Laparoscopic hyperthermic isolated limb perfusion a new minimally invasive approach for HILP

Hyperthermic isolated limb perfusion (HILP) represents a limb-sparing treatment for unresectable soft tissue sarcoma (STS) of the extremities with substantial complete response rates. HILP often provides good functional limb preservation, hence a significant improvement also in terms of quality of life of the patient. Notwithstanding these clear advantages, the traditional technique is still hindered by relatively high post-operative morbidity.We treated a 78-year-old female with unresectable angiosarcoma of the left leg using a new surgical approach: an entirely laparoscopic HILP.No conversion from laparoscopic to "open" surgery was necessary. Since no abdominal muscle section was performed, post-operative pain was low and easily manageable; early mobilisation and early discharge were achieved. Patient developed moderate toxicity, which resolved spontaneously within 3-4 weeks, with complete return to normal daily activities after 30 d. Complete clinical response with preservation of leg function was obtained.We describe for the first time an entirely laparoscopic HILP. Demonstration of this technique's efficacy and safety on a large series of patients is clearly necessary but its therapeutic efficacy appears to be comparable to the standard technique. Furthermore, laparoscopic HILP has shown low post-operative morbidity: no wound complications, mild and easily manageable post-operative pain and early discharge from the hospital and early resuming of daily activities

The rotor as a sensor – observing shear and veer from the operational data of a large wind turbine

This paper demonstrates the observation of wind shear and veer directly from the operational response of a wind turbine equipped with blade load sensors. Two independent neural-based observers, one for shear and one for veer, are first trained using a machine-learning approach and then used to produce estimates of these two wind characteristics from measured blade load harmonics. The study is based on a dataset collected at an experimental test site featuring a highly instrumented 8 MW wind turbine, an IEC-compliant (International Electrotechnical Commission) met mast, and a vertical profiling lidar reaching above the rotor top. The present study reports the first demonstration of the measurement of wind veer with this technology and the first validation of shear and veer with respect to lidar measurements spanning the whole rotor height. Results are presented in terms of correlations, exemplary time histories, and aggregated statistical metrics. Measurements of shear and veer produced by the observers are very similar to the ones obtained with the widely adopted profiling lidar while avoiding its complexity and associated costs.</p

Dispersal of methicillin resistant Staphylococcus aureus (MRSA) in a burn intensive care unit

Methicillin resistant Staphylococcus aureus (MRSA) is a pathogen of special concern in intensive care units (ICUs). The burn units are a very susceptible habitat to colonization and infection events by this organism. In this paper isolation of MRSA from a sepsis case and from samples of the care unit air is described, along with simultaneous circulation of two clones of MRSA. Some peculiar epidemiological features of MRSA in burn intensive care wards are confirmed

Il danno indiretto

Il capitolo descrive analiticamente gli elementi costitutivi del danno erariale indiretto e le questioni problematiche sollevate dall'istituto. In particolare si ricostruiscono i rapporti tra giudizio risarcitorio in sede ordinaria e azione di rivalsa contabile, compresa la possibilità di utilizzare le prove raccolte nel primo giudizio all'interno del secondo, la possibile concorrenza della rivalsa civilistica e dell'azione di responsabilità amministrativa e la querelle giurisprudenziale sul dies a quo di decorrenza del termine di prescrizione dell'azione innanzi alla Corte dei conti, offrendo soluzioni precarie ma possibilmente innovative ai profili critici ancora insoluti. Il contributo costituisce un aggiornamento al 2019 di quanto già pubblicato sul volume "La nuova Corte dei conti" e contiene conclusioni parzialmente divergenti rispetto al precedente

Safety and feasibility of fasting\u2010mimicking diet and effects on nutritional status and circulating metabolic and inflammatory factors in cancer patients undergoing active treatment

In preclinical studies, fasting was found to potentiate the effects of several anticancer treatments, and early clinical studies indicated that patients may benefit from regimes of modified fasting. However, concerns remain over possible negative impact on the patients\u2019 nutritional status. We assessed the feasibility and safety of a 5\u2010day \u201cFasting\u2010Mimicking Diet\u201d (FMD) as well as its effects on body composition and circulating growth factors, adipokines and cyto/chemokines in cancer patients. In this single\u2010arm, phase I/II clinical trial, patients with solid or hematologic malignancy, low nutritional risk and undergoing active medical treatment received periodic FMD cycles. The body weight, handgrip strength and body composition were monitored throughout the study. Growth factors, adipokines and cyto/chemokines were assessed by ELISA. Ninety patients were enrolled, and FMD was administered every three weeks/once a month with an average of 6.3 FMD cycles/patient. FMD was largely safe with only mild side effects. The patients\u2019 weight and handgrip remained stable, the phase angle and fat\u2010free mass increased, while the fat mass decreased. FMD reduced the serum c\u2010peptide, IGF1, IGFBP3 and leptin levels, while increasing IGFBP1, and these modifications persisted for weeks beyond the FMD period. Thus, periodic FMD cycles are feasible and can be safely combined with standard antineoplastic treatments in cancer patients at low nutritional risk. The FMD resulted in reduced fat mass, insulin production and circulating IGF1 and leptin. This trial was registered on Clinicaltrials.gov in July 2018 with the identifier NCT03595540

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system. Results A total of 3288 patients were included in the analysis, of whom 301 (9 center dot 2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P &lt; 0 center dot 001). There were no significant differences in rates of readmission between these groups (6 center dot 6 versus 8 center dot 0 per cent; P = 0 center dot 499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0 center dot 90, 95 per cent c.i. 0 center dot 55 to 1 center dot 46; P = 0 center dot 659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34 center dot 7 versus 39 center dot 5 per cent; major 3 center dot 3 versus 3 center dot 4 per cent; P = 0 center dot 110). Conclusion Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P &lt; 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients