Archivio istituzionale della ricerca - Università dell'Insubria
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Symbolic Analysis and Amplitude Symbolic Analysis Provide Complementary Information on Cardiac Control
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COVID-19 infection is a significant risk factor for death in patients presenting with acute cholecystitis: a secondary analysis of the ChoCO-W cohort study
No full textBackground: During the coronavirus disease (COVID-19) pandemic, there has been a surge in cases of acute cholecystitis. The ChoCO-W global prospective study reported a higher incidence of gangrenous cholecystitis and adverse outcomes in COVID-19 patients. Through this secondary analysis of the ChoCO-W study data, we aim to identify significant risk factors for mortality in patients with acute cholecystitis during the COVID-19 pandemic, emphasizing the role of COVID-19 infection in patient outcomes and treatment efficacy.” Methods: The ChoCO-W global prospective study reported data from 2546 patients collected at 218 centers from 42 countries admitted with acute cholecystitis during the COVID-19 pandemic, from October 1, 2020, to October 31, 2021. Sixty-four of them died. Nonparametric statistical univariate analysis was performed to compare patients who died and patients who survived. Significant factors were then entered into a logistic regression model to define factors predicting mortality. Results: The significant independent factors that predicted death in the logistic regression model with were COVID-19 infection (p < 0.001), postoperative complications (p < 0.001), and type (open/laparoscopic) of surgical intervention (p = 0.003). The odds of death increased 5 times with the COVID-19 infection, 6 times in the presence of complications, and it was reduced by 86% with adequate source control. Survivors predominantly underwent urgent laparoscopic cholecystectomy (52.3% vs. 23.4%). Conclusions: COVID-19 was an independent risk factor for death in patients with acute cholecystitis. Early laparoscopic cholecystectomy has emerged as the cornerstone of treatment for hemodynamically stable patients
Thymectomy in Ocular Myasthenia Gravis: Results Before and After Generalization and Prognostic Predictors of Outcomes
No full textBackground: The role of thymectomy in ocular myasthenia gravis (OMG) remains controversial, particularly before secondary generalization. Methods: We conducted a multicenter retrospective study on 174 OMG patients who underwent thymectomy (112 OMG, 62 generalized OMG [g-OMG]). The primary endpoint was complete stable remission (CSR; MGFA-PIS criteria). Multivariable analyses identified predictors of CSR and generalization. Results: Mean age at surgery was 42.3 +/- 13.0 years; 53.4% were male. Thymoma was present in 29.3%. CSR was achieved in 18.9% overall, significantly higher in OMG (23.2%) compared to g-OMG (11.3%, p = 0.036), with 5-year CSR probabilities of 43% vs. 22% (p = 0.017). In non-thymomatous patients, 5-year CSR remained higher in OMG (41% vs. 17%, p = 0.010). Postoperative myasthenic crisis occurred exclusively in g-OMG (8.1%, p = 0.004). Multivariable analysis identified preoperative cholinesterase inhibitor monotherapy as an independent predictor of CSR (HR = 31.776, 95% CI: 4.188-241.111, p = 0.001; non-thymomatous: HR = 19.746, 95% CI: 2.518-154.849, p = 0.005). Minimally invasive techniques (78.6%) were associated with low morbidity (5.2%). Conclusions: Thymectomy during the purely ocular stage is associated with higher CSR rates and lower perioperative neurological risk than after generalization, particularly in non-thymomatous disease. Use of cholinesterase inhibitors as sole therapy prior to thymectomy independently predicts CSR. These findings support earlier surgical consideration in selected OMG patients and highlight the safety of minimally invasive approaches
Lower Lip Reconstruction With the New Ascending Mental Artery Perforator Flap
No full textFull-thickness defects of the lower lip pose a considerable challenge for reconstructive surgeons. The primary objective should be the restoration of oral sphincter competence, achieving both functionally and aesthetically favorable outcomes. For defects involving more than one-third of the lower lip, multiple locoregional flaps have been described as the optimal solution due to their color and texture match. Unfortunately, complications such as reduction of buccal circumference or microstomia have been reported, impacting patients’ quality of life. For defects exceeding 80% of the lower lip, free flaps are required. In this study, we propose the new ascending mental artery perforator flap, based on the superficial perforating branches of the ascending mental artery. We applied this technique to 11 patients undergoing lower lip cancer excisions with defects involving 30%–70%. Our primary objective was to maintain oral continence, avoiding reduction of mouth circumference or various grades of buccal microstomia. All patients were satisfied with the functional and aesthetic final outcomes checked by long-term follow-up through clinical examination and photographs/videos (from 14 to 50 mo, with an average follow-up of 26.2 mo). This surgical procedure allows us to raise a safe and easy-to-harvest locoregional flap within a relatively short operative time, bringing a great amount of similar tissue to what is required for reconstruction. Finally, the AMAP flap has been demonstrated to fulfill the main goals of lower lip reconstruction, avoiding the most frequent complications described in the literature, especially the reduction of the circumference of the mouth
The Document on Human Fraternity and the “Arab Springs”: A Challenge from an Expanded Mediterranean
No full textPanoramica delle trasformazioni giuridiche, economiche e religiose nello spazio MENA del post Covid (e post-primavere arabe
Abdominal specimen retrieval in endometrial cancer patients with large uteri
No full textObjective: Endometrial cancer surgery has a low risk of specimen fragmentation, but removing large uteri can be challenging. This study aimed to assess whether the use of minilaparotomic incision for specimen retrieval compromises the benefits of minimally invasive surgery in endometrial cancer patients with a large uterus or utero-vaginal discrepancy. Methods: This is a retrospective multi-institutional study, including endometrial cancer patients with FIGO 2009 clinical stage I–II, undergoing minimally invasive staging surgery (laparoscopic or robot-assisted) followed by minilaparotomic specimen retrieval. A propensity-matched algorithm was used to compare outcomes of minimally invasive staging with open surgery. Results: The study included 45 propensity-matched pairs (90 patients): 45 underwent minimally invasive staging with minilaparotomic specimen retrieval and 45 underwent open staging. Patients undergoing minimally invasive surgery plus trans-abdominal specimen retrieval experienced longer median operative time (95 vs. 85 minutes; p=0.0017), lower blood loss (50 vs. 100 ml; p<0.001), and shorter length of hospital stay (3 vs. 5 days; p<0.001) in comparison to patients undergoing open surgery. No intraoperative complication occurred. No intraoperative transfusions were administered in both cohorts. No statistically significant differences in complications rates were registered between groups (p=0.266). No differences in term of disease-free (p=0.833, log-rank test) and overall (p=0.723, log-rank test) survival was noted between groups. Conclusions: Transabdominal specimen retrieval does not reduce the benefits of minimally invasive staging in endometrial cancer with large uteri or utero-vaginal disproportion. Uterine size is not a limitation for minimally invasive surgery. Further studies are needed to confirm these results and define the optimal approach
Sulfated Hyaluronan in Dermatology: What’s New? Overview of Evidence in Specific Dermatological Diseases
No full textBackground/Objectives: Sulfated hyaluronic acid (sHA) is a chemically modified derivative of native hyaluronic acid (HA), characterized by enhanced physicochemical stability and increased biological activity. Glycosaminoglycans (GAGs), including HA, are key regulators of skin structure, hydration, and immune homeostasis. This review aims to critically summarize current knowledge on the structural and functional properties of GAGs-particularly HA and its sulfated forms-and to explore their potential dermatological applications in skin aging and inflammatory diseases such as atopic dermatitis, psoriasis, and acne. Methods: A narrative literature review was conducted using PubMed and Scopus databases up to June 2025, including experimental, preclinical, and clinical studies investigating the biological effects, mechanisms of action, and dermatological uses of sHA compared with native HA and other HA derivatives. Results: Compared with HA, sHA demonstrates increased enzymatic resistance, higher charge density, and improved water-binding and antioxidant capacity. These properties contribute to the restoration of skin barrier function, modulation of oxidative stress and inflammation, and promotion of extracellular matrix remodeling. Preclinical evidence supports the efficacy of sHA in reducing dryness, irritation, and inflammatory responses in atopic dermatitis, psoriasis, and acne. Preliminary findings also suggest potential benefits in wound healing and skin barrier repair. Conclusions: sHA represents a promising multifunctional molecule in dermatology and cosmetology, capable of reducing inflammation and supporting tissue regeneration. However, current evidence remains limited to preliminary studies. Future controlled clinical trials are required to confirm efficacy, optimize formulations, and establish standardized treatment protocols