Operative and nonoperative management for renal trauma. Comparison of outcomes. A systematic review and meta-analysis

INTRODUCTION: Preservation of kidney and renal function is the goal of nonoperative management (NOM) of renal trauma (RT). The advantages of NOM for minor blunt RT have already been clearly described, but its value for major blunt and penetrating RT is still under debate. We present a systematic review and meta-analysis on NOM for RT, which was compared with the operative management (OM) with respect to mortality, morbidity, and length of hospital stay (LOS). METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed for this study. A systematic search was performed on Embase, Medline, Cochrane, and PubMed for studies published up to December 2015, without language restrictions, which compared NOM versus OM for renal injuries. RESULTS: Twenty nonrandomized retrospective cohort studies comprising 13,824 patients with blunt (2,998) or penetrating (10,826) RT were identified. When all RT were considered (American Association for the Surgery of Trauma grades 1-5), NOM was associated with lower mortality and morbidity rates compared to OM (8.3% vs 17.1%, odds ratio [OR] 0.471; 95% confidence interval [CI] 0.404-0.548; P<0.001 and 2% vs 53.3%, OR 0.0484; 95% CI 0.0279-0.0839, P<0.001). Likewise, NOM represented the gold standard treatment resulting in a lower mortality rate compared to OM even when only high-grade RT was considered (9.1% vs 17.9%, OR 0.332; 95% CI 0.155-0.708; P=0.004), be they blunt (4.1% vs 8.1%, OR 0.275; 95% CI 0.0957-0.788; P=0.016) or penetrating (9.1% vs 18.1%, OR 0.468; 95% CI 0.398-0.0552; P<0.001). CONCLUSION: Our meta-analysis demonstrated that NOM for RT is the treatment of choice not only for AAST grades 1 and 2, but also for higher grade blunt and penetrating RT

Hollow viscus injuries. Predictors of outcome and role of diagnostic delay

INTRODUCTION: Hollow viscus injuries (HVIs) are uncommon but potentially catastrophic conditions with high mortality and morbidity rates. The aim of this study was to analyze our 16-year experience with patients undergoing surgery for blunt or penetrating bowel trauma to identify prognostic factors with particular attention to the influence of diagnostic delay on outcome. METHODS: From our multicenter trauma registry, we selected 169 consecutive patients with an HVI, enrolled from 2000 to 2016. Preoperative, intraoperative, and postoperative data were analyzed to assess determinants of mortality, morbidity, and length of stay by univariate and multivariate analysis models. RESULTS: Overall mortality and morbidity rates were 15.9% and 36.1%, respectively. The mean length of hospital stay was 23±7 days. Morbidity was independently related to an increase of white blood cells (P=0.01), and to delay of treatment >6 hours (P=0.033), while Injury Severity Score (ISS) (P=0.01), presence of shock (P=0.01), and a low diastolic arterial pressure registered at emergency room admission (P=0.02) significantly affected postoperative mortality. CONCLUSION: There is evidence that patients with clinical signs of shock, low diastolic pressure at admission, and high ISS are at increased risk of postoperative mortality. Leukocytosis and delayed treatment (>6 hours) were independent predictors of postoperative morbidity. More effort should be made to increase the preoperative detection rate of HVI and reduce the delay of treatment

Relationship between rhinitis duration and worsening of nasal function

While it is well known that asthma is characterized by airway remodeling, few studies instead have investigated this issue in patients with allergic rhinitis (AR)

Environmental Impact Analysis of Flue Gases Emissions for a 20 Kwe Biomass Gasifier

Due to the potential ability to support local development, create local employment, and contribute to climate change mitigation decentralized bioenergy CHP systems are receiving increasing attention. With bioenergy CHP systems are possible to achieve energy efficiency by converting primary energy to heat and electricity, replacing fossil fuels and reducing carbon dioxide emissions in the atmosphere. In particular, biomass cogeneration is considered a reliable efficient energy production technology and an effective alternative to reduce greenhouse gas emissions due to their low CO2 emission, using near biomass production sites (e.g., agricultural activities, forestes), avoiding long supply chains. In this paper, a techno-environmental assessment for a biomass powered micro-scale CHP system based on gasifier combined with an internal combustion engine sized for a maximum electrical and thermal output of 20 kWe and 40 kWth, is analyzed. CO2 direct emissions and CO2 equivalent emissions for NO2, CO, HC were assessed in order to obtain the final environmental impact of the plant. Several cases were considered changing biomass kind and flue gas treatment systems. Results show that biomass kind has not an impact on the toxic gas emissions, while the bioscrubber is the best flue gas treatment technology to reduce concentrations of all pollutants

NO2 Dispersion Model Of Emissions Of A 20 kWe Biomass Gasifier

Biomass valorization represents a simple way to reduce Green House Gases emissions. However, the biomass-to-energy field is limited by high gaseous emission concentrations. Innovative abatement technologies can make gaseous emissions close to zero. In this work, three different NO2 abatement technologies were assessed and compared. A deterministic approach was used to estimate NO2 concentrations using experimental concentrations at the chimney for a 20 kWe biomass gasifier. The gasifier chimney was described as an equivalent stack. The pollutant propagation was simulated with a Gaussian plume dispersion model. On this purpose, the unknown equivalent stack flow rate in the model was adjusted using the available data of NO2 on the ground, considering the changing of the air stability between nighttime and daytime and the variable wind direction. Thanks to pollutants dispersion modeling, the evaluation of the optimal abatement technology was possible, investigating the potential effect produced on people and the environment. Results show a bioscrubber technology as the best one to reduce NO2 concentrations at 100, 1000, 3000 m from the emission point of 74, 75, 70 %, respectively

A phenomenological model of a downdraft biomass gasifier flexible to the feedstock composition and the reactor design

The development of a one-dimensional (1D) phenomenological model for biomass gasification in downdraft reactors is presented in this study; the model was developed with the aim of highlighting the main advantages and limits related to feedstocks that are different from woodchip, such as hydro-char derived from the hydrothermal carbonization of green waste, or a mix of olive pomace and sawdust. An experimental validation of the model is performed. The numerically evaluated temperature evolution along the reactor gasifier is found to be in agreement with locally measured values for all the considered biomasses. The model captures the pressure drop along the reactor axis, despite an underestimation with respect to the performed measurements. The producer gas composition resulting from the numerical model at the exit section is in quite good agreement with gas-chromatograph analyses (12% maximum error for CO and CO2 species), although the model predicts lower methane and hydrogen content in the syngas than the measurements show. Parametric analyses highlight that lower degrees of porosity enhance the pressure drop along the reactor axis, moving the zones characterized by the occurrence of the combustion and gasification phases towards the bottom. An increase in the biomass moisture content is associated with a delayed evolution of the temperature profile. The high energy expenditure in the evaporation phase occurs at the expense of the produced hydrogen and methane in the subsequent phases

Impact of allergic rhinitis on asthma: effects on bronchodilation testing

A remarkable relationship exists between the upper and lower airways. Bronchial obstruction is a paramount feature of asthma, and its reversibility is considered a main step in asthma diagnosis

Differences between computed tomoghaphy and surgical findings in acute complicated diverticulitis

Summary Background/Objective: A preoperative reliable classification system between clinical and computed tomography (CT) findings to better plan surgery in acute complicated diverticulitis (ACD) is lacking. We studied the inter-observer agreement of CT scan data and their concordance with the preoperative clinical findings and the adherence with the intraoperative status using a new classification of diverticular disease (CDD). Methods: 152 patients operated on for acute complicated diverticulitis (ACD) were retrospectively enrolled. All patients were studied with CT scan within 24 h before surgery and CT images were blinded reanalyzed by 2 couples of radiologists (A/B). Kappa value evaluated the inter-observer agreement between radiologists and the concordance between CDD, preoperative clinical findings and findings at operation. Univariate and multivariate analysis were used to evaluate the predicting values of CT classification and CDD stage at surgery on postoperative outcomes. Results: Overall inter-observer agreement for the CDD was high, with a kappa value of 0.905 (95% CI Z 0.850e0.960) for observers A and B, while the concordance between radiologica