AGROALIMENTARE E SVILUPPO ECONOMICO SOSTENIBILE: ENERGIA, EFFICIENZA ENERGETICA, AMBIENTE E CIBO

Nell’ultimo decennio, il sistema agroalimentare nazionale nella sua accezione più ampia di agricoltura e industria alimentare, ha assunto una configurazione fortemente sistemica, aperta al contributo di diverse discipline e tecnologie. Tale evoluzione ha consentito al sistema agricolo di raggiungere posizioni ragguardevoli se consideriamo che nel complesso l’agroalimentare rappresenta per l’economia italiana un valore di 250 miliardi €, pari a circa 16% del PIL. Il mondo agricolo, nel suo complesso, costituisce ormai uno snodo fondamentale per attività che riguardano: l’energia, l’ambiente, il cibo, il territorio, il benessere dei cittadini, il sistema economico aree urbane-aree rurali. Il lavoro è focalizzato sul ruolo strategico dell’agroalimentare per gli obiettivi del Pacchetto Europeo 20-20-20 nonché per lo sviluppo economico sostenibile del sistema Paese.Agriculture and economic sustainable development: energy, energy efficiency, environment and food This article briefly examines the evolution of the agricultural sector in Italy and outlines the concept of the agro-food system that includes the agriculture and the food industry activities. The Italian agro-food system has reached a global annual value of 250 billions €, which corresponds to about 16% of the added gross value. The agricultural system is also analyzed in respect to the objectives of the European Package 20-20-20. This article outlines the impact of the agro-food system in terms of energy, energy efficiency, use of renewable resources related to the food production. The impact of the large retail groups and the key role of the agro-food system are also analyzed in respect to the development of a sustainable economy

Latissimus dorsi rotational flap combined with a custom-made scapular prosthesis after oncological surgical resection: A report of two patients

BACKGROUND: Sarcomas that arise from the scapula or periscapular soft tissues often require a total scapulectomy. This often implies a large complex tissue defect that needs adequate reconstruction of both bone and soft tissue. Although various methods have been developed, no optimal procedure has emerged. Postoperative complications are common and functional recovery is not always satisfactory. This study aims to present a new surgical technique that combines a custom-made scapular prosthesis with a functional latissimus dorsi flap. CASE PRESENTATION: Two patients diagnosed with malignant tumour of the scapular region were surgically treated after proper multidisciplinary evaluation. The first patient underwent the procedure as a first surgery, the second as revision surgery. The new technique comprises three surgical stages: excisional surgery with soft tissue resection and scapulectomy, bone reconstruction with custom-made prosthesis, and soft tissue reconstruction using a latissimus dorsi rotational flap overturned on the prosthesis. The goal is to set up a new functional unit combining an anatomically shaped implant (manufactured using latest three-dimensional printing technology) and a muscular flap, and to maintain the neurovascular supply. The patients were followed up to evaluate functional outcome and complications. Both patients were alive with no evidence of disease. Functional results were satisfactory and the Musculoskeletal Tumor Society scores were 87% and 63%, respectively. No surgical complications such as implant breakage, joint collapse, wound dehiscence, or infection were observed. CONCLUSIONS: This new technique upgrades the role of the latissimus dorsi flap to a functional tool in combination with an anatomical, three-dimensionally printed, custom-made prosthesis, and provides adequate well-vascularized and healthy tissue to maximize the likelihood of successful limb salvage

Risks and benefits of combining denosumab and surgery in giant cell tumor of bone-a case series

BACKGROUND The RANK ligand inhibitor denosumab is being investigated for treatment of giant cell tumor of bone, but the available data in the literature remains sparse and controversial. This study analyzes the results of combining denosumab with surgical treatment and highlights possible changes for the oncologic surgeon in daily practice. METHODS A total of 91 patients were treated surgically for giant cell tumor of bone between 2010 and 2014 in an institution, whereas 25 patients of the total additionally received denosumab and were part of this study. The average age of the patients was 35 years. Eleven patients received denosumab pre- and postoperatively, whereas with 14 patients, the denosumab treatment was applied either before (7 patients) or after (7 patients) the surgery. The average preoperative therapy duration was 3.9 months and the postoperative therapy 6 months by default. RESULTS Sixteen patients presented a large tumor extension necessitating a resection of the involved bone or joint. In 10 of these patients, the indication for a resection procedure was abandoned due to the preoperative denosumab treatment and a curettage was performed. In the remaining six cases, the surgical indication was not changed despite the denosumab treatment, and two of them needed a joint replacement after the tumor resection. Also with patients treated with curettage, denosumab seems to facilitate the procedure as a new peripheral bone rim around the tumor was built, though a histologic analysis reveals viable tumor cells persisting in the denosumab-induced bone formation. After an average follow-up of 23 months, one histologically proven local recurrence occurred, necessitating a second curettage. A second patient showed a lesion in the postoperative imaging highly suspicious for local relapse which remained stable under further denosumab treatment. No adverse effect of the denosumab medication was observed in this study. CONCLUSIONS Denosumab can be a help to the oncologic surgeon by reconstituting a peripheral rim and switching the stage from aggressive to active or latent disease. But as tumor cells remain in the new-formed bone, the surgical technique of curettage has to be changed from gentle to more aggressive to avoid higher local recurrence rates

Sustainable greenhouse horticulture in Europe

The European greenhouse horticulture represents one of the most intensive energy sector in agriculture and strongly contributes to increase the energy and environmental vulnerability within regions having a large greenhouse farming systems. Specifically, the European greenhouse farming sector is facing a trend that responds to the changing consumer’s demands in a society that, globally, is increasingly affluent but more aware about some negative consequences, such as high energy-demand processes, and CO2 emissions. About 200,000 hectares of greenhouses in Spain, Italy, The Netherlands and Greece is the estimated covered surface, with not less than 3.4 MTOE of energy consumption and 9.2 MtCO2eq, and an yearly economy value of 7 billions of Euros. The installed energy power load of greenhouses in Europe depends on local climate conditions, and varies from 50-150 W/m2 (Southern regions of Europe) to 200-280 W/m2 (Northern and Central regions), while complete conditioning could even reach an energy load of 400 W/m2 (heating, lighting, cooling). Nowadays, the proportion of renewable use in the total energy consumption of greenhouse farming in Europe is very low, and there are no clear priorities set in this area, yet. Comprehensive and complete studies that evaluate the opportunities of renewable options in greenhouse sector are still not completeted. This, strongly hinders the process of setting concrete goals and legislative targets to support a wider introduction of sustainable energy technology, and appropriate legislation in greenhouse regions of Europe. This paper deals with the proposal of supporting the organization of a sustainable greenhouse agriculture, based on renewable energy sources, i.e. geothermal energy at low temperature, photovoltaic solar energy and solid biomass, in tune with the specific local assets, the local geo-climatic conditions and the protection of landscapes rather than with a careless perspective for local environment and potential societal costs

Are Vascularized Fibula Autografts a Long-lasting Reconstruction After Intercalary Resection of the Humerus for Primary Bone Tumors?

BackgroundA vascularized fibula graft (VFG) is the vascular autograft most frequently used to restore large segmental long bone defects, particularly in the upper limb. Because the use of a vascularized fibula involves an operation in an uninvolved extremity with potential morbidity, it is important to document that this type of reconstruction is successful in restoring function to the humerus. However, the long-term results of VFG after intercalary resection of the humeral diaphysis for bone tumors are still unknown.Questions/purposes(1) What was the complication rate of reconstruction? (2) What was the functional result after surgical treatment, as assessed by the Musculoskeletal Tumor Society (MSTS) score, the American Shoulder and Elbow Society (ASES) score, and Constant score? (3) What was the survivorship of these grafts free from revision and graft removal at 5, 10, and 15 years?MethodsBetween 1987 and 2021, 127 patients were treated at our institution with en bloc resection for a primary malignant or an aggressive benign bone tumor of the humerus; we excluded patients treated with extra-articular resection or amputation. Of those, 14% (18 of 127) were treated with intercalary resection of the humeral diaphysis for primary bone tumors and reconstruction with VFG, with or without a bulk allograft, and were analyzed in this retrospective study. Generally, our indications for reconstruction with VFG are intercalary resection of the humerus for primary malignant or aggressive benign bone tumors in patients with long life expectancy and high functional demands, in whom adequate bone stock of the proximal and distal epiphysis can be preserved. In 13 patients, VFG was used alone, whereas in five patients, a massive allograft was used. Our policy was to use VFG combined with a massive allograft in patients undergoing juxta-articular joint-sparing resections in which proximal osteotomy was performed close to the anatomic neck of the humerus to obtain more stable fixation and better tendinous reattachment of the rotator cuff and deltoid. All 18 patients who were treated with a VFG were available for follow-up at a minimum of 2 years (median follow-up 176 months, range 26 to 275 months), and although three have not been seen in the past 5 years and are not known to have died, they had 172, 163, and 236 months of follow-up, and were included. The median age at surgery was 25 years (range 2 to 63 years), the median humeral resection length was 15 cm (range 8 to 21 cm), and the median fibular length was 16 cm (range 12 to 23 cm). Complications and functional scores were ascertained by chart review that was performed by an individual not involved in patient care. Functional results were assessed with the MSTS score (range 0 to 30), the ASES score (range 0 to 100), and the Constant score (range 0% to 100%). Survivorship was estimated using a Kaplan-Meier survivorship estimator, which was suitable because there were few deaths in this series.ResultsSeven patients underwent a revision procedure (one radial nerve transient palsy because of screw impingement, four nonunions in three patients with one humeral head avascular necrosis, treatment for screw-related pain in one patient, and two VFG fractures), and one patient underwent VFG removal. Donor site complications were observed in four patients (one ankle valgus deformity and three claw toes - the first toe in two patients and the other toes in the third). At the final clinical control, at a median follow-up of 176 months (range 26 to 275 months), the median MSTS score was 30 of 30 (range 28 to 30), the median ASES score was 98.3 (range 93 to 100), and the median Constant score was 93.5% (range 79% to 100%). Revision-free survival was 71% (95% CI 53% to 96%) at 5 years and 57% (95% CI 37% to 88%) at 10 and 15 years; VFG removal-free survival was 94% (95% CI 83% to 100%) at 5, 10, and 15 years.ConclusionVFG appears to be an effective reconstructive option after humeral intercalary resection for primary bone tumors. These are complex procedures and should be performed by an experienced team of surgeons who recognize that complications may occur frequently in the first years after the procedure. The frequency of mechanical complications observed in the first 5 years postoperatively may be lessened by using long spanning-plate fixation, and if successful, this reconstruction provides a long-term, durable reconstruction with excellent functional results.Level of EvidenceLevel IV, therapeutic study

Custom-made 3d-printed implants as novel approach to reconstructive surgery after oncologic resection in pediatric patients

Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2–13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14–44). Three patients died after a mean of 19.3 months postoperatively—two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%. 3D prostheses may yield biological advantages due to possible integration with the host bone and also through the use of vascularized flaps. Further research is warranted

Proteomic changes and molecular effects associated with Cr(III) and Cr(VI) treatments on germinating kiwifruit pollen

The present study is aimed at identifying molecular changes elicited by Cr(III) and Cr(VI) on germinating kiwifruit pollen. To address this question, comparative proteomic and DNA laddering analyses were performed. While no genotoxic effect was detected, a number of proteins whose accumulation levels were altered by treatments were identified. In particular, the upregulation of some proteins involved in the scavenging response, cell redox homeostasis and lipid synthesis could be interpreted as an oxidative stress response induced by Cr treatment. The strong reduction of two proteins involved in mitochondrial oxidative phosphorylation and a decline in ATP levels were also observed. The decrease of pollen energy availability could be one of the causes of the severe inhibition of the pollen germination observed upon exposure to both Cr(III) and Cr(VI). Finally, proteomic and biochemical data indicate proteasome impairment: the consequential accumulation of misfolded/damaged proteins could be an important molecular mechanism of Cr(III) toxicity in pollen

Surgical treatment of central grade 1 chondrosarcoma of the appendicular skeleton.

Diagnosis and treatment of low-grade chondrosarcoma remain controversial. We performed a review of a single-center series with the aims of assessing the oncologic outcome of these patients, verifying if intralesional curettage can be adequate treatment, and defining clinical criteria to support the surgeon and the oncologist in decision-making for surgery and subsequent follow-up