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BACKGROUND: This observational study evaluates retrospectively the long-term outcomes after pleurectomy/decortication for pleural mesothelioma, with and without the resection/reconstruction of diaphragm and pericardium. METHODS: Data from 155 consecutive patients undergoing lung-sparing surgery for epithelial pleural mesothelioma were reviewed. Selection criteria for surgery were cT1-3, cN0-1, good performance status, age 12 months was strongly related to the overall survival (P12 months is predictive of an increased survival when the macroscopic complete resection is achieved.

Stencil-based algorithms are a relevant class of computational kernels in high-performance systems, as they appear in a plethora of fields, from image processing to seismic simulations, from numerical methods to physical modeling. Among the various incarnations of stencil-based computations, Iterative Stencil Loops (ISLs) and Convolutional Neural Networks (CNNs) represent two well-known examples of kernels belonging to the stencil class. Indeed, ISLs apply the same stencil several times until convergence, while CNN layers leverage stencils to extract features from an image. The computationally intensive essence of ISLs, CNNs, and in general stencil-based workloads, requires solutions able to produce efficient implementations in terms of throughput and power efficiency. In this context, FPGAs are ideal candidates for such workloads, as they allow design architectures tailored to the stencil regular computational pattern. Moreover, the ever-growing need for performance enhancement leads FPGA-based architectures to scale to multiple devices to benefit from a distributed acceleration. For this reason, we propose a library of HDL components to effectively compute ISLs and CNNs inference on FPGA, along with a scalable multi-FPGA architecture, based on custom PCB interconnects. Our solution eases the design flow and guarantees both scalability and performance competitive with state-of-the-art works.

Adult, benign, non-iatrogenic bronchoesophageal fistula (BEF) is a rare condition, which is occasionally described in single case reports. Therefore, little is known about its possible causes, presentation and management. A systematic search of the literature in MEDLINE, PubMed Central and EMBASE databases between 1990 and 2020 was carried out to identify all cases of BEF. The initial database search identified 19,452 articles, of which 183 (251 individual patient cases) were included in the final analysis. Main causes of BEF were congenital malformations (97/251, 38.7%) and infections (82/251, 32.7%), while 33/251 (13.1%) fistulae were regarded as idiopathic and 39/251 (15.5%) attributed to other causes. Esophagograpy was the most sensitive method of diagnosis (97.4%) compared with esophagoscopy (78.9%), computed tomography (49.6%) and bronchoscopy (46.0%). Definitive treatment was surgical for 176 patients (70%), endoscopic for 25 (10%) and medical for 37 (14.7%). Compared with congenital BEFs, infective BEFs had shorter median symptom duration and were distributed more proximally over the bronchial tree. Definitive treatment was almost only surgical for congenital BEFs, while infective BEFs were treated also endoscopically (12%) and by medical therapy (38%). Morbidity, treatment failure and recurrence rates were higher for infective BEFs. BEFs are rare. Symptoms are non-specific and a high index of suspicion is necessary for diagnosis. Patients with infective BEF tend to have a more severe clinical picture than those with congenital BEF. Surgery is the main treatment for patients affected by congenital BEF, while infective BEFs may heal conservatively.

In a quest for making FPGA technology more accessible to the software community, Xilinx recently released PYNQ, a framework for Zynq that relies on Python and overlays to ease the integration of functionalities of the programmable logic into applications. In this work we build upon this framework to enable transparent hardware acceleration for scientific computations for Zynq. We do so by providing a custom NumPy library designed for PYNQ, as it is the de-facto scientific library for Python. We then demonstrate the effectiveness of the proposed approach on a biomedical use case involving the extraction of features from the Electroencephalography (EEG).

A greenhouse pot experiment was conducted to evaluate the effect of biochar on the growth and uptake of Pb and Zn by tomato plants (Solanum lycopersicum, L.) cultivated in two highly contaminated Kosovo soils, A and B. Plants were cultivated in the biochar amended and unamended soils. As expected, the biochar addition to the two polluted soils has contributed to significantly improve the crop yields, in terms of both fresh and dry weight. Further, results indicated that the effect of biochar on metal mobility is closely related, besides its properties, to soil's native characteristics. In fact, the addition of biochar to soil B had also beneficial effects on the uptake of both metals, halving in some cases the values of the biological accumulation and transfer coefficients, while it did not show the same efficacy on soil A.

Background This group previously reported on the repair of a wide tracheoesophageal fistula with a bioabsorbable patch. The current study describes a consecutive series of patients operated on using the same technique. Methods Data of patients undergoing surgical closure of tracheoesophageal fistula at a single center from 2011 to 2018 were extracted and analyzed. Results An absorbable patch was used in 8 of 23 patients (34.8%) operated on for tracheoesophageal fistula during the study period. Causes of the fistulae included postintubation injury (n = 6), mediastinal radiotherapy (n = 1), and a complication of lung resection (n = 1). The median fistula size was 27.5 mm (range, 15 to 45 mm). In 3 patients, the surgical approach was through cervicotomy and in 5 it was through right thoracotomy. Prosthetic materials consisted of Gore Bio-A (W.L. Gore & Associates, Inc, Newark, DE) tissue reinforcement in 6 patients and polyglactin 910 knitted mesh in 2 patients. In every case, the prosthesis was covered with a pedicled muscle flap. The esophageal defect was treated by primary closure in 7 patients and by esophageal exclusion in 1. Fistula recurrence and postoperative death occurred in 1 patient (12.5%), whereas 7 patients experienced postoperative complications (87.5%). Five patients resumed oral intake, and 3 breathed without a tracheal appliance. Compared with the other patients, in those who underwent repair of their fistula using a prosthesis, the median size of the airway defect was larger, morbidity was greater, and the rate of resumption of oral intake was lower. Conclusions Repair of tracheoesophageal fistulae with synthetic prostheses is feasible and may be effective in complex cases. Further research is needed to identify the ideal prosthetic material.

This study evaluated the effects of ecology (plant community, topography and pedology), as well as of climate, on the composition of essential oils (EOs) from two officinal wild plant species (Lamiales) from Apulia, namely Satureja cuneifolia Ten. and Thymus spinulosus Ten. Few scientific data on their chemical composition are available, due to the fact that the first has a limited distribution range and the second is endemic of southern Italy. Results for both species, never officially used in traditional medicine and/or as spices, showed that the ecological context (from a phytosociological and ecological point of view) may influence their EO composition, and hence, yield chemotypes different from those reported in the literature. S. cuneifolia and Th. spinulosus can be considered good sources of phytochemicals as natural agents in organic agriculture due to the presence of thymol and α-pinene. Overall, the obtained trend for EOs suggests a potential use of both species as food, pharmacy, cosmetics and perfumery. Hence, their cultivation and use represent a positive step to reduce the use of synthetic chemicals and to meet the increasing demand for natural and healthier products.

Four taxa of the Lamiaceae family growing in Apulia (Clinopodium suaveolens, Satureja montana subsp. montana, Thymbra capitata, and Salvia fruticosa subsp. thomasii) that had not been previously studied for their potential use in the food sector, were analyzed for their essential oils (EOs) composition and antioxidant and antimicrobial properties against some microorganisms, isolated from bread and bakery products, including molds (Aspergillus niger, Penicillium roqueforti) and spore-forming bacteria (Bacillus amyloliquefaciens and Bacillus subtilis). Two different sites were considered for each plant species, and the strongest antimicrobial EOs, which were active against all of the microorganisms tested, were those from one S. montana subsp. montana sample (Sm2) and both T. capitata EOs (Tc1 and Tc2) with Minimal Inhibitory Concentration (MIC) values ranging between 0.093% and 0.375% (v/v) against molds, while higher values were registered for bacteria (0.75–1%). In particular, the biological activity of EOs from T. capitata and S. montana subsp. montana was maybe due to the high amount of thymol and carvacrol, which were also responsible for the highest antioxidant activity. S. fruticosa subsp. thomasii EOs had different chemical profiles but showed only a slight antibacterial effect and no antifungal activity. C. suaveolens showed no significant changes between EOs with an interesting antifungal activity (MIC 0.093%÷0.187% v/v), which may be due to the presence of pulegone. These plant species can be considered as promising sources of bioactive compounds to be exploited as biopreservatives in bread and bakery products mainly considering the low concentration needed to inhibit microorganism’s growth.

Food legumes are at the crossroads of many societal challenges that involve agriculture, such as climate change and food sustainability and security. In this context, pulses have a crucial role in the development of plant-based diets, as they represent a very good source of nutritional components and improve soil fertility, such as by nitrogen fixation through symbiosis with rhizobia. The main contribution to promotion of food legumes in agroecosystems will come from plant breeding, which is guaranteed by the availability of well-characterized genetic resources. Here, we analyze seeds of 25 American and European common bean purified accessions (i.e., lines of single seed descent) for different morphological and compositional quality traits. Significant differences among the accessions and superior genotypes for important nutritional traits are identified, with some lines showing extreme values for more than one trait. Heritability estimates indicate the importance of considering the effects of environmental growth conditions on seed compositional traits. They suggest the need for more phenotypic characterization in different environments over different years to better characterize combined effects of environment and genotype on nutritional trait variations. Finally, adaptation following the introduction and spread of common bean in Europe seems to have affected its nutritional profile. This finding further suggests the relevance of evolutionary studies to guide breeders in the choice of plant genetic resources.

To determine the statistical relationships among different consolidated performance tests (Yo-Yo, jump, sprint and agility), and the Powersprint™ device, an isotonic equipment, usually used to increase the muscular strength of athletes, used here as performance test. One hundred individuals were involved in the tests (16 females and 84 males). Ninety-five subjects were practicing different field sports, whereas 3 female and 2 male subjects were inactive. Gender, height and body mass were recorded. Participants completed the following tests: Squat Jump, Counter Movement Jump, 10 m sprint, 15 m sprint, Change of Direction, Yo-Yo Intermittent Recovery Test level 1 and PowerSprint 3.0™. Results of this experiment highlighted that PowerSprint 3.0™ is positively and significantly correlated with Squat Jump, Counter Movement Jump, 10 m sprint, 15 m sprint, Change of Direction, Yo-Yo Intermittent Recovery Test level 1. Additionally, the principal component analysis, as expected, was able to neatly differentiates between male, female and inactive subjects. The selected tests appeared particularly effective in giving information about athlete performances in soccer. Performances measured with the PowerSprint 3.0™ positively and significantly correlated with jumps, COD, sprint and YYIR1 tests. This is an indication of the possible use of this light, inexpensive and portable instrument for measuring athlete performances and checking the effectiveness of training programs.

About 15% of patients with myasthenia gravis are affected by thymoma. Precise tumor staging is necessary to plan the appropriate operation. In early stages, complete surgical resection is the mainstay of treatment. Minimally invasive approaches can be safely performed by highly trained surgeons, and may be preferred in myasthenic patients because they can ensure optimal results from the oncological, neurologic, and surgical point of views, avoiding the complications of open approach. For advanced stage thymoma in myasthenic patients, a careful, multidisciplinary planning of the therapeutic approach must be undertaken, particularly for extended resections involving the lung and great vessels.

The study focused on the effects of ecology (plant communities and topographical data) on composition of essential oils (EOs) of some officinal wild plant species (Lamiales): Clinopodium suaveolens, Salvia fruticosa subsp. thomasii, Satureja montana subsp. montana, and Thymbra capitata, in different environments of Apulia (Italy). C. suaveolens and S. fruticosa subsp. thomasii are rare species of conservation interest, while S. montana subsp. montana and T. capitata, have a wide distribution and are used in traditional medicine or as spices. Results showed that the ecological context (phytosociological and ecological features) may influence the composition of EOs of the studied species. High differences in the compound composition have been found in S. montana subsp. montana, whereas minor effects were observed in C. suaveolens, S. fruticosa subsp. thomasii, and T. capitata accessions. The understanding of such aspects is necessary for providing optimal conditions to produce EOs rich in compounds known for their biological activities. The results are of great interest also for EOs producers and at the same time to improve our knowledge and valorize wild officinal plants.

Cover crops are increasingly adopted in viticulture to enhance soil quality and balance the vegetative and reproductive growth of vines. Nevertheless, this sustainable practice has been only recently used for table grape viticulture, with results often contrasting. The aim of this study was to assess the effect of a fescue (Festucaarundinacea Schreb.) cover crop on soil quality, yield, and grape qualitative parameters in a table grape vineyard (cv &ldquo, Italia&rdquo, ) located in southern Italy, comparing results with the conventional tillage. Soil organic carbon (C), total nitrogen (N), microbial biomass C (MBC), &beta, glucosidase (BGLU) and alkaline phosphomonoesterase (APME) activities were assessed during three growing seasons (2012&ndash, 2014) and three phenological stages. The trend of soil chemical and microbiological properties was jointly influenced by the soil management system, growing season and phenological stage. Compared to conventional tillage, cover crops increased, on average, soil organic C, total N, MBC, BGLU and APME by 136%, 93%, 112%, 100% and 62%, respectively. Slight or no effects of cover crops were observed on grape quality and yield, except for 2012 (the driest season), when a yield reduction occurred. This study reveals that cover crops strongly enhance soil quality in the short-term, with potential advantages for grape production in the long-term.

A greenhouse pot experiment was conducted to evaluate the effect of biochar on the growth and uptake of Pb and Zn by tomato plants (

Background Chest drainage systems are affected by intra and inter-observer variability and poor sensibility in detecting minimal or apparent air leaks. Objectives Overcome intra and inter-observer variability in detecting air leaks. Methods After surgery, a single apical chest tube was connected to the Drentech™ PalmEVO device and air leaks were checked twice a day by observation of both bubbles-in-the-chamber and digital data. Results On a total of 624 observations, disagreement between digital and traditional systems was recorded in 60(9.6%) cases. In 25(21.4%) patients, a disagreement was recorded. Overall, the digital evaluation influenced clinical management in 13(52%). In 10(40%) patients with temporary discordant features, the presence of high pleural fluid output led to a progressive final concordance. Conclusions Disagreement between traditional and digital systems in checking air leaks is not negligible. Digital systems could give advantages in making an objective assessment of air leaks, standardizing the timing of chest tube removal.

Human activities are negatively affecting ecosystems through the erosion and impoverishment of natural resources. Considering soil, global warming and unsustainable agricultural practices are reducing soil organic matter with consequent loss of fertility. An issue of major concern is also the soil pollution by organic and inorganic compounds affecting soil ability to generate ecosystem services. Polycyclic aromatic hydrocarbons are a large group of pollutants, made of two or more aromatic rings, widespread in the environment, soil included, and extremely toxicity for human and environmental health. Polycyclic aromatic hydrocarbons persistence in soil is an issue great concern that could be effectively faced by microbial remediation techniques.In this work we studied the remediation of pyrene polluted soil through two parallel tests: bioremediation and biostimulatin techniques. The first involves inoculation into soil of exogenous microorganisms, in our case Trichoderma harzianum, whereas the latter was aimed at promoting the degrading ability of endogenous microorganisms. Moreover, in order to sustain microorganisms growth, we incorporated olive husk biochar in the two tested bioremediation systems.Biochar is currently considered an excellent soil conditioner and its incorporation into soil seems to promote PAHs adsorption and to interact positively with soil microorganisms. Biochar is a carbonaceous matrix produced through thermal processing of organic biomasses at high temperature and at very low oxygen partial pressure. Here we converted olive husks, that is a potentially toxic by-product of olive oil extraction, by slow pyrolysis process with the aim of deprived this waste biomass of its noxious characteristics.Soil samples were spiked with 50 ppm of pyrene, biochar was incorporated at a concentration of 13 g·kg–1 d.w. of soil and endogenous microbial growth, T. harzianum growth and microbial pyrene-degradation activity were measured weekly up to 28 days.Pyrene concentration was reduced of approximately 70% in 28 days in both bioaugmentation and biostimulation remediation systems. T. harzianum did not display a distinctive ability in degrading pyrene and partially inhibited the endogenous soil microflora from degrading pyrene. Olive husks biochar application did not limited pyrene bioavailability or neither affected microbial pyrene degrading activity. However, our results underline that olive husks biochar increases T. harzianum growth and stimulates soil endogenous microorganisms.

The effective incidence of cutaneous squamous cell carcinoma of the skin (cSCC) is unknown, in general cSCC is the second most common skin cancer, accounting for 20% of all cutaneous malignancies, with a continuous increase in its frequency (1). The skin of the thorax is a very rare localization for this kind of tumor (1-4). Despite cSCC is a malignant proliferation of keratinizing cells of the epidermis, generally, when the diagnosis is made, early surgical resection with adequate surgical margins is curative in more than 95% of the cases (5). Here we present a very rare case of local recurrence of a huge cSCC involving the anterior chest wall that underwent extensive chest wall resection associated to complex reconstruction by using a combination of synthetic materials and autologous flaps.

Introduction The soluble receptor of urokinase plasminogen activator (suPAR) is an innate immunity/inflammation biomarker predicting cardiovascular (CV) and non-CV events in various conditions, including type 2 diabetic patients on dialysis. However, the relationship between suPAR and clinical outcomes in the hemodialysis population at large has not been tested. Methods We measured plasma suPAR levels (R&D enzyme-linked immunosorbent assay [ELISA]) in 1038 hemodialysis patients with a follow-up of 2.9 years (interquartile range = 1.7−4.2) who were enrolled in the PROGREDIRE study, a cohort study involving 35 dialysis units in 2 regions in Southern Italy. Results suPAR was strongly (P < 0.001) and independently related to female gender (β = −0.160), age (β = 0.216), dialysis vintage (β = 0.264), CV comorbidities (β = 0.105), alkaline phosphatase (β = 0.136), albumin (β = −0.147), and body mass index (BMI; β = 0.174) (all P < 0.006). In fully adjusted analyses, suPAR tertiles predicted the risk of all-cause mortality (third tertile vs. first tertile hazard ratio (HR) = 1.91, 95% confidence interval (CI) = 1.47 – 2.48, P < 0.001), CV mortality (HR = 1.47, 95% CI = 1.03–2.09, P = 0.03), and non-CV mortality (HR = 1.94, 95% CI = 1.28–2.93, P = 0.002); these relationships were not modified by diabetes or other risk factors. suPAR added only modest prognostic risk discrimination and reclassification power for these outcomes to parsimonious models based on simple clinical variables. Conclusion In conclusion, suPAR robustly predicted all-cause and both CV and non-CV mortality in a large unselected hemodialysis population. Intervention studies are needed to definitively test the hypothesis that suPAR is causally implicated in clinical outcomes in this population.

Background/Aims: Fabry disease (FD) is a lysosomal storage disorder characterized by pervasive renal involvement. However, this disease is underdiagnosed in patient with chronic kidney disease (CKD), including those with end stage renal disease (ESRD), so their investigation represents an unexploited opportunity for early diagnosis of the disease and for its identification in relatives of affected patients. Methods: We investigated Fabry disease in a clinical and biological database including ESRD patients of unknown cause in a geographical area with 2 million residents. The study was based on state of art GLA gene sequencing and was extended to relatives of affected ESRD patients. Results: Among ESRD patients qualified for enrollment into this study, a previously undiagnosed young man harboring the mutation p.I91T was identified. The study of the proband's family led to the identification of 8 additional cases. In another ESRD male patient, we identified the functional polymorphism p.D313Y. Furthermore, in 55 ESRD patients (24.2%) we found intronic polymorphisms of uncertain functional relevance in the non-coding regions of the GLA gene. Conclusion: A comprehensive survey of ESRD patients in a geographical area of 2 million residents identified one undiagnosed case of Fabry disease and led to the identification of 8 additional cases among his relatives. Screening protocols starting from the dialysis population and upstream extended to families of affected individuals may be an effective strategy to maximize the early identification of subjects with Fabry disease.

Background: In patients submitted to major pulmonary resection, post-operative length of stay is mainly influenced by duration of air leaks and chest tube removal. The measurement of air leaks largely relies on traditional chest drainage systems which are prone to subjective interpretation. Difficulty in differentiating between active air leaks and bubbles due to a pleural space effect may also lead to tentative drain clamping and prolonged time for chest drain removal. New digital systems allow continuous monitoring of air leaks, identifying subtle leakage that may be not visible during daily patient evaluation. Moreover, an objective assessment of air leaks may lead to a reduced interobserver variability and to an optimized timing of chest tube removal. Methods: This study is a prospective randomized, interventional, multicenter trial designed to compare the electronic chest drainage system (Drentech™ Palm Evo) with the traditional one (Drentech™ Compact) in a cohort of patients undergoing pulmonary lobectomy through a standard 3-ports VATS approach both for benign or malignant disease. It will enroll 382 patients in 3 Italian centers. Duration of chest drainage and length of hospital stay will be evaluated in the two groups. Moreover, it will be evaluated if the use of a digital chest system compared with a traditional system reduces theinterobserver variability. Finally, it will be evaluated if the digital drain system may help in distinguishing an active air leak from a pleural space effect, by the digital assessment of intrapleural differential pressure, and in identifying potential predictors of prolonged air leaks. Discussion : To date, few studies have been performed to evaluate clinical impact of digital drainage systems. The proposed prospective randomized trial will provide new knowledge to this research area by investigating and comparing the difference between digital and traditional chest drain systems. In particular, the objectives of this project are to evaluate the feasibility and usefulness of digital chest drainages and to provide new tools to identify patients at higher risk of developing prolonged air leaks.

Pneumonectomy is a surgical treatment for locally advanced lung tumors that deeply infiltrate into the pulmonary hilum, and is a major thoracic procedure. An intrapericardial approach may be necessary in cases where it is impossible to safely deal with the extrapericardial non-invaded sections of the pulmonary vessels. This article describes our technique for intrapericardial left video-assisted thoracoscopic pneumonectomy in a patient with hilar squamous cell carcinoma. The procedure was performed through a two-incision approach and, because of the involvement of the proximal portion of the pulmonary vessels, an intrapericardial isolation and closure of these structures was performed. Radical lymphadenectomy was performed and a pericardial flap was used for coverage of the bronchial stump. This is a complex and challenging procedure, however the patient had an uneventful postoperative course and was discharged on the 7th postoperative day.

Background: Sternal resection is indicated for different pathological conditions. Sternectomy leaves a large anterior chest-wall defect, and so a correct reconstruction is mandatory to guarantee an optimal respiratory dynamic and to protect the mediastinal organs. This study is aimed to evaluate the results of anterior chest-wall reconstruction using a sternal allograft and to summarize the use of this technique in clinical experience worldwide. Methods: In the last ten years at our institution, 14 patients have undergone sternectomy followed by anterior chest wall reconstruction using cadaveric cryopreserved sternal allograft mainly for neoplastic disease except one patient whose surgery was performed for complex sternal dehiscence after cardiac operation. Results: One patient died in the perioperative period. No patients experienced postoperative respiratory failure, surgical site infections, or mechanical failure of the reconstruction. After a median follow-up time of 54 months, there no was occurrence of infection or graft rejection. No respiratory impairment or flail chest occurred in any patients. Eight patients are still alive at the present follow-up time. Conclusions: Thus far, complications related to graft necrosis or rejection have not been reported on in the literature. In our clinical experience, sternal allograft transplantation has been a safe and reproducible technique providing excellent results. At our institution, allografts have been well-tolerated biologically, even after long term follow-up. We hope that the good results obtained in our experience and in other published series may contribute to the further diffusion of this technique as the first choice in cases of anterior chest wall reconstruction. Further studies are necessary to consolidate the early and long term results.