Design of the Test Section for the Experimental Validation of Antipermeation and Corrosion Barriers for WCLL BB

Tritium permeation into the Primary Heat Transfer System (PHTS) of DEMO and ITER reactors is one of the challenging issues to be solved in order to demonstrate the feasibility of nuclear fusion power plants construction. Several technologies were investigated as antipermeation and corrosion barriers to reduce the tritium permeation flux from the breeder into the PHTS. Within this frame, alumina coating manufactured by Pulsed Laser Deposition (PLD) and Atomic Layer Deposition (ALD) are two of the main candidates for the Water Cooled Lithium Lead (WCLL) Breeder Blanket (BB). In order to validate the performance of the coatings on relevant WCLL BB geometries, a mock-up was designed and will be characterized in an experimental facility operating with flowing lithium-lead, called TRIEX-II. The present work aims to illustrate the preliminary engineering design of a WCLL BB mock-up in order to deeply investigate permeation of hydrogen isotopes through PHTS water pipes. The permeation tests are planned in the temperature range between 330 and 500 °C, with hydrogen and deuterium partial pressure in the range of 1–1000 Pa. The hydrogen isotopes transport analysis carried out for the design and integration of the mock-up in TRIEX-II facility is also shown

Watchful Waiting After Radiological Guided Drainage of Intra-abdominal Abscess in Patients With Crohn's Disease Might Be Associated With Increased Rates of Stoma Construction

Background: Management of spontaneous intra-abdominal abscess (IAA) in patients with Crohn's disease (CD) with radiologically guided percutaneous drainage (PD) was debated. Methods: This is a secondary analysis from a multicenter, retrospective cohort study of all the patients with CD who underwent PD followed by surgery at 19 international tertiary centers. Results: Seventeen patients (4.8%) who did not undergo surgery after PD were compared to those who had PD followed by surgical intervention 335/352 (95.2%). Patients who had PD without surgery were those with longer disease duration, more frequently had previous surgery for CD (laparotomies/laparoscopies), enteric fistula, on steroid treatment before and continue to have it after PD. Patients who had PD without subsequent surgical resection had a higher risk of stoma construction at later stages 8/17 (47.1%) versus 90/326 (27.6%) (P < .01). Patients with PD with no subsequent surgery had numerically higher rates of abscess recurrence 5/17 (29.4%) compared to those who had PD followed by surgery 45/335 (13.4%) the difference was not statistically significant (P = .07). Conclusions: Even with the low number of patients enrolled in this study who had PD of IAA without subsequent surgery, the findings indicate a markedly worse prognosis in terms of recurrence, length of stay, readmission, and stoma construction. Watchful waiting after PD to treat patients with spontaneous IAA might be indicated in selected patients with poor health status or poor prognostic factors

Anastomosis configuration and technique following ileocaecal resection for Crohn's disease: a multicentre study

A limited ileocaecal resection is the most frequently performed procedure for ileocaecal CD and different anastomotic configurations and techniques have been described. This manuscript audited the different anastomotic techniques used in a national study and evaluated their influence on postoperative outcomes following ileocaecal resection for primary CD. This is a retrospective, multicentre, observational study promoted by the Italian Society of Colorectal Surgery (SICCR), including all adults undergoing elective ileocaecal resection for primary CD from June 2018 May 2019. Postoperative morbidity within 30 days of surgery was the primary endpoint. Postoperative length of hospital stay (LOS) and anastomotic leak rate were the secondary outcomes. 427 patients were included. The side to side anastomosis was the chosen configuration in 380 patients (89%). The stapled anastomotic (n = 286; 67%), techniques were preferred to hand-sewn (n = 141; 33%). Postoperative morbidity was 20.3% and anastomotic leak 3.7%. Anastomotic leak was independent of the type of anastomosis performed, while was associated with an ASA grade ≥ 3, presence of perianal disease and ileocolonic localization of disease. Four predictors of LOS were identified after multivariate analysis. The laparoscopic approach was the only associated with a reduced LOS (p = 0.017), while age, ASA grade ≥ 3 or administration of preoperative TPN were associated with increased LOS. The side to side was the most commonly used anastomotic configuration for ileocolic reconstruction following primary CD resection. There was no difference in postoperative morbidity according to anastomotic technique and configuration. Anastomotic leak was associated with ASA grade ≥ 3, a penetrating phenotype of disease and ileo-colonic distribution of CD

National variations in perioperative assessment and surgical management of Crohn's disease: a multicentre study

Aim: Crohn's disease (CD) requires a multidisciplinary approach and surgery should be undertaken by dedicated colorectal surgeons with audited outcomes. We present a national, multicentre study, with the aim to collect benchmark data on key performance indicators in CD surgery, to highlight areas where standards of CD surgery excel and to facilitate targeted quality improvement where indicated. Methods: All patients undergoing ileocaecal or redo ileocolic resection in the participating centres for primary and recurrent CD from June 2018 to May 2019 were included. The main objective was to collect national data on hospital volume and practice variations. Postoperative morbidity was the primary outcome. Laparoscopic surgery and stoma rate were the secondary outcomes. Results: In all, 715 patients were included: 457 primary CD and 258 recurrent CD with a postoperative morbidity of 21.6% and 34.7%, respectively. Laparoscopy was used in 83.8% of primary CD compared to 31% of recurrent CD. Twenty-five hospitals participated and the total number of patients per hospital ranged from 2 to 169. Hospitals performing more than 10 primary CD procedures per year showed a higher adoption of laparoscopy and bowel sparing surgery. Conclusions: There is significant heterogeneity in the number of CD surgeries performed per year nationally in Italy. Our data suggest that high-volume hospitals perform more complex procedures, with a higher adoption of bowel sparing surgery. The rate of laparoscopy in high-volume hospitals is higher for primary CD but not for recurrent CD compared with low-volume hospitals

Clinical Features, Cardiovascular Risk Profile, and Therapeutic Trajectories of Patients with Type 2 Diabetes Candidate for Oral Semaglutide Therapy in the Italian Specialist Care

Introduction: This study aimed to address therapeutic inertia in the management of type 2 diabetes (T2D) by investigating the potential of early treatment with oral semaglutide. Methods: A cross-sectional survey was conducted between October 2021 and April 2022 among specialists treating individuals with T2D. A scientific committee designed a data collection form covering demographics, cardiovascular risk, glucose control metrics, ongoing therapies, and physician judgments on treatment appropriateness. Participants completed anonymous patient questionnaires reflecting routine clinical encounters. The preferred therapeutic regimen for each patient was also identified. Results: The analysis was conducted on 4449 patients initiating oral semaglutide. The population had a relatively short disease duration (42%  60% of patients, and more often than sitagliptin or empagliflozin. Conclusion: The study supports the potential of early implementation of oral semaglutide as a strategy to overcome therapeutic inertia and enhance T2D management

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Pyraclostrobin can mitigate salinity stress in tomato crop

Processing tomato is a widespread crop in the Mediterranean area where often there are problems of high salinity of irrigation water with considerable harmful effects on yield. Pyraclostrobin is a strobilurin based fungicide (PBF) having a broad range of applications. Strobilurins are reported to have biostimulant effect on plant mitigating abiotic stress. Therefore, the objective of this work was to investigate the ability of PBF to improve gas exchange parameters, chlorophyll, activity of antioxidative enzymes as superoxide dismutase (SOD), peroxidase (POD), catalase (CAT), ascorbate peroxidase (APX), yield characteristics, and water use efficiency (WUE) of tomato under salinity. A two-year research was carried out in Southern Italy, on tomato cv Coronel grown in pots under plastic greenhouse, to compare two soil salinity levels (electrical conductivity, ECe = 1.1 and 5.4 dS m−1) in combination with or without PBF. As expected, salinity had harmful effects on physiological and biochemical parameters of tomato that in turn affected yield and WUE, but improved fruit quality. In fact, salinity reduced fruit mean weight (19.0%) and yield (21.4%), and increased fruit blossom-end rot (55.7%), total soluble solids (18.2%) and dry matter (18.5%) content. Overall, PBF increased leaf chlorophyll content (6.1%) and the activity of SOD, POD, CAT and APX, mainly under salinity. Moreover, it reduced stomatal conductance (12.5%) and transpiration (11.7%), but improved assimilation rate (7.8%) and intrinsic WUE (23.3%), that in turn increased yield (8.1%) and yield WUE (6.5%). The improvement in yield produced by PBF was highest in salt stressed plants. In view of the positive effects of PBF, its use should be promoted in defence programs of tomato crop, above all in areas with salinity problems

Self-sieving DNA over superhydrophobic surfaces: a Raman spectroscopy study

The Raman spectra of DNA fibers were studied before and after suspension over superhydrophobic surface (SHS). At the end of the dehydration process of a droplet of nucleic acids solution over SHS, two structural areas appear: (i) a thicker droplet residual spot and (ii) a thinner free-standing, self-oriented DNA extended fibers region. For specimens deposited on reference samples (CaF2 slides), buffer contribution overrides the total Raman spectrum, while for free-standing lDNA, biological signature comes out readily with no interference. Our spectroscopy results confirm that a mechanical sieving effect occurs spontaneously during lDNA suspension process over superhydrophobic devices. Tailored designed devices and sample preparation separate small non-interacted molecules from the bundles and remove, concentrating, the non-suspended material in a defined area of the SHS. At the end of the process, helices retain only the ions that effectively have interacted with the DNA strand in solution, while all the other compounds were sieved away from the areas of interest. The self-sieving effect herein shown will provide a step forward for biomaterials studies as it allows the characterization of dilutions otherwise not detectable. The samples, autonomously purified, retain the effective interaction with environmental stresses free from any other misleading contribution allowing for characterization in optimal condition

Interactive Effect of Nitrogen and Azoxystrobin on Yield, Quality, Nitrogen and Water Use Efficiency of Wild Rocket in Southern Italy

Wild rocket (Diplotaxis tenuifolia L. DC) is an emerging vegetable which market requires high-quality standards that can be obtained through appropriate cultivation techniques such as the right level of nitrogen and the application of biostimulant substances. These include strobilurins, marketed mainly as fungicides that can have complementary positive effects on the yield, quality and resources’ use efficiency of many crops. For this reason, a trial in an unheated greenhouse, in Southern Italy, to evaluate the possibility of using Azoxystrobin to improve the production of wild rocket subjected to different nitrogen inputs, was carried out. Two N levels (40 and 140 kg ha−1), Azoxystrobin-based biostimulant (Azo+) and control without Azoxystrobin (Azo−) were compared. The yield, morphological characteristics, nitrogen and water use efficiency (NUE, WUE), antioxidant activity, the content of dry matter, chlorophyll, carotenoids, phenols, and nitrates were assessed. A higher N level resulted in a 16.3% yield increase that was matched by a 12.5% reduction in NUE, 15.8, 7.3, and 16.1% increases in yield WUE (Y_WUE), biomass WUE (B_WUE), and irrigation yield WUE (IY_WUE), respectively, and a worsening of some qualitative characteristics such as a 8.5% rise in nitrates, and a decline by 11.5, 10.1, and 26.1% in the carotenoids, phenols, and antioxidant activity, respectively. Azo+ increased the yield by 10.3%, NUE by 8.9%, and Y_WUE, B_WUE, and IY_WUE, by 13.9, 9.1, and 13.8% respectively. Moreover, Azo+ improved some qualitative characteristics such as total phenols (+9.4%), chlorophyll (+15.2%), carotenoids (+9.7%), and antioxidant activity (+17.4%), while it did not affect the nitrate content. Azoxystrobin can be an additional tool available for farmers to ensure high-quality standards of wild rocket