Toward an estimation of the relationship between cyclonic structures and damages at the ground in Europe

Cyclonic systems dominate European and Mediterranean meteorology throughout the year and often induce severe weather in terms of heavy and/or long-lasting precipitation with related phenomena such as strong winds and lightning. Surface cyclonic structures are often related to well defined precipitation patterns with different scales, duration and intensity. Cyclones confined in the upper troposphere, usually referred to as cut off low, may induce instability at lower levels and the development of convective precipitation. In this work the occurrence of cyclonic events (discriminated between surface ones and cut-off lows) is analyzed and matched with an economic losses database to highlight a relation between the atmospheric structures and the impact on the social environment in terms of casualties and material damages. The study focus on the continental Europe and, based on the ERA-40 reanalysis, two databases of surface cyclones and cut-off lows have been constructed by means of automatic pattern recognition algorithms. The impact on the local communities is estimated from an insurance company record, which provides the location, date and type of the events, as well as related losses in terms of damages and casualties. Results show the relatively high impact of cyclonic structures on human life in Europe: most of the weather induced damages occur close to a cyclonic center, especially during warm months. Damages and human losses are more frequent from late summer to January, and precipitation is the most relevant meteorological damaging feature throughout the year

Feminizing adrenocortical carcinoma with distant metastases: can surgery be considered?

Functioning adrenocortical carcinomas are rare diseases with dismal prognosis. A 41-yearold man presenting with gynecomastia had a giant feminizing adrenocortical carcinoma at stage IV. Although surgical resection was controversial, we removed the primary tumor to reduce the mass effects. He lived for 12 months with an acceptable quality of life. Gynecomastia may be the first sign of feminizing adrenal malignancies. Surgery may ameliorate the quality of life in selected patients with metastatic disease

CO2-free coal-fired power generation by partial oxy-fuel and post-combustion CO2capture: Techno-economic analysis

Among the carbon capture and storage (CCS) technologies suitable for power generation plants, partial oxy-combustion coupled with post combustion CO2capture is gaining interest, since such a hybrid configuration could allow to reduce the size and enhance the performance of post-combustion CO2capture by operating combustion with air enriched with oxygen and reducing the dilution of flue gas. Moreover, partial oxy-combustion is a potential candidate for the retrofit of existing steam plants because it could be based on an almost conventional boiler and requires a smaller CO2capture section. This work presents the results of a comparative techno-economic analysis of a 1000 MWthpartial oxy-combustion plant based on an ultra-supercritical pulverized coal combustion power plant integrated with a post-combustion CO2capture system and geological storage in saline aquifer. In particular, plant performance is assessed by using simulation models implemented through Aspen Plus 7.3 and Gate Cycle 5.40 commercial tools, whereas economic performance are evaluated on the basis of the expected annual cash flow. The analysis shows that, for new plants, this hybrid approach is not feasible from the economic point of view and full oxy-combustion potentially remains the most profitable technology even if, in the short-term period, the lack of commercial experience will continue to involve a high financial risk

The emerging role of pectoral nerve block (PECS block) in breast surgery: A case-matched analysis

To evaluate the benefits of pectoral nerve block (PECS block) in breast cancer surgery, we compared outcomes of 100 patients receiving PECS vs 107 without PECS. Intraoperative use of fentanyl (P < .001) acetaminophen (P = .02), morphine (P < .01), and nonsteroidal anti-inflammatory drugs (NSAIDS) (P < .01) was lower in the PECS group. Occurrence of postoperative nausea and vomiting (PONV) was lower in the PECS group (P = .04). On postoperative day 1, the use of acetaminophen (P = .23), morphine (P = .83), and NSAIDS (P = .4) did not differ. Twenty-one patients received surgery with PECS block plus sedation alone. PECS block can reduce intraoperative use of opioids and analgesic drugs, and is associated with reduced occurrence of PONV. Selected patients can receive breast-conserving surgery with PECS plus sedation, avoiding general anesthesia

The Impact on Survival and Morbidity of Portal-Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma. A Systematic Review and Meta-Analysis of Comparative Studies

Background: The literature is conflicting regarding oncological outcome and morbidity associated to portal-mesenteric resection during pancreaticoduodenectomy (PD) in patients with pancreatic head adenocarcinoma (PHAC). Methods: A meta-analysis of studies comparing PD plus venous resection (PD+VR) and standard PD exclusively in patients with adenocarcinoma of the pancreatic head was conducted. Results: Twenty-three cohort studies were identified, which included 6037 patients, of which 28.6% underwent PD+VR and 71.4% underwent standard PD. Patients who received PD+VR had lower 1-year overall survival (OS) (odds radio OR 0.79, 95% CI 0.67-0.92, p = 0.003), 3-year OS (OR 0.72, 95% CI 0.59-0.87, p = 0.0006), and 5-year OS (OR 0.57, 95% CI 0.39-0.83, p = 0.003). Patients in the PD+VR group were more likely to have a larger tumor size (MD 3.87, 95% CI 1.75 to 5.99, p = 0.0003), positive lymph nodes (OR 1.24, 95% CI 1.06-1.45, p = 0.007), and R1 resection (OR 1.74, 95% CI 1.37-2.20, p &lt; 0.0001). Thirty-day mortality was higher in the PD+VR group (OR 1.93, 95% CI 1.28-2.91, p = 0.002), while no differences between groups were observed in rates of total complications (OR 1.07, 95% CI, 0.81-1.41, p = 0.65). Conclusions: Although PD+VR has significantly increased the resection rate in patients with PHAC, it has inferior survival outcomes and higher 30-day mortality when compared with standard PD, whereas postoperative morbidity rates are similar. Further research is needed to evaluate the role of PD+VR in the context of multimodality treatment of PHAC

Post-translational deregulation of YAP1 is genetically controlled in rat liver cancer and determines the fate and stem-like behavior of the human disease

Previous studies showed that YAP1 is over-expressed in hepatocellular carcinoma (HCC). Here we observed higher expression of Yap1/Ctgf axis in dysplastic nodules and HCC chemically-induced in F344 rats, genetically susceptible to hepatocarcinogenesis, than in lesions induced in resistant BN rats. In BN rats, highest increase in Yap1-tyr357, p73 phosphorylation and Caspase 3 cleavage occurred. In human HCCs with poorer prognosis ( 3 years survival; HCCB). In the latter, higher levels of phosphorylated YAP1-ser127, YAP1-tyr357 and p73, YAP1 ubiquitination, and Caspase 3 cleavage occurred. Expression of stemness markers NANOG, OCT-3/4, and CD133 were highest in HCCP and correlated with YAP1 and YAP1-TEAD levels. In HepG2, Huh7, and Hep3B cells, forced YAP1 over-expression led to stem cell markers expression and increased cell viability, whereas inhibition of YAP1 expression by specific siRNA, or transfection of mutant YAP1 which does not bind to TEAD, induced opposite alterations. These changes were associated, in Huh7 cells transfected with YAP1 or YAP1 siRNA, with stimulation or inhibition of cell migration and invasivity, respectively. Furthermore, transcriptome analysis showed that YAP1 transfection in Huh7 cells induces over-expression of genes involved in tumor stemness. In conclusion, Yap1 post-translational modifications favoring its ubiquitination and apoptosis characterize HCC with better prognosis, whereas conditions favoring the formation of YAP1-TEAD complexes are associated with aggressiveness and acquisition of stemness features by HCC cells

a multidisciplinary approach in the diagnosis of allergic and non allergic respiratory diseases nasal cytology and feno

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Evidence for preferences of Italian patients for physician attire

BACKGROUND: The relationship between patient and physician is a complex interaction that includes multiple factors. The objective of this study was to explore Italian patients' preferences regarding physician appearance. METHODS: A questionnaire was developed to survey patients in different medical and surgical settings; each subject was asked to choose one picture of either a male or female physician from a selection of different attires (professional, casual, surgical scrubs, trendy, and careless). Patients were also surveyed about issues such as the presence of a name tag, hair length, trousers on women, amount of makeup, presence of tattoos, and body piercing. Statistical analysis was performed using a Chi-square test. RESULTS: A total of 765 questionnaires (534 completed from patients waiting for an internal medicine visit and 231 for other subspecialties) were completed. The majority (45%) of patients preferred the gastroenterologist to wear a surgical scrub with a white coat. For the other specialists, patients accepted either scrubs or formal dress under a white coat (P ≤ 0.05), with a name tag. Trendy attire was preferred by nine patients (1.1%). The entire sample judged it inappropriate for clinicians to have long hair, visible tattoos, body piercing, and, for women, to wear trousers and use excessive makeup. CONCLUSION: This is the first study conducted in Italy regarding physician attire. As in other Western countries, Italian patients favor physicians in professional attire with a white coat. Wearing professional dress is part of "etiquette based medicine" and may favorably influence clinician-patient relationships and patient compliance.</br