Safe introduction of laparoscopic and retroperitoneoscopic nephrectomy in clinical practice: impact of a modular training program

Purpose: To describe and validate a novel modular training scheme (MTS) for trans-peritoneal laparoscopic nephrectomy (LN) and retroperitoneoscopic nephrectomy (RN). Methods: Four consultant urologists attended a Masterclass in âAdvanced Laparoscopic and Robotic Surgery,â certified by the University of Turin (IT). The Masterclass was based on a supervised MTS, which involved progressive, proficiency-based training through nine and seven steps for LN and RN, respectively. After becoming proficient in all the steps, each trainee performed a minimum of five procedures as first operator under direct observation of the mentor in the training centre. Then, each trainee independently performed 10 LN and 10 RN at his home institution. The surgical outcomes were compared with those from a contemporary series of procedures performed by the mentor. Results: All trainees successfully completed the 12-week MTS program. Median number of training cases to become competent in trans-peritoneal LN and RN was 13.0 (IQR 11.5â20.5) and 23.5 (IQR 19.5â32.0), respectively. A significantly higher rate of conversion to open surgery was observed for RNs independently performed by the trainees in their hospital compared to the mentor (p = 0.033). Failure to progress due to difficult anatomical orientation and abdominal wall bleeding during dissection of retroperitoneal space were the most frequent reasons of conversion. Conclusions: A 12-week intensive modular program allows to achieve proficiency in performing independently LN and a RN after a median of 13 and 23.5 cases, respectively. Therefore, these procedures can be safely introduced and implemented in clinical practice within a relatively short time

Deltamethrin Residues in Milk and Cheese of Lactating Goats (Capra hircus)

peer-reviewedThe distribution of pyrethroid insecticide deltamethrin (DLM) in goat milk and cheese (caciotta) following pour-on administration at the sheep dosage (DLMS-10 mL/60 kg body weight) and double dosage (DLMD-20 mL/60 kg body weight) was studied. DLM concentrations were measured in milk collected from study animals (No.14) before treatment and at 2, 4, 8, 12, 16, 24, 30, 36, 48, 56, until 168 h (7 days) post treatment and in caciotta cheese at 12 and 24 h post treatment. At both dosages, the maximum level of DLM residues in goat milk and cheese was below the maximum residue limit (MRL) of 20 μg kg−1 established for bovine milk (EU No 37/2010) at all time points. However, in terms of public health, higher DLM residues in cheese show that further specific studies should be performed on double dosage efficacy and pharmacokinetic and pharmacodynamics properties of ectoparasites in lactating goats

Vector-borne pathogens of zoonotic concern in hunting dogs of southern Italy

Dogs are commonly exposed to vector-borne pathogens (VBPs), yet few data are available on hunting dogs, which are often at high risk of infection due to their involvement in field activities. To investigate the occurrence of VBPs and evaluate the relative performance of different diagnostic tools, blood and serum samples were collected from hunting dogs (n = 1,433) in rural areas of southern Italy. All samples were tested by Knott's technique for filarioids, serologically (SNAP® 4Dx® Plus) for Anaplasma spp., Borrelia burgdorferi sensu lato, Dirofilaria immitis and Ehrlichia spp. and molecularly (qPCR) for all except B. burgdorferi of the above pathogens plus Babesia spp. and Leishmania infantum. Logistic regression was run to evaluate the statistical associations between the risk of VBP infection and independent variables (such as geographic area of provenience, age class and sex) and K-Cohen formula for assessing the concordance among diagnostic tests. Overall, out of 321 dogs (22.4%) positive to at least one VBP, 28 (1.9%) were infected by filarial species at the Knott's technique. In particular, Acanthocheilonema reconditum was the most prevalent (1.6%), followed by D. immitis (0.2%) and Dirofilaria repens (0.1%). One hundred forty (9.8%) and 231 (16.1%) dogs scored positive to VBPs by serological and molecular methods, respectively. The most prevalent pathogens detected were Ehrlichia spp. (7.3%) with SNAP® 4Dx® Plus, and A. reconditum (7.7%) by qPCR. Statistics revealed a significant association (p < 0.001) between A. reconditum infestation and both Ehrlichia spp. seropositivity and geographical origin of dogs. An agreement of 99.9%, 94.0% and 95.7% for Knott - SNAP® 4Dx® Plus, Knott - qPCR and SNAP® 4Dx® Plus - qPCR for D. immitis was found, respectively. Data demonstrate a high prevalence of VBPs in hunting dogs, indicating that this group of animals is largely exposed to several arthropod vector species and suggesting the transmission risk of pathogens to humans in rural areas of southern Italy. A multi-diagnostic approach and a deeper cooperation among healthcare and stakeholders are required to prevent VBP infections to animals and humans

Efficacy and Safety of Neem Oil for the Topical Treatment of Bloodsucking Lice Linognathus stenopsis in Goats under Field Conditions

: The aim of the present study was to evaluate the efficacy and safety of neem oil on caprine pediculosis and on kids' growth performances. The neem (Azadirachta indica) belongs to the Meliaceae family, and in Eastern countries it is mainly considered for the insecticidal activities of the kernel oil. The neem seeds contain bioactive principles, such as azadirachtin A, salannin, nimbin, and nimbolide. The trial was carried out on 24 kids, 120 days old, maintained in open yards. Animals were divided in 4 homogeneous groups (n = 6 animals/group) based on age, louse count, body condition score (BCS) and live body weight: Control Group (C, saline NaCl, 0.9%), Neem Group 1 (NO-100, 100 mL of neem oil per 10 kg), Neem Group 2 (NO-200, 200 mL/10 kg), Neem Group 3 (NO-300, 300 mL/10 kg). The treatments were performed by spraying the insecticide on the goat's body. The study lasted 56 days, and weekly, the kids underwent louse count, BCS and body weight determination, and FAMACHA score. Data were analyzed by ANOVA for repeated measures. The species of lice identified was Linognathus stenopsis. Kids belonging to NO-200 and NO-300 showed a stronger reduction of louse count throughout the study (>95%). The daily weight gain recorded was significantly higher (p < 0.05) in NO-300 than C. No differences were found for BCS and FAMACHA scores. The results of this trial showed that the administration of neem oil to control caprine pediculosis caused by sucking lice represents an alternative to synthetic compounds

Development Methodology of the Novel Endoscopic Stone Treatment Step 2/A Training/Assessment Curriculum and a Roadmap on Developing Hands-on Training Curriculums in Future: An International Collaborative Work by European Association of Urology Sections

Background: Basic simulation training in endourology was established with the endoscopic stone treatment step 1 (EST-s1), which is now recognized worldwide for training and examination. Following on from EST-s1, the endoscopic stone treatment step 2 (EST-s2) was started by the European Association of Urology (EAU) sections. Objective: We describe the methodology used in the development of EST-s2 assessment curriculum. Materials and Methods: The "full-life cycle curriculum development" template was followed for curriculum development, focusing on intermediate training of EST protocol with complex endourologic tasks. A cognitive task analysis (CTA) was run in accordance with EAU Urolithiasis guidelines. The protocol and its details underwent a first consensus by Delphi method with EAU Urolithiasis Section experts in March 2017. Once the outcome and metrics were decided, curriculum development was carried out. Purpose-built stones were developed, and simulator system requirement was defined. Preliminary testing was done in European Urology Residents Education Programme 2019 and in phase five the protocol was finalized with full tutor instruction sheet. Results: The EST-s2/A curriculum development took 38 months and involved EAU Uro-technology and urolithiasis sections with coordination from the European School of Urology training group. Starting from the initial CTA, a 1277-word revision with preliminary task description was produced. Nine intermediate skills were identified and included in the final training protocol. The training content and session evaluations were carried out by 26 experts and 16 final year trainees, respectively. Although the experts agreed that EST-s2/A protocol was well structured (96%), covered the complex endourologic maneuvers (92%), and was useful to optimize and improve hands-on-training (HoT) sessions (92%), the overall evaluation was scored 4.25/5 by trainees. Conclusion: We describe the development methodology for intermediate EST curriculum, which also provides a roadmap on developing other HoT protocols in future. Patients Summary: In this report we described the development of the novel intermediate training curriculum for EST, called EST-s2, which took 3 years of collaborative work inside the EAU. This article is aimed to strengthen the standards in curriculum development and clearly describe the background of this new EAU official endourology protocol

Evaluation of a remote-controlled laparoscopic camera holder for basic laparoscopic skills acquisition : a randomized controlled trial

Unsteady camera movement and poor visualization contribute to a difficult learning curve for laparoscopic surgery. Remote-controlled camera holders (RCHs) aim to mitigate these factors and may be used to overcome barriers to learning. Our aim was to evaluate performance benefits to laparoscopic skill acquisition in novices using a RCH. Novices were randomized into groups using a human camera assistant (HCA) or the FreeHand v1.0 RCH and trained in the (E-BLUS) curriculum. After completing training, a surgical workload questionnaire (SURG-TLX) was issued to participants. Forty volunteers naïve in laparoscopic skill were randomized into control and intervention groups (n = 20) with intention-to-treat analysis. Each participant received up to 10 training sessions using the E-BLUS curriculum. Competency was reached in the peg transfer task in 5.5 and 7.6 sessions for the ACH and HCA groups, respectively (P = 0.015), and 3.6 and 6.8 sessions for the laparoscopic suturing task (P = 0.0004). No significance differences were achieved in the circle cutting (P = 0.18) or needle guidance tasks (P = 0.32). The RCH group experienced significantly lower workload (P = 0.014) due to lower levels of distraction (P = 0.047). Remote-controlled camera holders have demonstrated the potential to significantly benefit intra-operative performance and surgical experience where camera movement is minimal. Future high-quality studies are needed to evaluate RCHs in clinical practice. ISRCTN 8373397

Psychosocial risk factors in cardiac practice

A large number of studies investigated the link between psychosocial risk factors and atherosclerosis or cardiac events. They found that emotional factors and chronic stressors strongly influence the course of coronary artery disease, by promoting the same pathophysiological mechanisms responsible for atherosclerosis. Thus, cardiologists often find in cardiac practice patients that presents psychosocial risk factors, needing the development of interventions aimed to management of these factors. Some of these interventions are the same that are traditionally used in clinical practice, such as exercise training and nutritional counselling, while others are more specific, and require the presence of psychologists (behavioral strategies, relaxation training, social support, etc.). Behavioral cardiology is an emerging field of clinical practice based on the recognition that psychosocial risk factors can promote atherosclerosis and adverse cardiac events. It requires the development of practical solutions aimed at the management of adverse lifestyle behaviours, emotional factors, and chronic stress

Establishment of an in Vitro Human Blood-Brain Barrier Model Derived from Induced Pluripotent Stem Cells and Comparison to a Porcine Cell-Based System

The blood-brain barrier (BBB) is responsible for the homeostasis between the cerebral vasculature and the brain and it has a key role in regulating the influx and efflux of substances, in healthy and diseased states. Stem cell technology offers the opportunity to use human brain-specific cells to establish in vitro BBB models. Here, we describe the establishment of a human BBB model in a two-dimensional monolayer culture, derived from human induced pluripotent stem cells (hiPSCs). This model was characterized by a transendothelial electrical resistance (TEER) higher than 2000 Ω∙cm2 and associated with negligible paracellular transport. The hiPSC-derived BBB model maintained the functionality of major endothelial transporter proteins and receptors. Some proprietary molecules from our central nervous system (CNS) programs were evaluated revealing comparable permeability in the human model and in the model from primary porcine brain endothelial cells (PBECs)

First observation of quantum interference in the process phi -> KS KL ->pi+pi-pi+pi-: a test of quantum mechanics and CPT symmetry

We present the first observation of quantum interference in the process phi -> KS KL ->pi+pi-pi+pi-. This analysis is based on data collected with the KLOE detector at the e^+e^- collider DAFNE in 2001--2002 for an integrated luminosity of about 380pb^-1. Fits to the distribution of Delta t, the difference between the two kaon decay times, allow tests of the validity of quantum mechanics and CPT symmetry. No deviations from the expectations of quantum mechanics and CPT symmetry have been observed. New or improved limits on various decoherence and CPT violation parameters have been obtainedComment: submitted to Physics Letter B one number changed old:gamma=(1.1+2.9-2.4)10^-21 GeV new:(1.3+2.8-2.4)10^-21GeV corrected typo