The use of Versius CMR for pelvic surgery: a multicentric analysis of surgical setup and early outcomes

IntroductionVersius CMR is a novel robotic system characterized by an open surgical console and independent bedside units. The system has potentials of flexibility and versatility, and has been used in urological, gynecological, and general surgical procedure. The aim is to depict a comprehensive analysis of the Versius system for pelvic surgery.MethodsThis is a study involving two Institutions, ASST Santi Paolo and Carlo, Milan, and Apuane Hospital, Massa, Italy. All interventions performed in the pelvic area with the Versius were included. Data about indications, intra-, and post-operative course were prospectively collected and analyzed.ResultsA total of 171 interventions were performed with the Versius. Forty-two of them involved pelvic procedures. Twenty-two had an oncological indication (localized prostate cancer), the remaining had a non-oncological or functional purpose. The mostly performed pelvic procedure was radical prostatectomy (22) followed by annexectomy (9). No intra-operative complication nor conversion to other approaches occurred. A Clavien II complication and one Clavien IIIb were reported. Malfunctioning/alarms requiring a power cycle of the system occurred in 2 different cases. An adjustment in trocar placement according to patients' height was required in 2 patients undergoing prostatectomy, in which the trocar was moved caudally. In two cases, a pelvic prolapse was repaired concomitant with other gynecological procedures.ConclusionsPelvic surgery with the Versius is feasible without major complications; either dissection and reconstructive steps could be accomplished, provided a proper OR setup and trocar placement are pursued. Versius can be easily adopted by surgeons of different disciplines and backgrounds; a further multi-specialty implementation is presumed and long-term oncological and functional outcomes are awaited

Percutaneous radiofrequency ablation of the posterior and anterior interosseous nerves for chronic wrist pain: A novel technique

The treatment of chronic wrist pain, due to posttraumatic, degenerative, or inflammatory arthritis, is challenging to adequately manage. The ideal surgical procedure should preserve wrist mobility and provide long-lasting pain relief. In this regard, denervation aims to decrease wrist pain by interrupting sensory innervation, without impairing motor function, and avoids the need for postoperative immobilization to decrease the risk of stiffness. For these reasons, denervation is particularly attractive as a possible treatment for chronic wrist pain. Our aim was to describe our novel technique for partial percutaneous wrist denervation, performed by radiofrequency ablation of the posterior and anterior interosseous nerves, and to report on the prospective outcomes over a 1-year follow-up for 3 patients (4 wrists) treated as of March 2019. The technique is performed on an outpatient basis and does not require postprocedure wrist immobilization or restriction in activities of daily living or work. Findings at the 1-year follow-up indicate that partial denervation improved grip strength, provided pain relief, maintained wrist motion, and improved subjective report of disabilities of the arm, shoulder, and hand. One patient did not report a benefit of the procedures, with other patients being very satisfied. Our percutaneous procedure is an evolution of the traditional partial denervation technique, providing advantages of being less invasive, not requiring restriction of movement or activities in the postoperative phase, can be performed on an out-patient basis, and does not preclude the subsequent use of invasive surgical procedures, as needed

The online sexual offender: what we know to date

Introduction: Online grooming is an active communicative entrapment network involving a wide range of techniques. The interactions that groomers have with minors online are complex. The purpose of the present literature review is to contribute to the existing knowledge base regarding online sex offender typologies, predatory tactics and techniques. Evidence acquisition: We conducted a review of the current literature by an initial database research of papers published since 1990. Three independent reviewers selected relevant articles, initially based on title and abstract analysis, then by full text in order to make a final determination. After the final selection, a total of 21 articles were reviewed. Evidence synthesis: Overall, abundant data describing both groomer characteristics and grooming strategies are available in the literature, with authors attempting to analyze and adapt these to ever-complex models. However, the various models often feel redundant, determining a certain difficulty in understanding which would be the most suitable model to apply, making comparing data from different studies oftentimes troublesome. Conclusions: In our opinion, it would be desirable to reach a consensus on fewer univocally- interpretable models that would be easier to adopt as preventive tools against online grooming, in combination with other strategies. The present study may provide parents and guardians with information useful for keeping their youth safer while online, as well as data that may assist in the development of policy recommendations and prevention strategies, overall aiming to reduce the phenomenon of online grooming

Prevalence of adenoma of gallbladder, ultrasonographic and histological assessment in a retrospective series of 450 cholecystectomy

OBJECTIVES: Adenomyomas of the gallbladder (GA) are difficult to examine during standard ultrasound examination of the abdomen. They sometimes undergo malignant transformation and their optimal management still remains a problem. The authors have aimed to investigate the ultrasonographic (US) and histopathological prevalence of GA focusing on the diagnostic performance of US examination. MATERIALS AND METHODS: A retrospective series of 450 consecutive patients who underwent cholecystectomy is reported. Data regarding characteristics of the patients, US and histology examination of the gallbladder were collected. Sensitivity, specificity, positive and negative predictive values of US were calculated with respect to histological examination of the gallbladder. RESULTS: The study group consisted of 261 female and 189 male. US scan detected adenomyomas in 22 patients, confirmed by histopathology in 13 and found to be not present in 9. Incidental adenomyomas were found in 16 patients of 428 who underwent cholecystectomy for gallstones. Prevalence was 4.9% and 6.4% for US scan and histopathology respectively. US scan showed sensitivity of 43.3% (c.i.:25.4%-62.5%), specificity of 97.8% (c.i.:95.9%-99%) with a positive predictive value of 59% (c.i.:36.3%-79.2%) and with a negative predictive value of 96.2% (c.i.:93.7%- 97.6%). On histopathology, adenomyomas localized in the fundus were predominant. Two female patients with adenomyomas of the fundus (diameter 5 mm) and single stone showed intestinal metaplasia with high-grade dysplasia. CONCLUSIONS: The diagnosis of gallbladder adenomyomas by US scan still remains a problem because of its low sensitivity, which is mainly due to the association with gallstones. At present, the selection of patients requiring cholecystectomy is still controversial, surgery is indicated in the presence of GA>1cm and if symptomatic cholelithiasis is present, with respect to polyps smaller than 1cm the presence of diameter increase, the association of thickening (>3mm) of the gallbladder wall and the presence of dysmorphism at follow-up with US are widely considedered as indications for surgey. In our study histopathological findings in the perilesional mucosa confirm the hypothesis of a metaplasia-dysplasia-carcinoma sequence already shown in the colon-rectum, even if no cancer were found. According with our results surgery is proposed when GA is associated with cholelithiasis in all cases because of the increased risk of malignancy development, independently from the dimension of lesion

Immunotherapy versus standard of care in metastatic renal cell carcinoma. A systematic review and meta-analysis

Background: Recently, immune checkpoint inhibitors against PD-1/PD-L1 or CTLA4 have emerged as new treatments for metastatic renal cell carcinoma (mRCC), despite discrepancy between their effects on OS and PFS. We performed a meta-analysis of randomized trials comparing immunotherapy to standard of care (SOC) in mRCC. Methods: Searching the MEDLINE/PubMed, Cochrane Library and ASCO Meeting abstracts prospective studies were identified. Data extraction was conducted according to the PRISMA statement. The measured outcomes were OS, PFS, and ORR. Results: A total of 2832 patients were available for evaluation of OS, and 3033 for PFS and ORR. Compared to SOC, immunotherapy improved OS (HR = 0.75; 95%CI 0.66–0.85; p < 0.001), and PFS (HR = 0.88; 95%CI 0.80–0.97; p = 0.009). The PFS benefit was not confirmed when considering patients treated in first-line only (p = 0.10). Conversely, significant ORR improvement was found in patients treated in first-line only (HR = 1.14; 95%CI 1.02–1.28; p = 0.03) but not in the overall population. Conclusions: Immunotherapy improved OS compared to SOC in mRCC, irrespective of treatment line. In first-line, immunotherapy also increased the ORR compared to sunitinib. A lack of correlation between OS and PFS was confirmed, the latter to be used cautiously for the design and interpretation of trials involving immunotherapy in mRCC

Self-sampling versus physician-sampling of oropharyngeal swabs for molecular detection of respiratory viruses: a pilot study

Aim: This pilot study evaluated the adequacy of self-collected oropharyngeal swabs compared to those collected by trained physicians for molecular detection of respiratory viruses. Method: Oropharyngeal swabs1 were collected from influenza like-illness cases in Lombardy during the 2018/2019 season. Two groups of samples were considered: group 1) 131 swabs collected by general practitioners operating within the Italian Influenza Surveillance Network; group 2) 131 swabs self-collected by hospital healthcare workers (doctors, nurses, technicians, in-training students) after being trained on the sampling procedure by both an explanatory brochure describing the steps of swab collection, point-by-point, and a telephone call to a study staff member who guided sample collection. RNA was extracted from each swab and tested for the detection of the human ribonuclease P gene (RNP) by real-time RT-PCR. Samples with a cycle threshold (Ct)<35 were considered adequate for further virological analysis. Respiratory syncytial virus (RSV) was detected by real-time RT-PCR. Results: All samples were positive to RNP detection with Ct<35. The mean Ct value was 25.46 (SD: \ub12.40; range: 18.65-30.10) for swabs collected by physicians and 25.93 (SD: \ub12.22; range: 19.48-33.13) for self-collected swabs, with no statistically significant difference (p=0.10). RSV-positivity rates were similar among both groups (10.9% vs 7.3%; p=0.39). Conclusions: Self-collected oropharyngeal swabs resulted adequate and comparable to those collected by trained physicians for molecular detection of respiratory viruses. Self-sampling can be a worthwhile strategy of sample collection to implement molecular surveillance of respiratory viruses or to evaluate vaccine effectiveness involving population at lower costs