The need for new "patient-related" guidelines for the treatment of acute cholecystitis

Heterogeneity of patients affected by acute cholecystitis, and their co-morbidities make very difficult to standardize the therapy for this very common condition. The staging system suggested in the recent "Tokyo guidelines", did not show a relevant impact on the management of patients and on the outcome of the disease. The relation among local pathological picture, patient clinical status and treatment algorithm, has to be better studied

PM10 source apportionment based on PMF and chemical tracers during different cruises in Western Mediterranean

In the Western Mediterranean Basin, frequently exposed to high levels of air pollutants, an important source of pollution which influence the emission, is the intensive ship traffic. The Joint Research Centre of the European Commission (JRC, EC) has started a long-term monitoring program along different years over the Mediterranean Sea based on observations from a cruise ship following a regular route in the Western Mediterranean, in collaboration with the Department of Physics of University of Genoa. In this framework, an intensive PM10 sampling campaign was organized in the summer of 2011, in order to fill in the gap of data recovered (in term of PM speciation) during the previous campaigns (Schembari et al., 2014) and to get a better and complete description of PM sources. During this campaign the route of the ship was Civitavecchia-Savona-Barcelona-Palma de Mallorca- Malta (Valletta)-Palermo-Civitavecchia (see Figure 1). The PM samples were collected on Quartz and Teflon filters (47mm diameter, flow rate 2.3 m3/h) using in parallel two Sven Leckel Ingenieurburo sequential samplers, placed on the top of the cabin where the monitoring and meteorological station was located. Samples were analyzed with different techniques: Energy Dispersive X-Ray Fluorescence at the Department of Physics of Genoa (Ariola et al, 2006); Ion Chromatography (Chow and Watson, 1999) at Department of Chemistry of University of Milan; Thermo-optical analysis (Birch and Cary, 1996) at the JRC laboratory. Ion Beam Analysis measurements of the Teflon filters sampled during the week of September 2011, using simultaneously PIXE, EBS and PESA techniques (Chiari, 2005), were performed at the 3 MV Tandetron accelerator of the LABEC laboratory of INFN in Florence. The data were used to identify and characterize the main PM10 sources along the ship route, with a focus on ship emissions, through apportionment Positive Matrix Factorization receptor modelling, PMF (Paatero et al, 1994). Particular attention was given to the evidence of emissions from heavy fuel oil combustion by ships, known to be an important source of secondary sulphate aerosol. Five sources of aerosol were resolved by the PMF analysis with a new database. The analysis allows distinguishing between secondary and primary particle mass resulting from ship emissions: V and Ni were found to be suitable tracers of heavy fuel oil combustion source during the campaign. The source having the largest impact on PM10 was identified as Sulphate source by PMF. The correlations between Sulphate and V and Ni showed the influence of ship emissions on sulphate in marine air masses

Impact of impurities and cryoconite on the optical properties of the Morteratsch Glacier (Swiss Alps)

Abstract. The amount of reflected energy by snow and ice plays a fundamental role in their melting processes. Different non-ice materials (carbonaceous particles, mineral dust (MD), microorganisms, algae, etc.) can decrease the reflectance of snow and ice promoting the melt. The object of this paper is to assess the capability of field and satellite (EO-1 Hyperion) hyperspectral data to characterize the impact of light-absorbing impurities (LAIs) on the surface reflectance of ice and snow of the Vadret da Morteratsch, a large valley glacier in the Swiss Alps. The spatial distribution of both narrow-band and broad-band indices derived from Hyperion was analyzed in relation to ice and snow impurities. In situ and laboratory reflectance spectra were acquired to characterize the optical properties of ice and cryoconite samples. The concentrations of elemental carbon (EC), organic carbon (OC) and levoglucosan were also determined to characterize the impurities found in cryoconite. Multi-wavelength absorbance spectra were measured to compare the optical properties of cryoconite samples and local moraine sediments. In situ reflectance spectra showed that the presence of impurities reduced ice reflectance in visible wavelengths by 80–90 %. Satellite data also showed the outcropping of dust during the melting season in the upper parts of the glacier, revealing that seasonal input of atmospheric dust can decrease the reflectance also in the accumulation zone of the glacier. The presence of EC and OC in cryoconite samples suggests a relevant role of carbonaceous and organic material in the darkening of the ablation zone. This darkening effect is added to that caused by fine debris from lateral moraines, which is assumed to represent a large fraction of cryoconite. Possible input of anthropogenic activity cannot be excluded and further research is needed to assess the role of human activities in the darkening process of glaciers observed in recent years

Collective spin excitations in a quantum spin ladder probed by high-resolution Resonant Inelastic X-ray Scattering

We investigate magnetic excitations in the spin-ladder compound Sr$_{14}$Cu$_{24}$O$_{41}$ using high-resolution Cu $L_3$-edge Resonant Inelastic X-ray Scattering (RIXS). Our findings demonstrate that RIXS couples to collective spin excitations from a quantum spin-liquid ground state. In contrast to Inelastic Neutron Scattering (INS), the RIXS cross section changes only moderately over the entire Brillouin Zone (BZ), revealing a high sensitivity also at small momentum transfers. The two-triplon energy gap is found to be $100\pm 30$ meV. Our results are supported by calculations within an effective Hubbard model for a finite-size cluster.Comment: 10 pages, 4 figures, revised versio

Long-term chemical analysis and organic aerosol source apportionment at 9 sites in Central Europe : Source identification and uncertainty assessment

Long-term monitoring of the organic aerosol is important for epidemiological studies, validation of atmospheric models, and air quality management. In this study, we apply a recently developed filter-based offline methodology of the 20 aerosol mass spectrometer to investigate the regional and seasonal differences of contributing organic aerosol sources. We present offline-AMS measurements for particulate matter smaller than 10 \u3bcm 9 stations in central Europe with different exposure characteristics for the entire year of 2013 (819 samples). The focus of this study is a detailed source apportionment analysis (using PMF) including in-depth assessment of the related uncertainties. Primary organic aerosol (POA) is separated in three components: hydrocarbon-like OA which is related to traffic emissions (HOA), cooking OA (COA), and biomass- 25 burning OA (BBOA). We observe enhanced production of secondary organic aerosol (SOA) in summer, following the increase in biogenic emissions with temperature (summer oxygenated OA, SOOA). In addition, a SOA component was extracted that correlated with anthropogenic secondary inorganic species which is dominant in winter (winter oxygenated OA, WOOA). A factor (SC-OA) explaining sulfur-containing fragments (CH3SO2+), which has an event-driven temporal behavior, was also identified. The relative yearly average factor contributions range for HOA from 3 to 15%, for COA from 30 3 to 31%, for BBOA from 11 to 61%, for SC-OA from 5 to 23%, for WOOA from 14 to 28%, and for SOOA from 14 to 40%. The uncertainty of the relative average factor contribution lies between 5 and 9% of OA. At the sites north of the alpine crest, the sum of HOA, COA, and BBOA (POA) contributes less to OA (POA/OA=0.3) than at the southern alpine valley sites (0.6). BBOA is the main contributor to POA with 88% in alpine valleys and 43% north of the alpine crest. Furthermore, the influence of primary biological particles (PBOA), not resolved by PMF, is estimated and could contribute significantly to OA in PM10

Timing of sentinel node biopsy independently predicts disease-free and overall survival in clinical stage I-II melanoma patients: A multicentre study of the Italian Melanoma Intergroup (IMI)

Background: Sentinel lymph node biopsy (SNB) still remains a key procedure to appropriately stage melanoma patients and to select those who are candidate to novel treatments with immunotherapy and targeted therapy in the adjuvant setting. The impact of timing of SNB on disease-free survival (DFS) and overall survival (OS) is still unclear. Material and methods: The study was conducted at 6 Italian Melanoma Intergroup (IMI) centres and included 8953 consecutive clinical stage I-II melanoma patients who were diagnosed, treated, and followed up between November 1997 and March 2018. All patients were prospectively included in dedicated IMI database. Multivariable Cox regression analyses were performed to investigate how baseline characteristics and time interval until SNB are related to DFS and OS. Results: Considering the whole population, at multivariable analysis, after adjusting for age, gender, Breslow thickness, site, ulceration, and the SNB status, a delay in the timing of SNB was associated with a better DFS (adjusted hazard ratio [aHR, delayed versus early SNB] 0.98, 95% confidence interval [CI] 0.97\u20130.99, p < 0.001) and OS (aHR 0.98, 95% CI 0.97\u20130.99, p = 0.001). Specifically, in patients with a negative SNB status, a beneficial impact of delayed SNB (i.e. at least 32 days after primary excision) was confirmed for DFS (aHR 0.70, 95%CI 0.63\u20130.79, p < 0.001) and OS (aHR 0.69, 95%CI 0.61\u20130.78, p < 0.001), whereas in those with a positive SNB status, DFS (aHR 0.96, 95%CI 0.84\u20131.09, p = 0.534) and OS (aHR 0.94 95%CI 0.81\u20131.08, p = 0.374) were not significantly different in patients with early or delayed SNB. Conclusions: Our study does not support a strict time interval for SNB. These results may be useful for national guidelines, for counselling patients and reducing the number of high urgency referrals

A determination of the pairing interaction in the high Tc cuprate superconductor Tl2Ba2CaCu2O8 (Tl2212)

We have measured the near-normal reflectance of Tl2Ba2CaCu2O8 (Tl2212) for energies from 0.1 to 4.0 eV at room temperature and used a Kramers-Kronig analysis to find the complex, frequency dependent dielectric function, from which the optical conductivity was determined. Using Thermal-Difference-Reflectance (TDR) Spectroscopy the reflectance of the sample in the normal state just above the superconducting transition, and in the superconducting state were then obtained. From these data we determined the ratio of the superconducting- to normal-state optical conductivities. Mattis and Bardeen had calculated this function within the BCS theory, where the gap is a fixed energy-independent quantity. Taking into account the retarded nature of the electron-phonon coupling results in a complex, energy dependent gap causing deviations from the Mattis-Bardeen plot at energies where the phonon coupling function is large. We find a typical deviation near the phonon energies in Tl2212, and in addition, at 1.2 and 1.7eV. The phonon, and these electronic terms can each be described by a coupling constant. None of which by itself gives rise to a high transition temperature, but the combination does. Using Resonant Inelastic X-Ray Scattering (RIXS) we find that the d-to-d excitations of the cuprate ion in Tl2212 fall at the same energies as the dips in the Mattis-Bardeen plot. We conclude that the high superconducting transition temperature of the cuprates is due to the sum of the phonon interaction, and interactions with the Cu-ion d-shell.Comment: Preprint submitted to Physica C. Paper presented at M2S-HTSC-VIII, Dresden, Germany, July 9-14,200

Developmental language disorder: Early predictors, age for the diagnosis, and diagnostic tools. A scoping review

Background. Developmental Language Disorder (DLD) is frequent in childhood and may have long-term sequelae. By employing an evidence-based approach, this scoping review aims at identifying (a) early predictors of DLD; (b) the optimal age range for the use of screening and diagnostic tools; (c) effective diagnostic tools in preschool children. Methods. We considered systematic reviews, meta-analyses, and primary observational studies with control groups on predictive, sensitivity and specificity values of screening and diagnostic tools and psycholinguistic measures for the assessment of DLD in preschool children. We identified 37 studies, consisting of 10 systematic reviews and 27 primary studies. Results. Delay in gesture production, receptive and/or expressive vocabulary, syntactic comprehension, or word combination up to 30 months emerged as early predictors of DLD, a family history of DLD appeared to be a major risk factor, and low socioeconomic status and environmental input were reported as risk factors with lower predictive power. Optimal time for screening is suggested between age 2 and 3, for diagnosis around age 4. Because of the high variability of sensitivity and specificity values, joint use of standardized and psycholinguistic measures is suggested to increase diagnostic accuracy. Conclusions. Monitoring risk situations and employing caregivers\u2019 reports, clinical assessment and multiple linguistic measures are fundamental for an early identification of DLD and timely interventions

Insights into organic-Aerosol sources via a novel laser-desorption/ionization mass spectrometry technique applied to one year of PM10 samples from nine sites in central Europe

We assess the benefits of offline laser-desorption/ionization mass spectrometry in understanding ambient particulate matter (PM) sources. The technique was optimized for measuring PM collected on quartz-fiber filters using silver nitrate as an internal standard for m\uc4\u9d\ue2\u80\ua2z calibration. This is the first application of this technique to samples collected at nine sites in central Europe throughout the entire year of 2013 (819 samples). Different PM sources were identified by positive matrix factorization (PMF) including also concomitant measurements (such as NOx, levoglucosan, and temperature). By comparison to reference mass spectral signatures from laboratory wood burning experiments as well as samples from a traffic tunnel, three biomass burning factors and two traffic factors were identified. The wood burning factors could be linked to the burning conditions; the factors related to inefficient burns had a larger impact on air quality in southern Alpine valleys than in northern Switzerland. The traffic factors were identified as primary tailpipe exhaust and most possibly aged/secondary traffic emissions. The latter attribution was supported by radiocarbon analyses of both the organic and elemental carbon. Besides these sources, factors related to secondary organic aerosol were also separated. The contribution of the wood burning emissions based on LDI-PMF (laser-desorption/ionization PMF) correlates well with that based on AMS-PMF (aerosol mass spectrometer PMF) analyses, while the comparison between the two techniques for other components is more complex