The Use Of Selective Filtration Of Monocytes From Peripheral Blood In Patients With Vascular Ulcers Promotes Healing. A Pilot Study In A High Volume Vascular Surgery Centre

Introduction: Monocytes have a documented action to promote the healing of trophic lesions through the regenerative action of the transformation of M1 macrophages into M2 macrophages, with multilineage potential comparable to that of mesenchymal stem cells (MSC). Patients affected by peripheral artery disease in Rutherford 5 and 6 stage may be considered suitable. The monocytes can be harvested from peripheral venous blood and injected both in peri-arterial leg areas and in ulcerative lesions. Methods: From 2015 to 2018, 200 procedures were performed in our centre for obstructive arterial disease of the lower limbs, causing PAD. Twelve (12) patients were considered non-revascularisable (5.5%). This was a first therapeutic approach in 7/12 (58.3%), while it was proposed as a therapeutic alternative in patients already subjected to previous operations and / or revascularisation attempts in 5 (41.6%). Demographic and clinical features are collected. An informed consent was obtained in all patients. In 72.5% three or four cycles were performed. All patients followed post-operative medical therapies and adjuvant medications during the months following treatment. Results: Comorbidities included hypertension in 91%, CRC in 63%, dyslipidaemia in 90%, cardiopathy in 72%, COPD in 63%, diabetes in 20%, smoking in 55% (of which 50% ex-smokers) at median follow up of 18 months DS (+/- 7 months) the survival rate was 81.8% (ES 0,11) the limbs savage was 51.1% (ES 0,15). Amputation rate was respectively: minor 45.5% and major 9%. Considering minor amputation as a limb salvage, this percentage increased to 83.4%. Four deaths unrelated to therapy were observed. The pain with VAS score measurement varied from reduction in 36.3% to disappearance in 27.2%. Data regarding TCp02 has increased : a post-operative median level in the examined patients was 24.8 mmHg T2. Conclusion: The filtration procedure with mononuclear cells is safe and must be applied selectively. In high volume centres it is possible to evaluate candidate patients for this type of intervention. Additional procedures must be associated to complete the therapeutic procedure. Due to the increasing complexity and comorbidity of patients, careful selection is required; a multidisciplinary approach and accurate patient follow up is needed. Multicentre studies with multiple cases are needed to validate the Results

Spread of SARS-CoV-2 (COVID-19) in a High-Volume Hospital: Vascular Surgery Impact

Increasing population rates of coronavirus disease 2019 (COVID-19) are occurring in several countries and continents. The impact regarding vascular activity, consequences and complication is scarce and makes the future perspective unclear. The aim of this report is to describe the changes in a high-volume University Hospital, relevant for future decisions. The mortality and morbidity should be higher not only in COVID+ patients but also in vascular patients

DTT: Divertor Tokamak Test facility Project Proposal

One of the main challenges in the European fusion roadmap is to design a heat and power exhaust system able to withstand the large loads expected in the divertor of a DEMO fusion power plant. Therefore, in parallel with the programme to optimise the operation with a conventional divertor based on detached conditions to be tested on the ITER device currently under construction in Cadarache, a specific project has been launched to investigate alternative power exhaust solutions for DEMO, aimed at the definition and the design of a Divertor Tokamak Test facility. This tokamak should be capable of hosting scaled experiments integrating most of the possible aspects of the DEMO power and particle exhaust. DTT should retain the possibility to test different divertor magnetic configurations, liquid metal divertor targets, and other possible solutions for the power exhaust problem. The DTT design proposal refers to a set of parameters selected so as to have edge conditions as close as possible to DEMO (in terms of the temperature and the normalized collisionality, pressure and ion gyro radius), while remaining compatible with DEMO bulk plasma performance in terms of dimensionless parameters within a set of constraints related to flexibility and costs

Overview of JET results

High density and high confinement operation in ELMy H-mode is confirmed at or above the normalized parameters foreseen for the ITER operating point (H98(y,2) 3c 1, n/nGW 3c 1, \u3b2N > 1.8 at q95 3c 3). The scaling of the ELMy H-mode with \u3b2N could be more favourable than that predicted by the IPB98(y,2) scaling. In ELMy H-mode, ion cyclotron current drive (ICCD) control of large sawteeth stabilized by fast particle has been demonstrated and the underlying neo-classical tearing modes (NTMs) and sawtooth physics is being refined. At high-density, Type I ELMy H-modes show trends that would lead to marginally acceptable ELMs on ITER. Type II ELM regime has been produced, though under very restrictive conditions. Type III ELMy operation with radiation fractions up to 95% has been demonstrated by seeding of N2 in H-modes and could extrapolate to Q = 10 ITER operation, albeit at high current (17 MA). The mitigation of Type I ELMs, nevertheless, remains a challenge. Considerable progress has been obtained in internal transport barrier (ITB) plasmas, with operation at central densities close to the Greenwald density or/and low toroidal rotation or/and high triangularity. Demonstrations of full current drive and successful simultaneous real time control of safety factor and temperature profiles have been achieved in ITB plasmas. Physics of resistive wall modes (RWMs) has been compared with theory, showing favourable scaling for ITER. High \u3b2N 3c 2.8 operation of hybrid modes (also called improved H-modes) has been obtained with dominant neutral beam heating. Hybrid modes with dominant ion cyclotron resonance heating (ICRH) have also been achieved. Trace tritium experiments yielded valuable information on particle transport in H-mode, ITB and hybrid regimes. In Type I ELMy plasmas, successful tests of the conjugate-T ICRH scheme have been achieved as well as lower hybrid coupling at ITER-relevant 10\u201311 cm distances. Reduced D and T fuel retention has been observed, which could relate to operation with vertical targets in the divertor and/or lower (ITER-like) vessel temperature. It is confirmed that erosion occurs predominantly on the main chamber surfaces, with possible benefits for T retention in ITER, although consequences for the metallic first wall lifetime need to be assessed. Disruption and ELM studies indicate that transient power deposition could be less constraining than expected for the ITER divertor, but more challenging for the metallic first wall. Alpha particle tomography and direct observation of alpha particle slowing down have been made possible by \u3b3 -spectroscopy. Measurements of Alfve \u301n cascades have been improved by a new interferometric technique. Promising tests of ITER relevant neutron counting detectors have been conducted