Background
Natural orifice translumenal endoscopic surgery (NOTES) is an emerging concept in the recent literature that could lead to potential benefits in clinical applications. Restricted to animal ...experiments, however, human procedures have not yet been published. Because of the technical and ethical challenges involved in perforation and closure of a healthy organ—as is also seen in operating via the transgastric route—and because of the lack of understanding of the physiopathology and infection risk with these approaches, they have not been applied in the clinical setting. Thus the present study, based on previous animal experiments, describes preliminary clinical application in four cases of transvaginal NOTES cholecystectomy, and discusses safety, feasibility, and potential benefits of the method.
Methods
Preliminary acute and survival animal experiments developed by the NOTES Research Group at our institution solved such technical problems for transvaginal NOTES as spatial orientation, insufflation, and instrumentation, making possible the introduction of NOTES as a clinical application. The trials were approved by ethics committee of our institution, and informed consent was obtained from all patients. Since 13 March 2007, four female patients with elective surgical indication for cholecystectomy have undergone transvaginal NOTES cholecystectomy. All intraoperative and postoperative parameters were documented. Vaginal access was achieved under direct vision with conventional instruments, and a 2-channel colonoscope was inserted into the abdominal cavity. After endoscopic insufflation to achieve pneumoperitoneum with CO
2
, instruments were inserted through and alongside a colonoscope, allowing successful NOTES cholecystectomy in all patients, with vaginal extraction of the gallbladder. The vaginal wound was closed by direct vision using conventional instruments.
Results
The procedure was successful in all patients, with operative time of 45–115 min. Patients experienced low need for postoperative analgesia. Free oral intake was permitted 2 h after the procedure. There were no postoperative complications, and patients were discharged, according to the study protocol, 48 h after the procedure.
Conclusions
Preliminary results showed the feasibility and safety of the transvaginal NOTES method in this small initial study population. The technique, developed in our institution, and not transgastric NOTES, may be the preferred approach to serve as the basis for clinical studies.
Summary
Background
The inherited deficiency of C1‐inhibitor (C1‐INH), which can be quantitative (type I) or qualitative (type II), is characterized by recurrent attacks of oedema, and it is known as ...hereditary angioedema due to C1‐INH deficiency (HAE‐C1‐INH). The frequency of symptoms varies widely among patients and in the same patient during life.
Objective
To identify laboratory markers of disease severity in HAE‐C1‐INH patients.
Methods
We studied 162 patients with differently severe HAE‐C1‐INH during remission, 31 HAE‐C1‐INH patients during attacks, and 81 normal controls, evaluating complement parameters, spontaneous plasma kallikrein activity, the capacity of plasma to inhibit exogenous kallikrein activity, and cleavage of high‐molecular‐weight kininogen (HK). Sixty‐five HAE‐C1‐INH patients were screened for mutations in the C1‐INH gene.
Results
As expected, plasma C1‐INH levels and activity and C4 levels were low in the HAE‐C1‐INH patients. Spontaneous plasma kallikrein activity in patients in remission was higher than in controls (P = 0.001) and increased during acute attacks (P = 0.01), whereas the capacity of inhibiting kallikrein activity was lower in patients in remission than in controls (P = 0.001) and further reduced during attacks (P = 0.001). HAE‐C1‐INH patients in remission had higher levels of cleaved HK than controls (P = 0.001), and these further increased during acute attacks (P = 0.001). Cleaved HK levels were higher in highly symptomatic HAE‐C1‐INH patients than in those with less frequent attacks (P = 0.001). Thirty‐five different mutations in the C1‐INH gene were equally distributed in patients with different attack frequencies.
Conclusions
Measuring plasma levels of cleaved HK may be a sensitive mean of assessing disease severity in HAE‐C1‐INH patients.
COVID-19 pandemic had a great impact on mental health, both in the general population and psychiatric patients. Little is known about the difference between these two populations in perceiving the ...pandemic as a traumatic event. The aim of the study was to compare psychiatric patients and healthy controls (HC) in terms of change over time of post-traumatic (PTSD) symptoms. Demographic and clinical variables were collected. Impact of Event Scale Revised (IES-R) scores were registered at T1 as lockdown period (March-April 2020) and T2 as restarting (May-June 2020). Descriptive analyses and linear regression models were performed. A total of 166 outpatients and 57 HC were recruited. Time (F = 15.76; p < 0.001) and diagnosis (F = 4.94; p < 0.001) had a significant effect on the change of IES-R scores, which resulted T1 > T2 (p < 0.001), except for subjects affected by Obsessive-Compulsive Disorder (OCD). Overall, IES-R scores were < in patients than in HC (p = 0.02), particularly in the schizophrenia (SKZ) subgroup (p < 0.001). IES-R scores of subjects with personality disorders (PDs) resulted to be > HC, although not statistically significant. The lockdown period was perceived as more traumatic than the reopening phase by both groups, with the exception of OCD patients, probably because of the clinical worsening associated with the urge of control against risks of contamination. Overall, HC reported more PTSD symptoms than psychiatric patients did, particularly SKZ ones. PD patients, in contrast, may be more vulnerable to PTSD symptoms probably as a result of poor coping skills. Together with OCD patients, subjects with PDs may need closer monitoring during the different phases of the pandemic. Trial Registration: ClinicalTrials.gov Identifier: NCT04694482
Summary
Recent experimental data indicate a pathogenic role of complement activation in congestive heart failure (CHF). The aim of this study was to evaluate contact and complement systems activation ...in patients hospitalized for an acute episode of CHF. Forty‐two of 80 consecutive patients admitted at our hospital with confirmed diagnosis of acute CHF were enrolled. They underwent blood sampling within 24 h from admission (T0) and at clinical stability (T1). Patients were stratified for ejection fraction (EF) based on echocardiographic test. We measured plasma levels of C3, C4, sC5b‐9 and cleaved high molecular weight kininogen (contact activation marker). At T1, C3 levels increased significantly compared to T0 (97 ± 2 versus 104 ± 3% of total pooled plasma, P < 0·01). Classifying patients according to EF, only patients with preserved EF presented a significant increase of C3 from T0 to T1 (99 ± 3 versus 108 ± 4%, P = 0·03). When the sample was stratified according to clinical outcome, C3 (98 ± 3 versus 104 ± 4%, P = 0·03) and sC5b‐9 levels (204 ± 10 versus 230 ± 11 ng/ml, P = 0·03) were increased in patients who had positive outcome after hospitalization. CHF patients with preserved EF and positive outcome after hospitalization showed higher levels of sC5b‐9 in the T1 period compared with T0 (211 ± 14 versus 243 ± 14 ng/ml, P = 0·04). Our results suggest that the complement system reacts differently if CHF occurs with preserved or reduced EF. This finding is interesting if we consider the difference in epidemiology, pathogenesis and possible therapeutic approaches of these two clinical entities.
We evaluated contact and complement systems activation in patients hospitalized for an acute episode of congestive heart failure (CHF). Our results suggest that the complement system reacts differently if CHF occurs with preserved or reduced ejection fraction.
In the context of the European Water Framework Directive (2000/60), aquatic macrophytes have become important elements for ascribing the correct ecological value to water systems. Callitriche ...includes macrophyte species which are widespread and particularly sensitive to environmental cues. High plasticity and morphological variability of these plants have carried to great difficulties in their correct taxonomic determination. Diverse populations of Callitriche of the Po Valley (Northern Italy) have been studied. Plants of Callitriche spp. were collected in Northern Italian rivers with mesotrophic and eutrophic waters and their morphological, karyological, and molecular features were analyzed. Populations with a different chromosome number equal to 10, 18, or 20 were found. Chloroplast rbcL DNA showed the presence of three different sequences. Moreover, the presence of heterozygous rDNA-ITS sequences suggests the existence of a considerable number of hybrids. At ecological level, only one taxon lives in eutrophic waters, while all the others live in mesotrophic ones. Different morphological characters and chromosome set suggest the presence of a new taxon among Italian Callitriche populations. In conclusion, this research underlines that the possibility of Callitriche taxon misclassification, using only the "canonical" macro-morphological approach, is significant and that the incorrect determination of these plants would lead to erroneous evaluation of water quality.
Festuca s.l. is a crucial group of Crop Wild Relatives (CWR) genera, globally employed as fodder, lawn grasses and for habitat restoration. Lists elaborated strictly on the basis of a taxonomic ...approach are urgently needed to be used to find gaps in existing ex situ collections, to assess the conservation status of taxa of ascertained utility and include them in national Red Lists and to identify the most valuable taxa to be included in "preservation mixtures", as per Commission Directive 2010/60/EU. As an example, the first taxonomically based priority list of Italian CWRs of Festuca s.l. is here provided.
During Phase VIII (2009-2013) of the ECPGR Programme, its Brassica Working Group (BWG) decided to focus the attention of all members on the priority actions represented by the development of AEGIS (A ...European Genebank Integrated System), and to characterize collections both of B. rapa, which could be defined as a multicrop species for its multiple utilization, and of wild Brassica species (n=9) distributed in the Mediterranean basin. The activities planned are being carried out by DISPA-University of Catania (UNICT), the Centre for Genetic Resources (CGN), Wageningen, the Institute of Sustainable Agriculture of Cordoba (CSIC-Spain), and N.I. Vavilov Research Institute of Plant Industry (VIR), St Petersburg. The activity plan and first results obtained are presented and discussed.
The aim of this research is to define a new Macrophyte Index relevant in the context of the Po Valley. The application of biotic indexes, as the macrophyte ones, is required by both the Italian and ...the European law to provide an adequate classification of freshwaters, in association with physical–chemical and hydromorphological data. At the same time, these methodologies, based on the sensibility of macrophytes towards pollution, could be an important mean to evaluate the quality of the waters coming from wetlands, providing information related to the depuration capabilities of these important ecotonal zones. In this study, we elaborate a floristic list of about 340 taxa; moreover, we chose 19 sampling sites, analysed physical–chemical parameters and obtained floristic data. These results, integrated by literature information on ecological needs, distribution and rarity of all species, allowed the attribution of indicator values. Thus, two new indexes have been elaborated: Indice Macrofitico di Pianura (I.M.P.), mostly accounting for water quality, and Indice di Biodiversità Riparia (I.B.R.), mostly accounting for biodiversity of macrophytes on the banks. The efficacy of the proposed indexes has been evaluated by comparing them to analysed physical–chemical parameters and other indexes used in Europe, such asMacrophyte Index Scheme (M.I.S), Indice Biologique Macrophytique en Rivière (I.B.M.R.) and Extended Biotic Index (I.B.E.).
PDF
