Does defensive medicine change the behaviors of vascular surgeons? a qualitative review

Although in literature few successful claims have been shown in comparison with other medical specialties such as gynaecology and orthopaedics, vascular surgery is included among high-risk specialties. The high-risk of receiving medical claims may lead vascular surgeons to practice defensive medicine, as is normal in several other areas of clinical practice. No studies are available to our knowledge of the incidence of defensive medicine in the field of vascular surgery. Taking into consideration the scarce amount of information, the authors provide a critical discussion regarding the application of defensive medicine behaviour among vascular surgeon

Mitigating heat stress of dairy cows bred in a free-stall barn by sprinkler systems coupled with forced ventilation

This paper presents the results of a research study which had the objective of investigating the effect of a sprinkler system coupled with forced ventilation on the heat stress of dairy cows bred in a free stall barn without paddock. To this aim, an experiment was carried out inside a free-stall dairy house equipped with two different cooling systems: a fogging system associated with forced ventilation in the resting area and a sprinkler system associated with forced ventilation in the feeding alley. The experiment regarded two adjacent pens of the barn and was constituted by three different trials carried out in the following periods: 27th June – 7th July (P1), 25th July – 4th August (P2), 24th August – 3rd September (P3). The experimental protocol of each trial required that the treatment group was housed in one pen where the two cooling systems were always activated following an established timetable, whereas the control group was housed in the other pen, where the sprinkler system associated with forced ventilation was always deactivated. Climatic parameters were measured inside each pen of the barn and outside. Then, thermal humidity index (THI) was calculated. Rectal temperature and respiration rate of a sample of dairy cows were monitored each day during the three periods considered (P1, P2 and P3). During the three trials the cows of both groups were subjected to climatic conditions that resulted in average daily THI values between 72.8 and 74.7, corresponding to mild or moderate heat stress. However, during daytime, air temperature and relative humidity reached values corresponding to a severe heat stress, as attested by the maximum THI values that were higher than or very close to 80. Furthermore, it was observed that the sprinklers do not influence the microclimatic conditions. However, the physiological parameters values of the treatment group were always significantly lower than the corresponding ones of the control group. Specifically, the system especially influenced the respiration rate that, in the treatment group, was close to 50 breath/min, while in the control group it reached 70 breath/min. The sprinkler system had more limited effects on rectal temperature that, however, in the treatment group was significantly lower than in the control group (38.7°C to 38.8°C vs 39.1°C 39.4°C) in all the three periods of the experiment. These results show that the sprinkler system could be useful to mitigate heat stress in dairy cows

The tumor suppressor gene KCTD11REN is regulated by Sp1 and methylation and its expression is reduced in tumors

A hallmark of several human cancers is loss of heterozygosity (LOH) of chromosome 17p13. The same chromosomal region is also frequently hypermethylated in cancer. Although loss of 17p13 has been often associated with p53 genetic alteration or Hypermethylated in Cancer 1 (HIC1) gene hypermethylation, other tumor suppressor genes (TSGs) located in this region have critical roles in tumorigenesis. A novel TSG mapping on human chromosome 17p13.2 is KCTD11REN (KCTD11). We have recently demonstrated that KCTD11 expression is frequently lost in human medulloblastoma (MB), in part by LOH and in part by uncharacterized epigenetic events. Using a panel of human 177 tumor samples and their normal matching samples representing 18 different types of cancer, we show here that the down-regulation of KCTD11 protein level is a specific and a diffusely common event in tumorigenesis. Additionally, in order to characterize the regulatory regions in KCTD11 promoter, we identified a CpG island and several Sp1 binding sites on this promoter, and demonstrated that Sp1 transcription factor and DNA methylation contribute, at least in part, to regulate KCTD11 expression. Our findings identify KCTD11 as a widely down-regulated gene in human cancers, and provide a basis to understand how its expression might be deregulated in tumor cells

Microenvironmental regulation of the IL-23R/IL-23 axis overrides chronic lymphocytic leukemia indolence

Although the progression of chronic lymphocytic leukemia (CLL) requires the cooperation of the microenvironment, the exact cellular and molecular mechanisms involved are still unclear. We investigated the interleukin (IL)-23 receptor (IL-23R)/IL-23 axis and found that circulating cells from early-stage CLL patients with shorter time-to-treatment, but not of those with a more benign course, expressed a defective form of the IL-23R complex lacking the IL-12R beta 1 chain. However, cells from both patient groups expressed the complete IL-23R complex in tissue infiltrates and could be induced to express the IL-12R. 1 chain when cocultured with activated T cells or CD40L(+) cells. CLL cells activated in vitro in this context produced IL-23, a finding that, together with the presence of IL-23 in CLL lymphoid tissues, suggests the existence of an autocrine/paracrine loop inducing CLL cell proliferation. Interference with the IL-23R/IL-23 axis using an anti-IL-23p19 antibody proved effective in controlling disease onset and expansion in xenografted mice, suggesting potential therapeutic strategies

The evolution of legislation in the field of Medically Assisted Reproduction and embryo stem cell research in European union members.

Medically Assisted Reproduction (MAR), involving in vitro fertilisation (IVF), and research on embryos have created expectation to many people affected by infertility; at the same time it has generated a surplus of laws and ethical and social debates. Undoubtedly, MAR represents a rather new medical field and constant developments in medicine and new opportunities continue to defy the attempt to respond to those questions. In this paper, the authors reviewed the current legislation in the 28 EU member states trying to evaluate the different legislation paths adopted over the last 15 years and highlighting those EU countries with no specific legislation in place and MAR is covered by a general health Law and those countries in which there are no laws in this field but only "guidelines." The second aim of this work has been to compare MAR legislation and embryo research in EU countries, which derive from different origins ranging from an extremely prohibitive approach versus a liberal one, going through a cautious regulatory approach

The Evolution of Legislation in the Field of Medically Assisted Reproduction and Embryo Stem Cell Research in European Union Members

Medically Assisted Reproduction (MAR), involving in vitro fertilisation (IVF), and research on embryos have created expectation to many people affected by infertility; at the same time it has generated a surplus of laws and ethical and social debates. Undoubtedly, MAR represents a rather new medical field and constant developments in medicine and new opportunities continue to defy the attempt to respond to those questions. In this paper, the authors reviewed the current legislation in the 28 EU member states trying to evaluate the different legislation paths adopted over the last 15 years and highlighting those EU countries with no specific legislation in place and MAR is covered by a general health Law and those countries in which there are no laws in this field but only "guidelines. " The second aim of this work has been to compare MAR legislation and embryo research in EU countries, which derive from different origins ranging from an extremely prohibitive approach versus a liberal one, going through a cautious regulatory approach

The physician's breach of the duty to inform the parent of deformities and abnormalities in the foetus: "wrongful Life" actions, a new frontier of medical responsibility.

A recent decision of the Italian Highest Court for the first time legitimized wrongful life suits. The Court stated the following principles: (a) the contract between the mother and the doctor has also protective effects in favour of third parties (father, siblings and the disabled child) who have the right to be compensated; (b) the right to compensation is neither based on the right not to be born nor on the right to be born healthy, but rather it is based on the breach of duty of care which coincides with the child’s disabled status; (c) siblings may suffer the reduced availability of their parents; (d) the doctor is held responsible for not providing full information to the mother about the foetal deformity. The Supreme Court once again emphasized the importance of information on the matter of very personal choices, such as termination of pregnancy in case of foetal malformations. In the present case, the gynaecologist breached the duty to inform, especially after the patient requ

The physician’s breach of the duty to inform the parent of deformities and abnormalities in the foetus: “wrongful Life” actions, a new frontier of medical responsibility

Abstract A recent decision of the Italian Highest Court for the first time legitimized wrongful life suits. The Court stated the following principles: (a) the contract between the mother and the doctor has also protective effects in favour of third parties (father, siblings and the disabled child) who have the right to be compensated; (b) the right to compensation is neither based on the right not to be born nor on the right to be born healthy, but rather it is based on the breach of duty of care which coincides with the child's disabled status; (c) siblings may suffer the reduced availability of their parents; (d) the doctor is held responsible for not providing full information to the mother about the foetal deformity. The Supreme Court once again emphasized the importance of information on the matter of very personal choices, such as termination of pregnancy in case of foetal malformations. In the present case, the gynaecologist breached the duty to inform, especially after the patient requested diagnostic tests designed to highlight any foetal malformations and informed the doctor of the possibility of an eventual subsequent termination of pregnancy if foetal malformations were foun