UN APPROCCIO GEOMATICO PER LA GESTIONE DEL RICOVERO DEL PAZIENTE AFFETTO DA COVID-19

During the COVID-19 pandemic period, it is often necessary to hospitalize a patient positive for the virus and in serious health conditions in suitable hospitals. The difficulty in managing these emergencies arises from the fact that it is often not possible to know which is the nearest hospital with beds available for hospitalization of the COVID-19 patients. In this work, we pre-sent a GIS application based on a relational database that allows to determine an optimal path for the patient transport from a starting point to the nearest hospital with free places for hospitalization. The developed application re-duces the patient's transport time, decreasing the exposure time of the medi-cal staff in the ambulance in contact with the positive patient. The applica-tion was developed in the urban area of Catania where hospitals gather a large pool of users and therefore it is essential to have a system that in real-time provides the available beds and thus optimize the distribution of COVID-19 positive patients who need an admission to a hospital

Methacronous Intercostal and Peritoneal Metastases from Resected Well-differentiated Hepatocellular Carcinoma: Description of a Case and Review of Literature

Introduction: The aim of this report is to prove the possibility of simultaneous difficult cardiac and urologic operation. Important point to make in our report concerns the fact that the oncologic treatment was not delayed despite severe heart disease. There is also an advantage in avoiding second operation and hence anesthesiaCase Presentation: A 72 year old male presented to us with right renal mass lesion with tumour thrombus extending up to right atrium. He had undergone Percutaneous Transluminal Coronary Angioplasty 5 years ago and had two coronary stents in situ. Coronary angiography revealed triple vessel coronary re obstruction. After proper planning he underwent right radical nephrectomy with tumour thombectomy along with Coronary Artery Bypass Grafting in the same sitting.Conclusion: One-stage cardiac and uro-oncologic operation can be a safe and beneficial procedure, if performed in selected patients

Thymomectomy versus complete thymectomy in early-stage non-myasthenic thymomas: a multicentric propensity score-matched study

Objectives: Thymomectomy is gaining consensus over complete thymectomy in early-stage thymoma without myasthenia gravis. This is due both to the difficulty of establishing prospective and randomized controlled studies and to the lack of well-defined selection criteria. This bicentric, retrospective propensity score-matched study aims at comparing oncological outcomes, measured in terms of overall survival and thymoma-related survival, in patients undergoing either thymomectomy or complete thymectomy. Methods: We retrospectively analysed medical records of patients with clinical early-stage (I and II) thymoma undergoing thymomectomy or complete thymectomy. Exclusion criteria were the presence of myasthenia gravis, clinical advanced tumours and thymic carcinoma. A propensity score-matching analysis was applied to reduce potential preoperative selection biases such as comorbidity (Charlson score), tumour maximal diameter and surgical approach (open versus minimal). All variables were dichotomized. Results: A total of 255 patients were enrolled from 2 different Hospitals, 126 underwent complete thymectomy and 129 a thymomectomy. Disease-free and thymoma-related survivals showed a 5-year rate of 87.7% and 96.0% and a 10-year rate of 82.2% and 91.9%, respectively. Propensity score-matching analysis selected a total of 176 patients equally divided between the 2 groups. No difference was found for both disease-free (P = 0.11) and thymoma-related (P = 0.37) survival in the 2 groups of resection. Multivariable Cox regression analysis showed that histology (P < 0.001), residual disease (P < 0.001) and adjuvant chemotherapy (P < 0.001) were the only predictors of shorter disease-free survival. Whereas there was no evidence to confirm that disease-free and thymoma-related survivals were influenced by resection extent. Conclusions: Thymomectomy is an adequate surgical resection for non-myasthenic thymoma, achieving disease-free and thymoma-related survivals comparable to those after complete thymectomy

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas’s Experience

Background: We analysed a series of malignant pleural mesothelioma (MPM) patients who consecutively underwent extended Pleurectomy/Decortication (eP/D) in a centre with a high level of thoracic surgery experience (IRCCS Humanitas Research Hospital) to explore postoperative morbidity and mortality, pattern of recurrence and survival. Methods: A retrospective analysis was performed on MPM patients underwent eP/D in our centre from 2010 to 2021. All patients were identified from our departmental database. Postoperative complications were scored according to Clavien–Dindo criteria. Survival analysis was performed by the Kaplan–Meier methods and Cox multivariable analysis. Results: Eighty-five patients underwent extended pleurectomy decortication (eP/D) during study period. Macroscopical residual disease (R2) was reported in one case. A neoadjuvant chemotherapy regiment was administrated in 88% of the surgical cohort. A complete trimodality treatment including induction with platinum agents and pemetrexed, radical cytoreductive surgery and volumetric modulated arc therapy technology (VMAT) could be administered in 63 patients (74%). Postoperative morbidity rate was 54.11%, major complications (defined as Clavien–Dindo ≥ 3) were reported in 11 patients (12.9%). Thirty-day mortality and 90-day mortality were, respectively, 2.35% and 3.53%. Median disease-free and overall survival were, respectively, 13.7 and 25.5 months. The occurrence of major complications (Clavien–Dindo ≥ 3), operative time, pT3–T4, pathological node involvement (pN+) were prognostic factors associated with worse survival. Conclusions: In our experience, eP/D is a well-tolerated procedure with acceptable mortality and morbidity, allowing for the administration of trimodality regimens in most patients. eP/D offered in a multimodality treatment setting have satisfactory long term oncological results. To obtain best oncological results the goal of surgery should be macroscopic complete resection in carefully selected patients (clinical N0)

Evaluation of the Urban Microclimate in Catania Using Multispectral Remote Sensing and GIS Technology

This study focuses on the determination and examination of both the Land Surface Temperature (LST) and the atmospheric temperature in the city of Catania Sicily (Italy), through freely available satellite remote sensing images from the Sentinel-2 and MODIS missions. Satellite images were processed as raster data in free and open-source GIS environments. The GIS software allows the retrieval, processing of the satellite images for the estimation of the LST and the atmospheric temperature with a very coarse spatial resolution. In particular, the proposed procedure allows increasing the spatial resolution of satellite images, from 250 m (LRES) to 10 m (HRES) through the principle of “Disaggregation of thermal images”. The analysis provided georeferenced maps which show the LST, as well as the atmospheric temperature within the investigated area with a very fine resolution, 10 m. Such spatial resolution reveals evident correlations between areas with different urban densities and their microclimate. An important result of this study is that significant LST differences can be observed during both day (15–17 °C) and night (2–3 °C) between green and built-up areas. The outcomes of this study highlight the effectiveness of the combined use of satellite remote sensing and GIS for analyzing the thermal response of urbanized areas with different built density

Forest Fire Spreading Using Free and Open-Source GIS Technologies

Forest fires are one of the most dangerous events, causing serious land and environmental degradation. Indeed, besides the loss of a huge quantity of plant species, the effects of fires can go far beyond: desertification, increased risk of landslides, soil erosion, death of animals, etc. For these reasons, mathematical models able to predict fire spreading are needed in order to organize and optimize the extinguishing interventions during fire emergencies. This work presents a new system to simulate and predict the movement of the fire front based on free and open source Geographic Information System (GIS) technologies and the Rothermel surface fire spread model, with the adjustments made by Albini. We describe the mathematical models used, provide an overview of the GIS design and implementation, and present the results of some simulations at Etna volcano (Sicily, Italy), characterized by high geomorphological heterogeneity, and where the native flora and fauna may be preserved and perpetuated. The results consist of raster maps representing the progress times of the fire front starting from an ignition point and as a function of the topography and wind directions. The reliability of results is strictly affected by the correct positioning of the fire ignition point, by the accuracy of the topography that describes the morphology of the territory, and by the setting of the meteorological conditions at the moment of the ignition and propagation of the fire

Evaluation of the Urban Microclimate in Catania Using Multispectral Remote Sensing and GIS Technology

This study focuses on the determination and examination of both the Land Surface Temperature (LST) and the atmospheric temperature in the city of Catania Sicily (Italy), through freely available satellite remote sensing images from the Sentinel-2 and MODIS missions. Satellite images were processed as raster data in free and open-source GIS environments. The GIS software allows the retrieval, processing of the satellite images for the estimation of the LST and the atmospheric temperature with a very coarse spatial resolution. In particular, the proposed procedure allows increasing the spatial resolution of satellite images, from 250 m (LRES) to 10 m (HRES) through the principle of “Disaggregation of thermal images”. The analysis provided georeferenced maps which show the LST, as well as the atmospheric temperature within the investigated area with a very fine resolution, 10 m. Such spatial resolution reveals evident correlations between areas with different urban densities and their microclimate. An important result of this study is that significant LST differences can be observed during both day (15–17 °C) and night (2–3 °C) between green and built-up areas. The outcomes of this study highlight the effectiveness of the combined use of satellite remote sensing and GIS for analyzing the thermal response of urbanized areas with different built density

Sant’Agata "sicura": un’applicazione GIS per l’analisi del rischio e la gestione dei soccorsi

On 3rd, 4th and 5th of February Catania celebrates its Patron Saint Agata with a religious festival gathering every year more than 700,000 people. The scientific article below reports an experimental approach of Saint Agata celebration, analyzing risks and excellent relief routes on Q-GIS platform. The starting point of the project has been the collection of data about the street path of the celebration, such as paving materials, slope average and people density. All this information has been used to produce a risk scale to highlight the most dangerous phases of the procession. An example of excellent (relief routes) optimal path has been produced to reach the nearest hospitals. The project has been implemented using QGIS 2.0.1 and GRASS GIS