Laparoscopic Cholecystectomy in the Cirrhotic: Review of Literature on Indications and Technique

Cholelithiasis is twice more common in patients suffering from liver cirrhosis compared to overall population and in those patients, acute cholecystitis occurs significantly more often. Our goal was to review the literature and to overview the indications, contra-indications, and alternatives in the cirrhotic with biliary stones. We conducted a systematic review of the literature using the key words "Cirrhosis", "cholecystectomy", "laparoscopy"and "indications". Selected articles were reviewed for information specific to indications, contra-indications, and alternatives to laparoscopic cholecystectomy in cirrhotics. Results showed that laparoscopic cholecystectomy might offer several advantages in cirrhotic population, however cholecystectomy can be challenging: specific indications and alternatives to surgery must be discussed case by case. Laparoscopic cholecystectomy can be performed safely in selected patients with cirrhosis; special precautions are warranted regarding pneumoperitoneum pressure, trocar placement and increased safety with Indocyanine-green (ICG) fluorescence cholangiography. Nevertheless, in high-risk cirrhotic patients (Child C) and/or in common bile duct lithiasis endoscopic and non-surgical conservative treatments are preferable

Effects of open (Racket) and closed (running) skill sports practice on children’s attentional performance

Aims: The first aim of the study was to examine the attentional performance of children (8–13 years of age) who practiced two different sport disciplines: Open skill sport – racket and closed skill sport – running and also to investigate the acute effects of these two specific training sessions on children’s immediate and delayed attentional performance. The second aim of the present study was to verify gender differences in attentional performance. Eighteen children+ (8 girls and 10 boys; age = 10.6 ± 1.5 yrs; height = 144.3 ± 12.2 cm; weight = 44.2 ± 12.5 kg; BMI = 20.8 ± 2.7 kg/m2) engaged in a racket sports and eighteen children (9 girls and 9 boys; age = 9.9 ± 1.2 yrs; height = 142.4 ± 9.5 cm; weight = 40.0 ± 8.6 kg; BMI = 19.6 ± 2.4 kg/m2) engaged in running were enrolled. Methods: Children’s training and experience with these activities averaged 2.3 (± 1.0) years. Children’s attentional capacity was measured before, immediately after and 50 minutes after each specific training session by the d2 test of attention. This paper-and-pencil letter cancellation test evaluated concentration and sustained attention under stress induced by a fixed executing time. A 2 (Sport: open vs closed skill) x 2 (Gender: boys vs girls) x 3 (Time: pre vs 0’ post vs 50’ post) repeated measures ANOVA for time was used to compare the effect of an open skill session and a closed skill session on the individual attentional variables. Results: Children of open skill sport showed higher attentional scores (higher processing speed-TN, higher concentration performance-CP and lower percentage of errors-E%; p < 0.01), improved CP from pre to 0’ post intervention (p = 0.01) and maintained this improved performance at 50’ post intervention (50’ post vs pre; p < 0.01), and decreased E% from pre to 0’ post intervention (p = 0.01) and maintained this improvement at 50’ post intervention (50’ post vs pre; p < 0.001). Children of closed skill sport significantly decreased their CP from pre to 50’ post intervention (50’ post vs pre; p = 0.001 and 50’ post vs 0’ post; p < 0.0001) and worsened their E% across the time (50’ post vs pre; p = 0.001 and 50’ post vs 0’ post; p < 0.0001). Boys showed significantly higher TN values than girls only in closed skill sport (p = 0.023). Finally, all girls of both open and closed skill sports significantly improved their CP from pre to 0’ post intervention (p = 0.04). Conclusion: Results of the study showed that open skill sport practice and training session positively affects children’s attentional performance

Physical activity and hypocaloric diet recovers osteoblasts homeostasis in women affected by abdominal obesity.

Obesity is a multifactorial disease linked to metabolic chronic disorders such as diabetes, and hypertension. Also, it has recently been associated with skeletal alterations and low bone mineral density. We previously demonstrated that exposure of osteoblasts to sera of sedentary subjects affected by obesity alters cell homeostasis in vitro, leading to disruption of intracellular differentiation pathways and cellular activity. Thus, the purpose of the present study has been to evaluate whether sera of sedentary obese women, subjected to physical activity and hypocaloric diet, could recover osteoblast homeostasis in vitro as compared to the sera of same patients before intervention protocol. To this aim, obese women were evaluated at time 0 and after 4, 6, and 12 months of individualized prescribed physical activity and hypocaloric diet. Dual-energy-X-ray absorptiometry measurements were performed at each time point, as well as blood was collected at the same points. Cells were incubated with sera of subjects before and after physical activity as described: obese at baseline and after for 4, 6, and 12 months of physical activity and nutritional protocol intervention. Osteoblasts exposed to sera of patients, who displayed increased lean and decreased fat mass (from 55.5 ± 6.5 to 57.1 ± 5.6% p ≤ 0.05; from 44.5 ± 1.1 to 40.9 ± 2.6% p ≤ 0.01 respectively), showed a time-dependent increase of Wnt/β-catenin signaling, versus cells exposed to sera of obese patients before intervention protocol, suggesting recovery of osteoblast homeostasis upon improvement of body composition. An increase in β-catenin nuclear accumulation and nuclear translocation was also observed, accompanied by an increase in Adiponectin receptor 1 protein expression, suggesting positive effect on cell differentiation program. Furthermore, a decrease in sclerostin amount and an increase of type 1 procollagen amino-terminal-propeptide were depicted as compared to baseline, proportionally to the time of physical activity, suggesting a recovery of bone remodeling modulation and an increase of osteoblast activity induced by improvement of body composition. In conclusion, our results show for the first time that sera of obese sedentary women who increased lean mass and decreased fat mass, by physical activity and hypocaloric diet, rescue osteoblasts differentiation and activity likely due to a reactivation of Wnt/β-catenin-pathway, suggesting that a correct life style can improve skeletal metabolic alteration induced by obesity

[177Lu]Lu-DOTA-TATE versus standard of care in adult patients with gastro-enteropancreatic neuroendocrine tumours (GEP-NETs): a cost-consequence analysis from an Italian hospital perspective

Purpose: To assess and compare clinical outcomes and costs, to the Italian healthcare system, of three therapeutic options approved in the management of adult patients with gastro-enteropancreatic neuroendocrine tumours (GEP-NETs). Methods: We compared the efficacy, safety, and costs of [177Lu]Lu-DOTA-TATE, everolimus (both originator and generic products), and sunitinib in patients with advanced GEP-NETs (NET G1 and G2) that had progressed following treatment with somatostatin analogs (SSAs). A cost-consequence model was developed and validated by a panel of clinical experts from three NET reference centres in Italy. The clinical outcomes included in the model were median progression-free survival and the incidence of grade 3 or 4 adverse events (AEs), as reported in pivotal clinical trials. The costs for acquisition and administration of each treatment, and of managing AEs, were calculated from the perspective of the Italian national health service. Treatment costs per progression-free month were calculated separately for patients with NETs of pancreatic (PanNETs; all three treatments) and gastrointestinal (GI-NETs; [177Lu]Lu-DOTA-TATE and everolimus only) origin. Results: In patients with PanNETs, total costs per progression-free month were €2989 for [177Lu]Lu-DOTA-TATE, €4975 for originator everolimus, €3472 for generic everolimus, and €5337 for sunitinib. In patients with GI-NETs, total costs per progression-free month were €3189 for [177Lu]Lu-DOTA-TATE, €4990 for originator everolimus, and €3483 for generic everolimus. Conclusions: [177Lu]Lu-DOTA-TATE was associated with lower costs per progression-free month versus relevant treatment options in patients with GI-NETs or PanNETs (NET G1–G2; progressed following SSA treatment), although acquisition and administration costs are higher. These findings provide further economic arguments in the overall context of treatment decision-making

Prediction of 2 years-survival in patients with stage I and II non-small cell lung cancer utilizing (18)F-FDG PET/CT SUV quantification.

BACKGROUND: The purpose of the study was to evaluate the correlation between the maximum standardized uptake value (SUVmax), size of primary lung lesion, disease-free survival (DFS) and overall survival (OS) in patients with stage I and II non-small cell lung cancer (NSCLC) in 2 years follow-up. PATIENTS AND METHODS. Forty-nine patients with stage I–II NSCLC were included in this study. Pre-surgical 2-deoxy-2-[18F]fluoro-D-glucose positron-emission tomography ((18)F-FDG PET/CT) study was performed for all patients. The relationship between SUVmax, tumour size and clinical outcome was measured. The cut-off value for SUVmax and tumour size with the best prognostic significance, probability of DFS and the correlation between SUVmax and the response to therapy were calculated. RESULTS: There was a statistically significant correlation between SUVmax and DFS (p = 0.029). The optimal cut-offs were 9.00 for SUVmax (p = 0.0013) and 30mm for tumour size (p = 0.0028). Patients with SUVmax > 9 and primary lesion size > 30 mm had an expected 2years-DFS of 37.5%, while this rose to 90% if the tumour was <30 mm and/or SUVmax was <9. CONCLUSIONS: In stage I-II, SUVmax and tumour size might be helpful to identify the subgroup of patients with high chance for recurrence

An apical actin-rich domain drives the establishment of cell polarity during cell adhesion.

One of the most important questions in cell biology concerns how cells reorganize after sensing polarity cues. In the present study, we describe the formation of an actin-rich domain on the apical surface of human primary endothelial cells adhering to the substrate and investigate its role in cell polarity. We used confocal immunofluorescence procedures to follow the redistribution of proteins required for endothelial cell polarity during spreading initiation. Activated Moesin, vascular endothelial cadherin and partitioning defective 3 were found to be localized in the apical domain, whereas podocalyxin and caveolin-1 were distributed along the microtubule cytoskeleton axis, oriented from the centrosome to the cortical actin-rich domain. Moreover, activated signaling molecules were localized in the core of the apical domain in tight association with filamentous actin. During cell attachment, loss of the apical domain by Moesin silencing or drug disruption of the actin cytoskeleton caused irregular cell spreading and mislocalization of polarity markers. In conclusion, our results suggest that the apical domain that forms during the spreading process is a structural organizer of cell polarity by regulating trafficking and activation of signaling proteins

Effect of pre-season training phase on anthropometric, hormonal and fitness parameters in young soccer players

The aims of the study were to investigate 1) the effect of 8 weeks of PSP training on anthropometrics, salivary hormones and fitness parameters in youth soccer players, 2) the correlations between fitness and hormonal parameters, and 3) the impact of the experience of the coach and his methodology of training on these parameters. Weight, height, BMI, pubertal development (PDS), salivary Cortisol (sC), salivary Testosterone (sT), salivary sDHEAS, intermittent tests (VO2max), and countermovement jump test (CMJ) modifications of 35 youth soccer players (age: 14±0 yrs; BMI: 20.8±1.8 k/m2 ) from two Italian clubs (“Lupa Frascati” -LF-; “Albalonga” -AL) were analysed. A significant (p<0.05) time by club effect was observed in sC (F(1,31) = 9.7, ES = 1.13), sT (F(1,31) = 4.2, ES = 0.74), CMJ (F(1,28) = 26.5, ES = 1.94), and VO2max (F(1,28) = 8.5, ES = 1.10). Statistical differences (p<0.05) in weight (F(1,32) = 25.5, ES = 0.11), sC (F(1,31) = 32.1, ES = 1.43), sT/sC ratio (F(1,31) = 10.1, ES = 0.97), sDHEAS/sC ratio (F(1,31) = 6.3, ES = 0.70), and VO2max (F(1,28) = 64.3, ES = 1.74) were found within time factor. Between clubs, differences (p<0.05) in sC (F(1,32) = 8.5, ES = 1.17), sT (F(1,31) = 4.2, ES = 0.74), CMJ (F(1,28) = 26.5, ES = 1.50), and VO2max (F(1,28) = 8.5, ES = 1.10) were found. CMJ was inversely correlated with sDHEAS (r = -0.38) before PSP, while Δ of CMJ showed significant correlations with Δ of sC (r = 0.43) and ΔVO2max was inversely correlated with ΔBMI (r = -0.54) and ΔsC (r = -0.37) in all subjects. Considering each single club, ΔVO2max showed correlations with ΔBMI (r = -0.45) in AL, while ΔCMJ showed correlations with ΔPDS (r = 0.72) in LF club. Since the PSP is often limited training time to simultaneously develop physical, technical and tactical qualities, an efficient method to distribute the training load is important in youth soccer players to increase the performance and to avoid injuries