54 research outputs found
PESI - a taxonomic backbone for Europe
No full textThis is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
The attached file is the published version of the article.NHM Repositor
Parenchymal-Sparing Surgery for the Surgical Treatment of Multiple Colorectal Liver Metastases Is a Safer Approach than Major Hepatectomy Not Impairing Patients' Prognosis: A Bi-Institutional Propensity Score-Matched Analysis
No full textBackground: The performance of parenchymal-sparing hepatectomy (PSH) versus major hepatectomy (MH) in patients with multiple colorectal liver metastases (CLM) is a matter that is yet debated. We investigated the outcome of patients with multiple CLM undergoing PSH instead of MH. Methods: Databases at 2 institutions were reviewed. A propensity score-matched analysis was applied. Among 554 patients, 110 undergoing PSH and 110 undergoing MH were matched. They were similar in baseline characteristics, comorbidity, and tumor features. Primary outcomes were short- and long-term outcomes. Results: Morbidity was significantly higher in the MH group, while mortality was not significantly different. There were no differences in free-margins width, but a trend of increased survival was seen in the PSH group with a median advantage of 6 months over the MH group. Among the prognostic factors, the T status (hazard ratio [HR] 2.6; p = 0.001), the N status (HR 2.9; p = 0.001), the timing of CLM diagnosis (HR 2.1; p = 0.002), the tumor number (HR 2.0; p = 0.001), the tumor size (HR 2.2; p = 0.015), and the neo-adjuvant chemotherapy (HR 1.7; p = 0.023) were found to be statistically and independently significant for survival. Conclusions: PSH conveys advantage over MH in terms of decreased postoperative morbidity, and a trend of survival benefit. PSH should be considered a suitable alternative to MH whenever it is technically feasible
Parenchymal-Sparing Surgery for the Surgical Treatment of Multiple Colorectal Liver Metastases Is a Safer Approach than Major Hepatectomy Not Impairing Patients' Prognosis: A Bi-Institutional Propensity Score-Matched Analysis
No full textOPTIMIZATION OF PRE-, INTRA- AND POST-OPERATIVE SURGICAL MANAGEMENT IN PATIENTS AFFECTED BY INFLAMMATORY BOWEL DISEASE
No full textSalmonella in the Chicken Industry and the Carriage of the pESI-like Plasmid Associated Genes in Salmonella From Latin America
No full textThe pESI-like plasmid is a mobile genetic element commonly found in Enterobacteriaceae, including Salmonella enterica serotype Infantis. In Latin America, S. Infantis has emerged as a major cause of foodborne illness and has been associated with high occurances of antimicrobial resistance. The pESI-like plasmid carries a range of virulence factors, including those involved in biofilm formation and iron acquisition, which contribute to the pathogenicity of S. Infantis. Additionally, the plasmid encodes resistance genes to multiple classes of antibiotics, including extended-spectrum cephalosporins and fluoroquinolones. Several studies in Latin America have identified resistance to these antimicrobials in S. Infantis from chicken sources. Thus, the dissemination of S. Infantis strains with the pESI-like plasmid in Latin America has yet to be understood. Therefore, investigating the presence of the pESI-like plasmid in Salmonella from Latin America is necessary. Hence, our study investigated isolates of Salmonella from Mexico, Panama, Peru, and Colombia to identify if they carry the plasmid. A total of 220 presumptive Salmonella from Mexico were recovered from the chicken samples from Aguascalientes. From Colombia, 60 Salmonella isolates were obtained from the chicken processing plant and 40 from the pork processing plant, 55 from Panama, and 44 whole genome sequences of S. Infantis were obtained from Peru. All Salmonella isolates were presumptively confirmed by Maldi-TOF MS. A PCR assay designed to detect five targets associated with the pESI-like plasmid were used. Overall, 212 isolates from Mexico and Panama contained the pESI-like plasmid. Which 188 were subjected to a whole genome sequencing for further analysis. A total of 232 isolates, 150 from Mexico, 44 from Peru, and 38 from Panama, underwent whole genome sequencing and annotation to confirm the presence of the pESI-like plasmid. Of these isolates, 220 were found to carry the pESI-like plasmid and were predicted to be S. Infantis or a variant thereof. Antimicrobial resistance determinant genes and plasmid replicon were detected in all pESI-positive isolates, with IncFIB plasmid replicon present in all pESI-positive Infantis strains. The blaCTX-M-65 gene was identified in 96.4% (212/220) of the Salmonella strains with the pESI-like plasmid, with 83 of these isolates having the gene interrupted by an insertion sequence IS26. Resistance to heavy metals and biocides was also observed. Pangenome analysis showed that the isolates clustered together primarily based on their country of origin, indicating that the pESI-like plasmid may vary worldwide, even in a clonal chromosomal background. Additionally, clinical Peru and US isolates from previous studies were clustered together, supporting the speculation that the emergent Infantis with pESI-like was introduced to the US from Peru based on the oldest isolate identified in the US carrying this plasmid. The widespread dissemination of pESI-positive S. Infantis strains in Latin America is a cause for concern in chicken and in human health. These strains may pose a significant threat to public health by reducing antibiotic effectiveness during treatment of infection and require continuous monitoring and control efforts.Embargo status: Restricted until 09/2024. To request the author grant access, click on the PDF link
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Multiple hepatocellular carcinoma: Long-term outcomes following resection beyond actual guidelines. An Italian multicentric retrospective study
No full textHepatocellular carcinoma (HCC) is frequently diagnosed as multinodular. This study aims to assess prognostic factors for survival and identify patients with multiple HCC who may benefit from surgery beyond the Barcelona Clinic Liver Cancer classification indications
Outcomes of robotic liver resections for colorectal liver metastases. A multi-institutional analysis of minimally invasive ultrasound-guided robotic surgery
No full textBackground
Current evidence supporting robotics to perform minimally invasive liver resection is based on single center case series reporting surgical outcomes in heterogeneous groups of patients. On the contrary, relatively scarce data specifically focusing on secondary hepatic malignancies is available. The objective of this study is to assess short- and long-term outcomes following liver resection for colorectal liver metastasis on a multi-institutional series of patients.
Methods
All consecutive patients undergoing robotic surgery for colorectal liver metastasis at three different tertiary hospitals over a 10-year time frame were included in this analysis. All patients received ultrasound-guided liver resection according to tumor location following the principle of parenchymal sparing surgery. Perioperative, clinicopathologic and oncological outcomes were assessed.
Results
A total of 59 patients underwent liver resection. There were 7 cases of conversion to open surgery. The postoperative complication rate was 27%, 5% being the rate of major morbidity. Overall, the mean postoperative hospital stay was 6 days and no mortality occurred. R0 resection was achieved for 92% of lesions. At a mean follow-up of 19 months, the 1-year and 3-year DFS was 83.5% and 41.9%, while the 1-year and 3-year OS was 90.4% and 66.1%, respectively.
Conclusions
Robotic liver surgery does not impair surgical outcome and oncological results in patients with liver metastases from colorectal cancer
Senza passare per la città: processi territoriali a Roma metropolitana
No full textNegli anni recenti l’agenda urbana ha riservato crescente attenzione al rapporto tra agricoltura, dimensione rurale e città. Il piano e il progetto hanno tentato di riconoscere al paesaggio produttivo un ruolo come risorsa per la ricomposizione degli squilibri tra la città e il suo intorno senza tuttavia considerare l’agricoltura come fatto territoriale e, dunque, quale perno di rapporti tra modelli economici, sociali e ambientali.
Tali sviluppi ci interrogano come studiosi sulla necessità di ripensare traiettorie interpretative dell’agricoltura, superando gli approcci tradizionali connessi alla scala dell’unità aziendale o all’uso di suolo - entrambi inadeguati a restituire i rapporti tra ambienti insediativi e produttivi - come all’analisi delle forme e delle trame, che stentano a confrontarsi con i fatti economici e sociali.
Il lavoro recupera pertanto prospettive e approcci teorici legati alla tradizione economico-agraria tra gli anni ’30 e l’immediato dopoguerra, i quali nel costruire analisi funzionali all’intervento pubblico per lo sviluppo del settore primario (Lorenzoni, 1938; Turbati, 1938; Giusti, 1940; Medici, 1958; Sereni, 1961; Rossi Doria, 1969), restituivano quadri territoriali che guardavano al paesaggio produttivo nella sua proiezione di forme e funzioni – fisiche, sociali, economiche, ambientali – e ai rapporti tra esse. In questo approccio, tali prospettive e approcci collocavano il fatto produttivo in rapporto dialettico con la dimensione insediativa, anche a partire dalla sua unità funzionale di riferimento, ovvero l’impresa agraria.
Le relazioni che sussistono tra sistema ambientale, dinamiche socioeconomiche e la loro traduzione in forme insediative e processi produttivi, configurano percorsi di trasformazione delle matrici territoriali. Nel tentativo di analizzare i caratteri e concorrere alla costruzione di criteri interpretativi, l’indagine privilegia lo studio delle “ragioni” e degli “agenti” delle trasformazioni (Sereni, 1961), guardando alle diversità non come esito di percorsi identitari locali, bensì come possibile via per la definizione di nuove strutture territoriali, risultato di processi comuni
di trasformazione (Clementi et al., 1996).
Il contributo propone un percorso analitico e definisce alcune categorie interpretative dei mutamenti a partire da Roma Metropolitana, attraverso
un’analisi diacronica relativa a due momenti - agli anni ’60 del secolo scorso e all’oggi - dei rapporti tra sistemi agrari e fatti urbani. Le intenzioni analitiche mirano a esaminare pesi e forme tra Roma e la porzione mediana dell’Italia centrale, al fine di ricostruire la dimensione evolutiva del mutamento nelle relazioni tra la città e il territorio. Il contributo si articola intorno a un quadro di carattere metodologico, cui si accompagna l’analisi del caso romano nell’ambito dei processi di mutamento che hanno investito l’area regionale laziale e si conclude con alcune considerazioni di sintesi
Predicting in-hospital mortality in patients admitted from the emergency department for pulmonary embolism: Incidence and prognostic value of deep vein thrombosis. A retrospective study
No full textBackground Pulmonary embolism (PE) is one of the most common causes of death from cardiovascular disease. Although deep vein thrombosis (DVT) is the leading cause of PE, its prognostic role is unclear. This study investigated the incidence and prognostic value of DVT in predicting in-hospital mortality (IHM) in patients admitted from the emergency department (ED) for PE.Methods This retrospective cohort study was conducted in the ED of a third-level university hospital. Patients over 18 years admitted for PE between 1 January 2018 and 31 December 2022 were included.Results Five hundred and thirty patients (mean age 73.13 years, 6% IHM) were included. 69.1% of cases had DVT (36.4% unilateral femoral vein, 3.6% bilateral, 39.1% unilateral popliteal vein, 2.8% bilateral, 45.7% distal vein thrombosis and 7.4% iliocaval involvement). Patients who died in hospital had a higher Pulmonary Embolism Severity Index (PESI) (138.6 vs. 99.65, p < 0.001), European Society of Cardiology risk class (15.6% vs. 1%, intermediate-high in 50% vs. 6.4%, p < 0.001) and more DVT involving the iliac-caval vein axis (18.8% vs. 6.6%, p = 0.011). PESI class >II, right ventricular dysfunction, increased blood markers of myocardial damage and involvement of the iliocaval venous axis were independent predictors of IHM on multivariate analysis.Conclusions Although further studies are needed to confirm the prognostic role of DVT at PE, involvement of the iliocaval venous axis should considered to be a sign of a higher risk of IHM and may be a key factor in prognostic stratification
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