The surgical point of view about persistent air leaks: prevention first

No abstract availabl

Vena cava anomalies in thoracic surgery

Background: Vena cava anomalies are a rare group of anatomical variations due to an incorrect development of the superior or inferior vena cava during fetal life. They generally show no clinical relevance and the diagnosis is done due to the association with congenital heart diseases in most of cases. However, preoperative identification of these anomalies is mandatory for surgeons to proper surgical planning. If not recognized, lethal complications may occur, as already reported in literature. Case presentation: We report a case series of three different unidentified vena cava anomalies in patients undergoing lung resection. These unrecognized anomalies led to minor complications in two cases and required an accurate intraoperative evaluation in another. A careful retrospective evaluation of preoperative radiological images showed the anomalies. Conclusions: A careful evaluation of the vena cava anatomy at pre-operative imaging is mandatory for thoracic surgeons to properly plan the surgery and avoid complications

Fusing NIR and Process Sensors Data for Polymer Production Monitoring

Process analytical technology and multivariate process monitoring are nowadays the most effective approaches to achieve real-time quality monitoring/control in production. However, their use is not yet a common practice, and industries benefit much less than they could from the outcome of the hundreds of sensors that constantly monitor production in industrial plants. The huge amount of sensor data collected are still mostly used to produce univariate control charts, monitoring one compartment at a time, and the product quality variables are generally used to monitor production, despite their low frequency (offline measurements at analytical laboratory), which is not suitable for real-time monitoring. On the contrary, it would be extremely advantageous to benefit from predictive models that, based on online sensors, will be able to return quality parameters in real time. As a matter of fact, the plant setup influences the product quality, and process sensors (flow meters, thermocouples, etc.) implicitly register process variability, correlation trends, drift, etc. When the available spectroscopic sensors, reflecting chemical composition and structure, consent to monitor the intermediate products, coupling process, and spectroscopic sensor and extracting/fusing information by multivariate analysis from this data would enhance the evaluation of the produced material features allowing production quality to be estimated at a very early stage. The present work, at a pilot plant scale, applied multivariate statistical process control (MSPC) charts, obtained by data fusion of process sensor data and near-infrared (NIR) probes, on a continuous styrene-acrylonitrile (SAN) production process. Furthermore, PLS regression was used for real-time prediction of the Melt Flow Index and percentage of bounded acrylonitrile (%AN). The results show that the MSPC model was able to detect deviations from normal operative conditions, indicating the variables responsible for the deviation, be they spectral or process. Moreover, predictive regression models obtained using the fused data showed better results than models computed using single datasets in terms of both errors of prediction and R2. Thus, the fusion of spectra and process data improved the real-time monitoring, allowing an easier visualization of the process ongoing, a faster understanding of possible faults, and real-time assessment of the final product quality

Non-invasive brain stimulation for gambling disorder: a systematic review

Background:Gambling disorder (GD) is the most common behavioral addiction and shares pathophysiological and clinical features with substance use disorders (SUDs). Effective therapeutic interventions for GD are lacking. Non-invasive brain stimulation (NIBS) may represent a promising treatment option for GD. Objective:This systematic review aimed to provide a comprehensive and structured overview of studies applying NIBS techniques to GD and problem gambling. Methods:A literature search using Pubmed, Web of Science, and Science Direct was conducted from databases inception to December 19, 2019, for studies assessing the effects of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (t-DCS) on subjects with GD or problem gambling. Studies using NIBS techniques on healthy subjects and those without therapeutic goals but only aiming to assess basic neurophysiology measures were excluded. Results:A total of 269 articles were title and abstract screened, 13 full texts were assessed, and 11 were included, of which six were controlled and five were uncontrolled. Most studies showed a reduction of gambling behavior, craving for gambling, and gambling-related symptoms. NIBS effects on psychiatric symptoms were less consistent. A decrease of the behavioral activation related to gambling was also reported. Some studies reported modulation of behavioral measures (i.e., impulsivity, cognitive and attentional control, decision making, cognitive flexibility). Studies were not consistent in terms of NIBS protocol, site of stimulation, clinical and surrogate outcome measures, and duration of treatment and follow-up. Sample size was small in most studies. Conclusions:The clinical and methodological heterogeneity of the included studies prevented us from drawing any firm conclusion on the efficacy of NIBS interventions for GD. Further methodologically sound, robust, and well-powered studies are needed

High-dose dependence and cognitive side effects to medical prescription of etizolam

Introduction: The use of novel designer drugs has increased worldwide over the years. Etizolam is a designer benzodiazepine (BZD) that has raised concern because of its growing non-medical use, liability to tolerance and dependence, and related harms. Studies exploring the abuse liability and cognitive effects of etizolam outside the therapeutic doses are lacking.Aims: To explore the abuse liability of etizolam and the characteristics of patients affected by etizolam high-dose dependence in a nationwide tertiary referral addiction unit. To document the cognitive changes to etizolam high-dose use.Design and Methods: Sociodemographic and clinical data on subjects with etizolam high-dose use were retrospectively collected from a database of 1,293 patients consecutively admitted to the Addiction Medicine Unit, Verona University Hospital, Italy for detoxification from high-dose BZDs or Z-drugs dependence. Thorough neuropsychological testing explored the cognitive side effects of high-dose etizolam use.Results: We found eleven etizolam high-dose users, of which eight used etizolam only, and three used etizolam with other BZDs/zolpidem. All the patients were prescribed etizolam for medical reasons, i.e., anxiety and/or insomnia. Neuropsychological evaluation showed deficits of working memory, visuospatial memory and executive function in a 27-year-old woman who used etizolam 15 mg daily.Discussion: Our findings suggest that abuse and dependence liability of etizolam should be considered a public health and social problem. They offer preliminary evidence on the cognitive side effects of etizolam high-dose use.Conclusions: This report offers new information on the potential harms of etizolam in patients who are prescribed this drug for medical reasons

Adult attention-deficit/hyperactivity disorder symptoms, cognitive dysfunction and quality of life in high-dose use of benzodiazepine and Z-drug

High-dose use of benzodiazepines (BZDs) and Z-drugs was found to be associated with adult attention deficit/hyperactivity disorder (ADHD) and multidomain cognitive deficits, but the interplay between these factors and its effect on quality of life (QoL) is unclear. We explored (a) whether cognitive dysfunction differs in high-dose BZD/Z-drug users with and without adult ADHD and (b) the impact of cognitive deficits and adult ADHD on QoL in this substance-use disorder (SUD). From January 2015 to December 2019, we recruited 207 high-dose BZD/Z-drug users seeking treatment. We assessed the presence of adult ADHD with a screening tool, which was validated in SUD patients, and collected demographic, clinical and QoL data from the 76 included patients. A neuropsychological battery explored five cognitive domains. We found that: (a) screening for adult ADHD was frequently positive; (b) Short Form-36 (SF-36), a self-administered QoL questionnaire, was worse than the general population and worse in patients positive (ADHD+) vs. those negative (ADHD-) to ADHD screening tool; (c) executive function was significantly worse in ADHD+than ADHD- patients; (d) some SF-36 dimensions were negatively influenced by executive dysfunction; (e) multivariate analysis showed an interplay between adult ADHD and cognitive dysfunction in worsening QoL. We documented a complex interplay between adult ADHD, cognitive dysfunction and QoL in high-dose BZD/Z-drug users. Assessing adult ADHD, neuropsychological measures and QoL may offer a full scenario of these patients, who are frequently impaired in everyday activities. Future research should explore whether pharmacological treatment might improve cognitive dysfunction and QoL in this SUD

The Concentration of Asbestos Fibers in Bulk Samples and Its Variation with Grain Size

The aim of this work was to establish whether asbestos fibers homogeneously occur in the different fractions ground from naturally occurring asbestos lithotypes, and to calculate the contribution of fibers from each fraction to the overall concentration in the sample. Serpentinite, metabasalt, calc-schist, clay, debris material, and soil, were addressed. Grain size fractions below 20 mm were sieved at 2 mm and 0.106 mm; they were then were mechanically milled to obtain powders below 0.106 mm. The three powdered fractions were characterized using a scanning electron microscope coupled with energy dispersive spectroscopy following M.D. 06/09/94. The still in use (in some cases), Italian normative M.D. 161/2012 specifies that analyses must be performed on the <2 mm fraction and the concentration (mg/kg) correlated with the weight of the whole sample <20 mm. However, the fiber counts yielded asbestos concentrations 50\u201360% lower compared with total asbestos analyses according to the new R.P.D. 120/2017. Consequently, there is a need to standardize the normative worldwide regulations for the management of asbestos-containing materials, by re-evaluation of sample preparation and quantification of asbestos