Textbook outcome in urgent early cholecystectomy for acute calculous cholecystitis: results post hoc of the S.P.Ri.M.A.C.C study

Introduction: A textbook outcome patient is one in which the operative course passes uneventful, without complications, readmission or mortality. There is a lack of publications in terms of TO on acute cholecystitis. Objetive: The objective of this study is to analyze the achievement of TO in patients with urgent early cholecystectomy (UEC) for Acute Cholecystitis. and to identify which factors are related to achieving TO. Materials and methods: This is a post hoc study of the SPRiMACC study. It ́s a prospective multicenter observational study run by WSES. The criteria to define TO in urgent early cholecystectomy (TOUEC) were no 30-day mortality, no 30-day postoperative complications, no readmission within 30 days, and hospital stay ≤ 7 days (75th percentile), and full laparoscopic surgery. Patients who met all these conditions were taken as presenting a TOUEC. Outcomes: 1246 urgent early cholecystectomies for ACC were included. In all, 789 patients (63.3%) achieved all TOUEC parameters, while 457 (36.6%) failed to achieve one or more parameters and were considered non-TOUEC. The patients who achieved TOUEC were younger had significantly lower scores on all the risk scales analyzed. In the serological tests, TOUEC patients had lower values for in a lot of variables than non-TOUEC patients. The TOUEC group had lower rates of complicated cholecystitis. Considering operative time, a shorter duration was also associated with a higher probability of reaching TOUEC. Conclusion: Knowledge of the factors that influence the TOUEC can allow us to improve our results in terms of textbook outcome

A methodology to select bacteria able to remove synthetic polymers

Synthetic polymers have often been used for the protection and consolidation of cultural heritage. Although it was generally thought that synthetic polymers were not susceptible to deterioration, there are now many papers in the scientific literature demonstrating the opposite. The degradation of synthetic polymers can be due to chemical, physical and biological factors. At present, the traditional way for removing a degraded synthetic polymer is the use of mixtures of solvents that pose some health risks. This work proposes a method to select bacteria able to remove synthetic polymers from cultural heritage surfaces. The ability of five bacteria to attack Paraloid B72, the most commonly used polymer in conservation treatments, was evaluated by optical and scanning electron microscopy observations, weight loss measurements, Fourier transform infrared spectroscopy and differential scanning calorimetric analysis. Although none of the bacteria were able to attack Paraloid B72, the methodology developed can be applied to select other bacteria with this ability. Therefore the results offer insightful guidance to a better design of bioremoval experiments of synthetic resins used in conservation

Il parlar matto. Schizofrenia tra fenomenologia e linguistica. Il corpus CIPPS

Pubblicazione di fonti inedite consistenti in un corpus di parlato patologico interamente trascritto e annotato (Parte II), nonché commentato criticamente nella Parte I del volume composta unitamente ad altri autori secondo diverse prospettive di analisi. La progettazione del lavoro è stata condivisa con Monica Gemelli; le fasi di trascrizione, annotazioni e verifica dell'intero corpus sono responsabilità di F.M. D., che ne ha guidato la realizzazione fino alla stesura finale (pp. 265-596), insieme al commento linguistico del lessico del corpus (pp. 121-155). Scopo principale di questo lavoro è mettere a disposizione di studiosi e ricercatori interessati al tema della schizofrenia, anche afferenti a diverse branche del sapere (psichiatri, psicologi, psicoanalisti, filosofi, linguisti, neuroscienziati), un corpus di parlato patologico trascritto e annotato utilizzando specifiche di trascrizione standardizzate. Il corpus, costituito dalla trascrizione di dieci ore di conversazione avvenuta in psicoterapia tra uno psichiatra e i suoi pazienti, è preceduto da una sezione di studi nella quale si esplorano le possibilità di analisi e di interpretazione del parlato delle sedute. Il senso complessivo di questo lavoro si trova in un forte richiamo alla necessità del dialogo interdisciplinare, pur nel rispetto delle singole specificità, ancora più urgente in relazione a un tema come quello del linguaggio schizofrenico che si situa per sua natura al crocevia di prospettive e competenze differenti

Mechanical Network in Titin Immunoglobulin from Force Distribution Analysis

The role of mechanical force in cellular processes is increasingly revealed by single molecule experiments and simulations of force-induced transitions in proteins. How the applied force propagates within proteins determines their mechanical behavior yet remains largely unknown. We present a new method based on molecular dynamics simulations to disclose the distribution of strain in protein structures, here for the newly determined high-resolution crystal structure of I27, a titin immunoglobulin (IG) domain. We obtain a sparse, spatially connected, and highly anisotropic mechanical network. This allows us to detect load-bearing motifs composed of interstrand hydrogen bonds and hydrophobic core interactions, including parts distal to the site to which force was applied. The role of the force distribution pattern for mechanical stability is tested by in silico unfolding of I27 mutants. We then compare the observed force pattern to the sparse network of coevolved residues found in this family. We find a remarkable overlap, suggesting the force distribution to reflect constraints for the evolutionary design of mechanical resistance in the IG family. The force distribution analysis provides a molecular interpretation of coevolution and opens the road to the study of the mechanism of signal propagation in proteins in general

Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study

BackgroundLess invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models.MethodThe S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models-POSSUM Physiological Score (PS), modified Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade-receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities.ResultsA 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p < 0.001; 30-day mortality: AUC 0.94, p < 0.001; in-hospital major morbidity: AUC 0.73, p < 0.001; 30-day major morbidity: AUC 0.70, p < 0.001). POSSUM PS with a cutoff of 25 (defined in our study as a 'Chole-POSSUM' score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96-97% negative predictive value for major complications.ConclusionsThe Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate prediction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may find the most useful field of action.Trial Registration: ClinicalTrial.gov NCT04995380