Left Side Gallbladder: Clinical and Anatomical Implication

Left side gallbladder is a rare anatomical anomaly reported in the literature. It is associated with various anatomical variations of the biliary way and intrahepatic portal supply. Most of the time, it is discovered as an incidental finding during intervention for cholecystectomy, exposing patients and surgeons to high risk of complication. To prevent this, we analyze the critical aspects that must be known to perform safe interventions either in the normal setting or in the emergency setting. Different theories are proposed to describe this anomaly, but a debate is still open. Reviewing the literature and analyzing the different processes of formation, we create a classification that can explain how this anomaly can occur, dividing into four variation types

The brain tissue reaction to blunt trauma: a field of possible cooperation between neuroanatomists and forensic pathologists

The goal of this presentation is to describe, through the histological examination, the evolution over time of the biological processes, at the cellular and molecular level, in the neurological tissue after a blunt trauma. The origin of the secondary ischemia, that often occurs after a brain trauma, leading to death the patient, is almost studied on animal models and is not well known yet. It is presumed that hemorrhages and contusions result in brain ischemia, and that also brain edema arises intra-cranial pressure producing ischemia. Forensic pathology deals everyday with cases of traumatic deaths, and is therefore able to study the inflammatory reaction to trauma in a human casuistry giving information to other disciplines like neuroanatomy. The time-dependent appearance of different leucocyte subtypes can contribute to a forensic wound age estimation but, in contrast to peripheral tissue, the cellular reaction in the CNS is characterized by a minimal neutrophil exsudation and a delayed increase in mononuclear cell numbers. 62 deaths due to head injury with a survival time from few minutes till 30 days were studied. Samples of brain tissue were stained with immunohistochemistry using selectin P and E, GFAP, HIF1-α, CD 117 (c-kit), LCA. The schematic information about chronology of head trauma are given as follows: survival of a few minutes, of 1 hour, of 2-4 hours, of 4-12 horus, of 12-24 hours, 24-48 hours, 2-6 days, 6-14 days, 15-30 days. The number of platelets microthrombi increases with TBI age up to 3 days, afterward leukocytes start to take their place. Platelets aggregates may impair cerebral circulation causing ischemia. Cerebral ischemia plays an important role in SBD. There is also an involvement of CD 117+ cells and HIF-1 α in the modulation and progression of the brain injury. After brain injury a cascade of events occurs leading sometime to a brain secondary ischemic injury. Thanks to the availability of injured human brain tissues, forensic histopathologists might work together with neuroanatomists in order to help in the identification of glial cells and leukocytes communication with endothelial cells, and on the post-traumatic ischemic process that causes the death in prolonged survival time after brain injury

New surveys and archival documents for knowledge of architectural assets: the 1600 construction of a new atrium in the convent-sanctuary of Saint Francis of Paola (Paola-Italy)

[EN] The new 2012-2015 surveys, for the convent of Saint Francis of Paola (Paola-Italy), allow reflection on both the role of new software to acquire information on the ways of analyzing architecture, the result of parameters relating to: form, function and construction techniques. Parameters that can be evaluated only by crossing checking the data of new 3D models with information inferred from records of the past.The case-study proposed, relating to the parameter of architectural form, clearly exemplifies our statement.[ES] Los nuevos levantamientos de 2012-2015 para el Convento de San Francisco de Paula (Paula-Italia), permiten reflexionar tanto sobre los nuevos software de adquisición de información, como sobre los modos de analizar la arquitectura basados en parámetros relativos a forma, función y técnicas de construcción. Estos parámetros se pueden evaluar solamente a través de la acción de levantamiento y cruzando los datos de los nuevos modelos 3D con la información obtenida de los documentos del pasado. El caso-estudio propuesto, relativo, en particular, al parámetro de la forma arquitectónica, ilustra claramente lo que afirmamos y el contenido cognitivo inherente en el método mostrado.De Sanctis, A.; Fortunato, G.; Zappani, AA. (2017). Nuevos levantamientos y documentos de archivo para el conocimiento de los bienes arquitectónicos: la construcción en el siglo XVII de un nuevo vestíbulo en el Convento-Santuario de San Francisco de Paula (Paula-Italia). EGA. Revista de Expresión Gráfica Arquitectónica. 22(30):118-129. doi:10.4995/ega.2017.7835.SWORD1181292230Banchini, R., 2009. Francescani e Mini-mi: architetture in Calabria tra xvi e xvii se-colo. En: A. Anselmi, ed. 2009. La Calabria del viceregno spagnolo. Roma: Gangemi, pp. 559-591.Barozzi, J., 1562. Regola delli cinque or-dini d'architettura. Roma.Blaeu, J., 1658. Theatrum civitatum et admirandorum Italiae. Amsterdam: Typis Ioannis Blaeu.Gombrich, E.H. 1965. Arte e illusione. Torino: Einaudi.Lanovius, F., 1653. Chronicon generale Ordinis Minimorum. Paris: S. Cramoisy.Mortier, P., 1704. Novum Italiae thea-trum (III). Amsterdam: P. Mortier.Perrimezzi, G.M., 1707. Vita S. Fran-cisci de Paula. Notis, & dissertationibus illustrata. Pars secunda. Dissertationes. Roma: Typis Bernabò.Salmon, T., 1761. Lo stato presente di tut-ti i paesi, e popoli del mondo (XXIII, Regno di Napoli), Venezia: Giambattista Albrizzi

Reposicionamento de la imagen de Barcelona en la luz de una redefinición del modelo turistico de planificación urbana

El modelo de desarrollo urbanístico-turístico de Barcelona en los últimos quince años ha obtenido un éxito extraordinario en cuanto a número de visitantes, pernoctaciones, llegadas de pasajeros de cruceros, incremento de camas hoteleras y visitas a monumentos de pago. De este modo, la ciudad se ha convertido en una de las ciudades más visitadas de Europa y de mayor crecimiento del número de turistas. Pero, este crecimiento cuantitativo ha generado masificación turística, concentración en determinados barrios, enfrentamiento por el uso del espacio urbano entre turistas y residentes, además de generar algunas deficiencias infraestructurales como la conectividad y la intermodalidad. Estos problemas amenazan la posición competitiva de Barcelona. Este artículo revisa la competitividad entre las ciudades, comparando Barcelona con otras diez ciudades europeas. A partir de un análisis cualitativo a los players internos y externos y de un Estudio Delphi con players externos, se exploran las correcciones que hay que introducir en el modelo y los vectores del reposicionamiento. Esta nueva posición refuerza la competitividad en base a tres objetivos: la sostenibilidad del modelo, la gestión integral de la metrópolis turística y su gobernanza, y la orientación al cliente.Barcelona’s city tourism model over the last fifteen years has chalked up many successes in terms of soaring tourist numbers, overnight stays, cruise liner passengers, hotel beds and visits to priced sights. Growth in city breaks has soared to the point where Barcelona has become one of Europe’s most visited cities. But this growth has come at a heavy price: mass tourism, concentration in certain neighbourhoods, competition for space between tourists and residents, lack of adequate inter-modal transport. All of these problems threaten Barcelona’s competitive position. The paper reviews the city’s competitiveness, comparing Barcelona to ten other European cities. Starting out from a qualitative analysis of internal players and a Delphi Study with external players, we find the city’s tourism model needs correcting. We also identify the vectors and most important factors for achieving this repositioning. The vectors reinforce the competitiveness concerning the model’s sustainability, integrated management and governance, and client orientation. The proposed strategic repositioning will allow Barcelona to continue competing with Europe’s main cities

Current trends of minimally invasive therapy for cholecystocholedocholithiasis

IntroductionThe minimally invasive approach of endoscopic ultrasound (EUS)-guided procedures for cholecystocholedocholithiasis, such as EUS-guided gallbladder drainage (EUS-GBD), EUS-guided rendezvous (EUS-RV), and EUS-guided biliary drainage (EUS-BD), is affirmed as an effective treatment for patients with acute cholecystitis (AC) who are unfit for surgery and for patients with common bile duct stones (CBDSs) who have experienced a previous ERCP failure. Furthermore, in cases of difficult CBDS extraction during endoscopic retrograde cholangiopancreatography (ERCP), cholangioscopy-guided electrohydraulic lithotripsy (CS-EHL) has showed optimal results. The main objective of our study was to evaluate the effectiveness of EUS-GBD and percutaneous gallbladder drainage (PT-GBD) in patients with AC who are unfit for surgery. We also aimed to evaluate the efficacy of EUS-GBD, EUS-BD, and EUS-RV following ERCP failure and the effectiveness of CS-EHL for difficult CBDS extraction in our hospital. The secondary aim was to examine the safety of these procedures.Materials and methodsWe conducted a retrospective evaluation of all the EUS-GBD, PT-GBD, EUS-BD, EUS-RV, and CS-EHL procedures, which were prospectively collected in the gastroenterology and digestive endoscopy unit and the general surgery unit from January 2020 to June 2023. The efficacy was expressed in terms of technical and clinical success rates, while safety was assessed based on the rate of adverse events (AEs).ResultsWe enrolled 83 patients with AC and high surgical risk. Among them, 57 patients (68.7%, 24/57 male, median age 85 ± 11 years) underwent EUS-GBD, and 26 (31.3%, 19/26 male, median age 83 ± 7 years) underwent PT-GBD. The technical and clinical success rates were 96.5 and 100% for EUS-GBD, and 96.1 and 92% for PT-GBD. The AEs for EUS-GBD were 1.7%, and for PT-GBD, it was 12%. ERCP for CBDS extraction failed in 77 patients. Among them, 73 patients (94.8%) underwent EUS-RV with technical and clinical success rates of 72.6% (53/73) and 100%, respectively. No AEs were reported. Four out of 77 patients were directly treated with EUS-BD for pyloric inflammatory stenosis. In 12 patients (16.4%), following unsuccessful EUS-RV with a CBD diameter ≥ 12 mm, an EUS-BD was performed. Both technical and clinical success rates for EUS-BD were 100%, and no AEs were reported. EUS-GBD was the treatment of choice for the remaining 8 (10.9%) patients after failure of both ERCP and EUS-RV. The procedure had high technical and clinical success rates (both at 100%), and no AEs were reported. The 12 difficult CBDS extraction treated with CS-EHL also showed high technical and clinical success rates (both at 100%), with no reported AEs.ConclusionThe minimally invasive approach for cholecystocholedocholithiasis, especially EUS-guided procedures, had high efficacy and safety in treating AC in high-risk surgical patients and CBDS extraction after a previously unsuccessful ERCP

RocTest: A standardized method to assess the performance of root organ cultures in the propagation of arbuscular mycorrhizal fungi

Over the past three decades, root organ cultures (ROCs) have been the gold standard method for studying arbuscular mycorrhizal fungi (AMF) under in vitro conditions, and ROCs derived from various plant species have been used as hosts for AM monoxenic cultures. While there is compelling evidence that host identity can significantly modify AMF fitness, there is currently no standardized methodology to assess the performance of ROCs in the propagation of their fungal symbionts. We describe RocTest, a robust methodological approach that models the propagation of AMF in symbiosis with ROCs. The development of extraradical fungal structures and the pattern of sporulation are modeled using cumulative link mixed models and linear mixed models. We demonstrate functionality of RocTest by evaluating the performance of three species of ROCs (Daucus carota, Medicago truncatula, Nicotiana benthamiana) in the propagation of three species of AMF (Rhizophagus clarus, Rhizophagus irregularis, Glomus sp.). RocTest produces a simple graphical output to assess the performance of ROCs and shows that fungal propagation depends on the three-way interaction between ROC, AMF, and time. RocTest makes it possible to identify the best combination of host/AMF for fungal development and spore production, making it an important asset for germplasm collections and AMF research

Emilia-Romagna Surgical Colorectal Cancer Audit (ESCA): a value-based healthcare retro-prospective study to measure and improve the quality of surgical care in colorectal cancer

Purpose: Surgery is the main treatment for non-metastatic colorectal cancer. Despite huge improvements in perioperative care, colorectal surgery is still associated with a significant burden of postoperative complications and ultimately costs for healthcare organizations. Systematic clinical auditing activity has already proven to be effective in measuring and improving clinical outcomes, and for this reason, we decided to evaluate its impact in a large area of northern Italy. Methods: The Emilia-Romagna Surgical Colorectal Audit (ESCA) is an observational, multicentric, retro-prospective study, carried out by 7 hospitals located in the Emilia-Romagna region. All consecutive patients undergoing surgery for colorectal cancer during a 54-month study period will be enrolled. Data regarding baseline conditions, preoperative diagnostic work-up, surgery and postoperative course will be collected in a dedicated case report form. Primary outcomes regard postoperative complications and mortality. Secondary outcomes include each center’s adherence to the auditing (enrolment rate) and evaluation of the systematic feedback activity on key performance indicators for the entire perioperative process. Conclusion: This protocol describes the methodology of the Emilia-Romagna Surgical Colorectal Audit. The study will provide real-world clinical data essential for benchmarking and feedback activity, to positively impact outcomes and ultimately to improve the entire healthcare process of patients undergoing colorectal cancer surgery. Clinical trial registration: The study ESCA is registered on the clinicaltrials.gov platform (Identifier: NCT03982641)

Assessing the effectiveness of public investments in cultural built heritage: the case of the umbertine forts system in italy

The paper deals with the topic of the allocation of resources and investment strategies in cultural built heritage. The valorization of cultural assets is often guaranteed by the intervention of public funding. The need to allocate these funds efficiently and effectively, together with the transparency duties to which public administrations are subject, necessitates a careful measurement of the economic, cultural, environmental and social effects. Accordingly, the paper outlines the starting framework of a study on the ex-post evaluation of the effectiveness of public intervention towards the restoration and valorization of three forts in the Umbertine Forts System, located in the Metropolitan City of Reggio Calabria, southern Italy

Laparoscopic right hemicolectomy: a SICE (Società Italiana di Chirurgia Endoscopica e Nuove tecnologie) network prospective study on the approach to right colon lymphadenectomy in Italy: is there a standard?—CoDIG 2 (ColonDx Italian Group)

Background: Colon cancer is a disease with a worldwide spread. Surgery is the best option for the treatment of advanced colon cancer, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines, the gold standard was D3 dissection to remove the central lymph nodes (203, 213, and 223), but in 2009, Hoenberger et al. introduced the concept of complete mesocolic excision, in which surgical dissection follows the embryological planes to remove the mesentery entirely to prevent leakage of cancer cells and collect more lymph nodes. Our study describes how lymphadenectomy is currently performed in major Italian centers with an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH). Methods: CoDIG 2 is an observational multicenter national study that involves 76 Italian general surgery wards highly specialized in colorectal surgery. Each center was asked not to modify their usual surgical and clinical practices. The aim of the study was to assess the preference of Italian surgeons on the type of lymphadenectomy to perform during RH and the rise of any new trends or modifications in habits compared to the findings of the CoDIG 1 study conducted 4 years ago. Results: A total of 788 patients were enrolled. The most commonly used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%), side-to-side (98.7%), or isoperistaltic (96.0%) anastomosis. The lymph nodes at the origin of the vessels were harvested in an inferior number of cases (203, 213, and 223: 42.4%, 31.1%, and 20.3%, respectively). A comparison between CoDIG 1 and CoDIG 2 showed a stable trend in surgical techniques and complications, with an increase in the robotic approach (7.7% vs. 12.3%). Conclusions: This analysis shows how lymphadenectomy is performed in Italy to achieve oncological outcomes in RH, although the technique to achieve a higher lymph node count has not yet been standardized. Trial registration (ClinicalTrials.gov) ID: NCT05943951

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