Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Plug-and-Play Voltage and Frequency Control of Islanded Microgrids With Meshed Topology

In this paper we propose a new decentralized control scheme for Islanded microGrids (ImGs) composed by the interconnection of Distributed Generation Units (DGUs). Local controllers regulate voltage and frequency at the point of common coupling of each DGU and they are able to guarantee stability of the overall ImG. The control design procedure is decentralized, since, besides two global scalar quantities, the synthesis of a local controller uses only information on the corresponding DGU and lines connected to it. Most important, our design procedure enables Plug-and-Play (PnP) operations: when a DGU is plugged in or out, only DGUs physically connected to it have to retune their local controllers. We study the performance of the proposed controllers simulating different scenarios in MatLab/Simulink and using performance indexes proposed in IEEE standards

Voltage and frequency control of islanded microgrids: a plug-and-play approach

In this paper we propose a new decentralized control scheme for Islanded microGrids (ImGs) composed by the interconnection of Distributed Generation Units (DGUs). Local controllers regulate voltage and frequency at the Point of Common Coupling (PCC) of each DGU and they are able to guarantee stability of the overall ImG. The control design proce- dure is decentralized, since, besides two global scalar quantities, the synthesis of a local controller uses only information on the corresponding DGU and lines connected to it. Most important, our design procedure enables Plug-and-Play (PnP) operations: when a DGU is plugged in or out, only DGUs physically connected to it have to retune their local controllers. We study the performance of the proposed controllers simulating different scenarios in MatLab/Simulink and using indexes proposed in IEEE standards

Plug-and-play decentralized frequency regulation for power networks with FACTS devices

In this paper, we propose decentralized controllers for the design of the Automatic Generation Control (AGC) layer in power networks equipped with Flexible AC Transmission Systems (FACTS) devices. We focus on the capability, provided by FACTS, of redirecting power flows by controlling physical parameters of tie-lines. Control design is decentralized as the procedure for synthesizing a controller for a generation area uses information from neighboring areas only. Moreover, our method is termed plug-and-play because, if a generation area is plugged in or out, at most neighboring areas must update their controllers, leaving the rest of the network unaffected. Performance brought about by the proposed controllers is discussed on a benchmark example

La chirurgia laparoscopica del colon - Emicolectomia Destra

CD-ROM interattivo di tecnica chirurgic

Diagnostic flexible laparoscopy: a single incision procedure.

A novel, minimally invasive diagnostic laparoscopy procedure is described in this report. After positioning a percutaneous trocar and inducing CO2 pneumoperitoneum, a flexible endoscope is introduced through the trocar to inspect intra-abdominal organs, including the surface of the liver, the gallbladder, the stomach, the intestine, the pelvic organs, and free intraperitoneal fluid. Simple procedures such as gathering histological or cytological samples, intraperitoneal lavage, collecting peritoneal fluid for culture, removing adhesions and cyst puncturing are carried out at the endoscopic surgeon's discretion through 1 or 2 working channels. Only a single incision is necessary and, unlike Natural Orifice Translumenal Endoscopic Surgery, visceral iatrogenic perforations are unnecessar

Deterministic and stochastic MPC algorithms for minimizing mechanical stresses in wind farms

We consider the problem of dispatching WindFarm (WF) power demand to individual Wind Turbines (WTs) with the goal of minimizing mechanical stresses. We assume wind is strong enough to let each WT produce the required power and propose different closed-loop Model Predictive Control (MPC) dispatching algorithms. Similarly to existing approaches based on MPC, our methods do not require changes in WT hardware but only software changes in the SCADA system of the WF. However, differently from other MPC schemes, we augment the model of a WT with an ARMA predictor of the wind turbulence, which reduces uncertainty in wind predictions over the MPC control horizon. This allows us to develop both stochastic and deterministic MPC algorithms. In order to compare different MPC schemes and demonstrate improvements over classic open-loop schedulers, we use simulations based on the SimWindFarm toolbox for MatLab

Model predictive controllers for reduction of mechanical fatigue in wind farms

We consider the problem of dispatching WindFarm (WF) power demand to individual Wind Turbines (WT) with the goal of minimizing mechanical stresses. We assume wind is strong enough to let each WTs to produce the required power and propose different closed-loop Model Predictive Control (MPC) dispatching algorithms. Similarly to existing approaches based on MPC, our methods do not require changes in WT hardware but only software changes in the SCADA system of the WF. However, differently from previous MPC schemes, we augment the model of a WT with an ARMA predictor of the wind turbulence, which reduces uncertainty in wind predictions over the MPC control horizon. This allows us to develop both stochastic and deterministic MPC algorithms. In order to compare different MPC schemes and demonstrate improvements with respect to classic open-loop schedulers, we performed simulations using the SimWindFarm toolbox for MatLab. We demonstrate that MPC controllers allow to achieve reduction of stresses even in the case of large installations such as the 100-WTs Thanet offshore WF