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The mismatching between the predicted and the operational performance of buildings designed to be nearly zero-energy underlines the importance to study the post-occupancy behavior, to understand if the building-HVAC system is capable to meet the variable conditions even due to the progressive climate change. The paper proposes a discussion about the operational performance of an existing nearly zero-energy building in the Mediterranean climate, during the heating and cooling seasons. The monitoring shows that the required electrical power is always lower than the nominal one, also because the external conditions are not extreme as the design ones. In the colder days, the difference in the required power is −21%. In summer, there is a delay of two hours between the external maximum temperature and the maximum required power. However, the monitored power is usually higher than the nominal one, with a maximum value of +11%. Considering all proposed combinations for the design calculation, it is demonstrated that the real performance cannot be predicted during the design, because indoor and external conditions influence the dynamic behavior of the building-HVAC system.

The paper discusses the environmental and thermal characterization of an innovative opaque ventilated facade designed for the refurbishment of the old European building stock. It is characterized by components with high degree of recycled materials, with reversible structural dry connections for an easy assembly and disassembly. The thermo-physical characterization is based on more than one year of in-field continuous monitoring, carried out in a full-scale test-room placed in Mediterranean climate. The behavior of the designed system (test area of 15 m2) is compared with a not-insulated wall, representative of the European reference stock, and also with a wall with vacuum insulation panels. The developed methodological approach allows comparing the different walls under the same boundary conditions, also when these are monitored during different periods, Many benefits can be achieved by the application of designed system, such as stable and less daily fluctuant inner surface temperature with a reduction of the winter outgoing heat flux. The experimental time lag and decrement factor indicate good inertial properties and, during the summer, the proposed system causes temperature drops of more than 10 °C during the sunniest hours. The findings demonstrate that the solution is able to meet both objectives for realizing low-energy-demand building: energy efficiency and low impact over the whole life cycle point of view.

The paper proposes a discussion about the operational performance of an existing nearly zero energy building in the Mediterranean climate, during the heating season. The required electric power for variable winter conditions is analyzed and it is compared with design calculation, under stationary conditions. Indeed, the indoor and outdoor conditions, during the real operating mode, could be quite different compared to the ones adopted during the design period, also because of the progressive climate change. Thus, it is important to understand if the building-HVAC system is able to meet the variable conditions that can occur and what is the difference that could happen during the sizing of the systems for the microclimatic control.

Background The aim of our study was to investigate the postoperative course of calcium and parathyroid hormone (PTH) levels after total thyroidectomy to define a proper and low cost protocol. Methods We studied 144 patients who underwent total thyroidectomy between 2007 and 2010. Ionized calcium was determined preoperatively and on day 1 (POD1), day 2 (POD2) and day 7 (POD7) postoperatively; PTH preoperatively and on POD7. Patients with ionized calcium ≤1.11 mmol/L were considered hypocalcemic and treated only if symptoms, ≤1 mmol/L were treated in all cases. Results Ionized calcium and PTH declined postoperative in all patients compared to preoperative levels (P=0.000). Ionized calcium increased on POD7 compared to POD1 and POD2 (P=0.000). All hypocalcemic untreated 30 patients returned normocalcemic on POD7. Thirty-eight hypocalcemic patients were treated but 23 (61%) safely suspended therapy on POD7. We tested PTH and ionized calcium as independent factors of prolonged hypocalcemia (that required therapy beyond 7 days) with the following results (sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy): PTH ≤11 pg/mL (80%, 100%, 100%, 96% and 97%, respectively), ionized calcium ≤1.11 mmol/L (80%, 88%, 59%, 95%, and 87%, respectively) and ionized calcium ≤1 mmol/L (28%, 100%, 100%, 87% and 88%, respectively). Conclusions Our data show that our protocol, including serum ionized calcium on 1st, 2nd, 7th days and PTH on 7th day after surgery, is safe and low cost and therefore may be useful in the post-surgical management of total thyroidectomy.

One of the strategies of the European Green Deal is the increment of renewable integration in the civil sector and the mitigation of the impact of climate change. With a statistical and critical approach, the paper analyzes these aspects by means of a case study simulated in a cooling dominated climate. It consists of a single-family house representative of the 1980s Italian building stock. Starting from data monitored between 2015 and 2020, a weather file was built with different methodologies. The first objective was the evaluation of how the method for selecting the solar radiation influences the prevision of photovoltaic productivity. Then, a sensitivity analysis was developed, by means of modified weather files according to representative pathways defined by the Intergovernmental Panel on Climate Change Fifth Assessment Report. The results indicate that the climate changes will bring an increment of photovoltaic productivity while the heating energy need will be reduced until 45% (e.g., in March) and the cooling energy need will be more than double compared with the current conditions. The traditional efficiency measures are not resilient because the increase of the cooling demand could be not balanced. The maximization of installed photovoltaic power is a solution for increasing the resilience. Indeed, going from 3.3 kWp to 6.9 kWp for the worst emission scenario, in a typical summer month (e.g., August), the self-consumption increases until 33% meanwhile the imported electricity passes from 28% to 17%.

With the goal of preventing abdominal infections after implanting prostheses for hernia repair, polypropylene prostheses were coated with a silver nanoclusters-silica composite (Ag/SiO2) layer, by means of a sputtering process, to confer antibacterial properties. The Ag/SiO2 coating was deposited, with good uniformity and adhesion, either onto hernia prostheses (CMC) made of two polypropylene layers (macroporous light mesh and thin transparent film), or onto the mesh layer alone. The coating was optimized to achieve a good balance between antibacterial activity and biocompatibility. Antibacterial activity, fibroblast growth on CMC/mesh layer alone, in the presence/absence of Ag/SiO2, collagen, and some cytokines involved in inflammation and healing processes, were determined. Preliminary experiments showed that when both layers of CMC were entirely coated, antibacterial properties were achieved while losing prosthesis biocompatibility. Coating the entire CMC was a complex process, thus for subsequent experiments the mesh layer alone was coated, being the antibacterial properties unaffected by this choice and the mesh the part of CMC exposed to possible infection. With a duty cycle of 1 s over 24 on an Ag target, for 15 min deposition time, antibacterial activity, evaluated through the quantitative Colony–Forming Units test, was positive; fibroblasts colonized the coated mesh layer and produced collagen. Cell viability analysis showed that most cells were viable at all experimental times. Moreover, IL-1β and IL-6 decreased, and TGF-β2 increased, in fibroblasts seeded on mesh layer coated with Ag/SiO2 versus that without Ag/SiO2. Ag/SiO2-coated mesh layers allowed fibroblast growth and activity, without inducing cell death via apoptosis or necrosis and, at the same time, provided antibacterial activity.

Abdominal wall hernia is one of the commonest surgical disorders worldwide, and there is no single gold-standard operative technique to repair it. In an effort to improve techniques and technologies to reinforce hernia repair, synthetic meshes are employed. In this study, a new prosthesis (named composite) formed of two polypropylene layers, one macroporous (named mesh) and one transparent (named film), was examined to evaluate its capability to enable cell proliferation without inducing cell death. Inflammatory processes were also examined. Human fibroblasts BJ were seeded on multiwells, on which composite or film had been placed. After 7, 14, and 21 days, cell growth and viability, deposition of collagen, and release of IL-6, IL-1β, and TNF-α were evaluated. The “in vitro” protocol showed the composite to be colonized by human fibroblasts on the polypropylene macroporous mesh side; no cell growth occurred on the film. The slowdown of cell growth observed between 14 and 21 days was accompanied by an increase in type I collagen deposition and marked fibroblast activity. Inflammatory cytokines initially increased, followed by their reduction beginning at 14 days. The new prosthesis comprising two polypropylene layers of differing morphologies can be colonized by fibroblasts on the side facing the abdominal wall, whereas no cell growth occurs on the side facing the viscera. The transient inflammation, observed at early experimental times, is probably important for the healing process.

The aim of this study was to analyze, using a cognitive survey, how recurrent groin hernia are treated in our region by surgical centres. A form was sent to 49 surgical centres in our region, considering the period 2002 -first six months of 2004, asking the number of primitive hernias treated, surgical technique, number of recurrent hernias treated, surgical technique, kind of anaesthesia and types of complications. We sent 49 forms, 41 (83.7%) were given back. During the considered period, 18 580 primitive hernias and 1102 recurrent (5.6% of all repair) were treated. The greatest part of it was performed with an open mesh technique tension free (77% of primitive hernias, and 62% of recurrent ones). Laparoscopic repair was performed in 0.2% of primitive hernias and 3.2% of recurrent ones. The operations were carried out mainly in spinal anaesthesia (722, 65.5%). Recurrence occurred in 34 cases (3.1%). In our region inguinal hernia repair both for primitive and recurrent groin hernia has been performed mainly by an open mesh technique, tension free and sutureless and, in greatest part, in spinal anaesthesia. Laparoscopic repair has not been used very much.