Insight from an Italian Delphi Consensus on EVAR feasibility outside the instruction for use: the SAFE EVAR Study

BACKGROUND: The SAfety and FEasibility of standard EVAR outside the instruction for use (SAFE-EVAR) Study was designed to define the attitude of Italian vascular surgeons towards the use of standard endovascular repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) outside the instruction for use (IFU) through a Delphi consensus endorsed by the Italian Society of Vascular and Endovascular Surgery (Societa Italiana di Chirurgia Vascolare ed Endovascolare - SICVE). METHODS: A questionnaire consisting of 26 statements was developed, validated by an 18 -member Advisory Board, and then sent to 600 Italian vascular surgeons. The Delphi process was structured in three subsequent rounds which took place between April and June 2023. In the first two rounds, respondents could indicate one of the following five degrees of agreement: 1) strongly agree; 2) partially agree; 3) neither agree nor disagree; 4) partially disagree; 5) strongly disagree; while in the third round only three different choices were proposed: 1) agree; 2) neither agree nor disagree; 3) disagree. We considered the consensus reached when >70% of respondents agreed on one of the options. After the conclusion of each round, a report describing the percentage distribution of the answers was sent to all the participants. RESULTS: Two -hundred -forty-four (40.6%) Italian Vascular Surgeons agreed to participate the first round of the Delphi Consensus; the second and the third rounds of the Delphi collected 230 responders (94.3% of the first -round responders). Four statements (15.4%) reached a consensus in the first rounds. Among the 22 remaining statements, one more consensus (3.8%) was achieved in the second round. Finally, seven more statements (26.9%) reached a consensus in the simplified last round. Globally, a consensus was reached for almost half of the proposed statements (46.1%). CONCLUSIONS: The relatively low consensus rate obtained in this Delphi seems to confirm the discrepancy between Guideline recommendations and daily clinical practice. The data collected could represent the source for a possible guidelines' revision and the proposal of specific Good Practice Points in all those aspects with only little evidence available

A scuola per lo sviluppo sostenibile. P. Q. S. (Programma Qualita' Scuola)

Consiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7 , Rome / CNR - Consiglio Nazionale delle RichercheSIGLEITItal

Ileo biliare: diagnosi e trattamento. Case report

Gli Autori presentano un caso di ileo biliare intermittente insorto per il passaggio di un grosso calcolo (oltre 4 cm di diametro) nel lume intestinale, attraverso una fistola colecistoduodenale. Viene sottolineata la peculiarità del caso clinico occorso alla loro osservazione per le caratteristiche della sintomatologia presentata dal paziente e per l’occasionalità dell’accertamento diagnostico avvenuto in corso di esame ecografico. La malattia, di non frequente riscontro e spesso diagnosticata in corso di interventi chirurgici in urgenza per occlusione intestinale, ha oggi un più precoce riconoscimento per la diffusione delle moderne tecniche di imaging. La sintomatologia può essere intermittente e, pur presentando i segni classici della occlusione intestinale, varia a seconda della sede dell’ostruzione. Una scelta terapeutica tempestiva endoscopica o chirurgica (open o laparoscopica) è destinata a ridurre la morbilità e la mortalità dei pazienti trattati in urgenza

Fracture analysis of adhesive Joints using intrinsic cohesive zone models”, Key Eng Mat 348

ABSTRACT In this paper Cohesive Zone Model (CZM) concepts are applied in order to study mode I fracture in a pre-cracked bonded Double Cantilever Beam (DCB) specimen. A cohesive surface element is implemented in a Finite Element commercial code using intrinsic cohesive zone models: exponential, bilinear and trapezoidal traction-separation laws. The sensitivity of cohesive zone parameters in predicting the overall mechanical response is examined, then the load displacement curves obtained with the different CZMs are compared and some interesting features concerning the prediction of damage onset in adhesive joints are illustrated. Finally, cohesive parameters are identified comparing numerically simulated load-displacement curves with experimental data retrieved from literature

Surface patterning of metal substrates induced by laser ablation for improved adhesive bonding

The aim of the present work is to investigate the effect of surface patterning induced by laser ablation on metal substrates for adhesive bonding. To this aim an ytterbium (Yb) fiber laser has been employed. The morphological and elemental modifications induced by the laser process have been examined using several techniques, including surface profilometry, scanning electron microscopy (SEM) and X-Ray photoelectron spectroscopy (XPS). In addition, surface wettability has been studied by means of contact angle measurements. Finally, the capability of laser irradiation to improve the strength of adhesive joints has been assessed through mechanical tests carried out on single lap shear samples. In order to perform a comparative analysis, similar joints with grit blasted substrates have been also prepared and tested

On the effect of pulsed laser ablation on shear strength and mode I fracture toughness of Al/epoxy adhesive joints

The present work describes an experimental study about the shear strength and the mode I fracture toughness of adhesive joints with substrates pre-treated by pulsed laser ablation. An ytterbium-doped pulsed fiber laser was employed to perform laser irradiation on AA6082-T4 alloy. Morphological and chemical modifications were evaluated by means of surface profilometry, scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS). Thick adherend shear tests were carried out in order to assess the shear strength while the mode I fracture toughness was determined using the double cantilever beam. For comparison, control samples were prepared using classical surface degreasing. The results indicated that laser ablation has a favorable effect on the mechanical behavior of epoxy bonded joints; however, while a + 20% increase was recorded for shear strength, a remarkable threefold enhancement of fracture toughness was observed with respect to control samples. XPS analyses of treated substrates and SEM observations of the fracture surfaces indicated that laser pre-treatment promoted chemical and morphological modifications able to sustain energy dissipation through mechanical interlocking. As a result cohesive failure within the adhesive bond-line was enabled under predominant peel loading