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La lettura di questo caso clinico ha stimolato molto il nostro gruppo formato da psicologhe e psicoterapeute ad orientamento sistemico: esistiamo come tali all’interno di un gruppo di psicoterapeute più ampio con orientamenti diversi, del consultorio diffuso dell’Associazione ‘Progetto SUM’ nella sede di Torino. Nella nostra formazione dedichiamo diverse risorse per apprendere a collaborare in contesti co-terapici e d’equipe. Il nostro contributo teorico e pratico sarà guidato dall’attenzione alla complessità del sistema, al paziente designato fino ad arrivare alle emozioni del terapeuta, strumento indispensabile per la buona riuscita di un percorso terapeutico. Il nostro modello di riferimento si basa su un approccio di osservazione dell’individuo nei diversi sottosistemi di cui lo stesso è parte, in primis la famiglia. Quest’ultima è in continua trasformazione e governata da regole che evolvono nel tempo in interazione con l’ambiente circostante. I terapeuti quando incontrano i pazienti nella stanza di terapia diventano parte del sistema, generandone uno più complesso e ampio, indispensabile nel processo di cura.[...]

[This corrects the article DOI: 10.1371/journal.pone.0271469.].

Abstract Background BRCA1 and BRCA2 gene mutations are responsible for 5% of breast cancer (BC) and 10–15% of ovarian cancer (EOC). The presence of a germline mutation and therefore the identification of subjects at high risk of developing cancer should ideally precede the onset of the disease, so that appropriate surveillance and risk‐reducing treatments can be proposed. In this study, we revisited the family history (FH) of women who tested positive for BRCA mutations after being diagnosed with BC or EOC. Methods The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines®), and the Italian Association of Medical Oncology (AIOM) guidelines were applied to the FH of 157 women who were referred to San Gerardo Hospital for genetic counseling. Results Almost 85% of women had an FH of BRCA‐related cancer. 63.7% and 52.2% of women could have undergone genetic testing according to NCCN and AIOM testing criteria (p

Background: A peculiar complication of endometriosis is a superinfection. However, the superinfection of extra-ovarian endometriosis is anecdotal, and only a few cases have been described. We wanted to present the first cases of the superinfection of rectovaginal endometriosis and to perform a literature review of the superinfection of extra-ovarian endometriosis. Methods: We present a case of a 24-year-old woman who was referred to our Pelvic Floor Unit for rectal–perineal pain, dyspareunia, and recurrent episodes of dense purulent vaginal discharge for one year, in which the superinfection of rectovaginal endometriosis was diagnosed. Moreover, we performed a systematic search of the literature indexed on PubMed up to 31 January 2023. Results: Laparoscopic drainage was successful in managing this condition. In the literature, clinical presentation and instrumental and microbiological findings are very heterogeneous. However, the gold standard of management is represented by surgical or percutaneous drainage. Conclusions: In the case of a pelvic abscess, the superinfection of endometriosis lesions should be suspected, and this can represent the onset symptom of endometriosis. Ultrasonography may show nodular or flat hypoechoic lesions with hyperechoic debris and peripheral positive color/power Doppler intensities. The goal of management is to drain the abscess, either percutaneously or via traditional surgery, followed by proper hormonal therapy to reduce recurrence.

Our study aims to evaluate clinical predictors of menstrual cycle disorders in female athletes who compete in running disciplines. This is a prospective observational study. Women were recruited between January and May 2022. Fifty-three patients were enrolled and completed a questionnaire about menstrual cycle, physical activity, and food habit characteristics. Of the women in our population, 39.6% had menstrual irregularities and reported a significantly higher number of kilometers run per week (67 vs. 35, p:0.02). The number of kilometers run per week was associated with menstrual irregularities (for 10 km, OR 1.35; IC95% 1.05–1.73; p: 0.02) after adjusting for BMI, age, level of sport and caloric intake. The variable of "km run per week" appeared as a diagnostic indicator of irregular menstrual cycle with statistical significance (AUC ROC curve 0.71, IC95% 0.54–0.86, p-value=0.01) and the cut-off of 65 km run per week is a good indicator of the presence of irregular menstrual cycle (sensitivity (SE) and specificity (SP) of 55% and 81.48%). Menstrual cycle disorders are very frequent in female athletes, and the variable of km run per week may play a role in screening endurance athletes at high risk for these disorders. [ABSTRACT FROM AUTHOR]

AimsCoronary artery stents have profound effects on arterial function by altering fluid flow mass transport and wall shear stress. We developed a new integrated methodology to analyse the effects of stents on mass transport and shear stress to inform the design of haemodynamically-favourable stents.Methods and resultsStents were deployed in model vessels followed by tracking of fluorescent particles under flow. Parallel analyses involved high-resolution micro-computed tomography scanning followed by computational fluid dynamics simulations to assess wall shear stress distribution. Several stent designs were analysed to assess whether the workflow was robust for diverse strut geometries. Stents had striking effects on fluid flow streamlines, flow separation or funnelling, and the accumulation of particles at areas of complex geometry that were tightly coupled to stent shape. CFD analysis revealed that stents had a major influence on wall shear stress magnitude, direction and distribution and this was highly sensitive to geometry.ConclusionsIntegration of particle tracking with CFD allows assessment of fluid flow and shear stress in stented arteries in unprecedented detail. Deleterious flow perturbations, such as accumulation of particles at struts and non-physiological shear stress, were highly sensitive to individual stent geometry. Novel designs for stents should be tested for mass transport and shear stress which are important effectors of vascular health and repair.

Subcutaneous (SC) rituximab may be beneficial in terms of convenience and tolerability, with potentially fewer and less severe administration-related reactions (ARRs) compared to the intravenous (IV) form. This report presents the results of a phase IIIb study conducted in Italy. The study included adult patients with CD20+ DLBCL or FL having received at least one full dose of IV RTX 375 mg/m2 during induction or maintenance. Patients on induction received ≥4 cycles of RTX SC 1400 mg plus standard chemotherapy and FL patients on maintenance received ≥6 cycles of RTX SC. Overall, 159 patients (73 DLBCL, 86 FL) were enrolled: 103 (54 DLBCL, 49 FL) completed induction and 42 patients with FL completed 12 maintenance cycles. ARRs were reported in 10 patients (6.3%), 3 (4.2%) with DLBCL and 7 (8.1%) with FL, all of mild severity, and resolved without dose delay/discontinuation. Treatment-emergent adverse events (TEAEs) and serious adverse events occurred in 41 (25.9%) and 14 patients (8.9%), respectively. Two patients with DLBCL had fatal events: Klebsiella infection (related to rituximab) and septic shock (related to chemotherapy). Neutropenia (14 patients, 8.9%) was the most common treatment-related TEAE. Two patients with DLBCL (2.8%) and 6 with FL (7.0%) discontinued rituximab due to TEAEs. 65.2% and 69.7% of patients with DLBCL and 67.9% and 73.6% of patients with FL had complete response (CR) and CR unconfirmed, respectively. The median time to events (EFS, PFS, and OS) was not estimable due to the low rate of events. At a median follow-up of 29.5 and 47.8 months in patients with DLBCL and FL, respectively, EFS, PFS, and OS were 70.8%, 70.8%, and 80.6% in patients with DLBCL and 77.9%, 77.9%, and 95.3% in patients with FL, respectively. The switch from IV to SC rituximab in patients with DLBCL and FL was associated with low risk of ARRs and satisfactory response in both groups. This trial was registered with NCT01987505.

A precise prediction of the fluid dynamics in bubble columns is of fundamental importance to correctly design “industrial-scale” reactors. It is known that the fluid dynamics in bubble columns is related to the prevailing bubble size distribution existing in the systems. In this respect, multiphase computational fluid dynamic simulations, in the Eulerian multi-fluid framework, are able to predict the local bubble size distributions and, thus, the global fluid dynamics from the fluid flow conditions and by applying modeling closured. In particular, in in “industrial-scale” reactors, owing to the large gas sparger openings, the “pseudo-homogeneous” flow regime—characterized by a wide spectrum of bubble sizes—is typically observed. Unfortunately, reliable predictions of the “pseudo-homogeneous” flow regime are limited up to now: one important drawback concerns the selection of appropriate models for the coalescence and break-up. A set of closure relations was collected at the Helmholtz-Zentrum Dresden-Rossendorf that represents the best available knowledge. Recently, the authors have extended the validation of this set of closure relations to the “pseudo-homogeneous” flow regime, by comparing the numerical predictions to a comprehensive experimental dataset (gas holdup, bubble size distributions and local flow measurements). Unfortunately, the previous study suffers from some limitations; in particular, in the previous experimental dataset, the bubble size distributions concerned only one axial position and a detailed characterization of the gas sparger was missing. This study contributes to the existing discussion and proposed a step ahead in the study of the “pseudo-homogenous” flow regime. To this end, we propose an experimental study, to improve the comprehensive dataset previously obtained. The novel dataset—obtained for two gas velocities—concerns bubble size distributions at different axial and radial positions and a precise characterization of the gas sparger. The comprehensive bubble size distribution dataset may serve as basis to improve the coalescence and break-up closures; conversely, the precise characterization of the gas sparger served as an improved input to the numerical simulations. The numerical results, with two different lift force implementations, have been compared with the whole dataset and have been critically analyzed. Reasons for the discrepancies between the numerical results and the experimental data have been identified and may serve as basis for future studies. Keywords: CFD, Bubble column, Large-scale, Bubble size distribution, Coalescence and break-up, Validation

It is generally admitted that experimental data obtained in “laboratory-scale” bubble columns are representative of “industrial-scale” reactors if the well-known three “Wilkinson et al. scale-up criteria” are satisfied: (a) the diameter of the bubble column is larger than 0.15 m, (b) the sparger openings are larger than 1–2 mm and (c) the aspect ratio is larger than 5. The aim of this communication is to contribute to the existing discussion. To this end, this communication collects relevant experimental investigation and include new experimental data: in particular, we have experimentally studied the combined effect of the aspect ratio (within the range of 1–15) and the sparger design (considering both “coarse” and “fine” spargers) on the gas holdup in a large-diameter and large-scale gas-liquid bubble column. The bubble column has been operated both in the batch mode and in the counter-current mode. Filtered air has been used as the gaseous phase in all the experiments, while the liquid phase has included deionized water and different aqueous solutions of organic (i.e., ethanol) and inorganic (i.e., sodium chloride, NaCl) active agents. It is found that the “Wilkinson et al. scale-up criteria” are valid for the air-water case in the batch mode for “very-coarse” spargers. Conversely, they are no more valid when considering different liquid velocity, and/or aqueous solutions of active agents, and other sparger openings. Keywords: Bubble column, Scale-up, Gas sparger, Gas holdup, Liquid phase properties

The coexistence of the need to improve economic conditions and the conscious use of environmental resources plays a central role in today’s sustainable development challenge. In this study, a novel integrated framework to evaluate the impact of new technological interventions is presented and an application to smallholder coffee farms and their supply chains in Kenya is proposed. This methodology is able to combine multiple information through the joint use of three approaches: supply chain analysis, input-output analysis, and energy system modeling. Application to the context of the Kenyan coffee sector enables framework validation: shading management measures, the introduction of eco-pulpers, and the exploitation of coffee waste biomass for power generation were compared within a holistic high-level perspective. The implementation of shading practices, carried out with fruit trees, shows the most relevant effects from the economic point of view, providing farmers with an additional source of income and generating $903 of work for every million of local currency (about $9k) invested in this solution. The same investment would save up to 1.46 M m3 of water per year with the eco-pulpers technology. Investing the same amount in coffee-biomass power plants would displace a small portion of production from heavy-duty oil and avoid importing a portion of fertilizer, saving up to 11 tons of CO2 and around $4k per year. The results suggest the optimal allocation of a $100m budget, which can be affected by adding additional constraints on minimum environmental or social targets in line with sustainable development goals.