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OBJECTIVE: To retrospectively compare the clinical outcomes of percutaneous cholecystostomy (PC) and cholecystectomy in patients with acute cholecystitis admitted to an urban University Hospital. PATIENTS AND METHODS: We studied 646 patients with acute cholecystitis. Ninety patients had placement of a PC at their index hospitalization, and 556 underwent cholecystectomy. Of the 90 patients with PC, 13 underwent subsequent elective cholecystectomy. RESULTS: Overall, in-hospital mortality and postoperative complications were significantly higher in patients who received PC than in those who underwent cholecystectomy. In the ASA score 1-2 group, patients with PC were significantly older and had a longer postoperative stay while their mortality and morbidity were similar to patients who underwent cholecystectomy. In patients with ASA score of 3, PC and cholecystectomy did not differ significantly for demographic variables and clinical outcomes such as hospital stay, in-hospital mortality, postoperative complications and distribution of complications according to the classification of Clavien- Dildo. In mild, moderate, and severe cholecystitis, patients who underwent PC were significantly older than those who received cholecystectomy. In general, in mild, moderate and severe cholecystitis, the clinical outcomes did not differ significantly between patients who received PC and cholecystectomy. Morbidity was higher in patients with mild cholecystitis who underwent PC. Of the 77 patients dismissed from the hospital with drainage, 12 (15.6%) developed biliary complications and 5 needed substitutions of the drainage itself. CONCLUSIONS: PC does not offer advantages compared to cholecystectomy in the treatment of acute cholecystitis. Its routine use is therefore questioned. There is need of an adequate, randomized study that compares PC and cholecystectomy in high-risk patients with moderate- severe cholecystitis. [ABSTRACT FROM AUTHOR]

Among the approaches for run-off regulation, green infrastructure is identified as non-traditional measure to compensate the effects of soil sealing generated from urban development. It is recognized as a way to increase the provision of urban ecosystem services and is increasingly being used in research and practice on storm-water management through Sustainable Urban Drainage Systems (SUDS). The adoption of SUDS in urban planning might protect hydrological and ecological dimensions of landscapes while providing resilient options to face flood risk management. This paper shows the assessment of SUDS potential to increase the regulating service capacity in a dense urban catchment in southern Italy. A comparison between scenarios of pre-implementation and post-implementation of SUDS is performed through catchment simulations with a hydraulic model. Results showed different effectiveness of SUDS options, in terms of variations of the indicator chosen as proxy of the regulating service capacity. Results showed a better performance obtained by green roofs than permeable pavements, highlighting a limited capacity of run-off regulation achieved with SUDS deployment in public areas only. This suggests that innovative policies to encourage private land owners to adopt measures of SUDS could be fundamental for the retrofitting of urban settlements. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe for the first time in literature the specific methodology of use of negative pressure wound therapy (NPWT) for duodenal fistula through clinical cases. The constant increase of use of NPWT for complex surgical situations imposes tailored previously undescribed solutions for the technique. PATIENTS AND METHODS: Herein, three cases of high output duodenal fistula successfully treated with Negative Pressure Wound Therapy (NPWT) are reported. The technical details for the application of NPWT to these fistulas are discussed and described. RESULTS: A ll t hree p atients r ecovered w ithout the necessity of further surgical operations. CONCLUSIONS: When using NPWT, management of high-output duodenal fistulas must rely on some degree of customization of the aspiration systems. The aim of the procedure is to put under depression the duodenal hole and surrounding tissues "all in one" and not to separate the complex wound in sectors as usually indicated. We suggest calling this technique Negative Pressure Fistula Therapy. [ABSTRACT FROM AUTHOR]

The article offers information on the emergency surgery in present and future as independent specialty in Italy. Topics discussed includes treating patients on a part-time basis without specific training, admitting of patients in the emergency department for acute surgical illness or trauma, and failure of operating in a more complicated field by making medical or conservative treatment.

The relationship between sustainable urban development and environmental sustainability is crucial to every strategy of urban transformation, renewal and regeneration. In particular, urban regeneration entails programmes of urban transformation that involve the rehabilitation of existing parts of a city, re-use previously built-up area and abandoned buildings, and redevelop blighted urban spaces to increase urban sustainability. Few existing studies have evaluated the real environmental outcomes and effectiveness of regeneration programmes in terms of physical variables such as newly provided green spaces, access to public transportation, climate change or seismic-risk reduction. This paper proposes a method for spatially quantifying the benefits of regenerating areas with reference to environmental and urban factors, such as reduction of seismic risk, increase in accessibility and diversity of land use. Each aspect is evaluated by spatial indicators, calculated at different geographical units that steadily increase in size, in order to understand the effects of a single regeneration area and of a number of concurrent areas. The work focuses on the municipality of Catania (Italy), a high-density urban context, with a general lack of green spaces, and high levels seismic risk exposure. Results show that positive benefits can be extended from regeneration areas to contiguous relevant portions of the city, and that even a limited number of regeneration areas can produce relevant benefits. These benefits rely on the combination of characteristics of regeneration areas and urban environments in which they are located, such as population density, presence/accessibility of urban services, and land-use diversity. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Pancreatic cystic tumors are relatively rare tumors and only 1% of them are malignant. They are often asymptomatic and detected as incidental findings through diagnostic imaging. Currently there are no universal guide lines for the correct clinical approach to pancreatic cystic lesions. Cross-sectional imaging demonstrates some typical morphological features that determine the preoperative diagnosis of the pancreatic cystic lesions (serous or mucinous cystadenoma, intraductal papillary mucinous neoplasms). In addition, endoscopic ultrasonography permits the collection and analysis of the fluid content. The aim of this paper is to describe our case load in the management of pancreatic cystic neoplasms and propose some criteria for choosing between surgical or conservative approaches. PATIENTS AND METHODS: 12 patients with pancreatic cystic neoplasms were retrospectively evaluated. They were studied using cross-sectional imaging modalities (computed tomography and magnetic resonance); endoscopic ultrasonography was performed in 7 patients. RESULTS: In each patient a careful evaluation of several factors (age, comorbidity, imaging features, symptoms, life expectancy) conditioned our clinical decision. Among our 12 patients, surgical resection was performed in 7 cases. DISCUSSION: The treatment of pancreatic cystic lesions is still a dilemma because even in the presence of malignant potential, pancreatic surgery remains very complicated and demolitive. Many factors need to be considered in the management of cystic pancreatic tumors. The most important include histological type, location, size, age and clinical condition of the patient. CONCLUSIONS: A correct multidisciplinary pre-operative diagnosis is mandatory. Surgery should only be performed in selected cases. [ABSTRACT FROM AUTHOR]

The article analyzes American historian Hayden White's book "Metahistory: The Historical Imagination in Nineteenth-Century Europe" and the work of American philosopher and gender theorist Judith Butler. Topics mentioned include the notion of "figural realism" developed by White during the second half on the 20th century, his modernist theory regarding a progressive historiography, and Butler's theories on gender identity highlighted in the book "Gender Trouble." Finally, the author compares Butler and White's opinions on the connection between narrative and history.

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Non-Urbanised Areas (NUAs) are part of agricultural and green infrastructures that provide ecosystem services. Their role is fundamental for the minimization of urban pollution and adaptation to climate change. Like all natural ecosystems, NUAs are endangered by urban sprawl. The regulation of sprawl is a key issue for land-use planning. We propose a land use suitability strategy model to orient Land Uses of NUAs, based on integration of Land Cover Analysis (LCA) and Fragmentation Analysis (FA). With LCA the percentage of evapotranspiring surface is defined for each land use. Dimensions and densities of NUAs patches are assessed in FA. The model has been developed with Geographical Information Systems, using an extensive set of geodatabases, including orthophotos, vectorial cartographies and field surveys. The case of the municipality of Mascalucia in Catania metropolitan area (Italy), characterized by a considerable urban sprawl, is presented. [Copyright &y& Elsevier]

Objectiwe: We investigated the influence of hurricane exposure, stressors occurring during the hurricane and recovery period, and social support on children's persistent posttraumatic stress (PTS). Method: Using a 2-wave, prospective design, we assessed 384 children (54% girls; mean age = 8.74 years) 9 months posthurricane, and we reassessed 245 children 21 months posthurricane. Children completed measures of exposure experiences, social support, hurricane-related stressors, life events, and PTS symptoms. Results: At Time 1, 35% of the children reported moderate to very severe levels of PTS symptoms; at Time 2, this reduced to 29%. Hurricane-related stressors influenced children's persistent PTS symptoms and the occurrence of other life events, which in turn also influenced persistent PTS symptoms. The cascading effects of hurricane stressors and other life events disrupted children's social support over time, which further influenced persistent PTS symptoms. Social support from peers buffered the impact of disaster exposure on children's PTS symptoms. Conclusions: The effects of a destructive hurricane on children's PTS symptoms persisted almost 2 years after the storm. The factors contributing to PTS symptoms are interrelated in complex ways. The findings suggest a need to close the gap between interventions delivered in the immediate and short-term aftermath and those delivered 2 years or more postdisaster. Such interventions might focus on helping children manage disaster-related stressors and other life events as well as bolstering children's support systems. [ABSTRACT FROM AUTHOR]

Early studies indicate that the hypertension observed in the Schlager inbred mouse strain may be attributed to a neurogenic mechanism. In this study, we examined the contribution of the sympathetic nervous system in maintaining hypertension in the BPH/2J mouse and used c-Fos immunohistochemistry to elucidate whether neuronal activation in specific brain regions was associated with waking blood pressure. Male hypertensive (BPH/2J; n=14), normotensive (BPN/3J; n=18), and C57/Bl6 (n=5) mice were implanted with telemetry devices, and after 10 days of recovery, recordings of blood pressure, heart rate, and locomotor activity were measured to determine circadian variation. Mean arterial pressure was higher in BPH/2J than in BPN/3J or C57/Bl6 mice (P<0.001), and BPH/2J animals showed exaggerated day-night differences (17+/-2 versus 6+/-1 mm Hg in BPN/3J or +8+/-2 mm Hg in C57/Bl6 mice; P<0.001). Acute sympathetic blockade with pentolinium (7.5 mg/kg IP) during the active and inactive phases reduced blood pressure to comparable levels in BPH/2J and BPN/3J mice. The number of c-Fos-labeled cells was greater in the amygdala (+180%; P<0.01), paraventricular nucleus (+110%; P<0.001), and dorsomedial hypothalamus (+48%; P<0.001) in the active (hypertensive) phase in BPH/2J compared with BPN/3J mice. The level of neuronal activation was mostly similar in these regions in the inactive phase. Of all of the regions studied, neuronal activation in the medial amygdala, as detected by c-Fos, was highly correlated to mean arterial pressure (r=0.98). These findings indicate that the hypertension is largely attributable to sympathetic nervous system activity, possibly generated through greater levels of arousal regulated by neurons located in the medial amygdala. [ABSTRACT FROM AUTHOR]

Objective: To examine potential pathways between childhood depressive symptoms and adolescent cigarette use, controlling for potential "third variable" causes. Design: Participants included 250 youth (60% girls) who were in Grades 4 to 6 at study outset and in Grades 10 to 12 (M age = 16.78) at a 6-year follow-up. At Time 1, children completed measures of depressive symptoms, as well as peer nominations of peer acceptance, rejection, and aggressive behavior. Main Outcome Measures: Time 2 measures included adolescents' own and close friends' cigarette use, depressive symptoms, and externalizing behaviors; parents also reported on adolescent behaviors. Results: Higher levels of childhood depressive symptoms and aggressive behavior were associated longitudinally with cigarette use in adolescence. After controlling for other associations, higher levels of childhood depressive symptoms also were associated with higher levels of friends' cigarette use in adolescence and higher levels of adolescent depressive symptoms; each of these adolescent outcomes was concurrently associated with cigarette use. Conclusion: Depressive symptoms in childhood may lead to altered developmental trajectories that either directly or indirectly contribute to adolescent outcomes, including cigarette use. [ABSTRACT FROM AUTHOR]

Two preliminary studies were conducted to determine feasibility of using the electrocardiography (EKG) method to determine terminal tip location when inserting a peripherally inserted central catheter (PICC). This method uses the guidewire inside the catheter (or a column of saline contained in the catheter) as an intracavitary electrode. The EKG monitor is then connected to the intracavitary electrode. The reading on the EKG monitor reflects the closeness of the intracavitary electrode (the catheter tip) to the superior vena cava (SVC). The studies revealed that the EKG method was extremely precise; all tips placed using the EKG method and confirmed using x-ray were located in the superior vena cava. In conclusion, the EKG method has clear advantages in terms of accuracy, cost-effectiveness, and feasibility in conditions where x-ray control may be difficult or expensive to obtain. The method is quite simple, easy to learn and to teach, non-invasive, easy to reproduce, safe, and apt to minimize malpositions due to failure of entering the SVC. [ABSTRACT FROM AUTHOR]

Peer relations and close friendships play important roles in youngsters' emotional development and take on special significance when a child or adolescent has a chronic disease. This article reviews the key ways that peer relations have been examined in youth with chronic pediatric conditions and specifically focuses on (1) the role of peers and close friends as a source of support, (2) friends' influence on treatment adherence, and (3) peers' and friends' impact on health-promoting and health-risk behaviors. In general, youngsters with chronic conditions do not have more problems in their peer relations than other youth, although children with medical conditions that are stigmatizing or that involve the central nervous system (CNS) may encounter peer difficulties. Social support from friends and classmates appears to facilitate youngsters' disease adaptation and may help with the lifestyle aspects of treatment regimens. Adolescent peer-crowd affiliations (e.g., "brains," "jocks") that are linked with health-promoting behaviors may prove beneficial to youngsters' disease management and health. The findings underscore the need for helping children and adolescents disclose their medical condition to peers in positive ways and for including youngsters' close friends in the treatment process and in school-reentry programs after extended medical care. Additional research is needed to develop strategies for incorporating youngsters' peers and friends into the medical management of youth with chronic pediatric conditions. [ABSTRACT FROM AUTHOR]

ABSTRACT: Peer relations and close friendships play important roles in youngsters’ emotional development and take on special significance when a child or adolescent has a chronic disease. This article reviews the key ways that peer relations have been examined in youth with chronic pediatric conditions and specifically focuses on (1) the role of peers and close friends as a source of support, (2) friends’ influence on treatment adherence, and (3) peers’ and friends’ impact on health-promoting and health-risk behaviors. In general, youngsters with chronic conditions do not have more problems in their peer relations than other youth, although children with medical conditions that are stigmatizing or that involve the central nervous system (CNS) may encounter peer difficulties. Social support from friends and classmates appears to facilitate youngsters’ disease adaptation and may help with the lifestyle aspects of treatment regimens. Adolescent peer-crowd affiliations (e.g., “brains,” “jocks”) that are linked with health-promoting behaviors may prove beneficial to youngsters’ disease management and health. The findings underscore the need for helping children and adolescents disclose their medical condition to peers in positive ways and for including youngsters’ close friends in the treatment process and in school-reentry programs after extended medical care. Additional research is needed to develop strategies for incorporating youngsters’ peers and friends into the medical management of youth with chronic pediatric conditions. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text. Background: The HeartLogic algorithm combines multiple implantable cardioverter-defibrillator sensors to identify patients at risk of heart failure (HF) events. We sought to evaluate the risk stratification ability of this algorithm in clinical practice. We also analyzed the alert management strategies adopted in the study group and their association with the occurrence of HF events. Methods: The HeartLogic feature was activated in 366 implantable cardioverter-defibrillator and cardiac resynchronization therapy implantable cardioverter-defibrillator patients at 22 centers. The median follow-up was 11 months [25th–75th percentile: 6–16]. The HeartLogic algorithm calculates a daily HF index and identifies periods IN alert state on the basis of a configurable threshold. Results: The HeartLogic index crossed the threshold value 273 times (0.76 alerts/patient-year) in 150 patients. The time IN alert state was 11% of the total observation period. Patients experienced 36 HF hospitalizations, and 8 patients died of HF during the observation period. Thirty-five events were associated with the IN alert state (0.92 events/patient-year versus 0.03 events/patient-year in the OUT of alert state). The hazard ratio in the IN/OUT of alert state comparison was (hazard ratio, 24.53 [95% CI, 8.55–70.38], P <0.001), after adjustment for baseline clinical confounders. Alerts followed by clinical actions were associated with less HF events (hazard ratio, 0.37 [95% CI, 0.14–0.99], P =0.047). No differences in event rates were observed between in-office and remote alert management. Conclusions: This multiparametric algorithm identifies patients during periods of significantly increased risk of HF events. The rate of HF events seemed lower when clinical actions were undertaken in response to alerts. Extra in-office visits did not seem to be required to effectively manage HeartLogic alerts. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02275637. [ABSTRACT FROM AUTHOR]

Examines the predisaster behavioral and academic functioning of children in Florida as a predictor of posttraumatic stress following Hurricane Andrew. Assessment of children's functioning after the disaster; Regression analyses predicting posttraumatic stress; Implications for identifying and treating children at risk for stress reactions.

Examines the manifestation of posttraumatic stress symptoms in 3rd-5th grade children during the school year after hurricane Andrew struck United States. Guidance of conceptual model for research; Contributors to children's PSTD; Persistence of children's reactions over longer time periods; Suggestions made for the decline of stress filled reactions.