Drawing as a Way of Knowing: How a Mapping Model Assists Preoperative Evaluation of Patients with Thyroid Carcinoma.

Background: Effective pre-surgical planning is crucial for achieving successful outcomes in endocrine surgery: it is essential to provide patients with a personalized plan to minimize operative and postoperative risks. Methods: Preoperative lymph node (LN) mapping is a structured high-resolution ultrasonography examination performed in the presence of two endocrinologists and the operating surgeon before intervention to produce a reliable "anatomical guide". Our aim was to propose a preoperative complete model that is non-invasive, avoids overdiagnosis of thyroid microcarcinomas, and reduces medical expenses. Results: The use of 'preoperative echography mapping' has been shown to be successful, particularly in patients with suspected or confirmed neoplastic malignancy. Regarding prognosis, positive outcomes have been observed both post-surgery and in terms of recurrence rates. We collected data on parameters such as biological sex, age, BMI, and results from cytologic tests performed with needle aspiration, and examined whether these parameters predict tumor malignancy or aggressiveness, calculated using a multivariate analysis (MVA). Conclusions: A standard multidisciplinary approach for evaluating neck lymph nodes pre-operation has proven to be an improved diagnostic and preoperative tool.

Finite mixtures in capture-recapture surveys for modeling residency patterns in marine wildlife populations.

This work aims to show how prior knowledge about the structure of a heterogeneous animal population can be leveraged to improve the abundance estimation from capture-recapture survey data. We combine the Open Jolly-Seber model with finite mixtures and propose a parsimonious specification tailored to the residency patterns of the common bottlenose dolphin. We employ a Bayesian framework for our inference, discussing the appropriate choice of priors to mitigate label-switching and nonidentifiability issues, commonly associated with finite mixture models. We conduct a series of simulation experiments to illustrate the competitive advantage of our proposal over less specific alternatives. The proposed approach is applied to data collected on the common bottlenose dolphin population inhabiting the Tiber River estuary (Mediterranean Sea). Our results provide novel insights into this population's size and structure, shedding light on some of the ecological processes governing its dynamics.

Determinants of variability in signature whistles of the Mediterranean common bottlenose dolphin.

One of the most studied aspects of animal communication is the acoustic repertoire difference between populations of the same species. While numerous studies have investigated the variability of bottlenose dolphin whistles between populations, very few studies have focused on the signature whistles alone and the factors underlying differentiation of signature whistles are still poorly understood. Here we describe the signature whistles produced by six distinct geographical units of the common bottlenose dolphin (Tursiops truncatus) in the Mediterranean Sea and identify the main determinants of their variability. Particularly, the influence of the region (proxy of genetic distance), the geographic site, and the environmental (sea bottom-related) and demographical (population-related) conditions on the acoustic structure of signature whistles was evaluated. The study provides the first evidence that the genetic structure, which distinguishes the eastern and western Mediterranean bottlenose dolphin populations has no strong influence on the acoustic structure of their signature whistles, and that the geographical isolation between populations only partially affected whistle variability. The environmental conditions of the areas where the whistles developed and the demographic characteristics of the belonging populations strongly influenced signature whistles, in accordance with the "acoustic adaptation hypothesis" and the theory of signature whistle determination mediated by learning.

Bray-Call Sequences in the Mediterranean Common Bottlenose Dolphin (Tursiops truncatus) Acoustic Repertoire.

Acoustic sequences are commonly observed in many animal taxa. The vast vocal repertoire of common bottlenose dolphins (Tursiops truncatus) also includes sequences of multi-unit rhythmic signals called bray-call which are still poorly documented, both functionally and geographically. This study aimed to (1) describe, classify, and characterize series of bray-call recorded in two sites of the Mediterranean basin (Rome-Tyrrhenian Sea and Mazara del Vallo-Strait of Sicily) and (2) investigate for the existence of possible geographic differences. The acoustic analysis identified 13 different sequence types, only two detected in both study areas. The Sørensen-Dice index revealed a low degree of similarity between the sequence repertoire of the two common bottlenose dolphin sub-populations, with the Tyrrhenian being more diversified and complex than the Sicilian one. The acoustic parameters also showed variability between the study area. Different variants of the main acoustic elements composing the bray-call sequences were detected in the Tyrrhenian Sea only. The Markov-chain model demonstrated that the transition probability between acoustic elements is not uniform, with specific combinations of elements having a higher probability of occurrence. These new findings on common bottlenose dolphin bray-call sequences highlight the structural complexity of these vocalizations and suggest addressing future research on the context of emissions and the possible function(s) of such acoustic arrangements.

First Report of Epimeletic and Acoustic Behavior in Mediterranean Common Bottlenose Dolphins (Tursiops truncatus) Carrying Dead Calves.

Epimeletic behavior toward dead calves has been frequently reported in cetaceans, mostly with females (presumed mothers) showing supportive behaviors such as carrying, lifting, or sinking, often assisted by "escort" individuals. However, information on acoustic production in such contexts is scarce. This report describes two observations of epimeletic behavior toward dead newborns in bottlenose dolphins and associated acoustic production. Data were collected at the Tiber River estuary (Rome, Mediterranean Sea, Italy) with one hydrophone for passive acoustic monitoring and two digital cameras. In both cases, an individual (presumed mother) acting as the main supporter and directly interacting with the carcass by lifting it (case 1) or sinking it (case 2) was observed. Another adult individual (escort) was present in both encounters showing standing-by and excitement behaviors (case 1) and supportive behavior (case 2). In both encounters, whistles, pulsed sounds, and bray-call elements were recorded. The consistent vocal activity observed likely conveyed context-specific information. A signature whistle in the first encounter was also recorded, likely emitted by the putative mother as a distress call. This report confirms the occurrence of epimeletic behavior in bottlenose dolphins and reports a preliminary description of the acoustic production when a dead calf is involved, providing additional information on this largely unknown topic.

High spatial resolution underwater data for mapping seagrass transplantation: A powerful tool for visualization and analysis.

These datasets derived from our mapping protocol are presented as a research article in the Journal of Environmental Management [1]. In particular, by using a Structure from Motion photogrammetric workflow we produced high spatial resolution 2D raster maps and 3D outputs such as dense points clouds and textured meshes of an underwater seagrass restoration site. In this area transplanted fragments of Posidonia oceanica were planted to restore this impacted site after the Costa Concordia shipwrecking which occurred on 13 January 2012 along the NE coast of Giglio Island (Tuscany, Italy). Photogrammetric outputs were used to render the underwater environment by using the open-source software Blender allowing a fine 3D modelling and immersive visualization of the mapped area. This data other than providing an exceptional tool for analysing the benthic habitats from a biological point of view, following over time the progress transplanting operations, might also provide a new way to visualize and share the perception of such underwater shallow environments to a large plethora of users, increasing the public awareness on restoration programmes and promoting new action aimed at restored underwater habitats restoration.

Seagrass restoration monitoring and shallow-water benthic habitat mapping through a photogrammetry-based protocol.

Seagrasses rank among the most productive yet highly threatened ecosystems on Earth. Loss of seagrass habitat because of anthropogenic disturbances and evidence of their limited resilience have provided the impetus for investigating and monitoring habitat restoration through transplantation programmes. Although Structure from Motion (SfM) photogrammetry is becoming a more and more relevant technique for mapping underwater environments, no standardised methods currently exist to provide 3-dimensional high spatial resolution and accuracy cartographic products for monitoring seagrass transplantation areas. By synthesizing various remote sensing applications, we provide an underwater SfM-based protocol for monitoring large seagrass restoration areas. The data obtained from consumer-grade red-green-blue (RGB) imagery allowed the fine characterization of the seabed by using 3D dense point clouds and raster layers, including orthophoto mosaics and Digital Surface Models (DSM). The integration of high spatial resolution underwater imagery with object-based image classification (OBIA) technique provided a new tool to count transplanted Posidonia oceanica fragments and estimate the bottom coverage expressed as a percentage of seabed covered by such fragments. Finally, the resulting digital maps were integrated into Geographic Information Systems (GIS) to run topographic change detection analysis and evaluate the mean height of transplanted fragments and detect fine-scale changes in seabed vector ruggedness measure (VRM). Our study provides a guide for creating large-scale, replicable and ready-to-use products for a broad range of applications aimed at standardizing monitoring protocols in future seagrass restoration actions.

Capitoline Dolphins: Residency Patterns and Abundance Estimate of Tursiops truncatus at the Tiber River Estuary (Mediterranean Sea).

Periodic assessments of population status and trends to detect natural influences and human effects on coastal dolphin are often limited by lack of baseline information. Here, we investigated for the first time the site-fidelity patterns and estimated the population size of bottlenose dolphins (Tursiops truncatus) at the Tiber River estuary (central Mediterranean, Tyrrhenian Sea, Rome, Italy) between 2017 and 2020. We used photo-identification data and site-fidelity metrics to study the tendency of dolphins to remain in, or return to, the study area, and capture-recapture models to estimate the population abundance. In all, 347 unique individuals were identified. The hierarchical cluster analysis highlighted 3 clusters, labeled resident (individuals encountered at least five times, in three different months, over three distinct years; n = 42), part-time (individuals encountered at least on two occasions in a month, in at least two different years; n = 73), and transient (individuals encountered on more than one occasion, in more than 1 month, none of them in more than 1 year; n = 232), each characterized by site-fidelity metrics. Open POPAN modeling estimated a population size of 529 individuals (95% CI: 456-614), showing that the Capitoline (Roman) coastal area and nearby regions surrounding the Tiber River estuary represent an important, suitable habitat for bottlenose dolphins, despite their proximity to one of the major urban centers in the world (the city of Rome). Given the high number of individuals in the area and the presence of resident individuals with strong site fidelity, we suggest that conservation plans should not be focused only close to the Tiber River mouths but extended to cover a broader scale of area.

Nipple-Sparing Mastectomy Long-Term Outcomes: Early and Late Complications.

Background and Objectives: The surgical choice treatment of the breast cancer mostly depends on the stage of the disease. In the last years, breast cancer surgery has moved from being destructive to being more respectful of the anatomical and physiological integrity of the gland. The aim of the breast surgery should be finalized to obtain the best aesthetic and functional results, respecting the principles of oncologic radicality. The present study is a retrospective analysis aimed to evaluate the long-term outcomes of a conservative technique like the nipple-sparing mastectomy. Materials and Methods: We observed 894 patients with a median age of 47.5 years old, underwent nipple-sparing mastectomy between 2002-2017. The data acquired include population and tumor characteristics, patient reconstructive outcomes, including locoregional, regional, and distant metastases; other variables, among nipple-areola complex necrosis and infection were collected. Results: The complications detected were considered as "early" within 1 month later the nipple-sparing mastectomy or "late" after this time. The overall complications rate (early and late) and the overall survival and the relapses detected by this study were comparable with those reported in the literature. In order to identify factors that correlate with complications, either early or later, it has been processed an evaluation of the univariate analysis showing adjuvant chemotherapy as the only predictive factor for late complications, while we encountered no predictors for early complications. Conclusions: The present study adds to the data already present in literature, demonstrating that the nipple-sparing mastectomy is a safe procedure, providing good oncological and aesthetic results in patients carefully selected.

Testing for Afirma in Thyroid Nodules with High-Risk Indeterminate Cytology (TIR3B): First Italian Experience.

A percentage of 15 to 30% of thyroid fine-needle aspiration (FNA) is indeterminate, i.e., TIR3A and TIR3B according to the Italian consensus for thyroid cytology. Afirma, a molecular analysis of thyroid FNA specimens, has recently gained popularity as an adjunct to microscopic cytological evaluation, in order to avoid diagnostic surgery in patients with indeterminate thyroid cytology. We described the first Italian experience with Afirma tests in a single Italian institution and assessed the performance of the Afirma test in TIR3B. Moreover, this is a preliminary study to assess the patient response to the offer of Afirma testing. The Afirma test was proposed to 67 patients with thyroid nodules that had yielded TIR3B cytology. Fifty-one patients (76.1%) chose the Afirma test, 25/51 underwent the test but the remaining 26 did not because of cost. A total of 41/67 (61.2%) patients underwent surgery, and 22/41 (53.7%) nodules were carcinomas. Of the 25 tested by Afirma, 9 (36%) were classified as Afirma-suspicious (Afirma-S); seven of them underwent surgery, and in 6/7 (85.7%), a cancer was proven at histology. Afirma is the procedure that many Italian patients with TIR3B lesions would choose. However, its routine clinical application in Italy is currently limited by high costs for the patient. When Afirma is performed in this setting of patients, the cancer risk of suspicious result is higher than that expected in all the series of TIR3B. Therefore, testing for Afirma in these nodules may be useful for managing patients and tailoring their surgical approach.

The Ablation of Thyroid Nodule's Afferent Arteries Before Radiofrequency Ablation: Preliminary Data.

Induced radiofrequency thermal ablation is the cytoreductive treatment of symptomatic benign thyroid nodules, metastatic and recurrent thyroid tumors and papillary thyroid microcarcinomas. It is a safe and effective alternative to surgery and it allows to obtain satisfactory results in terms of volumetric reduction of the nodule with significant improvement in the quality of life. The trans-isthmic approach and the moving shot technique are the two basic techniques; however, an advanced technique, artery-first feeding radiofrequency ablation, has been developed and validated. We have prospectively included 29 consecutive patients who have undergone radiofrequency ablation (Group A) or artery- first vRFA (Group B). All included patients had a diagnosis of benign nodular goiter and they underwent a single session of radiofrequency ablation. All patients followed a follow-up program at 1 month, 3 months, and 6 months. Continuous variables (age, TSH value, basal volume of nodule, used Joule, time in second of the procedure, nodules' volume at 1-, 3-, and 6- months of follow-up and percentage of volume reduction at 1-, 3-, and 6- months of follow-up) were described as mean, standard deviation and range, while categorical variables (gender, nodule structure and nodule vascularization) were described as number of cases and percentage. Independent samples t-test were performed to compare the continuous variables. A Test of Proportions was applied to the categorical variables. The Fisher's exact test was used to analyze the gender. Statistical significance was considered in case of p-value <0.05. Solid structure and spongiform structure showed statistic differences with p-values of 0.022 and 0.023 respectively between two groups. The percentage of reduction at 1 month did not show a significant difference between two groups; instead, the percentage of volume reduction was decreased mostly in the Group B at 3 months and 6 months of follow-up with a p-value of 0.003 and 0.013, respectively. The Joules/energy used showed a statistically significant difference (p-value=0.05), more energy must be used in vascular radiofrequency ablation. These data allow us to hypothesize that vRFA may improve the effectiveness of the procedure, allowing for a reduction in volume more quickly. They were preliminary but promising results, clearly a larger series of cases and prolonged follow-up are needed to clarify and confirm our observations.

Awareness, understanding and attitudes of Italians regarding palliative care.

There are numerous difficulties encountered in the diffusion of palliative care (PC) in developed countries. A correct and widespread awareness of PC among the general public represents an important factor for its enhanced diffusion and use. The aim of this study is to verify the level of awareness of PC among Italians and their perception of the needs of patients with incurable illness. A random sample of 1897 adult subjects, aged 18 to 74 years, representative of the Italian population, was interviewed after stratification by gender, age (6 strata), education (3 levels), geographic area of residency (4 areas) and town of residency (4 dimensions). 59.4% of those interviewed had heard of PC, but only 23.5% of them believed that they had an adequate or precise idea of what PC is; 27% of them did not know or had a mistaken idea about the nature of PC. The most accepted perception was that PC alleviates pain and improves quality-of-life. The principal concerns attributed to incurable patients were: fear of suffering and of death, and the principal needs were perceived as: relief from pain and physical suffering. The primary needs of the family were identified in: medical and nursing care at home, followed by: care provided by volunteers and psychological support. The most appropriate care-setting for these patients was indicated as their home, possibly with the support of professional carers. In the case of children, the main concern indicated was that of being "separated" from family, friends, home and toys. Only 45.2% of interviewees thought that they knew a person who had experienced PC. In conclusion, the awareness of the Italian population of PC is scarce and often incorrect. In order to achieve a greater diffusion and better use of PC in our country, this awareness needs to be improved by appropriate intervention.