How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Plasma leptin measurements in epidemiological investigation: comparison of two commonly used assays and estimate of regression dilution bias.

As leptin is the object of intensive clinical research, we compared the radio-immunological assay (RIA) and enzyme-linked immunosorbent assay (ELISA) commercially available for measuring its plasma concentration in humans (Study 1), and sought to determine the power of a single plasma leptin measurement to characterise adequately a subject within a population on the basis of its intra- and inter-individual variations (Study 2).Study 1--Plasma leptin concentrations were determined by means of RIA and ELISA in a sample of 80 males. The measurements obtained using the two methods were closely correlated (r = 0.942), but the bias of the means was 21.1 +/- 73.5\% (M +/- SD, p < 0.001) and indicated that the two assays were not in agreement with each other. As expected, there were strong statistical associations between plasma leptin and a number of anthropometric indices, but the slopes of the regression of leptin concentration was significantly steeper when measured by ELISA. Study 2--ELISA was used to measure plasma leptin concentrations in three different samples obtained from 12 males and 12 females at two-week intervals. The inter-individual variation in plasma leptin was much greater than its intra-individual variation (the ratio of intra-to inter-individual variance = 0.05 and 0.04 in males and females, respectively), thus suggesting that a single fasting measurement is sufficient to characterise an individual's plasma leptin level within a population.ELISA is at least as effective as RIA in measuring plasma leptin, and is fully suitable for epidemiological investigations. A single measurement made in the morning and under fasting conditions is sufficient to characterise an individual within a population

Bioelectrical impedance analysis and age-related differences of body composition in the elderly

BACKGROUND AND AIM: Significant changes in body composition that have important health related effects may occur in the elderly. In this study, we evaluated the bioelectrical characteristics in a large group of apparently healthy Caucasian men in the age range 50-80 years, as a function of age and body mass index. METHODS: We studied 315 men with ages ranging from 50 to 80 years. They were divided into three groups according to body mass index (kg/m(2)): 18.5-24.9 normoweight (NW); 25.0-29.9 overweight (OW); &gt; or =30 obese (OB), and they were classified in nine age subgroups: 50-59 (young-old, YO); 60-69 (old, O); 70-80 (oldest, OS). Fat-free mass, fat mass and body cell mass were investigated using conventional bioelectrical impedance analysis. Body composition was also assessed by bioelectrical impedance vector analysis and the RXc graph method. RESULTS: Body cell mass decreased significantly with age particularly in subgroups of the OW and OB groups (p&lt;0.05). Mean vector displacement followed a definite pattern, with downward migration of the ellipses in the OW and OB groups, after 70 years of age. CONCLUSIONS: Ageing was associated with a pattern of vector bioelectrical impedance analysis indicating decreased soft tissue mass (fat-free mass and body cell mass), particularly in OW and OB-OS healthy men. We suggest 70 years of age as a cut-off for significant quantitative and qualitative (tissue electrical properties) body composition modifications. This bioelectrical impedance vector analysis pattern associated with ageing and across the different body mass index categories, may be useful for clinical purposes and can be used in geriatric routine to accurately assess the body composition modifications occurring in the elderl

Plasma leptin and blood pressure in men: graded association independent of body mass and fat pattern.

The role of leptin in the association between body mass, central adiposity, and blood pressure (BP) is controversial. This study evaluated the relationship between leptin and BP in relation to body mass index (BMI) and fat distribution in a large sample of untreated male adults.The study population was made up of 457 untreated male employees of the Olivetti factory in Naples. Plasma leptin, complete anthropometry, BP, and relevant biochemical variables were measured.Log-transformed plasma leptin levels were directly associated with BMI (r = 0.661, p or= 140 and/or 90 mm Hg) was associated with high plasma leptin levels when controlling for age and waist circumference (odds ratio, 1.99; 95\%CI, 1.06 to 3.72) or for age and BMI (odds ratio, 1.92; 95\%CI, 1.02 to 3.61).A graded positive relationship between plasma leptin levels and BP was observed in this sample of untreated male adults. This association was independent of age, BMI, abdominal adiposity, and fasting plasma insulin. Moreover, elevated plasma leptin concentrations were associated with greater probability of hypertension, again independently of potential confounders

Feasibility, reproducibility, and reliability for the T^*₂ iron evaluation at 3 T in comparison with 1.5 T

This study aimed to determine the feasibility, reproducibility, and reliability of the multiecho T*2 Magnetic resonance imaging technique at 3 T for myocardial and liver iron burden quantification and the relationship between T*2 values at 3 and 1.5 T. Thirty-eight transfusion-dependent patients and 20 healthy subjects were studied. Cardiac segmental and global T*2 values were calculated after developing a correction map to compensate the artifactual T*2 variations. The hepatic T*2 value was determined over a region of interest. The intraoperator and interoperator reproducibility for T*2 measurements at 3 T was good. A linear relationship was found between patients' R (1000/T*2) values at 3 and 1.5 T. Segmental correction factors were significantly higher at 3 T. A conversion formula returning T*2 values at 1.5 T from values at 3 T was proposed. A good diagnostic reliability for T*2 assessment at 3 T was demonstrated. Lower limits of normal for 3 T T*2 values were 23.3 ms, 21.1 ms, and 11.7 ms, for the global heart, mid-ventricular septum, and liver, respectively. In conclusion, T*2 quantification of iron burden in the mid-ventricular septum, global heart, and no heavy–moderate livers resulted to be feasible, reproducible, and reliable at 3 T. Segmental heart T*2 analysis at 3 T may be challenging due to significantly higher susceptibility artifacts. Magn Reson Med, 2012