Breast surgeons updating on the thresholds of COVID-19 era: results of a multicenter collaborative study evaluating the role of online videos and multimedia sources on breast surgeons education and training.

OBJECTIVE: Current trends show a rise of attention given to breast cancer patients' quality of life and the surgical reconstructive result. Along with this trend, surgical training quality and efficacy are gaining importance and innovative training methods such as online videos shared on social media portals, are becoming main updating tools. In hazardous times like COVID-19 pandemic nowadays, online communication becomes of vital importance and adaptation and innovation are fundamental to keep research and education alive. The authors aimed to investigate the role of video and multimedia sources on the daily activity and surgical training of a representative group of surgeons specifically dedicated to oncologic, oncoplastic and reconstructive breast surgeries. MATERIALS AND METHODS: A survey was produced and administered to 20 major Italian Breast Centers. Collected data were analyzed with Fisher's Exact Test. RESULTS: From October 2019 to March 2020, a total of 320 surveys were collected. Among the responders, there were 188 trainees (intern medical doctors and residents) and 110 faculty, 72% of them belonged to a plastic surgery environment, while 28% to general surgery environment. Almost all respondents have ever watched videos concerning breast surgery. CONCLUSIONS: The results of the study show how breast surgeons rely on videos and web platforms, mostly YouTube, when searching for training info about surgical procedures. Social media offer great opportunities for sharing knowledge and diffusion of new ideas but greater attention to their reliability is mandatory.

Pharmacokinetics and sedative effects of dexmedetomidine in dairy calves.

AIMS: To evaluate the pharmacokinetics of dexmedetomidine (DEX) administered I/V at a dose of 5 µg/kg bodyweight in dairy calves and to compare the sedative effects of anaesthetic protocols involving DEX and xylazine. METHODS: Nine dairy calves, aged 17-20 days, were treated with 5 µg/kg I/V dexmedetomidine. For pharmacokinetic evaluation, blood samples were collected over 12 hours and serum samples were analysed by high performance liquid chromatography-mass spectrometry. Another nine dairy calves, aged 16-20 days, were treated with 0.2 mg/kg I/V xylazine. After both treatments, heart rate, respiratory rate and rectal temperature were measured for 20 minutes. Sedation quality and recovery times were also assessed. RESULTS: The kinetics of DEX was best described by a two-compartment model. The distribution and elimination half-lives were 8.7 (SD 5.0) and 83.5 (SD 67.5) minutes, respectively. Mean maximum concentration and body clearance were 12.5 (SD 8.6) ng/mL and 27.9 (SD 13.1) mL/minute/kg, respectively; the mean volume of distribution at steady state was 2,170.8 (SD 1,657.5) mL/kg. A decrease in heart rate was observed after treatments with both DEX and xylazine. No differences in heart or respiration rate, or rectal temperature were observed between the two treatment groups. The onset of sedation occurred after 2.7 (SD 0.67) minutes for calves treated with DEX and 2.8 (SD 0.78) minutes for calves treated with xylazine, and was characterised by a similar degree of deep sedation and ease of handling of the calves. All recoveries were eventless, and no adverse reactions were noted. CONCLUSIONS AND CLINICAL RELEVANCE: Dexmedetomidine treatment resulted in a reliable and long lasting sedation in calves, a transient decrease in heart rate and no modification in respiratory rate or rectal temperature. The results were comparable to xylazine, the most popular alpha-2-agonist among bovine practitioners. The use of DEX in dairy calves for rapid procedures such as dehorning or castration could be suggested.

Lumbar sympathectomy under CT guidance: therapeutic option in critical limb ischaemia.

PURPOSE: Lumbar sympathectomy is a complementary therapeutic option for patients with severe peripheral vascular occlusive disease presenting rest pain or gangrene and not eligible for surgical revascularisation. Traditional surgical sympathectomy was widely used in the past. However, due to its invasive character, it has increasingly been replaced by percutaneous techniques and, in some recent cases, by laparoscopic procedures. Percutaneous lumbar sympathectomy is a safe, cost-effective and widely available treatment option. We report our experience on 19 patients subjected to percutaneous sympathectomy under CT guidance. MATERIALS AND METHODS: Between 1998 and 2000, 19 patients underwent percutaneous sympathectomy under CT guidance. All patients had severe vascular disease of the lower extremities (Fontaine stage IV), with rest pain and gangrene. They were not eligible for surgical revascularisation. Phenol was injected at the level of L2 and L4 using two 22 G needles (15 cm long). Signs of interrupted sympathetic activity usually occur 2'-15' after the procedure with warmth and flushing and dryness of the lower extremities. RESULTS: Percutaneous sympathectomy under CT guidance is a simple, safe and well-tolerated procedure with a low rate of complications. Of the 19 patients, 9 (47.3%) showed clinical improvement, whereas 5 experienced a worsening of ischaemia in the months immediately following the procedure. DISCUSSION: Results suggest that percutaneous lumbar sympathectomy causes a sympathetic blockade in patients with advanced vascular disease of the limbs. CT guidance ensures a high level of precision in drug dosing, thus lowering the risk of complications. Although the results are demoralizing. the impossibility of achieving surgical revascularisation in advanced peripheral arteriosclerosis enhances the role of CT-guided percutaneous sympathectomy in relieving rest pain and healing ulcers in order to postpone the amputation.

Inflammatory molecule release by beta-amyloid-treated T98G astrocytoma cells: role of prostaglandins and modulation by paracetamol.

Deposition of beta-amyloid in the brain triggers an inflammatory response which accompanies the neuropathologic events of Alzheimer's disease and contributes to the destruction of brain tissue. The present study shows that beta-amyloid can stimulate human astrocytoma cells (T98G) to secrete the proinflammatory factors interleukin-6 and prostaglandins. Furthermore, prostaglandins can stimulate T98G to secrete interleukin-6, which in turn triggers the formation of additional prostaglandins. Prostaglandins are, therefore, a key element in the induction and maintenance of a state of chronic inflammation in the brain which may exacerbate the fundamental pathology in Alzheimer patients. Paracetamol (0.01-1000 microM), an unusual analgesic/antipyretic drug which acts preferentially by reducing prostaglandin production within the central nervous system, and indomethacin (0.001-10 microM) caused a clear dose-dependent reduction of prostaglandin E2 production by stimulated T98G cells whereas interleukin-6 release was not affected. These data provide further evidence of the involvement of non-steroidal anti-inflammatory drugs in the inflammatory processes that can be generated by glial cells in intact brain.

The aging of memory: A method for the assessment of qualitative changes.

Age associated memory changes are traditionally described in terms of quantity of recall. Evidence of qualitative changes associated with aging could lead to a modification of this approach. The primacy and recency effects in serial learning provide a good model to evaluate these qualitative modifications. Our study was designed to investigate modifications of the serial effects in serial learning related to age and modality. We have comparatively investigated, with 120 normal subjects of both sexes, the influence of age and a latent semantic structure, consisting on four taxonomic categories, on the occurrence of primacy and recency effects in a list of verbal stimuli. The presence of a latent structure in the list of stimuli interacted with age in a relearning trial causing the recency effect to disappear more evidently in younger subjects. The same structure did not affect the primacy effect which, on the contrary, was influenced by age only. These results suggest a differential role across age of the automatic processing of working memory versus the role of the semantic-lexical processing of the central processing unit within working memory. They also, demonstrate the importance of age in influencing memory resources which change the quality and quantity of working memory proficiency.

Forgetting curves in long-term memory: evidence for a multistage model of retention.

An experimental study with 20 normal healthy young adult subjects was performed to evaluate the interaction of type of memory tasks, type of learning modalities, and length of acquisition/recall interval. Four different tasks were employed (serial learning, paired learning, rote learning, and visuolinguistic transfer), some requiring a single trial learning modality others a multitrial learning modality. Acquisition/recall intervals were immediate, intermediate (3 min), and delayed. The experimental design allowed for the comparison of effects from five different delayed recall intervals (2, 8, 12, 24, and 48 hr). Results demonstrated a specific interaction on learning rates due to different ceiling effects for the different types of memory tasks. Forgetting rates, on the other hand, demonstrated a specific effect due to type of memory tasks and learning modalities only for differences between immediate and intermediate recall. These differences remained stable during the longer intervals and were not affected by length of interval. A multistage composition of long-term retention was suggested to explain these results, and a practical indication to build experimental procedures to study memory in the clinical field was evidenced.

Memory improvements and pharmacological treatment: a method to distinguish direct effects on memory from secondary effects due to attention improvement.

Chronic cerebrovascular disturbances of the aged are characterized by a decline of attention. When these patients undergo pharmacological treatment, it is very difficult to distinguish between a direct benefit and/or a secondary effect on memory resulting from attention improvement. In our study we have proposed and evaluated a new method for identifying the different components of therapeutic efficacy on memory and attention in chronic cerebrovascular patients. This method is based on the use of the Randt Memory Test, traditional scores of memory efficiency (Acquisition, Recall, and a combined index), and the RMT three-factor scores derived from a structural model of memory functioning. The three scores have been called Encoding and Organization, Cognitive Efficiency, and Attention Efficiency. Participants were 96 selected chronic cerebrovascular patients treated in a double-blind study for 12 weeks with dihydroergocristine versus placebo. While changes in both acquisition and recall scores were related to the treatment, only changes of the Encoding and Organization factor scores were systematically related to therapy. Changes in Attention Efficiency were positively related to therapy only in proportion to the degree of cerebrovascular impairment.

Measuring cognitive processes in patients with Parkinson's disease.

Parkinsonians and control subjects completed a series of cognitive tasks which measured primed semantic retrieval, conceptual organization, and conjoint retention. Direct measures of cognitive processing failed to yield the wide range intellectual deficit patterns that have been found with parkinsonians.

[Tuberculosis of the breast. Report of a clinical case and review of the literature]. / La tubercolosi della mammella. Presentazione di un caso clinico e revisione della letteratura.

Tuberculosis of the breast is an uncommon disease and the correct diagnosis may be established only by histologic demonstration of granulomatous inflammatory infiltrates with central caseation. In fact, preoperative examination and mammography suggest carcinoma or sometimes bacterial abscess in most instances. Tuberculous mastitis was diagnosed in a 74-year-old woman. The case history and a review of the literature are presented. The Authors emphasize the role of excision of necrotic tissue and drainage, in combination with antimicrobial therapy, in the treatment of this pathology.

Pre-surgery information and psychological adjustment to enterostomy.

The post-surgery psychological adjustment to enterostomy was examined in a longitudinal study of 120 patients. Subjects were representative of the general enterostomy patients population. All had undergone surgery in various hospitals located in Rome and its surroundings. Adjustment to enterostomy was longitudinally evaluated by interviewing patients at various intervals after enterostomy: soon after surgery; 1 year after surgery; more than 1 year after surgery. When patients were initially interviewed, information was requested on how they were informed of their clinical condition which led to surgery, as well as of enterostomy and its consequences. 42% reported a low level of understanding about enterostomy on the basis of information received during hospitalization. Patients were consequently divided into two groups, one including those judged as adequately informed (AI), and the other including those judged as not adequately informed (NAI). These groups were compared, for immediate adjustment to enterostomy (within 3-6 mos. since surgery), delayed adjustment (1 yr. since surgery), and prolonged adjustment (more than 1 yr. since surgery). Patients of NAI group demonstrated a consistently poorer pattern of adjustment in all parameters under study (emotional, cognitive, behavioral, social) and their adjustment to enterostomy did not show any spontaneous improvement over the time. AI patients, on the other hand, showed a more favorable level of adjustment since after surgery and a more positive pattern in the follow-up period. Adequate information before surgery and during hospitalization has been evidenced as a necessary component of patient care and a very important element in determining the optimal functional and psychological recovery of patients with enterostomy.(ABSTRACT TRUNCATED AT 250 WORDS)