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OBJECTIVES Only few studies compared the surgical morbidity and mortality of thoracoscopic segmentectomy versus lobectomy for non-small-cell lung cancer, in particular, by relating the segmental resections with the corresponding anatomical lobes. METHODS We enrolled a total of 7487 patients who underwent VATS lobectomy (7269) or segmentectomy (218) from January 2014 to July 2019. A propensity score matching approach was used to account for potential confounding factors between the 2 groups. After matching, 349 lobectomies and 208 segmentectomies were included in the analysis. We analysed the operative and postoperative outcomes of video-assisted anatomical segmentectomy compared with video-assisted lobectomy and, in details, the results of segmentectomy with its corresponding lobectomy in a large cohort of patients from the Italian VATS Group Registry. RESULTS The overall conversion rate to thoracotomy was not statistically different between the groups (27 patients 8% vs 7 patients 3%, P = 0.1). The lobectomy group had a greater number of resected lymph nodes (median 11 vs 8, P = 0.006). No significant differences were detected in 30-day mortality (1.4%, 5 patients vs 0.9%, 2 patients), overall complications (18%, 62 patients vs 14%, 29 patients) and prolonged air leakage (31 patients, 9% vs 12 patients, 6%) between lobectomy and segmentectomy, respectively. No statistical differences were found regarding the median duration of drainage (3.2 days, P = 1) and the overall median length of hospital stay (6.4 days, P = 0.1) between the 2 groups. In the context of segmentectomy versus corresponding lobectomy, the right upper lobectomy compared with right upper segmentectomy showed a higher number of resected lymph nodes (P = 0.027). No statistical differences were reported in terms of conversion rate and postoperative complication and mortality. CONCLUSIONS Segmentectomy could be considered a safe procedure without significant differences compared to thoracoscopic lobectomy in terms of postoperative morbidity and mortality.

OBJECTIVES This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay. METHODS This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I–II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy. RESULTS Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P CONCLUSIONS Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.

OBJECTIVESInherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons’ ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry.METHODSThe registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications.RESULTSFour thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3–6). Grade 1 and 2 and Grade 3–5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (CONCLUSIONSVATS lobectomy is a safe procedure even in medically compromised patients. An improved classification system for conversions is proposed and prevention strategies are suggested to reduce conversion rates and possibly complications in less-experienced centres.

OBJECTIVES: Inherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons’ ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry. METHODS: The registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications. RESULTS: Four thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3–6). Grade 1 and 2 and Grade 3–5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (

Purpose Video-assisted thoracoscopic surgery (VATS) lobectomy has become an accepted procedure for the treatment of selected cases of lung cancer. The aim of this project was to establish national practical recommendations for the management of patients suitable for VATS lobectomy. Methods The Scientific Committee of the VATS Lobectomy Group (a branch of the Italian Society of Thoracic Surgery) identified the consensus conference as an appropriate tool for a national debate. The consensus conference was organized following indications of the Italian Department of Health: a panel of experts reviewed the literature, the jury board revised the experts’ reports, and the national conference discussed and voted on statements. The strength of recommendation for a statement was classified as weak, fair, or high when the total score ranged between 51% and 67%, 68% and 84%, or 85% and 100%, respectively. Results Eighty-six Italian thoracic surgeons attended the 1st Italian Consensus Conference on VATS lobectomy in Giulianova, Italy, on October 29-30, 2015. Thirty-three topics were discussed: indications, surgical strategy, perioperative management, and training were the main topics. Consensus was reached on 24 statements that were consequently recommended. Conclusions The Italian Consensus Conference is the first attempt to discuss VATS lobectomy-related issues in a national scientific community. Such experience determined an improvement in epistemic knowledge among the Italian thoracic surgeons and could be a suggestion for other national communities.

This study analyzes our experience with pulmonary resection for metastases from renal cell carcinoma. The goals were to search for factors influencing prognosis and to investigate the presence and the prognostic value of S100A4 protein in lung metastases and corresponding primary renal tumors. Sixty-five patients underwent surgical resection for renal and pulmonary lesions between 1992 and 2007. S100A4 protein expression was immunohistochemically examined in the peritumoral infiltrate of 64 lesions (32 metastases and the 32 corresponding primary carcinomas). Overall 3-, 5-, and 10-year survival rates were 58, 46, and 25%, respectively. Univariate analysis revealed that surgical radicality (p = 0.0039) and stratification into groups according to the International Registry of Lung Metastases classification (p = 0.0137) were prognostic factors. Multivariate analysis confirmed that this classification was a significant prognostic factor (p = 0.01). All metastases and the corresponding primary carcinomas expressed S100A4 protein. Twenty-one metastases (66%) had weak expression and 11 (34%) had strong expression. Twelve (37.5%) primary lesions had weak expression and 20 (62.5%) had strong expression. The 5-year survival rate for patients with strong expression in primary carcinoma was 41%, significantly lower than that of patients with weak expression (78%; p = 0.05). Pulmonary resection in metastatic renal cell carcinoma results in long-term survival. Complete resection and stratification into groups according to the International Registry of Lung Metastases classification were prognostic factors. Overexpression of S100A4 protein in primary tumors was correlated with a poor prognosis. If confirmed in larger studies this finding could be used to schedule adjuvant treatments in patients undergoing nephrectomy for renal cell carcinoma. RI ciriaco, paola/H-5716-2012 Background This study analyzes our experience withpulmonary resection for metastases from renal cell carcinoma.The goals were to search for factors influencingprognosis and to investigate the presence and the prognosticvalue of S100A4 protein in lung metastases andcorresponding primary renal tumors.Methods Sixty-five patients underwent surgical resectionfor renal and pulmonary lesions between 1992 and 2007.S100A4 protein expression was immunohistochemicallyexamined in the peritumoral infiltrate of 64 lesions (32metastases and the 32 corresponding primary carcinomas).Results Overall 3-, 5-, and 10-year survival rates were 58,46, and 25%, respectively. Univariate analysis revealedthat surgical radicality (p = 0.0039) and stratification intogroups according to the International Registry of LungMetastases classification (p = 0.0137) were prognosticfactors. Multivariate analysis confirmed that this classificationwas a significant prognostic factor (p = 0.01). Allmetastases and the corresponding primary carcinomasexpressed S100A4 protein. Twenty-one metastases (66%)had weak expression and 11 (34%) had strong expression.Twelve (37.5%) primary lesions had weak expression and20 (62.5%) had strong expression. The 5-year survival ratefor patients with strong expression in primary carcinomawas 41%, significantly lower than that of patients withweak expression (78%; p = 0.05).Conclusions Pulmonary resection in metastatic renal cellcarcinoma results in long-term survival. Complete resectionand stratification into groups according to the InternationalRegistry of Lung Metastases classification wereprognostic factors. Overexpression of S100A4 protein inprimary tumors was correlated with a poor prognosis. Ifconfirmed in larger studies this finding could be used toschedule adjuvant treatments in patients undergoingnephrectomy for renal cell carcinoma.

BACKGROUND AND STUDY AIM: The aim of this study was to assess the prevalence of nonpolypoid lesions (NPLs) in Italy and their risk of containing neoplasia or advanced histology. PATIENTS AND METHODS: This was a multicenter cross-sectional observational study on consecutive patients undergoing total colonoscopy over a 3-month period in 80 Italian centers. RESULTS: In all, 27,400 total colonoscopies were analyzed. Cancer was diagnosed in 801 patients (2.9 %). A total of 6553 precancerous lesions were detected in 5609 patients. Of these, 4154 patients (74.1 %) had polypoid lesions and 1455 patients (25.9 %) had NPLs. Therefore, the prevalence of NPLs was 5.3 % (95 %CI 5.0 - 5.6). NPLs larger than 10 mm were detected in 254 patients (17.5 %). NPLs were more predominant in the proximal colon (OR 2.92, 95 %CI 2.56 - 3.43; P < 0.0001 vs. polypoid lesions). Neoplastic tissue was diagnosed in 79.0 % and advanced histology (high-grade intraepithelial neoplasia or more) in 20.9 % of resected lesions. The risk of advanced histology was similar for polypoid and nonpolypoid lesions when adjusted for size. Depressed lesions had the highest risk of advanced histology (OR 10.56, 95 %CI 6.02 - 18.55; P < 0.0000 vs. flat-elevated). Age was an independent predictor of both neoplasia and advanced histology ( P = 0.0001). CONCLUSIONS: NPLs are relatively common in the Italian population, with a prevalence similar to that in other Western series. NPLs are not more aggressive than polypoid lesions, except for those with depressed morphology. Georg Thieme Verlag KG Stuttgart. New York.

This paper extends existing research on inclusive place marketing by advancing methodological reflections on how to rework research instruments toward greater inclusivity. Our methodological reflections intend to encourage the dialogue between place marketing theory and practice, as well as reflections on the role that academic researchers take on while co-creating territorial development and promotion projects with a variety of non-academic stakeholders. This is done in the form of a self-reflective account of the multi-disciplinary tourism research team engaged in “RECOLOR” (Reviving and EnhanCing artwOrks and Landscapes Of the adRiatic). This is an INTERREG project funded by the European Commission that aims to enhance the tourist potential of secondary urban and natural resources in Croatia and Italy, with a view to generating sustainable development. Academics and consultants can replicate the research methods suggested in this paper when conducting participatory audits in other destinations.

Place branding produces, reproduces, circulates and, perhaps, imposes place imaginaries that affect the lives of real people, reconstructing and reinforcing narratives of power. Such wonderings have provided the motivation and inspiration for this edited volume. It is the intention of both editors and contributors to consider the evident tensions around place branding in an attempt to shed light on them and make them more approachable as political phenomena. And, thus, perhaps identify ways to resolve them. It is for the readers to judge whether this intention is achieved or remains a pretention.

Among green microalgae, Scenedesmus sp. is known for its potential in wastewater remediation and lipid production, especially under starvation. Moreover, it is often characterised by a mixotrophic metabolism. In this work, we cultivated S. acutus PVUW12 in the presence of a liquid fraction of scotta (LFS), a cheese whey by-product, as source of nutrients. Subsequently, cultures were starved to evaluate lipid production. Cells were analysed to obtain information about growth, nutrient consumption during LFS cultivation, morphology and photosynthetic efficiency. We found that the alga boosted its growth when cultured in presence of LFS. Production of stromatic starch grains, polyphosphate granules, cell wall enlargement and reduction of the photosynthetic efficiency were also induced. Massive lipid accumulation was observed only during starvation, which also induced a strong slowdown of growth, loss of polyphosphate grains and further decrease in photosynthetic efficiency. This study demonstrates that S. acutus PVUW12 can be involved in a two-step cultivation, first by promoting growth using a by-product from cheese industry and second by transferring the microalgae on starvation to induce lipid accumulation for bioenergetics purposes.

Lo studio sulle attività alieutiche nei secoli dell'età moderna consente di ricostruire una specifica storia del Mediterraneo che trova nel Cinquecento un'epoca di transizione tra antiche e nuove maniere di pescare. La ricerca sulle fonti archivistiche ha restituito un quadro assai efficace dell'evoluzione della pesca dal XVI al XIX secolo che permette di seguire il passaggio dalla pratiche piscatorie svolte prevalentemente in prossimità della costa, a tecniche di pesca a strascico in alto mare esercitate con l'ausilio di tipi navali e attrezzature fino a quel momento mai sperimentati. L'aumento della produzione sollecita anche una migliore organizzazione dello smercio del pesce con l'utilizzo di ghiaccio per bloccare il facile deperimento del prodotto (conserve, neviere) e favorirne il trasporto sulle lunghe distanze. Nonostante le non poche problematiche sociali e organizzative del settore si avvia la trasformazione del commercio ittico che porta fra Sette e Novecento, in virtù del significativo allargamento della rete distributiva del prodotto fresco, anche un radicale cambiamento nelle abitudini alimentari.

This conceptual article intends to refi ne the understanding of place branding, in particular city branding, by framing place attractiveness as a mixture of haft and sord factors. This conceptualisation, by challenging the distinction ‘ hard versus soft factors ’ characterising the traditional place marketing discourses, allows to better look at the functional and representational dimensions interconnected in every brand and, even more, in every place brand. This article urges scholars and place managers to rearticulate these dimensions depending on the different groups of brand users involved, and claims for a closer collaboration between marketers and other professionals involved in policymaking. The advantages offered by these conceptualisations are explored with respect to some issues within the place brand literature, which still require to be fully understood, like the need to rearticulate the functional / physical and representational / symbolic dimensions in city branding.

PurposeThe purpose of this paper is to draw upon Johnson's “Circle of Culture” to develop a cultural approach for studying place marketing's internal audience. A research project on the small Italian Renaissance city of Urbino explores how a number of marketing events dedicated to the painter Raphael, who was born there, have been produced and then received among different urban “populations” (dwellers, commuters, students, etc.). The second part of the paper conceptualizes events as both “inward” and “outward” forces and compares the Raphaellian events with some of Urbino's traditional festivities.Design/methodology/approachThis is a qualitative study that applies discourse analysis to media texts, official documents and 42 in‐depth interviews held with both local officials and internal place consumers.FindingsThe inquiry reveals a predominance of discourses in support of the events: civic pride, identification, and economic benefits. What is more striking is that some participants not only appreciated the marketing events but “went beyond” by producing discourses in support of a more intensive exploitation of Urbino's cultural and heritage resources.Research limitations/implicationsQuantitative research is recommended to generalize evidence stemming from ethnographic inquiry and to measure “the magnitude” of the different discourses produced by the people.Originality/valueThis paper contributes to overcoming the materialist perspective which underpins a consistent part of literature by showing a new (counter)example of the “non‐oppositional voices” of place marketing. Moreover, it sheds more light on how “tertiary communication” takes place and how it can be properly investigated.

The presence of emphysema may lead to an underestimation of postoperative respiratory function after lobectomy when evaluated by standard functional assessment. The aim of the study was to assess the correlation between computed tomography (CT) densitometry, pathological grading of emphysema and variation of pulmonary function after lobectomy for lung cancer. Forty-one patients entered the study. Respiratory function was assessed preoperatively and after a mean period of 4.04 months following surgery. Postoperative function remained unchanged or increased after surgery in nine patients (Group A). In the remaining 32 patients (Group B) postoperative function was reduced after surgery. Preoperative forced expiratory volume in 1 s (FEV1)% was 68.5±13.1% in Group A and 91.7±21.0% in Group B. CT densitometry of the lobe to be resected was -877.8±57.6 HU in Group A and -827.5±64.4 HU in Group B. Pathological grading of emphysema of the resected lobe (range 0-10) was 4.1±2.2 in Group A and 3.1±1.2 in Group B. A significant correlation was observed (Spearman rank correlation) between the variation of FEV, and preoperative FEV, (P=0.003; r=-0.455), CT quantitative assessment (P=0.036; r=-0.430) and pathological grading (P=0.008; r=0.673). Patients with a higher degree of emphysema had a lower reduction of respiratory function after lobectomy and CT densitometry and pathological grading of emphysema correlated with the variation in respiratory function. © 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

Introduction: The incidence of lung adenocarci- nomas has steadily increased over the last de- cades. The aim of this study was to assess the re- sults of surgical treatment of multiple primary adenocarcinomas of the lung (MPAL) analyzing the radiological and histological features. Methods: From 1988 to 2005, 26 patients under- went surgical treatment for MPAL at our depart- ment, for a total of 52 tumors. Three patients had synchronous and 23 had metachronous tumors. Results: Thirty-seven tumors were classified as solid, two as ground-glass opacities (GGO) and 13 as mixed solid/GGO tumors on the basis of CT scan evaluation. Histology revealed 26 adenocar- cinomas, five adenocarcinomas with a bronchio- loalveolar (BAC) pattern and 21 BAC. There was no postoperative mortality. Five-year survival of patients with synchronous tumors was 66%. Sur- vival of patients with metachronous tumors was 95% and 70% from the first and second operation. Patients with stage II and IIIa tumors had signifi- cantly reduced survival rates (p< 0.05). Survival was 60% after lobectomy and 78% after wedge re- section. Conclusions: Surgical treatment of MPAL is asso- ciated with favorable results. Sublobar resec- tions, when technically feasible, provide ad- equate oncological management. " thoracic surgery l " pulmonary l " adenocarcinoma

Fig. 2. A MRI revealed a lymphoedema of the neck and mediastinum (arrow) (A, STIR image) that spontaneously disappeared in a few days. A MRI performed after a week was completely normal (B, T2-weighted image). The patient was conservatively treated. A physiotherapy program was started and she was encouraged to sleep with arms by the side. At the time of writing, 1 year after the event, the patient had experienced no further episode of cervical oedema.