Preliminary functional results after transanal irrigation in patients undergoing SHiP procedure for low rectal cancer

The short-stump and high-anastomosis pull-through procedure (SHiP) is a newly introduced technique in the treatment of rectal cancer. This procedure does not involve the creation of a diverting ostomy with great improvement of the patients' quality of life in the post-operative period. However, functional post-operative alterations such as low anterior rectal resection syndrome (LARS) may occur. In this context, trans-anal irrigation (TAI) may represent a viable option in the treatment and management of LARS symptoms. The aim of the present study is to investigate the role of TAI in patients operated on SHiP procedure for low rectal cancer. A prospective database of 17 patients who underwent a SHiP procedure was maintained from April 2019 to December 2021. Anal continence and functional outcomes were assessed through LARS score and Cleveland Clinic Incontinence Score (CCIS), respectively. All patients with a LARS score > 21 underwent TAI in the post-operative period. LARS median value was 36 (IQR = 8) and drastically improved after TAI treatment to 3 (IQR = 3), as the CCIS at a mean follow-up of 9 months (SD +/- 5.02). Good functional result was reached in 12 out of 13 patients (92%). Our study confirms that patients with severe post-operative dysfunction could benefit from the use of TAI

Search for gravitational-lensing signatures in the full third observing run of the LIGO-Virgo network

Gravitational lensing by massive objects along the line of sight to the source causes distortions of gravitational wave-signals; such distortions may reveal information about fundamental physics, cosmology and astrophysics. In this work, we have extended the search for lensing signatures to all binary black hole events from the third observing run of the LIGO--Virgo network. We search for repeated signals from strong lensing by 1) performing targeted searches for subthreshold signals, 2) calculating the degree of overlap amongst the intrinsic parameters and sky location of pairs of signals, 3) comparing the similarities of the spectrograms amongst pairs of signals, and 4) performing dual-signal Bayesian analysis that takes into account selection effects and astrophysical knowledge. We also search for distortions to the gravitational waveform caused by 1) frequency-independent phase shifts in strongly lensed images, and 2) frequency-dependent modulation of the amplitude and phase due to point masses. None of these searches yields significant evidence for lensing. Finally, we use the non-detection of gravitational-wave lensing to constrain the lensing rate based on the latest merger-rate estimates and the fraction of dark matter composed of compact objects

Search for eccentric black hole coalescences during the third observing run of LIGO and Virgo

Despite the growing number of confident binary black hole coalescences observed through gravitational waves so far, the astrophysical origin of these binaries remains uncertain. Orbital eccentricity is one of the clearest tracers of binary formation channels. Identifying binary eccentricity, however, remains challenging due to the limited availability of gravitational waveforms that include effects of eccentricity. Here, we present observational results for a waveform-independent search sensitive to eccentric black hole coalescences, covering the third observing run (O3) of the LIGO and Virgo detectors. We identified no new high-significance candidates beyond those that were already identified with searches focusing on quasi-circular binaries. We determine the sensitivity of our search to high-mass (total mass M>70 M⊙) binaries covering eccentricities up to 0.3 at 15 Hz orbital frequency, and use this to compare model predictions to search results. Assuming all detections are indeed quasi-circular, for our fiducial population model, we place an upper limit for the merger rate density of high-mass binaries with eccentricities 0<e≤0.3 at 0.33 Gpc−3 yr−1 at 90\% confidence level

Ultralight vector dark matter search using data from the KAGRA O3GK run

Among the various candidates for dark matter (DM), ultralight vector DM can be probed by laser interferometric gravitational wave detectors through the measurement of oscillating length changes in the arm cavities. In this context, KAGRA has a unique feature due to differing compositions of its mirrors, enhancing the signal of vector DM in the length change in the auxiliary channels. Here we present the result of a search for U(1)B−L gauge boson DM using the KAGRA data from auxiliary length channels during the first joint observation run together with GEO600. By applying our search pipeline, which takes into account the stochastic nature of ultralight DM, upper bounds on the coupling strength between the U(1)B−L gauge boson and ordinary matter are obtained for a range of DM masses. While our constraints are less stringent than those derived from previous experiments, this study demonstrates the applicability of our method to the lower-mass vector DM search, which is made difficult in this measurement by the short observation time compared to the auto-correlation time scale of DM

Terapia neoadiuvante nel cancro gastrico localmente avanzato: revisione della letteratura ed esperienza di un singolo centro.

Il cancro gastrico (CG) rappresenta il quarto cancro per incidenza e la seconda causa di morte legata a neoplasia nel mondo, con oltre 930.000 nuovi casi e 700.000 morti all'anno. Nel mondo l'incidenza del CG varia considerevolmente con livelli massimi in Giappone, Cina e Russia, e minimi livelli in Australia e America del Nord. L'Italia si colloca in una zona intermedia con un'incidenza più elevata nelle regioni centro-settentrionali. La chirurgia è ancora l'unica terapia curativa per il cancro gastrico ad estensione loco regionale. A tal proposito è importante ottenere margini liberi da infiltrazione neoplastica anche microscopica (R0) ed effettuare un'adeguata dissezione linfonodale. Purtroppo nella maggior parte dei casi si giunge alla diagnosi di cancro gastrico quando la malattia neoplastica è ad uno stadio localmente o diffusamente avanzato. Inoltre, anche quando è possibile realizzare una resezione con intento curativo è frequente osservare recidive nei pazienti affetti da CG. Tali considerazioni hanno portato allo sviluppo di differenti schemi terapeutici al fine di ottenere un miglioramento prognostico di questi pazienti. In aggiunta agli schemi di chemioterapia adiuvante, ampiamente studiati, molti autori hanno riportato risultati incoraggianti con l'impiego della chemioterapia neoadiuvante nel cancro gastrico localmente avanzato descrivendo in diversi articoli un miglioramento in termini di sopravvivenza globale (OS) e sopravvivenza libera da malattia (DFS). Scopo di questa tesi è fornire una panoramica quanto più completa possibile sui più recenti sviluppi in questo campo, focalizzando l'attenzione sugli effetti del trattamento neo-adiuvante nel cancro gastrico localmente avanzato. I dati presenti in letteratura suggeriscono un effetto benefico della CT neoadiuvante sulla sopravvivenza. Dal 01/2010 al 06/2014, presso l'area funzionale di Chirurgia Generale ad indirizzo addominale (direttore Prof. Andrea Renda), sono stati reclutati 24 pz affetti da adenocarcinoma gastrico localmente avanzato. Tutti i pz sono stati sottoposti a trattamento chirurgico ed in 2 casi si è fatto ricorso anche alla terapia neoadiuvante, osservando in un caso progressione di malattia ed in un altro mancato downstaging, con ripresa di malattia entro un anno. A causa del ristretto campione la nostra esperienza non ha raggiunto livelli di significatività. Tale esperienza preliminare rappresenta un punto di inizio da cui partire con l'obiettivo di aumentare il campione in esame. Sono necessari ulteriori studi con popolazioni più ampie per chiarire i diversi punti ancora controversi, quali il reale effetto sulla sopravvivenza, il rischio di ritardo nel trattamento chirurgico, la tossicità degli schemi adottati, il migliore schema terapeutico da adottare

Laparoscopic retrieval of retained intraperitoneal drain in the immediate postoperative period: report of two cases

Aim: The purpose of this study is to analyze a "rare" complication on the management of abdominal surgical drains: abdominal drainage’s retention. Starting from our experience we review literature on this topic. Material of study: We report two cases (occurred on 2004 and 2010) of retained intraperitoneal drain occurred in the immediate postoperative period after laparoscopic cholecistectomy. Results: Both patients were successfully treated by early laparoscopic removal. Discussion: We compared our experience with literature. Incidence, ethiology, prevention, diagnosis and treatment of this rare complication are analysed. We also considered the guidelines in the placement of intraperitoneal drains, the different fixation techniques, the causes of fragmentation of the drainage and removal techniques. Conclusions: Retained intraperitoneal drain secondary to fracture and adhesion in the immediate postoperative period is rare but probably underestimated surgical complication. It is impossible to know its real incidence. The role of laparoscopy is emphasized because this approach is cosmetically acceptable, contributes to early recovery and discharge of the patient, and helps to lessen the friction in worsening doctor-patient relationship

Analysis of the Effectiveness of Lornoxicam and Flurbiprofen on Management of Pain and Sequelae Following Third Molar Surgery: A Randomized, Controlled, Clinical Trial

The aim of this study was to analyze the effectiveness of Lornoxicam and Flurbiprofen in reducing perioperative sequelae after impacted mandibular third molar surgery. Ninety-one patients who needed surgical extraction of an impacted mandibular third molar were selected for the study. All subjects were randomly allocated to receive one of the following treatments twice a day for 5 days after surgery: placebo (n = 29), Flurbiprofen (n = 31), or Lornoxicam (n = 31). The primary outcome was postoperative pain, evaluated using the visual analogue scale (VAS) score at 30 min, 2, 6, 12, 24, 48 h, 7 and 10 days following surgery. The secondary outcomes chosen were changes in postoperative swelling and maximum mouth opening values compared to preoperative ones. Compared to placebo, treatment with Flurbiprofen and Lornoxicam was characterised by an improvement in the primary outcome. Moreover, the treatment with Lornoxicam presented significantly lower median pain scores at 2 h (p < 0.001) and at 6 h (p = 0.016) compared to Flurbiprofen and at 2 h (p < 0.001), 6 h (p = 0.01), and at 24 h (p = 0.018) after surgery compared with placebo. Swelling and maximum mouth opening values were not significantly different between the groups at each follow-up session. This trial demonstrated that treatment with Lornoxicam showed a decrease in the incidence and severity of pain in the first postoperative phase following third molar surgery compared to Flurbiprofen and placebo