Prompt and unavoidable requalification of ordinary hospital wards into a centralized department characterized by high-intensity treatment due to COVID-19 epidemic: the experience of Romano di Lombardia Hospital.

The Coronavirus epidemic quickly spread in Italy from China. In particular, it affected Bergamo province where Romano di Lombardia hospital is situated. Therefore, this hospital felt the urgency to requalify its activity in no time. It transformed itself into a unique centralized subintensive department to treat COVID-19 patients. The factors that made it possible to adequately face the stress due to patients' hospitalization were human resources and innovative elements to provide oxygen therapy. It is to underline that the logistic and methodological reality was not planned to cope with this emergency.

Evaluation of the healing time of non-operatively managed liver injuries.

BACKGROUND/AIMS: Post discharge prescriptions and follow-up protocols after non-operative treatment of blunt liver injuries are still controversial. The aim of this study was to detail the evolution of the hepatic injuries considering their different patterns and severity grades, stated by the Liver Injury Scale. METHODOLOGY: Analysis of a database concerning 79 consecutive patients submitted to ultrasound follow-up until complete recovery of liver injury. RESULTS: All patients had an uncomplicated course and the liver restoration was demonstrated between 3 and 300 days after the trauma. The median healing time of hematomas increased with the grading (p<0.001): 6 days (IQR=6.75), 45.5 days (IQR=91) and 108 days (IQR=89) for I, II and III grade lesions, respectively. Similarly behaved the lacerations and 29 days (IQR=14.25), 34 days (IQR=43.5) and 77.5 days (IQR=83.5) was the median healing time of II, III and IV grade lesions, statistical significance emerging only comparing II to IV grade lacerations (p<0.035). Considering the different lesion patterns within the same severity grade, the liver restoration was more prompt after lacerations (p<0.001). CONCLUSIONS: These data suggest that medical prescriptions and follow-up protocols can be tailored considering the lesion characteristics.

IL-6 Promotes compensatory liver regeneration in cirrhotic rat after partial hepatectomy.

Major hepatic resection in cirrhotic patients is associated with impaired liver regeneration and failure, leading to high peri-operative mortality. In this work, the causes of defective regeneration in cirrhotic liver and the utility of IL-6 treatment were investigated in an experimental model combining cirrhosis and partial hepatectomy in the rat. Relative to normal controls, decompensated cirrhotic animals showed decreased survival, while compensated cirrhotic animals showed similar survival but reduced hepatic DNA synthesis and newly regenerated liver mass amount. Defective liver regeneration was associated with a decrease in STAT3 and NF-kB activation, consistent with an increased accumulation of their respective inhibitors PIAS3 and IkBalpha, and with a decreased induction of Bcl-xL. Treatment with recombinant IL-6 enhanced survival of decompensated cirrhotic animals, while it did not affect survival of compensated cirrhotic animals but sustained liver regeneration, by restoring STAT3 and NF-kB activation and Bcl-xL induction to the levels found in normal controls. The pro-growth effects exerted by IL-6 treatment in cirrhotic liver were attained also at low, pharmacologically acceptable doses. In conclusion, our results suggest that IL-6 treatment may be therapeutic in major resection of cirrhotic liver.

Mechanisms of interleukin-6 protection against ischemia-reperfusion injury in rat liver.

Numerous animal studies simulating liver injury have demonstrated that interleukin-6 (IL-6) exerts a protective effect. This study was designed to further analyze the molecular mechanisms underlying the protective role of IL-6 in a rat model of liver ischemia/reperfusion injury. We show that IL-6: (i) at high doses reduces cell damage which occurs in ischemic-reperfused liver, while at low doses displays only a limited protective capacity, (ii) anticipates and enhances hepatocyte compensatory proliferation seen in ischemic-reperfused liver also at a low, more pharmacologically acceptable dose, (iii) sustains the acute phase response which is dampened in ischemic-reperfused liver, (iv) strengthens the heat shock-stress response shown by ischemic-reperfused liver and (v) overcomes the dysfunctions of the unfolding protein response found in ischemic-reperfused liver. We also show that IL-6-enhanced STAT3 activation probably plays a crucial role in the potentiation of the different protective pathways activated in ischemic-reperfused liver. Our data confirm that IL-6 is a potential therapeutic in liver injury of different etiologies and reveal novel mechanisms by which IL-6 sustains liver function after ischemia/reperfusion injury.

[Laparoscopic adrenalectomy: an initial experience]. / Surrenectomia laparoscopica: considerazioni su un'esperienza iniziale.

Our aim was to evaluate the short-term results of a series of 65 consecutive laparoscopic adrenalectomies performed on 63 patients with benign or metastatic tumours measuring < or = 7 cm. The surgical indication was primary hyperaldosteronism in 32 cases, pheochromocytoma in 7, Cushing syndrome and disease in 5 and 2 cases, respectively, incidentaloma in 11 and metastasis in 8 cases. The mean tumour size was 3.9 cm (range 0.6-7). Operative time averaged 130 min (range 45-270). In one case we produced an iatrogenic lesion by sectioning a peripheral recurrent branch of the left renal artery with consequent partial renal infarction. The conversion rate to the open approach was 6.1%; the morbidity rate was 4.6%. The mean hospital stay was 4 days (range 3-11). All patients were re-examined 30 days after surgery and no additional complications were observed. At this time 93.2% of patients with primary secreting tumours showed normal hormonal assays. Considering the 38 patients chronically treated during the preoperative period, we noted that the intake of specific drugs was suspended in 34.2%, reduced in 36.8%, maintained in 26.4% and transitorily augmented in 2.6%. On these basis we confirm the efficacy and safety of this surgical treatment.