The alterations of the sigmoid-rectal junction in diverticular disease of the colon revealed by MR-defecography.

PURPOSE: The sigmoidorectal junction (SRJ) has been defined as an anatomical sphincter with particular physiological behavior that regulates sigmoid and rectum evacuation. Its function in clinical conditions, such as diverticular disease has been advocated. The aim of our study is to identify the SRJ and to compare the morphometric and dynamic features of the SRJ between patients with diverticular disease and healthy subjects using MR-defecography. METHODS: Sixteen individuals, eight with uncomplicated diverticular disease and eight healthy subjects, were studied using MR-defecography to identify the SRJ and to compare the morphometric and dynamic features observed. RESULTS: In each subject studied, MR-defecography was able to identify the SRJ. This resulted in the identification of a discrete anatomical entity with a mean length of 31.23 mm, located in front of the first sacral vertebra (S1) and at a mean distance of 15.55 cm from the anal verge, with a mean wall thickness of 4.45 mm, significantly different from the sigmoid and rectal parietal thickness. The SRJ wall was significantly thicker in patients with diverticular disease than the controls (P = 0.005), showing a unique shape and behavior in dynamic sequences. CONCLUSION: Our findings support the hypothesis that SRJ plays a critical role in patients with symptomatic diverticular disease; further investigation may clarify whether specific SRJ analysis, such as MR-defecography, would predict inflammatory complications of this diffuse and heterogenic disease.

Environmental impact scenarios of organic fraction municipal solid waste treatment with Black Soldier Fly larvae based on a life cycle assessment.

Biowaste treatment with Black Soldier Fly (BSF) larvae is an alternative option for organic waste valorization. Its environmental impacts should be assessed and compared with conventional treatment options. The research aims to evaluate the treatment of organic fraction of municipal solid waste (OFMSW) with BSF larvae through a life cycle assessment (LCA). This study employed data inventories from literature and aimed to provide a wide range of production parameter values to identify the potentialities of BSF treatment in the best-case and worst-case scenarios. The SimaPro9, the database Ecoinvent3.5, and the impact assessment method IMPACT 2002+ have been employed for the analysis. A sensitivity analysis of relevant parameters was conducted, considering the avoided impacts that can be obtained thanks to the exploitation of larvae proteins for bioplastics or fishmeal production. Research findings highlight six main environmental impact indicators: respiratory inorganics (kg PM2.5-eq), ozone layer depletion (kg CFC-11-eq), terrestrial ecotoxicity (kg TEG soil), land occupation (m2 organic arable), global warming (kg CO2-eq), and non-renewable energy (MJ primary). The most relevant process generating impacts is BSF breeding, followed by boiling, storage, and OFMSW treatment. The environmental performance is better when the conventional fishmeal substituted, thanks to BSF larvae production, is made from areas 10,000 km far, implementing a 100% renewable energy scenario, reducing the energy consumption by 50%, increasing the lifespan of the equipment to 15 years, and products are employed locally. The current study represents the first attempt to evaluate the global higher or lower environmental impact scenario related to OFMSW treatment through BSF larvae.

Feasibility and efficacy of routinary PECs 1 block on perioperative and postoperative pain control in breast surgery: a prospective non-controlled trial in a medium-volume breast unit.

Strategies to reduce the postoperative pain in patients undergoing breast cancer surgery include the use of Interpectoral (PECs) block, first described by Blanco in 2011, but its feasibility and efficacy in everyday clinical practice has been debated. The aim of the study was to evaluate the routine feasibility and effectiveness of PECs block added to general anesthesia to reduce postoperative pain and opioids consumption in the Breast Unit's patients. From June to December 2021 all patients undergoing surgery were included to receive PECs1 block before general anesthesia; clinical and outcome data were prospectively collected. Fifty-eight out of 61 patients undergoing major or minor procedures were enrolled. The average time of block execution was 93.56 s (SD 42.45), with only one minor complication reported. Very low doses of intra and postoperative opioids consumption were reported, regardless of the type of surgery. The pain NRS resulted under the median value of 1 point [IQR 3] in the early postoperative period to 0 at 24-48 h, with beneficial effects lasting at least for two weeks, since no opioids consumption in the postoperative period had been reported, only 31% of patients required paracetamol with a dosage of 0.34 g (SD 0.548); comparison between type of surgery and different regimens of general anesthesia were reported. Routine use of PECs block, in addition to general anesthesia, was found to be safe, feasible and effective, resulting in low intraoperative opioids consumption, very low postoperative pain and analgesic requirement, with effects lasting up to two weeks after surgery.

Pinch Grip per SE Is Not an Occupational Risk Factor for the Musculoskeletal System: An Experimental Study on Field.

INTRODUCTION: Some ergonomic evaluation methods define pinch grip as a risk factor independent of the exerted force. The present experimental study was performed with the main aim of objectively measuring the muscle engagement during the execution of pinch grip. METHODS: the participants of the study were healthy workers occupationally involved in a high-intensity repetitive job related to the sorting of letters and small packages. Surface electromyography (sEMG) was used to study the activity of the abductor pollicis brevis and first dorsal interosseous fibers related to the execution of the required working tasks, while the force exerted during voluntary muscle contraction for pinch grip was measured by a portable acquisition system. The subjects were specifically asked to exert the maximum voluntary isometric contraction (MVIC) and further voluntary isometric contractions with a spontaneous force (SF) equal to 10%,20% and 50% of the MVIC; finally, the workers were asked to hold in pinch grip two types of envelopes, weighing 100 g and 500 g, respectively. RESULTS: The force required to pinch 100 and 500 g envelopes by the fifteen subjects of the study corresponded to 4 and 5% MVIC, respectively. The corresponding sEMG average rectified values (ARV) were approximately 6% of that at MVIC for first dorsal interosseus (FDI) fibers and approximately 20-25% of MVIC for abductor pollicis brevis (ABP) fibers. Bivariate correlation analysis showed significant relationships between force at MVIC and FDI ARV at MCV. CONCLUSIONS: The obtained results demonstrate that muscle recruitment during pinch grip varies as a function of the SF: not only the position but also the exerted force should be considered when assessing the pinch grip as risk factor for biomechanical overload of the upper limb.

Importance of Work-Related Psychosocial Factors in Exertion Perception Using the Borg Scale Among Workers Subjected to Heavy Physical Work.

Objective: This study aimed to analyse the role of several environmental and time variables, as well as individual and psychosocial factors, on the perception of exertion, expressed by using the Borg scale, on logistics workers performing heavy manual tasks. Materials and Methods: We enrolled 56 subjects working in logistics sector that were interviewed on the perceived exertion required to execute a task of manual lifting of heavy loads, by using the Borg scale. The interviews were carried out during different shifts, at different times during the shifts and during several different months of the year. We also assessed the workers' anthropometric characteristics, length of service, any musculoskeletal diseases, and physical activity outside work. Workers were also interviewed using the structured OREGE questionnaire, in order to evaluate the main symptoms of stress and work-related psychosocial risk factors. Results: Overall, the subjective perception of the strength exerted by the workers exposed to a high risk of manual handling of loads was moderate. The rating attributed using the Borg scale showed no correlation with any of the investigated variables. 100% of the workers denied to suffer from symptoms of stress, whereas in terms of psychosocial factors, the workload was globally perceived as positive. Conclusion: The study results support the hypothesis that optimal work conditions-from a psychosocial point of view-reduce the subjective perception of exertion by workers even if exposed to a high risk of biomechanical overload.

Gerota's fascia flap: a technique for autogenous packing in major liver injuries.

Hepatic trauma occurs in ∼ 5% of patients admitted to emergency rooms and nonoperative management has become the standard of care in hemodynamically stable patients with blunt trauma, for most of the injured solid organs. However, the staged surgery represents the first line of treatment in hemodynamically instable patients. The abdominal packing is considered the first step of this surgical policy. The authors describe a new surgical technique consisting of Gerota's fascia dissection that provide an autogenous pedunculated flap to obtain a definitive hemostasis of the injured liver with a permanent packing system.

[Emergency laparoscopic cholecystectomy in the treatment of acute cholecystitis: when and how?]. / Colecistectomia laparoscopica d'urgenza nel trattamento della colecistite acuta: "quando" e "come".

Optimal surgical timing and operative technique in the treatment of acute cholecystitis are of major importance and are still debatable issues. We report the results of our study on the timing of surgery in a consecutive series of 163 patients treated in the emergency setting for acute cholecystitis over the period from 1998 to 2008. Early surgery and the partially downwards laparoscopic cholecystectomy technique provide a safe and effective way of treating these patients and preventing major complications. The mean time period between onset of symptoms and surgery was 69.2 hrs, with a median value of 53 hrs. The mean operative time was 63.9 min, with a conversion rate of 0.6% and a specific complication rate of 1.22%. The mean postoperative hospital stay was 3.2 days. The timing of surgery (measured in hours) and operative time (measured in minutes) were recorded and analysed to verify whether or not there was a statistically significant relationship between these two variables and establish the best timing for surgery. Our results show a linear relationship between operative time and the timing of surgery. Moreover, at the cut-off point of 57 hrs, the later subgroup (over 57 hrs) had a two-fold increase in operative time compared to the earlier subgroup. At more than 60 hrs approximately from the onset of symptoms, the pathological changes in the surgical target begin, with increasing rapidity, to present a troublesome challenge to the surgeon, making laparoscopic cholecystectomy for acute cholecystitis more difficult and less safe than when performed earlier.

The best timing of surgery in laparoscopic cholecystectomy for acute cholecystitis: when and how is to be performed.

BACKGROUND/AIMS: In the treatment of acute cholecystitis the optimal timing of operation, regardless of whether performed laparoscopically or conventionally, is of major importance and not yet well defined feature among the different authors. We report our study on the timing of surgery in a consecutive series of 133 patients. METHODOLOGY: The surgical technique consists in a partially downwards cholecystectomy from the infundibulum to the cystic duct. The dissection never involves the Calot Triangle's structures; this provides a safe and effective way to prevent major complications procedure related. Length of time interval from the onset of symptoms to surgery (ST measured in hours) and operating time (OT measured in minutes) have been recorded and analyzed to find out how these two variables are each other linked and what is the best timing for surgery. We also split the series taking a progressively increasing of ST as a cut off point and analyzed the two derived subgroups to outline which was the time of surgery (period of ST) that provided the best result in term of worsening of laparoscopic procedure difficulty. RESULTS: 51.3 hrs of average time between the onset of symptoms and surgery has been reported, with minimum of 24 hrs and maximum of 90 hrs, and median value of 48 hrs. The curve fit analysis on the scatterplot of the variable ST (independent) and OT (dependent) shows that these two variables are directly each other linked. The best division of the series was at the cut off of 57 hrs; each subgroup reached a statistical correlation coefficient: the late subgroup (the one over the cut off time of 57 hrs) had a twofold operating time increasing respect to the early group. CONCLUSIONS: Our results outline that there is a linear relationship between the technical difficulties, expressed in term of operating time, and time intervals from the onset of symptoms to surgery. At the cut off time of 57 hrs of interval from the onset of symptoms to surgery, the linear regression coefficient that links the dependent variable OT to the independent variable ST changes increasing up to 1,92. Over 60 hrs from the onset of symptoms the pathological changes of the surgical target becomes more and more quickly a troublesome challenge to the surgeon, letting the laparoscopic cholecystectomy for AC more difficult and less safe than that performed early.

[Therapeutic and diagnostic protocol for mild acute biliary pancreatitis: our experience and review of the literature]. / Protocollo diagnostico terapeutico della pancreatite acuta biliare lieve: nostra esperienza e revisione critica della letteratura.

Through a critical review of the literature, the authors analyze and re-assess the current diagnostic and therapeutic algorithms used in the treatment of mild acute biliary pancreatitis, reporting their experience with 27 cases observed in the Policlinico Umberto I Emergency Department (Rome) over the period from March 2003 to May 2005. All patients were treated with the same diagnostic and therapeutic protocol: once the diagnosis of acute biliary pancreatitis had been made and the severity evaluated, patients presenting clinical or ultrasonographic signs of main biliary duct stones underwent ERCP within 72 hours of onset of symptoms. All patients then underwent a standard-technique laparoscopic cholecystectomy during the same hospital stay, and whenever ERCP had not been performed preoperatively, an intraoperative cholangiography was performed at the time of surgery. No intra- or postoperative complications were observed, with a mean hospital stay of 10.6 days (range: 5-25 days).

The rice Mybleu transcription factor increases tolerance to oxygen deprivation in Arabidopsis plants.

Mybleu is a natural incomplete transcription factor of rice (Oryza sativa), consisting of a partial Myb repeat followed by a short leucine zipper. We previously showed its localization to the apical region of rice roots and coleoptiles. Specifically, in coleoptiles, Mybleu is expressed under both aerobic and anaerobic conditions, whereas in roots, it is expressed only under aerobic conditions. Mybleu is able to dimerize with canonical leucine zippers and to activate transcription selectively. To investigate Mybleu function in vivo, we transformed Arabidopsis thaliana and evaluated several morphological, physiological and biochemical parameters. In agreement with a hypothesized role of Mybleu in cell elongation in the differentiation zone, we found that the constitutive expression of this transcription factor in Arabidopsis induced elongation in the primary roots and in the internodal region of the floral stem; we also observed a modification of the root apex morphology in transformed lines. Based on the high expression of Mybleu in anaerobic rice coleoptiles, we studied the role of this transcription factor in transgenic plants grown under low-oxygen conditions. We found that overexpression of this transcription factor increased tolerance to oxygen deficit. In transgenic plants, this effect may depend both on the maintenance of a higher metabolism during stress and on the higher expression levels of certain genes involved in the anaerobic response.

Complex lesion of the third metacarpophalangeal joint: complete tear of the radial collateral and deep transverse metacarpal ligament.

Injuries of collateral ligaments of MCPs joints are often underdiagnosed but have to be considered serious traumas of the hand. In many cases they concern thumb and rarely long fingers. Closed rupture of the deep transverse metacarpal ligament (DTML) is an unusual parallel injury. Both lesions present similar symptoms included local pain, swelling, ecchymosis and deviation of the finger in flexion and can be misdiagnosed. We describe the treatment of a 34 years old woman who sustained a complex lesion of the soft tissues of third metacarpophalangeal joint with complete close tear of the radial collateral and deep transverse metacarpal ligament following a fall during a walk thus leading to a multiplanar instability. Surgery consisted in mini anchor repair or the collateral ligament tear, direct resorbable suture of DTML and a double k-wire stabilization. Follow up at 11 months has shown excellent functional outcomes.

[Thyroid surgery: total and partial resection. Analysis of complications and a review of the literature]. / La chirurgia tiroidea: exeresi totale ed exeresi parziale. Analisi in termini di complicanze e revisione della letteratura.

The authors review the recent international literature relating to approximately 36,800 cases of thyroid surgery, analysing the complications associated with total thyroidectomy versus partial resection of the thyroid, with a view to drawing up lines of conduct in terms of indications for surgery of benign disease and suggestions on surgical technique to reduce complications such as recurrent laryngeal nerve injuries (transient and definitive), hypocalcaemia (transient and definitive) and superior laryngeal nerve injuries.

[Conservative approach to IV grade renal trauma]. / Approccio conservativo al trauma renale di IV grado.

A case of grade IV renal trauma is reported and the literature reviewed. A 29-year-old man was admitted in an emergency setting for a grade IV renal and splenic trauma as a result of a motorcycle accident. Since the patient was haemodynamically stable and the retroperitoneal haematoma was neither expanding nor pulsating, a conservative approach was adopted and the renal trauma was managed with interventional radiology. The case shows that major renal traumas can be usefully managed by non-operative treatment, necessarily consisting in a mutidisciplinary approach.

[Classification and management of gynecologic acute abdomen at a secondary level hospital emergency department]. / Inquadramento e gestione dell'addome acuto di origine ginecologica in un Dipartimento di Emergenza ed Accettazione di II livello. Analisi di 103 casi.

This study retrospectively evaluates the preoperative work-up and the classification and operative treatment of acute abdomen caused by gynaecological disorders in emergency admissions to our department. All female patients admitted in the emergency setting and operated on for gynaecological acute abdomen in our emergency department over the period from 1997 to 2002 were included in the study. A total of 103 patients were identified (54 undergoing emergency operations, 9 operated on within 72 hours, and 40 managed conservatively with medical therapy. The 54 emergency operations performed were 24 ovarian resections, 17 salpingectomies, 5 oophorectomies, 4 exploratory laparotomies, 2 uterine polypectomies and 2 hysterectomies. The non-specific presentation of the disease and an inadequate preoperative work-up in these patients often led to a generic diagnosis at admission. This approach tends to increase the number of operations performed on an emergency basis, whereas a wait-and-see type of management should be adopted. A proper use of surgery is mandatory especially in those patients in whom preservation of reproductive capability has a major impact on outcome.

[Multidisciplinary approach to the patient with multiple trauma: a case report]. / Approccio multispecialistico al paziente politraumatizzato: un caso clinico.

A multidisciplinary approach to severe polytraumatized patient is very important for a rapid, uncomplicated recovery. Specialized centres with special beds, monitoring equipment, and a multidisciplinary team are required. The authors report a case of a 26-year-old man admitted to their department in an emergency setting for a crush injury (occupational trauma) of the lumbar, gluteal and perineal areas, complicated with septic shock and gas gangrene of the injured areas. A multidisciplinary approach to the patient, consisting in surgical and plastic surgical therapy, hyperbaric oxygen therapy and the use of a special antidecubitus fluidized bed allowed complete recovery within 7 months without any motor or sphincter disorders.

Laparoscopic colorectal surgery in urgent and emergent settings.

Laparoscopic colectomy (LC) is slowly becoming the standard of care for elective resections. The use of LC in the emergency setting is relatively unstudied. Authors describe their experience with a series of 34 emergent and urgent LC cases for a variety of benign and neoplastic colorectal diseases, admitted from 2007 to 2009 at Emergency Department of a tertiary level hospital, comparing laparoscopic group with matched control open group. Twenty-one LC was performed for benign complicated disease, 12 for malignant disease and 1 for iatrogenic perforation during colonoscopy. Two cases were converted to open procedure (5.8%), the average operative time was 188 minutes (SD 61.84). The average postoperative length of hospital stay was 6.57 days (SD 1.75), with no postoperative mortality and no major morbidity. Results of laparoscopic group compared with 61 patients treated with open colorectal procedure confirm the advantages of laparoscopic approach similar to those established in elective colorectal surgery. With increasing experience, LC would be a feasible and an effective option in nonelective situations lowering complication rate and length of hospital stay.