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OBJECTIVES Only few studies compared the surgical morbidity and mortality of thoracoscopic segmentectomy versus lobectomy for non-small-cell lung cancer, in particular, by relating the segmental resections with the corresponding anatomical lobes. METHODS We enrolled a total of 7487 patients who underwent VATS lobectomy (7269) or segmentectomy (218) from January 2014 to July 2019. A propensity score matching approach was used to account for potential confounding factors between the 2 groups. After matching, 349 lobectomies and 208 segmentectomies were included in the analysis. We analysed the operative and postoperative outcomes of video-assisted anatomical segmentectomy compared with video-assisted lobectomy and, in details, the results of segmentectomy with its corresponding lobectomy in a large cohort of patients from the Italian VATS Group Registry. RESULTS The overall conversion rate to thoracotomy was not statistically different between the groups (27 patients 8% vs 7 patients 3%, P = 0.1). The lobectomy group had a greater number of resected lymph nodes (median 11 vs 8, P = 0.006). No significant differences were detected in 30-day mortality (1.4%, 5 patients vs 0.9%, 2 patients), overall complications (18%, 62 patients vs 14%, 29 patients) and prolonged air leakage (31 patients, 9% vs 12 patients, 6%) between lobectomy and segmentectomy, respectively. No statistical differences were found regarding the median duration of drainage (3.2 days, P = 1) and the overall median length of hospital stay (6.4 days, P = 0.1) between the 2 groups. In the context of segmentectomy versus corresponding lobectomy, the right upper lobectomy compared with right upper segmentectomy showed a higher number of resected lymph nodes (P = 0.027). No statistical differences were reported in terms of conversion rate and postoperative complication and mortality. CONCLUSIONS Segmentectomy could be considered a safe procedure without significant differences compared to thoracoscopic lobectomy in terms of postoperative morbidity and mortality.

The rapid human evolution has improved the quality of our lives through the use of technology. This not only resulted in increased raw materials extraction but also in the production of a worrying amount of electronic wastes. Indeed, in 2019 worldwide production of Electronic and Electric Equipment Waste (WEEE) was worth 50 million tons, causing several disadvantages such as the reduced space in landfills and massive shipping to countries with less restrictive regulations. On the other side, the billionaire electrical devices market is causing a significant increase in Precious Metals (PM) demand. Nowadays, the economic importance of PMs is as high as their supply risk. The answer to this problem consists of finding selective methods to extract and raffinate precious metals from disposed WEEE. On average, WEEEs contain around 30 % of plastics, 30 % ceramics, and 40 % metals; among these only around 0.1 % is characterized by PMs, such as gold, silver, rhodium, platinum, and palladium. The separation of PMs from other non-precious components is generally obtained using pyrometallurgy, which consists of fusing the wastes at temperatures up to 1500 ÷ 1700 °C. However, this method produces toxic gaseous byproducts and implies high energy costs. A possible alternative is given by hydrometallurgical processes, consisting of leaching the WEEE with solutions containing acids and oxidants at temperatures lower than 100°C. One of the main issues of the hydrometallurgical process is to leach copper and other non-precious base-metals selectively while keeping PMs in the solid-state. In this work, we report preliminary results of equilibrium and kinetic leaching tests in a well-stirred batch reactor, aimed at the optimization of the main operating parameters of a hydrometallurgical process for selective leaching of copper and other base-metals from Wasted Printed Circuit Boards (WPCBs). In particular, experiments have been carried out at different HCl and NaCl concentrations of the leaching solutions, exploring also the effect of temperature variation (20, 50, and 70 °C).

OBJECTIVES This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay. METHODS This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I–II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy. RESULTS Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P CONCLUSIONS Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.

OBJECTIVESInherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons’ ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry.METHODSThe registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications.RESULTSFour thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3–6). Grade 1 and 2 and Grade 3–5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (CONCLUSIONSVATS lobectomy is a safe procedure even in medically compromised patients. An improved classification system for conversions is proposed and prevention strategies are suggested to reduce conversion rates and possibly complications in less-experienced centres.

Background: The expertise curve of video-assisted thoracoscopic surgery (VATS) lobectomies still stirs debate and controversy both because of the number of procedures to carry out and of the evaluation of the learning threshold. The purpose of our study was the examination of the variables related to the learning curve of the video-assisted approach, to establish what may be an expression of the technical maturity of the surgeon. Methods: The National Register for VATS lobectomy built in 2013 was used to collect data from 65 Thoracic Surgery Units. Out of more than 3,700 patients enrolled, only information from Units with ≥100 VATS lobectomies were retrospectively analysed. Unpaired Student’s t-tests, Fisher’s exact tests, Pearson’s χ 2 were applied as needed. Cumulative summative analysis and one-way ANOVA were used to identify the expertise curve of VATS lobectomy. Results: Ten institutions contributed a total of 1,679 patients, who were divided into three uniform groups according to the chronological sequence of surgery. The length of utility incision, the number of dissected lymph nodes and the operative time were not statistically significant (P=0.999, P=0.972 and P=0.307, respectively) among groups. Conversion to thoracotomy and postoperative air leaks occurred in 125 (7.44%) and 109 (6.49%) patients, gradually declined in Group 3 with statistical signi cance (P=0.048 and P=0.00086). Conclusions: The conversion rate and the percentage of air leaks seem to de ne the expertise of VATS lobectomy, being linked to the ability to manage more complicated surgical cases or intraoperative adverse events.

OBJECTIVES: Inherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons’ ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry. METHODS: The registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications. RESULTS: Four thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3–6). Grade 1 and 2 and Grade 3–5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (

Introduction Malignant diseases are well-known complications after lung transplantation (LT). Among these, inflammatory myofibroblastic tumor (IMT) is a rare neoplasm with a not well-known and often aggressive biological behavior. Material and Methods We hereby describe 2 cases of cystic fibrosis patients who underwent bilateral sequential LT (BSLT) complicated by IMT. Results A 26-year-old man presented a right endobronchial lesion 6 months after BSLT. Two consecutive fiber bronchoscopic biopsies showed granulation tissue. For the persistent lesion growth, the patient underwent a transthoracic biopsy showing histologic diagnosis of IMT. Therefore, he underwent to right pneumonectomy that was unfortunately complicated after 6 months with a late bronchopleural fistula and empyema with exitus 6 months later. A 31-year-old woman 1 year after BSLT presented with a left voluminous pleural-parenchymal lesion; the histologic examination after biopsy revealed an IMT. She underwent a removal of the lesion with a macroscopic R0 resection. Histologic, immunophenotypic, and cytogenetic examinations showed a strong overexpression of anaplastic lymphoma kinase requiring biological adjuvant therapies; however, the patient refused it. Four years later, she presented a recurrence treated with debulking procedure and adjuvant radiotherapy. At last follow-up, the patient was alive with stable disease and optimal graft function. Conclusions Although IMT is a rare complication after lung transplant, to obtain a careful diagnosis, an early and aggressive treatment is mandatory.

Purpose Video-assisted thoracoscopic surgery (VATS) lobectomy has become an accepted procedure for the treatment of selected cases of lung cancer. The aim of this project was to establish national practical recommendations for the management of patients suitable for VATS lobectomy. Methods The Scientific Committee of the VATS Lobectomy Group (a branch of the Italian Society of Thoracic Surgery) identified the consensus conference as an appropriate tool for a national debate. The consensus conference was organized following indications of the Italian Department of Health: a panel of experts reviewed the literature, the jury board revised the experts’ reports, and the national conference discussed and voted on statements. The strength of recommendation for a statement was classified as weak, fair, or high when the total score ranged between 51% and 67%, 68% and 84%, or 85% and 100%, respectively. Results Eighty-six Italian thoracic surgeons attended the 1st Italian Consensus Conference on VATS lobectomy in Giulianova, Italy, on October 29-30, 2015. Thirty-three topics were discussed: indications, surgical strategy, perioperative management, and training were the main topics. Consensus was reached on 24 statements that were consequently recommended. Conclusions The Italian Consensus Conference is the first attempt to discuss VATS lobectomy-related issues in a national scientific community. Such experience determined an improvement in epistemic knowledge among the Italian thoracic surgeons and could be a suggestion for other national communities.

In this paper it is shown that multi-port dynamic thermal networks admit four canonical representations which generalize the four canonical representations of passive lumped RC networks: Foster I and II canonical forms, Cauer I and Cauer II canonical forms. In particular the generalized Foster I canonical form is equivalent to the time-constant representation and the generalized Cauer I canonical form is a passive multi-conductor RC transmission line.

A novel approach is presented for generating compact dynamic thermal networks having large numbers of power sources. The achievable accuracy of the compact model is controllable. The number of elements of the compact model linearly increases with the number of power sources.

A relation is established between the structure function of the RC transmission line modeling a one-port passive distributed thermal network and the spatial distribution of thermal properties in heat diffusion problems with generic multi-directional heat-flows.

A new series of 2-substituted-7,8-dimethyl-3H,9H-thieno[2',3':4,5]pyrimido[2,1- b][1,3,4]thiadiazin-9-ones 5a-d and 6a,b was synthesized through the hydrazinium(1+) salt of 3-amino-2,3-dihydro-5,6-dimethyl-2-thioxo- thieno[2,3-d]pyrimidin-4(1H)-one, 2. These derivatives and two analogs 10a,b were tested for their analgesic and antiinflammatory properties. The pharmacological results are discussed in comparison with those of related compounds previously tested.

Objective: The objective of the study is to analyse the causes and impact of conversion from VATS to thoracotomy identifying any possible pre-operative risk factors and related consequences. Methods: Data from patient who underwent VATS lobectomy (VATS-L) for NSCLC at VATS Group participating centres were retrospectively analysed and divided in two groups: patients treated with VATS-L and patients who suffered from conversion. Predictors of conversion were assessed with univariate and multivariable exact logistic regression. Complications were evaluated as dependent variables of conversion in a Cox multivariable logistic regression model. Results: A total of 4629 patients underwent planned VATS-L for NSCLC and of these, 432 (9.3%) required conversion; the most frequent causes were bleeding (30.4%) and fibro-calcified hilar lymph nodes (23.9%). The independent risk factors at multivariable analysis model were sex male (OR 1.458, p < 0.01), age older than 70years (OR 1.248, p = 0.036) and the clinically node-positive disease (OR 2.258, p < 0.01). The mortality rate was similar, but the percentage of patients who suffered from any complication (41.7% vs 24.4%, p < 0.01), the complication rate (65% vs 32.2%, p < 0.01), chest tube duration (p < 0.01) and the hospitalisation rate (p < 0.01) were higher for patients converted. Atrial fibrillation (OR 1.471, p = 0.019), prolonged air leak (OR 1.403, p = 0.043), blood transfusions (OR 4.820, p < 0.01), sputum retention (OR 1.80, p = 0.027) and acute kidney failure (OR 2.758, p = 0.03) were significantly associated with conversion at multivariable analysis. Conclusions: Conversion is associated with increased surgical morbidity, blood loss and hospital stay. Sex male, old age and the clinical involvement of lymph nodes were the strongest predictors of conversion.

Objectives Vascular injuries are among the most severe causes of unplanned conversion during VATS lobectomies. The study aimed to analyse the incidence of vascular injuries and their risk factors during VATS lobectomy. Methods The Italian VATS lobectomy Registry was used to collect data from 66 Thoracic Surgery Units. From 2013 to October 2016 (out of more than 3,700 patients enrolled) only information from Units with an enrollment >100 VATS lobectomies were retrospectively analysed. Logistic regression analysis was performed on selected variables of the univariate analysis. Results Ten institutions contributed a total of 1,679 patients. Vascular injuries leading to conversion occurred in 44 (2.6%) patients. Years of experiences were inversely related to the risk of vascular injuries. Univariate analysis showed age, gender, surgical activity, Charlson Index Score and number of resected lymph nodes like significantly associated variables. Multivariate analysis revealed that number of resected lymph nodes, VATS experience ratio (number of VATS lobectomies/total lobectomies performed in the same year at same centre), and surgical activity of the centre were significantly associated with the risk of conversion. Unplanned thoracotomy was correlated with postoperative morbidity. Conclusion Vascular injuries in VATS lobectomies represented a rare complication which could directly affect the postoperative outcomes. The predictive factors for conversion were multifactorial and depended on characteristics of centres and surgeons’ seniority. Minimally invasive VATS lobectomy approaches did not influence the risk of vascular damages.

Highlights • We report a case of 17 years-old male suffering from bronchogenic cysts of the mediastinum. • A complete surgical resection was performed by using bilateral simultaneous VATS with three-port access. • No intra and post-operative complications occurred., Introduction The mediastinal bronchogenic cysts represents 50%–60% of mediastinal cysts and rarely occurs in the posterior mediastinum. The final surgical resection is indicated for symptomatic patients and is recommended for some asymptomatic patients in order to establish the diagnosis and to avoid any subsequent complications. Case presentation We report a case of 17 years-old male suffering from bronchogenic cysts of the mediastinum. The patient was admitted to our hospital complaining with dry chough and dyspnea; CT scan showed a cystic mass in posterior mediastinum. To achieve a correct diagnosis and to prevent the risk of complications, a complete surgical resection was performed by using bilateral simultaneous VATS. Discussion Bronchogenic cysts manifest as solitary or multiple lesions, majority of which are located in the mediastinum while sometimes can occur in the lung parenchyma. They are usually asymptomatic and casually discovered at chest X-ray or CT scan. The most common complications are infections, pneumothorax and hemoptysis. The complete surgical resection is the only radical and definitive treatment of the bronchogenic mediastinal cysts. VATS permits good exposure of the thoracic cavity including the mediastinum and better evaluation of the anatomic relationship. The absence of intra and postoperative complications, the reduction of pain in the early postoperative period demonstrate the security of this approach. Conclusion Bilateral simultaneous VATS for resection of bilateral posterior mediastinal bronchogenic cyst may be a useful approach. In our case no intra and post-operative complications occurred and patient discharged home on 4 rd day.

Pulmonary sequestration (PS) is a rare congenital broncho-pulmonary malformation. The main feature of this disease is that partial lung tissues separate from the main lung during the embryonic period, receiving blood supply from systemic circulation arteries. Pathogenesis of PS is not clear, and categorized into congenital and acquired PS. We report a case of a 38 year old woman smoker with medical history characterized by difficult to treat asthma with frequent exacerbations and infections since childhood. CT scan showed a partial PS of left lower lobe, supplied by an abnormal artery arising from supradiaphragmatic aortic diverticulum. Surgical treatment through a lung sequestrectomy and laterobasal segment resection was performed.

The swelling behavior of molten poly(epsilon-caprolactone) in contact with carbon dioxide has been analyzed by using the pendant drop method. At subcritical pressures, the swelling kinetics of the polymer-gas solution follow the typical Fickian diffusion behavior, the volume approaching an equilibrium value after the initial transient. In supercritical conditions, after the first transient, the volume of the solution does not approach an equilibrium value but still, slowly increases. Raman experiments have suggested that this anomalous time-dependent swelling in scCO2 could be due or to slow, secondary diffusion, or to polymer dissolution in scCO2.

We prepare and characterize multiphase systems in which small amounts of recycled polymer, namely polyethylene terephtalate (PET) ground from waste bottles, are dispersed in a co-continuous blend of high-density polyethylene (HDPE) and polypropylene (PP). Some of such ternary systems are also filled with plate-like clay nanoparticles with different polarities, in order to assess their influence on the morphology and mechanical behaviour of the blends. On the basis of preliminary wettability considerations and inspections by means of scanning electron microscopy (SEM), the PET is found to preferentially locate within the PP phase. Such a positioning is desirable in order to minimize the presence of multiple interfaces, which is one of the major issues in the recycling process of co-mingles plastics. By means of SEM, dynamic-mechanical analysis and tensile tests we show that the addition of a filler with low polarity, which locates at the PET-matrix interface, has relevant implications on the structure and properties of the ternary systems, refining their morphology at the micro-scale and enhancing their high-temperature mechanical behaviour.

Epoxy nanocomposites with ceramic nanoparticles, i.e. Al2O3, Tio2 and SiO2, were prepared by combined dispersion techniques, namely mechanical mixing and sonication. The influence of fillers addition on thermal, mechanical and dielectric properties have been investigated by means of Differential Scanning Calorimetry (DSC), Dynamic‐mechanical analysis (DMA) and dielectric spectroscopy to measure the dielectric permittivity, tan δ and volume resistivity. Morphological investigations by Scanning Electron Microscopy (SEM) has been also performed.

Since the properties of semicrystalline polymers depend on the morphology, studies on effect of fillers on the composites crystallization are of great interest. In this work, a micrometric talc and a nanoclay are dispersed in a polypropylene matrix and the influence of two different fillers and temperature on the polymer crystallization behavior in quiescent conditions is assessed by means of differential scanning calorimetry (DSC) and rheological characterization through linear viscoelasticity (SAOS) [1]. The DSC tests lead to the half crystallization time, depending on overall crystallization rate (i.e. nucleation and growth) whereas by rheological measurement one can deduce also the induction time, depending only on nucleation [2].