Diaphragmatic hernia following oesophagectomy for oesophageal cancer – Are we too radical?

Background: Diaphragmatic herniation (DH) of abdominal contents into the thorax after oesophageal resection is a recognised and serious complication of surgery. While differences in pressure between the abdominal and thoracic cavities are important, the size of the hiatal defect is something that can be influenced surgically. As with all oncological surgery, safe resection margins are essential without adversely affecting necessary anatomical structure and function. However very little has been published looking at the extent of the hiatal resection. We aim to present a case series of patients who developed DH herniation post operatively in order to raise discussion about the ideal extent of surgical resection required. Methods: We present a series of cases of two male and one female who had oesophagectomies for moderately and poorly differentiated adenocarcinomas of the lower oesophagus who developed post-operative DH. We then conducted a detailed literature review using Medline, Pubmed and Google Scholar to identify existing guidance to avoid this complication with particular emphasis on the extent of hiatal resection. Discussion: Extended incision and partial resection of the diaphragm are associated with an increased risk of postoperative DH formation. However, these more extensive excisions can ensure clear surgical margins. Post-operative herniation can be an early or late complication of surgery and despite the clear importance of hiatal resection only one paper has been published on this subject which recommends a more limited resection than was carried out in our cases. Conclusion: This case series investigated the recommended extent of hiatal dissection in oesophageal surgery. Currently there is no clear guidance available on this subject and further studies are needed to ascertain the optimum resection margin that results in the best balance of oncological parameters vs. post operative morbidity

Smart transportation systems (STSs) in critical conditions

In the context of smart transportation systems (STSs) in smart cities, the use of applications that can help in case of critical conditions is a key point. Examples of critical conditions may be natural-disaster events such as earthquakes, hurricanes, floods, and manmade ones such as terrorist attacks and toxic waste spills. Disaster events are often combined with the destruction of the local telecommunication infrastructure, if any, and this implies real problems to the rescue operations.The quick deployment of a telecommunication infrastructure is essential for emergency and safety operations as well as the rapid network reconfigurability, the availability of open source software, the efficient interoperability, and the scalability of the technological solutions. The topic is very hot and many research groups are focusing on these issues. Consequently, the deployment of a smart network is fundamental. It is needed to support both applications that can tolerate delays and applications requiring dedicated resources for real-time services such as traffic alert messages, and public safety messages. The guarantee of quality of service (QoS) for such applications is a key requirement.In this chapter we will analyze the principal issues of the networking aspects and will propose a solution mainly based on software defined networking (SDN). We will evaluate the benefit of such paradigm in the mentioned context focusing on the incremental deployment of such solution in the existing metropolitan networks and we will design a "QoS App" able to manage the quality of service on top of the SDN controller

Seed germination report for Limonium merxmuelleri subsp. merxmuelleri (Plumbaginaceae)

The present report illustrates the first germination data of Limonium merxmuelleri subsp. merxmuelleri, a pioneer species of mine waste materials of Iglesiente region (South-West Sardinia). After harvesting, seeds were subjected to germination tests at the Sardinian Germplasm Bank (BG-SAR). The results show a high germination capability and germination rate at each tested temperature, with a slight germination reduction at the highest temperature (25°C) that simulates the aridity of the summer period

Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay

Follicular thyroid carcinoma: Differences in clinical relevance between minimally invasive and widely invasive tumors

Evidence on the biological behavior and clinical courses of minimally invasive and widely invasive follicular thyroid carcinoma (MI-FTC, WI-FTC) is still debatable. The current study was conducted to identify differences between MI and WI tumors and those prognostic parameters influencing late outcome such as local recurrence and survival

Nationwide analysis of open groin hernia repairs in Italy from 2015 to 2020

Introduction: Inguinal hernia repair is one of the most commonly performed operations in general surgery. A total of 130.000 inguinal hernia repairs are performed yearly in Italy, and approximately 20 million inguinal hernias are treated worldwide annually. This report represents the trend analysis in inguinal hernia repair in Italy from a nationwide dataset for the 6-year period from 2015 to 2020. Materials and methods: Based on regional hospital discharge records, all the inguinal hernia repairs performed in public and private hospitals in Italy between 2015 and 2020 were reviewed based on diagnosis and procedure codes. For the aim of this study, data from the AgeNas (The National Agency for Regional Health Services) data source were analyzed. Results: Elective inguinal hernia repairs outnumbered urgent operations over the 6-year study period, ranging from 122,737 operations in 2015 to 65,780 in 2020 as absolute numbers, and from 87.96 to 83.3% of total procedures in 2019 and 2020 respectively, with an annual change ranging from - 66.58%, between 2020 and 2019, to - 2.49%, between 2019 and 2018 (mean = - 18.74%; CI =- 46.7%-9.22%; p < 0.0001). Conclusions: This large-scale review of groin hernia data from a nationwide Italian dataset provides a unique opportunity to obtain a snapshot of open groin hernia repair activity. More specifically, there is a trend to perform more elective than urgent procedures and there is a steady decrease in the amount of open hernia repairs in favor to laparoscopy

Marine spatial planning for connectivity and conservation through ecological corridors between marine protected areas and other effective area-based conservation measures

Maritime Spatial Planning (MSP) promotes the sustainable human activities development and uses in the marine space, playing a role in their effective management. The enhancement of connectivity is crucial for the conservation of biodiversity and landscape planning. Ecological Corridors (ECs) are an important type of connectivity for biodiversity conservation in fragmented habitats. The EU Biodiversity Strategy 2030 includes ECs into the network of protected areas and allows for the creation of additional protected areas. MSP studies considering ECs remain still lacking, especially for the design of networks between Marine Protected Areas (MPAs) and Other Effective area-based Conservation Measures (OECMs). In this paper, knowledge, and tools for investigating marine ECs were reviewed, with a systematic bibliometric analysis to summarize the current scientific research. Previous studies integrating ecological connectivity into planning for marine conservation have focused on models of larval dispersal, adult movements, and dispersal of single species by using benthic habitat proxies. Few studies were found on ECs in marine environments: in the coral Caribbean reef systems in the Gulf of Mexico; within benthic habitats along the Pacific coast of Canada; between MPAs in British Columbia (Canada); and by analyzing migratory species in the Yangtze estuary (China). Commonly used approaches to project and map ECs in marine environments are least-cost and circuit theories allowing to incorporate movement with cost or resistance to movement, depending on species and preferred habitats. The systematic bibliometric analysis returned 25 studies, most of which were from North America (40%) and European countries (36%) and the largest share of papers (68%) from 2018 to 2022. This review pinpointed the need of integrating different disciplines to investigate connectivity and the need by policymakers and practitioners to recognize the importance of ecological connectivity, even there are significant challenges for integrating connectivity into policies, planning, and conservation

Statistical arbitrage powered by Explainable Artificial Intelligence

Machine learning techniques have recently become the norm for detecting patterns in financial markets. However, relying solely on machine learning algorithms for decision-making can have negative consequences, especially in a critical domain such as the financial one. On the other hand, it is well-known that transforming data into actionable insights can pose a challenge even for seasoned practitioners, particularly in the financial world. Given these compelling reasons, this work proposes a machine learning approach powered by eXplainable Artificial Intelligence techniques integrated into a statistical arbitrage trading pipeline. Specifically, we propose three methods to discard irrelevant features for the prediction task. We evaluate the approaches on historical data of component stocks of the S&P500 index and aim at improving not only the prediction performance at the stock level but also overall at the stock set level. Our analysis shows that our trading strategies that include such feature selection methods improve the portfolio performances by providing predictive signals whose information content suffices and is less noisy than the one embedded in the whole feature set. By performing an in-depth risk-return analysis, we show that the proposed trading strategies powered by explainable AI outperform highly competitive trading strategies considered as baselines