CHIRURGIA ROBOTICA DEL PANCREAS:presente e prospettive future

Il rapido sviluppo che la chirurgia mininvasiva ha avuto negli ultimi decenni è in parte dovuto al prorompente ruolo che le nuove tecnologie hanno avuto nel campo medico e che vedono il suo apice nella robot - assisted surgery . Il sistema robotico Da Vinci®, ad oggi, risulta essere il modello applicativo di questa tecnologia. Nonostante la sua rapida diffusione, l’utilizzo del robot è ancora ad uno stadio embrionale soprattutto per quanto riguarda l’ambito pancreatico dove, a causa dei limitati casi di applicazione, non è possibile stabilire una chiara superiorità rispetto alla chirurgia tradizionale. Le capacità tecniche del Da Vinci Surgical System® hanno permesso di eseguire interventi complessi superando alcune delle limitazioni della chirurgia laparoscopica tradizionale, garantendo un margine di sicurezza anche nelle più difficili fasi ricostruttive delle resezioni cefaliche pancreatiche. Questo studio si propone l’ obbiettivo di analizzare i risultati a breve termine di tutte le resezioni pancreatiche effettuate integralmente con l’ ausilio del Da Vinci Surgical System®. Lo studio si avvale di un gruppo di casistiche raccolte tra il 1 Ottobre 2008 e il mese di Settembre 2011 presso la divisione di Chirurgia Generale e Trapianti nell’Uremico e nel Diabetico della Azienda Ospedaliero-Universitaria Pisana. Gli interventi, eseguiti su lesioni pancreatiche per lo più a basso-moderato grado di malignità, comprendono duodenocefalopancreasectomie, pancreasectomie distali con conservazione o meno della milza e dei vasi splenici, pancreasectomie intermedie, pancreasectomie totali, enucleazioni e cisti-gastrostomie. I risultati, confrontati con casistiche analoghe presenti in letteratura, hanno dimostrato che l’utilizzo del robot Da Vinci® possa essere una valida alternativa all’intervento tradizionale almeno per lesioni a basso-moderato grado di malignità con equiparabili valori percentuali di morbilità e di mortalità. Considerando che questo tipo di chirurgia risulta essere solo agli albori, sarà importante valutare i risultati che essa otterrà nel lungo periodo. Assumerà un ruolo fondamentale la verifica, anche a seguito dell’ingresso di nuove macchine e tecnologie, di come questo tipo di approccio possa essere applicato ad un miglioramento della qualità della vita del paziente e quanto questo possa influire su una reale diminuzione del rapporto costo/beneficio nell’ambito della pancreatologia. Il seguente studio ha lo scopo di analizzare, nell'ambito della chirurgia resettiva e ricostruttiva pancreatica, i risultati a breve termine di un gruppo di interventi eseguiti utilizzando il sistema robotico chirurgico da Vinci®. Lo studio si avvale di dati ottenuti da una serie di pancreasectomie robotiche eseguite tra il 1 ottobre 2008 e il Settembre 2011

Trabecular metal cup without augments for acetabular revision in case of extensive bone loss and low bone-prosthesis contact.

Current evidences in revision hip arthroplasty suggest to treat severe acetabular bone loss with dedicated implants, such as anti-protrusio cages, stemmed cups, modular systems supplied with iliac flanges and obturatory hook. However recent literature is reporting satisfactory outcomes with simple elliptical Trabecular Metal cups. Purpose of the study was to evaluate mid-term results of such a surgical procedure. All hip revisions performed from 2008 to 2009 with implantation of a TMT multi-hole acetabular cup without augmentations were retrospectively reviewed. The cases with low-degree acetabular bone loss (stage I and II according to GIR classification), with surgical report poorly describing the bone defect, with inadequate pre- and post-operative x-rays were ruled out. Twenty-five cases were identified, but four were lost to follow-up. The twenty-one patients were 71 year-old on average (from 60 to 82), with stage IV bone loss in 6 cases and stage III bone loss in 15 cases. Mean interval from surgery to evaluation was 20.9 months (from 13 to 30). The evaluation included bone-prosthesis contact estimation, component position, survivorship, complications, final Harris Hip Score, presence of periprosthetic radiolucencies. Host bone-prosthesis contact was estimated to be about 35%. Only three implant were subsequently reoperated (for infection, early migration, recurrent dislocation). The HHS among non-reoperated 18 patients was 81.96 on average (from 63.44 to 95.82). Six cases showed thin radiolucencies in one of the three Charnley zones, while three cases showed radiolucencies in two. None of these images was evolutive, thus they were not considered signs of loosening. The mid-term results of this series confirm the hypothesis that a porous tantalum acetabular cup is an effective option to deal with difficult acetabular revisions. Although no extra-acetabular fixation device is available, the very high surface friction guaranteed by the material and the supplemental stability provided by trans-acetabular screws seem to be sufficient to allow satisfactory reimplantation even in severely damaged pelves

La Questione dell'Embrione tra Progresso Biomedico e Pluralismo Etico

Riassunto analitico. Da secoli l’uomo si pone una domanda che ancora non sembra aver trovato risposta: quando ha inizio l’esistenza di un individuo, di una "persona"? ma soprattutto che cos’ è la persona? persona è necessariamente sinonimo di essere umano? e infine l’embrione umano è una persona? Nel presente lavoro si cerca di dare una risposta a tutti questi interrogativi analizzando nello specifico il concetto di "persona" in relazione all’embrione umano. E, come le nuove modalità di intervento sull’inizio della vita umana ed il pluralismo etico contribuiscano quotidianamente ad alimentare (soprattutto nel nostro Paese) continue ed inutili polemiche rispetto alla questione dell’embrione umano. Per questo motivo la tesi è divisa in tre parti: nella prima parte si chiarisce brevemente che cosa sono l’etica, la bioetica e il pluralismo etico. Nella seconda parte, invece, viene preso in esame il concetto di persona ed esaminati i due principali ed opposti paradigmi filosofici oggi esistenti riguardo alla persona. Infine, la terza parte si prefigge lo scopo di mettere in evidenzia come in certi casi lo Stato metta da parte la laicità ed appoggi un determinato orientamento morale a discapito di altri, prevaricando in questo modo la libertà di alcuni dei suoi cittadini. Nello specifico si farà riferimento alla legge n°40/04 che nell’ordinamento civile italiano disciplina la procreazione medicalmente assistita: una legge che, ritenendo validi certi pregiudizi e appoggiando esplicitamente un orientamento ben preciso riguardo alla persona, nega di fatto a certi individui la possibilità di procreare, o meglio di esercitare la propria libertà procreativa

WHAT IS THE DIGESTATE?

As anaerobic digestion (AD) is quickly being harnessed in Italy and in other European countries, there is a need for a more in-depth description of the main by-product of the process, the digestate. Little information on digestate characteristics and composition is available and unclear legislation causes problems in biogas plant management. In this work, the organic matter (OM) of this matrix was described through chemical, biological, spectroscopic, and statistical approaches. It was shown that AD results in a strong reduction of the easily degradable fraction of the OM and an accumulation of recalcitrant molecules (possible humus precursors). This contributes to a relatively high biological stability of the residual OM content in the digestate and may lead to good amendment properties. Besides, the observed relative accumulation and the high mineralisation of nitrogen and phosphorus may point to the digestate as a readily available liquid fertiliser for agronomic use. Moreover, xenobiotics and pathogens respected limits for both biosolids and compost in Italian and European legislation

Influence of photobioreactor set-up on the survival of microalgae inoculum

Cultivation of specific microalgae is still difficult in an industrial setup as contamination and balancing the economic cost are not always possible. Understanding the ecology of cultivation of microalgae is therefore necessary to implement stable production. The aim of the study was to understand how different types of photobioreactors and types of culture medium influenced the survival of a specific microalgae inoculum, S. almeriensis. The bacterial and microalgae community were studied using Illumina sequencing. Only the closed configuration was able to maintain the inoculated species while all the other systems developed a different eukaryotic community due to contamination and the higher fitness of contaminants. Photobioreactor configuration was more important than medium in shaping the eukaryotes community, while the bacterial community was influenced strongly by both. Results showed that even a well-adapted strain is maintained only in the closed reactor while the open reactors are colonized by a multispecies consortium

Evaluating inhibition conditions in high-solids anaerobic digestion of organic fraction of municipal solid waste

High-solids anaerobic digestion (HSAD) processes, when applied to different types of organic fractions of municipal solid waste (OFMSW), may easily be subjected to inhibition due to organic overloading. In this study, a new approach for predicting these phenomena was proposed based on the estimation of the putrescibility (oxygen consumption in 20 h biodegradation, OD20) of the organic mixtures undergoing the HSAD process. Different wastes exhibiting different putrescibility were subjected to lab-scale batch-HSAD. Measuring the organic loading (OL) as volatile solids (VS) was found unsuitable for predicting overload inhibition, because similar VS contents corresponded to both inhibited and successful trials. Instead, the OL calculated as OD20 was a very good indicator of the inhibiting conditions (inhibition started for OD20 > 17\u201318 g O2 kg^(-1)). This new method of predicting inhibition in the HSAD process of diverse OFMSW may be useful for developing a correct approach to the technology in very different contexts

Prospective, observational, multicenter study on minimally invasive gastrectomy for gastric cancer: robotic, laparoscopic and open surgery compared on operative and follow-up outcomes - IMIGASTRIC II study protocol: IMIGASTRIC II

Background:Several meta-analyses have tried to defi ne the role of minimally invasive approaches. However, further evidence to get a wider spread of these methods is necessary. Current studies describe minimally invasive surgery as a possible alternative to open surgery but deserving further clarifi cation. However, despite the increasing interest, the difficulty of planning prospective studies of adequate size accounts for the low level of evidence, which is mostly based on retrospective experiences.A multi-institutional prospective study allows the collection of an impressive amount of data to investigate various aspects of minimally invasive procedures with the opportunity of developing several subgroup analyses.A prospective data collection with high methodological quality on minimally invasive and open gastrectomies can clarify the role of diff erent procedures with the aim to develop specifi c guidelines.Methods and analysis:a multi-institutional prospective database will be established including information on surgical, clinical and oncological features of patients treated for gastric cancer with robotic, laparoscopic or open approaches and subsequent follow-up.The study has been shared by the members of the International study group on Minimally Invasive surgery for GASTRIc Cancer (IMIGASTRIC)The database is designed to be an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centers.Ethics:This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevantlaws/regulations.Trial registration number:NCT0275108

Elemental characterization of bones dating back to 17-18th century by ICP-MS and CV-AAS

Inductively coupled plasma mass spectrometry ( ICP-MS) is an analytical technique which is able of detecting a wide number of elements with atomic mass ranges 7 to 250 (from Li to U) at concentration as low as one part per trillion to 100 milligrams per litre, around 8 orders of magnitude of concentration units. These characteristics, achieved by ionizing the sample with inductively coupled plasma connected with a mass spectrometer, make the ICP-MS the ideal tool for elemental and trace-elemental analysis. In this thesis ICP-MS was used to carry on elemental analysis on bones date back to XVII-XVIII century, in order to characterize the diet and life style of several people in their last years of life. The samples were collected from 3 different sites, 14 come from a private chapel in the Franciscan friary of Svendborg and 81 come from a Franciscan friary in Montella (Italy). The Italian samples come from 2 different places of the friary: 35 come from the Iannelli’s private chapel and the others were buried in a sidewalk inside the friary All the samples date back to the 1600-1700 ca., and the ones taken from the chapels belong to noble families. For each sample, 21 elements were quantified with ICP-MS, and Hg content was analyzed by CV-AAS, a dedicated instrument for Hg analysis. In order to achieve information about life style, the data analysis was focused on specific elements that are diet marker such Ba, Sr, Mg, Zn and Ca, and on some elements that are environmental pollution marker as Fe, Mn, Pb. With the help of statistical treatment of the data, especially with the use of PCA (principal component analysis), the samples were divided in 3 main groups according to the burial site. The analysis show also that the samples collected from the chapels had an elemental composition suggesting that the buried people followed a rich protein diet