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Head and neck squamous cell carcinoma of the (HNSCC) represents approximately 5% of malignant tumours in Italy. HNSCC are commonly treated with surgery or radiotherapy, or a combination of such therapies. The objectives of treatment are maximum cure rate balanced with organ preservation, restoration of form and function, reduction of morbidities and improvement or maintenance of the patient's quality of life. Immediate reconstructive surgery: local, regional or free flaps are now widely advised in the treatment of these patients. Microsurgical transfer requires expertise, is time and resource consuming, and as a whole requires substantial costs. These considerations introduce some concerns about the wide or indiscriminate use of free flap reconstructive surgery. When considering cost-benefit outcomes of such treatment, the main objective is undoubtedly, survival. This data is underreported in the current literature, whereas functional outcomes of free flaps have been largely diffused and accepted. This study collects data from 1178 patients treated with free flap reconstructive surgery following ablation of HNSCC in a group of Italian tertiary hospitals, all members of the HeadNeck Group affiliated with the Italian Society of Microsurgery. According to many authors, free flap surgery for HNSCC seems to be a beneficial option for treatment even in terms of survival.I tumori spinocellulari del distretto Cervico Facciale rappresentano circa il 5% dei tumori maligni in Italia. Essi sono comunemente trattati con chirurgia o radioterapia, o entrambi le terapie. La ricostruzione rappresenta un momento fondamentale della terapia nel rispetto della qualità di vita di questi pazienti. La microchirurgia ricostruttiva rappresenta la tecnica che offre i migliori risultati funzionali ma è oggetto di discussione in un rapporto costo-benefici. In questo lavoro sono raccolti ed analizzati i dati di 1178 pazienti provenienti dai membri del gruppo testa e collo, affiliato alla società Italiana di Microchirurgia, e i cui dati sono rapportati primariamente alla sopravvivenza.

Edizioni Ambiente, Bologna

Nanostructured Cu powders ranging from 3 to 4 nm in diameter have been prepared by the clustering of acetone solvated Cu atoms obtained via metal vapor synthesis (MVS). The copper nanoparticles are valuable catalytic precursors for the oxidation with molecular oxygen of a wide range of organic substrates under mild conditions and are largely more efficient than commercial Cu samples.

The paper describes the performance comparison between EGNOS system and an Augmentation & Integrity Monitoring Network (AIMN) Location Determination System (LDS) designed for train positioning in terms of PVT accuracy and integrity information. The proposed work is inserted in the scenario of introduction and application of space technologies based on the ERTMS architecture. It foresees to include the EGNOS-Galileo infrastructures in the train control system, with the aim at improving performance, enhancing safety and reducing the investments on the railways circuitry and its maintenance. The performance results will be shown, based on a campaign test acquired on a ring-shaped highway (named Grande Raccordo Anulare (GRA)) around Rome (Italy) to simulate movement of a train on a generic track.

This paper deals with high integrity systems based on a two-tiers Augmentation system architecture. The Augmentation System is based on a regional system and a local system. This work intends to define a Formal mathematical approach to improve the performance in terms of Integrity of a Local Area Augmentation and Integrity Monitoring Network. Such model is due to the stringent requirements in railways application that are described by SIL-4 (Integrity Risk < 10-9 during 1 hour). The Integrity Monitoring is performed on three different levels: Reference Station, Satellite, Constellation. For each of them the fault identification and exclusion algorithms are defined and analyzed. The novelty of this work is the integration of Local Area Augmentation Networks with single regional SBAS Systems in order to develop a 2-tiers High Accuracy and High Integrity Augmentation Systems able to reach the above Integrity requirements. At this aim the false alarm probability has been rigorously defined including 2-tiers Reference Stations fault probabilities. Simulation framework has been developed to assess both satellite and Reference Station faults and evaluate relevant 2-tier Augmentation Systems performances.

The technique of maxillectomy employing an anterior transfacial approach has practically remained unaltered since historical and suggestive descriptions of Lizars reported in 1829 and those of Fergusson reported in 1842. This procedure is suitable and efficacious for benign tumors as well as for malignant tumors which involve the inferior, anterior, medial or lateral wall of the maxillary sinus. However, when the tumor erodes the posterior wall, surrounding and destroying the pterygoid and invading the pterygo-maxillary and the infratemporal fossae, sometimes causing thrismus as a result of infiltration of the pterygoid muscles, surgical control of the posterior extension through an anterior approach is impossible. Many authors maintain that in these cases surgery is useless if not detrimental in light of the low survival rates reported. We propose a new surgical technique (a double approach--transfacial and infratemporal preauricolar) to be followed in these patients. These approaches allow us to completely surround the extension of the tumor as well as to achieve surgical radicality in T4. Moreover, with this technique it is possible to use the temporalis muscle to repair the resulting post-maxillectomy cavity thus eliminating the necessity of the obturator. From 1992 to 1994 we operated 46 patients with T3 and T4 malignant tumors of the maxillary sinus following this procedure. We had 1 death due to heart infarction 3 days after surgery. On the other hand no serious local complications were observed. There were only 7 suppurations in the temporal region, either resolved quickly and spontaneously or through simple surgical drainage. The follow-up is still too brief to allow us to draw definite conclusions. At any rate, presently 30 of our 46 patients are alive and disease free.

The UICC and AJCC never classified ethmoid malignancies prior to the latest edition (1997). Most classifications in the literature refer to a single histological type (estensioneuroblastoma or carcinoma) while others basically consider the intracranial extension, without distinguishing between intra or extradural. Still others consider invasion of the orbit. There is as yet no classification which considers all the prognostic factors associated with the extension of this neoplasm. The authors reviewed 84 patients with ethmoid malignancy who had undergone anterior cranio-facial resection between 1987 and 1994 and had been followed up for a minimum of 36 months. Of these patients, 43 were recurrences of previous treatment while 42 had not previously been treated. The breakdown was as follows: 45 adenocarcinoma, 14 squamous cell carcinoma (more or less differentiated), 8 etesioneuroblastoma, 6 adenoidocistic carcinoma, 5 melanoma and 6 rare forms. These cases were staged according to a new classification identifying the worst prognostic factors: invasion into the dura and, above all, intradural extension; invasion of the sphenoid sinus, orbit, and in particular the orbit apex, the frontal sinus, the maxillary sinus, the pterygoid, infratemporal fossa and the skin. Until 1994 we used this classification which is similar to the one proposed by the UICC in 1997. On the basis of this classification our case breakdown is as follows: T2 35, T3 24, T4 25 (there were no cases of T1). Since a patient can live as much as 4-5 years with a recurrence but the recurrences all appeared within 2 years after surgery, we used a NED survival at 36 months as index of healing. The NED survival at 36 months was: T2 54%, T3 41%, T4 8%. In patients which had not received prior treatment the NED survival was: T2 63%, T3 45%, T4 9%. The progressive worsening of prognosis from T2 to T4, particularly in patients which had not been pretreated, leads us to assume that the true prognostic factors for malignant ethmoid tumors have been identified.

Gene amplifications in the q13 band of chromosome 11 are among the most frequent genetic alterations in head and neck squamous cell carcinomas. Previous studies have suggested that such amplification is a marker of aggressive tumor evolution. Their potential for predicting subclinical lymph node invasion or disease recurrence was investigated in a prospective series of 50 oral and oropharyngeal carcinomas. Cell DNA content was also measured in 32 tumors of this series. Gene amplifications affecting the 11q13 band were detected in 11 of 50 (20%) patients, a relatively low frequency in comparison with data reported previously for other carcinomas of the upper aerodigestive tract, especially hypopharyngeal carcinomas. These gene amplifications were preferentially associated with aneuploidy. Cervical lymph nodes of 26 clinically N0 (Tumor-Node-Metastasis staging) patients were surgically explored. The frequency of 11q13 amplifications was very similar in the presence or in the absence of histological invasion, 3 of 15 (20%) and 2 of 11 (18%), respectively. Thus, 11q13 amplifications do not appear to be a reliable marker for prediction of subclinical lymph-node invasion in oral and oropharyngeal carcinomas. The detection of 11q13 amplifications was also not associated with a higher risk of disease recurrence. These data suggest that not only the prevalence but also the prognostic significance of 11q13 amplifications varies between tumors at different sites in the upper aerodigestive tract.

Between 1987 and 1994 we performed 103 anterior cranio-facial resections in patients affected by tumors involving the ethmoid, the nasal cavities and, sometimes, the orbit, the maxillary and sphenoid sinuses. The cibriform plate was always involved. The tumor invaded the frontal dura in 20 patients without intradural neoplastic vegetations. These were present in 6 cases. Ninety-one of these patients had a malignant tumor; from the histologic point of view we had 50 adenocarcinomas, 16 epidermoid carcinomas, 8 estesioneuroblastomas, 6 adenoid cystic carcinomas, 5 melanomas and 6 infrequent types. The surgical technique became simplier in the second half of our patients. Now we perform a coronal skin incision and prepare a pericranial flap without the galea and use it to reconstruct the cranial base defect without bone or alloplastic material. The frontal craniotomy is rectangular, low and made by an oscillating saw without trephine holes. The posterior section of the skull base for a typical ethmoid tumor is always on the sphenoid roof and the lateral ones on the medial third of the orbital roof, al least in the more interested side. The anterior section is on the frontal sinus floor. The osteotomies may be enlarged according to tumor extension. Our facial incision is paranasal without splitting of the upper lip, but sometimes we used wider skin incisions and osteotomies for tumors involving the maxillary sinus and palate. We had many important complications in the first half of out patients with 7 postoperative deaths but none in the second half. Fifty-five percent of the adenocarcinomas, 7% of the epidermoid carcinomas, 75% of the estesioneuroblastomas, 100% of the adenoid cystic carcinomas and 0% of the melanomas are alive and well. Forty-six patients were previously treated elsewhere and 45 were untreated. The cure rate of these two groups of patients is very different: 38.1% of the first versus 61.9% of the second ones are alive and free of disease. Our experience proves that every transfacial or transnasal resection of an ethmoidal tumor involving the cribriform plate must be avoided.

This paper presents an innovative global navigation satellite system (GNSS) fault detection and exclusion approach for the adoption of satellite localization in the rail sector. Current global integrity monitoring systems cannot guarantee the safety level needed for such applications as train control where tolerable hazard rate in the order of 10−9/h is required. A new method, named two tiers, enabling to integrate local augmentation systems and global augmentation infrastructures, is presented. It is based on the comparison of single differences residuals among satellites for detecting signal in space (SIS) faults and double difference residuals among local augmentation stations and satellite-based augmentation systems ranging and integrity monitoring stations for detecting reference stations faults. GPS SIS faults described in literature and real GNSS raw data recorded on a train are taken into account. This study reports the performance analysis for the two-tiers approach carried out during relevant European projects. A test-bed architecture has been developed through the implementation of the algorithm in real time on a local augmentation operational center. Relevant performances have been tested on a rail track for validating the algorithm in real operative conditions. Significant results of the analysis are reported for SIS integrity assessment only.

ENC 2020, 28th European Navigation Conference, Dresden , ALLEMAGNE, 23-/11/2020 - 24/11/2020; The work shows the high level concept and methodology followed for designing a geo-distributed simulation and verification infrastructure connecting remotely GNSS excellence centres and ERTMS/ETCS laboratories to evaluate the GNSS performances in the railway environment. Proper methodology and tools are adopted to simulate GNSS behaviour in different railway scenarios in nominal or in presence of global and local hazards. Particularly, the test-bed main goals are: i) achieving a realistic characterization of the environment in terms of railway and GNSS infrastructures able to evaluate the performances and properties of some fail-safe train positioning components in nominal and fault conditions; ii) defining a common test process framework for zero on-site testing instead of testing on-site saving effort and time. The test-bed offers the unique advantage to stress the global system in presence of very rare GNSS fault events instead of performing long and expensive measurement campaigns on field for detecting them and analysing their impact on ETCS. The work will show its description and the methodology adopted for its design and implementation.

In the last years, several studies have addressed the introduction of the GNSS technology in the framework of the high integrity positioning methods for the land transportation. The main emphasis has been spent for the rail environment. The main driver is the possibility to realize cost effective solution for the modernization of the lines without losses in terms of safety. Furthermore, the rail community have recognized GNSS as one of the step charge innovation foreseen in the next generation train control systems. In the recent period, there has been some attempts to exploit the outcome of such studies even in the driverless car applications. As a matter of fact, these two transportation means share the same electromagnetical environment and both of them are subjected to constrained movement profile. Since one of the most important KI in the safety related application is represented by the integrity, we considered the presence of an external augmentation and integrity monitoring network. Particularly, we considered three different approaches for augmenting the PVT solution that are respectively the local area augmentation network, the wide area augmentation network and the 2-tiers augmentation schemes. For all these schemes we carried out the SWOT analysis considering the peculiarities of the application. On the basis of the SWOT, the system integrator can decide to implement the network that better suit its own requirement. In or vision, the best solution is to share a unique augmentation network for both rail and connected cars. In this way it is possible to increase the number of user served by the network itself.

Hybrid devices employing organic semiconductors interfaced with an aqueous solution represent a new frontier in bioelectronics and energy applications. Understanding of the energetics and photoinduced processes occurring at the organic/water interface is fundamental for further progress. Here, we investigate the interfacial electronic structure of poly-3-hexylthiophene (P3HT) sandwiched between an indium tin oxide (ITO) electrode and a liquid water electrolyte. The aqueous solution is found to polarize the polymer outermost layers, which together with the polymer p-(photo) doping by dissolved oxygen localizes photogenerated electrons at the P3HT/water interface, while holes can be transferred to the ITO electrode. Under illumination, the polymer/water interface is negatively charged, attracting positive ions from the electrolyte solution and perturbing the ion distribution in the aqueous solution. The observed mechanism is of general character and could underlie the behavior of a variety of devices characterized by an organic/water interface, such as prosthetic devices for artificial vision and organic-based systems for photoelectrochemical applications.

This paper deals with the introduction of the satellite navigation into the train control system. That topic has been widely investigated in this last years. To meet the stringent requirements imposed by the railway community the use of an external augmentation and integrity monitoring network is highly recommended. The exploitation of the data acquired by the reference stations can be performed by using a differential approach or by using a double difference approach. In this contribution, we have performed a comparison between these two approaches in the railway domain in terms of both complexity and performances. We made use of real data acquired on field to compare the results achievable with the two techniques and we carried out the SWOT analysis for both of them.