59% of 331 individuals followed up at 1 year post COVID-19, with implications for symptoms, quality of life and longer-term health, signalling the need for prevention and integrated care of long COVID.Trial Registration: ClinicalTrials.gov Identifier: NCT04369807

Programa intensivo ERASMUS: TOPCART. Documentación Geométrica del Patrimonio (memoria de actividades 2010-2011)

[EN] Data contained in this record come from the following accademic activity (from which it is possible to locate additional records related with the Monastery):● LDGP_inv_002: "Intensive Program ERASMUS: TOPCART. Geometric Documentation of the Heritage (administrative and academic documentation)", http://hdl.handle.net/10810/9906[ES] Los datos de este registro provienen de la una actividad académica que también aparece descrita en el repositorio y desde donde se puede acceder a otros trabajos relacionados con el Monasterio:● LDGP_inv_002: "Programa intensivo ERASMUS: TOPCART. Documentación Geométrica del Patrimonio (documentación administrativa y académica)", http://hdl.handle.net/10810/9906[EN] The main objective this project is looking for is the exchange of practical methodologies, in topics related with the measure and representation of heritage, between teachers and specially students from different countries. For the achievement of this aim we expect the participation of a group of about 30 students and 8 lecturers from Germany, Italy, Greece, Lithuania and Spain.Activities will be focused on the development of concrete projects in documentation of heritage, specifically in the San Prudencio Monastery (La Rioja, Spain). In this site, digital techniques for the acquisition of geometric information from GPS equipment, surveying total stations, laser scanner and photogrammetry systems, will be put into practice.Obtained data will be processed as follows: first of all, they will be documented by adding necessary metadata in order to ensure their use in the future, then, they will be treated to obtain cartographic representations and virtual models which can be distributed on the Internet.As results we expect: metric data of the monument, graphic models for difussion and collaboration partnertships.[ES] El objetivo principal que se persigue en este proyecto es el intercambio de metodológico práctico, en materias afines a la medida y la representación del patrimonio, entre profesores y fundamentalmente alumnos, de diferentes países. Para la consecución de este fin se espera la participación de un grupo de aproximadamente 25 alumnos y 8 profesores de (Alemania, Italia, Grecia, Lituania y España).Las actividades se centrarán en el desarrollo de proyectos concretos de documentación de elementos patrimoniales, en concreto el apartado práctico se desarrollará en el Monasterio de San Prudencio (La Rioja, España). En el se aplicarán técnicas digitales de registro de información geométrica, constituidas por receptores GPS, estaciones totales topográficas, escáneres láser y sistemas fotogramétricos.Los datos obtenidos serán tratados de la siguiente manera: en primer lugar serán documentados, mediante la adición de la metainformación necesaria para garantizar su utilidad a lo largo del tiempo, seguidamente serán procesados con el fin de obtener las representaciones cartográficas y modelos virtuales de representación que puedan ser difundidas por medio de Internet.Como resultados se pretenden: un conjunto de registros métricos del momento de la intervención, modelos gráficos de difusión y finalmente relaciones de colaboración interpersonal e interinstitucional.European Commission, DG Education and Culture (Erasmus 2009-1-ES1-ERAIP-0013, 2010-1-ES1-ERA10-0024); Organismo Autónomo Programas Educativos Europeos (OAPEE); Gobierno de La Rioja (Spain); Universidad de La Rioja; Clavijo City Council; Logroño City Council; Ilustre Colegio de Ingenieros Técnicos en Topografía (Delegación de La Rioja)[ES] Memoria de proyecto (PDF) [es el último fichero de la lista, el enlace directo es https://addi.ehu.es/bitstream/10810/7053/1053/ldgp_mem011-1_Clavijo_SanPrudencio.pdf] + 11 imágenes de la visita preliminar en abril de 2009, en formato JPEG + 19 nubes de puntos en formato txt (comprimido en ZIP junto a un fichero de metadatos y una imagen que sirve de croquis y que también se presenta suelta) + 27 fotografías tomadas desde un helicóptero radicontrolado en 2011 por el grupo H (JPEG) + 18 fotografías métricas del edificio en forma de -L- tomadas desde el Sur + 13 fotografías métricas del edificio en forma de -L- tomadas desde el Este + 95 fotografías métricas del interior del edificio en forma de -L- (JPEG) + 35 fotografías métricas tomadas desde el cerro que se encuentra al sur (JPEG) + 8 fotografías métricas que forman 4 pares estereoscópicos (2 del grupo B y 2 del grupo D) (JPEG) + 183 fotografías métricas que forman 91 tripletas (grupos B, C y D) (JPEG). [NOTA: este registro no está cerrado, se irán incorporando nuevos materiales de forma progresiva][EN] General report (PDF) [it is the last file of the list, the direct link is https://addi.ehu.es/bitstream/10810/7053/1053/ldgp_mem011-1_Clavijo_SanPrudencio.pdf] + 11 pictures taken during the preliminary visit in April 2009 (JPEG format) + 19 point clouds in plain text (compressed in a ZIP file together with a file with metadata and an image PNG as sketch, these image are also presented on their own) + 27 photographs taken from a remote-controlled helicopter for the group H in 2011(JPEG) + 18 metric pictures of the L-shaped building taken from the South (JPEG) + 13 metric pictures of the L-shaped building taken from the East (JPEG) + 95 metric pictures of the inside part of the L-shaped building (JPEG) + 35 metric photographs taken from the hill opposite in the Southern + 8 metric photographs in four stereopairs (2 from group B and 2 from group D) (JPEG) + 183 metric photographs arranged in 91 triplets from groups B, C and D (JPEG). [NOTE: this record is not closed, more data will be uploaded progressively

One year soy protein supplementation has positive effects on bone formation markers but not bone density in postmenopausal women

BACKGROUND: Although soy protein and its isoflavones have been reported to reduce the risk of osteoporosis in peri- and post-menopausal women, most of these studies are of short duration (i.e. six months). The objective of this study was to examine if one year consumption of soy-containing foods (providing 25 g protein and 60 mg isoflavones) exerts beneficial effects on bone in postmenopausal women. METHODS: Eighty-seven eligible postmenopausal women were randomly assigned to consume soy or control foods daily for one year. Bone mineral density (BMD) and bone mineral content (BMC) of the whole body, lumbar (L1-L4), and total hip were measured using dual energy x-ray absorptiometry at baseline and after one year. Blood and urine markers of bone metabolism were also assessed. RESULTS AND DISCUSSION: Sixty-two subjects completed the one-year long study. Whole body and lumbar BMD and BMC were significantly decreased in both the soy and control groups. However, there were no significant changes in total hip BMD and BMC irrespective of treatment. Both treatments positively affected markers of bone formation as indicated by increased serum bone-specific alkaline phosphatase (BSAP) activity, insulin-like growth factor-I (IGF-I), and osteocalcin (BSAP: 27.8 and 25.8%, IGF-I: 12.8 and 26.3%, osteocalcin: 95.2 and 103.4% for control and soy groups, respectively). Neither of the protein supplements had any effect on urinary deoxypyridinoline excretion, a marker of bone resorption. CONCLUSION: Our findings suggest that although one year supplementation of 25 g protein per se positively modulated markers of bone formation, this amount of protein was unable to prevent lumbar and whole body bone loss in postmenopausal women

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Consistent patterns of common species across tropical tree communities

Trees structure the Earth’s most biodiverse ecosystem, tropical forests. The vast number of tree species presents a formidable challenge to understanding these forests, including their response to environmental change, as very little is known about most tropical tree species. A focus on the common species may circumvent this challenge. Here we investigate abundance patterns of common tree species using inventory data on 1,003,805 trees with trunk diameters of at least 10 cm across 1,568 locations1,2,3,4,5,6 in closed-canopy, structurally intact old-growth tropical forests in Africa, Amazonia and Southeast Asia. We estimate that 2.2%, 2.2% and 2.3% of species comprise 50% of the tropical trees in these regions, respectively. Extrapolating across all closed-canopy tropical forests, we estimate that just 1,053 species comprise half of Earth’s 800 billion tropical trees with trunk diameters of at least 10 cm. Despite differing biogeographic, climatic and anthropogenic histories7, we find notably consistent patterns of common species and species abundance distributions across the continents. This suggests that fundamental mechanisms of tree community assembly may apply to all tropical forests. Resampling analyses show that the most common species are likely to belong to a manageable list of known species, enabling targeted efforts to understand their ecology. Although they do not detract from the importance of rare species, our results open new opportunities to understand the world’s most diverse forests, including modelling their response to environmental change, by focusing on the common species that constitute the majority of their trees.Publisher PDFPeer reviewe

Introduzione [a A. Arrighetti, R. Pansini (a cura di), Sistemi e tecniche di documentazione, gestione e valorizzazione dell’architettura storica: alcune recenti esperienze, «Archeologia e Calcolatori»]

International audienc

Laparoscopic removal of intragastric trichobezoar in a child: A case report

Introduction: A trichobezoar is a mass of indigestible hair in the gastrointestinal tract caused by hair ingestion, usually associated with trichotillomania and trichophagia. Although sometimes asymptomatic, it can become a rare cause of intestinal obstruction and require an emergent surgical intervention. The operative approach of choice, laparotomy versus laparoscopy, is still controversial. Case presentation: A 11-year-old girl was admitted to our institution with abdominal pain, vomiting and anorexia for 3 days. On abdominal examination, she had diffused abdominal pain with tenderness in the mesogastrium, with no palpable mass. Abdominal computed tomography (CT) scan and barium meal study shown a large gastric mass. Upper gastrointestinal (GI) endoscopy identified an enormous trichobezoar, which was later removed laparoscopically. An anterior gastrotomy was performed and the bezoar was then transferred en bloc into the endo-bag. The neck of the endobag was then exteriorized through the umbilical incision and removed by gradual fragmentation. The volume and size of the phytobezoars were 1875 cm3 and 25 × 15 × 5 cm. The patient was discharged on the 5th postoperative day without any complications. Conclusion: Successful laparoscopic management of pediatric trichobezoar may be accomplished by a 4-ports approach. It allows a lower intraoperative risk of contaminations, a rapid recovery and good cosmetic results in children