Impact of COVID-19 pandemic on general surgery training program: An Italian experience

The outbreak of COVID-19 infection in Italy started in late February with a rapid and dramatic spread. The hospitals in the most hit regions of Northern Italy started modifying their working schedule and, on the March 9, 2020, the Government approved the lock-down of the whole Country in order to minimize the further spread of the infection and to optimize health-care resources. This drastic measure transformed all hospitals activities, including suspension of all non-urgent outpatient visits and postponable sur- geries. The aim of this paper is to evaluate how this new organiza- tion affected the role of residents in their last year of training at a General Surgery Department in a tertiary center of North-East Italy (Trieste)

Effectiveness of Intraoperative Parathyroid Monitoring (ioPTH) in predicting a multiglandular or malignant parathyroid disease

Aim The main goal of our study was to confirm the usefulness of intra-operative parathyroid hormone (PTH) monitoring (ioPTH) when using minimally invasive techniques for treatment of sporadic Primary hyperparathyroidism (pHTP). Furthermore, we aimed to evaluate if ioPTH monitoring may help to predict the etiology of primary hyperparathyroidism, especially in malignant or multiglandular parathyroid disease. Methods A retrospective review of 125 consecutive patients with pHPT who underwent parathyroidectomy between 2001 and 2016\ua0at the Department of General Surgery was performed. For each patient, the specific preoperative work-up consisted of: high-resolution US of the neck by a skilled sonographer, sestamibi parathyroid scan, laryngoscopy, and serum measurement of PTH, serum calcium levels, and serum 25(OH)D levels. Results The study included 125 consecutive patients who underwent surgery for pHPT. At the histological examination, we registered 113 patients with simple adenomatous pathology (90,4%), 5 atypical adenomas (4%), 3 cases of parathyroid carcinoma (2,4%), and 4 histological exams of different nature (3,2%). Overall, 6 cases (4,8%) of multiglandular disease were found. We reported 10 cases (8%) of recurrent/persistent hyperparathyroidism: 1/10 in a patient affected by atypical adenoma, 9/10 in patients with benign pathology. Regarding these 10 cases, in three (30%) patients, ioPTH wasn't dosed (only frozen section (FS) exam was taken), in 5 cases (50%) ioPTH dropped more than 50% compared to basal value (false negative results), and in 2 (20%) cases, ioPTH did not drop >50% from the first samples taken, the extemporary exam had confirmed the presence of adenoma and the probable second hyperfunctioning adenoma was not found. Conclusions IoPTH determinations ensure operative success of surgical resection in almost all hyperfunctioning tissue; in particular it is very important during minimally invasive parathyroidectomy, as it allows avoiding bilateral neck exploration. The use of ioPTH monitoring offer increased sensitivity in detecting multiglandular disease and can minimize the need and risk associated with recurrent operations, and may facilitate cost-effective minimally invasive surgery. Moreover, intraoperative PTH monitoring could be a reliable marker to predict a malignant disease during parathyroidectomy, showing higher ioPTH baseline value and superior drop compared to benign disease

Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective

Introduction: The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy. Methods: Data were derived from the prospective multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥ 15 years who underwent appendectomy for appendicitis (November 2020-May 2021). Patients were categorized based on SARS-CoV-2 seropositivity: no infection, active infection, and prior infection. Appendectomy method, LOS, and complications were abstracted. The association between SARS-CoV-2 seropositivity and complications was determined using Poisson regression, while the association with LOS was calculated using a quantile regression model. Results: Appendectomy for acute appendicitis was performed in 4047 patients during the second and third European COVID waves. The majority were SARS-CoV-2 uninfected (3861, 95.4%), while 70 (1.7%) were acutely SARS-CoV-2 positive, and 116 (2.8%) reported prior SARS-CoV-2 infection. After confounder adjustment, there was no statistically significant association between SARS-CoV-2 seropositivity and LOS, any complication, or severe complications. Conclusion: During sequential SARS-CoV-2 infection waves, neither active nor prior SARS-CoV-2 infection was associated with prolonged hospital LOS or postoperative complication. Despite early concerns regarding postoperative safety and outcome during active SARS-CoV-2 infection, no such association was noted for those with appendicitis who underwent operative management

Spin states of asteroids in the Eos collisional family

Eos family was created during a catastrophic impact about 1.3 Gyr ago. Rotation states of individual family members contain information about the history of the whole population. We aim to increase the number of asteroid shape models and rotation states within the Eos collision family, as well as to revise previously published shape models from the literature. Such results can be used to constrain theoretical collisional and evolution models of the family, or to estimate other physical parameters by a thermophysical modeling of the thermal infrared data. We use all available disk-integrated optical data (i.e., classical dense-in-time photometry obtained from public databases and through a large collaboration network as well as sparse-in-time individual measurements from a few sky surveys) as input for the convex inversion method, and derive 3D shape models of asteroids together with their rotation periods and orientations of rotation axes. We present updated shape models for 15 asteroids and new shape model determinations for 16 asteroids. Together with the already published models from the publicly available DAMIT database, we compiled a sample of 56 Eos family members with known shape models that we used in our analysis of physical properties within the family. Rotation states of asteroids smaller than ~20 km are heavily influenced by the YORP effect, whilst the large objects more or less retained their rotation state properties since the family creation. Moreover, we also present a shape model and bulk density of asteroid (423) Diotima, an interloper in the Eos family, based on the disk-resolved data obtained by the Near InfraRed Camera (Nirc2) mounted on the W.M. Keck II telescope.Comment: Accepted for publication in ICARUS Special Issue - Asteroids: Origin, Evolution & Characterizatio

EAES Recommendations for Recovery Plan in Minimally Invasive Surgery Amid COVID-19 Pandemic

Background: COVID-19 pandemic presented an unexpected challenge for the surgical community in general and Minimally Invasive Surgery (MIS) specialists in particular. This document aims to summarize recent evidence and experts’ opinion and formulate recommendations to guide the surgical community on how to best organize the recovery plan for surgical activity across diferent sub-specialities after the COVID-19 pandemic. Methods: Recommendations were developed through a Delphi process for establishment of expert consensus. Domain topics were formulated and subsequently subdivided into questions pertinent to diferent surgical specialities following the COVID-19 crisis. Sixty-fve experts from 24 countries, representing the entire EAES board, were invited. Fifty clinicians and six engineers accepted the invitation and drafted statements based on specifc key questions. Anonymous voting on the statements was performed until consensus was achieved, defned by at least 70% agreement. Results: A total of 92 consensus statements were formulated with regard to safe resumption of surgery across eight domains, addressing general surgery, upper GI, lower GI, bariatrics, endocrine, HPB, abdominal wall and technology/research. The statements addressed elective and emergency services across all subspecialties with specifc attention to the role of MIS during the recovery plan. Eighty-four of the statements were approved during the frst round of Delphi voting (91.3%) and another 8 during the following round after substantial modifcation, resulting in a 100% consensus. Conclusion: The recommendations formulated by the EAES board establish a framework for resumption of surgery following COVID-19 pandemic with particular focus on the role of MIS across surgical specialities. The statements have the potential for wide application in the clinical setting, education activities and research work across diferent healthcare systems

A Lyman-alpha-only AGN from the Sloan Digital Sky Survey

The Sloan Digital Sky Survey has discovered a z=2.4917 radio-loud active galactic nucleus (AGN) with a luminous, variable, low-polarization UV continuum, H I two-photon emission, and a moderately broad Lyman-alpha line (FWHM = 1430 km/s) but without obvious metal-line emission. SDSS J113658.36+024220.1 does have associated metal-line absorption in three distinct, narrow systems spanning a velocity range of 2710 km/s. Despite certain spectral similarities, SDSS J1136+0242 is not a Lyman-break galaxy. Instead, the Ly-alpha and two-photon emission can be attributed to an extended, low-metallicity narrow-line region. The unpolarized continuum argues that we see SDSS J1136+0242 very close to the axis of any ionization cone present. We can conceive of two plausible explanations for why we see a strong UV continuum but no broad-line emission in this `face-on radio galaxy' model for SDSS J1136+0242: the continuum could be relativistically beamed synchrotron emission which swamps the broad-line emission; or, more likely, SDSS J1136+0242 could be similar to PG 1407+265, a quasar in which for some unknown reason the high-ionization emission lines are very broad, very weak, and highly blueshifted.Comment: AJ, in press, 10 pages emulateapj forma

The non-convex shape of (234) Barbara, the first Barbarian

Asteroid (234) Barbara is the prototype of a category of asteroids that has been shown to be extremely rich in refractory inclusions, the oldest material ever found in the Solar System. It exhibits several peculiar features, most notably its polarimetric behavior. In recent years other objects sharing the same property (collectively known as "Barbarians") have been discovered. Interferometric observations in the mid-infrared with the ESO VLTI suggested that (234) Barbara might have a bi-lobated shape or even a large companion satellite. We use a large set of 57 optical lightcurves acquired between 1979 and 2014, together with the timings of two stellar occultations in 2009, to determine the rotation period, spin-vector coordinates, and 3-D shape of (234) Barbara, using two different shape reconstruction algorithms. By using the lightcurves combined to the results obtained from stellar occultations, we are able to show that the shape of (234) Barbara exhibits large concave areas. Possible links of the shape to the polarimetric properties and the object evolution are discussed. We also show that VLTI data can be modeled without the presence of a satellite.Comment: 10 pages, 6 figure

Enhanced Cooperation in an Asymmetric Model of Tax Competition

This paper analyzes enhanced cooperation agreements in corporate taxation in a three country tax competition model where countries differ in size. We characterize equilibrium tax rates and the optimal tax responses due to the formation of an enhanced cooperation agreement. Conditions for strategic complementarity or strategic substitutability of tax rates are crucial for the welfare effects of enhanced cooperation. Simulations show that enhanced cooperation is unlikely to be feasible for small countries. When enhanced cooperation is feasible, it may hamper global harmonization. Only when countries are of similar size is global harmonization a feasible outcome

Design and Creative Methods as a Practice of Liminality in Community-Academic Research Projects

This paper aims to explore the types of spaces and experiences that are created by design and creative practices. More specifically, it focuses on how design and creative practices can engender transformations in the mindset, knowledge, emotions and social relations of people who participate in such practices. To do this, the paper investigates the concepts of liminality and liminal spaces, and the relationships between design/creative methods and liminal spaces using insights from four case studies. The results reveal that design and creative practices may create liminal spaces in many ways, such as neutralizing the working environments, encouraging people to experiment with new ideas and helping them express themselves more freely