Hiatoplasty with crura buttressing versus hiatoplasty alone during laparoscopic sleeve gastrectomy

Introduction. In obese patients with hiatal hernia (HH), laparoscopic sleeve gastrectomy (LSG) with cruroplasty is an option but use of prosthetic mesh crura reinforcement is debated. The aim was to compare the results of hiatal closure with or without mesh buttressing during LSG. Methods. Gastroesophageal reflux disease (GERD) was assessed by the Health-Related Quality of Life (GERD-HRQL) questionnaire before and after surgery in two consecutive series of patients with esophageal hiatus ≤ 4 cm2. After LSG, patients in group A (12) underwent simple cruroplasty, whereas in group B patients (17), absorbable mesh crura buttressing was added. Results. At mean follow-up of 33.2 and 18.1 months for groups A and B, respectively (p = 0 006), the mean preoperative GERD-HRQL scores of 16.5 and 17.7 (p = 0 837) postoperatively became 9.5 and 2.4 (p = 0 071). In group A, there was no difference between pre- and postoperative scores (p = 0 279), whereas in group B, a highly significant difference was observed (p = 0 002). The difference (Δ) comparing pre- and postoperative mean scores between the two groups was significantly in favor of mesh placement (p = 0 0058). Conclusions. In obese patients with HH and mild-moderate GERD, reflux symptoms are significantly improved at medium term follow-up after cruroplasty with versus without crura buttressing during LSG.Introduction. In obese patients with hiatal hernia (HH), laparoscopic sleeve gastrectomy (LSG) with cruroplasty is an option but use of prosthetic mesh crura reinforcement is debated. The aim was to compare the results of hiatal closure with or without mesh buttressing during LSG. Methods. Gastroesophageal reflux disease (GERD) was assessed by the Health-Related Quality of Life (GERD-HRQL) questionnaire before and after surgery in two consecutive series of patients with esophageal hiatus ≤ 4 cm2. After LSG, patients in group A (12) underwent simple cruroplasty, whereas in group B patients (17), absorbable mesh crura buttressing was added. Results. At mean follow-up of 33.2 and 18.1 months for groups A and B, respectively (p = 0 006), the mean preoperative GERD-HRQL scores of 16.5 and 17.7 (p = 0 837) postoperatively became 9.5 and 2.4 (p = 0 071). In group A, there was no difference between pre- and postoperative scores (p = 0 279), whereas in group B, a highly significant difference was observed (p = 0 002). The difference (Δ) comparing pre- and postoperative mean scores between the two groups was significantly in favor of mesh placement (p = 0 0058). Conclusions. In obese patients with HH and mild-moderate GERD, reflux symptoms are significantly improved at medium term follow-up after cruroplasty with versus without crura buttressing during LSG

El Sector Metalúrgico: Relaciones Sindicales, Motivación y Significados del Trabajo

En este estudio se describen las relaciones de trabajo en el sector metalúrgico brasileño, así como los significados y la motivación hacia el trabajo. Se desarrolló una investigación documental, aplicando la técnica de análisis de contenido categórica a boletines sindicales, acuerdos y convenciones colectivas (2009 a 2012) y a sitios electrónicos que abordan el contexto de trabajo de los metalúrgicos. Los resultados mostraron que la movilización de los trabajadores se ha realizado en torno a un amplio abanico de reivindicaciones, traspasando los ítems económicos. Se presentan hipótesis acerca de los significados y la motivación de los trabajadores y se expresan las tendencias de las relaciones de trabajo en este sector.Este estudio describió las relaciones de trabajo en el sector metalúrgico, enfocando a los trabajadores como actores y buscando reflexionar sobre los significados y la motivación para el trabajo. Se desarrolló una investigación documental, aplicando la técnica de análisis de contenido categórica en boletines sindicales, acuerdos y convenciones colectivas (2009 a 2012) y sitios electrónicos que abordan el contexto de trabajo de los metalúrgicos. Los resultados muestran que la movilización de los trabajadores se ha realizado en torno a un amplio abanico de reivindicaciones, ultrapasando los ítems económicos. Al final, se presentan hipótesis acerca de los significados y de la motivación, expresando las tendencias de las relaciones de trabajo

Serum Albumin Is Inversely Associated With Portal Vein Thrombosis in Cirrhosis

We analyzed whether serum albumin is independently associated with portal vein thrombosis (PVT) in liver cirrhosis (LC) and if a biologic plausibility exists. This study was divided into three parts. In part 1 (retrospective analysis), 753 consecutive patients with LC with ultrasound-detected PVT were retrospectively analyzed. In part 2, 112 patients with LC and 56 matched controls were entered in the cross-sectional study. In part 3, 5 patients with cirrhosis were entered in the in vivo study and 4 healthy subjects (HSs) were entered in the in vitro study to explore if albumin may affect platelet activation by modulating oxidative stress. In the 753 patients with LC, the prevalence of PVT was 16.7%; logistic analysis showed that only age (odds ratio [OR], 1.024; P = 0.012) and serum albumin (OR, -0.422; P = 0.0001) significantly predicted patients with PVT. Analyzing the 112 patients with LC and controls, soluble clusters of differentiation (CD)40-ligand (P = 0.0238), soluble Nox2-derived peptide (sNox2-dp; P < 0.0001), and urinary excretion of isoprostanes (P = 0.0078) were higher in patients with LC. In LC, albumin was correlated with sCD4OL (Spearman's rank correlation coefficient [r(s)], -0.33; P < 0.001), sNox2-dp (r(s), -0.57; P < 0.0001), and urinary excretion of isoprostanes (r(s), -0.48; P < 0.0001) levels. The in vivo study showed a progressive decrease in platelet aggregation, sNox2-dp, and urinary 8-iso prostaglandin F2 alpha-III formation 2 hours and 3 days after albumin infusion. Finally, platelet aggregation, sNox2-dp, and isoprostane formation significantly decreased in platelets from HSs incubated with scalar concentrations of albumin. Conclusion: Low serum albumin in LC is associated with PVT, suggesting that albumin could be a modulator of the hemostatic system through interference with mechanisms regulating platelet activation

COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context

Background and objectives: It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. Methods: Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). Results: The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). Discussion: Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Polygenic and multifactorial scores for pancreatic ductal adenocarcinoma risk prediction

Most cases of pancreatic ductal adenocarcinoma (PDAC) are asymptomatic in early stages, and the disease is typically diagnosed in advanced phases, resulting in very high mortality. Tools to identify individuals at high risk of developing PDAC would be useful to improve chances of early detection

El Sector Metalúrgico: Relaciones Sindicales, Motivación y Significados del Trabajo

The study describes labor relations in the Brazilian metals sector, as well as work motivation and work meaning in this context. A review of multiple documents was conducted, developing a set of categories from content analysis of union bulletins, agreements, and collective agreements (2009 to 2012) and of websites that address the metal workers’ context. Results showed that workers’ mobilizations have revolved around a broad range of claims that go beyond merely economic ones. The article sets forth hypotheses regarding the meanings of work and the work motivation, and describes the trends in labor relations in the sector.Neste estudo, descrevem-se as relações de trabalho no setor metalúrgico brasileiro, bem como os significados e a motiva- ção sobre o trabalho. Desenvolveu-se uma pesquisa documental, que aplica a técnica de análise de conteúdo categórica a boletins sindicais, acordos e convenções coletivas (2009 a 2012) e a sites que abordam o contexto de trabalho dos metalúrgicos. Os resultados mostraram que a mobilização dos trabalhadores tem sido realizada em torno de um amplo leque de reinvindicações, mais além dos itens econômicos. Apresentam-se hipóteses sobre os significados e a motivação dos trabalhadores e expressam-se as tendências das relações de trabalho nesse setor.En este estudio se describen las relaciones de trabajo en el sector metalúrgico brasileño, así como los significados y la motivación hacia el trabajo. Se desarrolló una investigación documental, aplicando la técnica de análisis de contenido categórica a boletines sindicales, acuerdos y convenciones colectivas (2009 a 2012) y a sitios electrónicos que abordan el contexto de trabajo de los metalúrgicos. Los resultados mostraron que la movilización de los trabajadores se ha realizado en torno a un amplio abanico de reivindicaciones, traspasando los ítems económicos. Se presentan hipótesis acerca de los significados y la motivación de los trabajadores y se expresan las tendencias de las relaciones de trabajo en este sector

El Sector Metalúrgico: Relaciones Sindicales, Motivación y Significados del Trabajo/ The Metals Sector: Labor Union Relations, Motivation, and Meanings of Work/ O Setor Metalúrgico: Relações Sindicais, Motivação e Significados do Trabalho

En este estudio se describen las relaciones de trabajo en el sector metalúrgico brasileño, así como los significados y la motivación hacia el trabajo. Se desarrolló una investigación documental, aplicando la técnica de análisis de contenido categórica a boletines sindicales, acuerdos y convenciones colectivas (2009 a 2012) y a sitios electrónicos que abordan el contexto de trabajo de los metalúrgicos. Los resultados mostraron que la movilización de los trabajadores se ha realizado en torno a un amplio abanico de reivindicaciones, traspasando los ítems económicos. Se presentan hipótesis acerca de los significados y la motivación de los trabajadores y se expresan las tendencias de las relaciones de trabajo en este sector