Pilonidal sinus disease. Preliminary case-control study on heat-related wound dehiscence

Background: Pilonidal disease is a morbid condition of the young population, that could impair quality of life with a high cost for the health care system. No consensus exists on optimal surgical treatment, even if several techniques have been proposed. In this preliminary case-control study we compared excision by knife and diathermy to investigate if wound dehiscence could be related to heat spreading during excision of the sinus. Materials and method: Between January 2017 and February 2018, 29 patients underwent to sinus excision.16 patients underwent sinus excision by diathermy (named "Hot" group, case-group) while 13 patients underwent excision by the knife as the control group (named "Cold" group). The temperature data were recorded for both groups. Were considered primary and secondary outcomes. Results: the cold group has worse outcomes in operative time and blood loss, but better results in post-operative pain at first day and first control, number of weekly and total dressings until healing, time for full wound recovery, days to return to work, patient feeling feedback and scar aspect. Wounds healed within 8-12 days were 84.6% in the Cold group and 18.8% in the Hot one. I° Dindo-Clavien complications were respectively 15.4% and 100.0% for the Cold and Hot group. No differences were recorded for II° Dindo-Clavien complications and in days of hospitalization. Conclusion: cold excision of the sinus pilonidalis has better results both in terms of precarious healing and quality of life, probably because the tissues are not subjected to diathermocoagulation damage and therefore the healing occurs more quickly. (United States National Institutes of Health, www.clinicaltrial.gov, number NCT03764657, www.researchregistry.com UIN 5003)

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

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

Gamma-ray irradiation tests of CMOS sensors used in imaging techniques

Technologically-enhanced electronic image sensors are used in various fields as diagnostic techniques in medicine or space applications. In the latter case the devices can be exposed to intense radiation fluxes over time which may impair the functioning of the same equipment. In this paper we report the results of gamma-ray irradiation tests on CMOS image sensors simulating the space radiation over a long time period. Gamma-ray irradiation tests were carried out by means of IGS-3 gamma irradiation facility of Palermo University, based on 60Co sources with different activities. To reduce the dose rate and realize a narrow gamma-ray beam, a lead-collimation system was purposely built. It permits to have dose rate values less than 10 mGy/s and to irradiate CMOS Image Sensors during operation. The total ionizing dose to CMOS image sensors was monitored in-situ, during irradiation, up to 1000 Gy and images were acquired every 25 Gy. At the end of the tests, the sensors continued to operate despite a background noise and some pixels were completely saturated. These effects, however, involve isolated pixels and therefore, should not affect the image quality

Design and realization of a radon chamber as a secondary standard

The air-radon mixture is the most significant source of natural radiation in workplaces and within dwellings. Despite some uncertainty in the risk estimates, it is widely believed that greater the exposure to radon, greater the risk of developing lung cancer. To assess the radiological hazard, accurate measurements of radon concentrations are necessary. A large variety of radon monitoring instruments have been developed in the last years, usually calibrated in radon chambers containing a known radon concentration released within the chamber by a specific solid radium-226 source. Radon calibration chamber has been constructed to test and calibrate radon and radon progeny detectors at various environmental conditions and to study the characteristic behaviour of radon decay products. The potential use of the above mentioned facility is still under study to assess its reliability and the reproducibility of results with respect to several variables of interest. A new radon chamber has been designed, constructed, and tested at Nuclear Engineering Department of Palermo University. The design was chosen to meet the needs of several different radon detection techniques, both active and passive. The chamber is a cylindrical shape made of stainless steel with volume about 0.4 m3. It has also the possibility to expose passive radon detectors at different levels inside the chamber as well as the radon gas concentration inside the chamber can be maintained constant by a fan. The radon chamber consists of an exposure room, a radon reference monitor, an equipment for control of radon circulation and air features. The variables that can be changed and controlled are radon activity, gas pressure (in the range 700 – 1100 mbar), temperature (5 – 50 °C), and humidity (10-90%), respectively. A number of experiments have been conducted to study the influences of environmental parameters on the equilibrium factor. This chamber can be used to perform researches and studies on radon behaviour, to calibrating different types of detectors (passive and active) which are used for measuring radon and its daughters

A chamber to test the response of radon detectors to changing environmental conditions

Radon risk assessment is carried out with accurate measurements with active or passive instrumentation. All radon detectors must be calibrated and tested using a radon chamber containing a known concentration of radon produced by specific sources of 226Ra. Some of the chambers can also be used to test the response of detectors as a function of environmental conditions. In this case, it can be inferred a calibration curve with respect to changing of the parameter considered. For this aim, a new chamber radon was designed and realized to perform both calibration of instruments and to study the detector response in a large range of variation of the environmental parameters (pressure, 700 - 1100 mbar; temperature, 5-50 ◦C; humidity, 10-90%). The experiments conducted to study the influence of environmental parameters on the detector response, in terms of variation of radon concentration and equilibrium factor, have shown flexibility and ease of use of the chamber

Una stazione per il monitoraggio on-line di radioattività atmosferica: criteri di progetto e valutazione dei costi

Presso la Sezione di Ingegneria Nucleare del Dipartimento dell’Energia (già Dipartimento di Ingegneria Nucleare, DIN) dell’Università di Palermo, è installato un sistema di aspirazione di particolato atmosferico ad altissimo volume (circa 1000 m3/h di aria). Costruito agli inizi degli anni ottanta del secolo scorso, risulta ormai datato in parte della strumentazione a corredo oltre che nella stessa struttura di protezione dagli agenti atmosferici che lo contiene. La stazione di prelievo è stata utilizzata fino a qualche anno addietro per il monitoraggio giornaliero di deboli concentrazioni di inquinanti radioattivi in aria, con livelli di Minima Attività Rivelabile (MAR) abbastanza ridotti (dell’ordine di 2÷5 microBq/m3 per il 137Cs) anche in relazione all’impiego di sistemi spettrometrici gamma con rivelatori HPGe tipo “Low Background”. Tale sensibilità e l’elevato volume aspirato permettono anche di adottare brevi tempi di campionamento e di misura, un aspetto che può essere molto importante in una situazione di emergenza, come già sperimentato durante il periodo immediatamente successivo l’incidente di Chernobyl. Questo sistema, tuttavia, seppure interessante e utile in situazioni di emergenza o per il monitoraggio di deboli attività, non è automatico e risulta oneroso sia per l’impegno di personale che di dotazione strumentale. Pertanto, non è proponibile come prototipo di una stazione di monitoraggio da adottare per misure di routine, da inserire nella cosiddetta “rete diradata”, o per la rete locale attorno alle centrali nucleari che dovrebbero essere realizzate sul territorio italiano. Si è voluto allora elaborare un progetto per la realizzazione di una stazione di monitoraggio di contaminanti radioattivi in aria che avesse caratteristiche di automaticità e rispondesse comunque e requisiti di efficienza e alto volume di campionamento. Inoltre l’installazione di una stazione meteorologica per il rilevamento automatico delle caratteristiche locali, inclusa la piovosità, dovrebbe assicurare la possibilità di controllare remotamente i parametri di funzionamento del sistema di aspirazione e modificare il volume aspirato in relazione alla variazione di temperatura. Il sistema di misura consiste in un rivelatore HPGe, con raffreddamento elettrico e adeguatamente schermato, le cui misure spettrometriche vengono automaticamente registrate e analizzate in modo da poter programmare anche misure on-line di concentrazioni rapidamente variabili. Il corredo della dotazione strumentale prevede anche l’installazione di dispositivi per la raccolta e misura del fall-out, la rilevazione automatica del kerma in aria, la possibilità di effettuare studi multifunzionali e/o di comparazione, etc. In questa presentazione sono evidenziati i criteri di progetto e le principali caratteristiche dei vari dispositivi, con una valutazione dei presumibili costi. La realizzazione di un prototipo sperimentale, per cui è necessario disporre di adatti fondi per l’acquisizione della dotazione strumentale completa, consentirà di verificare le prestazioni, la funzionalità, la possibilità di impiego come componente di una rete di monitoraggio, o di una rete di allarme

Progettazione e realizzazione di un irradiatore neutronico modulare basato su sorgenti Am-Be

Irradiatori neutronici basati su sorgenti radionuclidiche sono impiegati in diversi paesi per studiare le caratteristiche dei materiali sottoposti a irradiazione e/o la risposta di rivelatori e/o dosimetri personali sensibili alla componente neutronica. Per quest’ultima applicazione, l’uso di un irradiatore con sorgenti radionuclidiche risulta molto vantaggioso per la stabilità nel tempo del flusso neutronico, mentre è relativamente poco importante il valore assoluto del flusso neutronico, che può anche essere di qualche ordine di grandezza inferiore a quello di reattori o di acceleratori di particelle. Per l’effettuazione di test su rivelatori e/o dosimetri personali neutronici risulta molto interessante disporre sia di flussi di neutroni termici che di neutroni veloci. Ciò può essere realizzato tramite un irradiatore di tipo modulare, in grado di determinare una prevalenza di una componente del flusso neutronico, da termico a veloce, con adatte movimentazione dei suoi componenti. In questo lavoro è descritta la progettazione e la realizzazione di un irradiatore modulare basato su sorgenti di 241Am-Be, la cui struttura consente di posizionare al suo interno anche un fantoccio antropomorfo con cui testare dosimetri personali per neutroni anche di nuova concezione. Sono riportati i risultati dei primi test di irraggiamento effettuati con dosimetri di varia tipologia commercialmente disponibili.Neutron irradiation facilities based on radioactive sources are used in different countries to investigate the characteristics of the materials subjected to irradiation, but also to study the response of detectors and/or personal dosimeters to neutron fluxes. For the latter application, an irradiator based on radioactive sources is very useful for the stability of the neutron flux, while it is less important the absolute value of the neutron flux, which can also be a few orders of magnitude lower than the one of reactors or particle accelerators. To test the performance of detectors and/or personal neutron dosimeters is very interesting to have both thermal or fast neutron fluxes. This can be achieved through a modular-type irradiator, able to determine the prevalence of one component of the neutron flux, from thermal to fast, with appropriate handling of its components. This report describes the design and construction of a modular irradiator based on sources of 241Am-Be, able to place inside also an anthropomorphic phantom to test personal neutron dosimeters. The results of the first irradiation tests performed with various types of commercially available dosimeters are also reported

UN IRRADIATORE NEUTRONICO MODULARE CON SORGENTI DI 241Am-Be PER IL TEST DI DOSIMETRI NEUTRONICI PERSONALI

Irradiatori neutronici basati su sorgenti radionuclidiche sono impiegati in diversi paesi per l’analisi per attivazione di vari campioni, per studiare le caratteristiche dei materiali sottoposti a irradiazione, ma anche per studiare la risposta di rivelatori e/o dosimetri personali sensibili alla componente neutronica. Per quest’ultima applicazione, l’uso di un irradiatore con sorgenti risulta molto vantaggioso per la stabilità nel tempo del flusso neutronico, mentre è relativamente poco importante il valore assoluto del flusso neutronico, di qualche ordine di grandezza inferiore a quello di reattori o di acceleratori di particelle. Per l’effettuazione di test su rivelatori e/o dosimetri personali neutronici sarebbe molto interessante disporre sia di flussi di neutroni termici che di neutroni veloci. Ciò può essere realizzato tramite un irradiatore di tipo modulare, in grado di determinare una prevalenza di una componente del flusso neutronico, da termico a veloce, con adatte movimentazione dei suoi componenti. In questo lavoro è descritta la progettazione e la realizzazione di un irradiatore modulare di questo tipo, basato su sorgenti di 241Am-Be, flessibile e adatto a questa tipologia di indagine, la cui struttura consente di posizionare al suo interno un fantoccio antropomorfo su cui testare dosimetri personali per neutroni anche di nuova concezione. Sono riportati i risultati dei primi test di irraggiamento effettuati con dosimetri di varia tipologia commercialmente disponibili