Combined totally mini-invasive approach in necrotizing pancreatitis: A case report and systematic literature review

Background: Currently, both the step-up approach, combining percutaneous drainage (PD) and video-assisted retroperitoneal debridement (VARD), and endoscopic transgastric necrosectomy (ETN) are mini-invasive techniques for infected necrosis in severe acute pancreatitis. A combination of these approaches could maximize the management of necrotizing pancreatitis, conjugating the benefits from both the experiences. However, reporting of this combined strategy is anecdotal. This is the first reported case of severe necrotizing pancreatitis complicated by biliary fistula treated by a combination of ETN, PD, VARD, and endoscopic biliary stenting. Moreover, a systematic literature review of comparative studies on minimally invasive techniques in necrotizing pancreatitis has been provided. Case presentation: A 59-year-old patient was referred to our center for acute necrotizing pancreatitis associated with multi-organ failure. No invasive procedures were attempted in the first month from the onset: enteral feeding by a naso-duodenal tube was started, and antibiotics were administered to control sepsis. After 4 weeks, CT scans showed a central walled-off pancreatic necrosis (WOPN) of pancreatic head communicating bilateral retroperitoneal collections. ETN was performed, and bile leakage was found at the right margin of the WOPN. Endoscopic retrograde cholangiopancreatography confirmed the presence of a choledocal fistula within the WOPN, and a biliary stent was placed. An ultrasound-guided PD was performed on the left retroperitoneal collection. Due to the subsequent repeated onset of septic shocks and the evidence of size increase of the right retroperitoneal collection, a VARD was decided. The CT scans documented the resolution of all the collections, and the patient promptly recovered from sepsis. After 6 months, the patient is in good clinical condition. Conclusions: No mini-invasive technique has demonstrated significantly better outcomes over the others, and each technique has specific indications, advantages, and pitfalls. Indeed, ETN could be suitable for central WOPNs, while VARD or PD could be suggested for lateral collections. A combination of different approaches is feasible and could significantly optimize the clinical management in critically ill patients affected by complicated necrotizing pancreatitis

Anisakiasis and gastroallergic reactions associated with Anisakis pegreffii infection, Italy.

Human cases of gastric anisakiasis caused by the zoonotic parasite Anisakis pegreffii are increasing in Italy. The disease is caused by ingestion of larval nematodes in lightly cooked or raw seafood. Because symptoms are vague and serodiagnosis is difficult, the disease is often misdiagnosed and cases are understimated

Predicting the Evolution of Literature on Industrial Symbiosis Using Topic Modeling

The aim of this literature review is to suggest future research on industrial symbiosis. This study is based on the analysis of the latent topics related with the industrial symbiosis found in a collection of 611 scientific articles retrieved from Web of Science on 2022/3/11. Our research process applies the topic modelling technique, which allows the grouping of documents that discuss similar topics, even if these topics are not explicitly mentioned in the documents themselves The initial classification of the existing body of works made it possible to identify current trends and developments in the field and the most promising lines of future research. Specifically, we identified 12 themes, which we characterised with a short sentence rather than a single label. Among the 12 themes, we have highlighted those that are attracting increasing attention from scholars, while others are declining or remaining stable over time

Le recenti dinamiche di sviluppo nella regione mediterranea e la visione strategica dell'Unione Europea

La ricerca realizza una sintesi delle recenti dinamiche economico-sociali nell’area del Mediterraneo, con un particolare riferimento agli strumenti d’intervento che l’Unione Europea ha posto in essere per raggiungere alcuni obiettivi strategici per la Regione euro mediterranea. Essa si articola in due direzioni, fra loro connesse e sinergiche: da un lato, l’elaborazione di un quadro sintetico degli aspetti significativi della Regione e dei rapporti economico-sociali tra le diverse Sponde, anche in relazione alla recente crisi internazionale; e, dall’altro, lo stato di avanzamento delle iniziative di cooperazione promosse dalla politica europea per il Mediterraneo, con uno specifico approfondimento ad alcuni ambiti strategici (come le infrastrutture, l’energia e le piccole e medie imprese), tenuto conto dei processi di internazionalizzazione in atto e della crescente influenza geopolitica di nuovi attori (come Russia, India, Cina, Paesi del Golfo Persico)