Postoperative acute kidney injury (PO-AKI) is a leading cause of short- and long-term morbidity and mortality, as well as progression to chronic kidney disease (CKD). The aim of this study was to explore the physicians' attitude toward the use of perioperative serum creatinine (sCr) for the identification of patients at risk for PO-AKI and long-term CKD. We also evaluated the incidence and risk factors associated with PO-AKI and renal function deterioration in patients undergoing major surgery for malignant disease.Adult oncological patients who underwent major abdominal surgery from November 2016 to February 2017 were considered for this single-centre, observational retrospective study. Routinely available sCr values were used to define AKI in the first three postoperative days. Long-term kidney dysfunction (LT-KDys) was defined as a reduction in the estimated glomerular filtration rate by more than 10 ml/min/m2 at 12 months postoperatively. A questionnaire was administered to 125 physicians caring for the enrolled patients to collect information on local attitudes regarding the use of sCr perioperatively and its relationship with PO-AKI.A total of 423 patients were observed. sCr was not available in 59 patients (13.9%); the remaining 364 (86.1%) had at least one sCr value measured to allow for detection of postoperative kidney impairment. Among these, PO-AKI was diagnosed in 8.2% of cases. Of the 334 patients who had a sCr result available at 12-month follow-up, 56 (16.8%) developed LT-KDys. Data on long-term kidney function were not available for 21% of patients. Interestingly, 33 of 423 patients (7.8%) did not have a sCr result available in the immediate postoperative period or long term. All the physicians who participated in the survey (83 out of 125) recognised that postoperative assessment of sCr is required after major oncological abdominal surgery, particularly in those patients at high risk for PO-AKI and LT-KDys.PO-AKI after major surgery for malignant disease is common, but clinical practice of measuring sCr is variable. As a result, the exact incidence of PO-AKI and long-term renal prognosis are unclear, including in high-risk patients.ClinicalTrials.gov , NCT04341974 .
Abstract Background. Chronic pain after breast surgery (CPBS) has a disabling impact on postoperative health status. Mainly because of the lack of a clear definition, inconsistency does exist in the literature concerning both the actual incidence and the risk factors associated to CPBS. The aim of this prospective, observational study is to describe the incidence of and risk factors for CPBS, according to the definition provided by the IASP taskforce. The impact of CPBS on patients’ function and quality of life is also described. Methods. Adult female patients scheduled for oncological or reconstructive breast surgery at the Breast Unit of Careggi Hospital (Florence, Italy) were prospectively observed. Postoperative pain was evaluated at 2 months (“pain becoming chronic”) and at 3 months (CPBS) after surgery. Preoperative, intraoperative, and postoperative factors were compared in CPBS and No-CPBS groups through multivariate logistic regression analysis. Results. Among the 307 patients considered in this study, the incidence of “pain becoming chronic” was 25.4% [95%CI 20.6%-30.7%], while that of CPBS was 28% [95%CI 23.1%-33.4%]. The presence of pain at 2 months concords with the presence of CPBS at 3 months (Cohen k coefficient 0.63, IC95% 0.54-0.73). Results from the logistic regression analysis suggest that axillary surgery (OR [95%CI], 2.99 [1.13-7.87], p=0.03), preoperative use of pain medications (OR [95%CI], 2.04 [1.20-3.46], p=0.01), and higher dynamic NRS values at 6 hours postoperatively (OR [95%CI], 1.28 [1.05-1.55], p=0.01) were all independent predictors for CPBS. Conclusions. Chronic pain after breast surgery is a frequent complication. The presence of early pain at 2 months after surgery concords with the occurrence of CPBS. The possibility to early detect persistent pain, particularly in those patients at high risk for CPBS, might help physicians to more effectively prevent pain chronicization. In our cohort, long-term use of analgesics for preexisting chronic pain, axillary surgery, and higher dynamic NRS values at 6 hours postoperatively were all factors associated with increased risk of developing CPBS. Trial registration : clinicalTrials.gov registration NCT04309929
Radiocarbon dating of bones can be very useful in archaeological contexts, especially when dealing with funerary deposits lacking material culture, e.g. pottery vessels. 14C measurements of bone samples are usually performed on the extracted collagen residue. The content and the quality of collagen can vary significantly, mainly depending on bone preservation and diagenesis. Generally speaking, environmental conditions such as low pH level of soils, high temperatures, and percolating groundwaters, typical of arid and tropical zones, can affect the preservation of collagen; at the same time, bones recovered in such environments are more likely to be contaminated with carbon from the surrounding environment. Possible contamination of samples can also occur in temperate zones. While low collagen content is a condition we cannot overcome, we can use several chemical and elemental indicators in order to assess collagen quality. Among these, the C/N atomic ratio is considered a good parameter for detecting low-quality collagen and possibly contaminated samples. In a combustion and graphitization setup like that installed at INFN-LABEC, Florence, measurement can be easily performed using an elemental analyzer when combusting the sample prior to graphitization, thus requiring no extra effort (or extra amount of sample) during the preparation procedure. Bone samples recently 14C dated at INFN-LABEC have confirmed that the measurement of C/N atomic ratios can give some indications of the collagen quality. The bone material was collected from 3 necropoles of the Bronze Age period in Cyprus (Erimi-Laonin tou Porakou, Lophou-Kolaouzou, and Erimi-Kafkalla&Pitharka, along the Kouris Valley), an area characterized by environmental conditions that do not favor bone preservation. Samples were treated to extract collagen and measured by accelerator mass spectrometry (AMS). 14C results have been compared with the archaeological evidence, showing some relationship between measured C/N atomic ratios and collagen quality. In particular, when grouping the measured samples according to their C/N ratio, the agreement between 14C dates and archaeological evidence is good or inconsistent when the C/N ratio clearly falls inside or outside the “recommended” range, respectively, with a still reasonable agreement also when it is slightly above the upper limit of that range.
The archaeological site of Populonia-Baratti, in the southern part of Tuscany (Italy), was one of the most important centers in ancient Etruria, as seen in the evidence of metallurgical activities carried out at that time. During recent archaeological excavations (2005) in the ancient industrial area of Populonia, along the Baratti beach, 2 interesting tombs were found. The 2 graves were unusually located in an area dedicated to metallurgical activity and showed a particular structure of the burial chambers and an extreme richness in the grave goods. The unique character of the 2 tombs prompted many questions: who were these 2 individuals (a woman wearing many jewels and a tall, vigorous man) and when did they die? In order to obtain useful information about the chronology of the 2 tombs, accelerator mass spectrometry (AMS) radiocarbon analyses were performed on samples taken from the ribs of the 2 skeletons. Measured 14 C ages were converted to calibrated ages using additional information derived from stable isotope ratios measured in the extracted collagen. Actually, the 13 C data provided useful hints about the diet of the 2 individuals, thus allowing us to estimate the percentage of marine food consumed (about 30%) and exploit a combined marine-terrestrial calibration curve. As a result, the age of the 2 individuals can be dated to the 2nd century AD, during Roman times, which is in good agreement with the information obtained from archaeological, anthropological, and stylistic studies of the 2 tombs.
Radiocarbon dating of bones can be very useful in archaeological contexts, especially when dealing with funerary deposits lacking material culture, e.g. pottery vessels. 14 C measurements of bone samples are usually performed on the extracted collagen residue. The content and the quality of collagen can vary significantly, mainly depending on bone preservation and diagenesis. Generally speaking, environmental conditions such as low pH level of soils, high temperatures, and percolating groundwaters, typical of arid and tropical zones, can affect the preservation of collagen; at the same time, bones recovered in such environments are more likely to be contaminated with carbon from the surrounding environment. Possible contamination of samples can also occur in temperate zones. While low collagen content is a condition we cannot overcome, we can use several chemical and elemental indicators in order to assess collagen quality. Among these, the C/N atomic ratio is considered a good parameter for detecting low-quality collagen and possibly contaminated samples. In a combustion and graphitization setup like that installed at INFN-LABEC, Florence, measurement can be easily performed using an elemental analyzer when combusting the sample prior to graphitization, thus requiring no extra effort (or extra amount of sample) during the preparation procedure. Bone samples recently 14 C dated at INFN-LABEC have confirmed that the measurement of C/N atomic ratios can give some indications of the collagen quality. The bone material was collected from 3 necropoles of the Bronze Age period in Cyprus (Erimi-Laonin tou Porakou, Lophou-Kolaouzou, and Erimi-Kafkalla&Pitharka, along the Kouris Valley), an area characterized by environmental conditions that do not favor bone preservation. Samples were treated to extract collagen and measured by accelerator mass spectrometry (AMS). 14 C results have been compared with the archaeological evidence, showing some relationship between measured C/N atomic ratios and collagen quality. In particular, when grouping the measured samples according to their C/N ratio, the agreement between 14 C dates and archaeological evidence is good or inconsistent when the C/N ratio clearly falls inside or outside the “recommended” range, respectively, with a still reasonable agreement also when it is slightly above the upper limit of that range.
Abstract Background. Chronic pain after breast surgery (CPBS) has a disabling impact on postoperative health status. Mainly because of the lack of a clear definition, inconsistency does exist in the literature concerning both the actual incidence and the risk factors associated to CPBS. The aim of this prospective, observational study is to describe the incidence of and risk factors for CPBS, according to the definition provided by the IASP taskforce. The impact of CPBS on patients’ function and quality of life is also described. Methods. Women aged 18+ undergoing oncological or reconstructive breast surgery from Jan until Apr 2018 at the Breast Unit of Careggi Hospital (Florence, Italy) were prospectively observed. Postoperative pain was measured at 0hrs, 3hrs, 6hrs, 12hrs, 24hrs, 48hrs, and 3 months (CPBS) after surgery. Preoperative, intraoperative, and postoperative factors were compared in CPBS and No-CPBS groups through multivariate logistic regression analysis. Results. Among the 307 patients considered in this study, the incidence of CPBS was 28% [95%CI 23.1%-33.4%]. Results from the logistic regression analysis suggest that axillary surgery (OR [95%CI], 2.99 [1.13-7.87], p=0.03), preoperative use of pain medications (OR [95%CI], 2.04 [1.20-3.46], p=0.01), and higher dynamic NRS values at 6 hours postoperatively (OR [95%CI], 1.28 [1.05-1.55], p=0.01) were all independent predictors for CPBS. Conclusions. Chronic pain after breast surgery is a frequent complication. In our cohort, long-term use of analgesics for pre-existing chronic pain, axillary surgery, and higher dynamic NRS values at 6 hours postoperatively were all factors associated with increased risk of developing CPBS. The possibility to early detect persistent pain, particularly in those patients at high risk for CPBS, might help physicians to more effectively prevent pain chronicisation. Trial registration : clinicalTrials.gov registration NCT04309929
Abstract Background. Chronic pain after breast surgery (CPBS) has a disabling impact on postoperative health status. Mainly because of the lack of a clear definition, inconsistency does exist in the literature concerning both the actual incidence and the risk factors associated to CPBS. The aim of this prospective, observational study is to describe the incidence of and risk factors for CPBS, according to the definition provided by the IASP taskforce. The impact of CPBS on patients’ function and quality of life is also described. Methods. Adult female patients scheduled for oncological or reconstructive breast surgery at the Breast Unit of Careggi Hospital (Florence, Italy) were prospectively observed. Postoperative pain was evaluated at 3 months (CPBS) after surgery. Preoperative, intraoperative, and postoperative factors were compared in CPBS and No-CPBS groups through multivariate logistic regression analysis. Results. Among the 307 patients considered in this study, the incidence of CPBS was 28% [95%CI 23.1%-33.4%]. Results from the logistic regression analysis suggest that axillary surgery (OR [95%CI], 2.99 [1.13-7.87], p=0.03), preoperative use of pain medications (OR [95%CI], 2.04 [1.20-3.46], p=0.01), and higher dynamic NRS values at 6 hours postoperatively (OR [95%CI], 1.28 [1.05-1.55], p=0.01) were all independent predictors for CPBS. Conclusions. Chronic pain after breast surgery is a frequent complication. In our cohort, long-term use of analgesics for preexisting chronic pain, axillary surgery, and higher dynamic NRS values at 6 hours postoperatively were all factors associated with increased risk of developing CPBS. The possibility to early detect persistent pain, particularly in those patients at high risk for CPBS, might help physicians to more effectively prevent pain chronicisation. Trial registration : clinicalTrials.gov registration NCT04309929
Abstract Background . Chronic pain after breast surgery (CPBS) has a disabling impact on postoperative health conditions. Mainly because of the lack of a clear definition, inconsistency does exist in the literature concerning both the actual incidence of and the risk factors for CPBS. The aim of this prospective, observational study is to describe incidence of and risk factors for CPBS, defined in accordance with the IASP taskforce. The impact of CPBS on patients’ daily functions is also described. Methods. Adult female patients scheduled for oncological or reconstructive breast surgery at the Breast Unit of Careggi Hospital (Florence, Italy) were prospectively observed. Persistent postoperative pain was evaluated at 2 months (“pain becoming chronic”) and at 3 months (CPBS) after surgery. Preoperative, intraoperative, and postoperative factors were compared in CPBS and No-CPBS groups through multivariate logistic regression analysis. Results. Among the 307 patients considered in this study, the incidence of “pain becoming chronic” was 25.4% [95%CI 20.6%-30.7%], while that of CPBS was 28% [95%CI 23.1%-33.4%]. The presence of persistent pain at 2 months concords with the presence of CPBS at 3 months (Cohen k coefficient 0.63, IC95% 0.54-0.73). Results from the logistic regression analysis suggest that axillary surgery (OR [95%CI], 2.99 [1.13-7.87], p=0.03), preoperative use of pain medications (OR [95%CI], 2.04 [1.20-3.46], p=0.01), and dynamic NRS values at 6 hours postoperatively (OR [95%CI], 1.28 [1.05-1.55], p=0.01) were all independent predictors for CPBS. Conclusions. Chronic pain after breast surgery is a frequent complication. The presence of an earlier form of persistent pain at 2 months after surgery concords with the occurrence of CPBS. The possibility to early detect persistent pain, particularly in those patients at high risk for CPBS, might help physicians to more effectively prevent pain chronicization. In our cohort, long-term use of analgesics for preexisting chronic pain, axillary surgery, and higher dynamic NRS values at 6 hours postoperatively were all factors associated with increased risk of developing CPBS. Trial registration : clinicalTrials.gov registration NCT04309929
Depuis 2008 , le site d'Erimi-Laonin tou Porakou (Limassol ) fait l ’ objet d ’ une fouille systématique menée par une mission de l ’ Université de Florence en collaboration avec le Département des Antiquités de Chypre . L ’ objectif primaire de l ’ enquête était l ’ analyse du matériel funéraire de la nécropole Sud (Area E ), où plusieurs tombes à chambre individuelle ont été fouillées . Les petits objets et les assemblages céramiques , par leurs typologies et leurs décors , se rapprochent d ’ une production typique de la côte méridionale qui se développe du Chalcolithique ancien au Chalcolithique moyen III / Chalcolithique récent I . Au cours de la saison de fouilles 2010-2011 , des échantillons d ’ ossements ont été prélevés à partir des restes de squelettes de trois tombes (228 , 230 , 248 ), dans le but de réaliser des analyses radiocarbone . Les résultats des études anthropologiques et des datations radiocarbone peuvent être croisés avec le matériel archéologique , afin de dessiner une séquence chronologique de la nécropole d ’ Erimi-Laonin tou Porakou , et d ’ apporter ainsi de nouvelles données à l ’ étude de l ’ Age du Bronze dans la région de Kourion .
The site area of Erimi-Laonin tou Porakou (Limassol, Cyprus) has been surveyed and systematically excavated since 2007 as a joint research project of the University of Florence and the Department of Antiquities of Cyprus. A focused investigation was dedicated to analyzing funerary evidence from the southern Cemetery (Area E), where 7 single-chamber graves were excavated. The offering goods assemblages from the burials point to a general date ranging from Early to Late Bronze Age I, and draw a sequence of use that is contemporary to the stratigraphic deposits from the top mound Workshop Complex (Area A). During the 2010 field season, charcoal samples from the Workshop Complex and bone samples from the skeleton remains of 2 burials (tombs 228, 230) were opportunely taken for radiocarbon analyses. 14 C dating was performed at the AMS-IBA Tandetron accelerator of the INFN-LABEC Laboratory in Florence. This paper will discuss the results of the 14 C analyses and compare them with the archaeological evidence in order to outline a chronological sequence for the settlement and cemetery areas at Erimi-Laonin tou Porakou, thus collecting further data on the development and pattern of occupation of the Early to Late Cypriote period in the Kourion area.
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