Learning curve for laparoscopic cholecystectomy has not been defined: A systematic review

Background: Laparoscopic cholecystectomy is one of the most performed surgeries worldwide but its learning curve is still unclear. Methods: A systematic review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, and Google Scholar. Human studies investigating the learning curve of laparoscopic cholecystectomy were included. The Newcastle–Ottawa scale for cohort studies and the GRADE scale were used for the quality assessment of the selected articles. Results: Nine cohort studies published between 1991 and 2020 were included. All studies showed a great heterogeneity among the considered variables. Seven articles (77.7%) assessed intraoperative variables only, without considering patient's characteristics, operator's experience, and grade of gallbladder inflammation. Only five articles (55%) provided a precise cut-off value to see proficiency in the learning curve, ranging from 13 to 200 laparoscopic cholecystectomies. Conclusions: The lack of clear guidelines when evaluating the learning curve in surgery, probably contributed to the divergent data and heterogeneous results among the studies. The development of guidelines for the investigation and reporting of a surgical learning curve would be helpful to obtain more objective and reliable data especially for common operation such as laparoscopic cholecystectomy

Children’s Postdisaster Trajectories of PTS Symptoms: Predicting Chronic Distress

BACKGROUND: There are no studies of the distinct trajectories of children’s psychological distress over the first year after a destructive natural disaster and the determinants of these trajectories. OBJECTIVE: We examined these issues using an existing dataset of children exposed to Hurricane Andrew, one of the most devastating natural disasters in US history. METHODS: At 3-months postdisaster, 568 children (55 % girls; grades 3–5) residing in areas most directly affected by the hurricane completed measures of hurricane exposure and stressors, social support, coping, and general anxiety. Children also reported major life events occurring since the hurricane (at 7-months) and posttraumatic stress (PTS) symptoms at 3-, 7-, and 10-months postdisaster. RESULTS: Latent growth mixture modeling identified three trajectories of PTS reactions: resilient (37 %), recovering (43 %), and chronic distress (20 %). Predictors of the trajectories were examined. Odds ratios indicated that, compared to the resilient trajectory, girls were more likely to be in the recovering and chronically distressed trajectories, as were children reporting higher anxiety and greater use of coping strategies that reflected poor emotion regulation. Compared to the recovering trajectory, children in the chronically distressed trajectory had greater odds of reporting high anxiety, less social support, more intervening life events, and greater use of poor emotion regulation strategies. CONCLUSIONS: Hurricane exposure may be less effective in identifying children who develop chronic postdisaster distress than other child (anxiety, coping) and contextual variables (social support, life events). Effective screening after disasters is critical for identifying youth most in need of limited clinical resources

Polymorphisms in metabolic genes, their combination and interaction with tobacco smoke and alcohol consumption and risk of gastric cancer: a case-control study in an Italian population.

BACKGROUND: The distribution and the potential gene-gene and gene-environment interaction of selected metabolic genetic polymorphisms was investigated in relation to gastric cancer risk in an Italian population. METHODS: One hundred and seven cases and 254 hospital controls, matched by age and gender, were genotyped for CYP1A1, CYP2E1, mEH, GSTM1, GSTT1, NAT2 and SULT1A1 polymorphisms. Haplotype analysis was performed for EPHX1 exons 3 and 4, as well as CYP2E1 RsaI (*5 alleles) and CYP2E1 DraI (*5A or *6 alleles). The effect modification by alcohol and cigarette smoking was tested with the heterogeneity test, while the attributable proportion (AP) was used to measure the biological interaction from the gene-gene interaction analysis. RESULTS: Gastric cancer risk was found to be associated with the inheritance of GSTT1 null genotype (OR = 2.10, 95%CI: 1.27-3.44) and the SULT1A1 His/His genotype (OR = 2.46, 95%CI: 1.03-5.90). No differences were observed for the haplotype distributions among cases and controls. For the first time an increased risk was detected among individuals carrying the *6 variant allele of CYP2E1 if ever-drinkers (OR = 3.70; 95%CI: 1.45-9.37) with respect to never-drinkers (OR = 0.18; 95% CI: 0.22-1.46) (p value of heterogeneity among the two estimates = 0.001). Similarly, the effect of SULT1A1 variant genotype resulted restricted to ever-smokers, with an OR of 2.58 (95%CI: 1.27-5.25) for the carriers of His allele among smokers, and an OR of 0.86 (95%CI: 0.45-1.64) among never-smokers (p value of heterogeneity among the two estimates = 0.03). The gene-gene interaction analyses demonstrated that individuals with combined GSTT1 null and NAT2 slow acetylators had an additional increased risk of gastric cancer, with an OR of 3.00 (95%CI: 1.52-5.93) and an AP of 52%. CONCLUSION: GSTT1, SULT1A1 and NAT2 polymorphisms appear to modulate individual's susceptibility to gastric cancer in this Italian population, particularly when more than one unfavourable genotype is present, or when combined with cigarette smoke. The increased risk for the carriers of CYP2E1*5A or *6 alleles among drinkers need to be confirmed by larger prospective studies

Considerations about the experience in experimental microsurgery in Catania University

In the 1980s and 1990s Microsurgery has had a great diffusion in Italy. Our group, who worked in University of Catania, Sicily, got in touch with Sun Lee, the father of Experimental Microsurgery, and applied actively the microsurgical techniques both in the experimental and clinical field.Several Courses have been organized in Catania to involve young doctors who have been charmed by this new surgical branch.It is our opinion that in the present time Microsurgery could play an important role in the training of the general surgery residents. An experimental microsurgical training, together with simulators, could guarantee a more complete training of the residents, helping them to be familiar with surgical instruments and suture materials, improving their skill in performing microvascular anastomoses (carotid and femoral arteries) and more complex surgical operations (portocaval shunt) and leading them to a valid research activity

ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients

Central venous access devices are routinely used in clinical practice for administration of fluids and medications, for drawing blood samples and for hemodynamic monitoring. The adoption of ultrasound guided venipuncture has significantly reduced procedure-related complications, as documented by the recommendations of most recent guidelines. Ultrasound has also an important role also in other aspects of central venous catheterization, such as in the pre-procedural evaluation of the venous patrimony and in the detection of early and late non-infective complications. Recently, bedside ultrasound has been regarded as a promising tool also for ensuring an accurate and intraprocedural method of tip navigation and tip location. The aim of this paper is to review all the evidence about the accuracy of ultrasound methods for tip navigation and tip location in adult patients, and to suggest a structured standardized protocol for clinical practice

Downregulation of E-cadherin in pluripotent stem cells triggers partial EMT

Epithelial to mesenchymal transition (EMT) is a critical cellular process that has been well characterized during embryonic development and cancer metastasis and it also is implicated in several physiological and pathological events including embryonic stem cell differentiation. During early stages of differentiation, human embryonic stem cells pass through EMT where deeper morphological, molecular and biochemical changes occur. Though initially considered as a decision between two states, EMT process is now regarded as a fluid transition where cells exist on a spectrum of intermediate states. In this work, using a CRISPR interference system in human embryonic stem cells, we describe a molecular characterization of the effects of downregulation of E-cadherin, one of the main initiation events of EMT, as a unique start signal. Our results suggest that the decrease and delocalization of E-cadherin causes an incomplete EMT where cells retain their undifferentiated state while expressing several characteristics of a mesenchymal-like phenotype. Namely, we found that E-cadherin downregulation induces SNAI1 and SNAI2 upregulation, promotes MALAT1 and LINC-ROR downregulation, modulates the expression of tight junction occludin 1 and gap junction connexin 43, increases human embryonic stem cells migratory capacity and delocalize β-catenin. Altogether, we believe our results provide a useful tool to model the molecular events of an unstable intermediate state and further identify multiple layers of molecular changes that occur during partial EMT.Fil: Aban, Cyntia Estefania. Fundacion P/la Lucha C/enferm.neurologicas Infancia. Instituto de Neurociencias. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Ciudad Universitaria. Instituto de Neurociencias.; ArgentinaFil: Lombardi, Antonella. Fundacion P/la Lucha C/enferm.neurologicas Infancia. Instituto de Neurociencias. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Ciudad Universitaria. Instituto de Neurociencias.; ArgentinaFil: Neiman, G.. Fundacion P/la Lucha C/enferm.neurologicas Infancia. Instituto de Neurociencias. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Ciudad Universitaria. Instituto de Neurociencias.; ArgentinaFil: Biani, María Celeste. Fundacion P/la Lucha C/enferm.neurologicas Infancia. Instituto de Neurociencias. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Ciudad Universitaria. Instituto de Neurociencias.; ArgentinaFil: La Greca, A.. Fundacion P/la Lucha C/enferm.neurologicas Infancia. Instituto de Neurociencias. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Ciudad Universitaria. Instituto de Neurociencias.; ArgentinaFil: Waisman, Ariel. Fundacion P/la Lucha C/enferm.neurologicas Infancia. Instituto de Neurociencias. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Ciudad Universitaria. Instituto de Neurociencias.; ArgentinaFil: Moro, Lucía Natalia. Fundacion P/la Lucha C/enferm.neurologicas Infancia. Instituto de Neurociencias. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Ciudad Universitaria. Instituto de Neurociencias.; ArgentinaFil: Sevlever, Gustavo. Fundacion P/la Lucha C/enferm.neurologicas Infancia. Instituto de Neurociencias. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Ciudad Universitaria. Instituto de Neurociencias.; ArgentinaFil: Miriuka, Santiago Gabriel. Fundacion P/la Lucha C/enferm.neurologicas Infancia. Instituto de Neurociencias. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Ciudad Universitaria. Instituto de Neurociencias.; ArgentinaFil: Luzzani, Carlos Daniel. Fundacion P/la Lucha C/enferm.neurologicas Infancia. Instituto de Neurociencias. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Ciudad Universitaria. Instituto de Neurociencias.; Argentin

Effects of non-solvents and electrolytes on the formation and properties of cellulose I filaments

Coagulation is a critical process in the assembly of cellulose nanofibrils into filaments by wet spinning; however, so far, the role of the coagulation solvent has not been systematically elucidated in this context. This work considers organic non-solvents (ethanol, acetone) and aqueous electrolyte solutions (NaCl(aq), HCl(aq), CaCl2(aq)) for the coagulation of negatively charged cellulose nanofibrils via wet spinning. The associated mechanisms of coagulation with such non-solvents resulted in different spinnability, coagulation and drying time. The properties of the achieved filaments varied depending strongly on the coagulant used: filaments obtained from electrolytes (using Ca2+ and H+ as counterions) demonstrated better water/moisture stability and thermomechanical properties. In contrast, the filaments formed from organic non-solvents (with Na+ as counterions) showed high moisture sorption and low hornification when subjected to cycles of high and low humidity (dynamic vapor sorption experiments) and swelled extensively upon immersion in water. Our observations highlight the critical role of counter-ions and non-solvents in filament formation and performance. Some of the fundamental aspects are further revealed by using quartz crystal microgravimetry with model films of nanocelluloses subjected to the respective solvent exchange

Quantum Theory contents insertion in High School curricula

A inovação científica e tecnológica do século XX foi esmagadora. Contudo, a nossa experiência docente permite-nos afirmar que as aprendizagens na escola secundária estão longe de acompanhar a evolução que se verifica na sociedade atual. No entanto, já estão a ser incluídos alguns conteúdos de Física Moderna nos currículos oficiais de vários países, parecendo evidenciar uma preocupação em atualizar a preparação dos jovens para o mundo que os rodeia. Neste artigo relatamos um estudo que fizemos acerca dos currículos de Física de alguns países, sobretudo no que diz respeito à Teoria Quântica, a grande invenção do século XX, tentando identificar os conteúdos selecionados e a maneira como estes se integram nas orientações curriculares gerais.In the XXth century, scientific and technological innovation has been overwhelming. Our teaching profession lead us to believe that studies in High Schools do not follow the evolution of ideas that characterizes our modern society. However, some contents of Modern Physics are already included in the official curricula of several countries, which seem to be worried about the improvement of today’s youth training. In this paper we report a study made about Physics’ curricula in several countries, emphasizing Quantum Theory issues, the biggest invention of the XXth century, trying to identify the selected subjects selected and the way they fit into general curricula orientations

Minimal fluoroscopic approaches and factors associated with radiation dose when high-definition mapping is used for supraventricular tachycardia ablation: insight from the CHARISMA registry

Abstract Funding Acknowledgements Type of funding sources: None. Background Limited data exist on factors associated with radiation exposure during ablation procedures when a high definition mapping technology is used. Purpose To report factors associated with radiation exposure and data on feasibility and safety of a minimal fluoroscopic approach using the Rhythmia mapping system in supraventricular tachycardia (SVT) ablation procedures. Methods Consecutive patients indicated for arrhythmia ablation were enrolled in the CHARISMA study at 12 centers. We included in this analysis consecutive right-side procedures performed through a minimal fluoroscopy approach with the Rhythmia mapping system were analyzed. A 3D geometry of chambers of interest was reconstructed on the basis of the electroanatomic information taken from the mapping system. Fluoroscopy was used only if deemed necessary. The effective dose (ED) was calculated using accepted formula. For our purpose high dose exposure was defined as an ED greater than the median value of ED of the population exposed to radiation. Results This analysis included 325 patients (mean age = 56 ± 17 years, 57% male) undergoing SVT procedures (152 AVNRT, 116 AFL, 41 AP and 16 AT). During the study, 27481 seconds of fluoroscopy was used (84.6 ± 224 seconds per procedure), resulting in a mean equivalent ED of 1.1 ± 3.7 mSv per patient. The mean reconstructed RA volume was 99 ± 54 ml in a mean mapping time of 12.2 ± 7 min. The mean number of radiofrequency ablations (RFC) to terminate each arrhythmia was 9.4 ± 9 (mean RFC delivery time equal to 6.7 ± 6 min). 192 procedures (59.1%) were completed without any use of fluoroscopy; during the remaining 133 procedures (39.9%), 206.6 ± 313.4 seconds of fluoroscopy was used (median ED = 1.2 mSv). In a minority of the cases (n = 25, 7.7%) the fluoroscopy time was higher than 5 minutes (median ED = 6.5 mSv), whereas radiologic exposure time greater than 1 minute occurred in ninety cases (27.7%, median ED = 2.1 mSv). On multivariate logistic analysis adjusted for baseline confounders the RFC application time (OR = 1.0014, 95%CI: 1.0007 to 1.0022; p = 0.0001) was independently associated to an ED greater than 1.2 mSv, whereas female gender had an inverse association (0.54, 0.29 to 0.98; p = 0.0435). Acute success was reached in 97.8% of the cases. During a mean of 290.7 ± 169.6 days follow-up, no major adverse events related to the procedure were reported. Overall, the recurrence rate of the primary arrhythmia during follow-up was 2.5%. Conclusions In our experience, arrhythmias ablation through minimal fluoroscopy approach with the use of a novel ablation technology is safe, feasible, and effective in common right atrial arrhythmias. High-dose exposure occurred in a very limited number of cases, without any reduction of the safety and acute and long-term effectiveness profile