Ultrasound-Guided Radiofrequency Thermal Ablation of Uterine Fibroids: Medium-Term Follow-Up

Previous studies have shown that radiofrequency thermal ablation (RFA) of uterine fibroids through a percutaneous ultrasound (US)-guided procedure is an effective and safe minimally invasive treatment, with encouraging short-term results. The aim of this study was to assess the results in terms of volume reduction and clinical symptoms improvement in the midterm follow-up of fibroids with a diameter of up to 8 cm. Eleven premenopausal females affected by symptomatic fibroids underwent percutaneous US-guided RFA. Symptom severity and reduction in volume were evaluated at 1, 3, 6, 9, and 12 months. The mean symptom score (SSS) before the procedure was 50.30 (range 31.8–67.30), and the average quality of life (QOL) score value was 62 (range 37.20–86.00). The mean basal diameter was 5.5 cm (range 4.4–8) and the mean volume was 101.5 cm3 (range 44.58–278 cm3). The mean follow-up was 9 months (range 3–12 months). The mean SSS value at the end of the follow-up was 13.38 (range 0–67.1) and the QOL 90.4 (range 43.8–100). At follow-up the mean diameter was 3.0 cm (range 1.20–4.5 cm), and the mean volume was 18 cm3 (range 0.90–47.6 cm3). In 10 of 11 patients we obtained total or partial regression of symptoms. In one case the clinical manifestations persisted and it was thus considered unsuccessful. In conclusion, US-guided percutaneous RFA is a safe and effective treatment even for fibroids up to 8 cm

Two Brothers with Skewed Thiopurine Metabolism in Ulcerative Colitis Treated Successfully with Allopurinol and Mercaptopurine Dose Reduction

Thiopurine therapy effectively maintains remission in inflammatory bowel disease. However, many patients are unable to achieve optimum benefits from azathioprine or 6-mercaptopurine because of undesirable metabolism related to high thiopurine methyltransferase (TPMT) activity characterized by hepatic transaminitis secondary to increased 6-methylmercaptopurine (6-MMP) production and reduced levels of therapeutic 6-thioguanine nucleotide (6-TGN). Allopurinol can optimize this skewed metabolism. We discuss two brothers who were both diagnosed with ulcerative colitis (UC). Their disease remained active despite oral and topical mesalamines. Steroids followed by 6-mercaptopurine (MP) were unsuccessfully introduced for both patients and both were found to have high 6-MMP and low 6-TGN levels, despite normal TMPT enzyme activity, accompanied by transaminitis. Allopurinol was introduced in combination with MP dose reduction. For both brothers addition of allopurinol was associated with successful remission and optimized MP metabolites. These siblings with active UC illustrate that skewed thiopurine metabolism may occur despite normal TPMT enzyme activity and can lead to adverse events in the absence of disease control. We confirm previous data showing that addition of allopurinol can reverse this skewed metabolism, and reduce both hepatotoxicity and disease activity, but we now also introduce the concept of a family history of preferential MP metabolism as a clue to effective management for other family members

Music as a Manifestation of Life: Exploring Enactivism and the ‘Eastern Perspective’ for Music Education

The enactive approach to cognition is developed in the context of music and music education. I discuss how this embodied point of view affords a relational and bio-cultural perspective on music that decentres the Western focus on language, symbol and representation as the fundamental arbiters of meaning. I then explore how this ‘life-based’ approach to cognition and meaning-making offers a welcome alternative to standard Western academic approaches to music education. More specifically, I consider how the enactive perspective may aid in developing deeper ecological understandings of the transformative, extended and interpenetrative nature of the embodied musical mind; and thus help (re)connect students and teachers to the lived experience of their own learning and teaching. Following this, I examine related concepts associated with Buddhist psychology in order to develop possibilities for a contemplative music pedagogy. To conclude, I consider how an enactive-contemplative perspective may help students and teachers awaken to the possibilities of music education as ‘ontological education.’ That is, through a deeper understanding of ‘music as a manifestation of life’ rediscover their primordial nature as autopoietic and world-making creatures and thus engage more deeply with musicality as a means of forming richer and more compassionate relationships with their peers, their communities and the ‘natural’ and cultural worlds they inhabit

Environmental consequences of refurbishment vs. demolition and reconstruction: a comparative life cycle assessment of an Italian case study

In the building sector, the new standards for energy efficiency are reducing the energy consumption and the carbon emissions for building operation to nearly zero. As a result, the greenhouse gases emissions and related environmental impacts from materials production, and especially insulation, are becoming dominant. In the next future, most of building stock is expected to be refurbished and a great amount of construction materials will be consequently required. A relevant share of waste is generated from building construction and demolition and limiting the volume is a priority of the EU community. In this work the renovation of industrial buildings in a dismissed area located in Lecco, Italy, was considered as case study. Five alternative construction systems for renovating the building envelopes were assumed, and a life cycle assessment (LCA) adopted in order to measure the environmental impact of each alternative. The results where compared with a scenario which includes demolition and reconstruction of a similar building with the same net volume and thermal resistance. The results showed that timber and concrete are the most valuable materials to rebuild the structures in case of demolition, contrarily to steel which leads generally to higher environmental impacts, except land use. Refurbishment scenarios generally account for a lower global warming potential (GWP) even if demolition, waste treatment and benefit from recycling/reuse are taken into account.ISSN:1755-1315ISSN:1755-130

Environmental consequences of refurbishment vs. demolition and reconstruction: a comparative life cycle assessment of an Italian case study

Abstract. In the building sector, the new standards for energy efficiency are reducing the energy consumption and the carbon emissions for building operation to nearly zero. As a result, the greenhouse gases emissions and related environmental impacts from materials production, and especially insulation, are becoming dominant. In the next future, most of building stock is expected to be refurbished and a great amount of construction materials will be consequently required. A relevant share of waste is generated from building construction and demolition and limiting the volume is a priority of the EU community. In this work the renovation of industrial buildings in a dismissed area located in Lecco, Italy, was considered as case study. Five alternative construction systems for renovating the building envelopes were assumed, and a life cycle assessment (LCA) adopted in order to measure the environmental impact of each alternative. The results where compared with a scenario which includes demolition and reconstruction of a similar building with the same net volume and thermal resistance. The results showed that timber and concrete are the most valuable materials to rebuild the structures in case of demolition, contrarily to steel which leads generally to higher environmental impacts, except land use. Refurbishment scenarios generally account for a lower global warming potential (GWP) even if demolition, waste treatment and benefit from recycling/reuse are taken into account