a new sustainable direct solid state recycling of aa1090 aluminum alloy chips by means of friction stir back extrusion process

Abstract Friction stir extrusion is an innovative process designed to recycle metal chips from various machining operations. In this research, the feasibility of solid-state recycling of pure aluminum AA1090 machining chips using FSE process is investigated. In the early stage, a FE simulation was conducted in order to optimize the die design (spiral scroll of the plunge, hole size and bearing distance) and the process parameters in terms of plunge rotational speed and extrusion rate. The AA1090 aluminum chips were produced by turning off an as-received bar without lubrication. The chips were compacted on a MTS machine up to 150KN of load. The resulting chip-billets had a diameter of 40mm and 30mm high. The chip-based billet was FS Extruded at 1000rpm rotational speed and 0.8mm/s of plunge displacement. The extruded samples were analyzed by optical microscope in order to see the material flow and to characterize the microstructure. Finally, micro-hardness Vickers profiles were carried out, in both longitudinal and transversal direction, in order to investigate the homogeneity of the mechanical properties of the extrudate

Effect of Geometric Parameters and Moisture Content on the Mechanical Performances of 3D-Printed Isogrid Structures in Short Carbon Fiber-Reinforced Polyamide

AbstractThe present paper aims at studying the effect of geometric parameters and moisture content on the mechanical performances of 3D-printed isogrid structures in short carbon fiber-reinforced polyamide (namely Carbon PA). Four different geometric isogrid configurations were manufactured, both in the undried and dried condition. The dried isogrid structures were obtained by removing the moisture from the samples through a heating at 120 °C for 4 h. To measure the quantity of removed moisture, samples were weighted before and after the drying process. Tensile tests on standard specimens and buckling tests on isogrid panels were performed. Undried samples were tested immediately after 3D printing. It was observed that the dried samples are characterized by both Young modulus and ultimate tensile strength values higher than those provided by the undried samples. Similar results were obtained by the compression tests since, for a given geometric isogrid configuration, an increase in the maximum load of the dried structure was detected as compared to the undried one. Such discrepancy tends to increase as the structure with the lowest thickness value investigated is considered. Finally, scanning electron microscopy was carried out in order to analyze the fractured samples and to obtain high magnification three-dimensional topography of fractured surfaces after testing

Pregnancy vaccination predictive factors and uptake profiles among Italian women: A cross-sectional survey study on a large population

Objectives: To assess influenza and Tdap (tetanus, diphtheria, pertussis) vaccine coverage during pregnancy, explore key socioeconomic and maternity pathway-related predictors of vaccination, and detect specific patterns of vaccination uptake. Methods: The authors cross-sectionally analyzed self-reported data obtained from the systematic survey on the maternity pathways of Tuscany. They selected all pregnant women that completed from March 2019 to June 2022 the third-trimester questionnaire (n = 25 160), which included two dichotomous items on influenza and Tdap vaccination, as well as socioeconomic and pathway-related questions. Multilevel logistic models were performed to assess vaccination predictors and cluster analysis to identify vaccination patterns. Results: Vaccination coverage was higher for pertussis (56.5%) than for influenza (18.9%). The main predictors of vaccination were high socioeconomic status, attending private gynecologists, and receiving vaccine information. Three clusters were identified: cluster 1 included women receiving both Tdap and influenza vaccines; cluster 2 included women receiving no vaccinations; and cluster 3 included women receiving only the pertussis vaccine. Although women from cluster 3 were of middle to low education status, vaccine information was the main adherence determinant also in this group. Conclusions: Health workers and policymakers should focus on groups of pregnant women less prone to vaccination to promote vaccination information and encourage wider uptake and coverage

Driving time drives the hospital choice: choice models for pelvic organ prolapse surgery in Italy

Objective: The Italian healthcare jurisdiction promotes patient mobility, which is a major determinant of practice variation, thus being related to the equity of access to health services. We aimed to explore how travel times, waiting times, and other efficiency- and quality-related hospital attributes influenced the hospital choice of women needing pelvic organ prolapse (POP) surgery in Tuscany, Italy. Methods: We obtained the study population from Hospital Discharge Records. We duplicated individual observations (n = 2533) for the number of Tuscan hospitals that provided more than 30 POP interventions from 2017 to 2019 (n = 22) and merged them with the hospitals' list. We generated the dichotomous variable "hospital choice" assuming the value one when hospitals where patients underwent surgery coincided with one of the 22 hospitals. We performed mixed logit models to explore between-hospital patient choice, gradually adding the women's features as interactions. Results: Patient choice was influenced by travel more than waiting times. A general preference for hospitals delivering higher volumes of interventions emerged. Interaction analyses showed that poorly educated women were less likely to choose distant hospitals and hospitals providing greater volumes of interventions compared to their counterpart. Women with multiple comorbidities more frequently chose hospitals with shorter average length of stay. Conclusion: Travel times were the main determinants of hospital choice. Other quality- and efficiency-related hospital attributes influenced hospital choice as well. However, the effect depended on the socioeconomic and clinical background of women. Managers and policymakers should consider these findings to understand how women behave in choosing providers and thus mitigate equity gaps

The impact of new surgical techniques on geographical unwarranted variation: The case of benign hysterectomy

Since the 1980s, the international literature has reported variations for healthcare services,especially for elective ones. Variations are positive if they reflect patient preferences, while ifthey do not, they are unwarranted, and thus avoidable. Benign hysterectomy is among the mostfrequent elective surgical procedures in developed countries, and, in recent years, it has beenincreasingly delivered through minimally invasive surgical techniques, namely laparoscopic orrobotic. The question therefore arises over what the impact of these new surgical techniques onavoidable variation is. In this study we analyze the extent of unwarranted geographical variation oftreatment rates and of the adoption of minimally invasive procedures for benign hysterectomy in anItalian regional healthcare system. We assess the impact of the surgical approach on the provision ofbenign hysterectomy, in terms of efficiency (by measuring the average length of stay) and efficacy (bymeasuring the post-operative complications). Geographical variation was observed among regionalhealth districts for treatment rates and waiting times. At a provider level, we found differences forthe minimally invasive approach. We found a positive and significant association between rates andthe percentage of minimally invasive procedures. Providers that frequently adopt minimally invasiveprocedures have shorter average length of stay, and when they also perform open hysterectomies,fewer complications

Impact of new systemic oral and local, hormonal and non-hormonal treatments on genitourinary syndrome and Vulvo-Vaginal-Atrophy (VVA) through the menopausal transition: the right therapy in patients at risk

During the menopausal transition, women experience a number of symptoms due to declining estrogen levels, including vasomotor symptoms and vulvar and vaginal atrophy (VVA). Unlike vasomotor symptoms, vaginal dryness and dyspareunia, the main symptoms of VVA, typically worsen without treatment and can significantly impact the quality of life. Up to 60% of postmenopausal women may be affected by VVA, but many women unfortunately do not seek treatment due to embarrassment, cardiovascular and oncologic risk factor, or other factors. Therefore, local estrogen treatment is still controversial due to the systemic absorption of estradiol and its potential effects on the breast and endometrium.The fact that up to 26% of women using systemic hormonal therapy continue to experience symptoms of urogenital atrophy is sufficient reason to justify not recommending systemic hormonal therapy in women with vaginal symptoms only; many women initially require a combination of systemic and local estrogen therapy, especially when it is used at low doses.Intravaginal application of DHEA as an alternative treatment compared to local estrogen therapy. Intravaginal DHEA does not increase serum E2 levels and may be a better option for long term treatment of VVA as there is no increase in serum E2 levels with DHEA. Previous data have shown that intravaginal dehydroepiandrosterone (DHEA, prasterone) improved all the domains of sexual function, an effect most likely related to the local formation of androgens from DHEA.As the first non-hormonal alternative to estrogen-based products for this indication, the approval of ospemifene represents a significant milestone in postmenopausal women's health. Ospemifene is a non-steroidal estrogen receptor agonist/antagonist, also known as a selective estrogen receptor modulator (SERM), which seems to be effective in genitourinary symptoms.There is now a new alternative to systemic hormone therapy with estrogen/gestagens. The tissue-selective estrogen complex (TSEC) which combines a SERM (bazedoxifene, BZA) with conjugated equine estrogens (CEE) is designed not only to improve menopausal symptoms but to prevent osteoporosis, while maintaining the benefits of estrogen therapy on vasomotor symptoms and vulvovaginal atrophy, but antagonizing stimulatory effects on the endometrium and mammary gland. The two studied doses of BZA/CEE (20 mg BZA + 0.425 mg CEE and 20 mg BZA + 0.625 mg CEE) have been shown to improve the percentage of superficial cells, reducing the percentage of basal cells. Thus, 20 mg BZA + 0.625 mg CEE reduces the severity of symptoms caused by atrophic vulvovaginitis by 56% and normalizes vaginal histology and pH. This efficacy persists for 2 years.Here we aim to evaluate current experimental and actual clinical strategies to achieve the main therapeutic goal for genitourinary syndrome and VVA in menopause which is the relief of symptoms, a better quality of life and women' s health in menopausal women not eligible for Hormonal Replacement Therapy (HRT)

Dehydroepiandrosterone modulates endothelial nitric oxide synthesis via direct genomic and nongenomic mechanisms.

Abstract Dehydroepiandrosterone (DHEA) and its sulfate ester (DHEAS) are the major circulating steroid hormones in humans, and their levels progressively decline with age. Epidemiological studies suggest that DHEA/DHEAS concentrations may be inversely related to cardiovascular risk, but disagreement exists on this issue. Preliminary studies show that DHEA regulates vascular function, but few data have been published on the mechanisms. We show that DHEA administration to human endothelial cells triggers nitric oxide synthesis, due to enhanced expression and stabilization of endothelial nitric oxide synthase (eNOS). Additionally, DHEA rapidly activates eNOS, through a nontranscriptional mechanism that depends on ERK1/2 MAPK, but not on phosphatidylinositol 3-kinase/Akt. DHEA is not converted to estrogens or androgens by endothelial cells, and its genomic and nongenomic effects are not blocked by antagonists of the estrogen, progesterone, glucocorticoid, or androgen receptors, suggesting that DHEA acts through a specific receptor. Oral DHEA administration to ovariectomized Wistar rats dose-dependently restores aortic eNOS levels and eNOS activity, confirming the effects of DHEA in vivo. Our present data suggest that DHEA may have direct genomic and nongenomic effects on the vascular wall that are not mediated by other steroid hormone receptors, leading to eNOS activation and induction

Robotic Approach to Ureteral Endometriosis: Surgical Features and Perioperative Outcomes

Introduction: Surgical treatment of ureteral endometriosis is necessary to relieve urinary symptoms of obstruction and to preserve renal function. Which surgical approach to ureteral endometriosis should be considered the most appropriate is debated, due to the lack of scientific evidence. The aim of the present study is to assess the feasibility and to describe the perioperative outcomes of minimally invasive treatment of deep ureteral endometriosis using robotic assistance, highlighting the technical benefits and the limits of this approach. Method: A case-series including 31 consecutive patients affected by high-stage endometriosis including ureteral endometriosis using robotic assistance in our Department between November 2011 and September 2017. Results: All procedures were successfully completed by robotic technique, resulting in full excision of the parametrial nodules involving the ureter. Mean operating time was 184.8 ± 81min. Mean hospital stay was 4.02 ± 3 days. Perioperative complications occurred in five patients and 4 out of 5 involved the urinary tract. Conclusions: Robotic surgery for deep infiltrating endometriosis of the ureter was feasible and allowed complete resection of ureteral nodules in all cases. No intraoperative complications arose, but a non-negligible rate of urinary tract complications was detected. This calls for a careful assessment of the benefits and specific risks associated with the use of robotic surgery for the treatment of deep infiltrating endometriosis of the ureter