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ObjectiveThe primary endpoint of this study was to compare the disease-free survival of patients undergoing open versus minimally invasive pelvic exenteration. The secondary endpoints were cancer-specific survival and peri-operative morbidity.MethodsA multi-center, retrospective, observational cohort study was undertaken. Patients undergoing curative and palliative anterior or total pelvic exenteration for gynecological cancer by a minimally invasive approach and an open approach between June 2010 and May 2021 were included. Patients with distant metastases were excluded. A 1:2 propensity match analysis between patients undergoing minimally invasive and open pelvic exenteration was performed to equalized baseline characteristics.ResultsAfter propensity match analysis a total of 117 patients were included, 78 (66.7%) and 39 (33.3%) in the open and minimally invasive group, respectively. No significant difference in intra-operative (23.4% vs 10.3%, p=0.13) and major post-operative complications (24.4% vs 17.9%, p=0.49) was evident between the open and minimally invasive approach. Patients undergoing open pelvic exenteration received higher rates of intra-operative transfusions (41.0% vs 17.9%, p=0.013). Median disease-free survival was 17.0 months for both the open and minimally invasive groups (p=0.63). Median cancer-specific survival was 30.0 months and 26.0 months in the open and minimally invasive groups, respectively (p=0.80). Positivity of surgical margins at final histology was the only significant factor influencing the risk of recurrence (hazard ratio (HR) 2.38, 95% CI 1.31 to 4.31) (p=0.004), while tumor diameter ≥50 mm at the time of pelvic exenteration was the only significant factor influencing the risk of death (HR 1.83, 95% CI 1.08 to 3.11) (p=0.025).ConclusionIn this retrospective study no survival difference was evident when minimally invasive pelvic exenteration was compared with open pelvic exenteration in patients with gynecological cancer. There was no difference in peri-operative complications, but a higher intra-operative transfusion rate was seen in the open group.

Purpose: The most appropriate therapy for HR + /HER2-positive (HER2 +) advanced breast cancer (ABC) is a matter of debate. Co-targeting of both receptors represents an attractive strategy to overcome the cross-talk between them. Methods: The HERMIONE 9 is an observational retrospective multicentric study which aimed to describe the clinical outcome of patients with HR + /HER2 + ABC who received the combination of Fulvestrant (F) and Trastuzumab (T) as part of their routine treatment at 10 Italian Institutions. Results: Eighty-seven patients were included. Median age was 63 (range, 35–87) years. The median number of previous treatments was 3 (range, 0–10) and F and T were administered as ≥ 3rd line in 67 patients. Among the 86 evaluable patients, 6 (6.9%) achieved CR, 18 (20.7%) PR, and 44 (50.6%) had SD ≥ 24 weeks with an overall CBR of 78.2%. At a median follow-up of 33.6 months, mPFS of the entire cohort was 12.9 months (range, 2.47–128.67). No difference was observed in mPFS between patients treated after progression or as maintenance therapy (mPFS 12.9 and 13.9 months in 64 and 23 patients, respectively), neither considering the number of previous treatment lines (≤ 3 or < 3). Conclusion: The combination of F and T was active in this cohort at poor prognosis and deserves further investigations possibly in combination with pertuzumab in patients with high ER expression.

PurposeThis paper aims to provide and empirically test a conceptual model in which artificial intelligence (AI), knowledge management processes (KMPs) and supply chain resilience (SCR) are simultaneously considered in terms of their reciprocal relationships and impact on manufacturing firm performance (MFP).Design/methodology/approachIn the study, six hypotheses have been developed and tested through an empirical survey administered to 120 senior executives of Italian manufacturing firms. The data analysis has been carried out via the partial least squares structural equation modelling approach, using the Advanced Analysis for Composites 2.0 variance-based software program.FindingsUsing a conceptual model validated using an empirical survey, the study sheds light on the relationships between AI, KMPs and SCR, as well as their impacts on MFP. In particular, the authors show the positive effects of the adoption of AI on KMPs, as well as the influence of KMPs on SCR and MFP. Finally, the authors demonstrate that KMPs act as a mediator through which AI affects SCR and MFP.Practical implicationsThis study highlights the critical role of KMPs for manufacturing firms that can deploy AI to stimulate KMPs and through attaining a high level of the latter might succeed in enhancing both their SCR and MFP.Originality/valueThis study demonstrates that manufacturing firms interested in properly applying AI to ameliorate their performance and resilience must carefully consider KMPs as a mediator mechanism.

Il contributo restituisce gli esiti di un lavoro di Ricerca-Formazione coordinato dalla cattedra di Pedagogia Sperimentale e Valutazione Scolastica dell’Università di Roma Tre con docenti di scuola primaria nel periodo Febbraio-Giugno 2021, ovvero nei primi mesi dall’emanazione dell’Ordinanza Ministeriale 172-2020. Il confronto con i docenti ha riguardato le loro percezioni su aspetti critici e punti di forza dell’abbandono del voto numerico quali l’efficacia per gli apprendimenti, la validità, l’equità, la sostenibilità e la coerenza del cambiamento, le attività avviate negli istituti per l a r e v i s i o n e d e i c u r r i c u l i , p e r l a documentazione, per la comunicazione ad alunni, alunne e famiglie. L’indagine è stata seguita da una Ricerca-Formazione, realizzata a partire dai bisogni formativi autenticamente percepiti dal corpo docente.

This paper returns the outcomes of a research-training project, as result of the collaboration between university researchers and teachers and principals of a network of schools in Lazio. Research-training is a way of doing empirical research that, making use of differentiated methodologies aims to develop teaching professionalism through the construction of research paths agreed between universities and schools. The present investigation started from a training need made explicit by schools: the need to develop skills useful for dealing with the transition from grades to judgments. A synthesis of teachers’ diverse views on assessment and perceptions of change is proposed here. The reflection and evidence gathered can help to prefigure the direction to be taken to overcome the risk that the use of feedback or levels may trace a construct that refers to the grade, de-emphasizing or effectively nullifying its value. Feedback and restitution, on the other hand, are tools of a motivating design that aims to provide learners with guidance for understanding and analysing their own learning and support for making effective and conscious choices in organising future learning.

Demands on neural interfaces in terms of functionality, high spatial resolution, and longevity have recently increased. These requirements can be met with sophisticated silicon-based integrated circuits. Embedding miniaturized dice in flexible polymer substrates significantly improves the adaptation to the mechanical environment in the body and thus the systems’ structural biocompatibility as well as the ability to cover larger areas of the brain. This work addresses main challenges in developing a hybrid chip-in-foil neural implant. Assessments were related to: first, the mechanical compliance to the recipient tissue that allows a long-term application, and second, the suitable design that allows the implant’s scaling and modular adaptation of chip arrangement. Finite element model studies were performed to identify design rules regarding die geometry, interconnect routing, and positions for contact pads on dice. Providing edge fillets in the die base shape was an effective measure to improve die-substrate integrity and increase the area available for contact pads. Furthermore, the routing of interconnects in the immediate vicinity of die corners should be avoided, as the substrate in these areas is prone to mechanical stress concentration. Contact pads on dice should be placed with a clearance from the die rim to avoid delamination when the implant is conformed to a curvilinear body. A microfabrication process was developed to transfer, align and electrically interconnect multiple dice into conformable polyimide-based substrates. The process enabled arbitrary die shape and size and independent target positions on the conformable substrate from the die position on the fabrication wafer.

ObjectiveCurrently, there is no clear guidance defining the ideal candidate for minimally invasive interval debulking surgery. This study aimed to identify predictive factors for a minimally invasive approach in patients with advanced ovarian cancer who are candidates for interval debulking surgery after neoadjuvant chemotherapy.MethodsThis was a single institution retrospective study conducted between January 2014 and June 2020 Perioperative variables were used to predict the likelihood of minimally invasive interval debulking surgery using multivariable models. A nomogram was developed, and internal validation was performed using the bootstrapping correction technique. This nomogram was built to visualize the effect of perioperative variables on the estimated probability of minimally invasive interval debulking surgery in patients with a clinical response after neoadjuvant chemotherapy. We used the four significant perioperative variables according to logistic regression.ResultsA total of 108 (28.4%) and 272 (71.6%) patients underwent interval debulking surgery by a minimally invasive or open approach, respectively. Absence of omental cake (odds ratio (OR) 9.15, 95% confidence interval (CI) 4.26 to 19.64, pConclusionsOur nomogram may serve as a useful tool to choose the surgical approach in patients with advanced ovarian cancer undergoing interval debulking surgery.

Supplemental material, sj-pdf-2-tmj-10.1177_03008916231179251 for Outcomes in patients with BRAFV600–mutated melanoma and brain metastases at baseline treated with dabrafenib plus trametinib by Massimo Aglietta, Vanna Chiarion-Sileni, Paolo Fava, Massimo Guidoboni, Roberta Depenni, Alessandro Minisini, Francesca Consoli, Paolo Antonio Ascierto, Gaetana Rinaldi, Maria Banzi, Riccardo Marconcini, Rossana Gueli, Virginia Ferraresi, Marco Tucci, Giuseppe Tonini, Giovanni Lo Re, Michele Guida, Michele Del Vecchio, Ilaria Gioia Marcon and Paola Queirolo in Tumori Journal

Supplemental material, sj-pdf-2-tmj-10.1177_03008916231179251 for Outcomes in patients with BRAFV600–mutated melanoma and brain metastases at baseline treated with dabrafenib plus trametinib by Massimo Aglietta, Vanna Chiarion-Sileni, Paolo Fava, Massimo Guidoboni, Roberta Depenni, Alessandro Minisini, Francesca Consoli, Paolo Antonio Ascierto, Gaetana Rinaldi, Maria Banzi, Riccardo Marconcini, Rossana Gueli, Virginia Ferraresi, Marco Tucci, Giuseppe Tonini, Giovanni Lo Re, Michele Guida, Michele Del Vecchio, Ilaria Gioia Marcon and Paola Queirolo in Tumori Journal

Supplemental material, sj-pdf-1-tmj-10.1177_03008916231179251 for Outcomes in patients with BRAFV600–mutated melanoma and brain metastases at baseline treated with dabrafenib plus trametinib by Massimo Aglietta, Vanna Chiarion-Sileni, Paolo Fava, Massimo Guidoboni, Roberta Depenni, Alessandro Minisini, Francesca Consoli, Paolo Antonio Ascierto, Gaetana Rinaldi, Maria Banzi, Riccardo Marconcini, Rossana Gueli, Virginia Ferraresi, Marco Tucci, Giuseppe Tonini, Giovanni Lo Re, Michele Guida, Michele Del Vecchio, Ilaria Gioia Marcon and Paola Queirolo in Tumori Journal

Supplemental material, sj-pdf-1-tmj-10.1177_03008916231179251 for Outcomes in patients with BRAFV600–mutated melanoma and brain metastases at baseline treated with dabrafenib plus trametinib by Massimo Aglietta, Vanna Chiarion-Sileni, Paolo Fava, Massimo Guidoboni, Roberta Depenni, Alessandro Minisini, Francesca Consoli, Paolo Antonio Ascierto, Gaetana Rinaldi, Maria Banzi, Riccardo Marconcini, Rossana Gueli, Virginia Ferraresi, Marco Tucci, Giuseppe Tonini, Giovanni Lo Re, Michele Guida, Michele Del Vecchio, Ilaria Gioia Marcon and Paola Queirolo in Tumori Journal

Introduction Arrhythmogenic cardiomyopathy (AC) is an important cause of sudden cardiac death (SCD). AC is characterized by areas of fibro-fatty replacement of the myocardium of one or both ventricles, which can be characterized through cardiovascular magnetic resonance (CMR). Several mutations have been associated with the development of AC, most commonly in desmosomal genes. The relationship between the genotype and the disease phenotype (i.e., the extent and severity of myocardial disease and patient outcome) is unclear. Methods We evaluated 280 consecutive patients evaluated in a single CMR laboratory over a 10-year timespan and diagnosed with AC according to the Padua criteria, based on a retrospective evaluation of the electronic health records. All these patients had undergone a genetic testing through Sanger sequencing or Next Generation Sequencing (after 2012). Pathogenic or likely pathogenic mutations and variants of unknown significance were considered. CMR scans performed at diagnosis were examined by an expert blinded to the results of genetic testing to retrieve the location and extent of the areas of fibro-fatty replacement and late gadolinium enhancement (LGE), biventricular volumes and function. Follow-up data were also retrieved. The primary endpoint was SCD or aborted SCD (following successful defibrillator discharge). The secondary endpoint included SCD or aborted SCD plus sustained or non-sustained ventricular tachycardia episodes. Results Patients were more often males (67%), with a mean age of 48±16 years. Gene mutations related to cardiomyopathy were found in 123 patients, and 85 patients harbored mutations in desmosomal genes (DSP, n=41; DSG2, n=16; PKP2, n=16; DSC2, n=6; JUP, n=6), while the other mutations were in genes including TMEM43, LMNA, SCN5A, MYH7, and RYR2. Patients with mutations in desmosomal genes had more often LGE in the left ventricle (LV) than patients with other mutations or with no mutations detected (66% vs. 58% vs. 46%, respectively; p=0.025). Patients with mutations in the DSP gene had a greater LGE extent in terms of number of segments affected (p=0.011), or percent of the LV (p9% (considered one at the time) independently predicted both endpoints. Conclusions In patients with AC, mutations in desmosomal genes are found in almost half of patients, and are associated with the presence and a larger extent of LGE in the LV. In turn, the presence and extent of LGE are independent predictor of SCD or aborted SCD.

Although chemotherapy (CHT) exposure is an established cause of telomere attrition, determinants of telomere length (TL) dynamics after chemotherapy are poorly defined. In this study, we analyzed granulocyte telomere dynamics in 34 adult lymphoma patients undergoing first-line CHT. TL was measured by southern blot at each CHT cycle and after 1 year from CHT completion. Median age was 59 yrs (range 22-77). Median number of CHT cycles was 6 (range 3-6). The majority of patients (79%, n = 27) experienced TL shortening following CHT exposure. Mean telomere loss was 673 base pairs (bp) by cycle 6. Telomere shortening was an early event as 87% of the total telomere loss (mean 586 bp) occurred by the end of cycle 3, with no significant recovery after 1 year. A significant correlation was observed between baseline TL and total or fractional telomere loss (p 0.001), with telomere shortening by cycle 3 observed predominantly in male patients with long telomeres at pre-treatment evaluation. Stratifying the analysis by gender and age only young women (51 years of age) did not show significant telomere shortening following chemotherapy exposure. These findings indicate that gender and baseline TL are major determinants of TL dynamics following chemotherapy exposure in lymphoma patients.

Study Objective: The effect of the different types of vaginal cuff closures on posthysterectomy sexual function has not been investigated in depth. We evaluated if there is a difference between transvaginal versus a laparoscopic closure after total laparoscopic hysterectomy (TLH) on female sexual function, using a validated questionnaire. Design: Secondary analysis of a prospective randomized controlled trial. Setting: Three academic research centers. Patients: Women consenting to telephone interviews on their sexual life before and after undergoing TLH were included. Interventions: Patients were randomly assigned to a laparoscopic or transvaginal approach for vaginal cuff closure at the end of TLH for benign indications. Measurements and Main Results: A validated questionnaire (the Female Sexual Function Index [FSFI]) was used to explore sexuality before and after the operation. Of the 1408 patients enrolled in the primary study, 400 patients were asked to complete the questionnaire. Of them, 182 (41.4%) were eligible and accepted enrollment in the present analysis. No difference was found in terms of pre- and postoperative FSFI scores between groups. Patients with a low preoperative FSFI score (

The aim of this study was to investigate the prevalence of peritoneal human papillomavirus (HPV) infection in different clinical cervical cancer (CC) settings, and its association with potential clinical and/or histological factors. This is a single-center, prospective, observational study. Consecutive patients with newly diagnosed or recurrent/persistent CC, between March 2019 and April 2020, were included. A group of patients undergoing surgery for benign gynecological conditions was included as control group. All patients underwent HPV-DNA test in the cervix and in the peritoneal cavity simultaneously at time of surgery. Two-hundred seventy-two patients had cervical and peritoneal HPV test analyzed. Cervical and peritoneal HPV positivity (PHP) was found in 235 (88.0%) and 78 (28.7%) patients, respectively; the prevalence of PHP was 17.7% in early stage, 28.8% in locally advanced cervical cancer (LACC) and 46.6% in the metastatic/persistent/recurrent setting (P = .001). No control patient was found to have peritoneal HPV infection. Higher frequency of PHP was documented in patients with larger tumor size (P = .003), presence of cervical HPV 16/18 genotypes (P

Aim To assess the prevalence and prognostic significance of NI-LGE in patients undergoing stress-CMR. Methods Stress-CMR with either dipyridamole or adenosine was performed in 283 patients (228 men, 81%) including perfusion imaging, wall motion evaluation and LGE. Follow-up was completed in all enrolled patients (median time: 1850 days; interquartile range: 1225-2705 days). Composite endpoint included cardiac death, ventricular tachycardia, myocardial infarction, stroke, hospitalization for cardiac cause and coronary revascularization performed beyond 90 days from stress-CMR scans. Results One hundred and twelve patients (40%) had negative LGE (no-LGE), 140 patients (49%) I-LGE and 31 patients (11%) NI-LGE. Twenty-five events occurred in the no-LGE group, 68 in I-LGE and 11 in the NI-LGE group. On survival curves, patients with NI-LGE had worse prognosis than patients with no-LGE regardless of the presence of inducible perfusion defects. No significant prognostic differences were found between I-LGE and NI-LGE. Conclusion NI-LGE can be detected in 11% of patients during stress-CMR providing a diagnosis of nonischemic cardiac disease. Patients with NI-LGE have worse prognosis than those with no-LGE.

Introduction: The aim of this study is to analyze the available scientific evidence regarding the quality of life (QoL) and sexual function (SF) in patients affected by cervical cancer (CC) after surgical and adjuvant treatments. Materials and Methods: Preliminary research was conducted via electronic database (MEDLINE, PubMed and Cochrane Library) with the use of a combination of the following keywords: SF, QoL, and CC. The principal findings considered in the present review were the study design, the number of patients included in each study, the information about the malignancy (histology and stage of disease), the questionnaires administered, and the principal findings concerning SF and QoL. Results: All studies were published between 2003–2022. The studies selected consisted of one randomized control study, seven observational studies (three prospective series), and nine case control studies. The scores used were focused on SF, QOL, fatigue, and psychological aspects. All studies reported a decreased SF and QOL. The most developed questionnaires were the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Female Sexual Function Index (FSFI), the Hospital Anxiety and Depression scale (HADS), and the Female Sexual Distress Scale (FSDS). Discussion: All studies reported a decreased SF and QOL. In addition to the perception of body image, several factors coexist in influencing the outcomes such as the physical, hormonal, psychological. Conclusions: Sexual dysfunction after CC treatment has a multifactorial aetiology which negatively affects the quality of life. For these reasons, it is important to follow and support patients with a multidisciplinary team (doctors, nurses, psychologists, dieticians) before and after therapy. This type of tailored therapeutic approach should become a standard. Women should be informed about possible vaginal changes and menopausal symptoms after surgery and on the positive effects of psychological therapy.

Knee osteoarthritis (KOA) is a degenerative and inflammatory disease with a rising incidence and prevalence worldwide. Various therapeutic strategies have been proposed over time, depending on the degrees of severity and usually based on individual clinical practice. However, several European and international scientific societies published guidelines, to provide practical clinical stepwise guidance and to facilitate individualized therapeutic decisions regarding the management of KOA. The aim of this prospective multicentre observational study was to describe the real outpatient territorial management of patients with knee osteoarthritis and to compare it with the ESCEO guidelines, in order to identify operational strategies for delivering patient-centric care.The educational project was divided in three modules: the first and the last through webinar; the second held in daily practice. The participants had to register structured observations.The project has been joined by 155 discussants, and the 2,656 observations collected allowed the understanding of the most common therapeutic approaches for knee osteoarthritis on the Italian territory.The educational project proved to be useful for updating on the state of the art of therapeutic management of knee osteoarthritis, and to increase expertise in detecting prevention and treatment strategies according to ESCEO guidelines to apply in the Real-Life context.

This paper aims at assessing the use of nanomaterials in painting conservation and in cleaning practices that could be alternative to the traditional ones to overcome the limits of new green materials. Titanium dioxide nanoparticles have been spread and studied on historical painting surfaces with good results. In particular, the properties of TiO2 nanoparticles have been considered useful for self-cleaning and protective purposes against the accumulation of dirt and dust that represents the first phase in deterioration of historical painting surfaces. TiO2 nanoparticles, prepared in distilled water by Pulsed Laser Ablation in Liquids, were applied on painting mock-ups realized in the laboratory according to old recipes and using historical binders and pigments. The surface characteristics of the painting were investigated by contact angle measurement and by Atomic Force Microscopy. The optical and aesthetical compatibility of the colloidal dispersions with the painting was assessed by spectrophotometry, and then the cleaning efficiency was evaluated by discoloration of a dye under ultraviolet irradiation, at fixed time intervals, using colorimetric technique. Because of the high reactivity of nanoparticles, the possibility of degrading the painting surface, together with the chromatic marker, was examined by colorimetric measurements. The evaluation of the color changes is important for all the materials belonging to cultural heritage, especially painting, for which the color modification induced by protective and/or cleaning interventions could irremediably compromise the work of art.

Study objective To assess the effects of a protective ventilation strategy during Trendelenburg pneumoperitoneum surgery on postoperative oxygenation.Parallel-group, randomized trial.Operating room of a university hospital, Italy.Morbidly obese patients undergoing Trendelenburg pneumoperitoneum gynaecological surgery.Participants were randomized to standard (SV: tidal volume = 10 ml/kg of predicted body weight, PEEP = 5 cmHPrimary outcome was PaOSixty patients were analyzed (31 in SV group, 29 in PV group). Median [IqR] tidal volume was 350 ml [300-360] in PV group and 525 [500-575] in SV group. Median PaOIn obese patients undergoing Trendelenburg pneumoperitoneum surgery, PV did not improve postoperative oxygenation nor day-2 respiratory function. PV was associated with intraoperative respiratory mechanics indicating less injurious ventilation. The high prevalence of complete airway closure may have affected study results.Prospectively registered on http://clinicaltrials.govNCT03157479 on May 17th, 2017.

Duke-Davidoff-Masson syndrome (DDMS) is a rare neurological condition with unknown global prevalence. It typically manifests with body asymmetry, drugs resistant epilepsy, mental retardation, cerebral atrophy, skull bone thickening and hyperpneumatization of the frontal sinuses. In this report, we present an unusual case of DDMS revealed by status epilepticus.

Multiple brain metastases single-isocenter stereotactic radiosurgery (SRS) treatment is increasingly employed in radiotherapy department. Before its use in clinical routine, it is recommended to perform end-to-end tests. In this work, we report the results of five HyperArc

IntroductionThe J-Plasma has recently been introduced into the surgical community with different intrinsic characteristics aimed to further reduce the thermal effect and enhance precision when compared to standard radiofrequency. This study aimed to investigate the role of this new technology in different conditions of gynecological carcinomatosis characterized by the indication for regional peritonectomy and/or ablation, either in laparotomy (LPT) or in laparoscopy (LPS), in the context of a modern personalized approach to the surgical management of gynecological malignancies.Material and MethodsFrom January 2019 to April 2019, 12 patients were selected for this prospective pilot study at the Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome. In this single surgeon experience, the inclusion criteria were: histologically proven advanced ovarian/endometrial cancer, primary or interval debulking surgery, and intraoperative indication for regional peritonectomy. Six patients were treated by LPS (Group 1) and 6 by LPT (Group 2).ResultsIn Group 1 the indication for debulking surgery was in 4 cases an interval debulking surgery and 2 advanced endometrial cancer. All patients in Group 2 underwent primary debulking surgery for advanced ovarian cancer. The whole cohort achieved a complete tumor excision after surgery. The median OT and median EBL were 195 min and 100 ml in Group 1, and 420 min and 500 ml in Group 2. The median hospital stay was 4 days in Group 1 and 13 days in Group 2, respectively. No intra and postoperative complications were registered within 60 days after surgery.ConclusionsJ-Plasma allows to approach delicate maneuvers on viscera, mesentery, and blood vessels with a high degree of safety and precision thanks to its limited vertical and lateral thermal spread, favoring the surgeon to push ever higher the cytoreduction/morbidity tradeoff. The use of J-Plasma in cytoreductive surgery could also increase the range of possible minimally invasive procedures, narrowing the technical distance with the open technique and thus contributing to designing a personalized surgical strategy for each patient in different scenarios of peritoneal carcinomatosis.

Bulk metallic glass (BMG), a comparatively new engineering material, is gaining popularity for its amorphous structure, improved mechanical properties, (i.e., high elasticity, hardness, and fracture toughness), and corrosion resistance. Some of the recent and prospective areas of applications of BMGs include biomedical implants, nuclear reactor, and space and electronic applications. As a result, machinability and surface treatment of BMGs have become an important area of research. In this study, a nanosecond laser with 1064 nm wavelength is used to modify the surface of a Zr-based bulk metallic glass Vitreloy 1b. (Zr67Cul0.6Ni9.8Ti8.8Be3.8). The effects of laser pulse energy level and the lens-to-sample distance on the crater and slot forming are assessed. Single shot mode of the laser system is used to generate craters, and totally six laser pulse energy levels are used. In addition, three lens-to-sample distance values are selected. These six energy levels are 0.053 J, 0.122 J, 0.296 J, 0.415 J, 0.526 J, and 0.662 J. The three different lens-to-sample distance values are 150 mm, 170 mm, and 190 mm. The focal length of the lens is 150 mm. Continuous shot mode of the laser system is used to machine slots on the BMG. For slot forming, two energy levels (0.296 J and 0.662 J) and two distance values between the lens and the workpiece (150 mm and 190 mm) along with two different overlapping ratios (0.75 and 0.95) are used. An interesting observation on the modified surface of BMG is the ripple formation at the edge of the craters, while the center of the crater has comparatively a smoother surface. The modified surface using focal length (150 mm) generated craters with higher number of wrinkles or ripples at the edge compared to the other distances between the lens and the workpiece. The characteristic of formation of ripples remains the same for slot forming also, although the intensity of ripple formation or number of ripples is decreased. Finally, a 3D surface profilometer is used to study the variation of crater depth with laser parameters. The scanning electron microscope (SEM) and energy dispersive x-ray spectroscopy (EDS) analyses are used to investigate surface topography, ripple formation, surface modification, and laser-induced elemental composition on the BMG surfaces.

This study provides a detailed description of the new HUGO™ RAS System and suggests docking settings for gynecological surgery. The system is composed of an “open” surgical console with an HD–3D passive display, a system tower, and four arm carts. Each arm has an extremely wide range of adaptability resulting from the numerous joints. The human cadaver labs were performed at the ORSI Academy between August and December 2021. All procedures were performed by two surgical teams, each composed of a high-volume surgeon experienced in robotic surgery, gynecologic oncology, and pelvic sidewall surgery, and one bedside assistant. Three main gynecological surgical scenarios were identified: standard pelvic surgery, pelvic sidewall surgery, and para-aortic/upper abdominal surgery. Concerning the port placement, the chosen options were called “straight” and “bridge”; instead, the so-called “compact” and “butterfly” configurations were identified for the arm cart positioning. Four cadavers were used to perform total hysterectomy, radical hysterectomy, pelvic exenteration, pelvic and para-aortic lymphadenectomy, and omentectomy. We performed several tests, identifying the best system configurations to draw the proper efficiency from the flexibility of the system in all gynecological surgical scenarios. The straight port placement seems to be adequate for standard pelvic surgery. The bridge trocar position is best to reach the deeper and lateral anatomical regions of the female pelvis. The compact and butterfly arm cart allocations are adequate for both straight and bridge port placement. When deep pelvic surgery was performed, the bedside assistant became more proficient by working with a standard laparoscopic instrument from an ancillary port placed in the left iliac fossa. The arm carts needed to be moved in an open manner, like for the proposed butterfly configuration. On the contrary, the compact disposition left enough space to assist from Palmer’s point port. Several basic and advanced gynecological surgical procedures were performed and completed successfully without encountering any technical or surgical issue, the results obtained were judged sufficient to proceed with the clinical experience in daily practice. The HUGO™ RAS system is flexible and highly performative in various surgical scenarios.

Inconel 718 superalloy is a widely used material in aerospace due to its high strength, corrosion resistance, and high resistance to thermal fatigue. Excellent mechanical and thermal properties also make Inconel 718 one of the most difficult-to-machine alloys. This study aims to take a different approach of analyzing tool wear during machining of Inconel 718 by measuring worn-out area on each flute from three different faces of flute. This paper also includes analysis of cumulative tool wear, cutting forces, surface roughness, topography, burr formation, and chip morphology at various machining parameters and cooling conditions. The cutting speed was kept constant at 60 m/min due to the goal of machining at highest possible speed and the limitation in maximum spindle speed of the machine tool. Experiments were carried out in dry and flood coolant machining using uncoated carbide tools by varying depth of cut and feed rate for four different settings each. It was found that the amount of tool wear varied for different flutes when measured from top, rake, and back faces of each flute, even for the same tool. The back and rake faces exhibit more chipping wear when machining is carried out at higher depth of cut, irrespective of the cooling conditions. At the same machining conditions for the range of parameters selected in this study, flood coolant machining resulted in slightly higher tool wear at the back and rake faces of cutting flutes and generated higher cutting speed, which may be interrelated. The gradual increase in tool wear over time resulted in an increase in surface roughness from entry to exit of a 76.2 mm machined slot. Flood coolant machining resulted in slightly smoother surface finish at the lower settings of depth of cut and feed rate, while the burr formation was marginally higher in flood coolant machining during machining at higher feed rate and depth of cut. The amount of serration was found to increase specifically with the increase of feed rate and was found to be higher for dry machining compared to flood coolant machining at the same parameter settings. Finally, the new approach of tool wear analysis from different faces of individual cutting flute could provide important guidelines for predicting tool life or potential catastrophic tool failure during machining of Inconel 718.

Nowadays, no standard approaches for follow up in ovarian cancer (OC) patients exist. While the role of ultrasound (US) is well defined in primary diagnosis of OC, it is still controversial during follow-up of surgically treated OC. The aim of this narrative review is to evaluate the role described in literature of US imaging in the early detection of OC recurrences. A review of the English literature present in PubMed and SCOPUS of the past 30 years regarding the use of US in recurrent ovarian cancer (ROC) has been performed. The following keywords were searched: "ultrasound and recurrent ovarian cancer" and "intraoperative ultrasound and recurrent ovarian cancer". A total of 15 articles were selected. US was mainly adopted in the detection of recurrent pelvic disease after debulking surgery, after fertility sparing surgery (FSS) and as an intraoperative tool for localization of OC recurrences. If introduced as a standard follow-up procedure, US may have a central role in the early detection of pelvic OC recurrence, in ovarian localization of relapses of borderline ovarian tumor (BOT) and early stages disease treated with FSS; it may also play an important role in the intraoperative localization of previously suspected secondary lesions.

The objective of the present review is to thoroughly investigate the role of minimally invasive surgery (MIS) in the setting of secondary cytoreduction for ovarian cancer recurrence, comparing this approach to traditional open surgery. PubMed, ClinicalTrials. gov, Scopus and Web of Science databases (between 1st January 1989 and 1st January 2020), have been systematically queried to identify all articles reporting either laparoscopic or robotic-assisted secondary surgical cytoreduction for recurrent ovarian cancer. We also manually searched the reference lists of the identified studies. Only English language papers were considered. Two independent reviewers screened and identified the reports. A sub-analysis was performed including studies comparing MIS vs. open abdominal secondary cytoreduction. A total of 617 articles were considered. Among them, we included 12 retrospective studies on minimally invasive secondary cytoreduction, enrolling 372 patients (260 of whom were submitted to whether robotics or laparosopy). Three studies compared 69 patients who underwent MIS vs. 112 cases of open abdominal secondary cytoreduction. Other 9 articles described a total of 191 patients who had minimally invasive secondary cytoreduction for recurrent ovarian cancer without a comparative arm. The quality of the evidence was low. The decision regarding the use of MIS was left to surgeon's discretion; in general, the candidates to MIS were selected patients with single-site disease or few localizations of relapse. Compared to open surgery, MIS was associated with significantly lower blood loss, shorter hospital stay and less postoperative complications; the rate of complete cytoreduction to residual tumor =0 was 95.5% in MIS cases vs. 87.5% in laparotomy cases. The risk of complications was generally low. Disease-free and overall survival were comparable between groups. There is no consensus on the criteria to select patients for laparoscopic or robotic secondary cytoreduction. Intra-operative ultrasound has been proposed as a possible tool to better identify the site of recurrence and for confirmation of complete resection of disease. In conclusion, MIS is an option in selected patients with recurrent ovarian cancer, provided there is no widespread disease. Selection of patients appears of utmost importance to obtain satisfactory survival outcomes.

Background Arrhythmogenic cardiomyopathy (ACM) is a primary disease of the myocardium with arrhythmic manifestations and fibro–fatty replacement either of the right (RV) or the left ventricle (LV) at the cardiac magnetic resonance (CMR). Over the last decade, different mutations in cardiac genes associated with heterogeneous phenotypes have been identified. Aim To investigate the genotype–phenotype relationships in ACM patients. Firstly, the phenotypic expression was defined in definite mutation carriers. Secondly, the prognostic significance of mutations was assessed across different phenotypes. Methods The study population included 281 patients with suspected ACM, based on family history, clinical and electrocardiographic evaluation, echocardiographic and CMR findings (Fig.1), studied at our Institution since 2012. All patients underwent genetic evaluation using Sanger sequencing and NGS of mutations in desmosomal (desmoplakin [DSP], plakophilin–2[PKP2], plakoglobin[JUP], desmoglein–2 [DSG2], desmocollin–2 [DSC2]) or non desmosomal genes. The composite endpoint included cardiac death, sustained and non–sustained ventricular tachycardia (VT), ventricular fibrillation (VF), appropriate defibrillator shock/antitachycardia pacing (ATP). Results The genetic test was positive in 113 patients (40%), 82 (73%) for desmosomal genes (41 DSP, 15 DSG2, 15 PKP2, 5 JUP, 6 DSC2), and 31 (27%) for non–desmosomal genes (4 titin, 2 TMEM 43, 2 lamin A/C, 23 others). Gene–positive compared to gene–negative (n = 168, 60%) patients showed a higher prevalence of LV ejection fraction (EF)

Background: The benefits of minimally invasive surgery are well known in gynaecology. Robotic-assisted surgery has gained widespread acceptance within the surgical community and seems to be the most rapidly developing sector of minimally invasive surgery. Objectives: This video shows the salient steps of total hysterectomy with new robotic technology, Hugo™ RAS. The objectives were to introduce and demonstrate the feasibility, efficacy, and safety of this new advanced device. Material and Methods: A sixty-two years-old woman affected by BRCA-1 mutation underwent the first European gynaecological surgical procedure using the new surgical robot Hugo™ RAS in the Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Main Outcomes measures: Docking and operative times. Results: The docking time was 6 minutes and the total operative time was 58 minutes. There were no system errors and faults in the robotic arms. The surgeon found no friction or rasping in the arms. The estimated blood loss was 30 mL. No intraoperative complications were recorded. Conclusion: Gynaecological surgery with Hugo™ RAS seems feasible, safe and effective as shown by initial experiences in urological surgery. A larger case series would confirm the current experience and determine whether this technology could offer any additional benefit.

In recent years, bioactive compounds have been the focus of much interest in scientific research, due to their low toxicity and extraordinary properties. However, they possess poor solubility, low chemical stability, and unsustainable bioavailability. New drug delivery systems, and among them solid lipid nanoparticles (SLNs), could minimize these drawbacks. In this work, morin (MRN)-loaded SLNs (MRN-SLNs) were prepared using a solvent emulsification/diffusion method, using two different lipids, Compritol® 888 ATO (COM) or Phospholipon® 80H (PHO). SLNs were investigated for their physical–chemical, morphological, and technological (encapsulation parameters and in vitro release) properties. We obtained spherical and non-aggregated nanoparticles with hydrodynamic radii ranging from 60 to 70 nm and negative zeta potentials (about −30 mV and −22 mV for MRN-SLNs-COM and MRN-SLNs-PHO, respectively). The interaction of MRN with the lipids was demonstrated via μ-Raman spectroscopy, X-ray diffraction, and DSC analysis. High encapsulation efficiency was obtained for all formulations (about 99%, w/w), particularly for the SLNs prepared starting from a 10% (w/w) theoretical MRN amount. In vitro release studies showed that about 60% of MRN was released within 24 h and there was a subsequent sustained release within 10 days. Finally, ex vivo permeation studies with excised bovine nasal mucosa demonstrated the ability of SLNs to act as a penetration enhancer for MRN due to the intimate contact and interaction of the carrier with the mucosa.

We present some results, obtained using a multi-scale approach, based on the employment of different and complementary techniques, i.e., Optical Microscopy (OM), Scanning Electron Microscopy-Energy Dispersive X-ray Spectroscopy (SEM-EDS), X-ray diffraction (XRD), Raman and µ-Raman spectroscopy, Fourier transform infrared (FT-IR) spectroscopy equipped with Attenuated Total Reflectance (ATR) analyses, Inductively Coupled Plasma–Mass Spectrometry (ICP-MS), and Thermal Ionization Mass Spectrometry (TIMS), of an integrated activity focused on the characterization of micro-fragments of original and previously restored paintings of the pictorial cycle at the San Panfilo Church in Tornimparte, sampled from specific areas of interest. The study was aimed, on one hand, at the identification of the overlapping restoration materials used during previous conservation interventions (documented and not), and, on the other hand, at understanding the degradation phenomena (current or previous) of the painted surfaces and the architectural structures. The study of stratigraphy allowed us to evaluate the number of layers and the materials (pigments, minerals, and varnishes) present in each layer. As the main result, the identification of blue, black, yellow, and red pigments (both ancient and modern) was achieved. In the case of blue pigments, original (azurite and lazurite) and retouching (Prussian blue and phthalo blue) materials were recognized, together with alteration products (malachite and atacamite). Traces of yellow ochre were found in the yellow areas, and carbon black in the blue and brown areas. In the latter, hematite and red ochre pigments were also recognized. The obtained results are crucial to support the methodological choices during the restoration intervention of the site, and help to ensure the compatibility principles of the materials on which a correct conservative approach is based.

This research activity regards the development of a sensor based on a Sansevieria cylindrica plant for the measurement of visible radiation. The proposed solution, based on the adoption of a soil-plant system as a chemo-electrical transducer, goes beyond “classical” silicon-based approaches that are not biodegradable nor eco-friendly and that produce CO2 from the production step to the disposal phase. It is worth noting that no toxicity can be associated with plants and, due to the natural process of photosynthesis, these systems, used as living sensors, are even able to absorb carbon dioxide from the environment. The working principle of the proposed device based on the metabolic processes of the natural organisms present in the living system, soil and plant, as a function of visible radiation will be presented here. Particular emphasis will be also given to the analysis of the visible radiation spectrum, the metrological characterization, the performance of the device, and the analyses in terms of insensitivity to other external physical quantities. The obtained results evince the suitability of the proposed device which presents the prerogative of being environmentally friendly, self-generating, battery-less, simple, mimetic, low-cost, non-toxic, and biodegradable. The aforementioned features pave the road for a disruptive technological approach for an ecological transition which can impact the variegated applied field, including in the security, cultural heritage, smart home, and smart agriculture aspects.

BQ.1.1 has dominated the Europe and Americas COVID-19 wave across the 2022–2023 winter, and further viral evolution is expected to escape the consolidating immune responses. We report here the emergence of the BQ.1.1.37 variant in Italy, peaking in January 2022 before suffering competition by XBB.1.*. We attempted to correlate the potential fitness of BQ.1.1.37 with a unique two-amino acid insertion within the Spike protein.

Introduction: Ovarian cancer (OC) represent nearly 4% of gynecologic malignancies and it is often diagnosed at advanced stage. Diaphragmatic surgery, a fundamental step of advanced stage ovarian cancer (ASOC) debulking surgery, is associated with a high post-operative complication incidence, which is supposedly reduced with thoracostomy tube placement. We assessed the role of intra-operative thoracostomy tube placement, as a prevention measure for post-operative complications, after diaphragmatic resection. Methods: This was a single center prospective randomized trial. Ovarian cancer patients, who underwent mono-lateral diaphragmatic resection, were randomized 1:1 into two arms. Arm A included patients receiving intra-operative thoracostomy tube placement (TP); Arm B patients did not receive thoracostomy tube placement (NTP). After surgery, all patients underwent seriate chest x-ray and ultrasound to record thoracic complications. Statistical analysis included uni- and multivariable logistic regression model (proportional odds model). Results: Three hundred seventy-one patients were screened and 88 patients were enrolled: 44 in arm A and B, respectively. No statistically significant differences for intra-operative (p = 0.291) and any grade of post-operative complication (p = 0.072) were detected, while 6.8% of patients in arm A and 22.7% in arm B experienced severe respiratory symptoms (p = 0.035); 18.2% of patients in arm A had a moderate/large pleural effusion versus 65.9% in arm B (p < 0.0001). At multivariable analysis, results confirmed that the NTP-group had a higher risk to receive post-operative thoracostomy tube placement due to pleural effusion than the TP-group (odds ratio [95% Confidence Interval] = 14.5 [3.7–57.4]). Conclusions: Thoracostomy intra-operative tube placement after diaphragmatic resection is effective to prevent post-operative thoracic complications. The extension of resection does not influence outcomes and the risk of post-operative thoracentesis or TP remain elevated.

Primary Hypobetalipoproteinemias (HBL) are a group of dominant and recessive monogenic genetic disorders caused by mutations in APOB, PCSK9, ANGPTL3, MTTP, Sar1b genes and characterized by plasma levels of total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C) and apolipoprotein B (apoB) below the 5To explore the complex genetic architecture of HBL we compared two polygenic risk scores in order to assess the role of the polygenic burden and the differences in the clinical phenotype between monogenic and polygenic HBL; we studied a cohort of 170 subjects with primary HBL referred over a 25-year period to 2 Italian reference centers have been studied.The genetic analyses have been based on: Sanger sequencing, in-house NGS customized panel and two scores, PRS1 and PRS2 for the polygenic burden.Sixty 60 (35%) and 63 (37%) subjects had a monogenic and polygenic HBL respectively. LDL-C plasma levels were significantly lower in monogenic HBL (30.87 ± 3.12 mg/dl) compared with the non-monogenic HBL (42.80 ± 2.18 mg/dl) (p0.002) with no differences in the percentage of fatty liver.Only PRS1 is effective in detecting polygenic HBL while PRS2 does not improve the polygenic diagnosis.

Color specification is an important challenge in many application domains including Cultural Heritage. The collection of metadata concerning Cultural Heritage involves the valorization, fruition and becomes part of the conservation process. It becomes essential to find methods that simplify and optimize the acquisition of such data as color information. In this regard, in this work we present the preliminary results of a project that involves the acquisition by 3D scanner of samples of different colors placed in a controlled environment and with different illumination conditions. To make more accurate the color rendering, the color coordinates of each sample were measured by a spectrophotometer. All the obtained measurements become part of a dataset with which to train a machine learning model that learns how to perform the transformation from the RGB to the CIELab color space in different lighting condition.

Demands on flexible neural interfaces in terms of functionality, spatial resolution and longevity have increased in the past years. These requirements can be met by sophisticated integrated circuits developed in CMOS (complementary metal oxide semiconductor) technology. Embedding such fabricated dice into flexible polymeric substrates greatly enhances the adaption to the mechanical environment in the body. With the process developed here, 100 % of individual dice (n = 34, 390 x 390 μm