Search

Background Aim Study Design Results Relevance to Clinical Practice Prone positioning improves oxygenation in adults with acute respiratory distress syndrome (ARDS) and has been extensively applied in intensive care units (ICU) during the COVID‐19 pandemic. Although some complications due to the manoeuvre are well known, brachial plexus injury after prone positioning is reported as a rare complication and the phenomenon could be either very rare or underestimated.This study aimed to evaluate the effect of swimmer position during prone ventilation on the onset of brachial plexus injury in patients admitted to ICU for ARDS. The study will also evaluate the safety of prolonged prone positioning collecting data on any adverse events occurred.A prospective, observational cohort study will be conducted in a tertiary level ICU in the metropolitan area of Milano (Italy) specialized in advanced treatment of patients with ARDS. This observational study will report clinical data on the electromyography (EMG) and the muscle strength assessment, including comorbidities and cardio‐respiratory status. A baseline EMG will be performed within 2 h from the first pronation manoeuvre and immediately at the end of each pronation cycle. The functional assessment of patients will be also performed at the end of ICU stay and at hospital discharge.The primary outcome is to estimate the prevalence of brachial plexus injury in patients with ARDS placed in the swimmer position during prone ventilation. Secondary outcomes will also include the safety of the manoeuvre by evaluation of all adverse events classified as skin or ocular damage, loss of tube and vascular access and new pressure ulcers.The findings of this study will contribute to understand the possible benefits/harms of prone ventilation performed using swimmer position. Eventually, this will call for the development of specific and tailored rehabilitation programs for patients with upper limb injuries during ICU stay, including also timely follow‐up upon ICU‐discharge. [ABSTRACT FROM AUTHOR]

Background: High‐flow nasal cannula (HFNC) therapy is a non‐invasive respiratory treatment characterized by high tolerability, which largely derives from the patient's comfort. Aim: The primary aim of this study was to explore whether the patient's perceived comfort was the same regardless of different approaches used to reach the target humidification temperature. The secondary aim was to assess the patient's perceived nasal dryness and humidity. Study Design: This single‐centre, pragmatic, randomized trial was registered at clinicaltrials.gov (NCT05688189). Patients in the intensive care unit (ICU) in need of HFNC therapy were randomly assigned to one of three study arms: a two‐step increase (31 to 34 to 37°C), a one‐step increase in temperature (34–37°C) or no temperature increase (started and remained at 37°C). The patients were asked to rate their perceived comfort, as well as their perceived nasal dryness and humidity on a scale from 1 (lowest value) to 5 (highest value). Results: We enrolled 21 patients, aged 34–85 years. The mean (±1 standard deviation) comfort level was 3.3 (1.3) for patients who received a one‐step increase, 3.1 (1.3) for those who received no increase and 2.7 (1.7) for those who received a two‐step increase (p =.714). There was also no difference in nasal dryness (p =.05) or humidity (p =.612) across the study arms. Greater comfort was fairly correlated with less nasal humidity (ρ = −0.34, 95% confidence interval −0.68 to 0.07) but not with nasal dryness (ρ = 0.01, p =.94). Conclusions: After 30 min of HFNC therapy at a target temperature of 37°C, overall comfort was rated similarly in the three study arms. Additional studies are needed to accumulate evidence corroborating the findings of this study. Relevance to Clinical Practice: The temperature of the mixture of air and oxygen is a fundamental component of HFNC therapy. A pragmatic approach irrespective of the initial temperature setting seems to yield a similar comfort score in hospitalized patients with mild respiratory failure because of extrapulmonary causes. [ABSTRACT FROM AUTHOR]

Vagus nerve stimulation (VNS) is the subject of exploration as an adjunct treatment for neurological disorders such as epilepsy, chronic migraine, pain, and depression. A non‐invasive form of VNS is transcutaneous auricular VNS (taVNS). Combining animal models and positron emission tomography (PET) may lead to a better understanding of the elusive mechanisms of taVNS. We evaluated the acute effect of electrical stimulation of the left vagus nerve via the ear on brain synaptic vesicle glycoprotein 2A (SV2A) as a measure of presynaptic density and glucose metabolism in naïve rats. Female Sprague–Dawley rats were imaged with [11C]UCB‐J (n = 11) or [18F]fluorodeoxyglucose ([18F]FDG) PET (n = 13) on two separate days, (1) at baseline, and (2) after acute unilateral left taVNS or sham stimulation (30 min). We calculated the regional volume of distribution (VT) for [11C]UCB‐J and standard uptake values (SUV) for [18F]FDG. We observed regional reductions of [11C]UCB‐J binding in response to taVNS ranging from 36% to 59%. The changes in taVNS compared to baseline were significantly larger than those induced by sham stimulation. The differences were observed bilaterally in the frontal cortex, striatum, and midbrain. The [18F]FDG PET uptake remained unchanged following acute taVNS or sham stimulation compared to baseline values. This proof‐of‐concept study shows for the first time that acute taVNS for 30 min can modulate in vivo synaptic SV2A density in cortical and subcortical regions of healthy rats. Preclinical disease models and PET ligands of different targets can be a powerful combination to assess the therapeutic potential of taVNS. [ABSTRACT FROM AUTHOR]

Background and Purpose: Chemotherapy‐induced peripheral neuropathy (CIPN) is perceived differently by patients and physicians, complicating its assessment. Current recommendations advocate combining clinical and patient‐reported outcomes measures, but this approach can be challenging in patient care. This multicenter European study aims to bridge the gap between patients' perceptions and neurological impairments by aligning both perspectives to improve treatment decision‐making. Methods: Data were pooled from two prospective studies of subjects (n = 372) with established CIPN. Patient and physician views regarding CIPN were assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI‐CTCAE), Total Neuropathy Scale–clinical version (TNSc) items, and the disease‐specific quality of life ‐ Chemotherapy‐Induced Peripheral Neuropathy questionnaire (QLQ‐CIPN20) from the European Organization for Research and Treatment of Cancer (EORTC). To identify inherent neurotoxic severity patterns, we employed hierarchical cluster analysis optimized with k‐means clustering and internally validated by discriminant functional analysis. Results: Both NCI‐CTCAE and TNSc demonstrated a significant difference in the distribution of severity grades in relation to QLQ‐CIPN20 scores. However, a proportion of subjects with different neurotoxic severity grades exhibited overlapping QLQ‐CIPN20 scores. We identified three distinct clusters classifying subjects as having severely impaired, intermediately impaired, and mildly impaired CIPN based on TNSc and QLQ‐CIPN20 scores. No differences in demographics, cancer type distribution, or class of drug received were observed. Conclusions: Our results confirm the heterogeneity in CIPN perception between patients and physicians and identify three well‐differentiated subgroups of patients delineated by degree of CIPN impairment based on scores derived from TNSc and QLQ‐CIPN20. A more refined assessment of CIPN could potentially be achieved using the calculator tool derived from the cluster equations in this study. This tool, which facilitates individual patient classification, requires prospective validation. [ABSTRACT FROM AUTHOR]

Motivationally significant events like oddball stimuli elicit both a characteristic event‐related potential (ERPs) known as P300 and a set of autonomic responses including a phasic pupil dilation. Although co‐occurring, P300 and pupil‐dilation responses to oddball events have been repeatedly found to be uncorrelated, suggesting separate origins. We re‐examined their relationship in the context of a three‐stimulus version of the auditory oddball task, independently manipulating the frequency (rare vs. repeated) and motivational significance (relevance for the participant's task) of the stimuli. We used independent component analysis to derive a P300b component from EEG traces and linear modeling to separate a stimulus‐related pupil‐dilation response from a potentially confounding action‐related response. These steps revealed that, once the complexity of ERP and pupil‐dilation responses to oddball targets is accounted for, the amplitude of phasic pupil dilations and P300b are tightly and positively correlated (across participants: r =.69 p =.002), supporting their coordinated generation. Significance Statement: Motivationally significant stimuli may trigger diffuse release of norepinephrine in many cortical regions eventually leading to both a P300 ERP and pupil dilation. However, previous studies repeatedly failed to observe a correlation between these two events. Here, we isolated a component of P300 and pupil‐dilation responses that were specifically related to the occurrence of task‐relevant infrequent events (auditory oddball). This revealed a strong positive association between their amplitude, measured across participants, supporting the hypothesis of a common origin. [ABSTRACT FROM AUTHOR]

Objectives: A new short device for percutaneous endoscopic cholangioscopy was recently developed. However, feasibility and safety has not yet been evaluated. The aim of this study was to assess clinical success, technical success, and adverse events (AEs). Methods: This observational multicenter retrospective study included all patients who underwent percutaneous cholangioscopy using a short cholangioscope between 2020 and 2022. The clinical success, defined as the complete duct clearance or obtaining at least one cholangioscopy‐guided biopsy, was assessed. The histopathological accuracy, technical success, and the AE rate were also evaluated. Results: Fifty‐one patients (60 ± 15 years, 45.1% male) were included. The majority of patients had altered anatomy (n = 40, 78.4%), and biliary stones (n = 34, 66.7%) was the commonest indication. The technique was predominantly wire‐guided (n = 44, 86.3%) through a percutaneous sheath (n = 36, 70.6%) following a median interval of 8.5 days from percutaneous drainage. Cholangioscopy‐guided electrohydraulic lithotripsy was performed in 29 cases (56.9%), combined with a retrieval basket in eight cases (27.6%). The clinical success was 96.6%, requiring a median of one session (range 1–3). Seventeen patients (33.3%) underwent cholangioscopy‐guided biopsies. There were four (7.8%) cholangioscopy‐related AEs (cholangitis and peritonitis). Overall, the technical success and AE rates were 100% and 19.6%, respectively, in a median follow‐up of 7 months. Conclusion: Percutaneous endoscopic cholangioscopy with a new short device is effective and safe, requiring a low number of sessions to achieve duct clearance or accurate histopathological diagnosis. [ABSTRACT FROM AUTHOR]

Echovirus 11 (E11) has gained attention owing to its association with severe neonatal infections. Due to the limited data available, the World Health Organization (WHO) considers public health risk to the general population to be low. The present study investigated the genetic variation and molecular evolution of E11 genomes collected from May to December 2023. Whole genome sequencing (WGS) was performed for 16 E11 strains. Phylogenetic analysis on WG showed how all Italian strains belonged to genogroup D5, similarly to other E11 strains recently reported in France and Germany all together aggregated into separate clusters. A cluster‐specific recombination pattern was also identified using phylogenetic analysis of different genome regions. Echovirus 6 was identified as the major recombinant virus in 3Cpro and 3Dpol regions. The molecular clock analysis revealed that the recombination event probably occurred in June 2018 (95% HPD interval: Jan 2016–Jan 2020). Shannon entropy analyses, within P1 region, showed how 11 amino acids exhibited relatively high entropy. Five of them were exposed on the canyon region which is responsible for receptor binding with the neonatal Fc receptor. The present study showed the recombinant origin of a new lineage of E11 associated with severe neonatal infections. [ABSTRACT FROM AUTHOR]

Monoamine oxidases (MAOs) are pivotal regulators of neurotransmitters in mammals, while microbial MAOs have been shown to be valuable biocatalysts for enantioselective synthesis of pharmaceutical compounds or precursors thereof. To extend the knowledge of how MAOs function at the molecular level and in order to provide more biocatalytic tools, we set out to identify and study a robust bacterial variant: a MAO from the thermophile Thermoanaerobacterales bacterium (MAOTb). MAOTb is highly thermostable with melting temperatures above 73 °C and is well expressed in Escherichia coli. Substrate screening revealed that the oxidase is most efficient with n-alkylamines with n-heptylamine being the best substrate. Presteady-state kinetic analysis shows that reduced MAOTb rapidly reacts with molecular oxygen, confirming that it is a bona fide oxidase. The crystal structure of MAOTb was resolved at 1.5 °A and showed an exceptionally high similarity with the two human MAOs, MAO A and MAO B. The active site of MAOTb resembles mostly the architecture of human MAO A, including the cysteinyl protein-FAD linkage. Yet, the bacterial MAO lacks a C-terminal extension found in human MAOs, which explains why it is expressed and purified as a soluble protein, while the mammalian counterparts are anchored to the membrane through an a-helix. MAOTb also displays a slightly different active site access tunnel, which may explain the specificity toward long aliphatic amines. Being an easy-to-express, thermostable enzyme, for which a high-resolution structure was elucidated, this bacterial MAO may develop into a valuable biocatalyst for synthetic chemistry or biosensing. [ABSTRACT FROM AUTHOR]

Background: During the Coronavirus disease 2019 (COVID‐19) pandemic, hospital visits were suspended and video calls were offered to connect patients with their family members, especially toward the end of life (EoL). Aim: The primary aim was to describe EoL care for COVID‐19 patients dying in an intensive care unit (ICU). The secondary aim was to explore whether making video calls and allowing visits was associated with lower death‐related stress in family members. Design: Single centre cross‐sectional study. The setting was the ICU of a COVID‐19 center in northern Italy, during the first year of the pandemic. Data on patients who died in the ICU were collected; death‐related stress on their family members was measured using the Impact of Event Scale‐Revised (IES‐R). The statistical association was tested by means of logistic regression. Results: The study sample included 70 patients and 56 family members. All patients died with mechanical ventilation, hydration, nutrition, analgesia and sedation ongoing. Resuscitation procedures were performed in 5/70 patients (7.1%). Only 6/56 (10.7%) of the family members interviewed had visited their loved ones in the ICU and 28/56 (50%) had made a video call. EoL video calls were judged useful by 53/56 family members (94.6%) but all (56/56, 100%) wished they could have visited the patient. High‐stress levels were found in 38/56 family members (67.9%), regardless of whether they were allowed ICU access or made a video call. Compared with other degrees of kinship, patients' offspring were less likely to show a positive IES‐R score (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.05 to 0.89). Conclusions: During the first year of the COVID‐19 pandemic, patients died without their family members at the bedside while on life‐sustaining treatment. Stress levels were high in most family members, especially in patients' spouses. Video calls or ICU visits were judged favourably by family members but insufficient to alleviate death‐related stress. Relevance for Clinical Practice: During a pandemic, ICU access by patients' family members should be considered, particularly as the time of death approaches. Although generally appreciated by family members, EoL video calls should be arranged together with other measures to alleviate death‐related stress, especially for the patient's spouse. [ABSTRACT FROM AUTHOR]

Background: The combination of prone positioning and extracorporeal membrane oxygenation (ECMO) in patients with acute respiratory distress syndrome (ARDS) is recognized as safe but its use has been limited due to potential complications. Aim: To report the prevalence of pressure ulcers and other complications due to prone positioning in adult patients receiving veno–venous ECMO. Study Design: This cross‐sectional study was conducted in a tertiary level intensive care unit (ICU) in Milan (Italy), between January 2015 and December 2019. The study population was critically ill adult patients undergoing veno–venous ECMO. Statistical association between pressure ulcers and the type of body positioning (prone versus supine) was explored fitting a logistic model. Results: In the study period, 114 patients were treated with veno–venous ECMO and 62 (54.4%) patients were placed prone for a total of 130 prone position cycles. ECMO cannulation was performed via femoro–femoral configuration in the majority of patients (82.4%, 94/114). Pressure ulcers developed in 57.0% of patients (95%CI: 44.0%–72.6%), most often arising on the face and the chin (37.1%, 23/62), particularly in those placed prone. The main reason of prone positioning interruption was the decrease of ECMO blood flow (8.1%, 5/62). The fitted model showed no association between body position during ECMO and occurrence of pressure ulcers (OR 1.3, 95%CI: 0.5–3.6, p =.532). Conclusions: Facial pressure ulcers were the most frequent complications of prone positioning. Nurses should plan and implement evidence‐based care to prevent such pressure injuries in patients undergoing ECMO. Relevance to Clinical Practice: The combination of prone positioning and ECMO shows few life‐threating complications. This manoeuvre during ECMO is feasible and safe when performed by experienced ICU staff. [ABSTRACT FROM AUTHOR]

Missense variants of hyperpolarization‐activated, cyclic nucleotide‐gated (HCN) ion channels cause variable phenotypes, ranging from mild generalized epilepsy to developmental and epileptic encephalopathy (DEE). Although variants of HCN1 are an established cause of DEE, those of HCN2 have been reported in generalized epilepsies. Here we describe the first case of DEE caused by the novel de novo heterozygous missense variant c.1379G>A (p.G460D) of HCN2. Functional characterization in transfected HEK293 cells and neonatal rat cortical neurons revealed that HCN2 p.G460D currents were strongly reduced compared to wild‐type, consistent with a dominant negative loss‐of‐function effect. Immunofluorescence staining showed that mutant channels are retained within the cell and do not reach the membrane. Moreover, mutant HCN2 also affect HCN1 channels, by reducing the Ih current expressed by the HCN1‐HCN2 heteromers. Due to the persistence of frequent seizures despite pharmacological polytherapy, the patient was treated with a ketogenic diet, with a significant and long‐lasting reduction of episodes. In vitro experiments conducted in a ketogenic environment demonstrated that the clinical improvement observed with this dietary regimen was not mediated by a direct action on HCN2 activity. These results expand the clinical spectrum related to HCN2 channelopathies, further broadening our understanding of the pathogenesis of DEE. [ABSTRACT FROM AUTHOR]

Introduction: Among patients with non‐valvular atrial fibrillation (AF) and percutaneous left atrial appendage closure (LAAC) undergoing direct current cardioversion (DCCV), the need for and use of LAA imaging and oral anticoagulation (OAC) is unclear. Objective: The purpose of this study is to evaluate the real‐world use of transesophageal echocardiography (TEE) or cardiac computed tomography angiography (CCTA) before DCCV and use of OAC pre‐ and post‐DCCV in patients with AF status post percutaneous LAAC. Methods: This retrospective single center study included all patients who underwent DCCV after percutaneous LAAC from 2016 to 2022. Key measures were completion of TEE or CCTA pre‐DCCV, OAC use pre‐ and post‐DCCV, incidence of left atrial thrombus (LAT) or device‐related thrombus (DRT), incidence of peri‐device leak (PDL), and DCCV‐related complications (stroke, systemic embolism, device embolization, major bleeding, or death) within 30 days. Results: A total of 76 patients with AF and LAAC underwent 122 cases of DCCV. LAAC consisted of 47 (62%), 28 (37%), and 1 (1%) case of Watchman 2.5, Watchman FLX, and Lariat, respectively. Among the 122 DCCV cases, 31 (25%) cases were identified as "non‐guideline based" due to: (1) no OAC for 3 weeks and no LAA imaging within 48 h before DCCV in 12 (10%) cases, (2) no OAC for 4 weeks following DCCV in 16 (13%) cases, or (3) both in 3 (2%) cases. Among the 70 (57%) cases that underwent TEE or CCTA before DCCV, 16 (23%) cases had a PDL with a mean size of 3.0 ± 1.1 mm, and 4 (6%) cases had a LAT/DRT on TEE resulting in cancellation. There were no DCCV‐related complications within 30 days. Discussion: There is a widely varied practice pattern of TEE, CCTA, and OAC use with DCCV after LAAC, with a 6% rate of LAT/DRT. LAA imaging before DCCV appears prudent in all cases, especially within 1 year of LAAC, to assess for device position, PDL, and LAT/DRT. [ABSTRACT FROM AUTHOR]

Brain plasticity and function is impaired in conditions of metabolic dysregulation, such as obesity. Less is known on whether brain function is also affected by transient and physiological metabolic changes, such as the alternation between fasting and fed state. Here we asked whether these changes affect the transient shift of ocular dominance that follows short‐term monocular deprivation, a form of homeostatic plasticity. We further asked whether variations in three of the main metabolic and hormonal pathways affected in obesity (glucose metabolism, leptin signalling and fatty acid metabolism) correlate with plasticity changes. We measured the effects of 2 h monocular deprivation in three conditions: post‐absorptive state (fasting), after ingestion of a standardised meal and during infusion of glucagon‐like peptide‐1 (GLP‐1), an incretin physiologically released upon meal ingestion that plays a key role in glucose metabolism. We found that short‐term plasticity was less manifest in fasting than in fed state, whereas GLP‐1 infusion did not elicit reliable changes compared to fasting. Although we confirmed a positive association between plasticity and supraphysiological GLP‐1 levels, achieved by GLP‐1 infusion, we found that none of the parameters linked to glucose metabolism could predict the plasticity reduction in the fasting versus fed state. Instead, this was selectively associated with the increase in plasma beta‐hydroxybutyrate (B‐OH) levels during fasting, which suggests a link between neural function and energy substrates alternative to glucose. These results reveal a previously unexplored link between homeostatic brain plasticity and the physiological changes associated with the daily fast‐fed cycle. [ABSTRACT FROM AUTHOR]

Objectives: To generate a prognostic model based on a nomogram for adverse event (AE) prediction after lumen‐apposing metal stents (LAMS) placement in patients with pancreatic fluid collections (PFC). Methods: Data from a large multicenter series of PFCs treated with LAMS placement were retrieved. AE (overall and excluding mild events) prediction was calculated through a logistic regression model and a nomogram was created and internally validated after bootstrapping. Results were expressed in terms of odds ratio (OR) and 95% confidence interval (CI). Discrimination was assessed by c‐statistics and calibrated by comparing deciles of predicted and observed ORs. Results: Overall, 516 patients were included (males 68%, mean age 61.6 ± 15.2 years). PFCs were predominantly walled‐off necrosis (52.1%). Independent predictors of AE occurrence were injury of main pancreatic duct (OR in the case of leak 2.51, 95% CI 1.06–5.97, P = 0.03; OR in the case of complete disruption 2.61, 1.53–4.45, P = 0.01), abnormal vessels (OR in the case of perigastric varices 2.90, 1.31–6.42, P = 0.008; OR in the case of pseudoaneurysm 2.99, 1.75–11.93, P = 0.002), using a multigate technique (OR 3.00, 1.28–5.24; P = 0.05), and need of percutaneous drainage (OR 2.81, 1.03–7.65, P = 0.04). By nomogram, a score beyond 200 points corresponded to a 50% probability of AE occurrence. The model was confirmed even when excluding mild AEs and it showed optimal discrimination (c‐index 76.8%, 95% CI 74–79), confirmed after internal validation. Conclusion: Patients with preprocedural evidence of pancreatic duct leak/disruption, vessel alteration, requiring percutaneous drainage or a multigate technique are at higher risk for AE. [ABSTRACT FROM AUTHOR]

Near‐infrared (NIR) photodetectors can be fabricated for various applications, such as imaging, military tracking, and medical diagnosis. However, achieving miniaturization and high responsivity for NIR photodetector arrays is still a challenge. In this study, a high‐density NIR photodetector array with a micro/nano chalcogenide and silver nanoparticle heterostructure is achieved using a low‐cost printing strategy. The Ag/Ge2Sb2Te5(GST)/Ag heterostructure is fabricated using a template‐assisted sequential printing strategy. At an absorption wavelength of λ = 980 nm, the NIR photodetector has a high light responsivity of 6.7 × 104 A W−1 owing to the high crystallinity of the GST microwire and refined GST/Ag heterointerface during the printing process. In addition, the sensing pixel interval can be reduced to 25 µm, corresponding to the highest resolution of NIR photodetectors achieved thus far (resolution: 1.0 × 103 dpi). In addition, the NIR photodetector printed on soft substrates exhibits flexibility. Thus, a simple and effective strategy for the fabrication of NIR photodetectors is demonstrated, and precise flexible infrared sensing is achieved. [ABSTRACT FROM AUTHOR]

Introduction: Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract illness in young children and can also cause influenza‐like illness (ILI). Here we investigated the epidemiological features of RSV infection in pediatric ILI cases in Lombardy (a region in Northern Italy accounting nearly 10 million inhabitants) from 2014–2015 to 2020–2021 winter seasons. Material and Methods: Data for this study were retrieved and statistically analyzed from the database of virological influenza surveillance of the regional reference laboratory for Lombardy within the Italian influenza surveillance network (InfluNet). Results: RSV accounted for nearly 19% of pediatric ILI with a risk of infection nearly two‐fold greater than that of individuals ≥15 years. RSV positivity rate increased to 28% considering 0–5 years old children. Although in children ≤5 years the risk of infection from influenza viruses resulted nearly two‐fold higher than the risk of RSV infection, the age group 4–6 months and 7–12 months showed a five‐fold greater risk of infection from RSV than from influenza. Children ≤5 years of age with pre‐existing underlying health conditions had a nearly five‐fold greater risk of getting RSV infection than otherwise healthy 0–5 years old children. RSV was identified in ILI cases <15 years of age in all considered winter seasons except in the 2020–2021 season. Discussion Sentinel surveillance of ILI allowed us to identify groups at higher risk of RSV and influenza infection and to define the start, duration, timing, and intensity of the RSV and influenza community circulation. This surveillance approach can be implemented to assess the RSV circulation and impact in a real‐time manner. [ABSTRACT FROM AUTHOR]

The N‐methyl‐D‐glucamine moieties exhibit high ability and selectivity toward arsenate ions in water by a complexation mechanism that involves their hydroxyl groups. In this work, the syntheses of two monomers containing N‐methyl‐D‐glucamine, namely 4‐vinylbenzyl‐N‐methyl‐D‐glucamine (VbNMDG), and N‐methyl‐D‐glucamine methacrylamide (MNMDG) were studied. Different synthetic routes were considered in order to obtain liquid monomers able to polymerize and selectively capture arsenic. Furthermore, the incorporation of protective groups like trimethylsilyl moieties in the molecular structure was assessed to prevent transfer reactions during further polymerization. After polymerization, hydroxyl groups were deprotected using hydrofluoric acid. Following this methodology, structured microporous polymeric films based on colloidal crystal templates were prepared. NMR and FTIR techniques were used to follow the reactions and to determine the chemical structure of the obtained products. The morphology of materials was characterized by SEM. The performances of the developed polymeric films to selectively capture arsenic were determined. Films showed an improved and reproducible sensitivity to arsenic detection exhibiting high values of arsenic capturing capability (around 90%). [ABSTRACT FROM AUTHOR]

Background: In 2015, the Lancet Commission on Global Surgery published six global surgery goals, one of which was to provide 80% of the world's population with timely access to the Bellwether Surgical procedures. Little is known about the prevalence or efficacy of subsequent interventions implemented in under-resourced countries to increase timely access to Bellwether surgical procedures. Methods: A systematic review of articles and grey literature published in MEDLINE, Embase, Cochrane, CINAHL, and Web of Science databases was conducted. Two independent reviewers evaluated 1923 captured abstracts using explicit inclusion and exclusion criteria. Following a thematic analysis, two reviewers conducted data extraction on the eleven manuscripts included in the final review. Results: The studied innovations, sparse in number, centred on improved educational resources, the development of orthopaedic devices, and models for assessing surgical access disparity. Eight papers were centred around timely access to caesarean sections, three around open fracture reduction, and three around laparotomy; all focused on adult populations. Five papers addressed innovations in West Africa, two in East Africa, two in South Asia, and one in Southeast Asia. Common outcome metrics were not used to assess improvements to timely surgical access. Conclusions: Few published interventions have been implemented since the publication of the 2015 Lancet Commission on Global Surgery goals that have or will longitudinally increase the availability of timely surgical access in Low and Middle-Income Countries (LMIC). Tangible outcome measures in existing literature are lacking. An up-scaling and wider adoption of successful strategies is necessary and possible. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Binda M, Koninckx P. Hyperoxia and prevention of adhesion formation: a laparoscopic mouse model for open surgery. BJOG 2010;117:331–339. Objective CO2 pneumoperitoneum with more than 10% oxygen enhances adhesions. As during open surgery the peritoneum is exposed to air (20% oxygen), in this hyperoxia-enhanced adhesion model we evaluated the effect of hypothermia and products with known effectiveness in hypoxia (pure CO2 pneumoperitoneum) and normoxia (CO2 pneumoperitoneum plus 3–4% oxygen) models. Results were expected to be important for adhesion prevention in open surgery, and, moreover, similarities and differences between the three models would be important to identify differences in pathways of adhesion formation between laparoscopy and laparotomy. Design Two experiments were performed in which the effect of hypothermia (32°C), a surfactant (phospholipids), a barrier (Hyalobarrier® gel), reactive oxygen species scavengers (superoxide dismutase, SOD, and ascorbic acid, AA), anti-inflammatory agents (dexamethasone and nimesulide), a calcium channel blocker (diltiazem) and recombinant plasminogen activator (r-PA) were evaluated upon adhesions. Setting University Hospital. Population BALB/c mice. Methods Hyperoxia-enhanced adhesions were induced by performing laparoscopically bipolar lesions during 60 minutes of CO2 pneumoperitoneum plus 12% oxygen at 37°C body temperature. Main outcome measures Adhesions were scored after 7 days. Results In this model, adhesions were reduced by hypothermia ( P < 0.02; Wilcoxon), phospholipids ( P = 0.03), Hyalobarrier® gel ( P < 0.004), dexamethasone ( P < 0.005) and diltiazem ( P < 0.01). A significant but quantitatively borderline effect was seen for AA ( P < 0.002) and r-PA ( P = 0.0005), whereas SOD and nimesulide did not have any effect. Conclusions Hyperoxia-enhanced adhesions were prevented by hypothermia, dexamethasone, phospholipids, Hyalobarrier® gel, diltiazem, r-PA and AA. All effects were similar to those in the hypoxia-enhanced adhesion model, suggesting that the underlying mechanisms are similar. [ABSTRACT FROM AUTHOR]

Background: Besides seasonal influenza viruses (IV), several other pathogens—including respiratory syncytial virus (RSV)—are involved in clinically undistinguished influenza‐like illnesses (ILIs). This study aimed at investigating the contribution of RSV in ILI cases in Lombardy (Northern Italy) during four consecutive winter seasons. Materials and Methods: In the framework of influenza surveillance, respiratory samples from ILI outpatients were collected from 2014‐2015 to 2017‐2018 season. IV‐negative swabs were included in the study and analyzed to detect and molecularly characterize RSV‐A and RSV‐B. Results: A total of 12.9% (135/1047) of samples were positive to RSV that was mostly detected among children ≤5 years (51/183, 27.8%) and those aged 6 to 15 years (30/158, 18.9%), whereas elderly >65 years accounted for 12% of RSV cases (15/125). The median start of RSV epidemic was in the end of November, with a peak in mid‐February and a width of nearly 4 months, almost overlapping seasonal influenza epidemic. RSV‐A and RSV‐B co‐circulated in all considered seasons, with RSV‐B predominating on RSV‐A (63.6% vs 36.4%; P <.001). Most (85.2%) RSV‐A belonged to genotype ON1 and the remaining to NA1. All RSV‐B clustered within the BA genotype. Conclusions: In this study, RSV significantly contributed to ILI cases, especially among pediatric population (<15 years), although it was detected in all age groups. RSV‐B predominated on RSV‐A, and the most recent evolved genotypes (BA and ON1, respectively) circulated. Investigating the epidemiological and molecular characteristics of RSV in ILI cases can increase baseline epidemiological information before the introduction of RSV vaccination. Highlights: RSV significantly contributed to influenza‐like illnesses (ILIs) cases, especially among pediatric population <15 yearsRSV‐B predominated on RSV‐A and the most recent evolved genotypes BA and ON1 circulated among ILI cases.To set up specific vaccination strategies, it is warrant increasing the current knowledge on RSV epidemiology and impact. [ABSTRACT FROM AUTHOR]

Aim: The goal of this European Society of Coloproctology (ESCP) guideline project is to give an overview of the existing evidence on the management of diverticular disease, primarily as a guidance to surgeons. Methods: The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements. Results: This guideline contains 38 evidence based consensus statements on the management of diverticular disease. Conclusion: This international, multidisciplinary guideline provides an up to date summary of the current knowledge of the management of diverticular disease as a guidance for clinicians and patients. [ABSTRACT FROM AUTHOR]

As an electrocatalyst with abundant resources and great potential, molybdenum disulfide is regarded as one of the most likely alternatives to expensive noble‐metals catalysts. However, it is still a challenge to achieve large scale production of few‐layer MoS2 with enhancing activity of electrocatalytic hydrogen reaction at ambient conditions. Herein, we developed a simple environmentally friendly two‐step method, which included intercalation reaction and a subsequent electrochemical reduction reaction for mass preparation of defect‐rich desulfurized MoSx (D−MoSx) nanosheets with plentiful sulfur vacancies. The ratio of sulfur‐molybdenum atoms can be adjusted from 2 : 1 to 1.4 : 1 by regulating the desulfurization voltage. It was found that the HER catalytic activity of the D−MoSx was enhanced compared with that of pristine MoS2 (P−MoS2), the current density of D−MoSx (desulfurization at −1.0 V) at −0.3 V versus RHE was about 169% of the P−MoS2, and the Tafel slope decreased to 136 mV dec−1. This method can be widely applied to large‐scale preparation of other two‐dimensional materials. [ABSTRACT FROM AUTHOR]

Aim: The optimal surgical treatment of splenic flexure neoplasm is still not well defined. Extended right hemicolectomy (ERH) and left colic resection (LCR) have been proposed but conclusive evidence concerning postoperative morbidity and oncological results is lacking. The aim of this study was to analyse the short‐term outcomes after surgery for splenic flexure cancer with regard to surgical procedure and surgeon's specialty. Methods: This was a multicentre study on patients who underwent surgery for primary colon cancer of the splenic flexure. Results: From 2004 to 2015, 324 patients fulfilled the criteria for inclusion into the study; 270 (83.4%) had elective surgery while 54 (16.6%) had emergency resection: 158 (48.8%) underwent ERH and 166 (51.2%) LCR; 176 (54.3%) procedures were performed by colorectal surgeons, 148 (46.7%) by general surgeons. In the ERH group a significantly higher rate of emergency operations was carried out (P = 0.005). After elective surgery, no significant differences between ERH and LCR concerning 30‐day mortality (3.3% vs 2.0%) and the need for reoperation (10.6% vs 7.4%) were found. Nodal harvesting was significantly higher in the ERH and colorectal surgeon groups in any clinical scenario. At multivariate analysis, age and smoking habit were predictive of the need for reoperation and major morbidity while the general surgeon group showed a higher risk of anastomotic failure (OR = 1.92; P = 0.168). Conclusion: We analysed the largest series in literature of curative resections for splenic flexure tumours. The optimal procedure still remains debatable as ERH and LCR appear to achieve comparable short‐term outcomes. Surgeon's specialty seems to positively affect patient's outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the experience of an intensive care unit (ICU) team in Milan, Italy in using video calls at end of life (EOL) during the COVID-19 pandemic. Topics covered include the debate among physicians and nurses with regards to the choice of using video calls peri mortem, with some believing that this modality could be traumatic for family members and for the staff, and psychological impact of video calling from the family-members' perspective.

Aim: In colorectal cancer, ligation of the inferior mesenteric artery (IMA) is a standard surgical approach. In contrast, ligation of the IMA is not mandatory during treatment of diverticular disease. The object of this meta‐analysis was to assess if preservation of the IMA reduces the risk of anastomotic leakage. Method: A search was performed up to August 2018 using the following electronic databases: MEDLINE/PubMed, ISI Web of Knowledge and Scopus. The measures of treatment effect utilized risk ratios for dichotomous variables with calculation of the 95% CI. Data analysis was performed using the meta‐analysis software Review Manager 5.3. Results: Eight studies met the inclusion criteria and were included in the meta‐analysis: two randomized controlled trials (RCTs) and six non‐RCTs with 2190 patients (IMA preservation 1353, ligation 837). The rate of anastomotic leakage was higher in the IMA ligation group (6%) than the IMA preservation group (2.4%), but this difference was not statistically significant [risk ratio (RR) 0.59, 95% CI 0.26–1.33, I2 = 55%]. The conversion to laparotomy was significantly lower in the IMA ligation group (5.1%) than in the IMA preservation group (9%) (RR 1.74, 95% CI 1.14–2.65, I2 = 0%). Regarding the other outcomes (anastomotic bleeding, bowel injury and splenic damage), no significant differences between the two techniques were observed. Conclusion: This meta‐analysis failed to demonstrate a statistically significant difference in the anastomotic leakage rate when comparing IMA preservation with IMA ligation. Thus, to date there is insufficient evidence to recommend the IMA‐preserving technique as mandatory in resection for left‐sided colonic diverticular disease. [ABSTRACT FROM AUTHOR]

Potential role of subcutaneous tocilizumab injections in patients with COVID-19 associated pneumonia Guaraldi et al.1 found a significant reduction in risk of invasive mechanical ventilation or death in patients with severe coronavirus disease 2019 (COVID-19) pneumonia who were treated with either I.V. or S.C. tocilizumab and standard of care, compared with those treated with standard of care only. Eleven (45.8%) had AST/ALT increases (<400 IU/L, but for one intensive care unit patient with multiorgan failure who had 4900/5100 U/L), four patients had thrombocytopenia (all higher than 55 × 10 SP 9 sp /L), three had mild neutropenia (all higher than 800 cells/mm SP 3 sp ). [Extracted from the article]

Aim Accurate preoperative discrimination between extra- and intraperitoneal rectal cancer has important treatment implications. Our main objective was to compare the diagnostic performance of MRI with rigid rectoscopy ( RRS) in assessing the location of rectal cancers above or below the peritoneal reflection ( PR), using the findings obtained during abdominal surgery for treatment of the cancer as the reference standard. We also compared the accuracy of MRI and RRS in assessing the level of the lower border of the tumour from the anal verge. Method Patients with rectal carcinoma awaiting surgery underwent MRI and RRS. The MRI images were reviewed by two abdominal radiologists who determined the location of the inferior border of the tumour in relation to the PR. Receiver-operating characteristics ( ROC) curve analysis was performed to determine the diagnostic performance of RRS at different cut-off values. Results The sensitivity and specificity were 98.15% and 100%, respectively, for MRI, and 100% and 76.92%, respectively, for RRS at a cut-off value of < 10 cm. The mean level of the lower border of the tumour from the anal verge was 68 ± 44.3 mm on RRS and 73.5 ± 42.4 mm on MRI ( P = 0.25), with a trend towards overestimation with MRI. Conclusion RRS is still the main means of assessing the level of a rectal tumour from the anal verge, but MRI has value in determining the level of the tumour in relation to the PR, which cannot be seen on endoscopy. [ABSTRACT FROM AUTHOR]

Abstract: Cellular senescence, the irreversible cell cycle arrest observed in somatic cells, is an important driver of age‐associated diseases. Mitochondria have been implicated in the process of senescence, primarily because they are both sources and targets of reactive oxygen species (ROS). In the heart, oxidative stress contributes to pathological cardiac ageing, but the mechanisms underlying ROS production are still not completely understood. The mitochondrial enzyme monoamine oxidase‐A (MAO‐A) is a relevant source of ROS in the heart through the formation of H2O2 derived from the degradation of its main substrates, norepinephrine (NE) and serotonin. However, the potential link between MAO‐A and senescence has not been previously investigated. Using cardiomyoblasts and primary cardiomyocytes, we demonstrate that chronic MAO‐A activation mediated by synthetic (tyramine) and physiological (NE) substrates induces ROS‐dependent DNA damage response, activation of cyclin‐dependent kinase inhibitors p21cip, p16ink4a, and p15ink4b and typical features of senescence such as cell flattening and SA‐β‐gal activity. Moreover, we observe that ROS produced by MAO‐A lead to the accumulation of p53 in the cytosol where it inhibits parkin, an important regulator of mitophagy, resulting in mitochondrial dysfunction. Additionally, we show that the mTOR kinase contributes to mitophagy dysfunction by enhancing p53 cytoplasmic accumulation. Importantly, restoration of mitophagy, either by overexpression of parkin or inhibition of mTOR, prevents mitochondrial dysfunction and induction of senescence. Altogether, our data demonstrate a novel link between MAO‐A and senescence in cardiomyocytes and provides mechanistic insights into the potential role of MAO‐dependent oxidative stress in age‐related pathologies. [ABSTRACT FROM AUTHOR]

Mechanisms by which hydrochemical changes occur after earthquakes are not well documented. We use the 2016–2017 central Italy seismic sequence, which caused notable hydrochemical transient variations in groundwater springs to address this topic, with special reference to effects on fractured carbonate aquifers. Hydrochemistry measured before and after the earthquakes at four springs at varying distances from the epicenters all showed immediate postmainshock peaks in trace element concentrations but little change in major elements. Most parameters returned to preearthquake values before the last events of the seismic sequence. The source of solutes, particularly trace elements, is longer residence time pore water stored in slow‐moving fractures or abandoned karstic flow paths. These fluids were expelled into the main flow paths after an increase in pore pressure, hydraulic conductivity, and shaking from coseismic aquifer stress. The weak response to the later earthquakes is explained by progressive depletion of high solute fluids as earlier shocks flushed out the stored fluids in the fractures. Spring δ13CDIC values closest to a deep magma source to the west became enriched relative to preearthquake values following the 24 August event. This enrichment indicates input from deeply sourced dissolved CO2 gas after dilation of specific fault conduits. Differences in carbon isotopic responses between springs are attributed to proximity to the deep gaseous CO2 source. Most of the transient chemical changes seen in the three fractured carbonate aquifers are attributed to local shaking and emptying of isolated pores and fractures and are not from rapid upward movement of deep fluids. Plain Language Summary: Understanding the mechanisms of chemical and fluid transport to groundwater springs after earthquakes is poorly understood. Recent earthquakes in the Apennine mountains of central Italy provide a unique example of pre and post earthquake changes to groundwater chemistry in different carbonate aquifers. Our data show that changes were temporary for about 4 months after the earthquakes and that distance from the earthquake gave different responses. We show that the cause of these temporary changes was caused by shaking of long residence time local water into the fast moving flow. Once this long residence time water was flushed from the system the chemistry returned to background concentrations. We found little evidence of precursor chemical changes and no change in arsenic, which had been reported elsewhere. We did find changes in carbon dioxide gas in some springs that indicated that where a deep source of this gas existed, that it could quickly be released to the springs. These findings have implications for water supply delivery immediately after earthquakes and show that local shaking is likely more important than fluids derived from deep sources. Key Points: Transient changes in trace elements after earthquakes in fractured carbonate aquifers are due to local ground shaking not deep fluid movementChanges in carbon isotopic ratio in some springs near a deep magma source indicate release of dissolved CO2 gas after shakingShaking out long residence time water from isolated pores and fractures into the main flow path is the reason for the transient response [ABSTRACT FROM AUTHOR]

Summary: HBV eradication in chronic hepatitis B (CHB) subjects is rarely achieved with either nucleos(t)ide analogues (NA) or pegylated interferon (Peg‐IFN), which both have a limited effect in restoring immune responses. Thirty CHB subjects on long‐term treatment with tenofovir (TDF) and HBV suppression were enrolled and randomized 1:2 to either receive Peg‐IFN‐α‐2a add‐on therapy or continue TDF alone. We studied γδ T and iNKT frequency and function (by flow cytometry) at baseline, at 12 weeks and 12 weeks after the end of treatment. A higher reduction in qHBsAg occurred in the add‐on group compared with the NA group at W12 (P = .016) and at W24 (P = .012). A decline of qHBsAg ≥0.5 log10 at week 24 occurred in 4 of 10 patients in the add‐on arm and 1 of 20 in the NA arm, respectively (P = .03). HBsAg loss was seen in 20% of subjects in the add‐on group and in none of the NA group. Compared to HBV negative, CHB on TDF showed lower frequency of iNKT (P = .03) and γδ T cells (P = .03) as well as fewer γδ T cells expressing Vδ2 T‐cell receptors (P = .005). No changes in unconventional T‐cell frequency and function were shown in both add‐on and NA patients nor were differences detected between the two treatment groups. We report persistent impairment of unconventional T cells in CHB. Despite a greater qHBsAg decline of add‐on patients, our data failed to detect any effect of Peg‐IFN treatment on unconventional T cells. [ABSTRACT FROM AUTHOR]

Abstract: Various flavoprotein oxidases were recently shown to oxidize primary thiols. Herein, this reactivity is extended to sec‐thiols by using structure‐guided engineering of 5‐(hydroxymethyl)furfural oxidase (HMFO). The variants obtained were employed for the oxidative kinetic resolution of racemic sec‐thiols, thus yielding the corresponding thioketones and nonreacted R‐configured thiols with excellent enantioselectivities (E≥200). The engineering strategy applied went beyond the classic approach of replacing bulky amino acid residues with smaller ones, as the active site was additionally enlarged by a newly introduced Thr residue. This residue established a hydrogen‐bonding interaction with the substrates, as verified in the crystal structure of the variant. These strategies unlocked HMFO variants for the enantioselective oxidation of a range of sec‐thiols. [ABSTRACT FROM AUTHOR]

Cytomegalovirus (CMV) infection is the most frequent congenital infection in humans and can cause permanent damage-particularly neurological-in about 20% of those infected, with or without symptoms at birth. Laboratory diagnosis is essential on account of the relatively non-specific clinical manifestations in symptomatic newborns but also because of the high frequency of asymptomatic cases that are nevertheless at risk of lesions later in life. However, these tests need samples taken within 3 weeks of birth to distinguish congenital infection from the more common, but clinically benign, perinatal infection. Tests for viral DNA have proved a valid means of diagnosing congenital CMV infection in neonatal blood dried on paper (DBS) widely used in screening for metabolic and genetic diseases, as an alternative to the conventional urine culture method. The DBS test is simpler, faster and less costly than viral isolation; in addition the samples can be safely stored for long periods, so diagnosis can be made even after several years. The sensitivity and specificity of the DBS test, compared to the reference method, have been reported to range between 71 and 100% and 99 and 100%, respectively, depending on the different studies and diagnostic criteria applied. The most interesting applications reported so far involve retrospective determination of the impact of congenital CMV in sensorineural deafness, abnormalities of cortical development, neonatal cholestasis and surveys of the prevalence of this infection in various populations. The test might be useful in the future for neonatal screening with a view to treating neonates and so avoiding the damage this disease can cause. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Composite scales such as the Total Neuropathy Score clinical version ( TNSc©) have been widely used to measure neurological impairment in a standardized manner but they have been criticized due to their ordinal setting having no fixed unit. This study aims to improve impairment assessment in patients with chemotherapy-induced peripheral neuropathy ( CIPN) by subjecting TNSc© records to Rasch analyses. In particular, we wanted to investigate the influence of factors affecting the use of the TNSc© in clinical practice. TNSc© has 7 domains (sensory, motor, autonomic, pin-prick, vibration, strength, and deep tendon reflexes [ DTR]) each being scored 0-4. Data obtained in 281 patients with stable CIPN were subjected to Rasch analyses to determine the fit to the model. The TNSc© did not meet Rasch model's expectations primarily because of misfit statistics in autonomic and DTR domains. Removing these two, acceptable model fit and uni-dimensionality were obtained. However, disordered thresholds (vibration and strength) and item bias (mainly cultural) were still seen, but these findings were kept to balance the assessment range of the Rasch-Transformed TNSc© ( RT-TNSc©). Acceptable reliability findings were also obtained. A 5-domains RT-TNSc© may be a more proper assessment tool in patients with CIPN. Future studies are needed to examine its responsive properties. [ABSTRACT FROM AUTHOR]

Three dimensional printing enables realization of complex shape rare earth permanent magnet that enable unlocking the full potential of electrical devices for energy consumption and renewable energy production. [ABSTRACT FROM AUTHOR]

Aim Laparoscopy offers the benefits of minimally invasive surgery and faster recovery. Acute surgical patients may potentially benefit from the great advantages of emergency laparoscopy, which is more clinically relevant in acute than elective patients. Fashioning a laparoscopic intracorporeal anastomosis ( ICA) after emergent colorectal resection, whenever technically feasible and not contraindicated by the patient's general and haemodynamic condition, is a most challenging technical skill. Method During the period 2010-2016, 59 patients underwent a laparoscopic procedure for colorectal emergency in an acute care setting by a single operating surgeon with advanced laparoscopic skills and specific expertise in both colorectal surgery and acute care surgery. This series includes 32 laparoscopic right colectomies (12 for obstruction and 20 for perforation/peritonitis) and 27 left colectomies (6 for obstruction and 21 for perforation/peritonitis). Twenty-eight ileocolic side-to-side ICA, and 27 left colonic ICA (3 colocolic, 24 colorectal) were performed. Results Reasonably good postoperative outcomes were observed in the entire series of 59 laparoscopic colectomies performed in an urgent setting. Overall, the major morbidity rate in the entire group was 16.9% (10/59) with an incidence of intra-abdominal abscess of 11.8% (7/59); the overall leak rate was 3.4% (2/59). The re-operation rate was 3.4% (2/59). A video included in the Supporting Information shows five different sites and techniques for ICA and describes technical details with tips and tricks. All patients shown in the video had an uneventful postoperative recovery and were managed postoperatively according to enhanced recovery after surgery protocols. Conclusion This case series illustrates all possible sites and techniques for colonic ICA in an emergency setting. All colorectal and acute care surgeons should have laparoscopic suturing skills. [ABSTRACT FROM AUTHOR]

Objectives Clinical trials of all-oral direct-acting antivirals ( DAAs) for chronic hepatitis C virus ( HCV) infection reported high response rates in HCV/ HIV coinfection, similar to those obtained in HCV monoinfection. We evaluated the safety and efficacy of these regimens in a clinical practice setting. Methods In this prospective observational study, all the HCV-monoinfected and HCV/ HIV-coinfected patients undergoing HCV treatment with all-oral DAA regimens in a routine clinical setting from December 2014 to December 2015 were included in the analysis. Sustained virological response 12 weeks after the end of therapy ( SVR12) and reported adverse events ( AEs) were evaluated. Resistance-associated variants ( RAVs) were analysed in a subgroup of patients at baseline and at the time of viral rebound in those with virological failure. Results One-hundred and nine patients (51 HCV-infected and 58 HCV/ HIV-coinfected) were enrolled in the study. Sixty per cent had cirrhosis and 52% were pegylated interferon and ribavirin (peg IFN/ RBV)-experienced. Thirty-six per cent received ombitasvir + paritaprevir/ritonavir + dasabuvir, 25% sofosbuvir + daclatasvir, 16% sofosbuvir + simeprevir, 17% sofosbuvir + ribavirin and 6% sofosbuvir + ledipasvir; ribavirin was used in 57% of subjects. The SVR12 rate was 91% and 96% in HIV-infected and uninfected patients, respectively ( P = 0.44). The 4-week HCV viral decline was similar in the two groups. RAVs were found at baseline in 23 of 49 patients and did not affect SVR12. No predictors of SVR12 were identified in our cohort. Conclusions Treatment with all-oral DAA combinations of patients infected with HCV and with HCV/ HIV under real-life conditions led to high and similar rates of SVR12. Moreover, the historical factors associated with a sustained virological response to peg IFN/ RBV were not predictive of the response to all-oral DAAs. [ABSTRACT FROM AUTHOR]

Background: In recent years, the emergency management of acute left colonic diverticulitis (ALCD) has evolved dramatically despite lack of strong evidence. As a consequence, management strategies are frequently guided by surgeon's personal preference, rather than by scientific evidence. The primary aim of IPOD study (Italian Prospective Observational Diverticulitis study) is to describe both the diagnostic and treatment profiles of patients with ALCD in the Italian surgical departments. Methods: IPOD study is a prospective observational study performed during a 6-month period (from April 1 2015 to September 1 2015) and including 89 Italian surgical departments. All consecutive patients with suspected clinical diagnosis of ALCD confirmed by imaging and seen by a surgeon were included in the study. The study was promoted by the Italian Society of Hospital Surgeons and the World Society of Emergency Surgery Italian chapter. Results: Eleven hundred and twenty-five patients with a median age of 62 years [interquartile range (IQR), 51-74] were enrolled in the IPOD study. One thousand and fifty-four (93.7%) patients were hospitalized with a median duration of hospitalization of 7 days (IQR 5-10). Eight hundred and twenty-eight patients (73.6%) underwent medical treatment alone, 13 patients had percutaneous drainage (1.2%), and the other 284 (25.2%) patients underwent surgery as first treatment. Among 121 patients having diffuse peritonitis, 71 (58.7%) underwent Hartmann's resection. However, the Hartmann's resection was used even in patients with lower stages of ALCD (36/479; 7.5%) where other treatment options could be more adequate. Conclusions: The IPOD study demonstrates that in the Italian surgical departments treatment strategies for ALCD are often guided by the surgeon's personal preference. [ABSTRACT FROM AUTHOR]

The human immunodeficiency virus ( HIV)/hepatitis B virus ( HBV) co-infection is likely to be associated with an increased risk of kidney disease, due to the additional factors that may affect renal function in the HIV population. We aimed to evaluate renal toxicity in HIV/ HBV and HBV mono-infected patients on long-term therapy with tenofovir ( TDF) and to explore the association of polymorphisms in ATP-binding cassette ( ABCC) 2, ABCC4, ABCC10 with the development of renal dysfunction. From September 2006 to November 2014, 44 HIV/ HBV co-infected and 34 HBV mono-infected patients were commenced on TDF. Data of renal safety were retrospectively collected and analyzed. ABCC2, ABCC4 and ABCC10 genotypes were identified by real-time PCR. Over 60 months of observation, there was a significant increase in mean creatinine levels from baseline ( P<.01) that was not significantly different between the two study groups. Moreover, a significant decline in estimated glomerular filtration rate ( eGFR) was observed from baseline ( P<.01), and it was significantly greater in HBV mono-infected than co-infected patients ( P=.03). The distribution of ABCC2, ABCC4 and ABCC10 genotypes among a subgroup of 34 patients did not show significant association with eGFR decline <90 mL/min per 1.73 m2. Although our findings showed a statistically significant decrease in eGFR with long-term use of TDF, its clinical impact seems to be modest. The role of genetic factors to identify patients at greater risk for developing tenofovir-induced renal toxicity needs to be further investigated. [ABSTRACT FROM AUTHOR]