Design of the Test Section for the Experimental Validation of Antipermeation and Corrosion Barriers for WCLL BB

Tritium permeation into the Primary Heat Transfer System (PHTS) of DEMO and ITER reactors is one of the challenging issues to be solved in order to demonstrate the feasibility of nuclear fusion power plants construction. Several technologies were investigated as antipermeation and corrosion barriers to reduce the tritium permeation flux from the breeder into the PHTS. Within this frame, alumina coating manufactured by Pulsed Laser Deposition (PLD) and Atomic Layer Deposition (ALD) are two of the main candidates for the Water Cooled Lithium Lead (WCLL) Breeder Blanket (BB). In order to validate the performance of the coatings on relevant WCLL BB geometries, a mock-up was designed and will be characterized in an experimental facility operating with flowing lithium-lead, called TRIEX-II. The present work aims to illustrate the preliminary engineering design of a WCLL BB mock-up in order to deeply investigate permeation of hydrogen isotopes through PHTS water pipes. The permeation tests are planned in the temperature range between 330 and 500 °C, with hydrogen and deuterium partial pressure in the range of 1–1000 Pa. The hydrogen isotopes transport analysis carried out for the design and integration of the mock-up in TRIEX-II facility is also shown

Watchful Waiting After Radiological Guided Drainage of Intra-abdominal Abscess in Patients With Crohn's Disease Might Be Associated With Increased Rates of Stoma Construction

Background: Management of spontaneous intra-abdominal abscess (IAA) in patients with Crohn's disease (CD) with radiologically guided percutaneous drainage (PD) was debated. Methods: This is a secondary analysis from a multicenter, retrospective cohort study of all the patients with CD who underwent PD followed by surgery at 19 international tertiary centers. Results: Seventeen patients (4.8%) who did not undergo surgery after PD were compared to those who had PD followed by surgical intervention 335/352 (95.2%). Patients who had PD without surgery were those with longer disease duration, more frequently had previous surgery for CD (laparotomies/laparoscopies), enteric fistula, on steroid treatment before and continue to have it after PD. Patients who had PD without subsequent surgical resection had a higher risk of stoma construction at later stages 8/17 (47.1%) versus 90/326 (27.6%) (P < .01). Patients with PD with no subsequent surgery had numerically higher rates of abscess recurrence 5/17 (29.4%) compared to those who had PD followed by surgery 45/335 (13.4%) the difference was not statistically significant (P = .07). Conclusions: Even with the low number of patients enrolled in this study who had PD of IAA without subsequent surgery, the findings indicate a markedly worse prognosis in terms of recurrence, length of stay, readmission, and stoma construction. Watchful waiting after PD to treat patients with spontaneous IAA might be indicated in selected patients with poor health status or poor prognostic factors

National variations in perioperative assessment and surgical management of Crohn's disease: a multicentre study

Aim: Crohn's disease (CD) requires a multidisciplinary approach and surgery should be undertaken by dedicated colorectal surgeons with audited outcomes. We present a national, multicentre study, with the aim to collect benchmark data on key performance indicators in CD surgery, to highlight areas where standards of CD surgery excel and to facilitate targeted quality improvement where indicated. Methods: All patients undergoing ileocaecal or redo ileocolic resection in the participating centres for primary and recurrent CD from June 2018 to May 2019 were included. The main objective was to collect national data on hospital volume and practice variations. Postoperative morbidity was the primary outcome. Laparoscopic surgery and stoma rate were the secondary outcomes. Results: In all, 715 patients were included: 457 primary CD and 258 recurrent CD with a postoperative morbidity of 21.6% and 34.7%, respectively. Laparoscopy was used in 83.8% of primary CD compared to 31% of recurrent CD. Twenty-five hospitals participated and the total number of patients per hospital ranged from 2 to 169. Hospitals performing more than 10 primary CD procedures per year showed a higher adoption of laparoscopy and bowel sparing surgery. Conclusions: There is significant heterogeneity in the number of CD surgeries performed per year nationally in Italy. Our data suggest that high-volume hospitals perform more complex procedures, with a higher adoption of bowel sparing surgery. The rate of laparoscopy in high-volume hospitals is higher for primary CD but not for recurrent CD compared with low-volume hospitals

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

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

Pyraclostrobin can mitigate salinity stress in tomato crop

Processing tomato is a widespread crop in the Mediterranean area where often there are problems of high salinity of irrigation water with considerable harmful effects on yield. Pyraclostrobin is a strobilurin based fungicide (PBF) having a broad range of applications. Strobilurins are reported to have biostimulant effect on plant mitigating abiotic stress. Therefore, the objective of this work was to investigate the ability of PBF to improve gas exchange parameters, chlorophyll, activity of antioxidative enzymes as superoxide dismutase (SOD), peroxidase (POD), catalase (CAT), ascorbate peroxidase (APX), yield characteristics, and water use efficiency (WUE) of tomato under salinity. A two-year research was carried out in Southern Italy, on tomato cv Coronel grown in pots under plastic greenhouse, to compare two soil salinity levels (electrical conductivity, ECe = 1.1 and 5.4 dS m−1) in combination with or without PBF. As expected, salinity had harmful effects on physiological and biochemical parameters of tomato that in turn affected yield and WUE, but improved fruit quality. In fact, salinity reduced fruit mean weight (19.0%) and yield (21.4%), and increased fruit blossom-end rot (55.7%), total soluble solids (18.2%) and dry matter (18.5%) content. Overall, PBF increased leaf chlorophyll content (6.1%) and the activity of SOD, POD, CAT and APX, mainly under salinity. Moreover, it reduced stomatal conductance (12.5%) and transpiration (11.7%), but improved assimilation rate (7.8%) and intrinsic WUE (23.3%), that in turn increased yield (8.1%) and yield WUE (6.5%). The improvement in yield produced by PBF was highest in salt stressed plants. In view of the positive effects of PBF, its use should be promoted in defence programs of tomato crop, above all in areas with salinity problems

Interactive Effect of Nitrogen and Azoxystrobin on Yield, Quality, Nitrogen and Water Use Efficiency of Wild Rocket in Southern Italy

Wild rocket (Diplotaxis tenuifolia L. DC) is an emerging vegetable which market requires high-quality standards that can be obtained through appropriate cultivation techniques such as the right level of nitrogen and the application of biostimulant substances. These include strobilurins, marketed mainly as fungicides that can have complementary positive effects on the yield, quality and resources’ use efficiency of many crops. For this reason, a trial in an unheated greenhouse, in Southern Italy, to evaluate the possibility of using Azoxystrobin to improve the production of wild rocket subjected to different nitrogen inputs, was carried out. Two N levels (40 and 140 kg ha−1), Azoxystrobin-based biostimulant (Azo+) and control without Azoxystrobin (Azo−) were compared. The yield, morphological characteristics, nitrogen and water use efficiency (NUE, WUE), antioxidant activity, the content of dry matter, chlorophyll, carotenoids, phenols, and nitrates were assessed. A higher N level resulted in a 16.3% yield increase that was matched by a 12.5% reduction in NUE, 15.8, 7.3, and 16.1% increases in yield WUE (Y_WUE), biomass WUE (B_WUE), and irrigation yield WUE (IY_WUE), respectively, and a worsening of some qualitative characteristics such as a 8.5% rise in nitrates, and a decline by 11.5, 10.1, and 26.1% in the carotenoids, phenols, and antioxidant activity, respectively. Azo+ increased the yield by 10.3%, NUE by 8.9%, and Y_WUE, B_WUE, and IY_WUE, by 13.9, 9.1, and 13.8% respectively. Moreover, Azo+ improved some qualitative characteristics such as total phenols (+9.4%), chlorophyll (+15.2%), carotenoids (+9.7%), and antioxidant activity (+17.4%), while it did not affect the nitrate content. Azoxystrobin can be an additional tool available for farmers to ensure high-quality standards of wild rocket

A comparative cost analysis of transanal and laparoscopic total mesorectal excision for rectal cancer

Despite proven clinical benefits in the short term, technical difficulties limit utilization of laparoscopy in rectal cancer surgery (RCS). Transanal Total Mesorectal Excision (taTME) overcomes many technical limitations of laparoscopic RCS. However, the costs of this procedure have not been addressed yet. Our goal was to perform a comparative cost analysis of taTME and laparoscopic TME (lapTME). Consecutive patients undergoing curative TME between 1 February 2014 and 31 October 2018 were selected from a prospectively maintained database and stratified, according to the type of procedure, into taTME and lapTME groups. Patient demographics, tumour characteristics, operative parameters, and short-term outcomes were analyzed. The main outcome measure was intraoperative costs of the two procedures. Secondary outcomes were short-term outcome and the utilization of hospital resources to manage the postoperative course. Hundred and fifty-two patients with rectal cancer (66 lapTME, 86 taTME) were included in the study. Surgical supplies required for taTME procedure exceeded the cost of lapTME of 754,54 €. The duration of surgery was not significantly different between the two approaches (266 ± 92.85 vs 271 ± 83.63, p = 0.50). Short-term outcomes were comparable including postoperative complication rate (17 vs 20%, p = 0.68), reintervention rate, and length of stay. There was no difference in hospital resources utilization to manage postoperative course including blood test, diagnostics, consultations, and medications. TaTME has higher intraoperative costs in terms of supplies with respect to lapTME. Short-term outcomes and hospital resources to manage postoperative course are comparable

Effects of Nitrogen Level and Biostimulant Application on Wild 2 Rocket Features at Harvest and During Storage

Recently, the use of biostimulant substances of different origins has been affirmed. They act differently on the physiological processes of the plant, helping to improve its productive response and resistance to biotic and abiotic stress. Therefore, the response of the wild rocket to two substances known to have biostimulating activity (Azoxystrobin, and a fluid extract of brown algae and yeast), was evaluated. Two experimental trials (Exp 1 and Exp 2) were carried out in the greenhouse. The collected product, in addition to being evaluated from a qualitative point of view, was used for evaluation of shelf life. Exp 1 involved the comparison of two N levels with two Azoxystrobin levels (treated–Azo+, and untreated control). Exp 2 involved the comparison of two N levels, and two biostimulating substances based on Azoxystrobin (Azo+) and on fluid extracts of yeast and brown algae (YBA+), in addition to untreated control. A split-plot experimental design with three replications was used. Azo+ increased marketable yield of wild rocket by 16.8% and enhanced some qualitative features at harvest as the increase in chlorophyll (+17.8%) and carotenoids (+13.5%), and decrease in nitrates (−10.6%), regardless of the nitrogen level. Furthermore, Azo+ increased the shelf life (+2.5 days) of wild rocket stored at 3.5 °C. In particular, Azo+ slowed the loss of chlorophyll (yellowing) and the worsening of odor and visual appearance. As Azoxystrobin is a fungicide effective for the control of some diseases of wild rocket, its use should be promoted as it would offer not only the benefit of disease control but also improved production and shelf life. YBA+ caused an increase in the chlorophyll content (+12.5%) at harvest of wild rocket, but reduced its antioxidant activity (−40%). YBA+ did not cause substantial variations in shelf life with the exception of a slowdown in the degradation of carotenoids. Further research is desirable to evaluate other variables such as the dose and time of application