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In the last few years there has been a growing offer and development of technologies for hydronic central heating space heaters and combination heaters. In our opinion as a manufacturer, not all new and forthcoming products seem to be covered by current standards and Ecodesign Regulation proposals. For example, some “hybrid heaters” consisting of gas boilers integrated with small-sized heat pumps seem not to fit previous definitions. Considering that future development of appliances will rely on the integration of many energy carriers, different technologies and devices in order to enhance the efficiency and environmental performance, we think that all possible and alternative design solutions should be investigated and evaluated. These appliances will contribute to widen the portfolio of possible solutions for building renovations and will provide an adding opportunity to reduce greenhouse gas emissions, with acceptable costs. Taking into account the current product standards, we propose additional definitions and new test methods that consider any possible heat recovery and integration aiming to place on the market new products under the same rules. The proposal aims to avoid loopholes and to accompany the product with the proper information on realistic significant environmental and energy performance in order to be comparable with already regulated products.

The injection of hydrogen into the natural gas network can contribute to the large-scale integration of renewables, as hydrogen can be easily produced through electrolysis from wind or solar energy. However, the addition of hydrogen to natural gas influences fuel properties, asking for the assessment of the safe and efficient operation of existing end-user equipment, such as domestic burners and boilers. In this work, 3-dimensional resolved numerical simulations based on Computational Fluid Dynamics are carried out to shed light on the effect of H2 addition on the combustion process occurring in condensing boilers equipped with perforated cylindrical burners. To this purpose, multi-hole geometries emulating a portion of a perforated burner are analyzed. Since the burner holes are positioned very close to each other, the interaction of the adjacent laminar premixed flames is observed to occur with influence on the flow and thermo-chemical fields which differ from those of a single premixed flame. The addition of hydrogen was found to lead to an anticipation of the reaction zone, although the general features observed with the G222 gas (23% H2, 77% CH4 ) were alike those of the G20 gas (100% CH4).

Pretransplant malignancy unrelated to hepatocellular carcinoma is a challenging condition in liver transplantation. Standard of care requires the completion of treatments and a disease-free period before the transplant. However, in the setting of a fulminant hepatic failure, these steps cannot be achieved. A 46-year-old woman with a recent diagnosis of stage 2 breast cancer presented to our center with a fulminant hepatic failure of unknown origin. Because of the rapid worsening of her clinical status, she was listed as eligible for transplant after a multidisciplinary evaluation. Because of a shortage of available donors, a deceased donor ABO-incompatible liver transplant with a synchronous mastectomy and first-level axillary lymphadenectomy was performed. To prevent antibody-mediated rejection, a triple immunosuppression therapy and a postoperative therapeutic plasmapheresis were performed. The patient remains without cancer recurrence at 18 months of follow-up. Recent studies have shown that cancer recurrence in recipients with pretransplant malignancy is considerably lower than suggested in previously published studies. However,this data is not sufficient to establish evidence-based guidelines on the indications and timing of transplant. In selected cases, the presence of a pretransplant malignancy does notrepresent a contraindication for a rescue liver transplant. Further studies are needed to stratify the risk and to help clinicians to choose the best strategy in an urgent context such as this.

Neurological complications (NCs) can frequently and significantly affect morbidity and mortality of liver transplant (LT) recipients. We analysed incidence, risk factors, outcome and impact of the immunosuppressive therapy on NC development after LT. We analysed 478 LT in 440 patients, and 93 (19.5%) were followed by NCs. The average LOS was longer in patients experiencing NCs. The 1-, 3- and 5-year graft survival and patient survival were similar in patients with or without a NC. Multivariate analysis showed the following as independent risk factors for NC: a MELD score ≥20 (OR = 1.934, CI = 1.186-3.153) and an immunosuppressive regimen based on calcineurin inhibitors (CNIs) (OR = 1.669, CI = 1.009-2.760). Among patients receiving an everolimus-based immunosuppression, the 7.1% developed NCs, vs. the 16.9% in those receiving a CNI (P = 0.039). There was a 1-, 3- and 5-year NC-free survival of 81.7%, 81.1% and 77.7% in patients receiving a CNI-based regimen and 95.1%, 93.6% and 92.7% in those not receiving a CNI-based regimen (P < 0.001). In patients undergoing a LT and presenting with nonmodifiable risk factors for developing NCs, an immunosuppressive regimen based on CNIs is likely to result in a higher rate of NCs compared to mTOR inhibitors., (© 2015 Steunstichting ESOT.)

Introduction: Pre-injury antithrombotic therapy might influence the outcome of subjects with head injuries and positive computed tomography (CT) scans. We aimed to determine the potential risk of pre-injury antiplatelet drug use on short- and long-term outcome of head injured subjects admitted to emergency departments (EDs) in Italy for extended observation., Methods: A total of 1,558 adult subjects with mild, moderate and severe head injury admitted to Italian EDs were studied. In multivariable logistic regression analyses, the short-term outcome was assessed by an evaluation of head CT scan at 6 to 24 hours after trauma and the long-term outcome by the Glasgow outcome scale (GOS) at six months., Results: Head CT scan comparisons showed that 201 subjects (12.9%) worsened. The risk of worsening was increased two fold by the use of antiplatelet drugs (106, 19.7% treated versus 95, 9.3% untreated; relative risk (RR) 2.09, 95% CI 1.63 to 2.71). The risk was particularly high in subjects on clopidogrel (RR 5.76, 95% CI 3.88 to 8.54), independent of the association with aspirin. By logistic regression, 5 of 14 items were independently associated with worsening (Glasgow coma scale (GCS), Marshall category, antiplatelet therapy, intraventricular hemorrhage, number of lesions). After six months, only 4 of 14 items were predictors of unfavorable outcome (GOS 1 to 3) (GCS score, Marshall category, age in decades, intracerebral hemorrhage/contusion). The risk increased by 50% in the group treated with antiplatelet therapy (RR 1.58, 95% CI 1.28 to 1.95; P<0.001)., Conclusions: Antithrombotic therapy (in particular clopidogrel) is a risk factor for both short-term and long-term unfavorable outcome in subjects with head injury, increasing the risk of progression and death, permanent vegetative state and severe disability.