On the Global Regularity of a Helical-decimated Version of the 3D Navier-Stokes Equations

We study the global regularity, for all time and all initial data in $H^{1/2}$, of a recently introduced decimated version of the incompressible 3D Navier-Stokes (dNS) equations. The model is based on a projection of the dynamical evolution of Navier-Stokes (NS) equations into the subspace where helicity (the $L^2-$scalar product of velocity and vorticity) is sign-definite. The presence of a second (beside energy) sign-definite inviscid conserved quadratic quantity, which is equivalent to the $H^{1/2}-$Sobolev norm, allows us to demonstrate global existence and uniqueness, of space-periodic solutions, together with continuity with respect to the initial conditions, for this decimated 3D model. This is achieved thanks to the establishment of two new estimates, for this 3D model, which show that the $H^{1/2}$ and the time average of the square of the $H^{3/2}$ norms of the velocity field remain finite. Such two additional bounds are known, in the spirit of the work of H. Fujita and T. Kato \cite{kato1,kato2}, to be sufficient for showing well-posedness for the 3D NS equations. Furthermore, they are directly linked to the helicity evolution for the dNS model, and therefore with a clear physical meaning and consequences

Anesthetic management of a parturient with Ehlers-Danlos syndrome posted for elective cesarean section

A heterogeneous group of inherited disorders of the connective tissue, characterized by skin hyperextensibility, joint hypermobility and tissue fragility, is defined as Ehlers-Danlos syndrome (EDS). The clinical manifestations vary depending on the type of disease. This syndrome may be associated with numerous pregnancy complications, ranging from mild articular discomfort to maternal death. We report the anesthetic management and the literature review of a parturient with EDS undergoing elective cesarean section

Responding to Incorrect ISDS Decision-Making: Policy Options

Criticism of the quality of investor-State dispute settlement (ISDS) decision-making often focuses on inconsistency (comparing ISDS decisions), and less frequently, incorrectness (evaluating individual ISDS decisions on a standalone basis). This article situates incorrect ISDS decision-making within the broader context of public international law and develops potential policy responses, guided by three considerations. First, criticism of ISDS decision-making has been significant. Second, criticism of particular ISDS decisions, even when widespread and intense, does not necessarily establish their incorrectness. Finally, development of policy options should be informed by a broad understanding of ‘incorrectness’, to include instances of questionable legal analysis that cast doubt on the reliability of ISDS legal conclusions and outcomes; that approach can support not only the avoidance of incorrect ISDS decision-making in a strict sense, but also, more expansively, the achievement of correct ISDS decision-making, consisting of two core elements: correct identification and precise application of applicable law

Appendectomy and women’s reproductive outcomes: a review of the literature

Background The most frequent abdominal surgery performed for benign disease in females of fertile age is appendectomy, which remains among the most common surgeries and is a possible cause of peritoneal adhesions. The fact that appendectomy can cause adhesions may lead one to think that this may be a relevant risk factor for infertility; however, there is no universal agreement regarding the association between appendectomy and fertility. The aim of this review is to evaluate weather appendectomy may have a relevant impact on female fertility.Methods The search was conducted in PubMed and there was no limitation set on the date of publication. All studies regarding populations of female patients who had undergone appendectomy for inflamed appendix, perforated appendix, or negative appendix between childhood and the end of the reproductive period were included. Results Some authors believe that pelvic surgery can cause adhesions which can potentially lead to tubal infertility by causing tubal obstruction or by altering motility of fimbriae, tubal fluid secretion, and embryo transport. On the other hand, the most recent evidence reported that removal of the appendix seems to be associated with an increased pregnancy rate in large population studies. Conclusion Despite the existence of contrasting opinions concerning fertility after appendectomy, the most recent evidence suggests that appendectomy may actually lead to improved fertility and decreased time to pregnancy. Appendectomy seems to be correlated with improved fertility and higher pregnancy rates

Fatal Takotsubo syndrome in critical COVID-19 related pneumonia

COVID-19 can involve several organs and systems, often with indirect and poorly clarified mechanisms. Different presentations of myocardial injury have been reported, with variable degrees of severity, often impacting on the prognosis of COVID-19 patients. The pathogenic mechanisms underlying cardiac damage in SARS-CoV-2 infection are under active investigation. We report the clinical and autopsy findings of a fatal case of Takotsubo Syndrome occurring in an 83-year-old patient with COVID-19 pneumonia. The patient was admitted to Emergency Department with dyspnea, fever and diarrhea. A naso-pharyngeal swab test for SARS-CoV-2 was positive. In the following week his conditions worsened, requiring intubation and deep sedation. While in the ICU, the patient suddenly showed ST segment elevation. Left ventricular angiography showed decreased with hypercontractile ventricular bases and mid-apical ballooning, consistent with diagnosis of Takotsubo syndrome (TTS). Shortly after the patient was pulseless. After extensive resuscitation maneuvers, the patient was declared dead. Autopsy revealed a subepicardial hematoma, in absence of myocardial rupture. On histology, the myocardium showed diffuse edema, multiple foci of contraction band necrosis in both ventricles and occasional coagulative necrosis of single cardiac myocytes. Abundant macrophages CD68+ were detected in the myocardial interstitium. The finding of diffuse contraction band necrosis supports the pathogenic role of increased catecholamine levels; the presence of a significant interstitial inflammatory infiltrate, made up by macrophages, remains of uncertain significance

Nociplastic Pain in Gynecology: Understanding This Painful Experience in Women

The term “nociplastic pain” was introduced in 2017 by the International Association for the Study of Pain (IASP) to describe pain that results from impaired nociception despite no clear evidence of actual or potential tissue damage causing activation of peripheral nociceptors or evidence of disease or lesion of the somatosensory system causing the pain. It is a definition born from the need to recognize early the presence of central sensitization of the nervous system in patients with chronic pain; we can find ourselves in the co-presence of nociceptive or neuropathic pain and nociplastic pain. In gynecological pathology, nociplastic pain plays an important role characterizing some important pathologies that can be associated with chronic pelvic pain in women. It is essential to understand the mechanisms of pathogenesis and maintenance of nociplastic pain in order to undertake a multidisciplinary path for the treatment of these patients

Vulvodynia: Pain Management Strategies

Background: Vulvodynia is defined in this international consensus as persistent vulvar pain that occurs for >3 months without an identifiable cause and with several potential associated factors. At present there is no univocal consensus in the therapeutic treatment of vulvodynia. The methods of intervention are based on various aspects including, above all, the management of painful symptoms. Methods: a research on scientific database such as “Pubmed”, “Medline Plus”, “Medscape” was conducted, using the words “women’s genital pain” and “vulvodynia” for the review of the scientific evidence on the assessment and treatment of women’s genital pain. Results: Among the drugs with pain-relieving action, the most effective in the treatment of vulvodynia would seem to be those with antidepressant and anticonvulsant action, even if their mechanisms of action are not known and there are still insufficient studies able to demonstrate their real validity. Among the least effective are non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. However, the ideal would seem to use a combined treatment with multiple types of drugs. Conclusions: Future studies are needed to draw up a unique therapeutic action plan that considers the stratification of patients with vulvodynia and the variability of the symptom

Opioids and breast cancer recurrence: a systematic review

Breast cancer has the greatest epidemiological impact in women. Opioids represent the most prescribed analgesics, both in surgical time and in immediate postoperative period, as well as in chronic pain management as palliative care. We made a systematic review analyzing the litera-ture’s evidence about the safety of opioids in breast cancer treatment, focusing our attention on the link between opioid administration and increased relapses. The research has been conducted using the PubMed database. Preclinical studies, retrospective and prospective clinical studies, review articles and original articles were analyzed. In the literature, there are several preclinical in vitro and in vivo studies, suggesting a possible linkage between opioids administration and progression of cancer disease. Nevertheless, these results are not confirmed by clinical studies. The most recent evidence reassures the safety of opioids during surgical time as analgesic associated with anesthet-ics drugs, during postoperative period for optimal cancer‐related pain management and in chronic use. Currently, there is controversial evidence suggesting a possible impact of opioids on breast cancer progression, but to date, it remains an unresolved issue. Although there is no conclusive evidence, we hope to arouse interest in the scientific community to always ensure the best standards of care for these patients

Opioids and Breast Cancer Recurrence: A Systematic Review

Breast cancer has the greatest epidemiological impact in women. Opioids represent the most prescribed analgesics, both in surgical time and in immediate postoperative period, as well as in chronic pain management as palliative care. We made a systematic review analyzing the literature’s evidence about the safety of opioids in breast cancer treatment, focusing our attention on the link between opioid administration and increased relapses. The research has been conducted using the PubMed database. Preclinical studies, retrospective and prospective clinical studies, review articles and original articles were analyzed. In the literature, there are several preclinical in vitro and in vivo studies, suggesting a possible linkage between opioids administration and progression of cancer disease. Nevertheless, these results are not confirmed by clinical studies. The most recent evidence reassures the safety of opioids during surgical time as analgesic associated with anesthetics drugs, during postoperative period for optimal cancer-related pain management and in chronic use. Currently, there is controversial evidence suggesting a possible impact of opioids on breast cancer progression, but to date, it remains an unresolved issue. Although there is no conclusive evidence, we hope to arouse interest in the scientific community to always ensure the best standards of care for these patients