Laparoscopic ventral hernia repair (LVHR) is a widely practiced treatment for primary (PH) and incisional (IH) hernias, with acceptable outcomes. Prevention of recurrence is crucial and still highly ...debated. Purpose of this study was to evaluate predictive factors of recurrence following LVHR with intraperitoneal onlay mesh with a single type of mesh for both PH and IH. A retrospective, multicentre study of data collected from patients who underwent LVHR for PH and IH with an intraperitoneal monofilament polypropylene mesh from January 2014 to December 2018 at 8 referral centers was conducted, and statistical analysis for risk factors of recurrence and post-operative outcomes was performed. A total of 1018 patients were collected, with 665 cases of IH (65.3%) and 353 of PH (34.7%). IH patients were older (p < 0.001), less frequently obese (p = 0.031), at higher ASA class (p < 0.001) and presented more frequently with large, swiss cheese type and border site defects (p < 0.001), compared to PH patients. Operative time and hospital stay were longer for IH (p < 0.001), but intraoperative and early post-operative complications and reinterventions were comparable. IH group presented at major risk of recurrence than PH (6.7% vs 0.9%, p < 0.001) and application of absorbable tacks resulted a significative predictive factor for recurrence increasing the risk by 2.94 (95% CI 1.18-7.31). LVHR with a light-weight polypropylene mesh has low intra- and post-operative complications and is appropriate for both IH and PH. Non absorbable tacks and mixed fixation system seem to be preferable to absorbable tacks alone.
Background and Objective
The role of liver resection in advanced hepatocellular carcinoma (multinodular or with macroscopic vascular involvement) is still controversial. The aim of this study is to ...evaluate the role of surgical resection compared to other therapeutic modalities in patients with advanced hepatocellular carcinoma (HCC).
Methods
Four hundred sixty four patients with HCC observed from 1991 to 2007 were included in the study. All the patients were evaluated for the treatment of HCC in relation to the severity of liver impairment and tumor stage. All the patients included in the study had no evidence of distant metastases.
Results
Median follow up time for surviving patients was 25 months (range 1–155). Two-hundred and eighty-three patients were in Child–Pugh class A, 161 in class B, and 20 in class C. Two-hundred and seventy-one patients had single HCC, 121 patients had two or three HCCs, and 72 more than three HCCs. One-hundred and thirty-six patients (29.3%) were submitted to liver resection (LR), 232 (50.0%) to local ablative therapies (LAT) (ethanol injection, radiofrequency ablation, chemoembolization), eight (1.7%) to liver transplantation (LT), and 88 (19%) to supportive therapy (ST). Median survival time for all patients was 36 months (95% CI 24–36). Median survival time was 57 months for LR, 30 months for LAT, and 8 months for ST, with a 5-year survival of 47%, 20%, and 2.5%, respectively (
p
= 0.001). Actuarial 5-year survival for patients submitted to LT was 75%. Overall survival was significantly shorter in patients with multiple HCCs compared to single HCC, with median survival times of 39, 16, and 11 months for patients with a single HCC, with two to three HCCs, and with more than three HCCs, respectively (
p
= 0.01). Survival for patients with single HCC was significantly longer in patients submitted to LR compared to LAT and ST with median survival times of 57, 37, and 14 months, respectively (
p
= 0.02). Also, in patients with multinodular HCCs (2–3 HCCs) LR showed the best results with a median survival time of 58 months compared to 22 and 8 months for LAT and ST (
p
= 0.01). In patients with more than three HCCs, LR did not show different results compared to LAT and ST. Seventy-three patients had evidence of macroscopic vascular involvement; median survival in this subgroup of patients was significantly shorter compared to patients without vascular involvement, 10 and 36 months, respectively. Survival for patients with macroscopic vascular involvement submitted to LR or LAT was significant longer compared to ST, with mean survivals of 27, 30, and 12 months, respectively (
p
= 0.01).
Conclusions
The present study shows that the surgery can achieve good results in patients with single HCC and good liver function. Also, patients with multinodular HCCs (two to three nodules)
could
benefit from LR where survival is longer than after LAT or ST. In patients with more than three HCCs, LR have similar results of LAT. Macroscopic vascular invasion is a major prognostic factor, and the LR is justified in selected patients, where it can allow good long-term results compared to ST.
Nowadays, Internet-of-Things (IoT), big data, and cloud computing technologies allow increasing the throughput and quality of manufacturing systems, bringing to the rise of the Industry 4.0 paradigm. ...The aim is to leverage the ICT technologies to achieve a flexible customised production with reduced time while avoiding resources waste. In this framework, Zero-Defect Manufacturing (ZDM) concept plays a crucial role in guaranteeing the minimisation of defects and errors in industry processes by trying to act at the first time properly. Due to its importance, this topic has received greater attention during the last two years by the technical literature. Given the increasing number of research works and the several approaches suggested by researcher interested into the topic, this study aims at providing a literature overview of the current trends in the ZDM field from 2018 to 2020. The focus of the work is to provide a state-of-the-art about ZDM strategies, i.e. Detection, Repair, Prediction and Prevention, by analyzing the related most significant works, thus providing a single-strategy analysis and the corresponding most frequently used methods. A brief bibliometric study corroborates the general research patterns and the relevant aspects emerging from each single-strategy analysis. Finally, based on the conducted study, we point out the shortcomings present in the current technical literature to target the future research directions in the ZDM field.
•We perform a systematic review of the technical literature in the appraised time period for each of the ZDM strategies, namely, Detection, Prediction, Prevention and Repair.•We describe their advantages and aims for each of these latter and the most significant critical findings of the related works.•A bibliometric analysis of all the selected works is conducted so to highlight the importance of the topic for the industry during the last years.•A discussion of the shortcoming and of the open challenges are given.
PurposeThis work aims at proposing a novel Internet of Things (IoT)-based and cloud-assisted monitoring architecture for smart manufacturing systems able to evaluate their overall status and detect ...eventual anomalies occurring into the production. A novel artificial intelligence (AI) based technique, able to identify the specific anomalous event and the related risk classification for possible intervention, is hence proposed.Design/methodology/approachThe proposed solution is a five-layer scalable and modular platform in Industry 5.0 perspective, where the crucial layer is the Cloud Cyber one. This embeds a novel anomaly detection solution, designed by leveraging control charts, autoencoders (AE) long short-term memory (LSTM) and Fuzzy Inference System (FIS). The proper combination of these methods allows, not only detecting the products defects, but also recognizing their causalities.FindingsThe proposed architecture, experimentally validated on a manufacturing system involved into the production of a solar thermal high-vacuum flat panel, provides to human operators information about anomalous events, where they occur, and crucial information about their risk levels.Practical implicationsThanks to the abnormal risk panel; human operators and business managers are able, not only of remotely visualizing the real-time status of each production parameter, but also to properly face with the eventual anomalous events, only when necessary. This is especially relevant in an emergency situation, such as the COVID-19 pandemic.Originality/valueThe monitoring platform is one of the first attempts in leading modern manufacturing systems toward the Industry 5.0 concept. Indeed, it combines human strengths, IoT technology on machines, cloud-based solutions with AI and zero detect manufacturing strategies in a unified framework so to detect causalities in complex dynamic systems by enabling the possibility of products’ waste avoidance.
We present the unusual case of a 76-year-old male who developed an intestinal recurrence of the same tumor 5 years after hepatic resection for an intrahepatic cholangiocarcinoma. At the time of the ...first surgery, the patient had undergone hepatic bisegmentectomy of segments IV and V with an 'en bloc' gallbladder resection and porta hepatis lymphadenectomy for the presence of a focal cholangiocarcinoma measuring about 3.0 x 2.5 cm in diameter. The histological report confirmed intrahepatic cholangiocarcinoma, the resection margins were free from disease, and there were no lymph node metastases. Five years later colonoscopy showed, at the level of the splenic flexure, the presence of a sessile bilobate polypoid neoplasm. The patient underwent left hemicolectomy with a histological diagnosis of an isolated recurrence of cholangiocarcinoma.
Background
Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallbladder lithiasis; nevertheless, the incidence of bile duct injuries (BDI) is still high (0.3–0.8%) ...compared to open cholecystectomy (0.2%). In 1995,
Strasberg
introduced the "Critical View of Safety" (CVS) to reduce the risk of BDI. Despite its widespread use, the scientific evidence supporting this technique to prevent BDI is controversial.
Methods
Between March 2017 and March 2019, the data of patients submitted to laparoscopic cholecystectomy in 30 Italian surgical departments were collected on a national database. A survey was submitted to all members of Italian Digestive Pathology Society to obtain data on the preoperative workup, the surgical and postoperative management of patients and to judge, at the end of the procedure, if the isolation of the elements was performed according to the CVS. In the case of a declared critical view, iconographic documentation was obtained, finally reviewed by an external auditor.
Results
Data from 604 patients were analysed. The study population was divided into two groups according to the evidence (Group A;
n
= 11) or absence (Group B;
N
= 593) of BDI and perioperative bleeding.
The non-use of CVS was found in 54.6% of procedures in the Group A, and 25.8% in the Group B, and evaluating the operator-related variables the execution of CVS was associated with a significantly lower incidence of BDI and intraoperative bleeding.
Conclusions
The CVS confirmed to be the safest technique to recognize the elements of the
Calot
triangle and, if correctly performed, it significantly impacted on preventing intraoperative complications. Additional educational programs on the correct application of CVS in clinical practice would be desirable to avoid extreme conditions that may require additional procedures.
Minimally invasive abdominal wall surgery is growing worldwide, with a constant and fast improvement of surgical techniques and surgeons’ confidence in treating both primary and incisional hernias ...(IH). The Italian Society of Endoscopic Surgery and new technologies (SICE) and the ISHAWS (Italian Society of Hernia and Abdominal Wall Surgery) worked together to investigate state of the art in IH treatment in elective and emergency settings in Italy. An online open survey was designed, and Italian surgeons interested in abdominal wall surgery were invited to fill out a 20-point questionnaire on IH surgical procedures performed in their departments. Surgeons were asked to express their points of view on specific questions about technical and clinical variables in IH treatment. Preferred approach in elective IH surgery was minimally invasive (59.7%). Open surgery was the preferred approach in 40.3% of the responses. In emergency settings, open surgery was the preferred approach (65.4%); however, 34.5% of the involved surgeons declare to prefer the laparoscopic/endoscopic approach. Most respondents opted for conversion to open surgery in case of relevant surgical field contamination, with a non-mesh repair of abdominal wall defects. Among those that used the laparoscopic approach in the emergent setting, the majority (74%) used the size of the defect of 5 cm as a decisional cut-off. The spread of minimally invasive approaches to IH repair in emergency surgery in Italy is gaining relevance. Code-sharing through scientific societies can improve clinical practice in different departments and promote a tailored approach to IH surgery.
Micro RNAs (miRNAs) are a type of non-coding RNA (ncRNA) and typically interact with specific target mRNAs through complementary base pairing, affecting their translation and/or stability. MiRNAs ...regulate nearly all cellular functions, including the cell fate of mesenchymal stromal cells (MSCs). It is now accepted that various pathologies arise at the stem level, and, in this scenario, the role played by miRNAs in the fate of MSCs becomes of primary concern. Here we have considered the existing literature in the field of miRNAs, MSCs and skin diseases, classified as inflammatory (such as psoriasis and atopic dermatitis-AD) and neoplastic (melanoma and non-melanoma-skin-cancer including squamous cell and basal cell carcinoma) diseases. In this scoping review article, the evidence recovered indicates that this topic has attracted attention, but it is still a matter of opinion. A protocol for this review was registered in PROSPERO with the registration number "CRD42023420245". According to the different skin disorders and to the specific cellular mechanisms considered (cancer stem cells, extracellular vesicles, inflammation), miRNAs may play a pro- or anti-inflammatory, as well as a tumor suppressive, or supporting, role, indicating a complex regulation of their function. It is evident that the mode of action of miRNAs is more than a switch on-off, and all the observed effects of their dysregulated expression must be checked in a detailed analysis of the targeted proteins. The involvement of miRNAs has been studied mainly for squamous cell carcinoma and melanoma, and much less in psoriasis and AD; different mechanisms have been considered, such as miRNAs included in extracellular vesicles derived both from MSCs or tumor cells, miRNAs involved in cancer stem cells formation, up to miRNAs as candidates to be new therapeutic tools.
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