The single surgeon learning curve of laparoscopic liver resection : a continuous evolving process through stepwise difficulties

The aim of the study was to evaluate the single-surgeon learning curve (SSLC) in laparoscopic liver surgery over an 11-year period with risk-adjusted (RA) cumulative sum control chart analysis.Laparoscopic liver resection (LLR) is a challenging and highly demanding procedure. No specific data are available for defining the feasibility and reproducibility of the SSLC regarding a consistent and consecutive caseload volume over a specified time period.A total of 319 LLR performed by a single surgeon between June 2003 and May 2014 were retrospectively analyzed. A difficulty scale (DS) ranging from 1 to 10 was created to rate the technical difficulty of each LLR. The risk-adjusted cumulative sum control chart (RA-CUSUM) analysis evaluated conversion rate (CR), operative time (OT) and blood loss (BL). Perioperative morbidity and mortality were also analyzed.The RA-CUSUM analysis of the DS identified 3 different periods: P1 (n = 91 cases), with a mean DS of 3.8; P2 (cases 92-159), with a mean DS of 5.3; and P3 (cases 160-319), with a mean DS of 4.7. P2 presented the highest conversion and morbidity rates with a longer OT, whereas P3 showed the best results (P<0.001). Fifty cases were needed to achieve a significant decrease in BL. The overall morbidity rate was 13.8%; no perioperative mortality was observed.According to our analysis, at least 160 cases (P3) are needed to complete the SSLC performing safely different types of LLR. A minimum of 50 cases can provide a significant decrease in BL. Based on these findings, a longer learning curve should be anticipated to broaden the indications for LLR

Vaccine Hesitancy: Lessons Learned and Perspectives for a Post-Pandemic Tomorrow

Infectious diseases have always posed a significant threat to mankind, resulting in high mortality and morbidity throughout history [1]. Currently, the burden of communicable diseases still remains very high in all age groups worldwide [2]. Moreover, the current COVID-19 pandemic has once again underlined the tremendous impact of transmittable diseases in terms of public health [1]. From this point of view, vaccines have always represented a fundamental public health tool. Indeed, mass immunization campaigns save millions of lives each year [3]. Furthermore, COVID-19 vaccines are enabling us to overcome the ongoing pandemic. Therefore, it is of utmost importance to promote vaccine uptake and to identify and address barriers for achieving adequate vaccination coverage. Among the obstacles to reaching adequate vaccination coverage, vaccine hesitancy (VH) is rightfully included. VH is defined by SAGE working group as “the delay in acceptance or refusal of vaccination despite the availability of vaccination services”[4] and was included by the World Health Organization (WHO) amongst the major health concerns in 2019 [5]. Going into detail, VH appears to be complex and context specific, varying across time, place and types of vaccines [4]. All these factors have been studied with respect to VH in recent decades and have played a big role during the COVID-19 pandemic and will certainly continue to do so in the post-pandemic future

Is it possible for a Procellariiform to raise two chicks? A case of chick adoption in Southern Giant petrels Macronectes giganteus in the South Shetland Islands, Antarctica

We report on the adoption of a Southern Giant Petrel Macronectes giganteus chick by a breeding pair on 25 de Mayo Island (King George Island), South Shetland Islands, Antarctica. Our observations showed both chicks received similar amounts of food, but there were differences in their growth rates that could be explained by their gender. After the third week of adoption, aggressive behaviors were common between chicks, usually expressed through regurgitation. This resulted in a low rate of growth in both chicks. Neither chick fledged, and both were found dead near the colony seven weeks after adoption. The constant fights between them could be one of the causes of their death, particularly if death resulted from excessive regurgitation. Although exclusion of unrelated chicks at nest sites has not been reported in M. giganteus, chick adoption seems to have no clear benefits and may contribute to brood failure.Fil: Archuby, Diego Ignacio. Ministerio de Relaciones Exteriores, Comercio Interno y Culto. Dirección Nacional del Antártico. Instituto Antártico Argentino; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Coria, Néstor Rubén. Ministerio de Relaciones Exteriores, Comercio Interno y Culto. Dirección Nacional del Antártico. Instituto Antártico Argentino; ArgentinaFil: Harrington, Ana. Ministerio de Relaciones Exteriores, Comercio Interno y Culto. Dirección Nacional del Antártico. Instituto Antártico Argentino; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Fusaro, Bruno. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo; ArgentinaFil: Montalti, Diego. Ministerio de Relaciones Exteriores, Comercio Interno y Culto. Dirección Nacional del Antártico. Instituto Antártico Argentino; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Favero, Marco. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; Argentin

Reversible Supramolecular Noncovalent Self-Assembly Determines the Optical Properties and the Formation of Melanin-like Nanoparticles

The role of noncovalent supramolecular self-assembly in the formation of melanin-like NP, as well as the nature of the electronic transition at the basis of their unique optical properties, is strongly debated. Here we demonstrate that, during the first stage of formation of synthetic melanin, polydopamine (PDA), a small fraction of the molecular precursor dopamine (DA) is oxidized to quinone (Q) and a simple supramolecular charge-transfer (CT) adduct is formed thanks to the electron donor and electron acceptor properties of DA and Q, respectively. This adduct, also detectable by HPLC-MS, presents the broad absorption band in the red-NIR region typical of melanin-like materials. Importantly, its disaggregation upon dilution can be easily detected since it leads to the disappearance of the CT band, indicating the reversibility of the process. Moreover, the stability constant K of the CT adduct could be obtained using a simple association model

Outcomes of robotic vs laparoscopic hepatectomy : a systematic review and meta-analysis

AIM: To perform a systematic review and meta-analysis on robotic-assisted vs laparoscopic liver resections. METHODS: A systematic literature search was performed using PubMed, Scopus and the Cochrane Library Central. Participants of any age and sex, who underwent robotic or laparoscopic liver resection were considered following these criteria: (1) studies comparing robotic and laparoscopic liver resection; (2) studies reporting at least one perioperative outcome; and (3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measures were set for estimated blood loss, operative time, conversion rate, R1 resection rate, morbidity and mortality rates, hospital stay and major hepatectomy rates. RESULTS: A total of 7 articles, published between 2010 and 2014, fulfilled the selection criteria. The laparoscopic approach was associated with a significant reduction in blood loss and lower operative time (MD = 83.96, 95% CI: 10.51-157.41, P = 0.03; MD = 68.43, 95% CI: 39.22-97.65, P < 0.00001, respectively). No differences were found with respect to conversion rate, R1 resection rate, morbidity and hospital stay. CONCLUSION: Laparoscopic liver resection resulted in reduced blood loss and shorter surgical times compared to robotic liver resections. There was no difference in conversion rate, R1 resection rate, morbidity and length of postoperative stay

Biocompatible and Light-Penetrating Hydrogels for Water Decontamination

Solar light-activated photocatalyst nanoparticles (NPs) are promising environment-friendly low cost tools for water decontamination, but their dispersion in the environment must be minimized. Here, we propose the incorporation of TiO2-NPs (also in combination with graphene platelets) into highly biocompatible hydrogels as a promising approach for the production of photoactive materials for water treatment. We also propose a convenient fluorescence-based method to investigate the hydrogel photocatalytic activity in real time with a conventional fluorimeter. Kinetics analysis of the degradation profile of a target fluorescent model pollutant demonstrates that fast degradation occurs in the matrix bulk. Fluorescence anisotropy proved that small pollutant molecules diffuse freely in the hydrogel. Rheological and scanning electron microscopy characterization showed that the TiO2-NP incorporation does not significantly alter the hydrogel mechanical and morphological properties

Graphene Materials Strengthen Aqueous Polyurethane Adhesives

Carboxyl-functionalized graphene platelets (GP) and graphene oxide (GO) sheets were added to a commercial aqueous adhesive dispersion of thermoplastic polyurethane (TP) (Idrotex 200 from FacGB s.r.l.). For both additives, the weight percentage was of industrial interest, 0.01 and 10.1 wt %. The addition of GP/GO was carried out in a simple and scalable-up process that can be applied to other materials and additives. Mechanical, peel tests were applied on polyurethane strips (75 mm long, IS mm wide, and 1.5 mm thick) prepared cutting extruded sheets obtained using Estane 58091, a 70D aromatic polyester-based TP. The tests with 0.01 wt % of GP showed statistically significant higher forces at first failure and maximum forces with respect to the pristine adhesive. Sample characterization was carried out with scanning electron microscopy, infrared spectroscopy, X-ray diffraction, and thermal analysis. A mechanism is suggested for the improved performance of the low-dose GP adhesive

Assessment of occupational exposure to gaseous peracetic acid

Objectives In order to assess short-term exposure to peracetic acid (PAA) in disinfection processes, the Authors compared 4 industrial hygiene monitoring methods to evaluate their proficiency in measuring airborne PAA concentrations. Material and Methods An active sampling by basic silica gel impregnated with methyl p-tolyl sulfoxide (MTSO), a passive solid phase micro-extraction technique using methyl p-tolyl sulfide (MTS) as on-fiber derivatization reagent, an electrochemical direct-reading PAA monitor, and a novel visual test strip PAA detector doped with 2,2’-azino-bis (3-ethylbenzothiazoline)-6-sulfonate were evaluated and tested over the range of 0.06–16 mg/m3, using dynamically generated PAA air concentrations. Results The linear regression analysis of linearity and accuracy showed that the 4 methods were suitable for PAA monitoring. Peracetic acid monitoring in several use applications showed that the PAA concentration (1.8 mg/m3) was immediately dangerous to life or health as proposed by the National Institute of Occupational Safety and Health, and was frequently exceeded in wastewater treatment (up to 7.33 mg/m3), and sometimes during food and beverage processes and hospital high-level disinfection operations (up to 6.8 mg/m3). Conclusions The methods were suitable for the quick assessment of acute exposure in PAA environmental monitoring and can assist in improving safety and air quality in the workplace where this disinfectant is used. These monitoring methods allowed the evaluation of changes to work out practices to reduce PAA vapor concentrations during the operations when workers are potentially overexposed to this strong antioxidant agent. Int J Occup Med Environ Health 2018;31(4):527–53

development of an innovative gas chromatography mass spectrometry method for assessment of formaldehyde in the workplace atmosphere

World consumption of formaldehyde (FA) is forecast to grow at an average annual rate of about 4% from 2015 to 2020 with world production to exceed 52 million tons in 2017. From the first day of January 2016, the Commission Regulation No. 91/2015 established the FA classification through an indication from European Chemical Agency as category 2 mutagenic and category 1B carcinogen. A novel method for the determination of gaseous FA in air is presented herewith. The sampling was carried out using a miniaturized cartridge by means of a medium-flow pumping system (1.0 L min-1, 5–60 min) and absorption of FA vapors on 2,4-dinitrophenylhydrazine. Cartridge desorption removing the excess derivatizing agent based upon solid-phase extraction was performed by an innovative xyz robotic system on-line with fast gas chromatography (GC)—mass spectrometry (MS). Through the generation of standard atmospheres of known concentration of FA, we evaluated the precision (relative standard deviation for n = 10, 8.8%), lower lim..