The surgical treatment of non-metastatic melanoma in a Clinical National Melanoma Registry Study Group (CNMR): a retrospective cohort quality improvement study to reduce the morbidity rates

Background: Reproducible, high-quality surgery is a key point in the management of cancer patients. Quality indicators for surgical treatment of melanoma has been presented with benchmarks but data on morbidity are still limited. This study presents the quality indicators on morbidity after surgical treatment for non-metastatic skin melanoma in an Italian registry. Methods: Data were extracted from the Central National Melanoma Registry (CNMR) promoted by the Italian Melanoma Intergroup (IMI). All surgical procedures (WE, SNLB or LFND) for non-metastatic skin melanoma between January 2011 and February 2017 were evaluated for inclusion in the study. Only centers with adequate completeness of information (> 80%) were included in the study. Short-term complications (wound infection, dehiscence, skin graft failure and seroma) were investigated. Results: Wound infection rate was 1.1% (0.4 to 2.7%) in WE, 1.3% (0.7 to 2.5%) in SLNB and 4.1% (2.1 to 8.0%) in LFND. Wound dehiscence rate was 2.0% (0.8 to 5.1%) in WE, 0.9% (0.2 to 3.0%) in SLNB and 2.8% (0.9 to 8.6%) in LFND. Seroma rate was 4.2% (1.5 to 11.1%) in SLNB and 15.1% (4.6 to 39.9%) in LFND. Unreliable information was found on skin graft failure. Conclusions: Our findings contribute to available literature in setting up the recommended standards for melanoma centers, thus improving the quality of surgery offered to patients. A consensus on the core issues around surgical morbidity is needed to provide practical guidance on morbidity prevention and management

Coronary artery calcium score: we know where we are but not where we may be

Cardiac computed tomography angiography (CCTA) has emerged as a cost-effective and time-saving technique for excluding coronary artery disease. One valuable tool obtained by CCTA is the coronary artery calcium (CAC) score. The use of CAC scoring has shown promise in risk assessment and stratification of cardiovascular disease. CAC scores can be complemented by plaque analysis to assess vulnerable plaque characteristics and further refine risk assessment. This paper aims to provide a comprehensive understanding of the value of the CAC as a prognostic tool and its implications for patient risk assessment, treatment strategies and outcomes. CAC scoring has demonstrated superior ability in stratifying patients, especially asymptomatic individuals, compared to traditional risk factors and scoring systems. The main evidence suggests that individuals with a CAC score of 0 had a good long-term prognosis, while elevated CAC score is associated with increased cardiovascular risk. Finally, the clinical power of CAC scoring and the develop of new models for risk stratification could be enhanced by machine learning algorithms

Effects of RFI and Underground Currents on a Smart Power Bandgap Voltage Reference

The effects on a band gap voltage reference circuit of a radio frequency conducted disturbing signal superimposed to the supply voltage are evaluated. The variations of the dc output voltage are investigated for different frequency and amplitude of the interfering signal. A dedicated PCB for the measurements is developed paying attention to careful HF layout. Also, the impact of substrate currents on the IC\u2019s behaviour is studied. The paper gives an analysis of the results obtained by measurements and simulation, focusing on the key macroscopic effects. A good agreement between simulations and measurements is found. At the end, a modified schematic based on simulation results is proposed to improve the immunity of the bandgap circuit

Performance Evaluation of a Schottky SiC Power Diode in a Boost PFC Application

The performance of a 600 V, 4 A silicon carbide (SiC) Schottky diode (Infineon SDP04S60) is experimentally evaluated. A 300 W boost power factor corrector with average current mode control (PFC) is considered as a key application. Measurements of overall efficiency, switch and diode losses and conducted electromagnetic interference (EMI) are performed both with the SiC diode and with two ultra-fast, soft-recovery, silicon power diodes, namely the RURD460 and the recently presented STTH5R06D. The paper compares the results to quantify the impact of the recovery current reduction provided by SiC diode on these key aspects of the converter behavior

Effects of RFI and Underground Condition on PWM Current-Mode Integrated Circuits for SMPS

The effects of a radio frequency conducted disturbing signal are evaluated on several pin-to-pin compatible control integrated circuits (IC) for PWM current-mode switching power supplies. The tested ICs were selected between some common models available on the market. The variations of the primary functional parameters (inner voltage reference, switching frequency, etc.) are investigated in conditions of different frequency and amplitude for the interfering signal. A dedicated PCB for the measurements was developed paying particular attention to HF layout. Also, the impact of underground condition (voltage at one pin below ground reference) on ICs’ behaviour is analysed. The paper gives a comparative view of the results, focusing on the key macroscopic effects

Susceptibility of Integrated Circuits to RFI: Analysis of PWM Current-Mode Controllers for SMPS

This paper deals with the analysis of the effects of radio frequency conducted interfering signals (RFI) on integrated circuits (ICs). After reviewing the basic results of the susceptibility analysis of operational amplifiers and smart power integrated circuits, the behavior of several pin-to-pin compatible control ICs for PWM current-mode switching power supplies (SMPS) has been tested in the presence of both continuous wave interfering signals (CW) as well as of pulsed noise signals (underground condition). The tested ICs were selected between some common models available on the market. The variations of the primary functional parameters (inner voltage reference, switching frequency, etc.) are evaluated in different test conditions. The paper gives a comparative view of the results, focusing on the key macroscopic effects

Performance Evaluation of a Schottky SiC Power Diode in a Boost PFC Application

The performance of a 600 V, 4 A silicon carbide (SiC) Schottky diode (Infineon SDP04S60) is experimentally evaluated. A 300Wboost power factor corrector (PFC) with average current mode control is considered as a key application. Measurements of overall efficiency, switch and diode losses, and conducted electromagnetic interference (EMI) are performed both with the SiC diode and with two ultra-fast, soft-recovery, silicon power diodes, namely the RURD460 and the recently presented STTH5R06D. The paper compares the results to quantify the impact of the recovery current reduction provided by SiC diode on these key aspects of the converter behavior. Based on the experimental results, the paper shows that the use of SiC diodes in PFC designs may only be justified in high switching frequency applications

Cardiac magnetic resonance imaging of arrhythmogenic cardiomyopathy: evolving diagnostic perspectives

Arrhythmogenic cardiomyopathy (ACM) is a genetically determined heart muscle disease characterized by fibro-fatty myocardial replacement, clinically associated with malignant ventricular arrhythmias and sudden cardiac death. Originally described a disease with a prevalent right ventricular (RV) involvement, subsequently two other phenotypes have been recognized, such as the left dominant and the biventricular phenotypes, for which a recent International Expert consensus document provided upgrade diagnostic criteria (the 2020 "Padua Criteria"). In this novel workup for the diagnosis of the entire spectrum of phenotypic variants of ACM, including left ventricular (LV) variants, cardiac magnetic resonance (CMR) has emerged as the cardiac imaging technique of choice, due to its capability of detailed morpho-functional and tissue characterization evaluation of both RV and LV. In this review, the key role of CMR in the diagnosis of ACM is outlined, including the supplemental value for the characterization of the disease variants. An ACM-specific CMR study protocol, as well as strengths and weaknesses of each imaging technique, is also provided. KEY POINTS: • Arrhythmogenic cardiomyopathy includes three different phenotypes: dominant right, biventricular, and dominant left. • In 2020, diagnostic criteria have been updated and cardiac magnetic resonance has emerged as the cardiac imaging technique of choice. • This aim of this review is to provide an update of the current state of art regarding the use of CMR in ACM, with a particular focus on novel diagnostic criteria, CMR protocols, and prognostic significance of CMR findings in ACM