Meridional-energy-transport extremes and the general circulation of Northern Hemisphere mid-latitudes: dominant weather regimes and preferred zonal wavenumbers

The extratropical meridional energy transport in the atmosphere is fundamentally intermittent in nature, having extremes large enough to affect the net seasonal transport. Here, we investigate how these extreme transports are associated with the dynamics of the atmosphere at multiple spatial scales, from planetary to synoptic. We use the ERA5 reanalysis data to perform a wavenumber decomposition of meridional energy transport in the Northern Hemisphere mid-latitudes during winter and summer. We then relate extreme transport events to atmospheric circulation anomalies and dominant weather regimes, identified by clustering 500 hPa geopotential height fields. In general, planetary-scale waves determine the strength and meridional position of the synoptic-scale baroclinic activity with their phase and amplitude, but important differences emerge between seasons. During winter, large wavenumbers (k = 2–3) are key drivers of the meridional-energy-transport extremes, and planetary- and synoptic-scale transport extremes virtually never co-occur. In summer, extremes are associated with higher wavenumbers (k = 4–6), identified as synoptic-scale motions. We link these waves and the transport extremes to recent results on exceptionally strong and persistent cooccurring summertime heat waves across the Northern Hemisphere mid-latitudes. We show that the weather regime structures associated with these heat wave events are typical for extremely large poleward-energy-transport events

Increased incidence of breast cancer in postmenopausal women with high body mass index at the modena screening program

Purpose: We conducted a study to evaluate the relationship between body mass index (BMI) and the risk of breast cancer (BC) and outcome in a population of 14,684 women aged 55 to 69 years eligible to participate in the Mammography Screening Program (MSP) in the Province of Modena, Italy. Methods: The study population was drawn from women who underwent mammography screening between 2004 and 2006 in the Province of Modena. Women were subdivided into obese, overweight, and normal-weight categories according to BMI and followed until July 31, 2010, to evaluate the BC incidence. The clinicopathological characteristics of BC were also evaluated in different groups of patients classified according to BMI. After BC diagnosis, patients were followed for a median period of 65 (range, 2\u2013104) months. Second events (recurrences and second tumors) were recorded, and the 5-year event-free survival (EFS) was calculated. Results: After a period of 73 months, 366 cases of BC were diagnosed. Compared with normal-weight women, obese women had a significantly higher incidence of BC (relative risk [RR], 1.32; p= 0.040) (RR=1), larger tumors (27% of tumors were larger than T2 size), and more nodal involvement (38.5% of tumors were node-positive). Furthermore, a significantly higher rate of total events was seen in obese women compared with overweight and normal-weight patients, respectively (17.9% vs. 11.4% vs. 10.8%, p=0.032). The 5-year EFS was 89.0%, 89.0%, and 80.0% for normal-weight, overweight, and obese patients, respectively. Conclusion: We observed a significantly higher risk of BC in obese women among those eligible to participate in the MSP in the Province of Modena. Finally, obese women had more second events and poorer EFS compared to nono bese women

An updated checklist of the vascular flora of Montagna di Torricchio State Nature Reserve (Marche, Italy)

This study aims to increase floristic knowledge of Marche by means of a survey in the Montagna di Torricchio State Nature Reserve (central Italy). The Reserve, located in the central Apennines, covers about 3.2 km2 at altitudes ranging from 820 to 1,491 m a.s.l. It has been owned and managed as a strict reserve by the University of Camerino since 1970: all the anthropic activities ceased about 50 years ago, except for a minimal area where mowing and cattle grazing are still allowed. The floristic list consists of 789 specific and subspecific taxa belonging to 81 families and 352 genera. Two species are new for Italy (Taraxacum calocarpum and T. pulchrifolium) and 14 for Marche regional flora. Compared to previous floristic studies, we found 127 more taxa but we showed a certain stability in the life-form spectrum, suggesting limited effects of dynamic processes related to climate and land-use changes. The negligible number of alien species (11) is probably related to the limitations to anthropic activities in the Reserve. The occurrence of taxa never recorded for Italy and Marche highlights the floristic value of the Reserve for species conservation in the central Apennines

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk