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The so-called Hoyle state in 12C (7.654 MeV, 0+) is an excited state of 12C characterized by a well-pronounced 3α cluster nature. Many possible cluster configurations, such as a linear-chain arrangement of 3α particles, bentarm, triangular or gas-like structures were theoretically conjectured within the previous decades, but, also due to the existence of ambiguities in experimental data, it is still impossible to draw a firm conclusion. Its direct α-decay partial width is accurately predicted by models but requires better experimental constraints. We performed a high-precision and high-selectivity investigation of its α-decay by using the 14N(d, α2)12C- reaction at 10.5 MeV incident energy with the aim of distinguishing between sequential and direct decay patterns. We are able to significantly improve the state of the art upper limit for direct 3α decays by placing the new limit at 0.043%. Such a low limit allows to give fundamental constraints to theoretical models attempting to describe the structure of the Hoyle state.

An intense activity in the field of experimental, as well as theoretical, nuclear structure is ongoing at the INFN-LNS laboratory in Catania. A short overview of the main recent results is reported.

Despite the drastic reversal of decarbonization effort by the Trump administration, the majority of U.S. states continue policies aimed at reducing greenhouse gas (GHG) emissions and increasing renewable energy technology (RET) deployment. Although electrical power utilities are required and/or encouraged to comply with these policies, their executives lack direct incentives to do so. In this study, a novel incentive mechanism is evaluated for aligning utility executive compensation with such policies. First, an overview is provided on chief executive officer (CEO) pay and the GHG emissions of utilities. The relationship between GHG emissions, renewable energy diversification, and CEO pay is examined using the case study of three of the largest electric utilities in Michigan. The results show that the regulated utility market is not consistently rewarding CEOs with higher compensation for decreasing GHG emissions and that both an approach incentivizing RETs adoption and an approach encouraging GHG emissions have deficiencies. A combined approach is then analyzed that results in a compensation equation allowing for utility executives to receive incentive pay for reducing overall emissions and increasing renewable generation. The results indicate that by careful calibration of the proposed incentive equations the harmful effects of emissions can be prevented through CEO incentive pay.

Fragmentation reactions represent a serious complication in hadrontherapy and space radiation protection. In order to predict their effects, both reliable Monte Carlo codes and experimental data are needed. The shortage of precise measurements, especially of double differential cross sections, has triggered many dedicated experiments at relativistic energies. Aiming to explore the Fermi energy regime, as well, where different reaction mechanisms are involved, we measured the 12C fragmentation at 62 AMeV on a 12C and a 197Au target. A high granularity Si-CsI hodoscope allowed to identify the charge and the mass of detected fragments and measure their energy and emission angle. In this work we report the double differential cross sections for the production of different fragments as a function of the emission angle. Experimental results are compared with the GEANT-4 Monte Carlo predictions performed using two reaction models, the Quantum Molecular Dynamic and the Binary Light Ion Cascade.

Despite clinical and technical advances, acute aortic dissection carries high operative mortality. This study was designed to establish whether this is influenced by institution and surgeon volume.Outcomes of 5,184 patients (mean age, 60.3 years; 65.9% male) diagnosed with acute aortic dissection from the Nationwide Inpatient Sample from 2003 to 2008 were analyzed with risk-adjustment for preoperative comorbidity using multivariate logistic regression analysis.Overall operative mortality was 21.6%, with similar preoperative patient risk profile across institutions and individual surgeons. A strong inverse relationship was observed between operative mortality and both institution and surgeon volume: surgeons who averaged less than 1 aortic dissection repair annually had a mean operative mortality of 27.5%, compared with 17.0% for those averaging 5 or more annually (odds ratio, 1.78; 95% confidence interval, 1.39 to 2.29; p0.001). This was similar to the relationship seen between institution volume and mortality: operative mortality was 27.4% in institutions performing 3 or fewer acute aortic dissections a year, compared with 16.4% in those performing more than 13 annually (p 0.001). Nationally, operative mortality decreased steadily from 23% in 1998-2000 to 19% in 2005-2008, with no significant decrease in patient risk profile.Patients undergoing emergency repair of acute aortic dissection by lower-volume surgeons and centers have approximately double the risk-adjusted mortality of patients undergoing repair by the highest volume care providers. Routine involvement, whenever feasible, of teams experienced in acute aortic dissection repair may be a strategy to reduce operative mortality and major morbidity.

Objectives The objective of this study was to investigate the impact of bilateral internal mammary artery (BIMA) on early outcomes after coronary artery bypass grafting. Design Retrospective database analysis. Setting US hospitals. Patients 1 526 360 patients (mean age 65 years, 73% male) from the Nationwide Inpatient Sample from 2002–2008 who underwent isolated coronary artery bypass grafting with at least one internal mammary artery. Interventions Single versus BIMA bypass grafting. Main outcome measures Inhospital mortality, deep sternal wound infection (DSWI). Results The rate of BIMA use was 3.9%. Use of BIMA was independently associated with slightly lower inhospital mortality (unadjusted rate 1.1% vs 1.7%, adjusted OR 0.86, 95% CI 0.79 to 0.93). The DSWI rate was 1.4%. The independent predictors of DSWI were female gender (OR 1.06), congestive heart failure (OR 6.22), chronic pulmonary disease (OR 1.57), obesity (OR 1.17), diabetes mellitus (OR 1.04; OR 1.51 with chronic complication) and chronic renal failure (OR 2.13; OR 2.63 with dialysis). The use of BIMA was not an independent predictor of DSWI (OR 1.03, 95% CI 0.96 to 1.10). BIMA was associated with higher incidence of DSWI in patients with chronic complications of diabetes mellitus (OR 1.90, 95% CI 1.51 to 2.41). Conclusions BIMA grafting is associated with increased risk of DSWI only in patients with severe, chronic diabetes. The incremental morbidity and mortality of DSWI does not justify denial of BIMA in the majority of patients.

International audience; The ${0}_{2}^{+}$ state in(12)C (7.654MeV, the Hoyle state) is important for the understanding of clustering phenomena in nuclei. The pronounced cluster nature of this state allows the triple-α process in stars with a reaction rate regulated by its structure properties. To precisely estimate the direct component in the 3α decay mechanism of the Hoyle state, we developed a new experiment using the(14)N(d,α)(12)C reaction at 10.5MeV. An anti-coincidence telescope was used to identify the α ejectiles leading the residual(12)C in the Hoyle state, while its decays in 3α were studied by means of a new hodoscope of silicon detectors, superOSCAR, placed in kinematical coincidence to fully reconstruct the events. Details of the experiment and preliminary results are discussed in the text.

The elastic scattering excitation function for 15O on 4He was measured - for the first time - by using the Inverse Kinematic Thick Target scattering method. The obtained spectrum was analysed in an R-matrix framework providing spectroscopic information for several states in the excitation energy of the nucleus 19Ne from 4.8 to 9 MeV. Eight of them are newly observed states. The set-up and the experimental technique will be described in detail and the results will be shown and discussed. European Unions Horizon 2020 659744

Background: For the deeply bound one-nucleon removal at intermediate energies using a $^{9}\text{Be}$ or $^{12}\text{C}$ target, a strong reduction of cross section was observed relative to the prediction of eikonal theoretical model. The large disagreement has not been explained and the systematic trend is inconsistent with results from transfer reactions. The recently observed asymmetric parallel momentum distribution of the knockout residue indicates the significant dissipative core-target interaction in the knockout reaction with a composite target, implying new reaction mechanisms beyond the eikonal reaction descriptions.Purpose: To investigate the reaction mechanism for deeply bound nucleon removal at intermediate energies.Method: Neutron removal from $^{14}\text{O}$ using a $^{12}\text{C}$ target at 60 MeV/nucleon was performed. Nucleon knockout cross sections were measured. The unbound excited states of $^{13}\text{O}$ were reconstructed by using the invariant mass method with the residues and the associated decay protons measured in coincidence. The measured cross sections are compared with an intra-nuclear cascade (INC) prediction.Results: The measured cross section of ($^{14}\text{O}$, $^{11}\text{C}$) is 60(9) mb, which is 3.5 times larger than that of ($^{14}\text{O}$, $^{13}\text{O}$) channel. This $2pn$-removal cross section is consistent with INC prediction, which is 66 mb with the main contribution being non-direct reaction processes. On the other hand, the upper limit of the cross section for one-neutron removal from $^{14}\text{O}$ followed by proton evaporation is 4.6(20) mb, integrated up to 6 MeV above the proton separation energy of $^{13}\text{O}$. The calculated total cross section for such reaction processes by the INC model is 2.5 mb, which is within the measured upper limit.Conclusions: The data provide the first constraint on the role of core excitation and evaporation processes in deeply bound nucleon removal from asymmetric nuclei. The experiment results suggest that non-direct reaction processes, which are not considered in the eikonal model, play an important role in deeply bound nucleon removal from asymmetric nuclei at intermediate energies.

Radial and longitudinal strain assessment in the carotid artery wall using speckle tracking

Procurement of a high number of progenitor cells is of primary interest in allogeneic PBSC transplantation. We have retrospectively compared toxicity, mobilization effect and progenitor cell yields of two different rhG-CSF schedules in 11 consecutive healthy individuals donating their PBSC. Five of them received rhG-CSF 16 micrograms/kg/d for 4 subsequent d in 2 divided subcutaneous injections (group A); similarly, 6 donors received rhG-CSF 10 micrograms/kg/d for 5 d (group B). The aphereses were started the last day of rhG-CSF treatment; 9 donors underwent 2 aphereses, one underwent 1 and another 3 procedures, always on subsequent days. Toxicity was mild, but moderate thrombocytopenia developed following apheretic collections, irrespective of rhG-CSF schedule. In all the donors WBC, as well as circulating CD34+ cells, CFU-GM, CFU-GEMM and BFU-E dramatically increased over the baseline values, peaking on d 5 or 6, with no statistical difference between the 2 groups for the height of the cell peaks. Also the peripheral lymphoid cell populations (CD3+, CD19+ and CD56+/CD3-) increased following the rhG-CSF administration. The number of MNC, CFU-GM, BFU-E, CFU-GEMM, as well as CD34+, CD3+, CD19+ and CD56+/CD3- cells collected by apheresis showed no statistical difference in the 2 groups. Overall, 8 of the 11 donors collected the target number of CD34+ cells > 4 x 10(6)/kg ideal recipient body weight with the first apheresis, with no difference between the 2 groups. Mobilization with rhG-CSF in healthy donors enables the collection of large number of progenitor cells with modest side effects. A schedule of 10 micrograms/kg for 5 d is as effective as 16 micrograms/kg for 4 d. A single apheresis would be enough in 80% of cases.

One of the most important tasks of urban and hazard planning is to mitigate the damages and minimize the costs of the recovery process after catastrophic events. In this context, the capability of urban systems and communities to recover from disasters is referred to as resilience. Despite the problem of resilience quantification having received a lot of attention, a mathematical definition of the resilience of an urban community, which takes into account the social aspects of an urban environment, has not yet been identified. In this article, we provide and test a methodology for the assessment of urban resilience to catastrophic events which aims at bridging the gap between the engineering and the ecosystem approaches to resilience. We propose to model an urban system by means of different hybrid social-physical complex networks, obtained by enriching the urban street network with additional information about the social and physical constituents of a city, namely citizens, residential buildings, and services. Then, we introduce a class of efficiency measures on these hybrid networks, inspired by the definition of global efficiency given in complex network theory, and we show that these measures can be effectively used to quantify the resilience of an urban system, by comparing their respective values before and after a catastrophic event and during the reconstruction process. As a case study, we consider simulated earthquakes in the city of Acerra, Italy, and we use these efficiency measures to compare the ability of different reconstruction strategies in restoring the original performance of the urban system

This Letter reports a study of the highly debated ^{10}Li structure through the d(^{9}Li,p)^{10}Li one-neutron transfer reaction at 100 MeV. The ^{10}Li energy spectrum is measured up to 4.6 MeV and angular distributions corresponding to different excitation energy regions are reported for the first time. The comparison between data and theoretical predictions, including pairing correlation effects, shows the existence of a p_{1/2} resonance at 0.45±0.03 MeV excitation energy, while no evidence for a significant s-wave contribution close to the threshold energy is observed. Moreover, two high-lying structures are populated at 1.5 and 2.9 MeV. The corresponding angular distributions suggest a significant s_{1/2} partial-wave contribution for the 1.5 MeV structure and a mixing of configurations at higher energy, with the d_{5/2} partial-wave contributing the most to the cross section.

The 13 C( 18 O, 16 O) 15 C reaction has been studied at 84 MeV incident energy. The ejectiles have been momentum analized by the MAGNEX spectrometer and 15 C excitation energy spectra have been obtained up to about 20 MeV. In the region above the two-neutron separation energy, a bump has been observed at 13.7 MeV. The extracted cross section angular distribution for this structure, obtained by using different models for background, displays a clear oscillating pattern, typical of resonant state of the residual nucleus.

In this contribution we will present the future activities that our collaboration will carry out at ELI-NP (Extreme Light Infrastructure Nuclear Physics), the new multi peta-watt Laser facility, currently under construction at Bucharest (Romania). The activities concerns the study of nuclear reactions in laser plasmas. In this framework we proposed the construction of a new, general-purpose experimental set-up able to detect and identify neutrons and charged particles.

The MAGNEX large-acceptance spectrometer has been commissioned with beams from the Tandem accelerator at INFN-LNS Catania. The optics were tested with elastically-scattered 7Li, 16O and 48Ti beams with various apertures mounted after the target. The momentum dispersion was verified to be in agreement with the optics calculations. A demonstration of the particle identification capabilities of the PSD start detector and the focal plane detector was given by a measurement of the 27Al(7Li,6Li)28Al transfer reaction at a mean angle of 25°. The measured charge state distribution of 48Ti ions is in agreement with predictions for a gold stripping foil. Preliminary results of the software reconstruction of incident angle and excitation energy, obtained through matrices based on a 3D-interpolation of the measured field maps, are encouraging.

The problem of the description of magnetic field for large bending magnets is addressed in relation to the requirements of modern techniques of trajectory reconstruction. The crucial question of the interpolation and extrapolation of fields known at a discrete number of points is analysed. For this purpose a realistic field model of the large dipole of the MAGNEX spectrometer, obtained with finite elements three dimensional simulations, is used. The influence of the uncertainties in the measured field to the quality of the trajectory reconstruction is treated in detail. General constraints for field measurements in terms of required resolutions, step sizes and precisions are thus extracted.

The 12C(18O,16O)14C two-neutron transfer reaction has been studied at an incident energy of 275 MeV and the ejectiles have been momentum analysed at forward angles by the MAGNEX spectrometer. The identification of the 16O ejectiles was obtained by combining a standard ΔE-E technique with the simultaneous measurement of the angle and the position at the focal plane. The 14C excitation energy spectra have been obtained and several known bound and resonant states of the residual nuclei have been identified. The results have been compared to a previous measurement of the same reaction at 84 MeV incident energy.

The knowledge of the nuclear matrix elements for the neutrinoless double beta decay is fundamental for neutrino physics. In this paper, an innovative technique to extract information on the nuclear matrix elements by measuring the cross section of a double charge exchange nuclear reaction is proposed. The basic point is that the initial and final state wave functions in the two processes are the same and the transition operators are similar. The double charge exchange cross sections can be factorized in a nuclear structure term containing the matrix elements and a nuclear reaction factor. First pioneering experimental results for the 40Ca(18O,18Ne)40Ar reaction at 270 MeV incident energy show that such cross section factorization reasonably holds for the crucial 0+ --> 0+ transition to 40Args, at least at very forward angles.

The lateral line system, formed of both superficial (pit organs) and canal neuromasts, is one of the major mechanosensory systems in fish. It has always been assumed that this system depends on neurotrophins and their cognate Trk receptors for development and maintenance, as has been shown in other mechanosensitive systems of vertebrates. However, until now this issue has not been specifically addressed. In this study we used immunohistochemistry to investigate the occurrence and localization both of neurotrophins (NGF-, BDNF- and NT-3-like) and of Trk-like proteins (TrkA-, TrkB-, TrkC-like) in alevins of Salmo salar and S. trutta. All cells in the pit organs of S. salar displayed strong immunoreactivity for TrkB-like and BDNF-like, whereas they were restricted to the hair cells in S. trutta. The hair, supporting and mantle cells of S. salar, and the mantle cells of S. trutta, also expressed TrkA-like immunoreactivity. In the canal neuromasts BDNF-, TrkA- and TrkB-like proteins were present in all cells, without differences between species. NGF-, NT-3- and TrkC-like immunoreactivity were never detected. The present results suggest that mechanoreceptive hair cells, as well as supporting cells, in the lateral line system are under the control of the BDNF–TrkB-like complex, and probably of ligands of TrkA-like receptors.

Study on clustering of nucleons in nuclei is recently focusing on unstable nuclei where new kinds of structures, namely molecular structures with excess nucleons, are predicted. The Coulomb shift of energy in the mirror system is suggested to reflect the size of these structures. Although the missing mass spectroscopy is expected to give access to these structures even beyond particle decay thresholds without any biases in excitation energy spectra but the detection of very low energy particles is challenging. To satisfy the requirement, a new active target system MAIKo has been developed at RCNP. The detector was commissioned using a 13C beam under the same kinematical condition as that of RI beam experiments.

The aim of this study was to determine the effect of pulmonary artery catheterization on clinical outcomes after cardiac surgery in higher-risk patients.Retrospective national database analysis.U.S. hospitals.A weighted sample of 2,063,337 patients undergoing cardiac surgery identified from the Nationwide Inpatient Sample (NIS) from January 1, 2000 to December 31, 2010.Pulmonary artery catheterization.Compared to patients who did not receive a pulmonary artery catheter, those who did on the whole were on average slightly older (66.6±11.9 years v 65.5±12.8 years, p0.001), more likely to have pulmonary hypertension (7.5% v 5.1%, p0.001), chronic obstructive pulmonary disease (24.6% v 20.7%, p0.001), obesity (15.0% v 13.1%, p0.001), and chronic renal failure (10.9% v 9.2%, p0.001). In multivariate analysis, the risk of operative mortality in patients who underwent pulmonary artery catheterization was significantly higher than in those who did not (4.6% v 3.1%, p0.001), adjusted OR 1.34 (95% CI 1.26-1.43, p0.001). In propensity matched subgroup analysis operative mortality risk was higher in octogenarian patients (OR 1.24, p = 0.24), and patients with congestive heart failure (OR 1.39, p = 0.023) who underwent pulmonary artery catheterization. No significant difference in operative mortality was observed in low-risk patients according to whether or not they underwent pulmonary artery catheterization. The incidence of prolonged mechanical ventilation and length of stay30 days was higher in patients who underwent pulmonary artery catheterization in all subgroups.In contemporary practice pulmonary artery catheters do not appear to be associated with reductions in operative mortality or morbidity and are associated with increases in duration of ventilation and length of stay in the intensive care unit.

The paper presents main features of a system for monitoring of WWT plants and forecasting of air quality, recently installed in industrial area ("the leather district"). Basic functions of the system are recalled and the role of dispersion models, neural networks and K-nn models is illustrated, putting into evidence their relative merits for the scope of reconstruction of specific episodes and for forecasting pollutant ground concentrations.

One hundred and one donors who had received filgrastim (rhG-CSF) for the purpose of donating either granulocytes or peripheral blood stem cells (PBSC) for their relatives more than 3 years ago were contacted. All donors had received daily rhG-CSF at a median dose of 16 microg/kg/day (range 3-16) for a median of 6 days (range 3-15 days). All collection procedures were completed and short-term side-effects of rhG-CSF were mild in the majority of the donors. At a median time interval of 43.13 months (range 35-73), the donors were contacted to assess whether adverse effects related to rhG-CSF administration had occurred. Prior to rhG-CSF two donors had cancer, one had a myocardial infarction, one was hepatitis C virus positive, one had a history of sinusitis, one had Graves' disease and two had arterial hypertension. None worsened with the rhG-CSF administration but the donor with a history of infarction had an episode of angina following apheresis, and the donor with Graves' disease had a stroke 15 months after rhG-CSF. Two pregnancies occurred after the rhG-CSF administration and one donor was 2-3 weeks pregnant during rhG-CSF treatment. Three pregnancies resulted in two normal births and one in a spontaneous abortion of a pregnancy which occurred more than 2 years following rhG-CSF. In the time following rhG-CSF administration two donors developed cancer (breast and prostate cancer) at a follow-up of 70 and 11 months, respectively. One donor developed lymphadenopathy 38 months after the rhG-CSF, which spontaneously resolved. Blood counts were obtained in 70 donors at a median follow up of 40.4 months (range 16.8-70.8). Hematocrit was 43% (median, range 36.8-48), white blood cells were 5.7 x 109/l (median, range 3-14), granulocytes 3.71 x 109/l (median, range 1. 47-10.36), lymphocytes 1.67 x 109/l (median, range 0.90-3.96), monocytes 0.46 x 109/l (median, range 0.07-0.87) and platelet counts were 193.0 x 109/l (median, range 175.0-240.0). This study indicates that short-term administration of rhG-CSF to normal donors for the purpose of mobilizing the PBSC or granulocytes appears safe and without any obvious adverse effects more than 3 years after the donation. Bone Marrow Transplantation (2000) 25, 85-89.

Objectives The objective of this study was to assess the impact of robotic approaches on outcomes of coronary bypass surgery. Design Retrospective national database analysis. Setting United States hospitals. Participants A weighted sample of 484,128 patients undergoing isolated coronary artery surgery identified from the Nationwide Inpatient Sample from 2008 through 2010. Interventions Robotically assisted coronary artery bypass surgery versus conventional bypass surgery. Measurements and Main Results Robotic approaches were used in 2,582 patients (0.4%). Patients undergoing robotic surgery were less likely to be female (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.57-0.87), present with acute myocardial infarction (OR 0.53, 95% CI 0.38-0.73), or have cerebrovascular disease (OR 0.41, 95% CI 0.23-0.71) compared to patients undergoing conventional surgery. In 59% of robotic cases, a single bypass was performed, and 2 bypasses were performed in 25% of cases. After adjusting for comorbidity, reduced postoperative stroke (0.0% v 1.5%, p = 0.045) and transfusion (13.5% v 24.4%, p = 0.001) rates were observed in patients who underwent robotic single-bypass surgery compared to conventional surgery. In patients undergoing multiple bypass grafts, higher mortality (1.1% v 0.5%), and cardiovascular complications (12.2% v 10.6%) were observed when robotic assistance was used, but the differences were not statistically significant (p = 0.5). The mean number of robotic cases carried out annually at institutions sampled was 6. Conclusions Robotic assistance is associated with lower rates of postoperative complications in highly selected patients undergoing single coronary artery bypass surgery, but the benefits of this approach are reduced in patients who require multiple coronary artery bypass grafts.

ABCA12 mutations disrupt the skin barrier and cause harlequin ichthyosis. We previously showed Abca12(-/-) skin has increased glucosylceramide (GlcCer) and correspondingly lower amounts of ceramide (Cer). To examine why loss of ABCA12 leads to accumulation of GlcCer, de novo sphingolipid synthesis was assayed using [(14)C]serine labeling in ex vivo skin cultures. A defect was found in β-glucocerebrosidase (GCase) processing of newly synthesized GlcCer species. This was not due to a decline in GCase function. Abca12(-/-) epidermis had 5-fold more GCase protein (n = 4, P < 0.01), and a 5-fold increase in GCase activity (n = 3, P < 0.05). As with Abca12(+/+) epidermis, immunostaining in null skin showed a typical interstitial distribution of the GCase protein in the Abca12(-/-) stratum corneum. Hence, we tested whether the block in GlcCer conversion could be circumvented by topically providing GlcCer. This approach restored up to 15% of the lost Cer products of GCase activity in the Abca12(-/-) epidermis. However, this level of barrier ceramide replacement did not significantly reduce trans-epidermal water loss function. Our results indicate loss of ABCA12 function results in a failure of precursor GlcCer substrate to productively interact with an intact GCase enzyme, and they support a model of ABCA12 function that is critical for transporting GlcCer into lamellar bodies.

OBJECTIVES: The objective of this study was to compare the early outcomes of off-pump and on-pump surgeries in high-risk patient groups. METHODS: The outcomes of 83 914 high-risk patients undergoing off-pump or on-pump isolated coronary bypass surgery identified from the Nationwide Inpatient Sample from 2005 to 2010 were compared using propensity analysis. RESULTS: Off-pump surgery was associated with a significant reduction in stroke rates compared with on-pump surgery in propensitymatched patients ≥80 years (odds ratio [OR] 0.70, 95% confidence interval [CI] 0.52–0.93, P= 0.02), those with peripheral vascular disease (OR 0.53, 95% CI 0.36–0.77, P= 0.001) and those with aortic atherosclerosis (OR 0.30, 95% CI 0.13–0.72, P= 0.007). In these high-risk subgroups, off-pump surgery was associated with an absolute risk reduction in stroke rates of 0.5, 0.5 and 1.2%, respectively: the minimum number needed to treat to prevent one stroke is 200 patients. There was no significant difference in in-hospital mortality or the incidence of postoperative renal failure or respiratory failure between off-pump and on-pump surgeries in these patient subgroups, or in patients with preoperative renal failure, or chronic obstructive airways disease. CONCLUSIONS: High-risk patients undergoing coronary artery bypass surgery gain a short-term benefit from off-pump approaches due to a small absolute reduction in the risk of postoperative stroke.

The objective of this study was to quantify the impact of heparin-induced thrombocytopenia (HIT) on outcomes after cardiac surgery.Retrospective analysis of national database.United States hospitals.Patients identified from 186,771 discharge records undergoing cardiac surgery from the Nationwide Inpatient Sample between 2009 and 2010.None.Heparin-induced thrombocytopenia was diagnosed in 506 (0.3%), and secondary thrombocytopenia was diagnosed in 16,809 (8.7%). Operative mortality was 11.1% in patients with HIT compared to 4.5% for patients without thrombocytopenia (p0.001) and 4.0% for patients with a diagnosis of secondary thrombocytopenia (p0.001). After adjusting for baseline patient comorbidity, the strongest independent predictors of HIT in patients undergoing cardiac surgery were female gender (OR 1.4, 95% confidence interval [CI] 1.28-1.48), congestive heart failure (OR 1.8, 95% CI 1.71-1.98), cardiac insufficiency (OR 2.2, 95% CI 1.97-2.39), atrial fibrillation (OR 1.4, 95% CI 1.30-1.51), liver disease (OR 2.2, 95% CI 1.96-2.50), and chronic renal failure (OR 1.4, 95% CI 1.30-1.51). HIT was associated with significantly increased risk of major adverse postoperative outcomes including death (OR 1.5, 95% CI 1.3-1.7), stroke (OR 2.4, 95% CI 1.9-3.1), amputation (OR 7.46, 95% CI 4.0-14.0), and acute renal failure (OR 2.3, 95% CI 2.1-2.5), respiratory failure (OR 1.9, 95% CI 1.8-2.1), and need for tracheostomy (OR 2.7, 95% CI 2.3-3.1).Heparin-induced thrombocytopenia is associated with a 50% increase in early mortality, and most patients with this diagnosis experience major postoperative morbidity or functional deficits.

The incidence of colorectal cancer increases as age progresses. At present, elderly patients have received substandard cancer treatment not supported by “evidence.” Geriatric assessment should be performed preoperatively and selected elderly patients must be offered standard surgical treatment receiving the same complementary therapies as a younger patient. It should be stressed that elderly patients should not be deprived of their decision-making role. In our experience, more than 43% of patients with colorectal cancer are ≥70 years of age, and we believe that they should receive the same type of follow-up. This would allow for the detection and removal of polyps, treatment of malignant tumors, and psychological support similarly to younger patients. Significantly, in our experience, the incidence of reoperation for neoplastic disease is similar in the two patient populations.

International audience; Nuclear fragmentation processes are relevant in different fields of basic research and applied physics and are of particular interest for tumor therapy and for space radiation protection applications. The FIRST (Fragmentation of Ions Relevant for Space and Therapy) experiment at SIS accelerator of GSI laboratory in Darmstadt, has been designed for the measurement of different ions fragmentation cross sections at different energies between 100 and 1000 MeV/nucleon. The experiment is performed by an international collaboration made of institutions from Germany, France, Italy and Spain. The experimental apparatus is partly based on an already existing setup made of the ALADIN magnet, the MUSIC IV TPC, the LAND2 neutron detector and the TOFWALL scintillator TOF system, integrated with newly designed detectors in the interaction Region (IR) around the carbon removable target: a scintillator Start Counter, a Beam Monitor drift chamber, a silicon Vertex Detector and a Proton Tagger for detection of light fragments emitted at large angles (KENTROS). The scientific program of the FIRST experiment started on summer 2011 with the study of the 400 MeV/nucleon 12C beam fragmentation on thin (8mm) carbon target.

Scrotal calcifications are commonly encountered in the clinical practice at ultrasound, and they may be occasionally identified also at CT and Rx ray examination performed for other purposes. Intra- or extra-testicular calcifications have different clinical relevance. Intratesticular calcifications are usually benign, but may also be found in tumors, or follow trauma, infarction, and inflammation. Testicular microlithiasis is increasingly encountered in otherwise healthy men. Currently, there is no evidence that it is either a premalignant condition or a causative agent for neoplasia, but a clear association exists between this condition, other testicular calcifications, and an increased risk of testicular malignancy. Extra-testicular calcifications are more frequent than intratesticular calcifications and are almost always benign. They include scrotal pearls, calcifications of the epididymis and appendages, and those involving the tunicae and the scrotal wall.

Oxidative stress has been suggested to play a main role in the pathogenesis of type 2 diabetes mellitus and its complications. As a consequence of this increased oxidative status a cellular adaptive response occurs requiring functional chaperones, antioxidant production and protein degradation. This study was designed to evaluate systemic oxidative stress and cellular stress response in patients suffering from type 2 diabetes and in age-matched healthy subjects. Systemic oxidative stress has been evaluated by measuring plasma reduced and oxidized glutathione, as well as pentosidine, protein carbonyls lipid oxidation products 4-hydroxy-2-nonenal and F2-isoprostanes in plasma, and lymphocytes, whereas the lymphocyte levels of the heat shock proteins (HSP) HO-1, Hsp72, Sirtuin-1, Sirtuin-2 and thioredoxin reductase-1 (TrxR-1) have been measured to evaluate the systemic cellular stress response. Plasma GSH/GSSG showed a significant decrease in type 2 diabetes as compared to control group, associated with increased pentosidine, F2-isoprostanes, carbonyls and HNE levels. In addition, lymphocyte levels of HO-1, Hsp70, Trx and TrxR-1 (P

A study of light neutron‐rich nuclei has been performed at the INFN‐LNS laboratory in Catania (Italy) by the (18O, 16O) reaction at 84 MeV incident energy on 9Be, 11B and 13C targets. The 16O ejectiles have been momentum analyzed and detected at forward angles by the MAGNEX magnetic spectrometer. The energy spectra of 15C show several known low lying states up to about 7 MeV excitation energy and unknown resonant structures at higher excitation energy. The strong excitation of these latter together with the measured width of about 2 MeV FWHM could indicate the presence of collective modes of excitation connected to the transfer of a correlated neutron pair. Also considerations regarding the reaction mechanism and the nuclei involved in the transfer seem to confirm such a conclusion. Similar features characterize the energy spectra of the 11Be and 13B nuclei. The achieved mass resolution (about 1/160) guarantying the identification of the reaction products corresponding to different reaction channels has a...

The main features of the MAGNEX large acceptance magnetic spectrometer are described. It has a quadrupole + dipole layout and a hybrid detector located at the focal plane. The aberrations due to the large angular (50 msr) and momentum (± 13%) acceptance are reduced by an accurate hardware design and then compensated by an innovative software ray‐reconstruction technique. The obtained resolution in energy, angle and mass are presented in the paper. MAGNEX has been used up to now for different experiments in nuclear physics and astrophysics confirming to be a multipurpose device.

The MAGNEX large‐acceptance ray‐tracing magnetic spectrometer has recently been used with beams from the INFN‐LNS Tandem accelerator. After an accurate commissioning, the instrument has started an ambitious experimental program. In the first experiment the 19F(7Li,7Be)19O charge‐exchange reaction was studied at 52 MeV incident energy. The 19O excitation energy spectrum was reconstructed and the angular distributions measured. The second experiment was aimed at the study of the 15C via the 13C(18O,16O)15C reaction at 84 MeV incident energy. The ejectiles where detected at forward angles and mass identified by means of an innovative technique. The 15C excitation energy spectra up to about 20 MeV were obtained with a 250 keV FWHM energy resolution. In addition to several known states, the spectra show two unknown resonant‐like structures at 11.4 and 14.0 MeV. The strong population of these structures, together with the measured widths, could indicate the collective nature of these states associated to a corr...

The 19F(7Li,7Be)19O reaction at 52 MeV incident energy has been performed at INFN‐LNS in Catania using the MAGNEX large acceptance spectrometer. The use of an algebraic ray‐reconstruction technique has allowed to extract the 19O excitation energy spectrum and the experimental angular distributions. A theoretical analysis based on the Quasi‐particle Random Phase Approximation has described the transitions to the 1p‐1h states of the 19O, in close agreement with the experimental cross sections without using any scaling factor.

Late onset of cutaneous fistulas associated with inguinal hernia repair represents an extremely rare complication that occurs especially after affixing a prosthesis. The authors report a case of a patient developing this complication after a hernia repair (Shouldice's technique), emphasize that the fistula appeared after more than 12 years (the longest interval reported in the literature), and explain how it resolved only with the surgical removal of the suture used for hernia repair. The authors emphasize the aetiology of this complication and stress that it can occur even after a hernia repair without prosthesis.

A study of the 15C states was pursued in 2008 at the Catania INFN‐LNS laboratory by the 13C(18O,16O)15C reaction at 84 MeV incident energy. The 16O ejectiles were detected at forward angles by the MAGNEX magnetic spectrometer. The spectra show several known low lying states up to about 7 MeV excitation energy as well as two unknown resonant structures at about 11.4 and 13.5 MeV. The strong excitation of these latter together with the measured width of about 2 MeV FWHM could indicate the presence of collective modes of excitation connected to the transfer of a correlated neutron pair.

To identify predisposing factors and to evaluate clinical and microbiological characteristics of bacterial keratitis.A retrospective analysis was performed on the charts of patients hospitalized for microbial keratitis and treated at the Department of Ophthalmology of the Policlinico Umberto I Hospital, Rome, Italy. The study was performed during a 42-month period. Risk factors, clinical and microbiological data were collected.A total of 65 patients with bacterial keratitis were documented. Contact lens wear was the most common risk factor (46.1%). Trauma or a history of keratopathy was found in 18.5% and 15.4% of cases, respectively. An organism was identified in 62% of cases. 74% of all positive cultures involved gram negative bacteria. The most frequently cultured organism was Pseudomonas aeruginosa alone (72.2%) or in combination with other microorganisms (16.7%). Fifty-eight per cent of patients had visual acuity better than the level at admission, and 12% had very poor visual outcome.Contact lens wear is the most important risk factor. The role of initial therapy for microbial keratitis remains important.