Laparoscopic versus open rectal resection. a 1:2 propensity score-matched analysis of oncological adequateness, short- and long-term outcomes

Laparoscopic resections for rectal cancer are routinely performed in high-volume centres. Despite short-term advantages have been demonstrated, the oncological outcomes are still debated. The aim of this study was to compare the oncological adequateness of the surgical specimen and the long-term outcomes between open (ORR) and laparoscopic (LRR) rectal resections

Comparison between balloon angioplasty and additional coronary stent implantation for the treatment of drug-eluting stent restenosis: 18-month clinical outcomes

OBJECTIVE: To evaluate the long-term outcomes after different modalities of treatment of drug-eluting stent (DES) in-stent restenosis (ISR) in a 'real world' setting. METHODS: Actually, few and conflicting data are available about the management of in-stent restenosis (ISR) after DES implantation. In our 'real world' registry 1082 consecutive patients who received a DES implantation were included. At 9-month angiographic follow-up, 93 patients presented a DES ISR that was treated with 'homo-DES' (HMD) (N = 27), 'hetero-DES' (HTD) (N = 19) and conventional balloon angioplasty (POBA) (N = 47). We evaluated the clinical outcomes in terms of major adverse cardiac event (MACE) (death, myocardial infarction and target vessel revascularization) at 18 months. RESULTS: There was no difference for clinical and angiographic characteristics between the three groups, except for the presence of silent ischaemia as clinical presentation (7.7 HMD vs. 2.2% POBA; P = 0.0001). No late stent thrombosis was found. At 18-month clinical follow-up patients treated with HMD, HTD and POBA presented a rate of MACE of 10.2, 0 and 8.7%, respectively (P = NS). Kaplan-Meier survival probability showed that HTD and POBA treatment tended to have more favourable outcomes at 18 months than the HMD treatment. CONCLUSION: In our registry, POBA seems to be as effective as other DES implantations in cases of DES ISR, especially in cases of focal type (Mehran classification IA, IC), in terms of long-term outcomes

Life-stage dependent response of the epiphytic lichen Lobaria pulmonaria to climate

Lichens are poikilohydric organisms, whose internal water content tends to reflect external humidity conditions. After drying, they can reactivate their metabolic activity through water vapor uptake or liquid water input. Thus, lichen water-related functional traits are important as they are involved in the duration of the hydrated period. Models predicting the effect of environmental conditions on lichens are based mainly on the presence or absence of adult thalli. Nevertheless, ecological conditions required by lichens might vary during their life cycle, for example during propagule establishment or in the first stages of thallus development. Little is known about the different ecological requirements at the different development stages in lichens. In this work, we measured water holding capacity (WHC) and specific thallus mass (STM) of adult and juvenile thalli of the model species Lobaria pulmonaria along a climatic gradient to constrain the processbased model LiBry. The LiBry model allows accounting for the productivity of lichens with different physiological strategies under various environmental conditions. We simulated the activity and performance of adult and juvenile thalli in 9 regions of Italy and Corsica. The model was used to test if adult thalli of L. pulmonaria have a higher survival probability due to their higher aerodynamic resistance. In the current climatic condition, the LiBry model predicts a higher survival probability of adults with decreasing absolute survival rates of both life stages with increasing temperature. Adult thalli also result in having higher active time, STM, and relative growth rate (RGR). We discuss the main implications of our simulation outputs, provide future perspectives and possible implementations of the LiBry mode

Health and Ecological Risk From Potentially Toxic Elements in Soils and Extra Virgin Olive Oils From Valdichiana Senese, Tuscany (Italy)

Background Extra virgin olive oils (EVOOs) are widely consumed but rarely analysed for potentially toxic elements (PTEs), whose concentrations in EVOOs can be significantly influenced by contamination in olive grove soils. As food consumption is the main PTE accumulation pathway in humans, thorough investigation on EVOOs is necessary. Aim The concentrations of 12 PTEs were determined in olive grove soils and EVOOs from Valdichiana Senese (Southern Tuscany, Italy), with the aim of identifying any contamination by PTEs in olive grove soils and evaluating the associated ecological risk as well as of assessing the potential risk for human health related to PTE intake from EVOO consumption. Methods The soil and EVOO samples were collected from 18 farms, and the concentration of As, Cd, Co, Cr, Cu, Ni, Pb, Sb, Tl, U, V and Zn was determined by inductively coupled plasma mass spectrometry (ICP–MS). The data were used to calculate the health risk index (HRI) for EVOOs and the geoaccumulation index (Igeo) and potential ecological risk index (PERI) for soils. Results Analytical data suggested that the PTE concentrations in the investigated olive grove soils are natural as comparable to their normal geochemical background in soils from Southern Tuscany formed from the same parent rocks of Valdichiana Senese soils or due to local geogenic enrichments in some parent rocks. Among the analysed PTEs in the EVOO samples, Zn, Cu and Ni had the highest concentrations, followed by Cr and Pb. Most PTEs showed a high variability of their concentrations in EVOOs from Valdichiana Senese. Conclusion On the basis of values of indices applied to PTE concentrations in the soil samples, a low-to-moderate Cu contamination emerged only in the olive grove soils of two farms, probably as a consequence of the diffuse use of Cu-based products in agriculture, and overall, the ecological risk was low. Furthermore, although EVOOs from Valdichiana Senese have somewhat slightly high concentrations of some PTEs such as Cu and Zn, the health risk associated with their intake through the EVOO consumption is definitely negligible

Minimally Invasive Surgery for Perihilar Cholangiocarcinoma. A Systematic Review of the Short- and Long-Term Results

Surgery and postoperative systemic chemotherapy represent the standard treatment for patients with perihilar cholangiocarcinoma (PHC). Minimally Invasive Surgery (MIS) for hepatobiliary procedures has spread worldwide in the last two decades. Since resections for PHC are technically demanding, the role of MIS in this field is yet to be established. This study aimed to systematically review the existing literature on MIS for PHC, to evaluate its safety and its surgical and oncological outcomes. A systematic literature review on PubMed and SCOPUS was performed according to the PRISMA guidelines. Overall, a total of 18 studies reporting 372 MIS procedures for PHC were included in our analysis. A progressive increase in the available literature was observed over the years. A total of 310 laparoscopic and 62 robotic resections were performed. A pooled analysis showed an operative time ranging from 205.3 ± 23.9 and 840 (770-890) minutes, and intraoperative bleeding between 101.1 ± 13.6 and 1360 ± 809 mL. Minor and major morbidity rates were 43.9% and 12.7%, respectively, with a 5.6% mortality rate. R0 resections were achieved in 80.6% of patients and the number of retrieved lymph nodes ranged between 4 (3-12) and 12 (8-16). This systematic review shows that MIS for PHC is feasible, with safe postoperative and oncological outcomes. Recent data has shown encouraging results and more reports are being published. Future studies should address differences between robotic and laparoscopic approaches. Given the management and technical challenges, MIS for PHC should be performed by experienced surgeons, in high-volume centers, on selected patients

The lichen biota of the Special Area of Conservation Rio Pentemina (Ligurian Apennines, N Italy)

Despite its restricted geographical extent, Liguria hosts a very rich lichen biota. Nevertheless, the lichenological exploration of Liguria remains highly fragmented, both in space and time. Indeed, there are only a handful of comprehensive lichen biota lists for specific areas of Liguria. To address this gap of knowledge and support broader biodiversity, taxonomic, and ecological studies, we present a list of the lichen biota of the Pentemina Valley, which we consider to be one of the most interesting areas in the Ligurian Apennines from a lichenological point of view. The list includes 200 infrageneric taxa, fourteen of which are new to Liguria (e.g., Loxospora elatina). Additionally, fourteen other species of conservation interest have been collected (e.g., Buellia hyperbolica), while many others have been recorded after a century or more since the first and, in some cases, only report (e.g., Ochrolechia szatalaensis or Verrucaria papillosa)

Phenotypical Characterization of C9ALS Patients from the Emilia Romagna Registry of ALS: A Retrospective Case–Control Study

Background/Objectives: C9ORF72 expansion is associated with significant phenotypic heterogeneity. This study aimed to characterize the clinical features of C9ALS patients from the Emilia Romagna ALS registry (ERRALS) and compare them with non-mutated ALS (nmALS) patients matched for sex, age at onset, and diagnostic delay, sourced from the same register. Methods: In total, 67 C9ALS patients were compared to 201 nmALS. Clinical data, phenotype, and prognostic factors were analyzed in the two groups and within the C9ALS group after stratification by sex. Results: C9ALS patients displayed a higher disease progression rate and shorter times to gastrostomy and invasive ventilation, despite no differences in overall survival. Female C9ALS had a more severe bulbar and upper motor neuron involvement compared to males. Cognitive and behavioral symptoms were more common in the C9ALS group, and the former was an independent prognostic factor. Prevalences of, autoimmune diseases, and dyslipidemia were significantly higher among C9ALS patients. Conclusions: In our dataset, we show an overall increased disease progression rate in C9ALS patients and hint at sex-specific discrepancies in some phenotypical characteristics. We also suggest a possible clinically relevant involvement of C9ORF72 expansion in metabolism and autoimmunity