The management of knee osteoarthritis in elderly: results from a national survey compared to ESCEO guidelines

OBJECTIVE: Knee osteoarthritis (KOA) is a degenerative and inflammatory disease with a rising incidence and prevalence worldwide. Various therapeutic strategies have been proposed over time, depending on the degrees of severity and usually based on individual clinical practice. However, several European and international scientific societies published guidelines, to provide practical clinical stepwise guidance and to facilitate individualized therapeutic decisions regarding the management of KOA. The aim of this prospective multicentre observational study was to describe the real outpatient territorial management of patients with knee osteoarthritis and to compare it with the ESCEO guidelines, in order to identify operational strategies for delivering patient-centric care. MATERIALS AND METHODS: The educational project was divided in three modules: the first and the last through webinar; the second held in daily practice. The participants had to register structured observations. RESULTS: The project has been joined by 155 discussants, and the 2,656 observations collected allowed the understanding of the most common therapeutic approaches for knee osteoarthritis on the Italian territory. CONCLUSIONS: The educational project proved to be useful for updating on the state of the art of therapeutic management of knee osteoarthritis, and to increase expertise in detecting prevention and treatment strategies according to ESCEO guidelines to apply in the Real-Life context

Flood and landslide warning based on rainfall thresholds and soil moisture indexes: the HEWS (Hydrohazards Early Warning System) for Sicily

The main focus of the paper is to present a flood and landslide early warning system, named HEWS (Hydrohazards Early Warning System), specifically developed for the Civil Protection Department of Sicily, based on the combined use of rainfall thresholds, soil moisture modelling and quantitative precipitation forecast (QPF). The warning system is referred to 9 different Alert Zones in which Sicily has been divided into and based on a threshold system of three different increasing critical levels: ordinary, moderate and high. In this system, for early flood warning, a Soil Moisture Accounting (SMA) model provides daily soil moisture conditions, which allow to select a specific set of three rainfall thresholds, one for each critical level considered, to be used for issue the alert bulletin. Wetness indexes, representative of the soil moisture conditions of a catchment, are calculated using a simple, spatially-lumped rainfall–streamflow model, based on the SCS-CN method, and on the unit hydrograph approach, that require daily observed and/or predicted rainfall, and temperature data as input. For the calibration of this model daily continuous time series of rainfall, streamflow and air temperature data are used. An event based lumped rainfall–runoff model has been, instead, used for the derivation of the rainfall thresholds for each catchment in Sicily characterised by an area larger than 50 km2. In particular, a Kinematic Instantaneous Unit Hydrograph based lumped rainfall–runoff model with the SCS-CN routine for net rainfall was developed for this purpose. For rainfall-induced shallow landslide warning, empirical rainfall thresholds provided by Gariano et al. (2015) have been included in the system. They were derived on an empirical basis starting from a catalogue of 265 shallow landslides in Sicily in the period 2002–2012. Finally, Delft-FEWS operational forecasting platform has been applied to link input data, SMA model and rainfall threshold models to produce warning on a daily basis for the entire region

Geology of the lower Belice River valley, epicentral area of the M > 5 1968 seismic sequence (south-western Sicily, Italy)

We present a new 1:25,000-scale geological map of the lower Belice River valley, the area struck by the M > 5.0 devastating 1968 seismic sequence, whose seismic source and seismotectonic framework are still controversial. The map, utilizing dating methods and traditional field survey approaches integrated by high-resolution topography, provides an unprecedented detail and precision on the spatial distribution and on the compressional growth geometries of the prominent sedimentary sequence. This map, supported by the first recognition of an on-shore Chibanian-Calabrian deposition and by identifying a flight of marine terraces, offers new insights on the long-lasting syn-depositional tectonic forces up to late-Pleistocene-Holocene times. Such tectonic forces may take part in the regional ongoing deformational phase, prompting detailed studies on the potential seismic sources affecting the area

Use of Laparoscopic and Laparotomic J-Plasma Handpiece in Gynecological Malignancies: Results From A Pilot Study in A Tertiary Care Center

Introduction: The J-Plasma has recently been introduced into the surgical community with different intrinsic characteristics aimed to further reduce the thermal effect and enhance precision when compared to standard radiofrequency. This study aimed to investigate the role of this new technology in different conditions of gynecological carcinomatosis characterized by the indication for regional peritonectomy and/or ablation, either in laparotomy (LPT) or in laparoscopy (LPS), in the context of a modern personalized approach to the surgical management of gynecological malignancies. Material and Methods: From January 2019 to April 2019, 12 patients were selected for this prospective pilot study at the Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome. In this single surgeon experience, the inclusion criteria were: histologically proven advanced ovarian/endometrial cancer, primary or interval debulking surgery, and intraoperative indication for regional peritonectomy. Six patients were treated by LPS (Group 1) and 6 by LPT (Group 2). Results: In Group 1 the indication for debulking surgery was in 4 cases an interval debulking surgery and 2 advanced endometrial cancer. All patients in Group 2 underwent primary debulking surgery for advanced ovarian cancer. The whole cohort achieved a complete tumor excision after surgery. The median OT and median EBL were 195 min and 100 ml in Group 1, and 420 min and 500 ml in Group 2. The median hospital stay was 4 days in Group 1 and 13 days in Group 2, respectively. No intra and postoperative complications were registered within 60 days after surgery. Conclusions: J-Plasma allows to approach delicate maneuvers on viscera, mesentery, and blood vessels with a high degree of safety and precision thanks to its limited vertical and lateral thermal spread, favoring the surgeon to push ever higher the cytoreduction/morbidity tradeoff. The use of J-Plasma in cytoreductive surgery could also increase the range of possible minimally invasive procedures, narrowing the technical distance with the open technique and thus contributing to designing a personalized surgical strategy for each patient in different scenarios of peritoneal carcinomatosis

Geological record of tsunami inundations in Pantano Morghella (south-eastern Sicily) both from near and far-field sources

Abstract. Analysis of tsunami deposits from the Pantano Morghella area provided geological evidence for two inundations occurred along the south-eastern Ionian coast of Sicily. Pantano Morghella is a large pond characterised by a fine-grained sedimentation indicating a low-energy depositional environment. Two anomalous yellow sandy layers found at different depths indicate the occurrence of high-energy marine inundations. We studied sedimentological and paleontological features of the anomalous deposits as well as their spatial distribution observing the following properties: different facies with respect to the local stratigraphic sequence; erosive bases, rip-up clasts and broken elements testifying violent deposition mechanisms; macro and micro fauna of marine environment; relatively constant thickness throughout most of the depositional zone with thinning at the distal end; large sand sheets that extend inland. These observations, jointly with their infrequency in the sedimentary record and the age indicating a fast deposition, provided strong evidence for tsunami inundations. Correlations between anomalous layers and historical tsunamis are supported by radiocarbon and OSL dating results. The younger deposit is likely due to the 1908 near-source tsunami, whereas the flooding of the oldest event is most likely associated with a far and large source, the Crete 365 AD earthquake

Obesity and iron deficiency anemia as risk factors for asymptomatic bacteriur

Background: Few studies examined the risk factors of asymptomatic bacteriuria, showing contradictory results. Our study aimed to examine the association between different clinical and laboratory parameters and asymptomatic bacteriuria in internal medicine patients. Materials and methods: 330 consecutive hospitalized subjects, asymptomatic for urinary tract infections (UTIs), underwent to microscopic examination of urine specimens. 100 subjects were positive for microscopic bacteriuria and were recruited into the study. At the quantitative urine culture 31 subjects of study population were positive while 69 subjects were negative for bacteriuria. Results: The analysis of clinical characteristics showed that the two groups of subjects (positive and negative urine culture for bacteriuria) were significant different (p b 0.05) about obesity (76.7% vs 42% respectively), metabolic syndrome (80.6% vs 44,9%), cholelithiasis (35.5% vs 13,2%) and iron deficiency anemia (80.6% vs 53,6%). The univariate analysis showed that only obesity, cholelithiasis and iron deficiency anemia were positively associated with positive urine culture for bacteriuria (Odds Ratios [OR] = 3.79, p = 0.0003; OR = 2,65, p =0.0091; OR = 2.63, p = 0.0097; respectively). However, the multivariate analysis by logistic regression showed that only obesity and iron deficiency anemia, independently associated with positive urine culture for bacteriuria (OR = 3.9695, p = 0.0075; OR = 3.1569, p = 0.03420 respectively). Conclusions: This study shows that obesity and iron deficiency anemia are independent risk factors for asymptomatic bacteriuria

Prolonged survival in the absence of disease-recurrence in advanced-stage follicular lymphoma following chemo-immunotherapy: 13-year update of the prospective, multicenter randomized GITMO-IIL trial

Aprospective trial conducted in the period 2000-2005 showed no survival advantage for high-dose chemotherapy with rituximab and autograft (RHDS) versus conventional chemotherapy with rituximab (CHOP-R) as firstline therapy in 134 high-risk follicular lymphoma patients aged <60 years. The study has been updated at the 13-year median follow up. As of February 2017, 88 (66%) patients were alive, with overall survival of 66.4% at 13 years, without a significant difference between R-HDS (64.5%) and CHOP-R (68.5%). To date, 46 patients have died, mainly because of disease progression (47.8% of all deaths), secondary malignancies (3 solid tumor, 9 myelodysplasia/acute leukemia; 26.1% of all deaths), and other toxicities (21.7% of all deaths). Complete remission was documented in 98 (73.1%) patients and associated with overall survival, with 13- year estimates of 77.0% and 36.8% for complete remission versus no-complete remission, respectively. Molecular remission was documented in 39 (65%) out of 60 evaluable patients and associated with improved survival. In multivariate analysis, complete remission achievement had the strongest effect on survival (P<0.001), along with younger age (P=0.002) and female sex (P=0.013). Overall, 50 patients (37.3%) survived with no disease recurrence (18 CHOP-R, 32 R-HDS). This follow up is the longest reported on follicular lymphoma treated upfront with rituximab-chemotherapy and demonstrates an unprecedented improvement in survival compared to the pre-rituximab era, regardless of the use of intensified or conventional treatment. Complete remission was the most important factor for prolonged survival and a high proportion of patients had prolonged survival in their first remission, raising the issue of curability in follicular lymphoma

Geological record of tsunami inundations in Pantano Morghella (south-eastern Sicily) both from near and far-field sources

Analysis of tsunami deposits from the Pantano Morghella area provided geological evidence for two inundations occurred along the south-eastern Ionian coast of Sicily. Pantano Morghella is a large pond characterised by a finegrained sedimentation indicating a low-energy depositional environment. Two anomalous yellow sandy layers found at different depths indicate the occurrence of high-energy marine inundations. We studied sedimentological and paleontological features of the anomalous deposits as well as their spatial distribution observing the following properties: different facies with respect to the local stratigraphic sequence; erosive bases, rip-up clasts and broken elements testifying violent deposition mechanisms; macro and micro fauna of marine environment; relatively constant thickness throughout most of the depositional zone with thinning at the distal end; large sand sheets that extend inland. These observations, jointly with their infrequency in the sedimentary record and the age indicating a fast deposition, provided strong evidence for tsunami inundations. Correlations between anomalous layers and historical tsunamis are supported by radiocarbon and OSL dating results. The younger deposit is likely due to the 1908 near-source tsunami, whereas the flooding of the oldest event is most likely associated with a far and large source, the Crete 365AD earthquake

Post Treatment Sexual Function and Quality of Life of Patients Affected by Cervical Cancer: A Systematic Review

Introduction: The aim of this study is to analyze the available scientific evidence regarding the quality of life (QoL) and sexual function (SF) in patients affected by cervical cancer (CC) after surgical and adjuvant treatments. Materials and Methods: Preliminary research was conducted via electronic database (MEDLINE, PubMed and Cochrane Library) with the use of a combination of the following keywords: SF, QoL, and CC. The principal findings considered in the present review were the study design, the number of patients included in each study, the information about the malignancy (histology and stage of disease), the questionnaires administered, and the principal findings concerning SF and QoL. Results: All studies were published between 2003–2022. The studies selected consisted of one randomized control study, seven observational studies (three prospective series), and nine case control studies. The scores used were focused on SF, QOL, fatigue, and psychological aspects. All studies reported a decreased SF and QOL. The most developed questionnaires were the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Female Sexual Function Index (FSFI), the Hospital Anxiety and Depression scale (HADS), and the Female Sexual Distress Scale (FSDS). Discussion: All studies reported a decreased SF and QOL. In addition to the perception of body image, several factors coexist in influencing the outcomes such as the physical, hormonal, psychological. Conclusions: Sexual dysfunction after CC treatment has a multifactorial aetiology which negatively affects the quality of life. For these reasons, it is important to follow and support patients with a multidisciplinary team (doctors, nurses, psychologists, dieticians) before and after therapy. This type of tailored therapeutic approach should become a standard. Women should be informed about possible vaginal changes and menopausal symptoms after surgery and on the positive effects of psychological therapy

A Multicentric Randomized Trial to Evaluate the ROle of Uterine MANipulator on Laparoscopic/Robotic HYsterectomy for the Treatment of Early-Stage Endometrial Cancer: The ROMANHY Trial

Objective: This prospective randomized trial aimed to assess the impact of the uterine manipulator in terms of lymph vascular space invasion (LVSI) in patients undergoing minimally invasive staging for early-stage endometrial cancer. Methods: In this multicentric randomized trial, enrolled patients were randomly allocated in two groups according to the no use (arm A) or the use (arm B) of the uterine manipulator. Inclusion criteria were G1-G2 early-stage endometrial cancer at preoperative evaluation. The variables collected included baseline demographic characteristics, perioperative data, final pathology report, adjuvant treatment, and follow-up. Results: In the study, 154 patients (76 in arm A and 78 in arm B) were finally included. No significant differences were recorded regarding the baseline characteristics. A statistically significant difference was found in operative time for the laparoscopic staging (p=0.005), while no differences were reported for the robotic procedures (p=0.419). The estimated blood loss was significantly lower in arm A (p=0.030). No statistically significant differences were recorded between the two study groups in terms of peritoneal cytology, LVSI (p=0.501), and pattern of LVSI (p=0.790). No differences were detected in terms of overall survival and disease-free survival (p=0.996 and p=0.480, respectively). Similarly, no differences were recorded in the number of recurrences, 6 (7.9%) in arm A and 4 (5.2%) in arm B (p=0.486). The use of the uterine manipulator had no impact on DFS both at univariable and multivariable analyses. Conclusions: The intrauterine manipulator does not affect the LVSI in early-stage endometrial cancer patients undergoing laparoscopic/robotic staging. Clinical Trial Registration: https://clinicaltrials.gov, identifier (NCT: 02762214