Evaluation of Clinical Outcome after Laparoscopic Antireflux Surgery in Clinical Practice: Still a Controversial Issue

Background. Laparoscopic antireflux surgery has shown to be effective in controlling gastroesophageal reflux (GERD). Yet, a universally accepted definition and evaluation for treatment success/failure in GERD is still controversial. The purpose of this paper is to assess if and how the outcome variables used in the different studies could possibly lead to an homogeneous appraisal of the limits and indications of LARS. Methods. We analyzed papers focusing on the efficacy and outcome of LARS and published in English literature over the last 10 years. Results. Symptoms scores and outcome variables reported are dissimilar and not uniform. The most consistent parameter was patient's satisfaction (mean satisfaction rate: 88.9%). Antireflux medications are not a trustworthy outcome index. Endoscopy and esophageal manometry do not appear very helpful. Twenty-four hours pH metry is recommended in patients difficult to manage for recurrent typical symptoms. Conclusions. More uniform symptoms scales and quality of life tools are needed for assessing the clinical outcome after laparoscopic antireflux surgery. In an era of cost containment, objective evaluation tests should be more specifically addressed. Relying on patient's satisfaction may be ambiguous, yet from this study it can be considered a practical and simple tool

The Master in International Health of Parma University: a possible model of sanitary cooperation with developing Countries

The Master in “International Health and Medicine for Cooperation with Developing Countries” was established by CUCI, based on the evaluation that many health facilities and hospitals in the low-middle income Countries are not properly equipped to face daily emergencies. The objective of the Master’s program is to train doctors with multi-sector skills, necessary to operate in healthcare ambulatories, hospitals and medical districts, characterized by poor infrastructures and management systems, that are typical in areas of high-poverty, facing cases of emergencies of various entities. The Italian Ministry of Foreign Affairs and International Cooperation is funding a number of scholarships for the best candidates classified in the final selection rating and residing in African Countries. The Course is also open to Italians who wish to extend their professional skills in order to work in resource-constrained settings. The Master course lasts one year and includes lectures, seminars, videoconferencing and internships both at the University Hospital of Parma and in other Structures / Laboratories. The final work includes a scientific section and a project work for future collaboration with the Countries from which the doctors come from. Besides the various fields of medicine, other important themes are addressed in the course, like guidelines for hospital managements, health cooperation, development, prevention strategies. Why this Master could be a model of sanitary cooperation? The WHO and the Geneva Foundation for Medical Education and Research provide scientific support and they are involved in the teaching programme; the physicians formed in the course, once back in their Countries, are expected to facilitate training of the local staff (physicians, nurses and auxiliary personnel) and to continue collaboration; the project allows strengthening of partnerships with other Universities, Ministries, local and international Associations, NGO. The feedback of the participants who have attended the previous editions will also be discussed

Report of the interlaboratory comparison organized by the Community Reference Laboratory Food Contact Material: Plasticisers in Gaskets and Oil

The Institute for Health and Consumer Protection (IHCP) of the European Commission¿s Directorate-General Joint Research Centre hosts the Community Reference Laboratory for Food Contact Materials (CRL-FCM). One of its core tasks is to organize interlaboratory comparisons (ILCs) among appointed National Reference Laboratories (NRLs). This report presents the results of the first ILC of the CRL-FCM which focused on the determination of Plasticisers content in PVC Gasket and in Oil matrix. The test materials used in this exercise were virgin gasket lids coming from industrial sources for the proficiency exercise part A. For the second part of the exercise an industrial source of sunflower oil was used and spiked with several plasticisers by the CRL-FCM. There were 41 participants to whom samples were dispatched 34 of which submitted results for at least 1 analyte-material. 21 laboratories reported results for more than 10 analyte-material combination out of 14 required. The homogeneity studies were performed by the CRL-FCM laboratory. The assigned value and its uncertainty for part A, virgin gaskets, were obtained after applying the robust statistics to the results obtained from the participants. The assigned values for part B, oil samples, were those obtained based on formulation, from the gravimetric measurements used to spike the material. The uncertainty of the assigned values for oil samples was calculated combining the uncertainty of the spiking procedure with a contribution for the between-bottle homogeneity. Participants were invited to report four replicates measurements. This was done by most of the participants. Laboratory results were rated with z and z¿ scores in accordance with ISO 13528 [1] Standard deviations for proficiency assessment (also called target standard deviations) were set based on Horwitz equation for substances in the two oil samples. For the plasticisers in the two gasket samples the target standard deviation was set by the organizers to 15% in order to fulfil the required criteria for sufficient homogeneity of the sample within the lots.JRC.I.2-Chemical assessment and testin

Challenges of Meeting Surgical Needs in the Developing World

The burden of surgical conditions and diseases is increasing in low-income and middle-income countries, but the capacity to meet the demands they present is not following pace. Ongoing initiatives, such as brief visits by surgeons from advantaged countries, sending surgical residents to spend time in a developing country as part of their training, or ships weighing anchor offshore and offering some limited on-shore or on-board services, have not proven successful. More comprehensive and sustainable solutions include the development of local training programs, better retention of trainees with adequate incentives particularly in rural areas, and engaging government and professional associations, as well as academic institutions, to develop and implement policies to address local training needs

Variabilidade genética e evolução do gênero Calibrachoa (Solanaceae)

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The zCOSMOS 10k-Bright Spectroscopic Sample

We present spectroscopic redshifts of a large sample of galaxies with I_(AB) < 22.5 in the COSMOS field, measured from spectra of 10,644 objects that have been obtained in the first two years of observations in the zCOSMOS-bright redshift survey. These include a statistically complete subset of 10,109 objects. The average accuracy of individual redshifts is 110 km s^(–1), independent of redshift. The reliability of individual redshifts is described by a Confidence Class that has been empirically calibrated through repeat spectroscopic observations of over 600 galaxies. There is very good agreement between spectroscopic and photometric redshifts for the most secure Confidence Classes. For the less secure Confidence Classes, there is a good correspondence between the fraction of objects with a consistent photometric redshift and the spectroscopic repeatability, suggesting that the photometric redshifts can be used to indicate which of the less secure spectroscopic redshifts are likely right and which are probably wrong, and to give an indication of the nature of objects for which we failed to determine a redshift. Using this approach, we can construct a spectroscopic sample that is 99% reliable and which is 88% complete in the sample as a whole, and 95% complete in the redshift range 0.5 < z < 0.8. The luminosity and mass completeness levels of the zCOSMOS-bright sample of galaxies is also discussed

Identification and Characterization of Six Spectroscopically Confirmed Massive Protostructures at 2.5<z<4.52.5<z<4.5

We present six spectroscopically confirmed massive protostructures, spanning a redshift range of $2.5<z<4.5$ in the Extended Chandra Deep Field South (ECDFS) field discovered as part of the Charting Cluster Construction in VUDS and ORELSE (C3VO) survey. We identify and characterize these remarkable systems by applying an overdensity measurement technique on an extensive data compilation of public and proprietary spectroscopic and photometric observations in this highly studied extragalactic field. Each of these six protostructures, i.e., a large scale overdensity (volume $>9000$\thinspace cMpc$^3$) of more than $2.5\sigma_{\delta}$ above the field density levels at these redshifts, have a total mass $M_{tot}\ge10^{14.8}M_\odot$ and one or more highly overdense (overdensity$\thinspace>5\sigma_{\delta}$) peaks. One of the most complex protostructures discovered is a massive ($M_{tot}=10^{15.1}M_\odot$) system at $z\sim3.47$ that contains six peaks and 55 spectroscopic members. We also discover protostructures at $z\sim3.30$ and $z\sim3.70$ that appear to at least partially overlap on sky with the protostructure at $z\sim3.47$, suggesting a possible connection. We additionally report on the discovery of three massive protostructures at $z=2.67$, 2.80, and 4.14 and discuss their properties. Finally, we discuss the relationship between star formation rate and environment in the richest of these protostructures, finding an enhancement of star formation activity in the densest regions. The diversity of the protostructures reported here provide an opportunity to study the complex effects of dense environments on galaxy evolution over a large redshift range in the early universe.Comment: 10 pages, 4 figures, 1 tabl

Epidemiology and Microbiology of Skin and Soft Tissue Infections: Preliminary Results of a National Registry

Skin and soft tissue infections (SSTIs) represent a wide range of clinical conditions characterized by a considerable variety of clinical presentations and severity. Their aetiology can also vary, with numerous possible causative pathogens. While other authors previously published analyses on several types of SSTI and on restricted types of patients, we conducted a large nationwide surveillance programme on behalf of the Italian Society of Infectious and Tropical Diseases to assess the clinical and microbiological characteristics of the whole SSTI spectrum, from mild to severe life-threatening infections, in both inpatients and outpatients. Twenty-five Infectious Diseases (ID) Centres throughout Italy collected prospectively data concerning both the clinical and microbiological diagnosis of patients affected by SSTIs via an electronic case report form. All the cases included in our database, independently from their severity, have been managed by ID specialists joining the study while SSTIs from other wards/clinics have been excluded from this analysis. Here, we report the preliminary results of our study, referring to a 12-month period (October 2016–September 2017). During this period, the study population included 254 adult patients and a total of 291 SSTI diagnoses were posed, with 36 patients presenting more than one SSTIs. The type of infection diagnosed, the aetiological micro-organisms involved and some notes on their antimicrobial susceptibilities were collected and are reported herein. The enrichment of our registry is ongoing, but these preliminary results suggest that further analysis could soon provide useful information to better understand the national epidemiologic data and the current clinical management of SSTIs in Italy