Hyperfunctioning Parathyroid Giant Adenoma

Purpose: The objective of this paper is to report the management and treatment of a 47-year-old patient admitted with multiple problems including asthenia, nausea and bradycardia, and was diagnosed with a giant parathyroid adenoma. Case report: A 47-year-old man was admitted to the Department of General Surgery for acute and worsening asthenia, nausea and bradycardia. Blood tests showed hypercalcemia, hypophosporemia, very high serum parathormone level, so that he was diagnosed with primary hyperparathyroidism. Cervical ultrasonography and scintigraphy with technetium 99 mTc Methoxyisobutylisonitrile (99 mTc-MIBI) showed the presence of positive nodule at the isthmus of the thyroid gland. The patient underwent neck exploration. Intra-operative iPTH essay was measured. A giant parathyroid adenoma was identified and excised, with no macroscopic signs of malignancy. Discussion and conclusion: Hyper functioning parathyroid giant adenoma can present with typical symptoms of hypercalcemic crisis: ECG alterations, kidney failure, emotional lability, confusion, delirium, psychosis, asthenia, epilepsy. Elective treatment is the excission. The surgical technique contemplates neck exploration and to ensure the finding of the adenoma, previously identified with imaging tests. It is necessary to measure intra-operative iPTH assay

Health-related quality of life and functional changes in DMD:A 12-month longitudinal cohort study

Family caregivers of people with amyotrophic lateral sclerosis (ALS) live stressful lives in which they spend most of their time caring for their loved ones and managing difficult situations, thereby reducing the time spent in taking care of themselves. This situation may last several years. Previous literature has widely highlighted that this situation reduces caregivers' quality of life and increases their psychological distress and risk of health problems, but there is a lack of studies that focus on psychological interventions for these situations. This qualitative study examined a pilot experience of two mutual support groups for family caregivers of people with ALS. The aim was to identify caregivers' needs, the prominent aspects of their experience, and to understand whether and how this intervention strategy might help them. Six partners (four men and two women) and six adult children (five women and one man) participated in the groups, which were conducted in northern Italy. After the support groups finished, participants underwent semi-structured interviews. The authors conducted a content analysis of the transcripts of the interviews and the 20 group sessions. The thematic areas identified were "caregiving," "being the son/daughter of a person with ALS," "being the partner of a person with ALS," "group experience" and "group evaluation." The caregiving experience was profoundly different depending on whether the caregiver was a son/daughter or a partner of a patient with ALS. Moreover, comparison with peers and mutual support helped participants to better cope with ALS and its consequences, to improve their care for their relatives and to overcome typical caregiver isolation. These results suggest the usefulness of involving communities in caregiver support in order to create new networks and activate personal and social resources for well-being

Crystal structure and phonon softening in Ca3Ir4Sn13

We investigated the crystal structure and lattice excitations of the ternary intermetallic stannide Ca3Ir4Sn13 using neutron and x-ray scattering techniques. For T > T* ~ 38 K the x-ray diffraction data can be satisfactorily refined using the space group Pm-3n. Below T* the crystal structure is modulated with a propagation vector of q = (1/2, 1/2, 0). This may arise from a merohedral twinning in which three tetragonal domains overlap to mimic a higher symmetry, or from a doubling of the cubic unit cell. Neutron diffraction and neutron spectroscopy results show that the structural transition at T* is of a second-order, and that it is well described by mean-field theory. Inelastic neutron scattering data point towards a displacive structural transition at T* arising from the softening of a low-energy phonon mode with an energy gap of Delta(120 K) = 1.05 meV. Using density functional theory the soft phonon mode is identified as a 'breathing' mode of the Sn12 icosahedra and is consistent with the thermal ellipsoids of the Sn2 atoms found by single crystal diffraction data

Thermofluid-dynamic assessment of the EU-DEMO divertor single-circuit cooling option

Until 2019, the thermo-hydraulic development of the EU-DEMO divertor was based on the “double-circuit” concept, in which two independent cooling circuits served by two different Primary Heat Transfer Systems were used to cool the Plasma-Facing Components (PFC) and the Cassette Body (CB). During the Divertor Final Design Review Meeting, held in May 2020, the possibility to adopt a single cooling circuit to serve both components was suggested. This new cooling circuit was originally conceived with the aim of simplifying remote maintenance, with potential benefits for some aspects of safety and balance of plant design and integration. During the years from 2020 to 2022, in the framework of the Work Package DIV 1 - “Divertor Cassette Design and Integration” of the EUROfusion action, University of Palermo and ENEA carried out a research campaign focussed on the preliminary thermofluid-dynamic assessment of this new concept, highlighting its strengths and weaknesses. The research campaign was carried out following a theoretical–computational approach based on the finite volume method and adopting the commercial computational fluid-dynamic code ANSYS-CFX. The steady-state thermal-hydraulic performances of the single-circuit DEMO divertor concept were assessed in terms of coolant pressure drop and flow velocity distribution, mainly in order to check coolant aptitude to provide a uniform and effective cooling to CB, shielding liner, reflector plates, PFCs and the newly introduced neutron shields to improve the shielding of the vacuum vessel. Moreover, the margin against critical heat flux distributions among the plasma-facing channels were assessed by adopting appropriate correlations, to check the compliance with the applicable constraints. Models, loads and boundary conditions assumed for the analyses are herewith reported and critically discussed, together with the main results obtained

Development and Validation of the Metric-Based Assessment of a Robotic Vessel Dissection, Vessel Loop Positioning, Clip Applying and Bipolar Coagulation Task on an Avian Model

The evolution of robotic technology and its diffusion does not seem to have been adequately accompanied by the development and implementation of surgeon training programs that ensure skilled and safe device use at the start of the learning curve. The objective of the study is to develop and validate performance metrics for vessel dissection, vessel loop positioning, clip applying and bipolar coagulation using an avian model. Three robotic surgeons and a behavioral scientist characterized the performance metrics of the task according to the proficiency-based progression methodology. Fourteen experienced robotic surgeons from different European countries participated in a modified online Delphi consensus. Eight experienced surgeons and eight novices performed the robotic task twice. In the Delphi meeting, 100% consensus was reached on the performance metrics. Novice surgeons took 26 min to complete the entire task on trial 1 and 20 min on trial 2. Experts took 10.1 min and 9.5 min. On average the Expert Group completed the task 137% faster than the Novice Group. The amount of time to reach the vessel part of the task was also calculated. Novice surgeons took 26 min on trial 1 and 20 min on trial 2. Experts took 5.5 min and 4.8 min. On average the experts reached the vessel 200% faster than the novices. The Expert Group made 155% fewer performance errors than the Novice Group. The mean IRR of video-recorded performance assessments for all metrics was 0.96 (95% confidence intervals (CI) lower = 0.94-upper = 0.98). We report the development and validation for a standard and replicable basic robotic vessel dissection, vessel loop positioning, clip applying and bipolar coagulation task on an avian model. The development of objective performance metrics, based on a transparent and fair methodology (i.e., PBP), is the first fundamental step toward quality assured training. This task developed on the avian model proved to have good results in the validation study.info:eu-repo/semantics/publishedVersio

Insulated fixation system of plasma facing components to the divertor cassette in Eurofusion-DEMO

The design activities of an insulated Plasma Facing Components-Cassette Body (PFCs-CB) support has been carried out under the pre-conceptual design phase for Eurofusion-DEMO Work Package DIV-1 \u201cDivertor Cassette Design and Integration\u201d - Eurofusion Power Plant Physics & Technology (PPPT) program. The Eurofusion-DEMO divertor is a key in-vessel component with PFCs which directly interact with the plasma scrape-off layer. The PFCs have to cope with high heat loads, neutron irradiation and electromagnetic loads. The mechanical integrity of the PFCs and water cooling pipes can be jeopardized by high heat loads and by electromagnetic loads generated in a disruption event. In European-DEMO the possibility to estimate the heat load by measuring the relative thermocurrents is under investigation. In order to allow thermocurrents measurements, a divertor design option provides that PFCs are electrically insulated from CB. In this work authors aim to analyze the opportunity that the PFC-CB fixing system incorporates an electrical insulation system, thus acquiring also an important diagnostic role in the measurement of the thermocurrents and in the management of the current flows. The possible use of ceramic material (e.g. alumina) as the insulating layer between the support components is investigated