Learning curve for laparoscopic cholecystectomy has not been defined: A systematic review

Background: Laparoscopic cholecystectomy is one of the most performed surgeries worldwide but its learning curve is still unclear. Methods: A systematic review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, and Google Scholar. Human studies investigating the learning curve of laparoscopic cholecystectomy were included. The Newcastle–Ottawa scale for cohort studies and the GRADE scale were used for the quality assessment of the selected articles. Results: Nine cohort studies published between 1991 and 2020 were included. All studies showed a great heterogeneity among the considered variables. Seven articles (77.7%) assessed intraoperative variables only, without considering patient's characteristics, operator's experience, and grade of gallbladder inflammation. Only five articles (55%) provided a precise cut-off value to see proficiency in the learning curve, ranging from 13 to 200 laparoscopic cholecystectomies. Conclusions: The lack of clear guidelines when evaluating the learning curve in surgery, probably contributed to the divergent data and heterogeneous results among the studies. The development of guidelines for the investigation and reporting of a surgical learning curve would be helpful to obtain more objective and reliable data especially for common operation such as laparoscopic cholecystectomy

The July 2006 eruption of Mount Etna (Italy) monitored through continuous soil radon measurements

Radon (222Rn) is a short-lived decay product derived from 238U, with a half-life of only 3.8 days. This gas ascends towards the earth’s surface mainly through cracks or faults. In recent decades radon has been used as a tool for predicting earthquakes and volcanic eruptions, because anomalous variations of its activity have often been reported before the occurrence of such geodynamic events. The recent eruptive activity of Mount Etna in Sicily (Italy) has been documented by multidisciplinary visual, geochemical, and instrumental observations. Here we describe the results obtained during the 10-day July 2006 Strombolian-effusive eruption of Mount Etna by using a radon probe installed near Torre del Filosofo (˜2950 m above sea level). This site is located ˜1 km south of the Southeast Crater, the youngest and most active of the four summit craters of the volcano, and the site of the July 2006 eruption. In order to better interpret the soil radon data we have compared them with simultaneously acquired volcanic tremor signals and a relative measurement of the thermal radiance emitted from the eruption area, derived from thermal camera measurements. During the month prior to the onset of the 2006 eruption, soil radon activity remained at low levels (˜1 x 103 Bq/m3); similar values persisted even when effusive activity started late on 14 July 2006. Only at ˜02:50 on the 15th July, radon activity showed a sharp increase (up to ˜50 x 103 Bq/m3) in a 20 minute interval, and a further increase to ˜20 x 106 Bq/m3 during the following hours. Explosive activity started at 04:30, 100 minutes after the initial rise in soil radon activity. High values in radon activity with numerous peaks persisted through the following four days, and were then followed by a marked decline until early on 20th July, when an extremely sharp rise brought the levels of radon activity to unprecedented values of nearly 1.7 x 108 Bq/m3, and remained very high for the next ˜24 hours. The episode of lava fountaining of 20th July occurred during this interval, starting 10 hours after the maximum in radon activity. From then on through the end of the eruptive phase, the levels of radon activity fluctuated with values rarely exceeding 106 Bq/m3 and then gradually declined starting from around noon on 22nd July. At the end of the eruption, radon levels remained higher (10-100 x 103 Bq/m3) than those recorded before the eruption. In conclusion, the onset of the Strombolian activity (15 July) and the lava fountaining (20 July) were related to significant changes in the magma pressure within the conduit. These two events were preceded by some hours with increases in radon soil emission by 4-5 orders of magnitude. For this reason we can imagine in the future the use of this signal as a potential precursor of this type of volcanic activity. Minor changes in eruptive behaviour did not produce significant variations in the monitored parameters. We interpret peaks in radon activity as due primarily to microfracturing of uranium-bearing rock. These observations suggest that radon measurements in the summit area of Etna are strongly controlled by the state of stress within the volcano and demonstrate the usefulness of radon data acquisition before and during eruptions

Monitoring System of Eastern Sicily (Italy) devised by a specialist team (UFSO) at the INGV- Catania Section, Italy.

Eastern Sicily in Italy is well-known as a high seismic and volcanic risk area. From a monitoring point of view, a team/unit of people has been created (UFSO) with the task of managing all the activities connected to the faultless operation of the Working Room that is the strategic centre during periods of routine operations or in the case of emergency. Among the primary activities of monitoring and surveillance, the management of the video camera network located on the main Sicilian active volcanoes represents a major goal. This task is achieved by means of permanent, visible and infrared cameras together with similar mobile systems, in order to observe each phenomenon related to the volcanic activity. The expert staff can therefore make decisions, in real time, from useful information in order to understand the phenomena in action. With the aim of maximizing the results and performance of all the networks, the UFSO is attentive to the planning and realization of hardware and software systems that are always available in the mobile van unit. In this context, the staff actively participates in national and European research projects dealing with the development and use of new systems with high technological content. Another aspect of the work, moreover, is represented by the development of supervisory control software, namely software providing automatic control of the working systems. Such algorithms allow to immediately and remotely signal to the duty-personnel states of alert of several modules, indicating, when possible, the probable failure causes

TheKnowRISKproject:Tools and strategies for risk communication and learning

Damage of non-structural elements of buildings (i.e. partitions, ceilings, cladding, electrical and mechanical sys- tems and furniture) is known to cause injuries and human losses. Also it has a significant impact on earthquake resilience and is yet being worldwide underestimated. The project KnowRISK (Know your city, Reduce seISmic risK through non-structural elements) is financed by the European Commission to develop prevention measures that may reduce non-structural damage in urban areas. Pilot areas of the project are within the three European participating countries, namely Portugal, Iceland and Italy. They were chosen because they are prone to damage level 2 and 3 (EMS-98, European Macroseismic Scale) that typically affects non-structural elements. We will develop and test a risk communication strategy taking into ac- count the needs of households and schools, putting into practice a portfolio of best practice to reduce the most common non-structural vulnerabilities. Wewilltargetouractionstodifferentsocietalgroups,consideringtheirculturalbackgroundandsocialvulnerabil- ities, and implement a participatory approach that will promote engagement and interaction between the scientific community, practitioners and citizens to foster knowledge on everyone’s own neighborhoods, resilience and vul- nerability. A Practical Guide for citizens will highlight that low-cost actions can be implemented to increase safety of house- holds,meantasbeingtheplaceswherethemostvulnerablesocietalgroups,includingchildrenandelderlypeople, spend much of their time. Since our actions towards communication will include education, we will define tools that allow a clear and direct understanding of elements exposed to risk. Schools will be one of our target societal groups and their central role played at the community level will ensure spreading and strengthening of the communication process. Schools are often located in old or re-adapted build- ings,formerlyusedforotheruses,orwhenthegrowingnumberofstudentsornewneedsrequireadaptingthespace to the necessities, often without taking enough care of safety. Moreover, in urban areas, schools may be hosted in tall buildings where the shaking of moderate-to-low magnitude earthquakes can cause damage level 2 and 3. Students will be involved into looking after their own situation in terms of non-structural vulnerability to promote education and prevention, while increasing resilience in terms of societal capacity to cope with future disasters. The actions will undergo specific effectiveness assessment with ex-ante and ex-post surveys. The results of this assessmentwillallowanevaluationofon-siteriskcommunicationactivities,thecomparabilitybetweenpilot-areas achievements, and an opportunity for learning and guidance for future risk communication.PublishedVienna, Austria3T. Pericolosità sismica e contributo alla definizione del rischioope

Predictors of mortality following emergency open colectomy for ischemic colitis: A single-center experience

Background: Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery. The aim of the present study was to identify the predictors of postoperative mortality after emergent open colectomy for IC treatment. Additionally, we compared postoperative outcomes of patients undergoing emergent colectomy due to aortic surgery-related IC (AS-IC group) vs. other IC etiologies (Other-IC group). Methods: We analyzed records of consecutive patients who underwent emergency open colectomy for IC between 2008 and 2019. Logistic regression analysis was performed to identify clinical and operative parameters associated with postoperative mortality. The AS-IC and Other-IC groups were compared for mortality, morbidity, ICU stay, hospital stay, and survival. Results: During the study period, 94 patients (mean age, 67.4 ± 13.7 years) underwent emergent open colectomy for IC. In the majority of cases, IC involved the entire colon (53.2%) and vasopressor agents were required preoperatively (63.8%) and/or intraoperatively (78.8%). Thirty-four patients underwent surgery due to AS-IC, whereas 60 due to Other-IC causes. In the AS-IC group, 9 patients had undergone endovascular aortic repair and 25 open aortic surgery; 61.8% of patients needed aortic surgery for ruptured abdominal aortic aneurism (AAA). Overall, 66 patients (70.2%) died within 90 days from surgery. The AS-IC and Other-IC groups showed similar operative outcomes and postoperative complication rates. However, the duration of the ICU stay (19 days vs. 11 days; p = 0.003) and of the total hospital stay (22 days vs. 16 days; p = 0.016) was significantly longer for the AS-IC group than for the Other-IC group. The rate of intestinal continuity restoration at 1 year after surgery was higher for the Other-IC group than for the AS-IC group (58.8% vs. 22.2%; p = 0.05). In the multivariate model, preoperative increased lactate levels, a delay between signs/symptoms' onset and surgery > 12 h, and the occurrence of postoperative acute kidney injury were statistically associated with postoperative mortality. Neither IC etiology (aortic surgery vs. other etiology) nor ruptured AAA was associated with postoperative mortality. Conclusion: Emergency open colectomy for IC is associated with high postoperative mortality, which appears to be unrelated to the IC etiology. Preoperative lactate levels, > 12-h delay to surgery, and postoperative acute kidney injury are independent predictors of postoperative mortality

Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry

Backgrounds: The COVID-19 pandemic drastically strained the health systems worldwide, obligating the reassessment of how healthcare is delivered. In Lombardia, Italy, a Regional Emergency Committee (REC) was established and the regional health system reorganized, with only three hospitals designated as hubs for trauma care. The aim of this study was to evaluate the effects of this reorganization of regional care, comparing the distribution of patients before and during the COVID-19 outbreak and to describe changes in the epidemiology of severe trauma among the two periods. Methods: A cohort study was conducted using retrospectively collected data from the Regional Trauma Registry of Lombardia (LTR). We compared the data of trauma patients admitted to three hub hospitals before the COVID-19 outbreak (September 1 to November 19, 2019) with those recorded during the pandemic (February 21 to May 10, 2020) in the same hospitals. Demographic data, level of pre-hospital care (Advanced Life Support-ALS, Basic Life Support-BLS), type of transportation, mechanism of injury (MOI), abbreviated injury score (AIS, 1998 version), injury severity score (ISS), revised trauma score (RTS), and ICU admission and survival outcome of all the patients admitted to the three trauma centers designed as hubs, were reviewed. Screening for COVID-19 was performed with nasopharyngeal swabs, chest ultrasound, and/or computed tomography. Results: During the COVID-19 pandemic, trauma patients admitted to the hubs increased (46.4% vs 28.3%, p < 0.001) with an increase in pre-hospital time (71.8 vs 61.3 min, p < 0.01), while observed in hospital mortality was unaffected. TRISS, ISS, AIS, and ICU admission were similar in both periods. During the COVID-19 outbreak, we observed substantial changes in MOI of severe trauma patients admitted to three hubs, with increases of unintentional (31.9% vs 18.5%, p < 0.05) and intentional falls (8.4% vs 1.2%, p < 0.05), whereas the pandemic restrictions reduced road- related injuries (35.6% vs 60%, p < 0.05). Deaths on scene were significantly increased (17.7% vs 6.8%, p < 0.001). Conclusions: The COVID-19 outbreak affected the epidemiology of severe trauma patients. An increase in trauma patient admissions to a few designated facilities with high level of care obtained satisfactory results, while COVID-19 patients overwhelmed resources of most other hospitals

Analogue modelling of basin inversion: a review and future perspectives

Basin inversion involves the reversal of subsidence in a basin due to compressional tectonic forces, leading to uplift of the basin's sedimentary infill. Detailed knowledge of basin inversion is of great importance for scientific, societal, and economic reasons, spurring continued research efforts to better understand the processes involved. Analogue tectonic modelling forms a key part of these efforts, and analogue modellers have conducted numerous studies of basin inversion. In this review paper we recap the advances in our knowledge of basin inversion processes acquired through analogue modelling studies, providing an up-to-date summary of the state of analogue modelling of basin inversion. We describe the different definitions of basin inversion that are being applied by researchers, why basin inversion has been historically an important research topic and what the general mechanics involved in basin inversion are. We subsequently treat the wide range of different experimental approaches used for basin inversion modelling, with attention to the various materials, set-ups, and techniques used for model monitoring and analysing the model results. Our new systematic overviews of generalized model results reveal the diversity of these results, which depend greatly on the chosen set-up, model layering and (oblique) kinematics of inversion, and 3D along-strike structural and kinematic variations in the system. We show how analogue modelling results are in good agreement with numerical models, and how these results help researchers to better understand natural examples of basin inversion. In addition to reviewing the past efforts in the field of analogue modelling, we also shed light on future modelling challenges and identify a number of opportunities for follow-up research. These include the testing of force boundary conditions, adding geological processes such as sedimentation, transport, and erosion; applying state-of-the-art modelling and quantification techniques; and establishing best modelling practices. We also suggest expanding the scope of basin inversion modelling beyond the traditional upper crustal “North Sea style” of inversion, which may contribute to the ongoing search for clean energy resources. It follows that basin inversion modelling can bring valuable new insights, providing a great incentive to continue our efforts in this field. We therefore hope that this review paper will form an inspiration for future analogue modelling studies of basin inversion.</p

Seismological constraints for the dyke emplacement of the July-August 2001 lateral eruption at Mt. Etna volcano, Italy

In this paper we report seismological evidence regarding the emplacement of the dike that fed the July 18 - August 9, 2001 lateral eruption at Mt. Etna volcano. The shallow intrusion and the opening of the eruptive fracture system, which mostly occurred during July 12, and July 18, were accompanied by one of the most intense seismic swarms of the last 20 years. A total of 2694 earthquakes (1 £ Md £ 3.9) were recorded from the beginning of the swarm (July 12) to the end of the eruption (August 9). Seismicity shows the upward migration of the dike from the basement to the relatively thin volcanic pile. A clear hypocentral migration was observed, well constraining the upwards propagation of a near-vertical dike, oriented roughly N-S, and located a few kilometers south of the summit region. Earthquake distribution and orientation of the P-axes from focal mechanisms indicate that the swarm was caused by the local stress source related to the dike intrusion

Multidisciplinary model for hospital-territory integrated management of patient with bone fragility: primary and secondary prevention of fractures according to severity and complexity.

The aim of this study was to promote the construction of a real network and a shared diagnostic and therapeutic management model between hospitals and out-of-hospital healthcare services to capture as many patients with bone fragility as possible. Starting from the analysis of the clinical competences present in the province of Pavia, the bone specialists (BSs) organized some educational events involving both general practitioners (GPs) and hospital specialists. The Fracture Liaison Service (FLS) model, the revision of Note 79, the national plan for chronicity and the health reform of the Lombardy Regional Authority supported the structure of our model, in which the roles of clinicians are well defined and based on the complexity and severity of patients. In our method the GP has a central role as clinical manager, facilitating patient management and communication between the specialists and the BS. In January 2019, the Therapeutic Care Diagnostic Path (PDTA) shared between 2 bone specialists (BSs), 9 GPs, as reference treaters, and a multidisciplinary group of 25 specialists of the Province of Pavia was defined. The strategic directions of the two largest public hospitals in Pavia have supported the PDTA, which was validated by the quality departments of the hospitals themselves. Finally, sixty GPs belonging to the network have joined the PDTA. This model is the first example of integrated management between hospitals and out-of-hospital healthcare services for the primary and secondary prevention of fragility fractures (FF), where the GPs play a pivotal role as managers and supervisors to ensure proper care to chronic patients according to their levels of severity