Valutazione dell'andamento perioperatorio e delle complicazioni in corso di chirurgia toracica: confronto tra toracotomia intercostale, sternotomia e toracoscopia

Riassunto Obbiettivo: confrontare l’andamento perioperatorio in interventi di toracotomia intercostale, sternotomia e toracoscopia nel cane per valutare i vantaggi e gli svantaggi di ciascun approccio. Materiali e metodi: sono stati impiegati nello studio 21 cani sottoposti a toracotomia intercostale, 6 sottoposti a sternotomia e 12 sottoposti a toracoscopia. I pazienti sono stati seguiti nel periodo perioperatorio per registrare: le durate delle chirurgie, la temperatura corporea ad inizio (T0) e a fine intervento (T1), dopo sei ore (T2) e dopo dodici ore (T3) dall’intervento, il presentarsi di bradicardia o ipotensione intraoperatorie; il posizionamento di un drenaggio toracico e la sua permanenza in situ; la durata del ricovero in terapia intensiva. La mortalità in seguito a tali interventi è stata valutata mediante un questionario telefonico effettuato sui proprietari dei cani. Risultati: la durata degli interventi di toracoscopia è risultata significativamente più breve di quella degli interventi di toracotomia intercostale e di sternotomia. Per le temperature, nelle toracoscopie non sono state rilevate differenze statisticamente significative tra nessuno dei tempi di misurazione, al contrario delle toracotomie intercostali e delle sternotomie, in cui abbiamo un forte calo della temperatura tra l’inizio e la fine delle chirurgie. È stata riscontrata una percentuale minore di complicazioni in corso di toracoscopia, mentre non vi è molta differenza tra la percentuale riscontrata nelle toracotomie intercostali rispetto alle sternotomie. Il posizionamento del drenaggio, la durata della sua permanenza e la durata del ricovero in terapia intensiva sono risultati dipendenti dal tipo di intervento eseguito e dalla patologia, non permettendo un confronto tra i tre approcci. La mortalità intraoperatoria e nel ricovero riscontrata è molto bassa. La mortalità a lungo termine è legata ad una diagnosi di neoplasia precedente ed è maggiormente concentrata nei primi 3 mesi dopo l’intervento. Conclusioni: quando possibile, l’utilizzo della toracoscopia è preferibile per una minore durata della chirurgia, una minore dispersione di calore e complicazioni intraoperatorie meno frequenti. Se è necessario effettuare una toracotomia, è consigliabile considerare anche l’utilizzo della sternotomia oltre della toracotomia intercostale. In generale i pazienti hanno dimostrato di tollerare bene interventi di chirurgia toracica, con una durata media del ricovero non elevata e una mortalità a breve termine ridotta. Abstract Purpose: to compare the perioperative period in intercostal thoracotomy, sternotomy and thoracoscopy in the dog to assess benefits and disadvantages of each overtures. Methods: for this study were enrolled 21 dogs underwent intercostal thoracotomy, 6 dogs underwent sternotomy and 12 dogs underwent thoracoscopy. Patients were followed in perioperative period and surgeries duration, body temperature at start (T0) and at the end of surgery (T1), after six hours (T2) and after twelve hours (T3) from surgery, the report of intraoperative bradycardia or hypotension were registered as well as the placement of chest drain and its time of in-situ permanence and hospitalization duration. Mortality after these surgeries were assessed with a telephone questionnaire carried out on owners. Results: duration of thoracoscopic surgeries was significantly shorter than Intercostal thoracotomy and sternotomy. About the temperature, in thoracoscopy were not noticed statistically significant differences between any of measurement times, contrary to intercostal thoracotomy and sternotomy, in which we have a severe temperature drop between the start and the end of surgeries. A lower rate of intraoperative complications were observed in thoracoscopy, while there is not much difference between intercostal thoracotomy rate and sternotomy rate. The placement of chest drain, its time in-situ permanence and hospitalization duration results are dependent on the type of surgery performed and on the pathology, not allowing a comparison between the three overtures. Intraoperative mortality and mortality during the hospitalization was low. The long-term mortality is linked to a previous neoplasia diagnosis and is mainly concentred in the first 3 month after surgery. Conclusions: when it’s possible, the use of thoracoscopy is preferable due to shorter duration of surgery, less heat dispersion and less frequent intraoperative complications. If is required a thoracotomy, is advisable to consider also the use of sternotomy over intercostal thoracotomy. The majority of patients proved to tolerate well this surgery, with a short hospitalization time and a low perioperative mortality

Studies on Air Pollution and Air Quality in Rural and Agricultural Environments: A Systematic Review

Studies on air quality in rural environments are fundamental to obtain first-hand data for the determination of base emissions of air pollutants, to assess the impact of rural-specific airborne pollutants, to model pollutant dispersion, and to develop proper pollution mitigation technologies. The literature lacks a systematic review based on the evaluation of the techniques and methods used for the sampling/monitoring (S/M) of atmospheric pollutants in rural and agricultural settings, which highlights the shortcomings in this field and the need for future studies. This work aims to review the study design applied for on-field monitoring campaigns of airborne pollutants in rural environments and discuss the possible needs and future developments in this field. The results of this literature review, based on the revision of 23 scientific papers, allowed us to determine (i) the basic characteristics related to the study design that should always be reported; (ii) the main techniques and analyses used in exposure assessment studies conducted in this type of setting; and (iii) contextual parameters and descriptors of the S/M site that should be considered to best support the results obtained from the different studies. Future studies carried out to monitor the airborne pollution in rural/agriculture areas should (i) include the use of multiparametric monitors for the contextual measurement of different atmospheric pollutants (as well as meteorological parameters) and (ii) consider the most important boundary information, to better characterize the S/M site

Sistema integrato di previsione delle piene in tempo reale nel bacino idrografico Brenta-Bacchiglione

-Modello idrologico-idrodinamico per la previsione delle piene in tempo reale nel Brenta-Bacchiglione. -Interfaccia grafica GIS funzionale alla gestione delle emergenze in corso di evento. -Limitazione dell\u2019incertezza delle condizioni iniziali forzando il modello con misure di precipitazione e di livello. -Buona precisione e affidabilit\ue0 del sistema confermate dalle simulazioni di eventi passati

Diagnosis, treatment, and follow-up of a case of Wolman disease with hemophagocytic lymphohistiocytosis

: Wolman Disease (WD) is a severe multi-system metabolic disease due to lysosomal acid lipase (LAL) deficiency. We report on a WD infant who developed an unusual hemophagocytic lymphohistiocytosis (HLH) phenotype related to WD treated with sebelipase alfa. A male baby came to our attention at six months of life for respiratory insufficiency and sepsis, abdominal distension, severe hepatosplenomegaly, diarrhea, and severe growth retardation. HLH was diagnosed and treated with intravenous immunoglobulin, steroids, cyclosporine, broad-spectrum antimicrobial therapy, and finally with the anti-IL-6 drug tocilizumab. WD was suspected for the presence of adrenal calcifications and it was confirmed by LAL enzyme activity and by molecular analysis of LIPA. Plasma oxysterols cholestan-3β,5α,6β-triol (C-triol), and 7-ketocholesterol (7-KC) were markedly increased. Sebelipase alfa was started with progressive amelioration of biochemical and clinical features. The child died from sepsis, 2 months after sebelipase discontinuation requested by parents. Our case shows the importance of an early diagnosis of WD and confirms the difficulty to reach a diagnosis in the HLH phenotype. Sebelipase alpha is an effective treatment for LAL deficiency, also in children affected by WD. Further data are necessary to confirm the utility of measuring plasma c-triol as a biochemical marker of the disease

Ancient pathogen-driven adaptation triggers increased susceptibility to non-celiac wheat sensitivity in present-day European populations

Details of sequence profiles for each NCWS subject. (XLSX 47 kb

Management of Pediatric Urinary Tract Infections: A Delphi Study

Urinary tract infection (UTI) is one of the most common infectious diseases in the pediatric population and represents a major cause of antibiotic consumption and hospitalization in children. Considering the ongoing controversies on the management of pediatric UTI and the challenges due to increasing antimicrobial resistance, the aim of the present study was to evaluate the level of agreement on UTI management in pediatric age in Emilia-Romagna Region, Italy, and to assess on the basis of recent studies whether there is the need to change current recommendations used by primary care pediatricians, hospital pediatricians, and pediatric surgeons in everyday clinical practice to possibly improve outcomes. This consensus provides clear and shared indications on UTI management in pediatric age, based on the most updated literature. This work represents, in our opinion, the most complete and up-to-date collection of statements on procedures to follow for pediatric UTI, in order to guide physicians in the management of the patient, standardize approaches, and avoid abuse and misuse of antibiotics. Undoubtedly, more randomized and controlled trials are needed in the pediatric population to better define the best therapeutic management in cases with antimicrobial resistance and real usefulness of long-term antibiotic prophylaxis

Antibiotic Resistance in Paediatric Febrile Urinary Tract Infections

: Febrile urinary tract infection (UTI) is currently considered the most frequent cause of serious bacterial illness in children in the first 2 years of life. UTI in paediatrics can irreversibly damage the renal parenchyma and lead to chronic renal insufficiency and related problems. To avoid this risk, an early effective antibiotic treatment is essential. Moreover, prompt treatment is mandatory to improve the clinical condition of the patient, prevent bacteraemia, and avoid the risk of bacterial localization in other body sites. However, antibiotic resistance for UTI-related bacterial pathogens continuously increases, making recommendations rapidly outdated and the definition of the best empiric antibiotic therapy more difficult. Variation in pathogen susceptibility to antibiotics is essential for the choice of an effective therapy. Moreover, proper identification of cases at increased risk of difficult-to-treat UTIs can reduce the risk of ineffective therapy. In this review, the problem of emerging antibiotic resistance among pathogens associated with the development of paediatric febrile UTIs and the best potential solutions to ensure the most effective therapy are discussed. Literature analysis showed that the emergence of antibiotic resistance is an unavoidable phenomenon closely correlated with the use of antibiotics themselves. To limit the emergence of resistance, every effort to reduce and rationalise antibiotic consumption must be made. An increased use of antibiotic stewardship can be greatly effective in this regard

Switch to raltegravir-based regimens and HIV DNA decrease in patients with suppressed HIV RNA

Raltegravir intensification is associated with an increase in 2-LTR episomal HIV DNA= circles, indicating a persistent low-level replication, in some individuals in ART with suppressed HIV RNA. We aimed at monitoring residual plasma HIV RNA and cellular HIV DNA in virologically suppressed patients switching to a raltegravir-based regimen

Response of high-risk MDS to azacitidine and lenalidomide is impacted by baseline and acquired mutations in a cluster of three inositide-specific genes

Specific myeloid-related and inositide-specific gene mutations can be linked to myelodysplastic syndromes (MDS) pathogenesis and therapy. Here, 44 higher-risk MDS patients were treated with azacitidine and lenalidomide and mutations analyses were performed at baseline and during the therapy. Results were then correlated to clinical outcome, overall survival (OS), leukemia-free-survival (LFS) and response to therapy. Collectively, 34/44 patients were considered evaluable for response, with an overall response rate of 76.25% (26/34 cases): 17 patients showed a durable response, 9 patients early lost response and 8 patients never responded. The most frequently mutated genes were ASXL1, TET2, RUNX1, and SRSF2. All patients early losing response, as well as cases never responding, acquired the same 3 point mutations during therapy, affecting respectively PIK3CD (D133E), AKT3 (D280G), and PLCG2 (Q548R) genes, that regulate cell proliferation and differentiation. Moreover, Kaplan–Meier analyses revealed that this mutated cluster was significantly associated with a shorter OS, LFS, and duration of response. All in all, a common mutated cluster affecting 3 inositide-specific genes is significantly associated with loss of response to azacitidine and lenalidomide therapy in higher risk MDS. Further studies are warranted to confirm these data and to further analyze the functional role of this 3-gene cluster

Complex interplay between neutral and adaptive evolution shaped differential genomic background and disease susceptibility along the Italian peninsula

The Italian peninsula has long represented a natural hub for human migrations across the Mediterranean area, being involved in several prehistoric and historical population movements. Coupled with a patchy environmental landscape entailing different ecological/cultural selective pressures, this might have produced peculiar patterns of population structure and local adaptations responsible for heterogeneous genomic background of present-day Italians. To disentangle this complex scenario, genome-wide data from 780 Italian individuals were generated and set into the context of European/Mediterranean genomic diversity by comparison with genotypes from 50 populations. To maximize possibility of pinpointing functional genomic regions that have played adaptive roles during Italian natural history, our survey included also ∼250,000 exomic markers and ∼20,000 coding/regulatory variants with well-established clinical relevance. This enabled fine-grained dissection of Italian population structure through the identification of clusters of genetically homogeneous provinces and of genomic regions underlying their local adaptations. Description of such patterns disclosed crucial implications for understanding differential susceptibility to some inflammatory/autoimmune disorders, coronary artery disease and type 2 diabetes of diverse Italian subpopulations, suggesting the evolutionary causes that made some of them particularly exposed to the metabolic and immune challenges imposed by dietary and lifestyle shifts that involved western societies in the last centuries