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Hydrogen, as a versatile and sustainable energy carrier, plays a pivotal role in the global transition towards a low-carbon economy. However, the safe and efficient operation of hydrogen production plants is paramount to exploiting the full potential of this clean energy source. This scientific article investigates typical HILP (High Intensity Low Probability) scenarios that can occur in hydrogen production plants and storage. The assessment is based on a HazOp (Hazard and Operability) study on a representative electrolysis unit. The study has been conducted through a multidisciplinary approach, integrating knowledge from chemical engineering, process safety and risk analysis, focusing on consequence modelling, to understand root causes, potential impacts and mitigation strategies. Through the analysis of plant design and operation parameters, the article identifies common vulnerabilities in hydrogen production processes. The main accident scenarios explored include equipment failures and leaks, each with the potential to compromise plant safety and disrupt production. Furthermore, the article analyses the dynamic interaction between technological progress and safety protocols in shaping the risk landscape of hydrogen production and storage facilities. The insights from this analysis help to propose possible risk management strategies, emphasising the importance of proactive safety measures, early detection systems and effective emergency response plans. By elucidating the typical incident scenarios in hydrogen production plants, this article seeks to enhance industry awareness, facilitate knowledge sharing, and drive continuous improvement in the design, operation, and maintenance of hydrogen facilities. The findings presented herein offer valuable insights for engineers, researchers, and policymakers working towards the widespread adoption of hydrogen as a clean and sustainable energy solution.

The management of dust hazards within industrial environments remains a critical concern, as sadly testified by the catastrophic events occurred in recent history. Dust Hazard Analysis (DHA) is a risk assessment technique used for identifying, managing, and mitigating the risks related to the handling, production, and storage of combustible dusts. This study explores the efficacy of employing a semi-quantitative approach within the framework of DHA, leveraging a Risk Matrix to assess and define the severity and likelihood of potential hazardous events associated with combustible dust. The semi-quantitative method presented herein integrates qualitative expert judgments with quantitative data, fostering a comprehensive evaluation of various scenarios involving dust-related hazards: central to this approach is the utilization of a Risk Matrix, where severity and likelihood classes are intersected to generate risk levels associated with identified dust-related scenarios. This allows the prioritization of mitigation strategies, focusing resources on high-risk scenarios while acknowledging lower-risk occurrences. Furthermore, the use of a common Risk Matrix facilitates the decision-making process, allowing the same benchmark to be applied to the recommendations and actions emerging from different risk assessment techniques (e.g., HazOp). The study underscores the value of a semi-quantitative approach in DHA, highlighting the potential and the limitations of the current model, offering a structured methodology that aids stakeholders in decision-making processes concerning risk mitigation and control measures, ensuring the safety and integrity of industrial operations.

The main goal of process safety is to analyse and reduce risks related to industrial processes in order to ensure that the final risk on people and environment is as low as possible. To establish whether the risk related to the process is tolerable or not it is therefore necessary to calculate the risk associated with the events under consideration and to compare the result with the selected tolerability criteria: this is the common approach used in Quantitative Risk Assessment (QRA) analysis. The risk associated with an event, whatever is its nature (on people, on the environment or financial) is a function of the likelihood of the event (generally expressed in events/year) and the consequences (expressed in terms of damage) of the event itself. The aim of this article is to focus on the first parameter (frequency evaluation): the main goal is not to write a math paper on frequency calculation (there are a lot of articles and specialised sources in the scientific literature that deal with the theory of probability calculation and, therefore, it would not make sense to focus on math) but to report the main conceptual errors in frequency calculation found in existing risk analysis reports. Frequency calculation depends especially on the quality of the performed hazard identification study (e.g HAZOP) and on the proper identification of the common cause failures present within a complex system which, if not properly identified, can lead to an incorrect assessment of the likelihood of a dangerous event. The final scope is to show how it is possible to fall into pitfalls during frequencies calculation if the hazards identification is not properly performed and if dependencies between safeguards are not properly assessed: usually these errors lead to obtain frequency values that have no physical meaning.

Background and Objectives: Transgender people are defined as individuals whose gender identity does not entirely match their sex assigned at birth. Gender surgery typically represents the conclusive and irreversible step in the therapeutic process, especially for the impact on the reproductive sphere. The increased awareness of gender dysphoria and the expanding array of medical and surgical options, including minimally invasive techniques, contribute to the gradual increase in the social impact of transgender surgery. There are several surgical techniques for “gender assignment”, such as vaginal, laparotomic, laparoscopic, and robotic, and the novel approach of vaginal natural orifice transluminal endoscopic surgery to perform a hysterectomy and bilateral salpingo-oophorectomy (BSO). The purpose of this review is to assess the various surgical approaches (hysterectomy and salpingo-oophorectomy) for gender reassignment in order to determine the best option in clinical practice for the female-to-male population in terms of surgical outcomes such as operative time, surgical complication, hospital discharge, postoperative pain, and bleeding. Materials and Methods: This systematic review includes studies from 2007 to 2024. Special consideration was given to articles documenting the characteristics and management of female-to-male reassignment surgery. Finally, eight papers were included in this review. Results: The literature analysis considered surgical techniques ranging from traditional surgery to innovative methods like vaginal natural orifice transluminal endoscopic surgery and robotic-assisted laparoscopic hysterectomy. Vaginal natural orifice transluminal endoscopic surgery and the robotic approach offer potential benefits such as reduced postoperative pain and shorter hospital stays. While vaginal natural orifice transluminal endoscopic surgery may encounter challenges due to narrow access and smaller vaginal dimensions, robotic single-site hysterectomy may face instrument conflict. Conclusions: The conventional laparoscopic approach remains widely used, demonstrating safety and efficacy. Overall, this review underscores the evolving landscape of surgical techniques for gender affirmation and emphasizes the necessity for personalized approaches to meet the specific needs of transgender patients.

Abstract Endometriosis is a chronic gynecological disorder involved in the pathogenesis of chronic pelvic pain, based on a probable up regulation of the inflammatory system. The objective of the study is to investigate the peritoneal and serum levels of ENA-78 with the severity of endometriosis symptoms (dysmenorrhea, chronic pelvic pain and dyspareunia) using the visual analogue scale (VAS). This is a prospective case–control study that included 53 symptomatic women with evidence of endometriosis and 53 age-matched controls who underwent elective laparoscopic surgery for benign diseases. The concentration of ENA-78 was assessed in blood and peritoneal fluid samples in the follicular phase. In peritoneal fluid and plasma, the concentration of ENA-78 was significantly higher in cases than in controls (p

Adrenal dysfunction (AD) and, in particular, adrenal crisis are uncommon events in pregnant women, but associated with significant maternal and fetal morbidity and mortality if untreated or undiagnosed. Adrenal crisis may be confused with the common symptoms of pregnancy: the obstetricians should be able to promptly diagnose and treat it in order to avoid the adverse outcomes regarding the mother and the fetus. For this reason, AD must be treated by an expert multidisciplinary team. We presented a case report of a young pregnant woman with adrenal crisis due to tuberculosis, cocaine abuse, and massive bilateral hemorrhage with symptoms of emesis, hypotension, sudden abdominal pain, and leukocytosis. The most common issues of diagnosis and treatment are discussed and analyzed. Finally, we performed a review of the literature regarding adrenal crisis and adrenal insufficiency (AI) in pregnancy in order to clarify the management of these diseases in obstetrics setting.

Pelvic organ prolapse (POP) affects many women and contributes significantly to a decrease in their quality of life causing urinary and/or fecal incontinence, sexual dysfunction and dyspareunia. To better understand POP pathophysiology, prevention and treatment, many researchers resorted to evaluating animal models. Regarding this example and because POP affects principally older women, our aim was to provide an overview of literature on the possible biomechanical changes that occur in the vaginas of animal models and their supportive structures as a consequence of aging. Papers published online from 2000 until May 2021 were considered and particular attention was given to articles reporting the effects of aging on the microscopic structure of the vagina and pelvic ligaments in animal models. Most research has been conducted on rodents because their vagina structure is well characterized and similar to those of humans; furthermore, they are cost effective. The main findings concern protein structures of the connective tissue, known as elastin and collagen. We have noticed a significant discordance regarding the quantitative changes in elastin and collagen related to aging, especially because it is difficult to detect them in animal specimens. However, it seems to be clear that aging affects the qualitative properties of elastin and collagen leading to aberrant forms which may affect the elasticity and the resilience of tissues leading to pelvic floor disease. The analysis of histological changes of pelvic floor tissues related to aging underlines how these topics appear to be not fully understood so far and that more research is necessary.

Background and Objectives: Minimally invasive surgery, especially the single-site approach, has demonstrated several advantages in the gynaecological setting. The aim of this study was to compare the surgical outcomes of single-site hysterectomy for benign conditions between the traditional laparoendoscopic approach and robotic surgery. Materials and Methods: We consecutively enrolled 278 women between 2012 and 2019 in this multicentre trial. The patients underwent robotic single-site hysterectomy (RSSH) or laparoendoscopic single-site hysterectomy (LESSH) procedures with or without salpingo-oophorectomy for benign indications. Surgical parameters and surgical outcomes were analysed. Results: There was a statistical difference between the two surgical techniques for total operative time (p = 0.001), set-up time (p = 0.013), and anaesthesia time (p = 0.001). Significant differences in intraoperative blood loss were observed (p = 0.001), but no differences were shown for blood transfusion or intraoperative or postoperative complications in the two groups. Conclusions: LESSH outperformed RSSH in terms of surgical performance and clinical outcomes, with no differences in adverse events.

Human Papillomavirus is the main cause of cervical cancer, including squamous cell carcinoma of the oropharynx, anus, rectum, penis, vagina, and vulva. In recent years, considerable effort has been made to control HPV-induced diseases using either prophylactic or therapeutic approaches. A critical review of the literature about the therapeutic Human Papillomavirus vaccine was performed to analyze its efficacy in the treatment of female lower genital tract lesions and its possible perspective application in clinical practice. The most important medical databases were consulted, and all papers published from 2000 until 2021 were considered. We retrieved a group of seven papers, reporting the role of anti HPV therapeutic vaccines against the L2 protein in the order of their efficacy and safety in female lower genital tract disease. In addition, the immune response due to vaccine administration was evaluated. The development of therapeutic vaccines represents an interesting challenge for the treatment of HPV infection of the lower genital tract. Literature data underline that the L2 protein may be an interesting and promising target in the development of therapeutic HPV vaccines, but the possible strengths and the unclear longevity of L2 immune responses are factors to be considered before clinical use.

The human papillomavirus (HPV) can cause different cancers in both men and women. The virus interferes with functions of the cervix, vulva, vagina, anus in the anogenital area, breast, and head and neck cancer due to the local lesions. The tumors lead to death if not treated as a result of distant metastasis to internal organs and brain. Moreover, HPV attenuates the immune system during chronic infection and releases viral antigens into the tumor microenvironment. The tumors know how difficult is to win the battle with a strong united army of immune cells that are equipped with cytokines and enzymes. They confuse the immune cells with secreting viral antigens. The immune system is equipped with cytokines, a complement system, antibodies, and other secretory proteins to overcome the foreign invaders and viral antigens. However, the majority of the time, tumors win the battle without having all the equipment of the immune cells. Thus, in this review, we describe the recent progression in cellular and humoral immunity studies during the progression of HPV-related cancers. First of all, we describe the role of B, plasmoid cells, and B regulatory cells (Breg) in their functions in the tumor microenvironment. Then, different subtypes of T cells such as T CD8, CD4, T regulatory (Treg) cells were studied in recently published papers. Furthermore, NK cells and their role in tumor progression and prevention were studied. Finally, we indicate the breakthroughs in immunotherapy techniques for HPV-related cancers.

Time trends prevalence of human papillomavirus (HPV) genotypes including negative and untypable infections were analyzed during a 15-year period (2005–2019) among 5807 subjects with abnormal pap-smears and/or cervical intraepithelial neoplasia (CIN). The rates of HPV16 dropped by 13% every 3 years (Prevalence Ratio, PR = 0.87, 95% CI = 0.82–0.93) in the CIN1 biopsy, while HPV16 status was unchanged over time in the CIN2+ biopsy. In CIN1 lesions, there was a corresponding increase of HR-HPV types unrelated to nonavalent vaccine. The rates of HPV 18, 31, and 52, decreased by 35% (PR = 0.65, 95% CI = 0.54–0.79), 19% (PR = 0.81, 95% CI = 0.73–0.91), and 21% (PR = 0.79, 95% CI = 0.73–0.86) every 3-year interval in CIN2+, respectively. Overall, the prevalence of negative/untypable HPV specimens in the entire database increased from 9.6% (129/1349) in the period 2011–2013 to 17.6% (161/913) and 28.4% (224/790) in the 2014–2016 period and in the 2017–2019 period, respectively (PR = 1.69, 95% CI = 1.52–1.88). HPV 16 prevalence decreased significantly among subjects with low-grade cervical squamous lesions. A significant increase of both HPV types unrelated to nonavalent vaccination and negative/untypable HPV infections was reported. The prevalence of HPV types among subjects with abnormal pap smears in Northern Italy is changing. Many variables including demographic factors and possibly vaccination could be responsible for this modification.

In Italian regions regularly affected by disasters and crises in the settlement process, half a century of earthquakes have underscored the acute vulnerability and extended risk exposure of the country’s architectural and urban heritage. On the whole, the greatest damage is found where interventions are incompatible with the technological, typological and morphological components of built fabric in smaller settlements. It is therefore reasonable to ask architecture and arts to commit to improving the resilience of communities settled in the most fragile territories. To be effective and timely this commitment should recover methods used by predecessors and forerunners, rather than be tempted to start from scratch.

¿Con cuáles métodos, instrumentos y técnicas la arquitectura y el urbanismo se miden con los efectos de las catástrofes sobre los asentamientos humanos? En una época que parece caracterizada por la “sociedad del riesgo” y por una “segunda modernidad”, parece necesario establecer si esté en curso o menos un cambio paradigmático de la cultura del proyecto arquitectónico y urbano. En esta perspectiva ningún ámbito de acción parece más idóneo de aquél que interpreta las intervenciones conexas con el “ciclo de vida de los desastres" (prevención, respuesta, reconstrucción, mitigación). A partir del reconocimiento teórico alrededor de los términos del problema (catástrofe, crisis, emergencia, paradigma) la contribución indaga la relación entre proyecto y catástrofe. La hipótesis es que el proyecto de sistemas complejos, turbulentos y dinámicos tenga que ser sustentado por la integración estratégica entre operaciones de conocimiento del espacio físico, del entorno técnico y del tejido socioeconómico y cultural de los lugares y de las comunidades expuesta al riesgo de manifestación de los desastres. Para eficacia esta integración tiene que demostrarse abierta a las modificaciones, sea ordinarias o excepcionales, del contexto de referencia. Metodológicamente se impone la implicación en el proyecto arquitectónico y urbano y a lo largo del ciclo de vida de los desastres, de los factores críticos realzados por mapas, expresados en escenarios y representados, mediante configuraciones adaptables y transitorias. En perspectiva, el cambio de paradigma anunciado propone el proyecto arquitectónico y urbano, como instrumento esencial en la prevención de los riesgos conexos con la manifestación de las catástrofes.

BackgroundEnvenomation by the South American Lonomia saturniid caterpillars, named lonomism, constitutes an emerging and somewhat neglected public health issue in Argentina and neighboring countries. Considering that there is an intricate relationship between environment and human health in such cases, this study aimed to analyze the eco-epidemiological profile of 40 accidents and 33 occurrences of Lonomia spp. in Misiones (Argentina) between January 2014 and May 2020.Methodology/principal findingsWe described the eco-epidemiological variables and characterized the abiotic scenario of such cases. Additionally, we obtained a density map that shows the punctual intensity of Lonomia records throughout Misiones. Most of the accidents occurred in the Department of Guaraní and involved male victims younger than 20 years old. The accidental/occasional occurrence of Lonomia spp. (considering both adult and caterpillar stages together) was significantly higher in the rural area, whereas only adult specimens were found in urban areas. We determined that the presence of this insect in Misiones is positively related to higher temperatures and solar radiation, and larger precipitation and evapotranspiration throughout the year.Conclusion/significanceThis study represents an initial step towards the global understanding of lonomism as a public health problem in Argentina. It provides a map of the risk level for this envenomation in Misiones, which could help authorities address public health policy efforts to implement sustainable strategies for prevention and response to this threat in Northeastern Argentina and neighboring regions.