International Benchmark Activity in the Field of Sodium Fast Reactors

Global interest in fast reactors has been growing since their inception in 1960 because they can provide efficient, safe, and sustainable energy. Their closed fuel cycle can support long-term nuclear power development as part of the world’s future energy mix and decrease the burden of nuclear waste. In addition to current fast reactors construction projects, several countries are engaged in intense R&D and innovation programs for the development of innovative, or Generation IV, fast reactor concepts. Within this framework, NINE is very actively participating in various Coordinated Research Projects (CRPs) organized by the IAEA, aimed at improving Member States’ fast reactor analytical simulation capabilities and international qualification through code-to-code comparison, as well as experimental validation on mock-up experiment results of codes currently employed in the field of fast reactors. The first CRP was focused on the benchmark analysis of Experimental Breeder Reactor II (EBR-II) Shutdown Heat Removal Test (SHRT-17), protected loss-of-flow transient, which ended in the 2017 with the publication of the IAEA-TECDOC-1819. In the framework of this project, the NINE Validation Process– developed in the framework of NEMM (NINE Evaluation Model Methodology) – has been proposed and adopted by most of the organizations to support the interpretation of the results calculated by the CRP participants and the understanding of the reasons for differences between the participants’ simulation results and the experimental data. A second project regards the CRP focused on benchmark analysis of one of the unprotected passive safety demonstration tests performed at the Fast Flux Test Facility (FFTF), the Loss of Flow Without Scram (LOFWOS) Test #13, started in 2018. A detailed nodalization has been developed by NINE following its nodalization techniques and the NINE validation procedure has been adopted to validate the Simulation Model (SM) against the experimental data of the selected test. The third activity deals with the neutronics benchmark of China Experimental Fast Reactor (CEFR) Start-Up Tests, a CRP proposed by the China Institute of Atomic Energy (CIAE) launched in 2018 the main objective of which is to improve the understanding of the start-up of a SFR and to validate the fast reactor analysis computer codes against CEFR experimental data. A series of start-up tests have been analyzed in this benchmark and NINE also proposed and organized a further work package focused on the sensitivity and uncertainty analysis of the first criticality test. The present chapter intends to summarize the results achieved using the codes currently employed in the field of fast reactor in the framework of international projects and benchmarks in which NINE was involved and emphasize how the application of developed procedures allows to validate the SM results and validate the computer codes against experimental data

Outcomes of three years of teamwork on critical limb ischemia in patients with diabetes and foot lesions

To evaluate the outcomes of a multidisciplinary team working on diabetic foot (DF) patients with critical limb ischemia (CLI) in a specialized center, the authors retrospectively traced all the patients admitted in their department in 3 consecutive years with a diagnosis of CLI. From January 2006 to December 2008, 245 consecutive DF patients with CLI according the TransAtlantic interSociety Consensus II criteria were included in the study. Treatment strategy was decided by a team of diabetologists, inteventional radiologists, and vascular surgeons. Technical and clinical success, mortality, and ulcer recurrence were evaluated at 6 months and at a mean follow-up of 19.5 +/- 13.4 months. Percutaneous transluminal angioplasty (PTA) was performed in 189 (77%) patients, whereas medical treatment, open surgical revascularization (OSR), and primary amputation were performed in 44 (18.3%), 11 (4.3%), and 1 (0.5%) patients, respectively. Revascularization was successful in 227/233 (97.4%) patients. At follow-up, the overall clinical success rate was 60.4%; it was significantly (P = .001) higher after revascularization (75.9%) compared with medical treatment (48.3%). During follow-up, surgical interventions in the foot were 1.5 +/- 0.4 in those treated with PTA, 1.6 +/- 0.5 in those treated with OSR, and 0.3 +/- 0.8 in those receiving medical therapy (P < .05 compared with the others). Ulcer recurrence occurred in 29 (11.8%) patients: 4 (1.6%) in PTA, 2 (0.8%) in OSR, and 23 (9.4%) in the medical therapy group (P < .05). Major amputation rate was 9.3%, being significantly (P = .04) lower after revascularization (5.2%) compared with medical therapy alone (13.8%). Cumulative mortality rate was 10.6%. In conclusion, this study confirms the positive role of a PTA-first approach for revascularizing the complex cases of DF with CLI in a teamwork management strategy

The Role of Quantic Molecular Resonance (QMR) in the Treatment of Inferior Turbinate Hypertrophy (ITH): Our Experience With Long-Term Follow-Up in Allergic and Nonallergic Rhinitis Refractory to Medical Therapy. Preliminary Results.

Objective: The aim of this study was to assess the long-term effectiveness of quantic molecular resonance (QMR) in the treatment of inferior turbinate hypertrophy (ITH) in allergic and nonallergic rhinitis refractory to medical therapy. Methods: This study enrolled 281 patients, 160 males (56.9%) and 121 females (43.1%), mean age 37.8 ± 4.1 years, range 18 to 71. Fifty-four patients have been lost to follow up and have been therefore excluded from the final analysis. Based on skin prick test results, 69 patients were considered allergic (group A) and 158 nonallergic (group B). All subjects underwent before surgery (T0) and 3 (T1), 12 (T2), 24 (T3), and 36 months (T4) after QMR treatment to: 4-phase rhinomanometric examination, nasal endoscopy evaluation, and visual analogue scale to quantify the subjective feelings about nasal obstruction. Results: Subjective and objective parameters showed statistically significant improvement in both groups. Group B parameters not changed during follow-up, while group A showed significant worsening between T1 and subsequent assessments. T4 outcome indicates a better result in nonallergic patients. Conclusions: In accordance with the literature, our preliminary data validate QMR treatment as a successful therapeutic option for nasal obstruction due to ITH. Nonallergic patients had a very good T4 outcome. Allergic patients showed a worsening trend after 1 year probably due to other causes

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Chemoembolization of Hepatocellular Carcinoma

Transarterial chemoembolization (TACE) is the current standard of care for patients with intermediate-stage hepatocellular carcinoma (HCC) and relatively preserved liver function. In a meta-analysis of randomized controlled trials comparing conventional TACE regimens—including the administration of an anticancer-in-oil emulsion followed by embolic agents—versus best supportive care, TACE was shown to improve median survival from 16 to 20 months. Various strategies to improve outcomes for this patient group have become the subject of much ongoing clinical research. The introduction of an embolic drug-eluting bead (DEB) has been shown to substantially improve the pharmacokinetic profile of TACE, providing levels of consistency and repeatability not available with conventional regimens while concomitantly significantly diminishing systemic drug exposure. In randomized trials, DEB-TACE significantly reduced liver toxicity and drug-related adverse events compared with conventional TACE. In this article, technique, indications and contraindications, and clinical outcomes of conventional and DEB-TACE in the management of HCC are reviewed. In addition, scientific background and early clinical experience with the use of combination regimens including TACE and systemically active molecular-targeted agents with antiangiogenic properties are discussed. The combination of DEB-TACE and antiangiogenic therapy represents a potentially powerful approach that is currently undergoing clinical investigation in a phase 3 setting

Studsvik R2 Materials Test Reactor Ad Hoc Depletion Strategy for the Derivation of the Fuel Isotopic Composition of the MPCMIV Benchmark

The Ad Hoc Depletion Strategy elaborated by the NINE company, developed in support of the organization of the MPCMIV (Multi-physics Pellet Cladding Mechanical Interaction Validation) benchmark input and output specifications, is presented. This work aims at illustrating the strategy itself and then showing the results obtained with its application over the Studsvik R2 Testing Reactor, which is analyzed in the benchmark. The objective of the application of the strategy is to compute the fuel elements isotopic compositions at the beginning of some core loadings of interest for the benchmark. To this objective, it is necessary to implement first the simulation model of the three single assembly types and perform the infinite lattice depletions, then, to build the full core model and to perform the simulation of the core cycle. All the models and simulations were carried out with the use of the Monte Carlo particle transport code Serpent 2. Finally, the simulations results are assessed against Studsvik isotopic compositions of the fuel elements discharged from the R2 Reactor at the end of the core loading. Several assumptions were necessary during all the steps of the strategy, to overcome the lack of information regarding the core management. For this reason, the solution found at the end of the current analysis may not be completely optimized and further improvements regarding the model assumptions will be tested in a future work