Microbial characterization of sourdough for sweet baked products in the Campania region (southern Italy) by a polyphasic approach

The microflora of nine sourdoughs used for sweet bakery products underwent preliminary microbiological characterization using lactic acid bacteria (LAB) and yeast enumeration. Five sourdough samples were submitted for microbial identification by culture-dependent techniques employing 16S and 26S rRNA genes sequencing, as well as a culture-independent technique using PCR-DGGE analysis. The LAB species isolated belonged principally to facultative heterofermentative Lactobacillus spp., Leuconostoc spp., and Lactococcus spp. Yeast strains were identified as Saccharomyces cerevisiae, with one exception represented by a strain belonging to Metschnikowia pulcherrima. PCR-DGGE analysis allowed the identification of Streptococcus thermophilus, Lactobacillus sakei, Weissella groceries and Lactobacillus sanfranciscensis among lactic acid bacteria and Saccharomyces cerevisiae and Metschnikowia pulcherrima among yeasts. This polyphasic approach highlighted different levels of biodiversity, from two to eight different typical LAB species, always associated to Saccharomyces cerevisiae, that could be selected to be specifically used in naturally fermented brioche and cornetto preparation

A K-band GaAs MMIC Doherty power amplifier for point-to-point microwave backhaul applications

This work reports the design of a GaAs monolithic K-band Doherty power amplifier for point-to-point microwave backhaul applications. The design of the module is described, from the choice of the architecture based on power budget and gain requirements, to the analysis of the solutions adopted. The MMIC is expected to achieve 32.5 dBm output power in the 20.8-24 GHz band, PAE higher than 32% at saturation (20% at 6 dB output back-off) and gain higher than 10 d

Development of a Nomogram Predicting the Risk of Persistence/Recurrence of Cervical Dysplasia

Background: Cervical dysplasia persistence/recurrence has a great impact on women's health and quality of life. In this study, we investigated whether a prognostic nomogram may improve risk assessment after primary conization. Methods: This is a retrospective multi-institutional study based on charts of consecutive patients undergoing conization between 1 January 2010 and 31 December 2014. A nomogram assessing the importance of different variables was built. A cohort of patients treated between 1 January 2015 and 30 June 2016 was used to validate the nomogram. Results: A total of 2966 patients undergoing primary conization were analyzed. The median (range) patient age was 40 (18-89) years. At 5-year of follow-up, 6% of patients (175/2966) had developed a persistent/recurrent cervical dysplasia. Median (range) recurrence-free survival was 18 (5-52) months. Diagnosis of CIN3, presence of HR-HPV types, positive endocervical margins, HPV persistence, and the omission of HPV vaccination after conization increased significantly and independently of the risk of developing cervical dysplasia persistence/recurrence. A nomogram weighting the impact of all variables was built with a C-Index of 0.809. A dataset of 549 patients was used to validate the nomogram, with a C-index of 0.809. Conclusions: The present nomogram represents a useful tool for counseling women about their risk of persistence/recurrence after primary conization. HPV vaccination after conization is associated with a reduced risk of CIN2+

Characteristics and patterns of care of endometrial cancer before and during COVID-19 pandemic

Objective: Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of EC patients. Methods: This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak. Results: Medical records of 5,164 EC patients have been retrieved: 2,718 and 2,446 women treated in period 1 and period 2, respectively. Surgery was the mainstay of treatment in both periods (p=0.356). Nodal assessment was omitted in 689 (27.3%) and 484 (21.2%) patients treated in period 1 and 2, respectively (p<0.001). While, the prevalence of patients undergoing sentinel node mapping (with or without backup lymphadenectomy) has increased during the COVID-19 pandemic (46.7% in period 1 vs. 52.8% in period 2; p<0.001). Overall, 1,280 (50.4%) and 1,021 (44.7%) patients had no adjuvant therapy in period 1 and 2, respectively (p<0.001). Adjuvant therapy use has increased during COVID-19 pandemic (p<0.001). Conclusion: Our data suggest that the COVID-19 pandemic had a significant impact on the characteristics and patterns of care of EC patients. These findings highlight the need to implement healthcare services during the pandemic

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

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

The role of immune suppression in COVID-19 hospitalization: clinical and epidemiological trends over three years of SARS-CoV-2 epidemic

Specific immune suppression types have been associated with a greater risk of severe COVID-19 disease and death. We analyzed data from patients >17 years that were hospitalized for COVID-19 at the “Fondazione IRCCS Ca′ Granda Ospedale Maggiore Policlinico” in Milan (Lombardy, Northern Italy). The study included 1727 SARS-CoV-2-positive patients (1,131 males, median age of 65 years) hospitalized between February 2020 and November 2022. Of these, 321 (18.6%, CI: 16.8–20.4%) had at least one condition defining immune suppression. Immune suppressed subjects were more likely to have other co-morbidities (80.4% vs. 69.8%, p < 0.001) and be vaccinated (37% vs. 12.7%, p < 0.001). We evaluated the contribution of immune suppression to hospitalization during the various stages of the epidemic and investigated whether immune suppression contributed to severe outcomes and death, also considering the vaccination status of the patients. The proportion of immune suppressed patients among all hospitalizations (initially stable at <20%) started to increase around December 2021, and remained high (30–50%). This change coincided with an increase in the proportions of older patients and patients with co-morbidities and with a decrease in the proportion of patients with severe outcomes. Vaccinated patients showed a lower proportion of severe outcomes; among non-vaccinated patients, severe outcomes were more common in immune suppressed individuals. Immune suppression was a significant predictor of severe outcomes, after adjusting for age, sex, co-morbidities, period of hospitalization, and vaccination status (OR: 1.64; 95% CI: 1.23–2.19), while vaccination was a protective factor (OR: 0.31; 95% IC: 0.20–0.47). However, after November 2021, differences in disease outcomes between vaccinated and non-vaccinated groups (for both immune suppressed and immune competent subjects) disappeared. Since December 2021, the spread of the less virulent Omicron variant and an overall higher level of induced and/or natural immunity likely contributed to the observed shift in hospitalized patient characteristics. Nonetheless, vaccination against SARS-CoV-2, likely in combination with naturally acquired immunity, effectively reduced severe outcomes in both immune competent (73.9% vs. 48.2%, p < 0.001) and immune suppressed (66.4% vs. 35.2%, p < 0.001) patients, confirming previous observations about the value of the vaccine in preventing serious disease

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Le mappe quali artefatti significanti per rappresentazioni altre

Una mappa per sua natura ha il ruolo di descrivere realtà, dimensioni e fenomeni differenti, comunicare, condurre e orientare. Questi artefatti visivi si realizzano attraverso segni, codici grafici, topografici, contenuti testuali e figurazioni. Le immagini di territori - piuttosto che di contesti urbani - veicolati attraverso la composizione di mappe, hanno costruito, attraverso i secoli, immagini iconiche dei luoghi, riconoscibili attraverso segni rappresentativi sia di elementi naturali (fiumi, laghi, vulcani, emergenze montuose), che attraverso segni interpretativi di fenomeni artificiali (strade, tracciati murari, figurazione degli isolati, architetture e infrastrutture). Tra cartografie, mappe storiche, portolani ecc., è possibile individuare una vasta raccolta di opere che non si distinguono solo per il valore informativo e descrittivo o in quanto manifesti delle capacità tecniche e del rigore impiegato nel rilevamento e nella rappresentazione dei dati; piuttosto, di sovente, si individuano esempi di vere e proprie espressioni d’arte, in cui le capacità tecniche si fondono con quelle artistiche dei rappresentatori o degli artisti coinvolti nelle loro realizzazioni. Quello che in questo saggio si propone è un ‘viaggio’ condotto attraverso mappe nate quali forme d’arte del nostro tempo, in cui artisti, grafici, illustratori veicolano il proprio pensiero. Su tutte ricordiamo il progetto Maps di Paula Scher, la più importante e famosa graphic designer americana, che realizza grandi tele dipinte in cui raffigura mappe. Il tema, quasi ossessivo, ruota intorno all’uso delle lettere e dei numeri, che diventano gli elementi configurativi e significanti delle mappe. Ma le mappe hanno rappresentato, anche per altri artisti, artefatti privilegiati per esprimersi. Lo sono per le narrazioni di Matthew Picton che realizza sculture concepite per rappresentare un determinato luogo in un determinato tempo. Si tratta di raffigurazioni ‘colte’, di opere che traducono in forme e in immagini la storia dei luoghi, piuttosto che quelle descritte e traguardate attraverso opere letterarie, composizioni musicali o opere cinematografiche. Numerose le opere di Alighiero e Boetti che realizza planisferi politici in cui utilizza le specifiche bandiere per descrivere ogni singolo Stato, ma anche le mappe dell’artista milanese Elisabetta di Maggio che crea labili e quasi evanescenti artefatti. Le sue mappe sono infatti ritagliate nella carta incisa a mano tramite bisturi, come le opere della serie City, piuttosto che quelle realizzate nel sapone, come i progetti dedicati alle città di Parigi, Algeri Casbah, New York, Città del Messico e Fez. Luoghi immaginari sono quelli rappresentati nella mappa di Jerry Gretzinger. Il suo è un artefatto che si modifica e si amplia in una dimensione che sembra non trovare mai compimento. Le Mappe declinate in forme differenti diventano interpreti del linguaggio di artisti, scultori, designer e grafici. In conclusione le mappe rimangono e rimarranno artefatti suggestivi e di ispirazione per forme d’arte altre. Abstract A map by its nature has the role of describing different realities, dimensions and phenomena, communicating, leading and orienting. These visual artifacts are realized through signs, graphic and topographical codes, textual contents and figurations. The images of territories rather than urban contexts conveyed through the composition of maps have built, over the centuries, iconic images of places, recognizable through representative signs of both natural elements (rivers, lakes, volcanoes, mountainous relief), and through interpretative signs of artificial phenomena (roads, wall layouts, figuration of blocks, architecture and infrastructures). Among cartographies, historical maps, portolans, etc., it is possible to identify a vast collection of works that are not only distinguished by their informative and descriptive value, manifestations of the technical skills and rigor employed in the survey and representation of data, but often, examples of true expressions of art are identified, in which the technical skills merge with the artistic ones of the representatives or artists often involved in their creations. What this essay proposes is a 'journey' conducted through maps created as art forms of our time in which artists, graphic designers, illustrators convey their thoughts. Above all we remember the Maps project by Paula Scher, the most important and famous American graphic designer, who creates large painted canvases depicting maps. The almost obsessive theme revolves around the use of letters and numbers that become the configurative and significant elements of the maps. But maps have represented, even for other artists, privileged artifacts to express themselves. They are for the narratives of Matthew Picton who creates sculptures conceived to represent a specific place at a given time. These are 'cultured' representations, works that translate the history of places into forms and images, rather than those described and viewed through literary works, musical compositions or cinematographic works. There are numerous works by Alighiero e Boetti who creates political planispheres in which he uses specific flags to describe each individual state, but also the maps of the Milanese artist Elisabetta di Maggio who creates fleeting and almost evanescent artifacts. His maps are in fact cut out of paper engraved by hand using a scalpel, like the works of the City series, rather than those made in soap, like the projects dedicated to the cities of Paris, Algiers Casbah, New York, Mexico City and Fez. Imaginary places are those represented in Jerry Gretzinger's map. His is an artifact that changes and expands to a dimension that never seems to find fulfillment. In conclusion, the maps remain and will remain suggestive artifacts and inspiration for other forms of art