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Graphene nanoplatelets (UGZ-1004) are emerging as a promising biomaterial in regenerative medicine. This study comprehensively evaluates UGZ-1004, focusing on its physical properties, cytotoxicity, intracellular interactions, and, notably, its effects on mesenchymal stem cells (MSCs). UGZ-1004 was characterized by lateral dimensions and layer counts consistent with ISO standards and demonstrated a high carbon purity of 0.08%. Cytotoxicity assessments revealed that UGZ-1004 is non-toxic to various cell lines, including 3T3 fibroblasts, VERO kidney epithelial cells, BV-2 microglia, and MSCs, in accordance with ISO 10993-5:2020/2023 guidelines. The study focused on MSCs and revealed that UGZ-1004 supports their gene expression alterations related to self-renewal and proliferation. MSCs exposed to UGZ-1004 maintained their characteristic surface markers. Importantly, UGZ-1004 promoted significant upregulation of genes crucial for cell cycle regulation and DNA repair, such as CDK1, CDK2, and MDM2. This gene expression profile suggests that UGZ-1004 can enhance MSC self-renewal capabilities, ensuring robust cellular function and longevity. Moreover, UGZ-1004 exposure led to the downregulation of genes associated with tumor development, including CCND1 and TFDP1, mitigating potential tumorigenic risks. These findings underscore the potential of UGZ-1004 to not only bolster MSC proliferation but also enhance their self-renewal processes, which are critical for effective regenerative therapies. The study highlights the need for continued research into the long-term impacts of graphene nanoplatelets and their application in MSC-based regenerative medicine.

Background: The aim of this study was to compare the short-term outcomes of laparoscopic right hemicolectomy between intracorporeal (IA) and extracorporeal (EA) anastomosis techniques., Methods: A retrospective chart review of 77 consecutive patients who underwent laparoscopic right hemicolectomy from January 2016 to June 2018 was performed. The intracorporeal group included 36 patients and the extracorporeal group 41 patients., Results: Patient demographics and disease-related characteristics were similar. Mean operative time was 152±38.3 minutes in IA vs. 148±34.8 minutes in EA (P=0.664). IA was not associated with less overall postoperative complications and decreased rate of surgical site infections. There was no statistically significant difference in the incidence of postoperative leak, length of stay, mortality in both groups. There was no perioperative difference in median number of lymph node harvested. There was statistically significant difference in the length of larger incision (50 [50-70] mm in IA vs. 80 [70-100] mm in EA; P<0.001), length of the specimen (323±52.7 mm in IA vs. 295±64.7 mm in EA; P<0.05), free tumor margin (113.6±47.4 in IA vs. 75.6±37.4 mm in EA; P<0.001). There was a statistically significant difference in IA in the less postoperative use of analgesics (P<0.032) and return of bowel function (P<0.021)., Conclusions: IA seems feasible and safe; it does not significantly affect the length of surgery, and it guarantees maintenance of radical oncological standards. Furthermore, IA significantly improves cosmesis and patient comfort postoperatively, reducing the rates of emesis, which leads to higher rates of early regular diet tolerance. Therefore, laparoscopic right hemicolectomy with intracorporeal anastomosis is associated with improved short-term outcomes.

Objective: The Communication Assessment Tool (CAT) has previously been translated and adapted to the Italian context. This national study aimed to validate the CAT and evaluate communication skills of practicing surgeons from the patient perspective., Methods: CAT consists of 14 items associated with a 5-point scale (5 = excellent); results are reported as the percent of ''excellent'' scores. It was administered to 920 consenting outpatients aged 18-84 in 26 Italian surgical departments., Results: The largest age group was 45-64 (43.8%); 52.2% of the sample was male. Scores ranged from 44.6% to 66.6% excellent. The highest-scoring items were "Treated me with respect" (66.6%), "Gave me as much information as I wanted" (66.3%) and "Talked in terms I could understand" (66.0%); the lowest was "Encouraged me to ask questions" (44.6%). Significant differences were associated with age (18-24 year old patients exhibited the lowest scores) and geographical location (Northern Italy had the highest scores)., Conclusion: CAT is a valid tool for measuring communication in surgical settings., Practice Implications: Results suggest that expectations of young people for communication in surgical settings are not being met. While there is room to improve communication skills of surgeons across Italy, patients highlighted the greatest need in the Central and Southern regions., (Copyright © 2021. Published by Elsevier B.V.)

Introduction: Total mesorectal excision (TME) performed for the first time by Held through an open approach, it has become the standard technique for the surgical treatment of rectal cancer. The aim the of this meta-analysis is to compare the outcomes provided by TaTME than LaTME., Material and Methods: In this meta-analysis, we included all comparative studies, prospective and retrospective, which addressed in low and middle rectal cancer, a comparison between TaTME and LaTME. A search was performed through MEDLINE and Cochrane Database. 846 records were identified., Results: Eight relevant studies have been included in this meta-analysis. The studies were from France, Russia, USA, Netherlands, Taiwan, Egypt. The eight studies including 471 patients with middle or low rectal cancer., Conclusion: The meta-analysis confirmed safety of TaTME for low and middle rectal cancer. TaTME can lead to a high quality of rectal cancer resection specimen., Competing Interests: Authors have no conflicts of interest to disclose., (© 2022 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Polymeric composite films have been explored for many photocatalytic applications, from water treatment to self-cleaning devices. Their properties, namely, thickness and porosity, are controlled mainly by the preparation conditions. However, little has been discussed on the effect of thickness and porosity of polymeric composite films for photocatalytic processes, especially in gas phase. In the present study, different preparation treatments of ZnO-based polymeric composite films and their effects on its performance and stability were investigated. The polymeric composites were prepared by solution mixing followed by non-solvent induced phase separation (NIPS), using poly(vinylidene fluoride) (PVDF) as the matrix and ZnO-based photocatalysts. Different wet thickness, photocatalyst mass, and treatments (e.g., using or not pore-forming agent and compatibilizer) were assessed. A low ZnO/PVDF ratio and higher wet thickness, together with the use of pore-forming agent and compatibilizer, proved to be a good strategy for increasing photocatalytic efficiency given the low agglomerate formation and high polymer transmittance. Nonetheless, the composites exhibited deactivation after several minutes of exposure. Characterization by XRD, FTIR-ATR, and SEM were carried out to further investigate the polymeric film treatments and stability. ZnO film was most likely deactivated due to zinc carbonate formation intensified by the polymer presence.

Introduction: The incidence of anastomotic leak (AL) has not decreased over the past decades and some important grey areas remain in its definition, prevention, and management. The aim of this study was to reach a national consensus on the definition of AL and to identify key points to be applied in clinical practice., Methods: A 3-step modified Delphi method was used to establish consensus. Ten representative members of the major Italian surgical scientific societies with proven colorectal expertise were selected after a call to action. After a comprehensive literature search, each expert drew a list of evidence-based statements which were voted in round one by the scientific board. Panel members were asked to mark "totally disagree", "partially agree" or "totally agree" for each statement and provide comments. The same voting method was used for round 2. Round 3 consisted of a final face-to-face meeting., Results: Thirty-three statements (clustered into 14 topics) were included in round 1. Following the third voting round, a final list of 16 items was formulated, which encompass the following 9 topics: AL definition, patient- and operative-related risk factors, prevention measures, bowel preparation, surgical technique, intraoperative assessment, early diagnosis, radiological diagnosis and management of specific patterns of AL. The overall response rate was 100% for all items in all the three rounds., Conclusions: This Delphi survey identified items that expert colorectal surgeons agreed were important to be applied in the prevention, diagnosis, and management of AL. This represents the first consensus involving all relevant national scientific societies, defining important and shared concepts in the diagnosis and management of AL.

Perioperative management of antithrombotic therapy in patients treated with coronary stents undergoing surgery remains poorly defined. Importantly, surgery represents a common reason for premature treatment discontinuation, which is associated with an increased risk in mortality and major adverse cardiac events. However, maintaining antithrombotic therapy to minimize the incidence of perioperative ischemic complications may increase the risk of bleeding complications. Although guidelines provide some recommendations with respect to the perioperative management of antithrombotic therapy, these have been largely developed according to the thrombotic risk of the patient and a definition of the hemorrhagic risk specific to each surgical procedure, key to defining the trade-off between ischemia and bleeding, is not provided. These observations underscore the need for a multidisciplinary collaboration among cardiologists, anesthesiologists, hematologists and surgeons to reach this goal. The present document is an update on practical recommendations for standardizing management of antithrombotic therapy management in patients treated with coronary stents (Surgery After Stenting 2) in various types of surgery according to the predicted individual risk of thrombotic complications against the anticipated risk of surgical bleeding complications. Cardiologists defined the thrombotic risk using a "combined ischemic risk" approach, while surgeons classified surgeries according to their inherent hemorrhagic risk. Finally, a multidisciplinary agreement on the most appropriate antithrombotic treatment regimen in the perioperative phase was reached for each surgical procedure., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: In recent years, the emergency management of acute left colonic diverticulitis (ALCD) has evolved dramatically despite lack of strong evidence. As a consequence, management strategies are frequently guided by surgeon's personal preference, rather than by scientific evidence. The primary aim of IPOD study (Italian Prospective Observational Diverticulitis study) is to describe both the diagnostic and treatment profiles of patients with ALCD in the Italian surgical departments., Methods: IPOD study is a prospective observational study performed during a 6-month period (from April 1 2015 to September 1 2015) and including 89 Italian surgical departments. All consecutive patients with suspected clinical diagnosis of ALCD confirmed by imaging and seen by a surgeon were included in the study. The study was promoted by the Italian Society of Hospital Surgeons and the World Society of Emergency Surgery Italian chapter., Results: Eleven hundred and twenty-five patients with a median age of 62 years [interquartile range (IQR), 51-74] were enrolled in the IPOD study. One thousand and fifty-four (93.7%) patients were hospitalized with a median duration of hospitalization of 7 days (IQR 5-10). Eight hundred and twenty-eight patients (73.6%) underwent medical treatment alone, 13 patients had percutaneous drainage (1.2%), and the other 284 (25.2%) patients underwent surgery as first treatment. Among 121 patients having diffuse peritonitis, 71 (58.7%) underwent Hartmann's resection. However, the Hartmann's resection was used even in patients with lower stages of ALCD (36/479; 7.5%) where other treatment options could be more adequate., Conclusions: The IPOD study demonstrates that in the Italian surgical departments treatment strategies for ALCD are often guided by the surgeon's personal preference.

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.

Computed tomography (CT) imaging is the most appropriate diagnostic tool to confirm suspected left colonic diverticulitis. However, the utility of CT imaging goes beyond accurate diagnosis of diverticulitis; the grade of severity on CT imaging may drive treatment planning of patients presenting with acute diverticulitis. The appropriate management of left colon acute diverticulitis remains still debated because of the vast spectrum of clinical presentations and different approaches to treatment proposed. The authors present a new simple classification system based on both CT scan results driving decisions making management of acute diverticulitis that may be universally accepted for day to day practice.

Background: A few studies investigating the use of structural allograft in foot and ankle surgery are available. The purpose of this study is to analyze the clinical, functional and radiological results of patients treated with non-irradiated frozen structural bone allograft., Methods: We analyzed 20 reconstructive surgeries of the hindfoot and midfoot performed between April 2004 and April 2010. The mean follow up period was 45.4 months. The results were evaluated according to AOFAS score, X-ray (allograft consolidation, alignment preservation, and allograft collapse or re-absorption), and complications., Results: We observed a 48-point mean improvement of AOFAS ankle and hindfoot score (17 cases), and a 53-point mean improvement of AOFAS midfoot score (3 cases). The mean bone consolidation time was 75 days. No graft fracture and no cases of non-union were seen., Conclusion: This treatment is a good option to treat severe defects or fill sequelae deformities., (Copyright © 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

The topic chosen by the Board of the Italian Society of Surgery for the 2013 annual Consensus Conference was gastric cancer. With this purpose, under the direction of 2 chairmen, 36 experts nominated by the Regional Societies of Surgery and by the Italian Research Group for Gastric Cancer (GIRCG) participated in an experts consensus exercise, preceded by a questionnaire and mainly held by telematic vote, in accordance with the rules of the Delphi method. The results of this Consensus Conference, presented to the 115th National Congress of the Italian Society of Surgery, and approved in plenary session, are reported in the present paper.

Achalasia is an esophageal motility disorder for which the pathophysiology is only partially known for the idiopathic subtype. Many factors are known to be involved with the development of secondary achalasia. Neurofibromatosis is one of the most common autosomal dominant conditions affecting the nervous system, and 25% of those with the disease have been reported to have involvement of the gastrointestinal tract. Three cases of association between neurofibromatosis and achalasia have been reported in the literature so far. Laparoscopic Heller myotomy is the gold standard surgical treatment for patients with achalasia, whereas esophagectomy is reserved for the more advanced stages of disease. There have been reports of successful long-term results in patients with stage IV achalasia treated with Heller myotomy. We report the fourth case in the literature of association between achalasia and neurofibromatosis; it is the first time that such an association is successfully treated with laparoscopic Heller myotomy.

Endovascular treatment options for visceral artery pseudoaneurysms depend on lesion location and size. Exclusion methods fall into two categories, embolization and stent placement, and these procedures aim to exclude the pseudoaneurysm from the circulation and if possible to maintain distal blood flow. Embolization of the afferent artery can be used in pseudoaneurysms that arise from a donor artery without collateral supply such as a visceral branch, whereas in the case of visceral arteries with well-established collateral supply, the embolization of both proximal and distal branches to the pseudoaneurysm is mandatory in preventing backflow from the collateral circulation. A direct embolization delivering coils or glue into the sac can also be performed if the aneurismal neck is narrow. Stent-graft placement represents another option to exclude the pseudoaneurysm, in the case of wide neck, reduced arterial tortuosity and large-diameter arteries. We present a case of common hepatic artery pseudoaneurysm involving the gastroduodenal artery origin treated by a combination of techniques. An hepatic stent-graft implantation plus retrograde embolization of the gastroduodenal artery through the pancreaticoduodenal anastomosis from the superior mesenteric artery was performed.

Paracolostomy hernia is a common occurrence, representing a late complication of stoma surgery. Different surgical techniques have been proposed to repair the wall defect, but the lowest recurrence rates are associated with the use of mesh. We present the case report of a patient in which laparoscopic paracolostomy hernia mesh repair has been successfully performed.