3D Object Detection From Images for Autonomous Driving: A Survey

3D object detection from images, one of the fundamental and challenging problems in autonomous driving, has received increasing attention from both industry and academia in recent years. Benefiting from the rapid development of deep learning technologies, image-based 3D detection has achieved remarkable progress. Particularly, more than 200 works have studied this problem from 2015 to 2021, encompassing a broad spectrum of theories, algorithms, and applications. However, to date no recent survey exists to collect and organize this knowledge. In this paper, we fill this gap in the literature and provide the first comprehensive survey of this novel and continuously growing research field, summarizing the most commonly used pipelines for image-based 3D detection and deeply analyzing each of their components. Additionally, we also propose two new taxonomies to organize the state-of-the-art methods into different categories, with the intent of providing a more systematic review of existing methods and facilitating fair comparisons with future works. In retrospect of what has been achieved so far, we also analyze the current challenges in the field and discuss future directions for image-based 3D detection research.

Disentangling Monocular 3D Object Detection: From Single to Multi-Class Recognition

In this paper we introduce a method for multi-class, monocular 3D object detection from a single RGB image, which exploits a novel disentangling transformation and a novel, self-supervised confidence estimation method for predicted 3D bounding boxes. The proposed disentangling transformation isolates the contribution made by different groups of parameters to a given loss, without changing its nature. This brings two advantages: i) it simplifies the training dynamics in the presence of losses with complex interactions of parameters; and ii) it allows us to avoid the issue of balancing independent regression terms. We further apply this disentangling transformation to another novel, signed Intersection-over-Union criterion-driven loss for improving 2D detection results. We also critically review the AP metric used in KITTI3D and resolve a flaw which affected and biased all previously published results on monocular 3D detection. Our improved metric is now used as official KITTI3D metric. We provide extensive experimental evaluations and ablation studies on the KITTI3D and nuScenes datasets, setting new state-of-the-art results. We provide additional results on all the classes of KITTI3D as well as nuScenes datasets to further validate the robustness of our method, demonstrating its ability to generalize for different types of objects.

Illicit drugs seizures in 2013-2018 and characteristics of the illicit market within the Neapolitan area

The study presents results of toxicological analysis performed on seized material in Neapolitan area in the period from 2013 to 2018. A constancy in THC and heroin percentages is evidenced (%THC ~10% and ~11.5% for marijuana and hashish; heroine: 20-24%), with mean values exceeding the European data. Data on cocaine revealed a constant increment of active principle percentage over the studied period (from 40% in 2013 to ~65% in 2018), with peak of 70% in 2017; also, number of samples exceeding the mean value increased over years. Active principles contents resulted higher than the ones reported in other Italian area ever the same period; marijuana was prevalent on hashish, confirming an Italian trend different from other European countries. A map of the Campania region evidenced two main "storage" districts, one corresponding to the city center and the second located in the northern part. If compared with literature data on the presence of local mafia, these areas are perfectly superimposable to those with the highest risk of homicides, thus confirming the degree of radicalization of local organizations and the relative weight of proceeds from drugs sale. Moreover, such radicalization within the territory seems to be the main reason of the absence of new psychoactive substances among the seized material.

Reconstruction of the Instantaneous Earth Rotation Vector with Sub-Arcsecond Resolution Using a Large Scale Ring Laser Array

Absolute rotation rate sensing with extreme sensitivity requires a combination of several large scale gyroscopes in order to obtain the full vector of rotation. We report on the construction and operation of a four-component, tetrahedral laser gyroscope array as large as a five story building and situated in a near surface, underground laboratory. It is demonstrated that reconstruction of the full Earth rotation vector can be achieved with sub-arcsecond resolution over more than six weeks.

Effect of Flap Design for Enamel Matrix Derivative Application in Intraosseous Defects

Objective:

To systematically review the literature addressing the focused question: What is the effectiveness of different surgical and nonsurgical procedures combined with enamel matrix derivative (EMD) on clinical, radiographic, and patient-centered outcomes in intraosseous defects?

Methods:

Electronic (Medline, Scopus, and Cochrane databases) and hand literature searches were performed for studies including at least 1 treatment arm where EMD had been applied according to 1 of the following procedures: modified Widman flap; papilla preservation variants (PPVs), including papilla preservation technique, modified papilla preservation technique, and simplified papilla preservation technique; minimally invasive variants, including minimally invasive surgical approach and minimally invasive surgical technique; single-flap variants (SFVs), including single-flap approach and modified minimally invasive surgical technique; or nonsurgical application (flapless approach). Data from 42 selected articles were used to perform a network meta-analysis, and a hierarchy of surgical and nonsurgical applications of EMD was built separately for EMD and EMD + graft based on 6- to 12-mo clinical and radiographic outcomes.

Results:

Among surgical approaches, EMD was associated with best regenerative outcomes when applied through SFVs, with a mean clinical attachment level gain of 3.93 mm and a reduction in the intrabony component of the defect of 3.35 mm. For EMD + graft, limited differences in regenerative outcomes were observed among surgical procedures. PPVs were associated with the highest residual probing depth for EMD (4.08 mm) and EMD + graft (4.32 mm).

Conclusions:

In the treatment of periodontal intraosseous defects, 1) SFVs appear to optimize the regenerative outcomes of EMD; 2) substantial regenerative outcomes can be obtained with SFVs and conservative double flaps (i.e., PPVs and minimally invasive variants) when EMD is combined with a graft; and 3) residual probing depth was higher following PPVs for EMD and EMD + graft.

Knowledge Transfer Statement:

The results of the present systematic review and meta-analysis can be used by clinicians to identify the most effective surgical or nonsurgical procedure to treat an intraosseous defect with EMD or EMD + graft. The main findings indicate that when EMD application is indicated, surgical access based on a single flap seems the most appropriate to optimize clinical outcomes. The application of EMD + graft can be effectively combined with single flaps and conservative double flaps.

Application of a chemiluminescence immunoassay system and GC/MS for toxicological investigations on skeletonized human remains

Hair, larvae and cardiac muscle, the only biological samples present on a skeletonized human body found in a rural area, were used for forensic toxicological analyses in order to determine possible causes of death. Since no information about the victim or the circumstances of death was available (except for the place where the corpse was found, known to be a gathering place for drug addicts), the first approach for the analysis of non-conventional matrices involved the screening of different classes of active principles, using a chemiluminescence-based screening assay designed for whole blood. The immunoassay test results showed positivity to amphetamines, cocaine and opiates on water/methanol extract from cardiac tissue, larvae and hair samples. Gas chromatography-mass spectrometry (GC/MS) analyses confirmed the immunoassay results, except for amphetamines. The minimal sample preparation (hydration and extraction in an ultrasonic bath), the reduced sample volume required for the analyses, together with the correctness of results as confirmed by GC/MS, showed the suitability of the screening test for forensic applications on non-conventional matrices. Quantitative analyses in GC/MS allowed the cause of death to be ascertained on the basis of the ratio between parent drugs and metabolites.

Analysis of 90 day operation of the GINGERINO gyroscope: publisher's note

This publisher's note identifies a figure error in Appl. Opt.57, 5844 (2018)APOPAI0003-693510.1364/AO.57.005844.

Analysis of 90 day operation of the GINGERINO gyroscope

Gyroscopes IN GEneral Relativity (GINGER) is a proposed experiment with the aim of measuring in a ground laboratory the gravitoelectric and gravitomagnetic effects foreseen by general relativity through an array of ring laser gyroscopes. GINGERINO is a square ring-laser prototype that has been built to investigate the level of noise inside the Gran Sasso underground laboratory. GINGERINO has shown the advantage of the underground location. Now it provides suitable data for geophysics and seismology. Since May 2017, it has continuously acquired data. The analysis of the first 90 days shows that the duty cycle is higher than 95%, and the quantum shot noise limit is of the order of 10^-10(rad/s)/Hz. It is located in a seismically active area, and it recorded part of the central Italy earthquakes. Its high sensitivity in the frequency band of fraction of hertz makes it suitable for seismology studies. The main purpose of the present analysis is to investigate the long-term response of the apparatus. Simple and fast routines to suppress the disturbances coming from the laser have been developed. The Allan deviation of the raw data reaches some 10^-6 after about 10⁶  s of integration time, while the processed data show an improvement of 1 order of magnitude. Disturbances at the daily time scale are present in the processed data, and the expected signal induced by polar motion and solid Earth tides is covered by those disturbances.

Does infant negative emotionality moderate the effect of maternal depression on motor development?

Maternal depression represents an important social/environmental factor in early childhood; however, its effect on children's motor development may vary depending on the role of infants' dispositional variables. The objective of this study is to investigate the effect of the interaction between maternal depressive symptoms in the first two years of a child's life and the child's temperamental negative emotionality on motor development during this time. Using a cross-sectional study, we assessed 272 infants aged 0 to 24 months old and their mothers. We measured the following variables: maternal depression, infant's negative emotionality, and motor development. A three-way interaction effect highlights that negative emotionality in infants and maternal depression together affect children's overall motor growth trajectory. Infants with low negative emotionality display no effect of maternal depression on motor development. Conversely, infants with high negative emotionality seem to be more susceptible to the effect of maternal depression. Specifically, high maternal depression tends to foster the negative effect of infant's negativity on motor development across time, albeit not significantly. Finally, the absence of maternal depression significantly buffers negative temperament in infants. Findings highlighted the importance of integrating different perspectives when describing early motor growth. In fact, only when considering the interdependence of potential predictors their effect on the motor growth significantly emerges. Screening for early temperamental vulnerability might help in tailoring interventions to prevent maternal depression from affecting infants' motor development.

Italian translation and cross-cultural comparison with the Childhood Attachment and Relational Trauma Screen (CARTS)

Background: The Childhood Attachment and Relational Trauma Screen (CARTS) is a computer-administered survey designed to assess retrospectively the socio-ecological context in which instances of child abuse may have occurred. To date, studies supporting the validity of the CARTS have only been undertaken in English-speaking North American populations. Validation projects in other countries and cross-cultural comparisons are therefore warranted. Objective: Develop and preliminarily evaluate the psychometric properties of an Italian version of the CARTS on college students and compare such observations to data acquired from Canadian students. Method: Seventy-nine undergraduate students from the University of Padua (Italy) completed an Italian translation of the CARTS as well as measures of childhood experiences, mental health and attachment, responses to which were compared to those obtained in 288 Canadian students who completed the CARTS in English. Results: Internal consistency and convergent validity with the Childhood Trauma Questionnaire and Parental Bonding Instrument were found to be acceptable for the Italian translation. Within the Italian sample, correlation analyses suggested that CARTS Mother ratings referring to attachment and abuse were associated with romantic attachment, whereas CARTS Father ratings were significantly correlated to PTSD symptoms and other symptoms of psychopathology-distress. Significant differences between Italian and Canadian students across the relationship types for the CARTS abuse and attachment scales were found, indicating that Italian students rated their mothers and fathers as simultaneously less abusive, but also less as a source of secure attachment. Conclusions: The results of this preliminary study seem to suggest convergent validity of the Italian CARTS and the association between childhood attachment-related experiences and romantic attachment. Cultural variations were identified between Canadian and Italian students in both attachment and abuse scales. Future studies to investigate cross-cultural variations in the relational context of childhood abuse and in order to boost Italian CARTS psychometric features are warranted.

Altered resting-state functional connectivity in emotion-processing brain regions in adults who were born very preterm

BACKGROUND

Very preterm birth (VPT; <32 weeks of gestation) has been associated with impairments in emotion regulation, social competence and communicative skills. However, the neuroanatomical mechanisms underlying such impairments have not been systematically studied. Here we investigated the functional integrity of the amygdala connectivity network in relation to the ability to recognize emotions from facial expressions in VPT adults.

METHOD

Thirty-six VPT-born adults and 38 age-matched controls were scanned at rest in a 3-T MRI scanner. Resting-state functional connectivity (rs-fc) was assessed with SPM8. A seed-based analysis focusing on three amygdalar subregions (centro-medial/latero-basal/superficial) was performed. Participants' ability to recognize emotions was assessed using dynamic stimuli of human faces expressing six emotions at different intensities with the Emotion Recognition Task (ERT).

RESULTS

VPT individuals compared to controls showed reduced rs-fc between the superficial subregion of the left amygdala, and the right posterior cingulate cortex (p = 0.017) and the left precuneus (p = 0.002). The VPT group further showed elevated rs-fc between the left superficial amygdala and the superior temporal sulcus (p = 0.008). Performance on the ERT showed that the VPT group was less able than controls to recognize anger at low levels of intensity. Anger scores were significantly associated with rs-fc between the superficial amygdala and the posterior cingulate cortex in controls but not in VPT individuals.

CONCLUSIONS

These findings suggest that alterations in rs-fc between the amygdala, parietal and temporal cortices could represent the mechanism linking VPT birth and deficits in emotion processing.

Evaluation by Environmental Monitoring of Pesticide Absorption in Farm Workers of 18 Italian Tomato Cultivations

Tomato cultivation farms of Southern Italy were investigated in order to evaluate the general working conditions and the levels of exposure of farm workers to pesticides, during the mixing/loading and the application of pesticides on fields. Information on working modalities, personal protective equipment, etc. was collected using a questionnaire. Inhaling and cutaneous exposure levels were measured, and the estimated pesticide total absorbed dose was compared with Admissible Daily Intakes (ADIs). Field treatments were mainly carried out by using sprayers with open cab tractors, and, in 57.9% of cases, the pesticide mixture was manually prepared by mixing pesticides in a pail, often without using gloves (59.5%). The estimated pesticides absorbed doses varied in the range 0.56–2630.31 mg (mean value, 46.9 mg), and 20% of the measured absorbed doses exceeded ADIs. The findings obtained in the 18 examined farms show a worrying situation, suggesting the investigation of many more farms, so that a statistically significant picture of tomato cultivations in Southern Italy could be formed. Besides, the planning of training courses aimed to increase workers consciousness about health risks and how they can be prevented is advisable.

Toward the optimization of double-pulse LIBS underwater: effects of experimental parameters on the reproducibility and dynamics of laser-induced cavitation bubble

Double-pulse laser-induced breakdown spectroscopy (LIBS) was recently proposed for the analysis of underwater samples, since it overcomes the drawbacks of rapid plasma quenching and of large continuum emission, typical of single-pulse ablation. Despite the attractiveness of the method, this approach suffers nevertheless from a poor spectroscopic reproducibility, which is partially due to the scarce reproducibility of the cavitation bubble induced by the first laser pulse, since pressure and dimensions of the bubble strongly affect plasma emission. In this work, we investigated the reproducibility and the dynamics of the cavitation bubble induced on a solid target in water, and how they depend on pulse duration, energy, and wavelength, as well as on target composition. Results are discussed in terms of the effects on the laser ablation process produced by the crater formation and by the interaction of the laser pulse with floating particles and gas bubbles. This work, preliminary to the optimization of the spectroscopic signal, provides an insight of the phenomena occurring during laser ablation in water, together with useful information for the choice of the laser source to be used in the apparatus.

[Production cycles and risk agents]

Agricultural working contexts are characterized by numerous and heterogeneous working activities, leading to a noteworthy variety of risks for workers' healthcare. Safety and health risks vary according to each specific working activity, following seasonal cycles and productive process's phases. In particular, here the attention has been focused on the main risks factors present in large farms for fruit crops production, greenhouses and silos. Preventive measures for risks management are indicated in relation to each working activity step. Together with injury risks, essentially due to work equipment and machinery, unfavourable microclimatic conditions and hazards related to the manual handling of loads are often present, as well as chemical and biological risk agents adopted during the sterilization, disinfection and fertilization of grounds, plants and storage places. The reported findings highlight the necessity of increasing the risk consciousness of agricultural operators in order to facilitate the adoption of indispensable preventive and protective measures.

Effect of smoking status on pocket probing depth and bleeding on probing following non-surgical periodontal therapy

AIM

Cigarette smoking is a risk factor for periodontitis incidence and progression. Contrasting results were obtained when the impact of cigarette smoking on the clinical outcomes of non-surgical periodontal therapy (NSPT) was evaluated. The present study was designed to evaluate the smoking status as outcome determinant of NSPT.

METHODS

Two groups of patients with different smoking status (smoker group, S, and non-smoker group, NS) were retrospectively selected from a pool of patients seeking care for periodontitis. The effectiveness of NSPT was assessed by evaluating the changes in 1) the prevalence of sites with different pocket probing depth (PPD), and 2) the patient- and site-specific bleeding.

RESULTS

Group S comprised of 65 patients (mean age: 45.6+/-8.7 years; 24 males and 41 females) and group NS comprised of 66 patients (mean age: 46.8+/-11.7 years; 17 males and 49 females). A statistically significant increase in the prevalence of sites with PPD< or =3 mm (P<0.000), as well as a significant decrease in the prevalence of sites with PPD 4/6 mm (P<0.000) and PPD> or =7 mm (P< or =0.01) was detected at re-evaluation. BoP scores were significantly reduced for the entire dentition (P<0.000) as well as for sites with PPD< or =3 mm (P<0.01) and PPD 4/6 mm (P<0.000) in both group S and group NS. No statistically significant differences in the post treatment change of PPD and BoP scores were detected between groups.

CONCLUSION

Our results seem to suggest that smoking status has a limited, if any, effect on the clinical outcomes of NSPT.

Toxicological properties of nanoparticles of organic compounds (NOC) from flames and vehicle exhausts

We examined the biological reactivity in vitro of nanoparticles of organic compounds (NOC) with diameters, d = 1-3 nm, a class of combustion-generated particulate relatively unstudied compared to larger more graphitic soot particles because of their small size even though they may contribute significantly to the organic fraction of PM sampled from vehicle exhausts and urban atmospheres. We tested NOC samples collected from 2004 model vehicle emissions and laboratory flames. NOC produced a dose dependent mutagenic response in Salmonella bacteria, suggesting that NOC may add significantly to the overall mutagenicity of vehicle emissions. Incubation with peptides caused agglomeration and precipitate of the otherwise stable NOC suspension, but the chemical and/or physical nature of the NOC-peptide interactions could not be resolved. A significant cytotoxic response was measured above a critical dose of NOC in mouse embryo fibroblasts NIH3T3 cells along with possible evidence of cellular uptake by optical and confocal microscopy. The toxicological assays showed that NOC collected from flames and vehicle exhausts effectively interacted in vitro with both prokaryotic and eukaryotic cells. Differences in mutagenic potencies observed for various Salmonella strains with and without metabolic activation indicate differences in the chemical composition of NOC collected from different vehicles and flames.

[Algorithm validation for pesticide exposure risk evaluation by environmental monitoring data]

The risk evaluation related to the occupational exposure to hazardous substances can be performed either by analytical data coming from environmental and/or biological monitoring or by using models and mathematical algorithms. Models are often considered economically more advantageous, nevertheless, in order to assure their reliability, they need to be validated by objective monitoring data. A predictive model for the evaluation of risks due to the exposure to pesticides in agriculture was elaborated, and, for model validations, 20 tomato farms were examined. For each farm, information necessary to the risk evaluation by using the elaborated algorithm were collected and, simultaneously, an environmental monitoring for the evaluation of inhaling and cutaneous exposure was carried out. The potential risk was estimated by comparing analytical data from environmental monitoring with respect to ADI (Admissible Daily Intake) values, for each investigated pesticide. Then, the accordance between the potential risk and the risk given by the elaborated model was evaluated and an agreement of 85.6% was found, showing a substantial reliability of the proposed model.

Analytical and semipreparative high performance liquid chromatography enantioseparation of new substituted 1-thiocarbamoyl-3,5-diaryl-4,5-dihydro-(1H)-pyrazoles on polysaccharide-based chiral stationary phases in normal-phase, polar organic and reversed-phase conditions

The direct HPLC enantioseparation of five pairs of new chiral pyrazole derivatives on coated cellulose- and amylose-based chiral stationary phases (Chiralpak AD, Chiralcel OJ and Chiralcel OJ-RH) and new immobilised amylose-based Chiralpak IA CSP was performed. Very high enantioselectivity factor (alpha) values were achieved in polar organic and reversed-phase conditions by using OJ-RH as CSP. Chiralpak IA exhibited an excellent chiral resolving ability in normal-phase mode and it allowed the enantioseparation of analytes investigated with resolution factors (Rs) >20. Due to its bonded nature, it was successfully employed at analytical and semipreparative scale in combination with normal-phase eluents containing "non-standards" solvents such as acetone.

[Combustion generated nanoparticles: mutagenicity and chemical reactivity]

Nanoparticles of organic carbon (NOC) are formed in combustion of hydrocarbon-rich fuels and have been detected in vehicle exhausts, suggesting their presence in urban atmospheres. Epidemiological studies showed that some causal relationships exist between particle concentration in the air and a wide range of health effects, but no toxicological studies are reported on the potential health risk of particles smaller than 4 nm. The present study investigated the mutagenicity and the reactivity of NOC collected in water samples from the exhausts of diesel and gasoline engines. Mutagenicity was tested following the Ames Test, with and without metabolic activation. Reactivity was investigated by using a new approach aimed to identify electrophilic agents present in the sample material, which if introduced into the organism, could interact with nucleophilic sites of biological macromolecules (DNA and proteins), forming adducts. Given the large number of nucleophilc sites within biological macromolecules, the complexity of NOC, and the inexact knowledge of its chemical structure, this approach was simplified by examining in vitro interactions between NOC particles and model peptides through LCIMS analyses of incubation mixtures The results indicate a high reactivity and, in several cases, the mutagenicity of NOCs, thus calling for suitable biomarkers assess NOC exposure associated with vehicle emissions.

Mono- and diiodocyclophosphamide as possible internal standards for cyclophosphamide quantification: characterization by ion trap multi-stage mass spectrometry and effects of iodine-chlorine substitution on the fragmentation pattern

Hospital personnel involved in antineoplastic drug preparation and administration to patients are exposed to large amounts of these drugs. Labour legislation indicates the necessity of planning monitoring strategies aimed at prevention and/or reduction of drug exposure. Monitoring strategies consist of quantitative determinations of indicators, present in environmental and biological matrices. Among the antineoplastic drugs widely used, cyclophosphamide (CP) has been identified as a suitable indicator of potential exposure to mixtures of antineoplastic drugs. Many literature methods for quantitative analysis of CP involve either liquid (LC) or gas chromatography (GC) with mass spectrometry (MS), both of which require use of a suitable internal standard. The present work focuses on the synthesis of mono- and diiodocyclophosphamide (CPI and CPI(2)) to be used as internal standard. These compounds were analyzed by GC/EI-MS/MS and LC/ESI-MS(n) using ion trap mass spectrometry. The product ion mass spectra are interpreted in terms of proposed structures of fragment ions. Iodine-chlorine substitution resulted in a weakening of the carbon-halogen bond with a noteworthy influence on the ion fragmentation processes. The proposed suitability of CPI and CPI(2) as internal standards was based on similarities to CP as regards ionization and fragmentation processes. The results obtained suggest that CPI could be used as internal standard for CP quantification by LC/ESI-MS/MS, and CPI(2) for GC/EI-MS/MS analyses.

Identification of 14 rare marker chromosomes and derivatives by spectral karyotyping in prenatal and postnatal diagnosis

Extra structurally abnormal chromosomes (ESACs) and cryptic rearrangements are often associated with mental retardation and phenotypic abnormalities. In some cases their characterisation, using standard cytogenetic techniques and fluorescence in situ hybridization (FISH), is difficult and time consuming, where a fast and accurate identification is essential, especially when such chromosomal aberrations are found in prenatal diagnosis. A recent molecular technique, spectral karyotyping (SKY), based on the spectral signature of 24 chromosome-specific painting probes labelled with different combinations of five fluorochromes, allows the simultaneous visualisation of all human chromosomes in different colours. We used SKY analysis on 14 cases with rare ESACs or cryptic unbalanced rearrangements found at pre- or postnatal diagnosis. SKY analysis permitted the classification of chromosome rearrangements in all 14 cases analysed in combination with FISH analysis.

Biliopancreatic diversion

Biliopancreatic diversion (BPD) has made reacceptable the malabsorptive approach to the surgical treatment of obesity. The procedure, in a series of 2241 patients operated on during a 21-year period, caused a mean permanent reduction of about 75% of the initial excess weight. The indefinite weight maintenance appears to be due to the existence of a threshold absorption capacity for fat and starch, and thus energy, and the weight loss is partly due to increased resting energy expenditure. Beneficial effects other than those consequent to weight loss or reduced nutrient absorption included permanent normalization of serum glucose and cholesterol without any medication and on totally free diet in 100% of cases, both phenomena being due to a specific action of the operation. Operative mortality was less than 0.5%. Specific late complications included anemia, less than 5% with adequate iron or folate supplementation (or both); stomal ulcer, reduced to 3.2% by oral H2-blocker prophylaxis; bone demineralization, increasing up to the fourth year and tending to decrease thereafter, with need of calcium and vitamin D supplementation; neurologic complications, totally avoidable by prompt vitamin B administration to patients at risk; protein malnutrition, which was reduced to a minimum of 3% with 1.3% recurrence, in exchange with a smaller weight loss, by adapting the volume of the gastric remnant and the length of the alimentary limb to the patient's individual characteristics. It is concluded that the correct use of BPD, based on the knowledge of its mechanisms of action, can make the procedure an effective, safe one in all hands.

[Morpho-functional adaptation and motility of the small intestine and colon after extensive intestinal exclusions]

Recent advances in anesthetic and surgical techniques have increased the survival of patients after extensive bowel exclusions. This, in addition to the increased use of intestinal bypass for the treatment of obesity, has substantially increased the number of persons living with a short bowel. Proper management of these individuals is based on a thorough understanding of the pathophysiology of the shortened gastrointestinal tract.

[6 years of experience in inguinal and femoral hernioplasty in patients over 65 years of age]

From April 1990 to November 1996, 313 inguinal and 14 femoral hernias were repaired in 295 subjects with a mean age of 74 years (66 to 97). Concomitant diseases increasing the operative risk were present in 206 subjects (70 per cent). A mesh repair was performed with "tension-free" or "plug" techniques in all but 23 inguinal and 2 femoral herniorrhaphies where the Bassini or the Shouldice procedures were adopted. Fifty-two inguinal hernias were recurrent, 11 emergency herniorrhaphies were performed for strangulation. Almost all operations (305), including 9 emergency herniorrhaphies, were carried out under local anaesthesia. There was no perioperative mortality. Acute intestinal bleeding occurred after surgery in a subject with colon diverticulosis. One urinary retention following emergency hernia repair under general anaesthesia and 2 following elective hernia repair under local anaesthesia in 2 subjects with hypertrophy of the prostate were observed. Some episodes of hypotension and/or bradycardia were observed either during or after surgery. Local complications following inguinal hernioplasty were 5 (1.5%) scrotal hematomas, 3 (0.9%) wound infections and 1 case (0.4%) of orchitis with atrophy after repair of a recurrent hernia. There were 1 recurrence after Bassini, 1 after Shouldice, and 1 (0.4%) after mesh inguinal hernioplasty. Using local anaesthesia and a mesh repair elective surgery of inguinal and femoral hernias can be safely and effectively performed in elderly patients. Consequently, early elective surgery should be recommended to avoid the risk of an emergency operation.

Achievement of near-normal body weight as the prerequisite to normalize sex hormone-binding globulin concentrations in massively obese men

OBJECTIVE

To investigate the effects of weight loss on sex hormone-binding globulin (SHBG) in massively obese males and whether normal SHBG concentrations could be obtained regardless or not of the achievement of normal body weight values.

DESIGN AND SUBJECTS

Sera were collected for SHBG determination from 63 massively obese men, partly before they underwent biliopancreatic diversion (pre-op group = 11) and partly during the post-surgical follow up (post-op group = 52), and twenty normal weight healthy control men.

MEASUREMENTS

Serum SHBG was measured using a noncompetitive liquid-phase immunoradiometric assay.

RESULTS

Baseline general characteristics were similar in both obese groups. Obese patients in the post-op group had lost 46.4 +/- 2.9 kg since they had undergone operation, namely during a mean period of 14.9 +/- 13.8 (range 1-58) months follow up. Obese groups had significantly lower SHBG than normal weight controls (66.2 +/- 18.6 nmol/l). However, pre-op obese (19.9 +/- 5.5 nmol/l) had significantly lower values than post-op obese subjects (45.5 +/- 24.8 nmol/l; P < 0.001). There were a highly significant correlation between SHBG and individual BMI values (r = -0.629; P < 0.001). Moreover, the post-op obese with BMI values lower or equal to 28 had significantly higher SHBG concentrations than those with BMI greater than 28 (62.8 +/- 22.2 nmol/l vs 32.1 +/- 19.6 nmol/l; P < 0.001), but not significantly different with respect to normal weight controls.

CONCLUSIONS

Massively obese men weight loss can completely reverse SHBG abnormalities, which can be restored to the normal range when near-normal body weight is achieved. Since reduced SHBG concentrations can be an independent risk factor for the development of diabetes and cardiovascular disease, this represents an additional benefit of weight loss program in massively obese individuals.

[Intrahepatic dilation of the bile ducts. Particularity of a clinical case]

We report the case of a 71 years old male patient with a "simple" form of Caroli's syndrome. The "simple" form is less common than the form associated with congenital hepatic fibrosis. In this case the intrahepatic bile duct dilatation was confined to the segments V and VI, and intrahepatic lithiasis and cholelithiasis were associated. Usually, Caroli's syndrome remains asymptomatic for the first 20 years of the patient's life, sometimes longer, and in few cases for the patient's whole life. "Simple" asymptomatic Caroli's syndrome is generally unrecognized and in our own case it was an intraoperative finding. Patient's age, the presence of a hepatitis C and the absence of malignant changes discouraged us from performing a right hepatectomy and then a Roux-en-Y intrahepatic bile duct jejunal anastomosis was done. One year after the operation the patient is leading a normal life, and he is symptom-free.

[Clinical and functional effects of domiodol and sobrerol in hypersecretory bronchopneumonias]

A double-blind study has been carried out in adult patients suffering from acute and chronic bronchitis, and acute exacerbation of chronic hypersecretory bronchitis, excluding the bronchorreic forms, in order to evaluate the mucolytic activity of orally given domiodol and sobrerol. Treatment with both drugs resulted in an improvement in the subjective measures of ease of expectoration, severity of coughing and sputum consistency; however, there was no improvement in respiratory functions. Moreover, domiodol resulted in a significant increase in sputum volumes, since the very first days of treatment.