Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN)

Background Evidence on the efficacy of minimally invasive (MI) segmental resection of splenic flexure cancer (SFC) is not available, mostly due to the rarity of this tumor. This study aimed to determine the survival outcomes of MI and open treatment, and to investigate whether MI is noninferior to open procedure regarding short-term outcomes. Methods This nationwide retrospective cohort study included all consecutive SFC segmental resections performed in 30 referral centers between 2006 and 2016. The primary endpoint assessing efficacy was the overall survival (OS). The secondary endpoints included cancer-specific mortality (CSM), recurrence rate (RR), short-term clinical outcomes (a composite of Clavien-Dindo > 2 complications and 30-day mortality), and pathological outcomes (a composite of lymph nodes removed >= 12, and proximal and distal free resection margins length >= 5 cm). For these composites, a 6% noninferiority margin was chosen based on clinical relevance estimate. Results A total of 606 patients underwent either an open (208, 34.3%) or a MI (398, 65.7%) SFC segmental resection. At univariable analysis, OS and CSM were improved in the MI group (log-rank test p = 0.004 and Gray's tests p = 0.004, respectively), while recurrences were comparable (Gray's tests p = 0.434). Cox multivariable analysis did not support that OS and CSM were better in the MI group (p = 0.109 and p = 0.163, respectively). Successful pathological outcome, observed in 53.2% of open and 58.3% of MI resections, supported noninferiority (difference 5.1%; 1-sided 95%CI - 4.7% to infinity). Successful short-term clinical outcome was documented in 93.3% of Open and 93.0% of MI procedures, and supported noninferiority as well (difference - 0.3%; 1-sided 95%CI - 5.0% to infinity). Conclusions Among patients with SFC, the minimally invasive approach met the criterion for noninferiority for postoperative complications and pathological outcomes, and was found to provide results of OS, CSM, and RR comparable to those of open resection

A machine-learning based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease

Background: Mechanisms of myocardial ischemia in obstructive and non-obstructive coronary artery disease (CAD), and the interplay between clinical, functional, biological and psycho-social features, are still far to be fully elucidated. Objectives: To develop a machine-learning (ML) model for the supervised prediction of obstructive versus non-obstructive CAD. Methods: From the EVA study, we analysed adults hospitalized for IHD undergoing conventional coronary angiography (CCA). Non-obstructive CAD was defined by a stenosis < 50% in one or more vessels. Baseline clinical and psycho-socio-cultural characteristics were used for computing a Rockwood and Mitnitski frailty index, and a gender score according to GENESIS-PRAXY methodology. Serum concentration of inflammatory cytokines was measured with a multiplex flow cytometry assay. Through an XGBoost classifier combined with an explainable artificial intelligence tool (SHAP), we identified the most influential features in discriminating obstructive versus non-obstructive CAD. Results: Among the overall EVA cohort (n = 509), 311 individuals (mean age 67 ± 11 years, 38% females; 67% obstructive CAD) with complete data were analysed. The ML-based model (83% accuracy and 87% precision) showed that while obstructive CAD was associated with higher frailty index, older age and a cytokine signature characterized by IL-1β, IL-12p70 and IL-33, non-obstructive CAD was associated with a higher gender score (i.e., social characteristics traditionally ascribed to women) and with a cytokine signature characterized by IL-18, IL-8, IL-23. Conclusions: Integrating clinical, biological, and psycho-social features, we have optimized a sex- and gender-unbiased model that discriminates obstructive and non-obstructive CAD. Further mechanistic studies will shed light on the biological plausibility of these associations. Clinical trial registration: NCT02737982

Solid Organ Transplantation During COVID-19 Pandemic: An International Web-based Survey on Resources’ Allocation

Background. Solid organ transplants (SOTs) are life-saving interventions, recently challenged by coronavirus disease 2019 (COVID-19). SOTs require a multistep process, which can be affected by COVID-19 at several phases. Methods. SOT-specialists, COVID-19-specialists, and medical ethicists designed an international survey according to CHERRIES guidelines. Personal opinions about continuing SOTs, safe managing of donors and recipients, as well as equity of resources' allocation were investigated. The survey was sent by e-mail. Multiple approaches were used (corresponding authors from Scopus, websites of scientific societies, COVID-19 webinars). After the descriptive analysis, univariate and multivariate ordinal regression analysis was performed. Results. There were 1819 complete answers from 71 countries. The response rate was 49%. Data were stratified according to region, macrospecialty, and organ of interest. Answers were analyzed using univariate- multivariate ordinal regression analysis and thematic analysis. Overall, 20% of the responders thought SOTs should not stop (continue transplant without restriction); over 70% suggested SOTs should selectively stop, and almost 10% indicated they should completely stop. Furthermore, 82% agreed to shift resources from transplant to COVID-19 temporarily. Briefly, main reason for not stopping was that if the transplant will not proceed, the organ will be wasted. Focusing on SOT from living donors, 61% stated that activity should be restricted only to "urgent"cases. At the multivariate analysis, factors identified in favor of continuing transplant were Italy, ethicist, partially disagreeing on the equity question, a high number of COVID-19- related deaths on the day of the answer, a high IHDI country. Factors predicting to stop SOTs were Europe except-Italy, public university hospital, and strongly agreeing on the equity question. Conclusions. In conclusion, the majority of responders suggested that transplant activity should be continued through the implementation of isolation measures and the adoption of the COVID-19-free pathways. Differences between professional categories are less strong than supposed

Condizioni di vita e di studio degli studenti dell’Università di Ferrara e impatto sul territorio: Edizione 2012

L’indagine sulle condizioni di vita e di studio degli studenti dell’Università di Ferrara e sul loro impatto sul territorio è un’indagine campionaria promossa e finanziata dalla Direzione Amministrativa dell’Ateneo ferrarese, dal Comune di Ferrara e dall’Ente Regionale per il Diritto allo studio ERGO. Essa è stata progettata e realizzata nella primavera 2012 dal centro per la Modellistica il Calcolo e la Simulazione in collaborazione con l’ufficio Statistica dell’Università di Ferrara

Seismic behaviour of wood-concrete frame shear-wall system and comparison with code provisions

Constructive systems adopting mixed shear walls made of a wood frame and fibrous or cementitious sheets nowadays are largely spread, particularly for prefabricated buildings. The use of gypsum boards as bracing panels is already widely proposed, but also fiber cement or reinforced concrete slabs can be used. The choice of such different materials allows to reach excellent thermal and acoustic insulation performance and for economic reason. Perhaps the demonstration of their sound structural behavior, especially towards the earthquake resistance is still to be given, and their ductility and dissipative capacities still need to be fully assessed even if some experimental tests have already been conducted. Moreover these particular constructive systems are yet not accounted in the building codes (Eurocode 5 and Eurocode 8) and no guidelines are given for their seismic design in order to assure an adequate overstrength of the bracing panels and the adequacy of the fixing system of the panels to the wooden frames. This work reports the investigation of the structural behavior of a newly developed wood-reinforced concrete constructive system. The investigated modular prefabricated system combines a typical platform frame system with an external thin reinforced concrete slab acting as a diaphragm against the horizontal actions and having also thermal ad acoustic functions. The structural design procedure of such innovative system imitates the calculations normally adopted for the platform frame system; the bracing stiffness and strength assured by a OSB panel nailed to the wooden structure are cumulated with those given by the concrete slabs which are screwed to the frame by means of large diameter connectors which assure a considerable stiffness and, in the meantime, a great capacity of energy dissipation in case of seismic events. In order to verify the real performance of this construction system under seismic actions several cyclic tests on single panel modules and on an assembled wall were carried out in accordance with the testing protocol specified in EN 12512. The results of the experimental tests are reported. It has been demonstrated that the seismic performance of the structural system fulfills the requirements given by EC8 for the structures that belong to the higher ductility class. The analytical expressions that best fit the experimental load-displacement curves are reported and the comparison of the obtained results with that calculated according to the analytical formulas given by EC5 for the used connection type are discussed. Finally a FEM nonlinear element able to reproduce the load-displacement hysteretic response of the connectors has been developed and implemented into a finite-element model to understand the mechanical behavior of the studied walls subjected by cyclic load. By the use of the this numerical model it was possible to estimate the seismic performance of the proposed wood-concrete system in terms of ductility and dissipative capacity. Several non-linear numerical analyses were performed and a sound behavior q-factor (i.e. reduction factor) for the wood-reinforced concrete walls was proposed