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

Growth factors and experimental arterial grafts

Background: The production of growth factors from several experimental arterial conduits was determined. Methods: We implanted 105 experimental arterial grafts that were 1 cm long in the abdominal aorta of Lewis rats (average weight, 250 g). Five different types of grafts were analyzed: arterial isografts, vein grafts, arterial allografts, and polytetrafluoroethylene (PTFE) grafts with normal or decreased compliance. Animals were killed humanely 4 weeks after surgery and the production of platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF), transforming growth factor-b, tumor necrosis factor-a, and interleukin-1 was analyzed. Results: Myointimal hyperplasia (MH) was evident in vein grafts, arterial allografts, and PTFE grafts, but not in arterial isografts. Growth factor production was increased for grafts prone to develop MH like vein, PTFE grafts, and arterial allografts. PDGF and bFGF were increased significantly for PTFE and vein grafts, but not for arterial allografts. The importance of bFGF and PGDF was confirmed by the capability of antibody to PDGF and to bFGF to reduce the mitogenic activity of smooth muscle cells, in vivo and in vitro, for PTFE and vein grafts, but not for arterial allografts, in which a predominant role was played by interleukin-1 and tumor necrosis factor-a. Conclusions: Agents able to neutralize this increased production of growth factors, either directly or by competition with their receptors, can prevent MH formation. (J Vasc Surg 2016;64:1444-9.) Clinical Relevance: Arterial grafts release growth factors, which can lead to myointimal hyperplasia formation and atherosclerosis progression in the arterial tree. Both phenomena can cause graft occlusion. Inhibition of growth factor release by arterial grafts can improve their clinical effectiveness

Optical gain in DNA-DCM for lasing in photonic materials

We present a detailed study of the gain length in an active medium obtained by doping of DNA strands with DCM dye molecules. The superior thermal stability of the composite and its low quenching, permits to obtain optical gain coefficient larger than 300 cm^-1. We also show that such an active material is excellent for integration into photonic nano-structures, to achieve, for example, efficient random lasing emission, and fluorescent photonic crystals

Deep learning-assisted analysis of automobiles handling performances

The luxury car market has demanding product development standards aimed at providing state-of-the-art features in the automotive domain. Handling performance is amongst the most important properties that must be assessed when developing a new car model. In this work, we analyse the problem of predicting subjective evaluations of automobiles handling performances from objective records of driving sessions. A record is a multi-dimensional time series describing the temporal evolution of the mechanical state of an automobile. A categorical variable quantifies the evaluations of handling properties. We describe an original deep learning system, featuring a denoising autoencoder and hierarchical attention mechanisms, that we designed to solve this task. Attention mechanisms intrinsically compute probability distributions over their inputs’ components. Combining this feature with the saliency maps technique, our system can compute heatmaps that provide a visual aid to identify the physical events conditioning its predictions

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

Experimental testing of a hybrid sensible-latent heat storage system for domestic hot water applications

Aim of this work is to present the results of the testing of a small scale hybrid sensible/latent storage system (nominal volume 48.6 dm3), consisting of water in which macro-encapsulated phase change materials (PCMs) are added. Two different PCMs were macro-encapsulated, a commercial paraffin and a hydrate salts mixture prepared in the CNR ITAE lab, and loaded inside the tank in order to be tested. Different volume ratios between the PCM and the water were tested. The tests were conducted simulating different domestic hot water draw-off profiles. The resulting data showed an appreciable increase of heat storage capacity per unit of volume, even for limited fractions of PCM employed, reaching up to 10% of heat storage increasing by 1.3 dm3 of hydrate salts mixture added. Finally, the experimental results were used to test a numerical method of a PCM enhanced tank for dynamic plant simulations in ESP-r environment

Wearable proximity sensors for monitoring a mass casualty incident exercise: a feasibility study

Over the past several decades, naturally occurring and man-made mass casualty incidents (MCI) have increased in frequency and number, worldwide. To test the impact of such event on medical resources, simulations can provide a safe, controlled setting while replicating the chaotic environment typical of an actual disaster. A standardised method to collect and analyse data from mass casualty exercises is needed, in order to assess preparedness and performance of the healthcare staff involved. We report on the use of wearable proximity sensors to measure proximity events during a MCI simulation. We investigated the interactions between medical staff and patients, to evaluate the time dedicated by the medical staff with respect to the severity of the injury of the victims depending on the roles. We estimated the presence of the patients in the different spaces of the field hospital, in order to study the patients' flow. Data were obtained and collected through the deployment of wearable proximity sensors during a mass casualty incident functional exercise. The scenario included two areas: the accident site and the Advanced Medical Post (AMP), and the exercise lasted 3 hours. A total of 238 participants simulating medical staff and victims were involved. Each participant wore a proximity sensor and 30 fixed devices were placed in the field hospital. The contact networks show a heterogeneous distribution of the cumulative time spent in proximity by participants. We obtained contact matrices based on cumulative time spent in proximity between victims and the rescuers. Our results showed that the time spent in proximity by the healthcare teams with the victims is related to the severity of the patient's injury. The analysis of patients' flow showed that the presence of patients in the rooms of the hospital is consistent with triage code and diagnosis, and no obvious bottlenecks were found

Unraveling the Effects of Dense Medium on a Near to Bohm-Limit Acceleration in Kepler's SNR

The maximum energy of electrons accelerated by supernova remnants (SNR) is typically limited by radiative losses. In this scenario, the synchrotron cooling time scale is equal to the acceleration time scale. On the other hand, the low propagation speed of a shock in a dense medium is expected to result in an extended acceleration time scale, thus inducing a decrease in the maximum electron energy for a given SNR age and in the X-ray nonthermal flux. The young Kepler's SNR shows an enhanced efficiency of the acceleration process, which is close to the Bohm limit in the north of its shell, where the shock is slowed down by a dense circumstellar medium. Conversely, in the south, where no interaction with a dense medium is evident and the shock speed is high, the acceleration proceeds with a higher Bohm factor. To investigate this scenario, we studied the temporal evolution of the non-thermal emission, taking advantage of two Chandra X-ray observations of Kepler's SNR (performed in 2006 and 2014). We analyzed the spectra of different filaments both in the north and south of the shell, and measured their proper motion. We found a region with low shock velocity where we measured a significant decrease in flux from 2006 to 2014. This could be the first evidence of fading synchrotron emission in Kepler's SNR. This result suggests that under a certain threshold of shock speed the acceleration process could exit the loss-limited regime

Effetti dell'empatia sull'adozione di strategie di acculturazione nei confronti degli immigrati albanesi

L&rsquo;obiettivo di questo studio era quello di indagare la relazione tra l&rsquo;empatia e le strategie di acculturazione adottate dalla comunit&agrave; ospitante (italiani residenti in Sicilia) nei confronti degli immigrati albanesi. I partecipanti sono stati 101 studenti universitari nati e residenti in Sicilia. Lo strumento era un questionario contenente le misure di empatia e delle strategie di acculturazione adottate dagli italiani nei confronti degli immigrati albanesi in tre domini esperenziali (lavoro, cultura, endogamia/esogamia). I risultati mostrano che gli italiani tendono ad adottare strategie positive (integrazione duplice, integrazione con trasformazione e individualismo) e a rifiutare le strategie negative (assimilazione, segregazione e esclusione). Per quanto riguarda la relazione tra empatie e strategie di acculturazione, i risultati indicano che l&rsquo;empatia favorisce l&rsquo;adozione delle strategie positive e riduce l&rsquo;adozione delle strategie negative.The aim of this study was to investigate the relationship between empathy and acculturation strategies adopted by the host community (Italians who live in Sicily) towards Albanian immigrants. Participants were 101 university students born and living in Sicily. The tool was a questionnaire containing measures of empathy and acculturation strategies adopted by Italians towards Albanian immigrants in three life domains (employment, culture, and endogamy/exogamy). Results show that Italians tend to adopt positive strategies (dual integration, integration with transformation, and individualism) and to reject negative ones (assimilationism, segregationism, and exclusionism). As far as the relationship between empathy and acculturation strategies is concerned, results indicate that empathy encourages the adoption of positive strategies and reduces the adoption of negative ones