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PURPOSE: The aim of the present study, conducted by a working group of the Italian Association of Medical Physics (AIFM), was to define typical z-resolution values for different digital breast tomosynthesis (DBT) models to be used as a reference for quality control (QC). Currently, there are no typical values published in internationally agreed QC protocols. METHODS: To characterize the z-resolution of the DBT models, the full width at half maximum (FWHM) of the artifact spread function (ASF), a technical parameter that quantifies the signal intensity of a detail along reconstructed planes, was analyzed. Five different commercial phantoms, CIRS Model 011, CIRS Model 015, Modular DBT phantom, Pixmam 3-D, and Tomophan, were evaluated on reconstructed DBT images and 82 DBT systems (6 vendors, 9 models) in use at 39 centers in Italy were involved. RESULTS: The ASF was found to be dependent on the detail size, the DBT angular acquisition range, the reconstruction algorithm and applied image processing. In particular, a progressively greater signal spread was observed as the detail size increased and the acquisition angle decreased. However, a clear correlation between signal spread and angular range width was not observed due to the different signal reconstruction and image processing strategies implemented in the algorithms developed by the vendors studied. CONCLUSIONS: The analysis led to the identification of typical z-resolution values for different DBT model-phantom configurations that could be used as a reference during a QC program.
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Procesamiento de Imagen Asistido por Computador , Mamografía , Mamografía/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Fantasmas de Imagen , Artefactos , AlgoritmosRESUMEN
Aquatic systems have been degraded by environmental changes aimed at increasing the productivity of farmland and ranches. These changes affect aquatic assemblages at both local and regional scales. The hypothesis of this study is that in-stream environmental conditions are more important determinants of species richness and composition of Gerromorpha assemblage, given that they are affected directly by changes that occur within the stream, rather than by landscape conditions. To test our hypothesis, we collected at 20 sites of agricultural and forested regions in the Brazilian Cerrado. We relate predictors of the landscape and sites, of the streams with the assemblages of Heteroptera. While landscape metrics play an important role in the formation of stream conditions, local and physico-chemical variables had a significant influence on the structure of the Gerromorpha assemblages in the study area. This indicates that these organisms are more dependent on the processes that occur within the stream than those that occur outside the area of the gallery forest, considering the spatial scale of this study.
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Heterópteros/crecimiento & desarrollo , Ríos , Agricultura , Animales , Brasil , Bosques , Pradera , Dinámica PoblacionalRESUMEN
Although most species distribution modeling (SDMs) are constructed at the species level, an appreciation of evolutionary processes has led to modeling above this level. In view of the difficulty in estimating the impacts of human actions on rare or deficient data species, we proposed a new approach to vulnerability assessment based on concepts already well established in the literature (ecological niche, niche conservatism, and extinction thresholds). We used distribution modeling to predict where species of the genus Phyllocycla (Calvert 1948) are most vulnerable to local extinctions and how the implementation of planned anthropic activities by the Brazilian government may modify the potential distribution of the genus in Brazil. We chose that genus because its conservation status is little known, especially due to the data gap about its geographical distribution. We proposed modeling the whole genus and used the niche conservatism theory to justify our methods. The anthropic activities considered in our analysis were agriculture and livestock, rural settlements, energy production installations, transportation, oil extraction, mining, and urbanization. We found that only 55.3% of the original potential distribution of Phyllocycla in Brazil remains available. The area compromised by anthropic activities comprises mainly the Cerrado and Atlantic Forest biomes, with less impact on the Amazon. However, with the implementation of activities planned by the Brazilian government, it is possible that an additional 13.6% of this area will be unavailable to species of Phyllocycla, especially in the Amazon, where interest in mining and the implementation of new hydroelectric production have increased.
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Conservación de los Recursos Naturales , Ecosistema , Extinción Biológica , Odonata , Agricultura , Animales , Brasil , Bosques , Gobierno , Actividades Humanas , Humanos , Minería , Modelos Teóricos , Industria del Petróleo y Gas , UrbanizaciónRESUMEN
INTRODUCTION: Since 1899 outpatient management of surgical patients had been increasing, becoming the best option when possible. In 1988 was described the first experience of outpatient management of proctologic disease. Advances in local anesthesia techniques have improved the outpatient approach to surgical disease, particularly in patients with proctological diseases. METHODS: From 2010 to 2016, 1160 patients who needed surgery for proctologic disease have been recruited: 239 hemorrhoidectomies using the variant of Milligan Morgan technique described by Phillips, 45 trans-anal hemorrhoidal DE-arterialization (THD), 315 sphincterotomies, 12 anal polypectomies, 230 loop seton positions, 65 cone-like fistulectomies and 254 fistulotomies for perianal fistulas. In 329 cases, we used the posterior perineal block, 603 local perineal blocks, and 228 tumescent anesthesia. RESULTS: On a total of 1160 procedure failure rate was of 4.7% (55 cases). Urinary retention (69% 38 cases); bleeding 18% (10 cases), uncontrolled pain 12% of cases (7 cases). The chi-square test demonstrates (p<0.01) that the failure rate of the three types of anesthesia is very different with high statistical significance. The failure rate in patient underwent Posterior Perineal Block was 27/329 cases (8.2%), 8/228 (3.5%) in patients who underwent Tumescent Anesthesia and 20/603 (3.3%) in who underwent Local Perineal Block. CONCLUSIONS: Outpatient protocols represent the most common approach to minor proctologic disease that needs a good local block, with a good analgesic and sedative assistance, the different local block seems to be the same concerning the pain control, but presents some little, not relevant difference concerning urinary retention rate.
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Procedimientos Quirúrgicos Ambulatorios/métodos , Anestesia Local/métodos , Enfermedades del Recto/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Canal Anal/cirugía , Enfermedades del Ano/cirugía , Femenino , Hemorreoidectomía/métodos , Hemorreoidectomía/estadística & datos numéricos , Hemorroides/cirugía , Humanos , Masculino , Persona de Mediana Edad , Bloqueo Nervioso/métodos , Bloqueo Nervioso/estadística & datos numéricos , Pacientes Ambulatorios , Estudios Retrospectivos , Insuficiencia del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Incisional hernia is one of the most common complications after abdominal surgery with an incidence rate of 11 to 20% post laparotomy. Many different factors can be considered as risk factors of incisional hernia recurrence. The aim of this study is to confirm and to validate the incisional hernia recurrence risk factors and to identify and to validate new ones. METHODS: In the period from July 2007 to July 2017, 154 patients were selected and subjected to incisional hernia repair. The surgical operations were conducted under general anaesthesia. Patients received antibiotic prophylaxis when indicated, according to the hospital prophylaxis scheme. Inclusion criteria of the study were single operator case studies and open laparotomy for incisional hernia repair. The statistical analysis proposed to identify and to verify the risk factors for recurrence of incisional hernia is the Support Vector Machine (SVM). The analysis was conducted verifying 34 risk factors. RESULTS: The data analysis confirmed the known correlations showed in the international literature with a greater incidence of comorbidities such as diabetes 37%, dyslipidaemia and hypercholesterolemia with a cumulative incidence of 16%; tobacco smoke - by combining categories smokers and ex-smokers - reach 46%, COPD 16% and hypertension 51%. CONCLUSIONS: The analysis of the data therefore confirmed the correlations showed in the international literature. A KSVM-based system to classify incisional hernia recurrence has been presented. The type of prosthesis and the site of its implant also play a significant role in the development of the recurrence. Sensitivity (86,25%), Specificity (87,14%), Negative Predictive Value (84,72%), Precision (88,46%), Accuracy (86,67%), and Error (13,33%) scores obtained using the proposed technique highlight the validity for the relapse's classification methodology.
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Análisis de Datos , Minería de Datos/métodos , Hernia Incisional/etiología , Factores de Edad , Anestesia General , Profilaxis Antibiótica , Índice de Masa Corporal , Comorbilidad , Conjuntos de Datos como Asunto , Femenino , Humanos , Hernia Incisional/cirugía , Aprendizaje Automático , Masculino , Persona de Mediana Edad , Recurrencia , Factores de Riesgo , Sensibilidad y Especificidad , Factores SexualesRESUMEN
BACKGROUND: The aim of this study is to evaluate the dose delivered and the image quality of pre-treatment MVCT images with Hi-Art TomoTherapy system, varying acquisition and reconstruction parameters. MATERIALS AND METHODS: Catphan 500 MVCT images were acquired with all acquisition pitch and reconstruction intervals; image quality was evaluated in terms of noise, uniformity, contrast linearity, contrast-to-noise ratio (CNR) and spatial resolution with the Modulation Transfer Function (MTF). Dose was evaluated as Multi Slice Average Dose (MSADw) and measurements were performed with the Standard TomoTherapy® Quality Assurance Kit composed by the TomoTherapy Phantom, the Exradin A1SL ion chamber and TomoElectrometer. For each pitch-reconstruction interval, acquisitions were repeated 5 times. RESULTS: Differences in noise and uniformity, though statistically significant in some cases, were very small: noise ranged from 2.3% for Coarse - 3â¯mm to 2.4% for Coarse - 6â¯mm, while uniformity passed from 99.5% for Coarse - 6â¯mm to 99.8% for Normal - 4â¯mm. No differences at all were found for CNR for high and low density inserts, while MTF was higher for pitch Coarse, even if no differences in spatial resolution were observed visually (spatial resolution was up to 4â¯lp/cm for all combinations of pitch and reconstruction interval). Dose was dependent on pitch, being 1.0â¯cGy for Coarse, 1.5â¯cGy for Normal and 2.85â¯cGy for Fine. CONCLUSIONS: We observed negligible differences in image quality among different pitch and reconstruction interval, thus, considerations regarding pre-treatment imaging modalities should be based only on dose delivered and on the desired resolution along the cranio-caudal axis for image-guided radiotherapy and adaptive radiotherapy purposes.
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Fantasmas de Imagen , Dosis de Radiación , Radioterapia Guiada por Imagen/instrumentación , Tomografía Computarizada por Rayos X , Control de Calidad , Dosificación RadioterapéuticaRESUMEN
The aim is to present the technical feasibility and efficacy of multiple re-irradiation (re-EBRT) for local recurrence of prostate cancer (PCa) using retrospective analysis of an updated series of patients who received ablative re-EBRT with stereotactic image-guided technique for isolated local recurrence of PCa. Eight patients received three RT courses (2 re-RTs); of those 2 received 4 RT courses (3 re-RTs). Local relapse in the prostate was assessed by multiparametric magnetic resonance and/ or choline positron emission tomography. Before treatment planning, all patients had been evaluated for late toxicity from previous RT according to RTOG/EORTC. Biochemical control was assessed according to Phoenix definition. Mean age at the third RT course was 68 (standard deviation, SD: 7.2); all patients had a good performance status. At diagnosis, four cases were classified as high risk PCa, three as intermediate and one as low per NCCN 2017. Biochemical progression free interval after first and second RT-course were 74 (IQR: 59.3-133.6) months and 33 (IQR: 20.8-53.1) months, respectively. Biochemical and radiological response was registered in all patients. At present, seven out of eight patients are disease free. Overall toxicity profile was good; no severe acute or late genitourinary or gastrointestinal events were recorded. Multiple RT courses with high precision technology and image guidance can be proposed as a possible salvage therapy for locally recurrent, low-burden PCa recurrence in adequately selected patients. Deeper understanding of radiobiological effects of hypofractionation and larger series of patients are warranted to fully evaluate the applicability of multiple RT courses in the setting of locally recurrent PCa.
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Recurrencia Local de Neoplasia/radioterapia , Neoplasias de la Próstata/radioterapia , Reirradiación , Humanos , Masculino , Estudios RetrospectivosRESUMEN
The slow transit constipation (STC) is a functional bowel pathology with slow total gut transit time with normal calibre colon in addition to a variety of other systemic symptoms. Patients with an abnormal colonic motility refractory to conservative treatment are regarded as appropriate candidates for surgery. Laparoscopic total colectomy with ileum-rectum anastomosis represents the commonest surgical operation in the treatment of STC, in well selected patients, after failure of conservative treatment. From 2012 to 2016, 8 patients suffering constipation according to Roma III criteria and diagnosed as STC were submitted to a total colectomy in our O.U. We evaluated the long-term post-operative quality of life and the bowel function, specifically the persistence of constipation and the number of daily bowel movements. Based on our results, we consider that the use of minimally invasive total colectomy with an ileum-rectal anastomosis is the procedure of choice in patients with colonic inertia, and should be performed by experts in laparoscopic colorectal surgery offering a satisfying post-operative quality of life with low morbidity and mortality rates.
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Estreñimiento/cirugía , Laparoscopía/métodos , Adulto , Anastomosis Quirúrgica/métodos , Colectomía/métodos , Estreñimiento/fisiopatología , Estreñimiento/psicología , Manejo de la Enfermedad , Femenino , Estudios de Seguimiento , Tránsito Gastrointestinal , Humanos , Íleon/cirugía , Masculino , Persona de Mediana Edad , Atención Perioperativa/métodos , Calidad de Vida , Recto/cirugíaRESUMEN
BACKGROUND: The success of every surgical procedure depends on an appropriate hemostatis. Topical haemostatic agents, like fibrin sealants, are an option for providing haemostasis and may be particularly useful for complex injuries. AIM: The aim of the study is to evaluate the use of TachoSil® in abdominal surgery and its benefits to prevent bleedings, and to establish its fields of use. METHODS: A retrospective observational study was performed on 308 patients underwent to emergency surgery with TachoSil®'s application into our department between January 2012 and March 2018. RESULTS: After the application of the hemostatic device there have been no haemorrhagic complications that have needed a second surgical intervention. Most frequently use of TachoSil® was in the gallbladder bed after cholecystectomy for an acute cholecystitis. CONCLUSIONS: Our experience, supported by other reports in the literature, suggests the use of TachoSil® may provide an effective option in helping to control bleedings.
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Abdomen/cirugía , Adhesivo de Tejido de Fibrina/uso terapéutico , Fibrinógeno/uso terapéutico , Hemostasis Quirúrgica/métodos , Hemostáticos/uso terapéutico , Trombina/uso terapéutico , Grupos Diagnósticos Relacionados , Combinación de Medicamentos , Urgencias Médicas , Servicio de Urgencia en Hospital , Femenino , Adhesivo de Tejido de Fibrina/administración & dosificación , Fibrinógeno/administración & dosificación , Hemostáticos/administración & dosificación , Humanos , Masculino , Estudios Retrospectivos , Servicio de Cirugía en Hospital , Trombina/administración & dosificaciónRESUMEN
INTRODUCTION: The surgical techniques described to approach the incisional hernia repair are various and there is not consensus about which of them to use. The Intra-Peritoneal Onlay Technique (IPOM) with classic mesh positioning is burdened by high post-operative complication rate. The study shows the preliminary results of a novel technique of open IPOM mesh positioning with "percutaneous" approach. PATIENTS AND METHODS: From January 2010 to December 2016 patients with abdominal wall incisional hernia that underwent surgical operation via open mesh technique for abdominal wall hernia repair at the "Policlinico Paolo Giaccone" at Palermo University Hospital were identified and the data collected were retrospectively reviewed; patients' medical and surgical records were collected from charts and the surgical registries. One hundred thirty-five patients with open IPOM percutaneous mesh positioning were selected. DISCUSSION AND CONCLUSIONS: The observational study proposed showed that the technique described for the abdominal wall incisional hernia repair seems to be hopeful in order to set a post-operative course not burdened by elevated rate of post-operative complications, estimated to be near 37% vs 13% reported by our series.
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Hernia Ventral/cirugía , Herniorrafia/métodos , Hernia Incisional/cirugía , Mallas Quirúrgicas , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Estudios RetrospectivosRESUMEN
INTRODUCTION: Bowel wall thickening is not an uncommon finding among patient undergoing abdomen CT scan. It may be caused by neoplastic, inflammatory, infectious or ischaemic conditions but also be a normal variant. Although specific radiologic patterns may direct to a precise diagnosis, occasionally misidentification may occur. Thus, in the absence of guidelines, further and not always needed diagnostic procedures (colonoscopy, esophagogastroduodenoscopy or capsule endoscopy) are performed. PATIENTS AND METHODS: We conducted a retrospective study on data collected from May 2016 to June 2017. We selected 40 adult patients, admitted in Emergency Department with "abdominal pain" and undergone an abdomen CT scan, in which bowel wall abnormalities were founded. RESULTS: 75% patients were found to have a benign condition vs 25% a malignant condition. In the stomach group, 50% were found to have a neoplasm, whilst 33.3% presented an aspecific pattern and 16.7% had an inflammatory disease. In the small bowel cluster, 33.3% patients had an ischaemic disease, 33.3% an aspecific pattern, 22.2% an inflammatory disease and 11.1% was diagnosed with cancer. In the colon group, 36% had an inflammatory disease, 24% a colon cancer, 24% an aspecific pattern and 16% an ischaemic condition. CONCLUSIONS: We recommend to perform a further endoscopic procedure to all patients with gastric or colonic wall abnormalities on CT scan, on the basis of growing rate of cancer and IBD. Capsule endoscopy should be taken into account in patients with severe symptoms and after a previous negative endoscopic examination.
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Dolor Abdominal/etiología , Neoplasias Gastrointestinales/diagnóstico por imagen , Intestinos/diagnóstico por imagen , Estómago/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Dolor Abdominal/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Colitis/diagnóstico por imagen , Colitis/patología , Diverticulitis del Colon/diagnóstico por imagen , Diverticulitis del Colon/patología , Urgencias Médicas , Endoscopía Gastrointestinal , Enteritis/diagnóstico por imagen , Enteritis/patología , Femenino , Gastritis/diagnóstico por imagen , Gastritis/patología , Neoplasias Gastrointestinales/patología , Humanos , Intestinos/irrigación sanguínea , Intestinos/patología , Isquemia/diagnóstico por imagen , Isquemia/patología , Masculino , Persona de Mediana Edad , Músculo Liso/diagnóstico por imagen , Músculo Liso/patología , Estudios Retrospectivos , Estómago/patología , Adulto JovenRESUMEN
Physiological constraints in insects are related to several large-scale processes such as species distribution and thermal adaptation. Here, we fill an important gap in ecophysiology knowledge by accessing the relationship between temperature and embrionary development time in four dragonfly species. We evaluated two questions (1) what is the effect of temperature on the development time of Odonata eggs, and (2) considering a degree-day relationship, could a simple linear model describe the dependence of embrionary development time on temperature or it is better described by a more complex non-linear relation. Egg development time of Erythrodiplax fusca (Rambur), Micrathyria hesperis Ris, Perithemis mooma Kirby, and Miathyria simplex (Rambur) (Odonata: Libellulidae) were evaluated. We put the eggs at different temperatures (15, 20, 25, and 30°C) and counted the number of hatched larvae daily. A nonlinear response of the development to the temperature was found, differing from the expected pattern for standard degree-day analysis. Furthermore, we observed that there is a similar process in the development time and hatching synchronization between species, with all species presenting faster egg development at high temperatures. Species-specific differences are more evident at lower temperatures (15°C), with no egg development in M. simplex. Only E. fusca was relatively insensitive to temperature changes with similar hatching rates in all treatments.
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Odonata , Óvulo/fisiología , Temperatura , Animales , BrasilRESUMEN
AIM: Mesh-mediated groin hernia repair is considered the goldstandard procedure. It has low recurrence rate. Rarely a deep Surgical Site Infection (SSI) is seen when a synthetic prosthesis is used. CASE REPORT: We describe a rare case of bilateral deep SSI after mesh-mediated groin hernia repair. Diagnosis was performed through the physical examination and radiological exams. Microbiological samples identified a methicillin-resistant Staphylococcus aureus responsible of the infection. Target therapy was performed and re-operation performed in order to remove the infected prosthesis and to apply a biological one to create the fibrous scaffold. During follow-up time, right side recurrence was observed. Tru-cut biopsy of fascia was obtained in order to identify the responsible of the recurrence. CONCLUSION: Combination of antibiotic therapy and surgical reoperation seems to be the correct way to approach the deep SSI after mesh-mediated groin hernia repair. The use of biological mesh after synthetic removal seems to improve the final outcome.
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Hernia Inguinal/cirugía , Herniorrafia , Mallas Quirúrgicas , Infección de la Herida Quirúrgica/terapia , Servicio de Urgencia en Hospital , Herniorrafia/métodos , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
The primary mammary chondrosarcoma corresponds to less than 0,5% of the mammary malignancies. For the period ranging from 1967 to 2014, only 18 cases were reported in the literature. A 41year old woman found a hard nodule on her external right superior quadrant/axillary prolongation through breast self-examination. The vacuum-assisted core biopsy (VACB) revealed "high grade extra-skeletal myxoid chondrosarcoma". A skin-nipple-sparing mastectomy with the insertion of a mammary expander was performed. A protocol of adjuvant radiotherapy was also indicated. Until 2013, the gold standard was the radical mastectomy. By 2014, there were two cases of conservative approach to quadrantectomy. To our knowledge, this represents the first case in the literature in which a skin-nipple-sparing mastectomy has been performed on a primitive mesenchymal neoplasm of the breast. Such an oncoplastic approach was performed considering the young age of the woman, to assure the surgical radicality and a better quality of life to the patient.
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Landscape structure is an important determinant of biological fluxes and species composition, but species do not respond equally to landscape features or spatial extents. Evaluating "multi-scale" responses of species to landscape structure is an important framework to be considered, allowing insights about habitat requirements for different groups. We evaluated the response of Brazilian Cerrado's bees (eusocial vs. solitary ones) to both the amount and isolation of remnant vegetation in eight nested multiple-local scales. Response variables included abundance, observed, and estimated species richness, and beta diversity (split into nestedness and turnover resultant dissimilarities). Eusocial species' abundance responded to landscape structure at narrow scales of fragment isolation (250 m of radius from sampling sites), while solitary species' abundance responded to broader scales to fragment area (2000 m). Eusocial species nestedness also responded to landscape features in broader scales (1500 m), especially to increasing fragment isolation. However, all the remaining response variables did not respond to any other landscape variables in any spatial scale considered. Such contrasting responses of the abundances of eusocial vs. solitary species are related to the inherent life-history traits of each group. Important attributes in this context are different requirements on food resources, population features, and flight abilities. Species-specific dispersal abilities may be the main determinants of the nested patterns found for eusocial species at 1500 m. Considering these results, we suggest that different bee groups are considered separately in further landscape analyses, especially in other Brazilian biomes, for a better understanding of landscape effects on these organisms.
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Abejas , Comportamiento de Nidificación , Animales , Brasil , Ecosistema , Dinámica PoblacionalRESUMEN
The aim of this work was to evaluate how different acquisition geometries and reconstruction parameters affect the performance of four digital breast tomosynthesis (DBT) systems (Senographe Essential - GE, Mammomat Inspiration - Siemens, Selenia Dimensions - Hologic and Amulet Innovality - Fujifilm) on the basis of a physical characterization. Average Glandular Dose (AGD) and image quality parameters such as in-plane/in-depth resolution, signal difference to noise ratio (SDNR) and artefact spread function (ASF) were examined. Measured AGD values resulted below EUREF limits for 2D imaging. A large variability was recorded among the investigated systems: the mean dose ratio DBT/2D ranged between 1.1 and 1.9. In-plane resolution was in the range: 2.2mm-1-3.8mm-1 in chest wall-nipple direction. A worse resolution was found for all devices in tube travel direction. In-depth resolution improved with increasing scan angle but was also affected by the choice of reconstruction and post-processing algorithms. The highest z-resolution was provided by Siemens (50°, FWHM=2.3mm) followed by GE (25°, FWHM=2.8mm), while the Fujifilm HR showed the lowest one, despite its wide scan angle (40°, FWHM=4.1mm). The ASF was dependent on scan angle: smaller range systems showed wider ASF curves; however a clear relationship was not found between scan angle and ASF, due to the different post processing and reconstruction algorithms. SDNR analysis, performed on Fujifilm system, demonstrated that pixel binning improves detectability for a fixed dose/projection. In conclusion, we provide a performance comparison among four DBT systems under a clinical acquisition mode.
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Mamografía/métodos , Dosis de Radiación , Artefactos , Humanos , Procesamiento de Imagen Asistido por Computador , Fantasmas de Imagen , Control de Calidad , Relación Señal-RuidoRESUMEN
INTRODUCTION: Incisional hernia is one of the main topics in the general surgery since there is not a unanimous consensus concerning to the best surgical methodology to adopt. It seems that prosthetic surgery is the best technique, even if responsible for the development of periprosthetic seroma. The aim of this study is to assess whether the preoperative abnormalities of the bio-humoral parameters may be considered as risk factors for seroma. PATIENTS AND METHODS: From July 2016 to July 2017 at the "Policlinico Paolo Giaccone", Palermo, Department of Emergency Surgery, 56 patients included in this study, underwent laparotomic mesh repair. The inclusion criteria were: age > 18 years, incisional hernia W2R0 according to the Chevrel classification and a monoperator technique. The main variables were: sex, age, BMI, smoke, ASA score, and co-morbidities. Among the main serum-blood variables: natraemia, kalaemia, chloraemia, calcaemia, PCR, level of glucose, creatinine, albumin and proteins in the blood. The data were analyzed using SPSS software. RESULTS: Univariate analysis highlighted hypo- and hyper-natraemia, hyper-kalaemia, hypo-chloraemia, high levels of PCR, hyper-glycemia, low level of serum-blood albumin and proteins, as statistically significant variables. Multivariate analysis revealed a p<0.05 for PCR, hypo-albuminemia and total serum-blood-protein level. CONCLUSIONS: Alterations of pre-operative bio-humoral parameters could be associated to a greater risk of seroma development. A better understanding of such alterations may lead to more efficient risk stratification methods. This could be essential to better address the medical resources, reducing the post-operative complications and the outpatient controls as well as the risk associated to seroma.
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Pared Abdominal/cirugía , Hernia Incisional/cirugía , Complicaciones Posoperatorias/epidemiología , Seroma/epidemiología , Mallas Quirúrgicas , Anciano , Femenino , Humanos , Hernia Incisional/complicaciones , Masculino , Peritoneo , Complicaciones Posoperatorias/etiología , Medición de Riesgo , Factores de Riesgo , Seroma/etiologíaRESUMEN
BACKGROUND: The seroma is one of the most common complications in the axillary lymph nodal dissection (different surgical approaches have been tried to reduce the seroma incidence). In our study we evaluate the outcome of patients using or not the ultrasonic scalpel (Harmonic scalpel) according to a standardized surgical technique. PATIENTS AND METHODS: From January 2011 to December 2015 120 patients underwent axillary dissection for breast cancer. Patients were divided in two groups: patients belonging to the first group underwent Harmonic scalpel dissection and patients belonging to the second group underwent classical dissection. Each group consisted of 60 patients. Quadrantectomy (QUAD) was performed in 54 patients, 66 women underwent mastectomy. In all patients axillary dissection included the I, II and III level. We compared two groups in terms of: time of surgery, hematoma, drainage volume, days of sealing drainage, seroma formation, number of post-seroma aspirations, upper limb lymphedema, wound infections, post-operative pain. RESULTS: Statistically significant results were obtained in terms of the total volume of the breast and axillary drainage in the two techniques. There were no significant differences in the two samples in terms of operative time incidence of seroma, post-operative hematoma, wound infection, and lymphedema of the upper limb. CONCLUSION: The small number of cases did not allow us to reach definitive conclusions. The use of Harmonic scalpel seems to show smaller incidence of seroma and reduction of the amount of both breast and axillary drainages. Further studies are needed to define the real advantage in terms of cost benefit of using these devices in the axillary surgery.
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Neoplasias de la Mama/cirugía , Escisión del Ganglio Linfático/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Axila , Neoplasias de la Mama/patología , Femenino , Humanos , Metástasis Linfática , Persona de Mediana EdadRESUMEN
AimThe knowledge of biodiversity facets such as species composition, distribution and ecological niche is fundamental for the construction of biogeographic hypotheses and conservation strategies. However, the knowledge on these facets is affected by major shortfalls, which are even more pronounced in the tropics. This study aims to evaluate the effect of sampling bias and variation in collection effort on Linnean, Wallacean and Hutchinsonian shortfalls and diversity measures as species richness, endemism and beta-diversity. Location Brazil. MethodsWe have built a database with over 1.5million records of arthropods, vertebrates and angiosperms of Brazil, based on specimens deposited in scientific collections and on the taxonomic literature. We used null models to test the collection bias regarding the proximity to access routes. We also tested the influence of sampling effort on diversity measures by regression models. To investigate the Wallacean shortfall, we modelled the geographic distribution of over 4000 species and compared their observed distribution with models. To quantify the Hutchinsonian shortfall, we used environmental Euclidean distance of the records to identify regions with poorly sampled environmental conditions. To estimate the Linnean shortfall, we measured the similarity of species composition between regions close to and far from access routes. ResultsWe demonstrated that despite the differences in sampling effort, the strong collection bias affects all taxonomic groups equally, generating a pattern of spatially biased sampling effort. This collection pattern contributes greatly to the biodiversity knowledge shortfalls, which directly affects the knowledge on the distribution patterns of diversity. Main conclusionsThe knowledge on species richness, species composition and endemism in the Brazilian biodiversity is strongly biased spatially. Despite differences in sampling effort for each taxonomic group, roadside bias affected them equally. Species composition similarity decreased with the distance from access routes, suggesting collection surveys at sites far from roads could increase the probability of sampling new geographic records or new species
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Biodiversidad , EcologíaRESUMEN
We report the rational design, based on docking simulations, and synthesis of the first fluorescent and selective probe of GPER for bioimaging purposes and functional dissecting studies. It has been conceived as a Bodipy derivative and obtained by accessible and direct synthesis. Its optical properties have been measured in different solvents, showing insensitivity to their polarity. Its binding to GPER was achieved by competition assays with [3H]E2 and [5,6-3H] nicotinic acid in ER-negative and GPER-positive SkBr3 breast cancer cells. SkBr3 cells, transfected with a GPER expression vector containing a FLAG tag, were used to confirm that the fluorophore binds to GPER in a specific manner.