Expanding the therapeutic options for Zenker’s diverticulum: from open diverticulectomy to transoral septoplasty

Significant technical changes and a shift toward a transoral approach have occurred in the management of Zenker’s diverticulum over the past three decades. Transoral stapling is already an established and commonly performed procedure. Zenker peroral endoscopic myotomy (Z-POEM) and Zenker peroral endoscopy septotomy (Z-POES) are innovative techniques that are rapidly spreading and replacing more traditional therapeutic options. This review provides an overview of the current status of minimally invasive transoral management to assess whether a tailored approach is feasible and safe and may improve quality of life and reduce recurrence rates

Long-lasting tissue inflammatory processes trigger autoimmune responses to extracellular matrix molecules

Extracellular matrix (ECM) remodeling is strongly favored by the conditions occurring in the inflammatory microenvironment and can lead to pathogenic reactions directed toward the ECM itself Several reports have described autoimmune responses to ECM molecules in patients with inflammatory diseases whose pathogenesis is not primarily related to ECM autoimmunity. This review will focus on the molecular interplay that governs ECM remodeling during tissue inflammation and will discuss how chronic inflammation can act as a driving force for the induction of autoimmune responses to ECM components as well as how the elicited autoimmunity can sustain local or induce distant tissue damage

PREVENTING FRAUDULENT ADULTERATIONS: PRELIMINARY STUDY FOR THE SELECTION OF HISTOLOGICAL PARAMETERS FOR THE DISCRIMINATION OF FRESH AND FROZEN-THAWED OCTOPUS MANTLE

The application of appropriate analytical techniques represents an important tool to prevent deliberate substitutions of fresh with thawed seafood. The histological method has already been validated to discriminate fresh from thawed fish [1,2], while it has never been applied to cephalopods [4]. The present study aimed at selecting histological parameters of freezing-induced structural alteration on Octopus (O. vulgaris), to be further used in the setting up of an operational grid for the discrimination of fresh and frozen-thawed samples. Ten whole fresh exemplars (F), maintained at 0-2°C, were sampled at different time (24h, 72h, 144h and 192h) within octopus shelf life [3]. obtaining longitudinal and transversal mantle samples. Samples were fixed in 10% formalin, embedded in paraffin and sections stained with H&E were observed to define fresh tissue morphological pattern and to highlight possible histological spoilage-related alterations. Then, 85 mantle tissue sections belonging to 20 fresh (F), 20 conventionally frozen in a laboratory freezer at -20 °C for 15 days (CF), 25 industrially frozen in bulk blocks at -80°C (IFB) and 20 curled and Individually Quick Frozen (IQF) exemplars, were analogously processed and screened to select histological parameters descriptive of freezing-thawing process. Overall tissue structural organization(4x magnification)gaping among muscle fiber bundles and white round-oval-saccular spaces or clefts between and within the muscle bundles,(10x magnification) were assessed on the central area of the longitudinal section, including radial, circular muscle bundles and a central connective tissue layer. Moreover, white spaces between and within muscles bundles were measured by morphometry and results expressed as percentage. Focal myofiber degeneration, shrinkage and swelling were histological modifications related to shelf-life. The increase of the overall tissue structure alteration, myofiber gaps and the presence of white spaces between and within muscle bundles were all statistically confirmed to be related to freezing as plausibly induced by the effects of water crystallization phenomena [4].The mean white space percentages recorded in F (22.97%), CF (43.09%), IF (46.57%), IQF (59.69%) highlighted significant differences between fresh and frozen tissue types. Thus, the study confirmed the suitability of all the aforesaid histological parameters as analytical indicators for the discrimination of fresh and frozen cephalopods. [1] Bozzetta E et al. Histology as a valid and reliable tool to differentiate fresh from frozen-thawed fish. Journal of Food Protection, 75(8):1536-1541, 2012; [2] Tinacci L., et al. Histological discrimination of fresh and frozen/thawed fish meat: European hake (Merluccius merluccius) as a possible model for white meat fish species ; [3] Barbosa, A. & Vaz-Pires, P. Quality index method (QIM): development of a sensorial scheme for common octopus. Food control 15, 161-168, 2004; [4] Ueng, YE. & Chow CJ. Textural and Histological Changes of Different Squid Mantle Muscle during Frozen Storage. Journal of Agricultural and Food Chemistry 46, 4728-4733, 1998

Giovanni Maroni, l'ultimo madrigalista estense prima della devoluzione

Questo volume a cura di Daniele Biancardi, Saggi ariosteschi. I primi 500 anni dell’Orlando Furioso, raccoglie gli Atti del Convegno “Ariosto e il suo tempo”, tenutosi a Bondeno (FE) il 18 giugno 2016. La presente preziosa pubblicazione, peraltro ricca di numerose illustrazioni, accoglie esemplari studî, frutto di approfondite ricerche, colte riflessioni e rare competenze, di: Marco Bertozzi, Dennis Looney, Andrea Marchesi, Lucio Scardino, Enrico Scavo, Daniele Biancardi, Alberto Balasso, Marco Dorigatti

Pushing the boundaries of TAMIS. Transanal minimally invasive surgery (TAMIS) resection of a very large circumferential rectal polyp with combined laparoscopy for a synchronous right colonic lesion

revealing an increasing number of large precursor lesions, for which local excision may be the optimal treatment. However, the choice whether to perform local excision and with which technique is still unclear, especially in Western countries where Endoscopic Submucosal Dissection (ESD) is rapidly spreadin

Fingerprinting Mediterranean hurricanes using pre-event thermal drops in seawater temperature

Extreme atmospheric‐marine events, known as medicanes (short for “Mediterranean hurricanes”), have affected the Mediterranean basin in recent years, resulting in extensive coastal flooding and storm surges, and have occasionally been responsible for several casualties. Considering that the development mechanism of these events is similar to tropical cyclones, it is plausible that these phenomena are strongly affected by sea surface temperatures (SSTs) during their development period (winter and autumn seasons). In this study, we compared satellite data and the numerical reanalysis of SSTs from 1969 to 2023 with in situ data from dataloggers installed at different depths off the coast of southeastern Sicily as well as from data available on Argo floats on the Mediterranean basin. A spectral analysis was performed using a continuous wavelet transform (CWT) for each SST time series to highlight the changes in SSTs prior to the occurrence of Mediterranean Hurricanes as well as the energy content of the various frequencies of the SST signal. The results revealed that decreases in SST occurred prior to the formation of each Mediterranean hurricane, and that this thermal drop phenomenon was not observed in intense extra‐tropical systems. The spectral analyses revealed that high CWT coefficients representing high SST energy contents were observed before the occurrence of a Mediterranean hurricane. This information may provide a useful fingerprint for distinguishing Mediterranean hurricanes from common seasonal storms at the onset of these events

Intraoperative radiotherapy for locally advanced prostate cancer: Treatment technique and ultra sound-based analysis of dose distribution

Background: To present the technique and dose distribution of intraoperative radiotherapy (IORT) for prostate cancer. Patients and Methods: Pelvic lymphadenectomy, prostate IORT and radical retropubic prostatectomy was performed in 11 prostate cancer patients. Prostate thickness and rectum depth were measured with intraoperative ultrasound. IORT was delivered by a mobile linear accelerator in the operating room (electron beam, 12 Gy at 90% isodose). Results: The mean preoperative probability of organ-confined disease was 10% (Memorial Sloan Kettering Cancer Center nomograms). Mean prostate thickness, width and length were 3.4 cm, 4.6 and 4.9 cm, respectively. Mean rectum depth was 3.3 cm. Mean doses to the posterior prostate capsule, 5-mm lateral prostate margins and at the subsequent uretheral stump area were 4.6 Gy, 8.7 Gy and 11.3 Gy, respectively. Maximum mean rectal dose was 4.9 Gy. Conclusion: IORT appeared a feasible approach for prostate cancer, showing a satisfactory dose coverage to the prostate bed with relatively low rectal dose. However, high variability in dose distribution calls for further study of patient selection criteria and dosimetry

Activity-based costing analysis of the analgesic treatments used in postoperative pain management in Italy

BACKGROUND: The aim of this analysis is to evaluate the costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in nine different Italian hospitals, defined as the cumulative cost of drugs, consumable materials and time required for anesthesiologists, surgeons and nurses to administer each analgesic technique. METHODS: Nine Italian hospitals have been involved in this study through the administration of a questionnaire aimed to acquire information about the Italian clinical practice in terms of analgesia. This study uses activity-based costing (ABC) analysis to identify, measure and give value to the resources required to provide the therapeutic treatment used in Italy to manage the postoperative pain patients face after surgery. A deterministic sensitivity analysis (DSA) has been performed to identify the cost determinants mainly affecting the final cost of each treatment analyzed. Costs have been reclassified according to three surgical macro-areas (abdominal, orthopedic and thoracic) with the aim to recognize the cost associated not only to the analgesic technique adopted but also to the type of surgery the patient faced before undergoing the analgesic pathway. RESULTS: Fifteen different analgesic techniques have been identified for the treatment of moderate to severe pain in patients who underwent a major abdominal, orthopedic or thoracic surgery. The cheapest treatment actually employed is the oral administration "around the clock" (€ 8.23), whilst the most expensive is continuous peripheral nerve block (€ 223.46). The intravenous patient-controlled analgesia costs € 277.63. In terms of resources absorbed, the non-continuous administration via bolus is the gold standard in terms of cost-related to the drugs used (€ 1.28), and when administered pro re nata it also absorbs the lowest amount of consumables (€0.58€) compared to all other therapies requiring a delivery device. The oral analgesic administration pro re nata is associated to the lowest cost in terms of health professionals involved (€ 6.25), whilst intravenous PCA is the most expensive one (€ 245.66), requiring a massive monitoring on the part of physicians and nurses. CONCLUSIONS: The analysis successfully collected information about costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in all the nine different Italian hospitals. The interview showed high heterogeneity in the treatment of moderate to severe pain after major abdominal, orthopedic and thoracic surgeries among responding anesthesiologists, with 15 different analgesic modalities reported. The majority of the analgesic techniques considered in the analysis is not recommended by any guideline and their application in real life can be one of the reasons for the high incidence of uncontrolled pain, which is still reported in the postoperative period. Health care costs have become more and more important, although the choice of the best analgesic treatment should be a compromise between efficacy and economic considerations

Intraoperative radiotherapy for locally advanced prostate cancer: The experience of the European institute of oncology

INTRODUCTION AND OBJECTIVE: To present the technique adopted for intraoperative radiotherapy (IORT) for locally advanced prostate cancer. METHODS: Between June 2005 and February 2007, 24 patients (pts) with non-metastatic prostate cancer were treated with IORT before prostatectomy as part of their surgical procedure. Median DJHZDV\HDUVUDQJH7HQSWVZHUHFODVVL\ubfHGDV 7FSWVDV\u9577KHPHGLDQL36$ZDVQJPODQGWKH median bioptic Gleason Score was 7. According to NCCN 2007, risk group distribution was as follows: intermediate risk 2 pts (8.33%) and high risk 22 pts (91.67%). A total of 11 pts (45.83%) were treated with neoadjuvant hormones. Immediately before IORT prostate dimensions and rectum depth were measured with intraoperative ultrasound. IORT was delivered by a mobile linear accelerator in the operating room. The prescribed dose was 12 Gy at the 90% isodose. In vivo dosimetry was performed. Three months later, postoperative external beam radiotherapy (EBRT) of 45-50,4 Gy in 25-28 fractions was prescribed to the prostatic bed alone and whole pelvis in case of pT3-4 pN0 and pN1, respectively. RESULTS: According to the MSKCC nomograms, the mean SUHRSHUDWLYHSUREDELOLW\RIRUJDQFRQ\ubfQHGGLVHDVHH[WUDFDSVXODUGLVHDVH and lymph node involvement were 8%, 40% and 25% respectively. 3RVWRSHUDWLYHKLVWRORJLFDO\ubfQGLQJVZHUHDVIROORZVPHGLDQ*6UDQJH 6-9), pT2 7 pts (29,2%), pT3 14 pts (58,3), pT4 3 (12,5%), pN0 12 pts, S1SWV2UJDQFRQ\ubfQHGGLVHDVHS7S15ZDVGLDJQRVHGLQ pts (16.6%) and no further radiation treatment was prescribed. Based RQWKHGH\ubfQLWLYHKLVWRORJLFDOUHSRUWVSRVWRSHUDWLYHSHOYLFDQGSURVWDWLF bed EBRT is planned in 12 and 8 pts, respectively. After a median follow up of 9.2 months (range 3.3-15.7) only 1 patient had evidence of biochemical relapse. No patients had major acute rectal toxicity. No acute urinary toxicity was observed in 6 patients, 17 patients had G1 toxicity. No increased risk of urinary incontinence was recorded. CONCLUSIONS: IORT delivered before prostatectomy appeared a feasible and safe approach for prostate cancer, showing a satisfactory dose coverage to the prostate bed with relatively low rectal wall dose. Longer follow-up is needed to evaluate late toxicity and clinical control