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Cold supply chains of food and beverage sectors represent one of the main drivers of the EU total final energy consumption. Within this context, food quality losses, changes in temperature regimes, energy use, environmental burdens, and the economic viability of energy efficiency measures are essential aspects to consider for improving cold supply chains’ overall sustainability. This paper presents a dedicated toolbox, developed within the Horizon 2020 project ICCEE, for supporting decision-making and actors to assess energy efficiency path within a specific type of food cold-supply (i.e., meat, fish, milk and cheese products, fruits, and vegetables). More in specific the toolbox offers support for decision-makers to understand and minimize the specific energy consumption, to decrease the overall environmental impact even including non-energy benefit evaluation many times underestimated. The six separated tools merged within a unique toolbox consider different methodological approaches such as: assessment of the whole energy requirements in stock and flows considering the storage impact, the logistics and quality losses over time, implementation of Life Cycle Assessment and Life Cycle costs within the environmental and financial assessment of energy efficiency measures, based on a benchmarking approach. Finally, a specific approach implementing Multi Criteria Analysis was developed on selected key performance indicators such as specific and cumulated energy consumptions, quality losses and environmental burdens (i.e., global warming potential and water scarcity). The latest version of the ICCEE toolbox is available as free downloadable package on the ICCEE website.

Background: Numerous designs of manual toothbrush are available in the market with the claims of superiority in plaque removal. It often makes the public confuse which is the best design. The sharp end bristle toothbrush is a modification that commercially available in the market. Purpose: The objective of the study was to compare the effectiveness in plaque removal of the sharp end bristle toothbrush and the rounded end bristle toothbrush. Methods: This clinical trial was a double blind crossover design. The subjects were 65 dental students, divided into two groups for comparing the 2 types of toothbrush. On the 1st day, the allocated toothbrushes were distributedto each group according to their designation, and the subjects were instructed to use the toothbrushes according their normal daily practices. On the 1st, 7th, and 14th day, the subjects were scored using the patient hygiene performance index (PHP index) and the gingival index. Based on cross over design, the same procedure was repeated during the 2 week second test periods using different type of toothbrush respectively. Results: The mean scores of the 2 groups showed no significant difference on the beginning the study. Though minor differences were observed in the effectiveness of toothbrush, but the comparison of the two types of toothbrush showed no statistically significant differences on 7th and 14th day. Conclusion: There were no significant differences between sharp end and rounded end bristle toot brusher. There is no manual toothbrush superiorly designed than the others single superior design of manual toothbrush.Latar belakang: Berbagai jenis desain sikat gigi saat ini terdapat di pasaran, dengan masing-masing menyatakan keunggulannya dalam membersihkan plak. Penelitian ini dilakukan terhadap dua jenis sikat gigi manual yaitu sikat gigi dengan ujung bulu sikat runcing dan ujung bulus sikat bulat. Tujuan: Penelitian ini dilakukan untuk membandingkan efektivitas membersihkan plak antara 2 jenis sikat gigi. Metode: Penelitian ini merupakan percobaan klinis dengan desain penyilangan (crossover) secara tertutup ganda (double blind). Subyek penelitian 65 mahasiswa dibagi 2 kelompok. Pada hari pertama, sikat gigi dibagikan pada masing-masing kelompok yang telah ditentukan jenis sikat giginya, dan diinstruksikan untuk menggunakannya sesuai kebiasaan mereka. Pada hari ke 1, 7, dan 14 dilakukan pengukuran indeks PHP dan indeks gingiva. Berdasarkan desain penyilangan, proses yang sama diulangi pada masing-masing kelompok dengan menggunakan jenis sikat gigi yang berbeda. Hasil: Pada awal penelitian tidak terdapat perbedaan skor pada ke 2 kelompok. Meski terdapat sedikit perbedaan, namun tidak terdapat perbedaan yang bermakna dalam efektivitas kedua jenis sikat gigi setelah penggunaan selama 7 dan 14 hari. Kesimpulan: Tidak ada perbedaan yang bermakna antara sikat gigi jenis ujung bulu sikat bulat dan ujung bulu sikat runcing. Tidak terdapat satupun jenis sikat gigi yang paling baik.

Introduction: In certain regions of the United States, there has been a dramatic proliferation of trauma centers. The goal of our study was to evaluate transport times during this period of trauma center proliferation., Methods: Aggregated data summarizing level I trauma center admissions in Arizona between 2009 and 2018 were provided to our institution by the Arizona Department of Health Services. We evaluated patient demographics, transport times, and injury severity for both rural and urban injuries., Results: Data included statistics summarizing 266,605 level I trauma admissions in the state of Arizona. The number of state-designated trauma centers during this time increased from 14 to 47, with level I centers increasing from 8 to 13. Slight decreases in mean Injury Severity Score (rural, 9.4 vs. 8.4; urban, 7.9 vs. 7.0) were observed over this period. Median transport time for cases transported from the injury scene directly to a level I center remained stable in urban areas at 0.9 hours in both 2009 and 2018. In rural areas, transport times for these cases were approximately double but also stable, with median times of 1.8 and 1.9 hours. Transport times for cases requiring interfacility transfer before admission at a level I center increased by 0.3 hours for urban injuries (5.3-5.6 hours) and 0.9 hours for rural injuries (5.6-6.5 hours)., Conclusion: Despite the threefold increase in the number of state-designated trauma centers, transport time has not decreased in urban or rural areas. This finding highlights the need for regulatory oversight regarding the number and geographic placement of state-designated trauma centers., Level of Evidence: Care management, level IV, Epidemiological, level III., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Rotator cuff tears are common musculoskeletal injuries that can cause significant pain and disability. While the clinical results of rotator cuff repair can be good, failure of tendon healing remains a significant problem. Molecular mechanisms underlying structural failure following surgical repair remain unclear. Histologically, enhanced inflammation, disorganization of the collagen fibers, calcification, apoptosis and tissue necrosis affect the normal healing process. Mesenchymal stem cells (MSCs) have the ability to provide improved healing following rotator cuff repair via the release of mediators from secreted 30-100 nm extracellular vesicles called exosomes. They carry regulatory proteins, mRNA and miRNA and have the ability to increase collagen synthesis and angiogenesis through increased expression of mRNA and release of proangiogenic factors and regulatory proteins that play a major role in proper tissue remodeling and preventing extracellular matrix degradation. Various studies have shown the effect of exosomes on improving outcome of cutaneous wound healing, scar tissue formation, degenerative bone disease and Duchenne Muscular Dystrophy. In this article, we critically reviewed the potential role of exosomes in tendon regeneration and propose the novel use of exosomes alone or seeded onto biomaterial matrices to stimulate secretion of favorable cellular factors in accelerating the healing response following rotator cuff repair.

Objective: A description of clinical features and treatment results in patients with a central nervous system (CNS) localization of systemic non-Hodgkin's lymphoma (NHL)., Design: Retrospective., Setting: Department of Neuro-oncology and Haematology, Daniel den Hoed Cancer Centre, Rotterdam, the Netherlands., Methods: All patients with NHL (but not primary CNS lymphoma) treated in the period January 1st, 1990-December 31st, 1996 at the department of neuro-oncology were reviewed for presence of CNS localizations. Clinical characteristics like malignancy grade, disease stage, presence of extranodal localizations, B-symptoms, serum LDH, neurological signs and symptoms, results of ancillary investigations, treatment and response were recorded., Results: In this period 25 patients were diagnosed with leptomeningeal lymphoma, 2 with an intracerebral lymphoma, and 7 with both. In almost all patients the CNS localization developed during systemic progression of the NHL. Most patients presented with a radicular syndrome, cranial nerve deficits, headache or encephalopathy. More than 80% of the patients showed clinical improvement after treatment with intrathecal chemotherapy, radiation therapy or a combination of both. The median survival was three and a half months, six month survival was 32%. Progression of systemic disease was the most frequent cause of death., Conclusion: In most patients good palliation of neurological signs and symptoms could be obtained with intrathecal chemotherapy and radiation therapy. Survival in these patients was limited, however, in part because of the frequent concurrent progression of systemic disease. Patients with CNS localizations with chemotherapeutic treatment possibilities with a realistic chance of cure or longterm survival should be treated accordingly. Otherwise, treatment should consist of intrathecal chemotherapy or radiation therapy of involved areas only.

Ferromagnetic materials with low Curie temperatures are being investigated for use as interstitial implants for fractionated hyperthermia treatment of prostatic disease. Previous investigations of the system have utilized alloys, such as NiCu, with inadequate corrosion resistance, requiring the use of catheters for removal of the implants following treatment or inert surface coatings which may interfere with thermal characteristics of the implants. We are evaluating a palladium-cobalt (PdCo) binary alloy which is very similar to high palladium alloys used in dentistry. Electrochemical corrosion tests and immersion tests at 37 degrees C for both NiCu and PdCo alloy samples in mammalian Ringer's solution were performed. Long-term corrosion rates are 5.8 x 10(-5) microm per year (NiCu) and 7.7 x 10(-8) microm per year (PdCo) from average immersion test results, indicating higher corrosion resistance of PdCo (P < 0.02); immersion corrosion rates were much lower than initial corrosion rates found electrochemically. Both alloys had significantly lower corrosion rates than standard surgical implant rates of 0.04 microm per year (P < 0.001 for both alloys). Scanning electron microscopy illustrates changes in the NiCu alloy surface due to pitting corrosion; no difference is observed for PdCo. The data indicate that the PdCo alloy may be suitable as a long-term implant for use in fractionated hyperthermia.

An interstitial temperature self-regulating implantable thermal seed for ablation of the prostate was investigated for the treatment of cancer. The technique is analogous to brachytherapy implants with three important advantages: highly localized temperatures may reduce complications, the thermal seed can be activated for retreatment at any point in time, and the seeds pose no radiation hazard to the clinical staff. Thermal seeds were implanted in the left lobe of the prostates in four dogs; the right lobe was a control to evaluate undesired heating outside the seed array. Linear-array thermometry probes were placed in both lobes, and the induction field for heating the implants was activated for 1 hour. After treatment, biopsies were taken from both lobes at 4-hour intervals up to 28 hours to evaluate thermal damage and thermotolerance as measured by expression of heat shock protein (hsp) 70. Only 5 minutes was required to heat the left lobe to 45 degrees to 55 degrees C. The maximum and minimum cumulative equivalent minutes at 43 degrees C (CEM43) thermal doses in the treated lobe were 174 and 4.4 hours, respectively; less than a 1-minute CEM43 was observed in the control lobe. Elevated hsp70 expression was detected in tissue of the treated lobe between 12 and 24 hours after treatment; minimal increases occurred in the control lobe. The thermal seed system was effective at heating the prostatic volume without damage to normal tissues outside the implant array, and subsequent treatments were simplified in comparison with other hyperthermia devices. Expression of hsp70 implies that retreatment of the prostate at intervals as short as 48 to 72 hours may avoid thermotolerance making weekly treatment an appropriate regimen.

We investigated the use of an interstitial temperature self-regulating implant for fractionated hyperthermia delivery for treatment of prostatic disease. Nonuniform heating, lower temperatures between the implants, and lingering thermotolerance for additional hyperthermia treatments are concerns associated with the technique. Thermotolerance of the Dunning R3327 prostate adenocarcinoma to a 1 hour interstitial heating of 42-43°C has been estimated using inducible heat shock protein (HSP) 72 as an assay. The duration of thermotolerance in a nonuniformly heated tumor is necessary for optimization of multiple-treatment planning. HSP 72 expression is increased between 8 and 16 hours posttreatment. Growth curves for conditioned (treated once at 42-43°C minimum) tumors retreated at a minimum temperature of 45°C after 10 hours recovery (where elevated HSP 72 expression is evident) were compared with those retreated after 48 hours recovery (with normal HSP 72 expression) and with conditioned controls; both retreatment groups differed from controls (p < 0.0001). Growth curves for tumors with elevated HSP 72 expression after 10 hours differed from those retreated after 48 hours (p ≤ 0.0202). The results indicate that in vivo measurement of HSP 72 expression in the Dunning tumor is an adequate indicator of thermotolerance for optimal sequencing of hyperthermia fractions and that sufficiently high thermal doses are effective against thermotolerant cell populations.

Ferromagnetic alloys heated by magnetic induction have been investigated as interstitial hyperthermia delivery implants for over a decade, utilizing low Curie temperatures to provide thermal self-regulation. The minimally invasive method is attractive for fractionated thermal treatment of tumors which are not easily heated by focused microwave or ultrasound techniques. Past analyses of ferromagnetic seeds by other authors depict poor experimental correlation with theoretical heating predictions. Improvements in computer hardware and commercially available finite element analysis software have simplified the analysis of inductively heated thermal seeds considerably. This manuscript examines end effects of finite length implants and nonlinear magnetic material properties to account for previous inconsistencies. Two alloys, Ni-28 wt% Cu (NiCu) and Pd-6.15 wt% Co (PdCo), were used for comparison of theoretical and experimental calorimetric results. Length to diameter (L/d) ratios of over 20 for cylindrical seeds are necessary for minimization of end effects. Magnetic properties tested for alloys of NiCu and PdCo illustrate considerable nonlinearity of these materials in field strength ranges used for induction heating. Field strength dependent magnetic permeabilities and calorimetric data illustrate that more detailed material information must be included to accurately estimate induction power loss for these implants.

Ferromagnetic Ni-Cu alloy wires were characterized in order to obtain well-defined thermoseeds for application in interstitial hyperthermia of prostate cancer. Thermoseeds have been produced which possess Curie points in the therapeutic hyperthermia range, approximately 40 to 50 degrees C. The effect of thermal treatment and composition on the heating characteristics of the thermoseeds were investigated. The preliminary study shows that the recrystallization is crucial for altering thermoseeds' heating characteristics. Obtaining thermoseeds which behave as desired depends on changes in annealing times and temperatures. One may increase the maximum heating temperature (similar to Curie temperature) by increasing the annealing time and cooling time. Decreasing the lower annealing plateau temperature also increases the maximum seed heating temperature. Higher nickel content compositions did not affect rise time but increased the maximum heating temperature.

Hyperthermia is being utilized individually and in conjunction with other therapies in treating malignant and benign tumors, though few studies have examined cellular effects of elevated temperatures in the prostate model. Highly conserved proteins of the 70 kDa heat shock protein family (HSP 70) are produced in response to environmental stresses, including heat, and are found in all organisms. HSPs are an indicator of cell damage, are associated with thermotolerance, and provide cells with transient resistance to subsequent thermal challenges. Transient thermotolerance is important in the determination of temperature, duration, and sequencing for treatments. This preliminary study analyzes the HSP 70 response of the Dunning R3327 adenocarcinoma model to a single 50 degrees C 1 hr treatment. Elevated HSP levels were found between 10 and 16 hr, returning to baseline by 24 hr. As some fractions of the cells are able to produce HSP 70 following treatment, the data suggest that currently utilized clinical temperatures (42-46 degrees C) administered for 1 hr are inadequate. HSP levels in response to hyperthermia, radiation, and chemotherapy may be useful in finding optimal treatment regimens for prostate cancer.

The effect of hyperthermia was examined on the Dunning prostate tumor model in rats. Hyperthermia was created by heating self-regulating interstitial seeds with an external oscillating magnetic field. The seed alloy was comprised of 70% nickel and 30% copper. One treatment with 50C seeds for two hours did not provide significant delay in tumor growth compared to controls. However, regimens with two treatments separated by either 48 hours or one week did cause significant delay (p = 0.0013 and p = 0.0096, respectively). These results suggest that an interstitial hyperthermia seed may provide an efficacious outpatient therapy for prostate cancer. Further, interstitial hyperthermia may be readily combined with existing radiotherapy with interstitial gold coated seeds to provide additive or synergistic anti-tumor effects.