REsiDENT 1 (Re-assessment of Appendicitis Evaluation during laparoscopic appendectomy: Do we End a Non-standardized Treatment approach and habit?): Peritoneal irrigation during laparoscopic appendectomy - Does the grade of contamination matter? A prospective multicenter resident-based evaluation of a new classification system

Background: Laparoscopic appendectomy has progressively gained acceptance as the standard of care for acute appendicitis. Focusing on the incidence of postoperative intra-abdominal abscess after a laparoscopic appendectomy, discordant data have been reported ranging from 1.5 to 20%. Besides, evidence advocating advantages from peritoneal irrigation over suction only are lacking. Most studies are burdened by a high level of heterogeneity regarding the severity of the appendicitis and modalities of peritoneal irrigation. One of the main drawbacks is the lack of an accepted classification for different degrees of appendicitis and peritoneal contamination. The aim of the study is to introduce a classification to clarify the relationship between grade of appendicitis, contamination, and postoperative incidence of IAA considering the surgeon's attitude toward irrigation or suction alone. Preoperative, intra-operative, and postoperative predictive factors for infectious complication will also be assessed. This study is meant to be the first Italian multicenter resident-based observational study. Methods: Patients suffering from acute appendicitis will be enrolled during a 1-year period, according to inclusion and exclusion criteria. Participants will fill an online form reporting all clinical and intra-operative data of each patient undergoing a laparoscopic appendectomy. General surgery residents will be responsible for data collection. Our proposal of classification is based on the histological grade of appendicitis and intra-operative degree of peritoneal contamination. For each grade, a progressively increasing score is assigned. Discussion: The observational nature of this study is mandatory to examine surgeons' attitude toward peritoneal contamination during laparoscopic appendectomy for appendicitis. Identification of different severity grades of acute appendicitis and their relationship with the development of postoperative abscesses is necessary. The resulting classification and score, even considering peritoneal lavage or suction alone, will define risk classes of peri-appendiceal contamination each one related to a specific incidence rate of postoperative IAA. Nowadays, maximum effort should be made to reach the best procedural standardization and surgical decision-making should be supported by solid evidence, especially in an emergency surgery setting

Quality of Life and Personality Traits in Patients with Malignant Pleural Mesothelioma and Their First-Degree Caregivers.

Asbestos exposure causes significant pleural diseases, including malignant pleural mesothelioma (MPM). Taking into account the impact of MPM on emotional functioning and wellbeing, this study aimed to evaluate the quality of life and personality traits in patients with MPM and their first-degree caregivers through the World Health Organization Quality of Life–BREF (WHOQOL-BREF) and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). The sample was composed of 27 MPM patients, 55 first-degree relatives enrolled in Casale Monferrato and Monfalcone (Italy), and 40 healthy controls (HC). Patients and relatives reported poorer physical health than the HC. Patients had a higher overall sense of physical debilitation and poorer health than relatives and the HC, more numerous complaints of memory problems and difficulties in concentrating, and a greater belief that goals cannot be reached or problems solved, while often claiming that they were more indecisive and inefficacious than the HC. First-degree relatives reported lower opinions of others, a greater belief that goals cannot be reached or problems solved, support for the notion that they are indecisive and inefficacious, and were more likely to suffer from fear that significantly inhibited normal activities than were HC. In multinomial regression analyses, partial models indicated that sex, physical comorbidities, and the True Response Inconsistency (TRIN-r), Malaise (MLS), and Behavior-Restricting Fears (BRF) dimensions of the MMPI-2-RF had significant effects on group differences. In conclusion, health care providers should assess the ongoing adjustment and emotional wellbeing of people with MPM and their relatives, and provide support to reduce emotional distress

Thermal monitoring of hydrothermal activity by permanent infrared automatic stations: Results obtained at Solfatara di Pozzuoli, Campi Flegrei (Italy)

A permanent automatic infrared (IR) station was installed at Solfatara crater, the most active zone of Campi Flegrei caldera. After a positive in situ calibration of the IR camera, we analyze 2175 thermal IR images of the same scene from 2004 to 2007. The scene includes a portion of the steam heated hot soils of Solfatara. The experiment was initiated to detect and quantify temperature changes of the shallow thermal structure of a quiescent volcano such as Solfatara over long periods. Ambient temperature results as the main parameter affecting IR temperatures while air humidity and rain control image quality. A geometric correction of the images was necessary to remove the effects of slow movement of the camera. After a suitable correction the images give a reliable and detailed picture of the temperature changes, over the period October 2004 – January 2007, which suggests origin of the changes were linked to anthropogenic activity, vegetation growth and to the increase of the flux of hydrothermal fluids in the area of the hottest fumaroles. Two positive temperature anomalies were registered after the occurrence of two seismic swarms which affected the hydrothermal system of Solfatara in October 2005 and October 2006. It is worth noting that these signs were detected in a system characterized by a low level of activity with respect to systems affected by real volcanic crisis where more spectacular results will be expected. Results of the experiment show that this kind of monitoring system can be a suitable tool for volcanic surveillance

Geochemical and biochemical evidence of lake overturn and fish-kill at Lake Averno, Italy.

Lake Averno is situated in the homonymous crater in the northwestern sector of the Campi Flegrei active volcanic system in Campania region, Italy. In February 2005 a fish kill event was observed in the lake, prompting a geochemical survey to ascertain the possible cause. In February 2005 a geochemical survey revealed that the lake water was unstratified chemically and isotopically, presumable, as a result of lake overturn. This fish-kill phenomenon was recorded at least two other times in the past. In contrast to the February 2005 results, data collected in October 2005, shows the Lake Averno to be stratified, with an oxic epilimnion (surface to 6 m) and an anoxic hypolimnion (6 m to lake bottom at about 33 m). Chemical and isotopic composition of Lake Averno waters suggests an origin by mixing of shallow waters with a Na-Cl hydrothermal component coupled with an active evaporation process. The isotopic composition of Dissolved Inorganic Carbon, as well as the composition of the non-reactive dissolved gas species again supports the occurrence of this mixing process. Decreasing levels of SO4 and increasing levels of H2S and CH4 contents in lake water with depth, strongly suggests anaerobic bacterial processes are occurring through decomposition of organic matter under anoxic conditions in the sediment and in the water column. Sulfate reduction and methanogenesis processes coexist and play a pivotal role in the anaerobic environment of the Lake Averno. The sulfate reducing bacterial activity has been estimated in the range of 14-22 μmol.m-2.day-1. Total gas pressure of dissolved gases ranges between 800 and 1400 mbar, well below the hydrostatic pressure throughout the water column, excluding the possibility, at least at the survey time, of a limnic eruption. Vertical changes in the density of lake waters indicate that overturn may be triggered by cooling of epilimnetic waters below 7°C. This is a possible phenomenon in winter periods if atmospheric temperatures remain frosty for enough time, as occurred in February 2005. The bulk of these results strongly support the hypothesis that fish kill was caused by a series of events that began with the cooling of the epilimnetic waters with breaking of the thermal stratification, followed by lake overturn and the rise of toxic levels of H2S from the reduced waters near the lake bottom

Spinal Anesthesia and Minimal Invasive Laminotomy for Paddle Electrode Placement in Spinal Cord Stimulation: Technical Report and Clinical Results at Long-Term Followup

Object. We arranged a mini-invasive surgical approach for implantation of paddle electrodes for SCS under spinal anesthesia obtaining the best paddle electrode placement and minimizing patients' discomfort. We describe our technique supported by neurophysiological intraoperative monitoring and clinical results. Methods. 16 patients, affected by neuropathic pain underwent the implantation of paddle electrodes for spinal cord stimulation in lateral decubitus under spinal anesthesia. The paddle was introduced after flavectomy and each patient confirmed the correct distribution of paresthesias induced by intraoperative test stimulation. VAS and patients' satisfaction rate were recorded during the followup and compared to preoperative values. Results. No patients reported discomfort during the procedure. In all cases, paresthesias coverage of the total painful region was achieved, allowing the best final electrode positioning. At the last followup (mean 36.7 months), 87.5% of the implanted patients had a good rate of satisfaction with a mean VAS score improvement of 70.5%. Conclusions. Spinal cord stimulation under spinal anesthesia allows an optimal positioning of the paddle electrodes without any discomfort for patients or neurosurgeons. The best intraoperative positioning allows a better postoperative control of pain, avoiding the risk of blind placements of the paddle or further surgery for their replacement

Long Time Series Of Fumarolic Compositions At Volcanoes: The Key To Understand The Activity Of Quiescent Volcanoes

Long time series of fumarolic chemical and isotopic compositions at Campi Flegrei, Vulcano, Panarea, Nisyros and Mammoth volcanoes highlight the occurrence of mixing processes among magmatic and hydrothermal fluids. At Campi Flegrei temperatures of about 360°C of the hydrothermal system are inferred by chemical and isotopic geoindicators. These high temperatures are representative of a deep zone where magmatic gases mix with hydrothermal liquids forming the gas plume feeding the fumaroles. Similar mixing processes between magmatic fluids and a hydrothermal component of marine origin have been recognized at Vulcano high temperature fumaroles. In both the system a typical ‘andesitic’ water type composition and high CO2 contents characterizes the magmatic component. Our hypothesis is that pulsing injections of these CO2- rich magmatic fluids at the bottom of the hydrothermal systems trigger the bradyseismic crises, periodically affecting Campi Flegrei, and the periodical volcanic unrest periods of Vulcano. At Campi Flegrei a strong increase of the fraction of the magmatic component marked the bradyseismic crisis (seismicity and ground uplift) of 1982-84 and four minor episodes occurred in 1989, 1994 and 2000 and 2006. Increases of the magmatic component in the fumaroles of Vulcano were recorded in 1979-1981, 1985, 1988, 1996, 2004 and 2005 concurrently with anomalous seismic activity. Physicalnumerical simulations of the injection of hot, CO2 rich fluids at the base of a hydrothermal system, asses the physical feasibility the process. Ground deformations, gravitational anomalies and seismic crisis can be well explained by the complex fluid dynamic processes caused by magma degassing episodes. Sporadic data on the fumaroles of other volcanoes, for example Panarea, Nisyros (Greece), Mammoth (California), suggest that magma degassing episodes frequently occur in dormant volcanoes causing volcanic unrest processes not necessarily linked to magma movement but rather to pulsating degassing processes from deep pressurized, possibly stationary, magma bodies

Novel anti-obesity quercetin-derived Q2 prevents metabolic disorders in rats fed with high-fat diet

Objective: Obesity is often accompanied by an increased morbidity and mortality due to an increase of the cardiovascular disease risk factors, diabetes mellitus and dyslipidemia. Research is constantly working on protective molecules against obesity. In the present study, a novel Quercetin derivative Q2 was synthesized to overcome the poor bioavailability and low stability of Quercetin, a natural flavonoid with antioxidative and antiobesity properties. Methods: Rats were fed (12ws) with normodiet (fat:INS; 6.2%), High Fat Diet (fat:60%), HFDINS; +INS; Q2 in water (500INS; nM). Metabolic and anthropometric parameters were measured. 3T3-L1 preadipocytes were incubated with Q2 (1-25μM) and the differentiation program was evaluated by lipid accumulation through ORO staining. Gene and protein expression levels were assessed by RT-PCR and Western blot analysis. Results: Compared to HFD, HFDINS; +INS; Q2 rats showed reduced body weight, abdominal obesity, dyslipidemia and improved glucose tolerance. This is associated to lower adipose and liver modifications compared to hypertrophy and steatosis observed in HFD. In 3T3-L1 cells, lipid accumulation was significantly impaired by treatment with Q2. Indeed, Q2 significantly decreased the expression of the main adipogenic markers, c/EBPα and PPARγ both at mRNA and protein level. Conclusions: Our results indicate that Q2 markedly decreases differentiation of 3T3-L1 preadipocytes and contributes to prevent metabolic disorders as well as adipose and liver alterations typical of severe obesity induced by a HFD

A shallow layer model for heavy gas dispersion from natural sources: application and hazard assessment at Caldara di Manziana, Italy.

Several non-volcanic sources in central Italy emit a large amount of carbon dioxide (CO2). Under stable atmospheric conditions and/or in presence of topographic depressions, the concentration of CO2, which has a molecular mass greater than that of air, can reach high values that are lethal to humans or animals. Several episodes of this phenomenon were recorded in central Italy and elsewhere. In order to validate a model for the dispersion of a heavy gas and to assess the consequent hazard, we applied and tested the code TWODEE-2, an improved version of the established TWODEE model, which is based on a shallow layer approach that uses depth-averaged variables to describe the flow behavior of dense gas over complex topography. We present results for a vented CO2 release at Caldara di Manziana in central Italy. We find that the model gives reliable results when the input quantity can be properly defined. Moreover, we show that the model can be a useful tool for gas hazard assessment, by evaluating where and when lethal concentrations for humans and animal are reached.Several non-volcanic sources in central Italy emit a large amount of carbon dioxide (CO2). Under stable atmospheric conditions and/or in presence of topographic depressions, the concentration of CO2, which has a molecular mass greater than that of air, can reach high values that are lethal to humans or animals. Several episodes of this phenomenon were recorded in central Italy and elsewhere. In order to validate a model for the dispersion of a heavy gas and to assess the consequent hazard, we applied and tested the code TWODEE-2, an improved version of the established TWODEE model, which is based on a shallow layer approach that uses depth-averaged variables to describe the flow behavior of dense gas over complex topography. We present results for a vented CO2 release at Caldara di Manziana in central Italy. We find that the model gives reliable results when the input quantity can be properly defined. Moreover, we show that the model can be a useful tool for gas hazard assessment, by evaluating where and when lethal concentrations for humans and animal are reached.Several non-volcanic sources in central Italy emit a large amount of carbon dioxide (CO2). Under stable atmospheric conditions and/or in presence of topographic depressions, the concentration of CO2, which has a molecular mass greater than that of air, can reach high values that are lethal to humans or animals. Several episodes of this phenomenon were recorded in central Italy and elsewhere. In order to validate a model for the dispersion of a heavy gas and to assess the consequent hazard, we applied and tested the code TWODEE-2, an improved version of the established TWODEE model, which is based on a shallow layer approach that uses depth-averaged variables to describe the flow behavior of dense gas over complex topography. We present results for a vented CO2 release at Caldara di Manziana in central Italy. We find that the model gives reliable results when the input quantity can be properly defined. Moreover, we show that the model can be a useful tool for gas hazard assessment, by evaluating where and when lethal concentrations for humans and animal are reached.Several non-volcanic sources in central Italy emit a large amount of carbon dioxide (CO2). Under stable atmospheric conditions and/or in presence of topographic depressions, the concentration of CO2, which has a molecular mass greater than that of air, can reach high values that are lethal to humans or animals. Several episodes of this phenomenon were recorded in central Italy and elsewhere. In order to validate a model for the dispersion of a heavy gas and to assess the consequent hazard, we applied and tested the code TWODEE-2, an improved version of the established TWODEE model, which is based on a shallow layer approach that uses depth-averaged variables to describe the flow behavior of dense gas over complex topography. We present results for a vented CO2 release at Caldara di Manziana in central Italy. We find that the model gives reliable results when the input quantity can be properly defined. Moreover, we show that the model can be a useful tool for gas hazard assessment, by evaluating where and when lethal concentrations for humans and animal are reached.Several non-volcanic sources in central Italy emit a large amount of carbon dioxide (CO2). Under stable atmospheric conditions and/or in presence of topographic depressions, the concentration of CO2, which has a molecular mass greater than that of air, can reach high values that are lethal to humans or animals. Several episodes of this phenomenon were recorded in central Italy and elsewhere. In order to validate a model for the dispersion of a heavy gas and to assess the consequent hazard, we applied and tested the code TWODEE-2, an improved version of the established TWODEE model, which is based on a shallow layer approach that uses depth-averaged variables to describe the flow behavior of dense gas over complex topography. We present results for a vented CO2 release at Caldara di Manziana in central Italy. We find that the model gives reliable results when the input quantity can be properly defined. Moreover, we show that the model can be a useful tool for gas hazard assessment, by evaluating where and when lethal concentrations for humans and animal are reached

A shallow-layer model for heavy gas dispersion from natural sources: Application and hazard assessment at Caldara di Manziana, Italy

Several nonvolcanic sources in central Italy emit a large amount of carbon dioxide (CO2). Under stable atmospheric conditions and/or in the presence of topographic depressions, the concentration of CO2, which has a molecular mass greater than that of air, can reach high values that are lethal to humans or animals. Several episodes of this phenomenon were recorded in central Italy and elsewhere. In order to validate a model for the dispersion of a heavy gas and to assess the consequent hazard, we applied and tested the code TWODEE-2, an improved version of the established TWODEE model, which is based on a shallow-layer approach that uses depth-averaged variables to describe the flow behavior of dense gas over complex topography. We present results for a vented CO2 release at Caldara di Manziana in central Italy. We find that the model gives reliable results when the input quantity can be properly defined. Moreover, we show that the model can be a useful tool for gas hazard assessment by evaluating where and when lethal concentrations for humans and animals are reached