A rare cause of left upper quadrant abdominal pain

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Design and Fabrication of Customized Tracheal Stents by Additive Manufacturing

Abstract Additive Manufacturing (AM) is already becoming part of our life from a technological, economic and social point of view. Nowadays, it is applied in several manufacturing sectors. In particular, AM shows huge opportunities in the medical field and for healthcare applications. Due to its capability to produce complex geometries directly working on medical 3D images and thanks to the possibility to 3D-print biocompatible materials, AM is a key technology for the fabrication both of external and internal medical devices. In particular, the use of AM for medical applications is typically articulated in three steps: 3D-scanning of the patient anatomy, segmentation the medical scan and elaboration through CAD software for the preparation of a STL file suitable for the AM process. One of the main research topic in this field is the definition and optimization of procedures that, taking precise data from an individual patient, could be applied to the design and fabrication of customized components for medical applications. Therefore, this paper presents a project aimed at the fabrication of customized tracheal stents starting from the actual patient anatomy. In particular, it follows an approach based on molds FDM fabrication followed by biocompatible silicone casting. Molds were designed to obtain a tracheal stent based the patient anatomical tracheal lumen and were fabricated using FDM technology. Moreover, since the surface roughness is one of the most critical aspects related to the FDM, the produced molds were finished with a chemical surface post-treatment based on the use of acetone vapours. Overall, the whole developed procedure results in an effective custom-made medical devices realization

How smart technologies can support sustainable business models: Insights from an air navigation service provider

Purpose: Although research on smart technologies explains their critical importance in sustainable business models (SBMs) (Mikalef et al., 2017), it remains unclear how organisations can embrace smart technologies to create and/or improve their sustainable business models. The purpose of this paper is to unravel and address the challenges of smart technologies to build and maintain a sustainable business model for organisations. Design/methodology/approach: The research develops an empirical analysis through a case study approach. We have investigated the case of ENAV – an Italian air navigation service provider – and how this firm uses smart technologies in the creation of its successful SBM. After constructing a basic theory, the authors moved to evidence collection. The data analysis has adopted a qualitative approach based on a thematic analysis of the transcripts and related documents. Findings: The findings from the case study support the idea that the business value and the strategic relevance of smart technologies still remain largely underestimated in SBM adoption (Mikalef et al., 2017). Case study findings suggest that until today smart technologies have played a minimal role in SBM adoption. However, the smart technologies show the potential to inform the SBM adoption process by contributing to corporate communication for external stakeholders and to the main dimensions of SBMs such as safety and security or the respect for social and environmental criteria in the supply chain. Practical implications: This study seeks to support organisations and their directors to build and improve sustainable business models through smart technologies to maintain their competitive advantages. Specifically, our findings suggest that smart technologies can help organisations bridge the design–implementation gap of sustainable business models. Originality/value: This research advances our understanding of the role of smart technologies by explaining how they can enhance sustainable business model adoption. Indeed, we offer a comprehensive view of the integration of insights from three different but related literature streams such as sustainability strategies, smart technologies and change management studies

Aliskiren, a renin inhibitor, downregulates TNF-α-induced tissue factor expression in HUVECS

Angiotensin (Ang)II, the effector arm of the locally active renin—angiotensin system (RAS), modulates Tissue Factor (TF), the principal initiator of blood coagulation and a key promoter of atherothrombotic events. Consistent with that knowledge, previous data showed inhibitory properties of angiotensin-converting enzyme inhibitor (ACEI)s and angiotensin II type-1 receptor blocker (ARB)s, but no data are available about the effect of renin inhibition. We aimed to evaluate whether aliskiren, a direct renin inhibitor (DRI), modulates TNF-α-stimulated TF expression in cultured human umbilical vein endothelial cells (HUVECs). Zofenopril, an ACEI, and olmesartan, an ARB, were the controls. HUVECs were incubated with experimental drugs (1 nM) 30 min prior to TNF-α stimulation (0.1 ng/ml × 4 h). Main evaluation variables were procoagulant activity (single-stage clotting assay), TF antigen (ELISA) and mRNA expression (real-time polymerase chain reaction) in cell lysates. TNF-α stimulated procoagulant activity and increased TF antigen and mRNA expression. Aliskiren inhibited TNF-α-mediated TF stimulation; zofenopril and olmesartan exerted a comparable effect. We conclude that aliskiren, a DRI, downregulates TNF-α-stimulated TF expression in HUVECs, possibly as a reflection of endothelial renin activation by the cytokine

Adult-type rhabdomyoma of the larynx: clinicopathologic study of an uncommon tumor in a rare location

Rhabdomyoma is an uncommon benign mesenchymal tumor with skeletal muscle differentiation that may occur either in the heart or in extra-cardiac sites. Even though the head and neck region is the most common area of extra-cardiac rhabdomyoma, the larynx is rarely involved. We present the case of an 85-year-old woman who reported a 10-day history of breathing difficulties, dysphagia and dysphonia. A computed tomography scan of the head and neck showed a contrast-enhanced, solid hypopharyngeal-laryngeal neoplasm with well-defined margins causing subtotal obliteration of the right pyriform sinus and a reduction in air lumen of the laryngeal vestibule. The patient underwent complete endoscopic removal of the lesion; histologic examination revealed an adult- type rhabdomyoma based on the histologic features and the immunoreactivity of the neoplastic cells for desmin, myoglobin and muscle-specific actin but not for cytokeratin, S-100, CD68R, chromogranin-A and synaptophysin. Since clinical and imaging features are not specific for rhabdomyoma, histologic examination and immunohistochemical analyses play a central role in the differential diagnosis of the adult-type rhabdomyoma from other laryngeal neoplasms. A correct diagnosis is mandatory to avoid inappropriate treatment

The effect of angiotensin receptor blockers on C-reactive protein and other circulating inflammatory indices in man

Anti-inflammatory properties may contribute to the pharmacological effects of angiotensin II receptor blockers (ARBs), a leading therapeutic class in the management of hypertension and related cardiovascular and renal diseases. That possibility, supported by consistent evidence from in-vitro and animal studies showing pro-inflammatory properties of angiotensin II, has been evaluated clinically by measuring the effect of ARBs on C-reactive protein and other circulating indices of inflammation (e-selectin, adhesion molecules, interleukin-6, tissue necrosis factor-alpha, monocyte chemoattractant protein-1) of potential clinical relevance, a body of evidence that this paper aims to review

Experimental tests on existing RC beams strengthened in flexure and retrofitted for shear by C-FRP in presence of negative moments

Abstract The shear strength of reinforced concrete beams extracted from existing buildings often reveals insufficient transversal steel reinforcement, mainly due to design or construction defects or increased design load requirements. FRP wrapping is one of the best solutions to improve beam shear strength as the retrofitting intervention is fast and the cost is modest. Design codes provide clear indication about the retrofitting design of simply supported beams, while the case of a beam with negative moments at the end is not considered, although this is in the case of a beam in a framed structure. One of the main uncertainties lies in the effectiveness of the FRP U sheet anchorage behavior in the area of negative bending moments with cracked concrete. This may limit the shear strength of the retrofitted beam. In this study, two beams extracted from an existing building constructed in the 1930s in Rome and retrofitted by carbon fiber-reinforced polymer (C-FRP) U strips placed at beam ends, where also negative bending moments were present, and have been evaluated with experimental tests at the laboratory of the Department of Architecture of Roma Tre University. Beam steel and concrete characteristics were evaluated by means of different tests. The experimental results are discussed considering the final results in terms of maximum shear resistance in the presence of negative bending moments. Load deflections at different points along the beam, shear-C-FRP deformation along the reinforcement strips and the damage state for different load levels, are presented. The importance of avoiding possible fragile mechanisms in the sections retrofitted with FRP is clearly shown

Peripheral Edema: Differential Diagnosis

Peripheral edemas can be generated by multiple causes, local and/or systemic. The difficulties in recognizing the exact nature of the edema and the cause that originates it often lead to erroneous considerations that determine an inappropriate therapeutic approach. In this chapter the various causes that generate peripheral edema are analyzed (systemic: cardiac diastolic dysfunction, kidney failure, liver failure, myxedema, from drugs, and idiopathic; and local: venous and/or lymphatic transport insufficiency). They are also described, according to the diagnosis made and the clinical and instrumental criteria to attain a correct and early diagnosis and to proceed to the most appropriate therapeutic measures (drugs, surgery, physical rehabilitative by means of manual and mechanical techniques) in individual cases

A Federated Learning Framework for Stenosis Detection

This study explores the use of Federated Learning (FL) for stenosis detection in coronary angiography images (CA). Two heterogeneous datasets from two institutions were considered: Dataset 1 includes 1219 images from 200 patients, which we acquired at the Ospedale Riuniti of Ancona (Italy); Dataset 2 includes 7492 sequential images from 90 patients from a previous study available in the literature. Stenosis detection was performed by using a Faster R-CNN model. In our FL framework, only the weights of the model backbone were shared among the two client institutions, using Federated Averaging (FedAvg) for weight aggregation. We assessed the performance of stenosis detection using Precision (P rec), Recall (Rec), and F1 score (F1). Our results showed that the FL framework does not substantially affects clients 2 performance, which already achieved good performance with local training; for client 1, instead, FL framework increases the performance with respect to local model of +3.76%, +17.21% and +10.80%, respectively, reaching P rec = 73.56, Rec = 67.01 and F1 = 70.13. With such results, we showed that FL may enable multicentric studies relevant to automatic stenosis detection in CA by addressing data heterogeneity from various institutions, while preserving patient privacy