How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

No viable bacterial communities reside in the urinary bladder of cats with feline idiopathic cystitis

Urinary microbial diversities have been reported in humans according to sex, age and clinical status, including painful bladder syndrome/interstitial cystitis (PBS/IC). To date, the role of the urinary microbiome in the pathogenesis of PBS/IC is debated. Feline idiopathic cystitis (FIC) is a chronic lower urinary tract disorder affecting cats with similarities to PBS/IC in women and represents an important problem in veterinary medicine as its aetiology is currently unknown. In this study, the presence of a bacterial community residing in the urinary bladder of cats with a diagnosis of FIC was investigated. Nineteen cats with clinical signs and history of FIC and without growing bacteria in standard urine culture were included and urine collected with ultrasound-guided cystocentesis. Bacterial community was investigated using a culture-dependent approach consisted of expanded quantitative urine culture techniques and a culture-independent approach consisted of 16S rRNA NGS. Several methodological practices were adopted to both avoid and detect any contamination or bias introduced by means of urine collection and processing which could be relevant due to the low microbial biomass environment of the bladder and urinary tract, including negative controls analysis. All the cats included showed no growing bacteria in the urine analysed. Although few reads were originated using 16S rRNA NGS, a comparable pattern was observed between urine samples and negative controls, and no taxa were confidently classified as non-contaminant. The results obtained suggest the absence of viable bacteria and of bacterial DNA of urinary origin in the urinary bladder of cats with FIC

Discovering Coptic Churches at Tebtunis

In 1931 Carlo Anti and Gilbert Bagnani excavated two Coptic churches at Tebtunis in the Fayyum. None of this was published but it has only recently come to light that reports, photos and plans survive in the Istituto Veneto, and that some of the artifacts were sent first to Rome and later transferred to the Turin Museum. In 1933 Bagnani excavated and recorded in a notebook a third church and its attached monastic outbuildings; significantly, the walls of its nave were covered with wall paintings. Above and below these representational scenes were depicted patterns presumably representing hanging tapestries, some of which were copied as watercolors by Gilbert\u2019s wife, Stewart. In 1934 and in 1936, Bagnani had a series of aerial photos taken over the entire site. Through analysis of archival documents, historical photos and artifacts, coming from Anti\u2019s and Bagnani\u2019s campaigns in Egypt (1930-1936), which are now in Italy and Canada, an international team has begun working on the Coptic period in Tebtunis. The team has been able to discover the positions of the three churches, reconstruct their interior design, shed new light on the wall paintings preserved only in black and white photos, and to see the Coptic textile artifacts, now preserved in the Egyptian Museum in Turin, in comparison with the watercolor drawings of Stewart Bagnani

Natural cases of polyarthritis associated with feline calicivirus infection in cats

The limping syndrome is occasionally reported during acute feline calicivirus (FCV) infections or as consequence of vaccination. In this retrospective study, three clinical cases of lameness in household cats naturally infected by FCV were described and phylogeny of the virus were investigated by analysing the hypervariable E region of the ORF2 viral gene. Cats were diagnosed with polyarthritis and FCV RNA or antigens were detected in symptomatic joints. One cat, euthanized for ethical reasons, underwent a complete post-mortem examination and was subjected to histopathological and immunohistochemical investigations. No phylogenetic subgrouping were evident for the sequenced FCV. Histopathology of the euthanized cat revealed diffuse fibrinous synovitis and osteoarthritis eight months after the onset of lameness and the first detection of FCV RNA, supporting the hypothesis of a persistent infection. FCV was demonstrated by immunohistochemistry in synoviocytes and fibroblasts of the synovial membranes. This study provides new data on the occurrence of polyarthritis in FCV-infected cats, demonstrates by immunohistochemistry the presence of FCV in the synovial membranes of a cat with persistent polyarthritis and supports the absence of correlation between limping syndrome and phylogenetic subgrouping of viruses

Feasibility, Reproducibility and Reference Ranges of Left Atrial Strain in Preterm and Term Neonates in the First 48 h of Life

: Left atrial strain (LAS) is the most promising technique for assessment of diastolic dysfunction but few data are available in neonates. Our aim was to assess feasibility and reproducibility, and to provide reference ranges of LAS in healthy neonates in the first 48 h of life. We performed one echocardiography in 30 neonates to assess feasibility and develop a standard protocol for image acquisition and analysis. LAS reservoir (LASr), conduit (LAScd) and contraction (LASct) were measured. We performed echocardiography at 24 and 48 h of life in an unrelated cohort of 90 neonates. Median (range) gestational age and weight of the first cohort were 34.4 (26.4-40.2) weeks and 2075 (660-3680) g. LAS feasibility was 96.7%. Mean (SD) gestational age and weight of the second cohort were 34.2 (3.8) weeks and 2162 (833) g. Mean (SD) LASr significantly increased from 24 to 48 h: 32.9 (3.2) to 36.8 (4.6). Mean (SD) LAScd and LASct were stable: -20.6 (8.0) and -20.8 (9.9), -11.6 (4.9) and -13.5 (6.4). Intra and interobserver intraclass correlation coefficient for LASr, LAScd and LASct were 0.992, 0.993, 0.986 and 0.936, 0.938 and 0.871, respectively. We showed high feasibility and reproducibility of LAS in neonates and provided reference ranges

1-hour time resolution data of PM2.5 composition and gaseous precursors in background Milan: pollution sources and atmospheric processes, and their implications for air quality.

Aim of this study is the investigation of processes leading to atmospheric pollutants formation and ageing in Milan, Po valley, i.e. one of the main hotspot region in Europe. Few 1-hour time resolution campaigns were accomplished in Milan urban area and none of these dealt with simultaneous characterization of atmospheric pollutants in both gas and particle phase. The present study is based on a thorough analysis of hourly data of atmospheric pollutants and of main PM2.5 compounds, and it includes several soluble inorganic aerosols (Cl-, NO2-, NO3-, SO42-, K+, Mg2+, Ca2+, Na+, NH4+), gases (HCl, HNO2, HNO3, NH3, NO, NO2, O3, SO2) organic, elemental and black carbon and meteorological parameters. The data proceed from an intensive sampling campaign in urban background Milan in summer 2012 (Bigi et al., 2017). Data analysis methods used include mean diurnal pattern on weekdays and Sundays, pollution roses, bivariate polar plots and statistical models using backtrajectories. Results show how nitrous acid (HONO) was mainly formed heterogeneously at nighttime, with a dependence of its formation rate on NO2 consistent with observations during the last HONO campaign in Milan in summer 1998, although since 1998 a drop in HONO levels occurred following to the decrease of its precursors. Nitrate showed two main formation mechanisms: one occurring through N2O5 at nighttime and leading to nitrate formation onto existing particles; another occurring both daytime and nighttime following the homogeneous reaction of ammonia gas with nitric acid gas. Air masses reaching Milan influenced nitrate formation depending on their content in ammonia and the timing of arrival. Notwithstanding the low level of SO2 in Milan, its peaks were associated to point source emissions in the Po valley or shipping and power plant emissions SW of Milan, beyond the Apennines. A distinctive pattern for HCl was observed, featured by an afternoon peak and a morning minimum, and best correlated to atmospheric temperature, although it was not possible to identify any specific source. The ratio of primary-dominated organic carbon and elemental carbon on hourly PM2.5 resulted 1.7. Black carbon was highly correlated to elemental carbon and the average mass absorption coefficient resulted MAC= 13.8 0.2 m2 g1. It is noteworthy how air quality for a large metropolitan area, in a confined valley and under enduring atmospheric stability, is nonetheless influenced by sources within and outside the valley

Hourly composition of gas and particle phase pollutants at a central urban background site in Milan, Italy

A comprehensive range of gas and particle phase pollutants were sampled at 1-hour time resolution in urban background Milan during summer 2012. Measurements include several soluble inorganic aerosols (Cl−,NO2−,NO3−,SO42−,Ca2+,K+,Mg2+,Na+,NH4+) and gases (HCl, HNO2,HNO3, NH3, NO, NO2,O3, SO2), organic, elemental and black carbon and meteorological parameters. Analysis methods used include mean diurnal pattern on weekdays and Sundays, pollution roses, bivariate polar plots and statistical models using backtrajectories. Results show how nitrous acid (HONO) was mainly formed heterogeneously at nighttime, with a dependence of its formation rate on NO2 consistent with observations during the last HONO campaign in Milan in summer 1998, although since 1998 a drop in HONO levels occurred following to the decrease of its precursors. Nitrate showed two main formation mechanisms: one occurring through N2O5 at nighttime and leading to nitrate formation onto existing particles; another occurring both daytime and nighttime following the homogeneous reaction of ammonia gas with nitric acid gas. Air masses reaching Milan influenced nitrate formation depending on their content in ammonia and the timing of arrival. Notwithstanding the low level of SO2 in Milan, its peaks were associated to point source emissions in the Po valley or shipping and power plant emissions SW of Milan, beyond the Apennines. A distinctive pattern for HCl was observed, featured by an afternoon peak and a morning minimum, and best correlated to atmospheric temperature, although it was not possible to identify any specific source. The ratio of primary-dominated organic carbon and elemental carbon on hourly PM2.5 resulted 1.7. Black carbon was highly correlated to elemental carbon and the average mass absorption coefficient resulted MAC = 13.8 ± 0.2 m2 g−1. It is noteworthy how air quality for a large metropolitan area, in a confined valley and under enduring atmospheric stability, is nonetheless influenced by sources within and outside the valley

Integrating a Comprehensive Cancer Genome Profiling into Clinical Practice: A Blueprint in an Italian Referral Center

The implementation of cancer molecular characterization in clinical practice has improved prognostic re-definition, extending the eligibility to a continuously increasing number of targeted treatments. Broad molecular profiling technologies better than organ-based approaches are believed to serve such dynamic purposes. We here present the workflow our institution adopted to run a comprehensive cancer genome profiling in clinical practice. This article describes the workflow designed to make a comprehensive cancer genome profiling program feasible and sustainable in a large-volume referral hospital

Next-Generation Sequencing for Screening Analysis of Cystic Fibrosis: Spectrum and Novel Variants in a South–Central Italian Cohort

The incidence of cystic fibrosis (CF) and the spectrum of cystic fibrosis transmembrane conductance regulator (CFTR) gene variants differ among geographic regions. Differences in CF carrier distribution are also reported among Italian regions. We described the spectrum of the CFTR variants observed in a large group of subjects belonging from central–southern Italy. We also provide a predictive evaluation of the novel variants identified. CFTR screening was performed in a south–central Italian cohort of 770 subjects. We adopted a next-generation sequencing (NGS) approach using the Devyser CFTR NGS kit on the Illumina MiSeq System coupled with Amplicon Suite data analysis. Bioinformatics evaluation of the impact of novel variants was described. Overall, the presence of at least one alternative allele in the CFTR gene was recorded for 23% of the subjects, with a carrier frequency of CF pathogenic variants of 1:12. The largest sub-group corresponded to the heterozygous carriers of a variant with a conflicting interpretation of pathogenicity. The common CFTR p.(Phe508del) pathogenic variants were identified in 37% of mutated subjects. Bioinformatics prediction supported a potential damaging effect for the three novel CFTR variants identified: p.(Leu1187Phe), p.(Pro22Thr), and c.744-3C > G. NGS applied to CF screening had the benefit of: effectively identifying asymptomatic carriers. It lies in a wide overview of CFTR variants and gives a comprehensive picture of the carrier prevalence. The identification of a high number of unclassified variants may represent a challenge whilst at the same time being of interest and relevance for clinicians