Omission of axillary clearance in patients with early breast cancer and positive sentinel node biopsy treated with conservative surgery: application of the ACOSOG Z011 trial in clinical practice

Background: Axillary lymph node dissection (ALND) in presence of sentinel lymph node (SLN) metastases has been the standard in breast cancer (BC) patients for many years. Today, after the publication of the ACOSOG Z0011 trial, ALND is a procedure restricted to a dwindling group of patients with a clearly metastatic axilla. Material and methods: This was a prospective observational trial involving two Italian Breast Units: Policlinico di Sant’Orsola and San Raffaele hospital. Objective was to evaluate that the omission of ALND in patients with cT1-2 cN0 BC undergoing breast conserving surgery (BCS) and histological finding of metastases in 1 or 2 SLN is not associated with a worse prognostic outcome. Primary endpoint was overall survival (OS). Secondary endpoints were disease free survival (DFS) and locoregional recurrence. All BC patients treated between the 1st of November 2020 and 31st of July 2023 with cT1-2 cN0 BC, preoperative negative axillary ultrasound and 1 or 2 metastatic SLN treated with sentinel node biopsy (SLNB) alone entered the study. Results: 795 cT1-2 cN0 BC patients underwent BCS and SLNB. Ninety patients were included. Median age was 60 (52-68) years. Seventy-five patients (83%) had T1 tumor and 15 (17%) T2. Median tumor size was 16 mm (11-19). The median SLN removed was 2 (1-3). Eighty-one patients had 1 positive SLN (90%), while 9 had 2 SLN metastasis (10%). 39 (43%) micrometastases were identified and 51 macrometastasis (57%). All patients underwent radiotherapy. Seventeen (19%) performed adjuvant chemotherapy. Two received immunotherapy with trastuzumab and pertuzumab. Endocrine therapy was given to 84 (93%). At a median follow-up of 19 months (IQR 13-23) OS and DFS were 100%. No loco-regional recurrence was seen. Conclusion: The preliminary results of our study confirm that omitting ALND in patients meeting Z011 criteria is oncologically safe and should be the standard of care.

The Bible in Medieval Love Lyrics: A Fundamental Element of European Poetry Books

The focus of this study is the relationship among three different manuscripts (Modena, Bibl. Estense, MS α.R.4.4; Firenze, Bibl. Laurenziana MS Rediano 9; and London, BL, MS Harley, 2253) and the poetry they transmit. The aim of this research is to show the ways that the Bible was used in the transmission of the lyric poetry in the three literatures that they represent: Occitan (primarily through Marcabru’s songs), Italian (through the love poetry of Guittone d’Arezzo), and Middle English (through the Harley love lyrics and the MS.’s primary scribe), in a medieval European context.

Chemical looping reforming from methane to syngas: investigation on CeO2 oxygen carrier lifetime and optimal process times

Emissions of CO2 are constantly growing since the beginning of industrial era. Interruption of the production of major emitters sectors (energy and agriculture) is not a viable way and reducing all the emission through carbon capture and storage (CCS) is not economically viable and little publicly accepted, therefore, it becomes fundamentals to take actions like retrofitting already developed infrastructure employing cleanest resources, modify the actual processes limiting the emissions, and reduce the emissions already present through direct air capture. The present thesis will deeply discuss the aspects mentioned in regard to syngas and hydrogen production since they have a central role in the market of energy and chemicals. Among the strategies discussed, greater emphasis is given to the application of looping technologies and to direct air capture processes, as they have been the main point of this work. Particularly, chemical looping methane reforming to syngas was studied with Aspen Plus thermodynamic simulations, thermogravimetric analysis characterization (TGA) and testing in a fixed bed reactor. The process was studied cyclically exploiting the redox properties of a Ce-based oxide oxygen carrier synthetized with a simple forming procedure. The two steps of the looping cycles were studied isothermally at 900 °C and 950° C with a mixture of 10 %CH4 in N2 and of 3% O2 in N2, for carrier reduction and oxidation, respectively. During the stay abroad, in collaboration with the EHT of Zurich, a CO2 capture process in presence of amine solid sorbents was investigated, studying the difference in the performance achievable with the use of contactors of different geometry. The process was studied at two concentrations (382 ppm CO2 in N2 and 5.62% CO2 in N2) and at different flow rates, to understand the dynamics of the adsorption process and to define the mass transfer limiting step.

High temporal resolution insights into early life histories: integrating histomorphometric, trace element and isotopic analyses of dental hard tissues in archaeological populations from Italy

Teeth, with their high mineralisation, incremental growth, and lack of remodelling, serve as biological archives that document an individual's development. This project aims to utilise the potential of teeth in bioarchaeological studies to achieve three primary objectives: 1) to investigate the application of histological and histochemical methods in reconstructing developmental bio-chronologies and early life histories; 2) to refine the temporal precision of isotopic analysis of dentine collagen by developing a novel protocol that integrates micro-sampling techniques with high-resolution histomorphometrics; and 3) to synthesise data from enamel and dentine for a comprehensive understanding of early life development and dietary transitions. This study adopts an integrated multidisciplinary bioarchaeological approach, conducting histomorphometric analysis on enamel and dentine across deciduous and permanent dentitions. It applies high-temporal resolution trace element analysis to enamel using LA-ICPMS and δ13C and δ15N isotope analyses through sequential micro-sampling to dentine of permanent teeth. Samples were selected from diverse archaeological contexts across the Italian peninsula, covering the Upper Palaeolithic, Copper Age, and Early Medieval periods, providing insight into diachronic variations in infant development and life history. Findings highlight the efficacy of histological and histochemical techniques in accurately determining growth rates, physiological stress, dietary shifts (particularly timing of weaning), and age at death in infant remains. The consistency and comparison between enamel and dentine underscores the enhanced insight obtained from integrating information from both tissues. Importantly, the newly proposed protocol significantly improves the temporal accuracy of dentine collagen analysis, facilitating precise chronological placement of the results over broad developmental associations. This study reaffirms the significance of teeth as valuable bioarchaeological instruments. By introducing and testing multidisciplinary methods, it provides deeper insights into early life history and cultural practices across diverse chronological contexts, highlighting the importance of advanced methodologies in extracting detailed, accurate, and nuanced information from past populations.