Use of balloon catheter dilation and steroid-eluting stent in light and severe rhinosinusitis of frontal sinus: a multicenter retrospective randomized study

OBJECTIVE: Frontal sinus surgery has an increased rate of re-stenosis, if compared to other sinuses, that mainly depends on recurrent inflammation and abnormal scarring at the frontal recess; its reduction represents one of the keys of therapeutic success. Balloon catheter dilation (BCD) and implantable sinus stents/spacers represent strategies to improve sinus ventilation respecting the integrity of mucosa and reducing abnormal post-surgical scarring. The purpose of this study is to evaluate the effectiveness, safety and correct indication for the use of BCD and a non-absorbable stent (Relieva Stratus™ MicroFlow spacer) in the management of chronic rhinosinusitis (CRS) of the frontal sinus. PATIENTS AND METHODS: In this multicentric retrospective study we included a population of 76 frontal sinuses with non-polypoid CRS. Forty-one frontal sinuses were treated with BCD alone and 35 with BCD + Spacer. We analysed both radiological (Lund-McKay CT scoring modified by Zienrich) and symptomatologic results (SNOT-20 questionnaire) before surgery and after 12 months, dividing patients in two main groups: group “L” (light/mild frontal CRS) and group “S” (moderate/severe frontal CRS). RESULTS: Our results confirm a good safety and effectiveness of BCD in management of frontal CRS and show a good safety, although without significant effectiveness, of Relieva Stratus™ MicroFlow spacer when added to BCD in the management of light and severe frontal CRS. CONCLUSIONS: BCD is an option in management of frontal CRS; the use of stents/spacers could become a new and effective tool in management of CSR, both in addition to standard therapies and in patients where the use of systemic drugs is contraindicated

CT radiomics-based machine learning classification of atypical cartilaginous tumours and appendicular chondrosarcomas

Background Clinical management ranges from surveillance or curettage to wide resection for atypical to higher-grade cartilaginous tumours, respectively. Our aim was to investigate the performance of computed tomography (CT) radiomics-based machine learning for classification of atypical cartilaginous tumours and higher-grade chondrosarcomas of long bones. Methods One-hundred-twenty patients with histology-proven lesions were retrospectively included. The training cohort consisted of 84 CT scans from centre 1 (n=55 G1 or atypical cartilaginous tumours; n=29 G2-G4 chondrosarcomas). The external test cohort consisted of the CT component of 36 positron emission tomography-CT scans from centre 2 (n=16 G1 or atypical cartilaginous tumours; n=20 G2-G4 chondrosarcomas). Bidimensional segmentation was performed on preoperative CT. Radiomic features were extracted. After dimensionality reduction and class balancing in centre 1, the performance of a machine-learning classifier (LogitBoost) was assessed on the training cohort using 10-fold cross-validation and on the external test cohort. In centre 2, its performance was compared with preoperative biopsy and an experienced radiologist using McNemar's test. Findings The classifier had 81% (AUC=0.89) and 75% (AUC=0.78) accuracy in identifying the lesions in the training and external test cohorts, respectively. Specifically, its accuracy in classifying atypical cartilaginous tumours and higher-grade chondrosarcomas was 84% and 78% in the training cohort, and 81% and 70% in the external test cohort, respectively. Preoperative biopsy had 64% (AUC=0.66) accuracy (p=0.29). The radiologist had 81% accuracy (p=0.75). Interpretation Machine learning showed good accuracy in classifying atypical and higher-grade cartilaginous tumours of long bones based on preoperative CT radiomic features

Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort

background: In italy, surgeons continue to drain the abdominal cavity in more than 50 per cent of patients after colorectal resection. the aim of this study was to evaluate the impact of abdominal drain placement on early adverse events in patients undergoing elective colorectal surgery. methods: a database was retrospectively analysed through a 1:1 propensity score-matching model including 21 covariates. the primary endpoint was the postoperative duration of stay, and the secondary endpoints were surgical site infections, infectious morbidity rate defined as surgical site infections plus pulmonary infections plus urinary infections, anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation and mortality rates. the results of multiple logistic regression analyses were presented as odds ratios (OR) and 95 per cent c.i. results: a total of 6157 patients were analysed to produce two well-balanced groups of 1802 patients: group (A), no abdominal drain(s) and group (B), abdominal drain(s). group a versus group B showed a significantly lower risk of postoperative duration of stay >6 days (OR 0.60; 95 per cent c.i. 0.51-0.70; P < 0.001). a mean postoperative duration of stay difference of 0.86 days was detected between groups. no difference was recorded between the two groups for all the other endpoints. conclusion: this study confirms that placement of abdominal drain(s) after elective colorectal surgery is associated with a non-clinically significant longer (0.86 days) postoperative duration of stay but has no impact on any other secondary outcomes, confirming that abdominal drains should not be used routinely in colorectal surgery

Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort

background current evidence concerning bowel preparation before elective colorectal surgery is still controversial. this study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any adverse event, OM) after elective colorectal surgery using four different types of bowel preparation. methods a prospective database gathered among 78 Italian surgical centers in two prospective studies, including 6241 patients who underwent elective colorectal resection with anastomosis for malignant or benign disease, was re-analyzed through a multi-treatment machine-learning model considering no bowel preparation (NBP; No. = 3742; 60.0%) as the reference treatment arm, compared to oral antibiotics alone (oA; No. = 406; 6.5%), mechanical bowel preparation alone (MBP; No. = 1486; 23.8%), or in combination with oAB (MoABP; No. = 607; 9.7%). twenty covariates related to biometric data, surgical procedures, perioperative management, and hospital/center data potentially affecting outcomes were included and balanced into the model. the primary endpoints were AL, SSIs, and OM. all the results were reported as odds ratio (OR) with 95% confidence intervals (95% CI). results compared to NBP, MBP showed significantly higher AL risk (OR 1.82; 95% CI 1.23-2.71; p = .003) and OM risk (OR 1.38; 95% CI 1.10-1.72; p = .005), no significant differences for all the endpoints were recorded in the oA group, whereas MoABP showed a significantly reduced SSI risk (OR 0.45; 95% CI 0.25-0.79; p = .008). conclusions MoABP significantly reduced the SSI risk after elective colorectal surgery, therefore representing a valid alternative to NBP

Effects induced by high and low intensity laser plasma on SiC Schottky detectors

Silicon-Carbide detectors are extensively employed as diagnostic devices in laser-generated plasma, allowing the simultaneous detection of photons, electrons and ions, when used in time-of-flight configuration. The plasma generated by high intensity laser (1016 W/cm2) producing high energy ions was characterized by SiC detector with a continuous front-electrode, and a very thick active depth, while SiC detector with an Interdigit front-electrode was used to measure the low energy ions of plasma generated by low intensity laser (1010 W/cm2). Information about ion energy, number of charge states, plasma temperature can be accurately obtained. However, laser exposure induces the formation of surface and bulk defects whose concentration increases with increasing the time to plasma exposure. The surface defects consist of clusters with a main size of the order of some microns and they modify the diode barrier height and the efficiency of the detector as checked by alpha spectrometry. The bulk defects, due to the energy loss of detected ions, strongly affect the electrical properties of the device, inducing a relevant increase of the leakage (reverse) current and decrease the forward current related to a deactivation of the dopant in the active detector region

Effects induced by high and low intensity laser plasma on SiC Schottky detectors

Silicon-Carbide detectors are extensively employed as diagnostic devices in laser-generated plasma, allowing the simultaneous detection of photons, electrons and ions, when used in time-of-flight configuration. The plasma generated by high intensity laser (1016 W/cm2) producing high energy ions was characterized by SiC detector with a continuous front-electrode, and a very thick active depth, while SiC detector with an Interdigit front-electrode was used to measure the low energy ions of plasma generated by low intensity laser (1010 W/cm2). Information about ion energy, number of charge states, plasma temperature can be accurately obtained. However, laser exposure induces the formation of surface and bulk defects whose concentration increases with increasing the time to plasma exposure. The surface defects consist of clusters with a main size of the order of some microns and they modify the diode barrier height and the efficiency of the detector as checked by alpha spectrometry. The bulk defects, due to the energy loss of detected ions, strongly affect the electrical properties of the device, inducing a relevant increase of the leakage (reverse) current and decrease the forward current related to a deactivation of the dopant in the active detector region

A Compact Transactional Memory Multiprocessor System on FPGA

reserved5In this paper we present a rapid prototyping platform on a single Field Programmable Gate Array (FPGA) with support for software transactional memory. The system is composed only by off-the-shelf cores and is useful for porting and early validation of programs to the transactional memory programming model. We discuss the implementation of the software layer of this platform, propose an analysis of the system and compare it to a hardware lock based multiprocessor architecture, showing the trade-offs in terms of performance and programming complexity.Matteo Pusceddu; Simone Ceccolini; Gianluca Palermo; Donatella Sciuto; Antonino TumeoMatteo, Pusceddu; Simone, Ceccolini; Palermo, Gianluca; Sciuto, Donatella; Antonino, Tume