Ruolo del gene YAP e della via YAP/CTGF nel corso della cancerogenesi epatica nel ratto e nell'uomo

Aim: YAP is a small protein that binds to many transcription factors and modulates their activity. The regulation of YAP activity is not well understood. CTGF is one of target genes of YAP. The aim of this study is to detect YAP/CTGF pathway activation through measuring gene expression and protein levels in samples of rat liver. In this study we assessed the role of YAP/CTGF pathway during hepatocarcinogenesis in susceptible Fisher F344 (F344) and resistant Brown Norway (BN) rats. Methods: Preneoplastic liver (4 weeks after initiation), early low-grade dysplastic nodules (12 weeks), dysplastic nodules (mostly low-grade in BN and high-grade dyplastic in F344 rats; 32 weeks) and HCCs (57-60 weeks) were induced in F344 and BN rats according to the resistant hepatocyte protocol. Levels of CTGF and YAP protein and RNA, were determined by Western Blotting and Real-Time–RT PCR analyses in rat samples. Results: The results, obtained in the weeks after treatment, generally show an increase of both YAP and CTGF in F344 strains compared to BN rats. In details the difference for YAP expression was more marked in IV and XII week. On the other hand, CTGF expression, after a substantial equivalence in IV week, was always higher in F344 than in BN. Moreover YAP and CTGF expression was higher in HCCs than in normal liver in both strains. Conclusion: Overexpression of YAP/CTGF pathway seems to be associated with progression of liver carcinogenesis, with maximum expression in HCCs nodules. This seems to reveal an important role of this pathway in liver cancer biology.</br

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 &lt; 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p &lt; 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 &lt; 0.0001) or urgent (20.4% vs. 38.5%; p &lt; 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 &lt; 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

A prospective cohort analysis of the prevalence and predictive factors of delayed discharge after laparoscopic cholecystectomy in Italy: the DeDiLaCo Study

Background: The concept of early discharge ≤24 hours after Laparoscopic Cholecystectomy (LC) is still doubted in Italy. This prospective multicentre study aims to analyze the prevalence of patients undergoing elective LC who experienced a delayed discharge &gt;24 hours in an extensive Italian national database and identify potential limiting factors of early discharge after LC. Methods: This is a prospective observational multicentre study performed from January 1, 2021 to December 31, 2021 by 90 Italian surgical units. Results: A total of 4664 patients were included in the study. Clinical reasons were found only for 850 patients (37.7%) discharged &gt;24 hours after LC. After excluding patients with nonclinical reasons for delayed discharge &gt;24 hours, 2 groups based on the length of hospitalization were created: the Early group (≤24 h; 2414 patients, 73.9%) and the Delayed group (&gt;24 h; 850 patients, 26.1%). At the multivariate analysis, ASA III class ( P &lt;0.0001), Charlson's Comorbidity Index (P=0.001), history of choledocholithiasis (P=0.03), presence of peritoneal adhesions (P&lt;0.0001), operative time &gt;60 min (P&lt;0.0001), drain placement (P&lt;0.0001), pain ( P =0.001), postoperative vomiting (P=0.001) and complications (P&lt;0.0001) were independent predictors of delayed discharge &gt;24 hours. Conclusions: The majority of delayed discharges &gt;24 hours after LC in our study were unrelated to the surgery itself. ASA class &gt;II, advanced comorbidity, the presence of peritoneal adhesions, prolonged operative time, and placement of abdominal drainage were intraoperative variables independently associated with failure of early discharge