PurposeIn this article, the authors study the gender pay-gap (GPG) among graduates in Italy (2011 cohort) who were employed four years after graduation. The authors focus on individuals who are new ...entering in the labour market or who match a low level of experience with a high level of education.Design/methodology/approachAimed at estimating the amount of the differential between male and female average wages, the authors have applied the Oaxaca–Blinder (O–B) decomposition. The results identify the presence of a GPG at the very beginning of graduates’ careers given that, shortly after graduation, women receive lower salaries than men, even after controlling for several characteristics (individual, academic, job and local labour market). The authors completed the analysis with the reweighted O–B decomposition using the recentered influence function (RIF) and the Juhn, Murphy and Pierce and Machado and Mata decomposition approaches.FindingsThe results show that the GPG is already present at the very beginning of graduates’ careers, and it increases when correcting for women’s lower level of participation in the labour market. The authors also identified sticky floor and the glass ceiling effects due to the existence of a relevant high GPG both at the bottom and the top of the graduates’ wage distribution.Originality/valueBy focussing attention particularly on graduates, this paper adds to the existing literature a deeper understanding not only of individuals who have recently entered the labour market, but also those who are highly skilled but have little on-the-job experience. In fact, the authors are looking at a particular sample (graduates who are all transitioning from university to work during the same period) with small heterogeneity which allows the authors to compare very similar young men and women graduates and gain a deeper understanding of GPGs in early careers while controlling for confounding and hidden sources of variability.
Robotic surgery has gained worldwide acceptance in the past decade, and several studies have shown that this technique is safe and feasible. The innovation of this system is the open surgical console ...with an HD–3D display, a system tower, and four independent arm carts. We describe the first robot-assisted cholecystectomy performed with the new Hugo RAS (robotic-assisted surgery) system (Medtronic, Minneapolis, MN, USA) in Spain. The procedure was completed without conversion. No intraoperative complication or technical failure of the system was recorded. The operative time was 70 min. The docking time was 3 min. Hospital length of stay was 1 days. This case report shows the safety and feasibility of cholecystectomy with the Hugo RAS system and provides relevant data that may be of help to early adopters of this surgical platform.
Differences in gut microbiota between Parkinson's disease patients and controls seem to depend on multiple—frequently unmeasured—confounders. Monozygotic twins offer a unique model for controlling ...several factors responsible for interpersonal variation in gut microbiota. Fecal samples from 20 monozygotic twin pairs (n = 40) discordant for Parkinson's disease were studied (metagenomic shotgun analysis). Paired data analysis detected minimal differences in bacterial taxa abundance at species level (Bacteroides pectinophilus p = 0.037, Bifidobacterium pseudocatenulatum p = 0.050, and Bifidobacterium catenulatum p = 0.025) and in predicted metabolic pathways (primary bile acid biosynthesis p = 0.037). Additional studies are warranted to understand the role of gut microbiota in the pathogenesis of Parkinson's disease. ANN NEUROL 2022;92:631–636
A variety of cellular processes, including vesicle clustering in the presynaptic compartment, are impaired in Parkinson's disease and have been closely associated with α-synuclein oligomerization. ...Emerging evidence proves the existence of α-synuclein-related pathology in the peripheral nervous system, even though the presence of α-synuclein oligomers in situ in living patients remains poorly investigated. In this case-control study, we show previously undetected α-synuclein oligomers within synaptic terminals of autonomic fibres in skin biopsies by means of the proximity ligation assay and propose a procedure for their quantification (proximity ligation assay score). Our study revealed a significant increase in α-synuclein oligomers in consecutive patients with Parkinson's disease compared to consecutive healthy controls (P < 0.001). Proximity ligation assay score (threshold value > 96 using receiver operating characteristic) was found to have good sensitivity, specificity and positive predictive value (82%, 86% and 89%, respectively). Furthermore, to disclose the role of putative genetic predisposition in Parkinson's disease aetiology, we evaluated the differential accumulation of oligomers in a unique cohort of 19 monozygotic twins discordant for Parkinson's disease. The significant difference between patients and healthy subjects was confirmed in twins. Intriguingly, although no difference in median values was detected between consecutive healthy controls and healthy twins, the prevalence of healthy subjects positive for proximity ligation assay score was significantly greater in twins than in the consecutive cohort (47% versus 14%, P = 0.019). This suggests that genetic predisposition is important, but not sufficient, in the aetiology of the disease and strengthens the contribution of environmental factors. In conclusion, our data provide evidence that α-synuclein oligomers accumulate within synaptic terminals of autonomic fibres of the skin in Parkinson's disease for the first time. This finding endorses the hypothesis that α-synuclein oligomers could be used as a reliable diagnostic biomarker for Parkinson's disease. It also offers novel insights into the physiological and pathological roles of α-synuclein in the peripheral nervous system.
We describe the first robot-assisted right hemicolectomy performed in Spain using the new Hugo RAS (robotic-assisted surgery) (Medtronic, Minneapolis, Minnesota, USA). No conversion was registered, ...and no intraoperative complications or technical failures of the system were recorded. The operative time was 200 min, the docking time was 5 min and the length of the hospital stay was 8 days. We conclude that a right hemicolectomy using the Hugo RAS system is safe and feasible. Our earlier experience provides important skills for those who are starting to use this new robotic system.
Peptide receptor radionuclide therapy (PRRT) with radiolabeled somatostatin receptor (SSR) analogs is now an established systemic treatment for neuroendocrine tumors (NET). However, more short- and ...long-term data about renal and hepatotoxicity is needed. Here we present our experience in this clinical scenario.
Eighty-six patients with progressive SSR-expressing malignancies underwent PRRT with Lu-177 Dotatate and were followed up for up to 2 years. Laboratory tests were done 1 week before each cycle and every 2 months at follow-up. Hepatic and renal toxicity was determined based on NCI CTCAE V5.0.
55/86 (64%) patients completed all 4 cycles of PRRT; 18/86 (20.9%) are currently being treated; 13/86 (15.1%) had to discontinue PRRT: 4/13 (31%) due to hematologic toxicity, 9/13 (69%) due to non-PRRT-related comorbidities. Out of the patients who finished treatment, only transient grade 2 toxicities were observed during PRRT: hypoalbuminemia in 5.5% (3/55), and renal toxicity (serum creatinine and estimated glomerular filtration rate) in 1.8% (1/55). No grade 3 or 4 liver and renal toxicity occurred. Patients presenting with impaired liver or renal function prior to PRRT, either improved or had stable findings. No deterioration was observed.
Peptide receptor radionuclide therapy does not have a negative impact on liver and renal function, even in patients with pre-existing impaired parameters. No grade 3 or 4 hepatic or renal toxicity was identified. Only transient grade 2 hypoalbuminemia in 5.5% and nephrotoxicity in 1.8% of patients were seen during PRRT.
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Background: PSMA PET has been widely adopted in restaging of prostate cancer at biochemical recurrence. We assess the clinical utility of quantitative parameters on
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F-DCFPyL PET/CT at ...biochemical recurrence and their association with the subsequent biochemical progression free survival (bPFS). Methods: This is a retrospective image analysis and longitudinal follow up of a prospective study evaluating
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F-DCFPyL PET in prostate cancer patients with biochemical recurrence after primary definitive treatment at Stanford Hospital. The
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F-DCFPyL PET images were quantitatively analyzed automatically by the aPROMISE application, a semi-automated analysis and structured reporting of PSMA PET/CT. aPROMISE uses deep learning to segment detailed anatomical information from the CT images and uses this information in combination with the PET image to detect and quantify candidates for prostate cancer lesions. The reader works in tandem with the software to vet the final list of lesions, from which the quantitative assessments and final report is created automatically. Based on the Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) criteria. SUVmean, PSMA positive total tumor volume (PSMAttv) and aPSMA scores, a quantitative score for tumor burden measuring the interaction of tumor volume and uptake stratified by local tumors (aPSMA-miT), regional lymph nodes (aPSMA-miN) and distant metastases (aPSMA-miMa for extrapelvic metastases, miMb for bone metastases and miMc for other organ metastases) were obtained based on the miTNM classification. The association of these quantitative parameters with the subsequent bPFS was evaluated. Results: 134 patients (age 70.1 ± 7.6, range 51 -91 years; PSA 13.9 ± 98.5, range 0.12 – 1126 ng/mL) were included in the quantitative image analysis. aPROMISE detected nodal and/or bone metastases in 94 of 134 patients (70%) and only 12 of 134 patients (9%) had visceral disease. With median follow up of 37 months, 66 of 134 patients (49%) have progressed again biochemically after treatment. The bPSF was 25.8 ± 15.1 months. Quantitative analysis of
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F-DCFPyL PET found that the subsequent bPFS is significantly associated with aPSMA-miMb ( P < 0.001), PSMAttv ( P < 0.001), aPSMA-miN ( P < 0.01), aPSMA-miMa ( P < 0.05) but not with SUVmean or aPSMA-miMc. Conclusions: Total and anatomically contextualized quantitative image analysis of
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F-DCFPyL PET/CT at biochemical recurrence may be useful in predicting the subsequent bPFS. Studies in larger patient cohort is necessary to validate these findings. Given many patients were treated based on lesions found on
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F-DCFPyL PET/CT, clinical implication of this findings remains to be elucidated.
OBJECTIVE:The aim of this study is to compare the clinical and cost-effective outcomes of the open Lichtenstein repair (OL) and laparoscopic trans-abdominal preperitoneal (TAPP) repair for bilateral ...inguinal hernias.
SUMMARY BACKGROUND DATA:A cost-effective analysis of laparoscopic versus open inguinal hernia repair is still not well addressed, especially regarding bilateral hernia.
METHODS:This is a clinical and cost-effectiveness analysis within a randomized prospective study conducted at Sanchinarro University Hospital.Cases of primary, reducible bilateral inguinal hernia were included and randomized using a simple randomization program.The outcome parameters included surgical and postoperative costs, quality adjusted life years (QALY), and incremental cost per QALY gained or the incremental cost effectiveness ratio.
RESULTS:Between March 2013 and January 2017, 165 patients were enrolled in this study (81 of them underwent TAPP and 84 OL).The TAPP procedure had less early postoperative pain (P = 0.037), a shorter length of stay (P = 0.001), and fewer postoperative complications (P = 0.002) when compared with the OL approach. The overall cost of TAPP procedure was higher compared with the OL cost (1,683.93 vs 1192.83 , P = 0.027). The mean QALYs at 1 year for TAPP (0.8094) was higher than that associated with OL (0.6765) (P = 0.018). At a willingness-to-pay threshold of 20,000 and 30,000 , there was a 95.38% and 97.96% probability that TAPP was more cost-effective relative to OL.
CONCLUSIONS:The TAPP procedure for bilateral inguinal hernia appears to be more cost-effective compared with OL.
Abstract INTRODUCTION Giant pancreatic insulinomas are rare endocrine tumors. We describe 2 cases reviewing the current literature. PRESENTATION OF CASE We report herein 2 female patients affected by ...giant insulinomas of 14 cm and 6 cm, respectively. Symptomatic hypoglycemia episodes occurred during 4 months in first case and 3 years in the second one until diagnosis. Both patients were successfully treated performing a distal pancreatectomy with splenic preservation in the first case and a Whipple's procedure in the second one. DISCUSSION Up to now only 7 cases have been reported previously. Insulinomas larger than 3 cm accounts for less than 5% of all. This literature review shows that despite the size hypoglycemic symptoms varies from 1 day to 3 years and only 1 out of 9 cases reported presented lymph nodes metastases. No recurrences have been described. CONCLUSION One of the cases here described (14 cm) is the largest presented in the literature. Despite the size, giant insulinoma is related apparently neither to metastases nor to the recurrences.
OBJECTIVEWe evaluated the efficacy of muscle-targeted nutritional support on the functional outcomes of multidisciplinary intensive rehabilitation treatment (MIRT) in patients with Parkinson disease ...(PD) or parkinsonism.
METHODSWe conducted a pragmatic, bicentric, randomized (1:1), assessor-blind controlled trial (Protein, Leucine and Vitamin D Enhancing Rehabilitation PRO-LEADER; April 2017 to January 2018) in cognitively intact patients with PD or parkinsonism and undergoing a 30-day MIRT. Patients (n = 150) received a standard hospital diet with or without a whey protein–based nutritional supplement enriched with leucine and vitamin D twice daily. The primary efficacy endpoint was the increase in the distance walked during a 6-minute walking test (6MWT). Secondary endpoints were changes in 4-meter walking speed, Timed Up and Go test (TUG), Berg balance scale, handgrip strength, Self-assessment Parkinsonʼs Disease Disability Scale, body weight, and skeletal muscle mass (SMM).
RESULTSNutritional support resulted in greater increase in the distance walked during 6MWT (mean 69.6 meters 95% confidence interval (CI) 60.7–78.6) than no support (51.8 meters 95% CI 37.0–66.7)center-adjusted mean difference, 18.1 meters (95% CI 0.9–35.3) (p = 0.039). Further adjustment for changes in dopaminergic therapy and SMM yielded consistent resultsmean difference, 18.0 meters (95% CI 0.7–35.2) (p = 0.043). A meaningful effect was also found for the following secondary endpoints4-meter walking speed (p = 0.032), TUG (p = 0.046), SMM, and SMM index (p = 0.029). Six patients discontinued the nutritional therapy due to mild side effects.
CONCLUSIONThe consumption of a whey protein–based nutritional formula enriched with leucine and vitamin D with MIRT improved lower extremity function and preserved muscle mass in patients with PD or parkinsonism.
CLINICALTRIALS.GOV IDENTIFIERNCT03124277.
CLASSIFICATION OF EVIDENCEThis study provides Class I evidence that for patients with parkinsonism undergoing intensive rehabilitation, a whey protein–based nutritional formula enriched with leucine and vitamin D increased distance walked on the 6MWT.
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