Gabapentin potentiates sensitivity to the interoceptive effects of alcohol and increases alcohol self-administration in rats

Gabapentin, a drug used in the treatment of epileptic seizures and neuropathic pain, has shown efficacy in the treatment of alcohol dependence. Moreover, given that gabapentin is used in the general population (e.g., non-dependent individuals, social drinkers), we sought to utilize preclinical assessments to examine the effects of gabapentin on sensitivity to moderate alcohol doses and alcohol self-administration in rats with a history of moderate drinking. To this end, we assessed whether gabapentin (0, 10, 30, 120 mg/kg, IG) pretreatment alters sensitivity to experimenter- and self-administered alcohol, and whether gabapentin alone has alcohol-like discriminative stimulus effects in rats trained to discriminate a moderate alcohol dose (1 g/kg, IG) vs. water. Second, we assessed whether gabapentin (0, 10, 30, 60 mg/kg, IG) would alter alcohol self-administration in rats with a history of moderate alcohol consumption. Gabapentin pretreatment potentiated the interoceptive effects of both experimenter-administered and self-administered alcohol in discrimination-trained rats. Additionally, the highest gabapentin doses tested (30 and 120 mg/kg) were found to have partial alcohol-like discriminative stimulus effects when administered alone (e.g., without alcohol). In the self-administration trained rats, gabapentin pretreatment (60 mg/kg) resulted in an escalation in alcohol self-administration. Given the importance of interoceptive drug cues in priming and maintaining self-administration, these data define a specific behavioral mechanism (i.e., potentiation of alcohol effects) by which gabapentin may increase alcohol self-administration in non-dependent populations

Results of Iliac Branch Devices in Octogenarians Within the pELVIS Registry

Purpose:To evaluate if the elderly could benefit from the implantation of iliac branch devices (IBDs) to preserve the patency of the internal iliac artery (IIA) in aneurysms involving the iliac bifurcation.Materials and Methods:From January 2005 to April 2017, 804 patients enrolled in the pELVIS registry underwent endovascular aneurysm repair with 910 IBDs due to aneurysmal involvement of the iliac bifurcation. Among the 804 patients, 157 (19.5%) were octogenarians (mean age 82.9 +/- 2.5 years; 157 men) with 171 target IIAs for preservation. Outcomes at 30 days included technical success, death, conversion to open surgery, and major complications. Outcomes evaluated in follow-up were patency of the IBD and target vessels, type I and type III endoleaks, aneurysm-related reinterventions, aneurysm-related death, and overall patient survival. Kaplan-Meier analyses were employed to evaluate the late outcome measures; the estimates are presented with the 95% confidence interval (CI).Results:Technical success was 99.4% with no intraoperative conversions or deaths (1 bridging stent could not be implanted, and the IIA was sacrificed). Perioperative mortality was 1.9%. The overall perioperative aneurysm-related complication rate was 8.9% (14/157), with an early reintervention rate of 5.1% (8/157). Median postoperative radiological and clinical follow-up were 21.8 months (range 1-127) and 29.3 months (range 1-127), respectively. Estimated rates of freedom from occlusion of the IBD, the IIA, and the external iliac artery at 60 months were 97.7% (95% CI 96.1% to 99.3%), 97.3% (95% CI 95.7% to 98.9%), and 98.6% (95% CI 97% to 99.9%), respectively. Estimated rates of freedom from type I and type III endoleaks and device migration at 60 months were 90.9% (95% CI 87% to 94.3%), 98.7% (95% CI 97.5% to 99.8%), and 98% (95% CI 96.4% to 99.6%), respectively. Freedom from all cause reintervention at 60 months was 87.4% (95% CI 82.6% to 92.2%). The estimated overall survival rate at 60 months was 59% (95% CI 52.4% to 65.6%).Conclusion:IBD implantation in octogenarians provided acceptable perioperative mortality and morbidity rates, with satisfying long-term freedom from IBD-related complications and should be considered a feasible repair option for selected elderly patients affected by aneurysms involving the iliac bifurcation

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Il trattamento dei dati personali alla luce del Regolamento (UE) 2016/679 (GDPR)

La protezione dei dati personali è una tematica che ha assunto importanza rilevante soprattutto negli ultimi anni. Essa è stata rilegata erroneamente sotto il termine privacy, non esaurendone completamente il concetto, dal momento che è funzionale alla protezione della privacy di un individuo, intesa come riservatezza e protezione della sfera privata del soggetto. Il diritto alla protezione dei dati personali ha come finalità quella di proteggere i dati dell’individuo, ovvero tutte quelle informazioni inerenti ai vari aspetti della vita dell’interessato, che lo stesso decide di rendere noto o, al contrario, di non divulgare. Si tratta di una tematica in costante evoluzione e non sempre risulta agevole districarsi in ogni sua particolarità. Basti pensare che da una concezione prettamente materialistica, originariamente riferita alla pura e semplice tutela del diritto di proprietà, si è passati, poi, ad una dimensione incentrata sulla declinazione dei diritti di libertà e dignità della persona. I dati personali, infatti, non vengono più considerati come un qualcosa di cui il titolare ha il possesso materiale, ma come un insieme di informazioni volte ad identificare la persona e la sua personalità. Grande incentivo è stata l’evoluzione della tecnologia, che ha permesso un uso sempre più ampio ed indiscriminato di suddette informazioni, portando alla necessità di bilanciare tra le posizioni giuridiche alla base del nostro essere soggetti di diritto e l’esigenza della predisposizione di tutte le misure adeguate a garantire la sicurezza nazionale. La presente tesi è strutturata in cinque capitoli. Nel primo ho posto l’attenzione sulla nascita ed evoluzione del concetto di privacy, partendo dalle origini, passando per la sua concezione a livello europeo, fino ad arrivare in Italia. Doverosa è stata, poi, l’analisi delle caratteristiche principali circa l’applicazione del nuovo Codice della privacy con il relativo confronto con la normativa europea, fil rouge che caratterizza inevitabilmente la totalità della presente tesi. Nel secondo capitolo mi sono soffermata sull’oggetto del trattamento, focalizzandomi sulla tipologia di dati che possono essere trattati, e sulla liceità dello stesso, tenendo in considerazione la finalità che questo deve avere e su cui vigilano delle figure preposte al controllo. In tal senso ho menzionato quelle del titolare e del responsabile del trattamento e la loro importanza nel garantire un’adeguata protezione ai dati dell’interessato, affiancati da Accredia, quale organismo nazionale che ha il potere di rilasciare certificazioni che attestino il possesso in capo agli organismi di valutazione di adeguate competenze tecniche per svolgere le rispettive funzioni. Il terzo capitolo è incentrato sui principi che disciplinano l’applicazione del Regolamento, ponendo l’attenzione sulla categoria più sensibile dei dati particolari, soggetti a maggiori restrizioni circa l’uso e a più forti misure di garanzia, considerando l’impatto che un trattamento indiscriminato degli stessi potrebbe recare al soggetto interessato, includendo anche l’ipotesi dell’inutilizzabilità degli stessi. Nel quarto capitolo ho affrontato la tematica della tutela che l’interessato dal trattamento ha nei confronti dei propri dati e il ricorso che può fare alla figura del Garante. A tal proposito ho analizzato l’importanza del Garante e dell’Ufficio del Garante, quali tutele ulteriori per l’interessato e la funzione di accertamento e controllo che questi fanno nei confronti del trattamento stesso. Nell’ultimo capitolo, infine, è presente un riferimento alle misure per l’adeguamento dell’Amministrazione Difesa al Regolamento, soffermandomi su quali sono per noi le figure principali del trattamento e le tutele previste

Benefits and Role of Carbon Dioxide Angiography in Case of Misalignment Between Fenestration and Target Vessel During Fenestrated Endovascular Aneurysm Repair

Purpose: To report the benefits and the role of carbon dioxide (CO2) angiography in case of misalignment between fenestration and target vessel during fenestrated endovascular aneurysm repair (F-EVAR). Technique: During F-EVAR, misalignment between fenestration and target vessel is a potentially catastrophic complication. In 2 patients, we experienced that one of the target vessels were not visible during standard angiography in different projections after positioning a fenestrated graft and even after cannulation of the corresponding fenestration. In both cases, the graft was sealed to the aortic wall but not in the predictable position. Consequently, acute occlusion of the target vessel was hypothesized. However, CO2 angiography was useful to evaluate patency of the target vessel clarifying the relative position of the fenestration versus the target vessel. Rescue maneuvers were feasible under the guidance of CO2 angiography in order to obtain the cannulation of both renal arteries. In both cases, the procedure was successfully accomplished. Conclusion: In case of misalignment of a fenestration during F-EVAR and non-visualization of the target vessel with standard angiography, CO2 angiography could have the unique and complementary role of clarifying the patency and position of the target vessel. In addition, CO2 could guide the rescue maneuvers