ANALISI SPETTRALE E CICLI DI MILANKOVITCH IN SUCCESSIONI CRETACICHE DEL SUDALPINO ORIENTALE

Spectral analysis technique has been applied for the first time in the Southern Alps, to three pelagic and hemipelagic sections (Venetian Prealps and Dolomites) of Barremian-Cenomanian age, characrerized by a couplet alternation of carbonate rich and carbonate poor layers. This technique is used to detect these lithologic periodicities in the measured sections, in order to search for climatic Milankovitch-type cycles (short eccentricity, obliquity and precession cycles). We have applied two different processing routines: the FFT algorithm has been developed to process, for example, bed thickness, bed-joint position and calcimetric time series; for the other cases rhe FWT algorithm has been used to deal with a codified time series, such as lithotype signals or the presence/absence of some bioturbation signal. The results of the data processing are amplitude and power spectra, showing frequency peaks with maximum energy. They are computed first in terms of space measurements (cm) and later are converted into time (thousand of years) using the average sedimentation rate, inferred for each section by the duration of stratigraphic units (stages) and their thickness in the studied section. To prevent distortion related to the form of the input signal a smoothed triangular filter of different length was used, as a way of obtaining a sinusoidal-like wave. The stability of the most relevant peaks can be tested by dividing the original time series into two or more subsections. They are then processed by sample rates to generate spectra with different resolution levels

Reliable Prediction of Post-Operative Complications’ Rate Using the G8 Screening Tool: A Prospective Study on Elderly Patients Undergoing Surgery for Kidney Cancer

Abstract: In the last years the incidence of renal neoplasms has been steadily increasing, along with the average age of patients at the time of diagnosis. Surgical management for localized disease is becoming more challenging because of patients’ frailty. We conducted a multi-center prospective study to evaluate the role of the G8 as a screening tool in the assessment of intra and post-operative complications of elderly patients ( 70 y.o.) undergoing surgery for kidney cancer. A total of 162 patients were prospectively enrolled between January 2015 to January 2019 and divided into two study groups (frail vs. not-frail) according to their geriatric risk profile based on G8 score. Several factors (i.e., age, CCI, ASA score, preoperative anemia, RENAL score, surgical procedures, and techniques) were analyzed to identify whether any of them would configure as a statistically significant predictor of surgical complications. According to the G8 Score, 90 patients were included in the frail group. A total of 52 frail patients vs. 4 non-frail patients developed a postoperative complication of any kind (p < 0.001). Of these, 11 were major complications and all occurred in the frail group. Our results suggest that the G8 screening tool is an effective and useful instrument to predict the risk of overall complications in elderly patients prior to renal surgery

Testis Sparing Surgery of Small Testicular Masses: Retrospective Analysis of a Multicenter Cohort

PURPOSE: We evaluated possible factors predicting testicular cancer in patients undergoing testis sparing surgery. MATERIALS AND METHODS: We retrospectively analyzed the records of all patients who underwent testis sparing surgery for a small testicular mass at a total of 5 centers. All patients with 1 solitary lesion 2 cm or less on preoperative ultrasound were enrolled in the study. Testis sparing surgery consisted of tumor enucleation for frozen section examination. Immediate radical orchiectomy was performed in all cases of malignancy at frozen section examination but otherwise the testes were spared. Univariate and multivariate analysis were performed and ROC curves were produced to evaluate preoperative factors predicting testicular cancer. RESULTS: Overall 147 patients were included in the study. No patient had elevated serum tumor markers. Overall 21 of the 147 men (14%) presented with testicular cancer. On multivariate analysis the preoperative ultrasound diameter of the lesion was a predictor of malignancy (OR 6.62, 95% CI 2.26-19.39, p=0.01). On ROC analysis lesion diameter had an AUC of 0.75 (95% CI 0.63-0.86, p=0.01) to predict testicular cancer. At the best cutoff of 0.85 the diameter of the lesion had 81% sensitivity, 58% specificity, 24% positive predictive value and 95% negative predictive value. CONCLUSIONS: Our study confirms that small testicular masses are often benign and do not always require radical orchiectomy. Preoperative ultrasound can assess lesion size and the smaller the nodule, the less likely that it is malignant. Therefore, we suggest a stepwise approach to small testicular masses, including tumorectomy, frozen section examination and radical orchiectomy or testis sparing surgery according to frozen section examination results

Rates and Predictors of Perioperative Complications in Cytoreductive Nephrectomy: Analysis of the Registry for Metastatic Renal Cell Carcinoma

Background: Cytoreductive nephrectomy (CN) plays an important role in the treatment of a subgroup of metastatic renal cell carcinoma (mRCC) patients. Objective: We aimed to evaluate morbidity associated with this procedure and identify potential predictors thereof to aid patient selection for this procedure and potentially improve patient outcomes. Design, setting, and participants: Data from 736 mRCC patients undergoing CN at 14 institutions were retrospectively recorded in the Registry for Metastatic RCC (REMARCC). Outcome measurements and statistical analysis: Logistic regression analysis was used to identify predictors for intraoperative, any-grade (AGCs), low-grade, and high-grade (HGCs) postoperative complications (according to the Clavien-Dindo classification) as well as 30-d readmission rates. Results and limitations: Intraoperative complications were observed in 69 patients (10.9%). Thrombectomy (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.08-1.75, p = 0.009) and adjacent organ removal (OR 2.7, 95% CI 1.38-5.30) were significant predictors of intraoperative complications at multivariable analysis. Two hundred seventeen patients (29.5%) encountered AGCs, while 45 (6.1%) encountered an HGC, of whom 10 (1.4%) died. Twenty-four (3.3%) patients had multiple postoperative complications. Estimated blood loss (EBL; OR 1.49, 95% CI 1.08-2.05, p = 0.01) was a significant predictor of AGCs at multivariable analysis. CN case load (OR 0.13, 95% CI 0.03-0.59, p = 0.009) and EBL (OR 2.93, 95% CI 1.20-7.15, p = 0.02) were significant predictors solely for HGCs at multivariable analysis. Forty-one patients (11.5%) were readmitted within 30 d of surgery. No significant predictors were identified. Results were confirmed in a subanalysis focusing solely on patients treated in the contemporary targeted therapy era. Conclusions: Morbidity associated with CN is not negligible. Predictors of high-grade postoperative morbidity are predominantly indicators of complex surgery. EBL is a strong predictor of postoperative complications. CN case load correlates with lower high-grade morbidity and highlights the benefit of centralization of complex surgery. However, risks and benefits should be balanced when considering CN in mRCC patients. Patient summary: We studied patients with metastatic renal cancer to evaluate the outcomes associated with the surgical removal of the primary kidney tumor. We found that this procedure is often complex and adverse events are not uncommon. High intraoperative blood loss and a small number of cases performed at the treating center are associated with a higher rate of postoperative complications

Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors

Purpose The primary aim of this study was to evaluate if exposure to 5-alpha-reductase inhibitors (5-ARIs) modifies the effect of MRI for the diagnosis of clinically significant Prostate Cancer (csPCa) (ISUP Gleason grade >= 2).Methods This study is a multicenter cohort study including patients undergoing prostate biopsy and MRI at 24 institutions between 2013 and 2022. Multivariable analysis predicting csPCa with an interaction term between 5-ARIs and PIRADS score was performed. Sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of MRI were compared in treated and untreated patients.Results 705 patients (9%) were treated with 5-ARIs [median age 69 years, Interquartile range (IQR): 65, 73; median PSA 6.3 ng/ml, IQR 4.0, 9.0; median prostate volume 53 ml, IQR 40, 72] and 6913 were 5-ARIs naive (age 66 years, IQR 60, 71; PSA 6.5 ng/ml, IQR 4.8, 9.0; prostate volume 50 ml, IQR 37, 65). MRI showed PIRADS 1-2, 3, 4, and 5 lesions in 141 (20%), 158 (22%), 258 (37%), and 148 (21%) patients treated with 5-ARIs, and 878 (13%), 1764 (25%), 2948 (43%), and 1323 (19%) of untreated patients (p < 0.0001). No difference was found in csPCa detection rates, but diagnosis of high-grade PCa (ISUP GG >= 3) was higher in treated patients (23% vs 19%, p = 0.013). We did not find any evidence of interaction between PIRADS score and 5-ARIs exposure in predicting csPCa. Sensitivity, specificity, PPV, and NPV of PIRADS >= 3 were 94%, 29%, 46%, and 88% in treated patients and 96%, 18%, 43%, and 88% in untreated patients, respectively.Conclusions Exposure to 5-ARIs does not affect the association of PIRADS score with csPCa. Higher rates of high-grade PCa were detected in treated patients, but most were clearly visible on MRI as PIRADS 4 and 5 lesions.Trial registration The present study was registered at ClinicalTrials.gov number: NCT05078359

Absolute configuration of natural cyclohexene oxides by time dependent density functional theory calculation of the optical rotation: The absolute configuration of (-)-sphaeropsidone and (-)-episphaeropsidone revised

The optical rotatory power of some natural cyclohexene oxides, such as (+)-chaloxone, 1, (+)-epiepoformine, 2, (+)-epoformine, 3, (+)-epoxidone, 5, (-)-sphaeropsidone, 6, (-)-episphaeropsidone, 7, and the synthetic compound (+)-epitheobroxide, 4, has been calculated by means of the TDDFT/B3LYP method using the 6-31G(d) and aug- cc-pVDZ basis sets, both in the gas phase and in solution by means of the polarizable continuum model. For compounds 1 and 2, which possess high (about 300 units) optical rotations, gas-phase calculations with the smaller basis set are able to reproduce the experimental values both in sign and order of magnitude. By contrast, a larger basis set is required to satisfactorily simulate the OR values of 3 and 4, which show smaller (about 100 units or less) rotations. The inclusion of the solvent effects is different for different compounds; for 1 and 2, it leads to a better agreement between experiment and prediction, while for 3 and 4, the presence of hydrogen bonding groups makes the application of continuum solvation models less satisfactory. For the flexible system 5, the absolute configuration could not be determined using gas-phase calculations and the smaller basis set, but both inclusion of solvent and larger basis set effects are compulsory. It is noteworthy that calculations both in the gas phase and in the solvent lead to a positive rotatory power for the laevorotatory natural compounds 6 and 7 if the ACs reported in the literature are employed to do the theoretical prediction. This strongly indicates that the ACs previously assigned to these compounds in the literature are not correct and that the TDDFT prediction of OR values has become by now a practicable tool for AC assignments

MP46-17 INFECTIVE COMPLICATIONS AFTER NEPHROSTOMY TUBE REPLACEMENT WITHOUT USE OF ANTIMICROBICAL PROPHYLAXIS: A PROSPECTIVE STUDY

INTRODUCTION AND OBJECTIVE: Despite indications of international guidelines the use of antimicrobical prophylaxis (AMP) for routine nephrostomy catheter replacement is still quite common. So far in studies sustaining guidelines' indications, data about incidence of infective complications after nephrostomy replacement are poor. Aim of the study is to determine the frequency of febrile infective complications after office nephrostomy tube replacement in patients that did not receive AMP. METHODS: We prospectively enrolled all patients that underwent routine office nephrostomy tube replacement between July 2018 and September 2019 in our tertiary referral center. Each procedure was evaluated as an independent event. Clinical, microbiological and demographic data were collected. All patients that received AMP were excluded. 15-days after the nephrostomy tube replacement all patients received a phone interview aimed to investigate presence of fever, assumption of antimicrobial therapies and hospital admissions. Univariate and multivariate binomial logistic regression analysis was performed to assess the risk of infectious disease presented with temperature, flank pain and or hematuria that needed antibiotics administration. RESULTS: In the study period 145 routine nephrostomy tube replacements were performed. Before 19 procedures patients received AMP, these cases were excluded from the analysis. Mean patients\u2019 age was 78 (56-92). Charlson comorbidity index (CCI) score was 642 in 23,8% of patients, 3-4 in 23% and 655 in 53,2%. Mean glomerular filtration rate (CDK\u2013EPI) was 36.8 ml/min (s.d. 18.6). In 34 cases urine culture was positive but no patients received AMP. After 17 (13.49%) procedures patients reported temperature. In this subgroup 7 patients received antibiotic therapy while in 10 cases fever resolved spontaneously. 3 patients needed hospitalization, 2 for nephrostomy malfunction and 1 for temperature with elevations of inflammatory markers. At multivariate analysis only CCI score 655 showed to be significantly associated (p=0.03) with the risk of infective complications needing antibiotics administration. CONCLUSIONS: Episodes of fever after nephrostomy tube replacement could occur after about 10% of procedures. In our series of elderly patients with high burden of comorbities only 7 patients received an antibiotic therapy because of temperature or suspected infective complications related to the nephrostomy tube replacement, only one first aid readmission for infective complications was reported. Our prospective series strongly suggest that AMP can be safely omitted before routine office nephrostomy tube replacement

Yield and quality of milk and udder health in Martina Franca ass: effects of daily interval and time of machine milking

Twenty asses of Martina Franca breed, machine milked twice a day, were used to assess the influence of milking interval (3-h, 5-h, and 8-h; N=5) and time (700, 1200 and 1900) on milk yield and udder health. Individual milk samples were taken to determine fat, protein and lactose con- tent. Sensory analysis profile was also assessed. Milk&rsquo;s total bacterial count (TBC), somatic cell con- tent (SCC) and udder&rsquo;s skin temperature were considered to assess udder health. Milk yield increases by 28.4% (P<0.01) with a milking interval from 3-h to 8-h and is higher (P<0.01) at morning milking. The maximum milk yield per milking corresponds to 700 milking (1416.9 mL) thus indicating a circa- dian rhythm in milk secretion processes. Milking intervals of 5 and 8 hours cause a decrease (P<0.01) in milk fat and lactose content. The 8-h interval leads to an increase (P<0.01) in SCC but without any significance for the health udder. No alterations about CBT, clinical evaluation and temperature of ud- der were observed. Milk organoleptic characteristics were better in the 3-h interval milking

Arterioureteral fistula: An unusual cause of haematuria 10 years after the implantation of a synthetic iliac-femoral stent

In conclusion, AUF remains a rare but potentially lethal condition that clinicians should be aware of. Our experience shows that in patients with haematuria not otherwise explainable and previous history of vascular surgery with endovascular stent placement, the presence of an AUF should be suspected, especially if CT shows an extremity of the vascular stent laying in close proximity to the ureter. The present study was carried out according to the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Patient's written informed consent for treatment and publication was obtained. All anamnestic, clinical, and laboratory data containing sensitive information about the patient were de-identified in order to ensure analysis of anonymous data only

Analysis of clinical utility of abdominopelvic computer tomography in the follow up of Stage I Seminoma. A single center evaluation

BACKGROUND: Abdominopelvic computer tomography (CT) is widely used in the follow up of seminoma patients after radical orchidectomy. The aim of this study is to evaluate the clinical utility of abdominopelvic computer tomography in the follow-up of patients with Stage I seminoma. METHODS: The pathological reports of all patients that have undergone radical orchidectomy in our tertiary referral center between January 2002 and January 2018 have been retrospectively reviewed. All patients with Stage I seminoma and negative serum tumor markers after radical orchidectomy were included. Patients with follow-up shorter than 12 months were excluded. Surveillance records of every patient were reviewed with particular regard to abdominopelvic imaging. RESULTS: Of the 133 patients who have undergone radical orchidectomy in our center, 55 had stage I pure seminoma with normal levels of serum tumor markers after surgery. Two patients were excluded as the follow-up was inadequate. Mean follow-up was 63,2 months (IQR: 30-73). The results of 211 abdominopelvic CTs performed as part of the follow up were reviewed. Two (3,7%) patients developed recurrence; one consisted of a scrotal lump and was diagnosed with ultrasonography (US) while the second appeared as paraaortic nodal metastasis and was diagnosed with abdominopelvic CT. The recurrence was successfully treated in both patients. A single abdominopelvic CT was useful for the detection of recurrent disease in our entire study population. No cancer specific death has been reported in the study population. CONCLUSIONS\u2d0 Follow-up schedules for stage I seminoma exposes patients to potential risks of radiation- induced tumors, emotional distress and represent a significant burden for the healthcare system. The current series suggests that a better risk adapted patient-tailored follow-up program is needed in order to avoid unnecessary investigations