Integrated HTA and FMECA methodology for the evaluation of robotic surgery

Robotic surgery has been strongly improved since the beginning of the twenty-first century and chased important level of technical and clinical performances. Within the robotic area, the most worldwide used surgical robot is the da Vinci® system made by Intuitive Surgical Inc. The aim of this study was to evaluate at the hospital scale the robotic surgery (Hospital –Based Health Technology Assessment) in comparison to the open and laparoscopic procedures yet combining a FMECA analysis to accurately assess all those aspects involving patient and staff safety. The total number of robotic procedures directly observed by the surgical department and reported in the following study was 44, including 28 urology interventions and 16 general surgeries. The study confirmed clinical benefits carried out with the robot but bigger complexity in managing the whole surgical system in terms of structural needs, staff and technology. For the future, further steps regard the necessity to dispose of a wider number of robotic procedures in order to strength the analysis reliability and complete the socio-economic assessment with medium and long terms observation. Finally a new FMECA application will be essential to monitor the real effects of the suggested actions on the evaluated risks according to the already known and new failure modes

Fatal pulmonary hypertension and right-sided congestive heart failure in a kitten infected with Aelurostrongylus abstrusus

Aelurostrongylus abstrusus is considered the most important respiratory nematode of domestic cats worldwide. This parasite inhabits the alveoli, alveolar ducts, and bronchioles and causes a subacute to chronic respiratory clinical disease. Clinical signs may occur in domestic cats of any age, though they aremore oftendescribedin young animals. Physical examination, echocardiography, thoracic radiography, pulmonary and cardiac pathological findings, classical, and molecular parasitological analysis of a six-month-old kitten referred at the Veterinary Teaching Hospital of the University of Pisa (Italy) led to a diagnosis of parasitic bronchopneumonia caused by A. abstrusus, which was complicated by severe pulmonary hypertension (PH) and right-sided congestive heart failure (R-CHF) that caused the death of the animal. Cases of reversible PH associated with A. abstrusus infection have been seldom reported in cats. This is the first report of fatal PH and R-CHF in a kitten with clinical aelurostrongylosis

Epidemiology of leprosy in Italy (1920-2019): A comprehensive review on existing data

Background and aims: Incidence of leprosy in Italy has declined steadily over the last century, but available evidence remains fragmentary. Our review aims to summarize available data on the epidemiology of leprosy cases in Italy. Methods: The following keywords were used to explore PubMed and Embase: leprosy, Hansen’s disease, (Mycobacterium) leprae, Italy, without any chronological restriction. Results: We identified a total of 39 reports, including 7 national reports, 11 international reports, 20 case reports. Notified leprosy cases were: 839 between 1925 and 1948; 434 between 1955 and 1979; 76 cases for the decade 1980-1989; 112 between 1990 and 1999; 62 between 2000 and 2009, and a total of 25 cases since 2009. Since 2003, 53% of all cases occurred in illegal residents. Focusing on individual cases, latency between early signs/symptoms and a proper diagnosis ranged between 2 and 20 years in 52.1% of individual cases. Conclusion: Imported cases of leprosy are responsible for most leprosy incidence in Italy, and social stigma, the unfamiliarity of healthcare professionals with such disorders, and difficulties of some high-risk groups to be appropriately assessed hint to a possible under-diagnosis. Professionals should be made more aware of the potential for leprosy incidence among patients from countries where the disease is endemic. (www.actabiomedica.it)

A pilot study on the use of the super dimension navigation system for optimal cryobiopsy location in interstitial lung disease diagnostics.

BACKGROUND: Transbronchial cryobiopsies has become increasingly important in the diagnostic workup for interstitial lung diseases. The rate of complications and mortality are low compared to surgical lung biopsies, but the diagnostic yield is not as high. The reason for the lower diagnostic yield could in some cases be explained by biopsies taken too centrally or in less affected areas. In this pilot study we examined the feasibility of using the electromagnetic navigation system, superDimension (SD), when performing cryobiopsies to increase the diagnostic yield.METHODS: Electromagnetic navigation bronchoscopy and cryobiopsies were performed using SD. An electromagnetic board placed on the back of the patient and a position sensor at the tip of the navigational probe created a real-time 3D reconstruction of previously acquired computer tomography images. The procedure was performed with the patients in general anesthesia using a rigid bronchoscope when performed in Florence and with a flexible bronchoscope through an orotracheal tube when performed in Aarhus.RESULTS: In total, 18 patients were included. Five patients were excluded, partly due to technical difficulties. Disposable 1.7 mm cryoprobes were used in Aarhus, and reusable 1.9 mm probes in Florence. Pneumothorax was detected in three (23%), mild hemorrhage was seen in one (8%) and moderate hemorrhage in six (46%). The biopsies contributed to the diagnosis in 11 of the patients (85%).CONCLUSION: Using superDimension electromagnetic navigation system when performing cryobiopsies is feasible. A larger prospective trial is necessary to homogenize the technique between centres and to evaluate diagnostic advantage and complications

<i>Tayassu pecari</i> (Link) (Artiodactyla, Tayassuidae) en la Formación Tezanos Pinto (Pleistoceno tardío-Holoceno temprano) en la provincia de Santa Fe, Argentina

El registro paleontológico más antiguo de Tayassuidae en América del Sur se remonta al Plioceno medio (Buenos Aires, Argentina). A partir del Pleistoceno se produce un notable incremento en la riqueza taxonómica registrándose numerosos hallazgos en Argentina, Brasil, Uruguay y Bolivia. Actualmente, se reconocen al menos tres especies vivientes: Tayassu tajacu (Linnaeus), T. pecari (Link) y Catagonus wagneri (Rusconi). Tanto Catagonus Ameghino como Tayassu Fischer están representados en el registro fósil sudamericano. A éstos se le suma el género Platygonus Le Conte con representantes exclusivamente extintos. La presente contribución tiene por objetivo dar a conocer el primer registro fósil de un tayasuido en la Formación Tezanos Pinto, provincia de Santa Fe, asignando el material MFA-PV-1172 (serie dentaria inferior izquierda y pm4 derecho) a Tayassu pecari. Estos dientes provienen del miembro superior de dicha formación que fue acumulado entre 14 Ka y 8 Ka AP. El espécimen fue hallado en un ambiente de depositación afín a condiciones climáticas áridas a semiáridas frías y secas durante un período glacial, compatibles con ambientes abiertos, típicos de sabana, con predominio de pastizales. La presencia de esta especie (adaptada principalmente a climas húmedos, y ambientes boscosos y selváticos) en sedimentos depositados bajo condiciones climáticas propias del Último Máximo Glacial refleja su gran plasticidad y amplia tolerancia ecológica, lo cual concuerda con su amplia distribución geográfica actual. Asimismo la localidad fosilífera (Las Petacas, departamento San Martín) está ubicada geográficamente en el centro-oeste de Santa Fe, claramente alejada de la distribución actual de T. pecari.Sesiones libres.Facultad de Ciencias Naturales y Muse

Tayassu pecari (Link) (Artiodactyla, Tayassuidae) en la Formación Tezanos Pinto (Pleistoceno tardío-Holoceno temprano) en la provincia de Santa Fe, Argentina

El registro paleontológico más antiguo de Tayassuidae en América del Sur se remonta al Plioceno medio (Buenos Aires, Argentina). A partir del Pleistoceno se produce un notable incremento en la riqueza taxonómica registrándose numerosos hallazgos en Argentina, Brasil, Uruguay y Bolivia. Actualmente, se reconocen al menos tres especies vivientes: Tayassu tajacu (Linnaeus), T. pecari (Link) y Catagonus wagneri (Rusconi). Tanto Catagonus Ameghino como Tayassu Fischer están representados en el registro fósil sudamericano. A éstos se le suma el género Platygonus Le Conte con representantes exclusivamente extintos. La presente contribución tiene por objetivo dar a conocer el primer registro fósil de un tayasuido en la Formación Tezanos Pinto, provincia de Santa Fe, asignando el material MFA-PV-1172 (serie dentaria inferior izquierda y pm4 derecho) a Tayassu pecari. Estos dientes provienen del miembro superior de dicha formación que fue acumulado entre 14 Ka y 8 Ka AP. El espécimen fue hallado en un ambiente de depositación afín a condiciones climáticas áridas a semiáridas frías y secas durante un período glacial, compatibles con ambientes abiertos, típicos de sabana, con predominio de pastizales. La presencia de esta especie (adaptada principalmente a climas húmedos, y ambientes boscosos y selváticos) en sedimentos depositados bajo condiciones climáticas propias del Último Máximo Glacial refleja su gran plasticidad y amplia tolerancia ecológica, lo cual concuerda con su amplia distribución geográfica actual. Asimismo la localidad fosilífera (Las Petacas, departamento San Martín) está ubicada geográficamente en el centro-oeste de Santa Fe, claramente alejada de la distribución actual de T. pecari.Sesiones libres.Facultad de Ciencias Naturales y Muse

Quantification of the effect of mammographic screening on fatal breast cancers: The Florence Programme 1990–96

Breast cancer cases diagnosed in women aged 50–69 since 1990 to 1996 in the City of Florence were partitioned into those who had been invited to screening prior to diagnosis and those who had not. All cases were followed up for vital status until 31 December 1999. The cumulative number of breast cancer deaths among the cases were divided by screening and invitation status, to give the rates of cancers proving fatal within a period of 8 years of observation (incidence-based mortality). We used the incidence-based mortality rates for two periods (1985–86, 1990–96), pre and during screening. The incidence-based mortality ratio comparing 1990–96 and 1985–86 was 0.50 (95% CI : 0.38–0.66), a significant 50% reduction. For noninvited women, compared to 1985-86, there was a 41% significant mortality reduction (RR=0.59, 95% CI : 0.42–0.82). The comparable reduction in those invited was a significant 55% (RR=0.45, 95% CI : 0.32–0.61). The incidence ratio of rates of cancers stage II or worse was close to one when the noninvited in 1990–96 were compared with 1985–86 (RR=0.97, 95% CI : 0.78–1.21). Excluding prevalent cases, the rate of stage II+ breast cancer cases was 42% lower in Screened women compared with the noninvited (RR=0.58, 95% CI : 0.45–0.74). This study confirmed that new treatments and the first rounds of the screening programme contributed to reducing mortality from breast cancer

Time Until Partial Response in Metastatic Adrenocortical Carcinoma Long-Term Survivors

A partial response (PR) has been proposed as a surrogate for overall survival in advanced adrenocortical carcinoma (ACC). The primary endpoint of the study was to characterize the time until a PR in patients with metastatic ACC treated with a standard therapy is achieved. Long-term survivors were selected to allow evaluation of delayed tumor response to mitotane. Records from patients with metastatic ACC that survived for &gt; 24 months were retrieved. Tumor response was analyzed according to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. Time until a tumor response, after treatment initiation or therapeutic plasma mitotane level, was analyzed. Sixty-eight patients were analyzed. The first-line systemic therapy was mitotane as a monotherapy (M) (n = 57) or cytotoxic polychemotherapy plus/minus mitotane (PC ± M) (n = 11). The second-line therapy was M (n = 2) or PC ± M (n = 41). Thirty-two PRs occurred in 30/68 patients (44.1%): this was obtained for 13 (40.6%) during M and during PC ± M for 19/32 responders (59.4%). PRs were observed within 6 months of starting M or PC ± M in 76.9 and 94.7% of responses, respectively, within 6 months of therapeutic plasma mitotane being first observed in 88.9% of responses with M and in 53.3% of responses with PC ± M. All PRs (but one) occurred within 1 year after initiating treatment. To conclude, Most patients with metastatic ACC and long survival times had PRs within the first 6 months of standard systemic therapy, and almost all within the first year. The absence of response after that period could be considered as a treatment failure. Maintenance of mitotane therapy in non-responders after 1 year should be questioned in future randomized trials