Video-Laparoscopic versus Open Surgery in Obese Patients with Colorectal Cancer: A Propensity Score Matching Study

Background: Minimally invasive surgery in obese patients is still challenging, so exploring one more item in this research field ranks among the main goals of this research. We aimed to compare short-term postoperative outcomes of open and video-laparoscopic (VL) approaches in CRC obese patients undergoing colorectal resection. Methods: We performed a retrospective analysis of a surgical database including 138 patients diagnosed with CRC, undergoing VL (n = 87, 63%) and open (n = 51, 37%) colorectal surgery. As a first step, propensity score matching was performed to balance the comparison between the two intervention groups (VL and open) in order to avoid selection bias. The matched sample (N = 98) was used to run further regression models in order to analyze the observed VL surgery advantages in terms of postoperative outcome, focusing on hospitalization and severity of postoperative complications, according to the Clavien–Dindo classification. Results: The study sample was predominantly male (N = 86, 62.3%), and VL was more frequent than open surgery (63% versus 37%). The two subgroup results obtained before and after the propensity score matching showed comparable findings for age, gender, BMI, and tumor staging. The specimen length and postoperative time before discharge were longer in open surgery (OS) patients; the number of harvested lymph nodes was higher than in VL patients as well (p < 0.01). Linear regression models applied separately on the outcomes of interest showed that VL-treated patients had a shorter hospital stay by almost two days and about one point less Clavien–Dindo severity than OS patients on average, given the same exposure to confounding variables. Tumor staging was not found to have a significant role in influencing the short-term outcomes investigated. Conclusion: Comparing open and VL surgery, improved postoperative outcomes were observed for VL surgery in obese patients after surgical resection for CRC. Both postoperative recovery time and Clavien–Dindo severity were better with VL surgery

Predictors of Long-Term Outcomes of Video-Laparoscopic Versus Open Surgery in Obese Patients with Colorectal Cancer: A Propensity Score Matching Study

Background: Minimally invasive methods in colorectal surgery offer unquestionable advantages, especially in the context of obesity. The current study addresses the lack of scientific evidence on the long-term oncologic safety of video-laparoscopic (VL) approaches in excess-weight CRC patients undergoing surgery. Methods: We retrospectively analyzed a surgical database consisting of 138 CRC patients undergoing VL (n = 87, 63%) and open CRC surgery (n = 51, 37%). To reduce selection bias, a propensity score matching was applied as a preliminary step to balance the comparison between the two surgery groups, i.e., VL and open surgery. Data from patients treated by the same surgeon were used.to minimize bias. Additional Cox regression models were run on the matched sample (N = 98) to explore the observed benefits of VL surgery in terms of overall and cancer-free survival. The nonparametric Kaplan-Meier method was used to compare the two surgical approaches and assess the likelihood of survival and cancer relapse. Results: The study sample was mostly male (N = 86, 62.3%), and VL outnumbered open surgery (63% versus 37%). Both before and after the matching, the VL-allocated group showed better overall survival (p < 0.01) with comparable cancer-free survival over more than five years of median observation time (66 months). Kaplan Meier survival probability curves corroborated the VL significant protective effect on survival (HR of 0.32; 95% CI: 0.13 to 0.81) even after adjusting for major confounding factors (age, gender, comorbidity index, BMI, tumor localization, tumor staging, tumor grading, clearance, CRM). Findings on oncologic performance by tumor relapse were comparable but lacked significance due to the small number of events observed. Conclusions: Comparing CRC surgical approaches, VL allocation showed comparable cancer-free survival but also a better performance on overall mortality than open surgery over more than five years of median observation

Assessing the Effect of Disturbances on Ectomycorrhiza Diversity

Ectomycorrhiza (ECM) communities can be described on a species level or on a larger scale at an ecosystem level. Here we show that the species level approach of successional processes in ECM communities is not appropriate for understanding the diversity patterns of ECM communities at contaminated sites. An ecosystem based approach improves predictability since different biotic and abiotic factors are included. However, it still does not take into account the hierarchical structure of the ecosystem. We suggest that diversity patterns of ECMs communities in forests can best be investigated at three levels. This hypothetical approach for investigation can be tested at sites of secondary succession in areas contaminated with metals. Once the diversity patterns are appropriately described by a hierarchical ecosystem approach, to the species level is used to explain these patterns by populational and ecotoxicological mechanisms

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

INVECCHIAMENTO COGNITIVO E MEMORIA DI LAVORO: IL RUOLO DELL'EXECUTIVE CONTROL

This goal of this research was to study the effects of aging on WM tasks requiring a high level of executive control. Two first experiments focused on a highly controlled WM process, that of updating. The overall finding is that age-related differences in WM updating are clear in both verbal and spatial domain. This result is consistent with a number of studies addressing verbal updating tasks and broadens it to the spatial domain. Moreover, no modality-specific age effect was found: using memory tasks matched except for modality yielded no differential age-related decline for verbal and visuo-spatial updating processes (Kemps & Newson, 2006). Findings from our final experiment allowed the conclusion that age-related deficits are attributable to changes in executive control in WM, regardless of the type of information used for the task – verbal or visuo-spatial (Verhaeghen & Cerella, 2002): what makes the difference between young and older participants appears to be linked to the executive control required by the task, as emerged from the VSWM tasks.L'obiettivo generale della presente ricerca era quello di approfondire gli effetti dell’età in prove di MdL che richiedono un elevato controllo esecutivo. Nei primi due esperimenti, ci si è focalizzati su un processo altamente controllato della MdL, ovvero l’aggiornamento. In sintesi, è emerso che le differenze d’età nell’abilità di aggiornare le informazioni presenti in MdL sono evidenti sia con materiale verbale che spaziale. Questo dato conferma quanto già presente in letteratura con prove di updating di tipo verbale e lo amplia anche al materiale di natura spaziale. Inoltre, non è stato riscontrato alcun effetto dell’età modalità-specifico. Il ricorso a prove parallele sia verbale che spaziali, che pongono le stesse richieste di elaborazione, permette di stabilire che non vi è declino differenziale dipendente dall’età nell’abilità di aggiornare informazioni verbali e spaziali (Kemps & Newson, 2006). In conclusione, sembrerebbe che i deficit correlati all’età appaiano imputabili a cambiamenti nel controllo esecutivo in MdL, indipendentemente dalla natura del compito –verbale o visuo-spaziale – (Verhaeghen & Cerella, 2002). Infatti, anche in prove di MLVS (Esperimento 3), quello che differenzia gli anziani dai giovani sembra essere legato al controllo esecutivo richiesto dal compito

Mental imagery in a visuospatial working memory task and modulation of activation.

Ability to process information during a mental imagery task relying on visuospatial working memory and the advantages offered by the possibility of focusing the activation on specific items were examined in younger and older adults. The mental imagery task used for the study required participants to mentally move on a two-dimensional (5\ue0015) or three-dimensional (3\ue0013\ue0013) matrix, while having to hold in memory either the whole pathway (WP condition) or just the final position reached (FP condition). The results revealed age-related differences in ability to modulate activation of visuospatial information. In particular, older adults, unlike the younger counterparts, did not benefit when the task allowed just part of the presented material to be considered. In particular, they drew less advantage from the three- dimensional matrix than the younger group. The findings are discussed in terms of the importance of processes reducing visuospatial working memory activation of irrelevant information and of the difficulties encountered by older adults in the modulation of activation

Age differences in verbal and visuo-spatial working memory updating: Evidence from analysis of serial position curves.

Memory updating is the ability to select and update relevant information and suppress no-longerrelevant data. The few studies in this area, targeting mainly the verbal domain, have investigated and confirmed an age-related decline in working memory updating ability (De Beni & Palladino, 2004; Van der Linden, Bredart, & Beerten, 1994). The present research examines the ability of younger and older adults to update information in verbal and visuo-spatial running memory tasks. Results showed that the participants’ performance was higher in the verbal than in the visuo-spatial task. Nonetheless, independently of the task domain, an age-related decline in updating performance was found. Moreover, analysis of serial positions suggested that, in the updating procedure, the participants were not attempting to actively maintain items, preferring to adopt a low-effort, ‘‘recency-based’’ strategy. The use of this type of strategy is more evident in older participants, as shown in both the accuracy performance and the proportion of intrusion errors

Goblet Cell Carcinoma of the Appendix with Synchronous Adenocarcinoma of the Cecum: Distinct or Related Entities?

Goblet cell carcinoma (GCC) is a rare primary tumor of the appendix characterized by both epithelial and neuroendocrine components containing goblet cells. While in the past, the GCC has been associated with neuroendocrine tumors, recent studies consider that GCC is closer to adenocarcinoma than a neuroendocrine component. The association between gastro-intestinal (GI) carcinoids and second primary malignancies (SPMs) is widely described in the literature, but there is no reported case of GCC and synchronous adjacent adenocarcinoma of the colon. We describe the first case in the literature, to our knowledge, of synchronous colorectal adenocarcinoma of the cecum and GCC of the appendix that are incidentally discovered in the resected primary cancer specimen. The association between the two neoplasms seems to be not causal and maybe the “paracrine-effect theory” may explain the development of a second tumor close to the primary

Short-term memory for flavour

The short-term memory for the flavour of a wine in frequent but nonexpert drinkers was studied in an experiment comparing memory for wine under conditions where participants imagined and remembered a target wine with memory under conditions where participants carried out subsequent imaging and image rating tasks on the wine and on competing mental images. The results show that the cognitive operation of mental image rating produced enhanced memory when the operations were performed on the image of the target wine and somewhat impaired memory when operations were performed on an image of a competing flavour or operations performed on mental images in other domains. It is concluded that sensory traces of flavour may be effectively maintained in short-term memory when supported by appropriate encoding operations

A new technique for the laparoscopic treatment of simple hepatic cysts

Background: Simple hepatic cysts are commonly detected in the general population, both solitary and associated with Adult Dominant Polycystic Kidney Disease (ADPKD). Laparoscopic fenestration is a surgical option adopted as first-line treatment and to treat complications. The techniques reported in the literature are associated with cyst recurrence in up to 41% of cases. Methods: From 2012 to May 2021, 19 symptomatic patients diagnosed with simple HCs underwent an innovative technique for laparoscopic fenestration, which includes simultaneous ethanol injection into the residual cavity. The median follow up was 57 (range 4-116) months. We retrospectively analysed symptomatic relief obtained in the short and long term as primary outcome. We also evaluated the postoperative outcome, recurrence and re-intervention rates. Results: 11 patients (of 19) were female (58 %), with a median age of 58 (range 31-78) years. Most patients (17 of 19) experienced relief of symptoms after intervention (89,5 %). Radiological recurrence occurred in 21% of patients; nevertheless, only one patient, affected by ADPKD, experienced clinical relapse with abdominal discomfort. No patient needed reintervention. There was no major morbidity (Clavien-Dindo III-IV) nor 90-day mortality. The technique allowed early removal of abdominal drainage (median 2.5 days). Conclusions: Laparoscopic fenestration of a simple hepatic cyst, with simultaneous ethanol injection, combines the advantages of the laparoscopic approach with those of injecting sclerosing agent. The described technique is associated with symptomatic relief and a favourable outcome in the postoperative period, as well as with good long term results