305 research outputs found
Definizione dell'eta' scheletrica dall'entita' dell'obliterazione delle suture mascellari.
No full text26) Epifanio Ferdinando medico e storico del Seicento, “Atti del Convegno di Studi” (Mesagne, 28-29 maggio 1999), a cura di M. Marti e D. Urgesi, Nardò 2001, pp. 107-111.
No full textEn bloc resection of giant retroperitoneal liposarcoma involving the right colon – a video vignette
No full textWe present a video vignette illustrating an en bloc resection
of a giant retroperitoneal liposarcoma (RPLS)
involving the right kidney and colon in a 65-year-old
woman (Video S1).
She presented with a 2-month history of non-specific
abdominal pain. Abdominal CT scan showed a large
retroperitoneal tumour. A biopsy was performed and
the histopathological diagnosis was RPLS. At laparotomy,
a mass of 20 9 23 9 25 cm was removed en bloc
with the right kidney and right colon. A stapled sideto-
side ileocolic anastomosis was done. The histopathological
diagnosis was of well-differentiated RPLS (sclerosing
and adipocytic variety) with MDM2 gene
amplification. The patient was discharged on the eighth
postoperative day. After 5 years of follow-up, she is
alive and disease-free.
RPLS is usually associated with a high rate of recurrence.
In the absence of effective systemic therapies,
surgery represents the mainstay of treatment with curative
intent and complex multivisceral resections are frequently
required. Studies have demonstrated that the
prognosis of patients with RPLS is better when surgeons
adopt an aggressive surgical approach [1–5].
Contiguous organs need to be resected en bloc with the
tumour, even if they are not clearly infiltrated by RPLS.
Because the best chance of cure is at the time of primary
surgery, this rare and complex malignancy should
be managed by an experienced surgical team in a specialized
referral centre [2,4,5]. As the colon is one of
the organs more frequently involved, surgery for RPLS
should be carried out by sarcoma surgeons with experience
in colorectal surgery
Proteogenomic biomarkers in colorectal cancers: clinical applications
No full textIntroduction: Colorectal cancer (CRC) is one of the leading cancers in terms of incidence and mortality, rate requiring a multidisciplinary approach. The discovery of specific CRC biomarkers has caused a paradigm shift in its clinical management. Areas covered: The aim is to illustrate the possible clinical applications of CRC biomarkers through an updated literature review (from 2015 to 2020) based on the PubMed database. A relationship between cancer localization and genetic profile has been identified. Nowadays, the tumor markers are largely used to select patients that could really benefit from a specific type of adjuvant therapy, in order to optimize treatment programs, especially in metastatic patients. This review highlights both CRC biomarkers’ advantages and critical issues. Expert opinion: New biomarker discoveries allow to set noninvasive tests that could increase patient’s compliance with therapy. They also permit a cost-effective early diagnosis, as well as patient-tailored treatments, improving the overall survival. The CRC biomarkers could also have a prognostic value, and usually, they are included in follow-up programs. However, despite the continuous progression of new technologies, their clinical validation is still debated. In this context, additional clinical studies are still necessary to identify, among potential markers, the most effective ones
Ensemble Aggregation Approaches for Functional Optimization
No full textIn this work we investigate the use of ensemble methods, consisting in the aggregation of several approximating models, in the context of functional optimization. In fact, while ensemble techniques are routinely employed in the machine learning literature for classification and regression, there is little research on their application to general optimization problems. Here we consider two strategies to aggregate different solutions to a functional optimization problem, based on optimized weighted averaging and aggregation over the minimum, the latter also in approximate version. A theoretical analysis of approximate functional optimization in the context of ensemble aggregation is provided. Then, simulation results are reported to showcase the advantages of ensembles for functional optimization, in terms of better accuracy and improved robustness with respect to single solutions
Obstructing Left-Sided Colonic Cancer: Is Endoscopic Stenting a Bridge to Surgery or a Bridge to Nowhere?
No full textFor the 8–29% colorectal cancers that initially manifest with obstruction, emergency surgery (ES) was traditionally considered the only available therapy, despite high morbidity and mortality rates and the need for colostomy creation. More recently, malignant obstruction of the left colon can be temporized by endoscopic placement of a self-expanding metallic stent (SEMS), used as bridge to surgery (BTS), facilitating a laparoscopic approach and increasing the likelihood that a primary anastomosis instead of stoma would be used. Despite these attractive outcomes, the superiority of the BTS approach is not clearly established. Few authors have stressed the potential cancer risk associated with perforations that may occur during endoscopic stent placement, facilitating neoplastic spread and negatively impacting prognosis. For this reason, the current literature focuses on long-term oncologic outcomes such as disease-free survival, overall survival and recurrence rate that do seem not to differ between the ES and BTS approaches. This lack of consensus has spawned differing and sometimes discordant guidelines worldwide. In conclusion, 20 years after the first description of a colonic stent as BTS, the debate is still open, but the growing number of articles about the use of SEMS as a BTS signifies a great interest in the topic. We hope that these data will finally converge on a single set of recommendations supporting a management strategy with well-demonstrated superiority
A decision support tool based on a queueing model for performance analysis and optimization of container terminals
No full textThe constant growth of container traffic has posed the problem of devising efficient tools for the management of logistics activities at container terminals, where a number of tasks are carried out, including loading, unloading and storing. To this purpose, a decision support system (DSS) based on a discrete-time dynamic model of container flows in maritime terminals is proposed for performance analysis and simulation.
The tool can be used both for planning and real-time decision support in the management of the handling resources. More specifically, on the one hand, it is possible to evaluate the performance of a container terminal (in terms of different indexes of interest) and the improvements attainable by possible changes in the resources (for example, to understand the impact of adding or removing a crane) in various scenarios. On the other hand, the DSS is also able to compute a real-time strategy of resource allocation aimed at optimizing the overall efficiency of the operations dynamically. The model at the core of the DSS has control inputs that represent the percentages of capacities of the available handling machines used to move containers inside a terminal. We regard such capacities as limited resources to be allocated to the various operations they are required for. By suitably choosing different cost functions, it is possible to address various optimization problems that can take into account different performance indexes. The model is based on a discrete-time state equation that describes the dynamic behaviour of the quantities of containers stored or transferred across a maritime terminal. It is basically a system of queues that represent either temporal storages or delays that may occur during the container transfers due to the unavailability of resources.
The proposed tool integrates simulation and optimization in an easy-to-use fashion, thus making it useful also for those with no experience in simulation. An example of the possible uses of the tool is reported to show its effectiveness in evaluation of the terminal performance.
The paper is structured as follows: Section 1 concerns introduction; Section 2 describes the main features of the tool, specifically for performance analysis and container flow optimization; Section 3 contains a simulation case study that shows possible uses of the DSS; Section 4 illustrates the basic ideas of the dynamic model of the container flows that is the basis of the proposed DSS; finally, Section 5 addresses conclusions and further comments
Nonlinear model predictive control for resource allocation in the management of intermodal container terminals
No full textLife expectancy in the districts of Taranto
No full textThe "Taranto case" has aroused the scientific interest of demographers, statisticians, epidemiologists and doctors, to understand what is happening today to the health of citizens, finding excesses of mortality and morbidity in certain pathologies strictly connected to pollution, in particular in the Ionian capital and in some neighboring municipalities. We have developed abbreviated mortality tables, using a methodology essentially different from that of Istat due to the fact that we do not rework the probabilities of death at all, which remain real. This solution is valid as Taranto is a large municipality, with almost 200,000 inhabitants.Il “caso Taranto” ha suscitato l’interesse scientifico di demografi, statistici, epidemiologi e medici, per capire cosa accade oggi alla salute dei cittadini, riscontrandosi eccessi di mortalità e morbosità in determinate patologie strettamente connesse all’inquinamento, in particolare nel capoluogo jonico ed in alcuni comuni limitrofi. Abbiamo elaborato tavole di mortalità abbreviate, utilizzando una metodologia essenzialmente differente da quella Istat per il fatto che non rielaboriamo affatto le probabilità di decesso, che rimangono quelle reali. Tale soluzione risulta valida in quanto Taranto è un comune con quasi 200.000 abitanti
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