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The long-term results after biliopancreatic diversion (BPD) in patients with type 2 diabetes (T2D) and severe obesity is still being debated. Retrospective evaluation of the long-term metabolic and clinical conditions of patients with T2D following BPD. University hospital. A total of 173 patients with T2D and severe obesity were investigated prior to and at 3–5 and 10–20 years after BPD. Anthropometric, biochemical, and clinical findings preoperatively and throughout follow-up were considered. The long-term data were compared with those of a cohort of 173 T2D patients with obesity treated with conventional therapy. T2D resolved within the first postoperative phases in most patients, and in the long and very long term, the fasting blood glucose level remained above the normal range in only 8% of patients. Likewise, a stable improvement of blood lipid pattern was observed (follow-up rate 63%). In contrast, in nonsurgical patients in the long term, the glucose and lipid metabolic parameters remained in the pathologic range in all cases. In the BPD group, a very high number of severe BPD-related complications was recorded, and 27% of the BPD patients died, whereas in the control group, 87% of patients were still alive at the end of the follow-up period (P <.02). Despite the high T2D stable resolution rate and the normalization of most metabolic data at 10–20 years following surgery, these results indicate that BPD should be indicated with caution in the surgical treatment of T2D in patients with severe obesity. [ABSTRACT FROM AUTHOR]

To develop and undertake validation testing of a survey designed to measure patients' experiences of and preferences for surgical wound care discharge education. A literature review and content analysis was undertaken on patients' experiences of and preferences for surgical wound care discharge education. Four themes were uncovered in the literature (wound care discharge education, preferences for discharge education delivery, participation in wound care decisions and patient ability to manage their surgical wound to prevent wound complications), which guided item generation. Three types of validity testing occurred including: 1) face validity testing by the research team; 2) content validity testing (using Delphi study) with an international panel of experts including patients, clinicians and researchers; and 3) content validity (using pilot-testing) of the survey with seven patients from the target population. Initially 106 items were generated from the literature, and of these, 55 items were subjected to content validity testing by an international panel of 41 experts. After two Delphi rounds, 18 items were retained. Most patients provided limited and very minor feedback during pilot-testing. However, pilot-testing resulted in a revised survey administration plan to deliver the survey via telephone, including adding prompts and preambles to items. An 18-item survey comprised of three groups of items and an individual item was rigorously developed. The survey requires further testing among a larger sample of patients to confirm the items reflect important aspects of patients' experiences of and preferences for surgical wound care discharge education. • Survey measures patient experience of and preferences for surgical wound care discharge education. • The survey has face and content validity. • The survey was developed with patients and health consumers. [ABSTRACT FROM AUTHOR]

Tobacco use remains a leading cause of death in the U.S. Varenicline is a preferred medication for tobacco cessation, and a prior report in the literature showed its use fell dramatically after the voluntary recall of Chantix (brand) varenicline (name) in July 2021. Working with data on prescriptions for varenicline and nicotine-replacement therapy (NRT), we studied use from 2018 to 2023 to determine if varenicline use had recovered or if there had been a compensatory increase in NRT use. Data are yearly from state employees and their dependents who were ≥18 years of age and were health-insurance beneficiaries of the Washington Public Employees Benefits Board from July 2018 through June 2023. Data include numbers of tobacco users and numbers of prescriptions filled. The 5-year prevalence of tobacco use among 224,816 beneficiaries was 4.6%. The percentage of tobacco users who filled a prescription for varenicline fell from highs of 9.5% and 9.6% in the 2018–2019 and 2019–2020 years to lows of 5.3% and 6.4% in the 2021–2022 and 2022–2023 years. For nicotine replacement therapy, prescriptions rose modestly over the 5 years, from 4.5% in 2018–2019% to 6.0% in 2022–2023. Varenicline use dropped after the voluntary recall of Chantix by Pfizer in mid-2021 and has not returned to prerecall levels. Pharmacists and other clinicians should address this drop, in addition to addressing longer-term challenges to increasing varenicline use; these include the requirement for a prescription and the black-box warning by the Food and Drug Administration, rescinded in 2016. [ABSTRACT FROM AUTHOR]

This case involves an 11-year-old female patient who was asymptomatic but had a periapical radiographic finding associated with tooth 46. The radiograph revealed a well-defined radiolucent area in the apical region of the tooth. An excisional biopsy was performed with the initial suspicion of an inflammatory follicular cyst. During the procedure, the presence of purulent secretion was noted. Microscopically, the examination revealed fibrous connective tissue with a capsular appearance, covered by a few layers of epithelial cells. Within the fibrous capsule, there was a lymphoplasmacytic and neutrophilic inflammatory infiltrate, along with pseudoxanthomatous cells. Based on the radiographic, epidemiological, and microscopic characteristics, the final diagnosis was a mandibular buccal bifurcation cyst. This is an uncommon condition with odontogenic and inflammatory origins that typically develops on the buccal surface of the newly erupted first or second permanent mandibular molar, often resulting from infections of the periodontal tissues. This condition can lead to symptoms such as swelling, pain, and buccal tipping of the affected tooth, necessitating surgical intervention. [ABSTRACT FROM AUTHOR]

Recent reports suggested that blind laparoscopic entry techniques, including Veress needle (VN), might increase the risks of potentially fatal complications. All consecutive patients who underwent laparoscopy in two Pediatric Hospitals with the use of a Veress needle during a 14-year period have been included. In all cases the first trocar was a radially expanding one (STEP). Complications related to the insertion technique are reported as well as those related to the whole laparoscopic technique. A total of 3463 patients younger than 18 years of age underwent laparoscopy between January 2006 and December 2019. Of these, 205 (5.9%) were younger than 6 months of age at surgery. Two-hundred-eighty-four patients (8.2%) previously underwent abdominal surgery. During first trocar insertion no major or minor vascular injuries occurred. Two patients (0.06%) experienced bowel lesions. Nine (0.26%) experienced failed entry. Fourteen patients (0.4%) experienced postoperative issues related to trocars positioning, namely, 9 omental eviscerations through port site insertion and 5 cases of hemoperitoneum owing to epigastric vessels lesion during operative trocar positioning. No other issues strictly related to laparoscopic entry technique have been recorded during the study period. No specific risk factors predisposing to complications have been identified but the presence of a positive history of previous abdominal procedures proved to be significantly related to a higher occurrence of bowel injury during Veress needle insertion (p = 0.0067). Although with a number of biases and limitations, our study suggests that creation of pneumoperitoneum with VN combined to first trocar entry with STEP technology in children can represent a safe alternative. An exception is represented by patients who underwent previous abdominal surgeries who should be approached with caution, possibly with an open approach. Anyway, given the relatively poor quality of high-quality studies on this regard, we strongly support the implementation of well-designed RCT in children in order to answer this delicate topic. Retrospective. IV [ABSTRACT FROM AUTHOR]

Purpose: Malformations of cortical development (MCD) are a phenotypically and genetically heterogeneous group of disorders, for which the diagnostic rate of genetic testing in a clinical setting remains to be clarified. In this study we aimed to assess the diagnostic rate of germline and pathogenic variants using a custom panel in a heterogeneous group of subjects with MCD and explore genotype-phenotype correlations.Methods: A total of 84 subjects with different MCD were enrolled. Genomic DNA was isolated from peripheral blood. Fifty-nine tartget genes were assessed using a custom next-generation sequencing (NGS) panel.Results: Genetic causes were identified in one-fourth of our cohort (21.4 %). Overall, we identified 19 pathogenic or likely pathogenic single-nucleotide variants in 11 genes among 18 subjects, including PAFAH1B1 (LIS1) (n = 3), TUBA1A (n = 3), DYNC1H1 (n = 3), ACTG1 (n = 2), TUBB2B (n = 1), TUBB3 (n = 1), DCX (n = 1), FLNA (n = 1), LAMA2 (n = 1), POMGNT2 (n = 1) and VLDLR (n = 1). The diagnostic yield was higher in patients with lissencephaly/pachygyria (60 %) (p = 0.001), cobblestone malformation (50 %), and subcortical band heterotopia (SBH) (40 %). Furthermore, five out of six subjects with suspect tubulinopathies on imaging harboured pathogenic variants in tubulin genes. Overall, germline pathogenic variants were more likely to be identified if MCD were diffuse (p = 0.002) and associated with other central nervous system malformations (p = 0.029). Moderate to severe intellectual disability was also more commonly associated with pathogenic variants (p = 0.044).Conclusion: Customized gene panels may support the diagnostic work-up for some specific MCD, especially when these are diffuse, bilateral and associated with other brain malformations. [ABSTRACT FROM AUTHOR]

Major events possess limited resources relative to those they must seize, extract and control from a host destination. All sport events, to varying degrees, are parasitic as they are highly dependent onexternal host destination resource environments to deliver complex operational and strategic event objectives. This dynamic poses a management challenge as the event's existence, sustenance and survival is principally determined by: 1) the host's munificence (the host destination's willingness to offer up local resources), and 2) the event's ability to secure the resources required for an extended period of time. This article investigates these complex resourcing relationships through an in-depth case study of the 2018 Commonwealth Games held on the Gold Coast, Australia, a well-developed tourist destination. Methodologically, we draw on interviews with representatives from the government, event managers and host community networks. Alongside the interviews, we analyse policy and planning documentation, and review in-person, observational evidence gathered before and during the 2018 Commonwealth Games. We apply, and extend, resource dependency theory and associated concepts to explain the event-host destination resourcing relationship. We detail how and why major events deploy constraint absorption (hard power) and co-optation (soft power) tactics to render a host destination's resource under internal control, reflecting on the parasitic nature of the event-host relationship. We conclude that the transfer of resource to external agents, justified as a means of reducing organisational uncertainty and operational failure, actually leads to deleterious outcomes for local stakeholders and the host destination, undermining the event's own social sustainability and inclusivity objectives. • Events act as parasites; they are dependent on host destination resource environments for delivery. • Relying on external resource outside of internal control poses a strategic challenge for managers. • Constraint absorption & co-optation tactics enable managers to control & extract resource. • Utilises resource dependency theory to explain why tactics help reduce risk of uncertainty & failure. • Proposes how events can better balance event resourcing & stakeholder needs in host destinations. [ABSTRACT FROM AUTHOR]

Abstract Purpose To explore adherence to oral hormone treatment in patients with metastatic prostate cancer (mCRPC) and to identify the factors that influence it. Methods A qualitative exploratory study was conducted at the National Cancer Institute of Rome. Patients aged >18 years with castration-resistant prostate cancer (mCRPC) and who were using oral hormone drugs were recruited. Semi-structured interviews were used for data collection, subsequently transcribed verbatim and analysed using Ritchie and Spencer's framework analysis. Results The sample included 13 patients with a median age of 72 who were treated, on average, for seven months with abiraterone acetate (AA) (76.9%) and enzalutamide (ENZ) (23.1%). Five themes were identified: expression of the concept of adherence, favouring factors, obstacle factors, functional strategies and levels of adherence. Conclusions The patients express a good level of adherence, which they define in different ways—the helping relationship with the attending physician, the support of the family members and the few side effects of the drugs. For the future, it is recommended to perform a multicentre mixed method study to explain the levels of adherence and distress in women with breast cancer. Highlights • Patients give different meanings to the concept of adherence. • Patients, despite having a medium-high age, expressed a good level of adherence to hormonal treatment. • Favoring factors of adherence are the information received from the healthcare staff, the support of family members and the few side effects related to treatment. • Obstructive factors of adherence are polytherapy, drug size and procurement. [ABSTRACT FROM AUTHOR]

Background & Aims Infection with Tropheryma whipplei has a range of effects—some patients can be chronic carriers without developing any symptoms, whereas others can develop systemic Whipple disease, characterized by a lack a protective inflammatory immune response. Alterations in HLA-G function have been associated with several diseases. We investigated the role of HLA-G during T whipplei infection. Methods Sera, total RNA, and genomic DNA were collected from peripheral blood from 22 patients with classic Whipple's disease, 19 patients with localized T whipplei infections, and 21 asymptomatic carriers. Levels of soluble HLA-G in sera were measured by enzyme-linked immuosorbent assay, and expressions of HLA-G and its isoforms were monitored by real-time polymerase chain reaction. HLA-G alleles were identified and compared with a population of voluntary bone marrow donors. Additionally, monocytes from healthy subjects were stimulated with T whipplei , and HLA-G expression was monitored by real-time polymerase chain reaction and flow cytometry. Bacterial replication was assessed by polymerase chain reaction in the presence of HLA-G or inhibitor of tumor necrosis factor (TNF) (etanercept). Results HLA-G mRNAs and levels of soluble HLA-G were significantly increased in sera from patients with chronic T whipplei infection compared with sera from asymptomatic carriers and control individuals. No specific HLA-G haplotypes were associated with disease or T whipplei infection. However, T whipplei infection of monocytes induced expression of HLA-G, which was associated with reduced secretion of TNF compared with noninfected monocytes. A neutralizing antibody against HLA-G increased TNF secretion by monocytes in response to T whipplei , and a TNF inhibitor promoted bacteria replication. Conclusions Levels of HLA-G are increased in sera from patients with T whipplei tissue infections, associated with reduced production of TNF by monocytes. This might promote bacteria colonization in patients. Graphical abstract [ABSTRACT FROM AUTHOR]

Urease (urea amidohydrolase, EC 3.5.1.5) is a nickel-containing enzyme produced by plants, fungi, and bacteria that catalyzes the hydrolysis of urea into ammonia and carbamate. Urease is of historical importance in Biochemistry as it was the first enzyme ever to be crystallized (1926). Finding nickel in urease’s active site (1975) was the first indication of a biological role for this metal. In this review, historical and structural features, kinetics aspects, activation of the metallocenter and inhibitors of the urea hydrolyzing activity of ureases are discussed. The review also deals with the non-enzymatic biological properties, whose discovery 40 years ago started a new chapter in the study of ureases. Well recognized as virulence factors due to the production of ammonia and alkalinization in diseases by urease-positive microorganisms, ureases have pro-inflammatory, endocytosis-inducing and neurotoxic activities that do not require ureolysis. Particularly relevant in plants, ureases exert insecticidal and fungitoxic effects. Data on the jack bean urease and on jaburetox, a recombinant urease-derived peptide, have indicated that interactions with cell membrane lipids may be the basis of the non-enzymatic biological properties of ureases. Altogether, with this review we wanted to invite the readers to take a second look at ureases, very versatile proteins that happen also to catalyze the breakdown of urea into ammonia and carbamate. [ABSTRACT FROM AUTHOR]

Abstract The water hyacinth (Eichhornia crassipes) is a floating aquatic plant belonging to the Pontederiaceae family. This plant, native to South America, grows on the surface of lakes, rivers and canals in tropical and sub-tropical areas. Because of its human transport in other tropical climate areas and its high grow rate, the water hyacinth is considered one of the prominent invading macrophytes in eutrophic water basins; the quality of water in those regions have been negatively affected. The water hyacinth is characterized by a high content of lignocellulosic biomass, with a 10% average content of lignin, useful in both thermochemical and biochemical processes. The anaerobic digestion process should be considered as a very attractive solution to produce biogas. This kind of biomass needs to be chemically and thermally treated before being directly involved into the anaerobic digestion reaction. This work aims to give a detailed analysis of water hyacinth biomass energy properties in terms of its use in anaerobic digestion processes, before and after targeted treatments, highlighting any improvements that should be made to the procedures by literature. Related process parameters are also investigated. The conducted experimental campaign shows how the thermal pre-treatment at low temperatures increases the volatile solids content from 57% to 74% (w/w), decreasing the ash content. [ABSTRACT FROM AUTHOR]

Background Data regarding management of former bariatric operations after onset of a malignancy are still lacking and there is no consensus whether bariatric surgery negatively influences the oncologic management of patients. Objectives To investigate the strategy by which patients previously submitted to bariatric surgery were managed after diagnosis of malignancy of the digestive apparatus, whether a revision was performed or not, to assess the incidence of nutritional complications, and the effect of revision versus no revision of bariatric surgery on the outcome of cancer treatment. Setting University Hospital, Italy. Methods Occurrence of a malignancy of the digestive apparatus in patients submitted to biliopancreatic diversion was investigated retrospectively. Patients’ data were collected preoperatively, at 2 and 3 years after the operation, at oncologic diagnosis, and at the longest available postoncologic follow-up. Results From May 1976 to January 2017, 3341 morbidly obese patients were submitted to biliopancreatic diversion. Sixteen patients were diagnosed with a malignancy involving the digestive apparatus 5 to 28 years after bariatric surgery. Of 10 patients diagnosed with colorectal cancer, 6 were revised. At 2 years after biliopancreatic diversion, body mass index, hemoglobin, and iron levels were significantly lower than preoperatively. Serum transferrin and total protein were unchanged. There was no difference between body mass index, hemoglobin, transferrin, and total protein levels at 2 years and at oncologic diagnosis, or between revised and unrevised patients. Conclusion Revision of a preexisting bariatric operation after digestive cancer surgery is common, although selected, unrevised cases do not seem to be associated with worse outcome. [ABSTRACT FROM AUTHOR]

Albumin is a protein produced by the liver essential for maintaining blood volume and regulating fluid balance. Hypoalbuminemia is characterized by low levels of albumin in the blood. It is also a marker of malnutrition-inflammatory syndrome. Several studies have demonstrated its prognostic role in patients with chronic heart failure; however, data regarding hypoalbuminemia in acute heart failure admissions are scarce. This study aims to analyze the relationship between hypoalbuminemia and heart failure. We used a retrospective cohort study surveying data from the 2016-2018 combined National Inpatient Sample (NIS) database. Adult hospitalizations for heart failure patients were identified using the ICD-10 codes, stratified into cohorts with and without hypoalbuminemia. Primary outcomes were (1) in-patient mortality, (2) length of stay, and total hospital charge. We also reclassified the HF admissions with hypoalbuminemia to those with systolic or diastolic heart failure to compare any differences in mortality and other in-patient complications. Multivariate linear and logistic regression were used to adjust for confounders and to analyze the outcomes. There were 1,365,529 adult hospitalizations for Congestive Heart Failure (CHF), and among them 1,205,990 (88 %) had secondary diagnoses of hypoalbuminemia. Patients with comorbid hypoalbuminemia were, on average, 8 years older (P < 0.001), predominantly white race, and males (P -value <0.001). HF hospitalizations with hypoalbuminemia had double in‐hospital mortality than those without (4.8% vs 2.7%, P < 0.001). However, there was no difference in mortality between patients with Systolic heart failure and Diastolic heart failure with concomitant low albumin levels (from 4.9 % vs 4.7%, P 0.13). We found that patients admitted with HF and concomitant Hypoalbuminemia (HA) had nearly twice the odds of in-patient mortality than those with normal albumin levels. The Length of Stay (LOS) was higher between comparison groups. THC remained statistically indifferent in patients regardless of albumin levels but was greater in hypoalbuminemic patients with Systolic heart failure than Diastolic heart failure ones. [ABSTRACT FROM AUTHOR]

Summary Background Hemicolectomy is the treatment of choice for intestinal obstruction from right colon cancer. This review compares the laparoscopic vs open access in hemicolectomy for patients with right colon cancer. Methods A systematic review and meta-analysis of clinical studies published after January 2017 was performed according to the Prisma guidelines. The study has been recorded on the Prospero register (CRD42016044108). Results Five studies were included for review. Only one anastomotic leak was reported in conventional open anastomosis group (1.9%) and none of the studies included in the meta-analysis reported re-operations during the first 30 postoperative days. The 30-day postoperative mortality did not differ between the two groups. The length of incision, blood loss, early mobilization after surgery, the 30-day postoperative overall complication rate and hospital length of stay were significantly shorter in the laparoscopic group. The difference in the duration of procedure was statistically significant in favor of the open group. The number of dissected lymph nodes, the overall survival at 5 years and time to flatus were described only in one study, without any significant difference. Finally, none of the trials reported any information concerning differences in the costs between the two techniques. Conclusions The better outcomes described in this study achieved with laparoscopy, must be interpreted with caution because of the small number of patients involved, the selection and publication bias and the low level of evidence of the analysed trials. Indeed, the advantages of a minimally invasive approach, which have been demonstrated by the present meta-analysis, should encourage the use of laparoscopy also in emergency setting. [ABSTRACT FROM AUTHOR]

Traumatic injuries and sudden death can prematurely end the breeding career of a stallion. In such cases, a final spermatozoa collection can be obtained by harvesting the cauda epididymis. Semen samples can then be used for fresh artificial insemination or cryopreserved. Centrifugation is a critical point of sperm cryopreservation processing and can be detrimental to spermatozoa. Colloid centrifugation approaches reduce this physical damage and can be used to select better quality sperm. The aim of this research was to determine the effect of cushioned and single layer centrifugation (SLC) on epididymal stallion sperm motility postcentrifugation. Eight stallions were submitted to bilateral orchiectomy and the resulting epididymal cauda (n = 16) were flushed with semen extender. After harvesting, the samples were submitted to three centrifugation protocols: conventional (20 minutes at 600× g ), cushioned (20 minutes at 900× g ), and SLC (20 minutes at 300× g ). The pellets were resuspended and sperm parameters were evaluated. Sperm morphology was evaluated under a phase-contrast microscope, total motility (TM) and progressive motility (PM) were evaluated with computer-assisted semen analyses. The proportion of morphologically normal spermatozoa was 72.2% for SLC, 72% for cushioned, and 67% for conventional ( P > .05). After conventional centrifugation, it was recorded a TM of 7.4% and PM of 2.7%. After cushioned centrifugation, it was recorded a TM of 13.9% and PM of 6.5%. After SLC, it was recorded a TM of 46% and PM of 32.1%. The motility of spermatozoa recovered by SLC ( P < .05) and cushioned centrifugation ( P > .05) were higher than those recovered by conventional centrifugation. Colloids, including cushioned and SLC, improved epididymal stallion sperm motility postcentrifugation. [ABSTRACT FROM AUTHOR]

To determine key priorities for critical care nursing research in three Australian regional public hospitals, representing the shared priorities of healthcare professionals and patient representatives. A three phase priority setting study, including consensus methods (nominal group), survey, qualitative interviews and focus groups were conducted between May 2021 and March 2022. Healthcare professionals and patient representatives from critical care units in regional public hospitals in Australia participated. A patient representative contributed to research design and co-authored this paper. In phase one, 29 research topics were generated. In phase two, during a nominal group ranking process, the top 5 priority areas for each site were identified. In the final phase, three themes from focus groups and interviews included patient flow through intensive care, patient care through intensive care journey and intensive care patient recovery. Identifying context specific research priorities through a priority setting exercise provides insight into the topics that are important to healthcare professionals and to patients in critical care. The top research priorities for nursing research in critical care in regional Australian hospitals include patient flow, patient recovery, and evidence based patient care through the intensive care journey, such as delirium management, pain and sedation, and mobilisation. These shared priorities will be used to guide future nursing research in critical care over the next 3–5 years. The method we used in identifying the research priorities can be used by other researchers and clinicians; close collaboration among researchers and clinicians will be beneficial for practice improvement; and how we can be reassured that our practice is evidence based is worthy of attention. [ABSTRACT FROM AUTHOR]

Cryopreservation of epididymal spermatozoa is the last method for preserving gametes of valuable stallions in case of sudden death, severe injuries, or orchiectomy. Due to harvesting methods, sperm is unavoidably contaminated with epithelial and red blood cells, leukocytes, debris, and bacteria. These contaminants and dead spermatozoa can cause detrimental effects on sperm quality. Colloid centrifugation can reduce the load of these contaminants and select a subpopulation of motile spermatozoa. The objective of this experiment was to evaluate whether single layer centrifugation (SLC) prior to cryopreservation or post-thawing improves the quality of stallion epididymal sperm. Ten stallions were submitted to bilateral orchiectomy and harvesting of epididymal cauda spermatozoa (n=20) was performed by retrograde flushing with an extender. Epididymal sperm samples were subjected to conventional centrifugation (no colloid - 600xg for 20 minutes), and SLC prior to cryopreservation (SLC-PC) or SLC post-thaw (SLC+). SLC was performed at 300 x g for 10 minutes (Androcoll-Equine, Minitube, Tiefenbach, Germany). All samples were cryopreserved, thawed, and evaluated. The post-thaw group (SLC+) was thawed, centrifuged by SLC, and resuspended in freezing extender (SLC+F) or cooling extender (SLC+C). Total motility and progressive motility were evaluated with computer-assisted semen analyses (CASA). Sperm morphology was evaluated by examining a wetmount preparation of unstained samples fixed in formol saline. Mitochondrial functionality, membrane integrity, and DNA integrity were evaluated in a fluorescence microscope with specific fluorescent dyes. All variables were normally distributed according to the Shapiro–Wilk test. Data were evaluated by descriptive statistics, one-way analysis of variance, and Tukey's test. Significance was set at p <0.05. SLC-PC (24.6 ± 3.6%) and SLC+F (26.2 ± 4%) treatments yielded significantly higher total sperm motility than SLC+C (16.7 ± 1.7%) and conventional (16 ± 3.5%) treatment. SLC+F (17.5 ± 3.8%) yielded significantly higher progressive motility than the conventional (8.8 ± 2%), SLC+C (9.8 ± 1.3%), and SLC-PC (12.9 ± 4.1%) treatments. The mitochondrial functionality of all SLC groups was significantly higher (SLC-PC 72 ± 2%; SLC+C 74.6 ± 1.8%; SLC+F 82.5 ± 1.9%), than that of the conventional group (25.2 ± 2.1%). Plasma membrane integrity was higher in SLC-PC (48.6 ± 4%) than in SLC+F (30 ± 6.5%), SLC+C (36 ± 4.8%), and conventional (22.8 ± 4.5%) samples. DNA integrity and percentage of morphologically normal samples were unaffected by treatment. SLC is a simple procedure that can be performed prior to cryopreservation or post-thawing and that can improve stallion epididymal sperm quality. Epididymal spermatozoa submitted to SLC only after thawing is best extended using freezing extender than cooling extender. [ABSTRACT FROM AUTHOR]

Objectives: To test the hypothesis that first alcohol use during childhood is associated with heavy drinking patterns during adolescence and with parental drinking patterns and parental rules about alcohol consumption. Study design: A national cross-sectional survey of 17 371 high-school students. Students were drawn from 789 public and private schools in all the Brazilian state capitals using a multistage probabilistic sampling method and a self-report questionnaire. Weighted data were analyzed through logistic regression testing for differences on the associated factors for first use of alcohol during childhood. Survival analysis and Cox proportional hazard models were used to confirm results. Results: Among the 82% alcohol lifetime users, 11% had first used alcohol before age 12 years. The lack of perception of possible punishment by parents is associated with childhood alcohol use (OR 2.22, 95% CI 1.67-2.95). Adolescents who first used alcohol during childhood compared with those who only used alcohol at later ages are more likely to engage in binge drinking behaviors (OR 1.57, 95% CI 1.17-2.10), to have a pattern of heavy alcohol use (OR 1.98, 95% CI 1.26-3.09), and to have recently used illegal drugs (OR 1.74, 95% CI 1.39-2.16). According to hazard ratios, students with an earlier age of onset were more likely to have used tobacco and any illegal drug in the past year. Conclusions: Childhood alcohol may be a risk factor for the most dangerous patterns of alcohol use in adolescence and is associated with parental alcohol use. Parental rules about child alcohol use must be clear because perception of punishment might delay the age of first alcohol use. [Copyright &y& Elsevier]

Remediation of residually contaminated soils remains a widespread problem. Biochar can immobilize polycyclic aromatic hydrocarbons (PAH). However, studies on its ability to immobilize PAH and N, S, and O substituted PAH (hetero-PAH) in real soils, and benchmarking with commercial activated carbon are missing. Here, we compared the ability of pristine biochar (BC), steam-activated biochar (SABC), and commercial activated carbon (AC) to immobilize PAH and hetero-PAH. The three carbons were tested on soils from four different contaminated sites in Austria. Different amendment rates (w/w) of the carbons were investigated (BC: 1.0, 2.5, and 5%; SABC: 0.5, 1.0, and 2.0%; AC: 1%) in batch experiments to cover meaningful ranges in relation to their performance. SABC performed better than AC, removing at least 80% PAH with the lowest application rate of 0.5%, and achieving a complete removal at an application rate of 1.0%. BC performed slightly worse but still acceptable in residually contaminated soils (40 and 100% removal at 1 and 5% amendment, respectively). The ability of BC and SABC to immobilize PAH decreased as the PAH-molar volume increased. PAH with three or more rings were preferentially removed by AC compared to SABC or BC. This can be explained by the difference in pore size distribution of the carbons which could limit the accessibility of PAH and hetero-PAH to reach sorption sites for π- π electron donor-acceptor interactions, which drive PAH and hetero-PAH sorption to carbons. Column percolation tests confirmed the results obtained in batch tests, indicating, that decisions for soil remediation can be derived from simpler batch experiments. In soil samples with 1% BC, a reduction of over 90% in the total concentration of PAH in the leached water was observed. Overall, BC and SABC were demonstrated to be valid substitutes for AC for stabilizing residually contaminated soils. [Display omitted] • Four contaminated soils from active remediation sites were investigated. • Biochar, steam-activated biochar, and commercial activated carbon were compared. • Pristine and steam-activated biochar strongly immobilize (hetero)-PAH in soil. • Biochar performance is similar to activated carbon in residually contaminated soils. • Size exclusion from pores limits sorption of high molar volume PAH to biochar. [ABSTRACT FROM AUTHOR]

Background Barriers to trauma care for rural populations are well documented, but little is known about the magnitude of urban-rural disparities in injury mortality. This study sought to quantify differences in injury mortality comparing rural and nonrural residents with traumatic injuries. Methods Using data from the 2009–2010 Nationwide Emergency Department Sample, multiple logistic regression analyses were conducted to estimate odds of death after traumatic injury for rural residents compared with nonrural residents, while controlling for age, sex, injury type and severity, comorbidities, trauma designation, and Census region. Results Rural residents were 14% more likely to die after traumatic injury compared with nonrural residents ( P < .001). Increased odds of death for rural residents were observed at level I (odds ratio = 1.20, P < .001), level II (odds ratio = 1.34, P < .001), and level IV/nontrauma centers (odds ratio = 1.23, P < .001). The disparity was greatest for injuries occurring in the South and Midwest (odds ratio = 1.54, P < .001 and odds ratio = 2.06, P < .001, respectively) and for cases with an injury severity score <9 or unknown severity (odds ratio = 2.09, P < .001 and odds ratio = 1.31, P < .001, respectively). Conclusion Rural residents are significantly more likely than nonrural residents to die after traumatic injury. This disparity varies by trauma center designation, injury severity, and US Census region. Distance and time to treatment likely play a role in rural injury outcomes, along with regional differences in prehospital care and trauma system organization. [ABSTRACT FROM AUTHOR]

According to many recent European and National Directives, ambitious targets are increasingly set so as to ensure a clean and sustainable future for the forthcoming generations. In order to change from being predominantly fossil fuelled to being fuelled by locally available sources, low-enthalpy geothermal installations for heating and cooling buildings can be successfully used, such as Down-hole Heat Exchangers (DHEs). Although in the last decades DHEs have been studied extensively, both numerically and experimentally, some aspects still need to be further investigated, namely the interaction between aquifer, well, and the DHE itself. Thus, the present paper investigates the thermal behaviour of a DHE in Central Italy, considering one-year experimental campaign. The numerical simulation is carried out by the finite-element program Comsol Multiphysics and is validated by the experimental data concerning the values of temperature within the DHE at a specific depth. In more detail, it is implemented by a model describing the U-tube and the surrounding aquifer. Although in most of the simulation only a single domain is taken into account, the adjacent medium is here implemented as a boundary condition. The results for the computational domain are presented in terms of temperature, highlighting that the numerical simulation is an efficient method to accurately reproduce the temperature pattern within the DHE. [ABSTRACT FROM AUTHOR]

In this paper the influence of heat transfer in industrial human hair depigmentation is studied together with some suitable solutions for optimizing the industrial process and the efficient energy use. In particular, the analysis was conducted by implementing the current process and the proposed solutions in Comsol Multiphysics. The fiber's damage and the energy loss are mainly due to a non-isothermal uncontrolled process. In order to implement an efficient energy use and to reduce the energy loss we propose a modification of the tank, where the depigmentation occurs, from a rectangular to an octagonal-shape configuration, characterized by the presence of located thermal sources. It will be shown that the depigmentation process realized with the heated octagonal tank structure significantly reduce the energy use. By reducing the thermal stress, arising in an invasive chemical procedure such as depigmentation, we obtain also a significant reduction of the hair-fibers damage. [ABSTRACT FROM AUTHOR]

The intrinsic richness and heterogeneity of large amount of data is paired with the extreme complexity in its storing and processing, as well as with the heterogeneity of their processing environments, ranging from super computers to federations of Cloud data-centres. This makes the conception, definition and implementation of software tools for programming applications dealing with very large amount of data really challenging from different perspectives, ranging from technological issues to economic concerns. We propose an approach focused on data-intensive applications that goes beyond the state of the art allowing a seamless exploitation of heterogeneous and distributed resources and satisfying users’ needs on data processing providing a dynamically determined set of features, depending on the running environment, the application, the user requirements. [ABSTRACT FROM AUTHOR]

Background Neurologic injury is still a frequent cause of mortality, morbidity, and long-lasting disability in patients undergoing an aortic arch operation with hypothermic circulatory arrest. The aim of this analysis was to evaluate short- and long-term outcomes in neurologic and cognitive functions in this group of high-risk patients. Methods A total of 333 patients undergoing an aortic arch operation between February 2004 and June 2010 were retrospectively reviewed. Cerebral protection was obtained with deep hypothermic circulatory arrest in 220 patients (66%) or with moderate hypothermic circulatory arrest in 113 cases (34%). Straight deep hypothermic circulatory arrest was adopted in 35 cases (11%), while the association with antegrade cerebral perfusion was adopted in 271 cases (81%) and with retrograde cerebral perfusion in 27 cases (8%). Seventy-eight patients were enrolled in a case control prospective study (mean follow-up time = 42 months) and underwent neuropsychologic evaluations; data were compared with those of a matched-control group of hypertensive patients without history of cardiac operations. Results Forty-one out of 333 patients experienced permanent neurologic dysfunction (12%) and 83 experienced temporary neurologic dysfunctions (25%). Acute aortic dissection and deep hypothermic circulatory arrest were significant predictors of mortality and permanent neurologic dysfunction. Acute aortic dissection and hypothermic circulatory arrest duration >30 minutes were significant predictors of temporary neurologic dysfunction, while antegrade cerebral perfusion was protective on mortality. Neuropsychologic evaluations showed no significant differences between the groups. The operative group showed worse verbal and working memory ( P = .003), worse semantic fluency ( P = .036), higher degree of alexithymia ( P = .004), and a lower quality of life ( P = .007). Conclusion Although moderate hypothermic circulatory arrest with antegrade cerebral perfusion demonstrated a lower mortality compared with deep hypothermic arrest, neurocognitive testing demonstrated no difference between the groups. Additionally, patients undergoing an aortic arch operation demonstrated long-term cognitive deficits and psychological dysfunction when compared to a matched cohort of nonoperative patients. [ABSTRACT FROM AUTHOR]

Background Bariatric surgery has been shown to be effective in severely obese patients with type 2 diabetes mellitus (T2DM). Objective Evaluate the long-term efficacy of biliopancreatic diversion (BPD) for the treatment of T2DM depending on the preoperative duration of T2DM. Setting University Hospital. Methods Retrospective analysis investigating 2 subsets of severely obese patients who had undergone BPD from 1984 to 1995. The first included 52 patients with a preoperative T2DM duration of ~1 year (SD group – 49 on oral agents and 3 on insulin), and the second included 68 patients who had been diabetic for>5 years before BPD (LD group – 52 on oral agents and 16 on insulin). Postoperatively, T2DM was regarded as in remission when fasting serum glucose (FSG) was lower than 100 mg/dL on regular diet and without antidiabetic therapy. Results In the SD patients, the number of individuals without T2DM remission were lower both at 5–10 (0/31, 0% of patients, versus 8/54, 15% of patients, p <.04) and at>15 years (1/28, 3% of patients, versus 10/41, 24% of patients, p <.0012). Furthermore, after BPD, the number of patients with dyslipidemia strongly reduced ( p <.001) in both groups, values at 5–10 years remaining very similar to those observed at>15 years. Conclusion These results indicate that severely obese patients with longer T2DM duration have a worse metabolic outcome maintained at long and very long term following BPD. [ABSTRACT FROM AUTHOR]

Co-digestion of organic waste is a technology always more frequently applied for simultaneous treatments of several solid and liquid organic wastes. In a co-digestion process the content of nutrients, as well as the negative effects of toxic compounds, can be balanced, increasing the gas yield. Moreover, co-digestion may contribute to a more efficient use of anaerobic digestion (AD) reactors and cost-sharing by processing multiple waste streams in a single facility. The aim of this study is to investigate the biogas production from mixture of Poultry Manure (PM) and Cheese Whey Wastewater (CWW). Batch experiments were performed under mesophilic conditions (37° C) at a pH from 6,5 to 7,5. The methanogenic reactor was operated at hydraulic retention time (HRT) 35 d. The trend of volatile solids (VS) have been verified. [ABSTRACT FROM AUTHOR]

The building thermal performance plays a fundamental role in reducing the national energy consumption, especially considering that the majority of the existing structures were built before energy efficiency was a concern at all. The paper presents the case study of the School of the State Forestry Corp in Sabaudia (Italy). The aim is to simulate the thermal behaviour both in stationary and dynamic conditions, and to identify the most appropriate action to improve the building energy efficiency, ensuring occupants’ thermal comfort during the year. The results clearly show that considerable thicknesses of insulating material do not represent an advisable retrofitting in summer. [ABSTRACT FROM AUTHOR]

In the present work, the bio-methane potential from anaerobic digestion of OMSW with inoculum and co-digestion of OMSW with cattle manure (CM) and cattle slurry (CS) has been analysed. The OMSW used for the analysis was a pollutant waste came from olive oil processing through three-phase centrifugation systems. A batch stirred tank reactor has been used, under mesophilic conditions (38 °C), in order to study the biogas yield. The whole process has been carried out under wet conditions, and with a Hydraulic Retention Time (HRT) of 55 days. Several tests have been carried out to achieve the best biogas yield. [ABSTRACT FROM AUTHOR]

Mountain sporting activities are an increasingly popular practice that exposes mountaineers to a high risk of adverse events. This report describes a unique case of recovery in an austere environment that involved explosives. In June 2012, a 52-year-old man ascended a cliff tower in the Eastern Alps, Italy. A landslide occurred, and a boulder crushed the climber against a large stone located farther down the cliff, causing compression of the lower limbs and the pelvis with consequent severe musculoskeletal trauma. The National Alpine and Cave Rescue Unit (NACRU) arrived and proceeded with stabilization of the injured climber, which took 6 hours and involved a difficult extrication supported by the Cave Rescue division of NACRU. Unfortunately, during transport to the trauma center of Borgo Trento, Verona, the patient exhibited signs of progressive traumatic shock because of crush syndrome, hypovolemia, and acidosis, which led to cardiac arrest and death. Based on an extensive literature review, this report was determined to be the only one of a mountain rescue using explosives for the extrication of a victim in the Northeast Italian Alps. This case describes how a rescue in austere environments can represent a high-risk situation, and it shows how improvisation and cooperation between rescue teams are crucial for a successful recovery. [ABSTRACT FROM AUTHOR]

Co-designed and accessible video resources improve an understanding of health information and can reduce unmet needs for caregivers of persons with brain cancer. This study developed and evaluated video resources that provide health information for persons caring for someone with brain cancer. A co-design approach with consumers was used to design, develop, and evaluate video resources. Twelve videos were designed with persons with brain cancer, caregivers, and health professionals. The video design and topics were informed by current literature. The videos were filmed with consumers to ensure authenticity. The evaluation was completed using data analytics and seven interviews with consumers. Content analysis identified four themes: needing information, authenticity, visual engagement, and key messages. The video length and presentation were important aspects to engage the caregiver, particularly when dealing with stress. The storage on YouTube enabled accessibility and various presentation formats met different learning styles. The development of co-designed health information videos provided resources to improve caregivers understanding of the information provided by the health professionals. The videos were easy to access and able to be viewed at home with family. • Brain cancer diagnosis leads to complex challenges for the family to manage, such as personality changes and seizures. • Family provides most of the care and support after cancer diagnosis, yet they often struggle with understanding information. • Authentic video resources available via YouTube enable the person affected by cancer to access and understand information. • Co-design enables resources developed with the consumer for the consumer and improves consumer outcomes. [ABSTRACT FROM AUTHOR]

Central giant cell lesion is a nonneoplastic intraosseous lesion, which can be classified as aggressive or nonaggressive, with predilection for women and for the mandible. A 16-year-old female patient identified in a control radiological exam had an extensive intraosseous lesion in the region of tooth 44 with cortical expansion and destruction. The patient underwent exodontia of tooth 44 and incisional biopsy, and anatomopathological examination indicated a central giant cell lesion. triamcinolone and denosumab were applied to the lesion as treatment. Triamcinolone was applied weekly (3 ml) concomitant to denosumab, which followed the following protocol: application of the first dose (120 mg), second dose after 8 days, and third dose after 15 days, and maintenance of a monthly dose until the return of the lesion. In this case, infiltrations were performed for 8 weeks until there was no space for infiltration and lesion control was achieved. The patient is being followed up with no recurrences. [ABSTRACT FROM AUTHOR]

Pneumatosis of the foregut is an extremely rare finding which may indicate a potentially serious condition. In newborn the presence of gastric intramural gas is mainly associated to necrotizing enterocolitis and is considered a condition which correlates with a poor prognosis. In infant and children pneumatosis of foregut may be secondary to several causes such as infection, mucosal ischemia, caustic ingestion, gastrointestinal obstruction or mucosal injury occurred during endoscopic procedure. Intramural gastric gas can be classified as "gastric emphysema" (GE) when a mechanical injury is the main causal factor or as "emphysematous gastritis" (EG) in cases of underlying gastrointestinal infection. Portal venous gas is also a rare condition. Necrotic bowel wall dues to infection or ischemia, associated with increased intraluminal pressure, seems to favor the entry of the air into portal venous system. We report a case of gastric pneumatosis associated to portal venous gas in a child affected by Down's Syndrome with a duodenal web and concomitant bacterial and mycotic gastric colonization. [ABSTRACT FROM AUTHOR]

Introduction The aim of this study was to investigate the effects of chlorhexidine (CHX) application time on the bond strength and durability of the adhesion of fiber posts relined with resin composite to the root dentin. Methods Eighty bovine incisor roots were divided into 4 groups after root preparation: control group (irrigation with physiological solution) and experimental groups, CHX for 30 seconds, CHX for 60 seconds, and CHX for 120 seconds. Fiber posts relined with resin composite were cemented with RelyX ARC. The Scotchbond Multi-Purpose total-etching adhesive system was used in half of the samples of each group, and the Clearfil SE Bond self-etching adhesive system was used in the other half. The samples were randomly divided into 2 subgroups, 24 hours of storage and 12 months of storage. All roots were sectioned transversely, and push-out tests were performed. Bond strength means were analyzed by analysis of variance and Tukey test ( α = 0.05). Failure mode was determined by examining specimen's surfaces under scanning electron microscope, and its distribution was evaluated by using χ 2 test ( α = 0.05). Results CHX pretreatment resulted in homogeneous bond strength values at 24 hours and 12 months of storage, irrespective of the CHX application time and adhesive system ( P < .05). A significant bond strength decrease was noticed after 12 months of storage when irrigation was performed with physiological solution in the control groups ( P > .05). Significant differences were observed for fracture patterns ( P < .001). Conclusions The use of CHX pretreatment could preserve the bond strength of the fiber post relined with resin composite to root dentin for 12 months, irrespective of the CHX application time and adhesive system used. [ABSTRACT FROM AUTHOR]

Background Bronchiectasis is a significant cause of morbidity. Surgical resection is a treatment option, but its main outcomes regarding quality of life (QOL) and physiologic consequences have not been addressed previously, to our knowledge. We aimed to evaluate the effect of surgical procedures on QOL, exercise capacity, and lung function in patients with bronchiectasis in whom medical treatment was unsuccessful. Methods Patients with noncystic fibrosis in whom medical treatment was unsuccessful and who were candidates for lung resection were enrolled in a prospective study. The main measurements before lung resection and 9 months afterward were QOL according to the Short Form 36 Health Survey and World Health Organization Quality of Life Questionnaires, lung function test results, and the results of maximal cardiopulmonary exercise testing on a cycle ergometer. Results Of 61 patients who were evaluated, 53 (50.9% male, age 41.3 ± 12.9 years) underwent surgical resection (83% lobectomies), and 44 completed the 9-month follow-up. At baseline, they had low QOL scores, mild obstruction, and diminished exercise capacity. After resection, 2 patients died and adverse events occurred in 24.5%. QOL scores improved remarkably at the 9-month measurements, achieving values considered normal for the general population in most dimensions. Functionally, resection caused mild reduction of lung volume; nevertheless, exercise capacity was not decreased. In fact, 52% of the patients improved their exercise performance. Multiple linear regression analysis showed that low QOL before resection was an important predictor of QOL improvement after resection ( p = 0.0001). Conclusions Lung resection promotes a significant improvement in the QOL of patients with noncystic fibrosis bronchiectasis without compromising their exercise capacity. [ABSTRACT FROM AUTHOR]

Abstract: Trans-caryophyllene is a sesquiterpene present in many medicinal plants’ essential oils, such as Ocimum gratissimum and Cannabis sativa. In this study, we evaluated the antinociceptive activity of trans-caryophyllene in murine models of acute and chronic pain and the involvement of trans-caryophyllene in the opioid and endocannabinoid systems. Acute pain was determined using the hot plate test (thermal nociception) and the formalin test (inflammatory pain). The chronic constriction injury (CCI) of the sciatic nerve induced hypernociception was measured by the hot plate and von Frey tests. To elucidate the mechanism of action, mice were pre-treated with naloxone or AM630 30min before the trans-caryophyllene treatment. Afterwards, thermal nociception was evaluated. The levels of IL-1β were measured in CCI-mice by ELISA. Trans-caryophyllene administration significantly minimized the pain in both the acute and chronic pain models. The antinociceptive effect observed during the hot plate test was reversed by naloxone and AM630, indicating the participation of both the opioid and endocannabinoid system. Trans-caryophyllene treatment also decreased the IL-1β levels. These results demonstrate that trans-caryophyllene reduced both acute and chronic pain in mice, which may be mediated through the opioid and endocannabinoid systems. [Copyright &y& Elsevier]

Abstract: The thermal performance of building plays a fundamental role in energy consumption since a large amount of energy is needed to balance heat transfers occurring through the envelope itself. The aim of the present paper is to simulate the heat transfer affecting a specific building envelope considering two different scenarios: current situation and future improvements by replacing transparent enclosures and adding an exterior insulation of different thicknesses. In order to identify the most convenient and suitable solution and to focus the attention on the most compelling action, an economical assessment is carried out taking into account the national incentives. [Copyright &y& Elsevier]

Abstract: Biodiesel is a renewable diesel fuel produced from fats and oils. Waste Vegetable Oil (WVO) is an important feedstock for biofuel production. WVOs availability as wastes from restaurants, workplace canteens and residential users and their utilization will reduce environmental pollution. In the present work, WVO has been transesterified in a pilot plant under different conditions. The assessment of the parameters affecting the biodiesel conversion factor has been investigated, namely catalyst type and concentration and alcohol concentration. In order to maximize the yield of the process and to obtain biodiesel with lower specific gravity, an optimization process has been carried out. [Copyright &y& Elsevier]

A young man, 19 years of age, with the chief complaint of an anterior open bite, came for orthodontic treatment with a skeletal Class I relationship, anterior open bite, shortened maxillary incisor roots, and relative macroglossia. The malocclusion was treated by extracting the maxillary first premolars and using a fixed edgewise appliance. A partial glosseetomy was performed before the orthognathic surgery with a 3-piece segmental LeFort I mandibular setback, and advancement was achieved with a reduction genioplasty. A functional and esthetic occlusion with an improved facial profile was established, and the apex of the maxillary left central incisor became slightly rounded after prolonged and significant tooth movement. Four years after treatment, there was occlusal stability of the results, and no further root shortening was observed. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We aimed to investigate the relationship between the presence and severity of depression and the degree of motor and functional disability in Parkinson''s disease (PD). Methods: One hundred twenty-two outpatients with PD were enrolled in a neurology department: 65 satisfied the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition criteria for major depression, and 57 did not (PD-C). Depressive symptoms were assessed by means of the Hamilton Rating Scale for Depression (HRSD), and the PD severity was assessed according to the Hoehn and Yahr System. Activities of daily living and motor symptoms were measured by the Unified PD Rating Scale (UPDRS), parts II and III. Results: Twenty-nine patients had a mild depression (HRSD total score ranging between 8 and 17), 30 had a moderate depression (HRSD total score ranging between 18 and 24), and 6 had a severe depression (HRSD total score, ≥25). By comparing the 3 groups of patients, it emerged that those with a severe depression showed significantly higher scores at the UPDRS II, UPDRS III, and HY scales than did PD-C or patients with a mild depression. Moreover, patients with a moderate depression scored significantly higher on the UPDRS II, UPDRS III, and HY scales than did PD-C or those with a mild depression. Conclusions: Our findings suggest that depression and motor symptoms/well-being are highly intertwined in patients with PD. [Copyright &y& Elsevier]

Abstract: Background: To gain insight into the role of epigenetic factors in determining body weight in adolescence, we studied the body weight of siblings born to the same mother before and after biliopancreatic diversion (BPD) for obesity. The study was performed in a university hospital during a 20-year period. Methods: The siblings born before and after BPD were retrospectively rated by their mother as normal, overweight, or obese at 1, 6, and 12 years. Results: At 1 and 6 years, the body weight was rated as similar in the subsets. However, at 12 years of age, a greater percentage of those born before BPD were considered overweight (42% versus 33%) and obese (22% versus 3%; P <.009) than their counterparts born after BPD. Considering only the subjects aged 21–25 years at the study period, the body weight and body mass index in subjects born before BPD were greater (P <.02 and P <.012, respectively) than in those born after BPD (79.5 ± 16.5 kg versus 66.7 ± 11.8 kg, and 27.5 ± 3.9 kg/m2 versus 23.4 ± 3.7 kg/m2, respectively). Conclusion: The results of the present study, in which the influences of the genetic pattern and environmental and educational factors were minimized, show that adolescents born to post-BPD mothers weigh less than their siblings born to the same mother before BPD when she was still obese. An insulin-resistant milieu during pregnancy could account for the greater body weight later in adolescence. [Copyright &y& Elsevier]

Summary: The impact of interstitial inflammatory cells, such as mast cells, and angiogenesis on the prognosis of cancer patients has been reported in many solid tumors, although there is disagreement about their role. We undertook a retrospective study with tissue samples from 65 patients with stage I and II non–small cell lung cancer to assess the clinical pathologic role and prognostic significance of mast cells. Mast cell phenotypes were identified by immunohistochemistry for tryptase and chymase. In addition, we identified microvessels using the endothelial marker CD34. Mast cell and microvessel density was quantified by assessing immunopositive cells in the intratumoral and peritumoral zones of tumor specimens. Both mast cell and microvessel density was higher in the peritumoral zone than the intratumoral zone (P ≤ .05). A positive correlation between mast cell (tryptase-chymase phenotype) and microvessel densities was observed in the intratumoral zone (P ≤ .05), supporting the involvement of mast cells in the angiogenic process. Regarding survival, a subset of stage I patients had a worse prognosis at five years when low mast cell (tryptase-chymase phenotype) density was found in the peritumoral zone (median survival in months [range]: 27 [1-60] versus 46 [1-60]). Multivariate Cox analysis indicated that this parameter may be an independent prognostic factor (P ≤ .05) useful for selecting candidates for earlier treatment. [Copyright &y& Elsevier]

Background: A minimally invasive approach through an upper ministernotomy (UMS) has been used in our Division since 1997. On the basis of favorable outcome we have gradually extended this approach from isolated aortic valve replacement (AVR) to more complex cardiac surgery procedures and it is currently our first choice for a variety of procedures. Here we report our 11 years experience. Methods: From 1997 to December 2007, 1,126 procedures were performed at our department, using UMS. Isolated procedures on the aortic valve were performed in 695 patients (61%). Isolated procedures on the aortic valve as redo operation were performed in 77 patients (7%). Complex cardiac surgery procedures (including double valve replacement-repair, ascending aorta-aortic arch replacement, aortic root replacement, aortic dissection, AVR combined with coronary surgery, and complex redo procedures) were performed in 354 patients (32%). Early postoperative outcome was evaluated considering three different groups according to the surgical procedure (first time AVR, redo AVR, and complex procedure). Results: Overall conversion to full sternotomy was required in 16 patients (1.4%) with no significant differences between isolated AVR (9 patients, 1.3%) and complex or redo procedures (1 patient [1.2%] and 6 patients [1.6%], respectively). Forty-seven patients died in hospital (cumulative in-hospital mortality of 4.1 %). Mortality according to the procedure was 6.7, 3.8, and 2.8% for complex, redo AVR, or isolated AVR procedures, respectively, with a significant difference only for the complex procedures. Similarly, early postoperative outcome in terms of incidence of prolonged mechanical ventilation and ICU stay was significantly different only in the complex procedure group. Incidence of surgical revision (5.1, 2.9, and 2.7% for complex, redo, or isolated AVR procedures, respectively) showed no statistically significant differences regardless the type of procedures. Conclusions: Our experience clearly shows that a minimally invasive approach through upper ministernotomy is feasible and safe not only for isolated AVR but that it can also be utilized for a variety of complex surgical procedures. Minimizing surgical access may be helpful in patients undergoing complex surgical procedures, especially redo procedures, without compromising the surgical result. [Copyright &y& Elsevier]

Purpose: The aim of this study was to evaluate a modified surgical technique for premaxilla repositioning with concomitant autogenous bone grafting in bilateral trans-foramen cleft lip and palate patients. Patients and Methods: The study included 50 bilateral trans-foramen cleft lip and palate patients. Bone graft was harvested from the mandibular symphysis in 24 patients. Whenever more grafting was necessary, the iliac crest bone was used as the donor site (26 patients). The premaxilla was displaced by rupturing the bone and the palatine mucosa, and repositioned in a more adequate position using a surgical guide. The premaxilla and the grafts were fixed with miniplates and screws or screws only. The surgical guide was kept in place for 2 months, whereas the miniplates and screws were removed after 6 months, together with the complete bilateral lip and nose repair. Follow-up examinations were performed at 3, 6, and 12 months by means of periapical and occlusal radiographs, and by clinical examination. Thereafter, the patients were referred for completion of the orthodontic treatment. Results: Overall, in 48 cases (96%) the treatment achieved total graft integration, with complete closure of the bucconasal and palatal fistulas, and premaxilla stability (either at first surgery or after reoperation). In the remaining 2 patients (4%), the treatment failed, due to necrosis of the premaxilla. Conclusions: The procedure is complex and involves risk. However, the patient''s social inclusion, especially at the addressed age group, is the best benefit achieved. [Copyright &y& Elsevier]

• Fintech affects banks' innovation strategies. • Banks' investment in fintech firms has a negative effect on stock market returns. • Banks' investment in younger, technology-oriented fintech firms shows higher negative equity returns. This paper investigates the effect of banks' investment in FinTech firms (FTF) on stock returns. We hand-collect data on 581 investment rounds made by FTFs, within at least one European or North American bank acting as investor. Our results show that banks' investment in fintech affect stock markets. The abnormal reaction is negative, larger for young and technology-oriented firms, and stronger in the case of multiple investments. Bank size, leverage and profitability do not moderate abnormal returns. Overall, our study suggests that bank equity investment in FTFs is an important determinant of abnormal stock returns. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the efficacy of the application of allogenous bone at the maxillomandibular reconstructions for future rehabilitation with dental implants. The patients were submitted to reconstruction of maxilla, using allogeneic bone grafts, in 3 different techniques: onlay grafts for lateral ridge augmentation, onlay and particulate bone for sinus lift grafting, and particulate alone for sinus lift grafts. Clinical and radiographic control was done at the postoperative phase for at least 8 months, until the patient could be submitted to the installation of dental implants. The results showed success in the majority of the cases, and dental implants could be installed. This can be considered an excellent alternative when compared with the use of autogenous grafts; because handling is easier, there is a great amount of material available and a possibility of using local anesthesia, and consequently there is a reduction of patient morbidity. [Copyright &y& Elsevier]