Il ruolo della fluorescenza nella valutazione della perfusione intestinale in chirurgia robotica

La deiscenza anastomotica costituisce una delle principale complicanze in chirurgia colorettale. Oggetto di studio da anni, molti sono i fattori di rischio ad essa correlati ma non su tutti è possibile intervenire riducendone il rischio d'insorgenza. Una corretta perfusione dei monconi è fondamentale per la costruzione di un'anastomosi sana e funzionale. La NIRF è una tecnica innovativa d'imaging intraoperatorio, utilizzata tra l'altro per valutare la vascolarizzazione tissutale. Nel seguente lavoro si analizza l'utilità clinica del sistema robotico Firefly Imaging Sistem nella valutazione della perfusione intestinale nel corso di chirurgia robotica resettiva del colon sinistro/retto

Pediatric trauma and emergency surgery: an international cross-sectional survey among WSES members

Background: In contrast to adults, the situation for pediatric trauma care from an international point of view and the global management of severely injured children remain rather unclear. The current study investigates structural management of pediatric trauma in centers of different trauma levels as well as experiences with pediatric trauma management around the world. Methods: A web-survey had been distributed to the global mailing list of the World Society of Emergency Surgery from 10/2021-03/2022, investigating characteristics of respondents and affiliated hospitals, case-load of pediatric trauma patients, capacities and infrastructure for critical care in children, trauma team composition, clinical work-up and individual experiences with pediatric trauma management in response to patients´ age. The collaboration group was subdivided regarding sizes of affiliated hospitals to allow comparisons concerning hospital volumes. Comparable results were conducted to statistical analysis. Results: A total of 133 participants from 34 countries, i.e. 5 continents responded to the survey. They were most commonly affiliated with larger hospitals (> 500 beds in 72.9%) and with level I or II trauma centers (82.0%), respectively. 74.4% of hospitals offer unrestricted pediatric medical care, but only 63.2% and 42.9% of the participants had sufficient experiences with trauma care in children ≤ 10 and ≤ 5 years of age (p = 0.0014). This situation is aggravated in participants from smaller hospitals (p < 0.01). With regard to hospital size (≤ 500 versus > 500 in-hospital beds), larger hospitals were more likely affiliated with advanced trauma centers, more elaborated pediatric intensive care infrastructure (p < 0.0001), treated children at all ages more frequently (p = 0.0938) and have higher case-loads of severely injured children < 12 years of age (p = 0.0009). Therefore, the majority of larger hospitals reserve either pediatric surgery departments or board-certified pediatric surgeons (p < 0.0001) and in-hospital trauma management is conducted more multi-disciplinarily. However, the majority of respondents does not feel prepared for treatment of severe pediatric trauma and call for special educational and practical training courses (overall: 80.2% and 64.3%, respectively). Conclusions: Multi-professional management of pediatric trauma and individual experiences with severely injured children depend on volumes, level of trauma centers and infrastructure of the hospital. However, respondents from hospitals at all levels of trauma care complain about an alarming lack of knowledge on pediatric trauma management

It is time to define an organizational model for the prevention and management of infections along the surgical pathway: a worldwide cross-sectional survey

Background The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants' perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. Methods A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. Results Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. Conclusion Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened

It is time to define an organizational model for the prevention and management of infections along the surgical pathway : a worldwide cross-sectional survey

Background The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants' perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. Methods A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. Results Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. Conclusion Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened.Peer reviewe

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

“Elementi di una educazione cosmica”: scienza, futuro e modernità fra «Corriere dei Piccoli», «Il Vittorioso» e «Pioniere» (1950-1960)

Durante gli anni Cinquanta andava codificandosi anche in Italia il genere letterario commercialmente noto come “fantascienza”. Si dava così un’etichetta specifica alle innumerevoli suggestioni riguardo le meraviglie e i pericoli dello sviluppo tecno-scientifico che già dal secolo precedente circolavano nel nostro paese. Nel contesto bipolare della Guerra fredda, che vedeva opporsi due distinte concezioni di modernità - e in cui la sfida tra il modello sovietico e quello statunitense si articolava anche attraverso la competizione scientifica - questo insieme di visioni sul futuro dell’uomo acquisì particolare rilevanza. L’immaginario fantascientifico, diffuso attraverso gli strumenti della cultura di massa, forniva così anche al pubblico italiano spunti e cornici interpretative utili ad orientarsi tra i sentieri di un contraddittorio sviluppo tecnico e consumistico. I simboli evocati da queste narrazioni raramente sono stati presi in considerazione dalla storiografia e, nelle poche ricostruzioni di questo immaginario, è stato spesso sottovalutato il ruolo giocato dalla stampa periodica per l’infanzia e la giovinezza. Al tema è perciò dedicata questa ricerca, che si basa sull’analisi approfondita dei materiali pubblicati durante gli anni Cinquanta da tre periodici italiani mirati ai più giovani. Tali pubblicazioni sono state scelte perché legate a orizzonti ideologici, politici e pedagogici tra loro distanti. Il «Pioniere» era infatti il settimanale dell’Associazione Pionieri d’Italia (API), che riuniva comunisti e socialisti, mentre «Il Vittorioso» era emanazione della GIAC, la Gioventù italiana di Azione cattolica. Il «Corriere dei Piccoli», non legato ad appartenenze associazionistiche, era invece filiazione illustrata del «Corriere della Sera». Si trattava di un’operazione più votata al mercato editoriale, rappresentativa però anche di un gusto medio influente e non privo di richiami a visioni tradizionali. Attraverso il confronto e l’analisi dei contenuti pubblicati, tanto grafici e illustrati quanto scritti, si cerca in questa tesi di indagare i significati attribuiti da questi giornalini al futuro, alla modernità e allo sviluppo scientifico. Si scopre così nella divulgazione scientifica un polo discorsivo considerato fondamentale per il rapporto con i giovani e soprattutto per la loro formazione, anche morale. Formativo, oltre che di intrattenimento, era infatti il compito che si attribuivano questi periodici, in opposizione alla percepita immoralità delle pubblicazioni più commerciali. Alla nascita del fumetto e al suo complesso rapporto con la stampa giovanile, oltre che al fecondo legame con le narrazioni futuribili, è perciò dedicato il capitolo I. Il capitolo II invece ha l’obiettivo di esaminare i caratteri ideologici e editoriali dei tre settimanali scelti, utilizzando testi e immagini esplicativi raccolti durante la ricerca, ma non direttamente riguardanti le rappresentazioni della scienza e della tecnica. I restanti tre capitoli sono centrati ciascuno su di un argomento cardine per l’immaginazione scientifica dell’epoca. Tutti i temi sono trattati evidenziando le differenti concezioni dei tre settimanali, ma senza dimenticare le convergenze, a volte inaspettate, che emergono attraverso una lettura attenta di fumetti, editoriali e articoli. Il capitolo III approfondisce ad esempio le visioni meravigliose legate all’esplorazione spaziale: dalle rappresentazioni del trionfo sovietico dello Sputnik si passa all’esame dei simboli legati ai possibili incontri fantastici con altri esseri viventi e altre società. Il capitolo IV prende invece in considerazione i sogni e gli incubi dell’energia atomica, spazio simbolico in cui più forte era l’investimento propagandistico che opponeva USA e URSS. Nel capitolo V infine si analizzano con attenzione le rappresentazioni della macchina, forse l’archetipo principale della modernità e dei suoi ritrovati.During the 1950s, the literary genre known today as “science fiction” was starting to be recognized in Italy, successfully translated as “fantascienza”. Therefore, a specific label was finally available to describe the numerous visions of scientifical development, both wonderous and nightmarish, that had been circulating in the country since the nineteenth century. This tangle of ideas about the future of mankind acquired particular relevance during the Cold War, a context in which two distinct notions of modernity opposed each other, and in which the challenge between the Soviet and American models was articulated also through technological competition. The imaginary of science fiction, spread using the instruments of mass culture, provided the Italian public with possible meanings and interpretative frames. These could prove useful to navigate the uneven paths of scientific development and of rising consumerism. The symbols evoked by these kinds of narratives have been rarely considered by historiography. Even the few investigations published, tend to underestimate the role played by children and youth magazines in the construction of the popular imagination of science and technology. This research represents a first attempt to fill this gap, proposing a close reading of all the materials published during the 1950s by three Italian illustrated periodicals for the youth. The weeklies were chosen to mirror the variety of the Italian ideological tendencies of the period. They are the «Pioniere», the magazine of the socialist-communist organization Associazione Pionieri d’Italia (API), «Il Vittorioso» (tied to the GIAC, the youth section of catholic association Azione cattolica), and the more centerfield «Corriere dei Piccoli». This last one was not linked with any youth association, but was instead an illustrated spin-off of the «Corriere della Sera»: more aware of the rules of the editorial market, the weekly still demonstrated some ideological leanings. Through the analysis and the comparison of the published contents, both written and illustrated, this thesis seeks to investigate the meanings attributed by these magazines to the future, to the idea of modernization and to the ongoing process of scientific development. Following this route, the fantastical popularization of science is shown to be a fundamental discursive resource to appeal to younger generations and to contribute to their education, especially regarding moral and ethical values. These periodicals, in fact, considered themselves to be means of both entertainment and education, in opposition against the perceived immorality of comics. Chapter I is therefore dedicated to the birth of the comics medium and its ties with the juvenile press. Chapter II focuses instead on the ideological and editorial features of the three chosen magazines: these are examined with the help of images and text that were collected during the research but that do not directly involve the representations of science and technology. The three remaining sections contain the very core of the research and each one of them is devoted to one of the pivotal themes of Cold War scientific imagination. Throughout this part the different ideas and meanings conveyed by the periodicals are highlighted, but without forgetting the similarities made sometimes evident thanks to closed reading of comics, editorials and recurring features. Chapter III, for example, delves into the wondrous visions of space exploration: starting from the depictions of the Spunik triumph, this part of the thesis goes on towards exploring the fantastical possibilities of alien life. Chapter IV takes instead into account the dreams and nightmares of atomic energy, a symbolic arena that proved important for propaganda. Finally, Chapter V then is devoted to the analysis of the representations of machines and robots, archetypical characters of technical modernity

Utopia, determinismo tecnologico, ingegneria sociale: la dianetica tra scienza e fantascienza

In May 1950 L. R. Hubbard published in a science fiction magazine “Dianetics: The Evolution of a Science”, which would later form the basis of Scientology. Emerging from the technocratic mindset typically associated with the periodical, the article considered the human brain as a computer in need of rewiring, giving birth to a peculiar kind of utopian thinking whose aim was not the creation of a ‘new man’, but the return to an original perfection of the mind. Through an examination of this text and its context, I propose to investigate the relationship between engineering culture and literary fictions, trying to understand how the mind-computer analogy shaped the vision of a regenerated society