Negative Pressure Wound Therapy applied to a cholecystoparietal fistula: How to treat a rare complication of a common condition - a case report

A cholecystoparietal fistula is an uncommon complication of gallstone disease as a result of neglected gallbladder disease).The subcutaneous abdominal wall abscess, derived from this condition, might be wide and hard to treat, especially in elderly and debilitated patients. The best management of cholecystoparietal fistula depends on its etiology and may require medical, surgical, or endoscopic treatment. Negative Pressure Wound Therapy (NPWT) is a valuable support therapy that can improve the prognosis of the disease and the patient’s outcome. We report the case of an 89-year-old female patient affected by a spontaneous cholecystoparietal fistula with a wide abdominal wall abscess treated by a one-stage surgical approach combined with NPWT over the resulting skin loss

Reproducibility and Repeatability Tests on (SnTiNb)O2 Sensors in Detecting ppm-Concentrations of CO and Up to 40% of Humidity: A Statistical Approach

: Nowadays, most medical-diagnostic, environmental monitoring, etc. devices employ sensors whose fabrication reproducibility and response repeatability assessment are crucial. The former consists of large-scale sensor manufacture through a standardized process with almost identical morphology and behavior, while the latter consists of giving the same response upon repeating the same stimulus. The thermo-activated chemoresistive sensors, which change their conductance by interacting with the molecules composing the surrounding gas, are currently employed in many devices: in particular, thick-film (SnTiNb)O2 nanosensors were demonstrated to be particularly suitable in the medical and biological fields. Therefore, a set of thirteen of them, randomly selected from the same screen-printing deposition, were laboratory tested, and the outcomes were statistically analyzed in order to assess their consistency. At first, the working temperature that maximized both the sensor sensitivity and response repeatability was identified. Then, the sensors were subjected to different gas concentrations and humidities at this optimal working temperature. It resulted in the (SnTiNb)O2 nanosensors detecting and discriminating CO concentrations as low as 1 ppm and at high humidity degrees (up to 40%) with high repeatability since the response relative standard error ranged from 0.8 to 3.3% for CO and from 3.6 to 5.4% for water vapor

Effect of environmental conditions on the modal response of a 10-story reinforced concrete tower

We analyse the effect of temperature and wind velocity on the natural frequencies and modal damping ratios of the Faculty of Engineering Tower at the Università Politecnica delle Marche, a 10-story reinforced concrete frame building, permanently monitored with low-noise accelerometers. The data recorded over the first 5 months of monitoring demonstrate that temperature variations and wind intensity have a clear effect on the first three natural frequencies and the corresponding damping ratios. Temperature is positively correlated to the first and second frequencies, corresponding to shear displacement modes and negatively correlated to the third frequency, corresponding to a torsional mode. All frequencies are positively correlated to wind velocity and changes in damping ratios are inversely correlated to any change in frequency. A mechanical explanation of these phenomena is offered, based on a critical review of literature case studies. These results suggest that using changes in modal parameters for damage detection always requires accurate knowledge of the correlation between modal parameters and environmental quantities (temperature, humidity, and wind velocity), an information which is only available through long-term continuous monitoring of the structural response

WO3 processed by direct laser interference patterning for NO2 detection

In this paper two kind of sensors based on WO3 sputtered by magnetron sputtering and annealed at 600 °C have been studied. The first kind was processed by two-dimensional direct laser interfering patterning (DLIP) and the second one without any additional treatment. Morphological and structural characterization have shown a hole structure in a periodic line-pattern for the DLIP-processed sensors and a flat surface for the only-annealed sensors, both with a tetragonal WO3 phase. TOF-SIMS analysis has revealed that the first WO3 layers are reduced for both samples, which could improve sensing performance. Promising response enhancement of DLIP-processed sensors has been observed for low concentrations of NO2 (from 0.5 ppm to 5 ppm) at 200 °C, lowering the limit of detection (LOD) to 10 ppb, half of the LOD of the only-annealed sensors (20 ppb). Cross sensitivity to CO and HCHO have been investigated and the sensing mechanisms discussed

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Manhãs, poentes, zênites e noites : aspectos da representação de luz e sombra na música de Harry Crowl

This dissertation analyzes the cycle "light and shadow" of the brazilian composer Harry Crowl (1958) comprising the works: Na Perfurada Luz em Plano Austero (1992-93); Umbrae et Lumen (1993); Lumen de Lumine (1997) e No Silêncio das Noites Estreladas (1998); Aetherius (2002); E que Sejam Luminárias, no Céufogoágua (2004) e Tenebrae et Stellae (2005). The goal was to relate musical structures to phenomena of light and shadow that inspired these works, as well as aesthetically and historically situate the resources involved in this representation. The work of Harry Crowl makes a strong allusion to the visible with a musical language that is the synthesis of several references. First, its language is contextualized within postmodernism front of the most striking features of concert music in the second half of the century. In a second moment, considerations ball visible in music brings relationships between sound, color, light and texture. Subsequently, a survey on musical representation of light and shadow throughout history shows strategies used by other composers. Finally, through interviews with the composer, a study on the genesis of the cycle in question works and musical analysis with emphasis on texture attempts to uncover the structures involved in the musical depiction of light and shadow.Este trabalho analisa o ciclo ¿luz e sombra¿ do compositor brasileiro Harry Crowl (1958) formado pelas obras: Na Perfurada Luz em Plano Austero (1992-93); Umbrae et Lumen (1993); Lumen de Lumine (1997); No Silêncio das Noites Estreladas (1998); Aetherius (2002); E que Sejam Luminárias, no Céufogoágua (2004) e Tenebrae et Stellae (2005). O objetivo foi relacionar estruturas musicais aos fenômenos de luz e sombra que inspiraram estas obras bem como situar historicamente e esteticamente os recursos envolvidos nesta representação. A obra de Harry Crowl faz uma forte alusão ao visível com uma linguagem musical que é síntese de várias referências. Primeiramente, sua linguagem é contextualizada dentro do pós-modernismo frente às características mais marcantes da música de concerto na segunda metade do século XXI. Em um segundo momento, considerações sobre a esfera do visível em música traz relações entre som, cor, luz e textura. Posteriormente, um levantamento sobre a representação musical de luz e sombra ao longo da história mostra estratégias utilizadas por outros compositores. Finalmente, mediante entrevista com o compositor, um estudo sobre a gênese das obras do ciclo em questão e análise musical com ênfase na textura procura desvendar as estruturas musicais envolvidas na representação de luz e sombra.Coordenação de Aperfeiçoamento de Pessoal de Nível Superio

Requirements for applying a case-control study model and clinical significance of changes in the visual analogue scale score in abdominal pain

The framework of the study is a comparison of two groups of patient: one group formed of people affected by the pathological condition (cases) and the other constituted by people with the same features as the cases but free from the pathological condition to be analysed (controls). The crucial aspect of the design of a case–control study is that the cases are correctly selected, since the reliability of the study itself depends on this