I Simulatori in realtà virtuale: un ausilio nella formazione chirurgica

Negli ultimi anni la necessità di formazione in campo laparoscopico ha spinto verso la creazione di simulatori chirurgici di diversa fattura e diversa complessità. Al momento molti di questi sono disponibili in commercio. Ognuna di questi ha il proprio design, struttura e programma di formazione. L'evoluzione è rappresentata dall’utilizzo della Realtà Virtuale, che mima l'azione reale e lavora sulle diverse competenze acquisite durante i corsi di formazione e l’esperienza chirurgica al campo operatorio. Il ruolo della formazione "sicura ed efficiente" è necessario nel corso di una specializzazione in chirurgia e durante la formazione continua. La simulazione in realtà virtuale è in grado di offrire un numero infinito di scenari chirurgici. I simulatori chirurgici in realtà virtuale di ultima generazione sono forniti di percorsi di formazione graduali che guidano lo specializzando nell’acquisizione di manualità “fine” nei singoli tasks fino alla procedura completa “full task” di un intervento chirurgico, ad esempio una colecistectomia. In questo studio abbiamo voluto testare la validità di un’acquisizione graduale di tecnica manuale “step by step” rispetto all’esercizio diretto solo su una procedura completa mediante l’ausilio di un simulatore in Virtual Reality, il LapMentor®(Simbionix,Israele). Specializzandi in Chirurgia Generale privi di esperienza precedente in laparoscopia hanno ottenuto risultati migliori sulla procedura completa della colecistectomia laparoscopica procedendo durante il corso step by step rispetto a coloro che hanno eseguito la procedura completa “full task” direttamente. Il nostro studio conferma che una buona esperienza e la conoscenza delle capacità tecniche di base nel campo della formazione laparoscopica migliorano le prestazioni nella procedura completa.In the last years the need for training in laparoscopy has led to the creation of surgical simulators of varying complexity and different bill. Currently, many of these are commercially available. Each of these has its own design, structure and training program. The trend is the use of virtual reality, which mimics the real action and work on various skills acquired during the training and experience in the surgical operating field. The role of training on safe and efficient "is necessary in the course of specialization in surgery and during the training. The simulation in virtual reality is able to offer an infinite number of surgical scenarios. The surgical simulators in virtual reality are equipped with the latest training courses that guide the gradual specializing in the acquisition of manual skills "end" in the individual tasks to complete procedure "full task" for surgery, such as a cholecystectomy. In this study we wanted to test the validity of the gradual acquisition of technical manual "step by step" only on a direct comparison with the whole procedure with the help of a mortgage in Virtual Reality, the LapMentor ® (Simbionix, Israel) .Specializing in general surgery with no previous experience in laparoscopy have performed better on the whole procedure of laparoscopic cholecystectomy during the course of proceeding step by step than those who performed the procedure complete "full task" directly. Our study confirms that a good experience and knowledge of basic technical skills in training laparoscopic improve performance in the whole procedure

Preliminary archeological site survey by UAV-borne lidar. A case study

Preliminary analysis of an archaeological site requires the acquisition of information by several diverse diagnostic techniques. Remote sensing plays an important role especially in spatially ex-tended and not easily accessible sites for the purposes of preventive and rescue archaeology, landscape archaeology, and intervention planning. In this paper, we present a case study of a de-tailed topographic survey based on a light detection and ranging (LiDAR) sensor carried by an unmanned aerial vehicle (UAV; also known as drone). The high-resolution digital terrain model, obtained from the cloud of points automatically labeled as ground, was searched exhaustively by an expert operator looking for entrances to prehistoric hypogea. The study documents the useful-ness of such a technique to reveal anthropogenic structures hidden by vegetation and perform fast topographic documentation of the ground surface

Modelling the effect of SMP production and external carbon addition on S-driven autotrophic denitrification

The aim of this study was to develop a mathematical model to assess the effect of soluble microbial products production and external carbon source addition on the performance of a sulfur-driven autotrophic denitrification (SdAD) process. During SdAD, the growth of autotrophic biomass (AUT) was accompanied by the proliferation of heterotrophic biomass mainly consisting of heterotrophic denitrifiers (HD) and sulfate-reducing bacteria (SRB), which are able to grow on both the SMP derived from the microbial activities and on an external carbon source. The process was supposed to occur in a sequencing batch reactor to investigate the effects of the COD injection on both heterotrophic species and to enhance the production and consumption of SMP. The mathematical model was built on mass balance considerations and consists of a system of nonlinear impulsive differential equations, which have been solved numerically. Different simulation scenarios have been investigated by varying the main operational parameters: cycle duration, day of COD injection and quantity of COD injected. For cycle durations of more than 15 days and a COD injection after the half-cycle duration, SdAD represents the prevailing process and the SRB represent the main heterotrophic family. For shorter cycle duration and COD injections earlier than the middle of the cycle, the same performance can be achieved increasing the quantity of COD added, which results in an increased activity of HD. In all the performed simulation even in the case of COD addition, AUT remain the prevailing microbial family in the reactor

Impact of the COVID-19 pandemic on neuromuscular rehabilitation setting. Part 2: patients and families' views on the received health care during the pandemic

This study explored views of users with muscular dystrophies and their caregivers on staff-user relationships and the treatments provided by a Rehabilitation Centre during the pandemic. Patients and relatives were asked to anonymously complete an open-ended questionnaire exploring their views on these aspects. Fifty-four patients and 40 caregivers gave their informed consent and participated in the survey. Fifty-three patients were adults, 28% suffering from Duchenne/Becker muscular dystrophy. Patients reported 269 comments on health care services provided during the pandemic, 132 (49%) concerning positive aspects and 137 (51%) negative aspects. The prompt restart of the rehabilitation therapies and the staff closeness over the pandemic were the practical aspects most frequently appreciated (46.9%), while closer family contacts and the perception of being able to rely on the Centre's constant support were the most cited psychological aspects (53.1%). Architectural barriers, difficulties in accessing public health services, economic difficulties, and lack of support from welfare and other agencies were the practical critical points most frequently reported (89%). In addition, social isolation, and loneliness due to fear of contagion were the most negative psychological aspects (10.1%). As regard the caregivers' views, participants reported 151 comments. Of these, 86 (56.9%) were positive and 65 (43.1%) were negative. Among the positive aspects, the psychological ones - such as closer family contacts, not feeling abandoned and counting on the constant Centre's professional support prevailed (53.5%). As for the negative aspects, most caregivers (92.6%) believe that the pandemic exacerbated their financial and bureaucratic difficulties, particularly in poorer families

Laparoscopic approach for gonadectomy in pediatric patients with intersex disorders

Abstract The birth of a child with a disorder of sex development (DSD) prompts a long-term management strategy that involves a myriad of professionals working with the family. There has been progress in diagnosis, surgical techniques and in understanding psychosocial issues related to this condition. However, since these kinds of disorders are rare and have many anatomical variations, individual care is necessary, especially regarding surgical management. Gonadectomy is indicated in a number of intersex disorders with a Y chromosome to reduce the associated risk of cancer. Recently, laparoscopy has gained wide acceptance in pediatric urology. Laparoscopy is also reported to be a useful tool for diagnosing and treating DSD because of its minimal invasiveness and favorable cosmetic outcome. However, reports of evaluation and management using laparoscopy for large numbers of DSD patients are limited and debate is still open about indications and timing of gonadectomy. In this study, we reviewed the literature of the last 10 years about the role of laparoscopic gonadectomy in patients with DSD. In the analyzed papers, all the procedures were accomplished successfully using laparoscopy. No conversions to open surgery neither intra-operative complications were reported in all series. Post-operative complications were reported only in one series and included 1 umbilical port infection [2% (1/50)] and 1 pelvic abscess [2% (1/50)], both treated with antibiotic therapy (grade I Clavien-Dindo). Of the analyzed series, 7/10 reported postoperative diagnosis of gonadal tumors. The histopathologic examinations revealed 15 cases of gonadoblastoma, 7 cases of dysgerminoma and 2 cases of seminoma. Analyzing the single series, the incidence of these tumors varied between 10% and 33%. The results of our review confirmed the safety and efficacy of laparoscopic gonadectomy in DSD patients. In our mind, laparoscopic gonadectomy should be accepted as the treatment of choice in children and adolescents with these rare conditions. It thereby eliminates the risk of malignancies of gonadal origin with the advantages of a minimally invasive procedure, with lower morbidity, quicker postoperative recovery and excellent cosmetic results

Dieta del pez de San Francisco Synodus saurus (Linnaeus, 1758) (Pisces, Synodontidae) en el Mediterráneo central

The diet composition of the Atlantic lizardfish Synodus saurus, caught on sandy bottoms of the north-western coast of Sicily (southern Tyrrhenian Sea) is described. The stomachs of 224 specimens (from 73 to 280 mm TL) were collected between June 2005 and May 2006. The analysis of stomach contents showed that this species is almost exclusively piscivorous. Unlike other benthic predators of the study area, it mainly feeds on pelagic school-forming fish, such as Clupeidae, Engraulidae and Myctophidae and juveniles of Sparidae and Centracanthidae, and benthic prey play a secondary role. The diet of S. saurus is related to the seasonal availability of resources, depending on the occurrence of juveniles of several species and on the migration of pelagic fishes in the study area. There were no significant changes in prey items between predator length groups, but a positive, significant linear relationship between prey size and predator size was recorded.El presente trabajo ha estudiado la composición de la dieta del pez de San Francisco Synodus saurus, pescado sobre fondos arenosos en la costa nor-occidental de Sicilia (Tirreno meridional). El análisis del contenido estomacal de 224 individuos (entre 73 y 280 mm LT), pescados entre junio 2005 y mayo 2006, evidenció que S. saurus es una especie casi exclusivamente ictiófaga. A diferencia de otros depredadores bentónicos, S. saurus se alimenta fundamentalmente de peces que forman bancos pelágicos como Clupeidae, Engraulidae y Myctophidae y de los juveniles de las familias Sparidae y Centracanthidae, mientras las presas bentónicas resultaron secundarias. S. saurus exhibió una estrategia alimentaria relacionada con la disponibilidad estacional de recursos, dependiendo de la ocurrencia de juveniles de varias especies y de la migración de peces pelágicos en el área de estudio. No hubo cambio significativo de presas entre grupos de tallas pero se evidenció una relacción positiva, lineal y estadísticamente significativa entre el tamaño de la presa y del depredador

Rapid Evolution of an Aortic Endocarditis

Cardiac surgery is necessary in almost 50% of patients with endocarditis. Early surgery, i.e., the surgery performed during the first hospitalization, is required in the following cases: heart failure secondary to valve regurgitation; S. aureus, fungal organism, or other highly resistant organism infection; heart block, annular or aortic abscess, or destructive penetrating lesions; evidence of persistent infection as manifested by persistent bacteremia or fevers lasting >5 days after onset of appropriate antimicrobial therapy. A 62-year-old man developed a fever (38 °C) 3 days after a transaortic electrophysiological study; blood cultures were positive for S. aureus, and were sensitive to vancomycin and ceftaroline. Antibiotic therapy was started, controlling the fever and the patient's infective and inflammatory profiles well; however, 3 days later, acute aortic regurgitation developed. At transesophageal echocardiography (TEE), a rare condition was revealed-vegetation was attached to the aortic wall, impeding correct aortic valve closure. Cardiac operation was carried out and the time for surgery was discussed; based on the patient's clinically stable condition, and on the infection, which was controlled well by antibiotics therapy, surgery was not performed in emergency circumstance (within 24-48 h)-rather, it was programmed during the hospitalization. A TEE surveillance was initiated, and after 7 days, TEE revealed a new picture, with images of an aortic abscess with small perforation in the right atrium, requiring emergency surgery, carried out 20 h later. In our case, the rapid evolution of the vegetation attached to the aortic wall suggested the following: (1) that the time for the surgery cannot be guided only by clinical procedure but must also be guided by imaging pictures; (2) that strictly TEE surveillance is mandatory in patients with aortic endocarditis not initially referred for emergency surgery

Impact of Age and Heart Rate on Strain-Derived Myocardial Work in a Population of Healthy Subjects

The influence of age and gender on strain-imaging-derived myocardial work (MW) was recently investigated in healthy subjects. No information is available on the impact of heart rate (HR) on MW

Sarcopenia: Technological Advances in Measurement and Rehabilitation

Sarcopenia is an important recently defined disease affecting people aged ≥65 years all over the world. Improving the assessment of loss of muscle mass is becoming mandatory. In this regard, various new technologies have been advanced. Although the gold standard is represented by magnetic resonance imaging (MRI) or magnetic resonance spectroscopy (MRS), computed tomography (CT) or dual-energy X-ray absorptiometry (DXA), followed by biological impedance analysis (BIA) compared with DXA, there are numerous correlations between sarcopenia and health domain of everyday life that must be investigated and addressed, trying to obtain the best possible outcome in the older population. In this review, we focused on all types of new technologies assessing loss of muscle mass, frailty, independence, walking, capacity to get dressed, and loss of balance or sleepiness in older people and that could improve the diagnosis of sarcopenia or the rehabilitation of sarcopenic patients to prevent possible accidents. Different technologies have been proposed to investigate the factors promoting the loss of muscle mass and weakness. Despite the standard EWGSOP 2019 guidelines defining a specific methodology for the diagnosis of sarcopenia, not all domains and devices were included, and new frontiers of prevention have been explored