NO<inf>x</inf> Formation in MILD Combustion: Potential and Limitations of Existing Approaches in CFD

Emissions of nitrogen oxides (NOx) from combustion systems remain a lingering environmental issue, being these species either greenhouse gases or acid rain precursors. Moderate or Intense Low-oxygen Dilution (MILD) combustion can reduce the emissions of NOx thanks to its characteristic features (i.e., homogeneous reaction zones, reduced temperature peaks, diluted mixtures of reactants) that influence and change the main chemical pathways of NOx formation. A summary of the relevant routes of formation and destruction of NOx in MILD combustion is presented in this review, along with the identification of the sources of uncertainty that prevent reaching an overall consensus in the literature about the dominant NOx chemical pathway in MILD regime. Computational Fluid Dynamics (CFD) approaches are essential tools for investigating the critical phenomena occurring in MILD combustion and the design of pollutant-free turbulent combustion systems. This paper provides an outline of the modelling approaches employed in CFD simulations of turbulent combustion systems to predict NOx emissions in MILD conditions. An assessment of the performances of selected models in estimating NOx formation in a lab-scale MILD combustion burner is then presented, followed by a discussion about relevant modelling issues, perspectives and opportunities for future research

Using a weaning immunosuppression protocol in liver transplantation recipients with hepatocellular carcinoma: A compromise between the risk of recurrence and the risk of rejection?

Hepatocellular carcinoma (HCC) recurrence rate after liver transplantation (LT) is still up to 1520%, despite a careful selection of candidates and optimization of the management within the waiting list. To reduce tumour recurrence, the currently adopted post-transplant strategies are based on the administration of a tailored immunosuppression (IS) regimen. Drug-induced depression of the immune system is essential in preventing graft rejection, however has a well-established association with oncogenesis. The immune system has a key role as a defending mechanism against cancer development, preventing vascular invasion and metastasis. Thus, IS drugs represent one of few modifiable non-oncological risk factors for tumour recurrence. In HCC recipients, a tailored IS therapy, with the aim to minimize drugs' doses, is essential to gain the optimal balance between the risk of rejection and the risk of tumour recurrence. So far, a complete withdrawal of IS drugs after LT is reported to be safely achievable in 25% of patients (defined as "operational tolerant"), without the risk of patient and graft loss. The recent identification of non-invasive "bio-markers of tolerance", which permit to identify patients who could successfully withdraw IS therapies, opens new perspectives in the management of HCC after LT. IS withdrawal could potentially reduce the risk of tumour recurrence, which represents the major drawback in HCC recipients. Herein, we review the current literature on IS weaning in patients who underwent LT for HCC as primary indication and we report the largest experiences on IS withdrawal in HCC recipients

Penalized regression on principal manifolds with application to combustion modelling

For multivariate regression problems featuring strong and non–linear dependency patterns between the involved predictors, it is attractive to reduce the dimension of the estimation problem by approximating the predictor space through a principal surface (or manifold). In this work, a new approach for non- parametric regression onto the fitted manifold is provided. The proposed penal- ized regression technique is applied onto data from a simulated combustion sys- tem, and is shown, in this application, to compare well with competing regression routines

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p&lt;00001), age 70 years or older versus younger than 70 years (230 [165-322], p&lt;00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p&lt;00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Effects of municipal solid waste- and sewage sludge-compost-based growing media on the yield and heavy metal content of four lettuce cultivars

Compost has been recently suggested as an alternative to peat for the preparation of growing substrates in soilless cultivation systems. However, some physico-chemical properties of compost may reduce plant performance and endanger the quality of productions, in particular for possible heavy metal accumulation in edible parts. This study aims at evaluating the suitability of a municipal solid waste compost (MSWC) and a sewage sludge compost (SSC) as components of growing media for the soilless cultivation of lettuce (Lactuca sativa L.). Heavy metal content of SSC complied with legislation limits but, in MSWC, it exceeded (Cu, Pb) or was very close (Cd, Zn) to safe limits. A greenhouse experiment was carried out by cultivating four lettuce cultivars (“Maximus,” “Murai,” “Patagonia,” and “Aleppo”) in pots containing a mixture of MSWC and perlite (MSWC + P), SSC and perlite (SSC + P), or peat and perlite (peat + P), the latter used as control. Plant biometric parameters measured after 72 days of growth revealed that the yield of plants cultivated on SSC + P was similar to control plants, independently of the cultivar. Conversely, MSWC + P suppressed in general the biomass production, especially for Murai and Patagonia cultivars. Compared to peat + P, both compost-based substrates reduced the leaf accumulation of heavy metals, with a major effect in Maximus plants. The levels of Cd and Pb in the edible part were always below the safe limits imposed by European regulation. Therefore, risks of heavy metal intake in food chain associated with the replacement of peat with compost in the growing media are negligible, even when a compost with a significant amount of heavy metals is used. Besides compost quality monitoring, also an appropriate varietal choice is crucial to obtain good yields and safe products

Barattiere: An italian local variety of Cucumis melo L. with quality traits between melon and cucumber

Barattiere, belonging to the Cucumis melo L. species, is a local variety of Puglia (Southern Italy), which is consumed as a vegetable at the immature stage, like cucumber. In this study, three Barattiere populations (‘Monopoli’, ‘Carovigno’ and ‘Fasano’) were evaluated for the main quality traits. All genotypes showed a very light green-yellow colour of flesh, without any difference regarding chlorophyll and carotenoid contents. Carovigno’s Barattiere showed the highest values of dry weight (6.8 g 100 g−1 fresh weight-FW), sugars (45 g kg−1 FW), and sweetness index (7.3), while Monopoli’s Barattiere showed the lowest total phenols content (21 mg kg−1 FW). Fasano’s Barattiere showed the highest content of Zn and Cu (2.3 and 0.3 mg kg−1 FW, respectively), while ‘Monopoli’ showed the highest Ba content (0.3 mg kg−1 FW) and the lowest Mg content (94 mg kg−1 FW). No differences between populations were found concerning the content of Ca, K, Na, B, Mn, and Fe. In conclusion, the quality profile of Barattiere makes this local genotype interesting for its traits, and also suggests its consumption by people with specific dietary requirements

Quality of t-cell response to SARS-CoV-2 mrrna vaccine in art-treated plwh

We investigated specific humoral and T-cell responses in people living with HIV (PLWH) before (T0), after two (T1) and after six months (T2) from the third dose of the BNT162b2 vaccine. Healthy donors (HD) were enrolled. The specific humoral response was present in most PLWH already after the second dose, but the third dose increased both the rate of response and its magnitude. Collectively, no significant differences were found in the percentage of responding T-cells between PLWH and HD. At T0, stratifying PLWH according to CD4 cell count, a lower percentage of responding T-cells in 200 cells/mu L one was observed. At T1, this parameter was comparable between the two subgroups, and the same result was found at T2. However, the pattern of co-expression of IFN gamma, IL2 and TNF alpha in PLWH was characterized by a higher expression of TNF alpha, independently of CD4 cell count, indicating a persistent immunological signature despite successful ART. mRNA vaccination elicited a specific response in most PLWH, although the cellular one seems qualitatively inferior compared to HD. Therefore, an understanding of the T-cell quality dynamic is needed to determine the best vaccination strategy and, in general, the capability of immune response in ART-treated PLWH

Global management of a common, underrated surgical task during the COVID-19 pandemic. Gallstone disease. An international survery

Background: Since the Coronavirus disease-19(COVID-19) pandemic, the healthcare systems are reallocating their medical resources, with consequent narrowed access to elective surgery for benign conditions such as gallstone disease(GD). This survey represents an overview of the current policies regarding the surgical management of patients with GD during the COVID-19 pandemic. Methods: A Web-based survey was conducted among 36 Hepato-Prancreato-Biliary surgeons from 14 Countries. Through a 17-item questionnaire, participants were asked about the local management of patients with GD since the start of the COVID-19 pandemic. Results: The majority (n = 26,72.2%) of surgeons reported an alarming decrease in the cholecystectomy rate for GD since the start of the pandemic, regardless of the Country: 19(52.7%) didn't operate any GD, 7(19.4%) reduced their surgical activity by 50–75%, 10(27.8%) by 25–50%, 1(2.8%) maintained regular activity. Currently, only patients with GD complications are operated. Thirty-two (88.9%) participants expect these changes to last for at least 3 months. In 15(41.6%) Centers, patients are currently being screened for SARS-CoV-2 infection before cholecystectomy [in 10(27.8%) Centers only in the presence of suspected infection, in 5(13.9%) routinely]. The majority of surgeons (n = 29,80.6%) have adopted a laparoscopic approach as standard surgery, 5(13.9%) perform open cholecystectomy in patients with known/suspected SARS-CoV-2 infection, and 2(5.6%) in all patients. Conclusion: In the ongoing COVID-19 emergency, the surgical treatment of GD is postponed, resulting in a huge number of untreated patients who could develop severe morbidity. Updated guidelines and dedicated pathways for patients with benign disease awaiting elective surgery are mandatory to prevent further aggravation of the overloaded healthcare systems