Nell’antica Grecia, il mito delle Amazzoni, che, nell’immaginario collettivo greco, rappresentavano l’elemento “altro”, è spesso associato a tradizioni di fondazione e di eponimia in rapporto a ...città, soprattutto nella Ionia e nell’Eolide d’Asia Minore. Queste tradizioni si possono rintracciare in racconti locali, che si sono conservati fino all’età imperiale romana, in un momento in cui, in particolare, si assiste ad una ripresa delle tradizioni greche arcaiche e classiche durante la seconda sofistica. L’epoca dell’imperatore Adriano, più di ogni altra, sarebbe stata importante per la rinascita ed il recupero di questi miti di fondazione, in quanto molte città ioniche ed eoliche (come Efeso, Smirne, Cuma e Mirina) creavano un nesso con il loro passato e con la loro origine per mezzo della figura dell’Amazzone, rappresentata anche sulla monetazione locale, con l’obiettivo di affermare la loro antichità e priorità: tali tradizioni sono attestate anche nelle fonti letterarie. Grazie alla remota antichità ed adattabilità, il mito di fondazione basato sulle Amazzoni attraversò diversi processi di rielaborazione e rifunzionalizzazione e fu riutilizzato come “paradigma” in Asia Minore, soprattutto in età imperiale, per sottolineare l’archaiologia delle antiche poleis. Queste elaborazioni, fondate su antiche tradizioni mitiche locali, sono state determinanti per riaffermare e rivendicare l’identità culturale ed etnica dei Greci sotto l’Impero romano in un preciso momento storico. Obiettivo del presente lavoro è indagare i processi di costruzione e ri-costruzione dell’identità cittadina attraverso l’analisi delle fonti relative ai racconti di fondazione e di eponimia attestati in Ionia e in Eolide in relazione al particolare contesto legato al revival delle tradizioni locali greche in età imperiale.
Background
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for intrahepatic cholangiocarcinoma (ICC) demonstrated good long-term outcomes
1
and can increase the ...rate of resectability in locally advanced ICC;
2
however, the rates of postoperative complications (Clavien–Dindo grade III) and mortality range between 13.6 and 44% and 0 and 29%, respectively.
3
Minimally invasive strategies may reduce the risk of postoperative morbidity, with the same oncologic outcomes.
4
,
5
We report the first case of full robotic ALPPS for advanced ICC.
Methods
The patient was a 61-year-old male diagnosed with a 6.5 cm ICC involving segments IV, V, and VIII. The total clean liver volume was 1553 cc
3
, with a future liver remnant (FLR) volume of 21.6% (segments I, II, and III: 337 cc
3
). The procedure was performed by a senior hepato-pancreato-biliary (HPB) surgeon at the robotic console and a junior HPB surgeon at the table side.
Results
Computed tomography scan on postoperative day (POD) 9 after stage 1 showed that FLR increased up to 38%. The indocyanine green clearance test showed a plasma disappearance rate of 19.8%/min and a retention rate at 15 min of 5.1%; complete blood tests are available at the end of the video. ALPPS was completed on POD 14, the postoperative course was uneventful, and the patient was discharged in good general condition on POD 5. Final pathology showed a 6 cm ICC, G3, R0 margin (10 mm), T2–N0–M0. The patient started adjuvant capecitabine, and after 6 months was in good general condition without signs of local or systemic recurrence.
Conclusions
Robotic ALPPS combines the opportunity to perform a curative resection in patients presenting with insufficient FLR with the advantages of a minimally invasive approach. It is feasible and oncologically accurate for ICC when performed in fully trained HPB centers.
The myokine irisin increases cortical bone mass Colaianni, Graziana; Cuscito, Concetta; Mongelli, Teresa ...
Proceedings of the National Academy of Sciences - PNAS,
09/2015, Letnik:
112, Številka:
39
Journal Article
Recenzirano
Odprti dostop
It is unclear how physical activity stimulates new bone synthesis. We explored whether irisin, a newly discovered myokine released upon physical activity, displays anabolic actions on the skeleton. ...Young male mice were injected with vehicle or recombinant irisin (r-irisin) at a low cumulative weekly dose of 100 μg kg⁻¹. We observed significant increases in cortical bone mass and strength, notably in cortical tissue mineral density, periosteal circumference, polar moment of inertia, and bending strength. This anabolic action was mediated primarily through the stimulation of bone formation, but with parallel notable reductions in osteoclast numbers. The trabecular compartment of the same bones was spared, as were vertebrae from the same mice. Higher irisin doses (3,500 μg kg⁻¹ per week) cause browning of adipose tissue; this was not seen with low-dose r-irisin. Expectedly, low-dose r-irisin modulated the skeletal genes,OpnandSost,but notUcp1orPparγexpression in white adipose tissue. In bone marrow stromal cell cultures, r-irisin rapidly phosphorylated Erk, and up-regulatedAtf4, Runx2, Osx, Lrp5, β-catenin, Alp,andCol1a1; this is consistent with a direct receptor-mediated action to stimulate osteogenesis. We also noted that, although the irisin precursorFndc5was expressed abundantly in skeletal muscle, other sites, such as bone and brain, also expressedFndc5,albeit at low levels. Furthermore, muscle fibers from r-irisin–injected mice displayed enhanced Fndc5 positivity, and irisin inducedFdnc5mRNA expression in cultured myoblasts. Our data therefore highlight a previously unknown action of the myokine irisin, which may be the molecular entity responsible for muscle–bone connectivity.
Background
The benefits of pure laparoscopic and robot‐assisted liver resections (LLR and RALR) are known in comparison to open surgery. The aim of the present retrospective comparative study is to ...investigate the role of RALR and LLR according to different levels of difficulty.
Methods
The institutional databases of six high‐volume hepatobiliary centers were retrospectively reviewed. The study population was divided in two groups: LLR and RALR. The procedures were stratified for difficulty levels accordingly to three classifications. A propensity score matching was implemented to mitigate selection bias. Short‐term outcomes were the object of comparison.
Results
Nine hundred and thirty‐six LLR and 403 RALR were collected. RALR exhibited fewer cases of intraoperative blood loss, lower transfusion and conversion rates (especially for oncological radicality) than LLR in the setting of highly difficult operations, whereas LLR had lower postoperative morbidity and fewer low‐grade complications. For intermediate and low‐difficulty resections, the intraoperative advantages of RALR gradually decreased to nonsignificant results and LLR remained associated with lower postoperative morbidity.
Conclusion
Robot‐assisted liver resections do not show operative nor clinically significant benefits over LLR for low‐ and intermediate‐difficulty resections. By reducing conversion rates, RALR can favour the operative feasibility of difficult resections possibly extending the indications of minimally invasive approaches for liver resection.
Long-term outcomes of anterior cruciate ligament (ACL) reconstruction are good or excellent; however, 0.7%-20% of patients suffer from recurrent instability due to graft failure. The purpose of this ...paper was to analyse failure aetiology and the possibilities of revision surgical strategies, with a description of our experience. We obtained optimal and good results in most of our patients.
We retrospectively reviewed 42 patients who underwent revision surgery (43 revisions) due to relapsing instability after ACL reconstruction between 2006 and 2015. We used allografts in 39 cases and autografts in 4 cases.
The 85.7% of the patients obtained optimal results (normal knee; group A) and the 7.2% obtained good results (nearly normal knee; group B) according to the International Knee Documentation Committee score. The most frequent failure causes were traumatic events, non-anatomic tunnel placement, and lack of graft incorporation.
A correct revision surgery requires accurate patient evaluation and knee imaging. Preoperative planning starts with the identification of the cause of failure of the primary reconstruction. Then, the most suitable procedure should be determined for each case. It is also important to accurately inform the patient of all the complexity of an ACL revision surgery even if it is a procedure with high rates of excellent and good outcomes.
The purpose of this study is to characterize synovial fluid- (SF-) derived exosomes of patients with gonarthrosis comparing two methods of isolation and to investigate their immune regulatory ...properties. Extracellular vesicles (EVs) have been isolated from inflamed SF by polymer precipitation method and quantified by Exocet kit and by nanoparticle tracking analysis. Vesicles expressed all the specific exosomal markers by immunoblot and FACS. After isolation with Exoquick, a relevant contamination by immune complexes was detected, which required further magnetic bead-based purification to remove. SF-derived exosomes significantly stimulated the release of several inflammatory cytokines and chemokines and metalloproteinases by M1 macrophages but did not influence the expression of CD80 and CD86 costimulatory molecules. In conclusion, we characterized purified exosomes isolated from inflamed SF and demonstrate that purified exosomes are functionally active in their ability to stimulate the release of proinflammatory factors from M1 macrophages. Our data indicate that SF-derived exosomes from gonarthrosis patients play a role in disease progression.
Full robotic ALPPS for HCC with intrahepatic portal vein thrombosis Di Benedetto, Fabrizio; Assirati, Giacomo; Magistri, Paolo
The international journal of medical robotics + computer assisted surgery,
April 2020, 2020-Apr, 2020-04-00, 20200401, Letnik:
16, Številka:
2
Journal Article
Recenzirano
Background
The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique can induce a greater degree of hypertrophy of the future liver remnant (FLR) in a shorter ...time compared with other procedures. A robotic approach may reduce the complication rate, increasing the ability to perform classic ALPPS.
Methods
We report technical and clinical considerations on the first full robotic ALPPS (stages 1 and 2) for hepatocellular carcinoma (HCC) with portal vein intrahepatic tumor thrombus.
Results
The patient was a 38‐year‐old man with Milan‐out HCC and FLR volume of 19.6%. On postoperative day (POD) 8, FLR increased to 37%; therefore, he underwent completion of ALPPS on POD 10. The postoperative course was uneventful, and the patient was discharged in good general conditions on POD 3.
Conclusion
Robotic ALPPS is safe and feasible for selected patients with initially unresectable HCC or requiring extended resections, with good postoperative outcomes.
Nell’antica Grecia, il mito delle Amazzoni, che, nell’immaginario collettivo greco, rappresentavano l’elemento “altro”, è spesso associato a tradizioni di fondazione e di eponimia in rapporto a ...città, soprattutto nella Ionia e nell’Eolide d’Asia Minore. Queste tradizioni si possono rintracciare in racconti locali, che si sono conservati fino all’età imperiale romana, in un momento in cui, in particolare, si assiste ad una ripresa delle tradizioni greche arcaiche e classiche durante la seconda sofistica. L’epoca dell’imperatore Adriano, più di ogni altra, sarebbe stata importante per la rinascita ed il recupero di questi miti di fondazione, in quanto molte città ioniche ed eoliche (come Efeso, Smirne, Cuma e Mirina) creavano un nesso con il loro passato e con la loro origine per mezzo della figura dell’Amazzone, rappresentata anche sulla monetazione locale, con l’obiettivo di affermare la loro antichità e priorità: tali tradizioni sono attestate anche nelle fonti letterarie. Grazie alla remota antichità ed adattabilità, il mito di fondazione basato sulle Amazzoni attraversò diversi processi di rielaborazione e rifunzionalizzazione e fu riutilizzato come “paradigma” in Asia Minore, soprattutto in età imperiale, per sottolineare l’archaiologia delle antiche poleis. Queste elaborazioni, fondate su antiche tradizioni mitiche locali, sono state determinanti per riaffermare e rivendicare l’identità culturale ed etnica dei Greci sotto l’Impero romano in un preciso momento storico. Obiettivo del presente lavoro è indagare i processi di costruzione e ri-costruzione dell’identità cittadina attraverso l’analisi delle fonti relative ai racconti di fondazione e di eponimia attestati in Ionia e in Eolide in relazione al particolare contesto legato al revival delle tradizioni locali greche in età imperiale.
IMPORTANCE: Long-term oncologic outcomes of robotic surgery remain a hotly debated topic in surgical oncology, but sparse data have been published thus far. OBJECTIVE: To analyze short- and long-term ...outcomes of robotic liver resection (RLR) for hepatocellular carcinoma (HCC) from Western high-volume centers to assess the safety, reproducibility, and oncologic efficacy of this technique. DESIGN, SETTING, AND PARTICIPANTS: This cohort study evaluated the outcomes of patients receiving RLR vs open liver resection (OLR) for HCC between 2010 and 2020 in 5 high-volume centers. After 1:1 propensity score matching, a group of patients who underwent RLR was compared with a validation cohort of OLR patients from a high-volume center that did not perform RLR. MAIN OUTCOMES AND MEASURES: A retrospective analysis was performed of prospectively maintained databases at 2 European and 2 US institutions of patients who underwent RLR for HCC between January 1, 2010, and September 30, 2020. The main outcomes were safety and feasibility of RLR for HCC and its oncologic outcomes compared with a European OLR validation cohort. A 2-sided P < .05 was considered significant. RESULTS: The study included 398 patients (RLR group: 125 men, 33 women, median IQR age, 66 58-71 years; OLR group: 315 men, 83 women; median IQR age, 70 64-74 years), and 106 RLR patients were compared with 106 OLR patients after propensity score matching. The RLR patients had a significantly longer operative time (median IQR, 295 190-370 minutes vs 200 165-255 minutes, including docking; P < .001) but a significantly shorter hospital length of stay (median IQR, 4 3-6 days vs 10 7-13 days; P < .001) and a lower number of admissions to the intensive care unit (7 6.6% vs 21 19.8%; P = .002). Incidence of posthepatectomy liver failure was significantly lower in the RLR group (8 7.5% vs 30 28.3%; P = .001), with no cases of grade C failure. The 90-day overall survival rate was comparable between the 2 groups (RLR, 99.1% 95% CI, 93.5%-99.9%; OLR, 97.1% 95% CI, 91.3%-99.1%), as was the cumulative incidence of death related to tumor recurrence (RLR, 8.8% 95% CI, 3.1%-18.3%; OLR, 10.2% 95% CI, 4.9%-17.7%). CONCLUSIONS AND RELEVANCE: This study represents the largest Western experience to date of full RLR for HCC. Compared with OLR, RLR performed in tertiary centers represents a safe treatment strategy for patients with HCC and those with compromised liver function while achieving oncologic efficacy.
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