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Robotic surgery has recently been used for treatment of renal cell carcinoma (RCC) and neoplastic thrombus located in the renal vein or inferior vena cava (IVC). Accurate identification of the thrombus location is crucial, and three-dimensional augmented reality (3D AR) may be valuable in achieving this. We enrolled patients with nonmetastatic RCC and level 0–I venous thrombus (Mayo Clinic classification) for robot-assisted radical nephrectomy and thrombectomy with 3D AR guidance. Five patients were prospectively enrolled; three had a level 0 thrombus and two had a level I thrombus. The mean operative time was 123 ± 15 min, mean IVC clamping time was 9.4 ± 6.8 min, and mean estimated blood loss was 750 ± 150 ml. The AR system allowed precise estimation of the thrombus location in all cases. No intraoperative complications or postoperative Clavien-Dindo grade >2 complications occurred. Use of 3D AR guidance allowed correct estimation of the limits of the thrombus and guided the surgeon in selecting an appropriate surgical strategy.

Objective: To evaluate the accuracy of our new three-dimensional (3D) automatic augmented reality (AAR) system guided by artificial intelligence in the identification of tumour's location at the level of the preserved neurovascular bundle (NVB) at the end of the extirpative phase of nerve-sparing robot-assisted radical prostatectomy. Methods: In this prospective study, we enrolled patients with prostate cancer (clinical stages cT1c–3, cN0, and cM0) with a positive index lesion at target biopsy, suspicious for capsular contact or extracapsular extension at preoperative multiparametric magnetic resonance imaging. Patients underwent robot-assisted radical prostatectomy at San Luigi Gonzaga Hospital (Orbassano, Turin, Italy), from December 2020 to December 2021. At the end of extirpative phase, thanks to our new AAR artificial intelligence driven system, the virtual prostate 3D model allowed to identify the tumour's location at the level of the preserved NVB and to perform a selective excisional biopsy, sparing the remaining portion of the bundle. Perioperative and postoperative data were evaluated, especially focusing on the positive surgical margin (PSM) rates, potency, continence recovery, and biochemical recurrence. Results: Thirty-four patients were enrolled. In 15 (44.1%) cases, the target lesion was in contact with the prostatic capsule at multiparametric magnetic resonance imaging (Wheeler grade L2) while in 19 (55.9%) cases extracapsular extension was detected (Wheeler grade L3). 3D AAR guided biopsies were negative in all pathological tumour stage 2 (pT2) patients while they revealed the presence of cancer in 14 cases in the pT3 cohort (14/16; 87.5%). PSM rates were 0% and 7.1% in the pathological stages pT2 and pT3 (

This study collects the results obtained using the Getis-Ord local spatial autocorrelation index (Gi) with the aim of improving the classification of burned area detection maps generated from spectral indices (i.e., dNBR index) derived from Sentinel-2 satellite data. Therefore, the work proposes an adaptive thresholding approach that also includes the application of a similarity index (Sorensen–Dice Similarity Index) with the aim of adaptively correcting classification errors (false-positive burned pixels) related to the spectral response of burned/unburned areas. In this way, two new indices derived from the application of the Getis-Ord local autocorrelation analysis were created to test their effectiveness. Three wildfire events were considered, two of which occurred in Southern Italy in the summer of 2017 and one in Sardinia in the summer of 2019. The accuracy assessment analysis was carried out using the CEMS (Copernicus Emergency Management Service) on-demand maps. The results show the remarkable performance of the two new indices in terms of their ability to reduce the false positives generated by dNBR. In the three sites considered, the false-positive reduction percentage was around 95–96%. The proposed approach seems to be adaptable to different vegetation contexts, and above all, it could be a useful tool for mapping burned areas to support post-fire management activities.

Background: Lower urinary tract symptoms (LUTS) contribute to erectile dysfunction (ED) and premature ejaculation (PE). However, only a few studies have been conducted with representative groups of men that had well-balanced demographic characteristics. Thus, we aimed to confirm the effect of LUTS on ED and PE and to analyze the association between LUTS and men’s sexual activity in a large representative cohort. In addition, we evaluated the sex-specific and overall quality of life of men who had LUTS with either ED or PE. Methods: We used the latest census and estimated the sample size to build a group of men representative of the population. LUTS, ED, and PE were evaluated with reliable instruments. Regression models were used to analyze the data. Results: All included men were representative in relation to their age and residential location (n = 3001). ED and PE were more common in men who reported LUTS compared with men who did not have LUTS (p < 0.001). Age, comorbidity, and lifestyle did not affect the negative effect of LUTS on ED or PE (regression coefficients of 0.159 and 0.528 for ED and PE, respectively, p < 0.001). However, regression models did not validate the impact of LUTS on sexual activity, defined by intercourse frequency and number of sexual partners (odds ratio of 0.981, CI 0.961–1.001, p = 0.061). Nevertheless, men with LUTS and either ED or PE had worse quality of sexual life and general quality of life compared with the remaining respondents. Conclusion: LUTS worsened ED and PE but had no impact on men’s sexual activity. Our findings confirm the recommendations to assess for LUTS in men reporting ED or PE. Clinical Trial Registration: The study was registered with ClinicalTrials.gov (NCT05462171).

Objectives The research's purpose is to develop a software that automatically integrates and overlay 3D virtual models of kidneys harboring renal masses into the Da Vinci robotic console, assisting surgeon during the intervention. Introduction Precision medicine, especially in the field of minimally-invasive partial nephrectomy, aims to use 3D virtual models as a guidance for augmented reality robotic procedures. However, the co-registration process of the virtual images over the real operative field is performed manually. Methods In this prospective study, two strategies for the automatic overlapping of the model over the real kidney were explored: the computer vision technology, leveraging the super-enhancement of the kidney allowed by the intraoperative injection of Indocyanine green for superimposition and the convolutional neural network technology, based on the processing of live images from the endoscope, after a training of the software on frames from prerecorded videos of the same surgery. The work-team, comprising a bioengineer, a software-developer and a surgeon, collaborated to create hyper-accuracy 3D models for automatic 3D-AR-guided RAPN. For each patient, demographic and clinical data were collected. Results Two groups (group A for the first technology with 12 patients and group B for the second technology with 8 patients) were defined. They showed comparable preoperative and post-operative characteristics. Concerning the first technology the average co-registration time was 7 (3–11) seconds while in the case of the second technology 11 (6–13) seconds. No major intraoperative or postoperative complications were recorded. There were no differences in terms of functional outcomes between the groups at every time-point considered. Conclusion The first technology allowed a successful anchoring of the 3D model to the kidney, despite minimal manual refinements. The second technology improved kidney automatic detection without relying on indocyanine injection, resulting in better organ boundaries identification during tests. Further studies are needed to confirm this preliminary evidence.

Wildfires represent a significant threat to protected areas around the world. This threat has become even more pronounced in recent years due to climate change. These fires can destroy, among other things, natural habitats, cause a loss of biodiversity, and affect air quality. In addition, they can have a significant economic impact on countries that depend on tourism and protected area activities. In this context, Geographic Information Systems (GIS) can provide an important solution for fire management in protected areas. In this case study, the Basilicata region (Southern Italy) was taken as an example where data on protected areas and fire events are freely accessible and constantly updated. By exploiting several interoperable GIS tools, it was possible to perform a complex geospatial analysis that provided important information for sustainable and resilient land use planning. In particular, areas with the highest frequency of fires within or close to protected areas emerged, which can therefore be attended to at different planning levels. In addition, in general, the work has made it possible to implement simple methodologies of relational analysis between fires and protected areas that can be easily employed in administrative settings so as to make the territory more resilient to the expected increase in fires due to climatic changes.

Bladder blood clots represent an infrequent urinary condition in children. They usually result from hematuria with many underlying causes, such as urinary tract infections and urethral/bladder traumas. Treatment options for clot removal include trans-urethral or suprapubic bladder irrigation and, if unsuccessful, endoscopic management under general anesthesia with a resectoscope. In younger male children, however, the repeated passage of a trans-urethral resectoscope may be challenging and traumatic, due to the small lumen diameter. Eventually, an open surgical approach can be required in many patients. Few anecdotal non-surgical approaches have been proposed for the management of bladder blood clots in children. This review aims to summarize the conservative techniques described in the literature with the instillation of intravesical agents, analyzing the different strategies and their advantages.

Selective clamping during robot-assisted partial nephrectomy (RAPN) may reduce ischemia-related functional impairment. The intraoperative use of 3D-virtual models (3DVMs) can improve surgical planning, resulting in a greater success rate for selective clamping. Our goal is to introduce a new generation of 3DVMs, which consider the perfusion volumes of the kidney. Patients listed for RAPN from 2021 to 2022 were recruited. A selective clamping strategy was designed and intraoperatively performed based on the specifically generated 3DVMs. The effectiveness of selective clamping was evaluated using near-infrared-fluorescence imaging (NIRF) and 3DVM. Perfusion areas extensions were compared, and relevant preoperative characteristics were analyzed. In 61 of 80 (76.25%) cases, selective clamping was performed. The concordance between the 3DVM areas and the NIRF-enhanced areas was verified (k = 0.91). According to the distribution of perfused areas crossing the tumor, there were one, two, three, four, and five crossing areas, with relative perfusion rates of 13.75%, 35%, 32.5%, 13.75%, and 5%, respectively. Lesion diameter and mesorenal location were the only factors related to a higher number (>3) of perfusion volumes crossing the lesion. The implementation of mathematical algorithms to 3DVMs allows for precise estimation of the perfusion zone of each arterial branch feeding the organ, leading to the performance of safe and effective pedicle management planning.

The use of robot-assisted technology has been widely adopted in urological oncological surgery and its benefits have been well established. In recent years, robotic technology has also been used in several functional reconstructive and neuro-urology (FRNU) procedures. The aim of this review was to evaluate the current evidence in the use of robotic technology in the field of FRNU. We performed a PubMed-based literature search between July and August 2022. The keywords we included were ‘robotic assisted’, ‘ureteric reimplantation’, ‘cystoplasty’, ‘ileal conduit’, ‘neobladder’, ‘sacrocolpopexy’, ‘colposuspension’, ‘artificial urinary sphincter’, ‘genitourinary fistula’ and ‘posterior urethral stenoses’. We identified the latest available evidence in the use of robotic technology in specific FRNU procedures such as the reconstruction of the ureters, bladder and urinary sphincter, urinary diversion, and repair of genitourinary prolapse and fistula. We found that there is a lack of prospective studies to assess the robotic-assisted approach in the field of FRNU. Despite this, the advantages that robotic technology can bring to the field of FRNU are evident, including better ergonomics and visual field, less blood loss and shorter hospital stays. There is therefore a need for further prospective studies with larger patient numbers and longer follow-up periods to establish the reproducibility of these results and the long-term efficacy of the procedures, as well as the impact on patient outcomes. Common index procedures and a standardized approach to these procedures should be identified to enhance training.

Objective: Indocyanine green (ICG) and Three-dimensional virtual models (3DVMs) have been developed and introduced in surgical daily practice in the last years to improve preoperative planning and efficacy of selective clamping during nephron sparing surgery. Aim of the study is to evaluate ICG and 3DVMs usefulness in guiding the surgeon's strategy during robot-assisted partial nephrectomy (RAPN). Materials and methods: We retrospectively reviewed our institutional database and analysed all patients harboring organ-confined renal masses underwent RAPN from 2018 to 2023. Specifically, we included all the patients with a 3DVMs available for preoperative planning and intraoperative surgical navigation. In those cases in which a selective clamping was planned and intraoperatively preformed, ICG solution was injected allowing visualization of the kidney's perfusion regions during the surgery. All demographic, intraoperative, postoperative and functional data were extracted and evaluated, comparing the 3DVM-ICG selective clamping with the global clamping Group. Results: Overall, 212 patients were included. 111 (51%) patients underwent 3DVM-ICG selective clamping RAPNs. No differences were recorded in terms of preoperative or perioperative variables between the global and the selective clamping group, except for a lower operative time for the global clamping group (93.5 min vs. 100 min, p = 0.02). Focusing on the functional outcomes, the selective clamping group showed better postoperative outcomes in terms of ΔeGFR at every timepoint considered (postoperative: -10.4% vs. -16.7%, p = 0.003; 3rd month: -9% vs. -14%, p = 0.01; 6th month: -8.9% vs. -13.8%, p = 0.04). Conclusions: ICG and 3DVMs can be considered the most useful and advanced tools to plan an effective selective clamping strategy during RAPN. They can be used in different ways, matching the surgeon's needs from the planning phase to the time of the surgery, leading towards maximum safety and efficacy outcomes.

Abstract Prostate cancer (PCa) is a leading cause of death in the male population commonly treated with androgen deprivation therapy that often relapses as androgen-independent and aggressive castration-resistant prostate cancer (CRPC). Ferroptosis is a recently described form of cell death that requires abundant cytosolic labile iron to promote membrane lipid peroxidation and which can be induced by agents that inhibit the glutathione peroxidase-4 activity such as RSL3. Exploiting in vitro and in vivo human and murine PCa models and the multistage transgenic TRAMP model of PCa we show that RSL3 induces ferroptosis in PCa cells and demonstrate for the first time that iron supplementation significantly increases the effect of RSL3 triggering lipid peroxidation, enhanced intracellular stress and leading to cancer cell death. Moreover, the combination with the second generation anti-androgen drug enzalutamide potentiates the effect of the RSL3 + iron combination leading to superior inhibition of PCa and preventing the onset of CRPC in the TRAMP mouse model. These data open new perspectives in the use of pro-ferroptotic approaches alone or in combination with enzalutamide for the treatment of PCa.

The aim of “Precision Surgery” is to reduce the impact of surgeries on patients’ global health. In this context, over the last years, the use of three-dimensional virtual models (3DVMs) of organs has allowed for intraoperative guidance, showing hidden anatomical targets, thus limiting healthy-tissue dissections and subsequent damage during an operation. In order to provide an automatic 3DVM overlapping in the surgical field, we developed and tested a new software, called “ikidney”, based on convolutional neural networks (CNNs). From January 2022 to April 2023, patients affected by organ-confined renal masses amenable to RAPN were enrolled. A bioengineer, a software developer, and a surgeon collaborated to create hyper-accurate 3D models for automatic 3D AR-guided RAPN, using CNNs. For each patient, demographic and clinical data were collected. A total of 13 patients were included in the present study. The average anchoring time was 11 (6–13) s. Unintended 3D-model automatic co-registration temporary failures happened in a static setting in one patient, while this happened in one patient in a dynamic setting. There was one failure; in this single case, an ultrasound drop-in probe was used to detect the neoplasm, and the surgery was performed under ultrasound guidance instead of AR guidance. No major intraoperative nor postoperative complications (i.e., Clavien Dindo > 2) were recorded. The employment of AI has unveiled several new scenarios in clinical practice, thanks to its ability to perform specific tasks autonomously. We employed CNNs for an automatic 3DVM overlapping during RAPN, thus improving the accuracy of the superimposition process.

Background: Surgical aortic valve replacement with a rapid deployment valve (RDV) is a relatively recent treatment option. The aim of this study was to compare the hemodynamic performance of balloon-expandable (BE)-RDVs and BE-transcatheter heart valves (THVs) in a high surgical risk and frail-elderly population. Methods: BE-THVs and BE-RDVs were implanted in 138 and 47 patients, respectively, all older than 75 years and with a Canadian Study of Health and Aging category of 5 or above. Echocardiographic assessment was performed at discharge and six months later. Results: At discharge, transprosthetic pressure gradients and indexed effective orifice area (iEOA) were similar in both cohorts. At six-month follow-up, BE-RDVs showed lower peak (14.69 vs. 20.86 mmHg; p

Fires represent one of main challenges of the last decades as global changes are causing an increase in economic and environmental damages. Indeed, just in 2017, more than 10,000 km2 of land were burned in Europe, causing significant damage to both the natural heritage (25% of burned areas were part of Natura 2000 protected areas) and the economy with estimated losses around 10 billion euros. In addition, every year there are losses of human life that make even more necessary new strategies of action and monitoring. Therefore, an efficient management of forecasting, prevention, active fight and post fire phases, is essential to make the territories less vulnerable and reduce the impacts on human lives. But these steps require an integrated approach of different tools in order to make faster and more efficient the different operations. In this context, the study illustrates the expeditious and standardized methodologies in open source GIS environment proposed in a research project with the Civil Protection of Apulia Region in order to implement a vulnerability index to improve operations in forecasting, emergency management in real-near time and post-event analysis in urban-rural interface. All the techniques and methodologies proposed were based on the use of QGIS software as it is a highly user friendly software that can be easily used even by non-specialized technicians. Moreover, the methodologies have been validated through a direct comparison with the tools currently in use in Civil Protection Department of Apulia Region.

Objective: The aim of the study was to evaluate three-dimensional virtual models (3DVMs) usefulness in the intraoperative assistance of minimally-invasive partial nephrectomy in highly complex renal tumors. Methods: At our institution cT1-2N0M0 all renal masses with Preoperative Aspects and Dimensions Used for an Anatomical classification score ≥10 treated with minimally-invasive partial nephrectomy were considered for the present study. For inclusion a baseline contrast-enhanced computed tomography in order to obtain 3DVMs, the baseline and postoperative serum creatinine as well as estimated glomerular filtration rate values were needed. These patients, in which 3DVMs were used to assist the surgeon in the planning and intraoperative guidance, were then compared with a control group of patients who underwent minimally-invasive partial nephrectomy with the same renal function assessments, but without 3DVMs. Multivariable logistic regression models were used to predict the margin, ischemia, and complication score achievement. Results: Overall, 79 patients met the inclusion criteria and were compared with 143 complex renal masses without 3DVM assistance. The 3DVM group showed better postoperative outcomes in terms of baseline-weighted differential estimated glomerular filtration rate (−17.7% vs. −22.2%, p=0.03), postoperative complications (16.5% vs. 23.1%, p=0.03), and major complications (Clavien Dindo >III, 2.5% vs. 5.6%, p=0.03). At multivariable logistic regression 3DVM assistance independently predicted higher rates of successful partial nephrectomy (odds ratio: 1.42, p=0.03). Conclusion: 3DVMs represent a useful tool to plan a tailored surgical approach in case of surgically complex masses. They can be used in different ways, matching the surgeon's needs from the planning phase to the demolitive and reconstructive phase, leading towards maximum safety and efficacy outcomes.