A MOC-based neutron kinetics model for noise analysis

A 2-D noise model is implemented in the deterministic reactor code APOLLO3® to simulate a periodic oscillation of a structural component. The Two/Three Dimensional Transport (TDT) solver, using the Method of Characteristics, is adopted for the calculation of the case studies, constituted by a moving detector and control-rod bundle. The periodic movement is built by properly linking the geometries corresponding to the temporal positions. The calculation is entirely performed in the real time domain, without resorting to the traditional frequency approach. A specifically defined dynamic eigenvalue is used to renormalize in average the reactivity over a period. The algorithm is accelerated by the DPN synthetic method. For each cell of the domain, the time values of fission rates are analysed to determine the noise extent. Moreover we propose a systematic approach to the definition of the macroscopic cross sections to be used in dynamical calculations starting from library data. As an aside of our work we have found that even in static calculation this approach can produce significant changes

Serum klotho concentrations inversely correlate with the severity of nailfold capillaroscopic patterns in patients with systemic sclerosis

Klotho is a transmembrane and soluble glycoprotein that governs vascular integrity. Previous studies have demonstrated reduced serum klotho concentrations in patients with systemic sclerosis (SSc), and it is known that klotho deficiency can impair the healing of digital ulcers related to microvessel damage. The aim of this study was to evaluate the association between serum klotho levels and nailfold capillaroscopic abnormalities in SSc patients. We retrospectively enrolled 54 consecutive patients with SSc diagnosed on the basis of the 2013 EULAR/ACR criteria [11 with diffuse SSc; 47 females; median age 68.0 years (IQ 18); median disease duration 11.0 years (IQ 7)]. Serum klotho concentrations were determined by means of an enzyme-linked immunosorbent assay. On the basis of the 2000 classification of Cutolo et al., 14 patients had normal nailfold capillaroscopic findings, 8 had an early scleroderma pattern, 21 an active scleroderma pattern, and 11 a late scleroderma pattern. The median serum klotho concentration was 0.29 ng/mL (IQ 1). Regression analysis of variation showed an inverse correlation between serum klotho concentrations and the severity of the capillaroscopic pattern (p=0.02; t -2.2284), which was not influenced by concomitant treatment. Logistic regression did not reveal any significant association between the risk of developing digital ulcers and nailfold capillaroscopic patterns, serum klotho levels, or concomitant medications. The presence of avascular areas significantly correlated with calcinosis (p=0.006). In line with previous studies, our findings confirm that klotho plays a role in preventing microvascular damage detected with nailfold capillaroscopy

How can we treat vulvar carcinoma in pregnancy? A systematic review of the literature

According to our systematic literature review (PRISMA guidelines), only 37 vulvar squamous cell carcinomas (VSCCs) were diagnosed during pregnancy (age range: 17\u201341 years). The tumor size range was 0.3\u201315 cm. The treatment was performed after (14/37, 38%), before (10/37, 27%), or before\u2010and\u2010after delivery (11/37, 30%). We found that 21/37 (57%) cases were stage I, 2 II (5%), 11 III (30%), and 3 IVB (8%). HPV\u2010related features (condylomas/warts; HPV infection; high\u2010grade squamous intraepithelial lesion) were reported in 11/37 (30%) cases. We also found that 9/37 (24%) patients had inflammatory conditions (lichen sclerosus/planus, psoriasis, chronic dermatitis). The time\u2010to\u2010recurrence/progression (12/37, 32%) ranged from 0 to 36 (mean 9) months. Eight women died of disease (22%) 2.5\u201348 months after diagnosis, 2 (5%) were alive with disease, and 23 (62%) were disease\u2010free at the end of follow\u2010up. Pregnant patients must be followed\u2010up. Even if they are small, newly arising vulvar lesions should be biopsied, especially in women with risk factors (HPV, dermatosis, etc.). The treatment of VSCCs diagnosed in late third trimester might be delayed until postpartum. Elective cesarean section may prevent vulvar wound dehiscence. In the few reported cases, pregnancy/fetal outcomes seemed to not be affected by invasive treatments during pregnancy. However, clinicians must be careful; larger cohorts should define the best treatment. Definite guidelines are lacking, so a multidisciplinary approach and discussion with patients are mandatory

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

ANALISI E INCIDENZA DEI DISTURBI MUSCOLOSCHELETRICI E VALUTAZIONE DEL RISCHIO PROFESSIONALE NELL\u2019ATTIVIT\uc0 LAVORATIVA DEI CUOCHI

Obiettivo Analizzare l\u2019incidenza dei disturbi muscoloscheletrici e il rischio professionale nell\u2019attivit\ue0 lavorativa dei cuochi tramite la valutazione dei sintomi avvertiti dai soggetti e la registrazione delle attivit\ue0 svolte quotidianamente. Background La rachialgia \ue8 una delle maggiori cause di morbosit\ue0 nella popolazione generale ma, soprattutto, \ue8 presente in alcune categorie lavorative. Diversi autori hanno identificato i fattori di rischio correlabili alle attivit\ue0 lavorative svolte; quelli pi\uf9 frequentemente osservati nei cuochi sono: l\u2019uso ripetitivo degli arti superiori, il sollevamento, la spinta e la trazione di oggetti pesanti ed il prolungato mantenimento di posture scomode e inadeguate. Materiali e Metodi A 146 cuochi \ue8 stato somministrato il Roland and Morris Disability Questionnaire (RMDQ), per valutare la disabilit\ue0 come conseguenza del dolore al rachide lombare, e un Pain Drawing, unito alla Visual Analogue Scale (VAS), per determinare la localizzazione e l\u2019intensit\ue0 dei sintomi a carico dell\u2019apparato muscoloscheletrico. Su 35 cuochi \ue8 stata inoltre eseguita una valutazione delle attivit\ue0 svolte durante l\u2019intera giornata lavorativa. Risultati I dati raccolti tramite RMDQ e Pain Drawing, in relazione agli anni lavorativi, indicano che la presenza dei sintomi aumenta con l\u2019anzianit\ue0 di servizio; questa sintomatologia \ue8 risultata maggiore nelle donne. \uc8 emerso inoltre che le attivit\ue0 in media pi\uf9 frequenti in una giornata lavorativa sono: il sollevamento di pesi dalla stazione eretta, le torsioni ed il mantenimento della stazione eretta con il tronco flesso. Conclusioni I risultati suggeriscono che i cuochi sono una categoria a rischio, soprattutto per quanto riguarda la lombalgia, e confermano la correlazione fra lavoro e presenza di disturbi muscoloscheletrici. Si rende quindi necessario prevedere interventi di fisioterapia volti a migliorare la qualit\ue0 della vita di questi operatori tramite la prevenzione e la riduzione dei sintomi

The Necropolis of Vallerano (Rome, 2nd-3rd century AD): An anthropological perspective on the ancient romans in the suburbium

The present study investigates the skeletal remains of individuals who were part of a Roman suburban community, in order to assess lifestyle and living conditions in the town's outskirts during the Roman Imperial age. The existence of the community was linked to the functioning of one of the many villas that surrounded the town of Rome at that time. In order to assess health, several indicators were explored, including mortality, oral pathologies and specific (cribra orbitalia) and aspecific (linear enamel hypoplasia) indicators of nutritional and physiological impairment. The sample, which probably represents the tabour force of the villa, shows a high number of individuals dying in the early adult age and very few living beyond 50. Subadults were frequently affected by pathological conditions which may indicate anaemia and/or inflammations and infections, as witnessed by the frequency of cribra orbitalia. Growth was also impaired, as the individuals suffered from systemic disturbances during the early years of life that led to the formation of linear enamel hypoplasia (LEH) in their teeth. Frequency of LEH is very high, as well as its multiple occurrence through time (2.44 defects per individual) and its onset occurs from the earliest age classes. Diet, on the other hand, does not seem to have been particularly carbohydrate based. Oral pathologies are very low, which is consistent with meat consumption complementing a diet rich in low-calorific products of agriculture and seemingly low in refined carbohydrates. Copyright (c) 2005 John Wiley & Sons. Ltd