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External wall thermal insulation is one of the most effective solutions on the market to increase energy efficiency in the built environment. Off-Site Construction (OSC), through better control of the various parameters involved, can bring important advantages, such as the reduction of construction time, the improvement of product and process quality, etc. In the last years, the rapidly growing demand for thermal insulation systems, stimulated also by tax incentives, has generated a unique situation in Italy compared to the rest of Europe, also leading to a considerable fragmentation of the supply chain with several players involved (component and system manufacturers, distributors, and installers). The complexity of such context makes Italy an extremely challenging and insightful case study for a supply chain and sustainability study, also considering the fact that the energy efficiency of the Italian building stock represents a crucial challenge to achieve the country’s energy saving goals since 40% of final energy consumption derives from buildings and 75% of the building stock presents a low energy performance (energy labels E, F and G). This article presents both an analysis of the Italian market of manufacturers of building envelope thermal insulation solutions, highlighting the different players in the supply chain in terms of number, type, and marketed products and solutions, and a focus on sustainable and recycled materials. The study also aims to define a methodology to investigate the state of play and opportunities for industrialisation of this market and its bottlenecks. In the article, a questionnaire is proposed to collect information and opinions on the spread of OSC and the perception of companies and professionals regarding the advantages and disadvantages of industrializing the sector. A first validation of the survey is presented in the form of industrial focus groups.

One of the main sources of crude oil and product losses in refineries is the storage tanks. The lightest hydrocarbons in these tanks evaporate during operation, causing not only a loss of the precious raw hydrocarbon material but also a source of dangerous gas pollution. For calculating these losses, several direct and indirect approaches have been devised. In this study, we used a method based on the comparison of the differences in the characteristics of crude oil or other products. This work aimed to find the specifications of two products, kerosene and gas oil, and calculate the losses that occur for the quantities in the dispatch warehouse in the NRC. Four samples of kerosene were used and named: kero@02-1, kero@05-2, kero@10-3, and kero@11-4, while four samples of gas oil were named: gaso@02-1, gaso@05-2, gaso@10-3, and gaso@11-4. Also, they depend on the date of certificate issue, respectively. The received quantities were calculated in ml and converted to cubic meters using the tank coefficient (kerosene tank coefficient 0.638 and gas oil tank coefficient 0.408). Calculations were made of 1500 ml for kerosene and 2500 ml for gas oil. In addition, this project dealt with a simplified method of work that includes the physical properties to find the actual quantities that are lost for the mentioned petroleum products. Moreover, the highest losses were for kerosene (5 m 3 ) at sp. gr 0.750, and the highest losses were for gas oil (5 m 3 ) at sp. gr 0.820. The results showed that there is a quantity of fluctuating losses that does not exceed 5 m 3 / 1000 m 3 and that these losses are in accordance with the permissible limits. The results recommend directing the laboratory tester's teams in the NRC Baiji to conduct periodic examinations of the petroleum products, as well as not to collusion when receiving a low product with laboratory examination specifications to reduce losses in quantities.

Jessica Longhini,1 Federica Canzan,1 Paola Zambiasi,2 Stefano Toccoli,2 Lorenzo Gios,3 Maurizio Del Greco,2 Simona Sforzin,2 Monica Moz,3 Michela Fracchetti,2 Luisa Saiani,1 Renata Brolis,2 Annamaria Guarnier,2 Mariangela Soverini,2 Massimiliano Maines,2 Elisa Ambrosi1 1Department of Diagnostics and Public Health, University of Verona, Verona, Italy; 2Azienda Provinciale per i Servizi Sanitari, Trento, Italy; 3TrentinoSalute4.0, Competence Center for Digital Health, Trento, ItalyCorrespondence: Jessica Longhini, University of Verona, Strada le Grazie 8, Verona, Italy, Tel +393405322936, Email jessica.longhini@univr.itPurpose: To determine whether a nurse-led care model with telemonitoring in primary care for patients with stable heart failure and their caregivers is feasible and acceptable.Patients and Methods: A mixed-methods feasibility study was conducted. Patients with stable heart failure and their caregivers were consecutively enrolled from March 2021 to April 2022. Participants were managed by nurses in a community health center through education and monitoring with a mobile app. The outcomes were feasibility outcomes, self-care outcomes, and qualitative acceptability and satisfaction. Quantitative and qualitative outcomes were linked to understanding how the model of care might benefit patients.Results: Twenty-six patients and nine of their caregivers were enrolled. Ten participants used the mobile app. Nineteen patients and eight caregivers were interviewed. Participants who improved their self-care appreciated the help in finding coping strategies, being close to the clinic, and feeling cared for. Participants with fewer improvements in self-care perceived the model of care as useless and were far from the centre. Participants decided to use the app mainly for usefulness prevision, and most of them were satisfied.Conclusion: The model of care was not successful in recruiting patients, and adjustments are needed to improve the recruitment strategy and to engage people who perceive the model of care as not useful or unable to use the app.Keywords: nursing, primary care, heart failure, cardiology, general practice

Jessica Longhini,1 Federica Canzan,1 Paola Zambiasi,2 Stefano Toccoli,2 Lorenzo Gios,3 Maurizio Del Greco,2 Simona Sforzin,2 Monica Moz,3 Michela Fracchetti,2 Luisa Saiani,1 Renata Brolis,2 Annamaria Guarnier,2 Mariangela Soverini,2 Massimiliano Maines,2 Elisa Ambrosi1 1Department of Diagnostics and Public Health, University of Verona, Verona, Italy; 2Azienda Provinciale per i Servizi Sanitari, Trento, Italy; 3TrentinoSalute4.0, Competence Center for Digital Health, Trento, ItalyCorrespondence: Jessica Longhini, Email jessica.longhini@univr.it

Ewing sarcoma (ES), described as a diffuse endothelioma of the bone, is divided into two categories: osseous and extraosseous, which mainly affects adolescents. Extraosseous Ewing Sarcomas (EES) are rare tumors originating from soft tissues. Their clinical presentation depends mainly on the primary location of the tumor and are highly chemosensitive and radiosensitive. The purpose of this study was to describe the clinical characteristics and outcomes of 3 children with EES and uncommon presentation treated in our Unit. The diagnosis of EES was confirmed by biopsy and cytogenetic analysis with fluorescence in situ hybridization (FISH). Surgical excision was planned as primary treatment, followed by adjuvant chemotherapy according to EURO-E.W.I.N.G protocol. To date, all patients are alive, 1, 3 and 4 years after completion of treatment, with no signs of recurrence or metastasis.

Andrea Galbiati,1,2 Marco Sforza,1,2 Elisabetta Fasiello,1 Vincenza Castronovo,1 Luigi Ferini-Strambi1,2 1IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology – Sleep Disorders Center, Milan, Italy; 2Faculty of Psychology, “Vita-Salute” San Raffaele University, Milan, ItalyCorrespondence: Andrea GalbiatiDepartment of Clinical Neurosciences OSR-Turro, Neurology – Sleep Disorders Center, Università Vita-Salute San Raffaele, Milan, ItalyTel +39 0226433397Email andrea.galbiati.unisr@gmail.comAbstract: Insomnia is one of the most common mental disorders and the most frequent sleep disorder encountered in clinical practice, with a prevalence of about 7% in the European population. Insomnia Disorder (ID) is defined as a disturbance of sleep initiation or maintenance, followed by a feeling of non-restorative sleep and several diurnal consequences ranging from occupational and social difficulties to cognitive impairment. Cognitive-Behavioral Therapy for Insomnia (CBT-I) is considered the first-choice therapy for this disorder because its effectiveness has been proven to be greater in the long term with fewer side effects in comparison to pharmacotherapy. Although its effectiveness has been well established, it has been reported that nearly 40% of patients do not achieve remission after treatment. This finding could be the consequence of heterogeneity of ID between patients. It has been proposed that this heterogeneity might be ascribable to indices that are not related to sleep quality and quantity, such as comorbidities, life events, and personality traits. However, several works focused on the role of sleep markers, in particular objective total sleep time, for the phenotypization of ID and treatment response. The aim of this work is to summarize the available scientific literature regarding the impact of ID subtype on CBT-I response.Keywords: cognitive-behavioral therapy for insomnia, polysomnography, insomnia disorder, subtype, objective sleep duration

BackgroundItaly was the first country to largely experience the COVID-19 epidemic among other Western countries during the so-called first wave of the COVID-19 pandemic. Proper management of an increasing number of home-quarantined individuals created a significant challenge for health care authorities and professionals. This was especially true when considering the importance of remote surveillance to detect signs of disease progression and consequently regulate access to hospitals and intensive care units on a priority basis. ObjectiveIn this paper, we report on an initiative promoted to cope with the first wave of the COVID-19 epidemic in the Spring/Summer of 2020, in the Autonomous Province of Trento, Italy. A purposefully built app named TreCovid19 was designed to provide dedicated health care staff with a ready-to-use tool for remotely monitoring patients with progressive symptoms of COVID-19, who were home-quarantined during the first wave of the epidemic, and to focus on those patients who, based on their self-reported clinical data, required a quick response from health care professionals. MethodsTreCovid19 was rapidly developed to facilitate the monitoring of a selected number of home-quarantined patients with COVID-19 during the very first epidemic wave. The app was built on top of an existing eHealth platform, already in use by the local health authority to provide home care, with the following functionalities: (1) to securely collect and link demographic and clinical information related to the patients and (2) to provide a two-way communication between a multidisciplinary health care team and home-quarantined patients. The system supported patients to self-assess their condition and update the multidisciplinary team on their health status. The system was used between March and June 2020 in the province of Trento. ResultsA dedicated multidisciplinary group of health care professionals adopted the platform over a period of approximately 3 months (from March-end to June 2020) to monitor a total of 170 patients with confirmed COVID-19 during home quarantine. All patients used the system until the end of the initiative. The TreCovid19 system has provided useful insights of possible viability and impact of a technological–organizational asset to manage a potentially critical workload for the health care staff involved in the periodic monitoring of a relevant number of quarantined patients, notwithstanding its limitations given the rapid implementation of the whole initiative. ConclusionsThe technological and organizational model adopted in response to the COVID-19 pandemic was developed and finalized in a relatively short period during the initial few weeks of the epidemic. The system successfully supported the health care staff involved in the periodic monitoring of an increasing number of home-quarantined patients and provided valuable data in terms of disease surveillance.

Paolo Consigliere,1 Omar Haddo,2 Ofer Levy,1,3 Giuseppe Sforza1 1The Reading Shoulder Unit, Berkshire Independent Hospital Coley Park, Swallows Croft, Reading, Berkshire, UK; 2The Whittington Hospital NHS FT, London, UK; 3The Reading Shoulder Unit, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, UK Abstract: The painful shoulder is the most common condition seen in specialist shoulder clinics. It is often associated with lack of range of motion and reduced shoulder function. Lack of sleep and difficulties in performing basic daily life activities are common findings. Subacromial Impingement Syndrome (SAIS) has been considered as the most common cause of shoulder pain since it was described in 1852. Charles Neer, in 1972, described the presence of a “proliferative spur and ridge” on the undersurface of the acromion, which needs to be removed to improve the symptoms (acromioplasty). Neer’s “impingement” hegemony was undisputed for at least 30 years. A more extensive knowledge of the pathogenesis of SAIS, however, has led authors to challenge the role of “impingement” in the shoulder pain and the role of surgical intervention. The aim of this review was to understand if there is still a role for surgical decompression in patients with SAIS. A literature review was performed in PubMed, PEDro, Embase, and the Cochrane Central Register of Controlled Trials using impingement, subacromial space, rotator cuff tears, tendinopathy, and tendinitis as key words. Randomized clinical trials (RCTs) with long-term follow-up comparing surgical intervention and conservative treatments in SAIS were preferred; however, prospective articles studying the outcome of surgical decompression and physiotherapy were also included. The majority of the studies showed no difference in the outcome between patients randomized to surgical decompression or conservative management. However, some studies reported better results after surgery, especially in the long term. Interpretation of the results is very difficult as most of the studies are of poor quality and have short follow-up. In our opinion, the type of subacromial lesion needs to be considered; this may offer an explanation to the difference in severity of symptoms and to the varying degrees of response to certain treatments, including surgery. Further studies are mandatory to better understand the role of surgery in SAIS. Keywords: impingement, bursitis, supraspinatus tendon, rotator cuff, rotator cuff tears, tendinopathy, tendinitis

David Perez-Meza,1 Craig Ziering,2 Marcos Sforza,3 Ganesh Krishnan,4 Edward Ball,5 Eric Daniels6 1Ziering Medical, Marbella, Spain; 2Ziering Medical, Los Angeles, CA, USA; 3The Hospital Group, Bromsgrove, Worcestershire, 4Ziering Medical, Birmingham, 5Ziering Medical, London, UK; 6Kerastem Technologies, San Diego, CA, USA Abstract: Great interest remains in finding new and emerging therapies for the treatment of male and female pattern hair loss. The autologous fat grafting technique is >100 years old, with a recent and dramatic increase in clinical experience over the past 10–15 years. Recently, in 2001, Zuk et al published the presence of adipose-derived stem cells, and abundant research has shown that adipose is a complex, biological active, and important tissue. Festa et al, in 2011, reported that adipocyte lineage cells support the stem cell niche and help drive the complex hair growth cycle. Adipose-derived regenerative cells (also known as stromal vascular fraction [SVF]) is a heterogeneous group of noncultured cells that can be reliably extracted from adipose by using automated systems, and these cells work largely by paracrine mechanisms to support adipocyte viability. While, today, autologous fat is transplanted primarily for esthetic and reconstructive volume, surgeons have previously reported positive skin and hair changes posttransplantation. This follicular regenerative approach is intriguing and raises the possibility that one can drive or restore the hair cycle in male and female pattern baldness by stimulating the niche with autologous fat enriched with SVF. In this first of a kind patient series, the authors report on the safety, tolerability, and quantitative, as well as photographic changes, in a group of patients with early genetic alopecia treated with subcutaneous scalp injection of enriched adipose tissue. The findings suggest that scalp stem cell-enriched fat grafting may represent a promising alternative approach to treating baldness in men and women. Keywords: stem cell, alopecia, adipose, stromal vascular fraction, transplantation

The present work aims to investigate the integration into renewable energy communities (REC) schemes of micro and mini- Combined Heat and Power (CHP) plants. In detail, it has been evaluated the minimum self-consumption (SC) share needed to even out the revenues coming from the energy efficiency certificates (EECs). In order to establish a SC based tariff for CHP plants a correlation between SC share and the tariff value has been assessed for different commercial plants. A 70% of SC share has been set as a minimum target, which is related to incentive rates of 53 and 39.5 €/MWh, for mini and micro-CHPs, respectively. These values are about 65% lower than the current tariffs set by ARERA (Italian Regulatory Authority for Energy, Networks and Environment) to reward the renewable energy SC. A real building and two CHP plants have been considered as reference case studies. A dynamic simulation has been carried out in order to analyse the proposed incentive scheme in a real application. Starting from a 3-D BIM model, the energy flows have been calculated over one year period. Finally, it has been demonstrated how a SC based tariff can significantly reduce the share of injected electricity into the grid, also promoting the thermal carrier sharing. In so doing, the renewable energy sources intermittency can be easily mitigated and balanced, avoiding additional burdens on public expenditure.

Potential responses of marine mammals to anthropogenic underwater sound are usually assessed by researchers and regulators on the basis of exposure to a single, relatively loud sound source. However, marine mammals typically receive sounds from multiple, dynamic sources. We developed a method to aggregate modeled sounds from multiple sources and estimate the sound levels received by individuals. To illustrate the method, we modeled the sound fields of 9 sources associated with oil development and estimated the sound received over 47 d by a population of 10000 simulated bowhead whales Balaena mysticetus on their annual migration through the Alaskan Beaufort Sea. Empirical data were sufficient to parameterize simulations of the distribution of individual whales over time and their range of movement patterns. We ran 2 simulations to estimate the sound exposure history and distances traveled by bowhead whales: one in which they could change their movement paths (avert) in response to set levels of sound and one in which they could not avert. When animals could not avert, about 2% of the simulated population was exposed to root mean square (rms) sound pressure levels (SPL) ≥180 dB re 1 µPa, a level that regulators in the U.S. often associate with injury. When animals could avert from sound levels that regulators often associate with behavioral disturbance (rms SPL >160 dB re 1 µPa),

This study deals with the implementation of an analytical model to simulate the energy performance associated to a commercial Gas adsorption Heat Pump, when H2NG (Hydrogen Enriched Natural Gas) blends are used as fuel. In detail, a water source heat pump manufactured by Robur (GAHP-WS) has been used as a reference device for building the simulation model within the MATLAB-Simulink environment. Thereafter, the simulation results have been validated by the experimental campaign, testing on field and in actual operating conditions the heat pump. Specifically, the model has been developed by implementing the WaterAmmonia mass and energy balances for each component. It is able to evaluate fuel consumption, efficiency in terms of GUE, required thermal power from the cold heat sink as well as the water outlet temperature at the evaporator, once the heating load is used as the main input. The experimental campaign for the model calibration and validation has been carried out over the winter season. Additionally, the heat pump performance has been detected when it operates to supply hot water at 60 °C and 55 °C, and it is fuelled with growing hydrogen fractions, starting from 0% vol., 5% vol. up to 10% vol. In the end, the standard errors as well as the relative ones affecting the main output parameters have computed for the validation process. From the outcomes it emerges that the average relative standard error related to all load conditions is lower than 2.5% for natural gas operation. On the contrary, it ranges between 2.5% and 4% when H2NG at 5% and 10% by volume have been burnt.

The growing penetration of non-programmable energy sources will largely contribute to intensify the renewable capacity firming issues. Providing a higher systems flexibility, i.e. the ability to match the supply and the demand sides as much as possible, is the main challenge to cope with, by adopting new energy planning paradigms. In this framework, different combined strategies, aiming at efficiently integrating that large amount of variable RES (VRES), have to be implemented. In the recent years, the Smart Energy Systems (SES) concept has been introduced to overcome the single-sector approach, promoting a holistic and integrated vision. By that approach, it is possible to exploit synergies between different energy sectors so as to identify the best technical options to globally reduce the primary fossil energy consumption. Starting from a quantitative and qualitative analysis of the most recent international studies dealing with the SES approach, the aim of this paper is to critically review and analyse the role of the main potential flexibility measures applied in the energy planning sector. In detail, Power-to-X and Demand Side Management (DSM) application have been considered, highlighting strengths and weaknesses of such strategies to accomplish the ambitious target of 100% renewable. From this literature review, it emerges how a single strategy adoption is not enough to guarantee the required flexibility level for the whole energy system. Indeed, the best configuration can be attained by integrating different options matching all the external constraints.

Background Many different surgical techniques have been described to stabilize the acromion-clavicular (AC) dislocations. So far many of these procedures are performed only in arthroscopy. Objectives In this study, we describe a new technique that utilizes the tightrope with a mini-invasive open approach for the acute stabilization of the acromion-clavicular joint (ACJ) dislocation. Patients and Methods We set an prospective study aimed to verify the efficacy of this new surgical technique. We treated 28 patients with acute ACJ dislocation with ACJ TightRope ® System with dual mini access. We retrospectively reviewed the data of 34 patients treated with arthroscopic technique. They were considered as the control group. Results At 6 month’s follow-up, all the 28 patients showed a stable joint during clinical examination and obtained an average Constant score of 98.62/100, with a complete recovery of ROM and strength in abduction. The mean operation time was of 33.7 minutes. The mean recovery duration was 102.8 days. No significant difference was found between the experimental and control groups (P > 0.05). Conclusions Results of this trial suggest the effectiveness of this new mini-invasive surgical technique in producing clinical and functional recovery in patients with ACJ dislocations.

Introduction. Improved psychophysical condition after breast reconstruction in women has been well documented Objective. To determine the most optimal technique with minimal morbidity, the authors examined their results and complications based on reconstruction timing (immediate and delayed reconstruction) and three reconstruction methods: TRAM flap, latissimus dorsi flap and reconstruction with tissue expanders and implants. Methods. Reconstruction was performed in 60 women of mean age 51.1 years. We analyzed risk factors: age, body mass index (BMI), smoking history and radiation therapy in correlation with timing and method of reconstruction. Complications of all three methods of reconstruction were under 1.5-2-year follow-up after the reconstruction. All data were statistically analyzed. Results. Only radiation had significant influence on the occurrence of complications both before and after the reconstruction, while age, smoking and BMI had no considerable influence of the development of complications. There were no statistically significant correlation between the incidence of complications, time and method of reconstruction. Conclusion. Any of the aforementioned breast reconstruction techniques can yield good results and a low rate of re-operations. To choose the best method, the patient needs to be as well informed as possible about the options including the risks and benefits of each method.

Introduction. Otoplasty or correction of prominent ears, is one of most commonly performed surgeries in plastic surgery both in children and adults. Until nowadays, there have been more than 150 techniques described, but all with certain percentage of recurrence which varies from just a few up to 24.4%. Objective. The authors present an otoplasty technique, a combination of Mustardj’s original procedure with other techniques, which they have been using successfully in their everyday surgical practice for the last 9 years. The technique is based on posterior antihelical and conchal approach. Methods. The study included 102 patients (60 males and 42 females) operated on between 1999 and 2008. The age varied between 6 and 49 years. Each procedure was tailored to the aberrant anatomy which was analyzed after examination. Indications and the operative procedure are described in stepby- step detail accompanied by drawings and photos taken during the surgery. Results. All patients had bilateral ear deformity. In all cases was performed a posterior antihelical approach. The conchal reduction was done only when necessary and also through the same incision. The follow-up was from 1 to 5 years. There were no recurrent cases. A few minor complications were presented. Postoperative care, complications and advantages compared to other techniques are discussed extensively. Conclusion. All patients showed a high satisfaction rate with the final result and there was no necessity for further surgeries. The technique described in this paper is easy to reproduce even for young surgeons.

Os resultados de exames oficiais de avaliação têm revelado que, nos últimos anos, os estudantes brasileiros da educação básica não têm atingido o desempenho esperado para esse nível de ensino. Com base na teoria histórico-cultural, este trabalho apresenta uma reflexão sobre o impacto do baixo desempenho escolar dos alunos na sua formação e desenvolvimento humano. Toma como pressuposto que a propriação dos instrumentos simbólicos é o processo mediante o qual se produz em cada sujeito o desenvolvimento conquistado pelo gênero humano

Este artigo apresenta uma reflexão sobre a formação inicial de professores, tomando como referência a Teoria da Atividade de Leontiev. Tem como ponto de partida um artigo elaborado por uma acadêmica na disciplina chr(38)quot;Prática de Ensino - séries iniciais do Ensino Fundamentalchr(38)quot; do curso de Pedagogia, cujo tema tomou forma a partir de suas impressões como aprendiz. Nele, a estagiária, mobilizada pela experiência da docência, sente a necessidade de refletir sobre o próprio processo de formação, revelando o quanto a docência se tornou uma atividade para ela. No presente texto, suas inquietações e aprendizagens são compartilhadas com a professora orientadora e busca identificar elementos desencadeadores do movimento de formação docente

Introduction. Mature teratomas (benign cystic teratomas or dermoid cysts) are among the most common ovarian tumours; however, teratomas of the omentum and mesentery are extremely rare. Teratoma in the intraperitoneal cavity is uncommon and atypical, and it is even more uncommon in adulthood. Case Outline. An 82-year-old female was admitted to our department with clinical signs of abdominal tumour. The ultrasound scan and preoperative laboratory tests were done. Explorative laparotomy revealed tumour with torsion on its pedicle at the greater omentum. After removal of the mass and the incision a tooth and hair were found, characteristics of teratoma. Conclusion. The excision was very effective and also definitive treatment for this case. The patient recovered well and was discharged 3 days later. The patient probably carried the tumour all her life asymptomatically until admission.

Introduction. Amongst various causes responsible for the obstruction of digestive tract, intestinal ascariasis is certainly one of the least frequent. Case Outline. We report an extremely rare case of a 5-year-old male patient operated on for appendicitis due to adult Ascaris Lumbricoides worms intraoperatively detected in the appendiceal lumen. Conclusion. On examination patient’s clinical features indicated acute appendicitis. Therefore, the treatment-of-choice could only be surgical. Classic appendectomy was performed and the postoperative course was uneventful, with full recovery.

Abstract Background Management of established severe OHSS requires prolonged hospitalization, occasionally in intensive care units, accompanied by multiple ascites punctures, correction of intravascular fluid volume and electrolyte imbalance. The aim of the present study was to evaluate whether it is feasible to manage women with severe OHSS as outpatients by treating them with GnRH antagonists in the luteal phase. Methods This is a single-centre, prospective, observational, cohort study. Forty patients diagnosed with severe OHSS, five days post oocyte retrieval, were managed as outpatients after administration of GnRH antagonist (0.25 mg) daily from days 5 to 8 post oocyte retrieval, combined with cryopreservation of all embryos. The primary outcome measure was the proportion of patients with severe OHSS, in whom outpatient management was not feasible. Results 11.3% (95% CI 8.3%-15.0%) of patients (40/353) developed severe early OHSS. None of the 40 patients required hospitalization following luteal antagonist administration and embryo cryopreservation. Ovarian volume, ascites, hematocrit, WBC, serum oestradiol and progesterone decreased significantly (P Conclusions The current study suggests, for the first time, that successful outpatient management of severe OHSS with antagonist treatment in the luteal phase is feasible and is associated with rapid regression of the syndrome, challenging the dogma of inpatient management. The proposed management is a flexible approach that minimizes unnecessary embryo transfer cancellations in the majority (88.7%) of high risk for OHSS patients.

We present the result of the searches for a low mass Standard Model Higgs boson performed at the Tevatron pp¯ $par p$ collider (√s = 1.96 TeV) by the CDF and D0 experiments with an integrated luminosity of up to 8.5 fb-1. Individual searches are discussed and classified according to their sensitivity. Primary channels rely on the associate production with a vector boson (WH or ZH) and the H → bb¯ $H o bar b$ decay channel (favored for MH ≲ 135 GeV/c2). Event selection is based on the leptonic decay of the vector boson and the identification of b–hadron enriched jets. Each individual channel is sensitive, for MH = 115 GeV/c2, to less than 5 times the SM expected cross section and the most sensitive channels can exclude a production cross section of 2.3×σHSM Secondary channels rely on a variety of final states. Although they are from 2 to 5 times less sensitive than any primary channel, they contribute to the Tevatron combination and, in some cases, they pose strong constrains on exotic Higgs boson models.

Abstract Introduction Ductal adenocarcinoma is a rare variety of the common acinar adenocarcinoma. It usually presents with refractory symptoms, and during cystoscopy, it is seen as an exophytic lesion at the area of the verumontanum. Case presentation An 82-year-old Caucasian man was diagnosed with ductal adenocarcinoma of the prostate after undergoing transurethral resection of the prostate for urinary retention. Immunohistochemistry confirmed the nature of the tumor. The patient was treated with triptorelin, 3.75 mg once/month, and bicalutamide, 50 mg 1 × 1. The serum prostate-specific antigen at three, six and 12 months after transurethral resection of the prostate was 0.1 ng/ml. The patient remains asymptomatic, and he entered a six-month follow-up protocol. Conclusion Ductal adenocarcinoma often involves the central ducts of the gland and may present as an exophytic papillary lesion in the prostatic urethra. This is why it usually presents with refractory symptoms. The outcome for men with prostatic ductal adenocarcinoma is, in most studies, worse than the outcome for men with prostatic acinar adenocarcinoma. Aggressive management is indicated, even with low-volume metastatic disease.