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Background and Objectives: Axillary lymph node (ALN) staging is crucial for the management of invasive breast cancer (BC). Although various radiological investigations are available, ultrasound (US) is the preferred tool for evaluating ALNs. Despite its immediacy, widespread use, and good predictive value, US is limited by intra- and inter-operator variability. This study aims to evaluate US and Elastosonography Shear Wave (SW-ES) parameters for ALN staging to develop a predictive model, named the Cassandra score (CS), to improve the interpretation of findings and standardize staging. Materials and Methods: Sixty-three women diagnosed with BC and treated at two Italian hospitals were enrolled in the study. A total of 529 lymph nodes were surgically removed, underwent intraoperative US examination, and were individually sent for a final histological analysis. The study aimed to establish a direct correlation between eight US-SWES features (margins, vascularity, roundness index (RI), loss of hilum fat, cortical thickness, shear-wave elastography hardness (SWEH), peripheral infiltration (PI), and hypoechoic appearance) and the histological outcome (benign vs. malignant). Results: Several statistical models were compared. PI was strongly correlated with malignant ALNs. An ROC analysis for Model A revealed an impressive AUC of 0.978 (S.E. = 0.007, p < 0.001), while in Model B, the cut-offs of SWEH and RI were modified to minimize the risk of false negatives (AUC of 0.973, S.E. = 0.009, p < 0.001). Model C used the same cut-offs as Model B, but excluded SWEH from the formula, to make the Cassandra model usable even if the US machine does not have SW-ES capability (AUC of 0.940, S.E. = 0.015, p < 0.001). A two-tiered model was finally set up, leveraging the strong predictive capabilities of SWEH and RI. In the first tier, only SWES and RI were evaluated: a positive result was predicted if both hardness and roundness were present (SWES > 137 kPa and RI < 1.55), and conversely, a negative result was predicted if both were absent (SWES < 137 kPa and RI > 1.55). In the second tier, if there was a mix of the results (SWES > 137 kPa and RI > 1.55 or SWES < 137 kPa and RI < 1.55), the algorithm in Model B was applied. The model demonstrated an overall prediction accuracy of 90.2% in the training set, 87.5% in the validation set, and 88.9% across the entire dataset. The NPV was notably high at 99.2% in the validation set. This model was named the Cassandra score (CS) and is proposed for the clinical management of BC patients. Conclusion: CS is a simple, non-invasive, fast, and reliable method that showed a PPV of 99.1% in the malignancy prediction of ALNs, potentially being also well suited for young sonographers. [ABSTRACT FROM AUTHOR]

Background: Breast localization plays a key role in early breast cancer (BC) surgery. The current gold standard is wire-guided localization (WGL), despite the known disadvantages. The patients often experience anxiety and discomfort due the metallic wire placed in the breast, and surgeons are compelled to perform the surgery on the same day as the radiological release of the wire to prevent migrations or breakages. Various wireless systems have been proposed as alternative to WGL. LOCalizerTM offers the advantage of providing the exact distance from the marker called Tag. The combined technique using LOCalizerTM and US allows for determining the distance from the BC margin, a critical surgical goal for oncological radicality. Methods: Patients referred for breast surgery to two Italian hospitals were enrolled and divided into two groups: Group A, including patients undergoing a combined approach, and group B, including patients treated with conventional WGL. Results: The combined approach with LOCalizerTM and US was associated with better outcomes in terms of oncological radicality, cosmetic results, and patients' satisfaction. Conclusions: In the current study, LOCalizerTM associated with US could be considered an excellent approach for localizing non-palpable BC. Further larger comparative studies are needed to address this issue. [ABSTRACT FROM AUTHOR]

Biomass gasification is a thermochemical process that produces a gaseous end product known as syngas, the main components of which are CO, CO2, and H2. Starting from syngas it is possible to upgrade this mixture into Synthetic Natural Gas (SNG) through a catalytic methanation process. In this work, a thermodynamic study was conducted to see how operative parameters such as the temperature of the methanation reactor, the quality of the syngas (related to different gasification technologies), and the presence of a conditioning stage based on water gas shift reaction, can influence the output variables as the conversion degree of the reactants, the mass yield and the low heating value of the final products. [ABSTRACT FROM AUTHOR]

Breast angiosarcoma is a rare malignancy, accounting for less than 1% of all soft tissue cancers. It comprises primitive and secondary subtypes, such as radiogenic breast angiosarcoma (RAS). Despite multimodal treatment, angiosarcomas represent an incurable disease for many patients and a significant cause of deterioration in their quality of life. Surgery is a cornerstone in management, but high recurrence rates are reported. Electrochemotherapy (ECT) is a practicable locoregional treatment for patients with advanced angiosarcoma as part of a multimodal therapeutic strategy. The palliative benefits of ECT include optimal patient compliance, good local hemostasis control, and positive local responses. Since only 22 cases are described in the literature, we reported a rare case of RAS treated with ECT after a multidisciplinary approach, including Next Generation Sequencing (NGS). A literature review on the feasibility of ECT in RAS management was also performed. [ABSTRACT FROM AUTHOR]

This work proposes an innovative method, based on the use of low-cost infrared thermography (IRT) instrumentation, to assess in real time the effectiveness of scoliosis braces. Establishing the effectiveness of scoliosis braces means deciding whether the pressure exerted by the brace on the patient's back is adequate for the intended therapeutic purpose. Traditionally, the evaluation of brace effectiveness relies on empirical, qualitative assessments carried out by orthopedists during routine follow-up examinations. Hence, it heavily depends on the expertise of the orthopedists involved. In the state of the art, the only objective methods used to confirm orthopedists' opinions are based on the evaluation of how scoliosis progresses over time, often exposing people to ionizing radiation. To address these limitations, the method proposed in this work aims to provide a real-time, objective assessment of the effectiveness of scoliosis braces in a non-harmful way. This is achieved by exploiting the thermoelastic effect and correlating temperature changes on the patient's back with the mechanical pressure exerted by the braces. A system based on this method is implemented and then validated through an experimental study on 21 patients conducted at an accredited orthopedic center. The experimental results demonstrate a classification accuracy slightly below 70% in discriminating between adequate and inadequate pressure, which is an encouraging result for further advancement in view of the clinical use of such systems in orthopedic centers. [ABSTRACT FROM AUTHOR]

Background: Bleeding is one of the most fearsome and life-threatening complications after thyroid surgery. Several medical devices and haemostatic agents have been proposed to improve haemostasis during total and hemi-thyroidectomy. Resorbable polysaccharide powder (HaemoCer™) is a plant-based polymer that is helpful in terms of the coagulation cascade becoming a gel and forming a barrier to prevent further bleeding, having tested for haemostasis in different districts. The aim of the current study was the evaluation of drain output, the presence of significant postoperative blood loss and complications in patients treated with or without resorbable polysaccharide powder during thyroid surgery. Methods: From January to December 2022, postoperative bleeding, drainage output and the postoperative wound events of patients undergoing thyroid surgery, in a tertiary centre, with haemostasis completion with resorbable polysaccharide powder (Group A) or not (Group B), were retrospectively analysed. Results: Eighty-one patients in Group A received a haemostasis improvement with the use of reabsorbable polysaccharide powder, and 96 patients in Group B received thyroid surgery alone. Patients in Group A presented lower drainage output (0.005), lower incidence of neck haematoma (0.005) and seroma (0.021), confirmed also by multivariate analysis. Conclusions: The resorbable polysaccharide powder, in the current series, appeared to be an effective agent in achieving haemostasis in thyroidectomies, reducing the postoperative drainage output, and also neck events such as neck haematoma and seroma, improving the postoperative comfort of the patients. Further larger comparative studies are needed to address this issue. [ABSTRACT FROM AUTHOR]

Breast conservative surgery is the primary therapeutic choice for non-aggressive early breast cancers, and a minimally-invasive approach is strongly recommended. The breast localization represents a modern challenge for surgery. Wire-guided localization is still the gold standard technique, but new wireless systems have been proposed, such as radiofrequency identification with LOCalizerTM (Hologic, Santa Carla, CA, USA), which reports encouraging results. The current study aimed to evaluate the accuracy and efficacy of the combined use of LOCalizerTM and ultrasound compared with the results obtained using LOCalizerTM alone for the detection of non-palpable breast cancer. Ninety-six patients who were candidates for breast localization were enrolled. Group A received a combined localization with LOCalizerTM and US, while group B underwent only LOCalizerTM identification. Oncological radicality was reached in 100% of the patients in Group A and in 89.2% of the patients in Group B, with p = 0.006. The mean specimens' volume was 13.2 ± 0.6 cm3 for Group A and 16.1 ± 1.4 cm3 for Group B, while mean specimen weights were 21.8 ± 2.2 and 24.4 ± 1.8 g, respectively (p = 0.003 and p = 0.004, respectively). LOCalizerTM with ultrasound, in the current series, has resulted in the preferred option for the localization of non-palpable breast cancer, allowing limited resection (in weight and volume), guaranteeing excellent oncological outcomes, and great satisfaction for patients and physicians. [ABSTRACT FROM AUTHOR]

The paper reflects possible "transition" strategies for the industrialised residential building stock considering its systemic nature and current technological availability, with particular reference to digital technologies. Screening of some research on housing in the context of ecological and digital transition is proposed, starting from a critical review of interventions over the past decades, which reveal a fragmented framework of punctual solutions that cannot be codified as organic and replicable strategies. This highlights the research world's focus on broader holistic approaches that look at energy transition as closely related to the transition of the entire building organism and the inhabiting community. [ABSTRACT FROM AUTHOR]

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) were initially developed for the treatment of diabetes due to their antihyperglycemic activity. However, in the light of the most recent clinical studies, they are revolutionizing the approach to cardiovascular disease in patients with and without diabetes. We aimed to generate real-world data about the use of SGLT2i in patients with T2DM and coronary artery disease (CAD), focusing on their effectiveness in glycemic control, adherence, long-term efficacy, and safety outcomes. On the basis of the inclusion and exclusion criteria, 143 patients were enrolled. Patients were treated with canagliflozin (n = 33 patients; 23%), dapagliflozin (n = 52 patients, 36.4%), empagliflozin (n = 48 patients; 33.6%), or ertugliflozin (n = 10 patients; 7%) as monotherapy or in combination with other antidiabetic drugs. All patients performed a clinical visit, and their medical history, blood sampling, and anthropometric parameters were measured at discharge and at 1-year follow-up. The reduction in HbA1c % value at 12 months was significant (8.2 vs. 7.4; p < 0.001). Trends in body weight and body mass index also confirmed the positive effect of the treatment (p < 0.0001), as did the reduction in abdominal adiposity (expressed via waist circumference). At 1-year follow-up, 74.1% of patients were adherent to the treatment, and 81.1% were persistent to the treatment. A total of 27 patients (18.8%) had to discontinue treatment early due to drug intolerance caused by genitourinary infections (11.9%), the drub being permanently ineffective (HbA1c not at target or decreasing: 4.9%), or because of expressing. a desire not to continue (2%). No major drug-related adverse events (diabetic ketoacidosis, Fournier's gangrene, lower-limb amputations) occurred at follow-up, while MACE events occurred in 14 patients (9.8%). In real-world patients with T2DM and CAD, SGLT2i have been effective in long-term glycemic control and the improvement in anthropometric indices with good tolerance, high adherence, persistence to treatment, and no major adverse events at 1-year follow-up. [ABSTRACT FROM AUTHOR]

In 2020, European countries generated 807 mln tons of construction and demolition waste (CDW), accounting for 37.5% of total waste production. The UE Waste Framework Directive of 2008 established as a priority goal to increase the percentage of reuse, recycling and recovery of nonhazardous construction waste to a minimum of 70% by 2020. Pending the report that will define compliance with this goal, the average percentage currently stands at around 50%, of which only 3% involves upcycling operations. This doctoral research defines an operational methodology aimed at implementing digital processes for circularity in the AEC sector, with a focus on post-earthquake emergency Italian contexts. The treatment of CDW in earthquake-affected areas for the purpose of recovery/reuse, in a perspective of circularity, represents an underexplored field and limited, as in the rest of UE, to downcycling operations. By defining planning strategies and digital tools and procedures, the research aims to facilitate the reuse of building elements from post-earthquake demolition and reconstruction operations. The final output of the research consists of a cloud database, a Digital Material Bank (DMB), of informed building elements from post-earthquake selective demolition operations that can be reused in the construction market as a secondary raw material. The CDW management of the 2016 Central Italy earthquake is identified as the scope of application, with a focus on the situation in the Marche region. Finally, the main limitations and possible future scenarios of the research are reported. [ABSTRACT FROM AUTHOR]

Indeterminate follicular thyroid lesions (Thyr 3A and 3B) account for 10% to 30% of all cytopathologic diagnoses, and their unpredictable behavior represents a hard clinical challenge. The possibility to preoperatively predict malignancy is largely advocated to establish a tailored surgery, preventing diagnostic thyroidectomy. We analyzed the role of the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR) and the lymphocyte-to-monocyte ratio (LMR) as prognostic factors of malignancy for indeterminate thyroid nodules. In patients affected by cytological Thyr 3A/3B nodules, NLR, PLR and LMR were retrospectively compared and correlated with definitive pathology malignancy, utilizing student's t-test, ROC analysis and logistic regression. One-hundred and thirty-eight patients presented a Thyr 3A and 215 patients presented a Thyr 3B. After the logistic regression, in Thyr 3A, none of the variables were able to predict malignancy. In Thyr 3B, NLR prognosticated thyroid cancer with an AUC value of 0.685 (p < 0.0001) and a cut-off of 2.202. The NLR results were also similar when considering the overall cohort. The use of cytological risk stratification in addressing the management of indeterminate thyroid nodules in patients is not always reliable. NLR is an easy and reproducible inflammatory biomarker capable of improving the accuracy of preoperative prognostication of malignancy. [ABSTRACT FROM AUTHOR]

Introduction: The mesenchymal-epithelial transition factor (c-MET) receptor is overexpressed in about 14–54% of invasive breast cancers, but its prognostic value in clinical practice is still unclear. Methods: In order to investigate the relationship between c-MET expression levels and prognosis, we retrospectively reviewed the clinical features and outcomes of 105 women with estrogen receptor positive HER2 negative (ER+/HER2-) resected breast cancer. We used the Kaplan Meier method to estimate Disease Free Survival (DFS) and Breast Cancer Specific Survival (BCSS) in the subgroups of patients with high (≥50%) and low (<50%) c-MET expression. Univariate and multivariate Cox proportional regression models were performed to assess the prognostic impact of clinicopathological parameters for DFS an BCSS. Results: High c-MET values significantly correlated with tumor size, high Ki67 and low (<20%) progesterone receptor expression. At a median follow up of 60 months, patients with high c-MET tumor had significantly worse (p = 0.00026) and BCSS (p = 0.0013). Univariate analysis showed a significant association between large tumor size, elevated Ki67, c-MET values and increased risk of recurrence or death. The multivariate COX regression model showed that tumor size and high c-MET expression were independent predictors of DFS (p = 0.019 and p = 0.022). Moreover, large tumor size was associated with significantly higher risk of cancer related death at multivariate analysis (p = 0.017), while a trend towards a poorer survival was registered in the high c-MET levels cohort (p = 0.084). Conclusions: In our series, high c-MET expression correlated with poor survival outcomes. Further studies are warranted to validate the clinical relevance and applicability of c-MET as a prognostic factor in ER+/HER2- early BC. [ABSTRACT FROM AUTHOR]

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Background: Wire-guided localization is the gold-standard for the detection of non-palpable breast lesions, although with acknowledged limitations. The aim of this study was to evaluate the combined use of LOCalizerr™ (Hologic, Santa Carla, CA, USA), and intraoperative ultrasound (IOUS) for localization and surgery of nonpalpable breast cancer. Patients and Methods: Patients with non-palpable breast lesions underwent localization procedure with LOCalizer™ and IOUS. After the placement of the marker, eight measures were made to guide the excision. LOCalizerr™ Pencil and IOUS were performed to obtain the distance between the dissection plane and the margins of lesions. Results: The procedure was feasible in the five enrolled patients and associated with clear oncological margins in all cases. Moreover, a high satisfaction according to Likert scale for surgeons, radiologists and patients, performing limited and tailored resections, was reported. Conclusion: Combining LOCalizerr™ and IOUS is an effective method for locating non-palpable breast cancer, guarantying excellent oncological and cosmetic results. [ABSTRACT FROM AUTHOR]

Backgrounds. One of the major complications after laparoscopic sleeve gastrectomy (LSG) is represented by leaks along the staple line. Several reinforcement techniques have been proposed, but scarce data about the real strengthening offered are present. Thus, we aimed to evaluate if different reinforcements produced different bursting pressures after LSG, and then to verify if the clinical application of the stronger reinforcement produced a reduction in leakage rate. Methods. We prospectively enrolled all consecutive obese patients that underwent LSG. We tested 3 different types of staple lines, as follows: group 1, no reinforcement; group 2, bioabsorbable buttress reinforcement; group 3, invaginating overrunning barbed suture. A burst pressure test was applied to the gastric specimen by means of high-resolution manometric catheter. After burst pressure tests, a subsequent consecutive series of patients were treated with the most effective reinforcement, and rate of leaks was recorded. Results. We enrolled in total 110 obese patients; 20 patients for each group of staple line reinforcement and then other 50 consecutive patients underwent LSG with the higher burst pressure staple line reinforcement. Median burst pressures were similar in group 1 and group 2; group 3 showed a statistically significant pressure increase (P <.0001) than group 1 and group 2, with a 5.2-fold value. Other consecutive 50 obese patients underwent LSG with overrunning reinforcement. In none of them a leak was detected. Conclusions. Reinforcement of the SG staple line, with overrunning suture, seems to drastically increase bursting pressures in an ex vivo model and it is promising when reproduced in vivo. [ABSTRACT FROM AUTHOR]

What Mario Carpo defines as “the second digital turn” (Carpo 2017) represents for architecture an irreversible process meant to modify many consolidated rules in the professional practice. Without upgrading his methods and points of view, education in architecture turns out to be inappropriate for future scenarios, both in terms of content and methods. In this regard, in 2018 the School of Architecture and Design “Eduardo Vittoria” (SAAD) of the University of Camerino launched an experimental educational programme focused on: a) “digital fabrication” as a building strategy; b) the SAADLab# Prototype (the SAAD fab-lab) as fulcrum of an innovative workshop in the field of building construction. The paper presents the result of the 2018/19 workshop concerning a temporary settlement for students made with customised building systems. [ABSTRACT FROM AUTHOR]

• Percutaneous dilatation tracheotomy enables non-surgeons to perform tracheotomies at patients bedside. • Bleeding is a common complication of percutaneous dilatation tracheotomies. • Performing a pre-operative neck ultrasound can help identifying aberrant vessels and reduce the risk of periprocedural bleeding. Percutaneous dilatation tracheotomy (PDT) is a relatively recent technique that enables non surgeons to perform tracheotomies at bedside reducing operation rooms schedules. It is burdened by a moderate risk of postoperative bleeding. The patient was a 57 years old with a temporal intraparenchymal hematoma, submitted to percutaneous dilatation tracheotomy. Despite the favorable anatomical features, a pre-procedural US was performed, identifying a pulsating vessel with an arterial pattern, 2 cm above the hollow. The procedure was then considered at high risk, an operation room was required for the technique and an on-call surgeon was alerted. The procedure was ended safely and any bleeding was avoided because the technique was practiced with the best precautions. PDT strength is the possibility for non surgeons to perform tracheotomies in selected patients at bedside, reducing operation rooms congestion. Such technique though is a "blind" technique, and postoperative bleedings can occur and represent a feared complication. Conversely, the surgical tracheotomy permits a better control of hemorrhages, but needs the involvement of a surgeon and availability of an operation room. Performing a PDT guided by a neck ultrasound is useful to identify eventual aberrant vessel whose course could complicate the tracheotomy, it is part of PDT guidelines of some States. US-PDT could help reducing procedure related complications selecting those high risk patients still in need of operating room and surgical assistance. US-PDT feasibility combined to its easy availability and low costs encourage its introduction into everyday practice. [ABSTRACT FROM AUTHOR]

• Gastric perforation caused by intragastric balloon represents a rare but life-threatening complication. • There is a lack of information about perforation in the same day of surgery. • An endoscopic and laparoscopic approach with a gastric wedge resection was performed. IGB (Intragastric Balloon) is acknowledged to be a safe and secure device, whose outcomes in terms of weight loss are widely discussed. Bariatric community has soon noted tolerance and benefit of this tool, considered a first and easy step before bariatric surgery. Nevertheless, some authors have described a series of complications that, although rare, could be life threatening and hard to manage, as a gastric perforation. We reported a case of a 55-year-old obese woman, undergone placement of IGB device heisting in a gastric perforation. In the same day of surgery, we performed an emergency, applying a combined endoscopic and laparoscopic approach, to remove the balloon and to close perforation by a gastric resection. Discussion. Short term outcome was satisfactory, and the patient had a successful further follow up and weight loss. IGB is a valuable tool among bariatric procedure, nevertheless the surgeon has to consider the possible and life-threatening complications and to provide a multidisciplinary equip to face this occurrence. [ABSTRACT FROM AUTHOR]

Cancers of unknown primary (CUPs) are a heterogeneous group of tumors characterized by a difficult diagnosis. The primitive tumor remains unknown, whereas metastases are the most common manifestation. Occult male breast cancers are very rare types of CUPs. The present study describes the case of a 64-year-old man affected by a CUP of presumed mammary origin. The aim of the article and the present review was to focus on their management. To the best of our knowledge, only thirteen cases have been reported in the literature. Because no specific guidelines are available, various approaches have been applied, influencing the treatment and the prognosis of patients with CUP. [ABSTRACT FROM AUTHOR]

Horseshoe kidney (HSK) is the most common renal fusion anomaly. It frequently consists of kidney fusion in the lower pole across the midline and occurs during embryogenesis. The incidence of malignancies in HSKs can be 3–4 times higher than that in normal kidneys. A 69-year-old man with a voluminous right kidney neoplasm in HSK and a single omolateral axillary lymphadenopathy underwent complete excision of right axillary lymphadenopathy and ultrasound-guided percutaneous biopsy of the right kidney expansive lesion. The diagnosis of non-Hodgkin's B cell lymphoma both in HSK and right axilla was made. We report this case to raise awareness among physicians regarding the importance of a correct clinical evaluation and diagnostic workup so as to avoid surgery, which is not easy and without complications, in patients with this kidney anomaly. Primary renal lymphoma should also be included among possible neoplasms of HSK. Renal biopsy should always be recommended in cases where atypical findings are obtained from imaging techniques and when its outcome can impact clinical decision-making. In the present case, biopsy was performed, and thus, nephrectomy was avoided and specific medical therapy was quickly started. [ABSTRACT FROM AUTHOR]

The paper presents the ongoing results of a design research carried out at the School of Architecture and Design ”Eduardo Vittoria” of Ascoli Piceno (SAAD) of the University of Camerino. The specific objective of the research is to develop an innovative and replicable design methodology, and to experiment new design strategies devoted to the sustainable, compatible and innovative re-construction after natural disasters in rural areas and low density urban systems. The research is based on a “local-to-global” approach: it refers to Italy as a case study but it aims to achieve general results applicable in different geographical contexts. The specific case study relates to the earthquake that in 2016/2017 affected a significant area of Central Italy and that strongly hit a large part of the so called “Italian village system”, i.e. a peculiar environmental and productive urban system that is still now in real emergency. As in most of the international reconstruction experiences, this reconstruction will certainly require a long process which, still today, is full of unknowns. The massive damage caused by this disastrous event, the constraints imposed by regulations and the need for an adaptation of the building stock to the current housing standards, exclude the possibility of applying design strategies focused on a “where it was/as it was” model. This awareness, which increases the uncertainty about the future of the ”earthquake” communities, requires an innovative approach in relation to apparently incompatible aspects: the preservation of the identity of lost places and the upgrade of building performance often explicitly required by the population and however connected to a new housing demand. In relation to worldwide territories with a high level of disaster risk, this scenario can nowadays be considered a global issue which concerns both cultural and technical aspects. The design methodology pursued is based on a scientific approach to re-construction that focuses on a “systemic” and “design to build” approach that concerns also productive and technological aspects in relation to purposes of low-cost performance, constructive simplicity, cost-effectiveness of the interventions. This approach aims also at the introduction of lightweight building system in contexts of traditional and massive construction, according to an idea of a construction site as an “assembly point” of prefabricated parts, light and modular, with a controlled life-cycle. [ABSTRACT FROM AUTHOR]

The paper aims to provide food for thought about the declination of the executive design in the context of digital construction processes. To this end, the paper illustrates the first results of a constructive experimentation under way, carried out in the framework of an international research involving the "Eduardo Vittoria" School of Architecture and Design of Ascoli Piceno of the University of Camerino and two Japanese universities (Keio University and Kokushikan University). The experience of "digital construction" of an experimental module, result of the first research step, demonstrates how the digitalization of construction processes implies a re-coding of current design practices. Particularly in the digital construction culture, the variables related to materials and to construction and operational systems of Architecture come into play right from the early design phases. Consequence of this approach is the assumption of a new strategic dimension (as well as instrumental) of the executive design. [ABSTRACT FROM AUTHOR]

In this work we prove the consistency of an estimator for a stochastic damping Hamiltonian system considering that both position and velocity are observed. Next we perform some simulations, including the case when only position is available, to see how the estimators work numerically and then compare the obtained results with those obtained by other authors. [ABSTRACT FROM AUTHOR]

Background: Hemostasis during thyroidectomy is essential; however, the safest, most efficient, and most cost-effective way to achieve this is unclear. This randomized, multicenter, single-blind, prospective study evaluated the efficacy and safety of using different hemostatic approaches in patients undergoing total thyroidectomy.Methods: Patients aged ≥18 to 70 years were randomized to Floseal + a harmonic scalpel (HS), Floseal alone, HS alone, or standard total thyroidectomy. Primary endpoint was 24-hour drain output. Secondary endpoints included surgery duration and complications.Results: Two hundred and six patients were randomized to Floseal + HS (n = 52), Floseal alone (n = 54), HS alone (n = 50), and standard total thyroidectomy (n = 50). The 24-hour drain output was lower in the Floseal + HS group compared with standard thyroidectomy. Floseal + HS also had a shorter surgery time (P < .0001) versus the other 3 treatments.Conclusion: Floseal + HS can be effective at reducing postsurgical drain output and provides a complementary hemostatic approach in patients undergoing total thyroidectomy. [ABSTRACT FROM AUTHOR]

Background: Studies have previously shown laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients. The aim of the current study was to evaluate patients receiving laparoscopic antireflux surgery before and after 65 years of age and to assess their surgical outcomes and improvements in long term quality of life. Methods: Patients were given a standardized symptoms questionnaire and the Short-Form 36 Health Survey for quality-of-life evaluation before and after laparoscopic total fundoplication. Results: Forty-nine patients older than 65 years of age were defined as the elderly group (EG) whereas the remaining 262 younger than 65 years of age were defined as the young group (YG). There were 114 (36.6%) patients who filled out the SF36 questionnaire (98 in the younger group, rate: 37.4%; 16 in the elderly group, rate: 32.6%) pre- and post-operatively. There was no significant difference between the two age groups regarding preoperative PCS ( 45.6 ± 7.8 in YG vs. 44.2 ± 8.2 in EG; P = 0.51) and MCS ( 48.1 ± 10.7 in YG vs. 46.9 ± 9.2 in EG; P = 0.67). There was no significant difference between the two age groups regarding postoperative PCS (49.8 ± 11.9 in YG and 48.2 ± 9.5 in EG ; P = 0.61 and MCS (48.4 ± 10.7 in YG vs. 50.1 ± 6.9 in EG; P = 0.54). Conclusions: In conclusion, laparoscopic total fundoplication is a safe and effective surgical treatment for gastroesophageal reflux disease generally warranting low morbidity and mortality rates and a significant improvement of symptoms comparable. An improved long-term quality of life is warranted even in the elderly. [ABSTRACT FROM AUTHOR]

Il paper testimonia l'attività di ricerca sperimentale che l'Unità di Ricerca CHED (Concept House and Enviromental Design) svolge da alcuni anni presso la Scuola di Architettura e Design "Eduardo Vittoria" di Ascoli Piceno intorno alla tematica del Social Housing. Il CHED è una struttura temporanea di ricerca che si propone di far convergere saperi, culture, competenze e specialismi differenti verso un metodo di indagine teorica e concettuale e di sperimentazione progettuale e costruttiva nel campo dell'innovazione del costruire per un abitare sostenibile. In particolare l'esperienza che verrà sinteticamente ripercorsa riguarda una sperimentazione progettuale, svolta tra il 2010 ed il 2011, fuori dal contesto marchigiano, in accordo con l'Assessorato all'Edilizia e al Centro Storico del Comune di Napoli, riguardante la rigenerazione architettonica ed ambientale del quartiere residenziale di Selva Cafaro a San Pietro a Patierno (Na). [ABSTRACT FROM AUTHOR]

Objective: Non-invasive testing often does not identify coronary artery disease (CAD) in diabetic subjects. This study was designed in order to examine the prevalence of CAD in a cohort of asymptomatic type 2 diabetic patients at high cardiovascular risk and negative nuclear imaging, using multi-slice computed tomography (MSCT) angiography.Methods: In total, 770 type 2 diabetic patients were screened from January 2008 through July 2010. Of these, 132 Caucasians with diabetic nephropathy and asymptomatic for angina were eligible for a cross-sectional study. Patients underwent MSCT after ischaemia was excluded by myocardial Single Photon Emission Computed Tomography (SPECT) at rest and after dynamic exercise. When obstructive plaques were found (≥50% lumen narrowing), patients were sent to conventional coronary angiography (CCA).Results: Six subjects were not included in the analysis because of motion artefacts. MSCT was positive for CAD in 114 patients (90%). Within patients with positive MSCT, 60 (48% of all) showed one or more obstructive plaques. CCA confirmed significant stenosis (≥50%) in 48 of these 60 patients (80%). Some 21 (35%) showed stenosis ≥75% and were submitted to the revascularisation procedure.Conclusion: MSCT seems to better identify CAD than myocardial SPECT in asymptomatic patients with type 2 diabetes and diabetic nephropathy. [ABSTRACT FROM PUBLISHER]

Total thyroidectomy is very common in endocrine surgery and the haemostasis can be obtained in different ways across surgery; recently, some devices have been developed to support this surgical phase. In this paper, a health technology assessment is conducted through the define, measure, analyse, improve, and control cycle of the Six Sigma methodology to compare traditional total thyroidectomy with the surgical operation performed through a new device in an overall population of 104 patients. Length of hospital stay, drain output, and time for surgery were considered the critical to qualities in order to compare the surgical approaches which can be considered equal regarding the organizational, ethical, and security impact. Statistical tests (Kolmogorov–Smirnov, t test, ANOVA, Mann–Whitney, and Kruskal–Wallis tests) and visual management diagrams were employed to compare the approaches, but no statistically significant difference was found between them. Considering these results, this study shows that the introduction of the device to perform total thyroidectomy does not guarantee appreciable clinical advantages. A cost analysis to quantify the economic impact of the device into the practice could be a future development. Healthy policy leaders and clinicians who are requested to make decisions regarding the supply of biomedical technologies could benefit from this research. [ABSTRACT FROM AUTHOR]