GIS-based detection of terraced landscape heritage: comparative tests using regional DEMs and UAV data

The analysis of terraced heritage has implications in many different fields of study, as it is shaped itself by natural, socioeconomic, and cultural dynamics. Given that their abandonment impoverishes territories and communities and raises natural, especially hydrogeological hazards, and that their deactivation leads to a loss of cultural identity, this paper aims to study rapid mapping systems for their detection. Since a deep relation between high land division and the use of terraces for the exploitation of territories has been recognized, a first detection method is based on cadastral maps. The joint use of regional-scale digital elevation models (DEMs) and cadastral dataset polygons, based on a model that typically uses GIS analyses, identifies areas with a high probability of terracing. A second method is based on the use of new technologies for very high-scale data collection. The DEM models derived from UAV (unmanned aerial vehicle) photogrammetry, given their ability to determine the micro-topographical characterization of the terrain as well as the most expensive on-site techniques, can be considered an excellent low-cost means by which to locate terraced heritage. The proposed work includes comparative testing between methods implying GIS-based analysis of slope models. It aims to highlight the effectiveness of using both methods: regional-scale DEMs and cadastral maps to detect a high probability of terrace localization, and DEMs derived from the use of low-altitude aerial data and structure from motion (SfM) algorithms, which have greatly and effectively increased the use of aerial drone photogrammetry

A BRAF Negative Classic Hairy Cell Leukemia Patient in Long Lasting Complete Remission after Rituximab and Pentostatin

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Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Cladribine Efficacy in a Patient with Hairy Cell Leukemia and Severe Renal Insufficiency

Background: Hairy cell leukemia commonly presents with pancytopenia, indolent course, and predisposition as infectious complications. Current first-line therapeutic options are purine analogues, particularly cladribine, with a high percentage of complete responses and durable remissions. However, their use is poorly investigated in patients affected by severe chronic renal insufficiency. Case presentation: Here, we describe a case of HCL in a 68-year-old man affected by multiple comorbidities, including severe chronic renal failure. After a course of interferon-α, the patient received therapy with Cladribine every other week, obtaining a complete hematological remission and improvement of renal function. Discussion: With a different soft schedule of cladribine, the patient was treated adequately, obtaining a complete remission. Conclusion: Cladribine can be administered with caution, even in patients with renal failure, with good results. Copyright© Bentham Science Publisher

ANALISI DI DTM/DSM PER L’INDIVIDUAZIONE DI PAESAGGI TERRAZZATI. TEST COMPARATIVO USANDO DEM REGIONALI E DATI UAV

L'analisi del patrimonio terrazzato ha implicazioni in molti campi di studio differenti, in quanto racchiude in sé effetti e relazioni connesse alle dinamiche naturali e ambientali, socio-economiche e culturali. Dato che l’abbandono dei terrazzamenti impoverisce i territori e le comunità, causa rischi naturali, in particolare idrogeologici, e la loro disattivazione porta alla perdita dell’identità culturale delle comunità che li hanno prodotti, questo studio mira a individuare e sperimentare metodi e sistemi rapidi per identificarli e mapparli. Dal momento che nei territori montani è stata riconosciuta una profonda relazione tra l’elevata parcellizzazione fondiaria e l'utilizzo dei terrazzamenti produttivi, un primo metodo per il loro rilievo si basa su mappe catastali. L'utilizzo congiunto di DEM a scala regionale e dei datasets della cartografia numerica catastale, introdotti in un modello di calcolo che sfrutta analisi spaziali tipiche dei GIS, consente di identificare aree di elevata probabilità di terrazzamento. Un secondo metodo si basa sull'utilizzo delle nuove tecnologie per il rapid mapping a grande scala. I DEM derivati dalla fotogrammetria UAV (Unmanned Aerial Vehicle), data la loro capacità di determinare la caratterizzazione micro-topografica del terreno al pari delle più onerose tecniche terrestri, possono essere considerati uno strumento a basso costo per individuare e mappare il patrimonio terrazzato. Il lavoro proposto include test comparativi tra i metodi che sfruttano gli strumenti di analisi GIS applicati ai modelli di acclività. Questo lavoro mira ad evidenziare l'efficacia dell'utilizzo di entrambi i metodi: i DEM a scala regionale e i dataset della cartografia numerica catastale sono utili ad individuare l’elevata probabilità di localizzazione dei terrazzamenti e i DEM derivati dall'uso di dati UAV tramite gli algoritmi SfM (Structure from Motion) dimostrano l’efficacia dell’impiego dei sistemi di fotogrammetria da drone in questo campo

First reported case of secondary mixed phenotype acute leukemia after multiple myeloma

In recent years the outcome of patients with multiple myeloma (MM) has significantly improved, due to new drugs. However, some agents, i.e. the alkylating drug melphalan, can be associated with an increased incidence of secondary malignancies. Myelodysplastic syndromes and acute myeloid leukemia are reported in the literature, and rarely acute lymphoblastic leukemia. Here we describe a unique case of a 56-years old female patient affected by MM since 2015 in complete remission after autologous stem cell transplant and in lenalidomide maintenance, who developed 2 years later mixed phenotype acute leukemia (MPAL). The patient, refractory to both lymphoblastic and myeloid acute leukemia regimens, achieved complete remission with bi-specific anti-CD19/anti-CD3 monoclonal antibody blinatumomab and with hypomethylating agent azacytidine plus the BCL-2 inhibitor venetoclax. She then underwent hematopoietic stem cell transplantation from HLA-identical sibling donor and she is still in complete remission after 9 months. To the best of our knowledge, there are no cases in the literature describing MPAL after autologous transplant for MM. Our patient was treated with blinatumomab and venetoclax and achieved complete remission 9 months from allogeneic transplant. The mechanism underlying the development of MPAL is not completely understood and therapies are still lacking. In this context the combination of blinatumomab, azacytidine and venetoclax successfully used in this patient may provide food for thought for further studies in this rare setting of patients