Colecistectomia laparoscopica clipless con dissettore ad ultrasuoni versus colecistectomia laparoscopica tradizionale in regime di day surgery. Studio prospettico randomizzato

Il nostro studio nasce, dall’esigenza di valutare l’effettiva possibilità di utilizzare il dissettore ad ultrasuoni per eseguire la colecistectomia laparoscopica in day surgery sia come strumento di dissezione e coagulo che per sigillare il dotto cistico e l’arteria cistica. La colecistectomia laparoscopica clipless con dissettore ad ultrasuoni si è dimostrata una procedura efficace e sicura anche in regime di day surgery. L’utilizzo routinario del bisturi armonico non incide sui costi generali della procedura ed anzi consente un ipotetico risparmio rispetto alla colecistectomia laparoscopica tradizional

New Strategies to Control Brown Rot Caused by Monilinia spp. of Stone Fruit

The importance of brown rot caused by Monilinia spp. in all stone fruit growing areas is well recognized. The infection occurs in the field but the most dangerous fruit losses happen during storage and commercialization. The disease control depends mainly on integrated strategy based on cultural practices and fungicide spray programmes in the field. Among cultural practices, the sanitization of orchard by minimizing inoculum potential, reducing the risk of blossom and fruit infections is essential for brown rot management. However, the requirements in sustainable agriculture, integrated crop management and organic production are increased in the last few decades, resulting in the need to develop other methods than fungicide applications to disease control. Several studies focused on alternative strategies, defining three different approaches: i) biological control with microbial antagonists, ii) use of natural products and iii) use of physico-chemical methods. Significant progress has been achieved in the reduction of pesticide use with these methods; although a multidisciplinary methodology that integrates sanitary and alternative strategies has to be investigated more fully. The new strategy, starting from the field with agronomic interventions and the selection of cultivars tolerant to Monilinia spp. could be usefully integrated by postharvest treatments based on low risk chemical fungicides, natural antimicrobial substances and other physical means determining a sustainable approach to brown rot control

Found the needle in the haystack! The case of a fishbone causing vasovagal syncopes and abdominal pain: a case report

Foreign body ingestion is a very common reason for access to the Emergency Department and in most cases, it doesn't cause symptoms; in case of fishbones, intestinal perforation is rare but possible. In this report, besides the typical picture of bowel perforation, we found atypical symptoms due to the specific location. We present a case of a 70-year-old man who presented to the Emergency Department complaining abdominal pain and several syncopes; a CT scan of the abdomen revealed the presence of a foreign body in the pyloric area, which was removed by surgical intervention and resulted to be a fishbone. Both abdominal and neurological symptoms disappeared. Results and conclusion We suppose that the specific location of fishbone, in the area when the pyloric branches of left vagus nerve run, can explain both the abdominal symptoms and the vasovagal syncope, through a sympathetic inhibition mechanism: Emergency physicians and emergency surgeons must be aware when dealing with symptoms apparently discordant that could be attributable to one common factor

Positive Energy Building Definition with the Framework, Elements and Challenges of the Concept

Buildings account for 36% of the final energy demand and 39% of CO2 emissions worldwide. Targets for increasing the energy efficiency of buildings and reducing building related emissions is an important part of the energy policy to reach the Paris agreement within the United Nations Framework Convention on Climate Change. While nearly zero energy buildings are the new norm in the EU, the research is advancing towards positive energy buildings, which contribute to the surrounding community by providing emission-free energy. This paper suggests a definition for positive energy building and presents the framework, elements, and challenges of the concept. In a positive energy building, the annual renewable energy production in the building site exceeds the energy demand of the building. This increases two-way interactions with energy grids, requiring a broader approach compared to zero energy buildings. The role of energy flexibility grows when the share of fluctuating renewable energy increases. The presented framework is designed with balancing two important perspectives: technical and user-centric approaches. It can be accommodated to different operational conditions, regulations, and climates. Potential challenges and opportunities are also discussed, such as the present issues in the building’s balancing boundary, electric vehicle integration, and smart readiness indicators

First Report of Asiatic Brown Rot (Monilinia polystroma) and Brown Rot (Monilinia fructicola) on Pears in Italy

Brown rot caused by Monilinia spp. is an important fruit postharvest decay causing severe losses in stone and pome fruits with a significant economic impact. In Italy, three Monilinia species (M. laxa, M. fructicola, and M. fructigena) are the causal agents of blossom and twig blight and brown fruit rot in stone fruit. M. polystroma has been observed on peaches in Italy (2) and has been reported in Czech Republic and Hungary (3), Poland (4), Serbia (5), and Switzerland (1) on pome fruits and apricots. In September 2013, stored var. Abate Fetel pears showing brown rot symptoms were observed in Emilia Romagna region. In 20% of the symptomatic pears, circular and brown to black decay spots were observed, covered by a large number of yellowish or buff-colored stromata, while decayed tissues remained firm, resembling M. polystroma symptoms. In another 13% of stored pears, the decayed tissues remained firm, and decay lesions were covered with numerous grayish pustules containing spores. Putative pathogens were isolated on potato dextrose agar (PDA) and incubated at 25°C in darkness for 5 days. The colonies grown on PDA were yellowish, with irregular black stromatal crusts at the edges of the colonies after 10 to 12 days of incubation. Some colonies developed, at their margins, sporogenous tissue slightly elevated above the colony surface that was buff/pale luteous (4). Conidia developing from such cultures were one celled, ovoid or limoniform, smooth and hyaline, measuring 12.2 to 20.4 × 8.4 to 12.3 µm when grown on V8 juice agar (V8) at 22°C, and matched the description of those for M. polystroma. Other colonies, which developed a gray mass of spores in concentric rings with the reverse side black, were morphologically identified as M. fructicola. The colony margins were smooth edged, and the conidia were one-celled, limoniform, hyaline, and measuring 12.1 to 17.4 × 8.1 to 11.2 µm on V8 at 22°C. Isolate identificaton was obtained using the universal primers for Monilinia spp. (3). Pathogenicity was confirmed using surface-sterilized mature var. Abate Fetel and William pears wounded with a sterile needle, and inoculated with 20 µl of an M. polystroma or M. fructicola conidial suspension (103 spores/ml). After 7 days of incubation at 20°C, typical symptoms of Asiatic brown rot or brown rot developed on both the wounds of all inoculated pears, while controls remained symptomless. Mean colony diameters measured after 7 days were 47.3 mm for Asiatic brown rot and 44.1 mm for brown rot, and there were no significant differences in colony diameter after 7 days between M. polystroma and M. fructicola (α < 0.05). After 14 days, yellowish exogenous stromata appeared on the surface of pears infected by M. polystroma, whereas numerous grayish pustules containing spores appeared on pears inoculated with M. fructicola. Control pears still remained symptomless. The fungus isolated from inoculated fruit exhibited the same morphological features as the original isolates, and PCR/sequencing analysis using primers ITS1 and ITS4 confirmed the results of the universal primers (3) (GenBank Accession Nos. GU067539.1 and HQ893748.1). Although the presence of M. polystroma and M. fructicola has been documented in Italy, this is the first time these two species were observed on Italian pears. This report suggests a broader impact since M. polystroma and M. fructicola have not been previously reported on pears in Europe. Because of the importance of pears in the Italian fruit industry, knowledge about the occurrence of new pathogens will facilitate the adoption of adequate control strategies to reduce postharvest losses

What is Behind Counterproductive Work Behaviors in the Nursing Profession? A Systematic Review

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