Association between abdominal wall hernia and abdominal aortic aneurysm

n everyday clinical practice, an abdominal wall hernia (AWH) is rarely considered an expression or predictor of aortic aneurysmal disease; on the contrary, it should be. Actually, although rare, the association between primary AWH (including umbilical, paraumbilical, epigastric, Spigelian, inguinal and femoral hernia) and abdominal aortic aneurysm (AAA) represents a pathological duality which has drawn the attention of the medical community for the clinical originality of presentation and implication

O IMPACTO NAS VARIAÇÕES DAS MATRIZES ENERGÉTICAS E USO DA TERRA: ESTUDO SOBRE A EFICIÊNCIA AMBIENTAL DO G20

O objetivo foi avaliar o impacto na variação da matriz energética e da área das mudanças no uso da terra (reflorestamento, florestamento ou desmatamento) na redução de emissão de gases de efeito estufa entre os países membros do G20, no decênio 1990-2000-2010. A técnica de Análise Envoltória de Dados foi empregada no cálculo dos scores para avaliar a eficiência relativa dos países do G20. Os resultados evidenciam que as alterações na matriz energética (maior consumo de fontes menos poluentes) influenciam no desempenho em relação aos demais países e que as mudanças no uso da terra são fatores preponderantes no desempenho do país, em relação a ele mesmo e aos outros, ao longo do tempo

Life Cycle Assessment of a novel process of polyhydroxyalkanoates production with waste and by-products from wine industry value chain

EU wine production accounts for some 60 percent of worldwide output, with France and Italy being the largest wine producer countries in the world (Gaeta and Corsinovi, 2014). The wine industry influences the environment with the use of soil, water, energy, fertilizers and pesticides. In addition it produces liquid and solid organic waste that has to be managed in the proper manner in order to minimize environmental impacts. In recent years, some innovative technologies have been proposed for the valorization of winery waste and by-products (i.e. grape marcs, grape seeds, vinification lees, etc.) (Devesa-Rey et al., 2011). VALSOVIT is a research project funded by Emilia Romagna Region (Italy) which aims to valorize wine industry by-products. Its focus is the development of an integrated strategy for the transformation of waste from the whole oenological supply chain into high added-value products such as polymers, base chemicals, and molecules for the nutraceutical, cosmetic and agrochemical industries. In this framework, a novel experimental process for the valorization of wine lees and sewage sludge is carried out. These winery residues are subject to anaerobic acidogenic fermentation in order to produce volatile fatty acids (VFAs), which in turn are used to feed a mixed microbial community (MMC) able to accumulate polyhydroxyalkanoates (PHAs) granules as carbon and energy intracellular reserve. The last step consists of PHAs extraction using dimethyl carbonate (DMC). Life cycle assessment is applied to calculate and compare the environmental impacts related to the production of one kg of PHAs to those of an analogous amount of a fossil-based plastic (polypropylene, PP), and two bio-based plastics (bio-polypropylene, bio-PP, and polylactic acid, PLA). PHAs produced from wine industry residues show mixed results. Four different scenarios which vary in terms of feedstock used and pre-treatment process are analyzed. Results show that system setup including pyrolysis pre-treatment allows to reduce both energy demand and GHG emissions more efficiently than the setup without pyrolysis. The latter, on the other hand, is technologically simpler and therefore less effort and cost consuming than the one including pyrolysis. No significant differences between the two feedstock used are found in the results. Gaeta and Corsinovi, 2014. Economics, Governance, and Politics in the Wine Market. Palgrave Macmillan, US. Devesa-Rey et al., 2011. Waste Management. 31:2327-233

O IMPACTO NAS VARIAÇÕES DAS MATRIZES ENERGÉTICAS E USO DA TERRA: ESTUDO SOBRE A EFICIÊNCIA AMBIENTAL DO G20

RESUMO O objetivo foi avaliar o impacto na variação da matriz energética e da área das mudanças no uso da terra (reflorestamento, florestamento ou desmatamento) na redução de emissão de gases de efeito estufa entre os países membros do G20, no decênio 1990-2000-2010. A técnica de Análise Envoltória de Dadosfoi empregada no cálculo dos scorespara avaliar a eficiência relativa dos países do G20.Os resultados evidenciam que as alterações na matriz energética (maior consumo de fontes menos poluentes) influenciam no desempenho em relação aos demais países e que as mudanças no uso da terra são fatores preponderantes no desempenho do país, em relação a ele mesmo e aos outros, ao longo do tempo

High rate of durable responses with undetectable minimal residual disease with frontline venetoclax and rituximab in young and fit patients with chronic lymphocytic leukemia and an adverse biologic profile: results of the gimema phase II LLC1518 - 'Veritas' study

: The GIMEMA phase II LLC1518 VERITAS trial investigated the efficacy and safety of frontline, fixed-duration venetoclax and rituximab (VenR) combination in young (≤65 years) and fit patients with chronic lymphocytic leukemia (CLL) and unmutated IGHV and/or TP53 disruption. Treatment consisted of the Ven ramp-up, six-monthly courses of the VenR combination, followed by six monthly courses of Ven single agent. A centralized assessment of measurable minimal residual disease (MRD) was performed on the peripheral blood (PB) and bone marrow (BM) by ASO-PCR at the end of treatment (EOT) and during the follow-up. The primary endpoint was the complete remission (CR) rate at the EOT. Seventy-five patients were enrolled; the median age was 54 years (range 38-65), 96% had unmutated IGHV, 9 (12%) had TP53 disruption, and 4% were IGHV mutated with TP53 disruption. The overall response rate (ORR) at the EOT was 94.7%, with a CR rate of 76%. An undetectable (u) MRD was recorded in 69.3% of patients in the PB and 58.7% in the BM. The 12-month MRD-free survival in the 52 patients with uMRD in the PB at the EOT was 73.1%. After a median follow-up of 20.8 months, no disease progressions were observed. Three patients have died, two due to Covid-19 and 1 to tumor lysis syndrome. The first report of the VERITAS study shows that frontline VenR was associated with a high rate of CRs and durable responses with uMRD in young patients with CLL and unfavorable genetic characteristics

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)