Search

Opposed to whole wheat (WWP), traditional pizza (TP) is loved by patients with type 1 diabetes mellitus (T1DM) despite causing hyperglycemia. 50 well-trained T1DM patients had higher glucose levels after TP than after WWP or mixed flour pizza, which however was tasty, digestible and metabolically appropriate to break diet monotony. Image 1 • Consumption of traditional pizza causes high post meal glucose levels in patients with diabetes, especially those with type 1 disease. • Traditional pizza causes high post meal glucose levels in type 1 diabetes disease. 50 patients with type 1 diabetes, we compared effects of refined (traditional), whole wheat and mixed flour pizzas. • The latter two varieties cause lower glucose post meal hyperglycemia, and also have a pleasant taste. [ABSTRACT FROM AUTHOR]

This work focuses on the assessment, in terms of effectiveness, feasibility and sustainability, of three different procedures for the synthesis of vanadium-based mixed-acid electrolytes to be used in vanadium redox-flow batteries (VRFBs). Procedures considered consisted in: a) the mere mixing of suitable vanadium precursors (Electrolyte A); b) the chemical reduction of V 2 O 5 by oxalic acid (Electrolyte B); c) the electrochemical reduction of V 2 O 5 using a home-made “H-shaped” electrolysis cell (Electrolyte C). VRFB properties such as energy efficiency, mean charge–discharge voltages, cycle duration as well as stability and conductivity of the electrolyte were analysed and compared with the state-of-the-art. Experimental tests carried out on a laboratory scale VRFB battery comprised: thermal stability test, cyclic voltammetry, electrochemical impedance spectroscopy measurements and charge–discharge tests. A Life Cycle Assessment of the three electrolytes is also presented for benchmarking purposes. [ABSTRACT FROM AUTHOR]

Abstract: The effectiveness of a condensational growth technique for particle abatement, activated via heterogeneous nucleation, was evaluated both theoretically and experimentally. Based upon information present in the literature, the heterogeneous nucleation rate and particle activation probability were estimated as a function of the environmental conditions. This work demonstrated that it is possible to capture the dispersed particles in the water droplets with high efficiency, depending on operating conditions. Increased final particle size, which improves removal from the gas stream, was found with relatively high inlet vapor concentrations and low working temperatures. It is also worth noting that extreme working conditions might be useful for the particle coverage. In fact, both nucleation and growth processes are active at very low vapor concentrations, although the maximum growth factor at these conditions is relatively low. Although it is not valid in predicting the induction time, a theoretical evaluation of the activation probability provides an indication of the process effectiveness at high vapor concentrations and low inlet temperatures. In contrast, at low vapor concentrations, this method fails to predict the occurrence of the vapor condensation on particles. At the experimentally evaluated conditions, the characteristic induction and growth times are compatible with practical applications. [Copyright &y& Elsevier]

The typical reactive structure stabilized in a diffusion layer in standard conditions can be significantly modified whether injected flows are diluted and/or preheated. The flow high initial enthalpy and the low fuel and/or oxygen concentration can drastically modify the structure of the oxidative and pyrolytic region due to change of the physical and chemical kinetics respect to conventional diffusion flame. Such operative conditions are typical of MILD (Moderate or Intense Low-oxygen Dilution)combustion processes. The effect of inlet conditions on the stabilized reactive structure has been studied by analyzing the behavior of a steady, one-dimensional diffusive layer. The change of the structures of the reactive region induced by a hot oxidant and diluted oxidant flow (HODO) fed towards a fuel jet at environmental temperature was numerically analyzed by means of temperature and heat release profiles, that are key parameters to understand the main features of the reactive region. In addition, the effect of diluent nature was studied by comparing the reactive structures also obtained with steam and carbon dioxide. [ABSTRACT FROM AUTHOR]

Sensitivity and specificity of physical and laboratory findings have been evaluated for the purpose of establishing a differential diagnosis between cirrhosis and chronic active hepatitis on clinicolaboratory grounds. Data from 213 patients from southern Italy with biopsyproven chronic active hepatitis or cirrhosis have been studied retrospectively. Splenomegaly, hypocholesterolemia, and decreased sulfobromophthalein-Ki were among the most sensitive individual findings in cirrhosis, whereas decreased platelet count, jaundice, and hypoprothrombinemia were the most specific ones. The presence in the same patient of both one of the former and one of the latter findings yields a correct diagnosis of cirrhosis with at least 90% likelihood. Advantages of the proposed diagnostic technique and comparison with data from an American series are discussed. [ABSTRACT FROM AUTHOR]

Background: The Mediterranean diet (MD) is recognized as a cultural heritage by UNESCO, thus, is a nutritional model widely spread in all Mediterranean countries. As already demonstrated by several studies, high adherence to MD is a protective factor against many chronic diseases. Conversely, poor adherence to the diet is correlated with an increased prevalence of these pathologies. The aim of the current study was to investigate the relationship between the adherence to MD and the prevalence of benign and malignant thyroid disease., Methods: We analyzed the health status of 60 patients, referred to total thyroidectomy and histological examination, due to nodular thyroid disease. Eating habits were evaluated according to the PREDIMED questionnaire, and patients' results were evaluated according to histological findings of benign or malignant disease., Results: PREDIMED Score was lower in patients with malignant thyroid disease (MTD) than those with benign thyroid disease (BTD) (5.27±0.87 vs. 7.00±1.23, respectively; P value <0.001). A significant correlation was found between poor adherence to MD and diagnosis of MTD (r=0.454; P<0.001). Excessive consumption of butter and sugary drinks, along with low consumption of pasta, white meat, and rice were found to be predictive factors of MTD., Conclusions: In our cohort, a PREDIMED Score ≤7 resulted significantly related to MTD diagnosis, while a good adherence to MD resulted associated with BTD. Moreover, high consumption of sweetened beverages seemed to predict MTD histologic diagnosis, while, conversely, low consumption resulted predictor of BTD. Nevertheless, more studies are needed to evaluate the effective impact of MD on MTD incidence on larger cohorts.

Purpose: The aim of this study was to evaluate the diagnostic value of four commonly utilized ultrasound (US) RSSs, namely, the American College of Radiology [ACR], European [EU], Korean [K] TI-RADSs and American Thyroid Association [ATA] US-based RSS criteria, in combination with activating point mutations of the RAS genes (NRAS, HRAS, and KRAS) for detection of thyroid carcinoma in cytologically indeterminate and suspicious for malignancy thyroid nodules., Methods: We retrospectively analyzed cytologically indeterminate and suspicious for malignancy thyroid nodules which underwent US, molecular testing and surgery between September 1, 2018, and December 31, 2023. Receiver operating characteristic (ROC) curves were generated, and the area under the curve (AUC, 95% confidence interval [CI]) was calculated., Results: A total of 100 cytologically indeterminate and 24 suspicious for malignancy thyroid nodules were analyzed. Compared to the four US-based RSSs alone, the diagnostic value of the four US-based RSSs combined with RAS mutations did not significantly improved (cytologically indeterminate, AUC [95% CI] 0.6 [0.5-0.7] and 0.6 [0.5-0.7], respectively, p = 0.70; cytologically suspicious for malignancy, AUC [95% CI] 0.7 [0.5-0.9] and 0.8 [0.6-0.9], respectively, p = 0.23)., Conclusions: The diagnostic value of the four main US-based RSSs (ACR, EU, K, and ATA) was not improved in conjunction with the evaluation of RAS mutations for preoperative risk stratification of cytologically indeterminate thyroid nodules., Clinical Relevance Statement: In cytologically indeterminate nodules categorized according to US-based RSSs, isolated RAS positivity does not reliably distinguish between benignity and malignancy., (© 2024. The Author(s).)

The ionic exchange membranes represent a core component of redox flow batteries. Their features strongly affect the performance, durability, cost, and efficiency of these energy systems. Herein, the operating conditions of a lab-scale single-cell vanadium flow battery (VRFB) were optimized in terms of membrane physicochemical features and electrolyte composition, as a way to translate such conditions into a large-scale five-cell VRFB stack system. The effects of the sulfonation degree (SD) and the presence of a filler on the performances of sulfonated poly(ether ether ketone) (SPEEK) ion-selective membranes were investigated, using the commercial perfluorosulfonic-acid Nafion 115 membrane as a reference. Furthermore, the effect of a chloride-based electrolyte was evaluated by comparing it to the commonly used standard sulfuric acid electrolyte. Among the investigated membranes, the readily available SPEEK50-0 (SD = 50%; filler = 0%) resulted in it being permeable and selective to vanadium. Improved coulombic efficiency (93.4%) compared to that of Nafion 115 (88.9%) was achieved when SPEEK50-0, in combination with an optimized chloride-based electrolyte, was employed in a single-cell VRFB at a current density of 20 mA·cm -2 . The optimized conditions were successfully applied for the construction of a five-cell VRFB stack system, exhibiting a satisfactory coulombic efficiency of 94.5%.

Hybrid perovskites are well-known for their optoelectronic and photovoltaic properties. Molecular dynamics simulations allow the study of these soft and ionic crystals by including dynamical effects (e.g., molecular rotations, octahedra tilting, ionic diffusion and hysteresis), yet the high computational cost restricts the use of accurate ab initio forces for bulk or small atomic systems. Hence, great interest exists in the development of classical force-fields for hybrid perovskites of low and linear scaling computational cost, via both empirical methods and machine-learning. This work aims at extending the transferability of our MYP0 model, which has been successfully tailored to methylammonium lead iodide (MAPI) and applied to the study of molecular rotations, vibrations, diffusion of defects, and many other properties. The extended model, named MYP2, improves the description of inorganic or hybrid fragments and the processes of crystal formation while preserving a good description of bulk properties. More importantly, it allows for the direct simulation of the crystal growth of cubic MAPI from deposition of PbI and MAI precursors on the surfaces. Our findings pave the way toward classical force-fields able to model the microstructure evolution of hybrid perovskites and the crystalline synthesis from deposition in vacuo .

Digital technologies are gradually gaining ground in dentistry. In particular, taking impressions with intraoral scanners is becoming routine; however, even this must often be preceded by the use of retraction cords. This article presents an innovative technique to record digital impressions of natural tooth abutments using interim restorations relined with impression material instead of retraction cords. In the laboratory, using computer-aided design, the technician can segment the internal surface of the interim restoration and use it to replace the abutment of the intraoral scan, thus obtaining an accurate coping that yields more detailed information about the supragingival and intrasulcular surface of the preparation.

Background : Pancreatic neuroendocrine tumors (pNETs) represent a rare subset of pancreatic cancer. Functional tumors cause hormonal changes and clinical syndromes, while non-functional ones are often diagnosed late. Surgical management needs multidisciplinary planning, involving enucleation, distal pancreatectomy with or without spleen preservation, central pancreatectomy, pancreaticoduodenectomy or total pancreatectomy. Minimally invasive approaches have increased in the last decade compared to the open technique. The aim of this study was to analyze the current diagnostic and surgical trends for pNETs, to identify better interventions and their outcomes. Methods : The study adhered to the PRISMA guidelines, conducting a systematic review of the literature from May 2008 to March 2022 across multiple databases. Several combinations of keywords were used ("NET", "pancreatic", "surgery", "laparoscopic", "minimally invasive", "robotic", "enucleation", "parenchyma sparing") and relevant article references were manually checked. The manuscript quality was evaluated. Results : The study screened 3867 manuscripts and twelve studies were selected, primarily from Italy, the United States, and China. A total of 7767 surgically treated patients were collected from 160 included centers. The mean age was 56.3 y.o. Enucleation (EN) and distal pancreatectomy (DP) were the most commonly performed surgeries and represented 43.4% and 38.6% of the total interventions, respectively. Pancreatic fistulae, postoperative bleeding, re-operation, and follow-up were recorded and analyzed. Conclusions : Enucleation shows better postoperative outcomes and lower mortality rates compared to pancreaticoduodenectomy (PD) or distal pancreatectomy (DP), despite the similar risks of postoperative pancreatic fistulae (POPF). DP is preferred over enucleation for the pancreas body-tail, while laparoscopic enucleation is better for head pNETs.

Breast angiosarcoma is a rare malignancy, accounting for less than 1% of all soft tissue cancers. It comprises primitive and secondary subtypes, such as radiogenic breast angiosarcoma (RAS). Despite multimodal treatment, angiosarcomas represent an incurable disease for many patients and a significant cause of deterioration in their quality of life. Surgery is a cornerstone in management, but high recurrence rates are reported. Electrochemotherapy (ECT) is a practicable locoregional treatment for patients with advanced angiosarcoma as part of a multimodal therapeutic strategy. The palliative benefits of ECT include optimal patient compliance, good local hemostasis control, and positive local responses. Since only 22 cases are described in the literature, we reported a rare case of RAS treated with ECT after a multidisciplinary approach, including Next Generation Sequencing (NGS). A literature review on the feasibility of ECT in RAS management was also performed., Competing Interests: The authors have no conflicts of interest to declare.

Cancers of unknown primary (CUPs) are a heterogeneous group of tumors characterized by a difficult diagnosis. The primitive tumor remains unknown, whereas metastases are the most common manifestation. Occult male breast cancers are very rare types of CUPs. The present study describes the case of a 64-year-old man affected by a CUP of presumed mammary origin. The aim of the article and the present review was to focus on their management. To the best of our knowledge, only thirteen cases have been reported in the literature. Because no specific guidelines are available, various approaches have been applied, influencing the treatment and the prognosis of patients with CUP., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Parisi et al.)

Anal incontinence is a frequent pathological condition with devastating impact on quality of life. The prevalence is approximately 15% of the population, with higher incidence reported in the elderly and multiparous women, and several factors have a major role in its pathogenesis, such as anatomical sphincter defects (Glasgow and Lowry in Dis Colon Rectum 55(4): 482-490, 2012), delivery injuries, and colorectal, uro-gynecological, and perineal surgery. The direct surgical approach is the gold standard treatment for fecal incontinence, especially through anterior sphincteroplasty, although a permanent defect of continence persists over time. The aim of our study is to evaluate, throughout a systematic review of the literature, the short- and long-term outcomes of sphincteroplasty performed for obstetric injuries anal incontinence. A systematic review of the studies published in the literature from January 2000 to December 2021 was performed in accordance with the PRISMA guidelines. Of the 2543 studies extrapolated, only eight fulfilled the inclusion criteria and were admitted represented by retrospective and prospective studies. The data analyzed from the included studies were number and mean age of the female population, and incontinence improvement with preoperative and postoperative short- and long-term outcomes, as reported by QoL questionaries and incontinence scores. Overall 355 patients with obstetric sphincter damage underwent sphincteroplasty with an anterior external sphincter overlapping procedure. A consistent improvement in fecal incontinence at short-term follow-up with relative improvement in QoL was reported. In 7 of 8 studies, the authors found a progressive worsening of the incontinence symptoms on the long-term follow-up. However, it is not clear whether the decrease in long-term continence results is parallel to a simultaneous decrease in QoL scores. Nevertheless, compared to the preoperative findings, the improvement was maintained in the long-term follow-up. Despite the limited data in the literature, a properly performed sphincteroplasty can guarantee a consistent improvement of the continence in short term with encouraging outcomes, especially for solid stool continence, in long time. We believe that anterior sphincteroplasty, as a low cost, feasible, and safe procedure, still has a role in the treatment of fecal incontinence for obstetric injury. Further large cohort randomized clinical trials are necessary to validate these results., (© 2023. Italian Society of Surgery (SIC).)

Background: Laparoscopic adrenalectomy (LA), which avoids large abdomen incisions, is considered the gold standard technique for the treatment of benign small- and medium-size adrenal masses (<6 cm) and weighing < 100 g. A trascurable mortality and morbidity rate, short hospitalization and patient rapid recovery are the main advantages compared to traditional surgery. During the past decade, a new surgical technology has been developed that expedites a "clipless" adrenalectomy. Here, the authors analyze a clinical series of 254 consecutive patients who were affected by adrenal gland neoplasms and underwent LA by the transabdominal lateral approach over the two last decades. A literature review is also presented., Methods: Preoperative, intraoperative and postoperative data from 254 patients who underwent LA between January 2003 and December 2022 were retrospectively collected and reviewed. Diagnosis was obtained on the basis of clinical examination, laboratory values and imaging techniques. Doxazosin was preoperatively administered in the case of pheochromocytoma (PCC) while spironolactone and potassium were employed to treat Conn's disease. The same surgeon (CG) performed all the LA and utilized the same laparoscopic transabdominal lateral approach. Different dissection tools-ultrasonic, bipolar or mixed scissors-and hemostatic agents were used during this period. The following results were obtained: 254 patients were included in the study; functioning tumors were diagnosed in 155 patients, 52 patients were affected by PCCs, 55 by Conn's disease, 48 by Cushing's disease. Surgery mean operative time was 137.33 min (range 100-180 min) during the learning curve adrenalectomies and 98.5 min (range 70-180) in subsequent procedures. Mean blood loss was respectively 160.2 mL (range 60-280) and 96.98 mL (range 50-280) in the first 30 procedures and the subsequent ones. Only three conversions (1.18%) to open surgery occurred. No mortality or postoperative major complications were observed, while minor complications occurred in 19 patients (3.54%). In 153 out of 155 functioning neoplasms, LA was effective in the normalization of the endocrine profile. According to our experience, a learning curve consisting of 30 cases was identified. In fact, a lower operative time and a lower complication rate was reported following 30 LA., Conclusions: LA is a safe procedure, even for masses larger than 6 cm and PCCs. Undoubtedly, the development of surgical technology has made it possible reducing operative times, performing a "clipless" adrenalectomy and extending the indications in the treatment of more complex patients. A multidisciplinary team, in referral high-volume centers, is recommended in the management of adrenal pathology. A 30-procedure learning curve is necessary to improve surgical outcomes.

Indeterminate follicular thyroid lesions (Thyr 3A and 3B) account for 10% to 30% of all cytopathologic diagnoses, and their unpredictable behavior represents a hard clinical challenge. The possibility to preoperatively predict malignancy is largely advocated to establish a tailored surgery, preventing diagnostic thyroidectomy. We analyzed the role of the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR) and the lymphocyte-to-monocyte ratio (LMR) as prognostic factors of malignancy for indeterminate thyroid nodules. In patients affected by cytological Thyr 3A/3B nodules, NLR, PLR and LMR were retrospectively compared and correlated with definitive pathology malignancy, utilizing student's t -test, ROC analysis and logistic regression. One-hundred and thirty-eight patients presented a Thyr 3A and 215 patients presented a Thyr 3B. After the logistic regression, in Thyr 3A, none of the variables were able to predict malignancy. In Thyr 3B, NLR prognosticated thyroid cancer with an AUC value of 0.685 ( p < 0.0001) and a cut-off of 2.202. The NLR results were also similar when considering the overall cohort. The use of cytological risk stratification in addressing the management of indeterminate thyroid nodules in patients is not always reliable. NLR is an easy and reproducible inflammatory biomarker capable of improving the accuracy of preoperative prognostication of malignancy.

Background: Schwannomas, also called neurinomas, are rare benign tumors of the neural cells that can develop from the sheaths of nervous structures of several districts, although the most frequent sites are the cranial nerves (25%-45%). Rarely, cases show neck schwannomas in the thyroid parenchyma, while the cases of thyroid-bed schwannomas mimicking a thyroid-gland lesions are anecdotal., Methods: We report the case of a 70-year-old man with a preoperative-imaging diagnosis of a thyroid neoplasm, confirmed as Thyr 4 by fine-needle cytology., Results: During surgery, an extra-thyroidal lesion was discovered, determined to be a neck schwannoma through definitive pathology. A literature review of cases of thyroid-bed-lesion schwannomas misinterpreted as thyroid neoplasms was carried out., Conclusions: In the case of suspicious extra-thyroidal lesions, we advocate for a close routine cooperation between the cytologist, the radiologist, and the surgeon in the attempt to reach an accurate preoperative diagnosis.