Diet and other environmental factors and the risk of rheumatoid arthritis in a population-based prospective cohort study

Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that affects primarily the joints. RA leads to cartilage destruction and bone erosion, with substantial loss of quality of life. RA is associated with an increased risk of cardiovascular disease, osteoporosis, gastrointestinal disorders, thus increasing disability and mortality. RA affects 0.5-1% of the adult population, and is three times more common among women than among men. Twin studies have shown that the relative contribution of genetic factors to RA is about 50%, leaving the remaining part to environmental factors. Few epidemiological studies have examined risk factors for RA. Even though cigarette smoking is an established risk factor for RA, the role of its characteristics in the development of the disease is less clear. In addition, analyses of other risk factors have led to inconclusive and often conflicting results. Aims of this thesis were: 1) to analyze the association between characteristics of cigarette smoking (intensity, duration and cessation) and RA risk in a population-based prospective cohort study and by summarizing published evidence; 2) to evaluate the association of alcohol consumption and risk of RA; 3) to estimate the dose-response relationship between long-chain n-3 polyunsaturated fatty acids (PUFAs) and risk of RA; 4) to evaluate long-term intake of alcohol and long-chain n-3 PUFAs, as well as the long-term consumption of fish in relation to RA; 5) to prospectively evaluate the association between physical activity and RA. The data used to assess the association between selected exposures and the development of RA were obtained by means of questionnaires administered in 1987 and 1997 to the Swedish Mammography Cohort. Among the 35 187 women that did not have RA or non-RA joint conditions before the start of follow-up in 2003, 224 developed RA before 2010. Results showed a twofold increased risk among current smokers compared with never smokers, even when their exposure to smoking was low (<7 cigarettes per day). The risk of RA decreased over time following smoking cessation, but remained elevated after more than 15 years since smoking cessation compared with never smokers. Moderate alcohol consumption (a median of 6 glasses of alcohol per week) was associated with a 37% decreased risk of RA. In addition, long-chain n-3 PUFA dietary intake was inversely associated with RA risk, and women with an intake of more than 0.21 grams per day of long-chain n-3 PUFAs had a 35% decreased risk compared with women with a lower intake (≤0.21 grams per day). A consistent moderate long-term intake of both alcohol and long-chain n-3 PUFAs was associated with a halved risk of RA. Long-term consumption of fish was inversely associated with RA, but after adjustment for their content of long-chain n-3 PUFAs the association disappeared. Leisure-time activity (combination of walking and exercising) was associated with a decreased risk of RA. Results from this thesis showed that modifiable lifestyle factors, including smoking, alcohol consumption, long-chain n-3 PUFAs intake and physical activity, are associated with RA development

Review on Battery State Estimation and Management Solutions for Next-Generation Connected Vehicles

The transport sector is tackling the challenge of reducing vehicle pollutant emissions and carbon footprints by means of a shift to electrified powertrains, i.e., battery electric vehicles (BEVs) and plug-in hybrid electric vehicles (PHEVs). However, electrified vehicles pose new issues associated with the design and energy management for the efficient use of onboard energy storage systems (ESSs). Thus, strong attention should be devoted to ensuring the safety and efficient operation of the ESSs. In this framework, a dedicated battery management system (BMS) is required to contemporaneously optimize the battery’s state of charge (SoC) and to increase the battery’s lifespan through tight control of its state of health (SoH). Despite the advancements in the modern onboard BMS, more detailed data-driven algorithms for SoC, SoH, and fault diagnosis cannot be implemented due to limited computing capabilities. To overcome such limitations, the conceptualization and/or implementation of BMS in-cloud applications are under investigation. The present study hence aims to produce a new and comprehensive review of the advancements in battery management solutions in terms of functionality, usability, and drawbacks, with specific attention to cloud-based BMS solutions as well as SoC and SoH prediction and estimation. Current gaps and challenges are addressed considering V2X connectivity to fully exploit the latest cloud-based solutions

landscape conservation and valorization by satellite imagery and historic maps the case of italian transhumance routes

AbstractIn order to verify the potential use of old transhumance routes as tourist resource, the paper intends to illustrate a methodology to assess their conservation state, both in terms of track accessibility and viability, as well as in terms of heritage presence, and shows the results of a survey conducted on the Castel di Sangro—Lucera route (Molise region, Southern Italy). The methodology proposed represents a first step for integrated tourism planning as to the old transhumance routes in Southern Italy, starting from the digitization of the Custom Office historic maps and continuing on through an urgently needed program of conservation and restoration of the tracks supported by cartography and satellite imagery techniques

Laparoscopic management of adrenal tumors: a four-year experience in a single center

AIM: Today laparoscopy is considered the first choice treatment of many adrenal tumors, although its use is still controversial for large adrenal masses and incidentally found adrenal cortical carcinoma. METHODS: From January 2009 to February 2014 we performed 42 lateral transperitoneal laparoscopic adrenalectomies. The indications for surgery were non-functioning adenoma larger than 4 cm or rapid growth and hormone-secreting tumor. The diagnosis was confirmed in all cases with computed tomography and magnetic resonance imaging and also metaiodobenzylguanidine scintigraphy if pheochromocytoma was suspected. In all cases we realized a complete preoperative hormonal study. We describe and analyzed retrospectively: age, side, indication for surgery, tumor size, length of hospital stay, complication and conversion rate. RESULTS: Twenty-two patients with functional tumors and 20 with non functional tumor were subjected to laparoscopic adrenalectomy. There was no conversion to open surgery. Mean operative time was 120 min and estimated blood loss was 80 mL (range 50-350). There was no mortality or major complications. The average length of hospital stay was 3.5 day. During pheocromocitoma removal hypertension occurred in 2 cases. Patient with aldosteroma became normotensive and no required postoperative antihypertensive therapy. CONCLUSION: Laparoscopic adrenalectomy is a standard safe procedure for adrenal surgery. The risk of encountering incidental adrenal cortical cancer increases for large lesions and additional attention is required in these cases to observe oncologic surgical principles. Pre-operative work –up has a primary role in adrenal surgery. An accurate management of adrenal tumors requires an agreement among radiologist, endocrinologist, oncologist and surgeon. Previus abdominal surgery does not constituite a contraindication to laparoscopic transperitoneal adrenalectomy

Role and outcomes of laparoscopic cholecystectomy in the elderly.

Introduction: Laparoscopic cholecystectomy is the standard of treatment for gallstones disease and acute colecystitis. The prevalence of this disease increases with age and the population is aging in industrialized countries. So, in this study we report our experience in the treatment of gallstone disease in elderly patients, particularly analyzing the outcomes of laparoscopic approach. Methods: Between January 2010 and May 2014 we performed a total of 1227 cholecystectomies. In this retrospective study age group was the primary independent variable: 351 patients were 65-79 years of age and 65 were 80 years of age or older. Results: Only 65 patients (5.3%) of all population had primary open cholecystectomy, but the rate in young group was 3.7% respect the highest frequency (9.2%) in the elderly group. The conversion rate was higher (1.2%) in the older group but there was no significant difference with younger group. LC in emergency setting was performed in 10.3% of young patients and in 13.8% of elderly group. Conclusion: Laparoscopic cholecystectomy is a feasible and safe procedure in elderly patients and might be performed during the same hospitalization like definitive treatment of gallstone disease. The old age and subsequent comorbidity are the fundamental predictor of surgical outcomes. Elective treatment should be recommended when repeated gallstone symptoms have occurred in the elderly patient before the development of acute cholecystitis and related complications

Effects of Grazing on the Behaviour, Oxidative and Immune Status, and Production of Organic Dairy Cows

Abstract: This study compared the eects of a short daily grazing time with those of permanent free-stall housing on the behaviour, oxidative status, immune response, and milk production of organically reared cows. During a 63-day period, two homogeneous groups of eight lactating Brown cows were allocated to either housing (H) in a free-stall building for 24 h/day. Feeding was based on a total mixed ration or grazing (G) on barley grass for 5 h/day, and housing in a free-stall structure with feeding was based on the same total mixed ration oered to the H group. With regard to behaviour, H cows spent more time idling, walking, drinking, and self-grooming, whereas G cows showed a greater intent to eat and interact socially. Moreover, G cows exhibited slightly higher reactive oxygen metabolites and similar biological antioxidant potential concentrations than the H group, which indicates that short grazing resulted in an almost negligible increase in oxidative stress and an unchanged antioxidant capacity. Skin tests, performed by injecting phytohemoagglutinin intradermally, indicated that G cows had thicker skin than H cows at the end of the trial, an index of a better cell-mediated immune response. Grazing did not aect milk yield but improved milk quality in terms of an increase in fat and a reduction in urea content, somatic cell count, and total microbial count. Milk from G cows was richer in saturated fatty acids, likely because of the contribution of palmitic acid present in the grazed barley grass, and also showed higher contents of some healthy fatty acids, such as rumenic acid and -linolenic acid, and a lower omega-6/omega-3 ratio. These results show that including a short grazing time in the diets of organic dairy cows does not have negative consequences for milk production and contributes to improved milk quality as well as to a more ecient immune response in the cow

On the complexity of the boundary layer structure and aerosol vertical distribution in the coastal Mediterranean regions: A case study

The planetary boundary layer structure in the coastal areas, and particularly in complex orography regions such as the Mediterranean, is extremely intricate. In this study, we show the evolution of the planetary boundary layer based on in situ airborne measurements and ground-based remote sensing observations carried out during the MORE (Marine Ozone and Radiation Experiment) campaign in June 2010. The campaign was held in a rural coastal Mediterranean region in Southern Italy. The study focuses on the observations made on 17 June. Vertical profiles of meteorological parameters and aerosol size distribution were measured during two flights: in the morning and in the afternoon. Airborne observations were combined with ground-based LIDAR, SODAR, microwave and visible radiometer measurements, allowing a detailed description of the atmospheric vertical structure. The analysis was complemented with data from a regional atmospheric model run with horizontal resolutions of 12, 4 and 1 km, respectively; back-trajectories were calculated at these spatial resolutions. The observations show the simultaneous occurrence of dust transport, descent of mid-tropospheric air and sea breeze circulation on 17 June. Local pollution effects on the aerosol distribution, and a possible event of new particles formation were also observed. A large variability in the thermodynamical structure and aerosol distribution in the flight region, extending by approximately 30km along the coast, was found. Within this complex, environment-relevant differences in the back-trajectories calculated at different spatial resolutions are found, suggesting that the description of several dynamical processes, and in particular the sea breeze circulation, requires high-resolution meteorological analyses. The study also shows that the integration of different observational techniques is needed to describe these complex conditions; in particular, the availability of flights and their timing with respect to the occurring phenomena are crucial

Tertiary stent-in-stent for obstructing colorectal cancer. A case report and literature review

BACKGROUNDSelf-expandable metal stents (SEMSs) are frequently used in the setting of palliation for occluding, inoperable colorectal cancer (CRC). Among possible complications of SEMS positioning, re-obstruction is the most frequent. Its management is controversial, potentially involving secondary stent-in-stent placement, which has been poorly investigated. Moreover, the issue of secondary stent-in-stent re-obstruction and of more-than-two colonic stenting has never been assessed. We describe a case of tertiary SEMS-in-SEMS placement, and also discuss our practice based on available literature.CASE SUMMARYA 66-year-old male with occluding and metastatic CRC was initially treated by positioning of a SEMS, which had to be revised 6 mo later when a symptomatic intra-stent tumor ingrowth was treated by a SEMS-in-SEMS. We hereby describe an additional episode of intestinal occlusion due to recurrence of intra-stent tumor ingrowth. This patient, despite several negative prognostic factors (splenic flexure location of the tumor, carcinomatosis with ascites, subsequent chemotherapy that included bevacizumab and two previously positioned stents (1 SEMS and 1 SEMS-in-SEMS)) underwent successful management through the placement of a tertiary SEMS-in-SEMS, with immediate clinical benefit and no procedure-related adverse events after 150 d of post-procedural follow-up. This endoscopic management has permitted 27 mo of partial control of a metastatic disease without the need for chemotherapy discontinuation and, ultimately, a good quality of life until death.CONCLUSIONTertiary SEMS-in-SEMS is technically feasible, and appears to be a safe and effective option in the case of recurrent SEMS obstruction