Learning from the Route: a Pilot Project on Landscape Reading along the Itinerary of Via Lauretana Senese

The essay investigates the opportunities generated by recovering a European Pilgrimage Route’s pathway as device for landscape perception and territorial analysis. It is focused on a project conducted by Verdiana Network in collaboration with the Municipality of Asciano (Siena). The project aims to activate processes of landscape planning and management, and promote local tourism within the context of Asciano’s rural landscape and among the cultural and natural heritage intercepted by this pilgrimage route. It concerns the Siena branch of the Via Lauretana, the pilgrimage route toward the Sanctuary of Loreto in the Marche Region. The project focuses on the landscape structure of the route, modelled by the territorial dimension and spatial configuration of the itinerary, together with the social processes of landscape perception activated by the route itself. From this point of view, the project consisted of a process of discovering the landscape along the route and intercepting polar elements that make the itinerary the basis for the development of local tourism and cultural activities

Controversies in Surgical Staging of Endometrial Cancer

Endometrial cancer is the most common gynaecological malignancy and its incidence is increasing. In 1998, international federation of gynaecologists and obstetricians (FIGO) required a change from clinical to surgical staging in endometrial cancer, introducing pelvic and paraaortic lymphadenectomy. This staging requirement raised controversies around the importance of determining nodal status and impact of lymphadenectomy on outcomes. There is agreement about the prognostic value of lymphadenectomy, but its extent, therapeutic value, and benefits in terms of survival are still matter of debate, especially in early stages. Accurate preoperative risk stratification can guide to the appropriate type of surgery by selecting patients who benefit of lymphadenectomy. However, available preoperative and intraoperative investigations are not highly accurate methods to detect lymph nodes and a complete surgical staging remains the most precise method to evaluate extrauterine spread of the disease. Laparotomy has always been considered the standard approach for endometrial cancer surgical staging. Traditional and robotic-assisted laparoscopic techniques seem to provide equivalent results in terms of disease-free survival and overall survival compared to laparotomy. These minimally invasive approaches demonstrated additional benefits as shorter hospital stay, less use of pain killers, lower rate of complications and improved quality of life

Intra- and interobserver agreement with regard to describing adnexal masses using International Ovarian Tumor Analysis terminology: reproducibility study involving seven observers

To estimate intraobserver repeatability and interobserver agreement in assessing the presence of papillary projections in adnexal masses and in classifying adnexal masses using the International Ovarian Tumor Analysis terminology for ultrasound examiners with different levels of experience. We also aimed to identify ultrasound findings that cause confusion and might be interpreted differently by different observers, and to determine if repeatability and agreement change after consensus has been reached on how to interpret 'problematic' ultrasound images

Giant Sigmoid Diverticulum: A Rare Presentation of a Common Pathology

Although colonic diverticulum is a common disease, affecting about 35% of patients above the age of 60, giant sigmoid diverticulum is an uncommon variant of which only relatively few cases have been described in the literature. We report on our experience with a patient affected by giant sigmoid diverticulum who was treated with diverticulectomy. Resection of the diverticulum is a safe surgical procedure, provided that the colon section close to the lesion presents no sign of flogosis or diverticula; in addition, recurrences are not reported after 6-year follow-up

Classifying A-field and B-field configurations in the presence of D-branes

We "solve" the Freed-Witten anomaly equation, i.e., we find a geometrical classification of the B-field and A-field configurations in the presence of D-branes that are anomaly-free. The mathematical setting being provided by the geometry of gerbes, we find that the allowed configurations are jointly described by a coset of a certain hypercohomology group. We then describe in detail various cases that arise according to such classification. As is well-known, only under suitable hypotheses the A-field turns out to be a connection on a canonical gauge bundle. However, even in these cases, there is a residual freedom in the choice of the bundle, naturally arising from the hypercohomological description. For a B-field which is flat on a D-brane, fractional or irrational charges of subbranes naturally appear; for a suitable gauge choice, they can be seen as arising from "gauge bundles with not integral Chern class": we give a precise geometric interpretation of these objects.Comment: 28 pages, no figure

Process development and validation of expanded regulatory T cells for prospective applications: an example of manufacturing a personalized advanced therapy medicinal product

Background: A growing number of clinical trials have shown that regulatory T (Treg) cell transfer may have a favorable effect on the maintenance of self-tolerance and immune homeostasis in different conditions such as graft-versus-host disease (GvHD), solid organ transplantation, type 1 diabetes, and others. In this context, the availability of a robust manufacturing protocol that is able to produce a sufficient number of functional Treg cells represents a fundamental prerequisite for the success of a cell therapy clinical protocol. However, extended workflow guidelines for nonprofit manufacturers are currently lacking. Despite the fact that different successful manufacturing procedures and cell products with excellent safety profiles have been reported from early clinical trials, the selection and expansion protocols for Treg cells vary a lot. The objective of this study was to validate a Good Manufacturing Practice (GMP)-compliant protocol for the production of Treg cells that approaches the whole process with a risk-management methodology, from process design to completion of final product development. High emphasis was given to the description of the quality control (QC) methodologies used for the in-process and release tests (sterility, endotoxin test, mycoplasma, and immunophenotype). Results: The GMP-compliant protocol defined in this work allows at least 4.11 7 109 Treg cells to be obtained with an average purity of 95.75 \ub1 4.38% and can be used in different clinical settings to exploit Treg cell immunomodulatory function. Conclusions: These results could be of great use for facilities implementing GMP-compliant cell therapy protocols of these cells for different conditions aimed at restoring the Treg cell number and function, which may slow the progression of certain diseases

Predicting the risk of malignancy in adnexal masses based on the Simple Rules from the International Ovarian Tumor Analysis group

BACKGROUND: Accurate methods to preoperatively characterize adnexal tumors are pivotal for optimal patient management. A recent metaanalysis concluded that the International Ovarian Tumor Analysis algorithms such as the Simple Rules are the best approaches to preoperatively classify adnexal masses as benign or malignant. OBJECTIVE: We sought to develop and validate a model to predict the risk of malignancy in adnexal masses using the ultrasound features in the Simple Rules. STUDY DESIGN: This was an international cross-sectional cohort study involving 22 oncology centers, referral centers for ultrasonography, and general hospitals. We included consecutive patients with an adnexal tumor who underwent a standardized transvaginal ultrasound examination and were selected for surgery. Data on 5020 patients were recorded in 3 phases from 2002 through 2012. The 5 Simple Rules features indicative of a benign tumor (B-features) and the 5 features indicative of malignancy (M-features) are based on the presence of ascites, tumor morphology, and degree of vascularity at ultrasonography. Gold standard was the histopathologic diagnosis of the adnexal mass (pathologist blinded to ultrasound findings). Logistic regression analysis was used to estimate the risk of malignancy based on the 10 ultrasound features and type of center. The diagnostic performance was evaluated by area under the receiver operating characteristic curve, sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), positive predictive value (PPV), negative predictive value (NPV), and calibration curves. RESULTS: Data on 4848 patients were analyzed. The malignancy rate was 43% (1402/3263) in oncology centers and 17% (263/1585) in other centers. The area under the receiver operating characteristic curve on validation data was very similar in oncology centers (0.917; 95% confidence interval, 0.901-0.931) and other centers (0.916; 95% confidence interval, 0.873-0.945). Risk estimates showed good calibration. In all, 23% of patients in the validation data set had a very low estimated risk (<1%) and 48% had a high estimated risk (≥30%). For the 1% risk cutoff, sensitivity was 99.7%, specificity 33.7%, LR+ 1.5, LR- 0.010, PPV 44.8%, and NPV 98.9%. For the 30% risk cutoff, sensitivity was 89.0%, specificity 84.7%, LR+ 5.8, LR- 0.13, PPV 75.4%, and NPV 93.9%. CONCLUSION: Quantification of the risk of malignancy based on the Simple Rules has good diagnostic performance both in oncology centers and other centers. A simple classification based on these risk estimates may form the basis of a clinical management system. Patients with a high risk may benefit from surgery by a gynecological oncologist, while patients with a lower risk may be managed locally

All dried up: the materiality of drought in Ladismith, South Africa

This paper conceptualizes droughts as socioecological phenomena coproduced by the recursive engagement of human and non-human transformations. Through an interdisciplinary approach that integrates political ecology, material geographies and hydroclimatology, this work simultaneously apprehends the role of politics and power in reshaping drought, along with the agency of biophysical processes —soil, vegetation, hydrology and microclimate— that co-produce droughts and their spatiotemporal patterning. The drought-stricken Ladismith in Western Cape, South Africa, is the instrumental case study and point of departure of our empirical analysis. To advance a materiality of drought that seriously accounts for the coevolution of biophysical and political transformations, we alter the spatiotemporal and empirical foci of drought analyses thereby retracing Ladismith’s socioecological history since colonial times. In turn, such extended framework exposes the agency of soil, vegetation, hydrology and microclimate and their metabolic exchanges with processes of colonization, apartheid, capitalist and neoliberal transformations of South African economy. We argue that the narrow pursuit of profits and capital accumulation of the few has produced a fundamental disruption between nature and society which contributed to transform Ladismith’s drought into a socioecological crisis. Whilst advancing debates on materiality, we note two fundamental contributions to the study of drought. First, our approach makes hydrological accounts of droughts less politically naive and socially blind. Second, it develops a political ecology of droughts and socioecological crises more attuned to the materiality of drought. We contend that apprehending the materiality of drought and the active role of its non-human processes can further understandings of the workings of power and the production of socioecological injustices

Validation of the performance of International Ovarian Tumor Analysis (IOTA) methods in the diagnosis of early stage ovarian cancer in a non-screening population

Background: The aim of this study was to assess and compare the performance of different ultrasound-based International Ovarian Tumor Analysis (IOTA) strategies and subjective assessment for the diagnosis of early stage ovarian malignancy. Methods: This is a secondary analysis of a prospective multicenter cross-sectional diagnostic accuracy study that included 1653 patients recruited at 18 centers from 2009 to 2012. All patients underwent standardized transvaginal ultrasonography by experienced ultrasound investigators. We assessed test performance of the IOTA Simple Rules (SRs), Simple Rules Risk (SRR), the Assessment of Different NEoplasias in the adneXa (ADNEX) model and subjective assessment to discriminate between stage I-II ovarian cancer and benign disease. Reference standard was histology after surgery. Results: 230 (13.9%) patients proved to have stage I–II primary invasive ovarian malignancy, and 1423 (86.1%) had benign disease. Sensitivity and specificity with respect to malignancy (95% confidence intervals) of the original SRs (classifying all inconclusive cases as malignant) were 94.3% (90.6% to 96.7%) and 73.4% (71.0% to 75.6%). Subjective assessment had a sensitivity and specificity of 90.0% (85.4% to 93.2%) and 86.7% (84.9% to 88.4%), respectively. The areas under the receiver operator characteristic curves of SRR and ADNEX were 0.917 (0.902 to 0.933) and 0.905 (0.920 to 0.934), respectively. At a 1% risk cut-off, sensitivity and specificity for SRR were 100% (98.4% to 100%) and 38.0% (35.5% to 40.6%), and for ADNEX were 100% (98.4% to 100%) and 19.4% (17.4% to 21.5%). At a 30% risk cut-off, sensitivity and specificity for SRR were 88.3% (83.5% to 91.8%) and 81.1% (79% to 83%), and for ADNEX were 84.5% (80.5% to 89.6%) and 84.5% (82.6% to 86.3%). Conclusion: This study shows that all three IOTA strategies have good ability to discriminate between stage I-II ovarian malignancy and benign disease

Non-simply-laced Lie algebras via F theory strings

In order to describe the appearance in F theory of the non--simply--laced Lie algebras, we use the representation of symmetry enhancements by means of string junctions. After an introduction to the techniques used to describe symmetry enhancement, that is algebraic geometry, BPS states analysis and string junctions, we concentrate on the latter. We give an explicit description of the folding of D_{2n} to B_n of the folding of E_6 to F_4 and that of D_4 to G_2 in terms of junctions and Jordan strings. We also discuss the case of C_n, but we are unable in this case to provide a string interpretation.Comment: 24 pages, 3 figure