Assessment of fruit and vegetable residues suitable for renewable energy production: GIS-based model for developing new frontiers within the context of circular economy

Due to the necessity of developing renewable energy sources, the anaerobic digestion for producing biomethane has developed significantly in the last years, since it allows to both reduce disposal treatment and produce green energy. In this field, fruit and vegetable wastes have been recently put forward, since they could represent a suitable resource for producing biomethane as a new frontier within the context of a circular economy. This study aims at filling the gap in the knowledge of the production, quantities and biogas potential production of these residues. On this basis, a GIS-based model was developed and applied to the Sicily region by investigating the specific regulatory framework as well as by analysing descriptive statistics. The results of the GIS analyses enabled the localisation of the highest productive territorial areas and highlighted where fruit and vegetable wastes are abundantly located. In this regard, about 7 million Nm3 of biogas could be produced by reusing only the fruit and vegetable residues coming from the three most representative Sicilian wholesale markets among those considered. Finally, the regulatory framework is of crucial importance in inhibiting or supporting the use of the selected biomass in a specific sector, with regard to the case study considered

Shifting paradigms in two common abdominal surgical emergencies during the pandemic

During the pandemic there was a reduction in access to the hospital and surgical treatment of appendicitis and cholecystitis at a global level. Some strategies adopted during this challenging time could be applied even after the emergency has been controlled

Abdominal versus perineal approach for external rectal prolapse: systematic review with meta-analysis

BACKGROUND: External rectal prolapse (ERP) is a debilitating condition in which surgery plays an important role. The aim of this study was to evaluate the outcomes of abdominal approaches (AA) and perineal approaches (PA) to ERP. METHODS: This was a PRISMA-compliant systematic review with meta-analysis. Studies published between 1990 and 2021 were retrieved. The primary endpoint was recurrence at the last available follow-up. Secondary endpoints included factors associated with recurrence and function. All studies were assessed for bias using the Newcastle-Ottawa Scale and Cochrane tool. RESULTS: Fifteen studies involving 1611 patients (AA = 817; PA = 794) treated for ERP were included, three of which were randomized controlled trials (RCTs; 114 patients (AA = 54; PA = 60)). Duration of follow-up ranged from 12 to 82 months. Recurrence in non-randomized studies was 7.7 per cent in AA versus 20.1 per cent in PA (odds ratio (OR) 0.29, 95 per cent confidence interval (c.i.) 0.17 to 0.50; P < 0.001, I2 = 45 per cent). In RCTs, there was no significant difference (9.8 per cent versus 16.3 per cent, AA versus PA (OR 0.82, 95 per cent c.i. 0.29 to 2.37; P = 0.72, I2 = 0.0 per cent)). Age at surgery and duration of follow-up were risk factors for recurrence. Following AA, the recurrence rates were 10.1 per cent and 6.2 per cent in patients aged 65 years and older and less than 65 years of age, respectively (effect size [e.s.] 7.7, 95 per cent c.i. 4.5 to 11.5). Following PA, rates were 27 per cent and 16.3 per cent (e.s. 20.1, 95 per cent c.i. 13 to 28.2). Extending follow-up to at least 40 months increased the likelihood of recurrence. The median duration of hospital stay was 4.9 days after PA versus 7.2 days after AA. Overall, incontinence was less likely after AA (OR 0.32), but constipation occurred more frequently (OR 1.68). Most studies were retrospective, and several outcomes from RCTs were not consistent with those observed in non-RCTs. CONCLUSION: The overall risk of recurrence of ERP appears to be higher with PA versus AA. Incontinence is less frequent after AA but at the cost of increased constipation. Age at surgery and duration of follow-up are associated with increased risk of recurrence, which warrants adequate reporting of future studies on this topic

Enhancement of sustainable bioenergy production by valorising tomato residues: A GIS-based model

In order to increase the utilization of renewable energy sources, the biomethane production through anaerobic digestion has notably developed over the last years. Although, it is worldwide recognized, that valorising waste resources (i.e., by-products) is an opportunity to improve the efficiency rate of the agro-industrial chains, by reducing economic and environmental impact, it is necessary to support the strategic planning development of a future sustainable biomethane chain in line to circular economy. In this study, by adopting network information technologies, the importance of a strategic planning for sustainable developing biomethane sector was highlighted, since feedstocks logistic and supply phase is a key-aspect of any bioenergy project. The developed Geographic Information Systems (GIS) – methodology, that could be applied in any territorial area considering any type of biomass, allowed to define suitable locations for allocating new anaerobic digestion plants with the aim of developing a sustainable valorisation of tomato residues, by minimising the economic and environmental impacts. The achieved results provided advanced knowledge for the literature on the topic, helping to develop an operational GIS-tool for defining sustainable strategies for planning new plants, and proved that the development of integrated approach to define sustainable strategies for resource management along the whole supply chain is crucial

Assessment of tomato peels suitable for producing biomethane within the context of circular economy: A gis-based model analysis

Biomass is seen as one of the most dominant future renewable energy sources. In detail, agro-industrial by-products represent a cheap, renewable, and abundant feedstock useful for several new products, including biochemical, biomaterials, and above all biogas, which are taking on an ever-increasing role in Italy. In this context, the tomato chain was analysed aiming at estimating the amount of processed tomato and the related waste production as a new suitable resource for producing biofuel as a new frontier within the context of a circular economy. Due the importance of the tomato industry, this research aims at filling gaps in the knowledge of the production and yield of the by-products that are useful as biomass for energy use in those territorial areas where the biomethane sector is still developing. This aim could be relevant for planning the sustainable development of the biomethane sector by reducing both soil consumption for dedicated energy crops and GHG emissions coming from the biomass logistic supply. The achieved results show the localization of territorial areas highly characterized by this kind of biomass. Therefore, it would be desirable that the future policies of development in the biomethane sector consider the availability and the distribution of these suitable biomasses within the territory

Clinical efficacy of minimally invasive surgical (MIS) and non-surgical (MINST) treatments of periodontal intra-bony defect. A systematic review and network meta-analysis of RCT's

Objective: The aim of this systematic review was to explore the efficacy of different minimal invasive surgical (MIS) and non-surgical (MINST) approaches for the treatment of intra-bony defect in terms of clinical attachment level (CAL) gain and periodontal pocket depth (PPD) reduction. / Methods: A detailed review protocol was designed according to PRISMA guideline. Online search was conducted on PubMed, Cochrane library and Embase. Only randomized clinical trials (RCTs) testing MIS or MINST procedure, with or without the application of a regenerative tool for the treatment of intra-bony defect, were included. Cochrane checklist for risk of bias assessment was used. Network meta-Analysis (NMAs) was used to rank the treatment efficacy. / Results: Nine RCTs accounting for 244 patients and a total of 244 defects were included. Only two studies were at low risk of bias. CAL gain for included treatment ranged from 2.58 ± 1.13 mm to 4.7 ± 2.5 mm while PPD reduction ranged from 3.19 ± 0.71 mm to 5.3 ± 1.5 mm. On the basis of the ranking curve, MINST showed the lowest probability to be the best treatment option for CAL gain. Pairwise comparisons and treatment rankings suggest superiority for regenerative approaches (CAL difference 0.78 mm, (0.14–1.41); P < 0.05) and surgical treatment elevating only the buccal or palatal flap (CAL difference: 0.95 mm, (0.33–1.57); P < 0.05). / Conclusions: Minimally invasive surgical (MIS) and non-surgical (MINST) periodontal therapy show promising results in the treatment of residual pocket with intra-bony defect. / Clinical relevance: MIS procedures represent a reliable treatment for isolated intra-bony defect

FORCE- AND POWER-TIME RELATIONSHIP,EMG RESPONSES IN CONCENTRIG AND ISOMETRIC CONDITIONS,EFFECTS OF TRAINING AND INDIVIDUAL CRARACTERISTICS

Introduction The relationship between EHG (temporal pattern, IEMG, power spectra ) and the biomechanical parameter in isometric and dynamic muscle tension represents an essential method in the analysis of the specificity of training effects and of the individual characteristics in motor control modelling and in practical motor learning. METHODS Force-time, power-time relationships under concentric and isometric conditions (MVC) with and without preloading were determined. For EHG purpose, surface electrodes (O= 5 mm; interelectrode distance 40 mm) were placed over the belly of each muscle (Tric.br.;Bic.br.; Delt.an.; Pect.ma.). Bipolar myoelectrical potentials were recorded with the passive electrode placed between the two actives: signals were preamplified and band-pass filtered (CMRRT 70 db, BP= 10 Hz- 1 KHz: Zin=1,5 MR. gain= 1000). EMG signals and the force were digitized on-line with a sampling frequency of 1000 Hz. For time structure analysis EMG signals were full-wave rectified and bandpass filtered (20-70 Hz) to obtain envelop curve patterns of each muscle. Power spectra analysis (median frequency MF) were performed using 1024 and pl2 data points. 3 groups (n=4) of sport students were involved in the investigation. Subjects performed a 8 week training period under different loading conditions. RESULTS # In the concentric tasks subjects show individual strategies in the muscular coordination patterns dependent on the load intensity. # Differences in the muscular interactivity pattern are not necessarily matching similar variation in the mechanical output. # For increasing loads there is a linear relationship between muscular activation level and mechanical power output. # In the power spectra, trends are consistent but also discontinuous. Median frequency could possibly indicate that some subjects have resources in motor units recruitment . # Other considerations are discussed referring to the muscular activation and the isometric MVC under preloading conditions

Surgical management of complex ileocolonic Crohn’s disease: a survey of IBD colorectal surgeons to assess variability in operative strategy

Cirurgia colorectal; Malaltia de Crohn; Resecció ileocecalCirugía colorrectal; Enfermedad de Crohn; Resección ileocecalColorectal surgery; Crohn’s disease; Ileocaecal resectionIntroduction To explore the reported variability in the surgical management of ileocolonic Crohn’ s disease and identify areas of standard practice, we present this study which aims to assess how different colorectal surgeons with a subspecialty interest in inflammatory bowel disease (IBD) surgery may act in different clinical scenarios of ileocolonic Crohn’s disease. Methods Anonymous videos demonstrating the small bowel walkthrough and anonymised patients’ clinical data, imaging and pathological findings were distributed to the surgeons using an electronic tool. Surgeons answered on operative strategy, bowel resections, management of small bowel mesentery, type of anastomosis and use of stomas. Results Eight small bowel walkthrough videos were registered and 12 assessors completed the survey with a questionnaire completion rate of 87.5%. There was 87.7% agreement in the need to perform an ileocolonic resection. However, the agreement for the need to perform associated surgical procedures such as strictureplasties or further bowel resections was only 57.4%. When an anastomosis was fashioned, the side to side configuration was the most commonly used. The preferred management of the mesentery was dissection close to the bowel. Conclusions The decision on the main procedure to be performed had a high agreement amongst the different assessors, but the treatment of multifocal disease was highly controversial, with low agreement on the need for associated procedures to treat internal fistulae and the use of strictureplasties. At the same time, there was significant heterogeneity in the decision on when to anastomose and when to fashion an ileostomy

Efficacy and safety of first-line treatment strategies for anaplastic lymphoma kinase-positive non-small cell lung cancer: a Bayesian network meta-analysis.

Background: Targeted therapies have led to significant improvement in the management and prognosis of anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC). We performed a network meta-analysis of frontline treatment options of ALK-positive NSCLC to provide clinical guidance. Methods: PubMed, Embase, ClinicalTrials.gov, and international conference databases were searched to identify relevant trials from inception to June 30, 2021. Phase III randomized controlled trials (RCTs) comparing treatments for patients with ALK-positive advanced NSCLC in the first-line setting were included in a Bayesian network meta-analysis. Eligible studies reported at least one of the following clinical outcomes: progression-free survival (PFS), overall survival (OS), risk of the central nervous system (CNS) progression, adverse events (AEs) of grade (G) 3 or higher (G3 AEs), or serious AEs (SAEs). Hazard ratios (HRs) and CI for primary outcome of PFS and secondary outcome of OS and risk of CNS progression were obtained. A multivariate, consistency model, fixed-effects analysis was used in the network meta-analysis. Data on G3 AEs and SAEs were abstracted and meta-analyzed. Risk of bias (RoB) was assessed using the Cochrane Collaboration's tool. Results: Nine RCTs comprising 2,484 patients were included with seven treatments: alectinib, brigatinib, ceritinib, crizotinib, ensartinib, lorlatinib, and chemotherapy. Compared with chemotherapy, ALK-tyrosine kinase inhibitors (TKIs) significantly prolong PFS and reduced risk of CNS progression except for ceritinib. Lorlatinib appears superior at reducing risk of CNS progression. None of the ALK-TKIs have a significantly prolonged OS as compared with chemotherapy. Lorlatinib increases the risk of G3 AEs as compared with alectinib (odds ratio 4.26 [95% CrI 1.22 to 15.53]), while alectinib caused the fewest G3 AEs. Conclusions: Lorlatinib is associated with the highest PFS benefit and lowest risk of CNS progression benefits for patients with advanced ALK-positive NSCLC, compared with other first-line treatments, but with higher toxicity. The implementation of a newer generation of ALK-TKIs in the first-line treatment of ALK-positive NSCLC into current clinical practice is evolving rapidly