I.S.Mu.L.T. Achilles Tendon Ruptures Guidelines

This work provides easily accessible guidelines for the diagnosis, treatment and rehabilitation of Achilles tendon ruptures. These guidelines could be considered as recommendations for good clinical practice developed through a process of systematic review of the literature and expert opinion, to improve the quality of care for the individual patient and rationalize the use of resources. This work is divided into two sessions: 1) questions about hot topics; 2) answers to the questions following Evidence Based Medicine principles. Despite the frequency of the pathology andthe high level of satisfaction achieved in treatment of Achilles tendon ruptures, a global consensus is lacking. In fact, there is not a uniform treatment and rehabilitation protocol used for Achilles tendon ruptures

Pattern of care for re-irradiation in locally recurrent rectal cancer: a national survey on behalf of the AIRO gastrointestinal tumors study group

PurposeRadical resection (R0) represents the best curative treatment for local recurrence (LR) rectal cancer. Re-irradiation (re-RT) can increase the rate of R0 resection. Currently, there is a lack of guidelines on Re-RT for LR rectal cancer. The Italian Association of Radiation and clinical oncology for gastrointestinal tumors (AIRO-GI) study group released a national survey to investigate the current clinical practice of external beam radiation therapy in these patients.Material and methodsIn February 2021, the survey was designed and distributed to members of the GI working group. The questionnaire consisted of 40 questions regarding center characteristics, clinical indications, doses, and treatment techniques of re-RT for LR rectal cancer.ResultsA total of 37 questionnaires were collected. Re-RT was reported as an option for neoadjuvant treatment in resectable and unresectable disease by 55% and 75% of respondents, respectively. Long-course treatment with 30-40 Gy (1.8-2 Gy/die, 1.2 Gy bid) and hypofractionated regimen of 30-35 Gy in 5 fractions were used in most centers. A total dose of 90-100 Gy as EqD2 dose (& alpha;/& beta; = 5 Gy) was delivered by 46% of the respondents considering the previous treatment. Modern conformal techniques and daily image-guided radiation therapy protocols were used in 94% of centers.ConclusionOur survey showed that re-RT treatment is performed with advanced technology that allow a good management of LR rectal cancer. Significant variations were observed in terms of dose and fractionation, highlighting the need for a consensus on a common treatment strategy that could be validated in prospective studies

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Surface-induced stacking transition at SiC(0001)

We present the ab initio results for the energetics of several SiC surfaces having different underlying bulk polytypes, to investigate the role of surface effects in the mechanisms of stacking inversion in SiC. We considered the Si adatom √3×√3 reconstruction for the cubic SiC(111) and the hexagonal SiC(0001) surfaces, taking into account the different subsurface bulk terminations compatible with the 4H and 6H polytypes, and allowing for two opposite stacking orientations of the topmost surface layer. Our investigation reveals that the energy differences among SiC polytypes are enhanced at the surface with respect to the bulk, and two-dimensional effects favor the formation of cubic SiC. We discuss the relevant role played by the surface energetics in the homoepitaxial growth of SiC

Kinetic Monte Carlo simulations of C diffusion on root 3x root 3 beta-SiC(111) based on ab initio calculations

We performed ab initio calculations to identify and characterize the stationary points of the potential energy surface experienced by a C adatom deposited on the root 3- x root 3 beta-SiC(111) surface. A kinetic Monte Carlo simulation relying on the ab initio calculated parameters allowed us to follow C diffusion at realistic temperature and time scales. We found that the C diffusion occurs mostly around the Si adatoms characteristic of the root 3- x root 3- reconstruction

Combined ab initio and kinetic Monte Carlo simulations of C diffusion on the root(3)X root(3) beta-SiC(111) surface

We investigate the kinetic behavior of a single C adatom on the √3 X √3 β-SiC(111) surface by means of combined ab initio and kinetic Monte Carlo simulations. After identifying the metastable binding locations, we calculate the energy barriers the adatom must overcome when jumping among them. The presence of the √3 X √3 reconstruction creates considerable differences among the diffusion mechanisms that can be thermally activated. This has important implications for the C mobility on the surface, and therefore for SiC growth. The kinetic simulation at realistic temperatures and time scales revealed that C diffusion occurs mostly around the Si adatoms forming the √3 X √3 reconstruction. A reduced adatom mobility, as observed in many studies of surfactant-mediated growth, can favor the formation of a high density of nuclei, and thus promote a layer-by-layer growth. As a further result of the kinetic simulation we obtained the adatom diffusion coefficient, a macroscopic quantity accessible in experiments. ©2005 The American Physical Society

Xyloglucan-based hydrogel films for the design of "smart" bandages

A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do. Chronic wounds mostly affect people over the age of 60, but a significant proportion is becoming radiation induced chronic wounds caused by cancer radiotherapy. Hydrogels are often used as dressings in the management of a variety of wounds. These materials can help to maintain a moist wound environment, promote natural debridement, hydrate necrotic tissue, absorb slough and exudates.We are developing hydrogel dressings that can enable constant monitoring of selected key parameters through embedded radio-sensors, providing information on the progress of the reparative process, while maintaining the wound hydrated and oxygenated.Xyloglucan (XG) has been chosen asmain component of the hydrogel wound dressings. Chemical crosslinking has been induced to improve the mechanical properties of the films and prevent erosion. The effect of glycerol, used as plasticizer, on the structural and mechanical properties of the hydrogels has been investigated.Selected films resulted easy to handle, flexible and conformable, able to absorb high amounts of simulated biological fluids. Film biocompatibility and hemocompatibility was demonstrated by biological tests in which no injurious response was activated. Furthermore, we found that epithelial cells can partially adhere to the film whose ability to inhibit microorganisms growth and invasion was also demonstrated. The best candidate is now being integrated with a RFID radio-sensor to monitor the amount of exudates

Ab initio Simulations of Homoepitaxial SiC Growth

An ab initio simulation study of SiC homoepitaxial growth is presented. It is shown that the nonstoichiometric reconstruction plays a relevant role in favoring the attainment of high-quality films. It is observed that the energy gain upon surface stability can induce the reorganization of the deposited material into the crystalline structure, thus revealing that a surface-driven mechanism is able to stabilize defect-free layer deposition on Si-rich surfaces

Biocompatibility, hemocompatibility and antimicrobial properties of xyloglucan-based hydrogel film for wound healing application

Crosslinked xyloglucan-poly(vinyl alcohol) based hydrogel films are interesting materials for wound healing applications. This work focuses on the hydrolytic degradation and consequent morphological modification of a XG-PVA film and on its interaction with cells, blood, bacteria. Biocompatibility of the film was assessed in vitro by investigating different aspects, such as cell viability, oxidative stress level, mitochondrial dysfunction and specific stress biomarkers. Partial adhesiveness was demonstrated by performing different attaching assays and phalloidin staining. Hemocompatibility of XG-PVA film after interaction with blood was evaluated by using a multi-parametric approach, including human Red Blood Cells (RBC) count, hemolytic response and platelets activation. Thrombin and fibrinogen concentrations were examined as marker of the coagulation cascade. After direct contact with human blood and peripheral blood mononuclear cells (PBMC), no evidence of cell defense response was observed. Antimicrobial activity of XG-PVA film was tested against Escherichia coli (E.coli). XG-PVA film promotes bacterial retentivity and provides mechanical protection against bacterial infiltration. After loading the film with ampicillin, an inhibitory E. coli growth zone was observed. All together these results indicate that the XG-PVA system is a promising material to be tested in vivo for wound healing applications