Mucopexy-recto anal lifting: a standardized minimally invasive method of managing symptomatic hemorrhoids, with an innovative suturing technique and the HemorPex System®

BACKGROUND: Conservative surgery of hemorrhoidal disease is less painful than traditional hemorrhoidectomy, and mucopexy has less risk of serious postoperative complications than stapled hemorrhoidopexy. The aim of this study was to evaluate the safety and effectiveness of a standardized, modified hemorrhoidopexy, named Mucopexy-Recto Anal Lifting (MuRAL) with the HemorPex System (HPS) in patients with symptomatic III and IV degree hemorrhoids. METHODS: Patients were enrolled from May 2013 to Dec 2015 and operated on with the MuRAL technique, based on arterial ligation and mucopexy at 6 locations, using a standardized clockwise/anti-clockwise rotation sequence of the HPS anoscope. Follow-up controls were carried out by independent observers, as follows: a digital exploration 3 weeks after the intervention, digital exploration plus proctoscopy at 3 and 12 months and repeated at a 12 months interval. Patients who did not strictly follow the postoperative controls were excluded from the study. Primary outcome measurement was the recurrence rate. Secondary measurements were: operative time, hospital stay, postoperative pain, postoperative symptoms and satisfaction score. RESULTS: We operated on 126 patients (72 males, mean age 53.9, range 29-83): 87 (69.6%) with III degree and 39 with IV degree hemorrhoids; 13 patients had a MuRAL as a revisional procedure of a previous operation for hemorrhoids. Mean duration of follow-up was 554 days (range 281-1219). Four patients were excluded from the study. One-year recurrence rate was 4.1%. The mean duration of the intervention was 29.5 minutes (range 23-60) and 92 patients (73%) were discharged during the same day of the operation. Pain VAS Score in the first, second and third postoperative day was 3.9, 2.5, and 1.9, respectively. Twenty-two patients (18%), all submitted to spinal anesthesia, had postoperative acute urinary retention. Fecal urgency, observed in 18.8% of patients at the first control, disappeared within one year after the operation. Mean time to return to normal activity was 8 days (range 5 -10). The patient satisfaction scores at one-year follow up were 31.1% excellent, 57.4% good, 7.4% fairly good and 4.1% poor. In patients with III degree hemorrhoids operative time was significantly shorter, postoperative pain better and transient fecal urgency lower than in IV degree patients. In our experience the standardization of MuRAL operation with HPS, turned out to be a safe and effective minimally invasive approach in managing symptomatic III and IV degree hemorrhoids, avoiding the risk of severe complications, with the possibility to perform a redo-MuRAL in the event of recurrence. CONCLUSIONS: In our series up to 88% of the patients reported a good, or excellent one-year satisfaction score. Further comparative randomized studies with longer follow-up period are needed

Testing a Model of Flow and Heat Transfer for U-shaped Geothermal Exchangers

Among renewable resources, geothermal energy is one of the most promising for its independence on weather conditions. However, design and installation of borehole heat exchangers on low enthalpy regions must consider numerous influencing factors. Here, we focus on the efficiency improvement in hot water production and heating and cooling of buildings of a pilot geothermal plant, which was implemented as part of a hybrid system within the frame of a research project at the University of Camerino (Italy). The aims of the geothermal plant were to study the subsoil thermal properties and monitoring the parameters of the system during operation. As an important application for the design and sizing of low enthalpy geothermal systems, we propose a mathematical model to study the heat transfer between the fluid circulating in the pipes and the underground, where the mutual influence between the soil and the exchanger is considered. We present results of these approximated solutions based on experimental measurements acquired in the actual geothermal exchangers. Laboratory and in situ tests were also carried out to investigate the underground thermal properties and thermal regime of the heterogeneous soil sedimentary succession

Entanglement of two blocks of spins in the critical Ising model

We compute the entropy of entanglement of two blocks of L spins at a distance d in the ground state of an Ising chain in an external transverse magnetic field. We numerically study the von Neumann entropy for different values of the transverse field. At the critical point we obtain analytical results for blocks of size L=1 and L=2. In the general case, the critical entropy is shown to be additive when d goes to infinity. Finally, based on simple arguments, we derive an expression for the entropy at the critical point as a function of both L and d. This formula is in excellent agreement with numerical results.Comment: published versio

The Gap between Tobacco Treatment Guidelines, Health Service Organization, and Clinical Practice in Comprehensive Cancer Centres

Smoking cessation is necessary to reach a higher quality of life, and, for a cancer patient, it represents an important step in improving the outcome of both prognosis and therapy. Being a cancer patient addicted to nicotine may be a critical situation. We conducted a survey to monitor how many comprehensive cancer centres in Italy have an outpatient smoker clinic and which kinds of resources are available. We also inquired about inpatient services offering psychological and pharmacological support for smoking cessation, reduction, or care of acute nicotine withdrawal symptoms. What we have witnessed is a significant gap between guidelines and services. Oncologists and cancer nurses are overscheduled, with insufficient time to engage in discussion on a problem that they do not consider directly related to cancer treatment. Furthermore, smoking habits and limited training in tobacco dependence and treatment act as an important barrier and lead to the undervaluation of smokers' needs

Enhancement of parameter estimation by Kerr interaction

We address quantum estimation of displacement and squeezing parameters by the class of probes made of Gaussian states undergoing Kerr interaction. If we fix the overall energy available to the probe, without posing any constraint on the available Gaussian squeezing, then Gaussian squeezing represents the optimal resource for parameter estimation. On the other hand, in the more realistic case where the amount of Gaussian squeezing is fixed, or even absent, then Kerr interaction turns out to be useful to improve estimation, especially for probe states with large amplitude. Our results indicate that precision achievable with current technology Gaussian squeezing may be attained and surpassed for realistic values of the Kerr coupling