Closure of cutaneous incision after thyroid surgery: A comparison between metal clips and cutaneous octyl-2-cyanoacrylate adhesive. A prospective randomized clinical trial

Octyl-2-cyanoacrylate (Dermabond, Ethicon Inc.) has been introduced in clinical practice as an ideal system of closure of wounds, but no studies have confirmed the advantages of wound closure performed with Dermabond compared to skin staples (Proximate, Ethicon Inc.) in thyroid surgery. The objective of this study is to evaluate the short- and long-term results of wound closure in thyroid surgery performed with Dermabond (DERM) versus Proximate (PROX). Seventy patients after thyroidectomy were randomly assigned into the two groups (DERM vs PROX). The postoperative and the long-term outcomes were clinically evaluated by physicians, and the Stony Brook scar evaluation scale has also been used. The patients' satisfaction with the early postoperative management and with the cosmetic outcomes has been assessed by a numerical scale ranging from 0 to 10. Results were compared using appropriate statistical tests. Thirty-two patients used DERM, while 38 patients used PROX. Immediate results showed difficult application in two cases DERM (6.2%) and hyperemia in one case DERM (3.1%). Early results showed edema in eight cases DERM (25%) vs two cases PROX (5.2%; p<0.05); patients' satisfaction: optimum judgement in 100% DERM vs 15.7% PROX (p< 0.001); patients' self aesthetic evaluation: PROX higher percentage of excellent results vs DERM (p<0.005). After one month, results showed edema in nine cases DERM (28.8%) vs two cases PROX (5.2%; p<0.01), while after 6 months, DERM had lesser symptoms than PROX (p< 0.01). Octyl-2-cyanoacrylate has proven to be effective and reliable in the skin closure of cervical incision similar to suture with staples and yields similar final cosmetic outcomes. Because Dermabond offers the advantage of better management in the early postoperative phase, the patients' satisfaction is clearly better. © Springer-Verlag 2010

Patterns of phytoalexins in the grapevine leaf stripe disease (esca complex)/grapevine pathosystem

Vineyards containing vines affected with grapevine leaf stripe disease (GLSD), one of the diseases of the esca complex, suffer losses in grape yield and quality every growing season. To examine the relation between GLSD foliar symptoms and levels of phytoalexins in grapevine, phytoalexin levels were monitored in the leaves of symptomatic, asymptomatic/diseased, and healthy grapevine leaves, at various growth stages, in two vineyards in Italy, over four growing seasons. At the same time, the leaf symptoms of the vines at some of those growth stages were recorded in each vineyard and in each growing season. The compounds extracted and identified were: trans-resveratrol, trans-pterostilbene, trans-ε-viniferin and trans-δ-viniferin. The most common phytoalexin found was resveratrol. Amounts of all the phytoalexins were generally greater in symptomatic leaves than in asymptomatic/diseased or healthy leaves. In symptomatic leaves, resveratrol levels were greatest at pre-bunch closure, and peaks in pterostilbene occurred at the same time. Leaves of each category (symptomatic, asymptomatic/diseased, healthy) had lower amounts of these compounds at veraison and generally higher amounts at the stages of harvesting and/or the softening of berries. It seems therefore that the formation and pattern over time of the phytoalexins was linked to the growth stage of the vines. Leaf symptoms never occurred before pre-bunch closure, but became much more common from veraison to harvest. This study provides evidence of a relationship between the levels of phytoalexins, grapevine growth stage, and the seasonal pattern of development of GLSD symptoms

Patterns of phytoalexins in the grapevine leaf stripe disease (esca complex)/grapevine pathosystem

Vineyards containing vines affected with grapevine leaf stripe disease (GLSD), one of the diseases of the esca complex, suffer losses in grape yield and quality every growing season. To examine the relation between GLSD foliar symptoms and levels of phytoalexins in grapevine, phytoalexin levels were monitored in the leaves of symptomatic, asymptomatic/diseased, and healthy grapevine leaves, at various growth stages, in two vineyards in Italy, over four growing seasons. At the same time, the leaf symptoms of the vines at some of those growth stages were recorded in each vineyard and in each growing season. The compounds extracted and identified were: trans-resveratrol, trans-pterostilbene, trans-ε-viniferin and trans-δ-viniferin. The most common phytoalexin found was resveratrol. Amounts of all the phytoalexins were generally greater in symptomatic leaves than in asymptomatic/diseased or healthy leaves. In symptomatic leaves, resveratrol levels were greatest at pre-bunch closure, and peaks in pterostilbene occurred at the same time. Leaves of each category (symptomatic, asymptomatic/diseased, healthy) had lower amounts of these compounds at veraison and generally higher amounts at the stages of harvesting and/or the softening of berries. It seems therefore that the formation and pattern over time of the phytoalexins was linked to the growth stage of the vines. Leaf symptoms never occurred before pre-bunch closure, but became much more common from veraison to harvest. This study provides evidence of a relationship between the levels of phytoalexins, grapevine growth stage, and the seasonal pattern of development of GLSD symptoms

The impact of the Hippo pathway and cell metabolism on pathological complete response in locally advanced Her2+ breast cancer: the TRISKELE multicenter prospective study

The Hippo pathway and its two key effectors, Yes-associated protein (YAP) and transcriptional coactivator with PDZ-binding motif (TAZ), are consistently altered in breast cancer. Pivotal regulators of cell metabolism such as the AMP-activated protein kinase (AMPK), Stearoyl-CoA-desaturase 1 (SCD1), and HMG-CoA reductase (HMGCR) are relevant modulators of TAZ/YAP activity. In this prospective study, we measured the tumor expression of TAZ, YAP, AMPK, SCD1, and HMGCR by immunohistochemistry in 65 Her2+ breast cancer patients who underwent trastuzumab-based neoadjuvant treatment. The aim of the study was to assess the impact of the immunohistochemical expression of the Hippo pathway transducers and cell metabolism regulators on pathological complete response. Low expression of cytoplasmic TAZ, both alone and in the context of a composite signature identified by machine learning including also low nuclear levels of YAP and HMGCR and high cytoplasmic levels of SCD1, was a predictor of residual disease in the univariate logistic regression. This finding was not confirmed in the multivariate model including estrogen receptor &gt; 70% and body mass index &gt; 20. However, our findings were concordant with overall survival data from the TCGA cohort. Our results, possibly affected by the relatively small sample size of this study population, deserve further investigation in adequately sized, ad hoc prospective studies

La tiroidectomia totale per gozzo plurinodulare. Correlazioni tra classificazione citologica preoperatoria e l'esame istologico definitivo

Le lesioni nodulari della tiroide rappresentano un problema comune per il chirurgo e una sfida diagnostica per il patologo. La difficoltà riscontrata dai medici è quella di raggiungere una precisa diagnosi preoperatoria di malignità tale da garantire al paziente un trattamento tempestivo e appropriato. L'aspirazione con ago sottile (FNA) è l'unico test in grado di fornire una diagnosi preoperatoria di malignità. L'obiettivo della presente tesi è quello di testare il nuovo sistema nazionale di classificazione citologica tiroidea a sei livelli (Siapec 2014), sviluppato in accordo con i principali sistemi di classificazione mondiali (Bethesda, RC-Path), mettendolo a confronto con il precedente sistema SIAPEC a cinque livelli (2007), all’interno di un’ampia casistica operatoria riguardante 590 pazienti affetti da gozzo plurinodulare, sottoposti tra il 2009 e il 2018 ad intervento di “tiroidectomia totale”. In questo studio retrospettivo abbiamo analizzato la nostra casistica personale dal Gennaio 2008 al Settembre 2018, relativa a 590 pazienti con patologia plurinodulare della tiroide, giunti alla nostra osservazione con un citologico preoperatorio e operati di tiroidectomia totale . Abbiamo suddiviso la nostra casistica in due periodi: il primo dal Gennaio 2008 all’Aprile 2014, riguardante un gruppo di 434 pazienti, ed il secondo, dal maggio 2014 al Settembre 2018, riguardante 156 pazienti. Nel primo periodo, la classificazione citologica di riferimento è stata la classificazione SIAPEC del 2007, che prevedeva 5 classi: dal TIR1 al TIR5. Nel secondo periodo, i noduli erano stati analizzati mediante la classificazione SIAPEC-IAP del 2014 che prevedeva la suddivisione della precedente classe TIR3 in due sottoclassi (TIR3A e TIR3B). Retrospettivamente, abbiamo analizzato i risultati dell’esame istologico definitivo sul pezzo operatorio di ciascun paziente, e lo abbiamo posto a confronto con il relativo esame citologico preoperatorio. Successivamente abbiamo confrontato i risultati ottenuti dai due gruppi, allo scopo di verificare se l’introduzione della nuova classificazione avesse aggiunto o meno accuratezza diagnostica nel predire la presenza di neoplasie. La presa in carico dei pazienti con agoaspirato con caratteristiche “sospette o indeterminate” resta ancora problematica. In questi anni sono state adottate e aggiornate diverse classificazioni per poter gestire in modo sempre migliore questa classe di citologici. In Italia, la categoria precedentemente denominata TIR3, è stata suddivisa dal 2014 in due sottoclassi, TIR3A e TIR3B, con differente rischio di malignità e differenti approcci clinici, è al momento quasi sovrapponibile alle classi III e IV della classificazione di Bethesda ed alle classi Thy 3a e Thy 3f della classificazione UK RCPath. Tenendo in considerazione che i dati sono ancora preliminari ed attendono una maggiore numerosità per essere validati in maniera definitiva, possiamo affermare che la nuova classificazione SIAPEC-IAP del 2014, fornisce sicuramente una più precisa accuratezza diagnostica per quanto riguarda la presenza di neoplasie, ma non crediamo che questo possa influenzare la strategia di condotta chirurgica che abbiamo utilizzato fino ad oggi, in quanto anche gli adenomi follicolari, pur essendo lesioni benigne, poiché citologicamente indistinguibili dai carcinomi, meritano a nostro avviso il trattamento chirurgico. Continueremo, sulla scorta di questi dati, a consigliare l’intervento chirurgico di tiroidectomia totale per tutti i TIR3B, i TIR4, ed i TIR5. Per quanto riguarda la categoria TIR3A , a nostro avviso, sarebbe consigliabile la strategia chirurgica di un intervento conservativo (lobo-istmectomia) solo per i TIR3A uninodulari e con restante parenchima integro non potendo avere una sicura diagnosi pre-operatoria tra adenoma follicolare e carcinoma papillifero. Prima di inviare i pazienti ad uno stretto follow-up , come indicato dalle linee guida ,è utile procedere ad analisi aggiuntive, quali la valutazione della mutazione del B_RAF ed N_RAS. Solo se la mutazione di questi due geni risultasse negativa allora si può indirizzare il paziente, adeguatamente informato, a controlli clinico-laboratoristici-radiologici reiterati nel tempo. Nel caso contrario, cioè in presenza di mutazioni di questi due geni, la percentuale di probabilità che il nodulo sia neoplastico aumenta fino al 55 % in alcuni studi di settore per cui il paziente deve essere indirizzato sicuramente verso una terapia di tipo chirurgico

Evaluation of Post Processing Analysis to determine Optimal Thermo-Optical Properties for Adaptive Glazing Systems with Quick Adaptation Speed

Adaptive envelope technologies are considered as ones of the most promising for reducing the energy use in buildings. Nonetheless, their real-world implementation is low, because of fragmented researches and limited capabilities of current BPS (building performance simulation) tools in evaluating properly their behaviour at a time-scale consistent with the highly dynamic drivers effecting the adaptation mechanism. The aim of this research is to investigate the effectiveness of simplified methods to determine optimal thermo-optical properties for adaptive glazing systems able to modulate two parameters, g-value (or SGHC) and τvis, with quick adaptation speed (5 minutes), using inverse approach and post processing analysis. This type of study is meant to provide a useful tool in early design phase for choosing the best fitted adaptive technology and for the development of new adaptive glazing technologies, since it identifies the requirements to be satisfied by means of the best suited technological solutions

Ricostruzioni climatiche, ambientali e geoarcheologiche attraverso lo studio di suoli olocenici in Calabria

Scuola di Dottorato" Archimede" in Scienze, Comunicazione e Tecnologie, Dottorato di Ricerca in Scienze della Terra, XXIV Ciclo, a.a. 2008-2011Università della Calabri