Numerical Evaluation of Microwave Thermal Ablation to Treat Small Adrenocortical Masses

In this paper microwave thermal ablation is numerically evaluated in the context of a treatment for Conn’s Syndrome. This condition is caused by a benign shallow tumour in the cortex of adrenal gland. The modelling and design of microwave applicator to deliver thermal ablation to the adrenal gland requires accurate tissue characterisation. Measuring the dielectric properties of the constituent tissues in the adrenal gland, i.e. cortex and medulla, enables more accurate numerical modelling for electromagnetic and thermal simulations. This study presents an anatomically and dielectrically realistic numerical model of the adrenal gland, and investigates the feasibility of applying controlled heating to small targets in the adrenal cortex. In addition, the use of dielectric contrast between the fat and the cortex of the adrenal gland to focus the thermal energy in the gland has also been studied. Being conscious of limitations of numerical simulation of complex multiphysics problems like the microwave ablative treatment, calculated results provide a preliminary description of the electromagnetic and thermal phenomena involved

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

A review on energy efficiency in three transportation sectors: Railways, electrical vehicles and marine

The present paper is a review on efficiency issues related to three important sectors of the transportation systems: railways, electrical vehicles, and marine. For the three sectors, the authors, in reference of their knowledge and research area, show the results of a wide literature analysis, in order to highlight which are the measures, in terms of technological solutions and management techniques, which are recently investigated and implemented, for improving the three transportation systems, from the point of view of efficiency. In particular, for the railway transportation sector, a wide analysis is presented, detecting which are the main measures adopted for improving the efficiency, related to the power systems for supplying trains and to the train traffic control, with a focus on the storage system integration. For electric road vehicles the analysis is focused on the plug-in electrical vehicles and on the infrastructure for their recharge, with an emphasis on how these vehicles can support the grid, e.g., through Vehicle to Grid (V2G) applications. Finally, for the marine transport service the review is related to the propulsion systems and on how the different solutions can meet the objective of efficiency

A study on a high-reliability electromechanical undervoltage relay immersed in natural ester oil: application in mutual aid system for gensets using

The paper focuses on the reliability of an undervoltage electromechanical relay suitable for critical industrial applications. The specific application underlined in this paper is a mutual aid system for gensets: the relay is able to actuate the parallel of the batteries in case of failure of the starting-up of the genset. A particular 'Plunger-type' electromechanical device, with redundant contacts, has been proposed in order to maximize the MTBF parameter; electronics devices have been rejected in according with on-filed statistic surveys about the relative failure rates. The relay is equipped with a natural ester oil delaying system (dashpot): physical and dielectric characteristics of natural ester oil can assure better delaying system performances and insulating level. Other advantages obtainable by using insulating ester oil into the relay are also highlighted

A methodologic approach to define the railway junctions capacity

The paper reports a methodologic approach to define the capacity of railway junctions. The railway traffic increase, together with the improvement of passenger comfort, has produced a greater need for electricity. Consequently, solutions to augment the railway system capacity, including railway junctions, have to be achieved. In order to design new plants and to improve or certificate the existing ones, simulation of the overall railway system is necessary. In this paper the Authors propose a guideline with a theoretical approach to study the capacity of railway junctions

A review on rail transport in Europe and Italy

The paper describes the state of the art of passenger and freight rail transport in Italy and Europe taken into account market demand, consumption, emissions and costs. Present and future scenarios are analyzed (projections towards 2030 and 2050) to observe the evolution of rail transport and to evaluate how the demand for mobility will change and how the new development frontiers will impact pollution and economic management. Summarizing, the paper identifies the policies implemented to promote the railway sector and the existing limits to its development

A review on energy efficiency in three transportation sectors: Railways, electrical vehicles and marine

The present paper is a review on efficiency issues related to three important sectors of the transportation systems: railways, electrical vehicles, and marine. For the three sectors, the authors, in reference of their knowledge and research area, show the results of a wide literature analysis, in order to highlight which are the measures, in terms of technological solutions and management techniques, which are recently investigated and implemented, for improving the three transportation systems, from the point of view of efficiency. In particular, for the railway transportation sector, a wide analysis is presented, detecting which are the main measures adopted for improving the efficiency, related to the power systems for supplying trains and to the train traffic control, with a focus on the storage system integration. For electric road vehicles the analysis is focused on the plug-in electrical vehicles and on the infrastructure for their recharge, with an emphasis on how these vehicles can support the grid, e.g., through Vehicle to Grid (V2G) applications. Finally, for the marine transport service the review is related to the propulsion systems and on how the different solutions can meet the objective of efficiency