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Lichens are symbiotic organisms sensitive to climate change and susceptible to a severe decline in diversity, especially in high elevation environments that are already threatened. In this study, we focused on water-energy relationships derived from climatic variables and phylogenetic diversity indices of terricolous lichen communities occurring on a representative Mediterranean mountain. We hypothesized that the variation of precipitation and temperature and their interaction along the altitudinal gradient will shape the phylogenetic diversity and structure of lichen communities. Our results reveal that dry and arid conditions lead to a strong loss in phylogenetic diversity with consequent impoverishment of high elevation lichen communities under a climate change scenario. The interaction between variables, reflecting water-energy relationships with phylogenetic and community diversity patterns, suggests that in a future climate change scenario, the novel climatic conditions may reduce the capability of the species to survive harsher conditions, and Mediterranean mountains may face a severe loss of genetic diversity in a climate change scenario. [ABSTRACT FROM AUTHOR]

Background: ERAS has recently been implemented in pancreatic surgery settings, but there is little evidence regarding the effects as perceived by patients. Given the lack of the knowledge in the field, the aim of this study was to capture the experience of patients undergoing pancreatic surgery who received perioperative care based on the ERAS programme.Methods: We designed a qualitative study undertaken in the pancreatic surgery unit of San Raffaele Hospital in Milan, Italy. Twenty-two consecutive patients were invited to participate in the study and 13 patients were interviewed. Data was collected between March and December 2012 either through face-to-face or semi-structured telephone follow-up from three to six weeks after discharge. Data was analysed using the interpretative phenomenological approach.Results: Patients who underwent surgical pancreatic procedures and treated with ERAS programme reported experiences based on four themes: (1) Feeling prepared to face surgery, (2) Being actively "inside" or "outside" the programme, (3) Healing at home: the best setting, and (4) "Perceiving the ordinary as extraordinary": reaching independence, once at home.Conclusion: According to the findings, uncomplicated pancreatic surgery patients may benefit from the ERAS programme. Preadmission counselling should help patients to assume an active role. Once the patient returns home, the availability of a caregiver should be thoroughly assessed to guarantee the support needed by patients to successfully complete the ERAS(programme. Surgery and nursing staff should carefully monitor patients and suggest whether they continue, interrupt, or individualise the scheduled ERAS interventions in accordance with a patient's clinical condition and preferred personal timing. [ABSTRACT FROM AUTHOR]

Abstract: Background: The recurrence rate for stage I non-small cell lung cancer is high, with 20–40% of patients that relapse after surgery. The aim of this study was to evaluate new F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) derived parameters, such as standardized uptake value index (SUVindex), metabolic tumor volume (MTV) and total lesion glycolysis (TLG), as predictive factors for recurrence in resected stage I non-small cell lung cancer. Methods: We retrospectively reviewed 99 resected stage I non-small cell lung cancer patients that were grouped by SUVindex, TLG and MTV above or below their median value. Disease free survival was evaluated as primary end point. Results: The 5-year overall survival and the 5-year disease free survival rates were 62% and 73%, respectively. The median SUVindex, MTL and TLG were 2.73, 2.95 and 9.61, respectively. Patients with low SUVindex, MTV and TLG were more likely to have smaller tumors (p ≤ 0.001). Univariate analysis demonstrated that SUVindex (p = 0.027), MTV (p = 0.014) and TLG (p = 0.006) were significantly related to recurrence showing a better predictive performance than SUVmax (p = 0.031). The 5-year disease free survival rates in patients with low and high SUVindex, MTV and TLG were 84% and 59%, 86% and 62% and 88% and 60%, respectively. The multivariate analysis showed that only TLG was an independent prognostic factor (p = 0.014) with a hazard ratio of 4.782. Conclusion: Of the three PET-derived parameters evaluated, TLG seems to be the most accurate in stratifying surgically treated stage I non-small cell lung cancer patients according to their risk of recurrence. [Copyright &y& Elsevier]

Abstract: Objectives: to explore Italian mothers'' perception of latching difficulty in the first days postpartum. Latching difficulty is the only qualitative item included in the Breastfeeding Assessment Score (BAS) that has proven to be a valid instrument to identify women at risk of early breast-feeding cessation. Design and setting: a phenomenologic–hermeneutic study was conducted at the Mangiagalli Clinic, Milan, Italy. Participants: fifteen women who received a BAS <8 (indicating an early breast-feeding cessation risk) were interviewed before discharge, and later by phone, for member checking. Findings: six main themes emerged from the interviews: (1) Breast feeding can be difficult due to both the mother and newborn, and encountered problems are mainly physical. (2) Women have developed different strategies to overcome latching difficulties. (3) Early breast feeding, even if difficult, is mostly related to positive feelings. (4) Breast-feeding sustains the child–mother relationship. (5) Mothers have already developed constructive theories about human colostrum, breast milk and artificial milk. (6) Receiving integrated health-care support and education is fundamental to overcome early breast-feeding problems. Conclusions: the interviews suggest that although mothers experience difficulties during early breast feeding, positive feelings seem to prevail over the negative ones, and mothers have already developed strategies to overcome their latching problems. Receiving support is fundamental, but this must be consistent among health-care professionals. Implications for practice: when evaluating the BAS item ‘latching difficulty’, midwives should consider that difficulties are primarily related to physical problems. Furthermore, to sustain lactation, mothers should be helped to elicit their experience of early breast feeding, as it can be extremely satisfying, even when difficulties in latching the babies occur. [Copyright &y& Elsevier]

Abstract: Objectives: We undertook a historical cohort study to compare, in terms of morbidity, mortality and long-term survival associated with lung cancer resection, a group of patients with previous lymphoproliferative disorders and a group without a hematological history. Methods: We identified 29 patients with a previous lymphoproliferative disorder who underwent lung cancer resection. These subjects (Group-A) were matched with 87 patients without a hematological history who underwent pulmonary resection during the same period (Group-B). Results: We found no significant difference between the two groups in length of hospitalization, comorbidities, spirometric parameters, type of surgery, histology, neoadjuvant chemotherapy, morbidity, mortality, median survival (Group-A = 37 months; Group-B = 52 months) and 5-year survival (Group-A = 37%; Group-B = 42%). The mean age of Group-A patients was significantly lower than that of Group-B patients (62 vs 66 years; p = 0.024). Group-A patients had a well differentiated lung cancer more frequently than Group-B patients (p = 0.001). Group-A patients had transitory bacteraemies more frequently than Group-B patients (p = 0.005). Multivariate Cox regression analysis showed that age (p = 0.01) and lung cancer stage (p = 0.04) were significantly associated with survival. Conclusions: Patients with lymphoproliferative disorders had a lower age and more differentiated lung cancers than those without lymphoproliferative disorders. Patients with lymphoproliferative disorders and those without a hematological history had similar morbidity, mortality and long-term survival after pulmonary resection. Distinguishing patients with and without a lymphoproliferative disorder seems to be of limited value in the decision-making process of evaluating the indications for surgical treatment of lung cancer. [Copyright &y& Elsevier]

Abstract: Fungal food spoilage plays a pivotal role in the deterioration of food and feed systems and some of them are also able to produce toxic compounds for humans and animals. The mycotoxins produced by fungi can cause serious health hazards, including cancerogenic, immunotoxic, teratogenic, neurotoxic, nephrotoxic and hepatotoxic effects, and Kashin-Beck disease. In addition to this, fungal spoilage/pathogens are causing losses of marketable quality and hygiene of foodstuffs, resulting in major economic problem throughout the world. Nowadays, food spoilage can be prevented using physical and chemical methods, but no efficient strategy has been proposed so far to reduce the microbial growth ensuring public health. Therefore, lactic acid bacteria (LAB) can play an important role as natural preservatives. The protection of food products using LAB is mainly due to the production of antifungal compounds such as carboxylic acids, fatty acids, ethanol, carbon dioxide, hydrogen peroxide, and bacteriocins. In addition to this, LAB can also positively contribute to the flavor, texture, and nutritional value of food products. This review mainly focuses on the use of LAB for food preservation given their extensive industrial application in a wide range of foods and feeds. The attention points out the several industrial patents concerning the use of antifungal LAB as biocontrol agent against spoilage organisms in different fermented foods and feeds. [Copyright &y& Elsevier]

The article examines the physiochemical properties of oat varieties as well as their potential for breadmaking. It notes the determination of oat varieties' fat and protein contents as the primary factors for the difference in the quality of the oat bread. It observes the positive effect of the high setback and final viscosity of the bread on its quality.

Background: Scimitar syndrome is a rare congenital heart disease. To evaluate the results of managing this malformation surgically, we have embarked on a multicenter Italian study involving seven different centers and reporting the largest published series in the medical literature. Methods: From January 1997 to December 2007, 26 patients with scimitar syndrome who underwent surgical correction were included. Primary outcomes include hospital mortality and the efficacy of repair at the follow-up. Results: Median age was 11 years (interquartile range, 1.8 to 19.9 years). Nineteen patients (73%) presented with symptoms including upper respiratory tract infections (n = 13), recurrent pneumonia (n = 10), cardiac failure (n = 4), and cyanosis (n = 2). Associated cardiac anomalies were present in 16 patients (63%). Surgical repair included intraatrial baffle repair in 18 patients (69%; group 1), and reimplantation of the “scimitar vein” onto the left atrium in 8 patients (31%; group 2). One patient died in hospital (3.8%; group 1). Postoperative complications were less frequently reported in group 1 (4 of 18 patients, 22%) compared with group 2 (5 of 8 patients, 62%). Median follow-up time was 4 years (interquartile range, 1.8 to 9.7 years). There was 1 late death (1/25 patients, 4%; group 2). Four patients (16%) showed a complete occlusion of the scimitar drainage (2 in group 1, 12%; 2 in group 2, 25%) and 3 patients (12%) required balloon dilation or stenting for scimitar vein stenosis (1 in group 1, 6%; 2 in group 2, 25%). Conclusions: The intraatrial baffle repair seems to have a lower incidence of postoperative complications and a better patency rate, at last follow-up, than the reimplantation of the scimitar vein onto the left atrium. [Copyright &y& Elsevier]

Background: The objectives of this study were to analyze our experience with transbronchial needle aspiration as a minimally invasive procedure alternative to mediastinoscopy in the preoperative staging of non-small cell lung cancer patients with positive mediastinal positron emission tomography and to propose a staging algorithm that combines performance characteristics of these three methods. Methods: Fifty-one patients staged N2 or N3 after positron emission tomography imaging underwent transbronchial needle aspiration. Results: A malignant adenopathy was identified in 26 patients (51%) that were excluded from operation and referred for neoadjuvant chemotherapy or chemoradiotherapy according to the mediastinal status (N2 or N3), as determined on the positron emission tomography image. In the remaining 25 patients (49%), samples were considered adequate negative in 12 patients, inadequate in 11, or inconclusive in 2. These patients underwent mediastinoscopy. Mediastinoscopy showed N2 disease in 19 cases, and the patients received neoadjuvant chemotherapy. In the remaining 6 cases no mediastinal involvement was identified and patients underwent operation. Postoperatively, 5 patients were staged N0 and 1 was staged N2. For transbronchial needle aspiration, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 76%, 100%, 100%, 33%, and 79%, respectively. Conclusions: Transbronchial needle aspiration avoided a mediastinoscopy in approximately half of lung cancer patients referred for operation with positive mediastinal positron emission tomography, sparing the associated costs and risks of more invasive surgical procedures. The minimally invasive mediastinal staging algorithm that we proposed seems to be efficacious and easily applicable in clinical practice. [Copyright &y& Elsevier]

Background: We sought to investigate the role of the bidirectional Glenn with antegrade pulmonary blood flow in the surgical history of children with univentricular hearts. Methods: A series of 246 patients, from three joint institutions, having univentricular heart with restricted but not critical pulmonary blood flow received a bidirectional cavopulmonary shunt with additional forward pulmonary blood flow. All patients have been studied according to their progression, or not, to Fontan operation. Two hundred and eight (84.5%) patients underwent bidirectional cavopulmonary anastomosis as primary palliation. Twenty patients (8.1%) with previous pulmonary artery banding were also enrolled in the study. Patients who had received additional pulmonary blood flow through a previous systemic to pulmonary artery shunt for the critical pulmonary blood flow were excluded. Results: No in-hospital death occurred. Follow-up was complete at 100%. Mean follow-up was 4.2 ± 2.8 years (range, 6 months to 7 years). During the observational period 73 (29.7%) patients, considered optimal candidates, underwent Fontan completion for increasing cyanosis and (or) hematocrit and (or) fatigue with exertion. Three patients expired after total cavopulmonary connection (3 of 73; 4.1% mortality rate). The remaining 173 (70.3%) patients are alive with initial palliation. All patients were still well palliated with an arterial oxygen saturation at rest about 90%. Conclusions: According to our experience and results, bidirectional Glenn with antegrade pulmonary blood flow may be an excellent temporary palliation prior to a Fontan operation, which can be performed at the onset of symptoms. Bidirectional Glenn may also be the best possible palliation for a suboptimal candidate for Fontan. [Copyright &y& Elsevier]

Background: Thoracic surgeons have limited experience with treating localized organizing pneumonia owing to its rare occurrence in routine clinical practice. Methods: We retrospectively investigated the clinicopathologic features of 21 patients with localized organizing pneumonia observed between 2001 and 2004. Results: There were 15 men and 6 women. Mean age was 63 years. Eight patients (38%) were symptomatic. Computed tomographic scan showed a single lesion in 17 patients (12 nodules and 5 masses) and bilateral lesions in 4. Wedge resection was performed in 16 patients and lobectomy in 5. There was no operative mortality. Follow-up was complete in all patients (range, 2 to 46 months; median, 20 months). Surgery was curative in 15 of 17 patients with a single lesion, and no recurrence was observed (p < 0.005). The remaining 2 patients with a single lesion (2 masses) had a local relapse with the appearance of nodular lesions in the residual parenchyma. Both these patients received steroids with resolution of the lesions. All 4 patients with bilateral lesions who underwent surgery for diagnostic purposes received steroids with improvement of the radiologic aspect in 3 and stabilization of the lesions in 1. Conclusions: Clinical and radiologic findings of localized organizing pneumonia are nonspecific, and this unusual entity is difficult to differentiate from a primary or metastatic tumor. Surgical resection allows both diagnosis and cure. However, considering the benignity of the lesion and the efficacy of steroids, major pulmonary resections should be avoided. [Copyright &y& Elsevier]

In the Roman wall paintings different white colours were used, named Paraetonium, Melinum, Anularia, Eretria, Argentaria, etc. FTIR, Raman spectroscopy and X-Ray diffraction were applied to study different white pigments, such as calcite, aragonite, dolomite and huntite, white carbonates present in archaeological findings from roman walls in the Mediterranean region. This study showed that it is possible to distinguish and identify these components in white colours. About 450 samples of Roman wall paintings were analysed and it was observed that often aragonite is associated to precious coloured pigments. On the basis of the obtained results some considerations about the period in which the different kinds of white pigments were used are proposed. [ABSTRACT FROM AUTHOR]

Background: In this study, we analyze our experience with pulmonary resection for metastases from colorectal carcinoma. The aims were to search for factors influencing prognosis and to investigate the presence of microsatellite instability in the primary tumors and the corresponding lung metastases. Methods: We identified 81 patients who underwent surgical resection between 1991 and 2004. The microsatellite instability was determined by immunohistochemical evaluation of MSH2 and MLH1 in 117 lesions (41 primary tumors and 76 lung metastases). Results: Overall 3-, 5-, and 10-year survival rates were 50%, 42%, and 30%, respectively. Univariate analysis showed that stage of the primary tumor (p = 0.037), radicalness of the resection (p = 0.019), and stratification into groups according to the International Registry of Lung Metastases classification (p = 0.039) were prognostic factors. Multivariate analysis showed that stage of the primary tumor (p = 0.030) and the radicalness of the resection (p = 0.014) were independent prognostic factors. All tumors displayed preserved expression of MSH2 and MLH1 and were considered microsatellite stable lesions. Conclusions: Pulmonary resection of metastases from colorectal carcinoma results in long-term survival in selected patients. Complete resection, stage of the primary tumor and stratification into groups according to the International Registry of Lung Metastases classification were prognostic factors. All the metastases and the corresponding primary tumors were microsatellite stable lesions. This finding seems to demonstrate that pulmonary metastases are infrequent in colorectal carcinomas with microsatellite instability. [Copyright &y& Elsevier]

Objective: The purpose of this study was to evaluate the effect of lobectomy on pulmonary function in patients with chronic obstructive pulmonary disease. Methods: One hundred thirty-seven patients were analyzed; 49 had normal pulmonary function tests, and 88 had chronic obstructive pulmonary disease. Different functional parameter groups were identified: obstructive (forced expiratory volume in 1 second [FEV1], forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC], and chronic obstructive pulmonary disease index), hyperinflation (residual volume and functional residual capacity), and diffusion (transfer factor of the lung for carbon monoxide). Also, the ratio between observed and predicted postoperative FEV1 was calculated. Results: In patients with preoperative FEV1 greater than 80% of predicted, postoperative FEV1/FVC slightly but not significantly decreased, and postoperative FEV1 significantly decreased. In patients with preoperative FEV1 less than 65%, postoperative FEV1 and FEV1/FVC significantly increased. In patients with preoperative FEV1/FVC greater than 70%, postoperative FEV1 and FEV1/FVC significantly decreased. In patients with preoperative FEV1/FVC less than 70%, postoperative FEV1/FVC increased, and FEV1 remained unchanged. In patients with a chronic obstructive pulmonary disease index greater than 1.5, postoperative FEV1 and FEV1/FVC significantly decreased, whereas in patients with a chronic obstructive pulmonary disease index less than 1.5, postoperative FEV1/FVC significantly increased and FEV1 remained unchanged. In patients with residual volume and functional residual capacity greater than 115% and transfer factor of the lung for carbon monoxide less than 80% of predicted, postoperative FEV1 diminished less (not significant) compared with patients who had residual volume and functional residual capacity less than 115% (P = .0001). Observed postoperative/predicted postoperative FEV1 was higher if FEV1/FVC was less than 55% (1.46), if FEV1 was less than 80% of predicted (1.21), or if the chronic obstructive pulmonary disease index was less than 1.5 (1.17). Conclusions: Patients with mild to severe chronic obstructive pulmonary disease could have a better late preservation of pulmonary function after lobectomy than healthy patients. [Copyright &y& Elsevier]

Background: Thoracic surgeons have limited experience of inflammatory pseudotumors of the lung owing to their rare occurrence in routine clinical practice. Methods: We retrospectively investigated the clinicopathologic features of 18 patients with inflammatory pseudotumor of the lung observed between 1992 and 2002. Results: There were 13 men and 5 women. Median age was 57 years. Eight patients (44%) were symptomatic. Computed tomographic scan showed a solitary nodule (≤3 cm) in 12 patients, bilateral nodules in 1, and a mass in 5. Two patients had undergone prior incomplete resections. Lobectomy was performed in 5 patients, bilobectomy in 1, segmentectomy in 1, and wedge resection in 11. Complete resection was achieved in 13 patients (72%). There was no operative mortality. Follow-up was complete in all patients (range, 13 to 134 months; median, 63 months). Overall 3-year and 5-year survival rates were 82% and 74%, respectively. Thirteen patients are currently alive with no evidence of disease, 1 is alive with disease, 1 died of unrelated causes, and 3 had a relapse and died. Completeness of resection and lesion size less than or equal to 3 cm were associated with a better survival (p < 0.001 and p = 0.007, respectively). Multivariate Cox analysis confirmed the association between completeness of resection and better survival, which is independent of other clinicopathologic variables (p = 0.02). Conclusions: This series shows that a significant number of patients with inflammatory pseudotumor of the lung have a poor prognosis and confirms the need for radical resection in the treatment of this unusual entity. [Copyright &y& Elsevier]

: BackgroundThe association between discrete subaortic stenosis and other subaortic anomalies is a well known but rarely reported occurrence. The aim of this study is to define the incidence, morphology, and surgical impact of associated anomalies of the left ventricular outflow tract in children operated on for discrete subaortic stenosis.: MethodsBetween 1994 and 2000, 45 consecutive children were operated on for discrete subaortic stenosis. Patients were divided in two groups according to the obstructive lesion detected by echocardiography.: ResultsA localized shelf was found as an isolated lesion in 31 patients (group A), whereas additional subaortic anomalies were found in 14 cases (31%) and were multiple in 5 cases (group B). The anomalies included anomalous septal insertion of mitral valve (7 cases); accessory mitral valve tissue (2 cases); anomalous papillary muscle (2 cases); anomalous muscular band (8 cases); and muscularization of the anterior mitral valve leaflet (1 case). Cardiopulmonary bypass and aortic cross-clamping times were significantly shorter in group A. There were no operative deaths nor major complications or deaths during follow-up. A gradient of 15 mm Hg or more was found at follow-up in 5 cases whereas aortic regurgitation was estimated to be not clinically significant in all but 1 patient. Six cases of recurrent subaortic stenosis were found in our series, 3 of them with other subaortic anomalies.: ConclusionsThis study shows that discrete subaortic stenosis can often be associated with other subaortic abnormalities. Surgical treatment of these anomalies produces excellent early and mid-term relief of obstruction without any increase in mortality and morbidity. [Copyright &y& Elsevier]

Background Over the last years the ingestion of disk batteries has become frequent in children with serious consequences. The severity of injuries is related to the growing use of new lithium batteries that may cause catastrophic damages when lodged in the oesophagus. Methods The notes of three consecutive children with lithium batteries lodged in the oesophagus, admitted to our Institute from 2010 to 2014, were reviewed. Clinical presentation, management, and outcome were considered. Results The first child, a 22-month-old girl, died of a sudden exsanguination due to an aorto-oesophageal fistula. The second case, a 5-year-old boy, had an exploratory thoracotomy to exclude aortic lesion before battery removal, and a spontaneous oesophageal perforation. The third child, a 18-month-old boy, fully recovered after suffering ulcerative oesophageal burns. Conclusion Lithium battery lodged in the oesophagus is a paediatric emergency requiring a multidisciplinary approach that can be implemented in a tertiary children's hospital. [ABSTRACT FROM AUTHOR]