Laparoscopic right hemicolectomy: a SICE (Società Italiana di Chirurgia Endoscopica e Nuove tecnologie) network prospective study on the approach to right colon lymphadenectomy in Italy: is there a standard?—CoDIG 2 (ColonDx Italian Group)

Background: Colon cancer is a disease with a worldwide spread. Surgery is the best option for the treatment of advanced colon cancer, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines, the gold standard was D3 dissection to remove the central lymph nodes (203, 213, and 223), but in 2009, Hoenberger et al. introduced the concept of complete mesocolic excision, in which surgical dissection follows the embryological planes to remove the mesentery entirely to prevent leakage of cancer cells and collect more lymph nodes. Our study describes how lymphadenectomy is currently performed in major Italian centers with an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH). Methods: CoDIG 2 is an observational multicenter national study that involves 76 Italian general surgery wards highly specialized in colorectal surgery. Each center was asked not to modify their usual surgical and clinical practices. The aim of the study was to assess the preference of Italian surgeons on the type of lymphadenectomy to perform during RH and the rise of any new trends or modifications in habits compared to the findings of the CoDIG 1 study conducted 4 years ago. Results: A total of 788 patients were enrolled. The most commonly used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%), side-to-side (98.7%), or isoperistaltic (96.0%) anastomosis. The lymph nodes at the origin of the vessels were harvested in an inferior number of cases (203, 213, and 223: 42.4%, 31.1%, and 20.3%, respectively). A comparison between CoDIG 1 and CoDIG 2 showed a stable trend in surgical techniques and complications, with an increase in the robotic approach (7.7% vs. 12.3%). Conclusions: This analysis shows how lymphadenectomy is performed in Italy to achieve oncological outcomes in RH, although the technique to achieve a higher lymph node count has not yet been standardized. Trial registration (ClinicalTrials.gov) ID: NCT05943951

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Hall Effect Thruster Direct Drive PPUs, Experimental Investigation of the Cathode Potential Grounding Problem

In order to maximize system mass and cost savings, a Hall Effect Thruster Direct Drive Approach shall ideally get away with the need to provide galvanic isolation for the Anode voltage. In this respect, we present some experimental data aiming at characterising the implications of a direct connection between the HET Cathode Return Potential and the Spacecraft Ground

Hall Effect Thruster Direct Drive PPUs, Experimental Investigation of the Cathode Potential Grounding Problem

In order to maximize system mass and cost savings, a Hall Effect Thruster Direct Drive Approach shall ideally get away with the need to provide galvanic isolation for the Anode voltage. In this respect, we present some experimental data aiming at characterising the implications of a direct connection between the HET Cathode Return Potential and the Spacecraft Ground

The High-Voltage System of Calet Apparatus

CALET (CALorimetric Electron Telescope) is installed on the International Space Station since August 2015, is a mission devoted to measure the intensity of cosmic ray electrons and protons accelerated to near the speed of light. The apparatus is also designed to observe high energy gamma rays, nearby source of high energy radiation and it may even detect signatures of the elusive dark matter. One of the core components of the whole apparatus is the high voltage power supply system. It is based on hundred of independent DC/DC converters providing precise voltage regulation to two sections of CALET detectors. This paper presents the experience gained in the implementation of the CALET HV system: the system design requirements and the technical solutions adopted, the two system sections block schemes and the main characteristics of the DC/DC converters that guarantee the CALET HV system technical performance

The High-Voltage System of Calet Apparatus

CALET (CALorimetric Electron Telescope) is installed on the International Space Station since August 2015, is a mission devoted to measure the intensity of cosmic ray electrons and protons accelerated to near the speed of light. The apparatus is also designed to observe high energy gamma rays, nearby source of high energy radiation and it may even detect signatures of the elusive dark matter. One of the core components of the whole apparatus is the high voltage power supply system. It is based on hundred of independent DC/DC converters providing precise voltage regulation to two sections of CALET detectors. This paper presents the experience gained in the implementation of the CALET HV system: the system design requirements and the technical solutions adopted, the two system sections block schemes and the main characteristics of the DC/DC converters that guarantee the CALET HV system technical performance

Power Processing Unit For Micro Satellite Electric Propulsion System

The Micro Satellite Electric Propulsion System (MEPS) program has been originated by the increasing need to provide a low-cost and low-power Electric Propulsion System (EPS) for small satellites (<300Kg) and finds applications in orbit insertion after launcher separation, orbit maintenance, orbit transfers and deorbiting. The MEPS design was conceived as a “plug and play” subsystem that can be easily installed in a number of small spacecraft platforms, consisting of two Thruster Units (TU), Power Processing Unit (PPU), Xenon Propellant Tank Assembly (PTA) and Propellant Management Assembly (PMA). Being the “heart” of the system, the PPU supplies and monitors all the EPS voltages and currents. The objective of this paper is to present the design of the PPU whose concept is focused on high efficiency (> 92%), small size and weight and high reliability. Its functional modules and preliminary results obtained at breadboard level are also presented

Power Processing Unit For Micro Satellite Electric Propulsion System

The Micro Satellite Electric Propulsion System (MEPS) program has been originated by the increasing need to provide a low-cost and low-power Electric Propulsion System (EPS) for small satellites (<300Kg) and finds applications in orbit insertion after launcher separation, orbit maintenance, orbit transfers and deorbiting. The MEPS design was conceived as a “plug and play” subsystem that can be easily installed in a number of small spacecraft platforms, consisting of two Thruster Units (TU), Power Processing Unit (PPU), Xenon Propellant Tank Assembly (PTA) and Propellant Management Assembly (PMA). Being the “heart” of the system, the PPU supplies and monitors all the EPS voltages and currents. The objective of this paper is to present the design of the PPU whose concept is focused on high efficiency (> 92%), small size and weight and high reliability. Its functional modules and preliminary results obtained at breadboard level are also presented