ERAS in General Thoracic Surgery

Enhanced recovery after surgery (ERAS®) is a strategy that seeks to reduce patients’ perioperative stress response, thereby reducing potential complications, decreasing hospital length of stay and enabling patients to return more quickly to their baseline functional status. This programme results from the union of several perioperative clinical elements that have individually proved to be beneficial to the patient and have showed, when used together, a synergy that results in a significant outcome improvement. The term was coined at the end of the 1990s and originally used to refer to a complex fast-track programme in open colorectal surgery. Subsequently, the practice has spread to other surgical specialties centralising the interest of clinicians and researchers. The objective of this chapter is to analyse the key elements of an ERAS protocol applicable to minimally invasive thoracic surgery

A Low Cost Amplifier And Acquisition System For Cortical-Electroncephalography In Non-Human Applications

A simple circuit is described to make an AC-amplifier and an analog-to-digital converter in a single, compact solution, for use in basic research, but not on humans. The circuit sends data to and is powered from a common USB port of modern computers; using proper firmware and driver the communication with the device is an emulated RS232 serial port

Mozart’s or ambient music do not affect autoalgometric pain threshold

Nowadays, researchers and clinicians are increasingly interested in alternative nonpharmacological treatments, and music therapy seems to have additional and powerful effects on different pathologies and pain. However, since pain is a subjective perception, it is difficult to evaluate if and which effect music has on it. In this study, a new device and method have been introduced to objectively estimate pain threshold and its changes related to external stimuli. The abovementioned device, called autoalgometer, allows to evaluate pain threshold changes while listening to music or other sounds. In this experiment, the pain threshold was evaluated in twenty-seven volunteers after listening to one out of three different soundtracks: white noise, Mozart’s sonata K448 or Brian Eno’s ambient music. Compared to staying in silence, listening to the recordings had no significant effect on pain threshold, and the results did not show any significant difference between the experimental groups. Probably, the positive effect of music described in other studies can be ascribed to a psychological effect, meaning that music can improve subjective mood and, thus, modify pain perception

Differential Expression of Kisspeptin System and Kisspeptin Receptor Trafficking during Spermatozoa Transit in the Epididymis

The hypothalamus–pituitary–testis axis controls the production of spermatozoa, and the kisspeptin system, comprising Kiss1 and Kiss1 receptor (Kiss1R), is the main central gatekeeper. The activity of the kisspeptin system also occurs in testis and spermatozoa, but currently the need of peripheral kisspeptin to produce gametes is not fully understood. Hence, we characterized kisspeptin system in rat spermatozoa and epididymis caput and cauda and analyzed the possible presence of Kiss1 in the epididymal fluid. The presence of Kiss1 and Kiss1R in spermatozoa collected from epididymis caput and cauda was evaluated by Western blot; significant high Kiss1 levels in the caput (p < 0.001 vs. cauda) and constant levels of Kiss1R proteins were observed. Immunofluorescence analysis revealed that the localization of Kiss1R in sperm head shifts from the posterior region in the epididymis caput to perforatorium in the epididymis cauda. In spermatozoa-free epididymis, Western blot revealed higher expression of Kiss1 and Kiss1R in caput (p < 0.05 vs. cauda). Moreover, immunohistochemistry revealed that Kiss1 and Kiss1R proteins were mainly localized in the secretory epithelial cell types and in contractile myoid cells, respectively. Finally, both dot blot and Elisa revealed the presence of Kiss1 in the epididymal fluid collected from epididymis cauda and caput, indicating that rat epididymis and spermatozoa possess a complete kisspeptin system. In conclusion, we reported for the first time in rodents Kiss1R trafficking in spermatozoa during the epididymis transit and Kiss1 measure in the epididymal fluid, thus suggesting a possible role for the system in spermatozoa maturation and storage within the epididymis

incidence and factors influencing retinal displacement in eyes treated for rhegmatogenous retinal detachment with vitrectomy and gas or silicone oil

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Peripheral Amino Acid Levels in Schizophrenia and Antipsychotic Treatment

Abnormal levels of amino acids have been reported in patients with schizophrenia and have also been investigated as a biomarker to monitor antipsychotic treatment, however results have been inconsistent. The purpose of the present review is to summarize the evidence in the literature of whether amino acid levels can be a biomarker and predict the treatment outcome in schizophrenia. The current review does not support amino acid concentration as a useful biomarker for monitoring antipsychotic response in patients with schizophrenia, although there is evidence that high levels of serum homocysteine and glutamate might be considered as a trait marker for schizophrenia. This review has also highlighted a considerable dearth of studies, specifically of studies evaluating antipsychotic side-effects

Kidney Transplant Modifies the Architecture and Microenvironment of Basal Cell Carcinomas

Background/Aims: Basal cell carcinoma (BCC) is a frequent type of nonmelanoma skin cancer, which shows a greater prevalence in kidney-transplanted (KT) patients than in the general population. The study of this tumor in KT patients may allow us to understand the influence of the tumor inflammatory microenvironment on cancer behavior, and to design new image analysis methods to determine prognosis and apply personalized medicine. The major hypothesis of the present work is that antirejection drugs, by modifying the B-cell/T-cell balance, induce measurable differences in tumoral cell microarchitecture and in the inflammatory microenvironment in KT patients compared to nontransplanted controls. Methods: In this retrospective study in an Italian cohort including 15 KT patients and 15 control subjects from the general population who developed BCC, we analyzed tissue microarchitecture and inflammatory infiltrates of BCC using state-of-the-art nonlinear image analysis techniques such as fractal dimension and sample entropy of internuclear distances. Results: KT patients showed a nonsignificant trend to a greater number of nuclei in the basal cell layer compared to non-KT controls and subtle changes in the intact skin compared to controls. Similarly, the number of mitoses per unit length was almost doubled in the patients with KT compared to controls. However, when the number of mitotic cells was normalized by the total number of cells in the basal layer (mitotic index), these differences were not significant, although a clear trend was still present. Finally, KT patients showed a nonsignificant trend to an increased ­density of inflammatory cells close to the tumoral cell layer. When considering the intact skin, this difference was significant, with a 70% increase in the density of inflammatory cells. Conclusion: Data comparing the microarchitecture of BCC in normal subjects and KT patients are scanty, and the present study is the first to use nonlinear image analysis techniques to this aim. The observed differences underscore the relevance of T-cell suppression in cancer behavior. These data suggest that BCC develops in treated patients with specific biological characteristics which should be further analyzed in terms of therapeutic response

Mg(OH)2 Recovery from Real Bitterns: a Proof of Concept at Pilot Scale

Water, energy, and minerals are fundamental pillars for the future of humankind. Sustainable and renewable productive processes and resources are the only possibility to face the continuously growing global population and high living standards requirements. The present work introduces a proof of concept for the pilot scale production of magnesium hydroxide, Mg(OH)2, from waste saltworks bitterns located in the district of Trapani, Italy. Mg(OH)2 was produced by adopting a proprietary “Magnesium Crystals Granulometry Controlled Reactor”, Mg-CGCR. The influence of several parameters was investigated on Mg(OH)2 suspensions and powders characteristics: (i) the bittern flow rate, (ii) alkaline sodium hydroxide, NaOH, concentrations solutions (adopted as the precipitant agent) and (iii) the final suspension pH value (stoichiometric or OH- excess amounts). A Mg2+ recovery >99 % can be achieved thanks to the adoption of a product recycling strategy in the reactor. Furthermore, highly pure Mg(OH)2 powders, addressed by cationic purity, were synthesized. Results demonstrate the possibility of producing highly pure Mg(OH)2 products from waste-concentrated saline solutions, thus turning waste into valuable compounds

Nephroplex: a kidney-focused NGS panel highlights the challenges of PKD1 sequencing and identifies a founder BBS4 mutation

Background: Genetic testing of patients with inherited kidney diseases has emerged as a tool of clinical utility by improving the patients' diagnosis, prognosis, surveillance and therapy. Methods: The present study applied a Next Generation Sequencing (NGS)-based panel, named NephroPlex, testing 115 genes causing renal diseases, to 119 individuals, including 107 probands and 12 relatives. Thirty-five (poly)cystic and 72 non (poly)cystic individuals were enrolled. The latter subgroup of patients included Bardet-Biedl syndrome (BBS) patients, as major components. Results: Disease-causing mutations were identified in 51.5 and 40% of polycystic and non-polycystic individuals, respectively. Autosomal dominant polycystic kidney disease (ADPKD) patients with truncating PKD1 variants showed a trend towards a greater slope of the age-estimated glomerular filtration rate (eGFR) regression line than patients with (i) missense variants, (ii) any PKD2 mutations and (iii) no detected mutations, according to previous findings. The analysis of BBS individuals showed a similar frequency of BBS4,9,10 and 12 mutations. Of note, all BBS4-mutated patients harbored the novel c.332+1G&gt;GTT variant, which was absent in public databases, however, in our internal database, an additional heterozygote carrier was found. All BBS4-mutated individuals originated from the same geographical area encompassing the coastal provinces of Naples. Discussion: In conclusion, these findings indicate the potential for a genetic panel to provide useful information at both clinical and epidemiological levels