Initial Experience With Single-Isocenter Radiosurgery to Target Multiple Brain Metastases Using an Automated Treatment Planning Software: Clinical Outcomes and Optimal Target Volume Margins Strategy

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Evolution of Bariatric Surgery in Italy in the Last 11 Years: Data from the SICOB Yearly National Survey

Background: Bariatric surgery (BS) is a relatively novel surgical field and is in continuous expansion and evolution. Purpose: Aim of this study was to report changes in Italian surgical practice in the last decade. Methods: The Società Italiana di Chirurgia dell'Obesità (SICOB) conducted annual surveys to cense activity of SICOB centers between 2011 and 2021. Primary outcome was to detect differences in frequency of performance of adjustable gastric banding (AGB), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB), bilio-pancreatic diversion (BPD), and gastric plication (GP). Secondary outcome was to detect differences in performance of main non-malabsorptive procedures (AGB + SG) and overall bypass procedures (RYGB + OAGB). Geographical differences were also investigated. Results: Median response rate was 92%. AGB declined from 36% of procedures in 2011 to 5% in 2021 (p < 0.0001). SG increased from 30% in 2011 to 55% in 2021 (p < 0.0001). RYGB declined from 25 to 12% of procedures (p < 0.0001). OAGB rose from 0% of procedures in 2011 to 15% in 2021 (p < 0.0001). BPD underwent decrease from 6.2 to 0.2% in 2011 and 2021, respectively (p < 0.0001). Main non-malabsorptive procedures significantly decreased while overall bypass procedures remained stable. There were significant differences among regions in performance of SG, RYGB, and OAGB. Conclusions: BS in Italy evolved significantly during the past 10 years. AGB underwent a decline, as did BPD and GP which are disappearing and RYGB which is giving way to OAGB. The latter is rising and is the second most-performed procedure after SG which has been confirmed as the preferred procedure by Italian bariatric surgeons

Clinical Study Integrated Approaches for the Management of Staple Line Leaks following Sleeve Gastrectomy

Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years&apos; experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%). All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&amp;E because of the complication. The mean interval between surgery and readmission for leak was 13,4 days (range 6-34 days, SD ± 11.85). We recorded one death (16.67%) due to sepsis. The remaining five cases were successfully treated with a mean healing time of the gastric leak of 55,5 days (range 26-83 days; SD ± 25.44). Conclusion. Choosing the proper treatment depends on clinical stability and on the presence or not of collected abscess. Our treatment protocol showed being associated with low complication rate and minor discomfort to the patients, reducing the need for more invasive procedures

FMRI resting slow fluctuations correlate with the activity of fast cortico-cortical physiological connections

Recording of slow spontaneous fluctuations at rest using functional magnetic resonance imaging (fMRI) allows distinct long-range cortical networks to be identified. The neuronal basis of connectivity as assessed by resting-state fMRI still needs to be fully clarified, considering that these signals are an indirect measure of neuronal activity, reflecting slow local variations in de-oxyhaemoglobin concentration. Here, we combined fMRI with multifocal transcranial magnetic stimulation (TMS), a technique that allows the investigation of the causal neurophysiological interactions occurring in specific cortico-cortical connections. We investigated whether the physiological properties of parieto-frontal circuits mapped with short-latency multifocal TMS at rest may have some relationship with the resting-state fMRI measures of specific resting-state functional networks (RSNs). Results showed that the activity of fast cortico-cortical physiological interactions occurring in the millisecond range correlated selectively with the coupling of fMRI slow oscillations within the same cortical areas that form part of the dorsal attention network, i.e., the attention system believed to be involved in reorientation of attention. We conclude that resting-state fMRI ongoing slow fluctuations likely reflect the interaction of underlying physiological cortico-cortical connections

Toward an international consensus-Integrating lipoprotein apheresis and new lipid-lowering drugs

Background: Despite advances in pharmacotherapy of lipid disorders, many dyslipidemic patients do not attain sufficient lipid lowering to mitigate risk of atherosclerotic cardiovascular disease. Several classes of novel lipid-lowering agents are being evaluated to reduce atherosclerotic cardiovascular disease risk. Lipoprotein apheresis (LA) is effective in acutely lowering the plasma concentrations of atherogenic lipoproteins including low-density lipoprotein cholesterol and lipoprotein(a), and novel lipid-lowering drugs may dampen the lipid rebound effect of LA, with the possibility that LA frequency may be decreased, in some cases even be discontinued. Sources of material: This document builds on current American Society for Apheresis guidelines and, for the first time, makes recommendations from summarized data of the emerging lipid-lowering drug classes (inhibitors of proprotein convertase subtilisin/kexin type 9 or microsomal triglyceride transfer protein, high-density lipoprotein mimetic), including the available evidence on combination therapy with LA with respect to the management of patients with dyslipidemia. Abstract of findings: Recommendations for different indications are given based on the latest evidence. However, except for lomitapide in homozygous familial hypercholesterolemia and alirocumab/evolocumab in heterozygous familial hypercholesterolemia subjects, limited data are available on the effectiveness and safety of combination therapy. More studies on combining LA with novel lipid-lowering drugs are needed. Conclusion: Novel lipid-lowering agents have potential to improve the performance of LA, but more evidence is needed. The Multidisciplinary International Group for Hemapheresis TherapY and Metabolic DIsturbances Contrast scientific society aims to establish an international registry of clinical experience on LA combination therapy to expand the evidence on this treatment in individuals at high cardiovascular disease risk

VESPA_V2; AAVSO UID 000-BLJ-897; VSX = 399180 [a new variable star in Delphinus]

VESPA_V2; AAVSO UID 000-BLJ-897; VSX = 399180 [a new variable star in Delphinus

Vespa_V1; AAVSO UID 000-BLJ-883; VSX 399173 [a new variable star in Pegasus]

Vespa_V1; AAVSO UID 000-BLJ-883; VSX 399173 [a new variable star in Pegasus

La tecnica di analisi proattiva FMEA/FMECA per la gestione del rischio clinico in diagnostica di laboratorio

[FMEA/FMECA proactive analysis technique for clinical risk management in laboratory diagnostics]At the IRCCS Rizzoli Orthopaedic Institute of Bologna the FMEA/FMECA technique has been used for several years in the laboratory diagnostics setting for the analysis of processes, the proactive identification of possible mistakes and the implementation of improvement actions. In five laboratories of the Institute, current critical processes have been mapped to identify priority risks. Therefore, the intervention priorities have been defined, the improvement plans implemented and the efficacy in reducing the risks evaluated. The results were assessed by calculating the index of improvement (IM), as the ratio between the value of the Risk Priority Number (RPN) obtained by an evaluation before (ex-ante) and after (ex-post) the improvement actions. In all analyzed diagnostic processes initial values RPN were reduced and all IM showed values > 1. In addition, as result of risk analysis, 75 improvement actions were implemented, divided into: training/information (18,7%), organizational changes (53,3%), acquisition/maintenance of equipment and technologies (10,7%), revision and elaboration of procedures/protocols (16%), structural adjustments (1,3%).The technique FMEA/FMECA has proven to be useful to identify critical and high-risk processes proactively and to implement improvement actions according to priorities

Informatizzazione della checklist per la sicurezza in sala operatoria e i risultati raggiunti presso l'Istituto Ortopedico Rizzoli di Bologna

[Computerization of the checklist in the operating room safety and the results achieved at the Rizzoli Orthopaedic Institute in Bologna] Since 2010, the Rizzoli Orthopaedic Institute in Bologna has joined the project of the Emilia-Romagna «Project SOS.net: Network operating theaters safe», adopting the surgical safety checklist regional in hard copy from three surgical units.Over the years, the adoption of the checklist has been extended to all surgical units, thanks to the computerization of the same: at the Institute had in fact been initiated a process of computerization of operating rooms, which also included the introduction/editing tools for the management of clinical risk in the operating room. This change has allowed not only to integrate computationally the moment of verification, by means of the surgical safety checklist regional, with the detection of deviations from the expected standard but also to be able to have specific reporting in real time.These implementations have been accompanied by appropriate training and organizational interventions, bringing the level of adherence to the instrument until it reaches almost 100%.