Laparoscopy in liver transplantation: The future has arrived

In the last two decades, laparoscopy has revolutionized the field of surgery. Many procedures previously performed with an open access are now routinely carried out with the laparoscopic approach. Several advantages are associated with laparoscopic surgery compared to open procedures: reduced pain due to smaller incisions and hemorrhaging, shorter hospital length of stay, and a lower incidence of wound infections. Liver transplantation (LT) brought a radical change in life expectancy of patients with hepatic endstage disease. Today, LT represents the standard of care for more than fifty hepatic pathologies, with excellent results in terms of survival. Surely, with laparoscopy and LT being one of the most continuously evolving challenges in medicine, their recent combination has represented an astonishing scientific progress. The intent of the present paper is to underline the current role of diagnostic and therapeutic laparoscopy in patients waiting for LT, in the living donor LT and in LT recipients

Feasibility and acceptability of expressive writing with postpartum women: a randomised controlled trial

Abstract Background: Pregnancy, birth and adjusting to a new baby is a potentially stressful time that can negatively affect women’s mental and physical health. Expressive writing, where people write about a stressful event for at least 15 minutes on three consecutive days, has been associated with improved health in some groups but it is not clear whether it is feasible and acceptable for use with postpartum women. This study therefore examined the feasibility and acceptability of expressive writing for postpartum women as part of a randomised controlled trial (RCT). Methods: The Health After Birth Trial (HABiT) was an RCT evaluating expressive writing for postpartum women which included measures of feasibility and acceptability. At 6 to 12 weeks after birth 854 women were randomised to expressive writing, a control writing task or normal care, and outcome measures of health were measured at baseline, one month later and six months later. Feasibility was measured by recruitment, attrition, and adherence to the intervention. Quantitative and qualitative measures of acceptability of the materials and the task were completed six months after the intervention. Results: Recruitment was low (10.7% of those invited to participate) and the recruited sample was from a restricted sociodemographic range. Attrition was high, increased as the study progressed (35.8% at baseline, 57.5% at one month, and 68.1% at six months) and was higher in the writing groups than in the normal care group. Women complied with instructions to write expressively or not, but adherence to the instruction to write for 15 minutes per day for three days was low (Expressive writing: 29.3%; Control writing: 23.5%). Acceptability measures showed that women who wrote expressively rated the materials/task both more positively and more negatively than those in the control writing group, and qualitative comments revealed that women enjoyed the writing and/or found it helpful even when it was upsetting. Conclusions: The feasibility of offering expressive writing as a universal self-help intervention to all postpartum women 6 to 12 weeks after birth in the HABiT trial was low, but the expressive writing intervention was acceptable to the majority of women who completed it

The Case for Gun Policy Reforms in America

Debates about gun control often drift towards general arguments about whether guns make us safer or less safe, and gun control is equated with restricting gun ownership. However, with recent Supreme Court decisions overturning laws which ban firearm possession in the District of Columbia and Chicago, current gun control policies in the U.S. do not disarm lawabiding adults over the age of 21. Rather, gun control laws today focus on one or more of four general objectives. These laws aim to:Define conditions that prohibit a person from possessing firearms;Implement regulations to prevent prohibited persons from possessing firearms;Restrict carrying of concealed firearms outside the home; andRegulate the design of firearms to enhance public and personal safety.In this report we draw upon research evidence to suggest how improvements in each of these types of gun policies could enhance public safety in the United States

Invasive anisakiasis by the parasite Anisakis pegreffii (Nematoda: Anisakidae): diagnosis by real-time PCR hydrolysis probe system and immunoblotting assay

BACKGROUND: Anisakiasis is a fish-borne zoonosis caused by Anisakis spp. larvae. One challenging issue in the diagnosis of anisakiasis is the molecular detection of the etiological agent even at very low quantity, such as in gastric or intestinal biopsy and granulomas. Aims of this study were: 1) to identify three new cases of invasive anisakiasis, by a species-specific Real-time PCR probe assay; 2) to detect immune response of the patients against the pathogen. METHODS: Parasite DNA was extracted from parasites removed in the three patients. The identification of larvae removed at gastric and intestinal level from two patients was first obtained by sequence analysis of mtDNA cox2 and EF1 α-1 of nDNA genes. This was not possible in the third patient, because of the very low DNA quantity obtained from a single one histological section of a surgically removed granuloma. Real-time PCR species-specific hydrolysis probe system, based on mtDNA cox2 gene, was performed on parasites tissue of the three cases. IgE, IgG4 and IgG immune response against antigens A. pegreffii by Immunoblotting assay was also studied. RESULTS: According to the mtDNA cox2 and the EF1 α - 1 nDNA sequence analysis, the larvae from stomach and intestine of two patients were assigned to A. pegreffii. The Real-time PCR primers/probe system, showed a fluorescent signal at 510 nm for A. pegreffii, in all the three cases. In Immunoblotting assay, patient CC1 showed IgE, IgG4 reactivity against Ani s 13-like and Ani s 7-like; patient CC2 revealed only IgG reactivity against Ani s 13-like and Ani s 7-like; while, the third patient showed IgE and IgG reactivity against Ani s 13-like, Ani s 7-like and Ani s 1-like. CONCLUSION: The Real-time PCR assay, a more sensitive method than direct DNA sequencing for the accurate and rapid identification of etiological agent of human anisakiasis, was successfully assessed for the first time. The study also highlights the importance to use both molecular and immunological tools in the diagnosis of human anisakiasis, in order to increase our knowledge about the pathological findings and immune response related to the infection by zoonotic species of the genus Anisakis

Lista bibliografica

Questa lista bibliografica contiene il secondo aggiornamento della bibliografia della Lisy e deriva dall’assemblaggio da parte della redazione (M. Serdoz ed E. Panfili) dei contributi parziali stilati dai gruppi regionali

A small solitary non-parasitic hepatic cyst causing an intra-hepatic bile duct stricture: a case report

<p>Abstract</p> <p>Introduction</p> <p>We report an unusual presentation of a small hepatic cyst causing cholangitis.</p> <p>Case presentation</p> <p>A 70-year-old Asian man was hospitalized for aggravated chronic pain in the right upper portion of his abdomen. Fever developed after admission. Laboratory tests revealed elevated hepatobiliary enzymes, inflammatory markers and carbohydrate antigen 19-9 without hyperbilirubinemia. Ultrasound and computed tomography demonstrated dilatation of the left intra-hepatic bile ducts. Endoscopic retrograde cholangiopancreatography showed that the right intra-hepatic bile ducts were normally filled with contrast medium, but the left intra-hepatic bile ducts were not seen in the confluence. A left hepatectomy was performed because a hidden malignancy could not be excluded. The surgical findings showed no tumor around the bile duct but rather a 2 cm cyst in segment four of Couinaud's category of the liver around the hilum. The pathology report was a solitary non-parasitic hepatic cyst compressing the bile duct.</p> <p>Conclusion</p> <p>A very small solitary hepatic cyst might cause hepatic duct stricture if it is located near the hepatic hilum, and should be considered in the differential diagnosis of a hepatic duct stricture.</p

The effects of COVID-19 pandemic on elective post-bariatric surgery waiting list. A single plastic surgery center investigation

Objective: After massive weight loss, patients that meet specific criteria can be inserted in an ad-hoc post-bariatric surgery list in order to be subjected to body contouring procedures. During COVID-19 pandemic, the Italian National Health System has been overwhelmed by the continue load of life-threatening patients that needed medical assistance. Plastic surgery practice enormously scaled back during this period and this fact greatly affected elective procedures waiting lists. The aim of our study is to analyze how the lockdown and its related sanitary policies affected post-bariatric patients' behaviors towards the delay of their procedure. Patients and methods: A 7-item questionnaire was administered to all patients. Change in the desire to be subjected to body contouring procedures was recorded. Smoking status, level of training during quarantine and psychological co-morbidities were also evaluated. Results: 124 patients completed the questionnaire. Data analysis showed that none of them encountered a decrease of the desire to be subjected to post-bariatric plastic surgery procedures. Conclusions: The present study showed that all the patients in the waiting list did not modify their interest in being subjected to post-bariatric surgery procedures, even though the waiting time increased

The oldest Pinus nigra plantations in the central Apennines: distribution and floristic-vegetational characterisation

This paper represents the first syntaxonomic study on the Pinus nigra subsp. nigra artificial stands in the Apennines. It refers exclusively to the mature Pinus nigra forest plantations in the central Apennines that were planted before the 1950s, and then not managed. The mature Pinus nigra forest plantations in the central Apennines are distributed within four National Parks, on limestone substrata, mainly with southern aspects and rugged slopes, and at elevations ranging from 655 m to 1670 m a.s.l.. Two new phytosociological associations are described here and classified in the alliance Junipero communis–Pinion nigrae: Orthilio secundae–Pinetum nigrae and Digitalidi micranthae–Pinetum nigrae. The association Orthilio secundae–Pinetum nigrae comprises the relative mesophilous mature pine forests of the supratemperate thermotype in the plant landscape context of the alliance Aremonio agrimonioidis–Fagion sylvaticae potential vegetation belt. The Digitalidi micranthae–Pinetum nigrae comprises the thermophilous pine forests occurring on rocky stands within mesotemperate and lower supratemperate thermotypes in the potential belt of alliance Carpinion orientalis woods. The comparison of these two new associations and the phytosociological literature concerning the natural communities of Pinus nigra in the Apennines highlights their floristic and coenological autonomy

EU2030 biodiversity strategy: Unveiling gaps in the coverage of ecoregions and threatened species within the strictly protected areas of Italy

About 19 % of the Italian territory is covered by protected areas (PAs), 5.1 % of which fall in IUCN categories Ia and II, which can be considered strictly protected areas (StPAs). The 2030 EU Biodiversity Strategy sets a target of 30 % coverage for PAs (of which 10 % should be StPAs). We assessed the area coverage of StPAs, for the territory of Italy, with respect to biogeographical regions, ecoregions, elevation range, habitats, and the distribution of species threatened with extinction according to the IUCN Red List (Vulnerable, VU; Endangered, EN; or Critically Endangered, CR). We found that most of the StPAs are located in the Mediterranean biogeographical region, followed by the Alpine and Continental regions, and that the spatial distribution of such protected areas is biased towards higher elevation. Moreover, we found that three of the fourteen terrestrial ecoregions of Italy are not protected at all by StPAs (i.e., Illyrian, Ligurian-Provencal, and Central-Adriatic), while the Po Plain and the Sicilia Sections are only marginally protected. Moreover, nine habitats are not covered by any StPAs including one priority habitat (Inland salt meadows). Finally, we found unprotected species among freshwater fish (21), amphibians (3 VU, 3 CR), reptiles (1 CR), birds (2 NE), mammals (1 VU), and plants (20 VU, 14 EN, 21 CR). Our findings suggest that the current amount and spatial distribution of StPAs of Italy are far from the targets of the EU Biodiversity Strategy and needs improvements

Evaluated Community Fire Safety Interventions in the United States: A Review of Current Literature

The purpose of the study was to assess the state of fire prevention research, provide an updated synthesis of evaluated fire prevention programs, and discuss the role of fire fighters and data systems in prevention efforts. The review included all evaluations of U.S. based fire prevention interventions published between January 1998 and September 2004 and any earlier articles about U.S. fire prevention interventions not included in two prior review articles. We retrieved information from each identified study including evaluation findings, involvement of fire service personnel and use of existing data systems. We identified twelve articles: seven reported on smoke alarm interventions, three on multi-faceted programs, and two other programs. Five programs involved fire service personnel in the design, implementation, and/or evaluation, and three used existing data systems. Studies reviewed suggest that canvassing and smoke alarm installations are the most effective means of distributing alarms and increasing the functional status of distributed alarms. The functionality of smoke alarms, an issue noted in earlier reviews, remains a problem. Programs involving partnerships with fire departments have indicated success in preventing fires and deaths, improving smoke alarm ownership and functional status, and improving children’s fire safety knowledge. Using existing data systems to target and to evaluate interventions was effective. In the years since prior reviews, some improvements in the rigor of evaluation designs have been made, but there is still a need for high quality evaluations that will inform fire injury prevention efforts