Operative and nonoperative management for renal trauma. Comparison of outcomes. A systematic review and meta-analysis

INTRODUCTION: Preservation of kidney and renal function is the goal of nonoperative management (NOM) of renal trauma (RT). The advantages of NOM for minor blunt RT have already been clearly described, but its value for major blunt and penetrating RT is still under debate. We present a systematic review and meta-analysis on NOM for RT, which was compared with the operative management (OM) with respect to mortality, morbidity, and length of hospital stay (LOS). METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed for this study. A systematic search was performed on Embase, Medline, Cochrane, and PubMed for studies published up to December 2015, without language restrictions, which compared NOM versus OM for renal injuries. RESULTS: Twenty nonrandomized retrospective cohort studies comprising 13,824 patients with blunt (2,998) or penetrating (10,826) RT were identified. When all RT were considered (American Association for the Surgery of Trauma grades 1-5), NOM was associated with lower mortality and morbidity rates compared to OM (8.3% vs 17.1%, odds ratio [OR] 0.471; 95% confidence interval [CI] 0.404-0.548; P<0.001 and 2% vs 53.3%, OR 0.0484; 95% CI 0.0279-0.0839, P<0.001). Likewise, NOM represented the gold standard treatment resulting in a lower mortality rate compared to OM even when only high-grade RT was considered (9.1% vs 17.9%, OR 0.332; 95% CI 0.155-0.708; P=0.004), be they blunt (4.1% vs 8.1%, OR 0.275; 95% CI 0.0957-0.788; P=0.016) or penetrating (9.1% vs 18.1%, OR 0.468; 95% CI 0.398-0.0552; P<0.001). CONCLUSION: Our meta-analysis demonstrated that NOM for RT is the treatment of choice not only for AAST grades 1 and 2, but also for higher grade blunt and penetrating RT

Hollow viscus injuries. Predictors of outcome and role of diagnostic delay

INTRODUCTION: Hollow viscus injuries (HVIs) are uncommon but potentially catastrophic conditions with high mortality and morbidity rates. The aim of this study was to analyze our 16-year experience with patients undergoing surgery for blunt or penetrating bowel trauma to identify prognostic factors with particular attention to the influence of diagnostic delay on outcome. METHODS: From our multicenter trauma registry, we selected 169 consecutive patients with an HVI, enrolled from 2000 to 2016. Preoperative, intraoperative, and postoperative data were analyzed to assess determinants of mortality, morbidity, and length of stay by univariate and multivariate analysis models. RESULTS: Overall mortality and morbidity rates were 15.9% and 36.1%, respectively. The mean length of hospital stay was 23±7 days. Morbidity was independently related to an increase of white blood cells (P=0.01), and to delay of treatment >6 hours (P=0.033), while Injury Severity Score (ISS) (P=0.01), presence of shock (P=0.01), and a low diastolic arterial pressure registered at emergency room admission (P=0.02) significantly affected postoperative mortality. CONCLUSION: There is evidence that patients with clinical signs of shock, low diastolic pressure at admission, and high ISS are at increased risk of postoperative mortality. Leukocytosis and delayed treatment (>6 hours) were independent predictors of postoperative morbidity. More effort should be made to increase the preoperative detection rate of HVI and reduce the delay of treatment

On the Environmental Impacts of Voluntary Animal-based Policies in the EU: Technical and Political Considerations

The livestock sector has a large influence on direct and indirect (via land use change) greenhouse gas emissions, with potential negative impacts on climate change. We quantify the environmental impacts related to the introduction of a voluntary animal-based policy supported by the European Union (EU), the Measure 14 of Rural Development Programmes 2014-2020 on animal welfare. We focus on methane and nitrous oxide emissions (direct impacts), and on carbon-based and nitrous oxide emissions from land use change (indirect impacts). Our case study is the dairy sector of the EU Member States. We found that the animal-based measures have (on average) limited environmental impacts, although marked differences exist across Member States

Terminal differentiation of adult hippocampal progenitor cells is a step functionally dissociable from proliferation and is controlled by Tis21, Id3 and NeuroD2

Cell proliferation and differentiation are interdependent processes. Here, we have asked to what extent the two processes of neural progenitor cell amplification and differentiation are functionally separated. Thus, we analyzed whether it is possible to rescue a defect of terminal differentiation in progenitor cells of the dentate gyrus, where new neurons are generated throughout life, by inducing their proliferation and/or their differentiation with different stimuli appropriately timed. As a model we used the Tis21 knockout mouse, whose dentate gyrus neurons, as demonstrated by us and others, have an intrinsic defect of terminal differentiation. We first tested the effect of two proliferative as well as differentiative neurogenic stimuli, one pharmacological (fluoxetine), the other cognitive (the Morris water maze (MWM) training). Both effectively enhanced the number of new dentate gyrus neurons produced, and fluoxetine also reduced the S-phase length of Tis21 knockout dentate gyrus progenitor cells and increased the rate of differentiation of control cells, but neither factor enhanced the defective rate of differentiation. In contrast, the defect of terminal differentiation was fully rescued by in vivo infection of proliferating dentate gyrus progenitor cells with retroviruses either silencing Id3, an inhibitor of neural differentiation, or expressing NeuroD2, a proneural gene expressed in terminally differentiated dentate gyrus neurons. This is the first demonstration that NeuroD2 or the silencing of Id3 can activate the differentiation of dentate gyrus neurons, complementing a defect of differentiation. It also highlights how the rate of differentiation of dentate gyrus neurons is regulated genetically at several levels and that a neurogenic stimulus for amplification of neural stem/progenitor cells may not be sufficient in itself to modify this rat

Subtotal resection of vestibular schwannoma: evaluation with Ki-67 measurement, magnetic resonance imaging, and long-term observation

Purpose The aim of this study was to compare the postoperative clinical and radiological data of patients with vestibular schwannomas who were initially managed by near total resection (NTR) or subtotal resection (STR). The Ki-67 analysis results were compared with tumor regrowth to determine the presence of a correlation between this proliferative index and postoperative tumor regrowth. Study Design Seventeen adult patients (7 male, 10 female) were retrospectively reviewed. Nine (52.9%) and eight (47.1%) patients underwent NTR and STR, respectively. Postoperative clinical and radiological data associated with vestibular schwannoma growth were compared with the Ki-67 immunohistochemical analysis results. Results Evidence of clinically significant regrowth was observed in four (23.5%) patients. Patients who underwent NTR had a lower rate/incidence of tumor regrowth than did patients who underwent STR. Patients with a higher Ki-67 index had the highest tumor regrowth rates. Conclusions Our study indicates that assessment of the Ki-67 index may be useful for determining the probability of regrowth of vestibular schwannomas when only partial removal is accomplished

Differences between computed tomoghaphy and surgical findings in acute complicated diverticulitis

Summary Background/Objective: A preoperative reliable classification system between clinical and computed tomography (CT) findings to better plan surgery in acute complicated diverticulitis (ACD) is lacking. We studied the inter-observer agreement of CT scan data and their concordance with the preoperative clinical findings and the adherence with the intraoperative status using a new classification of diverticular disease (CDD). Methods: 152 patients operated on for acute complicated diverticulitis (ACD) were retrospectively enrolled. All patients were studied with CT scan within 24 h before surgery and CT images were blinded reanalyzed by 2 couples of radiologists (A/B). Kappa value evaluated the inter-observer agreement between radiologists and the concordance between CDD, preoperative clinical findings and findings at operation. Univariate and multivariate analysis were used to evaluate the predicting values of CT classification and CDD stage at surgery on postoperative outcomes. Results: Overall inter-observer agreement for the CDD was high, with a kappa value of 0.905 (95% CI Z 0.850e0.960) for observers A and B, while the concordance between radiologica

Multilevel Density Functional Theory

We introduce a novel density-based multilevel approach in density functional theory. In this multilevel density functional theory (MLDFT), the system is partitioned in an active and an inactive fragment, and all interactions are retained between the two parts. In MLDFT, the Kohn-Sham equations are solved in the MO basis for the active part only, while keeping the inactive density frozen. This results in a reduction of computational cost. We outline the theory and implementation, and discuss applications to aqueous solutions of methyloxirane and glycidol.Comment: 33 pages and 9 figure

Numerical modelling in the coastal aquifer between Burlamacca Canal and Bufalina Ditch, southern Versilia (Tuscany, Italy)

Groundwater numerical models are necessary instruments for management of water resources and for their protection, both in terms of quantity and quality. In this paper we present a study on an area located along the southern coastline of Versilia (Viareggio,LU) affected by marine intrusion. The main purpose of this work was to create a mathematical flow model based on a conceptual hydrogeological model defined by a multidisciplinary approach. For the realization of the numerical model the ModFlow code and the graphic interface Visual ModFlow was used. The procedure for defining the mathematical model involves a series of steps such as horizontal and vertical discretization of the space, the definition of the initial and boundary conditions, the assignment of the hydraulic properties of the cells and, finally, the definitions of external perturbations to the system (recharge, evapotranspiration, drainage and pumping wells). Implementation, development and calibration of the numerical flow model was performed both in steady and transient state. Both models were calibrated using the manual "trial and error adjustment" method using heads measurements. Moreover the model results gathered in transient state simulation were compared with the data continuously recorded by a piezometer of the monitoring network of the Regional Hydrological Service. There is a good correlation between the measured data and those calculated by the model which then turns out to be sufficiently representative and provides a solid basis for the development of a transport model that could be useful to control and manage the phenomenon of the salt water intrusion

The everyday-life in neanderthal times: a full-immersive Pleistocene reconstruction for the Casal De' Pazzi Museum (Rome)

[EN] The Museum of Casal De' Pazzi (Rome) is built since about ten years on a Pleistocene floor consisting in the ancient riverbed of the Aniene river, at about 200.000 bp. Since its opening, it has been characterized by a strong narrative approach, and communication effort. The digital project realized by the Italian CNR (Institut for Technology applied to Cultural Heritage) implies three applications: a flood simulation, to show the water refilling of the ancient riverbed; a movie in computer-graphic, to be shown to the public, explaining neanderthal man and ancient elephant's life, and an edu-game, for children's learning, the Plei-stostation, implemented by touch-screen interaction dynamics.[ES] El Museo de Casal De' Pazzi (Roma) se construyó hace unos diez años en un terreno pleistocénico, en el que hace aproximadamente 200.000 años se encontraba el antiguo cauce del río Aniene. Desde su apertura, el Museo se ha caracterizado por un fuerte enfoque narrativo y comunicativo. El proyecto digital realizado porel CNR italiano (Instituto de las Tecnologías aplicadas a Bienes Culturales) incluye tres aplicaciones: una simulación de las inundaciones, que muestra como se anegó del antiguo lecho del río; una película de animación por ordenador, en la que se presenta al público cómo era el antiguo hombre de Neanderthal y la vida de los elefantes antiguos, y un juego educativo, que fomenta el aprendizaje de los niños, el Plei-sto-station, implementado mediante un sistema dinámico con pantalla de interacción táctil.Palombini, A.; Arnoldus Huyzendveld, A.; Di Ioia, M.; Gioia, P.; Persiani, C.; Pescarin, S. (2012). The everyday-life in neanderthal times: a full-immersive Pleistocene reconstruction for the Casal De' Pazzi Museum (Rome). Virtual Archaeology Review. 3(7):73-76. https://doi.org/10.4995/var.2012.4391OJS737637FUNICIELLO R., GIORDANO G. (2008): "La geologia di Roma - Dal centro storico alla periferia". Memorie descrittive della Carta Geologica d'Italia n. 80/2008 - Servizio Geologico Nazionale - APAT