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Uniportal video-assisted thoracic surgery implies the positioning of a single chest drain at the mid thorax level. Therefore, this tube cannot reach simultaneously the basal and apical regions of the pleural cavity. We propose the off-label use of a T-tube usually utilized in biliary duct surgery. Despite mid thorax insertion, this tube allows effective air and fluid drainage of the entire pleural space. We tested it in 10 patients undergoing uniportal surgery and report satisfactory results. No postoperative chest tube displacement, pleural effusion infection, or subatelectasies occurred. We conclude that the T-tube represents a good alternative in patients at high risk of postoperative effusion undergoing the uniportal approach.

Objective: We aimed to compare the haemodynamic profiles of obese and non-obese pregnant women, alongside describing the haemodynamic changes that occur in hypertensive disorders of pregnancies with an Appropriate for Gestational Age Fetus (HDP-AGA) beyond 34 weeks' gestation.Study design: In this prospective case-control study, maternal haemodynamic assessment was carried out by a trained operator using an UltraSonic Cardiac Output Monitor during a routine clinical assessment after 34 weeks of gestation. Indexed and non-indexed parameters were evaluated.Main outcome measures: Maternal hemodynamic parameters.Results: Obese and non-obese women did not differ for non-indexed parameters (Cardiac Output, Stroke Volume, Systemic Vascular Resistance). Using indexed parameters, corrected for Body Surface Area, obese women presented significantly lower Cardiac Index z-score (-0.23 +/- 0.5 vs 0.26 +/- 1.2; p = 0.004), Stroke Volume Index z-score (-0.27 +/- 0.8 vs 0.31 +/- 1.0; p < 0.0001) and significantly higher Systemic Vascular Resistance Index (0.16 +/- 0.8 vs -0.36 +/- 0.7; p < 0.0001). In obese women, HDP-AGA (n = 19) had significantly higher Systemic Vascular Resistance Index z-score (1.26 +/- 1.7 vs 0.16 +/- 0.8; P = 0.009) and significantly lower Stroke Volume Index (-0.68 +/- 0.8 vs -0.27 +/- 0.8; 0.049).Conclusion: Using indexed parameters, differences in haemodynamic profiles between obese and non obese women can be highlighted. Obese women seem to present a cardiac maladapation to the pregnancy (reduced cardiac index and stroke volume and increased vascular resistance) that could explain the increased risk of complications in this subgroup.

Castleman’s disease is a benign lymphoproliferative disorder affecting both lymph nodes and extranodal loci. Castleman’s disease can occur in practically any part of the body, but it occurs mainly in the thorax (~70%) followed by the abdomen and pelvis, neck and axilla. Clinically, Castleman’s disease can be classified into a unicentric or multicentric form, depending on the number of lymph nodes involved, and histologically into a hyaline vascular variant, plasma cell, mixed cellular or plasmablastic variant. In this mini-review we briefly report and focus on all clinical thoracic manifestations of Castleman’s disease resuming for each of them the possible strategy of treatment.

Purpose: The aim of our study was to identify maternal characteristics of women who are responsive to the second application of vaginal dinoprostone in a cohort of patients with a low Bishop Score. Secondarily, we compared the outcome of the patients' response to a single application to that of the women's response to a double application. Materials and methods: This was a retrospective observational cohort study. Patients undergoing preinduction of labor with dinoprostone 10mg controlled-release vaginal device were included. Results: Among 216 included patients, 192 women (88.9%) achieved a cervical ripening after a single application of dinoprostone, while 24 (11.1%) required a second application. Patients notresponding to the first application of dinoprostone had a significantly higher body mass index (27.4 ± 6.7 kg/m2 vs 24.9 ± 5.2 kg/m2; p < 0.05) and a significant increase in gestational weight gain (14 ± 5.2 kg vs 11.6 ± 6.1; p < 0.005). Double application of dinoprostone resulted in spontaneousdelivery in 58.4% of cases, but it was related to poorer neonatal outcome, compared to a single application. Conclusions: Obese women, not responding to the first application of dinoprostone could respond to the second application of this vaginal prostaglandin. However, data related to the use of a double application are still very limited to recommend its use as a standardized procedurefor not responsive patients.

Vitamin D is an important nutrient involved in many fundamental health outcomes. However, its influence on female reproductive function remains ambiguous. Cholecalciferol seems to have a role in the reproductive processes and in the patients affected by polycystic ovary syndrome, endometriosis, uterine myomas and premature ovarian failure. Moreover, it may play an important role in the assisted reproductive techniques, given that it is capable of influencing oocyte quality, but also an adequate preparation of the endometrium for embryonic implantation. Although promising, available evidence is based on a limited number of in vitro, in vivo and clinical studies. We provide an overview of the association between vitamin D and female infertility reporting the most recent data published in the literature. Nevertheless, properly randomised clinical trials are mandatory to achieve more conclusive results about the promising role of vitamin D in the management of female assisted reproduction.

Background Different video-assisted thoracic surgery (VATS) approaches can be adopted to perform lobectomy for non-small cell lung cancer. Given the hypothetical link existing between postoperative inflammation and long-term outcomes, we compared the dynamics of systemic inflammation markers after VATS lobectomy performed with uniportal access (UNIVATS), multiportal access (MVATS), or hybrid approach (minimally invasive hybrid open surgery, MIHOS). Methods Peripheral blood-derived inflammation markers (neutrophil-to-lymphocyte [NTL] ratio, platelet-to-lymphocyte [PTL] ratio, and systemic immune-inflammation index [SII]) were measured preoperatively and until postoperative day 5 in 109 patients undergoing UNIVATS, MVATS, or MIHOS lobectomy. Differences were compared through repeated-measure analysis of variance, before and after 1:1:1 propensity score matching. Time-to-event analysis was also done by measuring time to NTL normalization, based on the reliability change index for each patient. Results After UNIVATS, there was a faster decrease in NTL ratio (p = 0.015) and SII (p = 0.019) compared with other approaches. MVATS exhibited more pronounced PTL rebound (p = 0.011). However, all these differences disappeared in matched analysis. After MIHOS, NTL ratio normalization took longer (mean difference: 0.7 ± 0.2 days, p = 0.047), yet MIHOS was not independently associated with slower normalization at Cox's regression analysis (p = 0.255, odds ratio: 1.6, confidence interval: 0.7–4.0). Furthermore, surgical access was not associated with cumulative postoperative morbidity, nor was it with incidence of postoperative pneumonia. Conclusion In this study, different VATS approaches resulted into unsubstantial differences in postoperative systemic inflammatory response, after adjusting for confounders. The majority of patients returned back to preoperative values by postoperative day 5 independently on the adopted surgical access. Further studies are needed to elaborate whether these small differences may still be relevant to patient management.

In 2018, under service conditions, excessive deflections were observed in the long-span timber beams of the first floor of the former Sant’Elisabetta Monastery in Palermo (Italy). The build...

Background Completion thymectomy may be performed in patients with non-thymomatous refractory myasthenia gravis (MG) to allow a complete and definitive clearance from residual thymic tissue located in the mediastinum or in lower neck. Hereby we present our short- and long-term results of completion thymectomy using subxiphoid video-assisted thoracoscopy. Methods Between July 2010 and December 2017, 15 consecutive patients with refractory non-thymomatous myasthenia, 8 women and 7 men with a median age of 44 [interquartile range (IQR) 38.5-53.5] years, underwent video-thoracoscopic completion thymectomy through a subxiphoid approach. Results Positron emission tomography (PET) showed mildly avid areas [standardized uptake value (SUV) more than or equal to 1.8] in 11 instances. Median operative time was 106 (IQR, 77-141) minutes. No operative deaths nor major morbidity occurred. Mean 1-day postoperative Visual Analogue Scale value was 2.53±0.63. Median hospital stay was 2 (IQR, 1-3.5) days. A significant decrease of the anti-acetylcholine receptor antibodies was observed after 1 month [median percentage changes -67% (IQR, -39% to -83%)]. Median follow-up was 45 (IQR, 21-58) months. At the most recent follow-up complete stable remission was achieved in 5 patients. Another 9 patients had significant improvement in bulbar and limb function, requiring lower doses of corticosteroids and anticholinesterase drugs. Only one patient remained clinically stable albeit drug doses were reduced. One-month postoperative drop of anti-acetylcholine receptor antibodies was significantly correlated with complete stable remission (P=0.002). Conclusions This initial experience confirms that removal of ectopic and residual thymus through a subxiphoid approach can reduce anti-acetylcholine receptor antibody titer correlating to good outcome of refractory MG.

International audience; The ongoing development and extensions of cities, as well as the requirement for large scale deployment of renewable energy sources and electro-mobility determine the transformation of current electrical grids towards smart grids. The increasing demand and the requirement for its reliable supply is imposing new planning challenges for the development of electrical networks. The present paper describes a method of optimizing the development of urban electricity networks, by selecting from a set of available locations, the positions and the size of new power sources, using a multistage model. Results can be useful to plan the installation of new power sources in an existing network (distributed sources, renewable sources for powering electric vehicles).

Anthropogenic (or human-caused) wildfire is an increasingly important driver of ecological change on Pacific islands including southeastern Polynesia, but fire ecology studies are almost completely absent for this region. Where observations do exist, they mostly represent descriptions of fire effects on plant communities before the introduction of invasive species in the modern era. Understanding the effects of wildfire in southeastern Polynesian island vegetation communities can elucidate which species may become problematic invasives with continued wildfire activity. We investigate the effects of wildfire on vegetation in three low-elevation sites (45-379 m) on the island of Mo’orea in the Society Islands, French Polynesia, which are already heavily impacted by past human land use and invasive exotic plants, but retain some native flora. In six study areas (3 burned and 3 unburned comparisons), we placed 30 transects across sites and collected species and abundance information at 390 points. We analyzed each local community of plants in three categories: natives, those introduced by Polynesians before European contact (1767 C.E.), and those introduced since European contact. Burned areas had the same or lower mean species richness than paired comparison sites. Although wildfire did not affect the proportions of native and introduced species, it may increase the abundance of introduced species on some sites. Non-metric multidimensional scaling indicates that (not recently modified) comparison plant communities are more distinct from one another than are those on burned sites. We discuss conservation concerns for particular native plants absent from burned sites, as well as invasive species (including Lantana camara and Paraserianthes falcataria) that may be promoted by fire in the Pacific.

This study reports the synthesis of new porous nanohydroxyapatites (HAPs) substituted with different Zn contents (HAP_Zn) employing calcium and zinc nitrates and diammonium hydrogen phosphate as precursors. The synthesis was conducted in the presence of a surfactant, L-asparagine, for controlling the pore size distribution and morphology of obtained nanopowders, using a co-precipitation route. Thus a new approach leading to HAP_Zn nanopowders with improved nucleation and crystallization ability was developed. After maturation treatment of dispersions and filtration, the precipitate was lyophilized and ground. Part of the samples was calcined at 300°C for 1 h. The zinc content in the nanoHAPs varies from 0.2 to 10 wt% (substitution degree of Ca by Zn from 0.3 to 15.8 mole %). XRD investigations indicated HAP as the unique phase present and the nanostructured nature of the obtained HAPs. FTIR spectra also confirmed the presence of HAP structure. TEM, SEM, and AFM images showed the morphology of the ...

Annually, 15 million people worldwide suffer a stroke. Establishing the disability status after stroke is the key for the Physical and Rehabilitation Medicine point of view. 90% of those who have suffered a stroke show multiple impairments. The post stroke walking pattern has a major impact on the patient’s activity and participation capacity and to regain a functional gait is one of the most important goals of the rehabilitation intervention. The instrumented gait analysis is the key for accurately assessing the efficiency of a gait rehabilitation program and may be an important tool for designing personalized training. The aim of this study is to evaluate the effect of a complex rehabilitation program on the walking pattern in patients with after stroke hemiparesis.

Muscle pain can be elicited by any irritation of the nociceptors in the muscle or central sensitization in the central nervous system and represent a challenge for medical as well as for neurological rehabilitation. The most frequently described muscle pain syndromes are myofascial pain syndrome (MPS) and fibromyalgia syndrome (FMS). The use of infrared thermography in rehabilitation medicine for assessment of musculoskeletal disorders is not well documented in the current literature. This study is focused around MPS due to the more localized manifestations of this syndrome and it’s objective is to asses a correlation between the clinical findings, ultrasound examination and the thermal pattern of trigger points.

In the context of depleting natural resources, climatic changes and consequently worldwide interest to generate energy from renewable sources, energy and non-energy companies have diversified their portfolio by investing in renewable energy. This has developed a growing interest in finding out what supports the corporate entrepreneurial behavior in the renewable energy field. With the improvement of renewable energy technologies and changes of the financial support systems, the further development of the renewable energy business strongly relies on innovation, in terms of technology and business models. The present article aims at assessing the innovation characteristics of companies that have broadened their domain of activity by investing in renewable energy, as well as to identify which organizational support factors would influence these characteristics the most. The analysis is based on a study of 30 companies that have invested in renewable energy following a corporate entrepreneurship strategy. Results suggest that management support for corporate entrepreneurship and work autonomy are the organizational factors that would support innovation in these diversifying companies the most.

Rationale: Muscle pain can be elicited by any irritation of the nociceptors in the muscle or central sensitization in the central nervous system. The most frequently described muscle pain syndromes are myofascial pain syndrome and fibromyalgia syndrome. Myofascial pain syndrome has a more localized manifestation, the trigger points. Objective: If there is a correlation between the clinical findings, the ultrasound examination and the thermal pattern of trigger points exist. Material and method: The presence of trigger points can be identified by using clinical criteria. An ultrasound examination was performed to evaluate the trigger point dimensions. The ultrasound showed an ellipsoidal hypoechogenic area in the muscle. A thermography of the low back region was performed in order to observe the thermal pattern of the area. Results: Trigger points are represented by a higher temperature area surrounded by a cooler area, probably caused by a deficit in the blood flow around those points. Discussion: Infrared thermography could be a great asset for the monitoring of neuromusculoskeletal disorders and their dynamics, as well as an important aid for the initial diagnosis of conditions associated with tissue temperature alterations.

This essay describes, models, and advocates for the role of reflective design in bibliography and textual studies. Popularized by Donald Norman, reflective design promotes critical inquiry over usability and exploratory prototyping over fully realized productions. We highlight four projects undertaken by the authors that embody reflective design, including three that explore the crossed codes of print and electronic books. A larger aim of the essay is to position bibliotextual scholarship and pedagogy as design-oriented practices that can be used to imagine the future as well as reconstruct the past.

Romania has a good natural potential for all renewable sources: solar, wind, biomass, geothermal. To reach at economic practicability of renewable energy sources (RES), Romania needs to accelerate the development of the national RES industry and to remove several legal and administrative barriers. To develop the potential of RES and reach the targets, Romania has established a legal and institutional framework appropriate for promoting the use of renewable energy sources. According to the Directive 2009/28/EC on the promotion of the use of energy from renewable sources the target for the share of energy from renewable sources in gross final consumption of energy in the year 2020 for Romania is 24%. In Romania there is a mandatory quota system accompanied by Green Certificates (GC) system. For the period 2020-2030, the quotas shall be set through a governmental decision and cannot be lower than the quota for 2020. The research is about of renewable energy sources implemented by a photovoltaic system in a pilot project and the electricity used in in-house consumption. The objectives consist in producing of electricity from renewable sources (solar-photovoltaic sources), environment protection, using the new technology and energy efficiency having in attention for better human life.

An Alternate Reality Game (ARG) is an interactive storygame hybrid whose core mechanics include collaborative problem solving and storytelling. ARGs are also participatory experiences, because game designers dynamically adjust content in response to players' actions as game play progresses. What if the participatory process was extended during the design phase of an ARG as well? Few, if any, studies have explored how to include player populations in the ARG design process -- especially ARGs that target youth. In this paper, we share the process we followed to design a large-scale ARG to promote scientific inquiry for teenagers (13-17 years old) by partnering with them. Our findings suggest that co-designing with youth resulted in novel design features in the final game, and gave us insight into adolescent attitudes toward various scientific concepts. We also share co-design techniques that were not as effective and offer suggestions for future approaches.

The study followed the results of 0.85% CO2 influence on chick embryonic development. Biological material wascomposed of chicken eggs obtained from COBB500 hybrid broiler breeder parents. After weight determination ofchick embryos in different stages of development, egg components and embryos annexes, pH measurements ofalbumen and yolk sac were made. All of this analysis was made in order to determine the positive influence of 0.85%CO2 level on multistage chick incubation.