Extreme Rainfall in the Mediterranean: What Can We Learn from Observations?

Abstract Flash floods induced by extreme rainfall events represent one of the most life-threatening phenomena in the Mediterranean. While their catastrophic ground effects are well documented by postevent surveys, the extreme rainfall events that generate them are still difficult to observe properly. Being able to collect observations of such events will help scientists to better understand and model these phenomena. The recent flash floods that hit the Liguria region (Italy) between the end of October and beginning of November 2011 give us the opportunity to use the measurements available from a large number of sensors, both ground based and spaceborne, to characterize these events. In this paper, the authors analyze the role of the key ingredients (e.g., unstable air masses, moist low-level jets, steep orography, and a slow-evolving synoptic pattern) for severe rainfall processes over complex orography. For the two Ligurian events, this role has been analyzed through the available observations (e.g., Meteosat Second Generation, Moderate Resolution Imaging Spectroradiometer, the Italian Radar Network mosaic, and the Italian rain gauge network observations). The authors then address the possible role of sea–atmosphere interactions and propose a characterization of these events in terms of their predictability

1st EFORT European Consensus: Medical & Scientific Research Requirements for the Clinical Introduction of Artificial Joint Arthroplasty Devices

Innovations in Orthopaedics and Traumatology have contributed to the achievement of a high-quality level of care in musculoskeletal disorders and injuries over the past decades. The applications of new implants as well as diagnostic and therapeutic techniques in addition to implementation of clinical research, have significantly improved patient outcomes, reduced complication rates and length of hospital stay in many areas. However, the regulatory framework is extensive, and there is a lack of understanding and clarity in daily practice what the meaning of clinical & pre‐clinical evidence as required by the MDR is. Thus, understanding and clarity are of utmost importance for introduction of new implants and implant-related instrumentation in combination with surgical technique to ensure a safe use of implants and treatment of patients. Therefore EFORT launched IPSI, The Implant and Patient Safety Initiative, which starting from an inaugural workshop in 2021 issued a set of recommendations, notably through a subsequent Delphi Process involving the National Member Societies of EFORT, European Specialty Societies as well as International Experts. These recommendations provide surgeons, researchers, implant manufacturers as well as patients and health authorities with a consensus of the development, implementation, and dissemination of innovation in the field of arthroplasty. The intended key outcomes of this 1st EFORT European Consensus on “Medical & Scientific Research Requirements for the Clinical Introduction of Artificial Joint Arthroplasty Devices”are consented, practical pathways to maintain innovation and optimisation of orthopaedic products and workflows within the boundaries of MDR 2017/745. Open Access practical guidelines based on adequate, state of the art pre-clinical and clinical evaluation methodologies for the introduction of joint replacements and implant-related instrumentation shall provide hands-on orientation for orthopaedic surgeons, research institutes and laboratories, orthopaedic device manufacturers, Notified Bodies but also for National Institutes and authorities, patient representatives and further stakeholders. We would like to acknowledge and thank the Scientific Committee members, all International Expert Delegates, the Delegates from European National & Specialty Societies and the Editorial Team for their outstanding contributions and support during this EFORT European Consensus

Ceftriaxone bone penetration in patients with septic non-union of the tibia

SummaryObjectivesA main determinant of clinical response to antibiotic treatment is drug concentration at the infected site. Data on ceftriaxone (CFX) bone penetration are lacking. We measured CFX concentrations in infected bone to verify their relationship with pharmacodynamic microbiological markers.MethodsEleven patients undergoing debridement for septic non-union of the tibia and receiving intravenous CFX were studied. Plasma and bone specimens were collected intraoperatively at a variable interval after CFX administration. Drug concentrations were measured by high-performance liquid chromatography with ultraviolet detection (HPLC-UV) method.ResultsBone samples were extracted at a mean of 3.3h (range 1.5–8.0h) since the start of CFX infusion. The mean±standard deviation intraoperative CFX plasma concentration was 128.4±30.8mg/l; the corresponding bone concentrations were 9.6±3.4mg/l (7.8%) in the cortical compartment and 30.8±8.6mg/l (24.3%) in the cancellous compartment. The mean 24-h area under the concentration–time curve (AUC24) values were 176.8±62.2 h*mg/l in cortical bone and 461.5±106.8 h*mg/l in cancellous bone. The time above the minimum inhibitory concentration (T>MIC) was 24h in all compartments. The estimated mean free AUC/MIC ratios and T>MIC were 140 and 24.4h, respectively, in cancellous bone and 42.4 and 21h, respectively, in cortical bone.ConclusionsCFX bone penetration was poor (<15%) in the cortical compartment and satisfactory in the more vascularized cancellous bone. The T>MIC and AUC/MIC ratios suggest that CFX achieves a satisfactory pharmacokinetic exposure in cancellous bone as far as pathogens with a MIC of <0.5 are concerned. However, considering free drug concentrations, pharmacokinetic/pharmacodynamic targets may not be fully achieved in cortical bone. As antibiotic exposure can be suboptimal in the infected cortical compartment, and drug penetration may be impaired into necrotic bone and sequesters, a radical surgical removal of purulent and necrotic tissues appears essential to shorten treatment duration and to prevent treatment failures

On Numbers in Different Bases: Symmetries and a Conjecture

Any number may be written in many different ways, using different strings in different bases. In few, very special cases, a symmetry emerges which is usually hidden beneath the surface: 230164 and 164230 are both equal to 54284 in base ten. This article analyzes the solution set to the (constrained) Diophantine equation that implements such symmetry, culminating in a conjecture on the number of solutions of the equation

Metal substrate with antibacterial and osteointegrative properties for implantology applications

The present invention relates to a substrate of a metal, preferably titanium or a titanium alloy, having at least one surface coated with an oxide layer of the metal itself, said surface being modified and enriched with Ca, P, Ga, Sr, and, optionally, Ag by anodic spark deposition (ASD). The present invention also relates to a process for producing said substrate by applying the anodic spark deposition (ASD) technique to a substrate, optionally pre-treated, immersed in an electrolytic solution comprising Ca, P, Ga, Sr and, optionally, Ag. Finally, the present invention also relates to a prosthesis and a surgical implant comprising or preferably produced with said substrate, as well as the use thereof for the prevention of bacterial colonisation and promotion of osteointegration in implantology operations, preferably orthopaedic prosthetic implantology

Induction of ovulation with purified urinary follicle-stimulating hormone in patients with polycystic ovarian syndrome

Purified urinary follicle-stimulating hormone was used to induce ovulation in 18 patients with polycystic ovarian syndrome. Each ampule contained 75 IU of follicle-stimulating hormone and less than 0.11 IU of luteinizing hormone. Initial doses were 150 to 225 IU/day, later increased to a maximum of 375 IU, according to daily clinical controls and estradiol values. After 12 to 16 days, follicle-stimulating hormone treatment was suspended. Within 36 to 48 hours each patient received 5000 or 10,000 IU of human chorionic gonadotropin, rarely more. Ovulation occurred in 39 of 43 treatment cycles and hyperstimulation in nine. Seven patients had normal pregnancies with viable fetuses, including one pair of twins. Two had abortions. Analysis of the endocrine situation during therapy does not permit either pregnancy or hyperstimulation to be predicted. However, hyperstimulation is frequently accompanied by endogenous luteinizing hormone peaks and greater estradiol increases during the final phase of induction. Purified follicle-stimulating hormone has thus demonstrated its validity in inducing ovulation in patients with polycystic ovarian syndrome, apparently with equal or lower risks of hyperstimulation than with other gonadotropin preparations