REsiDENT 1 (Re-assessment of Appendicitis Evaluation during laparoscopic appendectomy: Do we End a Non-standardized Treatment approach and habit?): Peritoneal irrigation during laparoscopic appendectomy - Does the grade of contamination matter? A prospective multicenter resident-based evaluation of a new classification system

Background: Laparoscopic appendectomy has progressively gained acceptance as the standard of care for acute appendicitis. Focusing on the incidence of postoperative intra-abdominal abscess after a laparoscopic appendectomy, discordant data have been reported ranging from 1.5 to 20%. Besides, evidence advocating advantages from peritoneal irrigation over suction only are lacking. Most studies are burdened by a high level of heterogeneity regarding the severity of the appendicitis and modalities of peritoneal irrigation. One of the main drawbacks is the lack of an accepted classification for different degrees of appendicitis and peritoneal contamination. The aim of the study is to introduce a classification to clarify the relationship between grade of appendicitis, contamination, and postoperative incidence of IAA considering the surgeon's attitude toward irrigation or suction alone. Preoperative, intra-operative, and postoperative predictive factors for infectious complication will also be assessed. This study is meant to be the first Italian multicenter resident-based observational study. Methods: Patients suffering from acute appendicitis will be enrolled during a 1-year period, according to inclusion and exclusion criteria. Participants will fill an online form reporting all clinical and intra-operative data of each patient undergoing a laparoscopic appendectomy. General surgery residents will be responsible for data collection. Our proposal of classification is based on the histological grade of appendicitis and intra-operative degree of peritoneal contamination. For each grade, a progressively increasing score is assigned. Discussion: The observational nature of this study is mandatory to examine surgeons' attitude toward peritoneal contamination during laparoscopic appendectomy for appendicitis. Identification of different severity grades of acute appendicitis and their relationship with the development of postoperative abscesses is necessary. The resulting classification and score, even considering peritoneal lavage or suction alone, will define risk classes of peri-appendiceal contamination each one related to a specific incidence rate of postoperative IAA. Nowadays, maximum effort should be made to reach the best procedural standardization and surgical decision-making should be supported by solid evidence, especially in an emergency surgery setting

Quality of Life and Personality Traits in Patients with Malignant Pleural Mesothelioma and Their First-Degree Caregivers.

Asbestos exposure causes significant pleural diseases, including malignant pleural mesothelioma (MPM). Taking into account the impact of MPM on emotional functioning and wellbeing, this study aimed to evaluate the quality of life and personality traits in patients with MPM and their first-degree caregivers through the World Health Organization Quality of Life–BREF (WHOQOL-BREF) and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). The sample was composed of 27 MPM patients, 55 first-degree relatives enrolled in Casale Monferrato and Monfalcone (Italy), and 40 healthy controls (HC). Patients and relatives reported poorer physical health than the HC. Patients had a higher overall sense of physical debilitation and poorer health than relatives and the HC, more numerous complaints of memory problems and difficulties in concentrating, and a greater belief that goals cannot be reached or problems solved, while often claiming that they were more indecisive and inefficacious than the HC. First-degree relatives reported lower opinions of others, a greater belief that goals cannot be reached or problems solved, support for the notion that they are indecisive and inefficacious, and were more likely to suffer from fear that significantly inhibited normal activities than were HC. In multinomial regression analyses, partial models indicated that sex, physical comorbidities, and the True Response Inconsistency (TRIN-r), Malaise (MLS), and Behavior-Restricting Fears (BRF) dimensions of the MMPI-2-RF had significant effects on group differences. In conclusion, health care providers should assess the ongoing adjustment and emotional wellbeing of people with MPM and their relatives, and provide support to reduce emotional distress

Spinal Anesthesia and Minimal Invasive Laminotomy for Paddle Electrode Placement in Spinal Cord Stimulation: Technical Report and Clinical Results at Long-Term Followup

Object. We arranged a mini-invasive surgical approach for implantation of paddle electrodes for SCS under spinal anesthesia obtaining the best paddle electrode placement and minimizing patients' discomfort. We describe our technique supported by neurophysiological intraoperative monitoring and clinical results. Methods. 16 patients, affected by neuropathic pain underwent the implantation of paddle electrodes for spinal cord stimulation in lateral decubitus under spinal anesthesia. The paddle was introduced after flavectomy and each patient confirmed the correct distribution of paresthesias induced by intraoperative test stimulation. VAS and patients' satisfaction rate were recorded during the followup and compared to preoperative values. Results. No patients reported discomfort during the procedure. In all cases, paresthesias coverage of the total painful region was achieved, allowing the best final electrode positioning. At the last followup (mean 36.7 months), 87.5% of the implanted patients had a good rate of satisfaction with a mean VAS score improvement of 70.5%. Conclusions. Spinal cord stimulation under spinal anesthesia allows an optimal positioning of the paddle electrodes without any discomfort for patients or neurosurgeons. The best intraoperative positioning allows a better postoperative control of pain, avoiding the risk of blind placements of the paddle or further surgery for their replacement

Novel anti-obesity quercetin-derived Q2 prevents metabolic disorders in rats fed with high-fat diet

Objective: Obesity is often accompanied by an increased morbidity and mortality due to an increase of the cardiovascular disease risk factors, diabetes mellitus and dyslipidemia. Research is constantly working on protective molecules against obesity. In the present study, a novel Quercetin derivative Q2 was synthesized to overcome the poor bioavailability and low stability of Quercetin, a natural flavonoid with antioxidative and antiobesity properties. Methods: Rats were fed (12ws) with normodiet (fat:INS; 6.2%), High Fat Diet (fat:60%), HFDINS; +INS; Q2 in water (500INS; nM). Metabolic and anthropometric parameters were measured. 3T3-L1 preadipocytes were incubated with Q2 (1-25μM) and the differentiation program was evaluated by lipid accumulation through ORO staining. Gene and protein expression levels were assessed by RT-PCR and Western blot analysis. Results: Compared to HFD, HFDINS; +INS; Q2 rats showed reduced body weight, abdominal obesity, dyslipidemia and improved glucose tolerance. This is associated to lower adipose and liver modifications compared to hypertrophy and steatosis observed in HFD. In 3T3-L1 cells, lipid accumulation was significantly impaired by treatment with Q2. Indeed, Q2 significantly decreased the expression of the main adipogenic markers, c/EBPα and PPARγ both at mRNA and protein level. Conclusions: Our results indicate that Q2 markedly decreases differentiation of 3T3-L1 preadipocytes and contributes to prevent metabolic disorders as well as adipose and liver alterations typical of severe obesity induced by a HFD

A shallow-layer model for heavy gas dispersion from natural sources: Application and hazard assessment at Caldara di Manziana, Italy

Several nonvolcanic sources in central Italy emit a large amount of carbon dioxide (CO2). Under stable atmospheric conditions and/or in the presence of topographic depressions, the concentration of CO2, which has a molecular mass greater than that of air, can reach high values that are lethal to humans or animals. Several episodes of this phenomenon were recorded in central Italy and elsewhere. In order to validate a model for the dispersion of a heavy gas and to assess the consequent hazard, we applied and tested the code TWODEE-2, an improved version of the established TWODEE model, which is based on a shallow-layer approach that uses depth-averaged variables to describe the flow behavior of dense gas over complex topography. We present results for a vented CO2 release at Caldara di Manziana in central Italy. We find that the model gives reliable results when the input quantity can be properly defined. Moreover, we show that the model can be a useful tool for gas hazard assessment by evaluating where and when lethal concentrations for humans and animals are reached

Long term variations at Campi Flegrei (Italy) volcanic system highlighted by the monitoring of hydrothermal activity

Long time-series of chemical composition of fumaroles and of soil CO2 flux reveal that important variations in the activity of Solfatara fumarolic field, the most important hydrothermal site of Campi Flegrei, occurred in the 2000- 2008 period. A continuous increase of the CO2 concentration and a general decrease of the CH4 concentration are interpreted as the consequence of the increment of the relative amount of magmatic fluids, rich in CO2 and poor in CH4, hosted by the hydrothermal system. Contemporaneously the H2O-CO2-He-N2 gas system shows remarkable compositional variations in the samples collected after July 2000 with respect to the previous ones, indicating the progressive arrival at the surface of a magmatic component different from that involved in the 1983-84 bradyseism. The change starts in 2000 concurrently with the occurrence of relatively deep long periods seismic events which, in our interpretation, were the indicator of the opening of an easy pathway for the transfer of magmatic fluids towards the shallower, brittle domain hosting the hydrothermal system. Since 2000 this magmatic gas source is active and causes ground deformations, seismicity as well as the expansion of the area interested by diffuse soil degassing of deeply derived CO2

Tomograms and other transforms. A unified view

A general framework is presented which unifies the treatment of wavelet-like, quasidistribution, and tomographic transforms. Explicit formulas relating the three types of transforms are obtained. The case of transforms associated to the symplectic and affine groups is treated in some detail. Special emphasis is given to the properties of the scale-time and scale-frequency tomograms. Tomograms are interpreted as a tool to sample the signal space by a family of curves or as the matrix element of a projector.Comment: 19 pages latex, submitted to J. Phys. A: Math and Ge

Models and experimental results from the wide aperture Nb-Ti magnets for the LHC upgrade

MQXC is a Nb-Ti quadrupole designed to meet the accelerator quality requirements needed for the phase-1 LHC upgrade, now superseded by the high luminosity upgrade foreseen in 2021. The 2-m-long model magnet was tested at room temperature and 1.9 K. The technology developed for this magnet is relevant for other magnets currently under development for the high-luminosity upgrade, namely D1 (at KEK) and the large aperture twin quadrupole Q4 (at CEA). In this paper we present MQXC test results, some of the specialized heat extraction features, spot heaters, temperature sensor mounting and voltage tap development for the special open cable insulation. We look at some problem solving with noisy signals, give an overview of electrical testing, look at how we calculate the coil resistance during at quench and show that the heaters are not working We describe the quench signals and its timing, the development of the quench heaters and give an explanation of an Excel quench calculation and its comparison including the good agreement with the MQXC test results. We propose an improvement to the magnet circuit design to reduce voltage to ground values by factor 2. The program is then used to predict quench Hot-Spot and Voltages values for the D1 dipole and the Q4 quadrupole.Comment: 8 pages, Contribution to WAMSDO 2013: Workshop on Accelerator Magnet, Superconductor, Design and Optimization; 15 - 16 Jan 2013, CERN, Geneva, Switzerlan