How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Sustainable highly selective toluene oxidation to benzaldehyde

Thanks to the well-recognized role of benzaldehyde in industry, nowadays the research of new and sustainable approaches to selectively synthesize such an interesting product is receiving great attention from the chemists’ community. In this paper, a V-based catalytic biphasic system is adopted to perform toluene oxidation to benzaldehyde. Importantly, to pursue sustainability, organic solvents have been avoided, so toluene is used as substrate and co-solvent, together with water. Also, the use of hydrophobic ionic liquids has been explored. To perform oxidation, NH4VO3 catalyst, H2O2, and a safe and inexpensive co-catalyst are used. Among the tested co-catalysts, KF and O2 were found to be the best choice, to guarantee good yields, in mild reaction conditions. In fact, with such a sustainable method, up to 30% of benzaldehyde can be obtained at 60 °C and, more interestingly, the oxidative system can be recharged, raising-up the yield. The entire process results highly selective, since no traces of benzyl alcohol or benzoic acid are detected. Hence, it constitutes a very appealing synthetic route, even suitable to be easily scaled-up at an industrial level

Sustainable Highly Selective Toluene Oxidation to Benzaldehyde

Thanks to the well-recognized role of benzaldehyde in industry, nowadays the research of new and sustainable approaches to selectively synthesize such an interesting product is receiving great attention from the chemists’ community. In this paper, a V-based catalytic biphasic system is adopted to perform toluene oxidation to benzaldehyde. Importantly, to pursue sustainability, organic solvents have been avoided, so toluene is used as substrate and co-solvent, together with water. Also, the use of hydrophobic ionic liquids has been explored. To perform oxidation, NH4VO3 catalyst, H2O2, and a safe and inexpensive co-catalyst are used. Among the tested co-catalysts, KF and O2 were found to be the best choice, to guarantee good yields, in mild reaction conditions. In fact, with such a sustainable method, up to 30% of benzaldehyde can be obtained at 60 °C and, more interestingly, the oxidative system can be recharged, raising-up the yield. The entire process results highly selective, since no traces of benzyl alcohol or benzoic acid are detected. Hence, it constitutes a very appealing synthetic route, even suitable to be easily scaled-up at an industrial level

The Road to Technical Proficiency in Cytoreductive Surgery for Peritoneal Carcinomatosis: Risk-Adjusted Cumulative Summation Analysis

Background: Cytoreductive surgery (CRS) is a technically demanding procedure, and there is considerable debate about its safe application. This study investigated the learning curve for CRS and the clinical outcomes of consecutive patients treated by a single surgeon at a single institution. Methods: We collected 251 consecutive patients who underwent CRS for peritoneal metastases by a single surgeon at Fondazione Policlinico Universitario A. Gemelli IRCCS, between January 2016 and December 2020. The learning curve was estimated using the cumulative summation analysis (CUSUM) for operative time (OT). Risk-adjusted CUSUM (RA-CUSUM) charts were developed using a composite variable (surgical failure), defined as the occurrence of at least one of the following events: major postoperative complications (Clavien-Dindo grade >= 3), blood loss >= 500 mL, incomplete cytoreduction. Three learning phases were thus derived from the RA-CUSUM analysis, and were compared in terms of perioperative outcomes. Results: CUSUM-OT showed that the operation time improved significantly after the 161(th) case. RA-CUSUM analysis allowed to break the CRS learning curve into three different phases: phase 1, "the learning phase " (cases 1-99), phase 2 "the experienced phase " (cases 100-188), and phase 3, "the mastership phase " (cases 189-251). The rate of major postoperative complications decreased significantly over the three phases (p = 0.019). Operative time decreased significantly as well (p = 0.031) and was significantly shorter in phase 3 with respect to the other two phases (phase 3 vs phase 2: 420 min vs 500 min, p = 0.017; phase 3 vs phase 1: 420 min vs 503 min, p = 0.021). Blood loss consistently decreased throughout the three phases (p = 0.001). The rate of incomplete cytoreduction was significantly lower in phase 3 than in phase 2 (4.8% vs 14.6%, p = 0.043). Conclusion: The CRS failure rate stabilized after the first 99 cases, and the complete surgical proficiency was achieved after 189 cases. A standardised and mentored learning model is a safer strategy to shorten the learning process, to reduce morbidity and mortality, to improve oncologic outcomes

Microparticles from dental calculus disclose paleoenvironmental and palaeoecological records

Abstract Plants have always represented a key element in landscape delineation. Indeed, plant diversity, whose distribution is influenced by geographic/climatic variability, has affected both environmental and human ecology. The present contribution represents a multi‐proxy study focused on the detection of starch, pollen and non‐pollen palynomorphs in ancient dental calculus collected from pre‐historical individuals buried at La Sassa and Pila archaeological sites (Central Italy). The collected record suggested the potential use of plant taxa by the people living in Central Italy during the Copper‐Middle Bronze Age and expanded the body of evidence reported by previous palynological and palaeoecological studies. The application of a microscopic approach provided information about domesticated crops and/or gathered wild plants and inferred considerations on ancient environments, water sources, and past health and diseases. Moreover, the research supplied data to define the natural resources (e.g., C4‐plant intake) and the social use of the space during that period. Another important aspect was the finding of plant clues referable to woody habitats, characterised by broad‐leaved deciduous taxa and generally indicative of a warm‐temperate climate and grassy vegetation. Other unusual records (e.g., diatoms, brachysclereids) participated in defining the prehistoric ecological framework. Thus, this work provides an overview on the potential of the human dental calculus analysis to delineate some features of the ancient plant ecology and biodiversity

10 Years of Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC): A Systematic Review and Meta-Analysis

Background: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a novel intraperitoneal drug delivery method of low-dose chemotherapy as a pressurized aerosol in patients affected by peritoneal cancer of primary or secondary origin. We performed a systematic review and meta-analysis with the aim of assessing the feasibility, safety, and efficacy of PIPAC. Methods: A systematic literature search was performed using Medline and Web of Science databases from 1 January 2011, to inception, to 31 December 2021. Data were independently extracted by two authors. The Newcastle-Ottawa Scale was used to assess the quality and risk of bias of studies. Meta-analysis was performed for pathological response, radiological response, PCI variation along treatment, and for patients undergoing three or more PIPAC. Pooled analyses were performed using the Freeman–Tukey double arcsine transformation, and 95% CIs were calculated using Clopper–Pearson exact CIs in all instances. Results: A total of 414 papers on PIPAC were identified, and 53 studies considering 4719 PIPAC procedure in 1990 patients were included for analysis. The non-access rate or inability to perform PIPAC pooled rate was 4% of the procedures performed. The overall proportion of patients who completed 3 or more cycles of PIPAC was 39%. Severe toxicities considering CTCAE 3–4 were 4% (0% to 38.5%). In total, 50 studies evaluated deaths within the first 30 postoperative days. In the included 1936 patients were registered 26 deaths (1.3%). The pooled analysis of all the studies reporting a pathological response was 68% (95% CI 0.61–0.73), with an acceptable heterogeneity (I2 28.41%, p = 0.09). In total, 10 papers reported data regarding the radiological response, with high heterogeneity and a weighted means of 15% (0% to 77.8%). PCI variation along PIPAC cycles were reported in 14 studies. PCI diminished, increased, or remained stable in eight, one and five studies, respectively, with high heterogeneity at pooled analysis. Regarding survival, there was high heterogeneity. The 12-month estimated survival from first PIPAC for colorectal cancer, gastric cancer, gynecological cancer and hepatobiliary/pancreatic cancer were, respectively, 53%, 25%, 59% and 37%. Conclusions: PIPAC may be a useful treatment option for selected patients with PM, with acceptable grade 3 and 4 toxicity and promising survival benefit. Meta-analysis showed high heterogeneity of data among up-to-date available studies. In a subset analysis per primary tumor origin, pathological tumor regression was documented in 68% of the studies with acceptable heterogeneity. Pathological regression seems, therefore, a reliable outcome for PIPAC activity and a potential surrogate endpoint of treatment response. We recommend uniform selection criteria for patients entering a PIPAC program and highlight the urgent need to standardize items for PIPAC reports and datasets

Roman Liver Tx Allocation: Results at 48 months of an innovative regional allocationmodel based on MELDNa and Donor-to-Recipient Match

Roman Liver Tx Allocation: Results at 48 months of an innovative regional allocation model based on MELDNa and Donor-to-Recipient Match Federica Ferracci1, Alfonso W. Avolio1, Francesca R. Ponziani1, Antonio Grieco1, Salvatore Agnes1, Stefano Ginanni Corradini2, Fabio Melandro2, Flaminia Ferri2, Massimo Rossi2, Tommaso M. Manzia3, Ilaria Lenci3, Matteo Manuelli3, Mario Angelico3, Giuseppe Tisone3, Giovanni Vennarecci4, Marco Colasanti4, Roberto L. Meniconi4, Ubaldo Visco Comandini4, Giuseppe M. Ettorre4, Raffaella Zaccaria5, Nicola Torlone5, Maurizio Valeri5; 1Transplant center - University Hospital “A. Gemelli”, Rome, Italy; 2Transplant center - University Hospital “Umberto I”, Rome, Italy; 3Transplant center - University Hospital “Tor Vergata”, Rome, Italy; 4Transplant center - San Camillo Hospital, Rome, Italy; 5Transplant center - Regione Lazio, Rome, Italy BACKGROUND Liver allocation policies are different between Countries and regions. An innovative allocation model based on MELDNa and donor age was developed in Italy in a donor-to-recipient match perspective. 244 Liver transplants (LT) performed (2013-2015) in a 4 Center regional Consortium were compared to 235 controls (2010- 2012). P&M In the 2013-2015 period, Standard Organs (SO, N=151, 61,8%) were allocated to patients (pts) on a common regional waiting list, based on MELDNa (5 classes: >30, N=32, 13.2%; 29-24, N=41, 16.8%; 23-20, N=19, 7.8%; 19-15, N=24, 9.8%; <15, N=35, 14.3%). Non-SO (donor age >65, N=76, 31.2%;other reasons, N=17, 6.9%) were allocated locally, according to priority defined in each Center. and to individual patient’s characteristics (mainly HCC pts with progressive disease). In the 2010-2012 period each Center used a MELD based allocation algorithm and HCC pts were equipoised to non-HCC pts using the MELD 22 rule. Univariate Kaplan Meier (KM) and multivariate Cox analyses (Cox) were used. RESULTS LT in 2013-2015 period were older, with higher MELDNa, and received organs by older donors. Regarding non-HCC patients: Recipient’s age: 52±11 vs 50±11; Donor’s age: 51±18 vs 52±18; MELD at LT: 23±7 vs 21±7, p=0.002; MELDNa at LT: 25±7 vs 22±7, p=0.003. Regarding HCC patients: Recipient’s age: 58±6 vs 57±8; Donor’s age: 56±17 vs 52±18; MELD at LT: 15±6 vs 14±6; MELDNa at LT: 16±7 vs 15±5. Waiting time was significantly lower for non-HCC group 2.0±4.4 vs 6.7±8.3 mo, p=0.0001, and unchanged for the HCC patients 5.7±5.2 vs 5.3±5. 48 mo patient survival was similar (KM: overall 76% continuos l vs 79% dotted l; non-HCC: 78% vs 80%; HCC: 73% vs 77%). MELDNa and recipient’s age resulted significant prognostic predictors at Cox. CONCLUSIONS Although overall survival was slightly reduced in the non-SO HCC subgroup, the innovative allocation model provides positive results about overall LT performed, using organs from older donors, and faster transplantation for pts with progressive liver disease