8 research outputs found

    Ecogeomorphology and vulnerability in a Mediterranean ria-type coast (La Maddalena Archipelago, NE Sardinia, western Mediterranean)

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    This paper presents a map describing the main geomorphological and sedimentological features, hydrodynamics, benthic habitat distributions and human impact on the coastal and marine areas of the Archipelago of La Maddalena (NE Sardinia, western Mediterranean). This cartography is based on an interdisciplinary sea-land approach, with the aim being to support sustainable and successful beach management in the face of a changing climate and environment, thereby contributing to the achievement of the Agenda 2030 Sustainable Development Goals (13, 14 and 15). In the Main Map (1:14,000 scale), the static and dynamic features of the beach systems and adjacent inner shelf are divided into thematic sections that include the geomorphological elements, hydrodynamics, sedimentological distributions, benthic habitat (mainly Posidonia oceanica meadow) and anthropogenic impacts. The map establishes a fundamental, multidisciplinary benchmark that is able to provide substantial scientific support to policymakers in relation to future vulnerability-assessment activities and the definition of land-management strategies

    Natural vs. Anthropic Influence on the Multidecadal Shoreline Changes of Mediterranean Urban Beaches: Lessons from the Gulf of Cagliari (Sardinia)

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    Urban Mediterranean beaches are often characterized by a fragile and unstable equilibrium that can be easily altered by ongoing climate change and by the increase in human pressure. This may pose serious threats to the survival of beach systems that cannot accommodate these modifications. In this paper, the spatio-temporal shift of the shoreline was investigated along two urban beaches in the Gulf of Cagliari (Poetto and Giorgino; southern Sardinia, western Mediterranean Sea) across a time frame of 62 years (1954–2016). The Digital Shoreline Analysis System (DSAS) ArcGISℱ extension was used to extract different statistical parameters which allowed us to quantify the erosion and accretion rates. These data were further examined in relation to a number of anthropic and natural forcings in order to disentangle the factors controlling shoreline evolution. Eight sectors with interchanging net erosive and accretion trends were identified along the Poetto and Giorgino beaches. In six decades, some sectors of the two study sites appeared to have undergone great shoreline modification as a result of the intense anthropogenic activities impacting these coastal areas. The westernmost portions of both beaches were found to be the most vulnerable to erosion processes; such conditions were likely controlled by the interplaying of local hydrodynamics and by the intense coastal development which affected these sectors. The highest retreat rates (mean end point rate (EPR) = −0.51/year) were recorded in the western limit of Giorgino beach. Along the western limit of Poetto beach, EPR erosion rates (mean EPR = −2.92/year) considerably increased in the years after the artificial beach nourishment carried out in 2002, suggesting that the majority of the nourished material was lost offshore or partly redistributed along the beach. Coastal structures, urban development, river catchment modification, industrial and port activities, beach cleaning and touristic and recreational activities have been identified as the ongoing causes of coastal alteration. If these factors remain constant, under projected climate change scenarios, these beaches are at risk of further increased flooding and erosion. In this context, the application of DSAS appeared as an essential tool, supporting a monitoring system able to provide understanding and, potentially, predictions of the short- to long-term evolution of these beach system

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

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    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

    Successful in vivo retrieval of oocytes after ovarian stimulation for fertility preservation before oophorectomy by laparotomy for a young patient with ovarian cancer: Case report and review of literature

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    Objective: To report a case of direct in vivo oocytes retrieval for fertility preservation before oophorectomy by open surgery in a young patient with ovarian cancer. Design: case report and literature review. Setting: University hospital. Patients: A 29-year-old nulliparous patient, recently diagnosed with low grade serous ovarian carcinoma.The patient consented to the removal of her remaining ovary but wished to preserve oocytes and declined hysterectomy. Conventional trans-vaginal US-guided oocyte retrieval was contra-indicated because of the risk of malignant cell dissemination to the abdomen and the vaginal puncture sites. Interventions: Controlled ovarian stimulation with gonadotrophins was realized. Comprehensive surgical staging was performed 35 h after ovulation triggering using rHCG. The oocytes retrieval was performed in vivo with ultrasound guidance at time of laparotomy before oophorectomy without any time of ischemia. Results: Seven mature oocytes were obtained and vitrified. Conclusions: This case highlights the feasibility of in vivo oocytes retrieval of mature oocytes during open surgery for gynecologic cancers. By avoiding transvaginal follicular retrieval, the risk of malignant cell contamination to vaginal and parametrial tissues is reduced, limiting cancer upstaging

    Molecular Tailoring of New Thieno(bis)imide-Based Semiconductors for Single Layer Ambipolar Light Emitting Transistors

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    Organic molecular semiconductors are key components for a new generation of low cost, flexible, and large area electronic devices. In particular, ambipolar semiconductors endowed with electroluminescent properties have the potential to enable a photonic field-effect technology platform, whose key building blocks are the emerging organic light-emitting transistor (OLET) devices. To this aim, the design of innovative molecular configurations combining effective electrical and optical properties in the solid state is highly desirable. Here, we investigate the effect of the insertion of a thieno­(bis)­imide (TBI) moiety as end group in highly performing unipolar oligothiophene semiconductors on the packing, electrical, and optoelectronic properties of the resulting materials. We show that, regardless of the HOMO–LUMO energy, orbital distribution, and molecular packing pattern, a TBI end moiety switches unipolar and nonemissive oligothiophene semiconductors to ambipolar and electroluminescent materials. Remarkably, the newly developed materials enabled the fabrication of single layer molecular ambipolar OLETs with optical power comparable to that of the equivalent polymeric single layer devices

    Effect of centre volume on pathological outcomes and postoperative complications after surgery for colorectal cancer: results of a multicentre national study

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    Background: The association between volume, complications and pathological outcomes is still under debate regarding colorectal cancer surgery. The aim of the study was to assess the association between centre volume and severe complications, mortality, less-than-radical oncologic surgery, and indications for neoadjuvant therapy.Methods: Retrospective analysis of 16,883 colorectal cancer cases from 80 centres (2018-2021). Outcomes: 30-day mortality; Clavien-Dindo grade >2 complications; removal of >= 12 lymph nodes; non-radical resection; neoadjuvant therapy. Quartiles of hospital volumes were classified as LOW, MEDIUM, HIGH, and VERY HIGH. Independent predictors, both overall and for rectal cancer, were evaluated using logistic regression including age, gender, AJCC stage and cancer site.Results: LOW-volume centres reported a higher rate of severe postoperative complications (OR 1.50, 95% c.i. 1.15-1.096, P = 0.003). The rate of >= 12 lymph nodes removed in LOW-volume (OR 0.68, 95% c.i. 0.56-0.85, P = 12 lymph nodes removed was lower in LOW-volume than in VERY HIGH-volume centres (OR 0.57, 95% c.i. 0.41-0.80, P = 0.001). A lower rate of neoadjuvant chemoradiation was associated with HIGH (OR 0.66, 95% c.i. 0.56-0.77, P < 0.001), MEDIUM (OR 0.75, 95% c.i. 0.60-0.92, P = 0.006), and LOW (OR 0.70, 95% c.i. 0.52-0.94, P = 0.019) volume centres (vs. VERY HIGH).Conclusion: Colorectal cancer surgery in low-volume centres is at higher risk of suboptimal management, poor postoperative outcomes, and less-than-adequate oncologic resections. Centralisation of rectal cancer cases should be taken into consideration to optimise the outcomes

    Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

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    Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)
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