Endoscopic Treatment of Anastomotic Bleeding in Laparoscopic Colorectal Surgery

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Cytokine storm and histopathological findings in 60 cases of COVID-19-related death: from viral load research to immunohistochemical quantification of major players IL-1\u3b2, IL-6, IL-15 and TNF-\u3b1

This study involves the histological analysis of samples taken during autopsies in cases of COVID-19 related death to evaluate the inflammatory cytokine response and the tissue localization of the virus in various organs. In all the selected cases, SARS-CoV-2 RT-PCR on swabs collected from the upper (nasopharynx and oropharynx) and/or the lower respiratory (trachea and primary bronchi) tracts were positive. Tissue localization of SARS-CoV-2 was detected using antibodies against the nucleoprotein and the spike protein. Overall, we tested the hypothesis that the overexpression of proinflammatory cytokines plays an important role in the development of COVID-19-associated pneumonia by estimating the expression of multiple cytokines (IL-1\u3b2, IL-6, IL-10, IL-15, TNF-\u3b1, and MCP-1), inflammatory cells (CD4, CD8, CD20, and CD45), and fibrinogen. Immunohistochemical staining showed that endothelial cells expressed IL-1\u3b2 in lung samples obtained from the COVID-19 group (p\u2009<\u20090.001). Similarly, alveolar capillary endothelial cells showed strong and diffuse immunoreactivity for IL-6 and IL-15 in the COVID-19 group (p\u2009<\u20090.001). TNF-\u3b1 showed a higher immunoreactivity in the COVID-19 group than in the control group (p\u2009<\u20090.001). CD8\u2009+\u2009T cells where more numerous in the lung samples obtained from the COVID-19 group (p\u2009<\u20090.001). Current evidence suggests that a cytokine storm is the major cause of acute respiratory distress syndrome (ARDS) and multiple organ failure and is consistently linked with fatal outcomes

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

Iconografia delle migrazioni nei libri di testo

Le dinamiche migratorie e i processi di integrazione sono ormai diventate un elemento costitutivo della società italiana. A questi temi i ricercatori e gli associati dell’Istituto di Ricerche sulla Popolazione e le Politiche Sociali del Consiglio Nazionale delle Ricerche hanno dedicato il presente volume, analizzando i due fenomeni dai seguenti punti di vista: partenze; luoghi e impatto dell’immigrazione straniera; scuola e minori; aree critiche e di disagio; concetti e pratiche dell’integrazione; politiche di integrazione

Le migrazioni nei testi dei manuali italiani di Storia e Geografia

Questa ricerca indaga la rappresentazione dei migranti e delle migrazioni nei libri di testo di Storia e Geografia nelle scuole secondarie italiane nel 2016, facendo seguito ad una prima indagine svolta nel 2011. Vengono riportati in questo capitolo i risultati dell’analisi dei testi scritti. I libri sono stati selezionati integrando elenchi provenienti da diverse fonti: Amazon, alcune grandi librerie e istituti scolastici di Roma, Napoli e Milano. Sono state elaborate griglie di analisi per rilevare lo spazio dedicato al tema e alle caratteristiche dei contenuti quali le dimensioni tematiche presentate, lo stile educativo adottato, il possibile utilizzo di designazioni improprie nel riferirsi ai migranti. L’apparizione nei libri di testo di specifici riferimenti alle politiche migratorie testimonia l’acquisizione di elementi del dibattito in corso; nella trattazione emerge il riferimento alle politiche relative alla limitazione degli ingressi che superano, sebbene di misura, quelle di inclusione. Pur non mancando la rappresentazione dei migranti come problema, come minaccia alla sicurezza e all’identità, il racconto prevalente è quello di immigrato “vittima” costretta a lasciare il proprio paese; difficilmente si lascia spazio alla dimensione dei migranti come portatori di diritti. Quando i migranti sono descritti come risorsa, si fa soprattutto riferimento all’aspetto economico, in seconda battuta a quello demografico, in ultima analisi a quello culturale; in comune c’è un’idea di accoglienza basata sulla “meritevolezza”, al pari di quanto emerso nell’approccio normativo italiano

Rappresentazione dei migranti nelle testate online europee

Questa ricerca indaga le modalità di rappresentazione dei migranti e delle migrazioni nei quotidiani online di diversi paesi europei con l’obiettivo di evidenziare le principali dimensioni tematiche affrontate e gli atteggiamenti nei confronti dei migranti e delle migrazioni che emergono dai testi degli articoli, nonché le caratteristiche iconografiche dominanti nelle fotografie e nei video, per poi inquadrare i risultati all’interno di frame narrativi ricorrenti. In particolare è stata analizzata la copertura mediatica da parte dei principali quotidiani online di Italia, Grecia, Francia e Regno Unito – tra i primi paesi europei per numero di prime richieste di asilo – in corrispondenza di 8 eventi-chiave avvenuti nel 2016, di rilievo sia per la politica europea che per quella nazionale. L’analisi dei quotidiani online ad accesso libero, che si caratterizzano per la loro multimedialità e per la capacità di raggiungere un bacino di lettori più ampio e più giovane rispetto al corrispettivo cartaceo, è stata condotta attraverso griglie elaborate per caratterizzare tre tipi di unità documentarie – testi scritti, immagini e video – condividendo l’approccio dell’Analisi Critica del Discorso Multimodale. Tra i risultati principali: una visione all’insegna dell’accettazione morale, che predomina su una visione esplicitamente in termini di “problema”, ma che allo stesso tempo limita fortemente il riconoscimento dei migranti sia come portatori di diritti che come risorsa per il paese ospitante; un atteggiamento positivo nei confronti dei migranti maggiormente presente nelle testate progressiste che in quelle conservatrici; la prevalenza della “topica della denuncia” nelle fotografie e nei video con migranti, nella descrizione del rapporto tra lo “spettacolo del dolore” e l’osservatore; la prevalenza di una rappresentazione in termini di gruppo anonimo de-umanizzato e “al maschile” che talvolta non corrisponde ai dati che descrivono il fenomeno

Fibrin sealants and axillary lymphatic morbidity: a systematic review and meta-analysis of 23 clinical randomized trials

Axillary dissection is a highly mobile procedure with severe lymphatic consequences. The off-label application of fibrin sealants in the axilla, with the sole aim to eliminate dead space and to provoke sealing of the disrupted lymphatic vessels at the end of axillary dissection, is an experimental procedure to reduce lymphatic morbidity. The aim of our systematic review and meta-analysis is to investigate the effects of fibrin sealants on lymphatic morbidity after axillary dissection. Our results show that this experimental procedure is able to decrease the total axillary drainage output, the number of days before the axillary drainage is removed, and the length of hospital stay. However, no effects on the occurrence rate of axillary lymphocele or on the surgical site complications rate were demonstrated Background: use of fibrin sealants following pelvic, paraaortic, and inguinal lymphadenectomy may reduce lymphatic morbidity. The aim of this meta-analysis is to evaluate if this finding applies to the axillary lymphadenectomy. Methods: randomized trials evaluating the efficacy of fibrin sealants in reducing axillary lymphatic complications were included. Lymphocele, drainage output, surgical-site complications, and hospital stay were considered as outcomes. Results: twenty-three randomized studies, including patients undergoing axillary lymphadenectomy for breast cancer, melanoma, and Hodgkin’s disease, were included. Fibrin sealants did not affect axillary lymphocele incidence nor the surgical site complications. Drainage output, days with drainage, and hospital stay were reduced when fibrin sealants were applied (p < 0.0001, p < 0.005, p = 0.008). Conclusion: fibrin sealants after axillary dissection reduce the total axillary drainage output, the duration of drainage, and the hospital stay. No effects on the incidence of postoperative lymphocele and surgical site complications rate are found

Fibrin Sealants and Axillary Lymphatic Morbidity: A Systematic Review and Meta-Analysis of 23 Clinical Randomized Trials.

BACKGROUND use of fibrin sealants following pelvic, paraaortic, and inguinal lymphadenectomy may reduce lymphatic morbidity. The aim of this meta-analysis is to evaluate if this finding applies to the axillary lymphadenectomy. METHODS randomized trials evaluating the efficacy of fibrin sealants in reducing axillary lymphatic complications were included. Lymphocele, drainage output, surgical-site complications, and hospital stay were considered as outcomes. RESULTS twenty-three randomized studies, including patients undergoing axillary lymphadenectomy for breast cancer, melanoma, and Hodgkin's disease, were included. Fibrin sealants did not affect axillary lymphocele incidence nor the surgical site complications. Drainage output, days with drainage, and hospital stay were reduced when fibrin sealants were applied (p < 0.0001, p < 0.005, p = 0.008). CONCLUSION fibrin sealants after axillary dissection reduce the total axillary drainage output, the duration of drainage, and the hospital stay. No effects on the incidence of postoperative lymphocele and surgical site complications rate are found