A comparison of surgical devices for grade II and III hemorrhoidal disease. Results from the LigaLongo Trial comparing transanal Doppler-guided hemorrhoidal artery ligation with mucopexy and circular stapled hemorrhoidopexy

PURPOSE: Little is presently known on the impact of device type for Doppler-guided hemorrhoidal artery ligation/mucopexy (DGHAL) or circular stapled hemorrhoidopexy (CSH) when a surgical treatment is considered for hemorrhoidal disease (HD). In this study, we aimed to compare the outcome in terms of adverse events and recurrence rate, of patients included in the multicenter LigaLongo RCT ( ClinicalTrials.gov NCT01240772) according to the type of devices used. METHODS: In the DGHAL arm (N = 193), the procedure was done with transanal hemorrhoidal dearterialization (THD)™ (THD, Correggio, Italy) (104 patients) and with HAL-RAR™ (Agency for Medical Innovations (AMI) GmbH, Feldkirch, Austria) (89 patients). In the CSH arm (N = 184), procedure for prolapse and hemorrhoids (PPH)-03™ (Ethicon Endo-Surgery, Cincinnati OH) and hemorrhoidopexy and prolapse (HEM)™ (Covidien, Inc.) staplers were used in respectively 106 and 78 cases. Surgery-related morbidity at 90 postoperative days (POD) based on the Clavien-Dindo procedure-related complication score and clinical outcome in terms of recurrence and reoperation rate at 12 postoperative months (POM) was collected. RESULTS: Three hundred and seventy-seven patients were randomized according to HD grade. In the DGHAL arm, the number of ligations and mucopexies was higher in the AMI group (p < 0.0001); at 90 POD, the overall morbidity was similar between the two groups. In the CSH arm, donut sizes were similar; at 90 POD, the PPH group had a higher risk of postoperative grade 1 morbidity (anal urgency or incontinence) compared to the HEM group (p = 0.003). At 12 POM, no statistical difference was found between the two groups of each arm in terms of grade III recurrence or reoperation. CONCLUSION: Postoperative morbidity and outcome at 1 year were similar regardless of the type of devices used. These findings suggest that device type has little impact on HD treatment results. TRIAL REGISTRATION: clinicaltrials.gov -Identifier NCT01240772

Transplantation tolerance: lessons from experimental rodent models

Immunological tolerance or functional unresponsiveness to a transplant is arguably the only approach that is likely to provide long-term graft survival without the problems associated with life-long global immunosuppression. Over the past 50 years, rodent models have become an invaluable tool for elucidating the mechanisms of tolerance to alloantigens. Importantly, rodent models can be adapted to ensure that they reflect more accurately the immune status of human transplant recipients. More recently, the development of genetically modified mice has enabled specific insights into the cellular and molecular mechanisms that play a key role in both the induction and maintenance of tolerance to be obtained and more complex questions to be addressed. This review highlights strategies designed to induce alloantigen specific immunological unresponsiveness leading to transplantation tolerance that have been developed through the use of experimental models

Metals impact into the Paranaguá Estuarine Complex (Brazil) during the exceptional flood of 2011

Abstract Particulate and dissolved metal concentrations were determined after the largest flood in the last 30 years on the east-west axis of the Paranaguá Estuarine Complex (PEC) and compared to the those of the dry period at two stations. Results confirmed that the flood greatly affected riverine outflows and the behavior of metals in the PEC. In particular, a sharp decrease in salinity was followed by extremely high SPM concentrations leading to a decrease in DO concentrations at both stations. For the dissolved phase, ANOSIM analysis showed a significant dissimilarity at each station between the sampled periods, whereas for the particulate phase this dissimilarity was found only for the samplings taken at the Antonina Station. KD values suggested dissolved Cu behavior was related to the presence of organic complexes and dissolved Mn had sediment resuspension of redox sediments and or/pore water injection as sources. Metal concentrations were lower than in polluted estuaries, though high enrichment factors found after the flood pointed to the influence of anthropogenic sources. In conclusion, the flood's influence was more evident at the Antonina Station, due to its location in the upper estuary, whereas in Paranaguá a high SPM content with low metal concentration was found, following the common pattern generally found in other marine systems subject to heavy rainfall events

La necessità del segreto. Indagini sullo spazio politico nell'Italia medievale ed oltre

Il segreto opera in senso selettivo, distintivo, azionando processi di inclusione e di esclusione, rapporti di forza, dinamiche di potere. Ingrediente costitutivo nella definizione del soggetto /suddito, il segreto è una leva fondamentale nella costruzione del pubblico. I saggi propositi cercano di afferrarne alcune traiettorie che dall'Italia delle città stato si spingono fino alla Cina dell'XI secolo e all'Etiopia del XVII secolo per esplorarne rituali, configurazioni, valenze

L’argent (Ag, Nanoag) comme contaminant émergent dans l’estuaire de la Gironde : Evaluations scientifiques et gouvernance des risques

Cet article présente les résultats d'une recherche pluridisciplinaire (géochimie, sociologie) portant sur l'accroissement observé des concentrations d'argent sous la forme particulaire et nanoparticulaire (Ag et nanoAg) dans les milieux aquatiques de l'estuaire de la Gironde. Il propose conjointement d'analyser les risques d'une contamination des milieux aquatiques par l'argent et d'observer le processus de construction sociale et politique de ce risque par les gestionnaires de l'eau, les autorités sanitaires, les agences et comités d'expertise et d'évaluation des risques, des associations environnementales et des industriels utilisateurs d'argent. La mise à jour de quatre types de construction du risque permet de comprendre les différentes logiques d'argumentation mobilisées. Cette coopération scientifique pluridisciplinaire ouvre des perspectives sur les problématiques santé-environnement en diffusant des savoirs pour l'action et en favorisant la réflexivité des acteurs locaux confrontés au problème émergent de la concentration de l'argent dans les milieux aquatiques. / This article presents the results of multidisciplinary research (geochemistry, sociology) into the increasing concentrations of silver (Ag and nanoAg) in the environment and their potential impact on aquatic environments. We investigate simultaneously the risk of contamination of these environments by silver and the process of the social and political construction of this risk by water managers, health authorities, agencies and committees responsible for expert evaluations, environmental associations, and potential users of silver or nano-silver. Four updated models of risk construction allow us to understand the logic of arguments mobilized at this stage of the emerging risk. This interdisciplinary cooperation opens up possibilities for dealing with some environmental health issues; it highlights the benefits of an approach aiming to disseminate knowledge to enable action and to promote awareness and analysis by the local stakeholders and officials who face this emerging problem

Adiabatic compression testing - part II: background and approach to estimating severity of test methodology

Adiabatic compression testing of components in gaseous oxygen is a test method that is utilized worldwide and is commonly required to qualify a component for ignition tolerance under its intended service. This testing is required by many industry standards organizations and government agencies; however, a thorough evaluation of the test parameters and test system influences on the thermal energy produced during the test has not yet been performed. This paper presents a background for adiabatic compression testing and discusses an approach to estimating potential differences in the thermal profiles produced by different test laboratories. A “Thermal Profile Test Fixture” (TPTF) is described that is capable of measuring and characterizing the thermal energy for a typical pressure shock by any test system. The test systems at Wendell Hull & Associates, Inc. (WHA) in the USA and at the BAM Federal Institute for Materials Research and Testing in Germany are compared in this manner and some of the data obtained is presented. The paper also introduces a new way of comparing the test method to idealized processes to perform system-by-system comparisons. Thus, the paper introduces an “Idealized Severity Index” (ISI) of the thermal energy to characterize a rapid pressure surge. From the TPTF data a “Test Severity Index” (TSI) can also be calculated so that the thermal energies developed by different test systems can be compared to each other and to the ISI for the equivalent isentropic process. Finally, a “Service Severity Index” (SSI) is introduced to characterizing the thermal energy of actual service conditions. This paper is the second in a series of publications planned on the subject of adiabatic compression testing