Left Spigelian Hernia in Super-Obese Patient: A Case-Report.

Abstract: We report a case in which a giant Spigelian hernia presented with severe, persistent abdominal pain in a 62- year-old super-obese woman with a history of total abdominal hysterectomy-bilateral salpingo-oopherectomy at the age of 40 years for benign neoplasia, who later underwent open hernia repair (maximal diameter of the hernia sac: 21 cm) because of the development of compartment syndrome. Afterward, although a large incarcerated hernia disease was found, the sac removal was technically difficult and an open procedure was carried out, with double-mesh placement. No complications were recorded during the post-operative course. We report a difficult issue related to the diagnosis and management of this pathology, underlining the complete surgical repair to avoid hernia recurrence

Laryngeal mask airway in neonatal stabilization and transport: a retrospective study.

Laryngeal mask airway (LMA) may be considered by health caregivers of level I–II hospitals for neonatal resuscitation and stabilization before and during interhospital care, but literature provides little information on this aspect. This study reviewed the use of LMA during stabilization and transport in a large series of neonates. This is a retrospective study evaluating the use of LMA in infants who underwent emergency transport by the Eastern Veneto Neonatal Emergency Transport Service between January 2003 and December 2021. All data were obtained from transport registry, transport forms, and hospital charts. In total, 64/3252 transferred neonates (2%) received positive pressure ventilation with an LMA, with increasing trend over time (p = 0.001). Most of these neonates were transferred after birth (97%), due to a respiratory or neurologic disease (95%). LMA was used before the transport (n = 60), during the transport (n = 1), or both (n = 3). No device-related adverse effects were recorded. Sixty-one neonates (95%) survived and were discharged/transferred from the receiving center

Time needed to intubate and suction a manikin prior to instituting positive pressure ventilation: a simulation trial

Tracheal suctioning in non-vigorous newborn delivered through meconium-stained amniotic fluid (MSAF) is supposed to delay initiation of positive pressure ventilation (PPV), but the magnitude of such delay is unknown. To compare the time of PPV initiation when performing immediate laryngoscopy with intubation and suctioning vs. performing immediate PPV without intubation in a manikin model. Randomized controlled crossover (AB/BA) trial comparing PPV initiation with or without endotracheal suctioning in a manikin model of non-vigorous neonates born through MSAF. Participants were 20 neonatologists and 20 pediatric residents trained in advanced airway management. Timing of PPV initiation was longer with vs. without endotracheal suctioning in both pediatric residents (mean difference 13\ua0s, 95% confidence interval 8 to 18\ua0s; p\ua0< 0.0001) and neonatologists (mean difference 12\ua0s, 95% confidence interval 8 to 16\ua0s; p < 0.0001). The difference in timing of PPV initiation was similar between pediatric residents and neonatologists (mean difference 12 1\ua0s, 95% confidence interval 12 7 to 6\ua0s; p\ua0= 0.85). Conclusions: Performing immediate laryngoscopy with intubation and suctioning was associated with longer\u2014but not clinically relevant\u2014time of initiation of PPV compared with immediate PPV without intubation in a manikin model. While suggesting negligible delay in starting PPV, further studies in a clinical setting are warranted. Registration: clinicaltrial.gov NCT04076189.What is Known:\u2022 Management of the non-vigorous newborn delivered through meconium-stained amniotic fluid remains still controversial.\u2022 Tracheal suctioning in non-vigorous newborn delivered through meconium-stained amniotic fluid is supposed to delay initiation of positive pressure ventilation, but the magnitude of such delay is unknown.What is New:\u2022 Performing immediate ventilation without intubation was associated with shorter\u2014but not clinically relevant\u2014time of initiation of ventilation compared to immediate laryngoscopy with intubation and suctioning in a manikin model.\u2022 Further studies in a clinical setting are warranted

Walls talk: Microbial biogeography of homes spanning urbanization.

Westernization has propelled changes in urbanization and architecture, altering our exposure to the outdoor environment from that experienced during most of human evolution. These changes might affect the developmental exposure of infants to bacteria, immune development, and human microbiome diversity. Contemporary urban humans spend most of their time indoors, and little is known about the microbes associated with different designs of the built environment and their interaction with the human immune system. This study addresses the associations between architectural design and the microbial biogeography of households across a gradient of urbanization in South America. Urbanization was associated with households' increased isolation from outdoor environments, with additional indoor space isolation by walls. Microbes from house walls and floors segregate by location, and urban indoor walls contain human bacterial markers of space use. Urbanized spaces uniquely increase the content of human-associated microbes-which could increase transmission of potential pathogens-and decrease exposure to the environmental microbes with which humans have coevolved

Overcoming Psychologism. Twardowski on Actions and Products

This paper is about the topic of psychologism in the work of Kazimierz Twardowski and my aim is to revisit this important issue in light of recent publications from, and on Twardowski’s works. I will first examine the genesis of psychologism in the young Twardowski’s work; secondly, I will examine Twardowski’s picture theory of meaning and Husserl’s criticism in Logical Investigations; the third part is about Twardowski’s recognition and criticism of his psychologism in his lectures on the psychology of thinking; the fourth and fifth parts provide an overview of Twardowski’s paper “Actions and Products” while the sixth part addresses the psychologism issue in the last part of this paper through the delineation of psychology and the humanities. I shall conclude this study with a brief assessment of Twardowski’s solution to psychologism

Cytomegalovirus Prophylaxis versus Pre-emptive Strategy: Different CD4(+) and CD8(+) T Cell Reconstitution after Allogeneic Hematopoietic Stem Cell Transplantation

Reconstitution of T cells after transplantation is a determinant of the long-term success of the procedure, and the correlation with T cell recovery and cytomegalovirus reactivation and disease is well known. We evaluated 110 patients who underwent transplantation: 55 received pre-emptive antiviral treatment, and in the other 55 patients, prophylaxis with letermovir was employed. A progressive statistically significant difference in T cell reconstitution between the 2 groups was observed, starting from day +60 with faster recovery in the pre-emptive group. Moreover, a higher incidence of cytomegalovirus reactivation was observed in prophylactic group after discontinuation of letermovir, and subsequent antiviral treatment has been necessary. Our findings confirm, as previously reported, that cytomegalovirus reactivation is a potent stimulator of T cell function

White Blood Cells Count as a Predictor of Bronchopulmonary Dysplasia in VLBW Infants with Histological Chorioamnionitis

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Landscapes of Northern Lombardy: from the glacial scenery of Upper Valtellina to the prealpine lacustrine environment of Lake Como

In the region between Valtellina and Lake Como in the Central Italian Alps, one can visit, in a relatively small area, some of the best examples of mountain geomorphological landscapes of Italy. Eight specific sites-showing peculiar glacial, periglacial, structural, gravity-induced and erosional landforms-have been selected to illustrate how different landscapes may originate from geomorphological modelling of different lithotypes in different morphogenetic systems. These eight sites are exemplary cases in which significant evidence of past and current climatic and structural conditions characterising this region is exhibited