Combined HLA matched limbal stem cells allograft with amniotic membrane transplantation as a prophylactic surgical procedure to prevent corneal graft rejection after penetrating keratoplasty: case report

Purpose. To determine if the use of combined HLA matched limbal stem cells allograft  with  amniotic  membrane  transplantation  (AMT)  is  a  safe  and  effective  prophylactic  surgical procedure to prevent corneal graft after penetrating keratoplasty (PK).Methods.  We  report  the  case  of  a  17  years  old  patient  with  a  history  of  congenital  glaucoma, trabeculectomy and multiple corneal graft rejections, presenting total limbal  cell deficiency. To reduce the possibility of graft rejection in the left eye after a new PK,  a two step procedure was performed. At first the patient underwent a combined HLA  matched limbal stem cells allograft (LAT) and AMT and then, 10 months later, a new  PK.Results. During 12 months of follow-up, the corneal graft remained stable and smooth,  with no sign of graft rejection.Conclusions. In our patient, the prophylactic use of LAT from HLA-matched donors  and AMT before PK, may result in a better prognosis of corneal graft survival.   

Design of a novel bimanual robotic system for single-port laparoscopy

Abstract—This paper presents the design and fabrication of Single-Port lapaRoscopy bImaNual roboT (SPRINT), a novel tele-operated robotic system for minimally invasive surgery. SPRINT, specifically designed for single-port laparoscopy, is a high-dexterity miniature robot, able to reproduce the movement of the hands of the surgeon, who controls the system through a master interface. It comprises two arms with six degrees of freedom (DOFs) that can be individually inserted and removed in a 30-mm-diameter umbilical access port. The system is designed to leave a central lumen free during operations, thus allowing the insertion of other laparoscopic tools. The four distal DOFs of each arm are actuated by on-board brushless dc motors, while the two proximal DOFs of the shoulder are actuated by external motors. The constraints gen-erated by maximum size and power requirements led to the design of compact mechanisms for the actuation of the joints. The wrist is actuated by three motors hosted in the forearm, with a peculiar differential mechanism that allows us to have intersecting roll– pitch–roll axes. Preliminary tests and validations were performed ex vivo by surgeons on a first prototype of the system. Index Terms—Bimanual robot, miniature robotic arm, mini-mally invasive surgery, robotic surgery, single-port laparoscopy (SPL). I

Clinical and psychological correlates of health-related quality of life in obese patients

<p>Abstract</p> <p>Background</p> <p>Health-related quality of life (HRQL) is poor in obese subjects and is a relevant outcome in intervention studies. We aimed to determine factors associated with poor HRQL in obese patients seeking weight loss in medical units, outside specific research projects.</p> <p>Methods</p> <p>HRQL, together with a number of demographic and clinical parameters, was studied with generic (SF-36, PGWB) and disease-specific (ORWELL-97) questionnaires in an unselected sample of 1,886 (1,494 women; 392 men) obese (BMI > 30 kg/m²) patients aged 20-65 years attending 25 medical units scattered throughout Italy. The clinics provide weight loss treatment using different programs. General psychopathology (SCL-90 questionnaire), the presence of binge eating (Binge Eating scale), previous weight cycling and somatic comorbidity (Charlson's index) were also determined. Scores on SF-36 and PGWB were compared with Italian population norms, and their association with putative determinants of HRQL after adjustment for confounders was assessed through logistic regression analysis.</p> <p>Results</p> <p>HRQL scores were significantly lower in women than in men. A greater impairment of quality of life was observed in relation to increasing BMI class, concurrent psychopathology, associated somatic diseases, binge eating, and weight cycling. In multivariate analysis, psychopathology (presence of previously-diagnosed mental disorders and/or elevated scores on SCL-90) was associated with lower HRQL scores on both psychosocial and somatic domains; somatic diseases and higher BMI, after adjustment for confounders, were associated with impairment of physical domains, while binge eating and weight cycling appeared to affect psychosocial domains only.</p> <p>Conclusions</p> <p>Psychopathological disturbances are the most relevant factors associated with poor HRQL in obese patients, affecting not only psychosocial, but also physical domains, largely independent of the severity of obesity. Psychological/psychiatric interventions are essential for a comprehensive treatment of obesity, and to improve treatment outcome and to reduce the burden of disease.</p

Weight Loss Expectations in Obese Patients and Treatment Attrition: An Observational Multicenter Study

Objective: To investigate the influence of weight loss expectations (expected 1-year BMI loss, dream and maximum acceptable BMI) on attrition in obese patients seeking treatment. Research Methods and Procedures: Obese subjects (1785; 1393 women; median age, 46 years; median BMI, 36.7 kg/m2) seeking treatment in 23 medical Italian centers were evaluated. Baseline diet and weight history, weight loss expectations, and primary motivation for seeking treatment (health or improving appearance) were systematically recorded. Psychiatric distress, binge eating, and body image dissatisfaction were tested at baseline by self-administered questionnaires (Symptom Check List-90, Binge Eating Scale, and Body Uneasiness Test). Attrition and BMI change at 12 months were prospectively recorded. Results: At 12 months, 923 of 1785 patients (51.7%) had discontinued treatment. Compared with continuers, dropouts had a significantly lower age, a lower age at first dieting, lower dream BMI, a higher expected 1-year BMI loss, and a higher weight phobia. At logistic regression analysis, the strongest predictors of attrition at 12 months were lower age and higher expected 1-year BMI loss. The risk of drop-out increased systematically for unit increase in expected BMI loss at 12 months (hazard ratio, 1.12; 95% confidence interval, 1.04 to 1.20; p 0.0018). The risk was particularly elevated in the first 6 months. Discussion: Baseline weight loss expectations are independent cognitive predictors of attrition in obese patients entering a weight-losing program; the higher the expectations, the higher attrition at 12 months. Unrealistic weight goals should be tackled at the very beginning of treatment

Exploring K2G30 Genome: A High Bacterial Cellulose Producing Strain in Glucose and Mannitol Based Media

Demands for renewable and sustainable biopolymers have rapidly increased in the last decades along with environmental issues. In this context, bacterial cellulose, as renewable and biodegradable biopolymer has received considerable attention. Particularly, acetic acid bacteria of the Komagataeibacter xylinus species can produce bacterial cellulose from several carbon sources. To fully exploit metabolic potential of cellulose producing acetic acid bacteria, an understanding of the ability of producing bacterial cellulose from different carbon sources and the characterization of the genes involved in the synthesis is required. Here, K2G30 (UMCC 2756) was studied with respect to bacterial cellulose production in mannitol, xylitol and glucose media. Moreover, the draft genome sequence with a focus on cellulose related genes was produced. A pH reduction and gluconic acid formation was observed in glucose medium which allowed to produce 6.14 ± 0.02 g/L of bacterial cellulose; the highest bacterial cellulose production obtained was in 1.5% (w/v) mannitol medium (8.77 ± 0.04 g/L), while xylitol provided the lowest (1.35 ± 0.05 g/L) yield. Genomic analysis of K2G30 revealed a peculiar gene sets of cellulose synthase; three bcs operons and a fourth copy of bcsAB gene, that encodes the catalytic core of cellulose synthase. These features can explain the high amount of bacterial cellulose produced by K2G30 strain. Results of this study provide valuable information to industrially exploit acetic acid bacteria in producing bacterial cellulose from different carbon sources including vegetable waste feedstocks containing mannitol

Psychological Distress in Morbid Obesity in Relation to Weight History

Background: Very few data are available on psychological distress in morbidly obese subjects in relation to the history of their weight. In subjects with childhood obesity, psychological distress might be better than in adult-onset obesity, because of progressive adaptation to the social stigma. Methods: Psychological distress was tested in relation to BMI at age 20 years (BMI-20), weight history and somatic co-morbidities in 632 treatment-seeking, morbidly obese participants from the QUOVADIS cohort (130 men, 502 women; mean age 45.5 years). The number of dieting attempts/year, BMI increase and cumulative BMI loss since age 20 were calculated as weight cycling parameters.The Symptom Check List-90 (SCL-90), the Psychological General Well- Being (PGWB), the Binge-Eating Scale, and the ORWELL-97 questionnaire were used to score psychometry and health-related quality of life (HRQL). Complications were quantitatively assessed by a modified Charlson\u2019s score. Results: BMI-20 was normal in 35% of cases and >35 kg/m2 in only 14%. Psychometric scores were not different in relation to BMI-20, when corrected for age, with the exception of the General Health scale of PGWB, showing a greater distress in subjects with normal BMI-20. In most cases, the prevalence of pathological results of questionnaires showed a Jshaped curve, with participants with normal BMI-20 or those with Class II-III obesity in early adulthood having the highest prevalence of psychological/psychiatric distress and poor HRQL.Weight cycling was a risk factor for binge-eating, depression and interpersonal sensitivity in SCL-90, whereas somatic co-morbidities adversely affected most SCL-90 and all PGWB scales. Conclusion: Weight cycling and somatic co-morbidities, but not age of onset of obesity, are the main factors negatively influencing psychological health in treatment-seeking, morbidly obese subjects

A simplified genomic profiling approach predicts outcome in metastatic colorectal cancer

The response of metastatic colorectal cancer (mCRC) to the first-line conventional combination therapy is highly variable, reflecting the elevated heterogeneity of the disease. The genetic alterations underlying this heterogeneity have been thoroughly characterized through omic approaches requiring elevated efforts and costs. In order to translate the knowledge of CRC molecular heterogeneity into a practical clinical approach, we utilized a simplified Next Generation Sequencing (NGS) based platform to screen a cohort of 77 patients treated with first-line conventional therapy. Samples were sequenced using a panel of hotspots and targeted regions of 22 genes commonly involved in CRC. This revealed 51 patients carrying actionable gene mutations, 22 of which carried druggable alterations. These mutations were frequently associated with additional genetic alterations. To take into account this molecular complexity and assisted by an unbiased bioinformatic analysis, we defined three subgroups of patients carrying distinct molecular patterns. We demonstrated these three molecular subgroups are associated with a different response to first-line conventional combination therapies. The best outcome was achieved in patients exclusively carrying mutations on TP53 and/or RAS genes. By contrast, in patients carrying mutations in any of the other genes, alone or associated with mutations of TP53/RAS, the expected response is much worse compared to patients with exclusive TP53/RAS mutations. Additionally, our data indicate that the standard approach has limited efficacy in patients without any mutations in the genes included in the panel. In conclusion, we identified a reliable and easy-to-use approach for a simplified molecular-based stratification of mCRC patients that predicts the efficacy of the first-line conventional combination therapy

Prevalence and burden of obesity in Rehabilitation Units in Italy: a survey

No abstract has been provide

Mask process matching using a model based data preparation solution

International audienc