SARS-CoV-2 vaccination modelling for safe surgery to save lives : data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.Peer reviewe

Chemical composition of essential oil from plants of abandoned mining site of Elba island

<p>The essential oil composition of three spontaneous species growing in an abandoned mining of Elba island was analyzed by GC–MS. A total of 194 compounds were identified representing 73.7–100% of the whole oil composition. The essential oils of <i>Cistus salvifolius</i> and <i>Dittrichia viscosa</i> from this site showed different profiles in comparison with those from not polluted area, where oxygenated sesquiterpenes were the main class. Volatiles from <i>D. viscosa</i> growing in ex-mining area presented 10-epi-γ-eudesmol and α-eudesmol as main compounds while β-caryophyllene and limonene were the main ones in not polluted area. Ambroxide and ambrial were the most important compounds in the essential oil from <i>C. salvifolius</i> harvested in polluted area while nonanal and tridecanal were the main compounds in control samples. Oxygenated monoterpenes were the most abundant class from both <i>Lavandula stoechas</i> samples, with fenchone and camphor as main compounds.</p

Essential oil composition of Salvia rosmarinus Spenn. wild samples collected from six sites and different seasonal periods in Elba Island (Tuscan Archipelago, Italy)

The hydrodistilled essential oils from eighteen samples of Salvia rosmarinus Spenn. collected in six localities of Elba Island (Tuscany, Italy) during three different seasonal periods were analyzed by GC-MS for the first time. Fifty-five components were identified, representing 96.8–99.6% of the total chemical composition. All the tested essential oils were characterized by a high content of monoterpenes (oxygenated 49.2–80.3%; hydrocarbons18.7–48.3%). Among them, 1,8-cineole (26.4–49.1%),a-pinene (4.5–34.8%), camphor (1.1–18.8%) and borneol (1.7–16.2%) were the main constituents. The high amount of 1,8-cineole/a-pinene/camphor/borneol may suggest the presence of an intermediate rosemary chemotype. Statistical analysis was also performed on the essential oil (EO) composition evidenced an expected difference depending on the collection seasons, to the geographical areas and soil composition. A comparison with the essential oil composition fromS. rosmarinus collected in all the other islands of Tuscan Archipelago (Italy) was also reported, together with a Multivariate Statistical Analysis

Heart, tracheo-bronchial and thoracic spine trauma. Succesful multidisciplinary management: a challenging thoracic politrauma

We reported the case of a 36 years old woman involved in a car accident and admitted to the Emergency Room with critical conditions. A CT scan showed hemopericardium, pneumomediastinum and D2 unstable vertebral fracture; then a sternotomy was promptly performed. After admittance to Intensive Care Unit a bronchoscopy showed a tear of the posterior wall of the trachea and the complete disruption of the left main bronchus with a 2 cm gap beetwen two consecutive cartilage rings. D2 fracture would have required stabilization, but pronation of the patient was contraindicated by the bronchial rupture. On the nineth day the vertebral fracture was stabilized, thus allowing a lateral decubitus and a left thoracotomy. The bronchial laceration was wrapped all around with a pedicled pericardial flap and a bronchial stent was placed inside the gap with a pediatric bronchoscope. Postoperative course was uneventful and the patient was transferred to the Physical Rehabilitation Unit after 23 d. The successful outcome of this case is the result of multidisciplinary management where every decision was shared by each specialist. From the surgical point of view survival is uncommon in such severe association of lesions. The use of pericardium wrap together with a bronchial stent represents an innovative solution to treat a complicated bronchial disruption

Relevance of Series-Elastic actuation in rehabilitation and assistance robotic: Two cases of study

This paper presents two cases of exoskeletal platform, embedding a properly-designed element working both as power-Transmission and torque-sensing unit. This element belongs to the Series-Elastic-Actuator (SEA) category, as it provides a mechanical stiffness in-series with the active motor, and provides measurement of the torque by means of its deflection. This allows presented exoskeletons to realize an intrinsically safe (as for the compliance) and controllable (both in position and torque) interaction with the user. The two cases respectively deal with upper-limb post-stroke rehabilitation and powered assistance for the lower-limbs. The former exoskeleton-namely NEUROExos-was used by therapists to record experimental torque-Angle profiles from desired rehabilitative sessions on the subject's impaired limb, in order to assess quantitatively the current joint resistance and evaluate patient's progression. The latter exoskeleton-namely APO-allowed the implementation of a torque control for gait assistance. Both systems, despite being rather powerful and in close contact with the human body, embeds safety checks and features, which allow them to safely operate in physical contact with the user, without the risk to harm him/her

Reprogramming of Amino Acid Transporters to Support Aspartate and Glutamate Dependency Sustains Endocrine Resistance in Breast Cancer

Endocrine therapy (ET) is the standard of care for estrogen receptor-positive (ER+) breast cancers. Despite its efficacy, ∼40% of women relapse with ET-resistant (ETR) disease. A global transcription analysis in ETR cells reveals a downregulation of the neutral and basic amino acid transporter SLC6A14 governed by enhanced miR-23b-3p expression, resulting in impaired amino acid metabolism. This altered amino acid metabolism in ETR cells is supported by the activation of autophagy and the enhanced import of acidic amino acids (aspartate and glutamate) mediated by the SLC1A2 transporter. The clinical significance of these findings is validated by multiple orthogonal approaches in a large cohort of ET-treated patients, in patient-derived xenografts, and in in vivo experiments. Targeting these amino acid metabolic dependencies resensitizes ETR cells to therapy and impairs the aggressive features of ETR cells, offering predictive biomarkers and potential targetable pathways to be exploited to combat or delay ETR in ER+ breast cancers

Reprogramming of Amino Acid Transporters to Support Aspartate and Glutamate Dependency Sustains Endocrine Resistance in Breast Cancer

Endocrine therapy (ET) is the standard of care for estrogen receptor-positive (ER+) breast cancers. Despite its efficacy, ∼40% of women relapse with ET-resistant (ETR) disease. A global transcription analysis in ETR cells reveals a downregulation of the neutral and basic amino acid transporter SLC6A14 governed by enhanced miR-23b-3p expression, resulting in impaired amino acid metabolism. This altered amino acid metabolism in ETR cells is supported by the activation of autophagy and the enhanced import of acidic amino acids (aspartate and glutamate) mediated by the SLC1A2 transporter. The clinical significance of these findings is validated by multiple orthogonal approaches in a large cohort of ET-treated patients, in patient-derived xenografts, and in in vivo experiments. Targeting these amino acid metabolic dependencies resensitizes ETR cells to therapy and impairs the aggressive features of ETR cells, offering predictive biomarkers and potential targetable pathways to be exploited to combat or delay ETR in ER+ breast cancers.status: publishe