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At the time of diagnosis synchronous colorectal cancer, liver metastases (SCRLM) account for 15–25% of patients. If primary tumour and synchronous liver metastases are resectable, good results may be achieved performing surgical treatment incorporated into the chemotherapy regimen. So far, the possibility of simultaneous minimally invasive (MI) surgery for SCRLM has not been extensively investigated. The Italian surgical community has captured the need and undertaken the effort to establish a National Consensus on this topic. Four main areas of interest have been analysed: patients’ selection, procedures, techniques, and implementations. To establish consensus, an adapted Delphi method was used through as many reiterative rounds were needed. Systematic literature reviews were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses instructions. The Consensus took place between February 2019 and July 2020. Twenty-six Italian centres participated. Eighteen clinically relevant items were identified. After a total of three Delphi rounds, 30-tree recommendations reached expert consensus establishing the herein presented guidelines. The Italian Consensus on MI surgery for SCRLM indicates possible pathways to optimise the treatment for these patients as consensus papers express a trend that is likely to become shortly a standard procedure for clinical pictures still on debate. As matter of fact, no RCT or relevant case series on simultaneous treatment of SCRLM are available in the literature to suggest guidelines. It remains to be investigated whether the MI technique for the simultaneous treatment of SCRLM maintain the already documented benefit of the two separate surgeries.

Background: Surgical outcomes may be associated with hospital volume and the influence of volume on minimally invasive liver surgery (MILS) is not known. Methods: Patients entered into the prospective registry of the Italian Group of MILS from 2014 to 2018 were considered. Only centres with an accrual period of at least 12 months and stable MILS activity during the enrolment period were included. Case volume was defined by the mean number of minimally invasive liver resections performed per month (MILS/month). Results: A total of 2225 MILS operations were undertaken by 46 centres; nine centres performed more than two MILS/month (1376 patients) and 37 centres carried out two or fewer MILS/month (849 patients). The proportion of resections of anterolateral segments decreased with case volume, whereas that of major hepatectomies increased. Left lateral sectionectomies and resections of anterolateral segments had similar outcome in the two groups. Resections of posterosuperior segments and major hepatectomies had higher overall and severe morbidity rates in centres performing two or fewer MILS/month than in those undertaking a larger number (posterosuperior segments resections: overall morbidity 30·4 versus 18·7 per cent respectively, and severe morbidity 9·9 versus 4·0 per cent; left hepatectomy: 46 versus 22 per cent, and 19 versus 5 per cent; right hepatectomy: 42 versus 34 per cent, and 25 versus 15 per cent). Conclusion: A volume–outcome association existed for minimally invasive hepatectomy. Complex and major resections may be best managed in high-volume centres.

Background: Coronavirus disease 2019 (COVID-19) is a potentially fatal disease that is of great global public health concern. Objective: We explored the clinical management of inpatients with COVID-19 in Italy. Methods: A self-administered survey was sent by email to Italian physicians caring for adult patients with COVID-19. A panel of experts was selected according to their clinical curricula and their responses were analyzed. Results: A total of 1,215 physicians completed the survey questionnaire (17.4% response rate). Of these, 188 (15.5%) were COVID-19 experts. Chest computed tomography was the most used method to detect and monitor COVID-19 pneumonia. Most of the experts managed acute respiratory failure with CPAP (56.4%), high flow nasal cannula (18.6%), and non-invasive mechanical ventilation (8%), while an intensivist referral for early intubation was requested in 17% of the cases. Hydroxychloroquine was prescribed as an antiviral in 90% of cases, both as monotherapy (11.7%), and combined with protease inhibitors (43.6%) or azithromycin (36.2%). The experts unanimously prescribed low-molecular-weight heparin to patients with severe COVID-19 pneumonia, and half of them (51.6%) used a dose higher than standard. The respiratory burden in patients who survived the acute phase was estimated as relevant in 28.2% of the cases, modest in 39.4%, and negligible in 9%. Conclusions: In our survey some major topics, such as the role of non-invasive respiratory support and drug treatments, show disagreement between experts, likely reflecting the absence of high-quality evidence studies. Considering the significant respiratory sequelae reported following COVID-19, proper respiratory and physical therapy programs should be promptly made available.

Background: Surgical outcomes may be associated with hospital volume and the influence of volume on minimally invasive liver surgery (MILS) is not known. Methods: Patients entered into the prospective registry of the Italian Group of MILS from 2014 to 2018 were considered. Only centres with an accrual period of at least 12 months and stable MILS activity during the enrolment period were included. Case volume was defined by the mean number of minimally invasive liver resections performed per month (MILS/month). Results: A total of 2225 MILS operations were undertaken by 46 centres; nine centres performed more than two MILS/month (1376 patients) and 37 centres carried out two or fewer MILS/month (849 patients). The proportion of resections of anterolateral segments decreased with case volume, whereas that of major hepatectomies increased. Left lateral sectionectomies and resections of anterolateral segments had similar outcome in the two groups. Resections of posterosuperior segments and major hepatectomies had higher overall and severe morbidity rates in centres performing two or fewer MILS/month than in those undertaking a larger number (posterosuperior segments resections: overall morbidity 30·4 versus 18·7 per cent respectively, and severe morbidity 9·9 versus 4·0 per cent; left hepatectomy: 46 versus 22 per cent, and 19 versus 5 per cent; right hepatectomy: 42 versus 34 per cent, and 25 versus 15 per cent). Conclusion: A volume–outcome association existed for minimally invasive hepatectomy. Complex and major resections may be best managed in high-volume centres.

Unmanned Aerial Vehicles (UAVs) have a great potential to support search tasks in unstructured environments. Small, lightweight, low speed and agile UAVs, such as multi-rotors platforms can incorporate many kinds of sensors that are suitable for detecting object of interests in cluttered outdoor areas. However, due to their limited endurance, moderate computing power, and imperfect sensing, mini-UAVs should be into groups using swarm coordination algorithms to perform tasks in a scalable, reliable and robust manner. In this paper a biologically-inspired mechanisms is adopted to coordinate drones performing target search with imperfect sensors. In essence, coordination can be achieved by combining stigmergic and flocking behaviors. Stigmergy occurs when a drone releases digital pheromone upon sensing of a potential target. Such pheromones can be aggregated and diffused between flocking drones, creating a spatiotemporal attractive potential field. Flocking occurs, as an emergent effect of alignment, separation and cohesion, where drones self organise with similar heading and dynamic arrangement as a group. The emergent coordination of drones relies on the alignment of stigmergy and flocking strategies. This paper reports on the design of the novel swarming algorithm, reviewing different strategies and measuring their performance on a number of synthetic and real-world scenarios.

Regional innovation is more and more considered an important enabler of welfare. It is no coincidence that the European Commission has started looking at regional peculiarities and dynamics, in order to focus Research and Innovation Strategies for Smart Specialization towards effective investment policies. In this context, this work aims to support policy makers in the analysis of innovation-relevant trends. We exploit a European database of the regional patent application to determine the dynamics of a set of technological innovation indicators. For this purpose, we design and develop a software system for assessing unfolding trends in such indicators. In contrast with conventional knowledge-based design, our approach is biologically-inspired and based on self-organization of information. This means that a functional structure, called track, appears and stays spontaneous at runtime when local dynamism in data occurs. A further prototyping of tracks allows a better distinction of the critical phenomena during unfolding events, with a better assessment of the progressing levels. The proposed mechanism works if structural parameters are correctly tuned for the given historical context. Determining such correct parameters is not a simple task since different indicators may have different dynamics. For this purpose, we adopt an adaptation mechanism based on differential evolution. The study includes the problem statement and its characterization in the literature, as well as the proposed solving approach, experimental setting and results., Comment: mail: luca.alfeo@ing.unipi.it

Physical activity level (PAL) in older adults can enhance healthy aging, improve functional capacity, and prevent diseases. It is known that human annotations of PAL can be affected by subjectivity and inaccuracy. Recently developed smart devices can allow a non-invasive, analytic, and continuous gathering of physiological signals. We present an innovative computational system fed by signals of heartbeat rate, wrist motion and pedometer sensed by a smartwatch. More specifically, samples of each signal are aggregated by functional structures called trails. The trailing process is inspired by stigmergy, an insects' coordination mechanism, and is managed by computational units called stigmergic receptive fields (SRFs). SRFs, which compute the similarity between trails, are arranged in a stigmergic perceptron to detect a collection of micro-behaviours of the raw signal, called archetypes. A SRF is adaptive to subjects: its structural parameters are tuned by a differential evolution algorithm. SRFs are used in a multilayer architecture, providing further levels of processing to realize macro analyses in the application domain. As a result, the architecture provides a daily PAL, useful to detect behavioural shift indicating initial signs of disease or deviations in performance. As a proof of concept, the approach has been experimented on three subjects., Comment: mail: luca.alfeo@ing.unipi.it

BackgroundDifficulty providing accurate diagnosis and prognosis, especially after mild forms of traumatic brain injury (TBI), has increased efforts to detect changes in white matter microstructure using advanced neuroimaging techniques. Although methods such as diffusion tensor imaging (DTI) have greatly increased knowledge of white matter changes resulting from TBI, several shortcomings limit the utility of these techniques particularly when applied to populations with mild TBI (mTBI) history. In vivo imaging of myelin may be particularly well suited to detect changes in white matter microstructure resulting from mTBI.ReviewThis manuscript will briefly review the animal and histological data supporting the important role of myelin following TBI, contributions and shortcomings of the use of diffusion tensor imaging (DTI) in mild TBI and the utility of multi-component relaxometry (MCR) techniques as a method for improved visualizing of white matter microstructural integrity in myelin.ConclusionThe use of MCR-based techniques has potential as a clinical and research tool to assess and track changes in myelin as well as the common behavioural changes such as slowed processing speed following TBI.

BackgroundDifficulty providing accurate diagnosis and prognosis, especially after mild forms of traumatic brain injury (TBI), has increased efforts to detect changes in white matter microstructure using advanced neuroimaging techniques. Although methods such as diffusion tensor imaging (DTI) have greatly increased knowledge of white matter changes resulting from TBI, several shortcomings limit the utility of these techniques particularly when applied to populations with mild TBI (mTBI) history. In vivo imaging of myelin may be particularly well suited to detect changes in white matter microstructure resulting from mTBI.ReviewThis manuscript will briefly review the animal and histological data supporting the important role of myelin following TBI, contributions and shortcomings of the use of diffusion tensor imaging (DTI) in mild TBI and the utility of multi-component relaxometry (MCR) techniques as a method for improved visualizing of white matter microstructural integrity in myelin.ConclusionThe use of MCR-based techniques has potential as a clinical and research tool to assess and track changes in myelin as well as the common behavioural changes such as slowed processing speed following TBI.

Rationale: The liver-specific natural killer (NK) cell population is critical for local innate immune responses, but the mechanisms that lead to their selective homing and the definition of their functionally relevance remain enigmatic. Objectives: We took advantage of the availability of healthy human liver to rigorously define the mechanisms regulating the homing of NK cells to liver and the repertoire of receptors that distinguish liver-resident NK (lr-NK) cells from circulating counterparts. Findings: Nearly 50% of the entire liver NK cell population is composed of functionally relevant CD56bright lr-NK cells that localize within hepatic sinusoids. CD56bright lr-NK cells express CD69, CCR5 and CXCR6 and this unique repertoire of chemokine receptors is functionally critical as it determines selective migration in response to the chemotactic stimuli exerted by CCL3, CCL5 and CXCL16. Here, we also show that hepatic sinusoids express CCL3pos Kupffer cells, CXCL16pos endothelial cells and CCL5pos T and NK lymphocytes. The selective presence of these chemokines in sinusoidal spaces creates a unique tissue niche for lr-CD56bright NK cells that constitutively express CCR5 and CXCR6. CD56bright lr-NK cells co-exist with CD56dim conventional NK (c-NK) cells that are, interestingly, transcriptionally and phenotypically similar to their peripheral circulating counterparts. Indeed, CD56dim c-NK cells lack expression of CD69, CCR5, and CXCR6 but express selectins, integrins and CX3CR1. Conclusion: Our findings disclosing the phenotypic and functional differences between lr-Nk cells and c-NK cells are critical to distinguish liver-specific innate immune responses. Hence, any therapeutic attempts at modifying the large population of CD56bright lr-NK cells will require modification of hepatic CCR5 and CXCR6.

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This investigation consisted of several tests of specially fabricated nickel-cadmium batteries having circular disk type electrodes. These batteries were evaluated as filter elements between a constant current power supply and a five hertz pulsed load demanding approximately twice the power supply current during the load on portion of the cycle. Short tests lasting 10,000 cycles were conducted at up to 21 C rate and an equivalent energy density of over 40 Joules per pound. In addition, two batteries were subjected to 10,000,000 charge/discharge cycles, one at a 6.5 C rate and the other at a 13 C rate. Assuming an electrode to battery weight ratio of 0.5, these tests represent an energy density of about 7 and 14 Joules per pound respectively. Energy density, efficiency, capacitance, average voltage, and available capacity were tracked during these tests.