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This study evaluates the effectiveness of a pilot-scale high-rate algae-bacteria pond (HRAP) to remove pharmaceutical compounds (PhACs) from municipal centrate. The studied PhACs belonged to different classes of synthetic active compounds: antihypertensives, antiepileptics, antidepressants, neuroprotectors, and anti-inflammatory drugs. The HRAP, growing a mixed microalgal consortium made of Chlorella spp. and Scenedesmus spp., was operated in continuous mode (6 days hydraulic retention time) from May to November 2021. Removal efficiencies were high (>85 %) for Sulfamethoxazole and Lamotrigine, promising (65–70 %) for Metoprolol, Fluoxetine, and Diclofenac but low (30–40 %) for Amisulpride, Ofloxacin, Carbamazepine, and Clarithromycin. Propyphenazone and Irbesartan were not removed, and their concentrations increased after the treatment. The combination of abiotic and biotic drivers (mostly global radiation and the synergy between microalgae and bacteria metabolisms) fostered photo and biodegradation processes. Overall, results suggest that microalgae-based systems can be a valuable solution to remove PhACs from wastewater.

Periphyton is the dominant primary producer in mountain streams and sustains the higher trophic levels. While certain periphyton groups, particularly diatoms, have received extensive study, the comprehensive characterization of the entire community has been largely neglected. This study aims to investigate the temporal pattern of biofilm in mountain streams characterized by different water thermal regimes. A one-year quantitative campaign, involving monthly samplings, was conducted in five subalpine streams in Northern Italy’s Orobic Alps to collect epilithic biofilm from a wide surface area. The total biomass was quantified and the periphyton was analyzed both for composition (diatoms, green algae, cyanobacteria, and red algae) and for pigments. Disturbance, water temperature, physico-chemical conditions, nutrients, substrate diversity, and light availability were assessed concurrently with biofilm samplings. Results show sharp biofilm variations over months. In all sites, the disturbance was the primary factor reducing biomass and pigment content. Annually, all sites experienced similar turnover in periphyton composition mainly associated with light and water temperature. Overall, the study indicates that frequent quantitative investigations of biofilm help understand intra-annual variations and identify key drivers. Such information is useful to understand the ecosystem processes and the food web dynamics.

The integration of microalgae cultivation in anaerobic digestion (AD) plants can take advantage of relevant nutrients (ammonium and ortho-phosphate) and CO2 loads. The proposed scheme of microalgae integration in existing biogas plants aims at producing approximately 250 ty(-1) of microalgal biomass, targeting the biostimulants market that is currently under rapid expansion. A full-scale biorefinery was designed to treat 50 kty(-1) of raw liquid digestate from AD and 0.45 kty(-1) of CO2 from biogas upgrading, and 0.40 kty(-1) of sugar-rich solid by-products from a local confectionery industry. An innovative three-stage cultivation process was designed, modelled, and verified, including: i) microalgae inoculation in tubular PBRs to select the desired algal strains, ii) microalgae cultivation in raceway ponds under greenhouses, and iii) heterotrophic microalgae cultivation in fermenters. A detailed economic assessment of the proposed biorefinery allowed to compute a biomass production cost of 2.8 +/- 0.3 kg DW-1, that is compatible with current downstream process costs to produce biostimulants, suggesting that the proposed nutrient recovery route is feasible from the technical and economic perspective. Based on the case study analysis, a discussion of process, bioproducts and policy barriers that currently hinder the development of microalgae-based biorefineries is presented.

Introduction: New digital technologies can become a tool for welcoming the patient through the artistic dimension. Cancer patients, in particular, need support that accompanies and supports them throughout their treatment. Materials and methods: The Art4ART project consist in the structural proposal to cancer patients of a web-based digital platform containing several forms of art as video-entertainments; a multimedia immersive room; an art-based welcoming of the patients with several original paintings; an environment with a peacefulness vertical garden; a reconceptualization of the chemotherapy-infusion seats. Data regarding patients’ preference and choices will be stored and analysed also using artificial intelligence (AI) algorithm to measure and predict impact indicators regarding clinical outcomes (survival and toxicity), psychological indicators. Moreover, the same digital platform will contribute to a better organization of the activities. Discussion: Through the systematic acquisition of patient preferences and through integration with other clinical parameters, it will be possible to measure the clinical, psychological, organisational, and social impact of the newly implemented Art4ART project. The use of digital technology leads us to apply the reversal of viewpoint from therapeutic acts to patient-centred care.

The results of a first campaign of sampling and analyses of emerging micropollutants in the influent (municipal centrate) and effluent of a pilot MBP raceway are reported. The algal population was chiefly made of Chlorella spp. and the pilot worked satisfactorily for the removal of nitrogen. 14 emerging micropollutants were analysed. Average removal efficiencies exceeding 80 % were observed for diclofenac, lamotrigine, ketoprofene, clarithromycin. For such compounds the variability of removal efficiency was also reduced, with respect to the other tested molecules, and was particularly low for diclofenac and lamotrigine. Removal efficiencies over 50 % were measured for azithromycin, metoprolol and irbesartan but with strong variability. Lower removal efficiencies were observed for amisulpride and 5-methylbenzotriazole, while for the remaining compounds the concentrations in the effluent were higher than in the influent.

The efficiency of an outdoor pilot-scale raceway pond treating the wastewaters generated by a large-scale piggery farm in Northern Italy was evaluated. The biomass productivity over 208 days of experimentation was 10.7 ± 6.5 g TSS·m−2·d−1, and ammoniacal nitrogen, orthophosphate, and COD average removal efficiencies were 90%, 90%, and 59%, respectively. Results were used to perform a comprehensive techno-economic analysis for integrating algae-based processes in farms of different sizes (100–10000 pigs). The amount of N disposed of on agricultural land could be reduced from 91% to 21%, increasing the fraction returned to the atmosphere from 2.4% to 63%, and the fraction in the biomass from 6.2% to 16%. For intensive farming, the release of 110 t N·ha−1·y−1 contained in the digestate could be avoided by including algae-bacteria processes. The biomass production cost was as low as 1.9 €·kg−1, while the cost for nitrogen removal was 4.3 €·kg N−1.

Recent literature on the mental health consequences of social distancing measures has found a substantial increase in self-reported sleep disorders, anxiety and depressive symptoms during lockdown periods. We investigate this issue with data on monthly purchases of psychotropic drugs from the universe of Italian pharmacies during the first wave of the COVID-19 pandemic and find that purchases of mental health-related drugs have increased with respect to 2019. However, the excess volumes do not match the massive increase in anxiety and depressive disorders found in survey-based studies. We also study the interplay between mobility, measured with anonymized mobile phone data, and mental health and report no significant effect of mobility restrictions on antidepressants and anxiolytics purchases during 2020. We provide three potential mechanisms that could drive the discrepancy between self-reported mental health surveys and psychotropic drugs prescription registries: (1) stockpiling practices in the early phases of the pandemic; (2) the adoption of compensatory behavior and (3) unexpressed and unmet needs due to both demand- and supply-side shortages in healthcare services.

The integration of microalgae-bacteria consortia within existing wastewater treatment plants as alternative biological treatment could be an interesting option to improve the sustainability of these facilities. However, the fate of the produced biomass is decisive to make that option economically attractive. The present study aimed to valorize the microalgae grown at a pilot scale and used for the treatment of the centrate from municipal sewage sludge, producing microalgal-based iron nanoparticles (ME-nFe), by hydrothermal carbonization. The final product had high carbon content, strong sorbent power, and reducing properties, due to the presence of zerovalent iron. Different synthesis conditions were tested, comparing iron (III) nitrate nonahydrate (Fe (NO3)(3)center dot 9H(2)O) and ammonium iron (III) sulfate dodecahydrate (NH4 Fe (SO4)(2)center dot 12 H2O) as iron sources, four different Fe/C molar ratios (0.02, 0.05, 0.1, 0.2), and three process temperatures (180, 200, 225 degrees C). Based on the characterization of all the prototypes, the best one (having a specific area of 110 m(2)g(-1)) was chosen and tested for the removal of selected heavy metals by Jar tests. The removal of copper, zinc, cadmium, and nickel from the treated effluent from the wastewater treatment plant was 99.6%, 97.8%, 96.4%, and 80.3%, respectively, also for very low starting concentrations (1 mg L-1). The removal of total chromium, on the contrary, was only 12.4%. Thanks to the magnetic properties, the same batch of ME-nFe was recovered and used effectively for three consecutive Jar tests.

This study aims at evaluating an innovative biotechnological process for the concomitant bioremediation and valorization of wastewater from textile digital printing technology based on a microalgae/bacteria consortium. Nutrient and colour removal were assessed in lab-scale batch and continuous experiments and the produced algae/bacteria biomass was characterized for pigment content and biomethane potential. Microbial community analysis provided insight of the complex community structure responsible for the bioremediation action. Specifically, a community dominated by Scenedesmus spp. and xenobiotic and dye degrading bacteria was naturally selected in continuous photobioreactors. Data confirm the ability of the microalgae/bacteria consortium to grow in textile wastewater while reducing the nutrient content and colour. Improvement strategies were eventually identified to foster biomass growth and process performances. The experimental findings pose the basis of the integration of a microalgal-based process into the textile sector in a circular economy perspective.

This study aims at evaluating the process efficiency of an outdoor pilot-scale microalgae-based wastewater treatment system. Experimental results from two monitoring campaigns were analysed, showing that the system removed on average 85.1 % and 36.2 % of the influent ammoniacal nitrogen and orthophosphate, respectively, with an associated algal productivity of 9.5 g TSS·m−2·d-1. Based on pilot-scale results, a comprehensive techno-economic assessment was performed, allowing to calculate a biomass production cost of 4.3 €·kg TSS-1 and a wastewater treatment cost of 2.7 €·m−3 (corresponding to a nitrogen removal cost of 12.5 €·kg N−1). These costs turned out to be comparable with conventional wastewater treatment processes, thus recognizing the potential of microalgae cultivation on wastewaters as feasible alternative to conventional energy-demanding bioremediation systems and to expensive algal cultivation processes. A sensitivity and scenario analysis indicated that, under the most optimistic condition (20 % increase in the productivity, and 20 % OPEX and CAPEX reduction), biomass production and nitrogen removal costs could be further reduced of approximately 44 %.

Introduction: The selection of surgery post-neoadjuvant chemotherapy (NACT) is difficult and based on surgeons’ expertise. The aim of this study was to create a post-NEoadjuvant Score System (pNESSy) to choose surgery, optimizing oncological and aesthetical outcomes. Methods: Patients (stage I–III) underwent surgery post-NACT (breast-conserving surgery (BCS), oncoplastic surgery (OPS), and conservative mastectomy (CMR) were included. Data selected were BRCA mutation, ptosis, breast volume, radiological response, MRI, and mammography pre- and post-NACT prediction of excised breast area. pNESSy was created using the association between these data and surgery. Area under the curve (AUC) was assessed. Patients were divided into groups according to correspondence (G1) or discrepancy (G2) between score and surgery; oncological and aesthetic outcomes were analyzed. Results: A total of 255 patients were included (118 BCS, 49 OPS, 88 CMR). pNESSy between 6.896–8.724 was predictive for BCS, 8.725–9.375 for OPS, and 9.376–14.245 for CMR; AUC was, respectively, 0.835, 0.766, and 0.825. G1 presented a lower incidence of involved margins (5–14.7%; p = 0.010), a better locoregional disease-free survival (98.8–88.9%; p < 0.001) and a better overall survival (96.1–86.5%; p = 0.017), and a better satisfaction with breasts (39.8–27.5%; p = 0.017) and physical wellbeing (93.5–73.6%; p = 0.001). Conclusion: A score system based on clinical and radiological features was created to select the optimal surgery post-NACT and improve oncological and aesthetic outcomes.

Background: The diffusion of screening programs has resulted in a decrease of cT4 breast cancer diagnosis. The standard care for cT4 was neoadjuvant chemotherapy (NA), surgery, and locoregional or adjuvant systemic therapies. NA allows two outcomes: 1. improve survival rates, and 2. de-escalation of surgery. This de-escalation has allowed the introduction of conservative breast surgery (CBS). We evaluate the possibility of submitting cT4 patients to CBS instead of radical breast surgery (RBS) by assessing the risk of locoregional disease-free survival, (LR-DFS) distant disease-free survival (DDFS), and overall survival (OS). Methods: This monocentric, retrospective study evaluated cT4 patients submitted to NA and surgery between January 2014 and July 2021. The study population included patients undergoing CBS or RBS without immediate reconstruction. Survival curves were obtained using the Kaplan-Meyer method and compared using a Log Rank test. Results: At a follow-up of 43.7 months, LR-DFS was 70% and 75.9%, respectively, in CBS and RBS (p = 0.420). DDFS was 67.8% and 29.7%, respectively, (p = 0.122). OS was 69.8% and 59.8%, respectively, (p = 0.311). Conclusions: In patients with major or complete response to NA, CBS can be considered a safe alternative to RBS in the treatment of cT4a-d stage. In patients with poor response to NA, RBS remained the best surgical choice.

The present white paper, referring to the 4th Assisi Think Tank Meeting on breast cancer, reviews state-of-the-art data, on-going studies and research proposals. < 70% agreement in an online questionnaire identified the following clinical challenges: 1: Nodal RT in patients who have a) 1-2 positive sentinel nodes without ALND (axillary lymph node dissection); b) cN1 disease transformed into ypN0 by primary systemic therapy and c) 1-3 positive nodes after mastectomy and ALND. 2. The optimal combination of RT and immunotherapy (IT), patient selection, IT-RT timing, and RT optimal dose, fractionation and target volume. Most experts agreed that RT- IT combination does not enhance toxicity. 3: Re-irradiation for local relapse converged on the use of partial breast irradiation after second breast conserving surgery. Hyperthermia aroused support but is not widely available. Further studies are required to finetune best practice, especially given the increasing use of re-irradiation.Copyright © 2023. Published by Elsevier B.V.

Objective: The aim of this paper is to provide an update about the current clinical indications of RT in this poorly explored field outside the traditional oncological setting. Materials and Methods: We performed a literature search on the main databases, including PubMed, Scopus and Cochrane from their inception until 31stDecember 2020. An additional manual check of scientific meeting proceedings and books was conducted in order to identify all the potentially useful sources. Only essays published in English have been considered for the purposes of this analysis. The searched items included: "Radiotherapy or Radiation Therapy" and "Benign disorder or Benign disease". Results: We provided a list of current clinical indications for benign disorders based on the latest international surveys available, including major sites: eye, bone, head and neck, skin, brain, heart and peripheral vascular system. Conclusions: Radiotherapy for benign diseases is still a feasible therapeutic strategy, which may allow to treat several invalidating conditions, especially after medical therapies have failed thus avoiding potentially invalidating major surgical procedures. A careful evaluation in selecting the indication is essential and all the choices should be thoroughly discussed with the patients.

The treatability of seven wastewater samples generated by a textile digital printing industry was evaluated by employing 1) anammox-based processes for nitrogen removal 2) microalgae (Chlorella vulgaris) for nutrient uptake and biomass production 3) white-rot fungi (Pleurotus ostreatus and Phanerochaete chrysosporium) for decolorization and laccase activity. The biodegradative potential of each type of organism was determined in batch tests and correlated with the main characteristics of the textile wastewaters through statistical analyses. The maximum specific anammox activity ranged between 0.1 and 0.2 g N g VSS-1 d-1 depending on the sample of wastewater; the photosynthetic efficiency of the microalgae decreased up to 50% during the first 24 hours of contact with the textile wastewaters, but it improved from then on; Pleurotus ostreatus synthetized laccases and removed between 20-62% of the colour after 14 days, while the enzymatic activity of Phanerochaete chrysosporium was inhibited. Overall, the findings suggest that all microbes have great potential for the treatment and valorisation of textile wastewater after tailored adaptation phases. Yet, the depurative efficiency can be probably enhanced by combining the different processes in sequence.

Sentinel lymph node biopsy (SLNB) following neoadjuvant treatment (NACT) has been questioned by many studies that reported heterogeneous identification (IR) and false negative rates (FNR). As a result, some patients receive axillary lymph node dissection (ALND) regardless of response to NACT, leading to a potential overtreatment. To better assess reliability and clinical significance of SLNB status on ycN0 patients, we retrospectively analyzed oncological outcomes of 399 patients treated between January 2016 and December 2019 that were either cN0-ycN0 (219 pa-tients) or cN1/2-ycN0 (180 patients). The Endpoints of our study were to assess, furthermore than IR: oncological outcomes as Overall Survival (OS); Distant Disease Free Survival (DDFS); and Regional Disease Free Survival (RDFS) according to SLNB status. SLN identification rate was 96.8% (98.2% in patients cN0-ycN0 and 95.2% in patients cN+-ycN0). A median number of three lymph nodes were identified and removed. Among cN0-ycN0 patients, 149 (68%) were confirmed ypN0(sn), whereas regarding cN1/2-ycN0 cases 86 (47.8%) confirmed an effective downstaging to ypN0. Three year OS, DDFS and RDFS were significantly related to SLNB positivity. Our data seemed to confirm SLNB feasibility following NACT in ycN0 patients, furthermore reinforcing its predictive role in a short observation timing.

Activated carbon pre-treatment was applied to anaerobic digestion effluent in order to reduce the optical density. Up to 78% reduction of OD was achieved suggesting activated carbon pre-treatment a promising tool to increase the light transmission of agricultural digestate. The pre-treated digestate was applied for microalgae cultivation as a source of nutrients and compared to the untreated diluted digestate. Microalgae growth was similar at the first period of cultivation in pre-treated and diluted untreated digestate. However, at the other part of the cultivation higher growth rate and biomass accumulation in untreated digestate was observed. We discuss the possibility of too high nutrient load in pre-treated digestate that may have limited the microalgae growth. PAM measurements showed no stress from the substrate highlighting that activated carbon pre-treated digestate is a suitable medium for microalgae growth. Moreover, vitality of cultures in pre-treated PBRs dropped at the end of the cultivation suggesting some inhibitory effect may be present. Results of current study demonstrate that activated carbon holds a great potential for agricultural digestate pre-treatment to decrease the optical density.

The role of P content on the treatment and valorization of the liquid fraction of digestate, namely centrate, through microalgae-based technologies was evaluated in this study. The performance of four column photobioreactors, which were fed on diluted centrate with corrected (10 mg N/ mg P) and not modified (129 mg N/ mg P) N:P ratio, were monitored and compared. The results demonstrated that P shortage in the centrate affected neither the total nitrogen and COD removal rate nor the volumetric biomass productivity, suggesting that expensive addition of P salts is not necessary to maximize the efficiency of the process. On the contrary, the addition of P to the centrate promoted the ammonia oxidation process as higher nitrite production was observed in the photobioreactors with adjusted N:P ratio than in the ones fed with the non-adjusted N:P ratio. These findings were confirmed by fluorescence in-situ hybridization and quantitative PCR assays, which revealed a higher number of ammonia-oxidizing bacteria in the microalgal suspensions cultivated on centrate with P addition. In conclusion, the N:P ratio in the centrate seems to have a role in controlling the nitrification process rather than in the overall nutrient removal rate and biomass productivity of the microalgae-based system.

The use of phototrophic organisms in wastewater treatment is gaining increasing interest, due to the possibility of exploiting photosynthetic oxygenation, thus lowering treatment costs and environmental impacts. Mixed consortia of phototrophic organisms and aerobic bacteria rapidly develop in photobioreactors receiving wastewaters; in this case, the complex mutualistic interactions among microorganisms cannot be easily described, making difficult to forecast removal efficiencies and biomass productivities. Respirometric methods are applied for evaluating bacterial activity in activated sludge (conventional respirometry) or photosynthetic activity in phototrophic organisms (photorespirometry). Photo-respirometric methods can be also exploited for monitoring algae-bacteria systems and for calibrating mathematical models, allowing for a better comprehension of the interactions involved and a more accurate prediction of system efficiencies. A general protocol and a series of guidelines for conducting photorespirometric tests on algal-bacterial suspensions are here proposed, based on the review of experimental protocols applied to evaluate the effects of several parameters on these systems.

The current epidemics of cardiovascular and metabolic noncommunicable diseases have emerged alongside dramatic modifications in lifestyle and living environments. These correspond to changes in our ”modern” postwar societies globally characterized by rural-to-urban migration, modernization of agricultural practices, and transportation, climate change, and aging. Evidence suggests that these changes are related to each other, although the social and biological mechanisms as well as their interactions have yet to be uncovered. LongITools, as one of the 9 projects included in the European Human Exposome Network, will tackle this environmental health equation linking multidimensional environmental exposures to the occurrence of cardiovascular and metabolic noncommunicable diseases.

Aim of this study was to systematically review the literature to assess efficacy and safety of stereotactic radiotherapy (SRT) in combination with immunotherapy for the treatment of melanoma brain metastases (MBM). The literature was searched using PubMed, Scopus, and Embase. Studies comparing SRT plus immunotherapy versus SRT or immunotherapy alone were deemed eligible for inclusion. Two studies showed improved overall survival after SRT plus immunotherapy in melanoma cancer patients with brain metastases. Three studies reported data on LC and DFS showing as SRT plus immunotherapy did not improve local control and DFS rates. G3-G4 toxicity was reported in only one study (20% in the SRT plus immunotherapy group versus 23% in the immunotherapy group). Despite SRT plus concurrent immunotherapy seems associated with possible survival advantage and low ≥ G3 late toxicity rates, the quality of evidence is very low. Therefore, in patients with brain metastases from melanoma, SRT plus immunotherapy should be evaluated on an individual basis after discussion by a multidisciplinary team.

Introduction: New digital technologies can become a tool for welcoming the patient through the artistic dimension. Cancer patients, in particular, need support that accompanies and supports them throughout their treatment. Materials and methods: The Art4ART project consist in the structural proposal to cancer patients of a web-based digital platform containing several forms of art as video-entertainments; a multimedia immersive room; an art-based welcoming of the patients with several original paintings; an environment with a peacefulness vertical garden; a reconceptualization of the chemotherapy-infusion seats. Data regarding patients’ preference and choices will be stored and analysed also using artificial intelligence (AI) algorithm to measure and predict impact indicators regarding clinical outcomes (survival and toxicity), psychological indicators. Moreover, the same digital platform will contribute to a better organization of the activities. Discussion: Through the systematic acquisition of patient preferences and through integration with other clinical parameters, it will be possible to measure the clinical, psychological, organisational, and social impact of the newly implemented Art4ART project. The use of digital technology leads us to apply the reversal of viewpoint from therapeutic acts to patient-centred care.

The integration of microalgae in the municipal wastewater treatment scheme could certainly be an interesting option to reduce the carbon footprint of the process. The obtained microalgae could be valorized through hydrothermal carbonization (HTC), producing a sorbent material to be used as an alternative to activated carbon. However, HTC of microalgae does produce potentially harmful byproducts. The present work aims to investigate the possibility of using the effluent derived from the hydrothermal carbonization of microalgae (HTC-LF), performed to produce microalgal-based carbon encapsulated iron nanoparticles (ME-nFe), as a growth medium for the microalgae. Since this raw effluent was proved to be toxic for Allivibrio fisheri (EC50 = 1.8 %), the microalgal activity was studied also for detoxification. A 20 % dilution of the HTC-LF, using municipal centrate as the diluent, was proved to be suitable for microalgal growth without affecting the photochemical efficiency. In a continuous test, a community made of Chlorella spp. and Euglena gracilis was able to grow with and without CO2 addition, with average productivity of 62 +/- 5 and 43 +/- 8 mg L-1 d(-1), respectively. The treatment led to a 60 % COD removal, suggesting that the HTC-LF was not harmful to the microalgae-bacteria consortia, which was also able to decrease its toxicity. Environmental implications: The liquid byproduct of the hydrothermal carbonization (HTC-LF) is a known toxic for the water compartment. The possibility to exploit its nutrient content for microalgal growth was already proved by different studies using strong dilution with synthetic medium to perform batch cultivations. Here, the HTC-LF was diluted with the blackwater from biosolid dewatering, without adding any microelements or main nutrients to perform a continuous cultivation. A microalgal community was grown, consuming nutrients and the COD, lowering the toxicity. The obtained biomass was used to produce second-generation nano -parti

Oncoplastic surgery level II techniques (OPSII) are used in patients with operable breast cancer. There is no evidence regarding their safety and efficacy after neoadjuvant chemotherapy (NAC). The aim of this study was to compare the oncological and aesthetic outcomes of this technique compared with those observed in mastectomy with immediate breast reconstruction (MIBR), in post-NAC patients undergoing surgery between January 2016 and March 2021. Local disease-free survival (L-DFS), regional disease-free survival (R-DFS), distant disease-free survival (D-DFS), and overall survival (OS) were compared; the aesthetic results and quality of life (QoL) were evaluated using BREAST-Q. A total of 297 patients were included, 87 of whom underwent OPSII and 210 of whom underwent MIBR. After a median follow-up of 39.5 months, local recurrence had occurred in 3 patients in the OPSII group (3.4%), and in 13 patients in the MIBR group (6.1%) (p = 0.408). The three-year L-DFS rates were 95.1% for OPSII and 96.2% for MIBR (p = 0.286). The three-year R-DFS rates were 100% and 96.4%, respectively (p = 0.559). The three-year D-DFS rate were 90.7% and 89.7% (p = 0.849). The three-year OS rates were 95.7% and 95% (p = 0.394). BREAST-Q highlighted significant advantages in physical well-being for OPSII. No difference was shown for satisfaction with breasts (p = 0.656) or psychosocial well-being (p = 0.444). OPSII is safe and effective after NAC. It allows oncological and aesthetic outcomes with a high QoL, and is a safe alternative for locally advanced tumors which are partial responders to NAC.

We report on the third Assisi Think Tank Meeting (ATTM) on breast cancer, a brainstorming project which involved European radiation and clinical oncologists who were dedicated to breast cancer research and treatment. Held on February 2020, the ATTM aimed at identifying key clinical questions in current clinical practice and "grey" areas requiring research to improve management and outcomes. Before the meeting, three key topics were selected: 1) managing patients with frailty due to either age and/or multi-morbidity; 2) stereotactic radiation therapy and systemic therapy in the management of oligometastatic disease; 3) contralateral breast tumour prevention in BCRA-mutated patients. Clinical practice in these areas was investigated by means of an online questionnaire. In the lapse period between the survey and the meeting, the working groups reviewed data, on-going studies and the clinical challenges which were then discussed in-depth and subjected to intense brainstorming during the meeting; research protocols were also proposed. Methodology, outcome of discussions, conclusions and study proposals are summarized in the present paper. In conclusion, this report presents an in-depth analysis of the state of the art, grey areas and controversies in breast cancer radiation therapy and discusses how to confront them in the absence of evidence-based data to guide clinical decision-making.Copyright © 2022 Elsevier B.V. All rights reserved.

In the past 30 years several studies have proved that the rivers flow regime is fundamental in structuring biotic communities. The condition of the ecosystem results from the occurrence of extreme events, such as floods and droughts, but also from habitat availability and from its temporal variation. Describe the relationships between macroinvertebrate community characteristics and environmental gradients of flow, temperature, nutrient supplies and habitat conditions is fundamental to understand ecological dynamics. This is the basis for predicting changes within the communities and in ecosystem functions and ultimately to properly manage and conserve the riverine ecosystems. Seven sites, along a 20-km river sector, were surveyed for macroinvertebrates and water chemistry seasonally, from 2012 to 2016. Habitat conditions were assessed along a 500 m stretch in each site. The river discharge was continuously monitored by two water level recorders and used to reconstruct various hydrological indices specific for each sampling location. During the sampling period numerous high flow events and some prolonged periods of low flow were observed. Quantile regression was used to describe the effects of potential limiting factors on macroinvertebrate community which were primarily driven by antecedent flow conditions and season while habitat conditions and water chemistry played only a minor role. Quantitative models have been developed to predict structural and functional characteristics of macroinvertebrate community as a function of antecedent flow conditions, habitat and physico-chemical water characteristics. Those models allow to identify the main drivers and predict the effect of different water management strategies to riverine ecosystem.

Alpine and pre-alpine lotic ecosystems are often remote and not affected by humans, which makes them some of the world’s most pristine ecosystems. However, their status is often altered by the presence of reservoirs that are built to fulfil agricultural needs and hydroelectric demands. These reservoirs also disrupt stream continuity and alter the magnitude, timing, and frequency of natural flows. The present work assessed how high altitude reservoirs affect the riverine ecosystems focusing on: i) the macroinvertebrate communities; ii) the breakdown of organic matter; iii) the thermal regime. Stretches altered by high altitude reservoirs had the best conditions for most macroinvertebrate families due to a more stable flow conditions. The breakdown rate of coarse particulate organic matter was not affected by high altitude reservoirs but its availability was higher in altered compared to pristine stretches. The presence of hydroelectric power plants modified the stream thermal regime. Reservoirs mitigate the atmospheric influence on stream water temperature while run of the river plants strengthen it in the diverted stretches. Where both these alterations were present the thermal regime of the stream was more similar to the natural ones compared to stretches subjected to only one kind of alteration. This research showed how river impoundment alters the structure of macroinvertebrate communities and the function of the downstream lotic ecosystems and can provide the basis to correctly guide management strategies for lotic ecosystems affected by hydrological alterations.