Recognition and management of hereditary colorectal cancer syndromes

Over 1,900 colorectal tumors will arise in association with a hereditary colorectal cancer syndrome in Spain in 2009. The genetic defects responsible for the most common syndromes have been discovered in recent years. Genetic testing helps diagnose affected individuals and allows identification of individuals at-risk. Colonoscopy and prophylactic colectomy decrease colorectal cancer incidence and overall mortality in patients with hereditary colon cancer. Extracolonic tumors are frequent in these syndromes, so specific surveillance strategies should be offere

Firm capacity of PV+STG systems

The security of supply becomes a key variable of the electrical system. Due to the discontinuity of solar irradiance, PV generators are essentially not dispatchable and they operate only when there is solar resource but cannot ensure their availability when the energy is needed, so PV systems are considered having a null capacity credit. Energy storage is considered a key for the power sector and its sustainability and different options need to be exploited. The objective of this paper is analyse the optimum size of the required battery, its relations with the peak power of the generation system and the optimum operation setpoint of a PV+STG system for providing firm capacity. © 2022, European Association for the Development of Renewable Energy, Environment and Power Quality (EA4EPQ). All rights reserved

Analysis of the main passive soft tissues associated with adult acquired flatfoot deformity development: A computational modeling approach

Adult acquired flatfoot deformity (AAFD) is a pathology with a wide range of treatment options. Physicians decide the best treatment based on their experience, so the process is entirely subjective. A better understanding of soft tissue stress and its contribution in supporting the plantar arch could help to guide the clinical decision. Traditional experimental trials cannot consistently evaluate the contribution of each tissue. Therefore, in this research a 3-Dimensional FE foot model was reconstructed from a normal patient in order to measure the stress of the passive stabilizers of the arch, and its variation in different scenarios related with intermediate stages of AAFD development. All bones, the plantar fascia (PF), cartilages, plantar ligaments and the spring ligament (SL) were included, respecting their anatomical distribution and biomechanical characteristics. An AAFD evaluation scenario was simulated. The relative contribution of each tissue was obtained comparing each result with a normal case. The results show that PF is the main tissue that prevents the arch elongation, while SL mainly reduces the foot pronation. Long and short plantar ligaments play a secondary role in this process. The stress increment on both PF and SL when one of two fails suggests that these tissues complement each other. These findings support the theory that regards the tibialis posterior tendon as a secondary actor in the arch maintenance, compared with the PF and the SL, because this tendon is overstretched by the hindfoot pronation around the talonavicular joint. This approach could help to improve the understanding of AAFD

Analysis of a domestic trigeneration scheme with hybrid renewable energy sources and desalting techniques

In this paper, experimental tests of a hybrid trigeneration pilot unit based on renewable energy sources are presented and analyzed. The plant provides electricity by coupling four photovoltaic/thermal collectors and a micro-wind turbine, fresh water by means of hybrid desalination (membrane distillation, and reverse osmosis), and sanitary hot water coming from the photovoltaic/thermal collectors and an evacuated tubes collector. Plant design was previously modeled to cover the power, freshwater and sanitary hot water for a typical family home (four residents) isolated from the power and water networks. The hybrid pilot unit has been tested from May 2017 to March 2018 in Zaragoza (Spain). Results from those tests show that daytime assessment of power, freshwater and sanitary hot water produced allowed a good coverage of scheduled energy and water demands. Flexible operation due to the combined production of power and heat was also observed. State of charge of the batteries and the temperature of the sanitary hot water tank are the key control variables, which allow to give priority to power, freshwater or sanitary hot water production according to the ordered demands or economic incentives. Environmental assessment of the pilot unit along its life cycle also has shown very low impacts with respect to the conventional supply of energy and water

Exergy assessment and exergy cost analysis of a renewable-based and hybrid trigeneration scheme for domestic water and energy supply

Exergy and exergy cost analyses are proposed as complementary methods for the assessment and better understanding of the efficiency of a hybrid trigeneration system based on renewable energy sources. The system combines photovoltaic/thermal collectors, an evacuated tube collector and a wind turbine and produces electricity, sanitary hot water and desalted fresh water for a single family house. The system includes two desalination technologies (reverse osmosis and membrane distillation) that consume power and heat respectively, and two kinds of energy storage devices (a hot water tank and two lead-acid batteries). The assessment is based on simulations developed by using TRNSYS software. As a first level of detail, exergy analysis is applied in ten-minute basis to selected plant components. As a second level of detail, it is proposed to apply exergy-based indicators that summarize the system behavior during a longer period of time (monthly basis). By using aggregated values, exergy accumulation terms become negligible, what allows applying symbolic thermoeconomics to calculate exergy cost and to analyze in depth the process of cost formation. The system has an exergy efficiency of 7.76% (6.68 due to electricity, 0.33 due to fresh water and 0.75 due to sanitary hot water)

Solar-assisted heat pump coupled to solar hybrid panels

A water-water solar-assisted heat pump (SAHP) is going to be installed on an academic building at the University of Zaragoza (Spain). It integrates a heat pump heating system with photovoltaics/thermal collectors and seasonal storage. Considerably higher performances than a conventional type air-source heat pump are expected to be reached. This paper shows the simulation of the system performed in trnsys, a graphically based software used to simulate the behaviour of transient systems. The obtained energy and monetary savings are analysed

Influence of tumor characteristics on the outcome of liver transplantation among

Hepatocellular carcinoma (HCC) may recur after liver transplantation (LT), mainly in patients with multinodular and large tumors. However, factors predictive of outcome after LT in patients with small tumors remain ill defined. We investigated which factors were related to mortality or tumor recurrence among 47 liver transplant recipients with liver cirrhosis and HCC and compared them with 107 patients with liver cirrhosis without tumor who underwent LT in the same period. Patients with HCC were older (P <.001), more frequently had cirrhosis of a viral origin (P <.001), and had lower Child-Pugh scores (P <.001) than patients without tumor. Survival of patients with and without tumor was not significantly different (P =.20). Among patients with HCC, those with lower recurrence-free survival rates had liver cirrhosis of a viral origin, vascular invasion, bilobar disease, and tumor-node-metastasis (TNM) stage IV. At multivariate analysis, the only factor associated with mortality or recurrence was TNM stage IV (P =.02). Our results suggest that in patients with HCC and TNM stage IV, LT might be contraindicate

Effectiveness of the Lapidus plate system in foot surgery: A PRISMA compliant systematic review

Lapidus arthrodesis is an established standard procedure to correct various foot surgery problems and hallux limitus, hypermobility of the first ray, hallux abductus valgus, and symptomatic lesser metatarsal. After decades, many fixation methods in the orthopaedic surgery industry have been developed for decreasing complications and improving this technique. The aim of this PRISMA compliant systematic review is to analyse the effectiveness of several lapidus plate systems in foot surgery. We have carried out the first systematic review of the relevant published literature so as to systematically evaluate the scientific knowledge available now on this association, assigning predefined eligibility criteria. Fourteen studies were selected which had an overall of 738 cases. The first tarsal metatarsal joint and hallux valgus were treated by the application of different types of Lapidus plate system. The optimal level of the fixation in these procedures is related with the type and system insertion place of the plate with or without screw in each specific foot disease. There is an insufficient number of studies about the effectiveness of the different types of Lapidus plate system in foot surgery, and there is a need to increase outcomes knowledge on the level of the fixation, sort of the system, and insert place in foot surgery

Structural interaction between bone and implants due to arthroplasty of the first metatarsophalangeal joint

Background: Currently, the metatarsophalangeal joint replacement through a restorative arthroplasty, where implants are used, is a viable invasive surgical medical procedure in the treatment of severe cases of osteoarthritis in this joint, better known as hallux rigidus. However, few things are known about the postoperative complications that implants can cause on the joint, like Swanson and Tornier implants.Research in this field can provide a valuable information that would help the specialist surgeon in the decision-making during the selection of the more suitable joint implant in each patient, as well as the redesign of the devices, to make them more efficient, durable and biocompatible with the human body. Methods: The aim of this work is to perform a structural biomechanical analysis of a restorative arthroplasty of the first metatarsophalangeal joint, and to analyze the interaction between bone and medical grade silicone implants. For that, a simulation of a foot with Swanson and Tornier joint implants were performed to evaluate the stress/strain distribution during a critical stage (toe-off). Results and conclusions: Principal stresses obtained for the first metatarsal with both implants suggest that failure is induced in this bone because, values exceed (up to 136.84% for Swanson model) the tensile strength reported for phalange trabecular bone, which may be related to osteolysis. Stress and strain values obtained in this work suggest that arthroplasty surgery with Swanson implant is more likely to cause postoperative complications versus Tornier implant