Search

Hospitalization; Influenza; Mortality Hospitalització; Grip; Mortalitat Hospitalización; Gripe; Mortalidad Background Influenza may trigger complications, particularly in at-risk groups, potentially leading to hospitalization or death. However, due to lack of routine testing, influenza cases are infrequently coded with influenza-specific diagnosis. Statistical models using influenza activity as an explanatory variable can be used to estimate annual hospitalizations and deaths associated with influenza. Our study aimed to estimate the clinical and economic burden of severe influenza in Spain, considering such models. Methods The study comprised ten epidemic seasons (2008/2009–2017/2018) and used two approaches: (i) a direct method of estimating the seasonal influenza hospitalization, based on the number of National Health Service hospitalizations with influenza-specific International Classification of Diseases (ICD) codes (ICD-9: 487–488; ICD-10: J09-J11), as primary or secondary diagnosis; (ii) an indirect method of estimating excess hospitalizations and deaths using broader groups of ICD codes in time-series models, computed for six age groups and four groups of diagnoses: pneumonia or influenza (ICD-9: 480–488, 517.1; ICD-10: J09–J18), respiratory (ICD-9: 460–519; ICD-10: J00–J99), respiratory or cardiovascular (C&R, ICD-9: 390–459, 460–519; ICD-10: I00–I99, J00–J99), and all-cause. Means, excluding the H1N1pdm09 pandemic (2009/2010), are reported in this study. Results The mean number of hospitalizations with a diagnosis of influenza per season was 13,063, corresponding to 28.1 cases per 100,000 people. The mean direct annual cost of these hospitalizations was €45.7 million, of which 65.7% was generated by patients with comorbidities. Mean annual influenza-associated C&R hospitalizations were estimated at 34,894 (min: 16,546; max: 52,861), corresponding to 75.0 cases per 100,000 (95% confidence interval [CI]: 63.3–86.3) for all ages and 335.3 (95% CI: 293.2–377.5) in patients aged ≥ 65 years. We estimate 3.8 influenza-associated excess C&R hospitalizations for each hospitalization coded with an influenza-specific diagnosis in patients aged ≥ 65 years. The mean direct annual cost of the estimated excess C&R hospitalizations was €142.9 million for all ages and €115.9 million for patients aged ≥ 65 years. Mean annual influenza-associated all-cause mortality per 100,000 people was estimated at 27.7 for all ages. Conclusions Results suggest a relevant under-detected burden of influenza mostly in the elderly population, but not neglectable in younger people. The BARI study was funded by Sanofi. Martinón-Torres F has received support for the present work from the Instituto de Salud Carlos III (Proyecto de Investigación en Salud, Acción Estratégica en Salud): Fondo de Investigación Sanitaria (FIS; PI070069/PI1000540/PI1601569/PI1901090) del plan nacional de I + D + I and ‘fondos FEDER’ and Proyectos GAIN Rescata-Covid_IN845D 2020/23 (GAIN, Xunta de Galicia).

This study aimed to identify and characterise indoor sources of particulate matter (PM) in domestic environments. 74 inhabited apartments located in the urban area of Gela (Sicily, Italy), close to a refinery, and in three villages of the hinterland were evaluated, in real-world conditions, for the elemental composition of PM

Hydrogen production from dry reforming of methane (DRM) was investigated on different Nickel based catalysts deposited on MgAl2O4. MgAl2O4 spinel was prepared using γ-Alumina supplied from different manufacturers (Sigma Aldrich, Alfa Aesar and Degussa) with low and high specific surface area. Moreover, the influence of different parameters on the catalytic activity on methane dry reforming was studied such as the effect of Ni content, the effect of commercial alumina and the effect of doping nickel with cerium and lanthanum. During this study, the catalytic activity was compared at atmospheric pressure at 750 °C during 4 h then 650 °C during 4 h toward methane dry reforming (DRM) reaction with a molar ratio CH4/CO2 = 1/1 and a Weight Hourly Space Velocity (WHSV) of 60.000 mL g−1.h−1. The results showed that among the different catalysts 1.5Ce–Ni5/MgAl2O4, synthesized with alumina from Alfa Aesar, exhibited the best catalytic activity for DRM. Furthermore, this catalyst showed the best performance during a stability test at 600 °C for 24 h under reacting mixture with a low carbon formation rate (2.71 mgC/gcat/h). Such superior activity is consistent with characterization results from BET, XRD, SEM, TPR and TPO analysis. Furthermore, it seems that the addition of Cerium on Ni/MgAl2O4 leads to an increase in catalyst efficiency. It can be due to an effective active oxygen transfer due to the redox properties of CeO2, leading to the formation of oxygen vacancies offering a benefit for DRM reaction.

Sviluppo di catalizzatori strutturati bidirezionali caratterizzati da proprietà chimicofisiche e catalitiche tali da consentirne l'impiego sia in processi di metanazione del syngas proveniente da celle SOEC e/o CO2 che in processi di reforming del gas naturale/biogas per produrre syngas (destinato all'alimentazione di una cella SOFC/SOEC reversibile per la produzione di energia elettrica e calore) a temperature comprese tra 600-750°C.

As more patients with skeletal metastases live longer, many implants are at risk for mechanical failure and for tumor progression in the face of previous treatment. The causes for and treatment options available to failed cases have received some attention in the literature, but few papers suggested what surgery was the best. Failures around tumor implants can be mechanical and not mechanical. The first include dislocation, soft tissue defect, wound dehiscence, aseptic loosening, and fractures, whereas the second infections and disease progression. For all types of failure, different strategies of treatment are described.

Electric pumps cannot be fed in those areas where they are not connected to the electric public distribution grid. In those areas, it is useful to feed electric pumps by means of the electricity generated from renewable energy sources plants. Among these, the Solar Water Pumping Systems feed electric pump thanks to the electricity generated by a photovoltaic plant. In this paper, a whole SWPS is fully designed, modelled, and simulated in Matlab environment. The proposed implementation is an useful tool for SWPS testing.

Introduction: The humerus is the second most common long bone site of metastatic disease from renal cell carcinomas (RCC) after femur. Surgery has an important role in the treatment of these lesions due to renal cell tumor's resistance to chemotherapy and radiotherapy. The aim of this study is to determinate if prosthetic replacement is an effective and safe solution in treatment of renal cancer. Hypothesis: Prosthetic replacement is an effective and safe solution in treatment of renal humeral metastasis. Material and methods: Fifty-six patients affected by RCC bone metastases of the humerus that underwent a surgical reconstruction were reviewed. Thirty-five lesions were localized on proximal third, 12 on the shaft, 9 on distal third. Among proximal 29 were treated with resection and endoprosthetic replacement and 6 with plate and cement. Six diaphyseal lesions were stabilized with intramedullary nailing, 5 with plate and cement and 1 with an intercalary prosthesis. Regarding distal lesions, 7 elbow prostheses and 2 plates and cement were used. Results: The average age was 63 years. Metastasis was single in 55% of cases, and in 45% metachronous. A pathologic fracture (PF) occurred in 64% of cases. Only 9% of patients had a mechanical complication, 7% an infection and 5% neurological deficit. A local recurrence occurred in 14% of patients. An implant failure has been observed in 10 patients, 5 for mechanical complications, 2 for infections and 3 for local recurrence; of these 7 were treated with a prosthesis and 3 with plate and cement. The mean value of MSTS score was 64%, 63% and 59% respectively in patients with proximal, diaphyseal and distal humerus metastases. Discussion: Solitary and metachronous bone metastases have a longer survival. Disease-free interval > 2 years is another important prognostic factor. Reconstruction with a modular prosthesis is recommended in proximal and distal third. Instead in diaphyseal lesions a closed reduction and fixation with intramedullary locked nailing are preferred. When surgical indications are correctly followed, good oncologic and functional outcomes are obtained, leading to markedly improvement of patients’ quality of life. Retrospective study: Level of evidence IV.

Extra-axial chordoma is an exceedingly rare tumor, with only 28 cases reported in the literature to date. Axial and extra-axial chordoma exhibits complete morphologic and immunophenotypic (expression of brachyury) overlap. However, in consideration of the non-canonical presentation, extra-axial chordoma is under-recognized and often misdiagnosed, most often as extraskeletal myxoid chondrosarcoma or myoepithelioma. To increase our understanding of the clinicopathologic features of extra-axial chordoma, six cases have been retrieved from the files of the Istituto Ortopedico Rizzoli and of the General Hospital of Treviso. The clinicoradiologic, morphologic, and molecular features have been analyzed, and the follow-up was updated. Our series included four female and two male patients; their ages ranged from 20 to 67 years (mean 45.8 years). All patients presented with a single mass localized in four cases in the soft tissue (posterior arm, left leg, dorsal aspect of the foot, and popliteal fossa), and in two cases in the bone (radius and second metacarpal bone). Grossly, the neoplasm was lobulated, with a fleshy cut surface and a diameter ranging between 0.8 and 8 cm (mean 3.4 cm). Morphologically, all six cases showed an epithelioid cell proliferation organized in nests and cords demarcated by fibrous septa and set in an abundant extracellular myxoid matrix. Neoplastic cells featured hyperchromatic nuclei and abundant vacuolated cytoplasm. Immunohistochemically, all six cases were strongly positive for EMA, cytokeratin AE1/AE3, S100, and brachyury. INI1 nuclear expression was retained. Smooth muscle actin, calponin, p63, and GFAP were all negative. Fluorescent in situ hybridization (FISH) analysis did not reveal rearrangements involving NR4A3, FUS, and EWSR1 genes. At follow-up (mean 55 months), all patients were alive without disease after local surgical treatment. One patient underwent thigh amputation following multiple local recurrences and inguinal node metastases treated with marginal resection. In conclusion, primary extra-axial chordoma is an extremely rare neoplasm with distinct morphological and immunohistochemical features. Immunomorphology and molecular analysis allow distinction from both extraskeletal myxoid chondrosarcoma and myoepithelioma. Complete surgical resection appears to be curative.

Background and purpose Only a few studies have considered the role of comorbidities in the prognosis of amyotrophic lateral sclerosis (ALS) and have provided conflicting results. Methods Our multicentre, retrospective study included patients diagnosed from 1 January 2009 to 31 December 2013 in 13 referral centres for ALS located in 10 Italian regions. Neurologists at these centres collected a detailed phenotypic profile and follow-up data until death in an electronic database. Comorbidities at diagnosis were recorded by main categories and single medical diagnosis, with the aim of investigating their role in ALS prognosis. Results A total of 2354 incident cases were collected, with a median survival time from onset to death/tracheostomy of 43 months. According to univariate analysis, together with well-known clinical prognostic factors (age at onset, diagnostic delay, site of onset, phenotype, Revised El Escorial Criteria and body mass index at diagnosis), the presence of dementia, hypertension, heart disease, chronic obstructive pulmonary disease, haematological and psychiatric diseases was associated with worse survival. In multivariate analysis, age at onset, diagnostic delay, phenotypes, body mass index at diagnosis, Revised El Escorial Criteria, dementia, hypertension, heart diseases (atrial fibrillation and heart failure) and haematological diseases (disorders of thrombosis and haemostasis) were independent prognostic factors of survival in ALS. Conclusions Our large, multicentre study demonstrated that, together with the known clinical factors that are known to be prognostic for ALS survival, hypertension and heart diseases (i.e. atrial fibrillation and heart failure) as well as haematological diseases are independently associated with a shorter survival. Our findings suggest some mechanisms that are possibly involved in disease progression, giving new interesting clues that may be of value for clinical practice and ALS comorbidity management.

BACKGROUND: Surgical treatment of pelvic tumors with or without acetabular involvement is challenging. Primary goals of surgery include local control and maintenance of good quality of life, but the procedures are marked by significant perioperative morbidity and complications. QUESTIONS/PURPOSES: We wished to (1) evaluate the frequency of infection after limb salvage surgical resection for bone tumors in the pelvis; (2) determine whether infection after these resections is associated with particular risk factors, including pelvic reconstruction, radiotherapy or chemotherapy, type of resection, and age; and (3) analyze treatment of these infections, particularly with respect to the need of additional surgery or hemipelvectomy. METHODS: From 1975 to 2010, 270 patients with pelvic bone tumors (149 with chondrosarcoma, 40 with Ewing's sarcoma, 27 with osteosarcoma, 18 with other primary malignant tumors, 11 with metastatic tumors, and 25 with primary benign tumors) were treated by surgical resection. Minimum followup was 1.1 years (mean, 8 years; range, 1-33 years). The resection involved the periacetabular area in 166 patients. In 137 patients reconstruction was performed; in 133 there was no reconstruction. Chart review ascertained the frequency of deep infections, how they were treated, and the frequency of resection arthroplasty or hemipelvectomies that occurred thereafter. RESULTS: A total of 55 patients (20%) had a deep infection develop at a mean followup of 8 months. There were 20 infections in 133 patients without reconstruction (15%) and 35 infections in 137 patients with reconstruction (26 %). Survivorship rates of the index procedures using infection as the end point were 87%, 83%, and 80% at 1 month, 1 year, and 5 years, respectively. Infection was more common in patients who underwent pelvic reconstruction after resection (univariate analysis, p = 0.0326; multivariate analysis, p = 0.0418; odds ratio, 1.7718; 95% CI, 1.0243-3.0650); no other risk factors we evaluated were associated with an increased likelihood of infection. Despite surgical débridements and antibiotics, 16 patients (46%) had the implant removed and five (9%) underwent external hemipelvectomy (four owing to infection and one as a result of persistent infection and local recurrence). CONCLUSIONS: Infection is a common complication of pelvic resection for bone tumors. Reconstruction after resection is associated with an increased risk of infection compared with resection alone, without significant difference in percentage between allograft and metallic prosthesis. When infection occurs, it requires removal of the implant in nearly half of the patients who have this complication develop, and external hemipelvectomy sometimes is needed to eradicate the infection. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Background Studies for patients with pelvic chondrosarcomas are limited. This study determines the outcome of patients with pelvic chondrosarcomas, and whether there is any association with tumors' grade, type, stage, margins and pelvic location. Materials and Methods We retrospectively studied 215 patients with pelvic chondrosarcomas. All patients had biopsy and histological diagnosis of their tumors followed by limb salvage or amputation. We staged patients using the Musculoskeletal Tumor Society system. We performed a univariate and multivariate analysis of the survival to death, local recurrence and metastasis with respect to grade, type (central vs. peripheral), stage, margins, and pelvic location, and the survival to death of patients with and without local recurrence. Results Grade was the most important univariate and multivariate predictor of the survival of the patients. Dedifferentiation was associated with significantly lower overall survival. Peripheral chondrosarcomas predicted survival only in the univariate analysis. Surgical margins predicted local recurrence only in the multivariate analysis. Periacetabular location was associated with lower survival to death and local recurrence. The occurrence of local recurrence compromises the overall survival. Conclusion Grade was the most important predictor of the overall survival of patients with chondrosarcomas of the pelvis. J. Surg. Oncol. 2013 108:19–27. © 2013 Wiley Periodicals, Inc.

Introduction The humerus is the second most common long bone site of metastatic disease from renal cell carcinomas (RCC) after femur. Surgery has an important role in the treatment of these lesions due to renal cell tumor's resistance to chemotherapy and radiotherapy. The aim of this study is to determinate if prosthetic replacement is an effective and safe solution in treatment of renal cancer. Hypothesis Prosthetic replacement is an effective and safe solution in treatment of renal humeral metastasis. Material and methods Fifty-six patients affected by RCC bone metastases of the humerus that underwent a surgical reconstruction were reviewed. Thirty-five lesions were localized on proximal third, 12 on the shaft, 9 on distal third. Among proximal 29 were treated with resection and endoprosthetic replacement and 6 with plate and cement. Six diaphyseal lesions were stabilized with intramedullary nailing, 5 with plate and cement and 1 with an intercalary prosthesis. Regarding distal lesions, 7 elbow prostheses and 2 plates and cement were used. Results The average age was 63 years. Metastasis was single in 55% of cases, and in 45% metachronous. A pathologic fracture (PF) occurred in 64% of cases. Only 9% of patients had a mechanical complication, 7% an infection and 5% neurological deficit. A local recurrence occurred in 14% of patients. An implant failure has been observed in 10 patients, 5 for mechanical complications, 2 for infections and 3 for local recurrence; of these 7 were treated with a prosthesis and 3 with plate and cement. The mean value of MSTS score was 64%, 63% and 59% respectively in patients with proximal, diaphyseal and distal humerus metastases. Discussion Solitary and metachronous bone metastases have a longer survival. Disease-free interval > 2 years is another important prognostic factor. Reconstruction with a modular prosthesis is recommended in proximal and distal third. Instead in diaphyseal lesions a closed reduction and fixation with intramedullary locked nailing are preferred. When surgical indications are correctly followed, good oncologic and functional outcomes are obtained, leading to markedly improvement of patients’ quality of life. Retrospective study Level of evidence IV.

This paper is based on the experience gained in the development and setting up of a hard brazing procedure of butt joints by induction heating method, adopted for the manufacturing of copper conductor lengths of rectangular section, with two cooling channels inside. Such conductor has been used by ASG Superconductors for the winding of the resistive coils of the dipole magnets for the Synchrotron Ring at the ‘Centro Nazionale di Adroterapia Oncologica’ of Policlinico S. Matteo Hospital in Pavia. This will be the first such machine in Europe and shall distinguish for the type of particles used (hadrons) and the energy levels applied. This paper describes the contractual requirements, the phases of the selection of the brazing machine, the jigs and tools used for the manufacturing and the tests, the final process adopted and the results obtained.

The series production of the LHC main dipole magnets was completed in November 2006. This paper presents the organization implemented at CERN and the milestones fixed to fullfil the technical requirements and to respect the master schedule of the machine installation. The CERN organization for the production follow-up, the quality assurance and the magnet testing, as well as the organization of the three main contractors will be described. A description of the design work and procurement of most of the specific heavy tooling and key components will be given with emphasis on the advantages and drawbacks.

Background Prostheses can be used in elbow reconstruction in both primary and metastatic lesions. Several authors have reported their experience with different types of implant, but not with modular prostheses. Hypothesis Limb salvage using an elbow prosthesis is effective in obtaining good functional results and reliable local tumor control. Material and methods Forty-seven patients treated at the Rizzoli Institute for elbow neoplasm from 1990 to 2012 were evaluated. There were 30 primary tumors (64%), 24 bone tumors and 6 soft tissue sarcomas, and 17 bone metastases. Elbow reconstruction used a modular prosthesis in 25 patients and a standard prosthesis in 22. Reconstruction was primary in 30 patients and secondary in 17. Results At last control, 15 (32%) were dead of disease (DOD) at a mean follow-up of 35 months, 12 (25%) were alive with disease (AWD) at a mean follow-up of 29 months, 19 (40%) showed no evidence of disease (NED) at a mean follow-up of 80 months. Early complications were related to unexpected neurological damage, observed in 12 patients (25%): in 5 cases the deficit resolved in a mean 6 months; in the others, no or only partial recovery was observed. Two implants (4%) developed infection: 1 was treated with antibiotic therapy, and the other required implant revision. One implant showing cement extrusion was revised. In 3 patients (6%) radiography showed a radiolucent halo around the stem (2 humeral, 1 ulnar); no measures were taken, as the patients were completely asymptomatic at every follow-up. In 3 patients (6%) partial resorption of the allograft was observed on X-ray, but remained unchanged at last follow-up, without pain or functional impairment. Seven local recurrences (15%) were observed, at a mean of 16 months after surgery; 5 were treated by resection and/or radiotherapy, and 2 by amputation. Mean functional scores on MEPS and MSTS were respectively 84% and 22/30 (73%). Conclusions Elbow prostheses provided better function in primary than in metastatic tumor. Elbow prosthesis reconstruction after tumor resection is a viable option both for primary and secondary bone neoplasms. Type of study Therapeutic. Level of evidence IV, retrospective study.

The direct hydrogenation of CO2 to dimethyl ether (DME), has been studied in a fixed bed reactor, in presence of supported CuZnZr/zeolite hybrid catalysts. To study the effects of zeolite topology on catalyst performance, two different home-made zeolite structures (i.e., FER and MOR) were used as carriers during gel-oxalate coprecipitation of CuZnZr precursors. The hybrid FER-based catalyst showed a very good activity-selectivity pattern at 5.0 MPa, also exhibiting an interesting DME productivity (STY, 752 g(DME)/Kg(cat)/h), with no coke formation under the adopted experimental conditions (T-R, 280 degrees C; GHSV, 8800NL/Kg(cat)/h). The presence of well dispersed metal-oxide clusters of the precursors on the 2-D zeolite framework of FER was indicated as a key factor to realize a more efficient mass-transferring of MeOH from CuZnZr sites to zeolite surface, favoring so the formation of DME with higher yields than obtained using MOR as support. (C) 2016 Elsevier B.V. All rights reserved.

The dreaded consequence of Paget’s disease is sarcomatous transformation, a neoplasm with poor prognosis. This report describes a 61-year-old patient who developed two sarcoma in Paget disease: the first on right distal humerus and the second on right clavicle. Time elapsed beetwen lesions was 5 years. Clavicle’s tumor should be considered as metastasis, but in our opinion, some interesting elements support theory of a second primitive tumor with a metachromous onset. We present clinical, radiological and pathological features of this case comparing it with a review of literature.

Background Prostheses can be used in elbow reconstruction in both primary and metastatic lesions. Several authors have reported their experience with different types of implant, but not with modular prostheses. Hypothesis Limb salvage using an elbow prosthesis is effective in obtaining good functional results and reliable local tumor control. Material and methods Forty-seven patients treated at the Rizzoli Institute for elbow neoplasm from 1990 to 2012 were evaluated. There were 30 primary tumors (64%), 24 bone tumors and 6 soft tissue sarcomas, and 17 bone metastases. Elbow reconstruction used a modular prosthesis in 25 patients and a standard prosthesis in 22. Reconstruction was primary in 30 patients and secondary in 17. Results At last control, 15 (32%) were dead of disease (DOD) at a mean follow-up of 35 months, 12 (25%) were alive with disease (AWD) at a mean follow-up of 29 months, 19 (40%) showed no evidence of disease (NED) at a mean follow-up of 80 months. Early complications were related to unexpected neurological damage, observed in 12 patients (25%): in 5 cases, the deficit resolved in a mean 6 months; in the others, no or only partial recovery was observed. Two implants (4%) developed infection: 1 was treated with antibiotic therapy, and the other required implant revision. One implant showing cement extrusion was revised. In 3 patients (6%), radiography showed a radiolucent halo around the stem (2 humeral, 1 ulnar); no measures were taken, as the patients were completely asymptomatic at every follow-up. In 3 patients (6%), partial resorption of the allograft was observed on X-ray, but remained unchanged at last follow-up, without pain or functional impairment. Seven local recurrences (15%) were observed, at a mean 16 months after surgery; 5 were treated by resection and/or radiotherapy, and 2 by amputation. Mean functional scores on MEPS and MSTS were respectively 84% and 22/30 (73%). Conclusions Elbow prostheses provided better function in primary than in metastatic tumor. Elbow prosthesis reconstruction after tumor resection is a viable option both for primary and secondary bone neoplasms. Type of study Therapeutic. Level of evidence IV, retrospective study.

BACKGROUND: Infection of megaprostheses after bone tumor resection is a major concern; management is challenging. This study evaluated the survivability from such infections, the microbial isolates, treatment tactics, and outcome of megaprosthesis reconstructions. MATERIALS AND METHODS: We studied 1,161 patients retrospectively who underwent megaprosthesis reconstruction for limb salvage after a sarcoma from 1983 to 2010. The mean followup was 9 y (range 3-20 y). We evaluated the overall survival of the megaprosthesis reconstructions in patients with infection and the survival with respect to the type of megaprosthesis, site of reconstruction, cemented or cementless fixation, type of tumor, adjuvant treatments, microbial isolate(s), treatment tactics, and outcome. RESULTS: The incidence of infection was 8.6%. The most common microbial isolate was Staphylococcus epidermidis (47%). Overall survival with definitive management of infection was 88% at 10 y and 84% at 20 y. Survival was higher for cementless reconstructions and not different with respect to the type of megaprosthesis, site of reconstruction, or adjuvant therapy. Infections resolved completely with one- or two-stage surgery in 75% of patients. The rate of amputation because of infection was 21%. CONCLUSIONS: Megaprosthesis reconstructions may be infected in 8.6% of cases. Infections more commonly occur late, caused usually by S. epidermidis. The survival rate is higher with cementless megaprosthesis reconstructions and no different with respect to the type of tumor or megaprosthesis or the adjuvant treatments. One-stage revision is effective for acute post-operative infections; however, two-stage revision surgery is necessary for early and late infections. The rate of amputation because of occurrence or persistence of megaprosthesis infection is 21%.

The magnet system of the ATLAS detector, which presently is being installed in the LHC accelerator at CERN, consists of four components: the inner Solenoid, two End Cap Toroids and the Barrel Toroid (BT). The Barrel Toroid is composed by 8 separated superconducting coils, race-track shaped, 25 m long and 5 m large, each containing two superconducting windings referred as double pancakes. At the present time all the 8 coils have been completed and independently tested on surface under nominal conditions, and the final assembly of the toroid in the ATLAS cavern is in progress. The construction of double pancakes of unprecedented size has required a great effort in order to match the tight design dimensional tolerances and to obtain a good impregnation quality. In this paper we summarize the most relevant features of the manufacturing process of the double pancakes and the results of the measurements performed to guarantee the geometrical, impregnation and electrical quality. These data can be now considered as the "status of the art" for large size superconducting coils

Steroids may have a powerful role in neuronal degeneration. Recent research has revealed that steroids may influence the onset and progression of some retinal disorders as well as neurodegenerative diseases and, as in brain, they accumulate in the retina via a local synthesis (neurosteroids) and metabolism of blood-circulating steroid hormones. Their crucial role as neurodegenerative and neuroprotective agents has been also upheld in a retinal excitotoxic paradigm. These findings are reviewed especially from the emerging perspective that after an insult local changes in steroidogenic responses and consequent neurosteroid availability might turn out to be offensive or defensive cellular adaptations for the potentiation or prevention of neuronal death.

BACKGROUND Incidence and risk factors for delirium during clozapine treatment require further clarification. METHODS We used computerized pharmacy records to identify all adult psychiatric inpatients treated with clozapine (1995-96), reviewed their medical records to score incidence and severity of delirium, and tested associations with potential risk factors. RESULTS Subjects (n = 139) were 72 women and 67 men, aged 40.8 +/- 12.1 years, hospitalized for 24.9 +/- 23.3 days, and given clozapine, gradually increased to an average daily dose of 282 +/- 203 mg (3.45 +/- 2.45 mg/kg) for 18.9 +/- 16.4 days. Delirium was diagnosed in 14 (10.1 % incidence, or 1.48 cases/person-years of exposure); 71.4 % of cases were moderate or severe. Associated factors were co-treatment with other centrally antimuscarinic agents, poor clinical outcome, older age, and longer hospitalization (by 17.5 days, increasing cost); sex, diagnosis or medical co-morbidity, and daily clozapine dose, which fell with age, were unrelated. CONCLUSIONS Delirium was found in 10 % of clozapine-treated inpatients, particularly in older patients exposed to other central anticholinergics. Delirium was inconsistently recognized clinically in milder cases and was associated with increased length-of-stay and higher costs, and inferior clinical outcome.

Individuazione di sistemi catalitici attivi nella conversione di olio di pirolisi a biocarburanti, al fine di massimizzare l'efficienza globale del processo stesso. Sintesi di catalizzatori attivi in processi catalitici di idrogenazione degli ossidi di carbonio, finalizzati a: 1. ottenimento di: alcoli (metanolo); 2. produzione di eteri a catena corta (dimetiletere); 3. sintesi di idrocarburi a lunga catena costituiti in prevalenza da prodotti olefinici e paraffinici. Preparazione, caratterizzazione e testing di catalizzatori eterogenei convenzionali e strutturati per la conversione di olio in biodiesel

Multifunctional CuZnZr-zeolite catalysts were investigated for the direct synthesis of dimethyl ether (DME) from carbon dioxide (CO2) hydrogenation. Physical mixtures prepared by pre-pelletized CuZnZr methanol catalysts and home-made MFI-type zeolites as well as hybrid systems prepared by coprecipitation of metal-oxide precursors in solutions containing the zeolites were tested in a plug-flow reactor at 240°C, pressure of 3.0-5.0MPa and space velocity comprised between 2500 and 10,000NL/kgcat/h. Preliminary experiments in methanol (MeOH) synthesis reaction from CO2-H2 mixtures allowed to individuate a suitable CuZnZr composition ensuring good activity in CO2 conversion, high MeOH selectivity and limited CO formation. Parallel tests in MeOH-to-DME reaction were also carried out to investigate the functionality of the zeolites prepared. The results disclosed that an optimal Si/Al ratio is necessary to obtain dehydration catalysts characterized by suitable acidity and good resistance to deactivation in presence of water. The performance of the multifunctional CuZnZr-MFI catalysts in the direct CO2-to-DME hydrogenation reaction showed that, by controlling the coprecipitation of CuZnZr methanol synthesis precursors, the availability of the active sites is maximized over the zeolite surface. That allowed to reach both high CO2 conversion levels (up to 24%) and high rate of MeOH dehydration to DME.

Individuazione di sistemi catalitici attivi nella conversione di olio di pirolisi a biocarburanti, al fine di massimizzare l'efficienza globale del processo stesso Studio e sviluppo catalizzatori innovativi per la conversione di bio-syngas (H2/CO/CO2) a nuovi biocarburanti Preparazione, caratterizzazione e testing di catalizzatori eterogenei convenzionali e strutturati per la conversione di olio in biodiesel

In 1999 INFN (Istituto Nazionale di Fisica Nucleare) ordered to ANSALDO the manufacturing of 16 double pancakes for the ATLAS BARREL TOROID. In July 2001 four Double Pancakes have already been completed and shipped to the integration site. In this paper the main aspects of the manufacturing of the largest superconducting coils ever built (5/spl times/25 m) are described. The main phases of the manufacturing procedure are reviewed starting from the conductor preparation to the VPI impregnation, including references to the materials used as well as to the relevant customer's requirements. In particular the special winding form and the winding technique are treated. For each phase the most critical aspects and the relevant solutions are pointed out. Particular details about the technical solutions adopted for the impregnation and curing of the Double Pancake, which could not be performed inside an autoclave due to the huge dimension of the coil itself, are reported. Finally the methods used for the dimensional and electrical tests are described and the results obtained on the first double pancakes are analyzed.

Differences in incidence and survival in osteosarcoma reports are considerable worldwide.This study describes the incidence and survival of patients with osteosarcoma in Argentina with data from the National Pediatric Cancer Registry (ROHA), and the impact of age, gender, stage, regional, and socioeconomic indicators on outcome.Pediatric patients with osteosarcoma reported to ROHA from 2000 through 2013 were analyzed, the annual age-standardized incidence rate (ASR) was calculated using the National Vital Statistics, and survival was estimated. The extended human development index (EHDI) for each reporting region was used as an indicator of socioeconomic status.There were 515 cases of osteosarcoma identified, yielding an ASR of 3.2/1,000,000 children (0-14 years old). The ASR did not vary significantly by year of diagnosis but ranged from 4.0/1,000,000 in the Cuyo/Western Central region to 2.7/1,000,000 in the northeast region (P0.000). The estimated 5-year survival rate was 45% (95% confidence interval [CI] 44-51%), with no difference by sex, diagnosis year, region, or EHDI score (P0.1 in all cases). Survival rate for localized disease was 52% (95% CI 45-57%) and for metastatic 22% (95% CI 15-30%).In Argentina, ASR of osteosarcoma is similar to that in high-income countries, but survival is lower in all regions. Future work will focus on identification and reduction of causes of preventable treatment failure.

Objective -To establish which traditional and conditional risk factors were effectively treated, and which remained active, in patients with previous myocardial infarction (PMI). Methods and results - In 47 PMI patients recently submitted to cardiological assessment and in 42 controls (50-70 years old men), traditional risk factors (total cholesterol, high-density lipoprotein cholesterol, blood glucose, blood pressure, cigarette smoking and body mass index) and the following variables were measured: fibrinogen, plasminogen activator inhibitor-1 (PAT-1), lipoprotein(a) [Lp(a)], total homocysteine, plasma folates, vitamin B12, high sensitivity C-reactive protein and C3 complement. Most patients were taking beta-blockers, ACE inhibitors and statins. Accordingly, patients had lower blood pressure and cholesterol values than controls. Moreover, they consumed less alcohol and coffee and did not differ from controls in cigarette smoking and body mass index. Conversely, patients had higher levels of homocysteine, fibrinogen, C3 complement and Lp(a), although of these factors only C3 and homocysteine remained significantly associated with PMI in multivariate analysis. C-reactive protein, PAT-1 and especially C3 often correlated with traditional risk factors in controls, but these correlations tended to disappear or reverse in PMI patients. Fibrinogen inversely correlated with alcohol consumption. Homocysteine correlated (inversely) with plasma folates only. Lp(a) did not correlate with any variable. Conclusions - Forty-seven patients with previous myocardial infarction displayed an excellent control of traditional risk factors, but they had higher mean C3 and homocysteine levels than the control group.

Objective– We have investigated recurrence of stroke in a consecutive series of young adults, aged 16 to 45 years, after a first cerebral infarction. Methods– From January 1, 1988 to December 31, 1996 we submitted those patients to a diagnostic protocol including angiographic, cardiological, and haematological investigations. The patients were followed at 6 month intervals up to December 31, 1998. Results– We have evaluated and followed-up 135 patients, 71 men and 64 women, who were 3.99% of all the admitted stroke patients. At 12 months after stroke, 83 patients had returned to work, 40 patients were mildly to moderately handicapped, 4 were using a wheel-chair, and 8 had died. Follow-up was 26 to 123 months (mean 68.8). Recurrence of stroke, always of ischaemic nature, was seen in 15 patients (11.1%), 3 to 76 months after the first stroke (mean 27.4), for an annual incidence of 2.26%. Recurrence was significantly associated with Partial Anterior Circulation Syndrome and Haematological subtype of first stroke (respectively, P=0.0209 and P=0.0135, ξ2 test), but not with age (≤ or >35 years) or risk factors. Repetition of stroke was never fatal, but it caused heavy disability in 13 patients, 8 of whom had completely or nearly completely recovered after the first event. Conclusions– Our data suggest that recurrence of stroke is a major clinical problem also for the patients aged less than 45 years and that it might be more frequent with specific clinical syndromes and etiologic subtypes of first stroke.

Aims Serum C3 is a powerful indicator of the risk of myocardial infarction, which correlates with body mass index, serum lipids and blood pressure. This study was performed to ascertain whether such correlations may be explained by an association of C3 with fasting insulin, and to assess comparatively the relationships of C3 and traditional risk factors to previous myocardial infarction. Methods and Results The fasting levels of C3, insulin, and the main risk factors were evaluated in 1090 unselected men aged 55-64 years, including 129 cases of previous ischaemic events (51 myocardial infarctions). In multivariate analysis C3 was associated with insulin (r=0.27, P

In the present paper a fully gauged T,/spl Psi/-A-/spl Psi/ formulation for transient quasi-static 3D eddy current problems, in which the symmetry of the finite element system is achieved without differentiating in time any equation, is proposed. It is desirable to avoid such a differentiation, used in the literature to gain symmetry, because it is expected to produce finite element schemes safer against error growth, but leads to unsymmetrical matrices after discretization in space. Here, a technique proposed by the authors permits one to recover symmetry when discretizing in time. The differential model is carefully described and the way it incorporates the Coulomb gauge is discussed, as well as the existence and uniqueness of the solution. Comparisons with TEAM results are reported. >

In the present paper a new A, V-A-/spl Psi/ formulation for transient quasi-static eddy current problems using V=0, instead of A/spl middot/n=0, on conductor boundaries is proposed. This choice appears to advantageous for finite element solution problems without any symmetry plane or involving curved boundaries, even though unsuitable if the fields change very slowly. The differential formulation is carefully defined; the ways in which the Coulomb gauge is imposed and the existence and the uniqueness of the solution are discussed. A new method to obtain the symmetry of the final algebraic system is introduced. This symmetrisation technique leads to an indefinite system of algebraic equations with peculiar structure, that led to the development of a special solver. The results are extremely encouraging, the formulation is based on thorough theoretical basis, and it is fairly easy to impose the conditions on conductor boundaries. >

Hibernomas are rare benign adipose tumors composed of brown fat cells with granular, multivacuolated cytoplasm admixed with white adipose tissue. They account for 1.6% of benign lipomatous tumors and approximately 1.1% of all adipocytic tumors. They are more common in the third and fourth decades of life. The most common location is the thigh, followed by the shoulder, back, and head and neck. Four histological types have been reported; abundant vascularity is characteristic, and atypias are rare. The treatment of choice for hibernomas is complete surgical excision. Metastases or malignant transformation have not been reported. This article presents a series of 17 patients with hibernomas diagnosed and treated at our institution from January 1986 to December 2009. Six men and 11 women (M:F, 1:2) had a mean age of 38 years (range, 10 months to 64 years). All patients underwent surgical treatment; 14 patients had marginal and 3 had wide excision. Adjuvants such as radiation therapy, chemotherapy, or embolization were not administered for any patient. The most common symptom was a painless palpable mass, followed by a tender or painful mass; in 2 patients, the tumor was an incidental finding. The duration of symptoms ranged from 1 month to 10 years (mean, 27 months). The most common location was the thigh, followed by the buttock, scapula, and neck. The most common histological variant was the typical variant followed by the lipoma-like variant. At a mean follow-up of 5 years (range, 1–9 years), local recurrences were not observed.

A procedure for the estimation of field errors in finite element analysis based on a local approach is presented. The error estimate is numerically computed over each element solving a problem formulated in terms of field according to Helmholtz's theorem. For the numerical solution of the problem an edge elements approach was used. The proposed method and the numerical techniques used are described and some comparisons with other methods are reported. The proposed method has been implemented in the 2-D environment CEDEF, in the interactive module developed for the comparison of adaptive meshing and error estimation techniques. The new method has shown better, or at least equivalent, performances in the correct overestimate of the behavior of the numerical errors. >

17beta-Estradiol (E2) exerts neurotrophic and neuroprotective effects in the retina as well as in other CNS structures, independently of sex. Retinal effects, however, have not been supported by evidence on local synthesis, and whether CNS 17beta-estradiol is formed in a neurosteroidogenic pathway starting from cholesterol conversion into pregnenolone is a question still left unanswered. In the adult male rat retina, we have previously showed localization and activity of the P450 side chain cleavage (P450scc) enzyme, which is involved in pregnenolone synthesis. Here, we demonstrate both the mRNA and protein expression of 3beta-hydroxysteroid dehydrogenase (3beta-HSD), P450aromatase and also of P450scc, but only the protein expression of P450 17alpha-hydroxylase/lyase (P450c17). Using radiolabeled pregnenolone and testosterone as precursors, in the isolated and intact retina of adult male rats, E2 is produced in a large amount by each precursor within 1-4h, suggesting a highly active metabolic pathway towards its formation. The immunolocalization pattern shows enzymes and estrogen receptor subtypes (ERalpha, ERbeta) scattered in the retina with different intensities throughout the layers. The results point to the adult male rat retina as a neurosteroidogenic structure where E2 synthesis via a progesterone pathway and the presence of estrogen receptors provide important clues for understanding the neurotrophic and neuroprotective effects of the steroid hormone.