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Background The gold standard approach for surgical treatment of benign and malignant adrenal lesion is considered the laparoscopic one, due to a lot of advantages compared to open approach. The rapid propagation of this surgical technique is due to the diffusion of haemostatic devices in laparoscopic adrenal surgery. The principal aim of this study is to analyze the outcome of LA using each energy modality, evaluating the eventual superiority of an instrument over the others. Methods A retrospective study, involving 75 consecutive patients submitted to LA by transperitoneal lateral approach from January 2013 to June 2017, was performed. Age less than 70 years old, adrenal adenomas less than 8 cm in diameter, incidentalomas 0.05). Significant statistical difference are detectable in operation time and intraoperative blood losses. Thunderbeat, compared respectively with Ligasure and Harmonic Scalpel, is the fastest device (p

This paper reports the experimental and modelling results of the absorption of sulphur dioxide by seawater solutions doped with sodium chlorite, a strong oxidant, to improve the conversion of the S(IV) ions produced by SO2 absorption to the more soluble S(VI) ones. The experiments show that sodium chlorite oxidation is very fast and determines a constant SO2 solubility regardless of the solution pH, i.e. its alkalinity. However, it was demonstrated the effect of chlorite is alternative but not additive to that of alkalinity. In fact, during tests carried out at acidic pH and with a dosage of chlorite identical to that of carbonate in a natural seawater, the solubility resulted the same as the figure observed for natural seawater. The results show that the absorption increases by increasing the sodium chlorite content because of the higher solubility. Also in this case, the absorption efficiency of sodium chlorite solutions keeps almost constant regardless of the solution pH. This result suggests that the rate controlling step for chemical absorption is the diffusion of chlorite and S(IV) ions at the gas–liquid interface, with a fast reaction kinetics, similar to the case of reactions with bicarbonate. Finally, a modelling analysis show that ASPEN PLUS® simulations provide excellent predictions of SO2 solubility and removal efficiency data.

This paper presents an experimental procedure and an extended modelling analysis aimed to characterize the mass transfer coefficients and the pressure drops of structured packings to support the design of packed absorption columns. The study is applied to Hastelloy C-22 Mellapak 250.X, an effective packing for distillation and absorption processes. The experimental campaign is performed with model aqueous solutions to separately address the mass transfer coefficients in the gas and liquid films and to evaluate the column pressure drops in the operating conditions typically adopted for absorption processes. An extensive analysis of the main available models for mass transfer coefficients and pressure drops available in the open literature is presented. Subsequently, the experiments are used to calibrate the models for the investigated packing and to select the most reliable for its thorough characterization. The predictive capacity of the calibrated mass transfer models is implemented in an ASPEN PLUS® simulation and successfully tested through a set of new desulphurization experimental data carried out on a model flue-gas at different SO2 concentrations and temperatures and with different sorbents. The calibrated simulations accurately predict the experimental SO2 removal efficiency, the wash water pH and temperature.

International audience; OBJECTIVE: To analyze the impact of the modification of the authors' institutional protocol on outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA). DESIGN: An observational analysis. The protocol complied with national recommendations. A further eligibility criterion was added since January 2015: the presence of sustained shockable rhythm at extracorporeal life support (ECLS) implantation. To assess the impact of this change, patients were divided into two groups: (1) from January 2010 to December 2014 (group A) and (2) from January 2015 to December 2019 (group B). The primary endpoint was survival to hospital discharge with good neurologic outcome. Predictors of survival were searched with multivariate analyses. SETTING: University hospital. PARTICIPANTS: Adult patients supported with ECPR for refractory OHCA. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: From January 2010 to December 2019, 85 patients had ECLS for OHCA (group A, n = 68, 80%; group B, n = 17, 20%). The mean age was 42.4 years, 78.8% were male. The rate of implantation of ECLS was significantly lower in group B (p = 0.01). Mortality during ECLS support was significantly lower (58.8 v 86.8%; p = 0.008), and the weaning rate was significantly higher (41.2 v 13.2%; p = 0.008) in group B. Survival to discharge with good neurologic outcome was significantly improved (23.5 v 4.4%; p = 0.027) in group B. A sustained shockable rhythm was the only independent predictor of survival to hospital discharge with good neurologic outcome. CONCLUSIONS: The modification of the authors' institutional protocol throughout the further criterion of sustained shockable rhythm yielded a favorable impact on outcomes after ECPR for OHCA.

International audience; BACKGROUND AND AIM OF THE STUDY: Data about the beating heart (BH) technique for isolated tricuspid valve (TV) surgery compared to the arrested heart (AH) technique are sparse. We compared the outcomes of isolated TV surgery between BH and AH technique. METHODS: We performed an observational analysis of our database of isolated TV surgery. Patients were divided into two groups according to whether surgery was performed without (BH group) or with (AH group) aortic cross-clamping and cardioplegic arrest. The primary endpoint was survival to hospital discharge. Risk factors for in-hospital mortality were searched with multivariate analyses. We undertook further comparisons after propensity-score matching. RESULTS: From January 2007 to December 2017, we performed 82 isolated TV surgery (BH group, n = 47, 57.3%; AH group, n = 35, 42.7%). The mean age was 59.1 years, 56.1% were female. BH group patients were older (61.8 vs. 55.4 years; p = .035), had greater impaired renal function (glomerular filtration rate, 61.1 vs. 74.6 ml/min; p = .012), were more frequently operated for secondary TR (61.7 vs. 31.4%; p = .008), underwent more frequently a reoperation (53.2 vs. 28.6%; p = .042) and exhibited a higher surgical risk (EuroSCORE II, 3.92 vs. 2.50%; p = .013). In-hospital mortality was not different between both groups, either considering unmatched (BH = 10.6 vs. AH = 5.7%; OR = 1.96, 95% confidence interval [CI] = 0.36-10.77) or matched populations (BH = 10.6 vs. AH = 6.4%; OR = 1.89, 95% CI = 0.36-9.97). Age was the only predictor of in-hospital mortality. CONCLUSIONS: The BH technique showed comparable outcomes to the AH technique for isolated TV surgery despite a higher risk profile.

International audience; No abstract available

Flue Gas Desulphurization (FGD) is a key topic for all combustion fossil fuel plants and industrial applications. Wet processes are usually preferred when the removal efficiency required to comply with environmental regulation exceeds 90%. Recently, seawater (SW) has been considered as a viable absorbent for FGD processes in coastal and naval applications, thanks to its natural alkalinity and, of course, its large availability. Due to the typical constraints of naval applications, process design should be optimized to improve mass transfer rates and reduce seawater requirements while keeping a suitable absorber size. In this work, we report the experimental findings on process design and optimization of two different SW-FGD units: a spray column equipped with full hydraulic spray nozzles and a packed-bed column with structured packing. The experiments are used to develop and tune suitable models for the packed and spray towers design in representative operating conditions. These models are applied to compare both the units in a reference case study: an IFO fuelled marine diesel engine (4.35 MW) that has to comply with current IMO-MARPOL VI 14 regulation for SECAs. A preliminary costs analysis is also performed for comparison.

Methylenetetrahydrofolate Reductase (MTHFR) deficiency, is avery rare congenital defect of folate metabolism, inherited in an autosomal recessive pattern included in newbornscreening (NBS) programs in Italy. It is caused by mutations in the MTHFRgene and is characterized by elevatedplasma homocysteine and borderline-low or normal methionine levels, causing severe neurological signs, recurrentapnoea, microcephaly and convulsions, generally during the neonatal period. An early treatment may prevent theclinical manifestations with a positive impact on patient’s health. We report a new case of MTHFRdeficiency, identified during NBS that showed hypomethioninemia 4.6 μmol/L (r.i.6-20). The second level-test revealed hyperhomocysteinemia (106.7 μM, r.i. 5-15). The whole sequencing of theMTHFRgene showed two missense mutation: c.176G>C (p.Trp59Ser), reported as disease causing and the novelc.1769T>G (p.Leu590Arg), classified as likely pathogenetic. The baby was immediately treated with vitamin B12,folate and betaine; after 12 months of follow-up he has no signs or symptoms of the disease. In conclusion, this case report highlights the importance of NBS for inborn errors of metabolism and genetic analysis,that can prevent the establishment of a serious disorder of folate metabolism.

Aims The aim of this study was to identify determinants of in-hospital and mid-term outcomes after isolated tricuspid valve surgery (ITVS) and more specifically the impact of tricuspid regurgitation (TR) mechanism and clinical presentation. Methods and results Among 5661 consecutive adult patients who underwent a tricuspid valve (TV) surgery at 12 French tertiary centres in 2007–2017 collected from a mandatory administrative database, we identified 466 patients (8% of all tricuspid surgeries) who underwent an ITVS. Most patients presented with advanced disease [47% in New York Heart Association (NYHA) III/IV, 57% with right-sided heart failure (HF) signs]. Tricuspid regurgitation was functional in 49% (22% with prior left-sided heart valve surgery and 27% isolated) and organic in 51% (infective endocarditis in 31% and other causes in 20%). In-hospital mortality and major complications rates were 10% and 31%, respectively. Rates of survival and survival free of HF readmission were 75% and 62% at 5 years. Patients with functional TR incurred a worse in-hospital mortality than those with organic TR (14% vs. 6%, P = 0.004), but presentation was more severe. Independent determinants of outcomes were NYHA Class III/IV [odd ratios (OR) = 2.7 (1.2–6.1), P = 0.01], moderate/severe right ventricular dysfunction [OR = 2.6 (1.2–5.8), P = 0.02], lower prothrombin time [OR = 0.98 (0.96–0.99), P = 0.008], and with borderline statistical significance, right-sided HF signs [OR = 2.4 (0.9–6.5), P = 0.06] while TR mechanism was not [OR = 0.7 (0.3–1.8), P = 0.88]. Conclusion Isolated TV surgery was associated with high mortality and morbidity, both in hospital and during follow-up, predicted by the severity of the presentation but not by TR mechanism. Our results suggest that TV intervention should be performed earlier in the course of the disease.

Summary The TGFβ family member NODAL, primarily known for its role during embryonic development, has also been associated with tumor progression in a number of cancers. Some of the evidence supporting its involvement in melanoma has appeared contradictory, suggesting that NODAL in this context might rely on a non-canonical mode of signaling. To investigate this possibility we studied how a deletion of NODAL affected cell behavior in a metastatic melanoma cell line. The mutation does prevent melanoma cells from acquiring an invasive behavior. However, this phenotype was found to result not from the absence of NODAL, but from the disabled expression of a natural antisense transcript of NODAL now called LADON . Its expression promotes the mesenchymal to amoeboid transition that is critical to melanoma cells’ invasiveness. Our analyses revealed that the increase in LADON expression necessary to complete this transition is dependent on WNT/β-CATENIN signaling and that its downstream effectors include MYCN and the metastasis suppressor NDRG1, which controls changes in the cytoskeleton. These results identify LADON as a player in the network of interactions governing tumor progression in melanoma, and suggest a similar implication in other cancer types.

SummaryThe TGFβ family member NODAL, known for its role during embryonic development, has also been associated with tumor progression in several cancers. Some of the evidence supporting its involvement in melanoma appeared contradictory, suggesting that NODAL in this context might rely on a non-canonical signalling mode. We found that NODAL inactivation in a metastatic melanoma cell line prevents the cells from acquiring invasive behaviour. However, we show that this phenotype does not result from the absence of NODAL, but from a defect in the expression of a natural antisense transcript of NODAL, here called LADON. We found that LADON promotes the mesenchymal to amoeboid transition that is critical to melanoma cell invasiveness, and that a WNT/β-CATENIN signalling-dependent increase in LADON expression is required to complete this transition. LADON’s downstream effectors include, among others, the proto-oncogene MYCN. These results identify LADON as a player in the regulatory network that governs tumor progression in melanoma, and possibly in other types of cancer.

This thesis work is focused on the development of new seawater-based scrubbing process for flue-gas cleaning, to be applied to both land-based industrial and power generation plants and to maritime shipping. Seawater scrubbing is receiving a growing attention mostly thanks to the diffusion of marine scrubbers for desulphurization of IFO fueled Marine Diesel Engines exhaust. The process is a viable option also for coastal infrastructures where seawater is abundant and it is funded on the exploitation of seawater alkalinity, which provides a valid and cost-effective sorbent for SO2. Seawater scrubbing can be improved by using caustic soda or other less common additives. Among them, oxidative reactants such as sodium chlorite (NaClO2), hydrogen peroxide (H2O2), ferrous-EDTA (Fe(II)-EDTA), sodium persulfate (Na2S2O8) or potassium ferrate (K2FeO4) have been suggested. This work adopts experimental and modelling methodologies to investigate the seawater scrubbing with caustic soda and sodium chlorite addition for the treatment of model flue gases as those coming from real marine diesel engines and coal/oil combustion plants. The work provides an analysis of SO2 solubility in the different water-based absorbing solutions and the estimation of the absorption efficiency of SO2 in packed and spray columns. The experiments are ruled out to define the optimal operating conditions for industrial and marine applications and to interpret how chemical reactions improve the mass transfer rate. The experimental campaign is supported by a dedicated modelling analysis accounting for equilibria, mass transfer and pressure drops in a unique framework, which is a valuable tool for the design of large scales applications. As a real case application, a comparison between spray and packed towers for a realistic marine engines is carried out, demonstrating that the packed tower can be a valid and cost effective solution, thanks to the far lower size and weight, which overcome the additional cost of packing. Finally, the effects of seawater-based scrubbing on the quality of the exhaust scrubbing solution are analyzed, for the possible capture of other gas pollutants. To this aim, a critical analysis of the properties of scrubber wash water in terms of heavy metals and organics is carried out. Test on real marine diesel engines shows that the emissions of heavy metals and organic compounds are in line with the current EU regulations on wash water discharge in natural water bodies and mostly of the analytes comply with the 2016/39/EU amendment of the Water Framework Directive. Finally, in order to further extend the field of investigation, the effect on other gaseous pollutants such as NOx of sodium chlorite seawater scrubbing is analyzed. Experimental evidences shows that sodium chlorite solutions provides a valuable removal of NOx compounds, opening to the possibility of a joint de-SOx/de-NOx process that is particularly advantageous for marine applications. In particular, the capture of NOx was promoted by the presence of SO2 in the exhausted gas and a complete removal can be achieved without any competitive effect. This was due to particular oxidation mechanisms occurring under acidic conditions arising during the absorption process.

Compost is widely used to improve soil fertility for its chemical–physical properties, with particular regard to the abundance of humic substances. Compared to the untreated organic solid waste, the use of compost in microbial fuel cells (MFCs) could offer different advantages like the strong reduction of fermentative processes. The use of compost in MFCs in combination with soil or mixed with other substrates had been reported by some researchers to improve the performance of MFCs fed with agro-industrial residues and plant MFCs. In this chapter, we report the results of an experiment carried out using a compost of vegetable residues as feedstock in a single chamber, air cathode MFCs. We investigated the behavior of two MFCs serially connected, the possibility to use compost as a long-term source of energy in MFCs, the influence of cathode surface/cell volume ratio on MFCs performance in terms of power and current density. Our results showed for MFCs serially connected a maximum PD and CD of 234 mW/m2 and 1.6 A/m2, respectively, with a maximum OCV of 557 mV. Unexpectedly, the compost-based MFCs kept significant electric outputs (854 mV, 467 mW/m2 kg, and 114 mA/m2 kg) after being reactivated 2 years later its set-up, thus demonstrating its potential as long-term operation energy system.

Aims To identify determinants of in-hospital and mid-term outcomes after isolated tricuspid valve surgery (ITVS) as little is known regarding the impact of tricuspid regurgitation (TR) mechanism and clinical presentation. Methods and results Among 5661 consecutive adult patients who underwent a tricuspid valve surgery at 12 French tertiary centers in 2007-2017 collected from a mandatory administrative database, we identified 466 patients (8% of all tricuspid surgeries) who underwent an ITVS. Most patients presented with advanced disease (47% in NYHA III/IV, 57% with right-sided heart failure (HF) signs). TR was functional in 49% (22% with prior left-sided heart valve surgery and 27% isolated) and organic in 51% (infective endocarditis in 31% and other causes in 20%). In-hospital mortality and major complications rates were 10% and 31% respectively. Rates of survival and survival free of HF readmission were 75% and 62% at 5 years. Patients with functional TR incurred a worse in-hospital mortality than those with organic TR (14.4% vs. 6.3%, P = 0.004) but presentation was more severe. Independent determinants of outcomes were NYHA class III/IV (OR = 2.7[1.2–6.1], P = 0.01), moderate/severe right ventricular dysfunction (OR = 2.6[1.2–5.8], P = 0.02), lower prothrombin time (OR = 0.98[0.96–0.99], P = 0.008) and with borderline statistical significance, right-sided HF signs (OR = 2.4[0.9–6.5], P = 0.06) while TR mechanism was not (OR = 0.7[0.3–1.8], P = 0.88). Conclusion ITVS was associated with high mortality and morbidity, both in-hospital and during follow-up, predicted by the severity of the presentation but not by TR mechanism. Our results suggest that TV intervention should be performed earlier in the course of the disease.

Endoparasitoids in the order Hymenoptera are natural enemies of several herbivorous insect pest species. During oviposition they inject a mixture of factors, which include venom, into the host, ensuring the successful parasitism and the development of their progeny. Although these parasitoid factors are known to be responsible for host manipulation, such as immune system suppression, little is known about both identity and function of the majority of their venom components. To identify the major proteins of Toxoneuron nigriceps (Hymenoptera: Braconidae) venom, we used an integrated transcriptomic and proteomic approach. The tandem-mass spectrometric (LC-MS/MS) data combined with T. nigriceps venom gland transcriptome used as a reference database resulted in the identification of a total of thirty one different proteins. While some of the identified proteins have been described in venom from several parasitoids, others were identified for the first time. Among the identified proteins, hydrolases constituted the most abundant family followed by transferases, oxidoreductases, ligases, lyases and isomerases. The hydrolases identified in the T. nigriceps venom glands included proteases, peptidases and glycosidases, reported as common components of venom from several parasitoid species. Taken together, the identified proteins included factors that could potentially inhibit the host immune system, manipulate host physiological processes and host development, as well as provide nutrients to the parasitoid progeny, degrading host tissues by specific hydrolytic enzymes. The venom decoding provides us with information about the identity of candidate venom factors which could contribute to the success of parasitism, together with other maternal and embryonic factors.

Flue Gas Desulphurization (FGD) is a key topic for most of combustion fossil fuel plants and industrial applications. Wet processes are usually preferred when the removal efficiency required to comply with environmental regulation exceed 90 %, but their flexibility makes them useful also for lower performance requirements. Recently, seawater has been considered as a viable absorbent for FGD processes in coastal and naval applications, when SO2 concentration is below 1000 ppmv. This liquid absorbs SO2 mostly thanks to its natural alkalinity (on average 2.4 mmol/L) and, of course, is also largely available. The main costs of seawater FGD (SW-FGD) plants are related to the pumps needed to supply the required amount of liquid and the cost of wash water restoration before discharge. Corrosion related to the presence of acidic seawater is also a major issue of these units. While thermodynamic limitations cannot be overcome, process design can be optimized to improve mass transfer rates and reduce seawater requirements while keeping a suitable absorber size. In this work, we report the experimental findings achieved by our group on process design and optimization of SW-FGD units. Two different kinds of SW-FGD units were tested and compared: a spray column and a packed column with structured packing.

Scrubbing with seawater is a reliable technology for flue-gas desulfurization in coal-fired power plants or in marine applications. The introduction of new regulations for emission control in Europe and the due increment of operational efficiency are pushing forward the optimization of scrubber's design, for which packing columns may be a better solution compared to spray columns. The design of a seawater scrubber mainly relies on a correct assessment of the equilibrium conditions and of the mass transfer coefficients in the absorber. In this work, experiments are performed on a model flue-gas (32 m(3).h(-1)) having a SO2 concentration in the range 500-2000 ppm(v), treated in a packed column filled with a structured packing (Mellapak 250X (R)) at 1 atm and 25 degrees C, with liquid-to-gas ratio between 1.06 and 3.44 kg.kg(-1). Three different absorbing solutions are investigated: (a) a seawater; (b) a basic solution obtained by adding 200 mg.L-1 NaOH solution to the seawater and (c) distilled water, used as benchmark. In order to analyze the packed column tests, SO2 equilibrium absorption tests at low concentrations (100-2000 ppmv) are carried out in a feed-batch reactor, using the same absorbing solutions tested in column tests. The experimental tests in packed column indicate that, for SO2 concentration as low as 500 ppm, an absorption efficiency above 98% can be achieved by using liquid-to-gas mass ratio about to 2.91 kg.kg(-1). In this condition, few differences appear among solutions (a) and (b). For the highest SO2 concentration (i.e. 2000 ppmv), a maximum of 85% efficiency is observed for liquid-to-gas mass ratio of 3.44 kg.kg(-1). Modeling of both the equilibrium and the dynamic data are implemented in Aspen Plus (R) V 8.6. However, while modeling assures a very good prediction of the equilibrium data, it is not able to properly describe the dynamic test results, with a systematic underestimation for tests having a removal efficiency higher than 85%.