131 research outputs found

    Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

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    Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

    Non-invasive estimation of in vivo optical properties and hemodynamic parameters of domestic animals: a preliminary study on horses, dogs, and sheep

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    Biosensors applied in veterinary medicine serve as a noninvasive method to determine the health status of animals and, indirectly, their level of welfare. Near infrared spectroscopy (NIRS) has been suggested as a technology with this application. This study presents preliminary in vivo time domain NIRS measurements of optical properties (absorption coefficient, reduced scattering coefficient, and differential pathlength factor) and hemodynamic parameters (concentration of oxygenated hemoglobin, deoxygenated hemoglobin, total hemoglobin, and tissue oxygen saturation) of tissue domestic animals, specifically of skeletal muscle (4 dogs and 6 horses) and head (4 dogs and 19 sheep). The results suggest that TD NIRS in vivo measurements on domestic animals are feasible, and reveal significant variations in the optical and hemodynamic properties among tissue types and species. In horses the different optical and hemodynamic properties of the measured muscles can be attributed to the presence of a thicker adipose layer over the muscle in the Longissimus Dorsi and in the Gluteus Superficialis as compared to the Triceps Brachii. In dogs the absorption coefficient is higher in the head (temporalis musculature) than in skeletal muscles. The smaller absorption coefficient for the head of the sheep as compared to the head of dogs may suggest that in sheep we are indeed reaching the brain cortex while in dog light penetration can be hindered by the strongly absorbing muscle covering the cranium

    Inequalities in Childhood Nutrition, Physical Activity, Sedentary Behaviour and Obesity in Italy

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    Unhealthy diets, physical inactivity and high body mass index (BMI) are preventable risk factors for non-communicable diseases throughout a person’s lifespan. The higher prevalence of these risk factors in children from lower socio-economic groups has been generally observed. The aim of this study is to explore the effect of parents’ socio-economic conditions on children’s consumption of fruit, vegetables and sugar-sweetened drinks, and inactivity, sedentary behaviour, overweight and obesity. This study used data from the sixth cross-sectional survey of the surveillance “OKkio alla Salute” (Italian COSI), involving 2467 schools and 53,275 children in 2019. All the information was collected through four questionnaires addressed to parents, children, teachers and head teachers. The weights and heights of the children were measured with standard techniques and equipment to classify overweight/obesity according to the WOF-IOTF cut-offs. The results showed a high percentage of children who do not adhere to health recommendations and a high prevalence of overweight and obesity. In particular, “less healthy” behaviours and higher BMI were more frequent in children from families with a lower socio-economic status and those residing in Southern Italy. These findings highlight the need for effective interventions that address the differences in these health-related behaviours

    Gravitational distribution of regional opening and closing pressures, hysteresis and atelectrauma in ARDS evaluated by electrical impedance tomography

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    Background The physiological behavior of lungs affected by the acute respiratory distress syndrome (ARDS) differs between inspiration and expiration and presents heterogeneous gravity-dependent distribution. This phenomenon, highlighted by the different distribution of opening/closing pressure and by the hysteresis of the pressure-volume curve, can be studied by CT scan, but the technique expose the patient to radiations, cannot track changes during time and is not feasible at the bedside. Electrical impedance tomography (EIT) could help in assessing at the bedside regional inspiratory and expiratory mechanical properties. We evaluated regional opening/closing pressures, hysteresis and atelectrauma during inspiratory and expiratory low-flow pressure-volume curves in ARDS using electrical impedance tomography. Methods Pixel-level inspiratory and expiratory PV curves (PVpixel) between 5 and 40 cmH(2)O were constructed integrating EIT images and airway opening pressure signal from 8 ARDS patients. The lower inflection point in the inspiratory and expiratory PV(pixel)were used to find opening (OPpixel) and closing (CPpixel) pressures. A novel atelectrauma index (AtI) was calculated as the percentage of pixels opening during the inspiratory and closing during the expiratory PV curves. The maximal hysteresis (HysMax) was calculated as the maximal difference between normalized expiratory and inspiratory PV curves. Analyses were conducted in the global, dependent and non-dependent lung regions. Results Gaussian distribution was confirmed for both global OPpixel(r(2) = 0.90) and global CPpixel(r(2) = 0.94). The two distributions were significantly different with higher values for OPpixel(p < 0.0001). Regional OP(pixel)and CP(pixel)distributions were Gaussian, and in the dependent lung regions, both were significantly higher than in the non-dependent ones (p < 0.001). Both AtI and the HysMax were significantly higher in the dependent regions compared to the non-dependent ones (p < 0.05 for both). Conclusions Gravity impacts the regional distribution of opening and closing pressure, hysteresis and atelectrauma, with higher values in the dorsal lung. Regional differences between inspiratory and expiratory lung physiology are detectable at the bedside using EIT and could allow in-depth characterization of ARDS phenotypes and guide personalized ventilation settings

    Electrophysiological evidence of sustained spatial attention effects over anterior cortex: Possible contribution of the anterior insula

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    Spatial attention can improve performance in terms of speed and accuracy; this advantage may be mediated by brain processes at both poststimulus (reactive) and prestimulus (proactive) stages. Here, we studied how visuospatial attention affects both proactive and reactive brain functions using event-related potentials (ERPs). At reactive stage, effects of attention on parietal-occipital components are well documented; little data are available on anterior components. Seventeen participants performed simple and discriminative response tasks, while voluntarily and steadily attending either the left or right visual hemifield throughout one block. Response speed was faster for the attended side. At ERP level, attending to one hemifield did not produce lateralization of proactive components—that is, the BP and the pN. As for poststimulus components, we confirmed the well-known amplitude effects on the P1, N1, and P3. More interesting are results for the prefrontal components previously neglected in tasks modulating spatial attention. Previous studies suggest that these components reflect perceptual and sensory-motor awareness (pN1 and pP1 components), and stimulus-response mapping (pP2 component) associated to anterior insular activity. Spatial attention enhanced the pN1 and the pP1 amplitude but had no effect on the pP2. Overall, results extend knowledge on spatial attention, showing that sustained spatial attention affects the activity of anterior areas, such as the anterior insula, in addition to the known influence on occipital-parietal areas. Top-down spatial attention is likely mediated by increased sensory and sensory-motor awareness for attended events; this effect is evident in reactive, not proactive, brain activity

    A proposito di spazio, limite, reinvenzione

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    Qusto libro include 60 profili di artiste nell'area romana e non solo; contributi critici di 15 fra studiose e studiosi di discipline storico-artistiche, filosofiche, sociologiche, antropologiche, psicologiche. Questi sono i numeri di FEMM[E]: un progetto - e un libro - nato sotto la denominazione e l'intento di una "ricerca sulla specificità (eventuale) dell'arte femminile", realizzata dal 2016 al 2018 su iniziativa e cura della storica dell'arte Anna Maria Panzera e dell'artista Veronica Montanino. Il mio testo parla del tema dell'abitazione e in specifico di «casa» che Ú riccorente nelle opere di artiste in tutto il mondo. Dopo gli esempi conosciuti della storia dell'arte contemporanea, il testo prosegue con le storie degli artisti con cui l'autrice ha collaborato sul tema di "Casa"

    Brain insulin resistance impairs hippocampal synaptic plasticity and memory via FoxO3a/zDHHC3-dependent enhancement of GluA1 palmitoylation

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    High-fat diet (HFD) and metabolic diseases cause detrimental effects on hippocampal synaptic plasticity, learning, and memory through molecular mechanisms still poorly understood. Here, we demonstrate that HFD increases palmitic acid deposition in the hippocampus and induces hippocampal insulin resistance leading to FoxO3a-mediated overexpression of the palmitoyltransferase zDHHC3. The excess of palmitic acid along with higher zDHHC3 levels causes hyper-palmitoylation of AMPA glutamate receptor subunit GluA1, hindering its activity-dependent trafficking to the plasma membrane. Accordingly, AMPAR current amplitudes and, more importantly, their potentiation underlying synaptic plasticity were inhibited, as well as hippocampal-dependent memory. Hippocampus-specific silencing of Zdhhc3 and, interestingly enough, intranasal injection of the palmitoyltransferase inhibitor, 2-bromopalmitate, counteract GluA1 hyper-palmitoylation and restore synaptic plasticity and memory in HFD mice. Our data reveal a key role of FoxO3a/Zdhhc3/GluA1 axis in the HFD-dependent impairment of cognitive function and identify a novel mechanism underlying the cross talk between metabolic and cognitive disorder

    Reading and lexical-decision tasks generate different patterns of individual variability as a function of condition difficulty

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    We reanalyzed previous experiments based on lexical-decision and reading-aloud tasks in children with dyslexia and control children and tested the prediction of the difference engine model (DEM) that mean condition reaction times (RTs) and standard deviations (SDs) would be linearly related (Myerson et al., 2003). Then we evaluated the slope and the intercept with the x-axis of these linear functions in comparison with previously reported values (i.e., slope of about 0.30 and intercept of about 300 ms). In the case of lexical decision, the parameters were close to these values; by contrast, in the case of reading aloud, a much steeper slope (0.66) and a greater intercept (482.6 ms) were found. Therefore, interindividual variability grows at a much faster rate as a function of condition difficulty for reading than for lexical-decision tasks (or for other tasks reported in the literature). According to the DEM, the slope of the regression that relates means and SDs indicates the degree of correlation among the durations of the stages of processing. We propose that the need for a close coupling between orthographic and phonological processing in reading is what drives the particularly strong relationship between performance and interindividual variability that we observed in reading tasks

    Brain insulin resistance impairs hippocampal synaptic plasticity and memory by increasing GluA1 palmitoylation through FoxO3a.

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    High-fat diet (HFD) and metabolic diseases cause detrimental effects on hippocampal synaptic plasticity, learning, and memory through molecular mechanisms still poorly understood. Here, we demonstrate that HFD increases palmitic acid deposition in the hippocampus and induces hippocampal insulin resistance leading to FoxO3a-mediated overexpression of the palmitoyltransferase zDHHC3. The excess of palmitic acid along with higher zDHHC3 levels causes hyper-palmitoylation of AMPA glutamate receptor subunit GluA1, hindering its activity-dependent trafficking to the plasma membrane. Accordingly, AMPAR current amplitudes and, more importantly, their potentiation underlying synaptic plasticity were inhibited, as well as hippocampal-dependent memory. Hippocampus-specific silencing of Zdhhc3 and, interestingly enough, intranasal injection of the palmitoyltransferase inhibitor, 2-bromopalmitate, counteract GluA1 hyper-palmitoylation and restore synaptic plasticity and memory in HFD mice. Our data reveal a key role of FoxO3a/Zdhhc3/GluA1 axis in the HFD-dependent impairment of cognitive function and identify a novel mechanism underlying the cross talk between metabolic and cognitive disorders
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