Acute bleeding obstruction pancreatitis after Roux-en-Y anastomosis in total gastrectomy: a single center experience

Anastomotic intraluminal bleeding is a well-known complication after total gastrectomy. Nevertheless, few data are published on acute bleeding obstruction pancreatitis (BOP) due to a bleeding from the jejunojejunostomy (JJ). In this paper we describe our experience. A total of 140 gastrectomies for EGJ cancer were performed in our Institute from January 2012 to January 2017. All reconstructions were performed with a Roux-en-Y anastomosis: a mechanical end-to-side esophago-jejunostomy and a mechanical end-to-side JJ. Three patients suffered from a bleeding at the JJ with a consequent BOP. We analyzed the time of diagnosis, the treatment and the outcomes. The three patients presented anemia at the laboratory findings on postoperative day (POD) 1. In patient I laboratory findings of acute pancreatitis were found in POD 2. CT scan was performed and showed signs of BOP. Endoscopic treatment was tried without success. Therefore, patient underwent surgery: JJ take down, bleeding control and anastomosis rebuild were performed. In spite of this the patient died of MOF in POD 4. Patient II had a persistent anemia treated with blood transfusions until POD 3, when laboratory tests showed increased lipase and bilirubin levels. Patient was successfully treated with endoscopy but several blood transfusions and a prolonged recovery were necessary. Patient III had laboratory findings of acute pancreatitis on POD 1. Immediate surgery was performed and patient was discharged on POD 9 without sequelae. BOP is a rare but deadly complication after Roux-en-Y anastomosis. An early diagnosis and an aggressive treatment seem to improve the outcome

Harbour water managment for port structures and sea bottom design, coast proximity navigation managment, water quality control.

Tide is a sea level up-down water motion basically depending on three different phenomena: the Earth-Moon-Sun gravitational relationship, the water surface fluid reaction to atmospheric meteorological dynamic action and the Newtonian vertical adjustment of the sea surface due to atmospheric pressure variations. The first tide component (astro-tide) is periodic and well known in all points of the Earth surface; the second one is directly related to the meteorological phenomenon and then it is foreseeable; the Newtonian component, on the contrary, is not readily predictable by a general hydrostatic law, because the factor “J” that represents the Newtonian transfer (from the atmospheric weight to the consequent sea level) is variable in each harbour area. A statistical study and the related numerical data interpretation of the measurements performed in the Ports of Genoa, La Spezia, Marina di Carrara, Livorno, Piombino, Civitavecchia and Ravenna (belonging to the Italian Newtonian Meteotide Network) show port values of Jph (from 1.4-1.6 cm/hPa to > 2 cm/hPa, on the contrary of the off-shore areas where Jph is about 1 cm/hPa). This phenomenon (hydrobarometric tide wave) produces even double values of harbour sea level fluctuations amplitude in comparison to astronomic tide sea level oscillations, and is characterized by a wavelength from 8-12 h to same days and a 10-25 days/year as mean temporal occurrence in the Northern Tyrrhenian Sea. This is the most relevant ordinary risk factor for our ports activity and structures design. The present note shows a quantitative method to define the values of Jph factor for ports and its use in the Harbour WaterSide Management (HWSM) based on the joined use of barometers, hydrometers and clocks, the preliminary results related to the use of the gravimeters as hydrobarometric predictor in La Spezia Port and two examples of use of Jph factor in the port management: refloating of a landing ship and optimisation of a dock performance as pleasure boats mooring

Adiponectin and Sarcopenia: A Systematic Review With Meta-Analysis

Background: Sarcopenia is a progressive loss of skeletal muscle mass whose pathophysiology has been proposed to possibly involve mechanisms of altered inflammatory status and endocrine function. Adiponectin has been shown to modulate inflammatory status and muscle metabolism. However, the possible association between adiponectin levels and sarcopenia is poorly understood. In order to fill this gap, in the present manuscript we aimed to summarize the current evidence with a systematic review and a meta-analysis of studies reporting serum adiponectin levels in patients with sarcopenia compared to non-sarcopenic controls. Methods: An electronic search through Medline/PubMed, Cochrane Library, and Science Direct was performed till March 1, 2020. From the included papers, meta-analysis of cross-sectional studies comparing serum levels of adiponectin between patients with sarcopenia and controls was performed. Results: Out of 1,370 initial studies, seven studies were meta-analyzed. Sarcopenic participants had significantly higher levels of adiponectin Hedges’ g with 95% confidence interval (CI): 1.20 (0.19–2.22), p = 0.02 than controls. Subgroup analysis, performed in Asian population and focused on identification of the condition based on AWGS criteria, reported higher adiponectin levels in sarcopenic population (2.1 (0.17–4.03), p = 0.03 and I2 = 98.98%. Meta-regression analysis revealed female gender to significantly influence the results as demonstrated by beta = 0.14 (95% CI (0.010–0.280), p = 0.040). Conclusions: Our meta-analysis found evidence that sarcopenia is associated with higher adiponectin levels. However, caution is warranted on the interpretation of these findings, and future longitudinal research is required to disentangle and better understand the topic

Assessing the competitiveness of Matera and the Basilicata Region (Italy) ahead of the 2019 European Capital of Culture

Cities/regions are increasingly using events to aid social/economic development. The European Capital of Culture promotes urban management and economic production using culture to drive social legacies, job creation and civic repositioning. This paper aims to understand how Matera and Basilicata’s residents perceive destination competitiveness ahead of the 2019 European Capital of Culture. This paper adapts the Integrated Model of Destination Competitiveness and suggests a new determinant to understand resident perceptions. This paper contributes a new determinant to consider in competitiveness research: social conditions to improve local wellbeing. Two hundred respondents identify strengths/weaknesses of each competitiveness determinant. The results presented in this study display sample mean values and standard deviations for each indicator, as well as Wilcoxon test statistic (z). Competitive indicators are those showing means above 4.0. Descriptive and inferential analyses using SPSS 17 show strengths/weaknesses comparing Matera (city) and Basilicata (region) with similarities and differences outlined to consider both urban and regional perspectives and differences. For the data analysis, Wilcoxon paired signed rank test displays differences in the competitiveness factors between Matera and Basilicata. Wilcoxon (a nonparametric alternative to paired sample t-test) was performed since the data distribution was left skewed and Kolmogorov–Smirnov statistic indicates violation of normality assumption. Results show the majority of inherited, created and supporting resources are competitive, as well as image and social conditions; however, management and organisation needs improvement. It is essential that European Capital of Culture hosts have long-term competitive strategies in place to strengthen urban and regional capacity when delivering diverse cultural programmes, at present, and into the future. This study offers insight before the 2019 European Capital of Culture to inform planners and policymakers ahead of the event and offers consideration and discussion of social impacts and the need to gain such insight in competitiveness research going forward

The newtonian approach in the meteorological tide waves forecasting: preliminary observations in the East Ligurian harbours

Sea level oscillations are the superposition of many contributions, among which the main are astronomic and meteorological low-frequency tides. In Ligurian Sea meteo-tide components, being most ample than astronomic fluctuations, drive water exchange in harbours. The present note shows first results about port of Genoa concerning a coherency study between atmospheric variation and corresponding sea level adjustment (meteorological tide). The newtonian forecasting method of meteorological tides is based on measurements of time elapsing between barometric sea level unbalance (Δg) and its meteorological tide compensation (inverse barometer component). Meteorological tide component is independent on the Earth-Moon-Sun gravitational relationships, moreover parameters related to the shifted water mass are too many to describe the phenomenon analytically (basin topography, barometric strength position and time, chemical water quality, off-shore sea circulation, etc.); then, meteorological tide can’t be accurately foreseen by atmospheric pressure measurements only. A gravimeter can detect the geodetic unbalance starting time and a tide-gauge can detect the newtonian compensation (tide wave) coming time. The difference between these two times is the meteorological tide delay. An opportune statistic of this delay provides an experimental law typical for each harbour to forecast the meteo-tide compensation wave delay. This paper describes the methodological procedure adopted and first evidences of the phenomenon in Genoa harbour

The hERG1 potassium channel behaves as prognostic factor in gastric dysplasia endoscopic samples

Purpose: Gastric cancer (GC) is still a relevant health issue worldwide. The identification of prognostic factors for progression of gastric dysplasia (GD), the main pre-cancerous lesion of the intestinal-type GC, is hence mandatory.Patients and methods: A cohort of 83 GD endoscopic samples belonging to Italian subjects was collected. hERG1 expression was evaluated by immunohistochemistry and scored 0-3, depending on the percentage of stained cells. Expression data were analysed in conjunction with clinico-pathological and survival data.Results: hERG1 turned out to be expressed in 67.47% (56 out of 83) of the GD samples. hERG1 expression was higher in high-grade GD compared to low-grade GD (29 out of 39, 74.36% vs 27 out of 44, 61.36%), although the statistical significance was not reached (P=0.246). No association emerged between hERG1 expression and clinical features of the patients (age, gender, localization, H. pylori infection, gastritis and intestinal metaplasia). In a subset of cases for which sequential samples of gastric lesions (from GD to Early Gastric Cancer and Advanced Gastric Cancer) were available, hERG1 expression was maintained in all the steps of gastric carcinogenesis from GD onwards. A general trend to increased expression in advanced lesions was observed. hERG1 score had a statistically significant impact on both Progression-Free Survival (P=0.018) and Overall Survival (P=0.031). In particular, patients displaying a high hERG1 score have a shorter survival.Conclusion: hERG1 is aberrantly expressed in human GD samples and has an impact on both PFS and OS, hence representing a novel prognostic marker for progression of GD towards GC of the intestinal histotype. Once properly validated, hERG1 detection could be included in the clinical practice, during endoscopic surveillance protocols, for the management of GD at higher risk of progression, as already proposed for Barrett's oesophagus

Short-wavelength four wave mixing experiments using single and two-color schemes at FERMI

The development of ultra-bright extreme ultraviolet (EUV) and X-ray free electron laser (FEL) sources has enabled the extension of wave-mixing approaches into the short wavelength regime. Such a class of experiments relies upon nonlinear interactions among multiple light pulses offering a unique tool for exploring the dynamics of ultrafast processes and correlations between selected excitations at relevant length and time scales adding elemental and site selectivity as well. Besides the availability of a suitable photon source, the implementation of wave mixing methodology requires efforts in developing the instrumental set-up. We have realized at the FERMI FEL two dedicated set-ups to handle multiple FEL beams with preselected parameters in a non-collinear fashion and control their interaction sequence at the target. These unique apparatuses, combined with the exceptional characteristics of the seeded FERMI FEL, have allowed us to make the first steps into this field and further advances are foreseen in the near future

Nanoscale transient magnetization gratings excited and probed by femtosecond extreme ultraviolet pulses

We utilize coherent femtosecond extreme ultraviolet (EUV) pulses derived from a free electron laser (FEL) to generate transient periodic magnetization patterns with periods as short as 44 nm. Combining spatially periodic excitation with resonant probing at the dichroic M-edge of cobalt allows us to create and probe transient gratings of electronic and magnetic excitations in a CoGd alloy. In a demagnetized sample, we observe an electronic excitation with 50 fs rise time close to the FEL pulse duration and ~0.5 ps decay time within the range for the electron-phonon relaxation in metals. When the experiment is performed on a sample magnetized to saturation in an external field, we observe a magnetization grating, which appears on a sub-picosecond time scale as the sample is demagnetized at the maxima of the EUV intensity and then decays on the time scale of tens of picoseconds via thermal diffusion. The described approach opens prospects for studying dynamics of ultrafast magnetic phenomena on nanometer length scales

Primary Tumor Resection for Metastatic Colorectal, Gastric and Pancreatic Cancer Patients: In Search of Scientific Evidence to Inform Clinical Practice

The management of the primary tumor in metastatic colorectal, gastric and pancreatic cancer patients may be challenging. Indeed, primary tumor progression could be associated with severe symptoms, compromising the quality of life and the feasibility of effective systemic therapy, and might result in life-threatening complications. While retrospective series have suggested that surgery on the primary tumor may confer a survival advantage even in asymptomatic patients, randomized trials seem not to definitively support this hypothesis. We discuss the evidence for and against primary tumor resection for patients with metastatic gastrointestinal (colorectal, gastric and pancreatic) cancers treated with systemic therapies and put in context the pros and cons of the onco-surgical approach in the time of precision oncology. We also evaluate current ongoing trials on this topic, anticipating how these will influence both research and everyday practice

Oligometastatic Gastric Cancer: Clinical Data from the Meta-Gastro Prospective Register of the Italian Research Group on Gastric Cancer

Background: Interest in the field of metastatic gastric cancer has grown in recent years, and the identification of oligometastatic patients plays a critical role as it consents to their inclusion in multimodal treatment strategies, which include systemic therapy but also surgery with curative intent. To collect sound clinical data on this subject, The Italian Research Group on Gastric Cancer developed a prospective multicentric observational register of metastatic gastric cancer patients called META-GASTRO. Methods: Data on 383 patients in Meta-Gastro were mined to help our understanding of oligometastatic, according to its double definition: quantitative/anatomical and dynamic. Results: the quantitative/anatomical definition applies to single-site metastases independently from the metastatic site (p < 0.001) to peritoneal metastases with PCI ≤ 12 (p = 0.009), to 1 or 2 hepatic metastases (p = 0.024) and nodal metastases in station 16 (p = 0.002). The dynamic definition applies to a percentage of cases variable according to the metastatic site: 8%, 13.5 and 23.8% for hepatic, lymphatic and peritoneal sites, respectively. In all cases, the OS of patients benefitting from conversion therapy was similar to those of cases deemed operable at diagnosis and operated after neoadjuvant chemotherapy. Conclusions: META-GASTRO supports the two-fold definition of oligometastatic gastric cancer: the quantitative/anatomical one, which accounts for 30% of our population, and the dynamic one, observed in 16% of our cases