Laparoscopic subtotal gastrectomy for the treatment of advanced gastric cancer: a comparison with open procedure at the beginning of the learning curve

BACKGROUND

In the last decades, after some initial concern, laparoscopic subtotal gastrectomy (LSG) is gaining popularity also for the treatment of advanced gastric cancer (AGC). The aim of this study is to compare a single surgeon initial experience on LSG and open subtotal gastrectomy in terms of surgical safety and radicality, postoperative recovery and midterm oncological outcomes.

METHODS

a case control study was conducted matching the first 13 LSG for AGC with 13 open procedures performed by the same surgeon. Operative and pathological data, postoperative parameters and midterm oncological outcomes were analyzed.

RESULTS

There was no significant difference in mortality (0%) and morbidity, while the laparoscopic approach allowed lower analgesic consumption and faster bowel movement recovery. Operation time was significantly higher in LSG patients (301.5 vs 232 min, p: 0.023), with an evident learning curve effect. Both groups had a high rate of adequate lymph node harvest, but the number was significantly higher in LSG group (p: 0.033). No significant difference in survival was registered. Multivariate analysis identified age at diagnosis, diffuse-type tumor, pN and LODDS as independent predictors of worse prognosis.

CONCLUSIONS

LSG can be safely performed for the treatment of AGC, allowing faster postoperative recovery.

Invasive Meningococcal Disease on the Workplaces: a systematic review

Background and aims of the work: Invasive Meningococcal Disease (IMD) represents a global health threat, and occupational settings have the potential to contribute to its spreading. Therefore, here we present the available evidences on the epidemiology of IMD on the workplaces.

METHODS

The following key words were used to explore PubMed: Neisseria meningitidis, meningococcus, meningococcal, invasive meningococcal disease, epidemiology, outbreaks, profession(al), occupation(al).

RESULTS

We identified a total of 12 IMD cases among healthcare workers (HCW), 44 involving biological laboratory workers (BLW), 8 among school personnel, and eventually 27 from other settings, including 3 large industrial working populations. Eventual prognosis of BLW, particularly the case/fatality ratio, was dismal. As clustered in time and space, data about school cases as well as industrial cases seem to reflect community rather than occupational outbreaks. In general, we identified a common pattern for HCW and BLW, i.e. the exposure to droplets or aerosol containing N meningitidis in absence of appropriate personal protective equipment (PPE) and/or microbiological safety devices (MSD) (e.g. cabinets). Post-exposure chemoprophylaxis (PEC) was rarely reported by HCW (16.7%) workers, and never by BLW. Data regarding vaccination status were available only for a case, who had failed requested boosters.

CONCLUSIONS

The risk for occupational transmission of IMD appears relatively low, possibly as a consequence of significant reporting bias, with the exception of HCW and BLW. Improved preventive measures should be implemented in these occupational groups, in order to improve the strict use of PPE and MSD, and the appropriate implementation of PEC.

Lung fibrosis and exposure to wood dusts: Two case reports and review of the literature

INTRODUCTION

Increasing evidence suggests that idiopathic pulmonary fibrosis (IPF) occurs more often in subjects previously exposed to wood dusts than in non-exposed subjects. Here we report 2 cases of the IPF among workers prolongedly exposed to high levels of hardwood dusts.

CASE REPORT

The case No. 1: An 83 year-old male former smoker, retired joiner developed mild dyspnoea and chronic dry cough over the period preceding the examination. Pulmonary function tests (PFT) identified a mild restrictive pattern and diffusion capacity for carbon dioxide (CO₂) that was severely impaired (57% of predicted value). High resolution computer tomography (HRCT) identified bilateral, subpleural basal reticular opacities in honeycombing, without any nodules or ground-glass opacities. The case No. 2: A 73 year-old male retired jointer, never smoker, presented a 3-year history of progressive breathlessness and non-productive cough in mild hypoxemia. Pulmonary function tests suggested a moderate restrictive pattern in severely impaired diffusion capacity for CO₂(54% of predicted value). High resolution computer tomography identified diffuse peripheral reticular opacities and honeycombing of lower fields, with apico-basilar gradient. Both cases received diagnosis of the idiopathic pulmonary fibrosis.

DISCUSSION

The pulmonary fibrosis is a common feature of several diseases and may be induced by inflammatory disorders following inhalation of organic and inorganic dusts (e.g., asbestos, silica), and several reports suggest that many cases of the IPF may be in fact secondary to occupational dust exposure as in the case reports we present here.

CONCLUSIONS

Occupational exposure to wood dusts may be a risk factor for the IPF. Unfortunately, exposure reconstruction is frequently inconsistent and anamnesis often misses other causes of the pulmonary fibrosis (e.g., extrinsic allergic alveolitis).

NMR study of the superconducting gap variation near the Mott transition in Cs₃C₆₀

Former extensive studies of superconductivity in the A3C60 compounds, where A is an alkali metal, have led one to consider that Bardeen-Cooper-Schrieffer electron-phonon pairing prevails in those compounds, though the incidence of electronic Coulomb repulsion has been highly debated. The discovery of two isomeric fulleride compounds Cs3C60 which exhibit a transition with pressure from a Mott insulator (MI) to a superconducting (SC) state clearly reopens that question. Using pressure (p) as a single control parameter of the C60 balls lattice spacing, one can now study the progressive evolution of the SC properties when the electronic correlations are increased towards the critical pressure p(c) of the Mott transition. We have used 13C and 133Cs NMR measurements on the cubic phase A15-Cs3C60 just above p(c)=5.0(3) kbar, where the SC transition temperature Tc displays a dome shape with decreasing cell volume. From the T dependence below T(c) of the nuclear spin lattice relaxation rate (T1)(-1) we determine the electronic excitations in the SC state, that is 2Δ, the gap value. The latter is found to be largely enhanced with respect to the Bardeen-Cooper-Schrieffer value established in the case of dense A3C60 compounds. It even increases slightly with decreasing p towards p(c), where T(c) decreases on the SC dome, so that 2Δ/k(B)T(c) increases regularly upon approaching the Mott transition. These results bring clear evidence that the increasing correlations near the Mott transition are not significantly detrimental to superconductivity. They rather suggest that repulsive electron interactions might even reinforce elecron-phonon superconductivity, being then partly responsible for the large T(c) values, as proposed by theoretical models taking the electronic correlations as a key ingredient.

[The health-environment interaction in Italy]

In this paper an analysis is developed of the relationship between environment and health. It takes into account of the present situation and the outcome of the Referendum of 1993 which repeal certain environmental responsibilities of the NHS. The resulting framework denotes the backwardness of Italy on many aspects (wastes, water service, integrated environmental policies) and the difficulty of developing projects between the different professionals involved in environmental issues.

Vaccination status and prevalence of enteric viruses in internationally adopted children. The case of Parma, Italy

On age basis, internationally adopted children may have begun or fully completed all required vaccinations, but official documentation from original Countries is frequently insufficient. Aims of this study were to evaluate the seroprotection rate for tuberculosis, hepatitis B, poliomyelitis and tetanus according to immunization cards in 67 children recently adopted and to test the prevalence of enterovirus on faecal specimens. Seroprotection and vaccination status were frequently inconsistent and these results confirm that immunitary surveillance is a cornerstone for the prevention of diseases for which a vaccination is available. (www.actabiomedica.it).

Epidemiology of tuberculosis in a low-incidence Italian region with high immigration rates: differences between not Italy-born and Italy-born TB cases

BACKGROUND

Emilia Romagna, a northern Italian region, has a population of 4.27 million, of which 9.7% are immigrants. The objective of this study was to investigate the epidemiology of tuberculosis (TB) during the period 1996-2006 in not Italy-born compared to Italy-born cases.

METHODS

Data was obtained from the Regional TB surveillance system, from where personal data, clinical features and risk factors of all notified TB cases were extracted.

RESULTS

5377 TB cases were reported. The proportion of immigrants with TB, over the total number of TB cases had progressively increased over the years, from 19.1% to 53.3%. In the not Italy-born population, TB incidence was higher than in Italians (in 2006: 100.7 cases per 100,000 registered not Italy-born subjects and 83.9/100,000 adding 20% of estimated irregular presences to the denominators. TB incidence among Italians was 6.5/100,000 Italians). A progressive rise in the not Italy-born incident cases was observed but associated with a decline in TB incidence. Not Italy-born cases were younger compared to the Italy-born cases, and more frequently classified as "new cases" (OR 2.0 95%CI 1.61-2.49 for age group 20-39); 60.7% had pulmonary TB, 31.6% extra pulmonary and 7.6% disseminated TB. Risk factors for TB in this population group were connected to lower income status (homeless: OR 149.9 95%CI 20.7-1083.3 for age group 40-59).

CONCLUSIONS

In low-incidence regions, prevention and control of TB among sub-groups at risk such as the foreign-born population is a matter of public health concern. In addition, increasing immigration rates may affect TB epidemiology. TB among immigrants is characterized by particular clinical features and risk factors, which should be analyzed in order to plan effective action.

[The role of Health Impact Assessment (HIA) in the decision-making]

The review describes the evolution of the environmental policies in Italy underlying current delays and discords between the environment and its effects on human health. It also tries to define the major barriers to the introduction of the health impact assessment (HIA) in government policy-making process in Italy; the lack of regulations and the lack of methods to perform an HIA are the main reasons for its limited use. Epidemiology is a fundamental tool to produce effective health impact assessments along with a deep knowledge of medicine, environmental hygiene and risk communication. In conclusion, should the Italian scientific community agreed on a common and constructive approach avoiding possible exploitations and conflicts of interest, HIA could be a valuable method for helping to develop environmental policies and assisting policy-makers in important decisions.

NMR study of the Mott transitions to superconductivity in the two Cs3C60 phases

We report a NMR and magnetometry study on the expanded intercalated fulleride Cs3C60 in both its A15 and face centered cubic structures. NMR allowed us to evidence that both exhibit a first-order Mott transition to a superconducting state, occurring at distinct critical pressures p{c} and temperatures T{c}. Though the ground state magnetism of the Mott phases differs, their high T paramagnetic and superconducting properties are found similar, and the phase diagrams versus unit volume per C60 are superimposed. Thus, as expected for a strongly correlated system, the interball distance is the relevant parameter driving the electronic behavior and quantum transitions of these systems.

[Multiple chemical sensitivity: a study in a young adult population in Italy]

Multiple chemical sensitivity (MCS) is a chronic recurrent condition characterized by reduced tolerance to various environmental agents or to a class of chemical substances. An evidence-based diagnostic panel is not available nor is there a universally accepted definition of the syndrome. This study retrospectively evaluated the prevalence of MCS symptoms and associated risk factors in a sample of 660 young adults, by means of a structured questionnaire. Symptoms of MCS were found to be widely distributed in the sample population and several of the main risk factors suspected to be associated with MCS were not consistently associated with these symptoms in the sample. On the other hand a significant correlation (p<0.05) was found between atopy and symptoms. Further studies are therefore needed to evaluate this association and reach a unifying definition of the syndrome.

Superionic conductivity in the Li4C60 fulleride polymer

We report on the extraordinary superionic conductivity in the fulleride polymer Li4C60, a crystalline material with no disorder. 7Li, NMR, and dc frequency dependent conductivity show uncorrelated ionic hopping across small energy barriers (DeltaE_{a} approximately 200 meV) and an ionic conductivity of 10;{-2} S/cm at room temperature, higher than in "standard" ionic conductors. Ab initio calculations of the molecular structure find intrinsic unoccupied interstitial sites that can be filled by Li+ cations in stoichiometric Li4C60 even at low temperatures. The low energy required for the occupation of these sites allows a sizable Li+ diffusion above 130 K. The results suggest novel application of lithium intercalated fullerides as electrodes in Li ions batteries.

[Waste incinerator and human health: a state-of-the-art review]

Emissions of municipal solid waste incinerator plants consist as a suspected risk factor for the human health. Scientific literature about this theme appears contradictory: main sanitary outcomes actually evaluated, stating on geographic- or occupational-based epidemiologic approaches, produced inconsistent results. Research procedures applied, and effective quality of analyzed data, are the likely causes of such dissimilarities. Up to date, respiratory, cardiovascular renal, and hormonal pathologies, and also neoplasia, and developmental/reproductive disorders have been related to this kind of exposures: otherwise, an objective review of available data suggests a consistent relation only between residential or occupational exposure and the latter outcomes, always as a topic of multifactorial models. Finally, rigorous public health surveillance programs on exposed subjects appear mandatory steps to be established by Institutional Authorities. Also more accurate epidemiologic studies should be designed, eventually associating the retrieval of data relative to biomarkers of exposure or early health effect.

Oxaliplatin-induced hemolytic anemia during adjuvant treatment of a patient with colon cancer: a case report

We report the case of a 64-year-old patient who developed autoimmune hemolytic anemia with thrombocytopenia and acute renal failure shortly after the infusion of the 11th cycle of adjuvant chemotherapy with oxaliplatin, folinic acid and 5-fluorouracil (FOLFOX 4), and was successfully treated by means of plasmapheresis, corticosteroids and dialysis. To the best of our knowledge, only seven other cases have been described in the literature, but we believe this serious adverse event induced by oxaliplatin is more frequent than this would suggest.

Nuclear magnetic resonance structural investigations of ammonia-doped fullerides

The dynamic and structural properties of the ammonia-doped superconducting fulleride (NH3)xNaK2C60 (0.5< or =x< or =1), well known for its anomalous decrease of transition temperature with doping, have been investigated using sodium and deuterium solid-state NMR techniques. The independence of 23Na quadrupole splitting from the ammonia content x, which, at the same time, substantially affects Tc, suggests a marginal role of the cation position in the superconducting mechanism. On the other hand, a strong reduction of the deuterium quadrupole coupling with respect to the free ammonia value denotes the presence of weak hydrogen bonds between the deuterium atoms and fullerene pi orbitals. Despite the bond weakness, as evinced by the lively ammonia rotational dynamics even at very low temperatures, the resulting electron localization could explain the observed Tc anomaly. The motion of the ND3-Na group (located in the compound's octahedral voids), as well as the evolution of the ammonia dynamics as a function of temperature, were determined from deuterium NMR line shape analysis and from detailed numerical simulations. While at the lowest measured temperatures only the ammonia rotation around its own C3 axis takes place, above approximately 25 and 70 K, respectively, also the wobbling of the C3 axis and the ND3 relocation become active, successfully modeled by a strongly correlated motion involving two different time scales.