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Artificial Neuronal Networks are models widely used for many scientific tasks. One of the well-known field of application is the approximation of high-dimensional problems via Deep Learning. In the present paper we investigate the Deep Learning techniques applied to Shape Functionals, and we start from the so--called Torsional Rigidity. Our aim is to feed the Neuronal Network with digital approximations of the planar domains where the Torsion problem (a partial differential equation problem) is defined, and look for a prediction of the value of Torsion. Dealing with images, our choice fell on Convolutional Neural Network (CNN), and we train such a network using reference solutions obtained via Finite Element Method. Then, we tested the network against some well-known properties involving the Torsion as well as an old standing conjecture. In all cases, good approximation properties and accuracies occurred.

In the original article, there was a mistake in Figure 2F as published. The wrong image was included due to the incorrect labeling of a file. The correct Figure 2 appears below. In addition, there was a mistake in Figure 7. Incorrect panels were included in Figures 7B, C. The corrected Figure 7 appears below. Finally, there was a mistake in Figure 9 where the first two and last columns were mislabelled. The corrected Figure 9 appears below. The authors apologize for these errors and state that these do not change the scientific meaning and conclusions of the article in any way. The original article has been updated.

Haemangiopericytoma (HPC) is a rare vascular tumor comprising 1% of all vascular neoplasms and was first described by Stout and Murray in 1942. They are highly vascularized tumours located in any part of the body. Malignant HPCs represent1% of all vascular tumours and around 5% of all sarcomatous tumours. The majority has a relatively indolent behaviour with presenting symptoms being vague for several months and not specific. Surgical excision is the mainstay of treatment. We present the case of a 65-year old male with HPC of left infraclavicular region with no associated lymphadenopathy. Surgical management included en bloc excision. The patient did not require any adjuvant therapy and showed no signs of recurrence at 1-year follow up. KEY WORDS: Haemangiopericytoma, Extracranial, Surgical excision, Vascular tumor.Riportiamo un caso di tumore composto unicamente da cellule di Leydig derivate da cellule stromali ovariche e non da cellule di Leydig dell’ilo preesistenti, causa di disordine sessuale e irsutismo in menopausa. Il tumore stromale ovarico composto esclusivamente di cellule stromali di Leydig è raro,0,4% tra tutti i tumori ovarici. Può verificarsi anche in donne giovani, ma quasi sempre, si verifica in menopausa o in postmenopausa. Riportiamo un caso di tumore ovarico delle cellule di Leydig nel midollo lontano dall’ilo, derivato da cellule stromali ovariche piuttosto che da cellule di Leydig dell’ilo preesistenti, con sintomi clinici complessi e non comuni. In questa relazione, sottolineiamo a) l’importanza dell’anamnesi, dell’osservazione e della considerazione di tutti i sintomi clinici, b) il valore dell’ecografia transvaginale per la diagnosi, e c) il ruolo del psicologo nel sostenere la paziente interessata nel suo disagio esistenziale e sociale.

CgA and testosterone are two serum markers that may be involved in prostate cancer. The objective of this study was to evaluate the relationship of testosterone and CgA to grades and stages of prostate cancer, particularly whether low-serum testosterone and high-serum CgA are associated with more aggressive grades, and higher pathological stages of the disease.This perspective study included 121 men (Caucasian only) presenting with -newly-diagnosed, untreated prostate cancer. All the patients underwent radical prostatectomy.We subdivided the sample into two homogeneous groups, Group A with Gleason score ≤7 (3+4), and Group B with Gleason score ≥7 (4+3). Low testosterone (3 ng/ml) was most common among the members of Group B 80 % versus 12.6 % of Group A (p = 0.001). At the same time, elevated CgA (80 ng/ml) was present for a rate of 72 % in Group B, 28.1% in the Group A ( p = 0.001). The multivariate analysis we used revealed that low-serum testosterone and high-serum CgA are associated with higher pathological stages of the disease (p = 0.001).The principal findings of this investigation were that low testosterone is correlated with elevated CgA levels, and these two parameters are associated with more aggressive grades and higher pathological stages of prostatic adenocarcinoma.Chromogranin A, Prostate cancer, Risk factor for prostate cancer, Testosterone.La cromogranina A (CgA) e il testosterone sono due marker sierici che possono essere coinvolti nel cancro alla prostata. L’obiettivo di questo studio è stato quello di valutare la relazione tra testosterone e CgA in gradi e stadi del cancro alla prostata, in particolare se il testosterone a basso livello sierico e il CgA ad alto siero sono associati a condizioni più aggressive e a stadi patologici più elevati della malattia. Lo studio prospettico ha riguardato 121 uomini (solo caucasico) che presentavano un cancro alla prostata appena diagnosticato e non trattato. Tutti i pazienti sono stati sottoposti a prostatectomia radicale. Il campione è stato suddiviso in due gruppi omogenei: il gruppo A con il punteggio di Gleason ≤7 (3 + 4) e il gruppo B con il punteggio di Gleason ≥7 (4 + 3). Il basso livello di testosterone (3 ng / ml) era più comune tra i membri del gruppo B 80% rispetto al 12,6% del gruppo A (p = 0,001). Allo stesso tempo, il CgA elevato (80 ng / ml) era presente per un tasso del 72% nel gruppo B, del 28,1% nel gruppo A (p = 0,001). L’analisi multivariata che abbiamo utilizzato ha rivelato che il testosterone a basso livello sierico e il CgA ad alto siero sono associati a stadi patologici più elevati della malattia (p = 0,001). In conclusione i principali risultati di questa indagine indicano che il basso livello di testosterone è correlato con elevati livelli di CgA e questi due parametri sono associati a gradi più aggressivi ea stadi patologici più elevati dell’adenocarcinoma prostatico.

High ligation of sapheno-femoral junction and thermal ablation for lower limb primary varicosity in day hospital setting AIM: The traditional surgical treatment for lower limb primary varicosity has been for a long time high ligation of sapheno-femoral junction and stripping of great saphenous vein. Surgery, however, has been frustrated by postoperative pains and discomfort and recurrences so that it has been challenged by minimally invasive endovenous techniques such as laser treatment and radiofrequency ablation. The aim of the article is to assess the feasibility, in a day hospital setting, of a combined approach to greater saphenous vein reflux: high ligation of sapheno-femoral junction and thermal treatment of the great sapenous vein.A retrospective analysis on 95 patients treated with high ligation and thermal ablation at our institution from January 2009 to July 2017 was performed, assessing duration of surgery, post-operative pain and analgesics requirements, early complications and resumption of activities.Two patients (2.74%), in the laser group experienced skin burns in the course of the GSV. Moderate ecchymosis, by laser fibre-induced perforation of the vein wall, were observed in another two patients (2.74%). Four limbs (5.48%) in the EVLT group developed transient paraesthesias. Analgesic requirement on POD 3 was nil for RFA group; conversely half of the EVLT patients did take analgesics, either 2 or 3 tabs were required. On POD 7, the patients of RFA group continued to not ask for any analgesics, but the same half of the patients in EVLT group still needed 1-2 tabs to carry out their normal activities smoothly. On POD 15, no patient did require analgesics. Resumption of routine activities was earlier for RFA group patients than for those in the EVLT group. The RFA group resumed their activities within 3 days, whereas EVLT group in 8-9 days. High ligation of the SFJ didn't add too much time or morbidities.Catheter delivery of thermal energies for saphenous ablation, even when combined with high ligation of saphenous femoral arc, demonstrated to be minimally invasive, easy to learn and easy to perform in day hospital setting, with early return to normal activity. EVLT achieved similar results to RFA and both techniques were considered equally effective and safe; the results we obtained were not statistically significant but RFA showed less pain, ecchymosis and haematomas, as well as provided better short-term quality of life.Day Hospital setting, Endovenous laser treatment, High ligation ablation of the saphenous vein, Radiofrequency ablation.Il trattamento chirurgico tradizionale per le varici primitive degli arti inferiori è stato per lungo tempo la legatura prossimale della giunzione safeno-femorale e lo stripping della grande vena safena. Questo trattamento è spesso complicato da dolore postoperatorio, disagio del paziente e dalle recidive. Scopo del nostro studio è valutare la fattibilità, in un contesto di day hospital, di un approccio combinato mini-invasivo di legatura prossimale della giunzione safeno-femorale con il trattamento termico della vena grande safena.

The authors report their ex cusses the clinical, diagnostic and symptom of this rare condition of the upper digestive tract and treated the therapeutic approach. This, in the first instance, must be a physician, although, in selected patients and in selected cases, can carried out in a surgical treatment that varies according to the location of the diverticulum.

The authors report their experience on the treatment of diverticula of duodenum. Clinical features and diagnosis of this rare disease of the upper digestive tract are discussed. The medical treatment must be primarly preferred and only in selected cases is possible a surgical treatment, changing according to the site of diverticula.

Gastric cancer triggers an immune response, manifested by immunocompetent cells infiltrating the tumor, such as macrophages, NK cells, neutrophils, T and B-lymphocytes, and plasma cells.Were viewed 300 patients who received surgery for gastric cancer, with removal of at least 15 regional lymph nodes, from January 1998 through December 2008, at the Policlinico "Umberto I", Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, and at "Santa Maria Goretti" Hospital of Latina, Italy. We selected a subset of 46 patients identified according to the following selection criteria: presence of gastric cancer (both intestinal-type and diffuse-type), early-stage (T1 and T2), absence of nodal metastases (N0), or involvement of less than 8 lymph nodes (N1), absence of distant metastases (M0), stage I and II. The sample included 28 males and 18 females.Our results suggest that a high number of tumour-associated macrophages (TAM) along the margins of the tumour is related to a worse outcome, and an increased secretion of immunosuppressive cytokines by TAM may also indirectly affect the action of cytotoxic T cells. Our study also shows a statistically non significant trend of tumour-associated macrophages in promoting the expression of β-catenin, which is a subunit of the cadherin protein complex.Gastric cancer, Infiltrate, Lymphoplasmacellular, Prognostic factors, TNM.Il carcinoma dello stomaco è la seconda causa di morte per cancro in tutto il mondo. Come altre forme di neoplasia, esso innesca una risposta immunitaria caratterizzata dall’infiltrazione del tessuto tumorale e peritumorale da parte di diversi sottotipi di cellule immunocompetenti. Nel nostro studio è stato osservato che un elevato numero di macrofagi infiltranti i margini della neoplasia è associato ad una peggiore prognosi e ad una aumentata espressione di citochine immunosoppressive con conseguente ridotta attività dei linfociti T citotossici.

Sinonasal adenocarcinoma is a tumor typically associated with exposure to occupational carcinogens. The International Agency for Research on Cancer (IARC) published several data in order to classify carcinogenic power of physical-chemical agents as far as sinonasal cancer is concerned.We report a clinical case of sinonasal adenocarcinoma observed in an 84 years old patient, without clinical history of past exposure to carcinogens, smoke and alcohol.A sinonasal adenocarcinoma in a patient without risk factors is extremely rare. It is very important to recognize this cancer at an early stage in order to give better survival rates to the patients.Carcinogens, Intestinal-type adenocarcinoma, Sinonasal cancer.L’adenocarcinoma naso sinusale è una neoplasia tipicamente associata all’esposizione di sostanze cancerogene occupazionali. Lo IARC (International Agency for Research on Cancer) ha pubblicato differenti tabelle che classificano, in base a studi e ricerche effettuate, le sostanze fisico-chimiche il base alla loro capacità di sviluppare il cancro nasosinusale. Numerosi ed approfonditi studi attribuiscono a questo tipo di neoplasia, un carattere prevalentemente occupazionale.

This study is aimed at identifying the collateral circulation in case of femoral-aorta-iliac axis obstruction, with the purpose of a more correct therapeutic indication being either medical or surgical or physiotherapeutic or combined.

Cervical radiation for head and neck cancer has been associated with an increased incidence of carotid arterial stenosis. Modern radiation therapy delivers higher doses with increasing long-term survival. In our study 50 patients with head and neck malignancies treated with radiotherapy are analized with colour Doppler ultrasonographic scanning of the carotid arteries. These patients were compared with a population of asymptomatic historical controls (40) These findings suggest that radiation has an adverse effect on large vessels. Colour Doppler follow-up may be indicated for patients receiving head and neck radiation therapy.50-70 Gy is the local dose that all patients received. during a period of about 8 weeks. The ecodoppler scan of carotid arteries was performed in all patients with estimation of Common and internal carotid artery's intimal medial thickness (IMT). Stenosis grade were divided into low (0-30%), moderate (31-49 %) and severe (=50%). In add we considered ematochimics and flogosys parameters. Patients recruited from a hospital Radiation-oncology-surgery department from April 2007 to September 2011, 90 consecutive head and neck cancer patients were enrolled in this study. 50 of these patients had previously undergone RT (RT group) and 40 had no RT (control group). All patients were screened with bilateral carotid arterial duplex ultrasonography. We defined disease as "normal or mild" if the carotid stenosis was50%, and "significant" if50%. The relationship between standard demographic risk factors and screening outcomes was then analyzed.We found that severe carotid stenosis (=50% ) was higher (41%) in patients who underwent to radiotherapy than in control group. The Eco Doppler examination demonstrated that the most affected site was Internal Carotid Arthery 's fork . There were no differences in age or gender between the two groups. The RT group had a significantly higher plaque score than the non-irradiated group. Bilateral plaque score was significantly correlated with age, hyperlipidemia, and RT. This analysis showed that in RT patients50 years old, age was inversely correlated with plaque score; however, in RT patientsor= 41 years old, age was positively correlated with plaque score.Literature evidences about this subject are few and similar to ours. Moritz et all found a severe carotid stenosis in 30% of irradiated and 5.6% in the control group. Lam found carotid stenosis in 78.9% of irradiated and 21.6% in the other group. We can conclude that radiotherapy is able to induce atherosclerotic lesions only in sites included in radiation field. Should be important to perform pre and post radiotherapy Carotid Arthery Ecodoppler of patients who are going to undergo cervical radiotherapy The prevalence of carotid arterial disease in patients with prior cervical radiation therapy is clinically significant and warrants aggressive screening as part of routine preradiation and postradiation care. Focused screening of this high-risk population may be cost effective and medically beneficial in terms of risk factor modification and stroke preventionCarotid stenosis, Cervical radiotherapy, Stroke prevention.Il trattamento radiante per il carcinoma di testa e collo è stata associata ad un’aumentata incidenza di stenosi carotidea. La moderna radioterapia offre dosi più elevate con incremento aumento della sopravvivenza a lungo termine. Nel nostro studio 50 pazienti con tumori maligni di testa e collo trattati con radioterapia sono stati analizzati con la scansione color-Doppler ultrasonografica delle arterie carotidee. Questi pazienti sono stati confrontati con una popolazione di controlli storici asintomatici (40). Questi risultati suggeriscono che la radiazione ha un effetto negativo sui grossi vasi. Un eco- Color Doppler di follow-up può essere indicato per i pazienti trattati con radioterapia della testa e del collo.50-70 Gy è la dose locale che tutti i pazienti hanno ricevuto durante un periodo di circa 8 settimane. La scansione Ecodoppler delle Arterie Carotidee è stata effettuata in tutti i pazienti con la stima dello spessore intimale mediale(IMT) dell’arteria carotide comune ed interna. Il grado di stenosi è stato diviso in: basso (0-30%), moderata (31-49%) e grave (=50%). In aggiunta abbiamo considerato parametri ematochimici e di flogosi. I pazienti sono stati reclutati da un Dipartimento ospedaliero di radiaterapia, oncologia e chirurgia dal mese di aprile 2007 a settembre 2011. Sono stati arruolati in questo studio 90 pazienti con cancro di testa e collo. Di questi pazienti, 50 erano stati precedentemente sottoposti a RT (gruppo RT) e 40 senza RT (gruppo di controllo). Tutti i pazienti sono stati sottoposti a screening con Ecografia Doppler delle Arterie Carotidee bilateralmente. Abbiamo definito la malattia come “normale o lieve” se la stenosi carotidea è stata50%, e “significativa“, se50%. La relazione tra i fattori di rischio demografici e gli esiti di screening è stata poi analizzata.Abbiamo trovato che la stenosi carotidea grave (=50%) è stata superiore (41%) nei pazienti sottoposti a radioterapia rispetto al gruppo di controllo. L’esame Eco Doppler ha dimostrato che il luogo più colpito è la biforcazione della Arteria Carotide Interna . Non ci sono state differenze di età o di genere tra i due gruppi. Il gruppo RT aveva un Punteggio di Placca significativamente più alto rispetto al gruppo non irradiato. Punteggio di Placca bilaterale è risultato significativamente correlato con l’età, iperlipidemia, e RT. Questa analisi ha mostrato che nei pazienti con RT50 anni, l’età è risultata inversamente correlata con il Punteggio di Placca, tuttavia, nei pazienti RT con età minore o uguale a 41 anni, l’età era positivamente correlata con il Punteggio di Placca.Le evidenze nella letteratura su questo argomento sono poche e simili alla nostra. Moritz et all hanno trovato una grave stenosi carotidea nel 30% dei pazienti irradiati e del 5,6% nel gruppo di controllo. Lam ha trovato una stenosi carotidea nel 78,9% dei pazienti irradiati e del 21,6% nel gruppo di controllo. Si può concludere che la radioterapia è in grado di indurre lesioni aterosclerotiche solo nei siti inclusi nel campo di radiazione.Dovrebbe essere importante effettuare una Ecografia color-Doppler delle arterie Carotidee pre e post radioterapia carotidea nei pazienti in procinto di sottoporsi a radioterapia della testa e del collo. La prevalenza della malattia arteriosa carotidea in pazienti con precedente radioterapia cervicale è clinicamente significativa e garantisce lo screening aggressivo come parte della routine e del trattamento pre e post radiazione. Lo screening mirato di questa popolazione ad alto rischio può essere efficace e medicalmente vantaggioso in termini di modificazione dei fattori di rischio e prevenzione dell’ictus.

To analyze risk factors for type 2 diabetes among women attending menopause clinics in Italy for counselling about the menopause.Women attending a network of first-level outpatient menopause clinics in Italy for general counselling about menopause or treatment of menopausal symptoms.Cross-sectional study with no exclusion criteria. Type 2 diabetes was defined according to National Diabetes Data Groups Indications and the fasting blood glucose at an oral glucose tolerance test within the previous year.Out of the 44 694 considered in this analysis, 808 had a diagnosis of diabetes type 2 (1.8%). In comparison with women aged50 years, the multivariate odds ratios (OR) of type 2 diabetes were 1.31 (95% confidence interval (CI), 0.99-1.74) for women aged 50-52 years, 1.66 (95% CI, 1.27-2.17) at 53-56 years and 2.84 (95% CI, 2.20-3.67) in women agedor = 57 years. Type 2 diabetes was less frequently reported in more educated women (OR high school/university vs. primary school = 0.44 (95% CI, 0.36-0.55)). Being overweight was associated with an increased risk of type 2 diabetes. In comparison with women reporting a low level of physical activity, the multivariate OR of type 2 diabetes was 0.67 (95% CI, 0.54-0.84) for women reporting regular physical activity. In comparison with premenopausal women, the multivariate OR of type 2 diabetes was 1.38 (95% CI, 1.03-1.84) in women with natural menopause. This finding was present also after allowing for the potential confounding effect of age. The multivariate OR of diabetes for users of hormonal replacement therapy was 0.58 (95% CI, 0.46-0.73).This large cross-sectional study suggests that postmenopausal women are at higher risk of type 2 diabetes after allowance for the effect of age. Other main determinants of risk of type 2 diabetes in women around menopause were low socioeconomic status and being overweight. Diabetes was found less frequently in those taking hormone replacement therapy.

OBJECTIVE To obtain data on correlates of climacteric symptoms in women around menopause attending menopause clinics in Italy. METHODS Since 1997 a large cross sectional study has been conducted on the characteristics of women around menopause attending a network of first level menopause outpatient's clinics in Italy. A total of 66,501 (mean age 54.4 years) women are considered in the present paper. RESULTS The odds ratios of moderate and severe hot flashes/night sweats were lower in more educated women and (for severe symptoms only) in women reporting regular physical activity. Depression, difficulty to sleep, forgetfulness and irritability tended to be less frequent in more educated women and (depression only) in women reporting regular physical activity. Parous women reported more frequently these symptoms. CONCLUSIONS This large study confirms in Southern European population that low education, body mass index and low physical activity are associated with climacteric symptoms. Parous women are at greater risk of psychological symptoms.

The IGF system has recently been shown to play an important role in the regulation of breast tumor cell proliferation. However, also breast density is currently considered as the strongest breast cancer risk factor. It is not yet clear whether these factors are interrelated and if and how they are influenced by menopausal status. The purpose of this study was to examine the possible effects of IGF-1 and IGFBP-3 and IGF-1/IGFBP-3 molar ratio on mammographic density stratified by menopausal status.A group of 341 Italian women were interviewed to collect the following data: family history of breast cancer, reproductive and menstrual factors, breast biopsies, previous administration of hormonal contraceptive therapy, hormone replacement therapy (HRT) in menopause and lifestyle information. A blood sample was drawn for determination of IGF-1, IGFBP-3 levels. IGF-1/ IGFBP-3 molar ratio was then calculated. On the basis of recent mammograms the women were divided into two groups: dense breast (DB) and non-dense breast (NDB). Student's t-test was employed to assess the association between breast density and plasma level of IGF-1, IGFBP-3 and molar ratio. To assess if this relationship was similar in subgroups of pre- and postmenopausal women, the study population was stratified by menopausal status and Student's t-test was performed. Finally, multivariate analysis was employed to evaluate if there were confounding factors that might influence the relationship between growth factors and breast density.The analysis of the relationship between mammographic density and plasma level of IGF-1, IGFBP-3 and IGF-1/ IGFBP-3 molar ratio showed that IGF-1 levels and molar ratio varied in the two groups resulting in higher mean values in the DB group (IGF-1: 109.6 versus 96.6 ng/ml; p= 0.001 and molar ratio 29.4 versus 25.5 ng/ml; p= 0.001) whereas IGFBP-3 showed similar values in both groups (DB and NDB). Analysis of plasma level of IGF-1, IGFBP-3 and IGF-1/IGFBP-3 molar ratio compared to breast density after stratification of the study population by menopausal status (premenopausal and postmenopausal) showed that there was no association between the plasma of growth factors and breast density, neither in premenopausal nor in postmenopausal patients. Multivariate analysis showed that only nulliparity, premenopausal status and body mass index (BMI) are determinants of breast density.Our study provides a strong evidence of a crude association between breast density and plasma levels of IGF-1 and molar ratio. On the basis of our results, it is reasonable to assume that the role of IGF-1 and molar ratio in the pathogenesis of breast cancer might be mediated through mammographic density. IGF-1 and molar ratio might thus increase the risk of cancer by increasing mammographic density.