Gallstones in Elderly Patients: Impact of Laparoscopic Cholecystectomy

The use of laparoscopic cholecystectomy (LC) in elderly patients may pose problems because of their poor general condition, especially of cardiopulmonary function. Moreover, these patients present with acute cholecystitis and associated common bile duct stones more often than their younger counterparts. From 1990 to 1999, the authors performed 943 LCs; 31 (3.2%) were attempted on elderly patients, 11 (35%) of which were on an emergency basis because of acute cholecystitis, cholangitis or acute biliary pancreatitis. Ten per cent of LCs needed to be converted to an open cholecystectomy, most often because of an increase in the partial pressure of carbon dioxide in the blood produced by excessive operative time. A gasless procedure was used in the last three years of the study on eight cases; the overall rate of conversion from LC to open cholecystectomy in this group was 0%. Associated gallbladder and common bile duct stones were found in five (16%) patients (four preoperative LC endoscopic sphincterotomy and one transcystic approach). The success rate in both of these cases was 100%, overall morbidity was 29% and there was no mortality. These results show that LC is a feasible and safe procedure for use in elderly patients. Gasless LC should be preferred in patients classified as American Society of Anesthesiologists' class III because an excessive duration of operation is the most common reason for converting to an open cholecystectomy

Toolchain Modeling: Comprehensive Engineering Plans for Industry 4.0

The fourth industrial revolution (Industry 4.0) elevates the complexity and autonomy of industrial systems and engineering environments to levels not seen before. The novel challenges involve not only the software running on the partaking autonomous devices, but also architectural considerations and the technological infrastructure around the entire engineering process. In this paper, complementing the trends in industrial systems design, we propose an approach to toolchain modeling, i.e. an integrated specification for the interoperability of tools along with the holistic architectural framework, designed in the context of the Arrowhead Framework. In particular, we propose an intuitive, yet founded definition for toolchains and their mappings to a versatile engineering process model. Those definitions then serve as a basis for proposing our comprehensive toolchain modeling approach. The methodology is demonstrated using (simplified) real-world engineering case studies based on the Arrowhead Framework and platform

Nationwide analysis of open groin hernia repairs in Italy from 2015 to 2020

Introduction: Inguinal hernia repair is one of the most commonly performed operations in general surgery. A total of 130.000 inguinal hernia repairs are performed yearly in Italy, and approximately 20 million inguinal hernias are treated worldwide annually. This report represents the trend analysis in inguinal hernia repair in Italy from a nationwide dataset for the 6-year period from 2015 to 2020. Materials and methods: Based on regional hospital discharge records, all the inguinal hernia repairs performed in public and private hospitals in Italy between 2015 and 2020 were reviewed based on diagnosis and procedure codes. For the aim of this study, data from the AgeNas (The National Agency for Regional Health Services) data source were analyzed. Results: Elective inguinal hernia repairs outnumbered urgent operations over the 6-year study period, ranging from 122,737 operations in 2015 to 65,780 in 2020 as absolute numbers, and from 87.96 to 83.3% of total procedures in 2019 and 2020 respectively, with an annual change ranging from - 66.58%, between 2020 and 2019, to - 2.49%, between 2019 and 2018 (mean = - 18.74%; CI =- 46.7%-9.22%; p < 0.0001). Conclusions: This large-scale review of groin hernia data from a nationwide Italian dataset provides a unique opportunity to obtain a snapshot of open groin hernia repair activity. More specifically, there is a trend to perform more elective than urgent procedures and there is a steady decrease in the amount of open hernia repairs in favor to laparoscopy

Splenic Trauma: WSES Classification and Guidelines for Adult and Pediatric Patients

Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines

Evaluando los factores que afectan a la tasa de mortalidad en la carretera: el caso de Sapo Común Bufo bufo, cerca de un área de reproducción

The Common Toad Bufo bufo is the amphibian with the highest rates of road mortality in many European countries. This elevated incidence of road kills has frequently been associated with migration to breeding sites. In this study, we analysed the mortality of the Common Toad in the road network in Catalonia (NE Spain), and investigated the related causative factors on four roads near a breeding site in the Pyrenees. Results suggest that the high mortality rate is due to a combination of factors: toad abundance, traffic density and quality of water bodies for breeding. On the road with the highest incidence of road kills we investigated whether deaths occurred at specific spots or in a random manner. The road was divided into 500 m sections and each section was classified according to biotic (type of vegetation) and abiotic (presence of streams, roadside topography) variables. Multiple correspondence analysis showed that sections with streams crossing under the road had the highest mortality rate, suggesting that such water bodies flowing into the breeding pond are the toads’ main migratory pathways for hibernation and breeding. As toads use the same migratory routes each year, it is critical to identify areas with a high potential mortality so that efficient measures can be designed to increase wildlife permeability, and thereby reduce habitat fragmentation. This methodology could be applied in other areas with high amphibian mortality. Key words: Amphibian, Common Toad, Bufo bufo, Landscape fragmentation, Migration, Mortality, Road permeability, Pyrenees.El Sapo Común Bufo bufo, es el anfibio con mayor tasa de mortalidad en la carretera en numerosos países de Europa. Esta elevada mortalidad se debe principalmente a las migraciones que realiza hacia las zonas de reproducción. En este estudio se analiza la mortalidad del Sapo Común en la red de carreteras de Cataluña (NE España) y más específicamente qué factores influyen sobre dicha mortalidad en cuatro carreteras cercanas a un punto de reproducción en los Pirineos. Los resultados sugieren que la alta tasa de mortalidad se debe a la combinación de tres factores: abundancia de sapos, densidad de tráfico y calidad de los puntos de agua para la reproducción. En la carretera con mayor índice de atropellos, se analizó si existía agregación en los animales atropellados o estos se distribuían al azar. Para ello, la carretera se dividió en tramos de 500 m, cada uno de los cuales se caracterizó por el tipo de vegetación circundante, así como otros factores que pudieran influir sobre la migración de los sapos (p.e. inclinación del margen de la carretera, presencia de riachuelos, etc.). El análisis de correspondencias múltiple demostró que los tramos con torrentes cruzando bajo la carretera presentaban mayor mortalidad. Esto sugiere que dichos torrentes son las vías principales usadas por los sapos para acudir a los puntos de reproducción. Dado que los sapos utilizan cada año las mismas vías migratorias, es fundamental identificar dichos puntos para predecir cuáles presentan mayor mortalidad potencial y así diseñar más eficazmente los mecanismos de permeabilidad para la fauna en las vías de comunicación. Esta metodología puede ser aplicada a otras zonas con elevada mortalidad de anfibios en la red de carreteras. Palabras clave: Anfibio, Sapo Común, Bufo bufo, Fragmentación del paisaje, Migración, Mortalidad, Permeabilidad de la carretera, Pirineos

Comparison between the sponge fauna living outside and inside the coralligenous bioconstruction. A quantitative approach

Coralligenous habitat results from a multi-stratified accumulation of crustose coralline algae and animal builders in a dynamic equilibrium with disruptive agents. The result is a complex architecture crossed by crevices and holes. Due to this three-dimensional structure, coralligenous may host a rich and diversified fauna, more abundant than any other Mediterranean habitat. Unfortunately, very few data are available about the cryptic fauna that lives inside the conglomerate. As already reported for coral reefs, the cryptic fauna plays an important role in the exchange of material and energy between water column and benthic assemblages. Here we compare the sponge community present inside and outside the coralligenous framework of Portofino Promontory (Ligurian Sea) at different depths (15 and 30 meters) not only in terms of taxonomic diversity but for the first time also in term of biomass. Sponges present on the surface of each block were collected, weighed and identified; after blocks dissolution in HCl, target cryptic sponges were separated from other organisms, weighed, and identified. We recorded a total of 62 sponge species. The average number of sponge taxa occurring outside the coralligenous accretions is lower than the number of taxa identified inside. This pattern is confirmed also regarding sponge biomass. These results underlines that studies focused on coralligenous functioning should take in account the important contribution of cryptic fauna, as recently evidenced also for tropical reef habitats

Understanding the training and education needs of homecare workers supporting people with dementia and cancer: a systematic review of reviews

Many people with dementia, supported by family carers, prefer to live at home and may rely on homecare support services. People with dementia are also often living with multimorbidities, including cancer. The main risk factor for both cancer and dementia is age and the number of people living with dementia and cancer likely to rise. Upskilling the social care workforce to facilitate more complex care is central to national workforce strategies and challenges. Training and education development must also respond to the key requirements of a homecare workforce experiencing financial, recruitment and retention difficulties. This systematic review of reviews provides an overview of dementia and cancer training and education accessible to the homecare workforce. Findings reveal there is a diverse range of training and education available, with mixed evidence of effectiveness. Key barriers and facilitators to effective training and education are identified in order to inform future training, education and learning development for the homecare workforce supporting people with dementia and cancer

Comparison of mid-latitude single- And mixed-phase cloud optical depth from co-located infrared spectrometer and backscatter lidar measurements

The long-wave downwelling spectral radiance measurements performed by means of the Far-Infrared Radiation Mobile Observation System (FIRMOS) spectrometer at the summit of the Zugspitze (German Alps) in the winter 2018/19 allowed the retrieval of the optical and micro-physical properties of ice and mixed clouds, showing a good agreement of the statistical relationship between the ice water path and the ice optical depth with the ones from previous works. In this paper the optical depths retrieved from FIRMOS are initially compared with selected cases calculated from backscattering light detection and ranging (lidar) data by using a transmittance method. Then, in order to compare the whole FIRMOS dataset, the power-law relationship between backscattering and extinction is used to apply the Klett method and automatize the routine. Minimizing the root mean square differences, the exponent k of the power-law relationship is assessed to be 0.85 with a variability in the range of 0.60–1.10 for ice clouds and 0.50 with a variability within 0.30–0.70 for mixed clouds

The RNA-binding protein MEX3A is a prognostic factor and regulator of resistance to gemcitabine in pancreatic ductal adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive cancer. Most patients present with advanced disease at diagnosis, which only permits palliative chemotherapeutic treatments. RNA dysregulation is a hallmark of most human cancers, including PDAC. To test the impact of RNA processing dysregulation on PDAC pathology, we performed a bioinformatics analysis to identify RNA-binding proteins (RBPs) associated with prognosis. Among the 12 RBPs associated with progression-free survival, we focused on MEX3A because it was recently shown to mark an intestinal stem cell population that is refractory to chemotherapeutic treatments, a typical feature of PDAC. Increased expression of MEX3A was correlated with higher disease stage in PDAC patients and with tumor development in a mouse model of PDAC. Depletion of MEX3A in PDAC cells enhanced sensitivity to chemotherapeutic treatment with gemcitabine, whereas its expression was increased in PDAC cells selected upon chronic exposure to the drug. RNA-sequencing analyses highlighted hundreds of genes whose expression is sensitive to MEX3A expression, with significant enrichment in cell cycle genes. MEX3A binds to its target mRNAs, like cyclin-dependent kinase 6 (CDK6), and promotes their stability. Accordingly, knockdown of MEX3A caused a significant reduction in PDAC cell proliferation and in progression to the S phase of the cell cycle. These findings uncover a novel role for MEX3A in the acquisition and maintenance of chemoresistance by PDAC cells, suggesting that it may represent a novel therapeutic target for PDAC