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Purpose Obstructive sleep apnoea (OSA) is a common, significantly underdiagnosed sleep-related breathing disorder, characterised by upper airway collapse and resultant intermittent hypoxia. Oxygen plays an important role in collagen synthesis and as a result in wound healing. An association between OSA and wound healing has not been clearly delineated. A systematic review was performed to understand this association. Methods Randomised controlled trials, cohort, cross-sectional and case–control studies evaluating the relationship between OSA or OSA-related symptoms and wound healing in adult populations were searched in the systematic review using electronic databases PubMed, EMBASE and Ovid MEDLINE. Main results A total of 11 cohort studies and 1 case–control study with a total of 58,198,463 subjects were included. Most studies suggest that patients diagnosed with OSA or who are at high risk of having OSA are more likely to suffer from wound complications. Patients with OSA have been found to be at higher risk for post-operative wound infection and wound dehiscence. Contradictory results were obtained on time to heal, with one study concluding that individuals with OSA were more likely to heal earlier when compared to patients without OSA. Quality of evidence, however, was deemed very low due to high risk of bias. Conclusions This systematic review did identify an association between OSA and wound healing. However, due to the very low-quality evidence, further research is warranted to better characterise this association and investigate whether or not treating OSA can indeed affect wound healing.

ContextForest restoration plays an important role in global efforts to slow biodiversity loss and mitigate climate change. Vegetation in remnant forests can form striking patterns that relate to ecological processes, but restoration targets tend to overlook spatial pattern. While observations of intact reference ecosystems can help to inform restoration targets, field surveys are ill-equipped to map and quantify spatial pattern at a range of scales, and new approaches are needed.ObjectiveThis review sought to explore practical options for creating landscape-scale forest restoration targets that embrace spatial pattern.MethodsWe assessed how hierarchy theory, satellite remote sensing, landscape pattern analysis, drone-based remote sensing and spatial point pattern analysis could be applied to assess the spatial pattern of reference landscapes and inform forest restoration targets.ResultsHierarchy theory provides an intuitive framework for stratifying landscapes as nested hierarchies of sub-catchments, forest patches and stands of trees. Several publicly available tools can map patches within landscapes, and landscape pattern analysis can be applied to quantify the spatial pattern of these patches. Drones can collect point clouds and orthomosaics at the stand scale, a plethora of software can create maps of individual trees, and spatial point pattern analysis can be applied to quantify the spatial pattern of mapped trees.ConclusionsThis review explored several practical options for producing landscape scale forest restoration targets that embrace spatial pattern. With the decade on ecosystem restoration underway, there is a pressing need to refine and operationalise these ideas.

The particular structure and configuration of the Venice lagoon represents a paramount case study concerning coastal flooding which affects natural, historical/cultural properties, together with industrial, commercial, economical and port activities. In order to defend Venice (and other sites) within the lagoon from severe floods, the Italian Government promoted the construction of a complex hydraulic/maritime system, including a movable storm surge barrier named Experimental Electromechanical Module (MoSE), to be activated when specific water levels occur. When the MoSE barriers are raised, the only access to the lagoon for commercial and cruise ships is represented by the Malamocco lock gate, provided that suitable safety conditions (involving the significant wave height) are satisfied. In addition, the Italian Government has recently established that, in the near future, large ships will always have to enter/exit the lagoon only through the Malamocco entrance. In turn, the navigation within the Venice lagoon is (will be) controlled by the combined MoSE-Malamocco system, ruled by both univariate and bivariate paradigms/guidelines. As a novelty, in the present work, for the first time, the statistics of significant wave heights and water levels in the Venice lagoon (both univariate and bivariate ones) are investigated: in particular, these variables turn out to be dependent, and their joint occurrence (statistically modeled via Copulas) can determine the stop of ship navigation, yielding significant economic losses. Here, univariate and bivariate Return Periods and Failure Probabilities are used to thoroughly model the statistical behavior of significant wave heights and water levels, in order to provide useful quantitative indications for the management of the tricky hydraulic, maritime and economical system of the Venice lagoon.

Background A timely diagnosis is essential for improving breast cancer patients’ survival and designing targeted therapeutic plans. For this purpose, the screening timing, as well as the related waiting lists, are decisive. Nonetheless, even in economically advanced countries, breast cancer radiology centres fail in providing effective screening programs. Actually, a careful hospital governance should encourage waiting lists reduction programs, not only for improving patients care, but also for minimizing costs associated with the treatment of advanced cancers. Thus, in this work, we proposed a model to evaluate several scenarios for an optimal distribution of the resources invested in a Department of Breast Radiodiagnosis. Materials and methods Particularly, we performed a cost-benefit analysis as a technology assessment method to estimate both costs and health effects of the screening program, to maximise both benefits related to the quality of care and resources employed by the Department of Breast Radiodiagnosis of Istituto Tumori “Giovanni Paolo II” of Bari in 2019. Specifically, we determined the Quality-Adjusted Life Year (QALY) for estimating health outcomes, in terms of usefulness of two hypothetical screening strategies with respect to the current one. While the first hypothetical strategy adds one team made up of a doctor, a technician and a nurse, along with an ultrasound and a mammograph, the second one adds two afternoon teams. Results This study showed that the most cost-effective incremental ratio could be achieved by reducing current waiting lists from 32 to 16 months. Finally, our analysis revealed that this strategy would also allow to include more people in the screening programs (60,000 patients in 3 years).

Background The introduction of technology-assisted rehabilitation (TAR) uncovers promising challenges for the treatment of motor disorders, particularly if combined with exergaming. Patients with neurological diseases have proved to benefit from TAR, improving their performance in several activities. However, the subjective perception of the device has never been fully addressed, being a conditioning factor for its use. The aims of the study were: (a) to develop a questionnaire on patients’ personal experience with TAR and exergames in a real-world clinical setting; (b) to administer the questionnaire to a pilot group of neurologic patients to assess its feasibility and statistical properties. Methods A self-administrable and close-ended questionnaire, Technology Assisted Rehabilitation Patient Perception Questionnaire (TARPP-Q), designed by a multidisciplinary team, was developed in Italian through a Delphi procedure. An English translation has been developed with consensus, for understandability purposes. The ultimate version of the questionnaire was constituted of 10 questions (5 with multiple answers), totalling 29 items, exploring the patient’s performance and personal experience with TAR with Augmented Performance Feedback. TARPP-Q was then administered pre-post training in an observational, feasible, multi-centric study. The study involved in-patients aged between 18 and 85 with neurological diseases, admitted for rehabilitation with TAR (upper limb or gait). FIM scale was run to control functional performance. Results Forty-four patients were included in the study. All patients answered the TARPP-Q autonomously. There were no unaccounted answers. Exploratory factor analyses identified 4 factors: Positive attitude, Usability, Hindrance perception, and Distress. Internal consistency was measured at T0. The values of Cronbach’s alpha ranged from 0.72 (Distress) to 0.92 (Positive attitude). Functional Independence Measure (FIM®) scores and all TARPP-Q factors (Positive attitude, Usability, Hindrance perception, except for Distress (p = 0.11), significantly improved at the end of the treatment. A significant positive correlation between Positive attitude and Usability was also recorded. Conclusions The TARPP-Q highlights the importance of patients’ personal experience with TAR and exergaming. Large-scale applications of this questionnaire may clarify the role of patients’ perception of training effectiveness, helping to customize devices and interventions.

Isolated post-capillary pulmonary hypertension (Ipc-PH) occurs due to left heart failure, which contributes to 1 out of every 9 deaths in the United States. In some patients, through unknown mechanisms, Ipc-PH transitions to combined pre-/post-capillary PH (Cpc-PH) and is associated with a dramatic increase in mortality. Altered mechanical forces and subsequent biological signaling in the pulmonary vascular bed likely contribute to the transition from Ipc-PH to Cpc-PH. However, even in a healthy pulmonary circulation, the mechanical forces in the smallest vessels (the arterioles, capillary bed, and venules) have not been quantitatively defined. This study is the first to examine this question via a computational fluid dynamics model of the human pulmonary arteries, arterioles, venules, and veins. Using this model, we predict temporal and spatial dynamics of cyclic stretch and wall shear stress with healthy and diseased hemodynamics. In the normotensive case for large vessels, numerical simulations show that large arteries have higher pressure and flow than large veins, as well as more pronounced changes in area throughout the cardiac cycle. In the microvasculature, shear stress increases and cyclic stretch decreases as vessel radius decreases. When we impose an increase in left atrial pressure to simulate Ipc-PH, shear stress decreases and cyclic stretch increases as compared to the healthy case. Overall, this model predicts pressure, flow, shear stress, and cyclic stretch that providing a way to analyze and investigate hypotheses related to disease progression in the pulmonary circulation.

We study the geodesic connectedness of a globally hyperbolic spacetime (M,g) admitting a complete smooth Cauchy hypersurfaceSand endowed with a complete causal Killing vector fieldK. The main assumptions are that the kernel distribution$\mathcal D$Dof the one-form induced byKonSis non-integrable and that the gradient ofg(K,K) is orthogonal to$\mathcal {D}$D. We approximate the metricgby metricsgεsmoothly depending on a real parameterεand admittingKas a timelike Killing vector field. A known existence result for geodesics of such type of metrics provides a sequence of approximating solutions, joining two given points, of the geodesic equations of (M,g) and whose Lorentzian energy turns out to be bounded thanks to an argument involving trajectories of some affine control systems related with$\mathcal {D}$D.

Background Low-temperature expression of recombinant proteins may be advantageous to support their proper folding and preserve bioactivity. The generation of expression vectors regulated under cold conditions can improve the expression of some target proteins that are difficult to express in different expression systems. Main body of the abstract The cspA encodes the major cold-shock protein from Escherichia coli (CspA). The promoter of cspA has been widely used to develop cold shock-inducible expression platforms in E. coli. Moreover, it is often necessary to employ expression systems other than bacteria, particularly when recombinant proteins require complex post-translational modifications. Currently, there are no commercial platforms available for expressing target genes by cold shock in eukaryotic cells. Consequently, genetic elements that respond to cold shock offer the possibility of developing novel cold-inducible expression platforms, particularly suitable for yeasts, and mammalian cells. Conclusions This review covers the importance of the cellular response to low temperatures and the prospective use of cold-sensitive promoters to direct the expression of recombinant proteins. This concept may contribute to renewing interest in applying white technologies to produce recombinant proteins that are difficult to express. Graphical Abstract

We deal with the spatial distribution of the hydraulic conductivity K within heterogeneous porous formations where a radial flow (typical of pumping and slug tests) is taking place. In particular, the study provides a wide data-set which is instrumental to corroborate theoretical findings about the stochastic behavior of K in the above flow configuration. Here, K-data pertain to a series of slug tests conducted within a large caisson which was densely instrumented in order to capture the transitional behavior of the conductivity from the near field (close to the pumping well) to the far field (away from the pumping well). For the experiments at stake, it is shown that the apparent conductivity $$K_{\mathrm{app}}$$ is a very robust property. In fact, with the exception of a very tiny annulus surrounding the pumping well, $$K_{\mathrm{app}}$$ can be used to solve flow (and transport) problems in close analogy to the effective theory approach adopted for a groundwater-type flow. It is hoped that the data-set exploited in the present study will be useful for other researchers who are engaged with similar studies.

This study aimed to explore the relationship between action execution and mental rotation modalities. To this end, pantomime gesture (i.e. the mime of the use of an object) was used as its execution relies on imagery processes. Specifically, we tried to clarify the role of visuo-spatial or motor and body-related mental imagery processes in pantomime gestures performed away (AB, e.g. drawing on a sheet) and towards the body (TB, e.g. brushing the teeth). We included an "actual use" condition in which participants were asked to use a toothbrush and make 3, 6, or 9 circular movements close to their mouth (as if they were brushing their teeth) or to use a pencil and make 3, 6, or 9 circular movements on a desk (as if they were drawing circles). Afterwards, participants were asked to pantomime the actual use of the same objects ("pantomime" condition). Finally, they were asked to mentally rotate three different stimuli: hands, faces, and abstract lines. Results showed that participants were faster in AB than TB pantomimes. Moreover, the more accurate and faster the mental rotation of body-related stimuli was, the more similar the temporal duration between both kinds of pantomimes and the actual use of the objects appeared. Instead, the temporal similarity between AB pantomimes and pencil actual use, as well as, the duration of AB pantomime and actual use, were associated with the ability to mentally rotate abstract lines. This was not true for TB movements. These results suggest that the execution of AB and TB pantomimes may involve different mental imagery modalities. Specifically, AB pantomimes would not only require to mentally manipulate images of body-parts in movement but also represent the spatial relations of the object with the external world.

Abstract Purpose of Review There is an increasing recognition of the importance of sex in susceptibility, clinical presentation, and outcomes for heart failure. This review focusses on heart failure with reduced ejection fraction (HFrEF), unravelling differences in biology, clinical and demographic features and evidence for diagnostic and therapeutic strategies. This is intended to inform clinicians and researchers regarding state-of-the-art evidence relevant to women, as well as areas of unmet need. Recent Findings Females are well recognised to be under-represented in clinical trials, but there have been some improvements in recent years. Data from the last 5 years reaffirms that women presenting with HFrEF women are older and have more comorbidities like hypertension, diabetes and obesity compared with men and are less likely to have ischaemic heart disease. Non-ischaemic aetiologies are more likely to be the cause of HFrEF in women, and women are more often symptomatic. Whilst mortality is less than in their male counterparts, HFrEF is associated with a bigger impact on quality of life in females. The implications of this for improved prevention, treatment and outcomes are discussed. Summary This review reveals distinct sex differences in HFrEF pathophysiology, types of presentation, morbidity and mortality. In light of this, in order for future research and clinical medicine to be able to manage HFrEF adequately, there must be more representation of women in clinical trials as well as collaboration for the development of sex-specific management guidelines. Future research might also elucidate the biochemical foundation of the sex discrepancy in HFrEF.

Purpose Meniscal surgery is one of the most common orthopaedic surgical interventions. Total meniscus replacements have been proposed as a solution for patients with irreparable meniscal injuries. Reliable fixation is crucial for the success and functionality of such implants. The aim of this study was to characterise an interference screw fixation system developed for a novel fibre-matrix-reinforced synthetic total meniscus replacement in an ovine cadaveric model. Methods Textile straps were tested in tension to failure (n = 15) and in cyclic tension (70–220 N) for 1000 cycles (n = 5). The textile strap-interference screw fixation system was tested in 4.5 mm-diameter single anterior and double posterior tunnels in North of England Mule ovine tibias aged > 2 years using titanium alloy (Ti6Al4Va) and polyether-ether-ketone (PEEK) screws (n ≥ 5). Straps were preconditioned, dynamically loaded for 1000 cycles in tension (70–220 N), the fixation slippage under cyclic loading was measured, and then pulled to failure. Results Strap stiffness was at least 12 times that recorded for human meniscal roots. Strap creep strain at the maximum load (220 N) was 0.005 following 1000 cycles. For all tunnels, pull-out failure resulted from textile strap slippage or bone fracture rather than strap rupture, which demonstrated that the textile strap was comparatively stronger than the interference screw fixation system. Pull-out load (anterior 544 ± 119 N; posterior 889 ± 157 N) was comparable to human meniscal root strength. Fixation slippage was within the acceptable range for anterior cruciate ligament graft reconstruction (anterior 1.9 ± 0.7 mm; posterior 1.9 ± 0.5 mm). Conclusion These findings show that the textile attachment-interference screw fixation system provides reliable fixation for a novel ovine meniscus implant, supporting progression to in vivo testing. This research provides a baseline for future development of novel human meniscus replacements, in relation to attachment design and fixation methods. The data suggest that surgical techniques familiar from ligament reconstruction may be used for the fixation of clinical meniscal prostheses.

Jet-Electrochemical machining (Jet-ECM) is a novel variation of traditional electrochemical machining in which electrically conductive material is removed through anodic dissolution by means of a fine jet of electrolyte. In this study, the effect of nozzle geometry on material removal characteristics are investigated through physical experiments performed on a Jet-ECM system under development at the university of Manchester. A total of 8 nozzles with holes encompassing converging, diverging and rounded features are studied at flow rates between 0.125 and 0.225 l/min. The results show that the nozzle hole geometry has a significant effect on the machined profile produced due to variations in flow velocity, pressure, and electric current distribution with converging hole nozzles providing an increased depth of cut than the symmetrical cylindrical channel by up to 9.7%. A 2D Star CCM+ simulation is also proposed, and numerical results developed and compared with experimental ones to investigate the feasibility of using simulation to develop future nozzle designs. The simulated results show good profile comparison to the experimental results, however, the model needs developing to improve the process repeatability for future use in nozzle design.

Background Aerococcus urinae is a bacterium of emerging clinical interest that most commonly causes urinary tract infections (UTI) but can also result in invasive infections. It is a catalase-negative, alpha-haemolytic gram-positive coccus that grows in clusters or tetrads and usually causes urinary tract infections. While rare, infective endocarditis must be considered when A. urinae is isolated in blood culture. The mortality rate of A. urinae infective endocarditis is similar to overall endocarditis mortality. We report a rare case of aortic root abscess caused by A. urinae. Case presentation An 82-year-old Caucasian man presented to hospital with behavioural change and severe malnutrition and was managed for psychotic depression. On day 34 of his inpatient stay, a febrile episode prompted blood cultures, which grew Aerococcus. urinae. Investigations revealed a bicuspid aortic valve, aortic valve endocarditis and aortic root abscess. He also had prostatomegaly. He underwent aortic valve replacement, received 6 weeks of intravenous ceftriaxone and recovered. Conclusion Infective endocarditis should be considered in patients with persistent Aerococcus urinae bacteraemia. Accurate identification with mass spectrometry is recommended to avoid misidentification as staphylococcus, streptococcus or enterococcus, which is a possibility with conventional laboratory methods.

This work presents preliminary results of a multifunctional lightweight material for radiation sensing and protection. The proposed concept is built with off-the-shelf components: molded high-density polyethylene (HDPE) sheets and a commercial carbon black coating designed as a shield for electromagnetic interference (EMI). The HDPE is a hydrogen-rich lightweight material that is commonly used for radiation protection. The carbon black coating is a non-structural, electrically conductive coating that serves here not only the purpose of structural health monitor, but also protects the underlying HDPE structure. The carbon black-coated area in the HDPE samples was instrumented with electrodes for electrical resistance tomography (ERT), the structural monitoring method that we propose in this work. Two types of radiation (UV-C radiation for 24 h and protons with a 50 Gy dose, lethal to humans) were used separately, as representative of a harsh space environment. Fourier transform infrared spectroscopy (FTIR) was applied to selected samples to determine the presence of chemical damage as a result of the radiation exposure. The results support this innovative proof of concept for further investigation in the area of radiation protection and monitoring.

The telemedicine studies, takes care and prevents diseases at distance basing on the interaction among physicians and patients remotely. Few data are available on its application to early postoperative after surgery. The endpoints of our preliminary experience were the detection, as primary, of feasibility and safety of home telemonitoring after robotic colo-rectal resection and, as secondary, perception and satisfaction of the patients. From December 2019 to March 2020, at the Division of Robotic Surgery of San Giovanni Hospital of Rome, 20 of 29 colorectal cancer patients, submitted to Robotic resection, were prospectively included in a program of postoperative home telemonitoring. Telemonitoring was considered feasible if at least 75% of data were available and safe if morbidity ≤ II by Clavien–Dindo classification. Perception and patients’ satisfaction were evaluated through a dedicated questionnaire. Out of 20 patients, the median age was 68 years, overall postoperative morbidity was 30%, all events classified Clavien–Dindo Grade I or II. Only 2 patients were corresponded to surgical consult without readmission during home telemonitoring. Compliance of patients was > 80%, overall grade of satisfaction was very high: 4.2 as median (range 0–5). In this preliminary study, the procedures of postoperative home telemonitoring were feasible and safe and high rate of patients’ satisfaction was observed. The telemedicine could enhance the role of robotic technique in decrease the hospital stay and improving postoperative recovery after surgery. Further structured prospective trial are needed to validate the routine application of telemedicine in healthcare.

Incidental lymphomas (ILs) are rare and challenging lesions with poorly characterized clinical-epidemiological and histological features. The present study addressed the open issues concerning these tumors, by assessing the clinical-pathological features of 28 consecutive ILs, diagnosed over a 10-year period at a tertiary center for surgical pathology. ILs were more frequently documented in elderly males (mean age at surgery 70.8 years; M/F ratio 3.3), with sharp prevalence of gastrointestinal and urinary tract involvement (22/28 [78.6%] cases). Low-grade B-cell lymphomas outnumbered all other entities, and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) was the most common subtype (18/28 [64.3%] cases). Compared to other ILs, CLL/SLL occurred at older age and was the sole lymphoid neoplasm affecting the urinary tract. In conclusion, ILs are rare lesions, mostly affecting the gastrointestinal and urinary tract of elderly males. The diagnosis of IL is based on a high degree of suspicion and on careful morphological/phenotypic characterization.

Bivalve mollusks as filter-feeders concentrate in their digestive tissue microorganisms likely present in the harvesting water, thus becoming risky food especially if consumed raw or poorly cooked. To eliminate bacteria and viruses eventually accumulated, they must undergo a depuration process which efficacy on viruses is on debate. To better clarify the worth of the depuration process on virus elimination from mussels, in this study we investigated rotavirus kinetics of accumulation and depuration in Mytilus galloprovincialis experimentally contaminated. Depuration process was monitored for 9 days and virus residual presence and infectivity were evaluated by real time quantitative polymerase chain reaction, cell culture and electron microscopy at days 1, 2, 3, 5, 7, 9 of depuration. Variables like presence of ozone and of microalgae feeding were also analyzed as possible depuration enhancers. Results showed a two-phase virus removal kinetic with a high decrease in the first 24 h of depuration and 5 days necessary to completely remove rotavirus.

Safe, lightweight, high-strength and sustainable materials are required for automotive parts and electrical components. In this paper, a polymeric composite based on nylon 6 and clinoptilolite (green fire retardant) was obtained by ultrasound-assisted extrusion. The materials were analyzed by Fourier transform infrared spectroscopy (FT-IR), thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), scanning electron microscopy (SEM) and cone calorimetry. From the FT-IR results, the presence of elements corresponding to the composition of the clinoptilolite that was used as an additive and nylon 6 was observed. TGA analysis showed that thermal stability improved, and in DSC analysis, we observed a slight increase in the crystallinity of the clinoptilolite polymer compounds, which was reflected in the flame retardation tests and by the mechanical properties. Significant improvement in the stiffness mechanical properties of nylon 6 with increasing clinoptilolite content was observed. For clinoptilolite contents of 1, 5 and 10% weight, the Young’s modulus increased by 3352.79, 3675.53 and 4327.06 MPa, respectively, compared to that of nylon 6, with a value of 2997.45 MPa. Meanwhile, the flexion resistance of nylon 6 increased from 84.75 to 95.05, 99.9 and 105.4 N/mm2 for the compounds obtained. The homogeneous distribution of clinoptilolite in the polymeric matrix due to processing by ultrasonic-assisted melt extrusion prevents the formation of stress concentration points. Flame retardant properties were studied with cone calorimetry, and a reduction in the peak heat release rate (HRR) was observed.