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Pulmonary metastasectomy has become a well-established procedure for patients with certain types of solid tumors. Patients are usually scheduled for staged lung metastasectomy in case of primary tumor control, the absence of distant non-lung metastases, and when complete resection is achievable. Nodules are removed with precision resection in order to ensure radical resection with minimal margins; this technique permits good oncological results, preserving the surrounding pulmonary parenchyma and causing minimal distortion compared to staplers. When possible, anatomical resections should be avoided since they are not justified by real oncological advantages and, in the majority of cases, sacrifice too much healthy tissue, possibly leading to inoperability in the case of metachronous relapses. Thus, preserving the maximum amount of pulmonary parenchyma is crucial because repeated metastasectomies are possible and frequent, with no theoretical limits to the number of reinterventions. In our multidisciplinary board team, we support the role of pulmonary metastasectomy as a useful curative therapy, with acceptable morbidity and mortality, with indications to be discussed case-by-case.

The European social housing stock, built since the early post-war period, now needs major energy, structural and functional upgrading. The owners, almost always public bodies, are therefore called upon to adapt these buildings to the new regulations issued by the European Community. To reduce the costs of intervention, the preferred solution is that of a complete demolition and a subsequent reconstruction by using newly supplied materials, without considering the non-sustainability and social fallout of this choice. The contribution, starting from the hypothesis that more sustainable building rehabilitation interventions are possible, analyses which social and material supply aspects must be considered, and which design strategies can be applied to achieve the objective. First, the characteristics of social buildings in their historical evolution are summarized to understand their value in a broader non-economic sense. Subsequently, the requirements for a sustainable renovation of the existing social dwellings are analysed, and three, out of many other, design strategies are proposed. A case study is then presented and the application of the three strategies done through three Master thesis works is described. In conclusion, the results of the application of the strategies to the case study is analysed to assess whether it is possible to intervene on existing social housing complexes to achieve better results with a more sustainability-oriented perspective.

The dematerialisation of information and the development of Information Systems combined with the use of flexible metadata standards enable a new accessibility for the sources. Matching this new accessibility with the bottom-up historiographic production promoted by Public History enables the development of new forms of history teaching and the generation of information objects through participatory metadata creation with a community of reference. Through the analysis of three different cases, this article brings out the importance of metadata for the organisation, archiving and use of historical sources in a Public History perspective.

Background: Congenital Pulmonary Malformations (CPMs) are rare benign lesions potentially causing infective complications and/or malignant transformation, requiring surgery even when asymptomatic. CPMs are rare in adulthood but potentially detected at any age. There is not a consensus on the correct extent of resection in both adults and paediatrics. This retrospective multicentric study aims to identify the appropriate surgical resection to prevent the recurrence of the related respiratory symptoms. Methods: Between 2010 and 2020, a total of 96 patients (adults and pediatrics) underwent surgery for CPMs in 4 centers. A 2:1 propensity score matching (considering sex and lesion side) was performed, identifying 2 groups: 50 patients underwent lobectomy (group A) and 25 sub-lobar resections (group B). Clinical and histopathological characteristics, early and late complications, and symptom recurrence were retrospectively analyzed and compared between the two groups by univariate and multivariate analysis. Results: Patients who underwent lobectomy had a statistically significant lower rate of recurrence (4% vs. 24% of group B, p = 0.014) and a lower rate of intraoperative complications (p = 0.014). Logistic regression identified sub-lobar resection (p = 0.040), intra- and post-operative complications (p = 0.105 and 0.022),and associated developed neoplasm (p = 0.062) as possible risk factors for symptom recurrence after surgery. Conclusions: Pulmonary lobectomy seems to be the most effective surgical treatment for CPMs, guaranteeing the stable remission of symptoms and a lower rate of intra- and postoperative complications. To our knowledge, this is one of the largest studies comparing lobectomy and sub-lobar resections in patients affected by CPMs, considering the low incidence worldwide.

Managing a building’s life cycle is a fundamental part of designing sustainable constructions and implementing efficient management strategies. The research described in this paper is inserted within this context, with the objective of integrating the facility management phase within this virtuous process. The purpose of the study is to develop a user-friendly and cost-effective strategy that can be used to create a digital twin, based on CMMS, on which to integrate real-time data in order to optimise the use and maintenance phases, moving towards a predictive system. The strategy was developed through two case studies. The first was linked to the procedure to build the digital twin on the CMMS database, and the second was to define the indicators necessary to collect data in real-time, a function underpinning diagnostic maintenance.

Extralobar bronchopulmonary sequestration (eBPS) is a congenital lung malformation characterized by non-functional lung tissue with no connection with the bronchial tree, receiving systemic blood supply and covered by its own visceral pleura. It is mostly asymptomatic, however it can rarely get complicated with infections and neoplastic degeneration. Its management is still debated: many authors suggest observation for asymptomatic cases and intervention only in case of symptoms, others advocate surgery even in asymptomatic patients. Pleuropulmonary blastoma (PPB) is a rare malignant sarcomatous neoplasm, representing the most common primary lung malignancy in children. Typically, PPB is associated with congenital pulmonary airway malformation (CPAM). eBPS is rarely associated with PPB. We report a case of a previously healthy three-year-old boy presented to our emergency room with massive hemothorax after a low-energy chest trauma. Imaging revealed active thoracic bleeding by an anomalous artery arising from the celiac tripod, and an irregular mass in the lower right hemithorax. After performing biopsy, pathologic examination revealed a PPB. The patient underwent four cycles of chemotherapy before surgery. The operative findings revealed a right supradiaphragmatic extralobar mass, with no communication with the bronchial tree, strictly adherent to the right middle lobe. After mass excision, histological analysis confirmed the diagnosis of PPB type 2. The patient underwent postoperative chemotherapy. No recurrence nor metastasis were noted during the current follow-up. DICER-1 research revealed biallelic mutation on the tumor and on the surrounding normal tissue. We reviewed the literature concerning PPB and BPS. Based on these data, we would recommend intervention even in case of asymptomatic eBPS.

Abstract Dual-energy x-ray absorptiometry (DXA) can provide quantitative (bone mineral density, BMD) and qualitative (trabecular bone score, TBS) indexes of bone status, able to predict fragility fractures in most osteoporotic patients. A new qualitative index of bone strength, based on finite element analysis and named bone strain index (BSI), has been recently developed from lumbar DXA scan. We present the preliminary results about the BSI ability to predict a refracture in patients with fragility fractures. A total of 143 consecutive fractured patients with primary osteoporosis (121 females) performed a spine x-ray examination for the calculation of spine deformity index (SDI) and a DXA densitometry for BMD, TBS, and BSI at basal time and in the follow-up. A refracture was considered as a one-unit increase in SDI. For each unit increase of the investigated indexes, the hazard ratio of refracture, 95% confidence interval, p value, and proportionality test p value were for BSI 1.201, 0.982−1.468, 0.074, and 0.218; for lumbar BMD 0.231, 0.028−1.877, 0.170, and 0.305; and for TBS 0.034, 0.001−2.579, 0.126, and 0.518, respectively. BSI was the index predictive of refracture nearest to statistical significance. If confirmed, it may be used for a better risk assessment of osteoporotic patients.

The use of routine ionizing imaging in identify and classify patients with dislocation or infection after surgery has some medical contraindication, in addition to risks associated with the ionizing load and elevated costs. A novel, less expensive and non-ionizing imaging technique, called infrared thermal imaging, can be proposed as a complementary method to routinely evaluate hip prosthesis patients and track their inflammation response following serious complications. Here we report a case of a total hip prosthesis which was dislocated during inpatient rehabilitation, and ultimately reduced without surgical procedure. During the process, routine clinical and radiographic diagnosis was complemented with an infrared examination. The infrared images were easy to take bedside, without direct contact with the area of surgery, and well tolerated. After the dislocation reduction, the thermal imaging procedure provided important feedbacks on the local inflammation, helping to exclude other complications such as the infections. [ABSTRACT FROM AUTHOR]

Abstract Background Access to adequate antenatal care (ANC) is critical in ensuring a good maternal health and in preventing maternal and neonatal morbidity and mortality. South Sudan has one of the world’s poorest health indicators due to a fragile health system and a combination of socio-cultural, economic, and political factors. This study was conducted to identify barriers to utilisation of ANC services in Rumbek North County. Methods Using a qualitative design, data were collected through 14 focus group discussions with 169 women and 45 men and 12 key informant interviews with community leaders, staff working in health facilities, and the staff of the County Health Department. Data were analysed using inductive content analysis. Results The perceived barriers to ANC utilisation were categorised as follows: 1) Issues related to access to health facilities and lack of resources. These included long distance to health facilities, lack of means of transportation to the health facilities, floods and poor roads, and demand for payment for health care at some health facilities; 2) The influence of the socio-cultural context and conflict including heavy burden of domestic chores, the negative influence of husbands who were reluctant to allow their wives to attend ANC, and insecurity; 3) Perceptions about pregnancy including misperceptions about the benefits of ANC and low perceived risk of pregnancy-related complications; and 4) Perceptions about the quality of care and the efficacy of medical treatment. Conclusions This study identified a myriad of factors deeply entrenched in the society, which prevent women from utilising ANC services. It also elicits broad aspects of interconnectedness among the barriers. To ensure effectiveness, strategies to improve utilisation of ANC in the study area and in similar contexts need to take into account the barriers identified by this study.

Fort360 project is a cultural initiative that receives the main directives of edutainment processes, trying to provide an answer to the necessity of a capillary system of information and awareness about the dismissing cultural heritage. The proposed study – carried out in the Fort Bravetta, Rome – presents a video where the educational aspect, related to the historical and architectural site contents, is strictly connected with the playful and emotional quality, resulted from a VR interaction with a panoramic video. This first case study focuses on the use of low-cost digital instrumentation and tries to improve the value of culture from the bottom, proposing an alternative way of cultural heritage enjoyment, based on participation and on interdisciplinarity of the proposed contents.

Effective from May 2014, community-based traditional birth attendants (TBAs) in Yirol West County, South Sudan, were directed to start referring all women in labour to health facilities for childbirth instead of assisting them in the villages. This study aimed to understand the degree of integration of TBAs in the health system, to reveal the factors influencing the integration, and to explore the perceived solutions to the challenges faced by TBAs. A qualitative study utilising 11 focus group discussions with TBAs, 6 focus group discussions with women, and 18 key informant interviews with members of village health committees, staff of health facilities, and staff of the County Health Department was conducted. Data were analysed using qualitative content analysis. The study found that many TBAs were referring women to health facilities for delivery, but some were still attending to deliveries at home. Facilitators of the adoption of the new role by TBAs were: acceptance of the new TBAs' role by the community, women and TBAs, perceptions about institutional childbirth and risks of home childbirth, personal commitment and motivation by some TBAs, a good working relationship between community-based TBAs and health facility staff, availability of incentives for women at health facilities, and training of TBAs. Challenges of integrating TBAs in the health system included, among others, communication problems between TBAs and health care facilities, delays in seeking care by women, insecurity, lack of materials and supplies for TBAs, health system constraints, insufficient incentives for TBAs, long distances to health facilities and transportation problems. This study has revealed encouraging developments in TBAs' integration in the formal health system in Yirol West. However, there is need to address the challenges faced by TBAs in assuming their new role in order to sustain the integration.

PURPOSEWe aimed to evaluate the validity of lung lobe weight assessment via computed tomography (CT) by comparing CT-derived and ex vivo measurements.MATERIALS AND METHODSUnenhanced CT scanning was performed in 30 consecutive patients before lobectomy for lung cancer. The CT images were analyzed using research software after allowing for lobar weight quantitation. The lobar weight estimated by CT was then compared with that measured after surgery using a precision scale (ex vivo measurement). Comparisons as well as assessment of intra- and interoperator variability were conducted using the Bland-Altman method and the coefficient of repeatability (CR). Correlations were examined using Pearson’s correlation analysis.RESULTSComparison analyses were feasible for 28 cases. The ex vivo lobe weight was 186.2±57.3 g, whereas the weights measured by the two operators by CT were 190.0±55 and 182.4±58.2 g, respectively. As compared with ex vivo weights, the CR was 36.4 for operator 1 and 50.4 for operator 2; the mean differences were 3.8 and -3.8 for operators 1 and 2, respectively. The intraoperator and interoperator CR were 20.9 and 36.6, respectively. The mean differences for the intra- and interoperator analysis were -1.5 and -7.5, respectively. The correlation was very high between CT-based and ex vivo measurements (r=0.95 and r=0.90 for operators 1 and 2, respectively; P < 0.001).CONCLUSIONEstimation of lung lobe weight by semi-automated CT analysis is sufficiently reproducible and in agreement with ex vivo measurements.

South Sudan has one of the world's poorest health indicators due to a fragile health system and a combination of socio-cultural, economic and political factors. This study was conducted to identify barriers to utilisation of institutional childbirth services in Rumbek North County.Data were collected through 14 focus group discussions with 169 women and 45 men, and 18 key informant interviews with community leaders, staff working in health facilities, traditional birth attendants, and the staff of the County Health Department. Data were analysed using inductive content analysis.The barriers to institutional childbirth were categorised under four main themes: 1) Issues related to access and lack of resources: long distance to health facilities, lack of transportation means, referral problems, flooding and poor roads, and payments in health facilities; 2) Issues related to the socio-cultural context and conflict: insecurity, influence of the husband, lack of birth preparedness, domestic chores of women, influence of culture; 3) Perceptions about pregnancy and childbirth: perceived benefit of institutional childbirth, low childbirth risk perception, and medicalisation of childbirth including birth being perceived to be natural, undesirable birth practices, privacy concerns, and fear of caesarean section; and 4) Perceptions about the quality of care: inadequate health facility infrastructure and perceived neglect during admission.Multiple factors hinder institutional childbirth in Rumbek North. Some of the factors such as insecurity and poor roads are outside the scope of the health sector and will require a multi-sectoral approach if childbirth services are to be made accessible to women. Detailed recommendations to increase utilisation of childbirth services in the county have been suggested.

Diagnóstico de enfermagem é um tema relevante e atual, o objetivo deste estudo foi identificar os diagnósticos de enfermagem mais freqüentes na unidade de recuperação pós-anestésica. Para fundamentarmos o estudo optamos pelo modelo conceitual de Levine. A amostra foi composta por 15 pacientes com idade entre 21 e 70 anos. Os dados foram coletados por meio de um instrumento que foi utilizado no acompanhamento de pacientes na primeira hora em que permaneceram na URPA. Na identificação dos diagnósticos de enfermagem utilizamos o processo de raciocínio diagnóstico descrito por RISNER (1986), que apontaram categorias as quais denominamos de acordo com a Taxonomia II da NANDA. O resultado evidenciou nove diagnósticos de enfermagem sendo que os que tiveram freqüência superior a 80% foram: temperatura corporal desequilibrada (hipotermia leve) (100%), (Alto) risco para infecção (100%), (Alto) risco para lesão por posicionamento perioperatório (100%), interação social prejudicada (100%), (alto) risco para função respiratória alterada (93,33 % e (alto) risco para aspiração (80%). Este estudo nos permitiu identificar os diagnósticos de enfermagem com vistas a implementação da assistência e prevenção de complicações, objetivando atenção integral na referida unidade.

L'articolo fornisce un'analisi preliminare sui rapporti che si possono stabilire tra i tassi di cambio a termine e i tassi di cambio secondo le aspettative di diverse ipotesi . Gli autori evidenziano le implicazioni di politica monetaria che i vari tipi di aspettative comportano. Per verificare in particolare il ruolo delle aspettative nella determinazione dei tassi di cambio, si procederà attraverso un paio di semplici test empirici che si riferiscono al prezzo a termine del marco tedesco contro la sterlina sul mercato di Francoforte nei primi quattro mesi del 1976. The paper provides preliminary analysis on the relationships that can be established between the rates of the forward exchange rate and the spot exchange rates at the various expectations hypothesis. The authors go on to highlight the implications of monetary policy that the various kinds of expectations entail. To test specifically the role of expectations in the determination of exchange rates at the end we will proceed through a couple of simple empirical tests that refer to the spot and forward prices of the Deutsche Mark against the pound on the Frankfurt market in the first four months of 1976. JEL: E52, E42, F31

RESUMO: Diagnóstico de enfermagem é um tema relevante e atual, o objetivo deste estudo foi identificar os diagnósticos de enfermagem mais freqüentes na unidade de recuperação pós-anestésica. Para fundamentarmos o estudo optamos pelo modelo conceitual de Levine. A amostra foi composta por 15 pacientes com idade entre 21 e 70 anos. Os dados foram coletados por meio de um instrumento que foi utilizado no acompanhamento de pacientes na primeira hora em que permaneceram na URPA. Na identificação dos diagnósticos de enfermagem utilizamos o processo de raciocínio diagnóstico descrito por RISNER (1986), que apontaram categorias as quais denominamos de acordo com a Taxonomia II da NANDA. O resultado evidenciou nove diagnósticos de enfermagem sendo que os que tiveram freqüência superior a 80% foram: temperatura corporal desequilibrada (hipotermia leve) (100%), (Alto) risco para infecção (100%), (Alto) risco para lesão por posicionamento perioperatório (100%), interação social prejudicada (100%), (alto) risco para função respiratória alterada (93,33 % e (alto) risco para aspiração (80%). Este estudo nos permitiu identificar os diagnósticos de enfermagem com vistas a implementação da assistência e prevenção de complicações, objetivando atenção integral na referida unidade. PALAVRAS-CHAVES: Diagnóstico de Enfermagem; Enfermagem Perioperatória; Filosofia em Enfermagem.

A 71-year-old male former smoker was referred for worsening hemoptysis from a hilar left tumor without radiologic or bronchoscopic identification of the bleeding source. He underwent an urgent upper lobectomy extended to the pericardium and left phrenic nerve to control active bleeding. Histologic analysis revealed a malignant triton tumor, a rare aggressive subtype of malignant peripheral nerve sheath tumors. This is a case report of unusual pulmonary involvement associated with hemoptysis. Despite radical surgery and multimodal treatment with adjuvant chemotherapy the patient died of systemic dissemination 10 months after surgery, with a disease-free survival of 3 months. [ABSTRACT FROM AUTHOR]

Background Extensive clinical experience has demonstrated the potential usefulness of autologous fat tissue (AFT) graft in tissue reconstruction, repair or regeneration. In the present study, we evaluated the feasibility and safety of AFT in the repair of surgically injured lung surface. Methods Eighty consecutive procedures of pulmonary metastasectomy by laser precision resection, were performed in 66 patients between March 2010 and December 2012. In the first 20 procedures, AFT graft was applied on the wounded pulmonary surface without closure of parenchymal surface. The following 40 procedures were carried on without AFT (20 leaving the resection margins open and 20 closing the resection margins with a running suture). In the remaining 20 procedures, AFT was applied and the resection margins closed. The efficacy of this technique was evaluated by comparing the AFT group with the non-AFT group, with respect to prolonged alveolar air leakage (PAAL), time to drain removal, length of hospital stay, and patient survival at four years. Results The occurrence of PAAL was lower in the AFT group as compared to non-AFT group (17.5% versus 42.5%, p = 0.027), and median time to drain removal shorter (4 versus 6 days respectively, p = 0.016). Overall 4-year survival was 70% for AFT group, and 59% for non-AFT group (p = 0.34). Conclusions This prospective cohort observational study demonstrated the feasibility and safety of AFT pulmonary grafting after laser metastasectomy. AFT graft improved pulmonary healing, by reducing the incidence and severity of PAAL. Moreover, there was no evidence of tumor promotion in the metastatic setting, with a similar overall survival at 4 years. [ABSTRACT FROM AUTHOR]