Prognostic factors influencing infectious complications after cytoreductive surgery and HIPEC. Results from a tertiary referral center

Background. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) showed promising results in selected patients. High morbidity restrains its wide application. The aim of this study was to report postoperative infectious complications and investigate possible correlations with preoperative nutritional status and other prognostic factors in patients with peritoneal metastases treated with CRS and HIPEC. Methods. For the study we reviewed the clinical records of all patients with peritoneal metastases from different primary cancers and treated by CRS and HIPEC in our Institution from November 2000 to December 2017. Patients were divided according to their nutritional status (SGA) in group A (well-nourished), B/C (mild or severely malnourished). Possible statistical correlations between risk factors and postoperative complications rates have been investigated by univariate and multivariate analysis. Results. Two hundred patients were selected and underwent CRS and HIPEC during the study period. Postoperative complications occurred in 44% of the patients, 35.3% in SGA-A patients and 53% in SGA-B /C patients. Cause of complications was infective in 42, non-infective in 37 and HIPEC related in 9 patients. Infectious complications occurred more frequently in SGA-B /C patients (32.6% vs. 9.8% of SGA-A patients). The most frequent sites of infection were Surgical Site Infections (SSI, 35.7%) and Central Line Associated BloodStream Infections (CLABSI, 26.2%). The most frequent isolated species was Candida (22.8%). ASA score, blood loss, performance status, PCI, large bowel resection, postoperative serum albumin levels and nutritional status correlated with higher risk for postoperative infectious complications. Conclusions. Malnourished patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are more prone to post-operative infectious complications and adequate perioperative nutritional support should be considered, including immune-enhancing nutrition. Sequential monitoring of common sites of infection, antifungal prevention of candidiasis, and careful patient selection should be implemented to reduce complications rate

Production, purification and recovery of caproic acid, Volatile fatty acids and methane from Opuntia ficus indica

Opuntia ficus-indica can grow in arid and semi-arid environments characterized by low water and nutrients availability. These features make it a more sustainable alternative to the common energy crops for biorefinery purposes. This work focused on the potential benefits of anaerobic processes applied to this plant. Specifically, it considered i) the substrate preparation, demonstrating the effect of the apparent viscosity on the process; ii) the evaluation of biomethane, Volatile Fatty Acids (VFAs), and caproic acid production in semi-continuous mode at different hydraulic retention times; iii) the purification of the Fatty Acids-rich output through pressure-driven membrane filtration. The rheology analysis found that a 5 %w/w water dilution of the substrate is needed to lower the apparent viscosity to 173 cP, which is below the acceptable apparent viscosity level of 200 cP for a good bioreactor mixing. Keeping this condition, the semi-continuous trials with the best biomethane performance was at HRT of 20 days, with 210 mLCH4/gVS and 232 mLCH4/gCODin of production and specific yield, respectively. The VFAs and caproic acid production reached their best at Hydraulic Retention Time 5, with 26 and 7.9 gCOD/L of VFAs and caproic acid, corresponding to specific yields of 79 and 30 % respectively. Pressuredriven filtration at 330 kDa allowed to obtain a permeate with a VFAs and caproic acid content of 96.72%w/w. Finally, the adsorption and desorption tests allowed to separate caproic acid from the permeate and to concentrate it from about 7.5 gCOD/L to about 26 gCOD/L

The Logistic Maturity Model: Application to a Fashion Company

This paper describes the structure of the logistic maturity model (LMM) in detail and shows the possible improvements that can be achieved by using this model in terms of the identification of the most appropriate actions to be taken in order to increase the performance of the logistics processes in industrial companies. The paper also gives an example of the LMM’s application to a famous Italian female fashion firm, which decided to use the model as a guideline for the optimization of its supply chain. Relying on a 5-level maturity staircase, specific achievement indicators as well as key performance indicators and best practices are defined and related to each logistics area/process/sub-process, allowing any user to easily and rapidly understand the more critical logistical issues in terms of process immaturity

Trabecular bone score (TBS) in the assessment of bone microarchitecture in acromegaly

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Mechanical Behavior of PET-G Tooth Aligners Under Cyclic Loading

Invisible aligners are medical devices, which allow repositioning of teeth through a treatment designed by the orthodontists. During this orthodontic treatment, patients use several aligners each for a couple of weeks. The aligner will apply a system of forces on the teeth to shift them to desired position. Since aligners exert forces thanks to their particular shape, it is important that during lifetime's service they do not undergo significant deformations. This research aims to study the mechanical behavior of invisible aligners made by polyethylene terephthalate-glycol (PET-G), which is one of most used the plastic materials to produce such devices. In this study, cyclic compression tests in atmospheric environment (∼25°C) as well as in the presence of saliva (to simulate intraoral environment) were performed. The mechanical behavior of aligners with two different thicknesses (0.75 and 0.88 mm) was studied. In particular, each aligner was subjected to 22500 load cycles from 0 to 50 N. The chosen number of load cycles simulates the average load history to which an aligner is subjected during its lifetime. The tests were performed on a testing machine, using a hard resin dental cast properly fixed to the machine. Analysis of the results shows that the stiffness of the aligners increases during the cyclic test. In particular, a gradual reduction of the crosshead displacement was observed during the test, highlighting the occurrence of cyclic hardening phenomena. It was also found that the aligners show a residual strain recovery after removing the applied load. Moreover, in the analyzed range of load rate, the aligners show a low tendency to accumulate residual strains as loading cycles progress

Identification and Measurement of Carbonic Anhydrase-II Molecule Numbers in the Rat Carotid Body

Carbonic anhydrase (CA) in the carotid body (CB) plays an important role in the maintenance of blood PO2 and PCO2/pH homeostasis by regulating ventilation. It has been observed that the activity of CA in the rabbit CB is stronger under hypoxic conditions than under normoxic and hyperoxic conditions. In conditions of chronic hypoxia, the volume of the CB increases significantly because the number of type I and II cells increases. So far, the number of CA molecules in the CB has not been assessed. We develop a technique to quantify the number of CA molecules in the CB. The CBs were dissected out from 8 rats, immediately frozen with liquid nitrogen, pulverized and centrifuged. The proteins extracted from CB tissue were heat-denatured and separated by electrophoresis on a 12.5% denatured-polyacrylamide gel (SDSPAGE); a 31 kDa protein band was determined which reacted with a rabbit polyclonal antibody specific for rat CA-II in Western blot analysis. The immunoreactive 31 kDa CA-II protein was detected and quantified by laser scanner densitometry using 125I-rProtein A as a tracer. The mean 125I radioactivity emitted by the antibody bound CA-II was 31277 cpm. This value corresponds to 4.57 ng CA-II. When compared with a rat CA-II calibration curve, an average of number of 3.54 x 107 CA-II molecules were quantified for 1 µg of whole CB tissue. This is a sensitive and accurate radioimmunoassay technique and may be useful in future studies on the role of CA-II in different pathophysiologic conditions

Assessment of Diagnostic and Prognostic Role of Copeptin in the Clinical Setting of Sepsis

The diagnostic and prognostic usefulness of copeptin were evaluated in septic patients, as compared to procalcitonin assessment. In this single centre and observational study 105 patients were enrolled: 24 with sepsis, 25 with severe sepsis, 15 with septic shock, and 41 controls, divided in two subgroups (15 patients with gastrointestinal bleeding and 26 with suspected SIRS secondary to trauma, acute coronary syndrome, and pulmonary embolism). Biomarkers were determined at the first medical evaluation and thereafter 24, 48, and 72 hours after admission. Definitive diagnosis and in-hospital survival rates at 30 days were obtained through analysis of medical records. At entry, copeptin proved to be able to distinguish cases from controls and also sepsis group from septic shock group, while procalcitonin could distinguish also severe sepsis from septic shock group. Areas under the ROC curve for copeptin and procalcitonin were 0.845 and 0.861, respectively. Noteworthy, patients with copeptin concentrations higher than the threshold value (23.2 pmol/L), calculated from the ROC curve, at admission presented higher 30-day mortality. No significant differences were found in copeptin temporal profile among different subgroups. Copeptin showed promising diagnostic and prognostic role in the management of sepsis, together with its possible role in monitoring the response to treatment