The Holocaust Is a Significant and Independent Risk Factor of Late-Onset Cancers: A Systematic Review of the Literature and Original Data on Jewish Israeli, Jewish Non-Israeli and Non-Jewish Non-Israeli Survivors.

BACKGROUND/AIM: Seventy-six years after Auschwitz Liberation, the Holocaust keeps on persecuting its surviving victims. As witnessed by the psychiatric and medical literature in the last decades, in fact, the Holocaust survivors (HS) appear to suffer from several Shoah-related late-onset diseases impacting their survival, such as internal illnesses and post-traumatic stress disorder (PTSD). Cancer represents a further severe pathology which seems to be connected with the Holocaust experience. Our aim was to review the existing knowledge of Holocaust-related cancer in HS in order to assess its real incidence and clinicoprognostic significance. MATERIALS AND METHODS: We systematically reviewed the literature dealing with Israeli Jewish and non-Jewish non-Israeli HS developing cancer. We also reviewed and analyzed the cancer data of noted Jewish HS not resident or having resided in Israel available as public information. RESULTS: We found 16 and 15 studies on Israeli Jews and non-Jewish non-Israeli survivors, respectively. A statistically significant association between the Holocaust and development of late-onset cancer in HS was seen in most studies with cancer adversely impacting the survival. We also selected 330 noted Jewish non-Israeli HS: genocide-related late-onset cancer resulted to be a significant and independent risk factor of poor prognosis (p<0.0001) imparting shorter survival in affected versus non-cancer subjects (57 versus 64 years, respectively, p=0.0001). CONCLUSION: Although 76 years have passed, our review shows how the Holocaust keeps on burdening its survivors. Moreover, we offered the first analysis of Jewish HS not resident or having resided in Israel in terms of genocide-related late-onset diseases focusing on cancer. Further studies on Jewish non-Israeli HS are needed in order to corroborate our findings on late-onset cancer occurring in this targeted population

Potential of Energy Saving of Propane Heat Pump as replacement of gas boilers with low and high temperature emitters

This work deals with the analysis of the energy performance and the environmental impact of a Heating, Ventilation and Air Conditioning (HVAC) system based on an innovative Air-to-Water electrical Heat Pump (AWHP) using propane (R290) as the refrigerant. A building of the University of Bologna located in Forlì (North of Italy) is considered for replacing a condensing gas boiler and a conventional chiller with an AWHP using R290. To evaluate the efficiency of the existing heating system and the potential savings linked to the adoption of the propane AWHP, the building energy model was created and calibrated by collecting monthly thermal and electrical consumptions as a function of the actual climate data. In this paper, the main features of the R290-based AWHP are described in detail by emphasising the device performance as a function of the operating conditions (i.e., air and water temperature and speed of the scroll compressor). A series of scenarios have been studied to evaluate the energy performance of the propane AWHP with respect to the reference scenario under various operating conditions. The results show that while the total primary energy demand increases adopting the propane AWHP with respect to the case of a gas boiler, the non-renewable primary energy fraction decreases significantly, with a dramatic increase in the renewable quote. From an economic point of view, lower annual costs are obtained by adopting a propane AWHP coupled to fan coils, mainly when the electrical heat pump is used in a thermally insulated building in which a photovoltaic system is installed

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p &lt; 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p &lt; 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p &lt; 0.0001) or urgent (20.4% vs. 38.5%; p &lt; 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p &lt; 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Artificial muscle: materials and actuation systems for mimicking the mechanical properties of biological muscle

Many years have been spent to study different kinds of actuators and still researches are in progress to design more powerful and compact systems able to generate force. Proofs of concept were realized using a wide variety of materials and structures, and some of them re-sulted to be outstanding actuators for their performances at the time they were built. In the se-cond half of the 20th century, actuators studies were focused to build prototypes that could have only better strictly mechanical features since it wasn’t put attention to humanoid robot¬ics and mimicking of muscle’s properties. However, in the last decades, actuators were also de-fined “artificial muscles”, including in the definition active materials able to produce a force and deform themselves through different energy sources, as well as concepts that aim to have muscle-like properties and behave as a real biological muscle. What emerges from literature on this topic is the difficulty to overcome issues such as large size, complex structures, high mechanical impedance while at the same time obtaining mechanical characteristics comparable to muscles and, as a more challenging feature, repro-duce muscle’s active and passive behavior. The present master thesis work is part of the development of new technologies and de-sign principles for the conception of actuators capable of replicating the active and passive behavior of muscle. A paper published on Nature journal by Lv et al. in 2010 on a novel titin-mimetic material inspired the work presented in this thesis, developed in collaboration with Prof. Li, leader of the team, and Lv (University of British Columbia, Canada). The aim of this thesis is the analysis and modeling of mechanical passive properties of the titin-like material in order to evaluate the possibility of employing it in design and devel-opment of biomimetic actuator for robotics, bioengineering and prosthetic applications. The first specific objective of this work is the study of the best suitable materials that state of the art on artificial muscle reports in the mimicking of active and passive behavior and muscle’s macroscopic properties. The second objective of thesis is the development of a lumped-parameter non-linear viscoelastic mechanical model of the titin-like material able to simulate its passive properties for the designing of an muscle-like actuator. The third purpose is the design and building of custom mechanical components suita-ble to perform a mechanical characterization on the titin-like material, provided by Lv and colleagues. Fourth objective is the performance of a mechanical characterization on a titin-like material sample through stress-relaxation and stress-strain tests at different strain-levels and stretch-speeds, in order to validate the previously designed model. The present work can be considered the preliminary stage of a more complex pathway towards a better knowledge of the material behavior, the ability to produce it in different shapes and sizes and the modalities of embedding it into a novel artificial muscle. An exten-sive study, in collaboration with the Canadian research team that designed and produced sam-ples of titin-like material, will be conducted to investigate the possible exploitation of a suita-ble active material that, working together with the titin-like material, could be able to confer a muscle-like behavior to a novel kind of artificial muscle

The modelling of reverse defrosting cycles of air-to-water heat pumps with TRNSYS

The most widespread defrosting technique adopted by Air-Source Heat Pumps (ASHPs) during the heating season is Reverse Cycle Defrosting (RCD). In this paper a dynamic model of RCD, based on performance data provided by the heat pump manufacturer, designed for TRNSYS and with a core-structure suitable for commercial units, is presented. A defrost cycle is divided in three phases. First, the unit heating capacity is reduced as a linear function of the ice layer thickness (Pre-Defrost phase). Subsequently, the reverse cycle operating mode is modelled on the basis of the performance data given by the manufacturer (Defrost phase) and, finally, the heat pump performances are altered taking into account the higher surface temperature of the external coil after the reverse mode (Post-Defrost phase). Then, the influence of defrosting energy losses on the heat pump seasonal performance factor in sites characterized by different climatic conditions has been assessed. Results point out that the ASHP seasonal efficiency decreases of about 5% taking into account defrost energy losses; in addition, the influence of defrost cycles on the internal air temperature is studied by assessing under which conditions the indoor thermal comfort can be guaranteed even in presence of frequent defrost cycles

The double challenge (preoperative diagnosis and surgical approach) of primary leiomyosarcoma of the sigmoid colon

Background and aim: Primary colonic leiomyosarcoma (cLMS) is a rare malignancy of muscularis mucosae or muscularis propria showing highly aggressive behaviour and poor prognosis. To date, making a preoperative diagnosis and performing the most appropriate treatment represent laborious tasks for the clinicians. On the one hand, in fact, cLMS diagnosis is often difficult to achieve preoperatively because of the low specificity of clinical, radiological and bioptical features: for these motives, the diagnosis is usually obtained at postoperative histology/immune-histochemistry. On the other hand, although surgery represents the main-stay of multi-modal treatment, in the current era of minimally invasive surgery the optimal approach to cLMS is debated: in the absence of a standardized and unanimous algorithm, in fact, laparoscopy is usually proposed for small tumors, whereas laparotomy for masses exceeding 4 cm in diameter. Our aim was to elucidate such two aspects by reporting our experience. Methods: We present the case of a 51-year-old man affected with a 6-cm LMS of the sigmoid colon. Results: Preoperative diagnosis was achieved through a preoperative echo-endoscopic biopsy. The lesion was successfully and safely managed by laparoscopic surgery. Conclusions: Our case suggests that a preoperative diagnosis of cLMS is possible in an appropriate setting. Moreover, laparoscopy seems to be a safe and successful approach to resect cancers even larger than the common 4 centimetres proposed by the current literature. (www.actabiomedica.it)

Pancreaticojejunostomy with or without reinforcement after pancreaticoduodenectomy: surgical technique of ligamentum teres hepatis wrap around pancreaticojejunostomy

Abstract In a previous issue of the Journal, Zhong et al. reported a retrospective study that compared the perioperative outcomes of the mesh-reinforced pancreaticojejunostomy with conventional pancreaticojejunostomy. They concluded that mesh-reinforced pancreaticojejunostomy was a safe and effective technique, as it provided a safe anchor site for suture, thus reducing the risk of pancreatic leakage. Considering these encouraging results, we present a further simple technique using ligamentum teres hepatis wrap around pancreatojejunostomy for prevention of postoperative pancreatic fistula after pancreaticoduodenectomy