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Background The incidence of ulcerative colitis (UC) in the elderly population is increasing. The aim of this study was to assess the degree to which age and other factors increase the risk of developing major complications in patients undergoing elective surgery for UC.Methods Using the ACS-NSQIP database from 2016 to 2020, patients undergoing elective surgery for UC were divided into four categories: younger than 30, 30-49, 50-69, and 70 or older. A composite outcome was created including major complications and multivariable analysis was performed to identify factors associated with composite major complications.Results 5946 patients diagnosed with ulcerative colitis who underwent elective surgery were included in the analysis. 14.1% of all patients developed a major complication. For patients with UC, factors associated with the development of a major complication were age 50-69 (OR 1.31, P= .034), male sex (OR 1.38, P< .001), Black race (OR 1.47, P= .049), dependent status (OR 2.06, P= .028), hypoalbuminemia (OR 1.92, P< .001), preoperative steroid treatment (OR 1.27, P= .038), preoperative transfusion (OR 1.91, P< .001), open surgical approach (OR 1.44, P= .002), and partial colectomy (OR 1.51, P= .007). Specifically in patients aged 70 or older, hypoalbuminemia (OR 3.20, P< .001) and preoperative transfusion (OR 2.78, P= .019) were associated with a major complication.Conclusion Age is a risk factor for the development of a major complication in UC patients undergoing elective surgery. However, it is not the only risk factor nor is it the one that increases the risk the most.

Extending the operation of proton exchange membrane fuel cells (PEMFCs) at high temperature (i.e., 120 °C) and/or low relative humidity (< 50% RH) remains a significant challenge due to dehydration and subsequent performance failure of the Nafion electrolyte. We approached this problem by integrating the Nafion matrix with a novel hybrid nanofiller, created through direct growth of TiO2nanoparticles on the surface of carbon nanotubes. This synthetic approach allowed to preserve an effective nanodispersion of Titania particles in the hosting matrix, thereby boosting dimensional stability, hydrophilicity, and physiochemical properties of the Nafion/MWCNTs-TiO2(NMT-x) nanocomposites compared to parental Nafion. At optimal concentration (i.e., 3 wt% with respect to the polymer), the nanocomposite membrane exhibited high transport characteristics with impressive water retention capabilities, resulting in a proton conductivity of 8.3 mS cm− 1at 80 °C and 20% RH. The Titania nanoparticles plays a key role in retaining water molecules even under dehydrating conditions, while also directly contributing to proton transport. Additionally, the long carbon nanotubes promote the formation of additional paths for proton conductivity. These combined features enabled the NMT-3 membrane to achieve a maximum power output of 307.7 mW/cm2in a single H2/air fuel cell (5 cm2active electrode area and 0.5 mg Pt/cm2at both electrodes) under very challenging conditions, specifically at 120 °C and 30% RH. This represents a significant advancement towards overcoming the limitations of traditional Nafion membranes and opens up new possibilities for high-temperature, low-humidity H2/air fuel cell applications.

Le onde d’urto a bassa intensità (LI-ESWT) emergono come un trattamento promettente per la disfunzione erettile (DE). Questa terapia non invasiva, che sfrutta l’utilizzo di onde acustiche, migliora il flusso sanguigno penieno con effetti positivi sulla funzionalità erettile. In letteratura sono emerse sempre maggiori evidenze rispetto all’efficacia delle LI-ESWT. I principali vantaggi di tale metodica includono la non invasività, i minimi effetti collaterali e la procedura eseguibile in setting ambulatoriale. Tuttavia, i costi della metodica, la necessità di sedute multiple e l’efficacia non garantita a tutte le classi di pazienti con DE rappresentano alcune limitazioni. Inoltre, sono ancora dubbi i benefici a lungo termine di tale terapia ed è ancora in fase di definizione un profilo chiaro dei pazienti che potrebbero trarne maggior vantaggio.

El desarrollo de nuevos síntomas como aparición o aumento de debilidad, dolor, atrofia y fatiga musculares, décadas después de haber padecido poliomielitis anterior aguda se conoce como síndrome pospolio (SPP). En Argentina no existen datos sobre su prevalencia.

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Obesity/overweight and its complications are a growing problem in many countries. Italian Society of Bariatric and Metabolic Surgery for Obesity (Società Italiana di Chirurgia dell'Obesità e delle Malattie Metaboliche-SICOB) decided to develop the first Italian guidelines for the endoscopic bariatric treatment of obesity. The creation of SICOB Guidelines is based on an extended work made by a panel of 44 members and a coordinator. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology has been used to decide the aims, reference population, and target health professionals. Clinical questions have been created using the PICO (patient, intervention, comparison, outcome) conceptual framework. We will perform systematic reviews, formal meta-analyses, and network meta-analyses for each PICO and critical outcomes aimed at assessing and rating the efficacy and safety of endoscopic bariatric procedures in comparison with either no interventions, lifestyle interventions, or approved anti-obesity treatments in trials with a follow-up of at least 52 weeks. For PICO on temporary endoscopic bariatric treatments, we will also consider RCT with a minimum duration of 6 months. The panel proposed 8 questions, organized into four domains: A. Indication for endoscopic bariatric surgery; B. Revisional surgery; C. Temporary gastric and duodenal–jejunal procedures; D. Endoscopic diagnosis/treatment of bariatric and metabolic surgery complications. These guidelines will apply to patients aged ≥ 14 years) with body mass index (BMI) ≥ 27 kg/m2and requiring endoscopic bariatric surgery or endoscopic diagnostic and/or therapeutic procedures. The areas covered by the clinical questions included indications of endoscopic bariatric surgery, types of surgery, revisional surgery, and management of bariatric and metabolic surgery complications.

Context effects constitute benchmark behavioral phenomena for theories of choice. Previous research using signal-to-respond paradigms suggests that these phenomena develop differentially over time. Importantly, however, such time pressure manipulations correspond to an externally controlled stopping rule, which may produce different behavior compared to an internally controlled stopping rule. The first goal of this work was to examine context effects as a function of internally controlled response time. Across eight data sets, we find a consistent crossover pattern such that the attraction and compromise effects are associated with slower response times and the similarity effect is associated with faster response times. The second goal is to utilize state-of-the-art methodology (Evans et al. in Psychonomic Bulletin & Review, 26, 1–33, 2019; Turner and Sederberg in Psychonomic Bulletin & Review, 21(2), 227–250, 2014) to determine whether four information-accumulation models (MDFT, the LCA, the AAM, and the MLBA) can correctly capture the direction in which preference evolves over time in each context when fit to joint choice and response time data with an internal stopping rule. Whereas the MLBA best fit the means, and MDFT and the AAM partially captured the qualitative patterns, none of the models captured the full spectrum of results. Despite a strong historical trend for empirical work in consumer choice, recent response time modeling has focused on fundamentally different non-consumer tasks. The third goal is to generalize that modeling to the consumer choice domain, providing a bridge to a wide range of prior work. The present work provides new insights into the relationship between choice and response times and sets important constraints for models that seek to account for such behavior.

Abstract: Background: We retrospectively evaluate the potential protective influence of patent paraumblical vein (PUV) collaterals against portal vein (PV) thrombosis and reduced PV diameter in candidates for orthotopic liver transplant (OLT) Methods: Dynamic 3D contrast-enhanced MRI at 1.5T was obtained in 309 patients with cirrhosis without evidence of malignancy. All MR studies were reviewed by one reader for PUV collaterals, PV thrombosis and PV diameter. Statistical analysis was performed by Fisher exact tests; 50 selected studies were reviewed independently by two additional readers to determine interobserver agreement via intraclass correlation coefficient (ICC). Results: Patent PUV was noted in 119 of 309 patients (38.5%). Mean PV diameter was 13.4 � 3.0 mm in patients with PUV compared with 11.3 � 3.6 mm without PUV (P < 0.01). Main PV thrombosis was present in 13 of 309 patients (4.2%) and significantly more frequent in those without PUV than with PUV (6.3% vs. 0.8%, P < 0.05). ICC indicated almost perfect agreement among three readers for presence of PUV collaterals (ICC = 0.91) and PV thrombosis (ICC = 0.96). Conclusion: Our results suggest that patients with patent PUV appear less likely to develop main PV thrombosis or small PV diameter, suggesting a protective effect of PUV on PV patency.

Abstract: Purpose: We sought to determine the nature and timing of complications after common anorectal operations by using a prospective quality tracking tool. Methods: A prospectively maintained quality database was queried to identify patients who underwent pilonidal sinus excision, hemorrhoidectomy, sphincterotomy, abscess drainage, or fistulotomy during an 11-year interval. All hospital complications were recorded by a single nurse practitioner and verified jointly by the surgical team. Any posthospital complications were registered at the first postoperative visit. Results: A total of 969 patients underwent one of the five index anorectal procedures during the study period. Forty-nine complications occurred in 38 patients (3.9 percent). The majority of complications were minor (40/49; 82 percent) and were primarily urinary retention, minor bleeding, and wound infection. Twenty-five of the 40 minor complications (62 percent) were identified only after hospital discharge in the outpatient setting. Eight of the nine major complications occurred in patients already hospitalized for major concomitant illnesses and were unrelated to the anorectal surgery. The remaining patient had a postoperative deep vein thrombosis. Conclusions: Complications after anorectal procedures are infrequent, typically minor, and occur after hospital discharge. Major complications reflect concomitant illness, not surgical quality. Meaningful outcome measures are needed to assess the quality of anorectal surgery.

Abstract: Purpose: Transanal endoscopic microsurgery, developed by Buess in the 1980s, has become increasingly popular in recent years. No large studies have compared the effectiveness of transanal endoscopic microsurgery with traditional transanal excision. Methods: Between 1990 and 2005, 171 patients underwent traditional transanal excision (n = 89) or transanal endoscopic microsurgery (n = 82) for rectal neoplasms. Medical records were reviewed to determine type of surgery, resection margins, specimen fragmentation, complications, recurrence, lesion type, stage, and size. Results: The groups were similar with respect to age, sex, lesion type, stage, and size. Mean follow-up was 37 months. There was no difference in the complication rate between the groups (transanal endoscopic microsurgery 15 percent vs. traditional transanal excision 17 percent, P = 0.69). Transanal endoscopic microsurgery was more likely to yield clear margins (90 vs. 71 percent, P = 0.001) and a nonfragmented specimen (94 vs. 65 percent, P < 0.001) compared with transanal excision. Recurrence was less frequent after transanal endoscopic microsurgery than after traditional transanal excision (5 vs. 27 percent, P = 0.004). Conclusions: Transanal endoscopic microsurgery is the technique of choice for local excision of rectal neoplasms.

We report on the synthesis of “clickable” graphene nanoribbons (GNRs) and their application as a versatile interface for electrochemical biosensors. GNRs are successfully deposited on gold-coated working electrodes and serve as a platform for the covalent anchoring of a bioreceptor (i.e., a DNA aptamer), enabling selective and sensitive detection of Interleukin 6 (IL6). Moreover, when applied as the intermediate linker on reduced graphene oxide (rGO)-based field-effect transistors (FETs), the GNRs provide improved robustness compared to conventional aromatic bi-functional linker molecules. GNRs enable an orthogonal and covalent attachment of a recognition unit with a considerably higher probe density than previously established methods. Interestingly, we demonstrate that GNRs introduce photoluminescence (PL) when applied to rGO-based FETs, paving the way toward the simultaneous optical and electronic probing of the attached biointerface.

Brain-derived neurotrophic factor (BDNF) and its precursor, proBDNF, are known to significantly contribute to brain homeostasis, neuroplasticity, and neuronal remodeling. Although these neurotrophins are thought to have opposing roles, both play a critical part in shaping long-lasting behavioral changes following substance use. In this context, our study sought to explore the implications of these neurotrophins in the pathophysiology of cocaine use disorder (CUD). We conducted a case-control study, which included 28 individuals seeking treatment for CUD and 38 matched healthy participants. We measured peripheral neurotrophin concentrations via an enzyme-linked immunosorbent assay. Additionally, all participants were screened for cocaine-associated pathways (e.g., cocaine intake, craving intensity), along with associated psychopathological data. Our findings highlighted an increased concentration of BDNF and proBDNF in CUD individuals when compared to healthy controls (BDNF: 18092.80 ± 6844.62 vs. 11334.42 ± 5061.85 pg/ml, p< 0.001; proBDNF: 87.03 ± 33.23 vs. 55.70 ± 23.26 ng/ml, p< 0.001). We further corroborated the relationship between neurotrophin levels and CUD using a linear regression model. Nevertheless, there was no significant difference in the proBDNF to BDNF ratio between the two groups. Interestingly, our study also demonstrated the influence of factors like usage of psychotropic medications, history of psychiatric hospitalizations, and psychiatric diagnoses on neurotrophin dynamics. In conclusion, our study underscores the significance of neurotrophin fluctuations in CUD. The observed increase in BDNF and proBDNF levels could play a pivotal role in driving craving and relapse risk. Thus, a nuanced understanding of these neurobiological underpinnings in CUD might contribute to the development of more targeted and effective therapeutic strategies.

Background Due to the rise in diverticular disease, the ASCRS developed practice parameters to ensure high-quality patient care. Our study aims to evaluate the impact of the 2014 practice parameters on the treatment of non-emergent left-sided diverticular disease.Methods This is a retrospective cohort study using the ACS-National Surgical Quality Improvement Project (ACS-NSQIP). Elective sigmoid resections performed by year were evaluated and compared before and after practice parameters were published.Results Overall, 46,950 patients met inclusion criteria. There was a significant decrease in the number of non-emergent operations when evaluating before and after guideline implementation (P< .001). There was a significant decrease in the number of patients younger than 50 years of age operated electively for diverticular disease (25.8% vs. 23.9%, P= .005). Adoption of minimally invasive surgery continued to increase significantly throughout the study period.Conclusions Publication of the 2014 ASCRS practice parameters is associated with a change in management of diverticular disease in the non-emergent setting.

Background: Atrial fibrillation (AF) and congestive heart failure often coexist due to their shared risk factors leading to potential worse outcome, particularly cerebrovascular events. The aims of this study were to calculate the rates of ischemic and severe bleeding events in ischemic stroke patients having both AF and reduced ejection fraction (rEF) (⩽40%), compared to ischemic stroke patients with AF but without rEF.Methods: We performed a retrospective analysis that drew data from prospective studies. The primary outcome was the composite of either ischemic (stroke or systemic embolism), or hemorrhagic events (symptomatic intracranial bleeding and severe extracranial bleeding).Results: The cohort for this analysis comprised 3477 patients with ischemic stroke and AF, of which, 643 (18.3%) had also rEF. After a mean follow-up of 7.5 ± 9.1 months, 375 (10.8%) patients had 382 recorded outcome events, for an annual rate of 18.0%. While the number of primary outcome events in patients with rEF was 86 (13.4%), compared to 289 (10.2%) for the patients without rEF; on multivariable analysis rEF was not associated with the primary outcome (OR 1.25; 95% CI 0.84–1.88). At the end of follow-up, 321 (49.9%) patients with rEF were deceased or disabled (mRS ⩾3), compared with 1145 (40.4%) of those without rEF; on multivariable analysis, rEF was correlated with mortality or disability (OR 1.35; 95% CI 1.03–1.77).Conclusions: In patients with ischemic stroke and AF, the presence of rEF was not associated with the composite outcome of ischemic or hemorrhagic events over short-term follow-up but was associated with increased mortality or disability.

Introduction: Ischaemic stroke patients with atrial fibrillation (AF) are at high risk of stroke recurrence despite oral anticoagulation therapy. Patients with cardiovascular comorbidities may take both antiplatelet and oral anticoagulation therapy (OAC/AP). Our study aims to evaluate the safety and efficacy of OAC/AP therapy as secondary prevention in people with AF and ischaemic stroke.Patients and methods: We performed a post-hoc analysis of pooled individual data from multicenter prospective cohort studies and compared outcomes in the OAC/AP cohort and patients on DOAC/VKA anticoagulation alone (OAC cohort). Primary outcome was a composite of ischaemic stroke, systemic embolism, intracranial bleeding, and major extracranial bleeding, while secondary outcomes were ischaemic and haemorrhagic events considered separately. A multivariable logistic regression analysis was performed to identify independent predictors for outcome events. To compare the risk of outcome events between the two cohorts, the relation between the survival function and the set of explanatory variables were calculated by Cox proportional hazard models and the results were reported as adjusted hazard ratios (HR). Finally another analysis was performed to compare the overall risk of outcome events in both OAC/AP and OAC cohorts after propensity score matching (PSM).Results: During a mean follow-up time of 7.5 ± 9.1 months (median follow-up time 3.5 months, interquartile range ±3), 2284 stroke patients were on oral anticoagulants and 215 were on combined therapy. The multivariable model demonstrated that the composite outcome is associated with age (OR: 1.03, 95% CI: 1.01–1.04 for each year increase) and concomitant antiplatelet therapy (OR: 2.2, 95% CI: 1.48–3.27), the ischaemic outcome with congestive heart failure (OR: 1.55, 95% CI: 1.02–2.36) and concomitant antiplatelet therapy (OR: 1.93, 95% CI: 1.19–3.13) and the haemorrhagic outcome with age (OR: 1.03, 95% CI: 1.01–1.06 for each year increase), alcoholism (OR: 2.15, 95% CI: 1.06–4.39) and concomitant antiplatelet therapy (OR: 2.22, 95% CI: 1.23–4.02). Cox regression demonstrated a higher rate of the composite outcome (hazard ratio of 1.93 [95% CI, 1.35–2.76]), ischaemic events (HR: 2.05 [95% CI: 1.45–2.87]) and bleeding outcomes (HR: 1.90 [95% CI, 1.06–3.40]) in OAC/AP cohort. After PSM analysis, the composite outcome remained more frequent in people treated with OAC + AP (RR: 1.70 [95% CI, 1.05–2.74]).Discussion: Secondary prevention with combination of oral anticoagulant and antiplatelet therapy after ischaemic stroke was associated with worse outcomes in our cohort.Conclusion: Further research is needed to improve secondary prevention by investigating the mechanisms of recurrent ischaemic stroke in patients with atrial fibrillation.

Biomass is often referred to as a carbon–neutral energy source, and it has a role in reducing fossil fuel depletion. In addition, biomass can be converted efficiently into various forms of biofuels. The biomass conversion processes involve several thermochemical, biochemical, and hydrothermal methods for biomass treatment integration. The most common conversion routes to produce biofuels include pyrolysis and gasification processes. On the other hand, supercritical water gasification (SCWG) and hydrothermal liquefaction (HTL) are best suitable for converting biomass and waste with high moisture content. Despite promising efficiencies, SCWG and HTL processes introduce operational issues as obstacles to the industrialization of these technologies. The issues include process safety aspects due to operation conditions, plugging due to solid deposition, corrosion, pumpability of feedstock, catalyst sintering and deactivation, and high production costs. The methods to address these issues include various reactor configurations to avoid plugging and optimizing process conditions to minimize other issues. However, there are only a few studies investigating the operational issues as the main scope, and reviews are seldomly available in this regard. Therefore, further research is required to address operational problems. This study reviews the main operational problems in SCWG and HTL. The objective of this study is to enhance the industrialization of these processes by investigating the operational issues and the potential solutions, i.e., contributing to the elimination of the obstacles. A comprehensive study on the operational issues provides a holistic overview of the biomass conversion technologies and biorefinery concepts to promote the industrialization of SCWG and HTL.

ARCADIA 1 and ARCADIA 2 were two randomized, placebo-controlled phase 3 trials showing the effectiveness of nemolizumab with concomitant use of low-to-medium potency topical corticosteroids, and/or with or without topical calcineurin inhibitors, in adults and adolescents with moderate-to-severe atopic dermatitis. Coprimary endpoints were met in the nemolizumab plus background therapy groups in both trials, with significant differences versus placebo.

Synthetic anion receptors are increasingly being explored for the transport of anions across lipid membranes because of their potential therapeutic applications. A considerable amount of research focuses on the transport of chloride, whereas the transmembrane transport of inorganic phosphate has not been reported to date, despite the biological relevance of this anion. Here we present a calix[4]pyrrole with a bisurea strap that functions as a receptor and transporter for H2PO4–, relying on the formation of eight hydrogen bonds and efficient encapsulation of the anion. Using a phosphate-sensitive lanthanide probe and 31P NMR spectroscopy, we demonstrate that this receptor can transport phosphate into vesicles by H2PO4–/Cl–antiport, H2PO4–uniport, and Cs+/H2PO4–symport mechanisms. This first example of inorganic phosphate transport by a neutral receptor opens perspectives for the future development of transporters for various biological phosphates.

Despite the presence of several cross-variety studies on spoken varieties of regional Italian, research on the intonational transition across geographically close varieties is still scarce. This article tackles this issue by providing a first cross-variety comparison of question intonation in three neighboring varieties of Italian spoken in Campania, namely Neapolitan, Salerno and Cilento Italian. The three varieties are chosen based on their position with respect to the isoglosses identifying the Eboli-Lucera line. Such comparison is made possible using the methodological protocol outlined by Gili Fivela et al. (2015) and specifically concerns yes-no, wh- and disjunctive questions. This explorative study aims at identifying intonational features differenced by frequency of occurrence across space, thereby providing a basis for further quantitative studies on spatial distribution. Based on a corpus elicited with a combination of Discourse Completion Task and reading task, we analyze the phonological features of question tunes in Cilento Italian, while also comparing them to their counterparts in Neapolitan and Salerno Italian. Results show that the three varieties present systemic, realizational and phonotactic differences as well as differences in the frequency of occurrence of tonal events. The intraregional variation across Campania Italian varieties hints at an intonational transition featuring a smooth geographic cline.

RESUMENA partir de los resultados obtenidos de los ensayos en modelo de las turbinas de Salto Grande, se observó que, debido a la incertidumbre con que se miden las diferentes magnitudes significativas en la operación de la central hidroeléctrica, el rendimiento de la turbina sería menor que el correspondiente a la combinatoria, es decir, al que resultaría de la combinación óptima de ángulo de pala y apertura del distribuidor. Se consideraron reducciones en la incertidumbre del salto neto de 50 cm a menos de 1 cm y en la medición del ángulo de pala de 0.4° a 0.11°. En virtud de estas reducciones de la incertidumbre de la medición, el rendimiento mínimo de cada turbina se incrementaría hasta en 0.78%, mientras que el rendimiento medio podría hacerlo hasta en 0.39%. Estos incrementos en el rendimiento podrían dar lugar a un aumento en el orden de los 3,5 millones de dólares en el ingreso anual de producción, siendo los principales aportes la reducción de la incertidumbre en la medición del salto neto y del ángulo de pala. Puesto que el error aleatorio en la medición del ángulo de pala del rotor podría ser elevado, incluso reduciendo la incertidumbre en el salto se podría tener rendimientos aún menores a los estimados previamente. En caso de reducir la incertidumbre en la fijación del ángulo de pala entre 1 ° y 0.1 ° se podría esperar un incremento en los ingresos, por venta al sistema de margen izquierda, de 1.4%.

RESUMENEn base a un planteo teórico y al análisis de datos se constató que el coeficiente de pérdida de carga de la conducción de entrada de las turbinas de Salto Grande sería de entre 2.38 y 2.77, siendo disímil en cada vano debido a que los caudales circulantes por cada vano serían diferentes. Además, el coeficiente de pérdida de carga, determinado a partir de la medida con un transductor de presión en la embocadura, resulta en promedio 3.6 veces superior al determinado a partir de la medida en la recata. Entre las acciones que actúan en dirección normal al flujo, parece ser mayor la debida a la aceleración de Coriolis, debido a lo cual el flujo presentaría una componente en dirección paralela a la entrada hacia margen izquierda. Sobre los tabiques que separan los vanos, se produciría una separación de capa límite, debido a lo cual se produciría un bloqueo diferente en cada vano. Esto tendría como consecuencia la diferencia en los caudales por cada vano y la diferencia entre las pérdidas de carga calculadas con el transductor de presión y la determinada a partir de la medición en la recata.

In Nepal, the informal sector is responsible for treating 15% of household waste. It is the only alternative to landfilling and open disposal; however, the current waste management system does not acknowledge informal recyclers aggravating various challenges and vulnerabilities that the sector already faces. This study identifies and validates for the first time the challenges of the informal waste sector while providing a granular understanding of the actors that shape waste management in the region. The study uses primary data collected over a period of 6 months in Kathmandu and Lalitpur, the first and third most populated areas in Nepal. The methods considered were semi-structured interviews, questionnaires, and a co-creation workshop with formal and informal actors. A novel characterization of waste management actors was conducted to identify two profiles namely cyclists and scavengers and question the formality of the collection centres. Findings suggest that the price volatility of recycled materials and the lack of treatment and absence of regulatory capacity are among the main challenges in promoting a circular economy from the informal sector. The recommendations to overcome these challenges are a series of policy reforms, such as an extended responsibility producer scheme and the review of the tax on recycled material transport. The main policy implication from the finding reveals that circular economy is already being promoted by the informal sector — a responsibility that should fall under the remit of the regional and national governments. The study concludes that integration is not only necessary to improve the conditions of informal workers but essential to developing a circular economy in Nepal.

We report the off-label application of the Castor single-branch stent graft for a complicated acute intramural haematoma involving the aortic arch. The endograft was deployed in zone 1 with the single branch in the left common carotid artery through a surgical left carotid and percutaneous right femoral artery access. The procedure was completed with the construction of a left carotid-subclavian bypass followed by plug embolization of the left subclavian artery.Α 58-year-old woman presented to our facility with a diagnosis of aortic intramural haematoma (IMH) extending from the distal aortic arch to the renal arteries (Fig. 1).

Functionalized porous silica materials were synthesized in alkaline conditions by post-grafting method using hexadecyltrimethylammonium bromide (CTAB) as templating agent, tetraethyl orthosilicate (TEOS) as silica precursors and trialkoxysilanes functionalised with different organic groups. Textural features, halfway between microporosity and mesoporosity, combined with the surface physico-chemical ones related to various organic groups, determined different CO2storage properties highlighting a strong interaction with the precursor 3-Aminopropyl)triethoxysilane. NMR spectroscopy also showed how physisorption is the mainstream mechanism for CO2adsorption in all the sorbents, except for the aforementioned organic group in which an important chemisorption contribution occurs. Diffusion and molecular mobility analysis revealed that at least two species coexist within the micro-/meso-pores of the sorbents, namely, CO2molecules powerfully interacting with the pore surface (pore-surface CO2) and “bulk-like” CO2filling the central region of the pores. Furthermore, the post functionalization suppresses the diffusion of CO2molecules through the pore channels with all the functionalized materials exhibiting a single self-diffusion coefficient. On the other side, D// strictly depends on the average pore size of the sorbent.

The Special Issue on Stress and Addiction is concerned with interrelationships between environmental stimuli such as stress and endogenous opioid systems that lead to addiction and other behaviors. Stress can have a profound effect on pain that is mediated in part through endogenous opioids. Here we briefly summarize investigation pertaining to the involvement of endogenous opioids in stress-induced analgesia, and their mediation by hypothalamo-pituitary-adrenal systems. Subsequent studies of the contribution of opioid receptor subtypes mediating supraspinal pain-inhibitory systems are examined using selective agonists and antagonists largely developed by Dr. Philip Portoghese. Because of the ongoing opioid epidemic yet the need to discover effective analgesics, we conclude with a discussion of several approaches to manage pain effectively without such serious side effects as tolerance and addiction, associated with traditional opioid use. These include opioid analgesic synergy, biased opioid agonism, and targeting of opioid receptor heteromers with bivalent ligands.

Convalescent plasma has been one of the most common treatments for COVID-19, but most clinical trial data to date have not supported its efficacy.

Background: Enhanced recovery after bariatric surgery (ERABS) is an approach developed to improve outcomes in obese surgical patients. Unfortunately, it is not evenly implemented in Italy. The Italian Society for the Surgery of Obesity and Metabolic Diseases and the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care joined in drafting an official statement on ERABS. Methods: To assess the effectiveness and safety of ERABS and to develop evidence-based recommendations with regard to pre-, intra-, and post-operative care for obese patients undergoing ERABS, a 13-member expert task force of surgeons and anesthesiologists from Italian certified IFSO center of excellence in bariatric surgery was established and a review of English-language papers conducted. Oxford 2011 Levels of Evidence and U.S. Preventive Services Task Force Grade Definitions were used to grade the level of evidence and the strength of recommendations, respectively. The supporting evidence and recommendations were reviewed and discussed by the entire group at meetings to achieve a final consensus. Results: Compared to the conventional approach, ERABS reduces the length of hospital stay and does not heighten the risk of major post-operative complications, re-operations, and hospital re-admissions, nor does it increase the overall surgical costs. A total of 25 recommendations were proposed, covering pre-operative evaluation and care (7 items), intra-operative management (1 item, 11 sub-items), and post-operative care and discharge (6 items). Conclusions: ERABS is an effective and safe approach. The recommendations allow the proper management of obese patients undergoing ERABS for a better outcome.

Background: Health Industry and physician collaboration generates innovation. Colorectal Surgeon (CRS) selection to collaborate might not be random. We aim to identify CRS personal and professional characteristics that facilitate collaboration with the Industry. Method: Cross-sectional study of Industry payments to CRS (2014–2018) using Open Payments Database from Centers for Medicare & Medicaid Services. Multivariable regression compared variables predicting payment amount including gender, years in practice, leadership positions, H-index, Twitter presence and geographic location. Results: Surgeons who were male received 3.1 times the amount in Industry payments as compared to females (p= 0.014). Chairs and Division Chiefs received 2.7 times the amount in payments as compared to those without these leadership positions (p= 0.003). Surgeons with an H-index ≥ 8 received 2.2 times the amount in payments as compared to those with H-index &lt; 8 (p= 0.001). Surgeons in practice for 12–19 and 20–30 years received 3 times and 4.4 times the amount in payments as compared to surgeons in practice for 1–11 years (p= 0.036 and p= 0.017, respectively). Surgeons in the South received 3.2 times and 2 times the amount in payments as compared to surgeons in the Northeast (p&lt; 0.0005) and in the Midwest (p= 0.006). Surgeons with Twitter accounts received 1.7 times the amount in payments as compared to surgeons without Twitter (p= 0.036). Among Twitter users, those with 321–17,200 followers received 4.7 times and 9.5 times the amount in payments as compared to those with 0–15 and 16–79 followers, respectively (p= 0.008 and p= 0.009). Conclusion: Industry payments are more commonly addressed to male, senior surgeons in leadership tracks with strong social media outreach. With the increasing gender and racial variety in the CRS field, it is expected that collaborations between industry and surgeons will become more diverse and inclusive.

Leptin is required for fertility, including initiation of estrous cycles. It is therefore challenging to assess the role of leptin signaling during pregnancy. Although neuron-specific transgene approaches suggest that leptin signaling in the central nervous system is most important, experiments with pharmacologic inhibition of leptin in the uterus or global replacement of leptin during pregnancy suggest leptin signaling in the reproductive tract may be required. Here, conditional leptin receptor knockout (Lepr cKO) with a progesterone receptor-driven Cre recombinase was used to examine the importance of leptin signaling in pregnancy. Lepr cKO mice have almost no leptin receptor in uterus or cervix, and slightly reduced leptin receptor levels in corpus luteum. Estrous cycles and progesterone concentrations were not affected by Lepr cKO. Numbers of viable embryos did not differ between primiparous control and Lepr cKO dams on Days 6.5 and 17.5 of pregnancy, despite a slight reduction in the ratio of embryos to corpora lutea, showing that uterine leptin receptor signaling is not required for embryo implantation. Placentas of Lepr cKO dams had normal weight and structure. However, over four parities, Lepr cKO mice produced 22% fewer live pups than controls, and took more time from pairing to delivery by their fourth parity. Abnormal birth outcomes of either dystocia or dead pups occurred in 33% of Lepr cKO deliveries but zero control deliveries, and the average time to deliver each pup after crouching was significantly increased. Thus, leptin receptor signaling in the reproductive tract is required for normal labor and delivery.Mice lacking leptin receptor in the reproductive tract produce fewer live pups and have more adverse labor outcomes than controls, but normal numbers of embryos near term, showing that leptin receptor signaling is required for normal parturition.

The current targeted therapy for BRAFV600E-mutant lung cancer consists of a dual blockade of RAF/MEK kinases often combining dabrafenib/trametinib (D/T). This regimen extends survival when compared to single-agent treatments, but disease progression is unavoidable. By using whole-genome CRISPR screening and RNA sequencing, we characterize the vulnerabilities of both persister and D/T-resistant cellular models. Oxidative stress together with concomitant induction of antioxidant responses is boosted by D/T treatment. However, the nature of the oxidative damage, the choice of redox detoxification systems, and the resulting therapeutic vulnerabilities display stage-specific differences. Persister cells suffer from lipid peroxidation and are sensitive to ferroptosis upon GPX4 inhibition in vivo. Biomarkers of lipid peroxidation are detected in clinical samples following D/T treatment. Acquired alterations leading to mitogen-activated protein kinase (MAPK) reactivation enhance cystine transport to boost GPX4-independent antioxidant responses. Similarly to BRAFV600E-mutant melanoma, histone deacetylase (HDAC) inhibitors decrease D/T-resistant cell viability and extend therapeutic response in vivo.