Routine Cysticotomy and Flushing of the Cystic Duct in Patients with Low Risk of Common Duct Stones: Can It Be Beneficial?

Gallstone disease affects 15\u201320% of the general population and up to 20% of these patients present common bile duct stones. Aim. This observational study reports our experience on routine cysticotomy and flushing of the cystic duct in patients with low risk of common duct stones. Materials and Methods. We analyzed 731 patients who underwent laparoscopic cholecystectomy between September 2013 and September 2015. Results. Patients were preoperatively stratified on the clinical risk; those presenting with low preoperative risk of common bile duct stones were referred to undergo laparoscopic cholecystectomy and routine cysticotomy with bile duct flushing. Patients presenting thick bile sludge, solid debrides, and/or increased tension of bile outflow underwent unplanned cholangiography. No intraoperative complications or conversion to open technique occurred. Average follow-up time was 22,8 months (range 12 to 37). Rate of retained ductal stones accounted for 0,3%. Conclusions. Routine cysticotomy and bile flushing in our experience is a valid, simple, and not time consumingmanoeuvre that can help decompressing and flushing CBD.Moreover, it is a valid tool for extending selective IOC approach in a focused manner. Further evaluations have to be conducted to evaluate risks and effectiveness of this manoeuvre

Transport Properties of Natural and Artificial Smart Fabrics Impregnated by Graphite Nanomaterial Stacks

none4noIn this work, we studied the transport properties (thermal and electrical conductivity) of smart fabric materials treated with graphite nanomaterial stacks–acetone suspensions. An innovative and easy method to produce graphite nanomaterial stacks–acetone-based formulations, starting from a low-cost expandable graphite, is proposed. An original, economical, fast, and easy method to increase the thermal and electrical conductivity of textile materials was also employed for the first time. The proposed method allows the impregnation of smart fabric materials, avoiding precoating of the fibers, thus reducing costs and processing time, while obtaining a great increase in the transport properties. Two kinds of textiles, cotton and Lycra®, were selected as they represent the most used natural and artificial fabrics, respectively. The impact of the dimensions of the produced graphite nanomaterial stacks–acetone-based suspensions on both the uniformity of the treatment and the transport properties of the selected textile materials was accurately evaluated using several experimental techniques. An empirical relationship between the two transport properties was also successfully identified. Finally, several theoretical models were applied to predict the transport properties of the developed smart fabric materials, evidencing a good agreement with the experimental data.openCarola Esposito Corcione; Francesca Ferrari; Raffaella Striani; Antonio GrecoESPOSITO CORCIONE, Carola; Ferrari, Francesca; Striani, Raffaella; Greco, ANTONIO STEFAN

An Innovative Method for the Recycling of Waste Carbohydrate Based Flours

This work represents an innovative study that, for the first time, explores the possibility to use waste flours to produce thermoplastic polymeric bio-films. To the best of our knowledge, this is the first time that waste flours, derived from bakeries, pizzerias or pasta factories, have been proposed for the production of bio-polymers, as a replacement of neat starch. To this aim, durum waste flour derived from a pasta factory, soft waste flour derived from pizzerias and neat maize starch used as control material were firstly analyzed from dimensional, morphological and chemical points of view. Afterwards, waste flour films were produced by the addition of a nature-based plasticizer, glycerol. Mechanical characterization of the plasticized thermoplastic films, produced by compression molding, evidenced low performances, even in the case of the neat maize starch. In order to improve the mechanical properties, the possibility to include polylactic acid and cardanol based plasticizer was also investigated. Mass transport properties of all the produced bio-films were investigated by measuring their water vapor permeability and hygroscopic absorption. The durability properties of the bio-films were assessed by accelerated ageing tests, while the biodegradability of the waste-based films was evaluated by measuring the solubility and the degradation in water. The physicochemical analyses of the novel bio-films evidenced good mechanical properties; specifically, the waste-based films showed a lower hygroscopic absorption and water solubility than those of the blends containing neat starch

Treatments and overall survival in patients with Krukenberg tumor

BACKGROUND: Krukenberg tumor (KT) is a rare secondary ovarian tumor, primarily localized at the gastrointestinal tract in most cases. KT is related to severe prognosis due to its aggressiveness, diagnostic difficulties and poor treatment efficacy. Several treatments have been used, such as cytoreductive surgery (CRS), adjuvant chemotherapy (CT) and/or hyperthermic intraperitoneal chemotherapy (HIPEC). To date, it is still unclear which treatment or combination of treatments is related to better survival. OBJECTIVE: To assess the most effective therapeutic protocol in terms of overall survival (OS). METHODS: A systematic review of the literature was performed by searching MEDLINE, Scopus, EMBASE, ClinicalTrial.gov, OVID, Web of Sciences, Cochrane Library, and Google Scholar for all studies assessing the association of treatments with OS in KTs. The effectiveness of each treatment protocol was evaluated by comparing the OS between patients treated with different treatment protocols. RESULTS: Twenty retrospective studies, with a total sample size of 1533 KTs, were included in the systematic review. Therapeutic protocols used were CRS in 18 studies, CT in 13 studies, HIPEC in 7 studies, neoadjuvant CT in 2 studies, and some combinations of these in 6 studies. Seven studies showed that CRS significantly improved OS compared to other treatments or association of treatments without it. 11 studies showed that CRS without residual (R0 CRS) had a significantly better OS than CRS with residual (R + CRS). Five studies showed that CT significantly improved OS, but other five showed it did not. Two studies showed that HIPEC in association with CRS improved OS, while another study showed that efficacy of HIPEC was comparable to CT. Two studies evaluated neoadjuvant CT, but results were conflicting. CONCLUSION: CRS and in particular R0 CRS are the treatments showing the clearest results in improving OS in KT patients. Results about CT are conflicting. HIPEC appears effective both alone and in combination with CRS, and also related to fewer adverse effect than CT. The usefulness of neoadjuvant CT is still unclear. The association of R0 CRS with HIPEC seems to be the most effective and safe therapeutic protocol for KT patients

valorization of food industries wastes for the production of poly vinyl alcohol pva biodegradable composites

This work is aimed to the development of new green composite materials by the incorporation of natural additives into poly(vinyl) alcohol (PVA). Two additives, shredded walnut shells and organic fraction of municipal solid waste (MW), were used to improve the mechanical properties of PVA. Both additives, derived from food industry wastes, were added in a PVA/water solution, which allowed to produce samples by the use of a pressure free process. Rheological analysis was performed in order to study the evolution of the material viscosity during thermal treatment, aimed at water removal. Samples obtained were characterized by means of differential scanning calorimetry (DSC), showing an improvement of the glass transition temperature brought by the addition of walnut shells. Finally, flexural tests were carried out on samples obtained after the incorporation of the different additives in PVA and compared with the mechanical properties of the neat matrix. Results obtained indicate the potential improvement brought by the addition of walnut shells, which allows increasing the flexural modulus of about 50%, at the expenses of a flexural strength reduction of about 30%. Also, at least for low amount of added water, the addition of MW was shown to provide an increase of the strain at break equal to 100%

Short-term effects of a nicotine-free e-cigarette compared to a traditional cigarette in smokers and non-smokers

BACKGROUND: A few studies have assessed the short-term effects of low-dose nicotine e-cigarettes, while data about nicotine-free e-cigarettes (NF e-cigarettes) are scanty. Concerns have been expressed about the use of NF e-cigarettes, because of the high concentrations of propylene glycol and other compounds in the e-cigarette vapor. METHODS: This laboratory-based study was aimed to compare the effects of ad libitum use of a NF e-cigarette or and a traditional cigarette for 5 min in healthy adult smokers (n\u2009=\u200910) and non-smokers (n\u2009=\u200910). The main outcome measures were pulmonary function tests, fraction of exhaled nitric oxide (FeNO) and fractional concentration of carbon monoxide (FeCO) in exhaled breath. RESULTS: The traditional cigarette induced statistically significant increases in FeCO in both smokers and non-smokers, while no significant changes were observed in FeNO. In non-smokers, the traditional cigarette induced a significant decrease from baseline in FEF75 (81 %\u2009\ub1\u200935 % vs 70.2 %\u2009\ub1\u200928.2 %, P\u2009=\u20090.013), while in smokers significant decreases were observed in FEF25 (101.3 %\u2009\ub1\u200916.4 % vs 93.5 %\u2009\ub1\u200931.7 %, P\u2009=\u20090.037), FEV1 (102.2 %\u2009\ub1\u20099.5 % vs 98.3 %\u2009\ub1\u200910 %, P\u2009=\u20090.037) and PEF (109.5 %\u2009\ub1\u200914.6 % vs 99.2 %\u2009\ub1\u200917.5 %, P\u2009=\u20090.009). In contrast, the only statistically significant effects induced by the NF e-cigarette in smokers were reductions in FEV1 (102.2 %\u2009\ub1\u20099.5 % vs 99.5\u2009\ub1\u20097.6 %, P\u2009=\u20090.041) and FEF25 (103.4 %\u2009\ub1\u200916.4 % vs 94.2 %\u2009\ub1\u200916.2 %, P\u2009=\u20090.014). DISCUSSION: The present study demonstrated that the specific brand of NF e-cigarette utilized did not induce any majoracute effects. In contrast, several studies have shown that both traditional cigarettes and nicotine-containing e-cigarettes have acute effects on lung function. Our study expands on previous observations on the effects of NF e-cigarettes, but also for the first time describes the changes induced by smoking one traditional cigarette in a group of never smokers. CONCLUSIONS: The short-term use of the specific brand of NF e-cigarette assessed in this study had no immediate adverse effects on non-smokers and only small effects on FEV1 and FEF25 in smokers. The long-term health effects of NF e-cigarette use are unknown but worthy of further investigations. TRIAL REGISTRATION: Clinicaltrials.gov: NCT02102191

Design and integration sensitivity of a morphing trailing edge on a reference airfoil: The effect on high-altitude long-endurance aircraft performance

Trailing edge modification is one of the most effective ways to achieve camber variations. Usual flaps and aileron implement this concept and allow facing the different needs related to take-off, landing, and maneuver operations. The extension of this idea to meet other necessities, less dramatic in terms of geometry change yet useful a lot to increase the aircraft performance, moves toward the so-called morphing architectures, a compact version of the formers and inserted within the frame of the smart structures’ design philosophy. Mechanic (whether compliant or kinematic), actuation and sensor systems, together with all the other devices necessary for its proper working, are embedded into the body envelope. After the successful experiences, gained inside the SARISTU (SmARt Intelligent Aircraft STrUctures) project where an adaptive trailing edge was developed with the aim of compensating the weight variations in a mediumsize commercial aircraft (for instance, occurring during cruise), the team herein exploits the defined architecture in the wing of a typical airfoil, used on high-altitude long-endurance aircraft such as the Global Hawk. Among the peculiarities of this kind of aerial vehicle, there is the long endurance, in turn, associated with a massive fuel storage (approximately around 50% of the total weight). A segmented, finger-like, rib layout is considered to physically implement the transition from the baseline airfoil to the target configurations. This article deals with an extensive estimation of the possible benefits related to the implementation of this device on that class of planes. Parametric aerodynamic analyses are performed to evaluate the effects of different architectural layouts (in-plane geometry extension) and different shape envelopes (namely, the rotation boundaries). Finally, the expected improvements in the global high-altitude long-endurance aircraft performance are evaluated, following the implementation of the referred morphing device

Exogenous Fungal Endophthalmitis: Clues to Aspergillus Aetiology with a Pharmacological Perspective.

Exogenous fungal endophthalmitis (EXFE) represents a rare complication after penetrating ocular trauma of previously unresolved keratitis or iatrogenic infections, following intraocular surgery such as cataract surgery. The usual latency period between intraocular inoculation and presentation of symptoms from fungal endophthalmitis is several weeks to months as delayed-onset endophthalmitis. Aspergillus spp., is the most common causative mould pathogen implicated in this ocular infection and early diagnosis and prompt antimicrobial treatment, concomitantly in most cases with expert surgical attention, reduce unfavorable complications and increase the possibility of eye function preservation. Topical, intravitreal and systemic antifungal molecules are the mainstay of a medical approach to the disease and azoles, polyenes and in particular cases echinocandins are the pharmacological classes most commonly used in clinical practice. This review discusses pharmacokinetics and pharmacodynamic of antifungal agents in their principal modes of administration with a focus on their ability to achieve high drug concentration in the vitreous and ocular tissues

Real-life experience with ceftobiprole in a tertiary-care hospital

n/