Robot-assisted laparoscopic single-site hysterectomy: our experience and multicentric comparison with single-port laparoscopy

Negli ultimi anni il campo della laparoscopia ginecologica e non ha subito diversi cambiamenti e sono stati fatti continui sforzi per migliorare la morbilità e la cosmesi della chirurgia laparoscopica con una particolare attenzione alla miniaturizzazione delle apparecchiature, e la riduzione delle dimensioni ed il numero delle porte. La chirurgia laparoscopica a sito unico (Laparoendoscopic Single Site, o LESS) è un termine che copre uno spettro di tecniche chirurgiche in cui tutte le porte vengono consolidate in una unica incisione [1]. Sebbene i primi risultati siano incoraggianti, questo non deve mascherare le difficoltà tecniche connesse con l'esecuzione ti tale procedura. Recentemente, l'ampia diffusione della robotica nella la chirurgia ginecologica ha portato alla ibridazione della tecnologia robotica con la LESS. Come conseguenza, l’uso del sistema chirurgico Da Vinci (Intuitive Surgical, Inc., a Sunnyvale, CA) consente una maggiore manovrabilità chirurgica e migliora l'ergonomia durante la LESS. Progressi preliminari in R-LESS sono stati già documentati nella chirurgia urologica, generale e, recentemente, anche nella chirurgia ginecologica. Il primo caso in tutto il mondo di isterectomia in laparoscopia robot-assistita a singola entrata con una porta multicanale di nuova concezione (Intuitive Surgical) per il sistema chirurgico da Vinci (VESPA, o video-endoscopic single-port access) è stato eseguito nel 2011 presso reparto di ginecologia dell’Universita’ di Pisa dall’equipe del Prof V. Cela. Un parametro fondamentale in un intervento di laparoscopia e’ la durata totale dell’intervento, che deve essere il piu’ rapido possibile in modo da ridurre la perdita di sangue e l’esposizine della paziente a rischi. Per corretto confnront tra queste due tecniche e’ indispensabile mettere a confronto campioni di pazienti omogenei, per eta’ e tipo di patologia, e numero. Lo scopo di questo studio e’ di mettere a confronto i tempi operativi in un campione di 12 pazienti sottoposte ad isterectomia totale con la tecnica R-LESS, con un campione di 15 pazienti sottoposte ad isterectomia con la tecnica SPAL-TH. Per corretto confronto tra queste due tecniche e’ indispensabile che i campioni di pazienti siano il più omogenei possibile per dati anamnestici, tipo di patologia e numero di pazienti a confronto

First observation of the quantized exciton-polariton field and effect of interactions on a single polariton.

© 2018 The Authors. Published by Science. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1126/sciadv.aao6814Polaritons are quasi-particles that originate from the coupling of light with matter and that demonstrate quantum phenomena at the many-particle mesoscopic level, such as Bose-Einstein condensation and superfluidity. A highly sought and long-time missing feature of polaritons is a genuine quantum manifestation of their dynamics at the single-particle level. Although they are conceptually perceived as entangled states and theoretical proposals abound for an explicit manifestation of their single-particle properties, so far their behavior has remained fully accounted for by classical and mean-field theories. We report the first experimental demonstration of a genuinely quantum state of the microcavity polariton field, by swapping a photon for a polariton in a two-photon entangled state generated by parametric downconversion. When bringing this single-polariton quantum state in contact with a polariton condensate, we observe a disentangling with the external photon. This manifestation of a polariton quantum state involving a single quantum unlocks new possibilities for quantum information processing with interacting bosons

Predictive Role of Cytokine and Adipokine Panel in Hospitalized COVID-19 Patients: Evaluation of Disease Severity, Survival and Lung Sequelae

Coronavirus disease 2019 (COVID-19) may determine a multisystemic chronic syndrome after resolution of SARS-CoV-2 infection in a significant percentage of patients. Persistent cytokine dysregulation can contribute to long-lasting inflammation and tissue damage, resulting in the diverse, often debilitating symptoms experienced by some patients (so-called long COVID syndrome). The aim of our study was to evaluate the value of a panel of serum biomarkers of severity and prognosis in patients hospitalized for COVID-19 and also as predictive factors for the development of post-COVID lung sequelae after discharge from the hospital. All blood sampling was performed in the first 24 h after admission to the hospital. Serum analyte concentrations of IL-4, IL-2, CXCL10 (IP-10), IL-1β, TNF-α, CCL2 (MCP-1), IL-17A, IL-6, IL-10, IFN-γ, IL-12p70 and TGF-β1 were quantified by bead-based multiplex LEGENDplex™ analysis and commercially available ELISA kits. A total of 108 COVID-19 patients were enrolled in the study. Comparative analysis of these proteins showed higher levels of TGF-β and IL-6 and lower levels of RBP-4 and IL-10 in the severe group. Age, adiponectin, IL-8 and IL-32 resulted as the best predictors for survival. Moreover, IL-1β, IL17A, TNF-α, TGF-β, IL-4 and IL-6 were significantly higher in patients who showed HRCT evidence of fibrotic interstitial alterations at follow-up than patients who did not. The initial inflammatory status of patients on admission to the hospital with COVID-19, as reflected by the present panel of adipose tissue-related biomarkers and cytokines, offered insights into medium-term prognosis

Increased Creatine Kinase May Predict A Worse COVID-19 Outcome

Early reports from Asia suggested that increased serum levels of the muscular enzyme creatine-(phospho)-kinase (CK/CPK) could be associated with a more severe prognosis in COVID-19. The aim of this single-center retrospective cohort study of 331 consecutive COVID-19 patients who were hospitalized during Italy’s “first wave” was to verify this relationship, and to evaluate the role of possible confounding factors (age, body mass index, gender, and comorbidities). We subdivided our cohort in two groups, based on “severe” (n = 99) or “mild” (n = 232) outcomes. “Severe” disease is defined here as death and/or mechanical invasive ventilation, in contrast to “mild” patients, who were discharged alive with no need for invasive ventilation; this latter group could also include those patients who were treated with non-invasive ventilation. The CK levels at admission were higher in those subjects who later experienced more severe outcomes (median, 126; range, 10–1672 U/L, versus median, 82; range, 12–1499 U/L, p = 0.01), and hyperCKemia >200 U/L was associated with a worse prognosis. Regression analysis confirmed that increased CK acted as an independent predictor for a “severe” outcome. HyperCKemia was generally transient, returning to normal during hospitalization in the majority of both “severe” and “mild” patients. Although the direct infection of voluntary muscle is unproven, transient muscular dysfunction is common during the course of COVID-19. The influence of this novel coronavirus on voluntary muscle really needs to be clarified

Ultrasound localization of central vein catheter tip by contrast-enhanced transthoracic ultrasonography: a comparison study with trans-esophageal echocardiography

Background To assess the usefulness of pre-operative contrast-enhanced transthoracic echocardiography (CE-TTE) and post-operative chest-x-ray (CXR) for evaluating central venous catheter (CVC) tip placements, with trans-esophageal echocardiography (TEE) as gold standard. Methods A prospective single-center, observational study was performed in 111 patients requiring CVC positioning into the internal jugular vein for elective cardiac surgery. At the end of CVC insertion by landmark technique, a contrast-enhanced TTE was performed by both the apical four-chambers and epigastric bicaval acoustic view to assess catheter tip position; then, a TEE was performed and considered as a reference technique. A postoperative CXR was obtained for all patients. Results As per TEE, 74 (67%) catheter tips were correctly placed and 37 (33%) misplaced. Considering intravascular and intracardiac misplacements together, they were detected in 8 patients by CE-TTE via apical four-chamber view, 36 patients by CE-TTE via epigastric bicaval acoustic view, and 12 patients by CXR. For the detection of catheter tip misplacement, CE-TTE via epigastric bicaval acoustic view was the most accurate method providing 97% sensitivity, 90% specificity, and 92% diagnostic accuracy if compared with either CE-TTE via apical four-chamber view or CXR. Concordance with TEE was 79% (p < 0.001) for CE-TTE via epigastric bicaval acoustic view. Conclusions The concordance between CE-TTE via epigastric bicaval acoustic view and TEE suggests the use of the former as a standard technique to ensure the correct positioning of catheter tip after central venous cannulation to optimize the use of hospital resources and minimize radiation exposure