Is remote live urologic surgery a reality? Evidences from a systematic review of the literature.

INTRODUCTION AND OBJECTIVES: The possibility of performing remote-surgery has been the goal to achieve, since the early development of the first surgical robotic platforms. This systematic review aims to analyse the state of the art in the field and to provide an overview of the possible growth of this technology. METHODS: All English language publications on Telementoring and Telesurgery for minimally invasive urologic procedures were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed®, Scopus®, and Web of Science™ databases (up to June 2019). RESULTS: Our electronic search identified a total of 124 papers in PubMed, Scopus, and Web of Science. Of these, 81 publications were identified for detailed review, which yielded 22 included in the present systematic review. Our results showed that remote surgery has been under-utilised until today, mostly due to the lack of appropriate telecommunication technologies. CONCLUSION: Remote live surgery is a growing technology that is catalyzing incremental interest. Despite not being yet reliable today on a regular basis in its most advanced applications, thanks to the advent of novel data-transmission technologies, telepresence might become a critical educational methodology, highly impacting the global healthcare system.

Hepatitis B and immigrants: a SIMIT multicenter cross-sectional study.

BACKGROUND: The continuing migration of individuals from geographic areas with high/medium endemicity has determined the arrival of new chronic hepatitis B virus (HBV) carriers in Italy. The magnitude of this phenomenon and clinical/virological features of HBsAg-positive migrants remain not very well defined. AIMS: To evaluate the proportion of HBsAg-positive immigrants enrolled in this multicenter Società Italiana di Malattie Infettive e Tropicali (SIMIT) cross-sectional study and to compare the characteristics of chronic hepatitis B infection in migrants to those of Italian carriers. METHODS: From February 1 to July 31 2008, anonymous data were obtained from all HBsAg-positive patients aged ≥ 18 years observed at 74 Italian centers of infectious diseases. RESULTS: Of the 3,760 HBsAg-positive subjects enrolled, 932 (24.8 %) were immigrants, with a prevalent distribution in central to northern Italy. The areas of origin were: Far East (37.1 %), Eastern Europe (35.4 %), Sub-Saharan Africa (17.5 %), North Africa (5.5 %), and 4.5 % from various other sites. Compared to Italian carriers, migrants were significantly younger (median age 34 vs. 52 years), predominantly female (57.5 vs. 31 %), and most often at first observation (incident cases 34.2 vs. 13.3 %). HBeAg-positives were more frequent among migrants (27.5 vs. 14 %). Genotype D, found in 87.8 % of Italian carriers, was present in only 40 % of migrants, who were more frequently inactive HBV carriers, with a lower prevalence of chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Only 27.1 % of migrants received antiviral treatment compared to 50.3 % of Italians. CONCLUSIONS: Twenty-five percent of all HBV carriers examined at Italian centers was composed of immigrants with demographic, serological, and virological characteristics that differed from those of natives and appeared to have an inferior access to treatment.

Factors associated with access to antiviral treatment in a multicentre cross-sectional study of patients with chronic hepatitis B in Italy.

A multicentre cross-sectional survey was performed to provide an accurate picture of patients with chronic hepatitis B (CHB) cared for by Italian Infectious Diseases Centers (IDCs). This analysis describes factors associated with access to the treatment of CHB in a country where barriers to treatment are not expected to exist because of comprehensive coverage under the National Health System (NHS). The study was performed in 74 IDCs. The analysis focused on 3305 patients with CHB of 3760 HBsAg-positive patients enrolled from March to September, 2008. To account for missing values, a Multiple Imputation method was used. Treatment was reported in 2091 (63.3%) patients. In the multivariate analysis, an increased chance of getting treatment was independently associated with 10 years increase of age at diagnosis (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 1.1-1.3, P < 0.001), HBeAg positivity (aOR 1.8, 95% CI 1.1-2.8, P < 0.001), cirrhosis (aOR 3.6, 95% CI 2-6.3, P = 0.012), HDV (aOR 1.6, 95% CI 1.02-2.5, P = 0.042) and HIV positivity (aOR 6.5, 95% CI 4-10.8, P < 0.001). Conversely, a decreased chance was associated with female gender (aOR 0.6, 95% CI 0.5-0.7, P < 0.001), immigration (aOR 0.6, 95% CI 0.5-0.9, P = 0.009), alcohol consumption (aOR 0.7, 95% CI 0.5-0.98, P = 0.04) and HCV positivity (aOR 0.5, 95% CI 0.3-0.8, P = 0.005). Our study shows that Italian IDCs treat a high percentage of patients with CHB. Nevertheless, disparities exist which are not related to the severity of disease limiting access to antiviral therapy of CHB, even in a country with a universal healthcare system.

Far infrared emitting plaster in knee osteoarthritis: a single blinded, randomised clinical trial.

OBJECTIVE: Therapeutic approach of osteoarthritis (OA) still represents a challenge in clinical practice. The aim of the study is to assess the efficacy of far infrared (FIR) emitting plaster in the treatment of knee OA. DESIGN: This is a randomized, single-blind, placebo-controlled, parallel group with equal randomization (1:1), clinical trial. Patients affected by knee OA were randomly allocated to 1 of 2 treatment groups, either placebo plaster or far infrared emitting plaster. Primary endpoint was to assess pain improvement from baseline to 1 months posttreatment in the visual analogue score (VAS). Secondary end point was to evaluate pain score after 1 week of treatment and to compare ultrasonographic findings after 1 month of treatment. RESULTS: Each group comprised 30 (in the FIR group) and 30 (in the placebo group) completers. VAS scores of the placebo and the FIR group were significantly lower at 1 week post-treatment (95% confidence interval CI = -1.14 to 0.31; P<0.05) and at the end of the study (95% confidence interval CI = -2.57 to -0.89; P=0.01). Effect size was -0.43 after one week of treatment and -1.38 after one month of treatment. The mean decrease in VAS values was ≥ 20% in the FIR group. The number of patients from the FIR group with joint effusion was lower (40%) compared to baseline (80%), while no changes were seen among the placebo group. CONCLUSIONS: Far infrared emitting plaster could be considered an effective non-pharmacological choice for the therapeutic management of knee OA.

Comparative mapping of the Oregon Wolfe Barley using doubled haploid lines derived from female and male gametes.

The Oregon Wolfe Barley mapping population is a resource for genetics research and instruction. Prior reports are based on a population of doubled haploid (DH) lines developed by the Hordeum bulbosum (H.b.) method, which samples female gametes. We developed new DH lines from the same cross using anther culture (A.C.), which samples male gametes. Linkage maps were generated in each of the two subpopulations using the same 1,328 single nucleotide polymorphism markers. The linkage maps based on DH lines derived from the products of megasporogeneis and microsporogenesis revealed minor differences in terms of estimated recombination rates. There were no differences in locus ordering. There was greater segregation distortion in the A.C.-derived subpopulation than in the H.b.-derived subpopulation, but in the region showing the greatest distortion, the cause was more likely allelic variation at the ZEO1 plant height locus rather than to DH production method. The effects of segregation distortion and pleiotropy had greater impacts on estimates of quantitative trait locus effect than population size for reproductive fitness traits assayed under greenhouse conditions. The Oregon Wolfe Barley (OWB) population and data are community resources. Seed is available from three distribution centers located in North America, Europe, and Asia. Details on ordering seed sets, as well as complete genotype and phenotype data files, are available at http://wheat.pw.usda.gov/ggpages/maps/OWB/ .

Flow injection flame atomic absorption determination of Cu, Mn and Zn partitioning in seawater by on-line room temperature sonolysis and minicolumn chelating resin methodology.

A flow-injection system is developed for Cu, Mn and Zn partitioning in seawater by flame atomic absorption spectrometry. The first approach is where the trace metal species are fractionated in situ, but analysis is performed by using a flow injection manifold in the laboratory. This operational mode is used for the determination of the dissolved labile metallic fraction and is based on the elution of this fraction from a minicolumn packed with a chelating resin containing iminodiacetic acid groups (Serdolit Chelite Che) loaded in situ with the sample. The second is used for the determination of total dissolved concentrations of trace metals. This last mode is based on the retention/preconcentration of total dissolved metals on the chelating resin after on-line sonolysis of seawater samples acidified with diluted nitric acid to breakdown the metal-organic matter complexes. The figures of merit for Cu, Mn and Zn determinations in both fractions are given and the obtained values are discussed. The fractionation scheme is applied to the analysis of coastal seawater samples collected in Galicia (Northwest, Spain). The results of fractionation showed that Mn and Zn are mainly in the labile fraction, while Cu was mainly present in the organic fraction.

Synthesis, crystal structures and magnetic properties of tricyanomethanide-containing copper(II) complexes.

The preparation, crystal structures and magnetic properties of the copper(II) complexes of formula [Cu(pyim)(tcm)(2)](n) (1), [Cu(bpy)(tcm)(2)](n) (2), [Cu(4)(bpz)(4)(tcm)(8)] (3), {[Cu(terpy)(tcm)].tcm}(n) (4) and {[Cu(2)(tppz)(tcm)(4)].3/2H(2)O}(n) (5) [pyim = 2-(2-pyridyl)imidazole, tcm = tricyanomethanide, bpy = 2,2'-bipyridine, bpz = 2,2'-bipyrazine, terpy = 2,2':6',2''-terpyridine and tppz = 2,3,5,6-tetrakis(2-pyridyl)pyrazine] are reported. Complexes, 1, 2 and 4 are uniform copper(II) chains with single- (1 and 4) and double-(2) micro-1,5-tcm bridges with values of the intrachain copper-copper separation of 7.489(1) (1), 7.520(1) and 7.758(1) (2) and 7.469(1) A (4). Each copper atom in 1, 2 and 4 is five-coordinate with bidentate pyim (1)/bpy (2) and tridentate terpy (4) ligands and nitrile-nitrogen atoms from bridging (1,2 and 4) and terminal (1) tcm groups building a distorted square pyramidal surrounding. The structure of 3 is made up of neutral centrosymmetric rectangles of (2,2'-bipyrazine)copper(II) units at the corners, the edges being built by single- and double-micro-1,5-tcm bridges with copper-copper separations of 7.969(1) and 7.270(1) A, respectively. Five- and six-coordinated copper atoms with distorted square pyramidal and elongated octahedral environments occur in . Compound 5 is a neutral copper(II) chain with regular alternating bis-tridentate tppz and double micro-1,5-tcm bridges, the intrachain copper-copper distances being 6.549(7) and 7.668(1) A, respectively. The two crystallographically independent copper atoms in 5 have an elongated octahedral geometry with three tppz nitrogen atoms and a nitrile-nitrogen atom from a bridging tcm group in the equatorial positions, and two nitrile nitrogen atoms from a terminal and a bridging tcm ligand occupying the axial sites. The investigation of the magnetic properies of 1-5 in the temperature range 1.9-295 K has shown the occurrence of weak ferro- [J = +0.11(1) cm(-1) (2)] and antiferromagnetic interactions [J = -0.093(1) (1), -0.083(1) (4), -0.04(1) and 1.21(1) cm(-1) (3)] across the micro-1,5-tcm bridges and intermediate antiferromagnetic coupling [-J = 37.4(1) cm(-1) (5)] through bis-tridentate tppz. The values of the magnetic interactions are analyzed through simple orbital symmetry considerations and compared with those previously reported for related systems.

Serum cystatin C as a reliable marker of changes in glomerular filtration rate in children with urinary tract malformations.

PURPOSE: Cystatin C has been suggested as a simple method of estimating GFR more accurately than creatinine in children. We compared the diagnostic accuracy of cystatin C with serum creatinine and the Schwartz formula for estimating GFR in patients with UTMs. MATERIALS AND METHODS: We prospectively compared 72 patients with UTMs (20 days to 36 months old, 58 males and 14 females) with a group of 72 healthy controls (10 days to 48 months old, 53 males and 19 females). All patients underwent nuclear medicine clearance investigations with (99m)Tc DTPA. RESULTS: Serum concentration of cystatin C revealed a higher correlation with (99m)Tc DTPA (r = 0.62, p <0.001) than serum concentration of creatinine (r = 0.30, p <0.01) or Schwartz formula (r = 0.51, p <0.001). These results were more evident in patients with uropathy (19) with mild renal impairment. Agreement between methods was assessed using Bland Altman analysis. Mean differences between GFR calculated with (99m)Tc DTPA and cystatin C based GFR estimation or Schwartz formula were -2.6% +/- 46.7% and -73.4% +/- 53.6%, respectively. Diagnostic accuracy in identifying decreased GFR measured as AUC was always highest for cystatin C but hardly sufficient for the 3 variables. Cystatin C performed better in the 0 to 6-month-olds (0.70 +/- 0.08 for cystatin C, 0.58 +/- 0.07 for Schwartz estimate) and patients older than 12 months (0.82 +/- 0.09 for cystatin C, 0.65 +/- 0.11 for Schwartz estimate). CONCLUSIONS: Cystatin C proved to be a superior marker rate over serum creatinine in estimating glomerular filtration in children younger than 3 years with UTMs and mild renal impairment, thus, offering a more specific and practical measure for monitoring GFR.

[Progressive multifocal leucoencephalopathy in AIDS patients. Hepatotoxicity of HAART in patients with hepatitis B or C]. / Leucoencefalopatía multifocal progresiva en pacientes con sida. Hepatotoxicidad de la terapia de alta eficacia (TARGA) en pacientes con coinfección por VHB o VHC.

Progressive multifocal leukoencephalopathy (PML) develops in 1-8% of patients with AIDS, for which it is a disease-defining condition. PML presents mainly in severely immunocompromised male intravenous drug users, having viral loads greater than log5 RNA copies/mL and CD4 populations lower than 150 cells/mm3. Death of AIDS patients with PML occurred after only 4 to 6 months before the introduction of highly active antiretroviral therapies (HAART), the only ones that have shown to prolong survival. Viral hepatitis is not the only liver condition affecting patients with AIDS, opportunistic infections and neoplasms, such as lymphoma and Kaposi's sarcoma, as well as biliary disease are also encountered but, fortunately, they are currently less frequent as a result of the new antiretroviral treatments. The risks of HAART hepatotoxicity in patients with hepatitis B or C have been studied by several groups.

Discrepancy in virological and biochemistry response of patients with chronic hepatitis HCV positive on treatment with PEG-IFN plus ribavirin.

Combination therapy of PEG-IFN alpha-2a o alpha-2b plus ribavirin represents a further improvement in treatment of chronic hepatitis HCV+ with a sustained virological response (SVR) either in monotherapy (25-39%) either in association with ribavirin (59-56%). SVR is highly predictable: 75% of all patients who achieve viral clearance at week 12 (EVR), if they had an adherence > 80% of planned therapy, they become sustained viral responders. In spite of virological response, 16-34% of patients on PEG-IFN monotherapy have high value of ALT, and this make them to reduce adherence. 62 patients whith chronic hepatitis HCV+ and no corrhosis, have been treated for 48 weeks with PEG-IFN and ribavirin to evaluate discrepancy incidence between virological (HCVRNA < 200UI) and biochemical (normal value of ALT) response of patients treated with PEG-IFN plus ribavirin and to verify the impact that stuch discrepancy can produce on SVR of treated patients. Our preliminary data confirm that PEG-IFN bring a superior virological response than biochemical one, either on naive patients either on experienced ones even with ribavirin in association. It will be useful to verify if this discepancy cause a superior SVR as already reported by several studies. Even the follow-up of our 5 discordant patients confirm this trend.

Blue rubber bleb nevus syndrome and gastrointestinal haemorrhage: which treatment?

PURPOSE: To describe a paediatric case of "Blue Rubber Bleb Nevus Syndrome" (BRBNS) or Bean's syndrome, a rare systemic disorder characterised by cutaneous and gastrointestinal vascular malformations that often lead to overt life-threatening gastrointestinal bleeding or occult blood loss with severe anaemia and iron deficiency. CASE REPORT: A 6-year-old girl with multiple characteristic cutaneous vascular lesions was admitted for a massive rectal bleeding. A few months previously she was endoscopically treated for gastric angiomas which developed into melaena. Preoperative investigations revealed the recurrence of gastric lesions. At laparotomy, more than 25 angiomas of the GI tract were found. Multiple intestinal resections were carried out. RESULTS: No intraoperative or postoperative problems occurred and the girl is completely healthy without further bleeding after a follow-up period of three years. CONCLUSIONS: BRBNS belongs to the group of vascular venous malformations. Most of the time it occurs sporadically, but it can be inherited as an autosomal dominant trait. Recent analysis identified a locus on chromosome 9 responsible for venous malformations. BRBNS patients present typical skin lesions, with some lesions having a rubber-like nipple appearance; the number of skin and GI lesions and the severity of anaemia are correlated. Treatment is dependent on the extent of gut involvement and the severity of the clinical picture. In the absence of massive bleeding, a conservative treatment will be sufficient; otherwise resections are mandatory, but additional lesions may subsequently develop. Management with electrocautery or laser photocoagulation are usually not effective even if some reports recommend them. Pharmacological treatment is useless. Prognosis of BRBNS is unknown.

Transumbilical laparoscopic-assisted appendectomy (TULAA): a safe and useful alternative for uncomplicated appendicitis.

AIM: To compare transumbilical laparoscopic-assisted appendectomy (TULAA) and open appendectomy (OA) in cases of acute uncomplicated appendicitis. METHODS: 58 TULAA and 65 OA in patients with a preoperative diagnosis of acute uncomplicated appendicitis are compared. Pneumoperitoneum was obtained with a transumbilical 10 mm trocar (telescope access) and a 5 mm operative channel introduced in the left iliac fossa. Appendectomy was performed outside the abdomen, after the exteriorisation of the appendix through the transumbilical incision. RESULTS: In the TULAA group, operative time and hospital stay were reduced. Conversion was necessary in one case (1.7 %), and in one case (1.7 %), an additional 5 mm operative channel was introduced. Neither intra- or postoperative complications were found in the TULAA group, with excellent cosmetic results. In the OA group we had a wound infection (1.5 %) and in 8 cases (12.3 %) an enlargement of the incision was necessary. CONCLUSIONS: TULAA is the best approach in uncomplicated appendicitis. It is less invasive and traumatic, permits a complete evaluation of the peritoneal cavity with superior cosmetic results, especially in obese patients and in cases of ectopic appendicitis.

Conservative treatment of neonatal primary megaureter.

The growing agreement toward the conservative treatment of primary megaureter (PM) is supported by the increasingly frequent reports in the literature of spontaneous resolution of this pathology after few years of attendance. If the PM is asymptomatic without the presence of parenchymatous damage, and the diuretic scintiscan does not show a definite obstruction of the uretero-vesical junction, the conservative treatment should be the choice for the neonatal forms of PM. We report our experience of 14 neonatal PM, conservatively managed out of a total of 22 PM observed between 1990 and 1996. All the patients have been controlled with serial ultrasonography and Tc99 DTPA scintigraphy. Three of them underwent a surgical operation because of persistence or impairment of the clinical and scintigraphic pictures after a 12-18 months' follow-up. Some of the remainders are completely recovered while others are going toward resolution. The conservative treatment of neonatal PM is therefore confirmed to be sure and effective, and in spite of the different attitudes expressed by reliable authors in the up-to-date literature we believe it should be undertaken for the asymptomatic forms in which there is no documented uretero-vesical obstruction.

Human polyomaviruses DNA detection in peripheral blood leukocytes from immunocompetent and immunocompromised individuals.

Peripheral blood leukocytes from immunocompetent and immunocompromised individuals were analyzed for human polyomarivus BK and JC DNA presence. A nested polymerase chain reaction which amplify the transcriptional control region of the genome of both viruses was employed. The immunocompromised patients included bone marrow transplantation recipients and AIDS patients. BKV sequences were detectable in 52.8-62.5% of the individuals included in this study, whereas the percentage of individuals with JCV sequences in peripheral blood lymphocytes varied from 38.8% to 50%. The frequency of reactivations of BKV and JCV were also determined by detection of shedding in urine of viral DNA. The highest frequency of reactivations of either BKV or JCV was demonstrable in the group of bone marrow transplantation recipients, but reactivations occurred also in immunocompetent individuals. JCV sequences amplified from urine samples showed a restriction pattern similar to the archetype one, whereas sequences obtained from lymphocytes showed rearranged pattern as well as archetype pattern. Finally all JCV sequences from cerebrospinal fluid seemed to be rearranged. These observations suggest that peripheral blood lymphocytes have a fundamental role in the persistence of polyomaviruses infection and in the dissemination at least of JCV within the organism allowing that rearranged variants, better adapted to grow in brain tissue, emerge.

Quantitation of HCV viraemia by branched DNA signal amplification in patients treated with alpha-interferon--a longitudinal study.

Using bDNA, the plasma viral load trend of HCV-infected patients undergoing IFN therapy was analyzed. Nine patients were enrolled, each assigned to one of three groups, based on IFN response as determined by ALT and AST level trend. HCV was genotyped using DEIA. Each patient's clinical stage was determined by liver biopsy analysis. In nonresponding patients elevated viral loads and biochemical parameters were observed. These values were not influenced by IFN treatment. In relapsed patients the cessation of IFN treatment increased viral load; this was associated with a rise in ALT and AST values. In responders ALT and AST levels remained normal; viral load was low. Patients with elevated HCV viral load showed a worsening in their liver histology during the follow-up period. These results confirm that plasma viral load is a good marker of biochemical change and disease progression.

Intrafamily spread of hepatitis C virus infection.

Using the second generation ELISA test, we studied the prevalence of antibodies against hepatitis C virus (anti-HCV) among 159 household contacts of 86 anti-HCV positive subjects (index cases). Fourteen (8.8%) relatives were found anti-HCV positive, a rate higher than the corresponding figure reported among the general population in the same area. The prevalence of anti-HCV was significantly higher among sexual partners than among household contacts without sexual relations with the index case (18% vs. 3.1%; P < 0.01). These findings indicate that sexual transmission may be the main route for intrafamily HCV spread.

[Platelet aggregation inhibitory therapy in chronic arterial occlusive disease of the lower limbs: results of short-term clinico-instrumental study with indobufen]. / La terapia antiaggregante piastrinica nelle arteriopatie obliteranti croniche degli arti inferiori: risultati di uno studio clinico-strumentale a breve termin con indobufene.

Aim of our study was to evaluate the effectiveness of indobufen in the treatment of II degree stage lower limb occlusive arterial disease. Forty patients were randomly assigned to the iIndobufen (400 mg/die) treatment group or the no treatment control group (20 patients each). Doppler pressure measurement (Winsor index) and subjective symptomatology were evaluated at the time of enrollment and after one month. A significant improvement (p less than 0.01) was noted only in the treated group. We conclude that indobufen may be of therapeutic value in the treatment of peripheral occlusive arterial disease.