49 research outputs found

    Recent Innovations & Daily Problems. A new prosthesis in inguinal hernia repair:preliminary results of a pilot study.

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    Introduction: Elective surgery for inguinal hernia is affected by very low mortality « 1 per 10000 operation); in contrast, when surgery is carried out for complicated inguinal hernia, risks of postoperative complication are higher. TAPP is a world-wide accepted surgical practice in the treatment of elective bilateral or recurrent inguinal hernia, above all in young patients. Few exploratory studies were published on laparoscopic approach in the treatment of urgent complicated inguinal hernia. Aim of this study was to analyze feasibility (operative time, conversion rate), safety (postoperative morbidity, length of hospital stay) and quality of life (acute and chronic pain, return to work) of trans-abdominal pre-peritoneal laparoscopic hernia repair in acute incarcerated inguinal hernia. Rationale of laparoscopic trans-abdominal approach is the easier hernia reduction under vision and a better exploration of the abdominal cavity. Methods: from September 2012 to September 2013, 15 consecutive patients admitted in emergency at the Division of General Surgery of University "Sapienza", Polo Pontino, for acute incarcerated inguinal hernia were submitted to TAPP using 3 trocars (1 of 10 mm and 2 of 5mm) and polyester prosthesis fixed by fibrin glue. Exclusion criteria for laparoscopic approach were age III, previous abdominal surgery, signs of strangulated hernia. All of them were evaluated for operative time, conversion rate, postoperative morbidity, organ resection or other surgery required. All patients were scored for pain by Visual Analogic Scale (VAS) during postoperative in hospital stay at 7 days, 1,6 and 12 months after surgery. Results: median follow-up was 16 months and 12 as minimum. In all cases reduction of hernia was always possible and none conversion to open surgery was recorded, median operative time was 89 minutes (55-137 as range), omental resection was carried out in one patient (6,6%), no other organ resections needed, whereas contralateral hernia was diagnosed and repaired at the same time in 4 patients (26,6%). No major complications were observed, median blood loss was 100 ml, minor morbidity was contained to 18% represented by fever and wound infection of surgical umbilical scar. Median in hospital stay was 1,5 days with 1-5 days as range. Postoperative median acute pain, measured by visual analogic scale (VAS), was 2 (range:0-4), none patient referred any pain during follow-up. Median time of return to work was 6,5 days, ranged between 3 to 15 days. Patients' compliance to treatment and to follow-up was complete as well their satisfaction. Conclusions: In centres skilled for laparoscopy in emergency, TAPP could be considered a feasible and safe technique. In well-selected patients (especially if emolled in controlled clinical trial) TAPP could represent an alternative surgical approach for complicated incarcerated inguinal hernia to conventional open surgery even in urgency. The main advantages of laparoscopic approach are the ability to perform surgical hernia reduction under vision, a better exploration and evaluation of abdominal cavity and diagnosis and treatment of eventual contralateral defect of wall, otherwise often missed. Finally, the good control of acute and chronic pain, faster return to normal activity and work, better aesthetic results contributed to total satisfaction and compliance of the patients

    Models of chronic obstructive pulmonary disease

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    Chronic obstructive pulmonary disease (COPD) is a major global health problem and is predicted to become the third most common cause of death by 2020. Apart from the important preventive steps of smoking cessation, there are no other specific treatments for COPD that are as effective in reversing the condition, and therefore there is a need to understand the pathophysiological mechanisms that could lead to new therapeutic strategies. The development of experimental models will help to dissect these mechanisms at the cellular and molecular level. COPD is a disease characterized by progressive airflow obstruction of the peripheral airways, associated with lung inflammation, emphysema and mucus hypersecretion. Different approaches to mimic COPD have been developed but are limited in comparison to models of allergic asthma. COPD models usually do not mimic the major features of human COPD and are commonly based on the induction of COPD-like lesions in the lungs and airways using noxious inhalants such as tobacco smoke, nitrogen dioxide, or sulfur dioxide. Depending on the duration and intensity of exposure, these noxious stimuli induce signs of chronic inflammation and airway remodelling. Emphysema can be achieved by combining such exposure with instillation of tissue-degrading enzymes. Other approaches are based on genetically-targeted mice which develop COPD-like lesions with emphysema, and such mice provide deep insights into pathophysiological mechanisms. Future approaches should aim to mimic irreversible airflow obstruction, associated with cough and sputum production, with the possibility of inducing exacerbations

    Microbiota and chronic inflammatory arthritis: an interwoven link

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    Scanning Electronic Microscopy Evaluation of the Roughness of the Stromal Bed After Deep Corneal Cut with the LDV Femtosecond Laser (Z6) (Ziemer) and the ONE Microkeratome (Moria).

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    To compare the stromal bed surface quality and the accuracy of dissection depth after deep lamellar cuts using the Leonardo Da Vinci (LDV) femtosecond laser (Z6) and the ONE Microkeratome. Deep lamellar cuts were performed on nine human donor corneoscleral buttons: five with the LDV femtosecond (FS) laser (Z6) (Ziemer) and four with the ONE Microkeratome (MK) (Moria). Corneal thickness was measured with ultrasound pachymetry before and after the dissection. The Stromal bed quality was evaluated using light microscopy (n = 4) and scanning electron microscopy (SEM) (n = 9). The surface roughness on SEM images was graded on the scale of 1 (smoothest) to 5 (roughest) by four observers, blinded to the method used. Particle analysis on the SEM images was performed in order to have an objective measure of smoothness. The achieved dissection depth using the FS laser was 496.4 ± 46.4 µm when attempting 500 µm and 474 ± 60 µm with the microkeratome when attempting 350 µm. Histological evaluation of the corneoscleral buttons by both light and electron microscopy showed significantly smoother surface using the FS laser compared to the microkeratome. There were fewer and smaller particles observed in the SEM images of FS laser cut buttons (p < 0.001).The average observer based score of anterior surface roughness (50×) was 2.2 for the FS laser and 3.9 for the microkeratome dissections (p < 0.001). The LDV femtosecond laser (Z6) platform is capable of creating deep corneal lamellar dissection with smoother surface quality and with more predictable cut depth as compared to the One Microkeratome

    ROCK Inhibitor Enhances Adhesion and Wound Healing of Human Corneal Endothelial Cells.

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    Maintenance of corneal transparency is crucial for vision and depends mainly on the endothelium, a non-proliferative monolayer of cells covering the inner part of the cornea. When endothelial cell density falls below a critical threshold, the barrier and "pump" functions of the endothelium are compromised which results in corneal oedema and loss of visual acuity. The conventional treatment for such severe disorder is corneal graft. Unfortunately, there is a worldwide shortage of donor corneas, necessitating amelioration of tissue survival and storage after harvesting. Recently it was reported that the ROCK inhibitor Y-27632 promotes adhesion, inhibits apoptosis, increases the number of proliferating monkey corneal endothelial cells in vitro and enhance corneal endothelial wound healing both in vitro and in vivo in animal models. Using organ culture human cornea (N = 34), the effect of ROCK inhibitor was evaluated in vitro and ex vivo. Toxicity, corneal endothelial cell density, cell proliferation, apoptosis, cell morphometry, adhesion and wound healing process were evaluated by live/dead assay standard cell counting method, EdU labelling, Ki67, Caspase3, Zo-1 and Actin immunostaining. We demonstrated for the first time in human corneal endothelial cells ex vivo and in vitro, that ROCK inhibitor did not induce any toxicity effect and did not alter cell viability. ROCK inhibitor treatment did not induce human corneal endothelial cells proliferation. However, ROCK inhibitor significantly enhanced adhesion and wound healing. The present study shows that the selective ROCK inhibitor Y-27632 has no effect on human corneal endothelial cells proliferative capacities, but alters cellular behaviours. It induces changes in cell shape, increases cell adhesion and enhances wound healing ex vivo and in vitro. Its absence of toxicity, as demonstrated herein, is relevant for its use in human therapy

    CoPart: Coordinated Partitioning of Last-Level Cache and Memory Bandwidth for Fairness-Aware Workload Consolidation on Commodity Servers

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    Workload consolidation is a widely-used technique to maximize server resource utilization in cloud and datacenter computing. Recent commodity CPUs support last-level cache (LLC) and memory bandwidth partitioning functionalities that can be used to ensure the fairness of the consolidated workloads. While prior work has proposed a variety of resource partitioning techniques, it still remains unexplored to characterize the impact of LLC and memory bandwidth partitioning on the fairness of the consolidated workloads and investigate system software support to dynamically control LLC and memory bandwidth partitioning in a coordinated manner. To bridge this gap, we present an in-depth performance and fairness characterization of LLC and memory bandwidth partitioning. Guided by the characterization results, we propose CoPart, coordinated partitioning of LLC and memory bandwidth for fairness-aware workload consolidation on commodity servers. CoPart dynamically analyzes the characteristics of the consolidated applications and allocates the LLC and memory bandwidth across the applications in a coordinated manner to improve the overall fairness. Our quantitative evaluation shows that CoPart significantly improves the fairness of the consolidated applications (e.g., 57.3% higher fairness on average than the resource allocation policy that equally allocates the resources to the consolidated applications), robustly provides high fairness across various application and system configurations, and incurs small performance overhead
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