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Zusammenfassung: Hintergrund: Die thorakale Sympathektomie ist eine etablierte Behandlungsoption bei Patienten mit primärer Hyperhidrose. Ungeklärte Fragen betreffen die optimale Technik der Sympathektomie und ob Patienten mit einer palmaren und axillären Hyperhidrose gleichermaßen von dem Eingriff profitieren. Patienten und Methoden: Es erfolgte eine retrospektive Analyse prospektiv gesammelter Daten von 204 konsekutiven Patienten, bei welchen 402 thorakale Sympathektomien wegen palmar-plantarer (123), palmar-axillärer (34), isoliert axillärer (35) und kraniofazialer (12) Hyperhidrose durchgeführt wurden. Standardeingriff war die zweizeitige thorakoskopische Resektion des sympathischen Grenzstranges von T2 bis T4/T5. Ergebnisse: Alle Eingriffe wurden thorakoskopisch durchgeführt, schwere perioperative Komplikationen traten nicht auf. Die postoperative Morbidität betrug 2,5% (10/402) und inkludierte 2 inkomplette Horner-Syndrome (0,5%). 143 Patienten wurden im Mittel 21 Monate (Spanne: 6–86) postoperativ nachuntersucht. Die palmare Hyperhidrose war in allen Fällen und die axilläre Hyperhidrose in 98,5% eliminiert, in 3 Axillen (1,5%) trat ein Rezidiv auf. Bei 60% der Patienten traten passagere, meist leichte Postsympathektomieneuralgien auf. Ein starkes kompensatorisches Schwitzen trat bei 17% der Patienten mit palmar-plantarer und palmar-axillärer und bei 53% der Patienten mit isolierter axillärer Hyperhidrose auf (p=0,001). Patienten mit palmar-plantarer und palmar-axillärer Hyperhidrose waren in 92% mit dem postoperativen Ergebnis sehr zufrieden, 90% gaben eine gesteigerte Lebensqualität an und 93% würden den Eingriff wieder durchführen lassen. Die entsprechenden Werte betrugen bei Patienten mit isolierter axillärer Hyperhidrose 47%, 44% und 66% (p<0,001). Schlussfolgerung: Die thorakoskopische Resektion des sympathischen Grenzstranges von T2 bis T4/T5 ist ein sicheres und komplikationsarmes Verfahren und führt in nahezu 100% zur Elimination einer palmaren und axillären Hyperhidrose. Im Gegensatz zu den ausgezeichneten Ergebnissen bei Patienten mit palmar-plantarer und palmar-axillärer Hyperhidrose, weisen Patienten mit isolierter axillärer Hyperhidrose signifikant schlechtere Resultate bez. des kompensatorischen Schwitzens, der Lebensqualität und Zufriedenheit mit dem postoperativen Resultat auf.

The war in Ukraine caused a huge number of displaced people in a very short time. Amongst the refugees were many school-age children who needed to continue studying in the schools of the host countries. Host schools and teachers had to arrange inclusive strategies to integrate the displaced pupils. This study analysed the factors that facilitated the inclusion of displaced pupils from Ukraine in Italian schools during the first months of the war. We involved in the study 208 teachers from all Italian areas working at all school levels who welcomed 461 Ukrainian pupils in their classrooms. The teachers completed an online qualitative instrument in which they had the opportunity to describe their experience from a personal and a professional point of view. The findings revealed five main factors that affected the effectiveness of inclusion. On these bases, some educational guidelines are provided to support teachers and schools in arranging successful contexts and actions to welcome and include displaced children.

Feldspar minerals are the most common rock formers in Earth’s crust. As such they play an important role in subjects ranging from geology to climate science. An atomistic understanding of the feldspar structure and its interaction with water is therefore desirable, not least because feldspar has been shown to dominate ice nucleation by mineral dusts in Earth’s atmosphere. The complexity of the ice/feldspar interface arising from the numerous chemical motifs expressed on the surface makes it a challenging system. Here we report a comprehensive study of this challenging system with ab initiodensity functional theory calculations. We show that the distribution of Al atoms, which is crucial for the dissolution kinetics of tectosilicate minerals, differs significantly between the bulk environment and on the surface. Furthermore, we demonstrate that water does not form ice-like overlayers in the contact layer on the most easily cleaved (001) surface of K-feldspar. We do, however, identify contact layer structures of water that induce ice-like ordering in the second overlayer. This suggests that even substrates without an apparent match with the ice structure may still act as excellent ice nucleating agents.

Two-dimensional radioactive 125I monolayers are a recent development that combines the fields of radiochemistry and nanoscience. These Au-supported monolayers show great promise for understanding the local interaction of radiation with 2D molecular layers, offer different directions for surface patterning, and enhance the emission of chemically and biologically relevant low-energy electrons. However, the elemental composition of these monolayers is in constant flux due to the nuclear transmutation of 125I to 125Te, and their precise composition and stability under ambient conditions has yet to be elucidated. Unlike I, which is stable and unreactive when bound to Au, the newly formed Te atoms would be expected to be more reactive. We have used electron emission and X-ray photoelectron spectroscopy (XPS) to quantify the emitted electron energies and to track the film composition in vacuum and the effect of exposure to ambient conditions. Our results reveal that the Auger electrons emitted during the ultrafast radioactive decay process have a kinetic energy corresponding to neutral Te. By combining XPS and scanning tunneling microscopy experiments with density functional theory, we are able to identify the reaction of newly formed Te to TeO2and its subsequent dimerization. The fact that the Te2O4units stay intact during major lateral rearrangement of the monolayer illustrates their stability. These results provide an atomic-scale picture of the composition and mobility of surface species in a radioactive monolayer as well as an understanding of the stability of the films under ambient conditions, which is a critical aspect in their future applications.

Objectives: The aim of this study was to determine the feasibility and safety of transcutaneous ablation of human testicular tissue by high-intensity focused ultrasound (HIFU). Methods: Transcutaneous ablation of human testicular tissue by HIFU was performed with equipment previously developed for transrectal prostate ablation. This device utilizes a piezoceramic transducer operating at 4.0 MHz with a site-intensity of 1,600–2,000 W/cm2. To study the histological impact of transcutaneous HIFU, testes of 4 patients with prostate cancer were subjected to transcutaneous HIFU-therapy prior to scrotal orchiectomy in a phase I trial. In a phase II clinical trial, 4 patients with the typical sonographic pattern of a tumor in a solitary testis were treated with transcutaneous HIFU as a minimally invasive organ-preserving approach followed by a 6 weeks’ course of prophylactic irradiation of the testis with 20 Gy. In all 4 patients, the contralateral testis had been previously removed for testis cancer. Results: Histologically, HIFU-treated areas exhibited signs of cellular necrosis in all cases (n = 4). The border between viable and necrotic tissue was extremely sharp comprising only 5–7 cell layers. In the phase II clinical study, we aimed to ablate the entire cancer in a single therapeutic HIFU session. HIFU treatment was performed under general anesthesia. As negative side effects we observed a cutaneous thermolesion in 1 individual. One patient refused to undergo postoperative irradiation and developed a local failure. This patient underwent radical orchiectomy. Another patient received two cycles of chemotherapy for a single suspicious retroperitoneal lymph node diagnosed 6 months after HIFU therapy. Three patients are tumor-free with a follow-up of 16, 23 and 31 months, respectively. Conclusions: This study demonstrates the feasibility and safety of transcutaneous testicular tissue ablation by HIFU. Despite the major drawback of this technique, i.e. that no tumor histology is obtained, we believe that transcutaneous HIFU followed by irradiation has the potential to be established as a minimally invasive treatment alternative to organ-preserving surgery for tumors in a solitary testis.

Transdermal clonidine (TTSC) treatment was evaluated in 29 patients with mild to moderate hypertension scheduled for minor surgery. Two weeks before the scheduled operation, patients underwent 24-h ambulatory blood-pressure monitoring (ABPM) to evaluate the efficacy of previous oral antihypertensive treatment, which was then substituted with TTSC, 0.1 mg/day. After 1 week, the efficacy of TTSC was clinically assessed, and the dose increased to 0.2 mg/day if needed. ABPM was repeated 2 days before the scheduled operation and 2 days after surgery. The 24-h blood pressure (BP) and heart rate (HR) profiles were smoothed by Fourier analysis. Three patients withdrew for adverse events and one for inefficacy after dose adjustment, TTSC being effective in the remaining 25 patients. Two patients who completed treatment lacked postsurgical ABPM recording. In the 23 patients with all ABPM recordings, average 24-h BP and HR obtained preoperatively during TTSC treatment were slightly reduced compared with values recorded during previous oral therapy. BP changes after surgery were negligible, whereas HR showed a moderate increase. Minor adverse events occurred in four (14%) of 29 patients. Our results demonstrate that TTSC provides adequate BP control in patients with mild to moderate hypertension undergoing minor surgery.