Studio trasversale sulle variabili di stress lavoro-correlato nei medici in formazione specialistica del maggiore Policlinico Universitario della Sicilia

Introduzione: Il rischio stress lavoro-correlato è uno degli obiettivi della valutazione e prevenzione dei rischi occupazionali negli operatori sanitari (O.S.). I medici in formazione specialistica (MIFS) rappresentano una tipologia di OS sovrapponibile ai dirigenti medici in termini di esposizione lavorativa e quindi di insorgenza di sindromi da stress lavoro-correlato. Obiettivi: Obiettivo dello studio è valutare un set di fattori di rischio stress lavoro-correlato nei MIFS del principale Policlinico Universitario della Sicilia, sottoposti a sorveglianza sanitaria. Materiali e Metodi: Studio trasversale condotto mediante questionario anonimo ed autosomministrato. Risultati: Il 45% dei MIFS di area clinica ed il 37% di area chirurgica usufruiscono del giorno di riposo compensativo a fronte del 92% dell’area dei servizi (p<0,001). Il sistema di rendicontazione delle presenze/monte orario è presente nell’80% delle scuole dell’area dei servizi, nel 60% di quelle di area medica e nel 50% di quelle di area chirurgica (p<0,001). I MIFS delle scuole dell’area chirurgica dichiarano di usufruire delle pause lavorative (41%) con frequenza minore rispetto ai MIFS dell’area medica (60%) e dell’area dei servizi (74%) (p<0,001). I MIFS sia di area medica (47%) che di area chirurgica (47%) risultano essere più esposti a stress lavoro-correlato (p<0,001) rispetto ai MIFS dell’area dei servizi (29%). Conclusioni: Il lavoro documenta un maggiore rischio di stress lavoro-correlato nei MIFS di area chirurgica rispetto alle altre aree professionali indagate. Appare necessario strutturare degli specifici programmi formativi finalizzati alla gestione dell’esposizione al rischio di stress lavoro-correlato per i MIFS, incentrandoli sia sulla persona che sull’ambiente di lavoro.Background: Among health care workers (HCWs), assessment and prevention of work-related stress in the workplace is one of the main goal. Post-graduate medical residents (MRs) are a group of HCWs comparable to medical doctors in terms of occupational exposure and of work-related stress syndromes occurrence. Objectives: To assess the risk of the exposition to work-related stress among MRs attending the major University Hospital of Sicily. Methods: Cross-sectional survey through an anonymous and self-administered questionnaire. Results: 45% of clinical MRs and 37% of surgical MRs have access to compensatory rest days against 92% of MRs of the services area (p <0.001). A work attendance detection system for MRs is available in 80% of the postgraduate medical schools of the services area, in 60% of the clinical postgraduate schools and in 50% of the surgical postgraduate schools (p <0.001). MRs of postgraduate surgical schools declare to have access to work breaks (41%) with less frequency compared to clinical (60%) and services MRs (74%) (p <0.001). Both clinical (47%) and surgical MRs (47%) result to be more exposed to work-related stress than MRs of the services area (27%) (p <0.001). Conclusions: The survey documents an exposure excess of work-related stress for all the considered variables in MRs of surgical area. It is strongly suggested to provide for specific training programs aimed to manage the MRs risk exposure to work-related stress, focusing both on the workers and the work environment

Erratum to nodal management and upstaging of disease. Initial results from the Italian VATS Lobectomy Registry

[This corrects the article DOI: 10.21037/jtd.2017.06.12.]

Cannabidiol Reduces Aβ-Induced Neuroinflammation and Promotes Hippocampal Neurogenesis through PPARγ Involvement

Peroxisome proliferator-activated receptor-γ (PPARγ) has been reported to be involved in the etiology of pathological features of Alzheimer's disease (AD). Cannabidiol (CBD), a Cannabis derivative devoid of psychomimetic effects, has attracted much attention because of its promising neuroprotective properties in rat AD models, even though the mechanism responsible for such actions remains unknown. This study was aimed at exploring whether CBD effects could be subordinate to its activity at PPARγ, which has been recently indicated as its putative binding site. CBD actions on β-amyloid-induced neurotoxicity in rat AD models, either in presence or absence of PPAR antagonists were investigated. Results showed that the blockade of PPARγ was able to significantly blunt CBD effects on reactive gliosis and subsequently on neuronal damage. Moreover, due to its interaction at PPARγ, CBD was observed to stimulate hippocampal neurogenesis. All these findings report the inescapable role of this receptor in mediating CBD actions, here reported

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P &lt; .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Bladder cancer: Innovative approaches beyond the diagnosis

Bladder carcinoma (BC) is the most common urinary malignant tumor. In the light of the unsuccessful current therapies and their side effects, new pharmacological strategies are needed. In addition to the well known therapeutic possibilities described in the first section, we focused our attention on very recent and innovative tools to approach this target (new drug candidates from epigenetic modulators to endothelin receptor inhibitors, improved technological formulations, active principles from plants, and dietary components). Then, in the last paragraph, we analyzed the etiology of recurrent BC, with particular attention to cellular microenvironment. In fact, the incidence of recurrence is up to 90%, and 25% of tumours show progression towards invasiveness

High Variability of Fabry Disease Manifestations in an Extended Italian Family

Fabry disease (FD) is an inherited metabolic disorder caused by partial or full inactivation of the lysosomal hydrolase \u3b1-galactosidase A (\u3b1-GAL). The impairment of \u3b1-GAL results in the accumulation of undegraded glycosphingolipids in lysosomes and subsequent cell and microvascular dysfunctions. This study reports the clinical, biochemical, and molecular characterization of 15 members of the same family. Eight members showed the exonic mutation M51I in the GLA gene, a disease-causing mutation associated with the atypical phenotype. The clinical history of this family highlights a wide phenotypic variability, in terms of involved organs and severity. The phenotypic variability of two male patients is not related to differences in \u3b1-GAL enzymatic activity: though both have no enzymatic activity, the youngest shows severe symptoms, while the eldest is asymptomatic. It is noticeable that for two female patients with the M51I mutation the initial clinical diagnosis was different from FD. One of them was diagnosed with Familial Mediterranean Fever, the other with Multiple Sclerosis. Overall, this study confirms that the extreme variability of the clinical manifestations of FD is not entirely attributable to different mutations in the GLA gene and emphasizes the need to consider other factors or mechanisms involved in the pathogenesis of Fabry Disease

Pleurodesis with Thulium Cyber Laser versus talc poudrage: a comparative experimental study

none12noSclerosing fluids to achieve pleurodesis could be hardly replaced for bed-side procedures, but other devices may be successfully applied during thoracoscopy. Thulium Cyber Laser was experimented for this purpose and compared to talc poudrage. Twenty pigs underwent operative videothoracoscopy (VATS). Ten models were subjected to double-port VATS and parietal pleura photoevaporation using Thulium Cyber Laser™ (TCL) 150 W 2010 nm on the posterior third of three ribs; the pleural surface was homogeneously treated inside the target perimeter. The remaining ten pigs underwent uniportal thoracoscopy; talc poudrage was performed using the current clinical practice dosage (1 g/18 kg) with accurate talc powder spread over the whole pleural surface. All models were followed up for 60 days. Pleurodesis firmness was graded on a three-tier scale (none-moderate-firm) and site-matching topographical expectancy was evaluated. TCL produced pleurodesis in all models: 7/10 were firm and 3/10 moderate. Talc poudrage pleurodesis was firm in 4/10 and moderate in 6/10. Pleural adhesions were found exclusively in the treated area after laser treatment, while talc created a wide spectrum of effects, most commonly anarchic jagged adhesions obliterating less than 50 % of the pleural cavity (7/10), mostly declivous. The pathologist found more aggressive inflammation (sometimes severe) in the talc group. Expected localized pleurodesis was always registered in laser group (10/10), while talc poudrage was found poorly effective if consistent pleurodesis is expected in an apico-dorsal position (2/10). Laser pleurodesis appears more homogeneous, qualitatively not inferior, and topographically more predictable than talc pleurodesis. Parietal photoevaporation seems effective and the localized pleurodesis is reproducible.mixedDroghetti, Andrea; Vannucci, Jacopo; Bufalari, Antonello; Bellezza, Guido; De Monte, Valentina; Marulli, Giuseppe; Bottoli, Maria Caterina; Giovanardi, Michele; Daddi, Niccolo'; De Angelis, Verena; Moriconi, Franco; Puma, FrancescoDroghetti, Andrea; Vannucci, Jacopo; Bufalari, Antonello; Bellezza, Guido; De Monte, Valentina; Marulli, Giuseppe; Bottoli, Maria Caterina; Giovanardi, Michele; Daddi, Niccolo'; De Angelis, Verena; Moriconi, Franco; Puma, Francesc

Heterogeneity of TdT +, HLA-DR + acute leukaemia: Immunological, immunocytochemical and clinical evidence of lymphoid and myeloid origin

15 cases of acute leukaemia (AL) displaying a TdT +, HLA-DR + phenotype were studied; surface immunoglobulins, T cell markers and the common acute lymphoblas-tic leukaemia (c-ALL) antigen were negative, as were peroxidase and non-specific esterase cytochemical reactions. All cases were extensively investigated by conventional immunofluorescence (IF) and immunoperoxidase (IP), with a panel of monoclonal antibodies (MoAb), using both light and electron microscopy, and for ultrastructural myeloperoxidase (MPO). 8 cases, which were OKB2+, BA1 +, B4+, J5- and BA2-by IF, expressed the J5 antigen in IP. These cases were therefore re-classified as ALL with a weak expression of the C-ALL antigen. The other 7 cases showed an OKB2-, BA1-, B4+, BA2+ phenotype at IF and were also positive for 1 or more anti-myeloid MoAb. These features were confirmed by IP study. 4 patients also presented ultra-structural positivity to MPO. These cases were considered as proliferations of early precursor cells capable of expressing both myeloid and lymphoid features. This study, while demonstrating the heterogeneity of TdT +, HLA-DR + AL, suggests that the cell origin of many cases may be defined by extensive immunotyping at both IF and IP level. The prognostic and therapeutic implications of these findings are discussed, also in view of the poor prognosis often observed in the more undifferentiated cases of AL

State-of-the-art imaging techniques in the management of preoperative staging and re-staging of prostate cancer

We aimed to review the current state-of-the-art imaging methods used for primary and secondary staging of prostate cancer, mainly focusing on multiparametric magnetic resonance imaging and positron-emission tomography/computed tomography with new radiotracers. An expert panel of urologists, radiologists and nuclear medicine physicians with wide experience in prostate cancer led a PubMed/MEDLINE search for prospective, retrospective original research, systematic review, meta-analyses and clinical guidelines for local and systemic staging of the primary tumor and recurrence disease after treatment. Despite magnetic resonance imaging having low sensitivity for microscopic extracapsular extension, it is now a mainstay of prostate cancer diagnosis and local staging, and is becoming a crucial tool in treatment planning. Cross-sectional imaging for nodal staging, such as computed tomography and magnetic resonance imaging, is clinically useless even in high-risk patients, but is still suggested by current clinical guidelines. Positron-emission tomography/computed tomography with newer tracers has some advantage over conventional images, but is not cost-effective. Bone scan and computed tomography are often useless in early biochemical relapse, when salvage treatments are potentially curative. New imaging modalities, such as prostate-specific membrane antigen positron-emission tomography/computed tomography and whole-body magnetic resonance imaging, are showing promising results for early local and systemic detection. Newer imaging techniques, such as multiparametric magnetic resonance imaging, whole-body magnetic resonance imaging and positron-emission tomography/computed tomography with prostate-specific membrane antigen, have the potential to fill the historical limitations of conventional imaging methods in some clinical situations of primary and secondary staging of prostate cancer