Search

In this letter, we investigate the effect of Carbon (C) doping concentration on dynamic RON, vertical leakage and Capacitance-Voltage (C-V) characteristics of p-GaN gate High Electron Mobility Transistors (HEMTs). Measurements performed on state-of-the-art samples show that further increasing C-doping concentration in the GaN buffer above $10^{{19}}$ cm $^{-{3}}$ yields a reduced dynamic-RON degradation, in contrast with the behavior reported in the literature for lower C-doping concentrations. This is confirmed by a complete data set showing a consistent increase in the vertical leakage and in the output capacitance while increasing the C doping, stemming from a less insulating buffer and a reduced 2-DEG depletion, respectively. These observations can be attributed to an increased incorporation of compensating donors leading to a reduction of the net acceptors as the C doping concentration is raised above $10^{{19}}$ cm $^{-{3}}$ .

Abstract: This paper has been developed in the framework of a larger research program, in which the University of Rome “Tor Vergata”, Tsinghua University and Yangzhou University are jointly involved to study and preserve historic towers. Cultural heritage is the intangible and tangible attributes of a society, including the natural heritage, that are inherited from past generations, preserved in the present and granted for the next generations. Nowadays we consider the cultural heritage as a world heritage belonging to all the people of the world, irrespective on which territory they are located. This paper presents a model and a methodological hypothesis to conserve cultural heritage in a sustainable way throughout the case study of Sichuan Towers (China) that could become an example for other cultural sites around the world, connecting the environmental and socio-economical aspect to the tourism development.

The REDISCOVER guidelines present 34 recommendations for the selection and perioperative care of borderline-resectable (BR-PDAC) and locally advanced ductal adenocarcinoma of the pancreas (LA-PDAC). These guidelines represent a significant shift from previous approaches, prioritizing tumor biology over anatomical features as the primary indication for resection. Condensed herein, they provide a practical management algorithm for clinical practice. However, the guidelines also highlight the need to redefine LA-PDAC to align with modern treatment strategies and to solve some contradictions within the current definition, such as grouping "difficult" and "impossible" to resect tumors together. Furthermore, the REDISCOVER guidelines highlight several areas requiring urgent research. These include the resection of the superior mesenteric artery, the management strategies for patients with LA-PDAC who are fit for surgery but unable to receive multi-agent neoadjuvant chemotherapy, the approach to patients with LA-PDAC who are fit for surgery but demonstrate high serum Ca 19.9 levels even after neoadjuvant treatment, and the optimal timing and number of chemotherapy cycles prior to surgery. Additionally, the role of primary chemoradiotherapy versus chemotherapy alone in LA-PDAC, the timing of surgical resection post-neoadjuvant/primary chemoradiotherapy, the efficacy of ablation therapies, and the management of oligometastasis in patients with LA-PDAC warrant investigation. Given the limited evidence for many issues, refining existing management strategies is imperative. The establishment of the REDISCOVER registry (https://rediscover.unipi.it/) offers promise of a unified research platform to advance understanding and improve the management of BR-PDAC and LA-PDAC.

BackgroundBRCA1/2testing is crucial to guide clinical decisions in patients with hereditary breast/ovarian cancer, but detection of variants of uncertain significance (VUSs) prevents proper management of carriers. The ENIGMA (Evidence-based Network for the Interpretation of Germline Mutant Alleles) BRCA1/2Variant Curation Expert Panel (VCEP) has recently developed BRCA1/2variant classification guidelines consistent with ClinGen processes, specified against the ACMG/AMP (American College of Medical Genetics and Genomics/Association for Molecular-Pathology) classification framework.MethodsThe ClinGen-approved BRCA1/2-specified ACMG/AMP classification guidelines were applied to BRCA1/2VUSs identified from 2011 to 2022 in a series of patients, retrieving information from the VCEP documentation, public databases, literature and ENIGMA unpublished data. Then, we critically re-evaluated carrier families based on new results and checked consistency of updated classification with main sources for clinical interpretation of BRCA1/2variants.ResultsAmong 166 VUSs detected in 231 index cases, 135 (81.3%) found in 197 index cases were classified by applying BRCA1/2-specified ACMG/AMP criteria: 128 (94.8%) as Benign/Likely Benign and 7 (5.2%) as Pathogenic/Likely Pathogenic. The average time from the first report as ‘VUS’ to classification using this approach was 49.4 months. Considering that 15 of these variants found in 64 families had already been internally reclassified prior to this work, this study provided 121 new reclassifications among the 151 (80.1%) remaining VUSs, relevant to 133/167 (79.6%) families.ConclusionsThese results demonstrated the effectiveness of new BRCA1/2ACMG/AMP classification guidelines for VUS classification within a clinical cohort, and their important clinical impact. Furthermore, they suggested a cadence of no more than 3 years for regular review of VUSs, which however requires time, expertise and resources.

Association of advanced age, neoplastic disease and immunocompromission (IC) may lead to surgical emergencies. Few data exist about this topic. Present study reports the preliminary data from the WIRES-T trial about patients managed for colorectal neoplastic emergencies in immunocompromised patients. The required data were taken from a prospective observational international register. The study was approved by the Ethical Committee with approval n. 17575; ClinicalTrials.gov Identifier: NCT03643718. 839 patients were collected; 753 (80.7%) with mild–moderate IC and 86 (10.3%) with severe. Median age was 71.9 years and 73 years, respectively, in the two groups. The causes of mild–moderate IC were reported such malignancy (753–100%), diabetes (103–13.7%), malnutrition (26–3.5%) and uremia (1–0.1%), while severe IC causes were steroids treatment (14–16.3%); neutropenia (7–8.1%), malignancy on chemotherapy (71–82.6%). Preoperative risk classification were reported as follow: mild–moderate: ASA 1–14 (1.9%); ASA 2–202 (26.8%); ASA 3–341 (45.3%); ASA 4–84 (11.2%); ASA 5–7 (0.9%); severe group: ASA 1-1 patient (1.2%); ASA 2–16 patients (18.6%); ASA 3–41 patients (47.7%); ASA 4–19 patients (22.1%); ASA 5–3 patients (3.5%); lastly, ASA score was unavailable for 105 cases (13.9%) in mild–moderate group and in 6 cases (6.9%) in severe group. All the patients enrolled underwent urgent/emergency surgery Damage control approach with open abdomen was adopted in 18 patients. Mortality was 5.1% and 12.8%, respectively, in mild–moderate and severe groups. Long-term survival data: in mild–moderate disease-free survival (median, IQR) is 28 (10–91) and in severe IC, it is 21 (10–94). Overall survival (median, IQR) is 44 (18–99) and 26 (20–90) in mild–moderate and severe, respectively; the same is for post-progression survival (median, IQR) 29 (16–81) and 28, respectively. Univariate and multivariate analyses showed as the only factor influencing mortality in mild–moderate and severe IC is the ASA score. Colorectal neoplastic emergencies in immunocompromised patients are more frequent in elderly. Sigmoid and right colon are the most involved. Emergency surgery is at higher risk of complication and mortality; however, management in dedicated emergency surgery units is necessary to reduce disease burden and to optimize results by combining oncological and acute care principles. This approach may improve outcomes to obtain clinical advantages for patients like those observed in elective scenario. Lastly, damage control approach seems feasible and safe in selected patients.

Trans-axillary robot-assisted total thyroidectomy (RATT) is nowadays worldwide accepted but the completeness obtained by RATT is still debated. The Aim of this study was to compare the completeness and safety of RATT with conventional open thyroidectomy (OT). We enrolled patients with nontoxic multinodular goiter, cytologically indeterminate nodules and well differentiated thyroid cancer without local and/or distant metastasis. In all cases the biggest nodule should be < 6 cm. The surgical completeness was evaluated by means of serum thyroglobulin (hs-Tg) and neck ultrasound (nUS) performed three months postoperatively. 100 patients underwent either RATT or OT. The type of surgical procedure was chosen by patients. They were then divided in two subgroups based on benign or malignant histology. There were no significant differences in the postoperatively values of hs-Tg in patients operated with RATT or OT, both in benign and malignant subgroups. The post-operative thyroid remnant volume estimated by nUS was not significantly different between the two groups, both in benign and malignant subgroups. We also analyzed the difference of the volume of the thyroid remnant ipsilateral to the axillary access vsthat of the remnant on the contralateral side and there was not significantly difference in both subgroups. RATT was demonstrated to determine a comparable surgical completeness as OT, both in benign and malignant thyroid diseases, with no differences in the prevalence of surgical complications. In our hands the surgical completeness of RATT by a single trans-axillary was satisfying.

The results of the geophysical surveys carried out in the city of Ugento, specifically in the St. Antonio area and into the Medieval Castle, are presented in this paper. The aim of this study is to integrate the results of Ground-Penetrating Radar and Electrical Resistivity Tomography surveys in order to support archaeological investigations aimed at the elaboration of a detailed archaeological map of the Messapian, Roman and Medieval settlement. Indeed, the obtained data were jointly analysed with archaeological data already known and were georeferenced on the general plans of the site in order to obtain an overall view of the anomalies detected by geophysical instrumentation and related to buried ancient structures. In particular, the geophysical surveys carried out in the St. Antonio area made it possible to reconstruct a stretch of the Messapian city walls and nearby necropolis, while the investigations inside the Castle allowed for the acquisition of very interesting data about previous phases dated to the Middle Ages (and maybe also the Messapian or Roman ages) and about the geo-morphological characteristics of the site.

The results of the geophysical surveys carried out in 2019 in the Abbey of Santa Maria di Cerrate (Lecce) are presented in this paper. The objective of this study was to achieve a better knowledge of the site, since it was only partially investigated by small archaeological excavation samples. The geophysical measurements were conducted inside and outside the church in order to identify buried ancient structures, using both the georadar and geoelectrical survey methodologies. The results of GPR (ground-penetrating radar), ERT (electrical resistivity tomography) and IP (induced polarisation) were jointly analysed with archaeological data already known and were georeferenced on the general plans of the site in order to obtain an overall view of the anomalies detected by geophysical instrumentation and probably linked to buried ancient structures.

Fewer than 100 cases of amiodarone-induced thyrotoxicosis (AIT) managed surgically have been reported worldwide. This study aims to assess the outcome of thyroidectomy under general anesthesia in a relatively large case series. A retrospective analysis of the clinical records of 53 patients who underwent thyroidectomy for AIT between 1995 and 2019 was conducted. There were 48 (90%) males and 5 females with an average age of 63.7 years. Type 1 and 2 AIT were present in 35 (66%) and 18 (34%) of patients, respectively. The mean preoperative ejection fraction (EF) was 45 ± 13%. Salvage surgery was performed in 6 (11%) patients due to decompensating heart failure and/or malignant arrhythmias. 35 (66%) patients underwent urgent surgery due to a predicted late response to medical therapy and/or the need to discontinue it. Elective surgery was performed in the remainder. A considerable improvement in mean EF occurred 12 months post-surgery (44% vs. 49%; p< 0.001). The overall survival rate following thyroidectomy was 96% at 12 months, and 83% at 5 years. No survival differences were observed based on systolic function. Cardiac-specific mortality was 11%, and these patients demonstrated a considerably shorter survival post-surgery compared to those who died of a non-cardiac cause (27 ± 18 vs. 77.5 ± 54 months; p< 0.05). Total thyroidectomy can be safely performed under general anesthesia despite severe cardiac disease. It considerably improves cardiac function and confers a survival advantage. Therefore, it should be considered early in the treatment plan of select cases.

In this paper, we propose a path-planning problem for stereotactic neurosurgery using concentric tube robots. The main goal is to reach a given region of interest inside the brain, e.g. a tumor, starting from a feasible point on the skull with an ideally short path avoiding certain sensitive brain areas. To describe the shape of the entire cannula from an entry point to the point of interest we use an existing mechanical model for continuum robots. We show numerically that our approach enables the surgeon to reach areas within the brain that would be impossible with a straight cannula as it is currently state of the art.

Background: The surgical treatment for perforated peptic ulcers (PPUs) can be safely performed laparoscopically. This study aimed to compare the outcomes of patients who received different surgical approaches for PPU and to identify the predictive factors for conversion to open surgery. Methods: This retrospective study analyzed patients treated for PPUs from 2002 to 2020. Three groups were identified: a complete laparoscopic surgery group (LG), a conversion to open group (CG), and a primary open group (OG). After univariate comparisons, a multivariate analysis was conducted to identify the predictive factors for conversion. Results: Of the 175 patients that underwent surgery for PPU, 104 (59.4%) received a laparoscopic-first approach, and 27 (25.9%) required a conversion to open surgery. Patients treated directly with an open approach were older (p&lt; 0.0001), had more comorbidities (p&lt; 0.0001), and more frequently had a previous laparotomy (p= 0.0001). In the OG group, in-hospital mortality and ICU need were significantly higher, while the postoperative stay was longer. Previous abdominal surgery (OR 0.086, 95% CI 0.012–0.626; p= 0.015), ulcer size (OR 0.045, 95% CI 0.010–0.210; p&lt; 0.0001), and a posterior ulcer location (OR 0.015, 95% CI 0.001–0.400; p= 0.012) were predictive factors for conversion to an open approach. Conclusion: This study confirms the benefits of the laparoscopic approach for the treatment of PPUs. Previous laparotomies, a greater ulcer size, and a posterior location of the ulcer are risk factors for conversion to open surgery during laparoscopic repair.

Abstract: Quality of care assessment is a crucial tool for patient safety implementation. Litigation relating to thyroid surgery is one of the most represented sectors also due to the continuous increase in the number of thyroid interventions. Given the incidence of the problem, the present study aims to outline an operational methodology for risk mapping and litigation management in thyroid surgery. The study was conducted through the analysis of data collected at Umberto I General Hospital in Rome from 2007 to 2018. All thyroid surgery claims were included and, subsequently, a descriptive statistical analysis of the categorical variables was performed with the representation of frequencies in absolute terms and as a percentage. The results obtained show that in 94% of cases (44 cases) the reported event consists of incorrect treatment. The most frequent adverse events were identified in unilateral or bilateral recurrent nerve lesions (31; 70%); incomplete removal of the thyroid gland (6; 14%), post-surgical hypoparathyroidism (4; 9%), aesthetic damage secondary to surgical scars (2; 5%), dental avulsion during intubation maneuvers (1; 2%). The experience derived from the risk mapping through management of thyroid claims proved it to be a reactive tool of considerable importance in clinical governance. The promotion of measures aimed at improving the satisfaction of some critical parameters identified in the litigation management activity such as adherence to the indications for surgery, the preoperative diagnostic path, and the adequacy of the surgical report allows to further implement the quality of care in the surgical treatment of thyroid pathology. Graphical Abstract:

Intracellular phosphorylation of therapeutic nucleoside analogues into their active triphosphate metabolites is a prerequisite for their pharmacological activity. However, the initial phosphorylation of these unnatural nucleosides into their monophosphate derivatives can be a rate-limiting step in their activation. To address this, we herein report the development of the aryloxy pivaloyloxymethyl prodrugs (POMtides) as a novel and effective nucleoside monophosphate prodrug technology and its successful application to the anticancer nucleoside analogue 5-fluoro-2′-deoxyuridine (FdUR).

Purpose: To develop and validate the Italian version of the Keratoconus Outcomes Research Questionnaire (KORQ).Methods: Cross-sectional validation study. Keratoconus patients with routine appointments at the outpatient clinic were consecutively enrolled in conjunction with a sample of non-keratoconus controls for comparison. The Italian translation from the original English version of the KORQ was administered to the patients together with the Italian version of the 25-item version of the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). The reliability and validity of the Italian KORQ were assessed using standardized internationally accepted methods for cultural adaptation and validation of health-related quality of life measures.Results: One hundred patients were deemed eligible and completed the questionnaires. The Cronbach’s alpha coefficient for internal consistency ranged from 0.71 to 0.956 across the subscales. Spearman correlation coefficient and intraclass correlation coefficient of 0.98 showed excellent test-retest reliability. The control group had better scores on every subscale. Statistically significant correlations were found between the KORQ and analogous domain of the NEI VFQ-25 and with disease severity indicators, such as visual acuity, maximum keratometry, and steepest keratometry, thus demonstrating good construct and concurrent validity.Conclusion: The Italian version of the KORQ exhibited excellent internal consistency, test-retest reliability, validity, discriminatory power, and psychometric properties comparable with those of the original English version, and thus may be adopted as a powerful vision-targeted quality of life assessment tool for Italian keratoconus patients.

La chirurgia della tiroide si è evoluta dalla sua descrizione iniziale di Kocher alla fine del XIX secolo. Alla fine del XX secolo, è apparsa la tiroidectomia endoscopica, chiamata anche videoassistita. All’inizio del XXI secolo, gli sviluppi tecnologici hanno permesso la realizzazione della tiroidectomia robotica. Se la tiroidectomia convenzionale tramite cervicotomia rimane la tecnica più ampiamente utilizzata in tutto il mondo, essa ha visto la sua pratica implementata dal monitoraggio dei nervi ricorrenti e vago. La tiroidectomia ha le sue indicazioni per il cancro della tiroide e per le patologie benigne della tiroide. In caso di cancro, comprende un trattamento del tumore tiroideo e delle aree linfonodali. Le raccomandazioni internazionali hanno tentato di standardizzare le indicazioni chirurgiche per le lesioni maligne. Questo articolo descrive la tecnica della tiroidectomia convenzionale tramite cervicotomia.

Comprehensive evidence‐based guidelines for the practice of pancreas transplantation are yet to be established. The First World Consensus Conference on Pancreas Transplantation was convened for this purpose. A steering committee selected the participants and defined the questions to be addressed. A group of literature reviewers identified 597 studies to be included in summaries for guidelines production. Expert groups formulated the first draft of recommendations. Two rounds of discussion and voting occurred online, using the Delphi method (agreement rate ≥85%). After each round, critical responses of experts were reviewed, and recommendations were amended accordingly. Recommendations were finalized after live discussions. Each session was preceded by expert presentations and a summary of results of systematic literature review. Up to three voting rounds were allowed for each recommendation. To avoid potential conflicts of interest, deliberations on issues regarding the impact of pancreas transplantation on the management of diabetes were conducted by an independent jury. Recommendations on technical issues were determined by experts and validated using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Quality of evidence was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology. Each recommendation received a GRADE rating (Grading of Recommendations, Assessment, Development and Evaluations). This article presents the results of literature search and the methods used to provide evidence‐based guidelines for the practice of pancreas transplantation at the First World Consensus Conference on Pancreas Transplantation.

The First World Consensus Conference on Pancreas Transplantation provided 49 jury deliberations regarding the impact of pancreas transplantation on the treatment of diabetic patients, and 110 experts’ recommendations for the practice of pancreas transplantation. The main message from this consensus conference is that both simultaneous pancreas‐kidney transplantation (SPK) and pancreas transplantation alone can improve long‐term patient survival, and all types of pancreas transplantation dramatically improve the quality of life of recipients. Pancreas transplantation may also improve the course of chronic complications of diabetes, depending on their severity. Therefore, the advantages of pancreas transplantation appear to clearly surpass potential disadvantages. Pancreas after kidney transplantation increases the risk of mortality only in the early period after transplantation, but is associated with improved life expectancy thereafter. Additionally, preemptive SPK, when compared to SPK performed in patients undergoing dialysis, appears to be associated with improved outcomes. Time on dialysis has negative prognostic implications in SPK recipients. Increased long‐term survival, improvement in the course of diabetic complications, and amelioration of quality of life justify preferential allocation of kidney grafts to SPK recipients. Audience discussions and live voting are available online at the following URL address: http://mediaeventi.unipi.it/category/1st‐world‐consensus‐conference‐of‐pancreas‐transplantation/246. This article described how pancreas transplantation impacts on life expectancy, quality of life, and course of diabetic complications based on the jury deliberations and expert recommendations from the First World Consensus Conference on Pancreas Transplantation.

This work deals with the analysis of the cork P50, an ablative thermal protection material (TPM) used for the heat shield of the qarmanRe-entry CubeSat. Developed for the European Space Agency (ESA) at the von Karman Institute (VKI) for Fluid Dynamics, qarmanis a scientific demonstrator for Aerothermodynamic Research. The ability to model and predict the atypical behavior of the new cork-based materials is considered a critical research topic. Therefore, this work is motivated by the need to develop a numerical model able to respond to this demand, in preparation to the post-flight analysis of qarman. This study is focused on the main thermal response phenomena of the cork P50: pyrolysis and swelling. Pyrolysis was analyzed by means of the multi-physics Computational Fluid Dynamics (CFD) code argo, developed at Cenaero. Based on a unified flow-material solver, the Volume Averaged Navier–Stokes (VANS) equations were numerically solved to describe the interaction between a multi-species high enthalpy flow and a reactive porous medium, by means of a high-order Discontinuous Galerkin Method (DGM). Specifically, an accurate method to compute the pyrolysis production rate was implemented. The modeling of swelling was the most ambitious task, requiring the development of a physical model accounting for this phenomenon, for the purpose of a future implementation within argo. A 1D model was proposed, mainly based on an a priori assumption on the swelling velocity and the resolution of a nonlinear advection equation, by means of a Finite Difference Method (FDM). Once developed, the model was successfully tested through a matlabcode, showing that the approach is promising and thus opening the way to further developments.

The First World Consensus Conference on Pancreas Transplantation provided 49 jury deliberations regarding the impact of pancreas transplantation on the treatment of diabetic patients, and 110 experts’ recommendations for the practice of pancreas transplantation. The main message from this consensus conference is that both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone can improve long-term patient survival, and all types of pancreas transplantation dramatically improve the quality of life of recipients. Pancreas transplantation may also improve the course of chronic complications of diabetes, depending on their severity. Therefore, the advantages of pancreas transplantation appear to clearly surpass potential disadvantages. Pancreas after kidney transplantation increases the risk of mortality only in the early period after transplantation, but is associated with improved life expectancy thereafter. Additionally, preemptive SPK, when compared to SPK performed in patients undergoing dialysis, appears to be associated with improved outcomes. Time on dialysis has negative prognostic implications in SPK recipients. Increased long-term survival, improvement in the course of diabetic complications, and amelioration of quality of life justify preferential allocation of kidney grafts to SPK recipients. Audience discussions and live voting are available online at the following URL address: http://mediaeventi.unipi.it/category/1st-world-consensus-conference-of-pancreas-transplantation/246.

ABSTRACTIntroductionDifferentiated thyroid cancer (DTC; >90% of all TCs) derives from follicular cells. Surgery is the main therapeutic strategy, and radioiodine (RAI) is administered after thyroidectomy. When DTC progresses, it does not respond to RAI and thyroid-stimulating hormone (TSH)-suppressive thyroid hormone treatment, and other therapies (i.e. surgery, external beam radiation therapy and chemotherapy) do not lead to a better survival. Thanks to the understanding of the molecular pathways involved in TC progression, important advances have been done. Lenvatinib is a multitargeted tyrosine kinase inhibitor of VEGFR1-3, FGFR1-4, PDGFRα, RET, and KIT signaling networks implicated in tumor angiogenesis, approved in locally recurrent or metastatic, progressive, RAI-refractory DTC. Unmet needs regarding the patient clinical therapy responsiveness in aggressive RAI-refractory DTC still remain.Areas coveredWe provide an overview from the literature of in vitro, in vivoand real-life studies regarding lenvatinib as an investigational agent for the treatment of aggressive TC.Expert opinionAccording to the SELECT trial, the treatment should be initiated with a dosage of 24 mg/day, subsequently decreasing it in relation to the side effects. The decision making process in patients with aggressive RAI-refractory DTC should be personalized and the potential toxicity should be properly managed.

La chirurgia della tiroide si è evoluta dalla sua descrizione iniziale di Kocher alla fine del XIX secolo. Alla fine del XX secolo, è apparsa la tiroidectomia endoscopica, chiamata anche videoassistita. All’inizio del XXI secolo, gli sviluppi tecnologici hanno permesso la realizzazione della tiroidectomia robotica. Se la tiroidectomia convenzionale tramite cervicotomia rimane la tecnica più ampiamente utilizzata in tutto il mondo, essa ha visto la sua pratica implementata dal monitoraggio dei nervi ricorrenti e vago. La tiroidectomia ha le sue indicazioni per il cancro della tiroide e per le patologie benigne della tiroide. In caso di cancro, comprende un trattamento del tumore tiroideo e delle aree linfonodali. Le raccomandazioni internazionali hanno tentato di standardizzare le indicazioni chirurgiche per le lesioni maligne. Questo articolo descrive la tecnica della tiroidectomia convenzionale tramite cervicotomia.

La cirugía tiroidea ha evolucionado desde su descripción inicial por Kocher a finales del siglo XIX. A finales del siglo XX, surgió la tiroidectomía endoscópica, también denominada videoasistida. A comienzos del siglo XXI, los avances tecnológicos han permitido la realización de la tiroidectomía robótica. Aunque la tiroidectomía convencional por cervicotomía sigue siendo la técnica más utilizada en todo el mundo, su técnica se ha complementado con la monitorización de los nervios recurrentes y vago. La tiroidectomía tiene sus indicaciones en caso de cáncer de glándula tiroidea y para patologías tiroideas benignas. En caso de cáncer, consta del tratamiento del tumor tiroideo y de las áreas ganglionares. Varias recomendaciones internacionales han intentado estandarizar las indicaciones quirúrgicas para las lesiones malignas. En este artículo se describe la técnica de la tiroidectomía abierta convencional por cervicotomía.

Purpose: Recent clinical practice guidelines consider thyroid lobectomy a viable alternative for low-risk papillary thyroid carcinoma PTC measuring 1–4 cm in size. We aimed to assess the likelihood of finding postoperatively determined high-risk histopathologic features that would lead to the recommendation of completion thyroidectomy. Methods: A retrospective review of patients who underwent total thyroidectomy for PTC measuring 1–4 cm in size between Jan 2012 and Jan 2018 was conducted. Patients with pre-operative high-risk characteristics were excluded: history of radiation exposure, positive family history, clinically suspicious cervical lymphadenopathy, and gross extrathyroidal extension (ETE). A hypothetical group of 245 patients remained eligible for lobectomy. The pathology specimens from the cancer-containing lobes were evaluated for high-risk features: aggressive histology, capsular and/or vascular invasion, microscopic ETE, and multifocality. A subgroup analysis was performed with 2 cm being the cut-off size. Results: The average age was 39 years with 73% being females. Mean cancer size was 16 mm. Evaluation of the cancer-containing lobe for high-risk features revealed: aggressive histology (33%), ETE (12%), capsular invasion (33%), vascular invasion (17%), and ipsilateral multifocality (30%). The cumulative risk of having ≥1 high-risk feature mandating completion thyroidectomy was 59%. The risk was considerably higher for lesions ≤2 cm compared to larger lesions (64% vs.48%; p= 0.049; RR = 1.3). Conclusions: A considerable proportion of patients initially eligible for lobectomy have high-risk features that only become evident at pathology. Therefore, a comprehensive approach is advocated to determine the extent of surgery for PTC incorporating patient preferences regarding risks and benefits.

AbstractRecent evidence show that the classical distinction between innate and acquired immunity can no longer be employed to thoroughly characterize immune defenses. As an example, both insects and vertebrates possess non-canonical defense activities that differ from those identified so far; namely, insects display immune memory and mammals show innate-like lymphocytes. At the base of these observations, it can be speculated that multicellular eukaryotes share immune cells deriving from ancestral granular and non-granular immunocytes as well as sets of soluble effectors and signaling immune-related molecules. On one hand, evolutionary pressure has selected genes coding for group-specific defense molecules; on the other, some cell types and gene products can be presently considered as being enriched with group-specific adaptations deriving from most ancient protostomes and deuterostomes. The immune defenses of more recent extant animal groups could then be seen as overlying layers constituted by both ancient cells retaining broad features for non-self defenses and more specialized cells and immunomodulatory molecules for group-specific capabilities.

Introduction: Adhesive capsulitis (AC), which is characterised by shoulder pain and a limited range of motion (ROM), is usually diagnosed on the basis of clinical suspicion, with imaging only being used to exclude other causes of similar symptoms. The aim of this study was to identify and describe the typical ultrasound (US) features of AC in a group of patients with shoulder pain and stiffness. Methods: This was a cross-sectional study of 1486 patients with AC in which two experienced US specialists examined the axillary pouch (AP), the coracohumeral ligament (CHL), the superior glenohumeral ligament (SGHL), and the long head of the biceps tendon (LHBT), and dynamically visualised the infraspinatus tendon during passive external rotation (PER) during a US evaluation of shoulder ROM. Results: AC was confirmed in 106 patients (7.1%). Thickening of the AP of more than 4 mm was observed in 93.4% of the patients, whereas 6.6% showed AP thickening of less than 4 mm but more than 60% of the thickening in the contralateral shoulder. Effusion within the LHBT sheath was detected in 71% of the patients, and thickening of the CHL or SGHL in 88%. The dynamic study of the infraspinatus tendon showed reduced sliding with folding towards the joint capsule in 73% of cases, thus changing the tendon’s profile from flat to concave during PER. The reduced tendon sliding was associated with a bouncing movement that returned the tendon to its baseline resting position in 41.5% of cases. Conclusions: We believe a sufficiently experienced US specialist can confirm a clinical diagnosis of AC by carrying out a comparative study of APs, evaluating the thickness of the CHL and SGHL, and detecting reduced sliding of the infraspinatus tendon.

La chirurgia tiroidea si è evoluta dalla sua descrizione iniziale da parte di Kocher alla fine del XIX secolo. Alla fine del XX secolo, è apparsa la tiroidectomia endoscopica, definita anche videoassistita. All’inizio del XXI secolo, gli sviluppi tecnologici hanno permesso la realizzazione della tiroidectomia robotica. Se la tiroidectomia convenzionale mediante cervicotomia rimane la tecnica più utilizzata al mondo, questa ha visto la sua pratica implementata dal monitoraggio dei nervi ricorrenti e vaghi. La tiroidectomia ha le sue indicazioni in caso di cancro alla tiroide e di alcune patologie tiroidee benigne. In caso di cancro, comprende il trattamento del tumore tiroideo e delle aree linfonodali. Alcune raccomandazioni internazionali hanno tentato di standardizzare le indicazioni chirurgiche per le lesioni maligne. Questo articolo descrive la tiroidectomia videoassistita nota anche come MIVAT (mini-invasive video-assisted thyroidectomy) e la tiroidectomia robotica.

Median arcuate ligament syndrome is a rare cause of chronic gastrointestinal ischemia caused by compression of median arcuate ligament on the celiac trunk. A 38-year-old male presented at our institution with unspecific crampy abdominal pain. After several diagnostic examinations, he firstly underwent arcuate ligament resection by laparoscopic approach and 2 months later, he underwent percutaneous transluminal angioplasty with stenting of the stenotic vessel. Postoperatory and follow-up controls showed regular patency of the artery with complete relief of abdominal symptoms. We propose a review of the literature on this uncommon condition, describing different surgical approaches.

One of the major causes of arteriovenous fistula failure is the venous stenosis due to aggressive neointimal hyperplasia. The aim of the study was to assess the arteriovenous fistula maturation comparing absorbable sutures and non-absorbable ones in native vessels. Surgeries performed during a period of 24 months by a single team of expert surgeons were evaluated. Surgeries that met the inclusion criteria, namely, age ⩾ 18 years and radio-cephalic arteriovenous fistula, were considered. According to type of suture, patients were classified as Max group (absorbable suture) and Prol group (non-absorbable). Data pertaining to 70 patients were collected; 51% were men and the mean age was 73 ± 12 years. In Max group, an increasing blood flow was observed during the first 4 weeks without post-operative complications. In Prol group, six patients had thrombosis that resulted in vascular access failure. After the first week, the duplex Doppler ultrasound of both groups showed a regular arteriovenous fistula maturation, with an increase of blood flow rate. Although pre-operative post-tourniquet mean vein diameters of Max group were not adequate, the mean vein diameter and mean blood flow rate increased after 4 weeks, respectively. On the contrary, in Prol group, mean vein diameters and blood flow rate decreased. The maturation of arteriovenous fistula and its functional performance were not altered by the type of suture (absorbable/non-absorbable). Absorbable sutures were associated with good results considering arteriovenous fistula maturation.

To assess the utility of mutational markers in determining the most appropriate initial surgery for patients with thyroglossal duct cyst carcinoma (TGDCCa) and a normal thyroid gland. Our sample comprised 15 patients with a diagnosis of TGDCCa and a thyroid gland histologically negative for any malignant involvement, who underwent surgery between the years 1994 and 2017. Clinical records were reviewed and tissue specimens were genetically tested for the presence of the most commonly encountered mutational markers in differentiated thyroid cancer: BRAF, N-RAS, and H-RAS. The primary outcome of interest was the correlation between mutational marker positivity and the T-stage of the primary tumor and its potential implication on therapeutic decision making. All 15 cases were papillary carcinomas with a mean tumor size of 17 mm (2–40 mm). According to the 7th edition of the American Joint Committee on Cancer TNM staging system, these represented: T1(n= 3), T2(n= 1), and T3(n= 11). Cancerous invasion of the pericystic soft tissue and/or hyoid bone was considered T3. BRAFV600Ewas the only mutational marker identified (7 in 15 cases). All BRAFV600E-positive lesions were T3, necessitating radioactive iodine ablation (RIA) therapy, therefore, total thyroidectomy. The correlation between BRAFV600Epositivity and extracystic cancerous extension was statistically significant [1.0 (7/7) vs. 0.5 (4/8); pvalue = 0.0035]. BRAFV600Epositivity seems to be predictive of locally advanced disease mandating RIA therapy. Therefore, it could serve as a preoperative tool that predicts the need for total thyroidectomy, in addition to Sistrunk’s procedure.

Juvenile primary hyperparathyroidism is uncommon and more symptomatic than the adult counterpart. The aim of this prospective monocentric study, conducted in a tertiary referral center, was to evaluate the clinical, biochemical, and densitometric data, and the outcome of a series of patients with juvenile primary hyperparathyroidism. The study group included 154 patients with sporadic and familial juvenile primary hyperparathyroidism, aged ≤40 years. Relative frequency of sporadic and familial forms, comparison of the clinical and biochemical characteristics, rate of cure after parathyroidectomy and the outcome of patients not undergoing surgery were evaluated. Familial cases (n= 42) were younger, less frequently females, and had milder disease compared to sporadic cases (n= 112). No difference was observed in biochemical and densitometric parameters. Among patients undergoing parathyroidectomy (n= 116), familial cases had a higher rate of multigland disease and a higher persistence/relapse rate compared to sporadic cases (73 vs. 3.6% and 48.1 vs. 5.7%, respectively). Patients who did not undergo parathyroidectomy had stable clinical, biochemical, and densitometric parameters during follow-up (median 27 months). Using the cut-off age of 25 years, there was no difference in clinical, biochemical and densitometric parameters between younger and older patients, with the exception of parathyroid hormone and phosphate, which were significantly lower and higher, respectively, in patients <25 years. In conclusion, this prospective study shows that juvenile primary hyperparathyroidism is frequently a sporadic disease, with no difference in the biochemical phenotype between sporadic and familial forms. Patients with familial juvenile primary hyperparathyroidism have a milder clinical phenotype and higher rate of persistence/recurrence after PTx than those with sporadic juvenile primary hyperparathyroidism.

Rumen fistulation is a widely used procedure that allows for collection of ruminal contents. However, fistulation is an invasive and costly procedure that generally limits the number of animals that can be recruited for experiments, thus encouraging the use of alternative techniques such as the intra-esophageal tube technique. One of the challenges of this technique is the limited ability to collect solid fractions from the rumen content pool which may impact the microbial community structure in the sample, particularly affecting the recovery and characterization of solid adherent-bacteria. We developed an intra-esophageal tube rumen sampling technique and device referred to as ‘Rumen Sampler MG’ with the aim of increasing the recovery of solid fractions from rumen content compared with other oro-ruminal sampling methods. The ‘Rumen Sampler MG’ device consists of a manual pump fitted with a barometer and an intra-esophageal flexible PVC tube with beveled terminal edge allowing for minimal clogging of the sampling tubing and a rapid flux of contents being sampled. Nine lactating Holstein-Friesian dairy cows (554.6 ± 25.2 kg BW; 8.3 ± 3.3 DIM) were recruited to evaluate the proposed method. During the procedure, animals were safely restrained in a chute and administered with a low dosage of a neuroleptic drug to reduce animal stress during sampling. An endoscopic camera was inserted into the reticulo-rumen through the esophagus to identify the sampling location and determine the length of the sampling tube necessary to reach the desired location. Following, the intra-esophageal sampling tube connected to a manual pump was inserted for collection of rumen contents. Samples collected did not present visual evidence of saliva contamination (e.g., high viscosity) and their pH ranged within expected values (6.33 - 7.04) for samples collected from the reticulo-rumen. Each sample contained 35–40% wet solids volume. Individual dry matter intake and milk production of cows continued to increase after sampling as expected for cows in the early postpartum period, suggesting that the sampling procedure did not affect cow performance. Results from microbiome analysis of rumen content samples suggest that the relative abundances of the main bacterial phyla are consistent with those from samples collected from dairy cows via rumen fistula in previous studies. The device and technique proposed allow for adequate samples of ruminal liquid and solid contents to be collected for microbiome analysis without disruption of animal performance.

•RTP improvement of p-GaN can reduce the temperature degradation of on-resistance.•Mg concentration increase in p-GaN can reduce the temperature increase of on-resistance.•Dynamic on-resistance degradation is not changing with temperature increase.•Al% increase in AlGaN can lead to higher power levels but worse lifetime performances.

Follicular variants of papillary thyroid carcinoma include encapsulated (with or without capsular/vascular invasion) and infiltrative forms, which have different clinical behaviors. The encapsulated forms that lack capsular invasion have an indolent clinical behavior that is similar to benign lesions; therefore, they were recently reclassified as ‘noninvasive follicular thyroid neoplasms with papillary-like nuclear features’ (NIFTPs). Because NIFTPs have nuclear features of papillary carcinomas, distinguishing between NIFTPs and infiltrative follicular variant of papillary thyroid carcinoma is almost impossible with cytological examination. The aim of this study is to determine whether miRNA expression profiles may help distinguish between NIFTPs versus follicular adenomas and infiltrative follicular variant of papillary thyroid carcinomas. The expression profiling of 798 miRNAs was tested in 54 thyroid tumors, including 18 follicular adenomas, 19 NIFTPs and 17 infiltrative follicular variant of papillary thyroid carcinomas, using nCounter Nanostring. We found that miR-146-5p, miR-221-5p, miR-222-3p, miR-30e-3p, and miR-152-3p could discriminate between benign and malignant lesions with a very high level of significance (P-value<0.001). High expression levels of miR-146-5p, miR-199a-5p, miR-199b-5p, miR-1285-5p, miR-1915-3p, and miR-4516, and low miR-148b-3p expression were associated with infiltrative growth of follicular variant of papillary thyroid carcinomas. Interestingly, miR-152-3p, miR-185-5p, and miR-574-3p were significantly downregulated in NIFTPs compared with follicular adenomas, whereas miR-10a-5p and miR-320e can discriminate between NIFTPs and infiltrative forms of follicular variant of papillary thyroid carcinomas. In conclusion, a panel of these markers could have high diagnostic potential as well as could be applied to presurgical fine-needle aspiration, especially for lesions classified as indeterminate thyroid nodules.

Follicular variants of papillary thyroid carcinoma include encapsulated (with or without capsular/vascular invasion) and infiltrative forms, which have different clinical behaviors. The encapsulated forms that lack capsular invasion have an indolent clinical behavior that is similar to benign lesions; therefore, they were recently reclassified as ‘noninvasive follicular thyroid neoplasms with papillary-like nuclear features' (NIFTPs). Because NIFTPs have nuclear features of papillary carcinomas, distinguishing between NIFTPs and infiltrative follicular variant of papillary thyroid carcinoma is almost impossible with cytological examination. The aim of this study is to determine whether miRNA expression profiles may help distinguish between NIFTPs versusfollicular adenomas and infiltrative follicular variant of papillary thyroid carcinomas. The expression profiling of 798 miRNAs was tested in 54 thyroid tumors, including 18 follicular adenomas, 19 NIFTPs and 17 infiltrative follicular variant of papillary thyroid carcinomas, using nCounter Nanostring. We found that miR-146-5p, miR-221-5p, miR-222-3p, miR-30e-3p, and miR-152-3p could discriminate between benign and malignant lesions with a very high level of significance (P-value<0.001). High expression levels of miR-146-5p, miR-199a-5p, miR-199b-5p, miR-1285-5p, miR-1915-3p, and miR-4516, and low miR-148b-3p expression were associated with infiltrative growth of follicular variant of papillary thyroid carcinomas. Interestingly, miR-152-3p, miR-185-5p, and miR-574-3p were significantly downregulated in NIFTPs compared with follicular adenomas, whereas miR-10a-5p and miR-320e can discriminate between NIFTPs and infiltrative forms of follicular variant of papillary thyroid carcinomas. In conclusion, a panel of these markers could have high diagnostic potential as well as could be applied to presurgical fine-needle aspiration, especially for lesions classified as indeterminate thyroid nodules.

The shape, size evolution, and nucleation mechanisms of GaAs nanoislands grown at 400 °C on As-stabilized (111)Si by metal–organic vapor phase epitaxy are reported for the first time. GaAs crystallizes in the zincblende phase in the very early nucleation stages until a continuous epilayer is formed. GaAs nanoislands grow (111)-oriented on Si as truncated hexagonal pyramids, bound by six equivalent {120} side facets and a (111) facet at the top. Their diameter and height appear to increase linearly with the deposition time, yielding a constant aspect ratio of ∼1/4. The nanoisland density (before coalescence) stays constant with time at ∼2 × 1010cm–2, suggesting that the nucleation occurs at specific Si surface sites (defects) during the very early growth stages, rather than being due to the continuous formation of new nuclei. To understand the molecular-level mechanisms driving the low-temperature MOVPE growth of GaAs on Si, we applied a deposition–diffusion–aggregation (DDA) nucleation model, which predicts a linear evolution of the overall GaAs growth rate with surface coverage, in good agreement with experimental observations, under the assumption that direct impingement of trimethylgallium (Me3Ga) molecules onto the nanoisland surface dominates the material nucleation and growth rate; the contribution of Me3Ga adsorbed onto the As-stabilized (111)Si is negligible, pointing out the reduced reactivity of the Si surface (As passivation). Our DDA model allows estimation of the effective reactive sticking coefficient of Me3Ga onto GaAs, which is equal to 2.82 × 10–5: the small value is compatible with the Me3Ga large steric hindrance and the competitive role of methyl radicals in surface adsorption at low temperature.

Supplemental digital content is available in the text.

Biocompatible, electrically conductive microfibers with superior mechanical properties have received a great attention due to their potential applications in various biomedical applications such as implantable medical devices, biosensors, artificial muscles, and microactuators. Here, we developed an electrically conductive and mechanically stable carbon nanotube-based microactuator with a low degradability that makes it usable for an implantable device in the body or biological environments. The microfiber was composed of hyaluronic acid (HA) hydrogel and single-wall carbon nanotubes (SWCNTs) (HA/SWCNT). HA hydrogel acts as biosurfactant and ion-conducting binder to improve the dispersion of SWCNTs resulting in enhanced electrical and mechanical properties of the hybrid microfiber. In addition, HA was crosslinked to prevent the leaking of the nanotubes from the composite. Crosslinking of HA hydrogel significantly enhances Young’s modulus, the failure strain, the toughness, the stability of the electrical conductivity, and the resistance to biodegradation and creep of hybrid microfibers. The obtained crosslinked HA/SWCNT hybrid microfibers show an excellent capacitance and actuation behavior under mechanical loading with a low potential of ±1 V in a biological environment. Furthermore, the HA/SWCNT microfibers exhibit an excellent in vitro viability. Finally, the biocompatibility is shown through the resolution of an early inflammatory response in less than 3 weeks after the implantation of the microfibers in the subcutaneous tissue of mice.

The aim of the study was to establish an apparent diffusion coefficient (ADC) cut-off value to classify active and non-active lesions in inflammatory bowel disease. We reviewed 167 paediatric magnetic resonance enterographies executed for suspected inflammatory bowel disease by using a 1.5- and 3-T scanner. We assessed the presence and activity of the disease by using morphologic and functional parameters such as the ADC. Each patient could have more than 1 examinations. Quantitative assessment of disease activity in the ADC map was measured placing 3 regions of interest in the areas of highest inflammation and the mean value was calculated, patients without sign of inflammation were assessed at 2 standardised site. Ileocolonoscopy, esophagogastroduodenoscopy, surgery, and video-capsule endoscopy were used as standards of reference. We enrolled 34 patients and 35 examinations: radiological findings of disease were identified in 29 examinations and 44 lesions were detected. Six patients had negative results and ADC assessment was taken at the terminal ileum and cecum. A total of 56 bowel segments were included in the study. Image analysis revealed 39 active lesions (69.6%) and their ADC values were lower compared to the ones of non-active segments. For each scanner a cut-off value was found (sensitivity: 0.91, specificity: 0.89 for 1.5 T and 0.81 for 3 T). Inter-rater agreement on disease activity between ADC values and magnetic resonance enterography results and between ADC values and the standard of reference were very good. ADC can provide a scanner-based quantitative measurement of disease activity.

La cirugía tiroidea ha evolucionado desde su descripción inicial por Kocher a finales del siglo xix. A finales del siglo xx, surgió la tiroidectomía endoscópica, también denominada videoasistida. A comienzos del siglo xxi, los avances tecnológicos han permitido la realización de la tiroidectomía robótica. Aunque la tiroidectomía convencional por cervicotomía sigue siendo la técnica más utilizada en todo el mundo, su práctica se ha complementado con la monitorización de los nervios recurrentes y vago. La tiroidectomía está indicada en el cáncer de glándula tiroidea y para patologías tiroideas benignas. En el cáncer, consta del tratamiento del tumor tiroideo y de las áreas ganglionares. Varias recomendaciones internacionales han intentado estandarizar las indicaciones quirúrgicas para las lesiones malignas. En este artículo se describen la tiroidectomía videoasistida, denominada también tiroidectomía videoasistida mínimamente invasiva o MIVAT (mini-invasive video-assisted thyroidectomy)y la tiroidectomía robótica.

Purpose:To evaluate the safety and efficacy of carotid artery stenting (CAS) performed without an embolic protection device (EPD) in a selected group of asymptomatic patients with primary internal carotid artery (ICA) stenosis or restenosis after carotid endarterectomy (CEA). Materials and Methods:Between May 2015 and May 2018, 77 patients (mean age 77 years; 60 men) underwent CAS without any embolic protection device. Forty-seven (61%) patients had primary ICA stenosis and were excluded from CEA because of high surgical risk; the other 30 (39%) patients had post-CEA restenosis (n=26) or a distal ICA flap after eversion CEA (n=4). The mean ICA stenosis was 82%. All procedures were performed from a femoral artery access. Pre- and/or postdilation were used in 64 patients. The primary outcome was the incidence of major complications (death, stroke, or myocardial infarction) during the procedure and within 30 days; the secondary outcome was the incidence of restenosis in follow-up. Results:No relevant bradycardia was encountered during CAS. The combined rate of stroke, death, or myocardial infarction at 30 days was 1.3%. The single stroke patient recovered fully after 2 months. Over a follow-up that ranged to 3 years (mean 24±18 months), no further neurological events were recorded. One (1.3%) patient had a >70% restenosis after 6 months; the lesion was dilated, successfully restoring the lumen contour. Conclusion:In our series, endovascular treatment of carotid stenosis without the use of protection devices in patients with primary stenosis or postsurgical restenosis can achieve satisfactory safety and efficacy outcomes. The choice of performing CAS without using EPDs should follow a tailored approach based on the appropriate patient anatomy and specific clinical parameters to minimize neurological complications.