Influence of COVID-19 Pandemic on Colorectal Cancer Presentation, Management and Outcome during the COVID-19 Pandemic

The aim of the study was to investigate whether the COVID-19 pandemic and related measures had an influence on colorectal cancer (CRC) presentation, management, and outcomes; it was a retrospective monocentric study. CRC patients undergoing surgery during the COVID-19 pandemic (1 March 2020-28 February 2022) (group B) were compared with patients operated on in the previous two years (1 March 2018-29 February 2020) in the same unit (group A). The primary outcome was to investigate whether there were differences in concern regarding the stage at presentation, as a whole and after dividing groups based on cancer location (right colon cancer, left colon cancer, rectal cancer). Secondary outcomes included differences in the number of patients admitted from emergency departments and emergency surgeries between periods, and differences in the postoperative outcomes. A subanalysis within the pandemic group was conducted on the same outcomes, dividing the aforementioned group based on pandemic trends. Two hundred and eighty (280) were operated on during the study period: 147 in group A and 133 in group B. Stage at presentation was similar between groups; however, the subgroups analysis showed that in the pandemic group, the number of early-stage left colon cancer occurrences almost halves, yet not significantly. Emergency department referral was more common in group B (p-value: 0.003); in group B, they also had longer operations and there was a more frequent use of ostomy. No differences in the number of postoperative complications nor in the postoperative outcomes were found. Patients with CRC were more frequently referred through the emergency department during the COVID-19 pandemic and left-sided cancers appear to be generally diagnosed at a more advanced stage. Postoperative outcomes showed that high specialized colorectal units can deliver standard high-level treatment under high-pressure external conditions.

Inner southern magnetosphere observation of Mercury via SERENA ion sensors in BepiColombo mission

Mercury's southern inner magnetosphere is an unexplored region as it was not observed by earlier space missions. In October 2021, BepiColombo mission has passed through this region during its first Mercury flyby. Here, we describe the observations of SERENA ion sensors nearby and inside Mercury's magnetosphere. An intermittent high-energy signal, possibly due to an interplanetary magnetic flux rope, has been observed downstream Mercury, together with low energy solar wind. Low energy ions, possibly due to satellite outgassing, were detected outside the magnetosphere. The dayside magnetopause and bow-shock crossing were much closer to the planet than expected, signature of a highly eroded magnetosphere. Different ion populations have been observed inside the magnetosphere, like low latitude boundary layer at magnetopause inbound and partial ring current at dawn close to the planet. These observations are important for understanding the weak magnetosphere behavior so close to the Sun, revealing details never reached before.

A compact evolved antenna for 5G communications

Flexible and bendable electronics are gaining a lot of interest in these last years. In this scenario, compact antennas on flexible substrates represent a strategical technological step to pave the way to a new class of wearable systems. A crucial issue to overcome is represented by the poor radiation properties of compact antennas, especially in the case of flexible and thin substrates. In this paper, we propose an innovative design of a miniaturized evolved patch antenna whose radiation properties have been enhanced with a Split Ring Resonator (SRR) placed between the top and the ground plane. The antenna has been realized on a flexible and biocompatible substrate polyethylene naphthalate (PEN) of 250 μm by means of a new fabrication protocol that involves a three-layer 3D-inkjet printing and an alignment step. The antenna has been characterized in terms of the scattering parameter S₁₁ and the radiation pattern showing a good agreement between simulations and measurements.

Acute appendicitis in elderly during Covid-19 pandemic

PURPOSE

During the past months, the Italian Government has reduced the restrictions and access to hospitals. Since then, up to 40% of non-traumatic abdominal emergencies have had unusual delayed treatment. Given the rapidly evolving situation and the absence of evidence to support recommendations during the pandemic, it is useful to assess how the current situation is influencing the management of elderly with acute appendicitis.

METHODS

Between February 2020 and December 2020, all patients older than 68 years old undergone appendectomy were included. Surgical approach, hospital stay, post-operative complications, radiology reports, and histologic examination were included in the retrospective analysis and compared with a same sample of the same period before the pandemic.

RESULTS

Twenty-seven patients underwent appendectomy for acute appendicitis during the pandemic and 34 patients in the pre-outbreak period. Laparoscopic approach was completed in 51.8% of the cases, while conversion to laparotomy in 22.3% of patients and open procedure in the 25.9%, before the pandemic 73.6%, 14.7%, and 11.7%, respectively. During the pandemic, complicated appendicitis occurred in 59.3% of the cases (26.5% before the outbreak). One patient was treated for a pelvic abscess, while no minor complications were detected. No mortality rate was reported, with a mean hospital stay of 5.64 days during the outbreak and 4.21 days before the pandemic.

CONCLUSION

Our data highlighted a partial delay in diagnosis in the elderly group, and an increase in complicated appendicitis also demonstrated by the need for conversion to laparotomy.

A Multisite Preregistered Paradigmatic Test of the Ego-Depletion Effect

We conducted a preregistered multilaboratory project (k = 36; N = 3,531) to assess the size and robustness of ego-depletion effects using a novel replication method, termed the paradigmatic replication approach. Each laboratory implemented one of two procedures that was intended to manipulate self-control and tested performance on a subsequent measure of self-control. Confirmatory tests found a nonsignificant result (d = 0.06). Confirmatory Bayesian meta-analyses using an informed-prior hypothesis (δ = 0.30, SD = 0.15) found that the data were 4 times more likely under the null than the alternative hypothesis. Hence, preregistered analyses did not find evidence for a depletion effect. Exploratory analyses on the full sample (i.e., ignoring exclusion criteria) found a statistically significant effect (d = 0.08); Bayesian analyses showed that the data were about equally likely under the null and informed-prior hypotheses. Exploratory moderator tests suggested that the depletion effect was larger for participants who reported more fatigue but was not moderated by trait self-control, willpower beliefs, or action orientation.

Challenges in quantification of photocatalytic NO2 abatement effectiveness under real world exposure conditions illustrated by a case study

Health risks due to NO₂ exposure commonly exceed acceptable levels in modern societies. Among the measures to reduce such risks, photocatalytic materials present a promising technology. However, while the pollutant remediation of such materials has been extensively validated in laboratory studies, the performance under real world environmental exposure conditions is still subject to controversy. Indeed, a comparison of available in-situ monitoring studies manifests non-conclusive and highly scattered results regarding the photocatalytic effectiveness observed. The reasons for this behaviour must be carefully explored in order to prevent non-efficient photocatalytic applications from being put into practice on a larger scale. This paper presents a comprehensive large-scale study for assessing the photocatalytic NO₂ remediation by active pavements in a street of Madrid (Spain), comprising different in-situ monitoring techniques. The discussion is enriched by relating the obtained results to those of other large-scale studies. The discrepancies between these results may be traced back to different circumstances, among them the distance between the active pavement and the pollutant concentration sampling inlet, as well as to significant site-specific and time-dependent variations of pollutant concentrations and climatic parameters. Under due consideration of these influences, for materials with relatively high initial effectiveness, it was concluded that in most such applications, the average NO₂ removal effectiveness, if evaluated at a typical inlet height of Air Quality Stations (3 m), will not exceed a value of 4% (averaged over a sufficiently large number of measurement points in the area of application and a sustained amount of time, i.e. several months). When considering more realistic human exposure conditions (lower heights and daytime), it might be justified to assume somewhat higher average effectiveness.

SERENA: Particle Instrument Suite for Determining the Sun-Mercury Interaction from BepiColombo

The ESA-JAXA BepiColombo mission to Mercury will provide simultaneous measurements from two spacecraft, offering an unprecedented opportunity to investigate magnetospheric and exospheric particle dynamics at Mercury as well as their interactions with solar wind, solar radiation, and interplanetary dust. The particle instrument suite SERENA (Search for Exospheric Refilling and Emitted Natural Abundances) is flying in space on-board the BepiColombo Mercury Planetary Orbiter (MPO) and is the only instrument for ion and neutral particle detection aboard the MPO. It comprises four independent sensors: ELENA for neutral particle flow detection, Strofio for neutral gas detection, PICAM for planetary ions observations, and MIPA, mostly for solar wind ion measurements. SERENA is managed by a System Control Unit located inside the ELENA box. In the present paper the scientific goals of this suite are described, and then the four units are detailed, as well as their major features and calibration results. Finally, the SERENA operational activities are shown during the orbital path around Mercury, with also some reference to the activities planned during the long cruise phase.

Sclerotherapy with 3% polidocanol foam for third- and fourth-degree hemorrhoids as "bridge treatment" during the COVID-19 pandemic in Italy

PURPOSE

In Italy, colorectal surgery has been strongly affected with the vast majority (90%) of operations treating benign diseases, with an estimated overall 12-week cancellation rate of 72%. Little is known on how to best manage patients with benign diseases and the consequences this interruption of care will have in post-pandemic times. Proctologic diseases have social, psychological, and healthcare repercussions for their high incidence and great impact on the quality of life.

METHODS

We decided to treated 10 urgent cases affected from III- and IV-degree hemorrhoids with 3% polidocanol foam in attempt to reduce hemorrhoidal symptoms while waiting for surgery so called "bridge treatment".

RESULTS

During the follow-up no complications were occurred, and all patients had resolution of bleeding and pruritus with a mean VAS of 1 (range, 0-1).

CONCLUSIONS

This treatment could reduce the bleeding that is the main symptom from which patients suffer and for which they underwent proctological evaluation and surgery. According to our preliminary experience in the impossibility of accessing the surgery during the COVID-19 pandemic, ST could be considered as the treatment of choice in those patients who are suffering from grade III- and IV-degree hemorrhoids while waiting for surgery.

Environmental impact of nano-functionalized construction materials: leaching of titanium and nitrates from photocatalytic pavements under outdoor conditions

There is a growing use of nano-functionalized construction materials, which contain nanoparticles embedded in their bulk or deposited on their surfaces. In the case of photocatalytic materials, nano-TiO₂ is usually added to provide it's functionality. One concern about these materials, in addition to release of nanoparticles as airborne, is that they can be leached into the aquatic environment. Moreover, water eutrophication could be caused due to the increase in NO₃^- as a product of the photocatalytic oxidation of NOx in runoff. In this paper, a systematic long term campaign assessing these potential side effects in the real outdoor environment has been carried out. Rainwater leachates from 4 m² slabs of 7 different photocatalytic materials exposed outdoors in two different locations (platforms) were collected and analysed over more than 800 days. Ti, NO₃^-, pH and conductivity were analysed. Ti was found in the leachates of almost every material, without a clear relation with the type of application (percolated cementitious slurry, suspension/emulsion or TiO₂ built-in). The highest concentration found was of 60 μg/L, which seems to be rather small when comparing with some threshold values for drinking water. In all the cases, the detected TiO₂ nanoparticles from water leachates were embedded in large microparticle agglomerates coming from the construction material matrix, which are less dangerous than nanoparticles. Nitrates were leached in clear relation with the NOx oxidation photocatalytic performance, and the observed concentrations were not higher than those in the recycled water used by the Madrid City Council to clean the streets.

New Holistic Conceptual Framework for the Assessment of the Performance of Photocatalytic Pavement

Despite serious health and environmental burdens associated with air pollution by NO_x, the emission ceilings have been systematically exceeded in big European cities for several years. Photocatalytic technology can be an efficient solution for the removal of chemical air pollutants. Because diesel engine exhaust is the main source of NO_x emissions, the application of a photocatalyst onto road pavement appears to be an effective NO_x abatement method due to the large surface area, proximity to the emission source, and relatively good solar irradiance. Several laboratory-scale studies provided evidence demonstrating that most harmful contaminants can be readily mineralized. Furthermore, several projects were aiming to scale up this technology to pilot and real scales. Although the photocatalytic performances of selected materials in real urban environments were determined in some of these studies, the data are not conclusive for evaluating the overall performance because other material characteristics relevant to their functionality were not assessed. The lack of conformity criteria suitable for the evaluation of the overall performance of photocatalytic pavement under real operational conditions has generated skepticism and mistrust among public authorities and relevant stakeholders, which constrains the widespread implementation of this promising technology. In this context, the project LIFE-Photoscaling was focused on developing a new holistic conceptual framework to assess the photocatalytic pavement performance using the decision tool "Photoscaling Decision Maker" based on a set of quantitative indicators. For this purpose, a large volume of data obtained for 10 types of photocatalytic pavement materials was systemized on both the laboratory and pilot plant scales and three main indicators were defined: (1) photocatalytic performance effectiveness, (2) intrinsic performance, and (3) undesired secondary effects. Each top-level indicator includes several low-level subindicators associated with specific material characteristics. Finally, the ranges of the main indicators and subindicators and methods for their assessment were determined. These methods include standard, adopted, and original characterization techniques, which were selected based on the criteria such as simplicity, cost- and time-effectiveness, and relevance regarding the operational conditions.

Assessment of urban air pollution related to potential nanoparticle emission from photocatalytic pavements

The main objective was to evaluate whether wearing and weathering of nanofunctionalized photocatalytic pavement in real urban environment can lead to undesirable emission of potentially toxic nanoparticle aerosols in urban air. The photocatalytic material was thoroughly tested before its application for conformity criteria in terms of photocatalytic effectiveness, intrinsic performance and undesired secondary effects, and then applied on a pilot scale in downtown Madrid. The aerosol monitoring on the pilot street before the coating applications as well as on the neighbouring streets during 10 months was used as a benchmark for evaluation of spatial and temporal variations. Analysis of the experimental data did not reveal any statistically significant variations in the aerosol concentrations on the pilot street in comparison with the benchmark. The concentration of Ti-containing particles was assessed by aerosol sampling and yielded values below 10 cm^-3 that is more than three orders of magnitude below the toxicological limits. A theoretical model was developed to assess the upper bound of nanoparticle aerosol concentration in air. These findings indicated that photocatalytic pavement materials, which comply with conformity criteria under laboratory tests, can have low impact on the particulate contamination of urban air.

Safer Surgery Checklist: Barriers in the Adoption of Tablets in Operating Room

It is crucial that registering the checklist needs to be done synchronously and according to the care tasks within the operating room. Therefore, we aim to find out what are the difficulties that the surgical technicians have when checking the list and exploring potential barriers to implementing the use of tablets. Qualitative research was conducted based on focus groups, in-depth interviews and on-site observations until a full coverage of the topics was achieved. We detected that this problem includes technical aspects (connectivity, hardware and software issues), those related to workflow and logistics, those related with registration process, and those related to organization culture and power structure. Based on results, we developed a plan to solve problems detected.

NOx removal efficiency of urban photocatalytic pavements at pilot scale

Photocatalytic technology implemented in construction materials is a promising solution to contribute to alleviate air quality issues found in big cities. Photocatalysis has been proved able to mineralise most harmful contaminants. However, important problems associated with monitoring the efficiency of these solutions under real conditions still remain, including the lack of affordable analytical tools to measure NO_x concentrations with enough accuracy. In this work, two pilot scale demonstration platforms were built at two different locations to assess the photocatalytic NO_X removal efficiency of ten selected materials exposed outdoors for AQmesh low-cost sensor PODs were used to measure ground-level to measure NO and NO₂ concentrations during nearly one year. The pollutant removal efficiency of the materials was then calculated based on a comparison with simultaneously concentration measurements carried-out on reference, non-active materials. It was found that the NO₂ removal efficiency presented large variations across the seasons, with maxima during the warmer months, while NO efficiencies were comparatively steadier. Statistical analysis delivered evidence that the efficiencies significantly depend on different meteorological variables (irradiance and relative humidity) besides NO, NO₂ ambient concentrations. Lower efficiencies were observed for higher concentration levels and vice versa. The influence of water vapour could be related to two different effects: a short-term contribution by the instantaneous air humidity and a long-term component associated with the hygroscopic state of the material. The contribution of wind to the pollutant removal efficiencies was principally related to the humidity of air masses moving above the location and to the advection of pollutants from specific emission sources.

Amplitude and phase modulation in microwave ring resonators by doped CVD graphene

In this paper, we numerically and experimentally demonstrate how to modulate the amplitude and phase of a microwave ring resonator by means of few-layers chemical vapour deposition graphene. In particular, both numerical and experimental results show a modulation of about 10 dB and a 90 degrees-shift (quadrature phase shift) when the graphene sheet-resistance is varied. These findings prove once again that graphene could be efficiently exploited for the dynamically tuning and modulation of microwave devices fostering the realization of (i) innovative beam-steering and beam-forming systems and (ii) graphene-based sensors.

Added value of chromosomal microarray analysis over karyotyping in early pregnancy loss: systematic review and meta-analysis

OBJECTIVE

To estimate the increased test success rate and incremental yield of chromosomal microarray analysis (CMA) over conventional karyotyping in detection of pathogenic copy number variants (CNVs) and variants of unknown significance (VOUS) in early pregnancy loss.

METHOD

This was a systematic review conducted in accordance with PRISMA criteria. All articles identified in PubMed, Ovid MEDLINE and Web of Science, between January 2000 and April 2017, that described CNVs in early pregnancy losses (up to 20 weeks) were included. Risk differences were pooled to estimate the incremental yield of CMA over karyotyping overall, and after stratification. In addition, test success rate, defined as the proportion of informative results, was compared in series in which CMA and karyotyping were performed concurrently.

RESULTS

Twenty-three studies, reporting on 5507 pregnancy losses up to 20 weeks with full data available, met the inclusion criteria for analysis. In the series in which CMA and karyotyping were performed concurrently, CMA showed a significant improvement in success rate, providing informative results in 95% (95% CI, 94-96%) of cases compared with karyotyping in which informative results were provided in 68% (95% CI, 66-70%) of cases. Combined data from reviewed studies revealed that incremental yields of CMA over karyotyping were 2% (95% CI, 1-2%) for pathogenic CNVs and 4% (95% CI, 3-6%) for VOUS. The most common pathogenic CNVs reported were 22q11.21 and 1p36.33 deletion.

CONCLUSION

In comparison with conventional karyotyping, CMA provides a significant increase in test success rate and incremental diagnostic yield in early pregnancy loss. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Endometriosis: Aetiopathogenetic Basis

Endometriosis, defined by the presence of endometrial tissue outside the uterine cavity, is a common condition affecting 10% of women in the reproductive age. Menstrual factors reported to increase risk include dysmenorrhea, early menarche, and shorter cycle lengths. The theory of retrograde menstruation with implantation of endometrial fragments, in conjunction with peritoneal factors to stimulate cell growth is the most widely accepted.

There is a growing body of evidence that immunological factors and angiogenesis play a key role in the pathogenesis of endometriosis. In women with endometriosis, there appears to be an alteration in the function of peritoneal macrophages, natural killer cells and lymphocytes, with production of growth factors and inflammatory mediators in the peritoneal fluid. Survival, adhesion, proliferation, invasion and vascularization of endometrial tissue in abdominal cavity may be the consequence of retrograde menstruation and referred to as implantation theory.

Carcinoma dei Dotti Collettori del Bellini: Case Report con Metastasi Cutanea Come Iniziale Manifestazione Clinica

Introduction

Bellini's collecting ducts carcinoma represents a rare tumor with an aggressive behaviour with a poor prognosis and often metastatic at diagnosis. We report the first case documented of Bellini tumor with an initial clinic presentation represented by a cutaneous metastasis of scalp.

Materials and Methods

All pertinent clinical information were compiled, including patient age, sex, mode of presentation, preoperative laboratory data, radiologic findings, surgery type, macro and microscopic findings, survival data.

Results

After reporting an histopathologic finding of cutaneous metastasis of unknown origin adenocarcinoma with poorly differentiation, a voluminous 6 cm left mesorenal mass is diagnosed through uro-CT. Consequently, it is performed a left radical transperitoneal nephrectomy with consensual exeresis of scalp cutaneous lozenge at the level of previous excision. The histopathologic diagnosis reported was Bellini tumor at stage pT3a-N2-M1. It has not reported significative responsiveness to adjuvant chemotherapy and the patient was died seven months after diagnosis of cutaneous metastasis.

Conclusions

Most of Bellini's carcinoma are already metastatic at presentation. Analiyzing literature, it is never documented a cutaneous metastasis as first sign at clinical presentation. In this context, radical nephrectomy, differently from others subtypes of advanced renal cell carcinoma, does not seem to improve survival of the patient but rather, it can keep a role in palliation or in the context of new chemotherapeutic protocols.

Energy allocation strategy of skipjack tuna Katsuwonus pelamis during their reproductive cycle

The lipid composition of somatic and reproductive tissues was determined for female skipjack tuna Katsuwonus pelamis caught in the western Indian Ocean between latitude 10° N and 20° S and longitude 40° and 70° E. The highest total lipid (TL) contents were in the liver and gonads, with white muscle levels approximately three-fold lower. Three lipid classes dominated: triacylglycerols (TAG), sterol esters and wax esters (SE-WE) and phospholipids (PL). Collectively, these accounted for between 70 and 80% of TLs. Changes in lipid concentrations were evaluated over the maturation cycle. Immature fish had the lowest gonad and liver TL levels; concentrations of TL, TAG, SE-WE and PL accumulated from immature to mature (spawning-capable) phase, reflecting sustained vitellogenic activity of the liver and a transfer of lipids to developing oocytes from the onset of vitellogenesis. Gonado-somatic and hepato-somatic indices were positively correlated with each other and positively related to TL in the gonads and liver. Fulton's condition index and lipid concentrations in muscle did not vary significantly over the maturation cycle; fat content in the main storage tissues was undepleted as the ovary developed. Hence, K. pelamis apparently supports reproduction directly from food intake over the breeding season. In the gonads, reserve lipids (SE-WE and TAG) and sterols were related to batch fecundity but this was not the case for somatic and hepatic tissues. These results suggest that K. pelamis utilizes an income breeding strategy.

Optically transparent microwave screens based on engineered graphene layers

We propose an innovative approach for the realization of a microwave absorber fully transparent in the optical regime. This device is based on the Salisbury screen configuration, which consists of a lossless spacer, sandwiched between two graphene sheets whose sheet resistances are different and properly engineered. Experimental results show that it is possible to achieve near-perfect electromagnetic absorption in the microwave X-band. These findings are fully supported by an analytical approach based on an equivalent circuital model. Engineering and integration of graphene sheets could facilitate the realization of innovative microwave absorbers with additional electromagnetic and optical functionalities that could circumvent some of the major limitations of opaque microwave absorbers.

Genomic microarray in fetuses with increased nuchal translucency and normal karyotype: a systematic review and meta-analysis

OBJECTIVE

To estimate the incremental yield of detecting copy number variants (CNVs) by genomic microarray over karyotyping in fetuses with increased nuchal translucency (NT) diagnosed by first-trimester ultrasound.

METHODS

This was a systematic review conducted in accordance with PRISMA criteria. We searched PubMed, Ovid MEDLINE and Web of Science for studies published between January 2009 and January 2015 that described CNVs in fetuses with increased NT, usually defined as ≥  3.5 mm, and normal karyotype. Search terms included: fetal or prenatal, nuchal translucency or cystic hygroma or ultrasound anomaly, array comparative genomic hybridization or copy number variants, with related search terms. Risk differences were pooled to estimate the overall and stratified microarray incremental yield using RevMan. Quality assessment of included studies was performed using the Quality Assessment tool for Diagnostic Accuracy Studies (QUADAS-2) checklist.

RESULTS

Seventeen studies met the inclusion criteria for analysis. Meta-analysis indicated an incremental yield of 5.0% (95% CI, 2.0-8.0%) for the detection of CNVs using microarray when pooling results. Stratified analysis of microarray results demonstrated a 4.0% (95% CI, 2.0-7.0%) incremental yield in cases of isolated NT and 7.0% (95% CI, 2.0-12.0%) when other malformations were present. The most common pathogenic CNVs reported were 22q11.2 deletion, 22q11.2 duplication, 10q26.12q26.3 deletion and 12q21q22 deletion. The pooled prevalence for variants of uncertain significance was 1%.

CONCLUSION

The use of genomic microarray provides a 5.0% incremental yield of detecting CNVs in fetuses with increased NT and normal karyotype.

Graphene-based perfect optical absorbers harnessing guided mode resonances

We investigate graphene-based optical absorbers that exploit guided mode resonances (GMRs) attaining theoretically perfect absorption over a bandwidth of few nanometers (over the visible and near-infrared ranges) with a 40-fold increase of the monolayer graphene absorption. We analyze the influence of the geometrical parameters on the absorption rate and the angular response for oblique incidence. Finally, we experimentally verify the theoretical predictions in a one-dimensional, dielectric grating by placing it near either a metallic or a dielectric mirror, thus achieving very good agreement between numerical predictions and experimental results.

Further insights into diastolic dysfunction in first-trimester trisomy-21 fetuses

OBJECTIVE

To assess fetal cardiac function in first-trimester trisomy-21 fetuses as compared with fetuses with other aneuploidies, euploid fetuses with cardiac defects or isolated increased nuchal translucency (NT) and controls.

METHODS

During a 2.5-year period, NT, ductus venosus (DV) blood flow, diastolic filling time, early filling time, tricuspid flow, tricuspid and mitral valve E/A velocity ratios, left ventricle shortening fraction, left myocardial performance index and fetal heart rate were assessed in fetuses with a crown-rump length between 45 and 84 mm undergoing chorionic villus sampling at our center. Cardiac parameters among study groups were compared with the use of 95% CIs.

RESULTS

The study population comprised 28 fetuses with trisomy 21, 25 with other aneuploidies, 94 euploid fetuses with abnormal findings (27 with cardiac defects, 31 with other structural anomalies and 36 with isolated increased NT) and 271 controls. Trisomy-21 fetuses showed signs of diastolic dysfunction such as increased DV pulsatility index and E/A ratios together with a higher prevalence of tricuspid regurgitation. However, no differences were found in euploid fetuses with cardiac defects or isolated increased NT.

CONCLUSIONS

No signs of cardiac dysfunction were observed in euploid fetuses with increased NT or cardiac defects, while in trisomy-21 fetuses signs of diastolic dysfunction could be potentially attributed to volume overload.

Graphene-based absorber exploiting guided mode resonances in one-dimensional gratings

A one-dimensional dielectric grating, based on a simple geometry, is proposed and investigated to enhance light absorption in a monolayer graphene exploiting guided mode resonances. Numerical findings reveal that the optimized configuration is able to absorb up to 60% of the impinging light at normal incidence for both TE and TM polarizations resulting in a theoretical enhancement factor of about 26 with respect to the monolayer graphene absorption (≈2.3%). Experimental results confirm this behavior showing CVD graphene absorbance peaks up to about 40% over narrow bands of a few nanometers. The simple and flexible design points to a way to realize innovative, scalable and easy-to-fabricate graphene-based optical absorbers.

Stable planar mesoscopic photonic crystal cavities

Mesoscopic self-collimation (MSC) in mesoscopic photonic crystals with high reflectivity is exploited to realize a novel high Q-factor cavity by means of mesoscopic PhC planar mirrors. These mirrors efficiently confine a mode inside a planar Fabry-Perot-like cavity, that results from a beam focusing effect that stabilizes the cavity even for small beam sizes, resembling the focusing behavior of curved mirrors. Moreover, they show an improved reflectivity with respect to their standard distributed Bragg reflector counterparts that allows higher compactness. A Q-factor higher than 10⁴ has been achieved for an optimized 5-period-long mirror cavity. The optimization of the Q-factor and the performances in terms of energy storage, field enhancement, and confinement are detailed.

Is nuchal translucency a useful aneuploidy marker in fetuses with crown-rump length of 28-44 mm?

OBJECTIVE

To investigate whether increased nuchal translucency (NT) in fetuses with a crown-rump length (CRL) below 45 mm needs to be re-evaluated at a later stage, or whether the early NT measurement can be used effectively as an aneuploidy marker.

METHODS

This was a prospective cohort study including all singleton fetuses with a CRL between 28 and 44 mm, scanned in our center during 2002-2012. The CRL, NT, fetal karyotype (when available) and pregnancy outcome were recorded. NT reference ranges were constructed using the Lambda-Mu-Sigma (LMS) method in non-referred pregnancies after exclusion of chromosomal anomalies. The 95(th) percentile was used to calculate detection rates for chromosomally abnormal fetuses.

RESULTS

NT was successfully measured in 643 of 672 fetuses with a CRL of 28-44 mm. Subsequent cytogenetic analysis revealed 11 cases of trisomy 21, 14 cases of trisomy 13 or 18, three cases of monosomy X, three sex trisomies, three triploidies and 12 balanced anomalies. NT was above the 95(th) percentile in 64% of the fetuses with trisomy 21, in 71% with trisomy 13 or 18 and in all three cases of monosomy X.

CONCLUSION

NT appears to be useful as a marker for the early detection of fetal trisomies at 9-10 weeks' gestation (28-44 mm CRL).

Nonlinear control of absorption in one-dimensional photonic crystal with graphene-based defect

Perfect, narrow-band absorption is achieved in an asymmetric 1D photonic crystal with a monolayer graphene defect. Thanks to the large third-order nonlinearity of graphene and field localization in the defect layer we demonstrate the possibility to achieve controllable, saturable absorption for the pump frequency.

First-trimester detection of major cardiac defects with the use of ductus venosus blood flow

OBJECTIVE

To assess the best method of combining fetal nuchal translucency (NT) and ductus venosus (DV) blood flow measurements in the detection of major cardiac defects in chromosomally normal fetuses during the first-trimester scan.

METHODS

During an 8-year period NT and DV blood flow were routinely assessed at 11-14 weeks' gestation. Only chromosomally normal singleton pregnancies were included in the study. When a cardiac defect was suspected, or when increased fetal NT and/or absent or reversed (AR) A-wave in the DV was observed, early fetal echocardiography was offered. Data on routine second- and third-trimester scans, neonatal follow-up or postmortem examination were obtained from hospital records. The detection and false-positive rates for all major cardiac defects were calculated for several screening strategies, including: NT or DV pulsatility index for veins (DV-PIV) above a fixed normal centile; AR A-wave; risk based on NT and DV-PIV or A-wave velocity above a fixed normal centile; and combinations of these strategies.

RESULTS

The study population included 37 chromosomally normal fetuses with a major cardiac defect and 12 799 unaffected pregnancies. Fetal NT above the 95(th) or the 99(th) centile and AR A-wave was observed in 40, 27 and 39% of the fetuses with major cardiac defects, respectively. A 47% detection rate with a 2.7% false-positive rate was obtained when AR A-wave or NT above the 99(th) centile was used as the selection criterion.

CONCLUSIONS

Half of major fetal cardiac defects could be detected in the first trimester if NT and DV Doppler are used to select 2.7% of the general pregnant population for extended fetal echocardiography.

Clinical application of midtrimester non-invasive fetal RHD genotyping and identification of RHD variants in a mixed-ethnic population

OBJECTIVE

This study aims to assess the suitability of non-invasive prenatal RHD genotyping in non-immunized midtrimester pregnant women from a mixed ethnic population, to prevent unnecessary anti-D immunoglobulin prophylaxis and to identify RHD variants

METHODS

Rhesus D-negative pregnant women were offered fetal RHD genotyping at 24 gestational weeks. A total of 284 samples were tested for RHD status using multiplex rt-PCR amplification of exons 5 and 7 of the RHD gene and exons 6 and 10 in selected cases. Women carrying RHD-negative fetuses were counseled about their option to avoid routine antenatal anti-D immunoglobulin administration. Diagnostic accuracy of RHD genotyping was compared with postnatal Rhesus D serotyping.

RESULTS

A total of 184 positives (65%), 91 negatives (32%) and 7 cases (2.5%) compatibles with RHD variants were detected by RHD genotyping. No false negative results were found, and a single false positive was observed in a twin pregnancy. Genotyping was accepted when offered by 94% of women (284/302), and anti-D immunoglobulin was avoided in 95% (90/95) of RHD-negative fetuses.

CONCLUSIONS

Non-invasive routine antenatal RHD genotyping at 24 weeks of pregnancy is a highly accurate method, resulting in the avoidance of 95% of unnecessary administrations of anti-D immunoglobulin, with no false negative results.

Rectus sheath haematoma: are there prognostic risk factors of haemodynamic instability motivating an early operative treatment?

PURPOSE

Rectus sheath haematoma (RSH) is an uncommon condition caused by lesion of the superior or inferior epigastric arteries or their branches or by rupture of the rectus muscle. Treatment is usually supportive; however, if haemodynamic compromise develops, intravascular embolisation or surgery may be required. Furthermore, in some cases, bleeding may be so conspicuous that it can determine the patient's death before an adequate treatment is performed. We performed a retrospective study on 78 consecutive patients with the diagnosis of RSH admitted to the General Surgery Unit of our hospital between January 2000 and December 2010 in order to identify possible prognostic risk factors that could affect the operational approach before the onset of haemodynamic instability.

METHODS

Demographic characteristics, patient history, laboratory and diagnostic imaging examinations were investigated. The variables considered were: gender, age, anti-coagulation or anti-platelet therapy, trauma, international normalised ratio (INR) and bleeding time in the first 72 h of observation and concomitant diseases. The data were used for statistical analysis.

RESULTS

Sixty patients received a conservative treatment, while 18 underwent operative treatment for haemodynamic instability (embolisation in 2 patients and surgery in 16 patients). Three of these 18 patients (17 %) died for consumption coagulopathy after surgery. None of the variables included in the univariate statistical analysis was significant (p = ns).

CONCLUSION

Ultrasonography or computed tomography are the most common methods used to establish the diagnosis of RSH, so it is no longer a diagnostic dilemma. Most patients can be treated conservatively and an operative treatment is justified only in case of haemodynamic instability. Our retrospective study could not identify any prognostic risk factor of haemodynamic instability in RSH. We believe that only a close observation of the patients with RSH and "common sense" can prevent a possible fatal outcome.

First-trimester detection of structural abnormalities and the role of aneuploidy markers

OBJECTIVES

To determine the sensitivity of first-trimester ultrasound for diagnosing different structural anomalies in chromosomally normal pregnancies, and to establish the role of aneuploidy markers in the detection of abnormalities.

METHODS

This was a retrospective study of chromosomally normal singleton pregnancies with an 11-14-week scan performed in our center during 2002-2009. The ultrasound examination included an early fetal anatomy survey and assessment of nuchal translucency, ductus venosus blood flow and nasal bone.

RESULTS

Among 13 723 scanned first-trimester pregnancies with no genetic anomalies and complete follow-up, 439 fetuses (3.2%) were found to present with structural anomalies (194 with major anomalies and 245 with only minor anomalies). Forty-nine per cent of major structural anomalies were detected during the first-trimester scan, the highest rates corresponding to acrania (17/17), holoprosencephaly (three of three), hypoplastic left heart syndrome (10/10), omphalocele (six of six), megacystis (seven of eight) and hydrops (eight of nine). Higher than expected detection rates were obtained for skeletal (69%) and cardiac (57%) defects, coincidentally showing the highest presence of an increased nuchal translucency or abnormal ductus venosus blood flow (38% and 52%, respectively). The finding of an absent nasal bone did not appear to be associated with structural defects.

CONCLUSION

About half of major structural abnormalities can be diagnosed in the first trimester. Increased nuchal translucency or abnormal ductus venosus blood flow appear to be associated with cardiac and skeletal defects and may facilitate early detection.

Focus on abdominal rectopexy for full-thickness rectal prolapse: meta-analysis of literature

BACKGROUND

Laparoscopic rectopexy to treat full-thickness rectal prolapse has proven short-term benefits, but there are few long-term follow-up and functional outcome data available. Using meta-analysis techniques, this study was designed to evaluate long-term results of open and laparoscopic abdominal procedures to treat full-thickness rectal prolapse in adults.

METHODS

A literature review was performed using the National Library of Medicine's PubMed database. All articles on abdominal rectopexy patients with a follow-up longer than 16 months were considered. The primary end point was recurrence of rectal prolapse, and the secondary end points were improvement in incontinence and constipation. A random effect model was used to aggregate the studies reporting these outcomes, and heterogeneity was assessed.

RESULTS

Eight comparative studies, consisting of a total of 467 patients (275 open and 192 laparoscopic), were included. Analysis of the data suggested that there is no significant difference in recurrence, incontinence and constipation improvement between laparoscopic abdominal rectopexy and open abdominal rectopexy. Considering non-comparative trials, the event rate for recurrence was similar in open and laparoscopic suture rectopexy studies and in open and laparoscopic mesh rectopexy trials. Improvement in constipation after the intervention was not statistically significant except for open mesh repair; postoperative improvement in incontinence was statistically significant after laparoscopic procedures and open mesh rectopexy.

CONCLUSIONS

Laparoscopic abdominal rectopexy is a safe and feasible procedure, which may compare equally with the open technique with regard to recurrence, incontinence and constipation. However, large-scale randomized trials, with comparative, strong methodology, are still needed to identify outcome measures accurately.

New trends in nutritional status assessment of cancer patients

BACKGROUND

Nutritional status assessment and support should be considered a valuable measure within the overall oncology strategy. Despite extensive research in the field of clinical nutrition, definite guidelines to base rational nutritional assessment and support in cancer patients are still debated. This review examines different approaches to nutritional status in cancer patients.

DESIGN

The assessment of nutritional status is usually based on anthropometric measures, biochemical or laboratory tests, clinical indicators and dietary assessment. At present, body composition (BC) is rarely measured in the clinical setting because it is thought to be too unmanageable and time-consuming. However, using new technologies, the estimation of fat, lean and body fluids, that is significant in the management of nutrition therapies in oncology, has become easy. The present study evaluates the different methods of nutrition assessment today available, especially body composition (BC) measurements. Furthermore, nutrition assessment, relevance of nutritional support and choice of nutritional strategy, in surgical patients, are discussed.

DISCUSSION

Given the clinical relevance of nutritional intervention in patients' quality of life, the nutritional status assessment has a key role in oncological and surgical practice and should include BC assessment in order to tailor nutritional treatment to patients' individual requirements. Furthermore, administration of the supplemented diet before and after surgery seemed to be the best strategy to reduce complications and length of hospital stay.