Complete endoscopic closure (clipping) of a large esophageal perforation after pneumatic dilation in a patient with achalasia

The risk of esophageal perforation following endoscopic balloon dilation for achalasia is in the range of 1 and 5% with a mortality rate of 1-20%. Perforations need to be recognized early and, if reasonable, an immediate endoscopic repair should be pursued quickly. Herein, we report a case of successful endoscopic closure by clipping of a large iatrogenic perforation in a patient with achalasia. An 80-year-old woman with achalasia was admitted to our institution to undergo pneumatic dilation. A 40-mm balloon dilator with inflation pressure of 20 PSI was used for 2 minutes as usual. During the procedure, the patient had a transient bradycardia. Endoscopic control showed a 2-cm rupture of the distal esophagus. Prompt endoscopic repair of the perforation by endoclips (n=6) was then attempted, followed by conservative management by total parenteral nutrition and intravenous antibiotics. Endoscopic clipping closed completely the esophageal perforation. The patient was given oral nutrition 10 days later without any complications. Six months after the discharge, the patient was healthy and free of dysphagia. Endoscopy showed complete healing of the esophageal mucosa without luminal stenosis. This report highlights that prompt endoscopic clipping is a useful means to close a large esophageal perforation caused by pneumatic dilation

Application of unmanned aerial vehicle data and discrete fracture network models for improved rockfall simulations

In this research, we present a new approach to define the distribution of block volumes during rockfall simulations. Unmanned aerial vehicles (UAVs) are utilized to generate high-accuracy 3D models of the inaccessible SW flank of the Mount Rava (Italy), to provide improved definition of data gathered from conventional geomechanical surveys and to also denote important changes in the fracture intensity. These changes are likely related to the variation of the bedding thickness and to the presence of fracture corridors in fault damage zones in some areas of the slope. The dataset obtained integrating UAV and conventional surveys is then utilized to create and validate two accurate 3D discrete fracture network models, representative of high and low fracture intensity areas, respectively. From these, the ranges of block volumes characterizing the in situ rock mass are extracted, providing important input for rockfall simulations. Initially, rockfall simulations were performed assuming a uniform block volume variation for each release cell. However, subsequent simulations used a more realistic nonuniform distribution of block volumes, based on the relative block volume frequency extracted from discrete fracture network (DFN) models. The results of the simulations were validated against recent rockfall events and show that it is possible to integrate into rockfall simulations a more realistic relative frequency distribution of block volumes using the results of DFN analyse

Superlinear emission in bare perovskite: amplified spontaneous emission in disordered film versus single crystal lasing

Abstract We present an experimental study concerning the superlinear emission in organic-inorganic halide perovskites. Microphotoluminescence experiments under CW and picosecond excitation condition at low temperature and near field optical photoluminescence spectra at room temperature provide clear evidence of the very different origin of the superlinear regime in disordered films and microplates/microwires. Insights on the origin of modal structures of the emission spectra in the high excitation regime will be given by polarization-resolved photoluminescence experiments

Back analysis of the 2014 San Leo Landslide using combined terrestrial laser scanning and 3D distinct element modelling

This is the author accepted manuscript. The final version is available from Springer Verlag via http://dx.doi.org/10.1007/s00603-015-0763-5© 2015 Springer-Verlag Wien Landslides of the lateral spreading type, involving brittle geological units overlying ductile terrains, are a common occurrence in the sandstone and limestone plateaux of the northern Apennines of Italy. The edges of these plateaux are often the location of rapid landslide phenomena, such as rock slides, rock falls and topples. In this paper, we present a back analysis of a recent landslide (February 2014), involving the north-eastern sector of the San Leo rock slab (northern Apennines, Emilia-Romagna Region) which is a representative example of this type of phenomena. The aquifer hosted in the fractured slab, due to its relatively higher secondary permeability in comparison to the lower clayey units leads to the development of perennial and ephemeral springs at the contact between the two units. The related piping erosion phenomena, together with slope processes in the clay-shales have led to the progressive undermining of the slab, eventually predisposing large-scale landslides. Stability analyses were conducted coupling terrestrial laser scanning (TLS) and distinct element methods (DEMs). TLS point clouds were analysed to determine the pre- and post-failure geometry, the extension of the detachment area and the joint network characteristics. The block dimensions in the landslide deposit were mapped and used to infer the spacing of the discontinuities for insertion into the numerical model. Three-dimensional distinct element simulations were conducted, with and without undermining of the rock slab. The analyses allowed an assessment of the role of the undermining, together with the presence of an almost vertical joint set, striking sub-parallel to the cliff orientation, on the development of the slope instability processes. Based on the TLS and on the numerical simulation results, an interpretation of the landslide mechanism is proposed

A Multi-Disciplinary Approach to the Study of Large Rock Avalanches Combining Remote Sensing, GIS and Field Surveys: The Case of the Scanno Landslide, Italy

This is the final version. Available from MDPI via the DOI in this record.This research aims to highlight the importance of adopting a multi-disciplinary approach to understanding the factors controlling large rock avalanches using the Scanno landslide, Italy, as a case study. The study area is the Mount Genzana, Abruzzi Central Apennines, characterized by the regional Difesa-Mount Genzana-Vallone delle Masserie fault zone. The Scanno landslide is famous for its role in the formation of the Scanno Lake. The landslide is characterized by a wide exposed scar, which was interpreted in previous studies as the intersection of high-angle joints and an outcropping bedding plane on which the landslide failed sometime between the Upper Pleistocene and the Holocene. In this study, the Scanno landslide was investigated through the integration of geological, geomechanical and geomorphological surveys. Remote sensing techniques were used to enrich the conventionally gathered datasets, while Geographic Information Systems (GIS) were used to integrate, manage and investigate the data. The results of the authors investigation show that the outcropping landslide scar can be interpreted as a low-angle fault, associated with the Difesa-Mount Genzana-Vallone delle Masserie fault zone, which di ers from previous investigations and interpretations of the area. The low-angle fault provides the basal failure surface of the landslide, with two systematic high-angle joint sets acting as lateral release and back scarp surfaces, respectively. In light of these new findings, pre- and post-failure models of the area have been created. The models were generated in GIS by combining LiDAR (Light Detection and Ranging) and geophysics data acquired on the landslide body and through bathymetric survey data of the Scanno Lake. Using the pre- and post-failure models it was possible to estimate the approximate volume of the landslide. Finally, back-analyses using static and dynamic limit equilibrium methods is also used to show the possible influence of medium-to-high magnitude seismic events in triggering the Scanno landslide

Application of unmanned aerial vehicle data and discrete fracture network models for improved rockfall simulations

This is the final version. Available from the publisher via the DOI in this record.In this research, we present a new approach to define the distribution of block volumes during rockfall simulations. Unmanned aerial vehicles (UAVs) are utilized to generate high-accuracy 3D models of the inaccessible SW flank of the Mount Rava (Italy), to provide improved definition of data gathered from conventional geomechanical surveys and to also denote important changes in the fracture intensity. These changes are likely related to the variation of the bedding thickness and to the presence of fracture corridors in fault damage zones in some areas of the slope. The dataset obtained integrating UAV and conventional surveys is then utilized to create and validate two accurate 3D discrete fracture network models, representative of high and low fracture intensity areas, respectively. From these, the ranges of block volumes characterizing the in situ rock mass are extracted, providing important input for rockfall simulations. Initially, rockfall simulations were performed assuming a uniform block volume variation for each release cell. However, subsequent simulations used a more realistic nonuniform distribution of block volumes, based on the relative block volume frequency extracted from discrete fracture network (DFN) models. The results of the simulations were validated against recent rockfall events and show that it is possible to integrate into rockfall simulations a more realistic relative frequency distribution of block volumes using the results of DFN analyses

Creating the cultures of the future: cultural strategy, policy and institutions in Gramsci. Part two: Cultural strategy and institutions in Gramsci’s early writings and political practice

In this article, I consider Gramsci’s pre-prison writings and political practice in relation to questions of cultural strategy and institutions. I argue that the analysis of these early texts, which were written in the years in which Gramsci was active in party organisation and leadership, is fundamental not only for understanding the nature of Gramsci’s early and continued involvement with questions of cultural strategy and institutions, but also as a key for interpreting cultural policy themes that he later developed in the prison notebooks, and which originated in earlier debates

Dark Heritage

Peer reviewe

Metabolic Syndrome (MetS), Systemic Inflammatory Response Syndrome (SIRS), and Frailty: Is There any Room for Good Outcome in the Elderly Undergoing Emergency Surgery?

Background: Patients with MetS or SIRS experience higher rates of mortality and morbidity, across both cardiac and noncardiac surgery. Frailty assessment has acquired increasing importance in recent years as it predisposes elderly patients to a worse outcome. The aim of our study was to investigate the influence of MetS, SIRS, and with or without frailty on elderly patients undergoing emergency surgical procedures. Methods: We analyzed data of all patients with nonmalignant diseases requiring an emergency surgical procedure from January 2017 to December 2020. The occurrence of MetS was identified using modified definition criteria used by the NCEP-ATP III Expert Panel: obesity, hypertension, diabetes, or if medication for high triglycerides or for low HDL cholesterol was taken. Systemic inflammatory response syndrome (SIRS) was evaluated according to the original consensus study (Sepsis-1). The frailty profile was investigated by the 5-modified Frailty Index (5-mFI) and the Emergency Surgery Frailty Index (EmSFI). Postoperative complications have been reported and categorized according to the Clavien–Dindo (C–D) classification system. Morbidity and mortality have been mainly considered as the 30-day standard period definition. Results: Of the 2,318 patients included in this study, 1,010 (43.6%) fulfilled the criteria for MetS (MetsG group). Both 5-Items score and EmsFI showed greater fragility in patients with MetS. All patients with MetS showed more frequently a CACI index greater than 6. The occurrence of SIRS was higher in MetSG. LOS was longer in patients with MetS (MetSG 11.4 ± 12 days vs. n-MetSG 10.5 ± 10.2 days, p = 0.046). MetSG has a significantly higher rate of morbidity (353 (35.%) vs. 385 (29.4%), p = 0.005). The mortality rate in patients with MetS (98/1010, 10%) was similar to that in patients without it (129/1308, 10%). Considering patients with MetS who developed SIRS and those who had frailty or both, the occurrence of these conditions was associated with a higher rate of morbidity and mortality. Conclusion: Impact of MetS and SIRS on elderly surgical patient outcomes has yet to be fully elucidated. The present study showed a 43.6% incidence of MetS in the elderly population. In conclusion, age per se should be not considered anymore as the main variable to estimate patient outcomes, while MetS and Frailty should have always a pivotal role