Permutation entropy of of weakly noise-affected

L.R. and A.P. contributed equally to this work. Funding: This research received no external funding.Peer reviewedPublisher PD

ERAS in General Thoracic Surgery

Enhanced recovery after surgery (ERAS®) is a strategy that seeks to reduce patients’ perioperative stress response, thereby reducing potential complications, decreasing hospital length of stay and enabling patients to return more quickly to their baseline functional status. This programme results from the union of several perioperative clinical elements that have individually proved to be beneficial to the patient and have showed, when used together, a synergy that results in a significant outcome improvement. The term was coined at the end of the 1990s and originally used to refer to a complex fast-track programme in open colorectal surgery. Subsequently, the practice has spread to other surgical specialties centralising the interest of clinicians and researchers. The objective of this chapter is to analyse the key elements of an ERAS protocol applicable to minimally invasive thoracic surgery

Development of a video-assisted thoracoscopic lobectomy program in a single institution: Results before and after completion of the learning curve

BACKGROUND: The development of a video assisted thoracic surgery lobectomy (VATS-L) program provides a dedicated surgical team with a recognized learning curve (LC) of 50 procedures. We analyse the results of our program, comparing the LC with subsequent cases. METHODS: From June 2012 to March 2015, we performed n = 146 VATS major pulmonary resections: n = 50 (Group A: LC); n = 96 (Group B). Pre-operative mediastinal staging followed the National Comprehensive Cancer Network guidelines. All procedures were performed using a standard anterior approach to the hilum; lymphadenectomy followed the NCCN recommendations. During the LC, VATS-L indication was reserved to clinical stages I, therefore evaluated case by case. RESULTS: Mean operative time was 191 min (120-290) in Group A and 162 min (85-360) in Group B (p <0,01). Pathological T status was similar between two Groups. Lymphadenectomy included a mean of 5.8 stations in Group A and 6.6 in Group B resulting in: pN0 disease: Group A n = 44 (88 %), Group B n = 80 (83.4 %); pN1: Group A n = 3 (6 %), Group B n = 8 (8.3 %); pN2: Group A n = 3 (6 %), Group B n = 8 (8.3 %). Conversion rate was: 8 % in group A (n = 4 vascular injuries); 1.1 % in Group B (n = 1 hilar lymph node disease). We registered n = 6 (12 %) complications in Group A, n = 10 (10.6 %) in Group B. One case (1.1 %) of late post-operative mortality (90 days) was registered in Group B for liver failure. Mean hospital stay was 6.5 days in Group A and 5.9 days in Group B. CONCLUSIONS: We confirm the effectiveness of a VATS-L program with a learning curve of 50 cases performed by a dedicated surgical team. Besides the LC, conversion rate falls down, lymphadenectomy become more efficient, indications can be extended to upper stages

Chemical Diversity in Protoplanetary Disks and Its Impact on the Formation History of Giant Planets

Giant planets can interact with multiple and chemically diverse environments in protoplanetary discs while they form and migrate to their final orbits. The way this interaction affects the accretion of gas and solids shapes the chemical composition of the planets and of their atmospheres. Here we investigate the effects of different chemical structures of the host protoplanetary disc on the planetary composition. We consider both scenarios of molecular (inheritance from the pre-stellar cloud) and atomic (complete chemical reset) initial abundances in the disc. We focus on four elemental tracers of different volatility: C, O, N, and S. We explore the entire extension of possible formation regions suggested by observations by coupling the disc chemical scenarios with N-body simulations of forming and migrating giant planets. The planet formation process produces giant planets with chemical compositions significantly deviating from that of the host disc. We find that the C/N, N/O, and S/N ratios follow monotonic trends with the extent of migration. The C/O ratio shows a more complex behaviour, dependent on the planet accretion history and on the chemical structure of the formation environment. The comparison between S/N* and C/N* (where * indicates normalisation to the stellar value), constrains the relative contribution of gas and solids to the total metallicity. Giant planets whose metallicity is dominated by the contribution of the gas are characterised by N/O* > C/O* > C/N* and allow for constraining the disc chemical scenario. When the planetary metallicity is instead dominated by the contribution of the solids we find that C/N* > C/O* > N/O*.Comment: 27 pages, 10 figures, 1 table. Published in The Astrophysical Journa

SIMBIO-SYS Near Earth Commissioning Phase: a step forward toward Mercury

On December 2018, the Near Earth Commissioning Phase (NECP) has been place forSIMBIO-SYS (Spectrometers and Imagers for MPO BepiColombo Integrated Observatory - SYStem), the suite part of the scientific payload of the BepiColombo ESA-JAXA mission. SIMBIO-SYS is composed of three channels: the high resolution camera (HRIC), the stereo camera (STC) and the Vis/NIR spectrometer (VIHI) . During the NECP the three channels have been operated properly. For the three channels were checked the operativity and the performance. The commanded operations allowed to verify all the instrument functionalities demonstrating that all SIMBIO-SYS channels and subsystems work nominally. During this phase we also validated the Ground Segment Equipment (GSE) and the data analysis tools developed by the team

Molecular Mechanisms Generating and Stabilizing Terminal 22q13 Deletions in 44 Subjects with Phelan/McDermid Syndrome

In this study, we used deletions at 22q13, which represent a substantial source of human pathology (Phelan/McDermid syndrome), as a model for investigating the molecular mechanisms of terminal deletions that are currently poorly understood. We characterized at the molecular level the genomic rearrangement in 44 unrelated patients with 22q13 monosomy resulting from simple terminal deletions (72%), ring chromosomes (14%), and unbalanced translocations (7%). We also discovered interstitial deletions between 17–74 kb in 9% of the patients. Haploinsufficiency of the SHANK3 gene, confirmed in all rearrangements, is very likely the cause of the major neurological features associated with PMS. SHANK3 mutations can also result in language and/or social interaction disabilities. We determined the breakpoint junctions in 29 cases, providing a realistic snapshot of the variety of mechanisms driving non-recurrent deletion and repair at chromosome ends. De novo telomere synthesis and telomere capture are used to repair terminal deletions; non-homologous end-joining or microhomology-mediated break-induced replication is probably involved in ring 22 formation and translocations; non-homologous end-joining and fork stalling and template switching prevail in cases with interstitial 22q13.3. For the first time, we also demonstrated that distinct stabilizing events of the same terminal deletion can occur in different early embryonic cells, proving that terminal deletions can be repaired by multistep healing events and supporting the recent hypothesis that rare pathogenic germline rearrangements may have mitotic origin. Finally, the progressive clinical deterioration observed throughout the longitudinal medical history of three subjects over forty years supports the hypothesis of a role for SHANK3 haploinsufficiency in neurological deterioration, in addition to its involvement in the neurobehavioral phenotype of PMS