Hiatoplasty with crura buttressing versus hiatoplasty alone during laparoscopic sleeve gastrectomy

Introduction. In obese patients with hiatal hernia (HH), laparoscopic sleeve gastrectomy (LSG) with cruroplasty is an option but use of prosthetic mesh crura reinforcement is debated. The aim was to compare the results of hiatal closure with or without mesh buttressing during LSG. Methods. Gastroesophageal reflux disease (GERD) was assessed by the Health-Related Quality of Life (GERD-HRQL) questionnaire before and after surgery in two consecutive series of patients with esophageal hiatus ≤ 4 cm2. After LSG, patients in group A (12) underwent simple cruroplasty, whereas in group B patients (17), absorbable mesh crura buttressing was added. Results. At mean follow-up of 33.2 and 18.1 months for groups A and B, respectively (p = 0 006), the mean preoperative GERD-HRQL scores of 16.5 and 17.7 (p = 0 837) postoperatively became 9.5 and 2.4 (p = 0 071). In group A, there was no difference between pre- and postoperative scores (p = 0 279), whereas in group B, a highly significant difference was observed (p = 0 002). The difference (Δ) comparing pre- and postoperative mean scores between the two groups was significantly in favor of mesh placement (p = 0 0058). Conclusions. In obese patients with HH and mild-moderate GERD, reflux symptoms are significantly improved at medium term follow-up after cruroplasty with versus without crura buttressing during LSG.Introduction. In obese patients with hiatal hernia (HH), laparoscopic sleeve gastrectomy (LSG) with cruroplasty is an option but use of prosthetic mesh crura reinforcement is debated. The aim was to compare the results of hiatal closure with or without mesh buttressing during LSG. Methods. Gastroesophageal reflux disease (GERD) was assessed by the Health-Related Quality of Life (GERD-HRQL) questionnaire before and after surgery in two consecutive series of patients with esophageal hiatus ≤ 4 cm2. After LSG, patients in group A (12) underwent simple cruroplasty, whereas in group B patients (17), absorbable mesh crura buttressing was added. Results. At mean follow-up of 33.2 and 18.1 months for groups A and B, respectively (p = 0 006), the mean preoperative GERD-HRQL scores of 16.5 and 17.7 (p = 0 837) postoperatively became 9.5 and 2.4 (p = 0 071). In group A, there was no difference between pre- and postoperative scores (p = 0 279), whereas in group B, a highly significant difference was observed (p = 0 002). The difference (Δ) comparing pre- and postoperative mean scores between the two groups was significantly in favor of mesh placement (p = 0 0058). Conclusions. In obese patients with HH and mild-moderate GERD, reflux symptoms are significantly improved at medium term follow-up after cruroplasty with versus without crura buttressing during LSG

GPM-DPR Observations on TGFs Producing Storms

Unique spaceborne measurements of the three-dimensional structure of convective clouds producing terrestrial gamma ray flashes (TGFs) were performed using both active and passive microwave sensors on board the Global Precipitation Measurement (GPM)-Core Observatory satellite, finding coherent features for nine TGF-producing storms. The delineation of cloud structure using the radar reflectivity factor shows convective cells with significant vertical development and thick layers with high ice content. Compared to other cumulonimbus clouds in the tropics, the TGFs counterparts have higher reflectivity values above 3 and 8 km altitude showing in all cases a cumulonimbus tower and the TGFs locations are very close, or coincident, to these high Z columns, where reflectivity exceeds 50dBz. Using the GPM Microwave Imager radiometer, most thunderstorms show a very strong depression of polarization corrected temperature (PCT) at channel 89GHz, indicating a strong scattering signal by ice in the upper cloud layers. At channel 166GHZ, the difference between vertical and horizontal brightness temperature signal always returns positive values, from 0.2 up to 13.7K indicating a complex structure with randomly/vertically oriented ice particles. The PCT was used to characterize the analyzed storms in terms of hydrometeor types, confirming in 7/9 cases a high likelihood of hail/graupel presence. To perform analysis on the TGFs parent flashes, radio atmospherics data from the Earth Networks Total Lightning Network lightning network were used. Waveform data indicate that all cases are intra-cloud events and TGFs typically take place during the peak of flash rate production. Finally, the analysis of the most intense event is shown

Grasping and releasing agarose micro beads in water drops

The micromanipulation of micro objects is nowadays the focus of several investigations, specially in biomedical applications. Therefore, some manipulation tasks are required to be in aqueous environment and become more challenging because they depend upon observation and actuation methods that are compatible with MEMS Technology based micromanipulators. This paper describes how three grasping-releasing based tasks have been successfully applied to agarose micro beads whose average size is about 60 \u3bcm: (i) the extraction of a single micro bead from a water drop; (ii) the insertion of a single micro bead into the drop; (iii) the grasping of a single micro bead inside the drop. The success of the performed tasks rely on the use of a microgripper previously designed, fabricated, and tested

Renal artery embolization before radical nephrectomy for complex renal tumour: Which are the true advantages?

Introduction: Renal artery embolization is performed before radical nephrectomy (RN) for renal mass in order to induce preoperative infarction and to facilitate surgical intervention through decrease of intraoperative bleeding. Moreover, in metastatic renal cancer it seems to stimulate tumour-specific antibodies, even if no established benefits in clinical response or survival have been reported. The role of preoperative renal artery embolization (PRAE) in management of renal masses has been often debated and its real benefits are still unclear. Nevertheless, in huge and complex renal masses, which are often characterized by a high and anarchic blood supply and rapid local invasion, radical nephrectomy can be challenging even for skilled surgeons. The aim of this prospective randomized study was to evaluate the effectiveness and safety of PRAE in complex masses by comparing perioperative outcomes of RN with and without PRAE.Materials and methods: From December 2015 to May 2018 we enrolled prospectively 64 patients who underwent RN for localized (T2a-b) or locally advanced (T3 and T4) or advanced (N+, M+) renal cancers. Patients were divided in two groups. The first group included 30 patients who underwent PRAE; in the second group we enrolled 34 patients who did not undergo RN without PRAE. Perioperative outcomes in terms of operative time, blood loss, transfusion rate and length of hospitalization were evaluated. Statistical analysis was performed using GraphPad Prism 6.0 software.Results: Median blood loss was 250 ml (50-500) and 400 ml (50-1000) in the first and second group, respectively, with a statistically significant difference (p=0.0066). Median surgical time was 200 min (90-390) and 240 min (130-390) in PRAE and No-PRAE group (p=0.06), respectively. No major complications occurred after embolization. Overall complication rate in Group 1 and 2 was 46.7% (14/30) and 50% (17/34), respectively (p=0.34). No major complications occurred in both groups. The mean follow up was 21,5 months.Conclusions: Our results prove PRAE to be a safe procedure with low complications rate. To our experience, PRAE seems to be a useful tool in surgical management of a large mass and advanced disease

Fournier's gangrene and intravenous drug abuse. An unusual case report and review of the literature

Fournier's gangrene is a potentially fatal emergency condition characterized by necrotizing fasciitis and supported by an infection of the external genital, perineal and perianal region, with a rapid and progressive spread from subcutaneous fat tissue to fascial planes.In this case report, a 52-year-old man, with a history of hepatitis C-virus (HCV)-related chronic liver disease and cocaine use disorder for which he was receiving methadone maintenance therapy, was admitted to the Emergency Department with necrotic tissue involving the external genitalia.Fournier's gangrene is usually due to compromised host immunity, without a precise cause of bacterial infection; here it is linked to a loco-regional intravenous injection of cocaine. A multimodal approach, including a wide surgical debridement and a postponed skin graft, was needed. Here we report this case, with a narrative review of the literature

AGILE Observations of the LIGO-Virgo Gravitational-wave Events of the GWTC-1 Catalog

We present a comprehensive review of AGILE follow-up observations of the Gravitational Wave (GW) events and the unconfirmed marginal triggers reported in the first LIGO-Virgo (LV) Gravitational Wave Transient Catalog (GWTC-1). For seven GW events and 13 LV triggers, the associated 90% credible region was partially or fully accessible to the AGILE satellite at the T 0; for the remaining events, the localization region was not accessible to AGILE due to passages into the South Atlantic Anomaly, or complete Earth occultations (as in the case of GW170817). A systematic search for associated transients, performed on different timescales and on different time intervals about each event, led to the detection of no gamma-ray counterparts. We report AGILE MCAL upper limit fluences in the 400 keV-100 MeV energy range, evaluated in a time window of T 0 ± 50 s around each event, as well as AGILE GRID upper limit (UL) fluxes in the 30 MeV-50 GeV energy range, evaluated in a time frame of T 0 ± 950 s around each event. All ULs are estimated at different integration times and are evaluated within the portions of GW credible region accessible to AGILE at the different times under consideration. We also discuss the possibility of AGILE MCAL to trigger and detect a weak soft-spectrum burst such as GRB 170817A