the place of belsey mark iv fundoplication in the era of laparoscopic surgery

Objectives: Laparoscopic fundoplication to correct or avoid gastroesophageal reflux decreased Belsey Mark IV fundoplication (BMIV) dramatically worldwide. The purpose of this paper was to determine the role of BMIV and its current indications. Methods: We reviewed all patients who underwent fundoplication between April 1997 and December 2001. All patients underwent a complete work-up included barium meal, endoscopy, 24-h pH-metry and manometry preoperatively. Results: Sixty-two consecutive fundoplications were performed. There were 23 males and 39 females. Forty-six patients were treated by laparoscopic approach (37 patients with total and nine patients with partial fundoplication). BMIV was preferred in 16 patients with the following indications: reoperations for failed oesophageal surgery (5), hiatal hernia fixed in the chest (4), epiphrenic oesophageal diverticula (3), diffuse oesophageal spam (2), hiatal hernia associated with bullous emphysema (1), leiomyoma of the oesophago ‐ gastric junction (1). Excellent to good results were reported in 14 patients and poor in two. Follow-up was completed in all patients. Conclusions: BMIV remains a valid fundoplication although the current indications are now limited. The technique is to be considered an additional, but necessary, weapon for thoracic surgeons with interest in oesophageal disease. q 2003 Elsevier B.V. All rights reserved

Open issues in mucopolysaccharidosis type I-hurler

Mucopolysaccharidosis I-Hurler (MPS I-H) is the most severe form of a metabolic genetic disease caused by mutations of IDUA gene encoding the lysosomal α-L-iduronidase enzyme. MPS I-H is a rare, life-threatening disease, evolving in multisystem morbidity including progressive neurological disease, upper airway obstruction, skeletal deformity and cardiomyopathy. Allogeneic hematopoietic stem cell transplantation (HSCT) is currently the gold standard for the treatment of MPS I-H in patients diagnosed and treated before 2-2.5 years of age, having a high rate of success. Beyond the child's age, other factors influence the probability of treatment success, including the selection of patients, of graft source and the donor type employed. Enzyme replacement therapy (ERT) with human recombinant laronidase has also been demonstrated to be effective in ameliorating the clinical conditions of pre-transplant MPS I-H patients and in improving HSCT outcome, by peri-transplant co-administration. Nevertheless the long-term clinical outcome even after successful HSCT varies considerably, with a persisting residual disease burden. Other strategies must then be considered to improve the outcome of these patients: one is to pursue early pre-symptomatic diagnosis through newborn screening and another one is the identification of novel treatments. In this perspective, even though newborn screening can be envisaged as a future attractive perspective, presently the best path to be pursued embraces an improved awareness of signs and symptoms of the disorder by primary care providers and pediatricians, in order for the patients' timely referral to a qualified reference center. Furthermore, sensitive new biochemical markers must be identified to better define the clinical severity of the disease at birth, to support clinical judgement during the follow-up and to compare the effects of the different therapies. A prolonged neuropsychological follow-up of post-transplant cognitive development of children and residual disease burden is needed. In this perspective, the reference center must guarantee a multidisciplinary follow-up with an expert team. Diagnostic and interventional protocols of reference centers should be standardized whenever possible to allow comparison of clinical data and evaluation of results. This review will focus on all these critical issues related to the management of MPS I-H

Basics and frontiers on pancreatic cancer for radiation oncology: Target delineation, SBRT, SIB technique, MRgRT, particle therapy, immunotherapy and clinical guidelines

Pancreatic cancer represents a modern oncological urgency. Its management is aimed to both distal and local disease control. Resectability is the cornerstone of treatment aim. It influences the clinical presentation\u2019s definitions as up-front resectable, borderline resectable and locally advanced (unresectable). The main treatment categories are neoadjuvant (preoperative), definitive and adjuvant (postoperative). This review will focus on i) the current indications by the available national and international guidelines; ii) the current standard indications for target volume delineation in radiotherapy (RT); iii) the emerging modern technologies (including particle therapy and Magnetic Resonance [MR]-guided-RT); iv) stereotactic body radiotherapy (SBRT), as the most promising technical delivery application of RT in this framework; v) a particularly promising dose delivery technique called simultaneous integrated boost (SIB); and vi) a multimodal integration opportunity: the combination of RT with immunotherapy

Decreased expression of Klotho in cardiac atria biopsy samples from patients at higher risk of atherosclerotic cardiovascular disease

Background. Klotho proteins (α- and β) are membrane-based circulating proteins that regulate cell metabolism, as well as the lifespan modulating activity of Fibroblast Growth Factors. Recent data has shown that higher plasma circulating Klotho levels reduce cardiovascular risk, suggesting Klotho has a protective role in cardiovascular diseases. However, although so far it has been identified in various organs, it is unknown whether cardiomyocytes express Klotho and Fibroblast Growth Factors(FGFs), and whether high cardiovascular risk could affect cardiac expression of Klotho, FGFs and other molecules. Methods. We selected 20 patients with an estimated 10-year high atherosclerotic cardiovascular disease and 10 age-matched control subjects with an estimated 10-year low risk undergone cardiac surgery for reasons other than coronary artery by-pass. In myocardial biopsies, we evaluated by immuno-histochemistry whether Klotho and FGFs were expressed in cardiomyocytes, and whether higher cardiovascular risk influenced the expression of other molecules involved in endoplasmic reticulum stress, oxidative stress, inflammation and fibrosis. Results. Only cardiomyocytes of patients with a higher cardiovascular risk showed lower expression of Klotho, but higher expressions of FGFs. Furthermore, higher cardiovascular risk was associated with increased expression of oxidative and endoplasmic reticular stress, inflammation and fibrosis. Conclusions. This study showed for the first time that Klotho proteins are expressed in human cardiomyocytes and that cardiac expression of Klotho is down-regulated in higher cardiovascular risk patients, while expression of stress-related molecules were significantly increased

Basics and frontiers on pancreatic cancer for radiation oncology: Target delineation, SBRT, SIB technique, MRgRT, particle therapy, immunotherapy and clinical guidelines

Pancreatic cancer represents a modern oncological urgency. Its management is aimed to both distal and local disease control. Resectability is the cornerstone of treatment aim. It influences the clinical presentation’s definitions as up-front resectable, borderline resectable and locally advanced (unresectable). The main treatment categories are neoadjuvant (preoperative), definitive and adjuvant (postoperative). This review will focus on i) the current indications by the available national and international guidelines; ii) the current standard indications for target volume delineation in radiotherapy (RT); iii) the emerging modern technologies (including particle therapy and Magnetic Resonance [MR]-guided-RT); iv) stereotactic body radiotherapy (SBRT), as the most promising technical delivery application of RT in this framework; v) a particularly promising dose delivery technique called simultaneous integrated boost (SIB); and vi) a multimodal integration opportunity: the combination of RT with immunotherapy

Esperança e Bem-Estar Psicológico durante a Crise Sanitária pela COVID-19: Estudo com Estudantes de Enfermagem

Objetivo: analisar as relações entre a esperança e o bem-estar psicológico de estudantes de enfermagem portugueses durante a crise pandêmica pela COVID-19. Método: estudo descritivo-correlacional, com recurso a questionário online para coleta de dados. Participaram 705 estudantes de enfermagem com idade média de 21,74 anos (DP=4,44). Os instrumentos de coleta de dados utilizados foram a Escala de Esperança de Herth (HHI-PT) e a Escala de Medida de Manifestação de Bem-Estar Psicológico (EMMBEP). Foi utilizada a estatística descritiva e inferencial. Resultados: na HHI-PT, o domínio afectivo-comportamental obteve a pontuação média mais alta, 3,30 (DP=0,45); no EMMBEP, foi o domínio sociabilidade, 3,64 (DP=0,77). Havia correlações moderadas a fortes (0,383 <r <0,917) entre o global e todos os domínios da esperança e bem-estar psicológico (≤0.001). Conclusão e implicações para a prática: a esperança e o bem-estar psicológico dos estudantes de enfermagem durante a pandemia são variáveis correlacionados positivamente entre si. As medidas de promoção da saúde mental, a implementar pelas instituições de ensino, devem ter em consideração a associação entre essas duas variáveis.Aim: to analyze the relationship between hope and the psychological well-being of Portuguese nursing students during the COVID-19 pandemic crisis. Method: this is a descriptive-correlational study using an online questionnaire for data collection. 705 nursing students participated, with a mean age of 21.74 years (SD=4.44). The data collection instruments used were the Herth Hope Index (HHI-PT) and the Well-Being Manifestations Measure Scale (WBMMS). Descriptive and inferential statistics were used. Results: in the HHI-PT, the affective-behavioral domain had the highest mean score (3.30; SD=0.45), while in the WBMMS, it was the sociability domain, 3.64 (SD=0.77). There were moderate to strong correlations (0.383 <r <0.917) between the global and all domains of hope and psychological well-being (≤0.001). Conclusion and implications for practice: nursing students’ hope and psychological well-being during the pandemic are variables that are positively correlated with each other. Strategies to promote mental health, to be implemented by educational institutions, must consider the association between these two variables.info:eu-repo/semantics/publishedVersio