Finite element simulation of semi-finishing turning of Electron Beam Melted Ti6Al4V under dry and cryogenic cooling

open6noIn the last few years, important step forwards have been made on Finite Element Simulation of machining operations. Wrought Ti6Al4V alloy has been deeply investigated both numerically and experimentally due to its wide application in the industry. Recently, Additive Manufacturing technologies as the Electron Beam Melting and the Direct Melting Laser Sintering are more and more employed in the production of biomedical and aeronautical components made of Ti6Al4V alloy. Fine acicular microstructures are generated by the application of additive manufacturing technologies, affecting the mechanical properties and the machinability. By the consequence, this peculiarity has to be considered in modelling the material behaviour. In this work, a numerical analysis of cylindrical external turning on Electron Beam Melted (EBM) Ti6Al4V alloy is presented. A Johnson-Cook constitutive equation was implemented as a flow stress model and adapted with respect to the wrought Ti6Al4V alloy. The model was calibrated and validated through the cutting forces and temperatures measurements acquired under dry and cryogenic lubricating conditions.openBordin, A; Imbrogno, S.; Rotella, G.; Bruschi, S.; Ghiotti, A.; Umbrello, D.Bordin, Alberto; Imbrogno, S.; Rotella, G.; Bruschi, Stefania; Ghiotti, Andrea; Umbrello, D

Interactional positioning and narrative self-construction in the first session of psychodynamic-interpersonal psychotherapy

The purpose of this study is to identify possible session one indicators of end of treatment psychotherapy outcome using the framework of three types of interactional positioning; client’s self-positioning, client’s positioning between narrated self and different partners, and the positioning between client and therapist. Three successful cases of 8-session psychodynamic-interpersonal (PI) therapy were selected on the basis of client Beck Depression Inventory scores. One unsuccessful case was also selected against which identified patterns could be tested. The successful clients were more descriptive about their problems and demonstrated active rapport-building, while the therapist used positionings expressed by the client in order to explore the positionings developed between them during therapy. The unsuccessful case was characterized by lack of positive self-comment, minimization of agentic self-capacity, and empathy-disrupting narrative confusions. We conclude that the theory of interactional positioning has been useful in identifying patterns worth exploring as early indicators of success in PI therapy

Advantages of alginate and PPI combination in relief of heartburn and regurgitation during the first days of treatment of gastroesophageal reflux disease

Aim of investigation. To estimate advantages of combined intake of proton pump inhibitor (PPI) and alginate in comparison to monotherapy by PPI in terms of symptom relief in the first days of gastroesophageal reflux disease (GERD) treatment.Material and methods. Overall 96 patients with GERD were investigated. All patients complained of heartburn, 41 patients had regurgitation. Symptoms were estimated by Likert scale prior to onset of therapy and daily during treatment course. General well-being was evaluated by visual-analog scale (VAS) prior to therapy, at the 7th and 14th days of treatment. The first group (46 patients, 19 males, mean age — 50,2±12,7 years) received combined therapy by pantoprazole 40 mg/day and alginate (Gaviscon DD) 20 ml qid at the 1st and 2nd days of treatment followed by «on demand» mode. The second group (50 patients, 22 males, mean age 51,3±14,4 year) received pantoprazole 40 mg per day. All patients underwent esophagogastroduodenoscopy.Results. At the 1st day of treatment heartburn has been completely relived in 61% of patients of the first group and in 14% — of the second (р<0,001), at the 2nd day — in 63% and 20% (р<0,001). At the 3rd day (alginate in «on demand» mode) the heartburn was absent in 48% of patients of the first group and in 44% — of the second (р=0,8). Regurgitation at the 1st day of treatment was relieved in 78% of patients of the first group and remained in all patients of the second group, who initially complained of it (р<0,001), at the 2nd day it stopped in 83% and 22% of patients respectively (р<0,001), at the 3rd day — in 67% and 22% (р=0,01). After the 4th day there were no intergroup differences. At the 7th day of treatment according to VAS wellbeing score in the first group increased from 57,3±9,7 to 78,1±11,2 mm (р <0,001), in the second — from 54,9±14,9 to 67,0±15,2 mm (р<0,001). The intergroup differences of the score at the 7th day was statistically significant (р<0,001). By the 14th day difference disappeared (78,8±9,7 mm vs 75,6±12,5 mm, р=0,1).Conclusions. This study has demonstrated advantages of the combined therapy in the first days of GERD treatment in decreased terms relief of symptoms and improvement of state of health

Features of the Parameters of 24-Hours pH-Impedance and High-Resolution Esophageal Manometry in Patients with Barrett's Esophagus on Proton Pump Inhibitors

Аim: to identify predictors of insufficient effectiveness of proton pump inhibitors based on the evaluation of the results of 24-hour pH-impedance and high-resolution esophageal manometry in patients with Barrett's esophagus.Materials and methods. 52 patients with histologically confirmed Barrett's esophagus who are on therapy with proton pump inhibitors were examined. All patients underwent daily pH-impedance and high-resolution esophageal manometry.Results. According to daily pH-impedance, group 1 consisted of 37 patients who responded satisfactorily to antisecretory therapy, group 2 of 15 patients who demonstrated insufficient response to acid-suppressive therapy, 11 of whom had no clinical manifestations. The total number of reflux averaged 55 in group 1 and 106 in group 2. The average number of acid reflux in group 1 was 5.68, in group 2 — 48.5. The average number of non-acid reflux prevailed in patients of group 2 and averaged 58, in group 1 the indicator averaged 47. Evaluation of the results of high-resolution esophageal manometry showed that violations of the structure and function of the esophago-gastric junction were detected in 21 patients out of 52. Disorders of the motility of the thoracic esophagus were detected in 31 patients out of 52. When comparing the frequency of motor disorders from the thoracic esophagus in groups 1 and 2, no significant differences were obtained. However, significantly more frequent registration of violations of the structure and/or function of the esophago-gastric junction was found in the group with unsatisfactory effectiveness of proton pump inhibitors.Conclusion. In a number of patients with Barrett's esophagus, there is an insufficient effect of acid-suppressive therapy and at the same time an asymptomatic course of the disease, which may increase the risk of its progression. Predictors of insufficiently successful treatment of patients with Barrett's esophagus may be both insufficient pharmacological effect of proton pump inhibitors themselves, and motility disorders that cause the presence of non-acid reflux, decreased esophageal clearance, which in turn may cause the patient's symptoms to persist and adversely affect the condition of the esophageal mucosa

«СЕРОЛОГИЧЕСКАЯ БИОПСИЯ» И СКРИНИНГ РАКА ЖЕЛУДКА

High morbidity and mortality of gastric cancer in Russia determine relevance of developing of a national strategy for gastric cancer and preneoplastic diseases of the stomach screening, especially atrophic gastritis. Review of the literature shows that the best non-invasive method to identify individuals at high risk of gastric cancer are H. pylori serological tests and markers of pepsinogens atrophy. H. pylori eradication is the most promising strategy to reduce the incidence of gastric cancer.Высокая заболеваемость и смертность от рака желудка в России определяют актуальность выработки национальной стратегии скрининга рака и пренеопластических заболеваний  желудка, прежде всего атрофического гастрита. Обзор литературы демонстрирует,  что наилучшим неинвазивным методом выявления лиц с высоким риском рака желудка признаны серологические тесты для диагностики H. pylori и маркеров атрофии пепсиногенов. Эрадикация H. pylori является наиболее перспективной стратегией снижения заболеваемости раком желудка

Antibiotic resistance prevalence and trends in patients infected with helicobacter pylori in the period 2013–2020: Results of the european registry on h. pylori management (hp-eureg)

Background: Bacterial antibiotic resistance changes over time depending on multiple factors; therefore, it is essential to monitor the susceptibility trends to reduce the resistance impact on the effectiveness of various treatments. Objective: To conduct a time-trend analysis of Helicobacter pylori resistance to antibiotics in Europe. Methods: The international prospective European Registry on Heli-cobacter pylori Management (Hp-EuReg) collected data on all infected adult patients diagnosed with culture and antimicrobial susceptibility testing positive results that were registered at AEG-REDCap e-CRF until December 2020. Results: Overall, 41,562 patients were included in the Hp-EuReg. Culture and antimicrobial susceptibility testing were performed on gastric biopsies of 3974 (9.5%) patients, of whom 2852 (7%) were naive cases included for analysis. The number of positive cultures decreased by 35% from the period 2013–2016 to 2017–2020. Concerning naïve patients, no antibiotic resistance was found in 48% of the cases. The most frequent resistances were reported against metronidazole (30%), clarithromycin (25%), and levofloxacin (20%), whereas resistances to tetracycline and amoxicillin were below 1%. Dual and triple resistances were found in 13% and 6% of the cases, respectively. A decrease (p < 0.001) in the metronidazole resistance rate was observed between the 2013–2016 (33%) and 2017–2020 (24%) periods. Conclusion: Culture and antimicrobial susceptibility testing for Helicobacter pylori are scarcely performed (<10%) in Europe. In naïve patients, Helicobacter pylori resistance to clarithromycin remained above 15% throughout the period 2013–2020 and resistance to levofloxacin, as well as dual or triple resistances, were high. A progressive decrease in metronidazole resistance was observed

The person-centred approach to an ageing society

Modern care is often based on investigations such as laboratory markers and imaging - for example, X-ray or ultrasound. The results contribute to a diagnosis and, if judged necessary, treatment is initiated. This diseased-oriented approach is the prevailing mode of management in modern medicine. In contrast, person-centered care (PCC) takes the point of departure from each person\ub4s subjective experience of illness and its impact on daily life. A patient is considered as a person with emotions and feelings. PCC is considered present within clinical care according to a definition articulated by the Centre for Person Centred Care at the University of Gothenburg (GPCC) when three core components are present: elicitation of a detailed patient narrative; formulated partnership between caregiver and patient and documentation of the partnership in the patient record. Accordingly, when there is an illness requiring care and the person is attended using these components, PCC is being applied. In most situations today, PCC is not applied in terms of the narrative and is not fully elicited or the partnership and/or the documentation are not included. It is proposed that the challenge to Society arising from changing demographics can be addressed by implementing PCC and creating an alternative to existing healthcare. The importance and benefits of such an approach on a wider scale is not yet clear as research has been limited to date. Studies in selected patient populations (heart failure and hip fractures), however, have shown promising results. As the population ages, there will be a dramatic increase in healthcare consumption. Even with technological developments, there will be a need for tremendous resources to be dedicated to care. A new organization and attitude from healthcare policymakers and providers above and beyond the present model appears required in order to respond to this demand. As part of such change, person-centred care, with the interaction between healthcare providers and the person of the patient, can facilitate, compensate and develop more effective healthcare services for the future