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A limited ileocaecal resection is the most frequently performed procedure for ileocaecal CD and different anastomotic configurations and techniques have been described. This manuscript audited the different anastomotic techniques used in a national study and evaluated their influence on postoperative outcomes following ileocaecal resection for primary CD. This is a retrospective, multicentre, observational study promoted by the Italian Society of Colorectal Surgery (SICCR), including all adults undergoing elective ileocaecal resection for primary CD from June 2018 May 2019. Postoperative morbidity within 30days of surgery was the primary endpoint. Postoperative length of hospital stay (LOS) and anastomotic leak rate were the secondary outcomes. 427 patients were included. The side to side anastomosis was the chosen configuration in 380 patients (89%). The stapled anastomotic (n = 286; 67%), techniques were preferred to hand-sewn (n = 141; 33%). Postoperative morbidity was 20.3% and anastomotic leak 3.7%. Anastomotic leak was independent of the type of anastomosis performed, while was associated with an ASA grade ≥ 3, presence of perianal disease and ileocolonic localization of disease. Four predictors of LOS were identified after multivariate analysis. The laparoscopic approach was the only associated with a reduced LOS (p = 0.017), while age, ASA grade ≥ 3 or administration of preoperative TPN were associated with increased LOS. The side to side was the most commonly used anastomotic configuration for ileocolic reconstruction following primary CD resection. There was no difference in postoperative morbidity according to anastomotic technique and configuration. Anastomotic leak was associated with ASA grade ≥ 3, a penetrating phenotype of disease and ileo-colonic distribution of CD. A limited ileocaecal resection is the most frequently performed procedure for ileocaecal CD and different anastomotic configurations and techniques have been described. This manuscript audited the different anastomotic techniques used in a national study and evaluated their influence on postoperative outcomes following ileocaecal resection for primary CD. This is a retrospective, multicentre, observational study promoted by the Italian Society of Colorectal Surgery (SICCR), including all adults undergoing elective ileocaecal resection for primary CD from June 2018 May 2019. Postoperative morbidity within 30days of surgery was the primary endpoint. Postoperative length of hospital stay (LOS) and anastomotic leak rate were the secondary outcomes. 427 patients were included. The side to side anastomosis was the chosen configuration in 380 patients (89%). The stapled anastomotic (n = 286; 67%), techniques were preferred to hand-sewn (n = 141; 33%). Postoperative morbidity was 20.3% and anastomotic leak 3.7%. Anastomotic leak was independent of the type of anastomosis performed, while was associated with an ASA grade ≥ 3, presence of perianal disease and ileocolonic localization of disease. Four predictors of LOS were identified after multivariate analysis. The laparoscopic approach was the only associated with a reduced LOS (p = 0.017), while age, ASA grade ≥ 3 or administration of preoperative TPN were associated with increased LOS. The side to side was the most commonly used anastomotic configuration for ileocolic reconstruction following primary CD resection. There was no difference in postoperative morbidity according to anastomotic technique and configuration. Anastomotic leak was associated with ASA grade ≥ 3, a penetrating phenotype of disease and ileo-colonic distribution of CD.

Background and Aims: The Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification of diverticulosis and diverticular disease (DD) is currently available. It scores severity of the disease as DICA 1, DICA 2 and DICA 3. Our aim was to assess the agreement on this classification in an international endoscopists community setting. Methods: A total of 96 doctors (82.9% endoscopists) independently scored a set of DD endoscopic videos. The percentages of overall agreement on DICA score and a free-marginal multirater kappa (κ) coefficient were reported as statistical measures of interrater agreement. Results: Overall agreement in using DICA was 91.8% with a free-marginal kappa of 88% (95% CI 80-95). The overall agreement levels were: DICA 1, 85.2%; DICA 2, 96.5%; DICA 3, 99.5%. The free marginal κ was: DICA 1 = 0.753, DICA 2 = 0.958, DICA 3 = 0.919. The agreement about the main endoscopic items was 83.4% (k 67%) for diverticular extension, 62.6% (k 65%) for number of diverticula for each district, 86.8% (k 82%) for presence of inflammation, and 98.5 (k 98%) for presence of complications. Conclusions: The overall interrater agreement in this study ranges from good to very good. DICA score is a simple and reproducible endoscopic scoring system for diverticulosis and DD.

Emissione stagionale di uova di parassiti gastrointestinali in cinghiali (Sus scrofa) e in mufloni (Ovis ammon) di un’area mediterranea (Italia centrale). E' stata studiata l'emissione stagionale di uova (o oocisti) di parassiti nelle feci di ungulati selvatici in una zona mediterranea protetta, il Parco dei Monti Livornesi (Livorno, Toscana, Italia Centrale). Per un anno sono stati raccolti mensilmente campioni di feci di Cinghiale (Sus scrofa) e di Muflone (Ovis ammon). Gli andamenti osservati di emissione di uova sono stati analizzati tenendo conto delle variazioni di temperatura e piovosità stagionali, del ciclo biologico e della strategia di sopravvivenza dei parassiti, e delle condizioni sanitarie dell'ospite. E’ risultato che in una zona mediterranea come quella considerata i picchi di emissione di uova appaiono in mesi differenti in relazione alla biologia e alle strategie di sopravvivenza dei diversi parassiti. Seasonal egg (or oocyst) output of gastro-intestinal parasites of wild ungulates was studied in a Mediterranean protected area, the Monti Livornesi Park (Livorno, Tuscany region, Central Italy). Samples of faeces of wild boars (Sus scrofa) and mouflons (Ovis ammon) were collected monthly for one year. The observed trends of egg output were analysed taking into account seasonal variations of temperature and rainfall, life-cycle and survival strategy of parasites, and health condition of hosts. In our Mediterranean study area, the peaks of egg output appear in different months according to different biology and survival strategies of parasites.

Purpose:To investigate the relation between type of intraocular tamponade and unintentional retinal displacement (URD) after standard vitrectomy. Methods:Twenty-three eyes of 23 consecutive patients affected by rhegmatogenous retinal detachment (RRD) underwent three-port pars plana vitrectomy (TPPV) with gas (perfluoropropane) or silicone oil tamponade, according to specific clinical conditions. All patients underwent complete ocular examination, including fundus autofluorescence (FAF) (Topcon TRC-50DX), spatial and quantitative assessment of fixation (Nidek MP-1 microperimetry) before surgery and on 7-day, 1-month, 3-month and 6-month post-operatory visits. Results:URD was noted on FAF in 12 of the 23 eyes (52.2%). Retinal displacement rate was greater in gas-injected eyes (10/14, 71.4%) compared with eyes with silicone oil (2/9, 22.2%) (Fisher’s exact test, p=0.036). Retina shifted downward in all gas-injected eyes and upward in all eyes with silicone oil. Preoperative and follow-up macular function assessment was reliably performed only in macula-on cases (7). In this subgroup a fixation shift was noted on the first post-operative visit, with a maximum value on the 7-day post-operative examination and decreasing throughout the follow-up examinations. Conclusions:In eyes with RRD treated with vitrectomy and gas or silicone oil injection, URD may occur despite successful retinal reattachment. The type of intraocular tamponade seems to influence retinal dislocation rate and direction.

Introduction Single-incision laparoscopic surgery (SILS) aims to minimize the surgical access trauma by reducing the number of abdominal incisions to a single site, potentially offering better cosmetic results and decreased postoperative pain. In this study, we compare the results of SILS ileocolic resection for Crohn’s disease (CD) to conventional laparoscopy and open surgery using a propensity score–matched analysis in a retrospective national multicentre study. Methods All consecutive patients undergoing elective SILS ileocaecal or redo ileocolic resection for primary and recurrent CD from 1 June 2018 to 31 May 2019 were included. Patients were matched 1:1:1 with laparoscopy and open surgery according to perianal disease, recurrent disease, penetrating phenotype of CD, history of previous abdominal surgery, preoperative medical treatment with steroids and anti-TNF. Postoperative morbidity within 30 days of surgery was the primary endpoint. Results Fifty-eight patients were included in each group, for a total of 174 patients. The conversion rate for SILS and laparoscopy was 10.3% and 12%, respectively, with no difference in the incidence of postoperative complications (13.8% and 12%, p = 0.77), whilst open surgery demonstrated a worse morbidity profile, with a complication rate of 25.9% (p < 0.0001). Median length of hospital stay following SILS ileocolic resection was 5 days, significantly shorter compared to 7 days for laparoscopy and 9 for open surgery (p < 0.0001). Conclusions SILS ileocolonic resection for CD demonstrated a comparable morbidity profile compared to laparoscopy in selected patients, with a reduced length of postoperative hospital stay.

For the first time, catalytic conversion of CO2 to CH4 (Sabatier reaction) has been studied on real vehicle exhaust. Preliminary tests were carried out on model gas mixtures using as reactants a N2/CO2 gas mixture (CO2 = 9.5 vol% concentration similar to that of road vehicle exhaust) and pure hydrogen. Ruthenium powder (5 wt%) on alumina was used as catalyst, in a fixed bed cylindrical reactor. The operating conditions investigated are P = 1 atm, temperature in the range 160–320 °C, contact time 0.6–1.29 s, and H2/CO2 ratio 2.75–4.11. Experimental conditions were varied to study the effect of temperature, contact time, and H2/CO2 ratio on conversion, yield, and selectivity of the process. Once evaluated the performance of the catalytic process and identified the best operating conditions, real exhausts of a two-wheel motorcycle and a four-wheel gasoline vehicle were treated with the same experimental apparatus. Analyses of physical and chemical characterization of catalyst samples before and after the use were also performed. Results show that, even though best performances are generally obtained with model mixtures, high CO2 conversion together with high yield and selectivity in CH4 can be obtained with real vehicle exhausts too. Moreover, phenomena causing the deactivation of catalyst have not been observed. Results seem to indicate good opportunities for the development of the process.

Organic Rankine Cycle (ORC) power plants are characterized by high efficiency and flexibility, as a result of a high degree of maturity. These systems are particularly suited for recovering energy from low temperature heat sources, such as exhaust heat from other plants. Despite ORCs having been assumed to be appropriate for stationary power plants, since their layout, size and weight constraints are less stringent, they represent a possible solution for improving the efficiency of propulsion systems for road transportation. The present paper investigates an ORC system recovering heat from the exhaust gases of an internal combustion engine. A passenger car with a Diesel engine was tested over a Real Driving Emission (RDE) cycle. During the test exhaust gas mass flow rate and temperature have been measured, thus calculating the enthalpy stream content available as heat addition to ORC plant in actual driving conditions. Engine operating conditions during the test were discretized with a 10-point grid in the engine torque–speed plane. The ten discretized conditions were employed to evaluate the ORC power and the consequent engine efficiency increase in real driving conditions for the actual Rankine cycle. N-pentane (R601) was identified as the working fluid for ORC and R134a was employed as reference fluid for comparison purposes. The achievable power from the ORC system was calculated to be between 0.2 and 1.3 kW, with 13% system efficiency. The engine efficiency increment ranged from 2.0% to 7.5%, with an average efficiency increment of 4.6% over the RDE test.

The valorization of residual biomass plays today a decisive role in the concept of &ldquo, circular economy&rdquo, according to which each waste material must be reused to its maximum extent. The collection and energy valorization at the local level of biomass from forest management practices and wildfire prevention cutting can be settled in protected areas to contribute to local decarbonization, by removing power generation from fossil fuels. Despite the evident advantages of bioenergy systems, several problems still hinder their diffusion, such as the need to assure their reliability by extending the operating range with materials of different origin. The Italian project &ldquo, INNOVARE&mdash, Innovative plants for distributed poly-generation by residual biomass&rdquo, funded by the Italian Ministry of Economic Development (MISE), has the main scope of improving micro-cogeneration technologies fueled by biomass. A micro-combined heat and power (mCHP) unit was chosen as a case study to discuss pros and cons of biomass-powered cogeneration within a national park, especially due to its flexibility of use. The availability of local biomasses (woodchips, olive milling residuals) was established by studying the agro-industrial production and by identifying forest areas to be properly managed through an approach using a satellite location system based on the microwave technology. A detailed synergic numerical and experimental characterization of the selected cogeneration system was performed in order to identify its main inefficiencies. Improvements of its operation were optimized by acting on the engine control strategy and by also adding a post-treatment system on the engine exhaust gas line. Overall, the electrical output was increased by up to 6% using the correct spark timing, and pollutant emissions were reduced well below the limits allowed by legislation by working with a lean mixture and by adopting an oxidizing catalyst. Finally, the global efficiency of the system increased from 45.8% to 63.2%. The right blending of different biomasses led to an important improvement of the reliability of the entire plant despite using an agrifood residual, such as olive pomace. It was demonstrated that the use of this biomass is feasible if its maximum mass percentage in a wood matrix mixture does not exceed 25%. The project was concluded with a real operation demonstration within a national park in Southern Italy by replacing a diesel genset with the analyzed and improved biomass-powered plant and by proving a decisive improvement of air quality in the real environment during exercise.