Medicina Artificiale

Il presente progetto si rivolge allo sviluppo di nuove tecniche per applicazioni oncologiche, grazie alle innovazioni nel settore delle tecnologie dell'informazione mediante metodologie basate su modelli predittivi knwoledge based addestrati con opportune tecniche di Machine Learning. Il progetto per: ➢ contenuti e obiettivi di ricerca e di applicazione alla pre-clinica (diagnosi) e alla clinica (trattamento e prognosi); ➢ finalità di ricerca industriale orientata alla messa a punto e concreta industrializzazione di prodotto/servizio digitale a tali fini concepito, presenta una natura profondamente interdisciplinare (il carcinoma polmonare, il cancro mammario, il cancro colo-rettale, i carcinomi gastro-intestinali, il carcinoma epatico, il carcinoma prostatico, il carcinoma tiroideo e i tumori maligni cutanei), che richiede la collaborazione tra settori e professionalità molto diversi (medici di medicina generale, medici specialisti, radiologi, chirurgi, patologi, biologi molecolari e naturalmente oncologi, oltre che il supporto di un team di ingegneri per gli aspetti di Machine Learning e Pattern Recognition e di sviluppatori di software esperti in ambito sanitario)

Chirurgia e Arte

Cosa unisce l’arte alla chirurgia: mi è sempre piaciuto credere che nell’etimo delle parole si nascondessero in modo più o meno evidente simboli ancestrali. La parola Arte sembra infatti venire dalla radice sanscrita “Ar” che significa Luce e la parola Chirurgia proviene dal greco “χειρ-ός” mano “εργόν o –μαι” che si può tradurre come azione, energia, opera, arte…appunto “arte della mano”. In effetti il chirurgo porta luce nelle viscere del corpo (visita interiora terrae), squarcia le tenebre della malattia o più semplicemente ha bisogno di luce per operare (scialitica e chirurgia videoassistita); ma è sicuramente la mano ciò che unisce l’artista al chirurgo o come mi piace credere è per mano che si tengono l’artista e il chirurgo. Forse la verità è solo che ho sempre amato dipingere e quasi con la stessa naturalezza ho amato la chirurgia: perdonatemi quindi se in questo viaggio insieme non riuscirò a celare il mio amore per l’una o per l’altra, tanto grande, quanto il dolore di percepire che siamo ormai sempre più incapaci di riconoscere il bello nel mondo che ci circonda

Antibiotic prophylaxis in thyroid surgery: a preliminary multicentric italian experience

Post-operatory wound infections are a very uncommon finding after thyroidectomy. For these reasons international guidelines do not routinely recommend systemic antibiotic prophylaxis

Origin of a folded repeat protein from an intrinsically disordered ancestor.

Repetitive proteins are thought to have arisen through the amplification of subdomain-sized peptides. Many of these originated in a non-repetitive context as cofactors of RNA-based replication and catalysis, and required the RNA to assume their active conformation. In search of the origins of one of the most widespread repeat protein families, the tetratricopeptide repeat (TPR), we identified several potential homologs of its repeated helical hairpin in non-repetitive proteins, including the putatively ancient ribosomal protein S20 (RPS20), which only becomes structured in the context of the ribosome. We evaluated the ability of the RPS20 hairpin to form a TPR fold by amplification and obtained structures identical to natural TPRs for variants with 2-5 point mutations per repeat. The mutations were neutral in the parent organism, suggesting that they could have been sampled in the course of evolution. TPRs could thus have plausibly arisen by amplification from an ancestral helical hairpin

Biliary tract injuries during laparoscopic cholecystectomy: three case reports and literature review

Introduction. Biliary tract injuries (BTI) represente the most serious and potentially life-threatening complication of cholecystectomy. During open cholecystectomies (OC), the prevalence of bile duct injuries has been estimated at only 0.1-0.2%. We report 3 cases of BTI during laparoscopic cholecystectomy (LC). Case 1. Ascalesi Hospital, Naples 2003-2007, 875 LC (BTI 0,11%). During the dissection of triangle of Calot a partial resection of biliary common duct was made. Immediatly the lesion was evident and sheltered in laparoscopy, suturing with a spin reabsorbable, without biliar drainage. The post-operative outcome was good, without alteration of the some parameters, and the patient was discharged after three days. At the last follow-up (January 2006) the cholangiography didn’t show stricture or leakage. Case 2. General and Laparoscopic Surgical Unit San Giovanni di Dio Hospital Frattamaggiore 2004-2007, 720 LC (BTI 0,13%). Patient affected by cholecystitis with gallstones. The patient did not present jaundice, but abdominal pain, leucocitosis, fever and US evidence of parietal gallbladder inflammation. LC was performed after 36 h; during operation, common biliar duct was misidentified for subverted anatomy caused by inflammation. The common bile duct was clipped, and the patient presented jaundice after three days after operation. The colangiography was performed showing the stop. Therefore a reoperation was needed and laparotomic Roux-en-Y hepaticojejunostomy was performed. Case 3. Dpt of Emergency Surgery, Second University of Naples 2000-2007, LC 520 (BTI 0,19%). Patient affected by more than 20 years symptomatic cholelithiasis, with only obesity risk factor; she underwent laparoscopic cholecystectomy and sudden bleeding of the cystic artery, poor vision and probably the long history of symptoms, producing a flogistic alteration of the anatomy, caused a misidentification of the cystic duct and the common bile duct with complete or lateral clipping of the common hepatic duct. The error was unrecognized intra-operatively but after progressive jaundice the postoperative colangiography showed a nearly complete stop by two clips. Roux-en-Y hepaticojejunostomy with intraoperative cholangiographic control was performed. Discussion. The most common cause of BTI is the failure to recognize the anatomy of the triangle of Calot. This is attributed to factors inherent to the laparoscopic approach, to inadequate training of the surgeon and to local anatomical risk factors. The laparoscopic "learning curve" of the surgeon is the most important factor of bile ducts injury. But also local anatomical risk factors are important such as acute cholecystitis, severe chronic scarring of the gallbladder and bleeding or excessive fat in the hepatic hilum. These local risk factors seem to be present in 15% to 35% of BTI. Abnormal biliary anatomy, such as a short cystic duct or a cystic duct entering into the right hepatic duct also may increase the incidence of BTI. Schematic representation of the common mechanisms of BTI during LC are: misidentification of the cystic duct and the common biliary duct, lateral clipping of the common biliary duct, traumatic avulsion the cystic duct junction, diatermic injury of common biliary duct during dissection of the Calot triangle or during the cholecystectomy, injury of anomalous right hepatic duct. Conclusion. Conversion to laparotomy, in difficult cases involving inflammatory changes, aberrant anatomy or excessive bleeding, is not to be considered as a failure but rather as good surgical decision in order to ensure the patient's safety