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Objective Methods Results Conclusion Dyspareunia can severely impact the quality of life of patients with endometriosis. This symptom is often linked to a specific form of deep infiltrating endometriosis, such as rectovaginal septum endometriosis. Despite the radicality of surgery, persistence and recurrence of symptoms post‐surgery are not uncommon. The aim of the present study was to determine whether adenomyosis contributes to the failure of surgical interventions for dyspareunia in these patients.A retrospective single‐cohort study was conducted at the at tertiary care gynecologic center of the University Federico II of Naples, using medical records from January 2020 to July 2023. The study included patients who underwent surgery for dyspareunia associated with rectovaginal endometriosis and had a definitive histologic diagnosis. Pain and sexual quality of life were assessed using the visual analog scale (VAS) and the sexual quality of life‐female (SQoL‐F) questionnaire, both before and 6 months after surgery. Patients with isolated rectovaginal endometriosis were compared to those with concurrent adenomyosis.A total of 94 patients were included: thirty‐five in group A (endometriosis with adenomyosis) and 59 in group B (isolated rectovaginal endometriosis). Histology confirmed deep infiltrating endometriosis (DIE) in all patients. Clinical characteristics such as age, BMI, abnormal uterine bleeding, and infertility, showed no significant differences between the groups. Multiparity was more common in group A (20%) compared to group B (5.1%) (P < 0.001). Pain VAS scores decreased significantly in both groups: from 7.11 to 5.40 in group A and from 7.34 to 3.31 in group B (both P < 0.001). Sexual quality of life (SQoL) scores improved significantly: from 42 to 57 in group A and from 41 to 66 in group B (both P < 0.001). Patients in group B showed a more significant improvement. Adjusted linear regression showed no significant association between parity and the severity of dyspareunia or sexual quality of life.Adenomyosis appears to reduce the effectiveness of surgical treatment for dyspareunia in patients with rectovaginal septum endometriosis. Comprehensive preoperative screening for adenomyosis is recommended to improve surgical outcomes and provide appropriate counseling. Future research should further explore the impact of adenomyosis on dyspareunia and the potential benefits of adjunctive medical therapies. [ABSTRACT FROM AUTHOR]

Recommendations for the management of malnutrition among infants aged less than 6 months (<6 m) are based on limited evidence. This study aimed to describe the characteristics, treatment outcomes and outcome‐associated factors among malnourished infants <6 m admitted at Médecins Sans Frontières (MSF) inpatient and ambulatory therapeutic feeding centres (ITFC and ATFC) in North–East Nigeria, 2019–2022. We conducted a descriptive analysis of the cohorts and logistic regression to measure the association between two selected outcomes—inpatient mortality and defaulting from the ambulatory programme—and possible factors associated. In total, 940 infants <6 m were admitted at ITFC. Most of them presented severe acute malnutrition and comorbidities, with diarrhoea being the most frequent. On discharge, 13.3% (n = 125) of infants were cured, 72.9% (n = 684) stabilized (referred to ATFC), 6.5% (n = 61) left against medical advice and 4.2% (n = 39) died. The median length of hospital stay was 10 days [IQR 7–14]. A hospital stay shorter than 10 days was significantly associated with inpatient mortality (aOR = 12.51, 95% confidence interval [CI] = 3.72–42.11, p ≤ 0.01). Among 561 infants followed up at the ATFC, only 2.8% reported comorbidities. On discharge, 80.9% (n = 429) were cured, 16.2% (n = 86) defaulted and 1.1% (n = 6) died. Male sex (aOR = 1.94, 95% CI = 1.15–3.27, p = 0.01), internally displaced status (aOR = 1.70, 95% CI = 1.05–2.79, p = 0.03) and <−3 WLZ (aOR = 1.95, 95% CI = 1.05–3.63, p = 0.03) were significantly associated with programme defaulting. Stabilization and recovery rates among malnourished infants <6 m in the studied project align with acceptable standards in this humanitarian setting. Notable defaulting rates from outpatient care should be further explored. Key messages: We found acceptable stabilization and recovery rates for malnourished infants aged less than 6 months (<6 m) receiving inpatient and ambulatory care in this humanitarian setting.There was a considerable proportion of defaulters from the ambulatory programme. Although some potential factors associated with programme defaulting were identified in this study, barriers affecting adherence to ambulatory care should be better explored in the community.The factors influencing treatment outcomes among malnourished infants <6 m should be more carefully explored in prospective studies, including additional variables related to infant and maternal characteristics, feeding practices and treatment components. [ABSTRACT FROM AUTHOR]

The randomized phase II VELO trial showed that the addition of panitumumab to trifluridine/tipiracil significantly improves progression‐free survival (PFS) as compared to trifluridine/tipiracil in third‐line therapy in patients with refractory RAS wild‐type (WT) metastatic colorectal cancer (mCRC). With longer follow‐up, final overall survival results and posttreatment subgroup analysis are presented. Sixty‐two patients with refractory RAS WT mCRC were randomly assigned to receive, as third‐line therapy, trifluridine/tipiracil alone (arm A) or in combination with panitumumab (arm B). Primary endpoint was PFS; secondary endpoints included overall survival (OS) and overall response rate (ORR). Median OS was 13.1 months (95% CI 9.5‐16.7) in arm A compared to 11.6 months (95% CI 6.3‐17.0) in arm B (HR: 0.96, 95% CI 0.54‐1.71, P =.9). To evaluate the impact of subsequent lines of treatment, subgroup analysis was performed for the 24/30 patients in arm A, that received fourth‐line therapy after disease progression. Median PFS was 4.1 months (95% CI 1.44‐6.83) for 17 patients treated with anti‐EGFR rechallenge as compared to 3.0 months (95% CI 1.61‐4.31) for seven patients that received other therapies (HR: 0.29, 95% CI 0.10‐0.85, P =.024). Median OS from the start of fourth‐line treatment was 13.6 months (95% CI 7.2‐20), and 5.1 months (95% CI 1.8‐8.3) for patients treated with anti‐EGFR rechallenge vs other therapies, respectively (HR: 0.30, 95% CI 0.11‐0.81, P =.019). Final results of the VELO trial support the role of anti‐EGFR rechallenge in the continuum of care of patients with RAS/BRAF WT mCRC. [ABSTRACT FROM AUTHOR]

Column base plate connections are used widely. Their design is currently codified by Eurocode 3, though with explicit consideration of only base plates without stiffeners and subjected to a proportional loading path. However, both new and existing steel structures might have stiffened base plates. Besides, there might be the need for analyzing the connection response for a non‐proportional loading path (e.g., increasing seismic loads and constant gravity loads). Therefore, the paper provides a contribution into the development of an analytical model for predicting the response of stiffened base plate connections subjected to a non‐proportional loading path. The paper deals with calculation of the connection rotational stiffness and moment resistance. The objective is pursued through finite element modelling and analysis. Then, the application of a proposed analytical model is shown and a comparison with the finite element analysis results is illustrated and discussed. [ABSTRACT FROM AUTHOR]

Prostate cancer is the most commonly diagnosed malignant tumor among men in the Western world. Robotic-assisted radical prostatectomy (RARP) is the preferred treatment for localized prostate cancer, as it allows for faster recovery of continence and erectile potency. However, some patients may face additional risk factors that can impair their potency after RARP, such as atherosclerosis, hypertension, hyperlipidemia, diabetes mellitus, or obesity. A recent study found that lipidic scores have limited value in predicting postoperative erectile dysfunction (ED) in prostate cancer patients undergoing RARP. Instead, the International Index of Erectile Function-5 (IIEF-5) scores and nerve-sparing approaches were found to be independent predictors of postoperative potency recovery. The study highlights the importance of accurate preoperative counseling and clinical potency assessment. Additionally, new surgical techniques and approaches, such as using chitosan to protect nerve fibers and selectively closing prostatic plexus arteries, may improve postoperative functional outcomes. The study suggests a more holistic approach to patient assessment and encourages the sharing of data in multicentric studies to obtain more information and confirm or contradict the results of this preliminary study. [Extracted from the article]

This paper analyses the response to the COVID‐19 pandemic of inbound tourism to Italy looking at variation across countries and provinces. To this end, it uses weekly data on the number of foreign visitors in Italy from January 2019 until February 2021, as provided by a primary mobile telephony operator. We document a very robust negative relation at the province level between the local epidemic situation and the inflow of foreign travellers. Moreover, provinces with a historically higher share in art‐tourism, and those that used to be 'hotel intensive' were hit the most during the pandemic, while provinces with a more prevalent orientation to business tourism proved to be more resilient. Entry restrictions with varying degrees of strictness played a key role in explaining cross‐country patterns. After controlling for these restrictions, we observed that the number of travellers that could arrive by private means of transportation decreased proportionally less. Overall, this evidence emphasises that contagion risk considerations played a significant role in shaping international tourism patterns during the pandemic. [ABSTRACT FROM AUTHOR]

Background: Malignant pleural mesothelioma (MPM) is an invasive, aggressive pleural tumor with a predominantly local spread. The objective of this study was to assess thoracic ultrasound (TUS) as an imaging modality with high sensitivity for the identification of malignant pleural involvement and in order to guide pleural biopsies. Methods: In this retrospective single‐center study between January 2018 and June 2022, 51 consecutive patients with impassable circumferential pleural thickening underwent TUS at the Thoracic Surgery Unit of the Vanvitelli University of Naples. Pleural biopsies were performed, and then large and multiple samples were sent to the pathological anatomy for histological examination. Results: In all patients who underwent ultrasound examination, we chose the optimal point of entry to perform pleural biopsies and selected the areas of greater thickening without pleural effusion. No patient had any complications. No drainage tubes were placed after the pleural biopsies and no pneumothorax was present during the following days of hospitalization. The patients were discharged on the second postoperative day. Conclusion: With TUS the precise pleural thickening localization, local infiltration, mass extent, its nature (solid, cystic or complex) and ultrasound features can be easily defined. Furthermore, ultrasound is more economical than computed tomography and avoids the risks associated with radiation. Thoracic ultrasound is an important component of the diagnostic procedure in detecting a safe entry site for biopsies of MPMs. [ABSTRACT FROM AUTHOR]

Introduction: Central airway tumors involving the trachea and main‐stem bronchi are a common cause of airway obstruction and a significant cause of mortality among the patients of thoracic diseases with respiratory failure. Debulking in rigid bronchoscopy is quick, safe, and effective. It can be complex and hard in patients with severe bronchial or tracheal obstruction and/or with intraluminal bleeding tumors because of inadequate distal airway control. We have used laser tube as a new technique of ventilation for severe central airway obstruction. Materials and Methods: Forty‐six patients with severe airway obstruction undergoing rigid bronchoscopy from September 2020 to June 2022 at the Thoracic Surgery Department of the University L. Vanvitelli of Naples underwent placement of laser tube. Results: In all patients who underwent rigid bronchoscopy with the use of the laser tube, a reduction of obstruction of more than 50% was obtained and in all patients no hypoxia (saturation < 88%), nor hypercapnia, nor significant bleeding were reported. Discussion: The results of this study suggest that rigid bronchoscopic debulking with the use of laser tube is a safe and effective technique in the management of central airway obstruction. Conclusions: The use of the laser tube allows the monitoring of gas exchange, which controls hypoxemia. Thanks to the double cuff put distally to the tracheal obstruction or in the contralateral bronchus to the obstructed one, the laser tube prevents the flooding of blood from debulking below the stenosis. Rigid bronchoscopy with laser tube will expand its use in the future. [ABSTRACT FROM AUTHOR]

In 1998, the World Health Organisation (WHO) published general guidelines proposing essential measures to achieve relactation. Yet, increased knowledge about the practical set‐up of relactation support interventions in different contexts is needed, especially in humanitarian settings, where nonbreastfed infants are particularly at risk. This study aimed to compile and assess the characteristics, outcomes and factors influencing the implementation of relactation support interventions reported since the latest WHO recommendations. We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) guidelines, undertaking a search from Medline, Embase, PubMed Central, Web of Science, Global Health and CINAHL electronic databases. Studies published in English and Spanish, reporting characteristics and outcomes of relactation support provided to non‐(breastfeeding) BF mothers with infants aged less than 6 months were included. Data were analysed by narrative synthesis and the Johanna Briggs Institute Critical Appraisal Tools were used for quality assessment. Overall, 16 studies met the inclusion criteria. Most were observational and conducted in middle‐income countries, only one focused on humanitarian settings. Studies reported inpatient and community‐based interventions, which generally followed WHO recommendations for relactation. In 13 out of 16 studies, over 80% of mothers restarted BF after receiving relactation support. Enabling factors included younger infant age, shorter lactation gap, mother's strong motivation, family support, and continuous skilled support. Although current literature suggests that intensive relactation support can contribute to re‐establish BF, its application and effectiveness in humanitarian settings remain uncertain. Further research is needed to explore the effectiveness, feasibility and acceptability of different approaches to relactation support, especially in humanitarian settings. Key messages: Providing intensive skilled support following the World Health Organisation's recommended measures for relactation can help mothers re‐establishing lactation, especially when combined with enabling factors (infant's young age, short lactation gap, and strong motivation).The feasibility and effectiveness of relactation support in humanitarian settings remain uncertain but are likely to be hampered during acute emergency phases and among populations with low baseline breastfeeding rates.Experimental studies are needed to explore the effectiveness of different approaches to relactation support. The feasibility and acceptability of relactation among different populations should be also assessed. Research in humanitarian settings should be prioritised. [ABSTRACT FROM AUTHOR]

Background. Endometrial cancer (EC) is one of the most common gynecologic malignancy, mostly in postmenopausal women. The gold standard treatment for EC is surgery, but in the early stages, it is possible to opt for conservative treatment. In the last decade, different clinical and pathological markers have been studied to identify women who respond to conservative treatment. A lot of immunohistochemical markers have been evaluated to predict response to progestin treatment, even if their usefulness is still unclear; the prognosis of this neoplasm depends on tumor stage, and a specific therapeutic protocol is set according to the stage of the disease. Objective. (1) To provide an overview of the conservative management of Stage 1A Grade (G) 2 endometrioid EC (FIGO) and the oncological and reproductive outcomes related; (2) to describe the molecular alterations before and after progestin therapy in patients undergoing conservative treatment. Materials and Methods. A systematic computerized search of the literature was performed in the main electronic databases (MEDLINE, Embase, Web of Science, PubMed, and Cochrane Library), from 2010 to September 2021, in order to evaluate the oncological and reproductive outcomes in patients with G2 stage IA EC who ask for fertility-sparing treatment. The expression of several immunohistochemical markers was evaluated in pretreatment phase and during the follow-up in relation to response to hormonal therapy. Only scientific publications in English were included. The risk of bias assessment was performed. Review authors' judgments were categorized as "low risk," "high risk," or "unclear risk" of bias. Results. Twelve articles were included in the study: 7 observational studies and 5 case series/reports. Eighty-four patients who took progestins (megestrol acetate, medroxyprogesterone acetate, and/or levonorgestrel-releasing intrauterine devices) were analyzed. The publication bias analysis turned out to be "low." 54/84 patients had a complete response, 23/84 patients underwent radical surgery, and 20/84 had a relapse after conservative treatment. Twenty-two patients had a pregnancy. The length of follow-up was variable, from 6 to 142 months according to the different studies analyzed. Several clinical and pathological markers have been studied to identify women who do not respond to conservative treatment: PR and ER were the most studied predictive markers, in particular PR appeared as the most promising; MMR, SPAG9, Ki67, and Nrf2-survivin pathway provided good results with a significant association with a good response to progestin therapy. However, no reliable predictive markers are currently available to be used in clinical practice. Conclusions. The conservative treatment may be an option for patients with stage IA G2 EEC who desire to preserve their fertility. The immunohistochemical markers evaluation looks promising in predicting response to conservative treatment. Further large series and randomized clinical trials are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Considering the significant strain‐hardening and ductility characteristics of stainless steel and the influential role of beam to column joints in the overall response of structures, a clear understanding of their moment rotation behaviour appears fundamental. In the present study, a review of the European design code for three typical semi‐continuous beam‐to‐column joints (extended end plate, flush end plate and top‐and‐seat angle connections) is first carried out. Then, using a hybrid modelling strategy with uncoupled elastic‐plastic springs for the bolts and shell elements for the members, more refined 3D finite element (FE) models are developed and validated against available test results. An equivalent stress definition is then proposed for calculating the joint moment resistance. Finally, the initial rotational stiffness, moment resistance, rotation capacity, and failure patterns are used to evaluate critically the accuracy of the predictions of the European design code. As a result, the need for more comprehensive design guidance in accordance with the observed findings is pointed out. [ABSTRACT FROM AUTHOR]

Effective mentoring of undergraduate students is a growing requirement for the promotion of faculty at many universities. It is often challenging for young investigators to define a successful mentoring strategy, partially due to the absence of a broadly accepted definition of what mentoring should entail. To overcome this, an outcome‐oriented mentoring framework was developed and used with more than 25 students over three years. It was found that a systematic mentoring approach can help students quickly realize their scientific potential and result in meaningful contributions to science. This report especially shows how the Critical Assessment of Protein Structure Prediction (CASP14) challenge was used to amplify student research efforts. As a result of this challenge, multiple publications, presentations and scholarships were awarded to the participating students. The mentoring framework continues to see much success in allowing undergraduate students, including students from underrepresented groups, to foster scientific talent and make meaningful contributions to the scientific community. [ABSTRACT FROM AUTHOR]

Background: Aim of this study is to analyse the performances of Clinical Risk Score (CRS) and European System for Cardiac Operative Risk Evaluation (EuroSCORE)‐II in isolated tricuspid surgery. Methods: Three hundred and eighty‐three patients (54 ± 16 year; 54% female) were enrolled. Receiver operating characteristic analysis was performed to evaluate the relationship between the true positive fraction of test results and the false‐positive fraction for a procedure. Results: Considering the 30‐day mortality the area under the curve was 0.6 (95% confidence interval [CI] 0.50–0.72) for EuroSCORE II and 0.7 (95% CI 0.56–0.84) for CRS‐score. The ratio of expected/observed mortality showed underestimation when considering EuroSCORE‐II (min. 0.46–max. 0.6). At multivariate analysis, the CRS score (p =.005) was predictor of late cardiac death. Conclusion: We suggest using both scores to obtain a range of expected mortality. CRS to speculate on late survival. [ABSTRACT FROM AUTHOR]

Aims As the world population grows older, the co-existence of cancer and cardiovascular comorbidities becomes more common, complicating management of these patients. Here, we describe the impact of a large Cardio-Oncology unit in Southern Italy, characterizing different types of patients and discussing challenges in therapeutic management of cardiovascular complications. Methods and results We enrolled 231 consecutive patients referred to our Cardio-Oncology unit from January 2015 to February 2020. Three different types were identified, according to their chemotherapeutic statuses at first visit. Type 1 included patients naïve for oncological treatments, Type 2 patients already being treated with oncological treatments, and Type 3 patients who had already completed cancer treatments. Type 2 patients presented the highest incidence of cardiovascular events (46.2% vs. 12.3% in Type 1 and 17.9% in Type 3) and withdrawals from oncological treatments (5.1% vs. none in Type 1) during the observation period. Type 2 patients presented significantly worse 48 month-survival (32.1% vs. 16.7% in Type 1 and 17.9% in Type 3), and this was more evident when in the three groups we focused on patients with uncontrolled cardiovascular risk factors or overt cardiovascular disease at the first cardiologic assessment. Nevertheless, these patients showed the greatest benefit from our cardiovascular assessments, as witnessed by a small, but significant improvement in ejection fraction during follow-up (Type 2b: from 50 [20; 67] to 55 [35; 65]; P = 0.04). Conclusions Patients who start oncological protocols without an accurate baseline cardiovascular evaluation are at major risk of developing cardiac complications due to antineoplastic treatments. [ABSTRACT FROM AUTHOR]

Critical Assessment of Structure Prediction (CASP) is an organization aimed at advancing the state of the art in computing protein structure from sequence. In the spring of 2020, CASP launched a community project to compute the structures of the most structurally challenging proteins coded for in the SARS‐CoV‐2 genome. Forty‐seven research groups submitted over 3000 three‐dimensional models and 700 sets of accuracy estimates on 10 proteins. The resulting models were released to the public. CASP community members also worked together to provide estimates of local and global accuracy and identify structure‐based domain boundaries for some proteins. Subsequently, two of these structures (ORF3a and ORF8) have been solved experimentally, allowing assessment of both model quality and the accuracy estimates. Models from the AlphaFold2 group were found to have good agreement with the experimental structures, with main chain GDT_TS accuracy scores ranging from 63 (a correct topology) to 87 (competitive with experiment). [ABSTRACT FROM AUTHOR]

The paper describes a study concerning the seismic response of some typical non‐residential single‐story older steel buildings. To this end, the design of two archetype buildings was simulated according to structural codes and standards of practice used in Italy in the 1980s‐1990s. The basic structural layout was assumed to be made of trussed portals in the transverse direction and concentric braces in the longitudinal direction. In the direction of the trussed portals, two alternative structural options were considered: (a) a pinned column base with moment action provided by the truss, and (b) a semi‐continuous column base with a pinned connection between the truss and the column top cross section. 3D finite element non‐linear models of the two case study structures were built. The model included the main frame members, some critical connections and explicit representation of fracture propagation for braces. Results from non‐linear static analysis are then presented and discussed. The paper highlights differences in the structural response due to differences in the selected design options, comparing both global and local response results. [ABSTRACT FROM AUTHOR]

Introduction: Endometriosis is a very common disease that affects up to 10% of the female population. The use of indocyanine green (ICG) dye has been proposed to allow the proper localization of endometriotic lesions during surgery. Our purpose is to offer an overview of near‐infrared (NIR)‐ICG in the surgical treatment of superficial peritoneal endometriosis and deep infiltrating endometriosis. Material and methods: Electronic databases were searched, including MEDLINE, Embase, Web of Science, Scopus, ClinicalTrial.gov, OVID and Cochrane Library. The studies were identified with the use of a mesh combination of the following keywords: "indocyanine green", "endometriosis", "deep endometriosis", "robotic surgery", "laparoscopy", "ureter", "rectosigmoid" from 2000 to May 2020. All articles describing the use of ICG applied to endometriosis surgery were considered for review. Only original papers that reported specific experience data on the topic were included. Moreover, video‐articles were included in the analysis. Quality and risk of bias were evaluated by two authors, respectively. Results: Fifty‐three studies were reviewed and reviews or comment articles not reporting original data and original articles lacking specific data on the application of ICG in patients affected by endometriosis were excluded. The quality of the 17 studies included was assessed. Eight studies suggested the usefulness of NIR‐ICG as a tool in the detection of endometriosis during surgery, and one randomized controlled trial and one prospective study did not confirm the advantage of its use. Eight studies found that NIR‐ICG was useful for the evaluation of vascularization in intestinal anastomoses and ureterolysis after surgery for deep infiltrating endometriosis. Conclusions: NIR‐ICG appears useful in the evaluation of vascularization in intestinal anastomoses after segmental resection, confirming its role even after ureterolysis for parametrial deep infiltrating endometriosis. However, its usefulness as a tool in the detection of endometriosis during surgery is inconsistent. [ABSTRACT FROM AUTHOR]

Aim: Human papillomavirus (HPV) is the etiologic agent of the majority of cervical intraepithelial lesions (CIN) and cervical cancers. While prophylactic HPV vaccines prevent infections from the main high‐risk HPV types associated with cervical cancer, alternative nonsurgical and nonablative therapeutics to treat HPV infection and preinvasive HPV diseases have been experimentally investigated. Therapeutic vaccines are an emerging investigational strategy. This review aims to introduce the results of the main clinical trials on the use of therapeutic vaccines for treating HPV infection and ‐related CIN, reporting the ongoing studies on this field. Methods: Data research was conducted using MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID and Cochrane Library querying for all articles related to therapeutic vaccines for the treatment of HPV‐related CIN. Selection criteria included randomized clinical trials, nonrandomized controlled studies and review articles. Results: Preliminary data are available on the evaluation of therapeutic vaccines for treating cervical HPV infections and CIN. Despite having in vitro demonstrated to obtain humoral and cytotoxic responses, therapeutic vaccines have not yet clinically demonstrated consistent success; moreover, each class of therapeutic vaccines has advantages and limitations. Early clinical data are available in the literature for these compounds, except for MVA E2, which reached the phase III clinical trial status, obtaining positive clinical outcomes. Conclusion: Despite promising results, to date many obstacles are still present before hypothesize an introduction in the clinical practice within the next years. Further studies will draw a definitive conclusion on the role of therapeutic vaccines in this setting. [ABSTRACT FROM AUTHOR]

Giant micrometeorites (MMs; 400–2000 µm) are exceedingly rare and scientifically valuable. Three‐dimensional nondestructive characterization by X‐ray computed tomography (X‐CT) provides information on the petrography and thus petrogenesis of MMs and serves as a guide to maximize subsequent multi‐analytical studies on such precious planetary materials. Here, we discuss the results obtained by X‐CT on 22 giant MMs and the classification based on their 3‐D density contrast images. Scoriaceous and unmelted MMs have distinct porosity ranges (10–40 vol% versus 0–25 vol%, respectively). We observe a porosity variation inside scoriaceous MMs, which allows their atmospheric entry flight history to be resolved. For the first time, spinning entry is explicitly demonstrated for four partially melted MMs. Furthermore, we are able to resolve the thermal gradient in a single particle, based on porosity variation (seen as a progressive increase in pore abundance and size with higher peak temperatures). Moreover, we explore parent body alteration through the 3‐D analysis of pores distribution, showing that shock fabrics are either absent or weakly developed in our data set. Finally, owing to the detection of pseudomorphic chondrules, we estimate that the intensively aqueously altered C1 or CI‐like material could represent 18% of the MM flux at this size fraction (400–1000 µm). [ABSTRACT FROM AUTHOR]

Objective. Evaluate the effects of carboxy-methyl-beta-glucan on cervical epithelialization and on the vaginal microbiota in patients with HPV infection or low-grade cervical preneoplastic lesion (CIN 1). Materials and Methods. Seven-hundred eighty-four women with positive HPV tests or diagnosed with CIN 1 were enrolled in a retrospective case-control study. All the recruited women performed, at baseline and after 6 months, Pap test, HPV test, evaluation of vaginal health according to the Amsel criteria, colposcopy, and punch biopsy. The study population was then divided into 2 groups in relation to the therapy performed during the follow-up period. Group A performed treatment with vaginal gel based on carboxy-methyl-beta-glucan (1 application/day for 20 days per month for 3 months). Group B was the control group. Results. The patients of group A had a significant improvement in the ectopia pattern and a greater number of cases with metaplasia in the maturation phase with a significant increase in Lugol uptake. In the experimental group, a significant improvement in the pH indices, a negative Swift test and a resolution of the leucorrhoea were observed. A negative result of the 37.1% Pap test and the 39.9% HPV test (vs. 15.2% and 16.5%, respectively) were demonstrated in the treatment group with respect to the control group. A negativization of the colposcopic pictures was observed with a reduction in the amount of CIN 1 found higher in the treatment group. Conclusions. Vaginal therapy based on carboxy-methyl-beta-glucan has been able to improve overall vaginal health; this effect seemed to positively impact the risk of persistence and progression of CIN. [ABSTRACT FROM AUTHOR]

The azygos system is the most important pathway for decompression of the superior vena cava (SVC) when a blood flow obstruction to the right atrium is present. Thoracic and mediastinal malignancies, mainly lung cancers, are responsible for 60%–85% of superior vena cava syndrome (SVCS) cases. An uncommon origin of SVCS is primary malignant mediastinal germ cell tumor (PMMGCT) which represent 1%–4% of all mediastinal tumors and can be divided into two broad groups: seminomas and nonseminomatous germ cell tumors (NSGCTs). Primary mediastinal seminomas clinical presentation is often nonspecific, even if the majority of patients present with superior vena cava involvement. Here, we present the radiologic features of asymptomatic azygos system overflow in a patient with primary mediastinal seminoma. [ABSTRACT FROM AUTHOR]

Introduction: The lowest incidence of perinatal morbidity and mortality occurs around 39-40 weeks. Therefore, some have advocated induction of uncomplicated singleton gestations once they reach full-term. The aim of the study was to evaluate the risk of cesarean delivery, and any maternal and perinatal effects of a policy of induction of labor in women with full-term uncomplicated singleton gestations.Material and Methods: We performed an electronic search from inception of each database to August 2018. All results were then limited to randomized trial. No restrictions for language or geographic location were applied. Inclusion criteria were randomized clinical trials of asymptomatic women with uncomplicated, singleton gestations at full-term (ie, between 39+0 and 40+6  weeks) who were randomized to either planned induction of labor or control (ie, expectant management). Only trials on asymptomatic singleton gestations without premature rupture of membranes or any other indications for induction evaluating the effectiveness of planned induction of labor in full-term singleton gestations were included. The primary outcome was the incidence of cesarean delivery.Results: Seven randomized clinical trials, including 7598 participants were analyzed. Three studies enrolled only women with favorable cervix, defined as a Bishop score of ≥5 in nulliparous women or ≥4 in multiparous women. One trial included only women aged 35 years or older. Women randomized to the planned induction of labor, received scheduled induction usually at 39+0 to 39+6  weeks of gestation, whereas women in the control group received expectant management usually until 41-42 weeks of gestation, or earlier if medically indicated. Methods of induction usually included cervical ripening, with either misoprostol or Foley catheter, in conjunction with or followed by oxytocin for women with unfavorable cervix, and oxytocin and artificial rupture of membranes for those with favorable cervix. Five trials also used artificial rupture of membranes as a method for induction. Uncomplicated full-term singleton gestations that were randomized to receive induction of labor had similar incidence of cesarean delivery compared with controls (18.6% vs 21.4%; relative risk 0.96, 95% CI 0.78-1.19). Regarding neonatal outcomes, induction of labor at full-term was associated with a significantly lower rate of meconium-stained amniotic fluid (4.0% vs 13.5%; relative risk 0.32, 95% CI 0.18-0.57), and lower mean birthweight (mean difference -98.96 g, 95% CI -126.29 to -71.63) compared with the control group. There were no between-group differences in other adverse neonatal outcomes.Conclusions: Induction of labor at about 39 weeks is not associated with increased risk of cesarean delivery. [ABSTRACT FROM AUTHOR]

Background and Objectives: Blood is a critical resource for responding to mass casualty incidents (MCI). The main framework for transfusion preparedness is the American Association of Blood Bank (AABB) Disaster Operation Handbook. A disaster preparedness plan for co‐ordinated blood supply was issued in Italy in 2016. Aim: To assess the level of preparedness of the Transfusion Centers (TS) in the Piedmont region, to evaluate the applicability of AABB checklist and to evaluate the application of the Italian plan. Materials and Methods: We surveyed all the Regional Transfusion Centers (TS) using the AABB checklist, addressing 74 priority action items grouped according to 16 preparedness domains. The Italian 2016 plan has been considered the regulatory cut‐off and hospitals were stratified based on the type and the TS workload. A principal component analysis (PCA) was conducted to summarize the variance among centres. Results: Twenty‐one out of 25 TS agreed to participate. Eighty‐one % were at high and 18% were at medium level of preparedness. All but two centres were above the cut‐off determined by the Italian law. A significant better preparedness was found in medium size hospitals compared to bigger and smaller hospitals. Other than that, the different TS showed a quite homogeneous distribution of preparedness variance. Conclusions: This study demonstrated a good level of preparedness in the Piemonte TS, above the Italian law requirements in the majority of TS. The AABB checklist could be used to highlight gaps and needs in the regional TS networks in case of emergency crisis. [ABSTRACT FROM AUTHOR]

Inversion of the uterus is quite a rare obstetric (puerperal) or gynecological (non‐puerperal) condition. Non‐puerperal type may be benign or malign mass induced or idiopathic. To the best of our knowledge, this is the first case with a large review of literature of uterine inversion in a patient without sexual experience. We report the case of a 52‐year‐old, unmarried virgo woman, affected by schizophrenia, was referred to our emergency room for evidence of a mass outside of the vaginal introitus, combined with vaginal bleeding and abdominal pain. The patient underwent vaginal myoma resection and abdominal hysterectomy with bilateral adnexectomy. The diagnosis of uterine inversion was confirmed during operation. Diagnosis of uterine inversion is often not easy and imaging studies might be helpful. Despite the rarity, uterine non‐puerperal inversion is possible: for this reason, it is necessary to perform appropriate, conservative treatment, especially in women affected by benign myomas and with a desire for pregnancy. [ABSTRACT FROM AUTHOR]

Predicting the response of beam-to-column joints is essential to evaluate the response of moment frames. The well-known component method is based on a mechanical modelling of the joint, through joint subdivision into more elementary components subsequently reassembled together to obtain the whole joint characteristics. Significant advantages of the component method are the following: (i) the mechanics-based modelling approach; (ii) the easier general characteristics of components. However, the method is commonly perceived by practicing engineers as being too laborious for practical applications. Within this context, this paper summarizes the results of a theoretical study aiming to develop simplified analysis tools for bolted end-plate beam-to-column joints, based on the Eurocode 3 component method. The accuracy of the component method was first evaluated, by comparing theoretical predictions of the plastic resistance and initial stiffness with corresponding experimental data collected from the available literature. Subsequently, design/analysis charts were developed through a parametric application of the component method by means of automatic calculation tools. They are easy and quick tools to be used in the first phases of the design process, in order to identify joint configurations and geometrical properties satisfying specified joint structural performances. The parametric analysis allowed also identifying further simplified analytical tools, in the form of nondimensional equations for predicting quickly the joint structural properties. With reference to selected geometries, the approximate equations were verified to provide sufficiently accurate predictions of both the stiffness and the resistance of the examined beam-to-column joints. [ABSTRACT FROM AUTHOR]

Abstract: This paper has a double challenge: (a) focusing on distrustful situations in interfirm collaboration; (b) clarifying the concept and role of destination governance, with specific attention to the situations of distrust or difficult processes of trust building between potential or actual partners. These objectives are verified in an empirical setting. It has been conducted a statistical survey on tourism firms operating in Italy, and through a dependent analysis, we have verified a very low real approach towards the idea of a governing pivotal actor in these well developed tourist areas. The current study has verified whether and to what extent distrust persists and if the diffusion of trust depends on the presence of leading actors also comparing the 2 areas. [ABSTRACT FROM AUTHOR]

Objective. Cesarean scar pregnancy (CSP) is a rare condition that occurs when the pregnancy implants in a cesarean scar. An early diagnosis and a proper management are fundamental to prevent maternal complications. We review and discuss the different treatment employed in our unit to reduce morbidity, preserve fertility, and predict possible complications. Methods. The reported treatment has been expectant management, operative hysteroscopy approach, and intramuscular injection of 50 mg methotrexate (MTX), followed by cervical dilation and manual vacuum aspiration (D&S) with a Karman cannula under ultrasound guidance, uterine artery embolization (UAE), and manual vacuum aspiration under ultrasound guidance and uterine artery embolization before surgical laparotomic resection. Results. Complications were more frequent in women with a history of three or more cesarean section deliveries and with a myometrial thickness thinner than 2 mm. MTX and D&S treatment appear to be most effective and safe at the early age of pregnancy, while UAE and D&S are related to the highest risk of complication in any age of pregnancy. Conclusion. An appropriate preoperative diagnostic evaluation, the identification of cases at higher risk, and those eligible for a conservative treatment are fundamental to reduce complications. [ABSTRACT FROM AUTHOR]

Abstract: Background & Aims: Treatment with the farnesoid X receptor (FXR) agonist obeticholic acid is ineffective in some patients with non‐alcoholic steatohepatitis (NASH) but the explanation is uncertain. We investigated hepatic FXR expression, and measurements of fibroblast growth factor 19 (FGF19) and bile acids (BAs) in children with NAFLD to investigate relationships with NASH. Methods: 33 children with NAFLD who underwent diagnostic liver biopsy were studied. Hepatic FXR protein levels and circulating FGF19 concentrations were compared with those analysed in five control subjects with proven normal liver histology. NASH was defined by the Paediatric NAFLD Histological Score (PNHS). Binary logistic regression with adjustment for covariates and potential confounders was undertaken to test factors independently associated with: a) NASH and b) hepatic FXR protein levels. Results: Mean ± SD age was 13.7 ± 1.9 years. Nineteen patients had NASH (PNHS ≥ 85) and 14 did not have NASH (PNHS < 85). Hepatic FXR level and plasma FGF19 concentration varied ~10‐fold and 5‐fold, respectively, between groups, and was highest in control subjects, intermediate in NAFLD without NASH, and lowest in NASH (between group differences P < .001 and P < .01 respectively). NASH was independently associated with both FXR protein levels (OR = 0.18, 95% CI 0.09, 0.38) and FGF19 concentration (OR = 0.55, 95% CI 0.20, 0.89). Conclusions: FXR protein levels vary markedly between normal liver, NAFLD without NASH, and NASH. Low levels of FXR are independently associated with NASH. [ABSTRACT FROM AUTHOR]

The ENEA superconductivity laboratory developed a novel design for Cable-in-Conduit Conductors (CICCs) comprised of stacks of 2nd-generation REBCO coated conductors. In its original version, the cable was made up of 150 HTS tapes distributed in five slots, twisted along an aluminum core. In this work, taking advantage of a 2D finite element model, able to estimate the cable’s current distribution in the cross-section, a multiobjective optimization procedure was implemented. The aim of optimization was to simultaneously maximize both engineering current density and total current flowing inside the tapes when operating in self-field, by varying the cross-section layout. Since the optimization process involved both integer and real geometrical variables, the choice of an evolutionary search algorithm was strictly necessary. The use of an evolutionary algorithm in the frame of a multiple objective optimization made it an obliged choice to numerically approach the problem using a nonstandard fast-converging optimization algorithm. By means of this algorithm, the Pareto frontiers for the different configurations were calculated, providing a powerful tool for the designer to achieve the desired preliminary operating conditions in terms of engineering current density and/or total current, depending on the specific application field, that is, power transmission cable and bus bar systems. [ABSTRACT FROM AUTHOR]

Understanding aortic root in vivo biomechanics can help in elucidating key mechanisms involved in aortic root pathologies and in the outcome of their surgical treatment. Numerical models can provide useful quantitative information. For this to be reliable, detailed aortic root anatomy should be captured. Also, since the aortic root is never unloaded throughout the cardiac cycle, the modeled geometry should be consistent with the in vivo loads acting on it. Achieving such consistency is still a challenge, which was tackled only by few numerical studies. Here we propose and describe in detail a new approach to the finite element modeling of aortic root in vivo structural mechanics. Our approach exploits the anatomical information yielded by magnetic resonance imaging by reconstructing the 3-dimensional end-diastolic geometry of the aortic root and makes the reconstructed geometry consistent with end-diastolic loading conditions through the estimation of the corresponding prestresses field. We implemented our approach through a semiautomated modeling pipeline, and we applied it to quantify aortic root biomechanics in 4 healthy participants. Computed results highlighted that including prestresses into the model allowed for pressurizing the aortic root to the end-diastolic pressure while matching the image-based ground truth data. Aortic root dynamics, tissues strains, and stresses computed at relevant time points through the cardiac cycle were consistent with a broad set of data from previous computational and in vivo studies, strongly suggesting the potential of the method. Also, results highlighted the major role played by the anatomy in driving aortic root biomechanics. [ABSTRACT FROM AUTHOR]

In summer, many temperate bat species use daytime torpor, but breeding females do so less to avoid interferences with reproduction. In forest-roosting bats, deep tree cavities buffer roost microclimate from abrupt temperature oscillations and facilitate thermoregulation. Forest bats also switch roosts frequently, so thermally suitable cavities may be limiting. We tested how barbastelle bats ( Barbastella barbastellus), often roosting beneath flaking bark in snags, may thermoregulate successfully despite the unstable microclimate of their preferred cavities. We assessed thermoregulation patterns of bats roosting in trees in a beech forest of central Italy. Although all bats used torpor, females were more often normothermic. Cavities were poorly insulated, but social thermoregulation probably overcomes this problem. A model incorporating the presence of roost mates and group size explained thermoregulation patterns better than others based, respectively, on the location and structural characteristics of tree roosts and cavities, weather, or sex, reproductive or body condition. Homeothermy was recorded for all subjects, including nonreproductive females: This probably ensures availability of a warm roosting environment for nonvolant juveniles. Homeothermy may also represent a lifesaver for bats roosting beneath loose bark, very exposed to predators, because homeothermic bats may react quickly in case of emergency. We also found that barbastelle bats maintain group cohesion when switching roosts: This may accelerate roost occupation at the end of a night, quickly securing a stable microclimate in the newly occupied cavity. Overall, both thermoregulation and roost-switching patterns were satisfactorily explained as adaptations to a structurally and thermally labile roosting environment. [ABSTRACT FROM AUTHOR]

Background and purpose In multiple sclerosis ( MS), depression is a common disorder whose pathophysiology is still debated. To gain insights into the pathophysiology of depression in MS, resting-state ( RS) functional connectivity ( FC) changes of the default mode network ( DMN), salience network ( SN) and executive control network ( ECN) were assessed in a group of depressed MS (D- MS) patients and in appropriately matched control groups. Methods Sixteen D- MS patients, 17 non-depressed MS ( ND- MS) patients, 17 non-depressed healthy controls and 15 depressed subjects (D-S), age, sex and education matched, cognitively preserved and non-fatigued, were enrolled. All participants underwent a neuropsychological evaluation and RS functional magnetic resonance imaging study. Results Comparing D- MS patients with D-S, within the DMN, a significant RS- FC suppression was found in the posterior cingulate cortex ( PCC); comparing D- MS with ND- MS, FC was significantly increased in the anterior cingulate cortex and significantly reduced in the PCC. Within the SN increased FC in the right supramarginal gyrus and right middle frontal gyrus was found in D- MS patients compared to D-S and to ND- MS; within the ECN increased FC in the right inferior parietal cortex was found in D- MS patients compared to ND- MS patients. Conclusions In cognitively preserved D- MS patients, FC derangement occurs in the SN, ECN and DMN. In the latter, changes occurring both in the anterior cingulate cortex and PCC suggest that depression in MS may be linked to MS itself and, in particular, to a peculiar pattern of network abnormalities favored by MS pathology through disconnection mechanisms. Reduced FC in the PCC, similar to MS patients with cognitive impairment, suggests a functional link between depression and cognitive impairment in MS. [ABSTRACT FROM AUTHOR]

For decades, clinicians have witnessed no therapeutic advances for small cell lung cancer, including no US Food and Drug Administration‐approved targeted therapies; recently, immune‐checkpoint blockade has emerged as a promising new option for the treatment of patients with relapsed small cell lung cancer (including recent US Food and Drug Administration approval of nivolumab in the third‐line setting) and soon may represent the frontline standard of care in combination with chemotherapy. However, there is a need to uncover biomarkers to guide patient selection and develop novel approaches to enhance response to immunotherapies. [ABSTRACT FROM AUTHOR]

The article describes a case of primary pleural squamous cell carcinoma (PPSCC) in a patient who had undergone thoracic surgery. Topics discussed include case history, the onset of PPSCC as an extremely rare event and the need for correct differential diagnosis for therapy and clinical management of the patient.

All Societies, AASLD, EASL, APASL and JSH, identify patients with cirrhosis as a target population for surveillance, with minor differences for additional categories of patients, such as chronic hepatitis B and hepatitis C patients with advanced fibrosis. According to AASLD, liver disease related to metabolic diseases including diabetes and obesity is a recognized target of screening, since those conditions have been causally related to HCC. All societies endorse radiological non-invasive techniques as the mainstay for early diagnosis of HCC, but discrepancies exist between Societies on the utilization of contrast-enhanced ultrasound and utilization of serum markers for surveillance and diagnosis of HCC. The diagnostic algorithm of the international societies differ substantially in the anatomic paradigm of EASL and APASL which identify 1 cm size as the starting point for radiological diagnosis of HCC compared to APASL algorithm based on the dynamic pattern of contrast imaging, independently on tumour size. While strengthening prediction in individual patients is expected to improve cost-effectiveness ratios of screening, the benefits of pre-treatment patient stratification by clinical, histological and genetic scores remain uncertain and exclusion of patients with severe co-morbidities and advanced age is still debated. [ABSTRACT FROM AUTHOR]

In the present paper, a constitutive model for the description of the dissipation in the concrete is provided. The theoretical description is based on a micromorphic model in which the microstructure is constituted by a kinematical scalar descriptor φ whose time derivative is linked to a dissipative potential. The scalar φ can be interpreted as the relative displacement between two opposite faces of the microcracks, and our physical interpretation of dissipation is indeed linked to the friction force (in a mixed Coulomb-type and viscous-type behavior) between them. To evaluate the effects of bending on the dissipation, the 3D model is then reduced by means of standard Saint-Venant's procedure in case of combined compression and bending over a cylindrical domain. A qualitative analysis of the reduced ODEs model is then provided. Numerical results showing comparison between different types of dissipative force and between pure compression and combined compression and bending are included in a dedicated section. Finally, the proposed model and our physical interpretation of the dissipation are supported by some experimental data concerning standard concrete and a concrete enriched by adding to the mixture a filler constituted by micro-particles capable of improving the dissipative behavior of the material. Measured data show very good fit with our theoretical previsions and provide a sufficiently sound basis for further deepening of the theoretical description of the considered phenomena. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to evaluate the metabolic effects of fatty pancreas (nonalcoholic fatty pancreas disease - NAFPD) in a group of obese paediatric patients with nonalcoholic fatty liver disease ( NAFLD). Methods We included 121 consecutive children with echographic evidence of hepatic steatosis. All patients underwent to abdominal ultrasound to evaluate pancreatic echogenic pattern. We divided the patients into two groups on the basis of the presence of fatty pancreas. In all patients liver function tests, lipid and gluco-insulinemic profile were evaluated. A selected subset of patients (67) underwent to liver biopsy. Results Of these 121 patients, 58 showed NAFPD and 63 patients exhibited a normal pancreatic echogenic pattern. No differences were found in age, transaminases serum levels, lipid profile and pancreatic enzymes between the two groups. The patients with NAFPD had a significantly higher z- BMI, fasting insulin, insulin resistance ( HOMA- IR) and lower ISI respect to the group without fatty pancreas. The patients with fatty pancreas showed a more advanced form of liver disease, with higher values of fibrosis, ballooning and NAS score with respect to the group without NAFPD. Conclusions Our study demonstrated that NAFPD is a frequent condition in obese paediatric patients affected by NAFLD. Our data suggest that pancreatic fat should not be considered an inert accumulation of fat, but as an additional factor able to affect glucose metabolism and severity of liver disease, increasing the risk of develop metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background Lifestyle interventions are often ineffective in the treatment of pediatric obesity. Weight loss devices have been introduced for the temporary nonsurgical treatment of morbid obesity. Objective The aim of the study is to evaluate the efficacy of Obalon Intragastric Balloon on weight loss and on metabolic and cardiovascular parameters in a pediatric population with severe obesity. Methods We enrolled 10 children with severe obesity. In all patients anthropometric parameters, biochemical tests, ultrasound liver examination and blood pressure monitoring were evaluated at the time of insertion and after removal of device. Results The Obalon had a positive effect on decrease of weight, body mass index and percentage of excess body weight within 3 months from placement. Moreover, this safe minimally invasive device improves the cardio-metabolic profiles of obese children. Conclusions The Obalon could be a useful tool in the difficult management of pediatric patients with morbid obesity, inducing in short-term a meaningful weight loss. [ABSTRACT FROM AUTHOR]

Abstract: Bicuspid aortic valve is the most prevalent cardiac valvular malformation. It is associated with a high rate of long‐term morbidity including development of calcific aortic valve disease, aortic regurgitation and concomitant thoracic aortic aneurysm and dissection. Recently, basic and translational studies have identified some key processes involved in the development of bicuspid aortic valve and its morbidity. The development of aortic valve disease and thoracic aortic aneurysm and dissection is the result of complex interactions between genotypes, environmental risk factors and specific haemodynamic conditions created by bicuspid aortic valve anatomy. Herein, we review the pathobiology of bicuspid aortic valve with a special emphasis on translational aspects of these basic findings. Important but unresolved problems in the pathology of bicuspid aortic valve and thoracic aortic aneurysm and dissection are discussed, along with the molecular processes involved. [ABSTRACT FROM AUTHOR]

APAH like seronegative AIH has been described as responsive to immunomodulatory therapy,2,3 but its efficacy in the case of ALF is poorly investigated and the unusual acute onset might implicate treatment delay and unfavorable outcome. A steroid treatment was started as rescue therapy for ALF together with a genetic test for indeterminate ALF protocol. [Extracted from the article]

The article discusses adverse impact of the use of general anesthesia in breast cancer surgery as it increases risk of complications, that could reduce patient satisfaction and delay patient recovery after surgery; complications associated with the breast surgical procedure such as endotracheal intubation, inhalation anesthetics and perioperative opioid analgesic use; and information on endotracheal intubation (ETI) which represents gold standard in the airway management in anesthetic practice.

SUMMARY This paper details the findings of an experimental program that assessed the seismic performances of a novel low-cost base isolation device. The proposed bearings are referred to as recycled rubber-fiber-reinforced bearings (RR-FRBs). Devices composed of a low-cost recycled elastomer and reinforced with fiber sheets were manufactured and tested. The main revolutionary concepts investigated in this study are as follows: low-performance elastomers can be used to produce rubber isolators, and vulcanization can be prevented by bonding different layers with an elastic compound. This study addresses all design and technical aspects related to the implementation of the proposed base isolation system. Shaking table tests showed a significant improvement in the seismic performance of an RR-FRB isolated building with respect to a corresponding fixed-base structure. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The anesthetic management of patients affected by myasthenia gravis is usually challenging in elective surgery and even more so in emergency procedures. The difficulties involved are several-fold, ranging from the choice of an appropriate muscle relaxant (i.e. one that enables safe and rapid airway management) to neuromuscular monitoring and normal muscular recovery. Additionally, optimizing patient conditions - either pharmacologically or with plasmapheresis - before intervention is well beyond the realm of possibility.We discuss the anesthetic management of two myasthenic patients undergoing emergency surgery (for sigmoid perforation and upper gastrointestinal bleeding respectively). In both cases, we opted for rapidsequence induction with high-dose rocuronium to prevent inhalation of gastric contents. We also report on the implication of neuromuscular monitoring. We found that the rocuronium- sugammadex combination was a useful and effective option in the emergency setting. [ABSTRACT FROM AUTHOR]