Treatment of 2-4 cm kidney stones: multicentre experience. Comparison of safety, efficacy, and costs of percutaneous nephrolithotomy and retrograde intrarenal surgery.

Introduction: The objective of this study is to compare the safety and efficacy, through the stone-free rate (SFR), as well as the costs, between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL), for 2-4 cm kidney stones. Material and methods: We analysed the data relating to RIRS and PCNL performed in 3 reference centres for kidney stones, in the period between 1/2019 and 12/2021. The total number of procedures was 130 (63 RIRS and 67 PCNL). We defined SFR as the absence of lithiasic fragments or stones <3 mm. Results were compared between 2 groups depending on the stone size: 2-3 cm stones (group 1) and >3 cm stones (group 2). Results: The duration of RIRS was 90 minutes for group 1 and 115 minutes for group 2, and for PCNL it was 135 minutes for group 1 and 145 minutes for group 2. RIRS had shorter duration with a significant difference in group 1 (p = 0.000014). SFR for RIRS was 78% for group 1 and 21% for group 2, and for PCNL it was 92% for group 1 and 81% for group 2. Therefore, there is a statistically significant difference, which is more evident for 3 cm and multiple stones (p = 0.0057 for group 1, p = 0.000146 for group 2). The difference in costs was estimated by calculating the expected costs for a single surgical procedure and the estimated cost per day for ordinary hospitalization. Conclusions: 2-4 cm stones can be safely treated with both RIRS and PCNL, but RIRS should not be chosen as an option for stones >3 cm, except in selected cases. PCNL remains the gold standard for the treatment of complex stones, especially for stones >3 cm. Risk of postoperative complications is higher in PCNL, even if this difference is not great. The costs associated with RIRS, even when recalculating with the need for new treatments, remain cheaper.

Impact of positive surgical margins (PSMs) after robotic prostatectomy on biochemical recurrence (BCR): Multicenter analysis.

OBJECTIVE: To study and analyze any correlations between positive surgical margins after RARP and biochemical recurrence. METHODS: We enrolled 105 patients who underwent robot-assisted radical prostatectomy (RARP) from 2016-2020 with PSMs on final pathology, all performed or supervised by a senior surgeon in two tertiary referral center. Pathology has been described indicating also the area (apical, base, mediolateral, anterior, or multiple) and the extent of PSMs: focal (≤3 mm) or extensive (>3 mm). Cox univariable and multi-variable regression models were used to find the correlation between clinico-pathologic factors: age, local staging, PSA, grading, area, and size of PSMs). RESULTS: We found a good correlation between PSA and grading and between PSA and local staging (T) (p < 0.001). There was no clear correlation between the PSM area with grading nor with T staging. There is a statistically significant correlation between extensive PSM and the worsening of grading and local staging (p < 0.001). BCR rate also has a strong correlation with the worsening of grading and local staging (T) (p < 0.001). A relevant fact is the difference between the BCR rate in the apical and base PSM (34.88%vs 62.5%; p < 0.001) which are the most frequent locations of PSMs. DISCUSSION: PSMs remain a predictor of BCR but which may have controversial significance. The likelihood of BCR increases as grading or local staging gets worse. However, apical PSM is a relatively less powerful predictor of postoperative BCR. This can help to better select patients for subsequent RT, which still causes important side effects.

Urban Seismic Network Based on MEMS Sensors: The Experience of the Seismic Observatory in Camerino (Marche, Italy).

Urban seismic networks are considered very useful tools for the management of seismic emergencies. In this work, a study of the first urban seismic network in central Italy is presented. The urban seismic network, built using MEMS sensors, was implemented in the urban district of Camerino, one of the cities in central Italy with the greatest seismic vulnerability. The technological choices adopted in developing this system as well as the implemented algorithms are shown in the context of their application to the first seismic event recorded by this innovative monitoring infrastructure. This monitoring network is innovative because it implements a distributed computing and statistical earthquake detection algorithm. As such, it is not based on the traces received by the stations from the central server; rather, each station carries out the necessary checks on the signal in real time, sending brief reports to the server in case of anomalies. This approach attempts to shorten the time between event detection and alert, effectively removing the dead times in the systems currently used in the Italian national network. The only limit for an instant alarm is the latency in the tcp/ip packages used to send the short reports to the server. The presented work shows the infrastructure created; however, there is not enough data to draw conclusions on this new early warning approach in the field, as it is currently in the data collection phase.

Selection of diagnosis with oncologic relevance information from histopathology free text reports: A machine learning approach.

Histopathology reports are a primary data source for the case definition phase of a Cancer Registry. By reading the histopathology report, the operator that evaluates an oncology case can define the morphology and topography of cancer, and validate the case with the highest diagnosis base. The key problem of the Catania-Messina-Enna Integrated Cancer Registry (RTI) is that these reports are written in natural language and relevant information for cancer evaluation is only a little part of the total annual histopathological reports. In this population-based retrospective cohort study, we try to optimize the working time spent by the RTI operators in seeking and selecting the right information among the histopathology reports in the east Sicily population, by developing a binary classifier on a training set of labeled historical data and validating its outcome by a test set of labeled data created by the operators during the years. Using a machine learning algorithm we built a classification model that evaluates each free text report and returns a score that indicates the probability that it contains oncologic relevant information. The best performing algorithm, among the eight analyzed in this study, was the LightGBM that reached an F1-Score of 98.9%. Using the chosen classifier we shortened the time for case evaluation, improving the timeliness of cancer statistics.

Molecular Subtypes, Metastatic Pattern and Patient Age in Breast Cancer: An Analysis of Italian Network of Cancer Registries (AIRTUM) Data.

Breast cancer stage at diagnosis, patient age and molecular tumor subtype influence disease progression. The aim of this study was to analyze the relationships between these factors and survival in breast cancer patients among the Italian population using data from the AIRTUM national database. We enrolled women with primary breast cancer from 17 population-based cancer registries. Patients were subdivided into older (>69 years), middle (50-69 years) and younger age groups (<50 years) and their primary tumors categorized into four molecular subtypes based on hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. There were 8831 patients diagnosed between 2010 and 2012 included. The most represented age group was 50-69 years (41.7%). In 5735 cases the molecular subtype was identified: HER2-/HR+ was the most frequent (66.2%) and HER2+/HR- the least (6.2%). Of the 390 women with metastases at diagnosis, 38% had simultaneous involvement of multiple sites, independent of age and molecular profile. In women with a single metastatic site, bone (20% of cases), liver (11%), lung (7%) and brain (3%) were the most frequent. In the studied age groups with different receptor expression profiles, the tumor metastasized to target organs with differing frequencies, affecting survival. Five-year survival was lowest in women with triple-negative (HER2-/HR-) tumors and women with brain metastases at diagnosis.

Sensing Advancement and Health Monitoring of Transport Structures.

Planning, design, construction, maintenance and management of transport infrastructure demand new methods and approaches to optimise utilisation of materials, energy and workforce [...].

Testing Sentinel-1 SAR Interferometry Data for Airport Runway Monitoring: A Geostatistical Analysis.

Multi-Temporal Interferometric Synthetic Aperture Radar (MT-InSAR) techniques are gaining momentum in the assessment and health monitoring of infrastructure assets. Amongst others, the Persistent Scatterers Interferometry (PSI) technique has proven to be viable for the long-term evaluation of ground scatterers. However, its effectiveness as a routine tool for certain critical application areas, such as the assessment of millimetre-scale differential displacements in airport runways, is still debated. This research aims to demonstrate the viability of using medium-resolution Copernicus ESA Sentinel-1A (C-Band) SAR products and their contribution to improve current maintenance strategies in case of localised foundation settlements in airport runways. To this purpose, "Runway n.3" of the "Leonardo Da Vinci International Airport" in Fiumicino, Rome, Italy was investigated as an explanatory case study, in view of historical geotechnical settlements affecting the runway area. In this context, a geostatistical study is developed for the exploratory spatial data analysis and the interpolation of the Sentinel-1A SAR data. The geostatistical analysis provided ample information on the spatial continuity of the Sentinel 1 data in comparison with the high-resolution COSMO-SkyMed data and the ground-based topographic levelling data. Furthermore, a comparison between the PSI outcomes from the Sentinel-1A SAR data-interpolated through Ordinary Kriging-and the ground-truth topographic levelling data demonstrated the high accuracy of the Sentinel 1 data. This is proven by the high values of the correlation coefficient (r = 0.94), the multiple R-squared coefficient (R2 = 0.88) and the Slope value (0.96). The results of this study clearly support the effectiveness of using Sentinel-1A SAR data as a continuous and long-term routine monitoring tool for millimetre-scale displacements in airport runways, paving the way for the development of more efficient and sustainable maintenance strategies for inclusion in next generation Airport Pavement Management Systems (APMSs).

Learning curve in robot-assisted partial nephrectomy: comparison between an expert surgeon and a team in training in single-center experiences.

INTRODUCTION: An important issue in robotic surgery is the training of urologists and the learning curve to perform a robot-assisted partial nephrectomy (RAPN), especially for those procedures that require vascular clamping. MATERIAL AND METHODS: We retrospectively enrolled 333 patients, undergoing RAPN in the period between 01/2014 and 12/2020. Surgical complexity, surgery duration, perioperative complications, and clamping were evaluated for each patient. Comparisons were made between an experienced surgeon and 3 urologists with initial experience in robotic surgery. RESULTS: Total number of RAPN was 333, of wich 172 were performed by the chief and 142 by the team. Analyzing the data, after an initial training in robotic surgery, it's possible to perform surgery of medium complexity (RENAL score 6-7) after 15 procedures performed in total independence. To proceed to high complexity tumors (RENAL score 8-9) with possible vascular clamping and warm ischemia time <25 minutes at least 25 completely independent procedures are required. There were no significant differences in the comparisons regarding the duration of the procedures (p = 0.19), complications (p = 0.44) and positive margins (p = 0.96). CONCLUSIONS: Robotic training for complex procedures, with low intra and postoperative complication rates, acceptable positive margin rates and sustainable cost-effective durations, requires a minimum number of medium complexity procedures, which in our study we have identified as 25 procedures, considering the initial ability in simple procedures of our 3 surgeons in training.

Road safety and simulation conferences: an interdisciplinary network for safer roads.

From 23rd to 25th October 2013 more than 300 researchers attended the 4th International Conference on Road Safety and Simulation (RSS 2013) in Rome, Italy, hosted by the Inter Universities Research Centre for Road Safety (CRISS) at the Department of Engineering of Roma Tre University. The aim of the Conference was to create a common interdisciplinary arena for researchers and professionals involved in road safety, facilitate the exchange of know-how and progress in the last advanced techniques, methods and tools and their applications to safety analysis. This special issue highlights some of the research presented at the Conference.

Sphenoidal-clival neoformation: an endoscopic approach.

The cranial base has distinct embryologic origins. The anterior cranial base is derived solely from the neural crest, similar to other facial bones, whereas the posterior cranial base is formed by the paraxial mesoderm. Both these parts also develop and grow with distinct features. Unlike other craniofacial bones that are mostly formed through intramembraneous ossification, the cranial base is formed through endochondral ossification, in which a cartilage plate, known as the chondrocranium, is formed first and soon replaced by bones. Individual bones are then connected by cartilaginous structures, termed synchondroses, which are morphologically similar to long-bone growth plates.These processes justify the presence of a disembryogenic cyst in the sphenoid bone. The authors present a case of a clival-sphenoidal region neoformation treated with a transnasal-endoscopic approach.