Hollow viscus injuries. Predictors of outcome and role of diagnostic delay

INTRODUCTION: Hollow viscus injuries (HVIs) are uncommon but potentially catastrophic conditions with high mortality and morbidity rates. The aim of this study was to analyze our 16-year experience with patients undergoing surgery for blunt or penetrating bowel trauma to identify prognostic factors with particular attention to the influence of diagnostic delay on outcome. METHODS: From our multicenter trauma registry, we selected 169 consecutive patients with an HVI, enrolled from 2000 to 2016. Preoperative, intraoperative, and postoperative data were analyzed to assess determinants of mortality, morbidity, and length of stay by univariate and multivariate analysis models. RESULTS: Overall mortality and morbidity rates were 15.9% and 36.1%, respectively. The mean length of hospital stay was 23±7 days. Morbidity was independently related to an increase of white blood cells (P=0.01), and to delay of treatment >6 hours (P=0.033), while Injury Severity Score (ISS) (P=0.01), presence of shock (P=0.01), and a low diastolic arterial pressure registered at emergency room admission (P=0.02) significantly affected postoperative mortality. CONCLUSION: There is evidence that patients with clinical signs of shock, low diastolic pressure at admission, and high ISS are at increased risk of postoperative mortality. Leukocytosis and delayed treatment (>6 hours) were independent predictors of postoperative morbidity. More effort should be made to increase the preoperative detection rate of HVI and reduce the delay of treatment

Milk somatic cell count and its relationship with milk yield and quality traits in Italian water buffaloes.

ABSTRACT In Southern Italy, buffalo (Bubalus bubalis) milk is mostly intended for the manufacture of Mozzarella di Bufala Campana Protected Denomination of Origin (PDO) cheese. Despite the economic boost of the last 2 decades, the buffalo farming system should be improved to maximize the efficiency of the dairy industry, improve yield and quality of milk and cheese, and work toward better animal welfare. Milk somatic cell count (SCC) is used worldwide as an indicator of udder health in individual milk and is useful for monitoring farm hygiene in bulk milk. Mastitis data are currently not available on a large scale in Italy; thus, SCC is essential for identifying animals with suspected udder infection and inflammation. Moreover, high milk SCC is associated with altered composition and acidity, and poor technological properties of milk. However, payment systems of the PDO area are based simply on the delivered volume of milk rather than on quality characteristics. Hence, currently there are no penalties for elevated SCC in bulk milk in the Italian buffalo dairy industry. In addition, SCC for buffalo milk is not mentioned by either the European Community regulations or the PDO protocol, evidencing a lack of rules for the maximum SCC limit. To provide a phenotypic characterization of SCC at the population level and to improve knowledge on buffalo milk quality, 876,299 test-day records of 70,156 buffaloes reared in the PDO area were analyzed. Data revealed that around 11% of herd-test-dates (≥5 animals sampled each) showed average milk SCC ≥400,000 cells/mL (i.e., above the threshold fixed by the European Community for bovine milk). This suggests that there is room to improve SCC at both the farm and individual level. Within first parity, more than 28 and 15% of lactations had average SCC ≥200,000 and ≥300,000 cells/mL, respectively. Both percentages increased with parity and were 39 and 25% in sixth parity, respectively. Supporting this, the proportion of lactations with average SCC ≥500,000 cells/mL increased from 6% in first parity to 12% in sixth parity. Milk yield and SCC were negatively correlated with each other, especially when SCC level was high. An ANOVA was carried out on test-day record milk yield and composition traits, with fixed effects of parity, lactation stage, class of somatic cell score (n = 6), month of calving, and their interactions; buffalo, herd-test-date, and residual were considered random effects. Significantly lower milk yield and lactose percentage were estimated in progressively higher classes of somatic cell score, whereas no significant differences were observed for fat and protein percentages. This is the first attempt to investigate milk SCC in a large data set of Italian dairy buffaloes. These findings may be helpful for defining reliable and effective SCC thresholds to be adopted whenever specific penalties for high SCC are included in milk payment systems. Finally, these results could be used in mastitis monitoring plans aiming to reduce SCC and udder issues at both the individual and farm levels in the Italian buffalo population

MiR-33a Controls hMSCS Osteoblast Commitment Modulating the Yap/Taz Expression Through EGFR Signaling Regulation

Mesenchymal stromal cells (hMSCs) display a pleiotropic function in bone regeneration. The signaling involved in osteoblast commitment is still not completely understood, and that determines the failure of current therapies being used. In our recent studies, we identified two miRNAs as regulators of hMSCs osteoblast differentiation driving hypoxia signaling and cytoskeletal reorganization. Other signalings involved in this process are epithelial to mesenchymal transition (EMT) and epidermal growth factor receptor (EGFR) signalings through the regulation of Yes-associated protein (YAP)/PDZ-binding motif (TAZ) expression. In the current study, we investigated the role of miR-33a family as a (i) modulator of YAP/TAZ expression and (ii) a regulator of EGFR signaling during osteoblast commitments. Starting from the observation on hMSCs and primary osteoblast cell lines (Nh-Ost) in which EMT genes and miR-33a displayed a specific expression, we performed a gain and loss of function study with miR-33a-5p and 3p on hMSCs cells and Nh-Ost. After 24 h of transfections, we evaluated the modulation of EMT and osteoblast genes expression by qRT-PCR, Western blot, and Osteoimage assays. Through bioinformatic analysis, we identified YAP as the putative target of miR-33a-3p. Its role was investigated by gain and loss of function studies with miR-33a-3p on hMSCs; qRT-PCR and Western blot analyses were also carried out. Finally, the possible role of EGFR signaling in YAP/TAZ modulation by miR-33a-3p expression was evaluated. Human MSCs were treated with EGF-2 and EGFR inhibitor for different time points, and qRT-PCR and Western blot analyses were performed. The above-mentioned methods revealed a balance between miR-33a-5p and miR-33a-3p expression during hMSCs osteoblast differentiation. The human MSCs phenotype was maintained by miR-33a-5p, while the maintenance of the osteoblast phenotype in the Nh-Ost cell model was permitted by miR-33a-3p expression, which regulated YAP/TAZ through the modulation of EGFR signaling. The inhibition of EGFR blocked the effects of miR-33a-3p on YAP/TAZ modulation, favoring the maintenance of hMSCs in a committed phenotype. A new possible personalized therapeutic approach to bone regeneration was discussed, which might be mediated by customizing delivery of miR-33a in simultaneously targeting EGFR and YAP signaling with combined use of drugs

Training software for orthogonal packing problems

An open source architecture for the interactive solution of packing problems in two dimensions is presented. Although primarily developed for helping engineering students to understand the algorithmic approaches to the solution of difficult combinatorial optimization problems, the application can be useful to practitioners and developers thanks to its visual tools. The paper gives intuitive and formal definitions of the problems at hand, discusses two natural heuristic approaches, provides technical information on the application, and reports the results of classroom experimental testings

Influence of initial season on PVC weathering

The forecast of the aging behavior of PVC items from the initial stage of formulation design is crucial and relies on accelerated weathering devices. However, running outdoor weathering tests is necessary to achieve more realistic data. Natural aging norms do not specify the initial season of exposure as a parameter, but there are natural outdoor exposure studies outlining the importance of this aspect and indicating that the lowest degradation is obtained when exposure program starts in autumn and the highest one is observed when exposure starts in winter. Therefore, the first aim of this work is to understand if the initial exposure season affects the final results. Another aim, is the investigation of the effect of titanium dioxide loading to understand if the increase in cost formulation, is worth the stabilization effect. The last goal, is the understanding of the effect of stabilizers’ types: tin-based ones mostly used in North America, compared to Calcium Organic ones mostly utilized in Europe. As for the first aim, neither the graphical comparison of discoloration data, nor their statistical analysis confirmed that starting season has a significant effect on degradation. As for the second aim, the same analysis showed that the increase of titanium dioxide from 7 to 9 phr (parts per 100 parts of PVC) is irrelevant on degradation rate. As for the effect of stabilizer type, our analysis indicated that there is a significant difference among only one tin-based stabilizer compared to the others

Differences between computed tomoghaphy and surgical findings in acute complicated diverticulitis

Summary Background/Objective: A preoperative reliable classification system between clinical and computed tomography (CT) findings to better plan surgery in acute complicated diverticulitis (ACD) is lacking. We studied the inter-observer agreement of CT scan data and their concordance with the preoperative clinical findings and the adherence with the intraoperative status using a new classification of diverticular disease (CDD). Methods: 152 patients operated on for acute complicated diverticulitis (ACD) were retrospectively enrolled. All patients were studied with CT scan within 24 h before surgery and CT images were blinded reanalyzed by 2 couples of radiologists (A/B). Kappa value evaluated the inter-observer agreement between radiologists and the concordance between CDD, preoperative clinical findings and findings at operation. Univariate and multivariate analysis were used to evaluate the predicting values of CT classification and CDD stage at surgery on postoperative outcomes. Results: Overall inter-observer agreement for the CDD was high, with a kappa value of 0.905 (95% CI Z 0.850e0.960) for observers A and B, while the concordance between radiologica

Light Sheet Fluorescence Microscopy Quantifies Calcium Oscillations in Root Hairs of Arabidopsis thaliana

Calcium oscillations play a role in the regulation of the development of tip-growing plant cells. Using optical microscopy, calcium oscillations have been observed in a few systems (e.g. pollen tubes, fungal hyphae and algal rhizoids). High-resolution, non-phototoxic and rapid imaging methods are required to study the calcium oscillation in root hairs. We show that light sheet fluorescence microscopy is optimal to image growing root hairs of Arabidopsis thaliana and to follow their oscillatory tip-focused calcium gradient. We describe a protocol for performing live imaging of root hairs in seedlings expressing the cytosol-localized ratiometric calcium indicator Yellow Cameleon 3.6. Using this protocol, we measured the calcium gradient in a large number of root hairs. We characterized their calcium oscillations and correlated them with the rate of hair growth. The method was then used to screen the effect of auxin on the properties of the growing root hairs

Analysing stress field conditions of the Colima Volcanic Complex (Mexico) by integrating finite-element modelling (FEM) simulations and geological data

In recent decades, finite-element modelling (FEM) has become a very popular tool in volcanological studies and has even been used to describe complex system geometries by accounting for multiple reservoirs, topography, and het- erogeneous distribution of host rock mechanical properties. In spite of this, the influence of geological information on numerical simulations is still poorly considered. In this work, 2D FEM of the Colima Volcanic Complex (Mexico) is pro- vided by using the Linear Static Analysis (LISA) software in order to investigate the stress field conditions with increas- ingly detailed geological data. By integrating the published geophysical, volcanological, and petrological data, we mod- elled the stress field considering either one or two magma chambers connected to the surface via dykes or isolated (not connected) in the elastic host rocks (considered homoge- neous and non-homogeneous). We also introduced tectonic disturbance, considering the effects of direct faults bordering the Colima Rift and imposing an extensional far-field stress of 5 MPa. We ran the model using the gravity in calculations. Our results suggest that an appropriate set of geological data is of pivotal importance for obtaining reliable numerical out- puts, which can be considered a proxy for natural systems. Beside and beyond the importance of geological data in FEM simulations, the model runs using the complex feeding system geometry and tectonics show how the present-day Col- ima volcanic system can be considered in equilibrium from a stress state point of view, in agreement with the long-lasting open conduit dynamics that have lasted since 1913

A new control parameter to predict micro‑warping‑induced job failure in LPBF of TI6AL4V titanium alloy

Laser powder bed fusion (LPBF) includes a few printing techniques widely used, in recent years, concerning the additive manufacturing of Ti6Al4V alloys. These produced parts, typically utilized in sectors such as aerospace and biomedical, are characterized by very high added value. It is therefore fundamental to identify the influence of process parameters typical of LPBF technology on the occurrence of warping leading to process failure. This study deals with the characterization of single-track and “micro-scale” level warping phenomena which may lead to protrusion of material over the powder bed and process failure before normal termination. This phenomenon was investigated as a function of process parameters, referring also to the strength and ductility characteristics of the manufactured samples. With this purpose, several samples were printed using variable process parameters both in terms of line energy density (LED) values and in terms of laser power and speed combinations such as to guarantee constant LED values. For the samples that did not show significant micro-warping phenomena, in addition to the transversal and longitudinal geometric characterization of the single track, tensile tests were performed to determine both the resistance of the material and the ductility characteristics. The single tracks, for given process parameters, were printed on a homogeneous material substrate. For every single track, a microstructural and morphological transverse and longitudinal characterization has been carried out and the measured geometrical features were correlated to the process parameters. The obtained results allowed the identification of a new threshold parameter, indicating the limit operating conditions beyond which significant warping phenomena and process failure occur

Non-operative management of blunt splenic injury: is it really so extensively feasible? a critical appraisal of a single-center experience

Introduction: the spleen is one of the most commonly injured organ following blunt abdominal trauma. Splenic injuries may occur in isolation or in association with other intra-and extra-abdominal injury. Nonoperative management of blunt injury to the spleen has become routine in children. In adult most minor splenic injuries are readily treated nonoperatively but controversy exists regarding the role of nonoperative management for higher grade injuries above all in multi-trauma patients. The aim of this study is the assessment of splenic trauma treatment, with particular attention to conservative treatment, its limits, its efficiency, and its safety in multi-trauma patient or in a severe trauma patient. Methods: the present research focused on a retrospective review of patients with splenic injury. The research was performed by analyzing data of the trauma registry of St. Andrea University Hospital in Rome. The St. Andrea University Hospital trauma registry includes 1859. The variables taken into account were spleen injury and general injuries, age, sex, cause and dynamic of trauma, hemoglobin, hematocrit, white blood cells count, INR, number and time blood transfusion, hemodynamic stability, type of treatment provided, hospitalization period, morbidity and mortality. Assessment of splenic injuries was evaluated according to Abbreviated Injury Scale (AIS). Results: the analysis among the general population of spleen trauma patients identified 68 patients with a splenic injury representing the 41.2% of all abdomen injury. The Average age was of 37.01 ± 17.18 years. The Average ISS value was of 22.88 ± 12.85; mediana of 24.50 (range 4-66). The average Spleen AIS value was of 3.13 ± 0.88; mediana 3.00 (range 2-5). The overall mortality ratio was of 19.1% (13 patients). The average ISS value in patients who died was of 41.92 ± 12.48, whereas in patients who survided was of 23.33 ± 10.15. The difference was considered to be statistically significant (p <0.001). The relashionship between the ISS and AIS values in patients who died was considered directly proportional but not statistically significant (Pearson test AIS/ISS = 0.132, p = n.s.). The initial management was a conservative treatment in 27 patients (39.7%) of them 4 patients (15%) failed, in the other 41 cases urgent splenectomies were performed. The average spleen AIS in all the patients who underwent splenectomy was 3.61 ± 0.63 whereas in the patients who were not treated surgically was 2.42 ± 0.69. The difference was deemed statistically significant (p <0.001). Conclusion: splenic injury, as reported in our statistic as well as in literature, is the most common injury in closed abdominal trauma. Nonoperative management of blunt injury to the spleen in adults has been applied with increasing frequency. However, the criteria for nonoperative management are controversial. The preference of a conservative treatment must be based on the hemodynamic stability indices as well as on the spleen lesion severity and on the general trauma severity. The conservative treatment represent a feasible and safe therapeutic alternative even in case of severe lesions in politrauma patients, but the choice of the treatment form requires an assessment for each singular case