Construcción de modelos CIM/PIM en MDA aplicando Ingeniería de Software Basada en Modelos, lenguajes notacionales SysML-UML-OCL y herramientas CASE de soporte a la evolución y trazabilidad de modelos

El Desarrollo Dirigido por Modelos (MDD) se ha convertido actualmente en un importante paradigma de la Ingeniería de Software, proponiendo sustituir - como artefacto principal en el proceso de desarrollo del software - al código fuente de lenguajes de programación por modelos, permitiendo nuevas posibilidades de crear, analizar y manipular sistemas. En este ámbito, los aspectos de rastreo o trazabilidad son un importante desafío teórico-práctico, necesarios tanto en actividades de modelado manual como en procesos de transformación automática entre modelos. Proponemos integrar - a través del desarrollo práctico de un Proyecto de Modelado - las bases conceptuales de MDD, técnicas de Ingeniería de Software Basada en Modelos, lenguajes notacionales SysML-UML-OCL, buenas prácticas del proceso iterativo RUP y uso de herramientas CASE, promoviendo mecanismos que destacan evolución y trazabilidad entre artefactos de modelado durante el proceso de construcción de modelos CIM/PIM, en contexto del estándar MDA para la visión MDD.Sociedad Argentina de Informática e Investigación Operativ

Evaluation of the oncogenic risk of diffuse gastric polyposis. A case report

OBJECTIVES: Benign polyps of the stomach undergo malignant transformation at a rate correlating to the histological type and size of the proliferative lesion. It has been shown that gastric carcinogenesis is a multi-step process, supported by multiple genetic and molecular alterations, and mutations at both the c-Ki-Ras gene and the HER2 gene are involved. Among the various pathogenetic hypotheses explaining the histomorphologic progression of gastric lesions, the one proposed by Correa (with the sequence: gastritis-intestinal metaplasia-dysplasia-gastric carcinoma) is greatly favored, whereas the direct sequence from adenoma to carcinoma, though generally accepted for colon cancer, is questioned. MATERIALS AD METODS: We report a case of a 50-year-old woman who was taking warfarin and was affected by severe sideropenic anemia (Hb 4.1 g/dl). The gastrin levels were within normal ranges. Esophagogastroduodenoscopy showed diffuse gastric polyposis marked out by more than 1.000 polyps scattered over the entire gastric cavity with signs of diffuse oozing. Colonoscopy showed the presence of a 3-cm wide pedunculated polyp of the ascending colon, which was removed by diathermy and resulted a tubulo-villous adenomatous polyp at histological examination. The patient was treated by total gastrectomy with Roux-Y esophagojejunostomy. Histological examination showed the presence of diffuse gastric polyposis with the contemporary occurrence of hyperplastic polyps and mixed hyperplastic and adenomatous polyps, with a tubular pattern and the focal aspect of serrate adenoma. The perilesional gastric mucosa was characterized by the presence of either atrophic or metaplastic areas and by a mild dysplasia. Immunohistochemistry showed that both beta-catenin and E-cadherin were expressed as a membrane diffuse positivity in the glandular epithelium of the polyps and the low grade dysplastic components. P53 protein expression was detected only in the hyperplastic areas with low grade dysplasia, the same areas where Ki-67 antigen positive cells were more frequently found. EGF receptor overexpression was detected at the level of the resting cells of the deep portion of foveola. The proliferative index ki-67 was highest among the dysplastic foci. Molecular assays failed to show the presence of c-Ki-Ras gene mutations, similarly HER2 amplification was not detected. CONCLUSIONS: This is the first case report of sporadic diffuse hyperplastic and adenomatous polyposis of the stomach. We speculate that the evolutive potential of precancerous gastric lesions into frank neoplasia may be assumed by immunohistochemistry and molecular assay. The absence of both high-grade dysplastic lesions and outbreaks of neoplastic transformation well correlated with the histochemical and molecular features, confirming the highly proliferative pattern of the polyps in the lack of signs of malignant progression

The influence of residents in the outcome of elective laparoscopic surgery: A prospective study comparing a teaching hospital and a private community hospital in Italy

OBJECTIVES: We compared the outcome of elective laparoscopic cholecystectomy (LC) in a teaching hospital and a private communityhospital to assess the impact of the involvement of residents. MATERIALS AND METHODS: The following parameters were studied prospectively in patients who underwent elective LC during the period from September 2014 to February 2016 in a teaching university hospital (group A) and in a private community hospital (group B): age, sex, body mass index (BMI), comorbidities, American Society of Anaesthesiologists (ASA) score, length of surgery from skin incision to skin closure, use of drain, 30-day perioperative morbidity and mortality, and length of postoperative hospital stay. RESULTS: The group A consisted of 93 elective LC and the group B of 167 elective LC. Operative time was significantly longer in group A. Intraoperative complications were similar and no conversion was necessary in both groups. An increased rate of postoperative complications was observed in group A. All postoperative complications were managed with conservative therapy. No mortality occurred. At logistic regression analysis, the only factor favouring the occurrence of complications was the hospital type. CONCLUSIONS: Our study shows that elective LC can be performed in a teaching hospital with comparable intraoperative morbidity and increased postoperative complications. The greater rate of morbidity found in the teaching hospital may be due to an increased vigilance linked to the presence of residents and not to the lack of expertise

Fattori che influiscono sulla durata dell'intervento di colecistectomia laparoscopica in elezione e sul decorso clinico, in due scuole di formazione, in una serie consecutiva di 190 pazienti a basso e medio rischio anestesiologico

OBIETTIVI. Identificare e valutare i fattori che influiscono sulla durata dell’intervento chirurgico di LC e gli effetti sul decorso clinico. MATERIALI E METODI. Studio prospettico osservazionale su 190 pazienti (113 F, 77 M, età media 52aa) a basso e medio rischio anestesiologico (ASA 1,2,3) sottoposti a LC per patologia benigna. Sono stati valutati i fattori preoperatori (sesso, età, fumo, alcool, BMI, patologie associate), intraoperatori (durata dell’intervento, contaminazione biliare della cavità peritoneale, posizionamento di drenaggio) e postoperatori (decorso clinico, durata della degenza, canalizzazione alle feci, sintomatologia dolorosa, risultato estetico). In tutti i casi veniva eseguito esame istopatologico della colecisti ed esame colturale della bile. Il confronto fra i dati è stato eseguito mediante software statistico SPSS della IBM statistics versione 20.1.1. Lo studio di correlazione è stato osservato con rho di Spearman. Il p value tramite t di Student (variabili continue) e test di Fischer (variabili non continue). RISULTATI. Secondo il parametro BMI 81/190 pazienti risultavano in sovappeso (BMI ≥25) e 37/190 obesi (BMI ≥30). La durata media dell’intervento è stata di 76 minuti, mediana 65 minuti, range 20180 minuti. Dall’analisi statistica emerge una significativa correlazione fra durata della LC e BMI (r=0.194 p=0.007 ), patologie associate (r=0.18 p=0.013) e consumo di alcool (r=0.173 p=0.017). Il leak biliare da microperforazione o rottura intraoperatoria della colecisti si correla significativamente con il prolungamento del tempo operatorio (r=0.161 p=0.026) la cui ulteriore espansione si osserva nei pazienti con drenaggio sottoepatico (r=0.629 p<0.001). La durata dell’intervento chirurgico si correla significativamente con la diagnosi istopatologica di colecistite cronica riacutizzata (r=0.200 p=0.006). Il prolungamento del tempo operatorio si correla in ordine decrescente di significatività statistica con un ritardo nella dimissione (r=0.527 p=<0.001) e nella canalizzazione alle feci (r=0.274 p<0.001), in una maggiore incidenza di infezioni del sito chirurgico (r=0.209 p=0.004), del rialzo termico (r=0.204 p=0.005) e peggiore risultato estetico (r=0.15 p=0.028).CONCLUSIONI. La durata della LC è significativamente correlata al BMI e alla presenza di patologie associate. Il prolungamento del tempo operatorio si correla significativamente a prolungata degenza, ritardata canalizzazione intestinale, infezione del sito chirurgico ombelicale, più intensa sintomatologia dolorosa postoperatoria e compromissione del risultato estetico. La riduzione dei tempi operatori (posizionamento del drenaggio solo in casi selezionati, limitazione delle procedure di lavaggio ed aspirazione solo quanto necessarie, limitazione al ricorso di estrazione del viscere in endobag) rappresenta l’obiettivo su cui potere concretamente agire per un reale contenimento dei costi

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services