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Invasive mosquitoes are an emerging ecological and sanitary issue. Many factors have been suggested as drivers or barriers to their control, still no study quantified their influence over mosquito management by local authorities, nor their interplay with local economic conditions. We assessed how multiple environmental, sanitary, and socio-economic factors affected the engagement of municipalities in Italy (n = 7,679) in actions against Aedes albopictus, an invasive mosquito affecting human health and well-being, between 2000 and 2020. Municipalities are more prone to manage A. albopictus if more urbanized, in lowlands, with long infestation periods and close to outbreaks of Chikungunya, for which A. albopictus is a competent vector. Moreover, these variables were more strongly associated with management in municipalities with a high median income, and thus more economic resources. Only 25.5% of Italian municipalities approved regulations for managing A. albopictus, and very few of them were in Southern Italy, the most deprived area of the country. Our findings indicate that local economic conditions moderate the effect of other drivers of mosquito control and ultimately can lead to better management of A. albopictus. Thus, to ensure social justice, existing policies for managing the impacts of invasive vectors should explicitly address territorial inequalities by providing policymakers with adequate economic means.

Purpose The impact of anastomotic leaks (AL) on oncological outcomes after low anterior resection for mid-low rectal cancer is still debated. The aim of this study was to evaluate overall survival (OS), disease-free survival (DFS), and local and distant recurrence in patients with AL following low anterior resection. Methods This is an extension of a multicentre RCT (NCT01110798). Kaplan–Meier method and the log-rank test were used to estimate and compare the 3-, 5-, and 10-year OS and DFS, and local and distant recurrence in patients with and without AL. Predictors of OS and DFS were evaluated using the Cox regression analysis as secondary aim. Results Follow-up was available for 311 patients. Of them, 252 (81.0%) underwent neoadjuvant chemoradiotherapy and 138 (44.3%) adjuvant therapy. AL occurred in 63 (20.3%) patients. At a mean follow-up of 69.5 ± 31.9 months, 23 (7.4%) patients experienced local recurrence and 49 (15.8%) distant recurrence. The 3-, 5-, and 10-year OS and DFS were 89.2%, 85.3%, and 70.2%; and 80.7%, 75.1%, and 63.5% in patients with AL, and 88.9%, 79.8% and 72.3%; and 83.7, 74.2 and 62.8%, respectively in patients without (p = 0.89 and p = 0.84, respectively). At multivariable analysis, AL was not an independent predictor of OS (HR 0.65, 95%CI 0.34–1.28) and DFS (HR 0.70, 95%CI 0.39–1.25), whereas positive circumferential resection margins and pathological stage impaired both. Conclusions In the context of modern multimodal rectal cancer treatment, AL does not affect long-term OS, DFS, and local and distant recurrence in patients with mid-low rectal cancer.

Magnetic biomonitoring methodologies were applied at Villa Farnesina, Rome, a masterpiece of the Italian Renaissance, with loggias frescoed by renowned artists such as Raffaello Sanzio. Plant leaves were sampled in September and December 2020 and lichen transplants were exposed from October 2020 to early January 2021 at increasing distances from the main trafficked road, Lungotevere Farnesina, introducing an outdoor vs. indoor mixed sampling design aimed at assessing the impact of vehicular particulate matter (PM) on the Villa Loggias. The magnetic properties of leaves and lichens - inferred from magnetic susceptibility values, hysteresis loops and first order reversal curves - showed that the bioaccumulation of magnetite-like particles, associated with trace metals such as Cu, Ba and Sb, decreased exponentially with the distance from the road, and was mainly linked to metallic emission from vehicle brake abrasion. For the frescoed Halls, ca. 30 m from the road, the exposure to traffic-related emissions was very limited or negligible. Tree and shrub leaves of the Lungotevere and of the Villa's Gardens intercepted much traffic-derived PM, thus being able to protect the indoor cultural heritage and providing an essential conservation service. It is concluded that the joint use of magnetic and chemical analyses can profitably be used for evaluating the impact of particulate pollution on cultural heritage within complex metropolitan contexts as a preventive conservation measure.

Robotics in right colectomy are still under debate. Available studies compare different techniques of ileocolic anastomosis but results are non-conclusive. Our study aimed to compare intraoperative outcomes, and short-term postoperative results between robotic and standard laparoscopic right colectomies for cancer with intracorporeal anastomosis (ICA) fashioned with the same technique. All consecutive patients scheduled for laparoscopic or robotic right hemicolectomies with ICA for cancer in two hospitals, one of which is a tertiary care centre, were prospectively enrolled in our prospective observational study, from April 2018 to December 2019. ICA was fashioned with the same stapled hand-sewn technique. Continuous and categorical variables were analysed using t test and chi-squared test as required. Statistical significance was set at p

Background The optimal timing of surgery in relation to chemoradiation is still controversial. Retrospective analysis has demonstrated in the recent decades that the regression of adenocarcinoma can be slow and not complete until after several months. More recently, increasing pathologic Complete Response rates have been demonstrated to be correlated with longer time interval. The purpose of the trial is to demonstrate if delayed timing of surgery after neoadjuvant chemoradiotherapy actually affects pathologic Complete Response and reflects on disease-free survival and overall survival rather than standard timing. Methods The trial is a multicenter, prospective, randomized controlled, unblinded, parallel-group trial comparing standard and delayed surgery after neoadjuvant chemoradiotherapy for the curative treatment of rectal cancer. Three-hundred and forty patients will be randomized on an equal basis to either robotic-assisted/standard laparoscopic rectal cancer surgery after 8 weeks or robotic-assisted/standard laparoscopic rectal cancer surgery after 12 weeks. Discussion To date, it is well-know that pathologic Complete Response is associated with excellent prognosis and an overall survival of 90%. In the Lyon trial the rate of pCR or near pathologic Complete Response increased from 10.3 to 26% and in retrospective studies the increase rate was about 23–30%. These results may be explained on the relationship between radiation therapy and tumor regression: DNA damage occurs during irradiation, but cellular lysis occurs within the next weeks. Study results, whether confirmed that performing surgery after 12 weeks from neoadjuvant treatment is advantageous from a technical and oncological point of view, may change the current pathway of the treatment in those patient suffering from rectal cancer. Trial registration ClinicalTrials.gov NCT3465982.

Background Neoadjuvant chemoradiotherapy followed by surgery is the mainstay treatment for locally advanced rectal cancer, leading to significant decrease in tumor size (downsizing) and a shift towards earlier disease stage (downstaging). Extensive histopathological work-up of the tumor specimen after surgery including tumor regression grading and lymph node status helped to visualize individual tumor sensitivity to chemoradiotherapy, retrospectively. As the response to neoadjuvant chemoradiotherapy is heterogeneous, however, valid biomarkers are needed to monitor tumor response. A relevant number of studies aimed to identify molecular markers retrieved from tumor tissue while the relevance of blood-based biomarkers is less stringent assessed. MicroRNAs are currently under investigation to serve as blood-based biomarkers. To date, no screening approach to identify relevant miRNAs as biomarkers in blood of patients with rectal cancer was undertaken. The aim of the study is to investigate the role of circulating miRNAs as biomarkers in those patients included in the TiMiSNAR Trial (NCT 03465982). This is a biomolecular substudy of TiMiSNAR Trial (NCT03962088). Methods All included patients in the TiMiSNAR Trial are supposed to undergo blood collection at the time of diagnosis, after neoadjuvant treatment, after 1 month from surgery, and after adjuvant chemotherapy whenever indicated. Discussion TiMiSNAR-MIRNA will evaluate the association of variation between preneoadjuvant and postneoadjuvant expression levels of miRNA with pathological complete response. Moreover, the study will evaluate the role of liquid biopsies in the monitoring of treatment, correlate changes in expression levels of miRNA following complete surgical resection with disease-free survival, and evaluate the relation between changes in miRNA during surveillance and tumor relapse. Trial registration Clinicaltrials.gov NCT03962088. Registered on 23 May 2019.

The concentration of selected trace elements and the magnetic properties of samples of the lichen Evernia prunastri exposed for 3 months in Milan (Italy) were investigated to test if magnetic properties can be used as a proxy for the bioaccumulation of chemical elements in airborne particulate matter. Magnetic analysis showed intense properties driven by magnetite-like minerals, leading to significant correlations between magnetic susceptibility and the concentration of Fe, Cr, Cu, and Sb. Selected magnetic particles were characterized by Scanning Electron Microscope and Energy Dispersion System microanalyses, and their composition, morphology and grain size supported their anthropogenic, non-exhaust origin. The overall combination of chemical, morphoscopic and magnetic analyses strongly suggested that brake abrasion from vehicles is the main source of the airborne particles accumulated by lichens. It is concluded that magnetic susceptibility is an excellent parameter for a simple, rapid and cost-effective characterization of atmospheric trace metal pollution using lichens.

The interpretation of lichen bioaccumulation data is of paramount importance in environmental forensics and decision-making processes. By implementing basic ideas underlying previous interpretative scales, new dimensionless, species-independent &ldquo, bioaccumulation scales&rdquo, for native and transplanted lichens are proposed. Methodologically consistent element concentration datasets were populated with data from biomonitoring studies relying on native and transplanted lichens. The scale for native lichens was built up by analyzing the distribution of ratios between element concentration data and species-specific background concentration references (B ratios), herein provided for Flavoparmelia caperata and Xanthoria parietina (foliose lichens). The scale for transplants was built up by analyzing the distribution of ratios between element concentration in exposed and unexposed samples (EU ratio) of Evernia prunastri and Pseudevernia furfuracea (fruticose lichens). Both scales consist of five percentile-based classes, namely, &ldquo, Absence of&rdquo, &ldquo, Low&rdquo, Moderate&rdquo, High&rdquo, and &ldquo, Severe&rdquo, bioaccumulation. A comparative analysis of extant interpretative tools showed that previous ones for native lichens suffered from the obsolescence of source data, whereas the previous expert-assessed scale for transplants failed in describing noticeable element concentration variations. The new scales, based on the concept that pollution can be quantified by dimensionless ratios between experimental and benchmark values, overcome most critical points affecting the previous scales.

In this study we investigated the bioaccumulation of selected trace elements in lichen samples transplanted for three months in Milan, Italy, with the aim of assessing the main environmental contaminants and the overall pollution load, and of disentangling the main air pollution sources as well as of estimating fluxes of element deposition. The results highlighted Cu and Sb as important contaminants and suggested a common origin for these two elements from railways and non-exhaust sources of vehicular traffic such as brake abrasion. High or very high global air pollution emerged for all study sites. Source apportionment outlined three main factors, that found reliable correlation with distance from major roads and railways, an industrial plant, and soil resuspension. Ranges of estimated mean annual element deposition rates in the study area were similar to those reported for other cities.

Intracorporeal anastomosis (IA) in right colectomies shows many advantages over extracorporeal anastomosis (EA). Many difficulties encountered in laparoscopic IA can be overcome with hybrid robot-assisted IA or recently with totally robotic procedures. In the literature, few works have been published comparing laparoscopic, hybrid, and totally robotic right colectomies. The aim of this study is to retrospectively analyze the improvements brought on by the evolution of robotic surgery at our specialized center.Two hundred six (hybrid and totally) robotic right colectomies (RRCs) with IA were compared with 160 laparoscopic right colectomies (LRCs) with EA. A separate analysis carried out by the robotic group compared 30 totally robotic right colectomies (TRRCs) with 176 hybrid robot-assisted right colectomies (HRRCs). Demographics, pathological features, operative details, and postoperative outcomes were retrospectively analyzed from a prospectively maintained database.The groups were comparable with respect to demographics and tumor staging. When compared with LRC, RRC showed shorter time to first flatus (P .001), stools (P .001), solid diet (P .001), and discharge (P .001). The number of lymph nodes harvested was 23.13 ± 11.2 in RRC versus 20.5 ± 11.2 in LRC (P = .031). Operative time was longer in RRC (253.0 ± 47 minutes versus 209.9 ± 64 minutes; P .001), but conversion to open (2.4% versus 18.1%; P .001), anastomotic leaks (0.5% versus 5%; P = .012), and bleeding (0.3% versus 4.4%; P = .024) were significantly less frequent. Subsequent analysis shows no significant increase in operative time in TRRC versus HRRC (261.0 ± 41 minutes versus 251.6 ± 47.6 minutes; P = .310). Even if not statistically significant, TRRC showed faster bowel function recovery and tolerance to solid diet.We confirmed the clinical advantages of RRC with IA over LRC with EA in postoperative recovery outcomes and complication rate. Furthermore, our preliminary analysis in a cohort of 30 TRRC shows promising results.

Biocidal products are widely used to devitalize lichen thalli on monumental surfaces before their mechanical removal, but there is still lack of information about the persistence of the toxic effects over time. This issue is of paramount importance since it can greatly influence the process of lichen recolonization. The aim of this study was checking for physiological recovery or residual vitality of lichens after exposure to two commercial biocidal products, Biotin T or Preventol RI80. Samples of the foliose lichen Xanthoria parietina were treated with solutions containing the two biocides at the highest concentration suggested by the producer (3% and 2% respectively). Selected physiological parameters were investigated as indicators of sample vitality: photosynthetic parameters (FV/FM and PIABS), the content of chlorophyll a, chlorophyll b, beta-carotene, ergosterol and soluble proteins, after 24 and 72 hours and, to check for recovery, after 20 and 90 days. Both biocidal treatments induced severe physiological alterations, causing impairment to both the lichen photobiont and mycobiont, with Preventol showing a faster effect. The substantial loss of vitality following treatments with Biotin T and Preventol persisted over time, and no physiological recovery was found after 90 days.

In this work, we aimed to identify the contribution of a municipal solid waste incinerator (MSWI) to the air contamination of a complex urbanized area of N Italy using lichen transplants as biomonitors, and to compare the values of contamination with the data of socio-economic deprivation of the population living in the area. The method adopted allowed the identification of the elements of atmospheric origin that contaminate the study area. Although not distinguishable from the background, the contribution of the MSWI could be apportioned and mercury emerged as atmospheric tracer. Although not posing immediate risk, it is advisable to monitor in time the accumulation of Hg in biological systems. Consistently with similar studies, in the surrounding of the MSWI, we observed also the highest socio-economic deprivation. Overall, we found a close correlation between socio-economic deprivation and air pollution, clearly showing that the most disadvantaged population is clustered in the most polluted areas.

Aim of the study The aim of this study was to describe the role of laparoscopy in the treatment of leaks occurring after minimally invasive colorectal resections. Materials and methods Thirty-four of 566 consecutive patients who underwent minimally invasive colorectal resection for cancer between January 2004 and December 2012 and who showed signs of anastomotic leakage (6%) requiring reoperation were studied using a prospectively maintained database. Patient characteristics, clinical signs, the surgical approach, the role of laparoscopy, operative and postoperative results, and the rate of permanent stoma were analyzed. Results The median time to diagnosis of an anastomotic leak after surgery was 5.5 days. The median time to reoperation from the diagnosis of leakage was 2 days. Leaks were treated laparoscopically in 21 of 34 (61.8%) patients. Anastomoses were dismantled in 14 patients (41.2%) and the procedure was performed laparoscopically in 28.6% of the cases. The postoperative morbidity was 55.9%, the perioperative mortality 5.7%, and the rate of permanent stoma was 8.8%. Conclusions Laparoscopic reoperation can be performed in most cases of anastomotic leaks occurring after minimally invasive colorectal resection for cancer. Anastomosis can be dismantled laparoscopically in 28.6% of the cases. A permanent stoma was necessary only in patients with terminal stomas.

Background Widespread diffusion of minimally-invasive surgery for gastric cancer treatment is limited by the complexity of performing an extended D2-lymphadenectomy. This surgical step can be facilitated by using robot-assisted surgery. The aim of this study is to describe our technique and short-term results of a consecutive series of full robotic gastrectomies with D2-lymphadenectomy for gastric cancer, using the da Vinci Surgical System. Materials and Methods Between May 2004 and December 2009, we performed 24 consecutive full robot-assisted total and subtotal gastrectomies with extended D2-lymphadenectomy for histologically-proven gastric adenocarcinoma. Data referring to 11 robot-assisted total gastrectomies and 13 subtotal gastrectomies were collected in a database and analyzed. Results Median operative time was 267.50 min (255–305). Median intraoperative blood loss was 30 mL. Median number of harvested lymph nodes was 28 (23–34). Resection margins were negative in all cases. No conversions occurred. Surgery-related morbidity was 8%. Thirty-day mortality was 0%. Liquid diet started on postoperative d 5 (2–5). Median length of stay was 6 d (5–8). Conclusions Robot-assisted gastrectomy with D2-lymphadenectomy is a safe technique and allows achieving an adequate lymph node harvest and optimal R0-resection rates with low postoperative morbidity and the learning curve appears to be shorter than in laparoscopic surgery. Longer follow-up and randomized clinical trials are needed to define the role of robot-assistance in gastric cancer surgery.

Extracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy for cancer has a significant risk of complications. The aim of this study is to evaluate the operative and postoperative results of hybrid right hemicolectomy with intracorporeal robotic-assisted anastomosis for adenocarcinoma of the ascending colon compared with the standard extracorporeal anastomosis in a case control study.Forty-eight right hemicolectomies for cancer (2009-2012) with laparoscopic medial to lateral dissection, vascular ligation, bowel transection, and robotic-assisted intracorporeal anastomosis with specimen extraction through a Pfannestiel incision (robotic group [RG]) were compared with 48 laparoscopic hemicolectomies (2009-2011) with extracorporeal anastomosis (laparoscopic group [LG]).The two groups were comparable with respect to age, gender, stage of cancer, and body mass index. Surgery time was significantly longer in RG patients (RG, 266±41 minutes; LG, 223±51 minutes; P.05). Operative results were similar in the two groups. Recovery of bowel function (day of first bowel movement: RG, 3.0±1.0 days; LG, 4.0±1.2 days; P.05) and hospital stay (RG, 7.5±2.0 days; LG, 9.0±3.2 days; P.05) were quicker and shorter, respectively, in RG. There were four anastomotic complications and four incisional hernias in LG and none in RG (P.05).There are fewer anastomotic and wound complications in RG patients. Intracorporeal robotic-assisted ileocolic anastomosis allows a faster recovery compared with extracorporeal anastomosis.

Retroperitoneal fibrosis is an uncommon disease in which dense fibrous tissue proliferates in the retroperitoneum. It frequently consists in an abdominal mass involving alimentary structures, ureters with obstruction, and vascular elements with stenosis. This pathological event may be associated with a history of ergotamine usage or a wide range of conditions including malignancy, injuries and infections. In the case described here, the cause was a midgut carcinoid tumour, releasing high concentrations of serotonin and other metabolites directly into the peritoneal fluid. Because carcinoid tumours of the bowel can remain silent for many years it is possible that similar cases of retroperitoneal fibrosis may be identified only many years after onset. For that reason, a long history of bowel obstruction must be considered a kind of unusual but no less important carcinoid syndrome.