Study and modelling of the passenger safety devices of an electric vehicle by finite elements

Abstract Electric mobility gets mainly involved quadricycles and cars. Between these two vehicle types there are differences in terms of stability, performance, cost, autonomy and safety. The authors studied the implementation of passenger safety devices on a prototype for an electric vehicle derived from a heavy quadricycle. A finite element analysis starting from experimental results was carried out in order to determine the effectiveness in case of frontal and side crashes

Valproic acid and phenobarbital blood levels during the first month of treatment with the ketogenic diet.

Objective – The aim of this study was to assess how the ketogenic diet influences the blood levels of antiepileptic drugs in the first month of treatment in a pediatric population with drug-resistant epilepsy. Methods – The plasma concentrations of antiepileptic drugs were investigated in an open study on 36 consecutive children and adolescents (20 males), aged between 6 months and 16 years (mean age 4.7 years), who were put on the ketogenic diet because of medically refractory epilepsy. The plasma levels of antiepileptic drugs were determined 30 days and immediately before the diet and on days 8, 15, 22 and 29 after the start of the diet. The daily dose of each drug was not changed during the first month of treatment, while the daily dose of benzodiazepines was reduced by up to 30% if excessive sedation or drowsiness occurred. Results – While plasma concentrations of phenobarbital did not change in the first month on the ketogenic diet (mean increase of 2.3 mg ⁄ l 1.0), valproic acid showed a slight but not significant decrease (mean decresase of 6.7 mg ⁄ l 3.2), 2 weeks after the start of the diet. Conclusions – Adjustments in the daily dose of either drug before the start of the diet do not however appear to be justified

Robotic Single-Port da Vinci Surgical System (SP1098) in Gynecologic Surgery: A Systematic Review of Literature

Background: Recently, new surgical systems less invasive than standard laparoscopy have been developed. Among these, robotic single site surgery is playing a pivotal role. In this field, the da Vinci SP (Single-Port) Surgical System (SP1098) is one of the newest surgical technology that presents innovative characteristics that may lead to better surgical outcomes. Few groups have already published their experience and results with this system in gynecology. Methods: The aim of the present systematic review was to provide a comprehensive overview of the status and applications of da Vinci SP1098 in gynecologic surgery. A systematic review of the literature was performed. Studies were identified until September 2022. Results: Six studies were included, reporting a total of 211 patients. The indication for surgery was both benign and malignant disorders. In terms of operative outcomes, the mean/median docking time varied from 2.1 to 5 min while mean/median operating time from 86.5 to 245 min. There was no conversion to multi-port laparoscopy or laparotomy and no major complications related to SP surgery. Conclusions: In conclusion, the preliminary and limited data available regarding the da Vinci SP1098 Surgical System suggest the technical feasibility and safety for its use in gynecologic surgery, with minimal alteration of the surgical technique

The combined use of neutrophil gelatinase-associated lipocalin and brain natriuretic peptide improves risk stratification in pediatric cardiac surgery

Abstract Background: The aim of this study is to test the hypothesis whether the combined use of a cardio-specific biomarker, the brain natriuretic peptide (BNP) and a marker of early renal damage, the assay of urinary neutrophil gelatinase-associated lipocalin (uNGAL), may improve risk stratification in pediatric cardiac surgery. Methods: We prospectively enrolled 135 children [median age 7 (interquartile range 1–49) months] undergoing to cardiac surgery for congenital heart disease. All biomarkers were evaluated pre- and post-operatively at different times after cardiopulmonary-bypass (CPB): uNGAL at 2, 6 and 12 h; BNP at 12 and 36 h; serum creatinine at 2, 6, 12, and 36 h. Primary endpoints were development of acute kidney injury (AKI) (defined as 1.5 serum creatinine increase) and intubation time. Results: AKI occurred in 39% of patients (65% neonates and 32% older children, p=0.004). The peak of uNGAL values occurred more frequently at 2 h. uNGAL values at 2 h [median 28.2 (interquartile range 7.0–124.6) ng/L] had a good diagnostic accuracy for early diagnosis of AKI with an AUC (area under the curve) ROC (receiver operating characteristic) curve of 0.85 (SE 0.034). Using multivariable logistic regression analysis, development of AKI was significantly associated with uNGAL values at 2 h after CPB [OR=1.88 (1.30–2.72, p=0.001)], together with the CPB time and Aristotle score, as an index of complexity of the surgical procedure, while pre-operative BNP values were not. Furthermore, uNGAL and pre-operative BNP values (together with Aristotle score) were significantly associated with adverse outcome (longer intubation time and mortality). Conclusions: Pre-operative BNP and uNGAL values after surgery (together with the Aristotle score) were independently associated with a more severe course and worse outcome in children undergoing cardiac surgery for congenital heart disease.</jats:p

Laparoscopic High Uterosacral Ligament Suspension vs. Laparoscopic Sacral Colpopexy for Pelvic Organ Prolapse: A Case-Control Study

Introduction: Laparoscopic sacral colpopexy is the gold standard technique for apical prolapse correction but it is a technically challenging procedure with rare but severe morbidity. Laparoscopic high uterosacral ligament suspension could be a valid technically easier alternative using native tissue. Material and Methods: In the period from 2015 to 2018, 600 women were submitted to laparoscopic sacral colpopexy while 150 to laparoscopic high uterosacral ligament suspension in three Italian urogynecology referral centers. We enrolled women with apical prolapse stage ≥2 alone or multicompartment descensus. To reduce allocation bias, we performed a propensity matched analysis. Women undergoing laparoscopic high uterosacral ligament suspension surgery were matched 1:2 to women undergoing laparoscopic sacral colpopexy. The cumulative proportion of relapse-free women in time was analyzed by the Kaplan–Meier method. The primary objective of this multicenter case-control retrospective study was to compare the recurrence rate while the secondary objectives were to compare feasibility, safety, and efficacy of laparoscopic sacral colpopexy and laparoscopic high uterosacral ligament suspension in surgical treatment of pelvic organ prolapse. Results: Three hundred and nine women were enrolled (103 laparoscopic high uterosacral ligament suspension; 206 laparoscopic sacral colpopexy). Median operatory time was significantly shorter in the laparoscopic high uterosacral ligament suspension group (P = 0.0001). No statistically significative difference was found in terms of estimated blood loss, admission time, intraoperative, and major early postoperative complications, postoperative pelvic pain, dyspareunia and de novo stress urinary incontinence. Surgical approach was the only independent risk factor for prolapse recurrence (RR = 6.013 [2.965–12.193], P = 0.0001). The objective cure rate was higher in the laparoscopic sacral colpopexy group (93.7 vs. 68%, 193/206 vs. 70/103, P = 0.0001) with a highly reduced risk of recurrence (RR = 5.430 [1.660–17.765]). Median follow up was 22 months. Conclusion: Both techniques are safe, feasible, and effective. Laparoscopic sacral colpopexy remains the best choice in treatment of multicompartment and advanced pelvic organ prolapse while laparoscopic high uterosacral ligament suspension could be appropriate for moderate and isolated apical prolapse when laparoscopic sacral colpopexy is not suitable for the patient or to prevent prolapse in women at high risk at the time of the hysterectomy

Primary flap closure of perineal defects to avoid empty pelvis syndrome after pelvic exenteration in gynecologic malignancies: An old question to explore a new answer

: Pelvic exenteration (PE) is a radical oncological surgical procedure proposed in patients with recurrent or persistent gynecological cancers. The radical alteration of pelvic anatomy and of pelvic floor integrity can cause major postoperative complications. Fortunately, PE can be combined with reconstructive procedures to decrease complications and functional and support problems of pelvic floor, reducing morbility and mortality and increasing quality of life. Many options for reconstructive surgery have been described, especially a wide spectrum of surgical flaps. Different selection criteria have been proposed to select patients for primary perineal defect flap closure without achieving any strict indication of the best option. The aim of this review is to focus on technical aspects and the advantages and disadvantages of each technique, providing an overview of those most frequently used for the treatment of pelvic floor defects after PE. Flaps based on the deep inferior epigastric artery, especially vertical rectus abdominis musculocutaneous (VRAM) flaps, and gracilis flaps, based on the gracilis muscle, are the most common reconstructive techniques used for pelvic floor and vaginal reconstruction. In our opinion, reconstructive surgery may be considered in case of total PE or type II/III PE and in patients submitted to prior pelvic irradiation. VRAM could be used to close extended defects at the time of PE, while gracilis flaps can be used in case of VRAM complications. Fortunately, numerous choices for reconstructive surgery have been devised. As these techniques continue to evolve, it is advisable to adopt an integrated, multi-disciplinary approach within a tertiary medical center

Servicio de asesoramiento grupal agropecuario

Outreach activities, along with teaching and research, are part of the educational mission of higher education institutions. All three must be integrated into the policies and strategies of the institutions, interacting and enriching each other through channels of communication and mutual support. The objective of this work was to contribute to the training and development of agricultural producers, considering good agricultural practices. In order to do this, we worked in the districts of Serrezuela, Caminiaga and Sebastian Elcano. We worked to consolidate groups of producers and to promote behavioural changes; to this end, two aspects were exploited: i) the group dynamics, which consists of an active, participatory and reflective methodology through gradual, intentional and continuous work, and ii) the space-workshop, through which the learning of new behaviors related to livestock production was generated. The training, action and management of three groups of producers were consolidated. Producers and young coordinators of the groups created a space where knowledge was exchanged through an informal educational process.La extensión, a la par de la docencia y la investigación, forma parte de la misión educativa de las instituciones de educación superior. Todas deben estar presentes en las políticas y estrategias de las instituciones, interrelacionándose y enriqueciéndose recíprocamente a través de canales de comunicación y de apoyo mutuo. El objetivo de este trabajo fue contribuir a la capacitación y desarrollo de los productores agropecuarios, considerando las buenas prácticas agropecuarias. Para ello, se trabajó en las localidades Serrezuela, Caminiaga y Sebastián Elcano. Se trabajó en consolidar la formación de grupos de productores y promover cambios de conductas; para esto, se utilizaron dos ejes: la dinámica de grupo, que consiste en una metodología activa, participativa y reflexiva a través de un trabajo gradual, intencional y continuo y el espacio-taller, a través del cual se generó el aprendizaje de nuevas conductas referidas a la producción pecuaria. Se consolidó la formación, acción y autogestión de tres grupos de productores. Los productores y los jóvenes profesionales coordinadores de grupo generaron un espacio donde se intercambiaron saberes mediante un proceso educativo no formal