Simultaneous Excisions and Extemporary Skin Plastics: New Reconstructive Techniques after Tumor Surgery

Occurrence of two or more skin tumors closely situated to each other is not so rare in clinical dermasurgical practice. Excision of multiple contiguous skin lesions can represent a major dermasurgical problem that can be solved in different surgical times. However, in our opinion, the best therapeutic solution is to carry out the removal in a single surgical session; this choice allows saving time, an easier plastic reconstruction, and better esthetic results. Many different reconstructive procedures can be designed and applied, to achieve the best result. The simplest Burow’s triangle flap permits excision of two contiguous lesions with less tension compared to two fusiform cuts, but many other plastic solutions can be chosen to satisfy the needs of different anatomical sites and according to skin features. In the author’s personal experience, of about 8000 patients who have undergone dermatologic surgery over the past 20 years, the presence of multiple contiguous lesions occurred in about 200 cases. In all of these, triangle, rotation, advancement, or transposition flaps allowed simultaneous removals, saving time and money and giving better esthetic results compared to multiple direct excision carried out at successive times. In this chapter, the different techniques are described and illustrated in detail

The Impact of Crystal Light Yield Non-Proportionality on a Typical Calorimetric Space Experiment: Beam Test Measurements and Monte Carlo Simulations

Calorimetric space experiments were employed for the direct measurements of cosmic-ray spectra above the TeV region. According to several theoretical models and recent measurements, relevant features in both electron and nucleus fluxes are expected. Unfortunately, sizable disagreements among the current results of different space calorimeters exist. In order to improve the accuracy of future experiments, it is fundamental to understand the reasons of these discrepancies, especially since they are not compatible with the quoted experimental errors. A few articles of different collaborations suggest that a systematic error of a few percentage points related to the energy-scale calibration could explain these differences. In this work, we analyze the impact of the nonproportionality of the light yield of scintillating crystals on the energy scale of typical calorimeters. Space calorimeters are usually calibrated by employing minimal ionizing particles (MIPs), e.g., nonshowering proton or helium nuclei, which feature different ionization density distributions with respect to particles included in showers. By using the experimental data obtained by the CaloCube collaboration and a minimalist model of the light yield as a function of the ionization density, several scintillating crystals (BGO, CsI(Tl), LYSO, YAP, YAG and BaF2) are characterized. Then, the response of a few crystals is implemented inside the Monte Carlo simulation of a space calorimeter to check the energy deposited by electromagnetic and hadronic showers. The results of this work show that the energy scale obtained by MIP calibration could be affected by sizable systematic errors if the nonproportionality of scintillation light is not properly taken into account

Conversion gastrectomy for stage IV unresectable gastric cancer: a GIRCG retrospective cohort study

Background: The aim of this study is to report the experience with conversion surgery from six Gruppo Italiano Ricerca Cancro Gastrico (GIRCG) centers, focusing our analysis on factors affecting survival and the risk of recurrence. Methods: A retrospective, multicenter cohort study was performed in patients who had undergone conversion gastrectomy between 2005 and 2017. Data were extracted from a GIRCG database including all metastatic gastric cancer patients submitted to surgery. Only stage IV unresectable tumors/metastases which became resectable after chemotherapy were included in this analysis. Results: Forty-five resected M1 patients were included in the analysis. Reasons for being deemed unresectable at diagnosis were peritoneal involvement (PCI > 6) (n = 38, 84.4%), distant metastatic nodes (n = 3, 6.6%) and extensive liver involvement (n = 4, 8.8%). Median follow-up was 25 months (IQR 9-50). Median overall survival from surgery was 15 months and 1-, 3- and 5-year survivals were 57.2, 36.1 and 24%, respectively. Median progression-free survival was 12 months with 1- and 3-year survival of 46.4 and 33.9%, respectively. At cox regression analysis the only independent prognostic factor for OS was the presence of more than one type of metastasis (HR 4.41, 95% CI 1.72\u201311.3, p = 0.002). A positive microscopic resection margin was the only risk factor for recurrence (HR 5.72, 95% CI 1.04\u201331.4, p = 0.045). Conclusions: Unresectable stage IV GC patients could benefit from radical surgery after chemotherapy and achieve long survivals. The main prognostic factor for these patients was the presence of more than one type of extra-gastric metastatic involvement

Structured and shared CT radiological report of gastric cancer: a consensus proposal by the Italian Research Group for Gastric Cancer (GIRCG) and the Italian Society of Medical and Interventional Radiology (SIRM)

Objectives Written radiological report remains the most important means of communication between radiologist and referring medical/surgical doctor, even though CT reports are frequently just descriptive, unclear, and unstructured. The Italian Society of Medical and Interventional Radiology (SIRM) and the Italian Research Group for Gastric Cancer (GIRCG) promoted a critical shared discussion between 10 skilled radiologists and 10 surgical oncologists, by means of multi-round consensus-building Delphi survey, to develop a structured reporting template for CT of GC patients. Methods Twenty-four items were organized according to the broad categories of a structured report as suggested by the European Society of Radiology (clinical referral, technique, findings, conclusion, and advice) and grouped into three "CT report sections" depending on the diagnostic phase of the radiological assessment for the oncologic patient (staging, restaging, and follow-up). Results In the final round, 23 out of 24 items obtained agreement ( >= 8) and consensus ( 0.05). Conclusions The structured report obtained, shared by surgical and medical oncologists and radiologists, allows an appropriate, clearer, and focused CT report essential to high-quality patient care in GC, avoiding the exclusion of key radiological information useful for multidisciplinary decision-making

CALOCUBE: An approach to high-granularity and homogenous calorimetry for space based detectors

Future space experiments dedicated to the observation of high-energy gamma and cosmic rays will increasingly rely on a highly performing calorimetry apparatus, and their physics performance will be primarily determined by the geometrical dimensions and the energy resolution of the calorimeter deployed. Thus it is extremely important to optimize its geometrical acceptance, the granularity, and its absorption depth for the measurement of the particle energy with respect to the total mass of the apparatus which is the most important constraint for a space launch. The proposed design tries to satisfy these criteria while staying within a total mass budget of about 1.6 tons. Calocube is a homogeneous calorimeter instrumented with Cesium iodide (CsI) crystals, whose geometry is cubic and isotropic, so as to detect particles arriving from every direction in space, thus maximizing the acceptance; granularity is obtained by filling the cubic volume with small cubic CsI crystals. The total radiation length in any direction is more than adequate for optimal electromagnetic particle identification and energy measurement, whilst the interaction length is at least sufficient to allow a precise reconstruction of hadronic showers. Optimal values for the size of the crystals and spacing among them have been studied. The design forms the basis of a three-year R&D activity which has been approved and financed by INFN. An overall description of the system, as well as results from preliminary tests on particle beams will be described

Notulae to the Italian alien vascular flora: 12

In this contribution, new data concerning the distribution of vascular flora alien to Italy are presented. It includes new records, confirmations, exclusions, and status changes for Italy or for Italian administrative regions. Nomenclatural and distribution updates published elsewhere are provided as Suppl. material 1

Contributi per una flora vascolare di toscana. IX (507-605)

Contributions for a vascular flora of Tuscany. IX (507-605). New localities and/or confirmations concerning 98 specific and subspecific plant taxa of Tuscan vascular flora, belonging to 81 genera and 42 families are presented: Alisma, Baldellia (Alismataceae), Chenopodium (Amaranthaceae), Sternbergia (Amaryllidaceae), Bupleurum (Apiaceae), Vinca (Apocynaceae), Muscari, Polygonatum (Asparagaceae), Carlina, Centaurea, Chondrilla, Filago, Pallenis, Tagetes, Tr a - gopogon, Tyrimnus (Asteraceae), Impatiens (Balsaminaceae), Campsis (Bignoniaceae), Cardamine, Iberis, Isatis, Lepidium, Rorippa (Brassicaceae), Humulus (Cannabaceae), Centranthus (Caprifoliaceae), Atocion, Paronychia, Sabulina, Scleranthus (Caryophyllaceae), Euonymus (Celastraceae), Fumana (Cistaceae), Phedimus, Sedum (Crassulaceae), Juniperus (Cupressacesae), Carex, Cyperus, Schoenus (Cyperaceae), Erica (Ericaceae), Euphorbia (Euphorbiaceae), Astragalus, Cytisus, Gleditsia, Lotus, Trifolium, Vicia (Fabaceae), Geranium (Geraniaceae), Philadelphus (Hydrangeaceae), Phacelia (Hydrophyllaceae), Hermodactylus, Iris, Romulea (Iridaceae), Salvia, Ziziphora (Lamiaceae), Gagea, Lilium (Liliaceae), Lindernia (Linderniaceae), Mirabilis (Nyctaginaceae), Nymphaea (Nymphaeaceae), Ligustrum (Oleaceae), Oenothera (Onagraceae), Oxalis (Oxalidaceae), Plantago, Veronica (Plantaginaceae), Armeria (Plumbaginaceae), Eleusine, Festuca, Phleum, Setaria, Stipa, Tragu s (Poaceae), Stuckenia (Potamogetonaceae), Anemonoides, Ranunculus (Ranunculaceae), Reseda (Resedaceae), Aphanes, Cotoneaster, Eriobotrya, Malus, Rosa (Rosaceae), Galium (Rubiaceae), Nicotiana, (Solanaceae). In the end, the conservation status of the units and possible protection of the cited biotopes are discussed

Contributi per una flora vascolare di Toscana. XI (664-738)

Vengono presentate nuove località e/o conferme relative 75 taxa specifici e sottospecifici di piante vascolari della flora vascolare toscana, appartenenti a 67 generi e 41 famiglie: Delosperma (Aizoaceae), Dysphania (Amaranthaceae), Leucojum, Nothoscordum (Amaryllidaceae), Bupleurum, Coriandrum (Apiaceae), Araujia (Apocynaceae), Lemna (Araceae), Hydrocotyle (Araliaceae), Aristolochia (Aristolochiaceae), Bellevalia (Asparagaceae), Asphodelus (Asphodelaceae), Artemisia, Crepis, Eclipta, Erigeron, Hieracium, Senecio, Symphyotrichum, Tolpis (Asteraceae), Symphytum (Boraginaceae), Alyssum, Cardamine, Eruca, Isatis (Brassicaceae), Valerianella (Caprifoliaceae), Petrorhagia, Scleranthus (Caryophyllaceae), Commelina (Commelinaceae), Dichondra (Convolvulaceae), Sedum (Crassulaceae), Diospyros (Ebenaceae), Moneses (Ericaceae), Euphorbia (Euphorbiaceae), Medicago, Trifolium (Fabaceae), Myriophyllum (Haloragaceae), Juncus (Juncaceae), Salvia, Teucrium (Lamiaceae), Broussonetia (Moraceae), Spiranthes (Orchidaceae), Phelipanche (Orobanchaceae), Papaver (Papaveraceae), Passiflora (Passifloraceae), Cedrus, Pseudotsuga (Pinaceae), Bromopsis, Calamagrostis, Cenchrus, Drymochloa, Melica, Oloptum, Phleum, Sporobolus, Tragus (Poaceae), Stuckenia (Potamogetonaceae), Lysimachia (Primulaceae), Anemone, Aquilegia (Ranunculaceae), Eriobotrya (Rosaceae), Crucianella (Rubiaceae), Verbascum (Scrophulariaceae), Typha (Typhaceae), Urtica (Urticaceae), Viola (Violaceae). Infine, viene discusso lo status di conservazione delle entità e gli eventuali vincoli di protezione dei biotopi segnalati.New localities and/or confirmations concerning 75 specific and subspecific plant taxa of Tuscan vascular flora, belonging to 67 genera and 41 families are presented: Delosperma (Aizoaceae), Dysphania (Amaranthaceae), Leucojum, Nothoscordum (Amaryllidaceae), Bupleurum, Coriandrum (Apiaceae), Araujia (Apocynaceae), Lemna (Araceae), Hydrocotyle (Araliaceae), Aristolochia (Aristolochiaceae), Bellevalia (Asparagaceae), Asphodelus (Asphodelaceae), Artemisia, Crepis, Eclipta, Erigeron, Hieracium, Senecio, Symphyotrichum, Tolpis (Asteraceae), Symphytum (Boraginaceae), Alyssum, Cardamine, Eruca, Isatis (Brassicaceae), Valerianella (Caprifoliaceae), Petrorhagia, Scleranthus (Caryophyllaceae), Commelina (Commelinaceae), Dichondra (Convolvulaceae), Sedum (Crassulaceae), Diospyros (Ebenaceae), Moneses (Ericaceae), Euphorbia (Euphorbiaceae), Medicago, Trifolium (Fabaceae), Myriophyllum (Haloragaceae), Juncus (Juncaceae), Salvia, Teucrium (Lamiaceae), Broussonetia (Moraceae), Spiranthes (Orchidaceae), Phelipanche (Orobanchaceae), Papaver (Papaveraceae), Passiflora (Passifloraceae), Cedrus, Pseudotsuga (Pinaceae), Bromopsis, Calamagrostis, Cenchrus, Drymochloa, Melica, Oloptum, Phleum, Sporobolus, Tragus (Poaceae), Stuckenia (Potamogetonaceae), Lysimachia (Primulaceae), Anemone, Aquilegia (Ranunculaceae), Eriobotrya (Rosaceae), Crucianella (Rubiaceae), Verbascum (Scrophulariaceae), Typha (Typhaceae), Urtica (Urticaceae), and Viola (Violaceae). In the end, the conservation status of the units and eventual protection of the cited biotopes are discussed