Artificial land use trends could represent an effective indicator of the settlement process quality and could also provide information about the efficacy of protection and exploitation policies in natural and rural areas. This work discusses an analytic procedure for the time series investigation of urban settlement development at the regional scale to verify the nexus between urban growth and demographic trends connected with the phenomenon of land take. In Italy, since 1950, the land take phenomenon has been a consequence of several factors: urbanization, realization of transport infrastructures including ports, airports, and highways, and the enhancement of industrial and productive systems. We analyzed all these territorial transformations that create waterproof soil, and more generally, a transition from natural and semi-natural uses toward artificial land use. After World War II, the demographic growth and the consequent housing demand generated a strong urbanization process in the main poles of economic development areas in Italy. Since the early 2000s, the situation has completely changed and the land take phenomenon is no longer mainly based on real need for new urban expansion areas based on effective urban planning tools, but is strongly related to a scattered demand for new housing in a weak territorial spatial planning system not able to drive effective urban development that minimizes speculative real estate initiatives. This uncontrolled occupation of soil generated, in Italy, a landscape fragmentation called the urban sprinkling phenomenon, different from urban sprawl, which is a wider phenomenon characterized by disordered urban growth. The present document aims to assess how uncontrolled expansion in areas characterized by low settlement density can generate fragmentation. To define if the territory is affected by the urban sprinkling phenomenon, two 50-year time series concerning urban expansion of buildings and demographic trends are analyzed calculating population and building density indices and their variation over the years. The sprinkling index is used to analyze the variation in the fragmentation degree at two different scales (regional and municipal). Finally, we discuss the context where this phenomenon has developed, analyzing the buildings located in hydrogeological risk zones and protected areas, and the correlation between demographic changes and the degree of territorial fragmentation variation.
Background: Minimally invasive cardiac surgery has increasingly been used for patients with valvular pathology. Two techniques of aortic occlusion are utilized with this technique: transthoracic aortic clamp (TTC) and endoaortic balloon occlusion (EAO). Both possibilities present peculiar advantages and limitations whose current evidence is based on few observational studies. We performed an analysis with the primary objective to evaluate outcomes and the incidence of major complications of these two techniques. Methods: The data of 258 patients who underwent minimally invasive mitral valve surgery through right mini-thoracotomy from January 2013 to July 2018 were reviewed. One hundred sixty-five patients were operated on with TTC and in 93 cases EAO was used. Univariate and multivariate analyses were performed to identify predictors of adverse outcome. Results: The mean age of the cohort was 60.4±13.9 years, patients with TTC were significantly older and had higher EuroSCORE II and reoperations were carried out mostly with EAO. Isolated mitral valve surgery was mostly performed (74%) and in 26% of the cases, other procedures were combined. No differences were detected in terms of types of operation, cardiopulmonary bypass (CPB) and cross-clamp times between the two techniques. Similar postoperative troponin I and CK-Mb values were recorded. Twenty-four patients (11%) suffered at least one complication. Of note, a new neurologic deficit occurred in six patients; in four cases a cerebral stroke, with all patients in the EAO group (P=0.06). There was no case of aortic dissection, no patient suffered peripheral ischemia nor femoral vessels complications. Thirty-day mortality was 1.9% (TTC 1.2% vs. EAO 3.2%; P=0.51), 30-day mortality excluding reoperations was 1.2% (TTC 1.2% vs. EAO 1.1%; P=0.61). Conclusions: Both techniques proved to be safe. Although non-statistically significant, there was a higher rate of cerebral stroke in the EAO group. However, EAO system shows technical advantages in avoiding tissue dissection and remains our choice in redo operations.
IntroductionCandida prophylaxis in ICU is still a matter of debate. Oral chemoprophylaxis has been advocated to reduce the incidence of Candida colonisation and infection.MethodsWe performed a randomised trial studying a single drug (nystatin) versus control in surgical/trauma ICU patients. Multiple-site testing for fungi was performed in each patient on ICU admission (T0) and subsequently every 3 days (T3, T6, T9, and so forth). The primary evaluation criterion was the time course of the corrected colonisation index.ResultsNinety-nine patients were enrolled. At admission, 69 patients exhibited Candida colonisation: the most frequently colonised body sites were the stomach and the pharynx. The most frequent isolated species was Candida albicans. The corrected colonisation index was similar in the two groups at T0 (P = 0.36), while a significant statistical difference was observed between the treatment and control groups at T6 (median 0.14 and 0.33, respectively; P = 0.0016), at T9 (median 0.00 and 0.28, respectively; P = 0.0001), at T12 (median 0.00 and 0.41, respectively; P = 0.0008), and at T15 (median 0.00 and 0.42, respectively; P <0.0003). The same results were obtained in the subgroup of patients already colonised at ICU admission.ConclusionThis trial shows that nystatin prophylaxis significantly reduces fungal colonisation in surgical/trauma ICU patients, even if already colonised.Trial registrationClinicalTrials.gov: NCT01495039
Background and Aim: The inflammatory reaction associated with cardiac surgery has been widely studied by means of laboratory biomarkers but rarely from a clinical perspective. Many anti-inflammatory treatments have failed to show clinical benefits. In 1992 the ACCP/SCCM conference defined the SIRS (table 1). Our aim is to verify the prevalence of clinically defined SIRS following heart surgery, to identify its predisposing factors and ascertain its impact on early outcome. Methods: We reviewed prospective data of 502 patients who underwent CPB-surgery. According to the mentioned criteria, we defined SIRS in the first day in ICU. We used an automated-matching procedure that for each SIRS-patient selected one without SIRS. A multivariate logistic regression model was used to evaluate the predisposition to develop postoperative-SIRS and its association with a composite outcome (death, TIA/stroke, renal replacement therapy, bleeding, IABP, stay in ICU > 96 hours). Results: 142 patients (28.3%) were SIRS-positive. Propensity-score matched 114 patients. Post-CPB lactates and transfusion-rates were greater in SIRS-patients. Positivity to each SIRS-criteria was associated to the composite outcome for fever (OR2.09; 95%CI1.15–3.80; p = 0.016), heart rate (OR2.08; 95%CI1.23–3.52; p = 0.007), leucocytes (OR1.70; 95%CI0.99–2.91;p = 0.051) adjusting for preoperative creatinine clearance, LVEF and duration of the intervention. Correcting for univariate predictors, the presence of SIRS in the first post-operative day was associated to the composite outcome independently by SIRS preoperative variables. Conclusions: SIRS is a common phenomenon in Cardiac surgery and is frequently associated with some unfavorable clinical outcomes. Therefore, SIRS observed in the first 24 hours after surgery can be a target to improve clinical outcome.
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