Evaluating the Surgeons' Perception of Difficulties of Two Techniques to Perform STARR for Obstructed Defecation Syndrome: A Multicenter Randomized Trial.

BACKGROUND After initial enthusiasm in the use of a dedicated curved stapler (CCS-30 Contour Transtar) to perform stapled transanal rectal resection (STARR) for obstructed defecation syndrome (ODS), difficulties have emerged in this surgical technique. OBJECTIVE First, to compare surgeons' perception of difficulties of STARR performed with only Transtar versus STARR performed with the combined use of linear staplers and Transtar to cure ODS associated with large internal prolapse and rectocele; second, to compare the postoperative incidence of the urge to defecate between the 2 STARR procedures. DESIGN AND SETTING An Italian multicenter randomized trial involving 25 centers of colorectal surgery. PATIENTS Patients with obstructed defecation syndrome and rectocele or rectal intussusception, treated between January and December 2012. INTERVENTIONS Participants were randomly assigned to undergo STARR with a curved alone stapler (CAS group) or with the combined use of linear and curved staplers (LCS group). MAIN OUTCOME MEASURES Primary end-points were the evaluation of surgeons' perception of difficulties score and the incidence of the "urge to defecate" at 3-month follow up. Secondary end-points included duration of hospital stay, rates of early and late complications, incidence of "urge to defecate" at 6 and 12 months, success of the procedures at 12 months of follow-up. RESULTS Of 771 patients evaluated, 270 patients (35%) satisfied the criteria. Follow-up data were available for 254 patients: 128 patients (114 women) in the CAS group (mean age, 52.1; range, 39-70 years) and 126 (116 women) in LCS group (mean age, 50.7 years; range, 41-75 years). The mean surgeons' perception score, was 15.36 (SD, 3.93) in the CAS group and 12.26 (SD, 4.22) in the LCS group (P < .0001; 2-sample t test). At 3-month follow-up, urge to defecate was observed in 18 (14.6%) CAS group patients and in 13 (10.7%) LCS group patients (P = .34; Fisher's exact test). These values drastically decrease at 6 months until no urge to defecate in all patients at 12 months was observed. At 12-month follow-up, a successful outcome was achieved in 100 (78.1%) CAS group patients and in 105 (83.3%) LCS group patients (P = .34; Fisher's exact test). No significant differences between groups were observed in the hospital stay and rates of early or late complications occurring after STARR. CONCLUSIONS STARR with Transtar associated with prior decomposition of prolapse, using linear staplers, seems to be less difficult than that without decomposition. Both procedures appear to be safe and effective in the treatment of obstructed defecation syndrome resulting in similar success rates and complications

A djuvant treatment in patients at high risk of recurrence of thymoma: Efficacy and safety of a three-dimensional conformal radiation therapy regimen

The clinical benefits of postoperative radiation therapy (PORT) for patients with thymoma are still controversial. In the absence of defined guidelines, prognostic factors such as stage, status of surgical margins, and histology are often considered to guide the choice of adjuvant treatment (radiotherapy and/or chemotherapy). In this study, we describe our single-institution experience of three-dimensional conformal PORT administered as adjuvant treatment to patients with thymoma. METHODS: Twenty-two consecutive thymoma patients (eleven male and eleven female) with a median age of 52 years and treated at our institution by PORT were analyzed. The patients were considered at high risk of recurrence, having at least one of the following features: stage IIB or III, involved resection margins, or thymic carcinoma histology. Three-dimensional conformal PORT with a median total dose on clinical target volume of 50 (range 44-60) Gy was delivered to the tumor bed by 6-20 MV X-ray of the linear accelerator. Follow-up after radiotherapy was done by computed tomography scan every 6 months for 2 years and yearly thereafter. RESULTS: Two of the 22 patients developed local recurrence and four developed distant metastases. Median overall survival was 100 months, and the 3-year and 5-year survival rates were 83% and 74%, respectively. Median disease-free survival was 90 months, and the 5-year recurrence rate was 32%. On univariate analysis, pathologic stage III and presence of positive surgical margins had a significant impact on patient prognosis. Radiation toxicity was mild in most patients and no severe toxicity was registered. CONCLUSION: Adjuvant radiotherapy achieved good local control and showed an acceptable toxicity profile in patients with high-risk thymoma

Axisymmetric Hybrid Plasma Model for Hall Effect Thrusters

Hall Effect Thrusters (HETs) are nowadays widely used for satellite applications because of their efficiency and robustness compared to other electric propulsion devices. Computational modelling of plasma in HETs is interesting for several reasons: it can be used to predict thrusters’ operative life; moreover, it provides a better understanding of the physical behaviour of this device and can be used to optimize the next generation of thrusters. In this work, the discharge within the accelerating channel and near-plume of HETs has been modelled by means of an axisymmetric hybrid approach: a set of fluid equations for electrons has been solved to get electron temperatures, plasma potential and the discharge current, whereas a Particle-In-Cell (PIC) sub-model has been developed to capture the behaviour of neutrals and ions. A two-region electron mobility model has been incorporated. It includes electron–neutral/ion collisions and uses empirical constants, that vary as a continuous function of axial coordinates, to take into account electron–wall collisions and Bohm diffusion/SEE effects. An SPT-100 thruster has been selected for the verification of the model because of the availability of reliable numerical and experimental data. The results of the presented simulations show that the code is able to describe plasma discharge reproducing, with consistency, the physics within the accelerating channel of HETs. A small discrepancy in the experimental magnitude of ions’ expansion, due probably to boundary condition effects, has been found

Bollettino storico di Salerno e Principato Citra. A.8, n. 2 (1990)

A.8, n.2 (1990): V. Cimmelli, Clero e popolo nella diocesi di Samo attraverso il sinodo di Mons. N. A. De Tura (a. 1677), P. 3 ; M. Bignardi, La città di Masuccio: il gusto, il decoro, lo spazio dell’immaginario, P.17 ; M. A. Iannelli, La ricerca archeologica nella valle del Samo: nuove acquisizioni, 33 ; D. Cosimato, Le rendite fiscali degli enti ecclesiastici a Salerno nel Seicento, p. 39 ; F. Sofia, «Ferma, signorparochiano, che io voglio...»: matrimoni clandestini nella diocesi di Salerno nel Seicento e nel Settecento, P. 51 ; G. Cirillo, La rendita feudale in Principato Citra nell’età moderna (secc.XVII-XVIII), P. 65 ; A. Sica, Per una esatta datazione della nascita e della morte del giureconsulto Domenico Alfeno Vario, P. 111 ; F. Barra, Cronache del brigantaggio del decennio francese in Principato Citra. IV. La missione di Marius Clary, P. 119 ; P. Tino, Il bisogno di terra: la piccola proprietà contadina nella Campania del primo dopoguerra, P. 125 ; A. D’Aniello, Appunti per Michele e Francesco Curio: la «cona» di Buccino, P. 145 ; G. Guardia, Intervista al Dott. Ferdinando Cappuccio, Assessore all’Urbanistica del Comune di Salerno; C. Pellecchia, Notizie su Portanova; A. Bottiglieri, Per il Centro Storico; A.P. Fiorillo, Gli spazi... di Casciello, P. 151

FORCE: A FORmation Flying SAR Based on CubEsat Assemblies

Space systems exploiting modularity, formation flying, payload distribution and fractionation concepts can be used for a variety of applications, including Earth observation and on-orbit servicing. Concerning Earth observation, in a Formation Flying SAR (FF-SAR) the Synthetic Aperture Radar (SAR) payload is distributed among several smaller platforms to enhance performance of a monolithic SAR, by exploiting the physical separation among the receivers. In this paper, a FF-SAR concept is described that exploits a cluster of three receiving-only platforms flying with separations of a few hundred meters. The cluster is then separated of about 100 km from an illuminator of opportunity, i.e. a transmitting-receiving SAR. The system is completely passive in the meaning that it exploits the signal transmitted by an illuminator of opportunity already in orbit. The paper presents an overview of the mission concept as well as system and platform design. Each platform is 12 U and has a modular architecture, being realized by assembling subsystems or modules, each composed by a number of Cubesat Units. In the paper, the antenna, propulsion and relative navigation modules are described. In addition, FF-SAR performance are preliminary evaluated within a realistic simulation environment, including orbit and attitude propagation, scene simulation, and image synthesis