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Great attention is increasingly paid to the heritage belonging to the XX century, particularly for the spatial structures made of concrete, that are a significant trait of this modern movement architecture. Since they demand today urgent conservation plans sustaining their deterioration, the multidisciplinary researches should devotes a profound investigations for tailored approaches providing a clear indication of best practices and recommendation for correct 3D documentation, information management and structural assessment and monitoring. In this framework, the Geomatics approaches are advancing the interests toward the multi-scale and multi-sensor digitization and for supporting management of complex information in enriched 3D models. The iconic halls B and C in Torino Esposizioni (Italy), designed by Pier Luigi Nervi, is the case study presented. It was recently awarded by the Getty Keeping it Modern grant. The multi-disciplinary research conducted, still in progress, focuses a particularly into the investigation of the structural analysis and consistency of ferrocement elements of the vaulted system finalized to the structural condition assessment. Here the role of multi-scale and multi-sensor 3D models is investigated, such as the development of a digital twin of the halls as a starting point to create an enriched informative system. The reconstruction of this model particularly considering the large extension and the complexity of the spaces, is addressed to works as a collector of 3D multi-sensor data and information related to the diagnostic investigation on structural health monitoring for the durability of ferrocement elements.

Backgrounds The COVID-19 pandemic drastically strained the health systems worldwide, obligating the reassessment of how healthcare is delivered. In Lombardia, Italy, a Regional Emergency Committee (REC) was established and the regional health system reorganized, with only three hospitals designated as hubs for trauma care. The aim of this study was to evaluate the effects of this reorganization of regional care, comparing the distribution of patients before and during the COVID-19 outbreak and to describe changes in the epidemiology of severe trauma among the two periods. Methods A cohort study was conducted using retrospectively collected data from the Regional Trauma Registry of Lombardia (LTR). We compared the data of trauma patients admitted to three hub hospitals before the COVID-19 outbreak (September 1 to November 19, 2019) with those recorded during the pandemic (February 21 to May 10, 2020) in the same hospitals. Demographic data, level of pre-hospital care (Advanced Life Support-ALS, Basic Life Support-BLS), type of transportation, mechanism of injury (MOI), abbreviated injury score (AIS, 1998 version), injury severity score (ISS), revised trauma score (RTS), and ICU admission and survival outcome of all the patients admitted to the three trauma centers designed as hubs, were reviewed. Screening for COVID-19 was performed with nasopharyngeal swabs, chest ultrasound, and/or computed tomography. Results During the COVID-19 pandemic, trauma patients admitted to the hubs increased (46.4% vs 28.3%, p < 0.001) with an increase in pre-hospital time (71.8 vs 61.3 min, p < 0.01), while observed in hospital mortality was unaffected. TRISS, ISS, AIS, and ICU admission were similar in both periods. During the COVID-19 outbreak, we observed substantial changes in MOI of severe trauma patients admitted to three hubs, with increases of unintentional (31.9% vs 18.5%, p < 0.05) and intentional falls (8.4% vs 1.2%, p < 0.05), whereas the pandemic restrictions reduced road- related injuries (35.6% vs 60%, p < 0.05). Deaths on scene were significantly increased (17.7% vs 6.8%, p < 0.001). Conclusions The COVID-19 outbreak affected the epidemiology of severe trauma patients. An increase in trauma patient admissions to a few designated facilities with high level of care obtained satisfactory results, while COVID-19 patients overwhelmed resources of most other hospitals.

The aim of this study was to analyze the results of 9 years of trauma care and data collection in a level 1 urban trauma center in Northern Italy. Overall, 6065 patients have been included in the study; the number of patients managed yearly has doubled between 2011 and 2019. This rise mostly involved patients with injury severity score (ISS)

Background Emergency surgery represents a unique context. Trauma teams are often multidisciplinary and need to operate under extreme stress and time constraints, sometimes with no awareness of the trauma’s causes or the patient’s personal and clinical information. In this perspective, the dynamics of how trauma teams function is fundamental to ensuring the best performance and outcomes. Methods An online survey was conducted among the World Society of Emergency Surgery members in early 2021. 402 fully filled questionnaires on the topics of knowledge translation dynamics and tools, non-technical skills, and difficulties in teamwork were collected. Data were analyzed using the software R, and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results Findings highlight how several surgeons are still unsure about the meaning and potential of knowledge translation and its mechanisms. Tools like training, clinical guidelines, and non-technical skills are recognized and used in clinical practice. Others, like patients’ and stakeholders’ engagement, are hardly implemented, despite their increasing importance in the modern healthcare scenario. Several difficulties in working as a team are described, including the lack of time, communication, training, trust, and ego. Discussion Scientific societies should take the lead in offering training and support about the abovementioned topics. Dedicated educational initiatives, practical cases and experiences, workshops and symposia may allow mitigating the difficulties highlighted by the survey’s participants, boosting the performance of emergency teams. Additional investigation of the survey results and its characteristics may lead to more further specific suggestions and potential solutions.

Introduction Quality in medical care must be measured in order to be improved. Trauma management is part of health care, and by definition, it must be checked constantly. The only way to measure quality and outcomes is to systematically accrue data and analyze them. Material and methods A systematic revision of the literature about quality indicators in trauma associated to an international consensus conference Results An internationally approved base core set of 82 trauma quality indicators was obtained: Indicators were divided into 6 fields: prevention, structure, process, outcome, post-traumatic management, and society integrational effects. Conclusion Present trauma quality indicator core set represents the result of an international effort aiming to provide a useful tool in quality evaluation and improvement. Further improvement may only be possible through international trauma registry development. This will allow for huge international data accrual permitting to evaluate results and compare outcomes.

Despite its rarity, traumatic hollow viscus and mesenteric injury (HVMI) have high mortality and complication rates. There is no consensus regarding its best management. Our aim is to evaluate contrast enhanced CT (ceCT) in the screening of HVMI and its capability to assess the need for surgery. All trauma patients admitted to an urban Level 1 trauma center between 2010 and 2018 were retrospectively evaluated. Patients with ceCT scan prior to laparotomy were included. Patients requiring surgical repair of HVMI and a ceCT scan consistent with HVMI were considered true positives. Six ceCT scan criteria for HVMI were used; at least one criterion was considered positive for HVMI. Sensitivity (Sn), specificity (Sp), predictive values (PV), likelihood ratios (LR) and accuracy (Ac) of ceCT of single ceCT criteria and of the association of ceCT criteria were calculated using intraoperative findings as gold standard. Therapeutic time (TT), death probability (DP), and observed mortality (OM) were described. 114 of 4369 patients were selected for ceCT accuracy analysis; 47 were considered true positives. Sn of ceCT for HVMI was 97.9%, Sp 63.6%, PPV 66.2%, NPV 97.6%, + LR 2.69, −LR 0.03, Ac 78%; no single criterion stood out. The association of four or more criteria improved ceCT Sp to 98.5%, PPV to 95.6%, + LR to 30.5. Median TT was 2 h (IQR: 1–3 h). OM was 7.8%—not significantly higher than overall OM. CeCT in trauma has become a reliable screening test for HVMI and a valid exam to select HVMI patients for surgical exploration.

Estimation of state of saturation with stone-forming salt represents a reliable tool to assess the overall risk. The available methods are based on computer-assisted ab initio calculations. Our earlier method URSUS was subsequently substituted by Lithorisk®, a software including visualization of risk profiles. Unfortunately, Lithorisk does not adapt to new versions of Windows® and Macintosh® Apple, neither runs on smartphones or tablets. We propose a novel version of the software which can be directly used online on any device equipped by different operating systems. Upon online connection and after registration, the software is ready for unlimited accesses, in either Italian, English or French. After digiting input variables (urea and creatinine also included) in a fixed dashboard, state of saturation is promptly given. In addition to state of saturation (ß) with calcium oxalate, brushite and uric acid, ß struvite and cystine are available. Both input variables and ß results are graphically depicted as green or red horizontal bars to indicate recommended values. The software was implemented with equations allowing to omit sulphate and ammonium excretion for users with difficult access to these measurements. This simplified version, tested for ßCaOx and ßBsh on 100 urine samples showed close correlation with the full version. The software gives a list of total and free concentrations and soluble complex species distribution. Results can be printed or saved as PDF. So, we propose an easily accessible software to estimate state of saturation usable on any operating system and personal device.

Purpose The Extra-Peritoneal Pelvic Packing (EPP) is a procedure used in emergency conditions to control pelvic hemorrhage. This procedure can be performed in Emergency Room (ER) if the patient is too unstable to be transported into the operating room (OR), with a possible increased risk of infections linked to a less sterile environment. Methods All patients who underwent EPP from 2009 to 2018 were selected from the trauma registry. The patients were divided into two groups according to where EPP was performed (ER or OR). A Propensity Score Matching was realized. EPP was removed in all patients in the OR after obtaining hemodynamic stabilization within 24–48 h and surgical pads were sent to the laboratory for microbiological analysis. Results Eighty-four patients underwent EPP during the period of the study. After PSM, 26 couples of patients were selected. No differences were observed between the two groups in the development of pelvic infection. Patients managed in OR showed a higher rate of associated abdominal injuries (p = 0.027) and an increasing need for external fixation (p = 0,005) as well as an increased proportion of laparotomies (p = 0.023), orthopedic interventions (p = 0.005) and a higher systolic blood pressure on admission (p = 0.003). Conclusions The EPP is a safe procedure, even when performed out of OR. The EPP in ER allows an earlier control of bleeding in patients in extremis. To minimize the risk of infection, EPP should be removed early, as soon as hemodynamics have been stabilized.

Introduction: In January 2020, the coronavirus disease 2019 (COVID-19) outbreak in Italy necessitated rigorous application of more restrictive safety procedures in the management and treatment of patients with cancer to ensure patient and staff protection. Identification of respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was a challenge during the pandemic owing to a large number of asymptomatic or mildly symptomatic patients. Methods: We report 5 patients with unknown SARS-CoV-2 infection undergoing positron emission tomography (PET)/computed tomography (CT) with radiopharmaceuticals targeting different tumor processes: 18F-FDG, 18F-choline (FCH), and 68Ga-PSMA. Results: In all patients, PET/CT showed increased tracer uptake in the lungs corresponding to CT findings of SARS-CoV-2 pneumonia. Quantitative assessment of tracer uptake showed more elevated values for the glucose analogue 18F-FDG (mean SUVmax 5.4) than for the other tracers (mean SUVmax 3.5). Conclusions: Our findings suggest that PET/CT is a sensitive modality to hypothesize SARS-CoV-2 pneumonia in patients with cancer, even when asymptomatic. More data are needed to verify the correlation among immune response to SARS-CoV-2 infection, clinical evolution, and PET results. Under the strict safety measures implemented at the PET center, the number of potentially SARS-CoV-2–positive patients undergoing PET/CT was very low (1.6%), and no staff member has been diagnosed with infection as of April 30, 2020.

Background Arterial traumas of the extremities are quite rare in civilian records; nevertheless, patients with trauma of limbs are admitted daily in emergency departments worldwide. The up-to-date information about epidemiology and treatment (open vs. endovascular surgery) comes from war records and it is not always easy getting data on mortality and morbidity in these patients. The aim of this study is to analyze the approach (open or endovascular) and the outcome of patients with vascular trauma of upper limbs (from the subclavian artery) and/or lower limbs (distal to the inguinal ligament), in the greater Milan area. Methods A retrospective analysis was conducted on data recorded by the emergency departments of two hospitals of the greater Milan between 2009 and 2017. We collected all patients with arterial injuries of the limbs in terms of demography, injury patterns, clinical status at admission, therapy (open or endovascular approach), and outcomes in terms of limb salvage and survival. Results We studied 52 patients with vascular trauma of extremities. The main mechanism of trauma was road accident (48.1%), followed by criminal acts (32.7%), self-endangering behavior (13.5%), work (3.8%), and sport accidents (1.9%). Associated lesions (orthopedic, neurological, and/or venous lesions of the limbs) were present in 39 patients (75%). All patients underwent emergency surgery, forty-six patients (88.5%) by open repair (polytetrafluoroethylene or greater saphenous vein bypass grafts, arterial suture or ligation), whereas endovascular approach was used only in 6 patients (11.5%), all treated with embolization. The overall postoperative mortality rate was 5.7% (3 patients). Among survivors, we report 5 major amputations of the lower limbs, 3 of them after bypass graft infection, and 2 after graft failure. The rate of limb salvage was 90.4%. Conclusions Isolated arterial trauma of the extremities are rare, usually they occur in the setting of multiple trauma patients. Despite progresses in surgical techniques, there are still controversies in diagnosis and treatment of these patients. We treated most cases with open surgery (n = 46), choosing endovascular approach (embolization performed mainly by interventional radiologists) in difficult anatomic districts. We believe that, during decision-making of the surgical strategy, it is important to consider the anatomical site of lesions and the general condition of the patients. Moreover, in case of multiple trauma, we suggest a multidisciplinary approach to provide the best medical care to the victims.

Purpose Diffusion tensor imaging is a magnetic resonance technique that provides information about the orientation and anisotropy of the white matter tracts. The aim of this study was to analyse diffusion tensor imaging quantitative parameters in idiopathic normal pressure hydrocephalus patients, in order to determine whether this method could correlate to clinical scores and cerebrospinal fluid flowmetry data. Methods and materials Fifteen consecutive patients with idiopathic normal pressure hydrocephalus and 15 age-matched controls underwent cerebrospinal fluid flowmetry and diffusion tensor imaging using a 1.5 Tesla system. Fractional anisotropy, mean diffusivity, axial diffusivity and radial diffusivity values were calculated using region of interest atlas-based tract-mapping in nine cerebral areas and compared among the two groups. In addition, for idiopathic normal pressure hydrocephalus patients, diffusion tensor imaging parameters were correlated to clinical scores (mini mental state examination and frontal assessment battery) and cerebrospinal fluid flowmetry data. Results Mean fractional anisotropy was significantly lower for the idiopathic normal pressure hydrocephalus group than for the control group in the forceps minor and motor cortex; the idiopathic normal pressure hydrocephalus group had significantly higher mean axial diffusivity for the genu of the corpus callosum and forceps minor. We did not find significant correlation between diffusion tensor imaging parameters and cerebrospinal fluid flowmetry and mini mental state examination, while we observed a correlation between forceps minor fractional anisotropy and frontal assessment battery; no correlation between flowmetry and clinical scores was found. Conclusion Our findings suggest that diffusion tensor imaging provides a non-invasive biomarker of white matter changes in idiopathic normal pressure hydrocephalus patients. Forceps minor is the best site to analyse. As diffusion tensor imaging offers a better correlation to clinical status than cerebrospinal fluid flowmetry, it should be included in the routine idiopathic normal pressure hydrocephalus protocol.

Psychosocial variables are key factors influencing the delicate equilibrium of chronic patients during crisis time. In this study, we explored distress, anxiety, depression, loneliness, coping strategies, and changes in life habits in 43 beta-thalassemia patients and 86 controls during Covid-19 pandemic. Patients showed higher anxiety levels and a predominant transcendent coping profile compared to controls. Patients significantly differed from controls in outdoor habits. Social isolation and habits changes in uncertain life-threaten situations as Covid-19 pandemic are particularly detrimental in fragile beta-thalassemia patients. Structured support interventions are needed to promote well-being in the Covid-19 era.

International standards of care in the trauma patient have recognized the importance of trauma registries across continents. Modern systems require modern datasets, which have to be uniform, compatible and interlinked. A regional trauma registry was developed in Lombardy thanks to the collaboration of all parties involved in trauma care, from field workers to rehabilitation professionals.

The use of moving devices equipped with range- and image-based sensor, generically defined Mobile Mapping systems (MMS), have been quite a disruptive innovation in the development of Geomatics techniques for 3D surveying large indoor-outdoor spaces and offer multiple solutions. The recent expansion of portable devices in the form of trolleys, backpacks, handheld tools largely implements SLAM (Simultaneous Localization and Mapping) algorithms and technology based on both Lidar and/or visual solutions for answering to the positioning and the 3D reconstruction problems. The research on MMS is directed to improve both multi-sensor integration implementation and usability of systems in diversified use contexts and application fields. The aim of the presented research is the evaluation of the potential of the Swift system recently developed by FARO Technologies, that has been fine-tuned for regular and large extent interiors mapping (such as factories, hospitals, airports, offices). The work tries to preliminary investigate the data delivery and usability of the integrated system. This is based on three elements mounted on a sliding trolley moved by the operator walking: the ScanPlan profilometer working for the 2D SLAM mapping, the static TLS Focus S-series, and the smartphone managing the sensors operation and the acquisition progress. The evaluation strategy undertaken will be based on the global and local performance analysis related to the trajectory, the data accuracy, the metric content and consistency. Two test studies belonging to the 20th century. architecture are presented in a preliminary framework of evaluation and validation: a Liberty-style cinema and the Torino Esposizioni Hall B designed in ferrocement by pier Luigi Nervi.

Study question Is the incidence of miscarriage rates increased in frozen embryo transfer (ET) compared with fresh ET? Summary answer The frozen ET is not associated with an increased risk of miscarriage in comparison with fresh ET. What is known already Nowadays, the freeze-all policy has gained great popularity because it minimizes OHSS and it seems to improve the reproductive outcomes. This increase was possible thanks to progress in vitrification procedures. Nevertheless, some recent evidence suggests more caution on the wide use of elective frozen ET in a general IVF population for its possible effect on some pregnancy-related complications. Endometrial preparation schemes for frozen ET include natural cycles or, more frequently, artificial cycles in which the endometrium is prepared with exogenous steroids. In this last case, the corpus luteum is absent, but its demise could be correlated with some pregnancy-related complications. Study design, size, duration A meta-analysis, based on PubMed, Cochrane CENTRAL, EMBASE, was conducted to estimate and compare the miscarriage rate (MR) in frozen versus fresh ET. Following PICOS, inclusion criteria were: Population, patients undergoing IVF/ICSI; Intervention, frozen ET; Comparison, fresh ET; Outcome, MR (primary one); clinical pregnancy rate (CPR), ongoing pregnancy rate (OPR) and live birth rates (LBR) (secondary ones). Study design: RCT. Participants/materials, setting, methods Electronic and manual search, conducted from 1990 to 2020, yielded 269 studies. Two researchers reviewed the studies independently, excluding 247 and 14 studies after the first and second screening. The outcome data from the 8 included studies were combined using a Mantel–Haenszel model and applying the random effects models. The dichotomous data results of each study were expressed as risk ratio (RR) with 95% confidence intervals (CI). Heterogeneity was evaluated using the I2 statistic. Main results and the role of chance The eight studies comprise 6,934 participants, 3,450 undergoing frozen ET and 3,484 fresh ET (Ferraretti et al., 1999; Shapiro et al., 2011a; Shapiro et al.; 2011b; Chen et al., 2016; Shi et al., 2018; Le et al., 2018; Wei et al., 2019; Stormlund et al., 2020). Preliminary analyses excluded interaction between covariates. RR of miscarriage ranged from 0.29 (Chen et al., 2016) to 3.24 (Ferraretti et al., 1999). The level of heterogeneity (I2) was 48% and it was considered as moderate. MR resulted not significantly different in frozen [279/1,601 pregnancies] compared with fresh ET [308/1,458 pregnancies] (RR = 0.727, 95%CI=0.43–1.25, p = 0.25). By analysing the 5 trials in which the endometrium was prepared with steroids (Ferraretti et al., 1999; Shapiro et al., 2011a; Shapiro et al., 2011b; Chen et al., 2016; Le et al., 2018), MR resulted not significantly different in frozen [126/720] versus fresh ET [160/682] (RR = 0.605, 95%CI 0.22–1.66; p = 0.33; I2=43%). For the secondary outcomes, CPR (RR = 1.14; 95%CI=0.97–1.35; 0.56 vs 0.52 for frozen and fresh ET, respectively), OPR (RR = 1.12; 95%CI=0.95–1.33; 0.49 vs 0.46 for frozen and fresh ET, respectively) and LBR (RR = 0.93; 95%CI=0.60–1.44; 0.49 vs 0.47 for frozen and fresh ET, respectively) were not significantly different between the two groups. Limitations, reasons for caution The MR was not the primary outcome of the included RCTs. This could have determined a sample size not calibrated for the analysis of the primary outcome of the present meta-analysis. Wider implications of the findings: This meta-analysis indicates that MR was similar between frozen and fresh ET. The endometrial preparation, in artificial cycles without corpus luteum, does not seem to influence the good course of pregnancy. Based on these results, the choice of a fresh ET should not derive by the presumed reduction of MR. Trial registration number Not applicable

The research tries to present a preliminary work into geo-spatial management of public administration assets thanks to interoperability of BIM-GIS models, related to urban scale scenarios. The strategy proposed tries to deepen the management, conversion and integration of databases related to public assets and particularly schools building, and related them into city-related geo-databases. The methodology, based on the real scenario of Torino Municipality and their needs addressed in recent studies in collaboration with FULL – Future Urban Legacy Lab from Politecnico di Torino, take advantage from the availability of two test dataset at different scale, with different potential and bottlenecks. The idea of developing a 3D digital twin of Torino actually stop long before the 3D city modelling only, but rather we have to deal with the integration and harmonization of existing databases. These data collections are often coming from different updating and based on non-homogeneous languages and data models. The data are often in table format and managed by different offices and as many management systems. Moreover, recently public administrations as the one of Torino, have increase availability of BIM models, especially for public assets, which need to be known, archived, and localized in a geographic dimension in order to benefit from the real strategic potential of a spatial-enabled facility management platform as Digital Twin. Combining the use of parametric modeler software (Revit) and visual programming language (Dynamo), the proposed methodology tries to elaborate rules on a set of shared language parameters (characterizing the buildings as attributes in both datasets: ID; address; construction; floors; rooms dimensions, use, floor; height; glass surfaces). This is tested as conversion workflow between the Municipality DB and the BIM model. This solution firstly allows the interaction and query between models, and then it proposes open issues once the enriched BIM model is imported into the geographical dimension of the Torino 3D city model Digital Twin (ArcGIS Pro platform), according to LOD standards, and enriched with semantic components from municipality DB.

Study question Is the incidence of ectopic pregnancy (EP) increased in fresh compared with frozen embryo transfer (ET)? Summary answer The fresh ET is not associated with an increase of the incidence of EP in comparison with frozen ET. What is known already EP represents the first cause of mortality in the first trimester of pregnancy. Assisted reproductive technologies (ART) are associated with an increased EP risk. The reasons of this effect are inadequately explained and may be associated with variables patients-related as tubal diseases and ART-related as the number of embryos transferred, the depth of insertion of the catheter tip during ET and the supraphysiological estradiol levels during ovarian stimulation affecting endometrial receptivity and tubal function. The role of this last factor seems to be corroborated by higher incidence of EP in fresh versus frozen ET, as highlighted by some retrospective studies. Study design, size, duration A meta-analysis, based on PubMed, Cochrane CENTRAL, EMBASE, was conducted to estimate and compare the EP rate in fresh versus frozen-thawed ET. Following PICOS, inclusion criteria were: Population, patients undergoing IVF/ICSI; Intervention, fresh ET; Comparison, frozen/thawed ET; Outcome, EP (primary one), clinical/ongoing pregnancy and live birth rates (secondary ones). Study design: RCT. Participants/materials, setting, methods Electronic and manual search, conducted from 1990 to 2020, yielded 269 studies. Two researchers reviewed the studies independently, excluding 247 and 16 studies after the first and second screening. The outcome data from the 6 included studies were combined using a Mantel–Haenszel model and applying the random effects models. The dichotomous data results of each study were expressed as risk ratio (RR) with 95% confidence intervals (CI). Heterogeneity was evaluated using the I2 statistic. Main results and the role of chance The six studies included in the present review comprise in total 6,675 participants, 3,320 undergoing frozen ET and 3,355 fresh ET (Ferraretti et al., 1999; Chen et al., 2016; Le et al., 2018; Shi et al., 2018; Wei et al., 2019; Stormlund et al., 2020). Preliminary analyses excluded interaction between covariates, defining intervention/control groups and outcome. In particular, the incidence of tubal infertility was comparable between the two groups. Risk ratio of EP ranged from 0.03 (Ferraretti et al., 1999) to 2.77 (Shi et al., 2018). The level of heterogeneity (I2) between studies was 42% and it was considered as moderate. EP incidence resulted not significantly different in fresh ET [56/1,703 pregnancies] compared with frozen ET [44/1,799 pregnancies] (RR = 0.450, 95% CI 0.13–1.81, p = 0.29; I2=42%). Analysis of the secondary outcomes was conducted on 5 studies; results showed that clinical pregnancy rate was not significantly different between fresh (0.52) and frozen ET (0.56) (RR = 1.11; 95% CI = 0.93–1.34); at the same manner, the ongoing pregnancy rate (RR = 1.11; 95%CI=0.91–1.37; 0.46 vs 0.49 for fresh and frozen, respectively) and the live birth rate (RR = 0.93; 95%CI=0.60–1.44; 0.47 vs 0.49 for fresh and frozen, respectively) resulted not significantly different between the two groups. Limitations, reasons for caution The EP incidence was not the primary outcome of the included RCTs. This could have determined a sample size not calibrated for the analysis of the primary outcome of the present meta-analysis. Wider implications of the findings: This meta-analysis indicates that EP incidence is similar between fresh and frozen ET. The possible role on EP risk of the supraphysiological estradiol levels during ovarian stimulation should be reconsidered. Based on these results, the choice of a frozen ET should not derive by the presumed reduction of EP risk. Trial registration number Not applicable

Immune thrombocytopenia (ITP) is a relatively frequent cause of thrombocytopenia during pregnancy. Thrombopoietin receptor agonists (TPO-RAs) are the most recent drugs approved for second-line treatment of ITP. Limited data are available about their use in pregnancy with only a few published cases; yet no data exist about their effect when administered only during conception and first trimester of gestation. We describe the case of a woman with refractory ITP who took eltrombopag during conception and first trimester of pregnancy. No fetal or maternal complications were reported. Moreover, the patient remained in complete response after delivery despite therapy discontinuation. The analysis of this case and the revision of the available literature suggest that the use of TPO-RAs, thanks to their short time to response, may be effective and feasible during the first trimester of pregnancy, even if not yet recommended by current guidelines.

To determine whether torso CT can be avoided in patients who experience high-energy blunt trauma but have normal vital signs. High-energy blunt trauma patients with normal vital signs were retrieved retrospectively from our registry. We reviewed 1317 patients (1027 men and 290 women) and 761 (57.8%) fulfilled the inclusion criteria. All patients were initially evaluated at the emergency room (ER), with a set of tests, part of a specific protocol. Patients with at least one altered exam at initial examination or after six-hour observation received a torso CECT. Sensitivity, specificity, accuracy, positive (PPV) and negative predictive values (NPV), and likelihood ratio (LH) of the protocol were evaluated. Of 761 patients, 354 (46.5%) received torso CECT because of the positive ER test, with 330 being true positive and 24 being false positive. The remaining 407 patients were negative at ER tests and did not receive torso CECT, showing a significantly (P

Despite widespread use of decitabine to treat acute myeloid leukaemia (AML), data on its effectiveness and safety in the real-world setting are scanty. Thus, to analyze the performance of decitabine in clinical practice, we pooled together patient-level data of three multicentric observational studies conducted since 2013 throughout Italy, including 306 elderly AML patients (median age 75 years), unfit for intensive chemotherapy, treated with first-line decitabine therapy at the registered schedule of 20 mg/m2 /iv daily for 5 days every 4 weeks. Overall response rate (ORR), overall survival (OS) curves, and multivariate hazard ratios (HRs) of all-cause mortality were computed. Overall, 1940 cycles of therapy were administered (median, 5 cycles/patient). A total of 148 subjects were responders and, therefore, ORR was 48.4%. Seventy-one patients (23.2%) had complete remission, 32 (10.5%) had partial remission, and 45 (14.7%) had haematologic improvement. Median OS was 11.6 months for patients with favourable-intermediate cytogenetic risk and 7.9 months for those with adverse cytogenetic risk. Median relapse-free survival after CR was 10.9 months (95% confidence interval [CI]: 8.7-16.0). In multivariate analysis, mortality was higher in patients with adverse cytogenetic risk (HR=1.58; 95% CI: 1.13-2.21) and increased continuously with white blood cell (WBC) count (HR=1.12; 95% CI: 1.06-1.18). A total of 183 infectious adverse events occurred in 136 patients mainly (>90%) within the first five cycles of therapy. This pooled analysis of clinical care studies confirmed, outside of clinical trials, the effectiveness of decitabine as first-line therapy for AML in elderly patients unfit for intensive chemotherapy. An adverse cytogenetic profile and a higher WBC count at diagnosis were, in this real life setting, unfavourable predictors of survival.

Flooding is one of the main natural hazards in Northern Europe and several areas of the Northern Boreal Hemisphere, where during intense rainfall events, several river basins are affected by a fast water level rise that may cause severe damage to human lives and properties. For these reasons, the development of flood models to identify susceptible areas is essential for decision-makers. Geographic Information Systems (GIS) are currently accurate and valuable support tools for defining flood susceptibility maps at different spatial scales. In this study, the prediction accuracy of different GIS-based procedures in the identification of flooding susceptibility is tested and compared. These procedures include the frequency ratio, a combination of the frequency ratio and logistic regression, a combination of the frequency ratio and Shannon’s entropy index, and the statistical index. Ten conditioning parameters of flooding susceptibility are considered: elevation, slope, curvature, land use, Topographic Wetness Index, Stream Power Index, hydrogeology, stream distance, flow direction and average annual rainfall. The comparison analysis is carried out by applying these methods to the study area of Devon County in Southwest England. A total of 225 flood events are used to define the models. For model validation, 1000 randomly selected training and testing sub-datasets have been used in the definition of the receiver operating characteristic (ROC) curves. The results show that the procedure based on the statistical index provides the highest accuracy and reliability in flood susceptibility predictions.

The investigation on the built urban heritage and its current transformations can progressively benefit from the use of geospatial data related to urban environment. This is even more interesting when urban design studies of historical and stratified cities meet the contribution of 4D geospatial data within the urban morphology researches, aiming at quickly and accurately identifying and then measuring with a spatial relationship, both localized transformation (volumes demolitions, addition, etc…) and wide-scale substantial modification resulting from urban zones of diversification spaces that incorporates urban legacies. In this domain, the comparison and analysis of multi-source and multi-scale information belonging to Spatial Data Infrastructures (SDI) organized by Municipality and Region Administration (mainly, orthoimages and DSM and digital mapping) are a crucial support for multi-temporal spatial analysis, especially if compared with new DSMs related to past urban situations. The latter can be generated by new solution of digital image-matching techniques applicable to the available historical aerial images. The goal is to investigate the amount of available data and their effectiveness, to later test different experimental tools and methods for quick detection, localization and quantification of morphological macro-transformation at urban scale. At the same time, it has been examined the opportunity to made available, with up-and-coming Mobile Mapping Systems (MMS) based on image- and range-based techniques, a rapid and effective approach of data gathering, updating and sharing at validated urban scales. The presented research, carried out in the framework of the FULL@Polito research lab, applies to urban legacies and their regeneration, and is conducted on a key redevelopment area in northern Torino, the Parco Dora, that was occupied by steel industries actively working up to 1992. The long-standing steel structures of the Ferriere FIAT lot have been refurbished and incorporated in the new urban park, generating a contemporary space with a new evolving urban fabric, and being integrated in the new updated geo-spatial databases as well.

Renal cell carcinoma (RCC) shows variable FDG uptake; recently, PET/CT with prostate-specific membrane antigen (PSMA)-target radiotracers was demonstrated to be a promising tool in staging and restaging of RCC patients. We describe the case of a 77-year-old man with a lung metastasis of papillary RCC missed by CT scan who successfully underwent [18F]FDG PET/CT restaging. Targeted therapy with sunitinib was administered. A [68Ga]PSMA PET/CT performed during follow-up demonstrated, among the already known lesions, also a bone marrow metastasis, missed by previous CT scans. This case demonstrates that PET/CT molecular imaging with [18F]FDG and [68Ga]PSMA is superior to conventional imaging in RCC restaging and in assessing therapy response.

Summary Epidemiological research may offer a key to interpreting gender incongruence (GI) and identifying the medical needs of people with GI. Currently, it is difficult to estimate the real prevalence of GI due to the use of different definitions. The data on GI prevalence are influenced by case definition and by the different methodologies applied by researchers to assess cases. Estimations of prevalence therefore vary widely and are estimated between 0.1% and 1.1% among adults, with a male-to-female (MtF) – female-to-male (FtM) sex ratio of 1–6. For children, the literature reports a prevalence ranging from 1% to 4.7%, with a predominance of MtF for children and from 1.2% to 16.1% in adolescents, among whom FtM appears to be predominant. Studies based on access to gender clinics may underestimate GI prevalence while studies focused on self- or parent-reported data may overestimate the phenomenon. The literature describes high rates of affective and anxiety disorders (18–80%) and frequent personality disorders (20–70%), suicide attempts, suicide and self-harm among people with GI. These problems seem to improve after gender affirmation treatment. Some authors report a high prevalence of Autistic Spectrum Disorders (ASD) (6–14%) among youth with GI. Mortality rates, HIV infection and sexually transmitted diseases are high among the transgender population, probably related to lack of prevention. It is crucial to determine the true prevalence of GI in order to deliver adequate medical support. Future studies should be based on large multicenter cohorts or population-based surveys, and should adopt respondent-driven sampling while including individuals who do not seek services offered at gender clinics, to limit the selection bias.

Immunization with mRNA SARS-CoV-2 vaccines has been highly recommended and prioritized in fragile categories with higher risk of mortality after COVID-19 disease compared to healthy people, including patients with myelofibrosis (MF). Available data on the vaccine immune response developed by MF patients, and the impact of the treatment with the inhibitor of JAK-STAT signaling ruxolitimib, are still fragmented to support an informed decision for a third dose for this category of subjects. Here, we show that 76% of MF patients develop spike-specific IgG after the second vaccine dose, but the response has a slower kinetic compared to healthy subjects, suggesting a reduced capability of their immune system to promptly react to vaccination. A reduced ACE2/RBD inhibition binding activity of spike-specific antibodies was also observed, especially in ruxolitimib treated patients. Our results contribute to answer the open question on the induction of the antibody responses in MF patients following vaccination with COVID-19 mRNA vaccines, showing a slow kinetic that support the need for a third dose of SARS-CoV-2 mRNA vaccines.

Pelvic trauma continues to have a high mortality rate despite damage control techniques for bleeding control. The aim of our study was to evaluate how Extra-peritoneal Pelvic Packing (EPP) and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) impact the efficacy on mortality and hemodynamic impact. We retrospectively evaluated patients who sustained blunt trauma, pelvic fracture and hemodynamic instability from 2002 to 2018. We excluded a concomitant severe brain injury, resuscitative thoracotomy, penetrating trauma and age below 14 years old. The study population was divided in EPP and REBOA Zone III group. Propensity score matching was used to adjust baseline differences and then a one-to-one matched analysis was performed. We selected 83 patients, 10 for group: survival rate was higher in EPP group, but not significantly in each outcome we analyzed (24 h, 7 day, overall). EPP had a significant increase in main arterial pressure after procedure (+20.13 mmHg, p &lt, 0.001), but this was not as great as the improvement seen in the REBOA group (+45.10 mmHg, p &lt, 0.001). EPP and REBOA are effective and improve hemodynamic status: both are reasonable first steps in a multidisciplinary management. Zone I REBOA may be useful in patients &lsquo, in extremis condition&rsquo, with multiple sites of torso hemorrhage, particularly those in extremis.

Multiple myeloma survival has significantly improved in recent years, due to novel agents that are available for treatment. The anti-CD38 monoclonal antibody Daratumumab is particularly efficient for patients with relapse/refractory disease, and many studies have shown its unprecedented efficacy also as a first treatment. However, to avoid the incidence of infusion reactions, long infusion schedules of 8 h at first dose and 4 h in the following doses are required, which can reduce the compliance of patients and health care professionals. A reduced infusion time of 90 min has been reported previously, but data are missing on the prolonged safety of this over time as well as the efficacy of this approach. In this work, we investigate the safety of 484 rapid Daratumumab infusions given early after the second dose over a 22 months period in 39 myeloma patients.

The design of a novel Banki-Michell type turbine, to be located in existing water pipelines, is proposed. The turbine has a very efficient diffuser which allows the turbine to be compact and, most important, to have in-line flanges for minimal piping modifications at existing sites. This turbine combines a simple geometry with stable efficiency in a wide range of water discharges. The design procedure estimates the outer diameter of the impeller, its width and the geometry of the diffuser. A series of experimental tests has been carried out to measure the efficiency of the proposed turbine prototype. The turbine was tested in two different configurations, with and without rotational velocity regulation. The results of the tests showed that rotational velocity adaptation improves turbine efficiency in a wide range of flow rates. A significant reduction of the optimal velocity ratio, with respect to the predicted two values, is likely due to 3D effects not accounted for in the design procedure. A simple way to roughly estimate this extra energy dissipation is derived from experimental data.

Musculoskeletal sarcomas are rare and aggressive human malignancies affecting bones and soft tissues with severe consequences, in terms of both morbidity and mortality. An innovative technique that combines photodynamic surgery (PDS) and therapy (PDT) with acridine orange has been recently suggested, showing promising results. However, due to the low incidence of sarcoma in humans, this procedure has been attempted only in pilot studies and stronger evidence is needed. Naturally occurring tumors in cats are well-established and advantageous models for human cancers. Feline injection-site sarcoma (FISS) shares with human musculoskeletal sarcomas a mesenchymal origin and an aggressive behavior with a high relapse rate. Furthermore, wide surgical excision is not always possible due to the size and site of development. We assessed the feasibility and the effectiveness of PDS and PDT with acridine orange to prevent FISS recurrence by treating a short case series of cats. For PDS, the surgical field was irrigated with an acridine orange solution and exposed to UV light to enlighten the residual tumor tissue, and the resultant fluorescent areas were trimmed. For PDT, before wound closure, the field was again irrigated with acridine orange solution and exposed to visible light to get the antitumoral cytocidal effect. The procedure was easy to perform and well tolerated, we did not observe any major complications, and all the surgical resection margins were free of disease. Finally, at follow-up, all treated patients did not show evidence of tumor recurrence and had a significantly higher event-free survival rate in respect to a control group treated only by surgery. In conclusion, by this study we demonstrated that, in FISS, PDS and PDT with acridine orange may improve local tumor control, granting a better outcome, and we laid the foundation to validate its effectiveness for the treatment of human musculoskeletal sarcomas.

Early management of critical bleeding and coagulopathy can improve patient survival. The aim of our study was to identify independent predictors of critical bleeding and to build a clinical score for early risk stratification. A prospective analysis was performed on a cohort of trauma patients with at least one hypotensive episode during pre-hospital (PH) care or in the Emergency Department (ED). Patients who received massive transfusion (MT+) (&ge, 4 blood units during the first hour) were compared to those who did not (MT&minus, ). Hemodynamics, Glagow Coma Score (GCS), diagnostics and blood tests were evaluated. Using multivariate analysis, we created and validated a predictive score for MT+ patients. The predictive score was validated on a matched cohort of patients of the German Trauma Registry TR-DGU. One hundred thirty-nine patients were included. Independent predictors of MT+ included a prehospital (PH) GCS of 3, PH administration of tranexamic acid, hypotension and tachycardia upon admission, coagulopathy and injuries with significant bleeding such as limb amputation, hemoperitoneum, pelvic fracture, massive hemothorax. The derived predictive score revealed an area under the curve (AUC) of 0.854. Massive transfusion is essential to damage control resuscitation. Altered GCS, unstable hemodynamics, coagulopathy and bleeding injuries can allow early identification of patients at risk for critical hemorrhage.

Noncompressible torso injuries (NCTIs) represent a trauma-related condition with high lethality. This study&rsquo, s aim was to identify potential prediction factors of mortality in this group of trauma patients at a Level 1 trauma center in Italy. Materials and Methods: A total of 777 patients who had sustained a noncompressible torso injury (NCTI) and were admitted to the Niguarda Trauma Center in Milan from 2010 to 2019 were included. Of these, 166 patients with a systolic blood pressure (SBP) &lt, 90 mmHg were considered to have a noncompressible torso hemorrhage (NCTH). Demographic data, mechanism of trauma, pre-hospital and in-hospital clinical conditions, diagnostic/therapeutic procedures, and survival outcome were retrospectively recorded. Results: Among the 777 patients, 69% were male and 90.2% sustained a blunt trauma with a median age of 43 years. The comparison between survivors and non-survivors pointed out a significantly lower pre-hospital Glasgow coma scale (GCS) and SBP (p &lt, 0.001) in the latter group. The multivariate backward regression model identified age, pre-hospital GCS and injury severity score (ISS) (p &lt, 0.001), pre-hospital SBP (p = 0.03), emergency department SBP (p = 0.039), performance of torso contrast enhanced computed tomography (CeCT) (p = 0.029), and base excess (BE) (p = 0.008) as independent predictors of mortality. Conclusions: Torso trauma patients who were hemodynamically unstable in both pre- and in-hospital phases with impaired GCS and BE had a greater risk of death. The detection of independent predictors of mortality allows for the timely identification of a subgroup of patients whose chances of survival are reduced.

Background Emergency Department Thoracotomy (EDRT) after traumatic Cardio-pulmonary Arrest (CPR) can be used to salvage select critically injured patients. Indications of this surgical procedure are widely debated and changed during last decades. We provide the available literature about EDRT in the effort to provide a comprehensive synthesis about the procedure, likelihood of success and patient’s outcome in the different clinical setting, accepted indications and technical details adopted during the procedure for different trauma injuries. Methods Literature from 1975 to 2020 was retrieved from multiple databases and reviewed. Indications, contraindications, total number and outcome of patients submitted to EDRT were primary endpoints. Results A total number of 7236 patients received EDRT, but only 7.8% survived. Penetrating trauma and witnessed cardiopulmonary arrest with the presence of vital signs at the trauma center are the most favorable conditions to perform EDRT. Conclusions EDRT should be reserved for acute resuscitation of selected dying trauma patient. Risks of futility, costs, benefits of the surgical procedure should be carefully evaluated before performing the surgical procedure.

Introduction Patients with severe neurogenic bowel dysfunction (NBD) may undergo the Malone antegrade continence enema (MACE) surgery to perform antegrade bowel irrigation (ABI). The standard approach may be prevented by a previous appendectomy or complicated by appendicular stenoses and/or stomal leakages. We present the experience by our tertiary referral center for NBD, adopting a modified surgical technique, based on a neoappendix with the terminal ileum to preserve the natural anti-reflux mechanism of the ileocecal valve and avoid stool leakage, and a largely available transanal irrigation (TAI) system to catheterize the neoappendix and perform ABI. Case presentation Three individuals with NBD successfully underwent our modified MACE program. Case 1 had cauda equina syndrome. He underwent surgery at 40. Case 2 was a man who suffered from spinal cord dysfunction due to acute disseminated encephalomyelitis, functionally T12 AIS B, at 57. Case 3 was a man with traumatic L1 AIS B paraplegia. At 60 he underwent surgery after 29 years since the injury. He needed a surgical revision due to a postoperative subcutaneous infection. After 121, 84 and 14 months from surgery, the three individuals performed ABI every 2 days, presented functional stomas, had no fecal incontinence, and reported an NBD score of 6, compared to 40, 33 and 35 pre-operatively. Discussion To our knowledge, this is the first report of MACE combining a tapered terminal ileum conduit and an adapted TAI system. Our approach proved to be a safe and effective strategy for severe NBD avoiding a colostomy.

Background Hemodynamically unstable pelvic fractures often require a multi-modal approach including both operative and endovascular management. While an important adjunct in hemorrhage control, time to angioembolization even at the most advanced trauma centers may take hours. Extraperitoneal packing (EPP) is a fast and effective procedure that can immediately address pelvic hemorrhage from the retroperitoneal space in severe pelvic injuries. The aim of this study was to evaluate the efficacy of early EPP, looking at 24 hours and overall mortality, and the hemodynamic impact of EPP in unstable blunt pelvic trauma. Methods All trauma patients admitted to an urban Level I trauma center were evaluated from 2002 to 2018 in a retrospective single-center comparative study. Inclusion criteria were patients 14 years or older who sustained blunt trauma with pelvic fractures and hemodynamic instability. Exclusion criteria were a concomitant head injury (Abbreviated Injury Scale >3) and patients who underwent resuscitative thoracotomy. The patient population was divided into two groups: an EPP group and a no-EPP group. Propensity score matching was used to adjust for differences in baseline characteristics in the two groups: a one-to-one matched analysis using nearest-neighbor matching was performed based on the estimated propensity score of each patient. Results Two hundred forty-four patients presented hemodynamically unstable, with a pelvic fracture (180 no-EPP, 64 EPP). With propensity score matching, 37 patients in each group were analyzed. Survival within the first 24 hours was significantly improved in the EPP group (81.1% vs. 59.5%, p = 0.042) and we registered similar results in overall survival rate (78.4% EPP group vs. 56.8% no-EPP group, p = 0.047). Those patients who underwent early EPP (n = 64) were associated with a significant improvement in hemodynamic stability, with a pre-EPP mean arterial pressure of 49.9 mm Hg and post-EPP mean arterial pressure of 70.1 mm Hg (p Conclusion Extraperitoneal pelvic packing is an effective procedure that can be performed immediately, even within the trauma bay, to improve hemodynamic stability and overall survival in patients who sustain severe blunt pelvic trauma. The early use of EPP can be lifesaving. Level of evidence Therapeutic, Level III.

Purpose of the Study: Gallium (Ga)-68-DOTA peptides targeting somatostatin receptors have been assessed as a valuable tool in neuroendocrine tumor imaging using positron emission tomography. However, at the moment, a specific monograph in the European Pharmacopoeia (Ph. Eur.) does exist only for Ga-68-edotreotide (DOTATOC) injection. Here, we report on the validation process of Ga-68-DOTA-Tyr3-octreotate (DOTATATE) cassette-based production and quality control (QC). Materials and Methods: Preparation of Ga-68-DOTATATE was performed according to the current European Union-good manufacturing practices, the current good radiopharmacy practice, the Ph. Eur., and the guidelines on validation of analytical methods for radiopharmaceuticals. Process was validated via three consecutive production runs to ensure that the methods are reproducible and reliable in routine use. The QC tests for Ga-68-DOTATATE were radiochemical purity (RCP – high-pressure liquid chromatography [HPLC]), radiochemical impurities 68Ga3+ (HPLC and instant thin layer chromatography [ITLC]), chemical purity (HPLC and gas chromatography [GC]), pH (pH-strips), radionuclidic purity (principal γ-photon), germanium-breakthrough (68Ge-content), Ga-68 half-life (γ-ray spectrometry), and sterility/endotoxin assay. Results: Radiolabeling procedure of Ga-68-DOTATATE fits all the applicable Ph. Eur. specifications. RCP measured via ITLC was >99% in the three validation batches. HPLC-measured RCP resulted 99.45%, 99.78%, and 99.75%. Germanium-breakthrough was far below the recommended level established in the Ph. Eur. Ga-68-DOTATOC injection (#2482). Residual ethanol tested with GC was less than 10%. All the batches were tested for endotoxin content, which always resulted lower than 17.5 EU/ml. All preparations passed the sterility tests. pH of the final product was 7 in all samples. Conclusion: Ga-68-DOTATATE fulfilled all the pre-set QCs and release criteria in the batches considered for this validation study. The results demonstrated a batch-to-batch reproducibility, ensuring that synthesis process leads to the expected final product in terms of yield, quality, reliability, safety, and efficacy.

In March 2020 the World Health Organization (WHO) declared the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a global pandemic [1]. Common symptoms, including fever, fatigue and dry ...

Dithiocarbamates (DTC) are the most commonly used synthetic fungicides in the Prosecco District (PD) of Treviso. The DTC biomarker is urinary ethylenethiourea (u-ETU). The aims of this biomonitoring study are to describe the level of u-ETU in residents in PD and to identify the factors associated with DTC exposure. In 2012 (baseline), we randomly extracted data for 126 children (3–5 years) and their families (260 adults), who were resident in 8 municipalities of PD and not occupationally exposed to DTC, from the local health database. For each subject, we obtained urine samples and socio-demographic, lifestyle and dietary information. In 2014 (after intervention), we evaluated the possible changes in u-ETU in 54 adults and 55 children at high risk of DTC exposure. The median baseline u-ETU was 0.35 µg/L. Approximately 5% of the samples had a u-ETU concentration > 5 µg/L. No u-ETU concentration exceeded 21 µg/L. Determinants of a higher u-ETU concentration were wine consumption (OR 2.04) and personal use of pesticides (OR 2.70) for adults; and living within 30 m from a vineyard (OR 9.51) and the pesticides use in the family (OR 6.25) for children. A significant u-ETU reduction in 49 adults and 25 children was observed from baseline to after intervention (p = 0.01). Wine consumption and production and DTC use in gardening influenced u-ETU concentrations in this population, although the levels were relatively low. The reduction in u-ETU from baseline to time after intervention probably reflects the effects of public health interventions.

Background In blunt trauma, orthopedic injuries are often associated with cerebral and torso injuries. The optimal timing for definitive care is a concern. The aim of the study was to develop evidence-based guidelines for damage-control orthopedic (DCO) and early total care (ETC) of pelvic and long-bone fractures, closed or open, and mangled extremities in adult trauma patients with and without associated injuries. Methods The literature since 2000 to 2016 was systematically screened according to Preferred Reporting Items for Systematic Reviews and meta-analyses protocol. One hundred twenty-four articles were reviewed by a panel of experts to assign grade of recommendation and level of evidence using the Grading of recommendations Assessment, Development, and Evaluation system, and an International Consensus Conference, endorsed by several scientific societies was held. Results The choice between DCO and ETC depends on the patient's physiology, as well as associated injuries. In hemodynamically unstable pelvic fracture patient, extraperitoneal pelvic packing, angioembolization, external fixation, C-clamp, and resuscitative endovascular balloon occlusion of the aorta are not mutually exclusive. Definitive reconstruction should be deferred until recovery of physiological stability. In long bone fractures, DCO is performed by external fixation, while ETC should be preferred in fully resuscitated patients because of better outcomes. In open fractures early debridement within 24 hours should be recommended and early closure of most grade I, II, IIIa performed. In mangled extremities, limb salvage should be considered for non-life-threatening injuries, mostly of upper limb. Conclusion Orthopedic priorities may be: to save a life: control hemorrhage by stabilizing the pelvis and femur fractures; to save a limb: treat soft tissue and vascular injuries associated with fractures, stabilize fractures, recognize, and prevent compartmental syndrome; to save functionality: treat dislocations, articular fractures, distal fractures. While DCO is the best initial treatment to reduce surgical load, ETC should be applied in stable or stabilized patients to accelerate the recovery of normal functions. Level of evidence Systematic review of predominantly level II studies, level II.

Mobile mapping systems are increasingly developing ad hoc solution and integrated approaches for rapid and accurate 3D digitization in different operating environments belonging to built heritage assets. The use of emerging compact, portable and low-cost solution for imaging and ranging well fits in the purposes of mapping complex indoor spaces especially for narrow and underground ones (tunnels, mines, caves and ancient spaces), that are very challenging contexts in which to experiment integrated technological solutions and tailored workflows. In these cases, the main key issues are generally the difficulty in the seamless positioning and the complete and successful metric-radiometric content association in metric surface, due to the reduced manoeuvring space and complex lighting conditions. The prevalent goals for which the 3D digitization could be conceived are, beyond the accurate metric documentation, the analysis of mutual relations of volumes in complex structures, the virtual reconstruction and navigation of spaces with reduced accessibility for dissemination aims. The new SLAM-based positioning solutions implemented in some recent portable systems for indoor/outdoor mapping are increasingly developing and favoured by geometric features extraction algorithms even in traveling through complex and irregular environments. In parallel, the possibility to exploit the advances in digital photogrammetry algorithms for image matching and dense reconstruction using action-cam, compact and fisheye cameras allows to deploy investigation solutions even in complex environments at first sight impossible to map by photogrammetric approach. Here within the F.I.N.E. benchmark in the site of the San Vigilio Castle (Bergamo) and the “nottole” tunnels, a fusion-based workflow is proposed. It is focused on the purposes of providing radiometrically enriched 3D data from the possibility to colourized ZEB point cloud and a textured mesh surfaces with an oriented image block, taking care of the time processing steps optimization.

In the framework of the digital documentation of complex environments the advanced Geomatics researches offers integrated solution and multi-sensor strategies for the 3D accurate reconstruction of stratified structures and articulated volumes in the heritage domain. The use of handheld devices for rapid mapping, both image- and range-based, can help the production of suitable easy-to use and easy-navigable 3D model for documentation projects. These types of reality-based modelling could support, with their tailored integrated geometric and radiometric aspects, valorisation and communication projects including virtual reconstructions, interactive navigation settings, immersive reality for dissemination purposes and evoking past places and atmospheres. The aim of this research is localized within the “Torino 1911” project, led by the University of San Diego (California) in cooperation with the PoliTo. The entire project is conceived for multi-scale reconstruction of the real and no longer existing structures in the whole park space of more than 400,000 m2, for a virtual and immersive visualization of the Turin 1911 International “Fabulous Exposition” event, settled in the Valentino Park. Particularly, in the presented research, a 3D metric documentation workflow is proposed and validated in order to integrate the potentialities of LiDAR mapping by handheld SLAM-based device, the ZEB REVO Real Time instrument by GeoSLAM (2017 release), instead of TLS consolidated systems. Starting from these kind of models, the crucial aspects of the trajectories performances in the 3D reconstruction and the radiometric content from imaging approaches are considered, specifically by means of compared use of common DSLR cameras and portable sensors.

The potential benefit of coupling hydraulic and electronic regulation to maximize the energy production of a Bank turbine in hydraulic plants is analyzed and computed with reference to a specific case. Design criteria of the Banki turbine inside hydraulic plants are first summarized, along with the use of hydraulic regulation in the case of constant water head and variable discharge at the end of aqueducts feeding water distribution systems. Optimal turbine impeller rotational speed is derived and traditional, as well as innovative systems for electricity production according to controlled rotational speed of the generator are presented. The study case at the purification plant named Risalaimi, in Italy, is analyzed, and the potential production of energy along the year is computed according to the known monthly average demand and two possible choices: the choice of hydraulic regulation only, called CFT1, and the choice of coupled hydraulic and electric regulations, called CFT2. The Return time of Capital Investment (RCI) is then computed for both the CFT1 and CFT2 cases. The result is that the CFT2 choice provides an increment of the total produced energy, along with an increment of about 30% of the corresponding RCI.

Background We already showed that in CML pts peripheral blood CD34+/CD38-/CD26+ cell population represent a "CML specific" leukemia stem cell (LSC) circulating compartment. Indeed, we demonstrated that CD26+LSCs are measurable by flow-cytometry in 100% of CML pts at diagnosis the latter representing an alternative and rapid diagnostic tool. In addition, in a cross-sectional study we were able to spot peripheral blood CD26+LSCs also in about 65% of CML during TKI treatment regardless of type and length of TKI treatment and degree of molecular response. However, no prospective data are available regarding the behavior of PB CD26+LSCs in terms of rate and timing of reduction during TKI therapy and the correlation, if any, with the attainment of response according to ELN guidelines. Interestingly, even CML patients in stable TFR may harbor circulating CD26+LSCs thus suggesting a probable active role of the immune system in the control of residual disease. One hypothesis could reside in the presence or absence on the LSCs of molecules (such as PD-L1) able to hamper an anti-leukemic T cell response. From Jan 2018 we conducted a prospective multicenter Italian study including CML pts at diagnosis treated and managed by each of 15 participating center according to ELN guidelines. We here present the first interim analysis after a median time of treatment of 12 mos. Aims The main goals of this study were to prospectively monitoring PB CD26+LScs in CML pts during TKI treatment and to correlate the behavior of LSCs with molecular response. In a proportion of pts PD-L1 expression on CD26+ LSCs at diagnosis was also evaluated. Methods At diagnosis and during TKI treatment, pts have been centrally evaluated in Siena lab for flow-cytometry PB CD26+ LSCs (+3, +6, +12, +18, +24 mos) and PD-L1 expression (at diagnosis). At each time point molecular BCR-ABL/ABLIS ratio was monitored locally in each center. Results 176 consecutive CML pts (IMA 92; NILO 61; DASA 23) were enrolled in the study so far (table 1). PB CD26+LSCs were measured at time 0 (baseline) in all 176 CML pts and in 165/176 (94%), 142/176 (81%) and 112/176 (71%) at +3, +6, +12 mos of TKI treatment, respectively. Median CD26+LSCs absolute number/µL at baseline was 6.96/µL (range 0.0126-64429), at +3 mos 0.0137/µL (range 0-6,49), at +6 mos 0.0056/µL (range 0-1.188), and at +12 mos 0.0112/µL (range 0-0.1824). No significant correlation between number of CD26+LSC, degree of response and BCR-ABL copies was found (Table 2). Interestingly, median CD26+LSCs at diagnosis was found significantly higher in NILO and DASA treated pts (12, 48/µL and 17,48/µL, respectively) than in IMA pts (4,58/µL). So far, 20/176 (11.4%) pts switched to different TKIs, due to failure/suboptimal response: of note, median CD26+ LSCs of this cohort at diagnosis was the highest (23.12/µL). Starting from Jun 2019, 44/176 (25%) CML pts have been evaluated also for PD-L1 expression at diagnosis: of these, 23/44 (52%) resulted PD-L1 positive and 21/44 (48%) resulted negative with a median of CD26+LSCs of 15.39/µL (range 1.28-635.5) and 4.45/µL (range 0.234-113.9), respectively. Conclusions After a sensible drop observed at 3 mos of any TKI treatment, CD26+LSCs are fluctuating and measurable at low level in most of pts (> 65%) even at 18 and 24 mos. We confirmed no correlation between the absolute number of persisting CD26+LSCs and BCR-ABL copies. However, pts with failure or suboptimal response showed the highest level of CD26+ at diagnosis. CD26+LSCs were found PD-L1+ in about half of 44 pts tested. At diagnosis higher CD26+LSCs number, PD-L1 positivity or both may correlate with a lower probability to achieve an optimal response; interim data of this first report will be presented; enrolment and follow up are ongoing. Disclosures Bocchia: Incyte: Honoraria; CELGENE: Honoraria. Abruzzese:Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Incyte: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bms: Honoraria. Galimberti:Novartis: Speakers Bureau; Incyte: Honoraria. Pregno:Incyte-Italy,: Membership on an entity's Board of Directors or advisory committees, Other: conference reports; Novartis-Italy: Membership on an entity's Board of Directors or advisory committees, Other: conference reports; Pfizer-Italy: Membership on an entity's Board of Directors or advisory committees, Other: conference reports. Crugnola:BMS: Honoraria; Janssen: Honoraria; Celgene: Honoraria; Novartis: Honoraria. Liberati:MORPHOSYS: Honoraria, Research Funding; ONCONOVA: Honoraria, Research Funding; INCYTE: Honoraria; VERASTEM: Honoraria, Research Funding; ROCHE: Honoraria, Research Funding; PFIZER: Honoraria, Research Funding; ONCOPEPTIDES AB: Honoraria, Research Funding; TAKEDA: Honoraria, Research Funding; FIBROGEN: Honoraria; BIOPHARMA: Honoraria; ARCHIGEN: Honoraria; BEIGENE: Honoraria; BMS: Honoraria; AMGEN: Honoraria; CELGENE: Honoraria; JANSSEN: Honoraria; ABBVIE: Honoraria, Research Funding; NOVARTIS: Honoraria, Research Funding; KARYOPHARM: Honoraria, Research Funding.

The project is part of the wider application and subsequent spread of innovative digital technologies involving robotic systems. Modern society needs knowledge and investigation of the environment and of the related built landscape; therefore it increasingly requires new types of information. The goal can be achieved through the innovative integration of methods to set new analysis strategies for the knowledge of the built heritage and cultural landscape. The experimental cooperation between different disciplines and the related tools and techniques, which this work suggests for the analysis of the architectural heritage and the historical territory, are the following: – 3D metric survey techniques with active and passive sensors – the latter operating in both terrestrial mode and by aerial pointof view. In some circumstances, beyond the use of terrestrial LiDAR, even the newest mobile mapping system using SLAMtechnology (simultaneous localization and mapping) has been tested. – Techniques of non-destructive investigation, such as geophysical analysis of the subsoil and built structures, in particularGPR (Ground Penetrating Radar) techniques. – Historic and stratigraphic surveys carried out primarily through the study and interpretation of documentary sources,cartography and historical iconography, closely related to the existing data or latent material. The experience through the application of these techniques of investigation connected to the built spaces and to the manmade environments has been achieved with the aim of improving the ability to analyse the occurred transformations/layers over time and no longer directly readable or interpretable on manufactured evidence.

It is important nowadays to underline some relevant topics concerning the effective contribution of 3D high detailed products derived from innovation and integration of Geomatics technologies, allowing a remarkable development in descriptive metric capabilities, supporting and improving the material recording, representation, analysis and characterization about alteration of the constructive systems. Considering the relevance of the complex interdisciplinary research of these issues that move around the Cultural Heritage safeguard and due to its extreme vulnerability, these models must give a response to different problems. Primarily they has to provide complete models on which to pursue accurate morpho-dimensional documentation, and to base structural assessment, decay investigations, and consequently to underpin restoration practices and support operational workflow in CH assets monitoring. Some peculiarities of new methods for semi-automatic processing algorithms are thus evidenced, advantaging their proficiency to behave as tools for a more sustainable approach in the general process of preservation and protection. Specifically about the ancient masonries documentation, the chance of using digital products derived from very high scale models, as the detailed orthoimages projection and surfaces development offers many opportunities. Here, a late-medieval stratified dovecote tower in Verolengo (TO) with a particular trunk-conical shape had been analysed in order to reconstruct an identity and a historical and architectural framework, de facto not recognized yet. A 3D reconstruction by dense matching techniques will be presented, in the complex context that are the vertical high buildings, presenting one of the highest level of vulnerability. The importance of the 3D model availability, closely connected to dense radiometric information, has been particularly expressed in two main direction for the diagnosis both of volumetric structure assessment and the material characterization of the mixed masonries walls.

One of the challenging purposes that must be undertaken by applied geomatics, is the need of monitoring by documenting continuously over time the evolution of urban spaces. Nowadays, this is a subject of great interest and study, mainly in case of sudden emergency events that implicate urban areas and specific historical buildings of our heritage. The newest Geomatics technique solutions must enable the demands of damage documentation, risk assessment, management and data sharing as efficiently as possible, in relation to the danger condition, to the accessibility constraints of areas and to the tight deadlines needs. In August 24th 2016, the first earthquake hit the area of central Italy with a magnitude of 6.0; since then, the earth never stop shaking in a wide area in the middle of Italy. On 26th and 30th of October, two other big seismic events were recorded (magnitude 5.9 and 6.5) and the already damaged built heritage were struck again. Since the beginning of the emergency all the available resources (human and material) were deployed and the world of researchers is trying to furnish an effective contribute as well. Politecnico di Torino, in coordination with the national institutions, is deploying people, expertise and resources. The geomatics research group and the connected Disaster Recovery team (DIRECT - http://areeweb.polito.it/direct/) is part of this process and is working in deep contact and collaboration with the Remotely Piloted Aircraft Systems (RPAS) group of the Italian Firefighter. Starting from the first earthquake the late medieval religious complex of S. Agostino has been carefully monitored and detected, using a multi-perspective oblique imagery strategy with the aim to achieve 3D aerial and terrestrial models, in a multi-temporal perspective concerning three different time situation.

This paper discusses some enhancements concerning 3D modelling, and the integration and comparison of 3D data from aerial and terrestrial sensors, developed by innovative geomatics techniques around the metric documentation of cultural heritage. In archaeology, it is interesting to deal with the considerable advantages of new multi-sensor approaches for the data acquisition and the management phases in terms of the sustainability (automated acquisition, quickness, precision, time and cost cutting). In particular, Unmanned Aerial Vehicles(UAVs)photogrammetry with the joint use of nadir and oblique cameras can be usefully combined with the large-scale details acquired by the terrestrial Light Detection and Ranging (LiDAR)in vast areas or complex objects, especially in mostly vertical sized objects. Here, we will report the results of an integrated 3D survey in an archaeological context in the Piedmont region of Italy. The Hercules Fountain is located in the gardens of the Venaria Reale (a Savoy Royal Palace included in the UNESCO heritage list) and has witnessed several events and historical phases during the past centuries–from its construction in the 16thcentury to its disuse and decline in the 17thcentury, right up to the 21stcentury when it was eventually brought back to light. The goal of the test is the creation of a3D continuous model of the site for documentation purposes, future consolidation, and enhancement projects finalised fora public promotion. To meet these strategic aims, a terrestrial laser scanning (TLS henceforth) survey has been designed together with multi-flights by a multi-rotor UAV and terrestrial close-range photogrammetry (CRP) acquisition to produce a highly detailed 3D textured model from which we have inferred standard 2D drawings, digital orthoimages, and further 3D products. In conclusion, the entire workflow and the outputs have been compared together to evaluate the effectiveness of each elaboration according to the different goals of the survey.

The increasing demand for renewable and sustainable energy sources has encouraged the development of small run-of-river plants. Preliminary studies are required to assess the technical and economic feasibility of such plants. In this context, the identification of optimal potential run-of-river sites has become a key issue. In this paper, an approach that is based on GIS tools coupled with a hydrological model has been applied to detect potential locations for a run-of-river plant. A great number of locations has been analyzed to identify those that could assure the achievement of different thresholds of potential power. The environmental and economic feasibility for small hydropower projects in these locations has been assessed and a multi-objective analysis has been carried out to highlight the most profitable configurations. The Soil and Water Assessment Tool (SWAT) has been calibrated to simulate runoff in the Taw at Umberleigh catchment (South West England). The results showed that, in the area of study, different locations could be selected as suitable for run-of-river plants.