Trapianto di rene in età pediatrica. Effetto della rianimazione del donatore in morte cerebrale sull'outcome dell'organo trapiantato

INTRODUCTION Kidney transplantation has progressively established as the treatment of choice for end stage renal disease (ESRD). The progressive loss of function of the transplanted organ is the leading cause of graft failure. The outcome of graft is influenced by many parameters: one of them is the "delayed graft function" (DGF). Graft damage can be influenced by events occurred during donor reanimation or at the time of brain death. The more recent available studies on this subject are almost exclusively based on an adult population. Assuming that some variables concerning donor resuscitation can influence DGF development and transplant outcome, the main purpose of this project was to understand whether this correlation also exists in the pediatric renal transplantation. MATERIALS AND METHODS We reviewed the data of all patients (<15 years) who underwent a kidney transplantion from 26/12/2003 to 18/04/2011. Donor data were extracted from observations of the intensive care units (ICU) after diagnosis of brain death. We considered: type and volume of plasma expander, transfusions, inotropic drugs, shock episodes, episodes of cardiac arrest, time of stay in ICU , serum creatinine, blood urea and urine output. the recipients data were obtained through the systematic review of medical records. Patients were divided into two Groups: Group 1 (DGF positive) and group 2 (DGF negative). Endpoints of the study were: DGF incidence, graft function and patient survival at 6,12,24 months after transplantation. RESULTS In this period were performed 141 kidney transplants of which 116 with complete donation data. Univariate analysis of donorâs parameters has shown that age, cause of death and donor sex are risk factors for development of DGF. The multivariate logistic regression model confirmed age of the donor as independent risk factor for DGF. CONCLUSIONS Donor age has been revealed as an important independent risk factor for development of DGF. DGF is also an important risk factor for long term loss of graft function, but has no effect on patientâs surviva

An Efficient Global Optimization Scheme for Building Energy Simulation Based on Linear Radial Basis Function

Motivation: The building performance optimization is considerably increasing since the design goals are moving from the solely energy saving target to the optimization of the overall performances, cost and sustainability objectives. The evolutionary algorithms coupled with building simulation codes are often used in academic researches, however, they are limited applied in actual building design. Indeed, the high number of expensive simulation runs required by evolutionary algorithms strongly limits their suitability for the professional practice. For this reason, an efficient optimization scheme is essential for the diffusion of the building performance optimization tools outside the academic world. What was done: The research focuses on the development of an efficient global optimization scheme (EGO) based on a radial basis function network (RBFN) meta-model to emulate the expensive function evaluation by means of the building energy simulation. In this surrogate model, each cost function can be approximated by a linear combination of unknown coefficient multiplied by a set of linear radial-basis function. In the proposed method, the surrogate model is firstly used in the evolutionary algorithm code to find the optimal solutions. Then, the actual fitness functions are evaluated for the optimal points by means of building simulation and the surrogate model is then update. These steps are continued until the convergence criterion is met. This efficient optimization scheme has been implemented in Matlab and verified on some test cases. The test bed of the method is the optimal building refurbishment of three simplified existing buildings, for which the optimal solutions have been also calculated by using the brute force approach. Finally, the EGO performances were also compared with those offered by the popular Non Sorting Genetic Algorithm (NSGA-II). Expected benefits of what was done: The results of this research show how the EGO algorithm is able to find a large number of optimal solutions with a reduced number of expensive simulation runs. This makes it possible to apply the algorithm to the optimization of building projects that use expensive simulation codes such as lighting models, CFD codes or coupled dynamic simulation of building and HVAC systems

Effect of Solar Radiation Model on the Predicted Energy Performance of Buildings

The building energy balance is strictly connected with the solar irradiation. Therefore, a reliable estimation of the global irradiation incident on various tilted surfaces is essential in order to account for the solar heat gains. In many meteorological stations, only global solar radiation on a horizontal plane is monitored while, in some stations, also the direct and diffuse components are collected. However, only few stations measure the solar radiation incident on tilted surface. For these reasons, a variety of mathematical and empirical models have been proposed in the literature for both the subdivision of horizontal solar radiation into direct and diffuse components (horizontal diffuse irradiance models) and for the calculation of irradiation on tilted surfaces (irradiance models for tilted surfaces). Nevertheless, there is no pair of models that can provide results with the same reliability for different worldwide localities. This topic has been widely discussed in the literature by means of solar model validation against experimental data for a particular location. Little is still known about the propagation of these model uncertainties through the building energy balance. This research work investigates the extent to which the choice of solar radiation models affects the predicted energy performance of a set of simplified reference buildings. By means of a full factorial plan, a set of 72 simplified residential buildings is defined by changing the insulation and thermal inertia of opaque components, the windows surface and orientations and the solar heat gain coefficient of glazing. Moreover, a full combination of 22 horizontal diffuse irradiance models coupled with 12 irradiance models for tilted surfaces is implemented and used as a pre-processor of solar data used in building energy simulation codes (i.e. TRNSYS). Starting from these data, the hourly dynamic energy simulations were performed for several European locations. In particular, the Europe region has been divided in 5 zones considering the classes of annual solar radiation and, for each zone, a representative city was identified and used for this work. Finally, the distribution of monthly energy needs and peak loads are studied and discussed by means of statistical techniques, in order to generalize the found discrepancies and to correlate the deviations to the building envelope characteristics

Modelling Of The Thermal Behavior Of Walls And Floors In Contact With The Ground

One of the most complex configuration to model in detail, both in the dynamic simulation of buildings and in the analytical quasi steady-state calculations, is the thermal dispersion through the walls and the floor in contact with the ground. The problem consists in determining the boundary conditions of the external wall surface directly exposed to the soil, whose temperature cannot be considered undisturbed. Different studies, both experimental and numerical, have been carried out in the last decades in order to determine the ground boundary conditions, some of which have been used to elaborate the technical standard EN ISO 13370. This standard gives some indications about the conditions to be considered in the use of quasi steady-state methods and within the dynamic simulation. The evaluation of the simulation software in the specific context of the ground heat transmission, has also driven the IEA to define a specific series of validation cases, the BESTEST In-depth ground coupled heat transfer tests. The present research aim is to test implement reliable calculation procedures for the thermal dispersion through the building envelope towards the ground, in dynamic simulation modelling systems. In this work, a test case of the EN ISO 13370 standard has been modelled with FEM codes, both in steady-state conditions and also in periodic external conditions. Different types of floor have been considered, with different thickness and position of the insulation layer. The results have been compared with those calculated following the prescriptions of the standard EN ISO 13370

Solar Irradiance Modelling And Uncertainty On Building Hourly Profiles Of Heating And Cooling Energy Needs

Building energy simulations require a detailed characterization of the boundary conditions in order to solve the air heat balance problem. While for dry and dew bulb temperatures and wind speed, hourly profiles can be successfully developed from raw data measurements, to be included in weather files, beam and diffuse solar irradiance on the external surfaces of the building envelope are not directly known. Measured global solar irradiance is rarely available for the possible orientations of buildings surfaces and when the distinction between the beam and diffuse irradiance components is recorded, it is only for horizontal measurements. Consequently, solar irradiance models are necessary to elaborate hourly beam and diffuse irradiation profiles on the various elements of the building envelope. We can distinguish the different models into two groups: horizontal diffuse irradiance models – to calculate the diffuse component on the horizontal plane starting from the global measurement, and irradiance models for tilted surfaces – to estimate the irradiance collected on tilted surface with a given orientation. Even if some models try to exploit some mathematical expressions to describe the phenomenon, most of them rely mainly on statistical correlations derived from empirical data. Since the samples of solar irradiance measurements used for the models development have been collected mostly in North America and European localities, these models are far from providing an adequate worldwide representativeness and none can be precisely defined as the best one. As observed in previous works in the literature and other authors’ works, the adoption of a pair of models for horizontal diffuse irradiance and for the irradiance on tilted surfaces introduces an uncertainty on the estimation of this specific boundary conditions in building energy simulation. However, different localities, building configurations and kind of energy need – heating and cooling, have different sensitivities to this suboptimal characterization of the solar irradiance. Thus, for some cases, the choice on the couple of models can affect significantly the simulation outputs and influences the robustness of the design solutions. Moreover, also the time discretization of the outputs can be relevant on the quantification of the uncertainty brought by the choice of solar irradiance models. Further expanding previous analyses, in this contribution, 22 horizontal diffuse irradiance models have been coupled with 12 irradiance models for tilted surfaces in order to develop hourly profiles of solar irradiance for 5 European localities (Berlin, Vienna, Trento, Rome and Messina). The 264 alternatives have been used as input in TRNSYS for the simulation of the hourly energy performances of a set of 72 simplified residential buildings, built varying parametrically insulation and thermal inertia of opaque components, windows surface and orientation and solar heat gain coefficient of glazing. The distributions of hourly heating and cooling energy needs along the year and for the different configurations of the sample have been studied in order to identify the building features enhancing the uncertainty due to the solar irradiance modelling on short-term outputs

Cardiac perforation during minimally invasive repair of pectus excavatum : a rare complication

Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2022.Life-threatening complications (LTCs) and negative results of surgical treatments often go unreported. Minimally invasive repair of pectus excavatum (MIRPE) represents a procedure with a low incidence of adverse outcomes. However, 15 potentially fatal cases of MIRPE-related heart injury have been published. We report a case of cardiac perforation (CP) during MIRPE. A 12-year-old female was admitted for elective repair of a severe asymmetric pectus excavatum. Preoperative computed tomography showed a Haller index of 4.9. MIRPE was performed under bilateral video-assisted thoracoscopy. After the placement of the pectus bar, cardiac arrhythmias, hypotension and bilateral hemothorax occurred. Emergency thoracotomy without pectus bar removal showed CP. The wound sites were repaired and the pectus bar was eventually successfully implanted. The patient was discharged on postoperative day 11. After 10 months, she remains asymptomatic. Reporting rare complications is essential for accurate calculations of the true prevalence of LTCs, maintaining high alertness in pediatric surgeons.publishersversionPeer reviewe

Effects of different moisture sorption curves on hygrothermal simulations of timber buildings

Building energy simulations are a key tool to design high performance buildings capable of facing the future challenges and to help reaching the emissions reduction targets. Currently, thermal properties of materials used in most building energy simulations are assumed to be constant and not dependent of moisture content and temperature. Heat and moisture dynamic transfer models allow to simulate building envelope performance considering thermal resistance reduction due to moisture effects. These models are generally considered more accurate than the heat transfer models and they could be used to simulate the heat transfer (increased by water vapour storage) and the moisture buffering effect on the indoor environment. For the simulation to be performed, hygrothermal material properties should be known as functions of moisture content. Nevertheless, hygrothermal material properties are rarely available and correlations from the literature have to be used. In this study, the moisture storage curves of CLT, OSB and two types of wood fibre insulation have been measured with a dynamic vapour sorption analyser. The other hygrothermal properties are estimated from values measured in previous studies or taken from the literature. The simulations of two small single room buildings in four Italian locations are performed with the software EnergyPlus, considering an ideal HVAC system, to calculate the heating and cooling needs of the building. The HAMT (heat and moisture transfer) module of EnergyPlus is used. With the results presented in this study, it is possible to evaluate how an approximated curve affects the results of a whole-building simulation in terms of wall average water content, indoor air relative humidity and heating/cooling loads

Long-Term Follow-Up of Testicular Microlithiasis in Children and Adolescents: Multicenter Prospective Cohort Study of the Italian Society of Pediatric Urology.

Introduction Testicular microlithiasis (TM), characterized by the presence of intratubular calcifications in a single or both the gonads, is an uncommon entity with unknown etiology and outcome in pediatric and adolescent age. In this study, the results of a multicenter long-term survey are presented. Materials and Methods From 11 units of pediatric urology/surgery, patients with TM were identified and yearly, followed up in a 7-year period, adopting a specific database. The recorded items were: age at diagnosis, presenting symptoms/associated abnormalities, ultrasonographic finding, surgery and histology at biopsy, if performed. Results Out of 85 patients, 81 were evaluated yearly (4 patients lost to follow-up). TM was bilateral in 66.6% of the patients. Associate genital abnormalities were present in 90%, more frequently undescended/retractile testis (23.4%) and varicocele (22.2%). TM remained unchanged at 4.7 years follow-up in 77 patients (93.8%) and was reduced in 4 patients after 1 to 5 years of inguinoscrotal surgery. Orchiectomy was performed in three patients (3.7%), one for severe testicular hypoplasia and two for seminoma (2.5%), respectively, concurrent and metachronous to diagnosis of TM. Tumorectomy with parenchymal sparing surgery was performed in a teratoma associated with TM. Conclusion TM is a controversial entity, often associated with several inguinogenital features, which rarely can recover. Testicular malignancy, although present in TM, has not proven definitively associated to microliths. Proper counseling, yearly ultrasound, and self-examination are long-term recommended

Pediatric vascular anomalies in Austria. Where are we at? A survey among primary care pediatricians

IntroductionVascular anomalies (VAs) are rare conditions and affected patients often experience a difficult patient journey. Timely diagnosis is only possible if primary caregivers are aware of the anomalies and are connected with dedicated specialists. Aim of our survey was to investigate the knowledge about diagnostic and therapeutic possibilities for children with VAs, and the existing networking among primary pediatric caregivers in Austria.MethodsPrimary care pediatricians in Austria were invited to complete an online questionnaire consisting of 28 questions focusing on pediatric VAs.ResultsOut of 373 invited pediatricians 93 (25%) returned the questionnaires, 86 of which were complete. Most physicians (39/93 42%) answered that they see between 15 and 30 patients with infantile hemangiomas per year. Vascular malformations are rarely treated in the primary care setting; most primary care pediatricians (58/86, 67%) reported that they currently treat fewer than 5 patients with such type of VAs. There was unequivocal agreement among the participants (84/86, 98%) on the need to establish a network of specialists and a registry dedicated to pediatric VAs.ConclusionsThis survey represents the first study shedding light on the awareness of VAs among Austrian pediatricians and can serve as a basis for future investigations and advances in the management of these conditions in Austria and other countries with a similar healthcare setting

The VASCERN-VASCA working group diagnostic and management pathways for lymphatic malformations

Lymphatic malformations (LMs) are developmental defects of lymphatic vessels. LMs are histologically benign lesions, however, due to localization, size, and unexpected swelling, they may cause serious complications that threaten vital functions such as compression of the airways. A large swelling of the face or neck may also be disfiguring and thus constitute a psychological strain for patients and their families. LMs are also highly immunologically reactive, and are prone to recurrent infections and inflammation causing pain as well as chronic oozing wounds.The European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN) is dedicated to gathering the best expertise in Europe. There are only few available guidelines on management and follow up of LMs, which commonly focus on very specific situations, such as head and neck LM (Zhou et al., 2011). It is still unclear, what constitutes an indication for treatment of LMs and how to follow up the patients. The Vascular Anomalies Working Group (VASCA-WG) of VASCERN decided to develop a diagnostic and management pathway for the management of LMs with a Nominal Group Technique (NGT), a well-established, structured, multistep, facilitated group meeting technique used to generate consensus statements. The pathway was drawn following 2 face-to-face meetings and multiple web meetings to facilitate discussion, and by mail to avoid the influence of most authoritative members.The VASCA-WG has produced this opinion statement reflecting strategies developed by experts and patient representatives on how to approach patients with lymphatic malformations in a practical manner; we present an algorithmic view of the results of our work.Peer reviewe