Association of a CT-based clinical and radiomics score of non-small cell lung cancer (NSCLC) with lymph node status and overall survival

Background: To evaluate whether a model based on radiomic and clinical features may be associated with lymph node (LN) status and overall survival (OS) in lung cancer (LC) patients; to evaluate whether CT reconstruction algorithms may influence the model performance. Methods: patients operated on for LC with a pathological stage up to T3N1 were retrospectively selected and divided into training and validation sets. For the prediction of positive LNs and OS, the Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression model was used; univariable and multivariable logistic regression analysis assessed the association of clinicalradiomic variables and endpoints. All tests were repeated after dividing the groups according to the CT reconstruction algorithm. p-values < 0.05 were considered significant. Results: 270 patients were included and divided into training (n = 180) and validation sets (n = 90). Transfissural extension was significantly associated with positive LNs. For OS prediction, high-and low-risk groups were different according to the radiomics score, also after dividing the two groups according to reconstruction algorithms. Conclusions: a combined clinical\u2013radiomics model was not superior to a single clinical or single radiomics model to predict positive LNs. A radiomics model was able to separate high-risk and low-risk patients for OS; CTs reconstructed with Iterative Reconstructions (IR) algorithm showed the best model performance

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Malattia di Paget perianale: presentazione di 5 casi

Obiettivo. La malattia di Paget extramammaria (EMPD) è una neoplasia molto rara che frequentemente si associa a carcinomi cutanei o viscerali, sincroni o metacroni. Obiettivo dello studio è valutare retrospettivamente i risultati ottenuti in 5 casi di malattia di Paget perianale osservati e rivedere la letteratura sull’argomento. Pazienti e metodi. Cinque pazienti con EMPD perianale sono stati trattati presso la nostra Divisione da marzo 1996 a dicembre 2006. In 3 casi la malattia era confinata entro l’epidermide, in un caso plurirecidivo era presente un’infiltrazione del derma e un paziente presentava un adenocarcinoma del retto inferiore con diffusione pagetoide. I pazienti sono stati sottoposti ad ampie exeresi perianali e ricostruzioni con graft cutanei. L’asportazione dell’adenocarcinoma del retto è stata realizzata per via transanale. In due casi è stata eseguita una sigmoidostomia di protezione per favorire la guarigione della ferita. Risultati. Non si sono verificate complicanze postoperatorie, neanche a distanza. In due casi la malattia ha recidivato localmente, ma nessun paziente ha presentato metastasi a distanza. Quattro pazienti sono vivi e liberi da malattia, mentre un paziente con recidiva di malattia è deceduto per insufficienza cardiocircolatoria. Discussione. L’analisi della letteratura consente un’identificazione chiara della EMPD primitiva (intraepiteliale/intradermica) e della forma associata ad adenocarcinomi anorettali, interpretata come diffusione pagetoide. Poche informazioni sono invece ricavabili nei casi in cui la malattia si presenta come adenocarcinoma degli annessi. La malattia tende a recidivare anche dopo chirurgia exeretica radicale e ha capacità metastatizzanti, anche nella forma in situ. Conclusioni. La malattia di Paget perianale è una patologia complessa e difficile da diagnosticare. L’ associazione con carcinomi sincroni o metacroni impone follow-up lunghi con controlli clinici e strumentali frequenti

Screening Tools in Igiene Industriale – l’Esempio del Rumore

Introduzione L’evoluzione tecnologica ha semplificato il nostro quotidiano. Lo strumento che incarna questo progresso è lo smartphone che consente di fare operazioni soprattutto tramite Applica zioni (App). Alcune emulano il funzionamento di strumenti di precisione impiegati per le misurazioni in materia di Salute e Sicurezza nei luoghi di lavoro. Obiettivo di questo studio è verificare l’affidabilità degli smartphone come strumenti di misurazione in Igiene Industriale relativamente alla Fonome tria per la valutazione del rischio rumore. Materiali e metodi È stata confrontata la misurazione fonometrica effettuata, sulle stesse sorgenti sonore, sia mediante smartphone che mediante uno strumento di precisione internazionalmente riconosciuto. È stato utilizzato 1 fonometro di Classe 1 e n. 3 smartphone, (2 Android e 1 iOS) per valutare le possibili differenze di risultato. Si sono installati gli smartphone su una piattaforma liscia fissata ad un cavalletto e successivamente fissati alla piattaforma con appositi supporti, per altezza e orientamento. Sono state scelte 4 App per condurre lo studio ed effettuate 14 misurazioni. Risultati Il confronto tra le misurazioni effettuate consente di evidenzia re i seguenti risultati: la prima App (per Android) ha mostrato valori sempre inferiori (differenza tra 15 e 20 dB) rispetto a quelli ottenuti col fonometro di Classe I, la seconda Applica zione (per Android) ha mostrato una differenza con i rilievi fonometrici che non ha mai superato i 5 dB e, nel caso di una misurazione ha registrato lo stesso valore LAeq del fonometro. Per quanto riguarda le App (per iOS) la prima ha presentato una differenza (tra 15 e 20 dB) in prossimità di sorgenti sonore con valori LAeq superiori a 78 dB (A), mentre si è rivelata precisa dove le sorgenti sonore presentano LAeq al di sotto dei 78 dB (A), con differenze di 2 dB. La seconda App, in diverse misurazioni, ha registrato valori LAeq coerenti a quelli fono metrici con differenze non superiori ai 2 dB. Conclusioni Gli smartphone possiedono buone potenzialità per essere degli strumenti di misurazione nel campo dell’igiene industriale. Que sto studio ha dimostrato che alcune App per la misura del rumore con smartphone potrebbero essere considerate attendibil