Nipple-Sparing Mastectomy After Neoadjuvant Chemotherapy: Definitive Results with a Long-Term Follow-Up Evaluation.

BACKGROUND: Nipple-sparing mastectomy (NSM) is increasingly used for women with breast cancer who are not candidates for conservative surgery. The authors previously reported satisfying results with NSM after neoadjuvant chemotherapy (NACT). METHODS: From 2010 to 2020, 1072 women underwent mastectomy at the authors' institution. In this group, 433 NSMs were performed (40%). The only contraindications to NSM were close proximity to the nipple-areola complex (NAC), bloody discharge, and Paget disease. RESULTS: In 112 cases involving 111 women, NSM followed NACT (group 1), whereas it was performed as primary surgery in 321 instances involving 306 women (group 2). At 5 years, local relapse was 7% in group 1 and 2% in group 2, although in the multivariate analysis, locoregional relapses (LRRs) did not differ between the two groups. An increased incidence of local relapse was associated with higher tumor stage (stage III; p = 0.046) and age younger than 51 years (p = 0.038). For 34 (30.3%) of the 111 women in group 1 with a pathologic complete response (pCR), no LRRs were recorded. Only one NAC recurrence was observed. Overall survival with each tumor stage did not differ between the two groups. No differences in complications were observed. Cosmetic results were satisfying in 83.8% of the cases and did not get worse after NACT. CONCLUSIONS: The study data definitively confirm that NSM is safe even after NACT, with good cosmetic results and complications comparable with those in the primary surgery setting. Tumor stage and age were the only independent factors for local relapse. Patients with pCR enjoyed optimal locoregional control.

Geosystemics View of Earthquakes.

Earthquakes are the most energetic phenomena in the lithosphere: their study and comprehension are greatly worth doing because of the obvious importance for society. Geosystemics intends to study the Earth system as a whole, looking at the possible couplings among the different geo-layers, i.e., from the earth's interior to the above atmosphere. It uses specific universal tools to integrate different methods that can be applied to multi-parameter data, often taken on different platforms (e.g., ground, marine or satellite observations). Its main objective is to understand the particular phenomenon of interest from a holistic point of view. Central is the use of entropy, together with other physical quantities that will be introduced case by case. In this paper, we will deal with earthquakes, as final part of a long-term chain of processes involving, not only the interaction between different components of the Earth's interior but also the coupling of the solid earth with the above neutral or ionized atmosphere, and finally culminating with the main rupture along the fault of concern. Particular emphasis will be given to some Italian seismic sequences.

Precursory worldwide signatures of earthquake occurrences on Swarm satellite data.

The study of the preparation phase of large earthquakes is essential to understand the physical processes involved, and potentially useful also to develop a future reliable short-term warning system. Here we analyse electron density and magnetic field data measured by Swarm three-satellite constellation for 4.7 years, to look for possible in-situ ionospheric precursors of large earthquakes to study the interactions between the lithosphere and the above atmosphere and ionosphere, in what is called the Lithosphere-Atmosphere-Ionosphere Coupling (LAIC). We define these anomalies statistically in the whole space-time interval of interest and use a Worldwide Statistical Correlation (WSC) analysis through a superposed epoch approach to study the possible relation with the earthquakes. We find some clear concentrations of electron density and magnetic anomalies from more than two months to some days before the earthquake occurrences. Such anomaly clustering is, in general, statistically significant with respect to homogeneous random simulations, supporting a LAIC during the preparation phase of earthquakes. By investigating different earthquake magnitude ranges, not only do we confirm the well-known Rikitake empirical law between ionospheric anomaly precursor time and earthquake magnitude, but we also give more reliability to the seismic source origin for many of the identified anomalies.

Cancers of the appendix. Case report and literatures review.

Cancers of appendix are very uncommon. As reported in the case of 85 years old man, that underwent right emicolectomy with restoration of bowel continuity, the appendix was found to be gangrenous and perforated during the surgery. The hystology that comes out was adenocarcinoma of appendix that after 1 yars of follow up ramanins asymptomatic. At last the emicolectomy rappresent the best surgical treatment for all appendix neoplasm, that could be recognised from the surgeon when possible wiht intraoperavite histological examination. KEY WORDS: Appendix, Cancer, Incidental diagnosis, Right emicolectomy.

Preoperative staging of resectability of colon cancer using virtual colonoscopy: correlation with surgical results. Our experience.

PURPOSE: To evaluate the clinical usefulness of preoperative computed tomography colonography (CTC) in locoregional staging in patients with abdominal pain secondary toocclusive colorectal cancer (CRC). MATERIALS AND METHODS: 80 patients with abdominal pain underwent CTC initially without contrast and after diagnosis with contrast. 47 patients had distal CRC and 33 had proximal CRC. CTimages were analyzed independently by two radiologists, using MPR reconstruction and VR images. Depending on the anatomical depth of wall invasion primary tumor (T) was classified ≤ T2, T3 and T4. The definition of node disease (N) was based on the number of involved regional lymph nodes. Metastases (M) were characterized by the presence and location of distant disease. Pre treatment stage (cT cN) was compared with pathologic stage (pT pN). Accuracy of CTC was also evaluated. RESULTS: The overall accuracy values for T staging of reviewer 1, reviewer 2 and consensus reading were 91.6%, 86.2% and 92.8% respectively; 92.2%, 79.8% and 92.5% for T2; 88.1%, 85.5%, and 89.7% for T3; and 94.5%, 93.5% and 96.2% for T4. The accuracy values for N staging and M staging were 81,.8%, 94.0% for reviewer 1; 78.2% and 88.1% for reviewer 2; 81.8% and 94.0% for consensus reading, respectively. CONCLUSION: In our experience CTC is not only useful in the evaluation of the proximal bowel, but can also provide surgeons with accurate information about staging and tumor localization. CTC is recommended for better evaluation of preoperative staging. KEY WORDS: CT colonography, Colorectal cancer, Extracolonic findings, Staging.

[Comment to DPR 177/011]. / Commento al DPR 177/2011.

The subject of this study is the analysis of DPR 177/2011 regarding occupational safety in confined environments suspected of pollution The study wishes to represent a platform for the knowledge of the relevant principles and issues that are the functional basis for occupational health professionals, to offer a scheme in which it is possible to implement local actions of occupational prevention in the confined spaces and to help Italian intervention plans Italian within the European area, such, e.g., the present "Healthy workplaces campaign working together for risk prevention" promoted by the European Agency for Safety and Health at Work. The interiorization of this behavioural scheme is needed for professionals and authorities in the occupational safety systems, both public and private, who have the institutional duty to obtain trheir effectiveness. To observe the safety system in the specific matter of confined spaces, their essential elements were considered. These elements were identified both in the DPR 177/2011 and in other pertinent documents. This study doesn't pretend to identify all relevant documents, but wishes to underline the open structure of the system for acquiring non strictly juridical documents, such as ICOH guidelines and International code of ethics for occupational health professionals and pertinent authorities. A specific matter of the study is the different role of rules and ethical principles in verifying the adequacy of the safety system. The role of guidelines and ethic principles in the internal evaluation of legal value was examined for their relevance in order to decide on adequacy of the employer's management in safety matter adequacy which can by evaluated looking at his effective knowledge of spaces and good selection of managers and professionals. Furthermore, the study establishes how central--in reaching the safety--is the method based on effectiveness in managing the prevention in occupational health. The managerial method, not based on formal interpretation but on the effective situation of the spaces and of the human resources, is a critical element in safety systems and represents an acceptable scheme for the conduct of the subjects in charge for the production cycle. They are those who effectively decide on the site, except for some situations, as it is for example the prevision of managerial liability for activity in outsourcing. It has been stressed in this study the dynamicity of safety system in confined spaces which can be derived by the employer's duty of vigilance for interference risks between his activity and the activity of other enterprises operating in outsourcing. This duty it is permanent in every space and moment of production cycle. This context of functional responsibility, and liability when it exists, based on reality as well as on the knowledge of the spaces and human resources, shows the central function of qualified MD and his functionality in both aspects. In the first, he is able to understand various risks existing for health. In the second, for the many strict contacts with workers, he can participate in developing their information and formation, which have educational importance for the safety system of the occupational health. To conclude about the occupational safety system, this study stresses that the activity of qualified MD is not a simple surveillance carried out by medical examinations as a routine, but it is a strategic issue for the realization of organizational wellness at work, which is functional to respect both the human rights and an efficient production cycle.