Current trends in surgical treatment of parapneumonic effusions and empyema thoracis

Surgical treatment of complicated parapneumonic effusions and empyema thoracis consists of drainage and obliteration of the pleural space. Two scientific Societies have published guidelines concerning management of empyema thoracis in the near past. American College of Chest Physicians (2000) has defined criteria of high-risk for poor outcome. Parapneumonic effusions which met the criteria of high-risk for poor outcome should undergo at least chest tube drainage, that is however unsuccessful in 25-50% of cases. Intrapleural instillation of fibrinolytics, thoracoscopic drainage and thoracotomy were, according to ACCP experts, accepted modalities of management. According to British Thoracic Society guidelines (2003), surgical treatment should be offered after failure of conservative treatment with antibiotics and chest tube drainage. We have nowadays enough evidence that early thoracoscopic drainage reduces hospitalization, chest tube drainage duration and that is successful initial treatment in 90% of cases. Minimally invasive thoracoscopic drainage can effectively drain loculations, inflammatory intrapleural fluid and gel, obliterate the pleural cavity and achieve strategic position of chest drains. Thoracoscopic drainage is unsuccessful management for organizing empyemas, where decortication is the treatment of choice. Early involvement of thoracic surgeons and early thoracoscopic drainage may effectively change the prognosis and outcome of complicated parapneumonic effusions and empyema thoracis

Price-Maker Wind Power Producer Participating in a Joint Day-Ahead and Real-Time Market

The large scale integration of stochastic renewable energy introduces significant challenges for power system operators and disputes the efficiency of the current market design.Recent research embeds the uncertain nature of renewable sources by modelling electricity markets as a two-stage stochastic problem, co-optimizing day-ahead and real-time dispatch. In this framework, we introduce a bilevel model to derive the optimal bid of a strategic wind power producer acting as price-maker both in day-ahead and real-time stages. The proposed model is a Mathematical Program with Equilibrium Constraints (MPEC) that is reformulated as a single-level Mixed-Integer LinearProgram (MILP), which can be readily solved. Our analysis shows that adopting strategic behaviour may improve producer’s expected profit as the share of wind power increases. However,this incentive diminishes in power systems where available flexible capacity is high enough to ensure an efficient market operation

Surgical treatment of pulmonary metastases. Review of the literature a propos of a case-series of 25 recent cases

Surgery is the optimal treatment for pulmonary metastases from certain extrathoracic tumors (soft tissue sar­comas, colorectal and renal cancer, breast cancer and others) which fulfill some strict criteria, such as control of the primary site, long disease free interval and absence of other extrathoracic metastases (with the exception of hepatic metastases from colorectal cancer that can be also eradicated with surgery). Prolonged survival is expected after metastasectomy (even if repeated metastasectomies are required), if the number of the metastases to be resected is low (<3), if complete eradication of the metastatic deposits can be achieved during surgery and if mediastinal lymph nodes are not involved by the tumor. Limited pulmonary resection with the form of wedge resection or enucleation or typical segmentectomy is the standard surgical in­tervention for pulmonary metastases. Major lung parenchyma resection such as lobectomy, bilobectomy or pneumonectomy at instances required in larger, deeply situated within the lung parenchyma, metastases. Formal thoracotomy is the access of choice, while thoracoscopic resection can be applied in selected patients with solitary, peripherally located metastases. Enucleation of the metastatic deposits can be performed using the cautery or preferably using the new generation Nd:YAG lasers. Sparing lung parenchyma is crucial during pulmonary metastasectomy

Current status of surgical treatment for pectus excavatum deformity

Pectus excavatum is the commonest anterior chest wall deformity which is the result of overgrowth and elon­gation of costal cartilages that push the normal sternum in. The deformity has serious pshychologic impact and limits the exercise tolerance of the patient, because of displacement of the heart within the left hemithorax. Repair of pectus excavatum is performed by the classical Ravich technique or the minimally invasive Nuss repair. The Ravich operation consists of resection of the deformed cartilages, bending the sternum in its normal position and maintenance of the sternum in the correct position by using a metal bar or a strong synthetic mesh. The Nuss procedure involves the thoracoscopic placement of a pre-formed curved metal bar behind the sternum which rises the sternum to the desired position. The selection of the technique depends on the age of the patient and the degree and symmetry of the deformity. The Nuss technique is suitable for children between 5 and 15 years old who have flexible chest wall and symmetric deformities, while the Ravich procedure is indicated in young adults and asymmetric forms. Indeed, the Nuss technique still undergoes modifications to become safer and simpler and further it needs expertise and special equipment

TELIOS: A Tool for the Automatic Generation of Logic Programming Machines

Abstract In this paper the tool TELIOS is presented, for the automatic generation of a hardware machine, corresponding to a given logic program. The machine is implemented using an FPGA, where a corresponding inference machine, in application specific hardware, is created on the FPGA, based on a BNF parser, to carry out the inference mechanism. The unification mechanism is based on actions embedded between the non-terminal symbols and implemented using special modules on the FPGA

Hybrid approach of ventricular assist device and autologous bone marrow stem cells implantation in end-stage ischemic heart failure enhances myocardial reperfusion

We challenge the hypothesis of enhanced myocardial reperfusion after implanting a left ventricular assist device together with bone marrow mononuclear stem cells in patients with end-stage ischemic cardiomyopathy. Irreversible myocardial loss observed in ischemic cardiomyopathy leads to progressive cardiac remodelling and dysfunction through a complex neurohormonal cascade. New generation assist devices promote myocardial recovery only in patients with dilated or peripartum cardiomyopathy. In the setting of diffuse myocardial ischemia not amenable to revascularization, native myocardial recovery has not been observed after implantation of an assist device as destination therapy. The hybrid approach of implanting autologous bone marrow stem cells during assist device implantation may eventually improve native cardiac function, which may be associated with a better prognosis eventually ameliorating the need for subsequent heart transplantation. The aforementioned hypothesis has to be tested with well-designed prospective multicentre studies

Synergistic exploitation of geoinformation methods for post-earthquake 3D mapping of Vrisa traditional settlement, Lesvos Island, Greece

The aim of this paper is to present the methodology followed and the results obtained by the synergistic exploitation of geo-information methods towards 3D mapping of the impact of the catastrophic earthquake of June 12th 2017 on the traditional settlement of Vrisa on the island of Lesvos, Greece. A campaign took place for collecting: a) more than 150 ground control points using an RTK system, b) more than 20.000 high-resolution terrestrial and aerial images using cameras and Unmanned Aircraft Systems and c) 140 point clouds by a 3D Terrestrial Laser Scanner. The Structure from Motion method has been applied on the high-resolution terrestrial and aerial photographs, for producing accurate and very detailed 3D models of the damaged buildings of the Vrisa settlement. Additionally, two Orthophoto maps and Digital Surface Models have been created, with a spatial resolution of 5cm and 3cm, respectively. The first orthophoto map has been created just one day after the earthquake, while the second one, a month later. In parallel, 3D laser scanning data have been exploited in order to validate the accuracy of the 3D models and the RTK measurements used for the geo-registration of all the above-mentioned datasets. The significant advantages of the proposed methodology are: a) the coverage of large scale areas; b) the production of 3D models having very high spatial resolution and c) the support of post-earthquake management and reconstruction processes of the Vrisa village, since such 3D information can serve all stakeholders, be it national and/or local organizations

Coherent Assessments of Europe’s Marine Fishes Show Regional Divergence and Megafauna Loss

Europe has a long tradition of exploiting marine fishes and is promoting marine economic activity through its Blue Growth strategy. This increase in anthropogenic pressure, along with climate change, threatens the biodiversity of fishes and food security. Here, we examine the conservation status of 1,020 species of European marine fishes and identify factors that contribute to their extinction risk. Large fish species (greater than 1.5 m total length) are most at risk; half of these are threatened with extinction, predominantly sharks, rays and sturgeons. This analysis was based on the latest International Union for Conservation of Nature (IUCN) European regional Red List of marine fishes, which was coherent with assessments of the status of fish stocks carried out independently by fisheries management agencies: no species classified by IUCN as threatened were considered sustainable by these agencies. A remarkable geographic divergence in stock status was also evident: in northern Europe, most stocks were not overfished, whereas in the Mediterranean Sea, almost all stocks were overfished. As Europe proceeds with its sustainable Blue Growth agenda, two main issues stand out as needing priority actions in relation to its marine fishes: the conservation of marine fish megafauna and the sustainability of Mediterranean fish stocks