Follow up a lungo termine dopo chirurgia conservativa per il tumore del testicolo a cellule di Leydig

Il tumore del testicolo a cellule di Leydig nella maggior parte dei casi è benigno, nonostante questo l'orchiectomia radicale è considerata la terapia standard. E' stato analizzato retrospettivamente il follow up a lungo termine di una serie di pazienti con tumore del testicolo a cellule di Leydig, trattati elettivamente con la chirurgia conservativa. Tra il novembre del 1990 e il dicembre del 2005, 17 pazienti sono stati sottoposti a chirurgia su base elettiva previa valutazione pre-operatoria, che includeva esame obbiettivo, markers sierici per tumori a cellule germinali, ecografia scrotale, TC addome, Rx del torace e profilo ormonale. La chirurgia conservativa del testicolo è stata eseguita per via inguinale con clampaggio del funicolo spermatico ed esecuzione dell'esame estemporaneo del campione, che si è rivelato utile al fine della diagnosi. Il follow up successivo includeva gli esami precedentemente elencati, eseguiti ogni sei mesi,per i primi due anni, infine annualmente, valutando la recidiva tumorale e la sopravvivenza. I risultati dello studio hanno evidenziato che la chirurgia conservativa del testicolo, affiancata dall'esame estemporaneo, prevede un'eccellente risultato oncologico a lungo termine (con una media di 91 mesi), poichè non è stata documentata nessuna recidiva

Chirugia robotica in urologia: indicazioni, risultati e follow up

Gli ultimi decenni, in campo chirurgico, sono stati caratterizzati dalla diffusione dei tecniche minimamente invasive e da uno sviluppo delle tecnologie legate soprattutto alla visione endoscopica e al perfezionamento dello strumentario chirurgico. L'introduzione e lo sviluppo della chirurgia “robot- assistita”, ha proprio l'obiettivo di raffinare ulteriormente gli interventi chirurgici, ottimizzandone i risultati e riducendone l'invasività. Il primo robot in campo urologico è stato sperimentato nel 1988. Il sistema, chiamato PROBOT, era stato progettato per ottimizzare l'intervento di resezione endoscopica di prostata (TURP) per il trattamento della Ipertrofia Prostatica Benigna. Con lo sviluppo del sistema master-slave che ha consentito di superare alcuni limiti della chirurgia endoscopica convenzionale si è avuta la diffusione della chirurgia robotica, soprattutto in ambito urologico. La prima prostatectomia radicale laparoscopica robot-assistita (robot da Vinci) è stata effettuata in Germania nel 2000 da Binder e Collaboratori e in pochi anni, grazie soprattutto all'esperienza di Menon del Vattikuti Institute di Detroit, è diventata l'indicazione principale alla chirurgia robotica. Attualmente in campo urologico il sistema robotico viene utilizzato per la prostatectomia radicale, per la plastica del giunto pieloureterale, per la cistectomia radicale, per la chirurgia oncologica del rene, per la chirurgia delle ghiandole surrenali e per la chirurgia delle vescicole seminali. Lo scopo di questo lavoro è stato di analizzare criticamente le indicazioni alla chirurgia robotica e i risultati ottenuti, alla luce dell'esperienza dell'Unità Operativa di Urologia Universitaria della Azienda Ospedaliero-Universitaria Pisana iniziata nel 2007

Testis-sparing surgery for benign and malignant tumors: A critical analysis of the literature

In order to explore the latest advances in organ-sparing treatment of testicular tumors, a literature search of the Medline/PubMed database was carried out for published data in the English language up to 2007

Describing astronomy identity of upper primary and middle school students through structural equation modeling

We describe how young students situate themselves with respect to astronomy through an identity framework that features four dimensions: interest, utility value, confidence, and conceptual knowledge. Overall, about 900 Italian students, from 5th to 9th grade (9–14 years old), were involved in the study. We tested our model using confirmatory factor analysis and structural equation modeling. Differences between girls and boys and across school levels were also investigated. Results show that interest has both a direct and an indirect effect on astronomy identity. The indirect effect of interest on identity is mediated by utility value. Moreover, confidence mediates the effect of interest on conceptual knowledge. Concerning differences between girls and boys, we found that the effect of interest on identity is greater for girls than for boys and that the utility value mediates the effect of interest on identity for boys but not for girls. Finally, our findings show also that the students’ interest in astronomy and confidence in their performance decrease with age, with a potential negative impact on conceptual knowledge and future career choice in astronomy. The astronomy identity framework can be employed to examine the role of affective variables on performance and persistence in astronomy and to improve the design of teaching-learning activities that can potentially stimulate a lasting interest in astronomy

The Impact of Unhealthy Behaviors on Personalized Well-Being Index in a Sample of School Dropout Adolescents

(1) Background: here is a growing need for integrated and multidimensional approaches to health, especially in a particular category of populations, school-dropout (SD) adolescents, who are traditionally more prone to risky behavior. This study aimed to describe the association between possible risk factors (substance use, eating disorders, social addiction) and well-being perception through the application of a personalized well-being index (PWBI) in SD youths. (2) Methods: Data were collected in 450 school-dropout adolescents (19 ± 2 years, male 308); the health-related quality of life (HRQoL) and risk behaviors were assessed by means of a battery of standardized questions. (3) Results: The results revealed an altered perception of well-being in association with eating disorders (p p p p p p p p < 0.001) when taking psychotropic drugs. (4) Conclusions: risk or unhealthy behaviors significantly worsen individual well-being. This study highlights the change of paradigm from a disease-oriented model to an educationally strength-based model when monitoring psychosocial well-being in order to define preventive and health promotion strategies in a vulnerable category of the population

The Use of COLD-PCR and High-Resolution Melting Analysis Improves the Limit of Detection of KRAS and BRAF Mutations in Colorectal Cancer

Fast and reliable tests to detect mutations in human cancers are required to better define clinical samples and orient targeted therapies. KRAS mutations occur in 30–50% of colorectal cancers (CRCs) and represent a marker of clinical resistance to cetuximab therapy. In addition, the BRAF V600E is mutated in about 10% of CRCs, and the development of a specific inhibitor of mutant BRAF kinase has prompted a growing interest in BRAFV600E detection. Traditional methods, such as PCR and direct sequencing, do not detect low-level mutations in cancer, resulting in false negative diagnoses. In this study, we designed a protocol to detect mutations of KRAS and BRAFV600E in 117 sporadic CRCs based on coamplification at lower denaturation temperature PCR (COLD-PCR) and high-resolution melting (HRM). Using traditional PCR and direct sequencing, we found KRAS mutations in 47 (40%) patients and BRAFV600E in 10 (8.5%). The use of COLD-PCR in apparently wild-type samples allowed us to identify 15 newly mutated CRCs (10 for KRAS and 5 for BRAFV600E), raising the percentage of mutated CRCs to 48.7% for KRAS and to 12.8% for BRAFV600E. Therefore, COLD-PCR combined with HRM permits the correct identification of less represented mutations in CRC and better selection of patients eligible for targeted therapies, without requiring expensive and time-consuming procedures

Effects of pre‐operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or &gt;= 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Search for CPCP violation in D0^0→\to KS0^0_\mathrm{S}KS0^0_\mathrm{S} decays in proton-proton collisions at s\sqrt{s} = 13 TeV

International audienceA search is reported for charge-parity D$^0$$\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$$CP$ violation in D$^0$$\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$ decays, using data collected in proton-proton collisions at $\sqrt{s}$ = 13 TeV recorded by the CMS experiment in 2018. The analysis uses a dedicated data set that corresponds to an integrated luminosity of 41.6 fb$^{-1}$, which consists of about 10 billion events containing a pair of ẖadrons, nearly all of which decay to charm hadrons. The flavor of the neutral D meson is determined by the pion charge in the reconstructed decays D$^{*+}$$\to$ D$^0\pi^+$ and D$^{*-}$$\to$ D$^0\pi^-$. The D$^0$$\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$$CP$ asymmetry in D$^0$$\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$ is measured to be $A_{CP}$( K$^0_\mathrm{S}$K$^0_\mathrm{S}$) = (6.2 $\pm$ 3.0 $\pm$ 0.2 $\pm$ 0.8)%, where the three uncertainties represent the statistical uncertainty, the systematic uncertainty, and the uncertainty in the measurement of the D$^0$ $\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$ $CP$ asymmetry in the D$^0$ $\to$ K$^0_\mathrm{S}\pi^+\pi^-$ decay. This is the first D$^0$ $\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$ $CP$ asymmetry measurement by CMS in the charm sector as well as the first to utilize a fully hadronic final state

Observation of the J/ψ\psi →\to μ+μ−μ+μ−\mu^+\mu^-\mu^+\mu^- decay in proton-proton collisions at s\sqrt{s} = 13 TeV

International audienceThe J/$\psi$$\to$$\mu^+\mu^-\mu^+\mu^-$ decay has been observed with a statistical significance in excess of five standard deviations. The analysis is based on an event sample of proton-proton collisions at a center-of-mass energy of 13 TeV, collected by the CMS experiment in 2018 and corresponding to an integrated luminosity of 33.6 fb${-1}$. Normalizing to the J/$\psi$$\to$$\mu^+\mu^-$ decay mode leads to a branching fraction [10.1$^{+3.3}_{-2.7}$ (stat) $\pm$ 0.4 (syst) ]$\times$ 10$^{-7}$, a value that is consistent with the standard model prediction