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

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Analysis of parasitic effects and reliability issues of Gallium Nitride (GaN) -based devices

The increasingly widespread use of electricity as an energy source with low environmental impact, involves the need to optimize the production, distribution and conversion of electricity with the aim of minimizing waste. About 10% of the electricity is wasted due to conversion losses. In many cases, energy conversion is achieved through switching circuits (converters, inverters...), where transistor performance plays a crucial role in defining overall system efficiency. Silicon has been widely used in electronic circuits since the 50s and this is mainly due to its high availability in nature at low cost. However, devices based on this technology have reached the performance limits dictated by the intrinsic properties of the material, and the challenge has become to find innovative materials for efficient energy conversion. The most promising material as an alternative to Silicon is Gallium Nitride (GaN), a wide energy gap semiconductor epitaxially grown on substrates mainly in Silicon; this guarantees excellent scalability (mass production) and reduced costs, to the disadvantage of the quality of the material. Despite the numerous advantages of this material, the technology based on this is still under development and presents reliability and stability issues. In order, for the Gallium Nitride transistors to be effectively available in international trade and used in the main high-power applications and not only, it is necessary to obtain a clear and deep characterization of the main properties and limits of these devices. This work is based on the detailed study of the physical mechanisms that govern the operation and degradation of devices, with the aim of explaining and modelling the phenomena that limit both their performance and lifetime under the thermal and bias conditions of the final application. The study is conducted through the combined use of experimental characterization techniques and physical model definition. As a result, an understanding of the main issues that afflict GaN-HEMTs and possible improvement strategies from both the materials and structure point of view are provided in order to obtain a performing and reliable technology.The increasingly widespread use of electricity as an energy source with low environmental impact, involves the need to optimize the production, distribution and conversion of electricity with the aim of minimizing waste. About 10% of the electricity is wasted due to conversion losses. In many cases, energy conversion is achieved through switching circuits (converters, inverters...), where transistor performance plays a crucial role in defining overall system efficiency. Silicon has been widely used in electronic circuits since the 50s and this is mainly due to its high availability in nature at low cost. However, devices based on this technology have reached the performance limits dictated by the intrinsic properties of the material, and the challenge has become to find innovative materials for efficient energy conversion. The most promising material as an alternative to Silicon is Gallium Nitride (GaN), a wide energy gap semiconductor epitaxially grown on substrates mainly in Silicon; this guarantees excellent scalability (mass production) and reduced costs, to the disadvantage of the quality of the material. Despite the numerous advantages of this material, the technology based on this is still under development and presents reliability and stability issues. In order, for the Gallium Nitride transistors to be effectively available in international trade and used in the main high-power applications and not only, it is necessary to obtain a clear and deep characterization of the main properties and limits of these devices. This work is based on the detailed study of the physical mechanisms that govern the operation and degradation of devices, with the aim of explaining and modelling the phenomena that limit both their performance and lifetime under the thermal and bias conditions of the final application. The study is conducted through the combined use of experimental characterization techniques and physical model definition. As a result, an understanding of the main issues that afflict GaN-HEMTs and possible improvement strategies from both the materials and structure point of view are provided in order to obtain a performing and reliable technology

Decommissioning of Offshore Platforms in Adriatic Sea: The Total Removal Option from a Life Cycle Assessment Perspective

The international energy scenario to date is heavily based on fossil energy sources such as coal, oil or natural gas. According to the international ecological goals of the UNFCCC formalized in the legally binding treaty called the Paris Agreement, the next global challenges will be the decommissioning, dismantling or reconversion of the current fossil energy system into a new, more sustainable system that makes more efficient use of renewable energy technologies. Worldwide, there are about 6500 offshore oil and gas facilities and about 130 of them are located in the Mediterranean basin, mainly in the Adriatic and Ionian Seas: more than 110 offshore gas platforms have been installed in these areas since 1960. In this paper, using Life Cycle Assessment, the environmental and economic impacts of the total removal operations of an existing offshore platform in the context of the Adriatic Sea are assessed based on existing and registered decommissioning projects. In addition, the avoided impacts of primary steel production due to its recovery and recycling from the removed platform are assessed using the system boundary expansion method

Retrospective Characterization of the 2006–2007 Swine Vesicular Disease Epidemic in Northern Italy by Whole Genome Sequence Analysis

Advances in the epidemiological tracing of pathogen transmission have been largely driven by the increasing characterisation of whole-genome sequence data obtained at a finer resolution from infectious disease outbreaks. Dynamic models that integrate genomic and epidemiological data further enhance inference on the evolutionary history and transmission dynamics of epidemic outbreaks by reconstructing the network of ‘who-infected-whom’. Swine Vesicular Disease (SVD) was present in Italy from 1966 until 2015, and since the mid-1990s, it has mainly been circulating within Italy’s central-southern regions with sporadic incursions to the north of the country. However, a recrudescence of SVD in northern Italy was recorded between November 2006 and October 2007, leading to a large-scale epidemic that significantly affected the intensive pig industry of the Lombardy region. In this study, by using whole-genome sequence data in combination with epidemiological information on disease occurrences, we report a retrospective epidemiological investigation of the 2006–2007 SVD epidemic, providing new insights into the transmission dynamics and evolutionary mode of the two phases that characterised the epidemic event. Our analyses support evidence of undetected premises likely missed in the chain of observed infections, of which the role as the link between the two phases is reinforced by the tempo of SVD virus evolution. These silent transmissions, likely resulting from the gradual loss of a clear SVD clinical manifestation linked to sub-clinical infections, may pose a risk of failure in the early detection of new cases. This study emphasises the power of joint inference schemes based on genomic and epidemiological data integration to inform the transmission dynamics of disease epidemics, ultimately aimed at better disease control

Psychological Disorders, Adverse Childhood Experiences and Parental Psychiatric Disorders in Children Affected by Headache. A Systematic Review

Background: Pediatric headaches have been linked to adverse life events or psychological factors in children and their families, with a complex and bidirectional association. Moreover, it is well-known that psychological stress can trigger headaches. Methods: We searched three databases for studies focusing on headaches and adverse events or psychological factors in children up to 12 years old or in their caregivers. Results: We included 28 studies. Child psychological factors, including internal and external symptoms, were commonly associated with all types of headaches. Sleep disturbances showed a positive association with headaches in 3 out of 5 studies. Family conflict and unhappiness were frequently found in children suffering with headaches, while single-parent families and divorce were not associated. Stressful environments and adverse life events, particularly bullying, were also found to be linked with headaches. Conclusions: Childhood headaches represent an alarm bell for clinicians to investigate and treat psychological or psychiatric disorders in children and their family. Further studies are needed to elucidate the role of early-life adverse events in children and their families

Fluorescence studies on 2-(het)aryl perimidine derivatives

8nononePerimidines are extensively studied for their different therapeutic properties, including antiulcer, antifungal, antimicrobial, immunosuppressive and anticancer activities. Moreover, their heterocyclic structure embodies the naphthalene moiety, exploited in bio-imaging and biomolecules staining due to its high fluorescence. In this work we present the spectroscopic characterization of a family of perimidine derivatives, in order to obtain information potentially useful for the design of compounds combining biological activity and detectable fluorescence in physiological environment.Giani, Arianna Maria; Lamperti, Marco; Maspero, Angelo; Cimino, Alessandro; Negri, Roberto; Giovenzana, Giovanni Battista; Palmisano, Giovanni; Nardo, LucaGiani, Arianna Maria; Lamperti, Marco; Maspero, Angelo; Cimino, Alessandro; Negri, Roberto; Giovenzana, Giovanni Battista; Palmisano, Giovanni; Nardo, Luc

Eosinophilic esophagitis in children: clinical findings and diagnostic approach

Eosinophilic esophagitis (EoE) is an emerging chronic immune and antigen-mediated clinicopathologic disease. During the last 2 decades, the incidence of this condition in children has increased significantly, thanks to practitioners for creating the awareness and higher use of diagnostic endoscopy. We have analysed paediatric literature on EoE focusing on the epidemiology, pathophysiology, clinical findings and diagnostic approach. EoE is pathogenically related to a Th2 inflammation characterized by a mixed IgE and non-IgEmediated reaction to food and/or environmental agents. This leads to esophageal dysfunction and remodeling accompanied by subepithelial fibrosis. EoE can be presented with several range of gastrointestinal symptoms, including regurgitation, vomiting, feeding difficulties or feeding refusal in infants and toddlers, as well as heartburn, dysphagia and food bolus impaction in older children and adults. The diagnostic suspicion is based on the presence of chronic symptoms of esophgeal dysfunction and esophageal eosinophilia characterised histologically by a significant eosinophilic infiltration of the oesophageal mucosa (>15 eosinophils per high powered field). In this review, we will provide an update on clinical presentation and diagnostic approach to EoE in children. We emphasized on the relevant aspects of the new clinical condition termed “PPI responsive esophageal eosinophilia”, as entities distinct from EoE and the role of PPI trial in the diagnostic workup, therefore we proposed a new diagnostic algorithm

The use of Berlin Heart EXCOR VAD in children less than 10kg: a single center experience

Objective: Despite the improvement in ventricular assist device (VAD) therapy in adults and in adolescents, in infant population only Berlin Heart EXCOR (BHE) is licensed as long term VAD to bridge children to Heart Transplantation (HTx). Particularly demanding in terms of morbidity and mortality are smallest patients namely the ones implanted in the first year of life or with a lower body surface area. This work aims at retrospective reviewing a single centre experience in using BHE in children with a body weight under 10kg. Methods: Data of all pediatric patients under 10kg undergoing BHE implantation in our institution from March 2002 to March 2016 were retrospectively reviewed Results: Of the 30 patients enrolled in the study, 53% were male, 87% were affected by a dilated cardiomyopathy with an average weight and age at the implantation of 6.75±2.16Kg and 11.57±10.12 months, respectively. Three patients (10%) required a BIVAD implantation. After the implantation, 7 patients (23%) required re-intervention for bleeding and 9 patients (30%) experienced BHE cannulas infection. A total of 56 BHE pump were changed for thrombus formation (1.86 BHE pump for patient). The average duration of VAD support was 132.8±94.4 days. Twenty patients (67%) were successfully transplanted and 10 patients (33%) died: 7 for major neurological complication and 3 for sepsis. Conclusion: Mechanical support in smaller children with end stage heart failure is an effective strategy for bridging patients to HTx. The need for BIVAD was relegated, in the last years, only to restrictive cardiomiopathy. Further efforts are required in small infants to improve anticoagulation strategy to reduce neurological events and BHE pump changes