SARS-CoV-2 Infection in Health Care Workers: Cross-sectional Analysis of an Otolaryngology Unit

The restart of routine in- and outpatient activity in the COVID-19 postepidemic peak needs to be carefully planned in light of specific patterns of viral diffusion. We evaluated SARS-CoV-2 serology in the entire personnel of a COVID-19-free otolaryngology department in a highly affected area. The aim was to determine the prevalence of SARS-CoV-2 positivity among staff to clarify the impact of different risk factors for infection. The entire staff of the otolaryngology unit was tested for SARS-CoV-2 serology. Symptomatic staff members were tested with nasal/pharyngeal swabs. All answered a survey focused on the number of in- and extrahospital positive contacts and type of activities in the unit. Five (9%) were positive for SARS-CoV-2 infection. The only variable associated with a higher risk of infection was the number of extrahospital contacts without personal protective equipment (P = .008). Our study shows that in non-COVID-19 departments, the use of adequate personal protective equipment leads to low rates of infection among health care workers. The prevalent risk of infection was related to extrahospital contact

A aplicação da ultrassonografia de alta frequência como método diagnóstico complementar para o prognóstico e terapêutica assertiva do Melanoma Cutâneo

Este estudo apresenta caso de paciente feminina, 39 anos, fototipo II, com lesão suspeita de melanoma no braço esquerdo. A rápida evolução, formato, pigmentação e exulceração central levaram à solicitação da Ultrassonografia de Alta Frequência (Usaf) como exame complementar. A Usaf classificou a lesão em relação à profundidade e infiltração, auxiliando no planejamento cirúrgico. A exérese confirmou melanoma extenso superficial. A Usaf oferece informações seguras, indolores e não invasivas sobre a estrutura anatômica e vascular, permitindo avaliar a extensão da lesão em diferentes eixos. Sua relevância cresce na prática clínica dermatológica, contribuindo para o diagnóstico e tratamento assertivos

Instance segmentation of upper aerodigestive tract cancer: site-specific outcomes

Objective. To achieve instance segmentation of upper aerodigestive tract (UADT) neoplasms using a deep learning (DL) algorithm, and to identify differences in its diagnostic performance in three different sites: larynx/hypopharynx, oral cavity and oropharynx.Methods. A total of 1034 endoscopic images from 323 patients were examined under narrow band imaging (NBI). The Mask R-CNN algorithm was used for the analysis. The dataset split was: 935 training, 48 validation and 51 testing images. Dice Similarity Coefficient (Dsc) was the main outcome measure.Results. Instance segmentation was effective in 76.5% of images. The mean Dsc was 0.90 & PLUSMN; 0.05. The algorithm correctly predicted 77.8%, 86.7% and 55.5% of lesions in the larynx/hypopharynx, oral cavity, and oropharynx, respectively. The mean Dsc was 0.90 & PLUSMN; 0.05 for the larynx/hypopharynx, 0.60 & PLUSMN; 0.26 for the oral cavity, and 0.81 & PLUSMN; 0.30 for the oropharynx. The analysis showed inferior diagnostic results in the oral cavity compared with the larynx/hypopharynx (p < 0.001). Conclusions. The study confirms the feasibility of instance segmentation of UADT using DL algorithms and shows inferior diagnostic results in the oral cavity compared with other anatomic areas

Centres històrics italians i marginalitat: per una estratègia de regeneració del territori històric contemporani

El estudio desarrollado por Ancsa * y Cresme ** muestra el estado actual de los centros históricos italianos desde el punto de vista económico y demográfico, que es el punto de partida del documento para reflexionar sobre las políticas urbanas italianas para la mejora y preservación de Territorio histórico contemporáneo. Además, el documento tiene como objetivo investigar más a fondo el fenómeno de la marginalidad que surge de la aplicación del concepto de "periferia" a los centros históricos.A partir de la metodología analítica-interpretativa utilizada en el informe Ancsa-Cresme 2017, nuestro estudio sigue un método inductivo basado en las tendencias de encuestas demográficas, sociales y económicas en las capitales de provincia. Aunque de forma cuantitativa, este enfoque refleja la tendencia por la que atraviesan las ciudades italianas y es útil para describir las características comunes del fenómeno de la marginalidad de algunos centros históricos. Esta investigación general representa el marco de referencia para el análisis profundo y comparativo de los estudios de caso útiles para comprender los fenómenos específicos que caracterizan a los centros históricos, así como las políticas, estrategias y resultados de planificación para su regeneración. Debido a su estructura y morfología, los centros históricos son organismos vivos y únicos, por lo que es difícil planificar un marco de política urbana predefinido y estandarizado. Es por eso que, a partir de un marco general, profundizamos algunos estudios de caso para delinear las políticas adecuadas para contextos urbanos similares.El documento propone un análisis comparativo entre dos estudios de caso italianos que se caracterizan por fenómenos de degradación o por turismo de senderismo, envejecimiento y disminución de la población (especialmente jóvenes y familias), así como la pérdida de actividades comerciales en el vecindario. Al mismo tiempo, el documento considera los centros históricos como nodos de la red de territorios históricos identificados a través de un enfoque de mejora del patrimonio histórico y cultural más en línea con la forma y las necesidades de la ciudad contemporánea. Estas dos condiciones demuestran que los centros históricos deberían ser cruciales para la nueva agenda de políticas urbanas.Los datos utilizados se toman de las encuestas censales del Instituto Nacional de Estadística y / o están disponibles en las bases de datos locales, así como los datos tomados de las herramientas de planificación urbana vigentes.Los resultados muestran las políticas urbanas que sería útil apoyar para promover una regeneración de la ciudad contemporánea. Estas políticas deben ser conscientes tanto de los problemas que afectan a los componentes históricos tradicionales (la marginalidad de los centros históricos) como de los nuevos desafíos derivados de los cambios socioeconómicos y ambientales, que extienden considerablemente los recuerdos de los habitantes y las competencias de planificación urbana más allá del perímetro de Los centros históricos.* Ancsa, Associazione Nazionale Centri Storici Artistici, Asociación Nacional de Centros Artísticos Históricos** Cresme, Centro di Ricerche Economiche e Sociologiche di Mercato dell’Edilizia, Centro de Investigación Económica y Sociológica en el Mercado de la ConstrucciónL'estudi desenvolupat per Ancsa * i Cresme ** mostra l'estat actual dels centres històrics italians des del punt de vista econòmic i demogràfic, que és el punt de partida del document per reflexionar sobre les polítiques urbanes italianes per a la millora i preservació de Territori històric contemporani. A més, el document té com a objectiu investigar més a fons el fenomen de la marginalitat que sorgeix de l'aplicació de el concepte de "perifèria" als centres històrics.A partir de la metodologia analítica-interpretativa utilitzada en l'informe Ancsa-Cresme 2017, el nostre estudi segueix un mètode inductiu basat en les tendències d'enquestes demogràfiques, socials i econòmiques en les capitals de província. Encara que de forma quantitativa, aquest enfocament reflecteix la tendència per la qual travessen les ciutats italianes i és útil per a descriure les característiques comunes del fenomen de la marginalitat d'alguns centres històrics. Aquesta investigació general representa el marc de referència per a l'anàlisi profunda i comparativa dels estudis de cas útils per comprendre els fenòmens específics que caracteritzen els centres històrics, així com les polítiques, estratègies i resultats de planificació per a la seva regeneració. A causa de la seva estructura i morfologia, els centres històrics són organismes vius i únics, de manera que és difícil planificar un marc de política urbana predefinit i estandarditzat. És per això que, a partir d'un marc general, aprofundim alguns estudis de cas per delinear les polítiques adequades per a contextos urbans similars.El document proposa una anàlisi comparativa entre dos estudis de cas italians que es caracteritzen per fenòmens de degradació o per turisme de senderisme, envelliment i disminució de la població (especialment joves i famílies), així com la pèrdua d'activitats comercials en el veïnat. A el mateix temps, el document considera els centres històrics com a nodes de la xarxa de territoris històrics identificats a través d'un enfocament de millora de el patrimoni històric i cultural més en línia amb la forma i les necessitats de la ciutat contemporània. Aquestes dues condicions demostren que els centres històrics haurien de ser crucials per a la nova agenda de polítiques urbanes.Les dades utilitzades es prenen de les enquestes censals de l'Institut Nacional d'Estadística i / o estan disponibles a les bases de dades locals, així com les dades preses de les eines de planificació urbana vigents.Els resultats mostren les polítiques urbanes que seria útil donar suport per promoure una regeneració de la ciutat contemporània. Aquestes polítiques han de ser conscients tant dels problemes que afecten els components històrics tradicionals (la marginalitat dels centres històrics) com dels nous desafiaments derivats dels canvis socioeconòmics i ambientals, que estenen considerablement els records dels habitants i les competències de planificació urbana més enllà del perímetre de Els centres històrics.* Ancsa, Associazione Nazionale Centri Storici Artistici, Associació Nacional de Centres Artístics Històrics** Cresme, Centre vaig donar Ricerche Economiche i Sociologiche vaig donar Mercato dell'Edilizia, Centre de Recerca Econòmica i sociològica al Mercat de la ConstruccióThe study developed by Ancsa* and Cresme** shows the current state of the Italian historic centers from the economic and demographic point of view, which is the starting point of the paper in reflecting on the Italian urban policies for the enhancement and preservation of the contemporary historic territory. Moreover, the paper aims to deeper investigate the phenomenon of marginality as arising from the application of the concept of “periphery” to historic centers.Starting from the analytical-interpretative methodology used in the Ancsa-Cresme 2017 report, our study follows an inductive method based on demographic, social and economic survey trends in the provincial capital cities. Although in a quantitative way, this approach reflects the trend Italian cities are going through, and is useful to outline the common characteristics of the marginality phenomenon of some historic centers. This general investigation represents the reference framework for the in-depth and comparative analysis of the case studies useful to understand the specific phenomena that are characterizing historic centers, as well as of the policies, strategies and planning outcomes for their regeneration. Due to their structure and morphology, historic centers are living and unique organisms, and it is thus difficult to plan a predefined and standardized urban policy framework. That is why, starting from a general framework, we deepen some case studies to outline the policies suitable for similar urban contexts.The paper proposes a comparative analysis between two Italian case studies that are characterized by phenomena of degradation or by hiking tourism, ageing and declining population (especially young people and families) as well as the loss of neighbourhood business activities. At the same time, the paper considers historic centers as nodes of the historic territory network identified through an enhancement approach of the historic and cultural heritage more in line with the shape and needs of the contemporary city. These two conditions demonstrate that historic centers should become crucial for the new urban policies agenda.The data used are taken from the census surveys of the National Institute of Statistics and/or available from local databases, as well as data taken from the urban planning tools in force.The results show the urban policies that it would be useful to support in order to promote a regeneration of the contemporary city. These policies must be aware of both the problems that afflict the traditional historic components (the marginality of historic centers) and the new challenges deriving from socio-economic and environmental changes, which considerably extend the inhabitants’ memories and urban planning competencies beyond the perimeter of the historic centers.* Ancsa, Associazione Nazionale Centri Storici Artistici, National Association of Historic Artistic Centers** Cresme, Centro di Ricerche Economiche e Sociologiche di Mercato dell’Edilizia, Center for Economic and Sociological Research on the Building MarketPeer Reviewe

Historical network for the regeneration of the contemporary city

The paper aims to investigate the cultural heritage role relating to the contemporary city. In particular, it analyses some case studies where planning highlight the role of historical network within strategies useful to regenerate the contemporary city, taking the opportunity to rebuild the - ences the concept of cultural heritage because its shape and topics (e.g. urban sprawl, environmental fragmenta- - ervation of the historical values (i.e. abandoned historical centers, fragmented signs impressed on the palimpsest, dispersion of local cultures) and so it represents the place where rediscover the rooted traces of today’s dispersed identity. These traces could constitute, in the regeneration strategies of the contemporary city, a network of value useful to protect what already exist (even giving a new role for the society) and, at the same time, to structure and re-shape the contemporary city (homologated, trivialized), integrating conservation and innovation, socio-economic revitalization and socio-cultural enhancement. It is not only important to preserve the historical features itself, but also the relationship that they create together and the historical continuity of the social evolution. This network of values (often unusual, opposite) is both the material and immaterial dimension of the public space where the contemporary society could enhance its identity

Historical network of Cultural Heritage for the regeneration of the contemporary city

The paper aims to investigate the cultural heritage role relating to the contemporary city. In particular, it analyses some case studies where planning highlights the role of “historical network”, where the cultural heritage is a strategic component, useful to regenerate the contemporary city and to rebuild the collective identity. The contemporary city influences the concept of heritage because its shape and topics (e.g. urban sprawl, environmental fragmentation, traffic and pollution, etc.) are a hazard for the preservation of historical values (i.e. abandoned historical centers, fragmented signs impressed on the palimpsest, dispersion of local cultures). However, it is the place where rediscover the traces of today’s identity. Today, new policies and strategies are promoted to regenerate the contemporary city. These historical traces could represent an implementation of theme. In particular, they are a network of different values useful both to protect what already exist (even giving a new meaning to them) and to re-shape the contemporary city (homologated, trivialized), integrating conservation and innovation, socio-economic revitalization and socio-cultural enhancement. The historical network is important because it preserves the historical features theme self, but also their relationship and, at least, the continuity of social evolution. This network of values (often unusual) is both the material and immaterial dimension of the public space where the contemporary society could enhance its identity

The Psychological Impact of COVID-19 among a Sample of Italian Adults with High-Functioning Autism Spectrum Disorder: A Follow-Up Study

The strict lockdowns imposed to contain the COVID-19 pandemic brought an increase in levels of stress, anxiety, and depression in the general population. However, in a previous study, our group found that individuals with High-Functioning Autism Spectrum Disorders (HF-ASD) reported an increase in their psychological wellbeing and a decrease in their daily tiredness, in relation to the social distancing measures imposed during the first Italian lockdown (between March and May 2020). In this follow-up study, conducted during the &ldquo;second wave&rdquo; of COVID-19, we included the same group of individuals with HF-ASD and evaluated their levels of stress, anxiety, depression, PTSD-related symptoms, tiredness, and perceived wellbeing; moreover, we compared our results to the ones we obtained during the first lockdown on the same population. We found that individuals with HF-ASD experienced higher levels of the aforementioned psychiatric symptoms during the second lockdown, with respect to the first one. These levels positively correlated with their scores at the Autism Quotient subscale Attention Switching: hence, we speculated that these symptoms might be due not only to the prolonging of the social distancing measures, but also to the uncertainty that HF-ASD participants started experiencing at the end of the first lockdown

Transoral Laser Microsurgery for Glottic Cancer in Patients Over 75 Years Old

Objectives/Hypothesis Laryngeal squamous cell carcinoma (LSCC) has a non-negligible incidence in elderly patients. However, there is still no clear indication on the ideal treatment for early-intermediate glottic LSCC in this specific age group. Both surgical and nonsurgical approaches may be burdened by complications and sequelae that negatively impact patient's health. In this setting, carbon dioxide transoral laser microsurgery (CO2 TOLMS) is a promising minimally invasive treatment option. Study Design Retrospective case series in a single tertiary academic institution. Methods Patients who underwent CO2 TOLMS for Tis-T3 glottic LSCC from 1997 to 2017 were reviewed. Demographic, clinical, and tumor characteristics, as well as postoperative complications were recorded. Overall (OS), disease-specific (DSS), recurrence-free (RFS), laryngo-esophageal dysfunction free survivals (LEDFS), and organ preservation (OP) were calculated. Results A total of 134 patients (mean age, 80 +/- 4 years; median, 79; range, 75-93) were included in the study. Seven lesions were classified as pTis, 65 as pT1a, 22 as pT1b, 35 as pT2, and 5 as pT3. No treatment-related death was observed. Twenty-eight (20.9%) patients reported 10 surgical and 19 medical complications. Five-year OS, DSS, RFS, LEDFS, and OP were 68.9%, 95.4%, 79.5%, 66%, and 92.5%, respectively. Age and comorbidities were associated with OS and LEDFS. Advanced T categories were negatively correlated with OS, DSS, RFS, LEDFS, and OP. Age and comorbidities were not significant risk factors for complications. Conclusions CO2 TOLMS can be considered a valuable therapeutic approach for selected Tis-T3 glottic LSCC even in the elderly given its favorable oncologic outcomes and minimal aggressiveness. Level of Evidence 4 Laryngoscope, 202

Use of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage

Objective: The American College of Radiology (ACR) and the European Thyroid Association (EU) have proposed two scoring systems for thyroid nodule classification. Here, we compared the ability of the two systems in triaging thyroid nodules for fine-needle aspiration (FNA) and tested the putative role of an approach that combines ultrasound features and cytology for the detection of malignant nodules. Design and Methods: The scores obtained with the ACR and EU Thyroid Imaging Reporting and Data Systems (TIRADS) from a prospective series of 480 thyroid nodules acquired from 435 subjects were compared to assess their performances in FNA triaging on the final cytological diagnosis. The US features that showed the highest contribution in discriminating benign nodules from malignancies were combined with cytology to improve its diagnostic performance. Results: FNA was recommended on 46.5% and 51.9% of the nodules using the ACR and EU-TIRADS scores, respectively. The ACR system demonstrated a higher specificity as compared to the EU-TIRADS (59.0% vs. 52.4%, p = 0.0012) in predicting ≥ TIR3A/III (SIAPEC/Bethesda) nodules. Moreover, specific radiological features (i.e., echogenic foci and margins), combined with the cytological classes improved the specificity (97.5% vs. 91%, p &lt; 0.0001) and positive predictive values (77.5% vs. 50.7%, p &lt; 0.0001) compared to cytology alone, especially in the setting of indeterminate nodules (TIR3A/III and TIR3B/IV), maintaining an excellent sensitivity and negative predictive value. Conclusions: The ACR-TIRADS system showed a higher specificity compared to the EU-TIRADS in triaging thyroid nodules. The use of specific radiological features improved the diagnostic ability of cytology

Diagnostic Performances of the ACR-TIRADS System in Thyroid Nodules Triage: A Prospective Single Center Study

Ultrasound scores are used to determine whether thyroid nodules should undergo Fine Needle Aspiration (FNA) or simple clinical follow-up. Different scores have been proposed for this task, with the American College of Radiology (ACR) TIRADS system being one of the most widely used. This study evaluates its ability in triaging thyroid nodules deserving FNA on a large prospective monocentric Italian case series of 493 thyroid nodules from 448 subjects. In ACR 1–2, cytology never prompted a surgical indication. In 59% of cases classified as TIR1c-TIR2, the FNA procedure could be ancillary, according to the ACR-TIRADS score. A subset (37.9%) of cases classified as TIR4-5 would not undergo FNA, according to the dimensional thresholds used by the ACR-TIRADS. Applying the ACR score, a total of 46.5% thyroid nodules should be studied with FNA. The ACR system demonstrated a sensitivity and specificity of 58.9% and 59% in the identification of patients with cytology ≥TIR3A, with a particularly high false negative rate for ACR classes ≥3 (44.8%, 43/96), which would dramatically decrease (7.3%, 7/96) if the dimensional criteria were not taken into account. In ACR 3–4–5, a correspondence with the follow-up occurred in 60.3%, 50.2% and 51.9% of cases. The ACR-TIRADS is a useful risk stratification tool for thyroid nodules, although the current dimensional thresholds could lead to an underestimation of malignant lesions. Their update might be considered in future studies to increase the screening performances of the system