Learning curve for laparoscopic cholecystectomy has not been defined: A systematic review

Background: Laparoscopic cholecystectomy is one of the most performed surgeries worldwide but its learning curve is still unclear. Methods: A systematic review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, and Google Scholar. Human studies investigating the learning curve of laparoscopic cholecystectomy were included. The Newcastle–Ottawa scale for cohort studies and the GRADE scale were used for the quality assessment of the selected articles. Results: Nine cohort studies published between 1991 and 2020 were included. All studies showed a great heterogeneity among the considered variables. Seven articles (77.7%) assessed intraoperative variables only, without considering patient's characteristics, operator's experience, and grade of gallbladder inflammation. Only five articles (55%) provided a precise cut-off value to see proficiency in the learning curve, ranging from 13 to 200 laparoscopic cholecystectomies. Conclusions: The lack of clear guidelines when evaluating the learning curve in surgery, probably contributed to the divergent data and heterogeneous results among the studies. The development of guidelines for the investigation and reporting of a surgical learning curve would be helpful to obtain more objective and reliable data especially for common operation such as laparoscopic cholecystectomy

Monitoring System of Eastern Sicily (Italy) devised by a specialist team (UFSO) at the INGV- Catania Section, Italy.

Eastern Sicily in Italy is well-known as a high seismic and volcanic risk area. From a monitoring point of view, a team/unit of people has been created (UFSO) with the task of managing all the activities connected to the faultless operation of the Working Room that is the strategic centre during periods of routine operations or in the case of emergency. Among the primary activities of monitoring and surveillance, the management of the video camera network located on the main Sicilian active volcanoes represents a major goal. This task is achieved by means of permanent, visible and infrared cameras together with similar mobile systems, in order to observe each phenomenon related to the volcanic activity. The expert staff can therefore make decisions, in real time, from useful information in order to understand the phenomena in action. With the aim of maximizing the results and performance of all the networks, the UFSO is attentive to the planning and realization of hardware and software systems that are always available in the mobile van unit. In this context, the staff actively participates in national and European research projects dealing with the development and use of new systems with high technological content. Another aspect of the work, moreover, is represented by the development of supervisory control software, namely software providing automatic control of the working systems. Such algorithms allow to immediately and remotely signal to the duty-personnel states of alert of several modules, indicating, when possible, the probable failure causes

The BINGO project: II. Instrument description

Context. The measurement of diffuse 21-cm radiation from the hyperfine transition of neutral hydrogen (Hi signal) in different redshifts is an important tool for modern cosmology. However, detecting this faint signal with non-cryogenic receivers in single-dish telescopes is a challenging task. The BINGO (Baryon Acoustic Oscillations from Integrated Neutral Gas Observations) radio telescope is an instrument designed to detect baryonic acoustic oscillations (BAOs) in the cosmological Hi signal, in the redshift interval 0:127 ≤ z ≤ 0:449. Aims. This paper describes the BINGO radio telescope, including the current status of the optics, receiver, observational strategy, calibration, and the site. Methods. BINGO has been carefully designed to minimize systematics, being a transit instrument with no moving dishes and 28 horns operating in the frequency range 980 ≤ v ≤ 1260 MHz. Comprehensive laboratory tests were conducted for many of the BINGO subsystems and the prototypes of the receiver chain, horn, polarizer, magic tees, and transitions have been successfully tested between 2018-2020. The survey was designed to cover ∼13% of the sky, with the primary mirror pointing at declination δ = -15°. The telescope will see an instantaneous declination strip of 14:75. Results. The results of the prototype tests closely meet those obtained during the modeling process, suggesting BINGO will perform according to our expectations. After one year of observations with a 60% duty cycle and 28 horns, BINGO should achieve an expected sensitivity of 102μK per 9.33MHz frequency channel, one polarization, and be able to measure the Hi power spectrum in a competitive time frame

Molecular Mechanisms Generating and Stabilizing Terminal 22q13 Deletions in 44 Subjects with Phelan/McDermid Syndrome

In this study, we used deletions at 22q13, which represent a substantial source of human pathology (Phelan/McDermid syndrome), as a model for investigating the molecular mechanisms of terminal deletions that are currently poorly understood. We characterized at the molecular level the genomic rearrangement in 44 unrelated patients with 22q13 monosomy resulting from simple terminal deletions (72%), ring chromosomes (14%), and unbalanced translocations (7%). We also discovered interstitial deletions between 17–74 kb in 9% of the patients. Haploinsufficiency of the SHANK3 gene, confirmed in all rearrangements, is very likely the cause of the major neurological features associated with PMS. SHANK3 mutations can also result in language and/or social interaction disabilities. We determined the breakpoint junctions in 29 cases, providing a realistic snapshot of the variety of mechanisms driving non-recurrent deletion and repair at chromosome ends. De novo telomere synthesis and telomere capture are used to repair terminal deletions; non-homologous end-joining or microhomology-mediated break-induced replication is probably involved in ring 22 formation and translocations; non-homologous end-joining and fork stalling and template switching prevail in cases with interstitial 22q13.3. For the first time, we also demonstrated that distinct stabilizing events of the same terminal deletion can occur in different early embryonic cells, proving that terminal deletions can be repaired by multistep healing events and supporting the recent hypothesis that rare pathogenic germline rearrangements may have mitotic origin. Finally, the progressive clinical deterioration observed throughout the longitudinal medical history of three subjects over forty years supports the hypothesis of a role for SHANK3 haploinsufficiency in neurological deterioration, in addition to its involvement in the neurobehavioral phenotype of PMS

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Qanat, gebbie and water sources: the last refuge for the malacologican freshwater fauna in Palermo (Sicily, Italy)

The surroundings of Palermo were characterized, over the centuries, by the presence of many natural environments of great ecological and faunal importance. These environments were placed in a context characterized by minimal and sustainable urban development and large agriculture areas, dedicated to the development of tree crops such as citrus and orchards. These crops were supported by an imposing irrigation system that, using natural resources such as watercourses, wells and springs, collected and distributed water in soils through tanks, gebbie, qanat, irrigation channels (saje), etc. Fresh water mollusks, like many other animal and vegetable organisms, spread from the natural freshwater environments in this artificial water system, thus creating a unique and varied ecosystem. The subsequent urban development of the city of Palermo and the destruction of many of those natural environments has further enhanced the ecological role of the artificial freshwater systems as an important refuge for the native fauna and flora. In the present study, we report on freshwater molluscs observed in the territory of Micciulla, a large relict area occupied almost entirely by an old citrus, now located inside the city of Palermo. In this area there are some springs, an extensive array of artificial freshwater to irrigate the crops, and the qanat Savagnone located in the “Camera dello Scirocco”. The results obtained by census of different populations of freshwater mollusks confirm the importance of these environments and the growing role they play as the last refuges for fauna and flora originally linked to natural humid environments

Pattern recognition to monitor Strombolian activity

The INGV (Catania Branch) camera network permits to monitor crater activity on Stromboli volcano. The goal of this work is monitoring strombolian activity in order to automatically classify different types of explosions and achieve real time identification of critical ones.PublishedUniversità Federico II Napoli5.5. Attività di Sala Operativaope