Localized waves in elastic plates with perturbed honeycomb arrays of constraints.

In this paper, we study wave propagation in elastic plates incorporating honeycomb arrays of rigid pins. In particular, we demonstrate that topologically non-trivial band-gaps are obtained by perturbing the honeycomb arrays of pins such that the ratio between the lattice spacing and the distance of pins is less than 3; conversely, a larger ratio would lead to the appearance of trivial stop-bands. For this purpose, we investigate band inversion of modes and calculate the valley Chern numbers associated with the dispersion surfaces near the band opening, since the present problem has analogies with the quantum valley Hall effect. In addition, we determine localized eigenmodes in strips, repeating periodically in one direction, that are subdivided into a topological and a trivial section. Finally, the outcomes of the dispersion analysis are corroborated by numerical simulations, where a time-harmonic point source is applied to a plate with finite arrays of rigid pins to create localized waves immune to backscattering. This article is part of the theme issue 'Wave generation and transmission in multi-scale complex media and structured metamaterials (part 1)'.

Reducing waiting times of elective surgical procedures: effectiveness evaluation of a multi-interventions approach.

Background: Increasing waiting times for elective surgery is a major concern for policymakers and healthcare staff in many countries, due to its effect on health, patient satisfaction and the perceived quality of health-care. Many organizational models to reduce surgical waiting times have been studied, but the international literature indicates that multidimensional interventions on different aspects of the surgical pathway can be more effective in reducing waiting times than interventions focused on optimizing a single aspect. Aim: The aim of the study is to evaluate the effectiveness of a multidimensional intervention in reducing waiting times for elective surgery. Study design: We used a pre-post approach to evaluate the effect of a multidimensional project to reduce waiting times and lists. Methods: In a district general hospital (Italy) with three elective surgery operating rooms open 6 hours/day, 5 days/week (surgery specialties: general surgery, orthopaedics, gynaecology and urology), a project for reducing surgery waiting times was implemented in October 2018. The project focused on three aspects: i) separation of the flow of day surgery from that of ordinary surgery; ii) increasing available operating time by reorganizing the staff; iii) allocation of operating sessions flexibly in proportion to the waiting list. Waiting times for surgery in the periods 1/10/2019-31/12/2019 and 1/10/2018-31/12/2018 were compared by t test. Results: Waiting times for non-high-priority cases shortened significantly for all specialities (p<0.01), ex-cept for urology. For general surgery, orthopaedics and gynaecology, mean waiting times for day surgery decreased from 198 to 100 days (-50%) and for ordinary operations from 213 to 134 days (-37%). Waiting times for high-priority cases also shortened. Conclusions: Our multidimensional project based on reorganization of staff and facilities and on improved scheduling proved effective in reducing waiting times for elective surgery.

Enteric α-synuclein impairs intestinal epithelial barrier through caspase-1-inflammasome signaling in Parkinson's disease before brain pathology.

Bowel inflammation, impaired intestinal epithelial barrier (IEB), and gut dysbiosis could represent early events in Parkinson's disease (PD). This study examined, in a descriptive manner, the correlation among enteric α-synuclein, bowel inflammation, impairments of IEB and alterations of enteric bacteria in a transgenic (Tg) model of PD before brain pathology. Human A53T α-synuclein Tg mice were sacrificed at 3, 6, and 9 months of age to evaluate concomitance of enteric inflammation, IEB impairments, and enteric bacterial metabolite alterations during the early phases of α-synucleinopathy. The molecular mechanisms underlying the interplay between α-synuclein, activation of immune/inflammatory responses and IEB alterations were investigated with in vitro experiments in cell cultures. Tg mice displayed an increase in colonic levels of IL-1ß, TNF, caspase-1 activity and enteric glia activation since 3 months of age. Colonic TLR-2 and zonulin-1 expression were altered in Tg mice as compared with controls. Lipopolysaccharide levels were increased in Tg animals at 3 months, while fecal butyrate and propionate levels were decreased. Co-treatment with lipopolysaccharide and α-synuclein promoted IL-1ß release in the supernatant of THP-1 cells. When applied to Caco-2 cells, the THP-1-derived supernatant decreased zonulin-1 and occludin expression. Such an effect was abrogated when THP-1 cells were incubated with YVAD (caspase-1 inhibitor) or when Caco-2 were incubated with anakinra, while butyrate incubation did not prevent such decrease. Taken together, early enteric α-synuclein accumulation contributes to compromise IEB through the direct activation of canonical caspase-1-dependent inflammasome signaling. These changes could contribute both to bowel symptoms as well as central pathology.

Supercritical extraction of volatile and fixed oils from Petroselinum crispum L. seeds: chemical composition and biological activity.

The supercritical fluid extraction (SFE) of volatile and fixed oil from milled parsley (Petroselinum crispum L.) seeds, using CO2 as solvent, is presented in this study. Extraction experiments were carried out in two steps: at pressures of (90 or 300) bar and temperature of 40 °C. The first extraction step, performed at 90 bar, produced a volatile fraction mainly formed by apiole (82.1%) and myristicin (11.4%). The volatile oil yield was 2.6% by weight of the charge. The second extraction step, carried out at 300 bar produced a fixed oil at a yield of 0.4% by weight. The most represented fatty acids in P. crispum fixed oil were 18:1 n-12 (49.9%), 18:2 n-6 (18.2%), 18:1 n-9 (11.8%), and 16:0 (7.4%). In particular, the unsaturated fatty acids 18:1 n-12 and 18:1 n-9 averaged 182.2 mg/g and 92.1 mg/g of oil extract, respectively. The quality of the oils extracted by SFE, in terms of its chemical composition, was compared to the oils obtained by hydrodistillation (HD) in a Clevenger apparatus and by solvent extraction (SE) using n-hexane in a Soxhlet apparatus. The antioxidant properties were determined by means of the ABTS assay. The results indicated that the fixed oil possessed low antioxidant activity (EC50 = 0.4 mg/mL) and the volatile oil had no antioxidant activity. The total phenolic content, expressed as concentration of gallic acid (gallic acid equivalent, GAE), of the fixed oil was 1.5 mg/g. The fixed oil found to have inhibitory effects against α-glucosidase, the volatile oil is active on acetylcholinesterase (AChE), tyrosinase, and α-glucosidase. Both samples have weak inhibitory activity on α-amylase and no activity on butyrylcholinesterase (BChE).

One-way interfacial waves in a flexural plate with chiral double resonators.

In this paper, we demonstrate a new approach to control flexural elastic waves in a structured chiral plate. The main focus is on creating one-way interfacial wave propagation at a given frequency by employing double resonators in a doubly periodic flexural system. The resonators consist of two beams attached to gyroscopic spinners, which act to couple flexural and rotational deformations, hence inducing chirality in the system. We show that this elastic structure supports one-way flexural waves, localized at an interface separating two sub-domains with gyroscopes spinning in opposite directions, but with otherwise identical properties. We demonstrate that a special feature of double resonators is in the directional control of wave propagation by varying the value of the gyricity, while keeping the frequency of the external time-harmonic excitation fixed. Conversely, for the same value of gyricity, the direction of wave propagation can be reversed by tuning the frequency of the external excitation. This article is part of the theme issue 'Modelling of dynamic phenomena and localization in structured media (part 2)'.

Flexural vibration systems with gyroscopic spinners.

In this paper, we study the spectral properties of a finite system of flexural elements connected by gyroscopic spinners. We determine how the eigenfrequencies and eigenmodes of the system depend on the gyricity of the spinners. In addition, we present a transient numerical simulation that shows how a gyroscopic spinner attached to the end of a hinged beam can be used as a 'stabilizer', reducing the displacements of the beam. We also discuss the dispersive properties of an infinite periodic system of beams with gyroscopic spinners at the junctions. In particular, we investigate how the band-gaps of the structure can be tuned by varying the gyricity of the spinners. This article is part of the theme issue 'Modelling of dynamic phenomena and localization in structured media (part 1)'.

Neurovascular alterations of muscularis propria in the human anterior vaginal wall in pelvic organ prolapse.

In the pathophysiology and progression of pelvic organ prolapse (POP), it has been demonstrated that there is a reorganisation of the muscularis propria of the anterior vaginal wall due to a phenotypic smooth muscle cell to myofibroblast switch. An abnormal deposition of collagen type III seems to be influenced by the involvement of advanced glycation end-products. The aim of the present study was to evaluate the hypothesis that this connective tissue remodelling could also be associated with neurovascular alterations of the muscularis in women with POP compared with control patients. We examined 30 women with POP and 10 control patients treated for uterine fibromatosis. Immunohistochemical analysis, using glial fibrillary acidic protein, S-100 protein, receptor tyrosine kinase, neurofilament and α-smooth muscle actin antibodies, was performed. S-100, receptor tyrosine kinase and neurofilament were also evaluated using Western blot analysis. We observed a decrease in all neurovascular-tested markers in nerve bundles, ganglia and interstitial cells of Cajal from POP samples as compared with controls. Even if the processes responsible for these morphological alterations are still not known, it is conceivable that collagen III deposition in the anterior vaginal wall affects not only the architecture of the muscle layer but could also modify the intramuscular neurovascularisation and account for an alteration of the neuromuscular plasticity of the layer.

Wave polarization and dynamic degeneracy in a chiral elastic lattice.

This paper addresses fundamental questions arising in the theory of Bloch-Floquet waves in chiral elastic lattice systems. This area has received a significant attention in the context of 'topologically protected' waveforms. Although practical applications of chiral elastic lattices are widely appreciated, especially in problems of controlling low-frequency vibrations, wave polarization and filtering, the fundamental questions of the relationship of these lattices to classical waveforms associated with longitudinal and shear waves retain a substantial scope for further development. The notion of chirality is introduced into the systematic analysis of dispersive elastic waves in a doubly-periodic lattice. Important quantitative characteristics of the dynamic response of the lattice, such as lattice flux and lattice circulation, are used in the analysis along with the novel concept of 'vortex waveforms' that characterize the dynamic response of the chiral system. We note that the continuum concepts of pressure and shear waves do not apply for waves in a lattice, especially in the case when the wavelength is comparable with the size of the elementary cell of the periodic structure. Special critical regimes are highlighted when vortex waveforms become dominant. Analytical findings are accompanied by illustrative numerical simulations.

Stereotactic body radiation therapy (SBRT) on renal cell carcinoma, an overview of technical aspects, biological rationale and current literature.

BACKGROUND: Stereotactic body radiotherapy (SBRT) is characterized by the delivery of high doses of ionizing radiation in few fractions. It is highly effective in achieving local control, and, due to the high biological effective dose administered, it seems to overcome the radioresistance of renal cell carcinoma (RCC). Thus, SBRT could constitute a treatment option for the management of localized RCC in patients who are not surgical candidates. In this paper, we report an overview about data from the current evidence about SBRT in patients affected by localized RCC. MATERIALS AND METHODS: A non-systematic review was performed, including data from both retrospective and prospective studies focusing on the use of SBRT for localized RCC and its biological rationale. Furthermore, ongoing trials on this issue are reported. CONCLUSION: Currently, SBRT might be considered a treatment alternative in inoperable patients affected by primary RCC. Currently, dose-escalation to 48 Gy in 3-4 fractions are effective and well tolerated. Emerging role of immune therapies in RCC patients warrant further studies to explore interactions between SBRT and immune response.

Interfacial waveforms in chiral lattices with gyroscopic spinners.

We demonstrate a new method of achieving topologically protected states in an elastic hexagonal system of trusses by attaching gyroscopic spinners, which bring chirality to the system. Dispersive features of this medium are investigated in detail, and it is shown that one can manipulate the locations of stop-bands and Dirac points by tuning the parameters of the spinners. We show that, in the proximity of such points, uni-directional interfacial waveforms can be created in an inhomogeneous lattice and the direction of such waveforms can be controlled. The effect of inserting additional soft internal links into the system, which is thus transformed into a heterogeneous triangular lattice, is also investigated, as the hexagonal lattice represents the limit case of the heterogeneous triangular lattice with soft links. This work introduces a new perspective in the design of periodic media possessing non-trivial topological features.

Waves and fluid-solid interaction in stented blood vessels.

This paper focuses on the modelling of fluid-structure interaction and wave propagation problems in a stented artery. Reflection of waves in blood vessels is well documented in the literature, but it has always been linked to a strong variation in geometry, such as the branching of vessels. The aim of this work is to detect the possibility of wave reflection in a stented artery due to the repetitive pattern of the stents. The investigation of wave propagation and possible blockages under time-harmonic conditions is complemented with numerical simulations in the transient regime.

Robotic Stereotactic Retreatment for Biochemical Control in Previously Irradiated Patients Affected by Recurrent Prostate Cancer.

AIMS: Robotic stereotactic body radiotherapy (rSBRT) to local recurrences emerged as a valuable option for exclusive local failure after prior external beam radiation therapy (EBRT) for localised prostate cancer. The aim of this study was to assess the efficacy and safety of rSBRT in patients experiencing locally recurrent prostate cancer after prior definitive or postoperative radiotherapy using the Cyberknife. MATERIALS AND METHODS: Data from 50 patients were retrospectively reviewed. Local recurrence was assessed by 18F-choline positron emission tomography and pelvic magnetic resonance imaging; a dose of 30 Gy was delivered in five fractions. Prostate-specific antigen (PSA) was assessed at 2 months, 6 months and every 4 months thereafter. Toxicity was assessed according to CTCAE v.4.03. RESULTS: All patients received prior EBRT. The median EQD2 total dose was 74 Gy (60-80 Gy). Eleven patients were receiving androgen deprivation after prior biochemical failure. At 6 months, 41 patients showed a median PSA decline of -77.1% (14.3-99.3%), whereas nine patients experienced a median PSA elevation of +58.7% (0-2300.0%). Biochemical relapse-free survival (BRFS) was 80.0%. Impaired BRFS was correlated with the high-risk category at diagnosis (P = 0.014, hazard ratio 5.61) and ongoing androgen deprivation (P = 0.025, hazard ratio 2.98). Neither clinical variables nor dosimetric parameters were found to be predictive for toxicity. CONCLUSION: Focal rSBRT can achieve durable remission in locally relapsing patients and systemic treatment can be postponed with acceptable toxicity. Accurate patient selection is mandatory to maximise disease control.

Gyro-elastic beams for the vibration reduction of long flexural systems.

The paper presents a model of a chiral multi-structure incorporating gyro-elastic beams. Floquet-Bloch waves in periodic chiral systems are investigated in detail, with the emphasis on localization and the formation of standing waves. It is found that gyricity leads to low-frequency standing modes and generation of stop-bands. A design of an earthquake protection system is offered here, as an interesting application of vibration isolation. Theoretical results are accompanied by numerical simulations in the time-harmonic regime.

"Deflecting elastic prism" and unidirectional localisation for waves in chiral elastic systems.

For the first time, a design of a "deflecting elastic prism" is proposed and implemented for waves in a chiral medium. A novel model of an elastic lattice connected to a non-uniform system of gyroscopic spinners is designed to create a unidirectional wave pattern, which can be diverted by modifying the arrangement of the spinners within the medium. This important feature of the gyro-system is exploited to send a wave from a point of the lattice to any other point in the lattice plane, in such a way that the wave amplitude is not significantly reduced along the path. We envisage that the proposed model could be very useful in physical and engineering applications related to directional control of elastic waves.

Changes in muscularis propria of anterior vaginal wall in women with pelvic organ prolapse.

The objective of this study was to evaluate the morphological and immunohistochemical alterations of tissue removed from the upper third of anterior vaginal wall in a sample group of the female population presenting homogenous risk factors associated with Pelvic Organ Prolapse (POP). The case study consisted of 14 patients with POP and there were 10 patients in the control group. Patient selection was carried on the basis of specific criteria and all of the patients involved in the study presented one or more of the recognized POP risk factors. Samples were taken from POP patients during vaginal plastic surgery following  colpohysterectomy, and from control patients during closure of the posterior fornix following hysterectomy. Samples were processed for histological and  immunohistochemical analyses for Collagen I and Collagen III, α-Smooth Muscle Actin (α-SMA), Platelet-Derived-Growth-Factor (PDGF), matrix metalloproteinase 3 (MMP3), Caspase3. Immunofluorescence analyses for Collagen I and III and PDGF were also carried out. In prolapsed specimens our results show a disorganization of smooth muscle cells that appeared to have been displaced by an increased collagen III deposition resulting in rearrangement of the muscularis propria architecture. These findings suggest that the increase in the expression of collagen fibers in muscularis could probably due to a phenotypic switch resulting in the dedifferentiation of smooth muscle cells into myofibroblasts. These alterations could be responsible for the compromising of the dynamic functionality of the pelvic floor.

Analgesia: effects on the first and second stages of labor.

BACKGROUND: This controlled observational study aimed at evaluating the effects of epidural analgesia on the first and second stages of delivery in nulliparous women, referred to the birth centers of the Sant'Omero "Val Vibrata" Hospital and the "San Salvatore" Hospital in L'Aquila, selected in accordance with specific inclusion criteria. MATERIALS AND METHODS: Between May Ws, 2012 and April 3 1s, 2013, 363 patients were enrolled at the birth centres of the "Val Vibrata" Hospital in Sant'Omero (TE) and of the "San Salvatore" Hospital in L'Aquila. 139 patients received epidural analgesia during labor at the "Val Vibrata" Hospital; 224 patients constituted the control group and went through natural delivery without analgesia at the "Val Vibrata" and "San Salvatore" hospitals. RESULTS: Dilation time was different in the two groups: in the group with analgesia, the median was 2.30 and 3.35 in the control group. The median expulsion time was 2.05 in the analgesia group and 0.40 in the control group. DISCUSSION: The statistical analysis of the study has highlighted the fact the analgesia influences the dilation and expulsion time of labor, confirming on the one hand the clinical evidence, and on the other, adding important results that have not been analyzed by other scientific studies. The results have shown that in nulliparous women, with spontaneous onset of labor, analgesia causes a major reduction in the dilation time of the cervical canal with respect to the control group.

Chinese IUD removal techniques in a Chinese population in central Italy.

OBJECTIVE: To describe routine techniques and a newly developed approach to the removal of Chinese intrauterine devices (IUs). METHODS: Office records regarding women of Chinese nationality who presented to a tertiary care hospital for IUD removal between January 2007 and March 2012 were retrieved. Their demographic data were reviewed and menstrual/obstetric history, IUD type, and reasons given for removal were recorded. All underwent pelvic transvaginal ultrasound scanning. RESULTS: Of 134 Chinese IUDs, 18 (13.4%) were removed successfully in an office setting using a hook or uterine curette without general anesthesia or cervical dilation. Extraction under brief general anesthesia was performed in 55 (41.0%) cases. A further 61 (45.5%) Chinese IUDs were successfully removed in an office setting using a miniature resectoscope. Four types of Chinese IUDs were removed, the most common being the stainless steel ring (55.7%). CONCLUSIONS: All removal procedures were effective and safe. The mini-resectoscope appears to be a safe and effective tool enabling minimally invasive surgery.

How does early cognitive behavioural therapy reduce postpartum depression?

Postpartum depression (PPD) is a frequent mood disorder. Early identification of mothers at risk is crucial to successful prevention. Cognitive Behavioural Therapy (CBT) is an effective preventing therapy. Objectives of this study are to identify mothers at risk for PPD using the Edinburgh Postnatal Depression Scale (EPDS) and evaluate the efficacy of CBT for the prevention of PPD in these mothers. Women were recruited during their second postpartum day. Two groups were selected: mothers with high risk (EPDS score ≥ 10) and mothers with low risk (EPDS score < 10) of PPD. The first group underwent CBT. Follow up was carried out at 40 days, three, six, and 12 months after childbirth. APGAR score, neonatal hospitalization, delayed breastfeeding, and cesarean section were significant obstetric risk factors. Mothers at high risk of PPD presented a statistically valid improvement of EPDS score. Mothers with low risk of PPD did not have CBT and showed a higher EPDS score than mother at high risk at 12 months. PPD prevention is possible through early identification of mothers at risk and early cognitive behavioural therapy.