Hydrothermal liquefaction of sewage sludge: use of HCOOH and KOH to improve the slurry pumpability in a continuously operated plant.

We studied the hydrothermal liquefaction (HTL) of digested sewage sludge (DSS) as model of waste biomass in batch and continuous reactors. HCOOH and KOH were used to improve the slurry pumpability. HTL experiments were conducted at the same kinetic severity factor in a batch reactor of 25 mL of volume and in a continuously operated tubular reactor with 350 mL of volume. The observed outcomes suggested that it was not possible to achieve the pumpability of native DSS when a high concentrated stream of suspended solid particles has been fed to the HTL continuous plant. Using acidic or basic homogeneous additives, as potassium hydroxide or formic acid, it was possible to enhance the pumpability of a concentrated slurry of DSS in the continuous plant achieving yields of heavy oil (fraction of biocrude) similar to those obtained in the batch reactor and with higher H/C ratios. Hence, we found that HCOOH and KOH are promising additives for the practical implementation of a continuous HTL process.

Quality of sex life in endometriosis patients with deep dyspareunia before and after laparoscopic treatment.

PURPOSE: The present work aims at showing how dyspareunia linked to endometriosis can affect the life of fertile age women and how surgical treatment of endometriosis can relieve painful symptoms and consequently improve sex and social life. METHODS: From a cohort of 320 women with a clinical and instrumental diagnosis of pelvic endometriosis, 67 patients were selected. These patients had deep dyspareunia that underwent laparoscopic surgical treatment. All the patients had filled out a pre- and post-surgery questionnaire. RESULTS: Six months after laparoscopic treatment, a significant reduction of dyspareunia was recorded, per VAS scores. A statistically significant improvement in sex life was observed between the pre- and post-surgical condition: in particular, an increased number of coituses and of non-difficult coituses, a higher number of patients who declared that pain did not negatively affect sexual pleasure and of patients achieving orgasm. CONCLUSIONS: The quality of the sex life in patients with endometriosis and dyspareunia showed significant improvement 6 months after laparoscopic treatment. In view of the diagnostic delay characterizing this disease and confirmed by our results, it is essential to involve a multidisciplinary team to assess all the signs and symptoms of endometriosis that may appear in a women of fertile age. This clinical approach is able to ensure a treatment that is as personalized as possible and an appropriate follow-up also with the objective of preserving reproductive performance.

Towards a smoke-free hospital: how the smoking status of health professionals influences their knowledge, attitude and clinical activity. Results from a hospital in central Italy.

OBJECTIVES: In Italy, the prevalence of smoking among health professionals is higher than in the general population and this might hamper their role in the promotion of health. This study aimed to investigate how the smoking status of healthcare professionals might influence knowledge, attitudes and clinical practice in a hospital in central Italy in order to enforce effective tobacco control measures. METHODS: Physicians and professionals of the hospital were asked to complete an anonymous questionnaire which yielded epidemiological and environmental information on knowledge, attitude, clinical practice and quality of the hospital environments, in relation to smoking. RESULTS: Overall, among the employees of the hospital, the smoking prevalence was 47%, (42% among physicians and 43% among nurses); 30% admitted smoking in the hospital and three quarters of the smokers would like to quit. Some knowledge, opinions and attitudes differ statistically among the smoking categories. For example, only 35% of the smokers admitted that smoking is more dangerous to health than atmospheric and car pollution compared with 60% of the ex or never smokers (p=0.04). Fewer smokers realize that their behavior is seen as a role model by patients. A greater percentage of smokers state that patients (34%) and visitors (43%) often smoke in hospital and these percentages are significantly higher than those reported by ex or never smokers (p≤0.05). All smokers claim that they never smoke in patient rooms, infirmaries and clinics, whereas over 20% of ex or never smokers report that smoking sometimes occurs in these places (p=0.015). The mean concentration of PM 2.5 in the 25 rooms was 2.4 µg/m3 with a range from 1 to 7 µg/m3. CONCLUSIONS: This study implies that the prevalence of smoking among health professionals may be very high, and might be twice the rate observed in the general population. Generally, smokers report less knowledge compared with ex and never-smokers and it seems that they systematically underestimate the dangers related to smoking both in their knowledge and in their behavior, and try to socially "normalize" smoking. All this and the evidence of cigarette butts in hospital rooms and clinics, notwithstanding the good quality of the air thanks to the modern ventilation system, imply that there is still a long way to go towards a smoke-free hospital.

Endovascular therapy of acute ischemic stroke: report of the Standards of Practice Committee of the Society of NeuroInterventional Surgery.

OBJECTIVE: To summarize and classify the evidence for the use of endovascular techniques in the treatment of patients with acute ischemic stroke. METHODS: Recommendations previously published by the American Heart Association (AHA) (Guidelines for the early management of adults with ischemic stroke (Circulation 2007) and Scientific statement indications for the performance of intracranial endovascular neurointerventional procedures (Circulation 2009)) were vetted and used as a foundation for the current process. Building on this foundation, a critical review of the literature was performed to evaluate evidence supporting the endovascular treatment of acute ischemic stroke. The assessment was based on guidelines for evidence based medicine proposed by the Stroke Council of the AHA and the University of Oxford, Centre for Evidence Based Medicine (CEBM). Procedural safety, technical efficacy and impact on patient outcomes were specifically examined.

Society of NeuroInterventional Surgery Standards of Practice: general considerations.

This is the first in a set of documents intended to standardize techniques, procedures, and practices in the field of endovascular surgical neuroradiology. Standards are meant to define core practices for peer review, comparison, and improvement. Standards and guidelines also form the basic dialogue, reporting, and recommendations for ongoing practices and future development.

Microvascular decompression for trigeminal neuralgia: visualization of results in a 3D stereoscopic virtual reality environment.

BACKGROUND: This study employs 3D stereoscopic virtual reality technology to demonstrate the surgical results of microvascular decompression (MVD) for trigeminal neuralgia. PATIENTS/MATERIAL AND METHODS: 3D models were rendered by fusing CTA and MRI fast imaging employing steady state acquisition (FIESTA) modalities of both pre- and post-operative scans. The brainstem, trigeminal nerve root and relevant vasculature were extracted, superimposed, and co-registered to bony and ventricular anatomy. RESULTS: 3 clinically successful MVD cases were evaluated for superior cerebellar artery (SCA) vessel displacement. Qualitative parameters included translational and rotational shift of the SCA, and distance decompressed from the trigeminal nerve root entry zone. Parameters were met in each case, with demonstration of vessel displacement and decompression of the nerve root. CONCLUSION: The 3D virtual-reality environment with stereoscopic visualization offers a method through which to visualize the results of MVD, and a potential reference point to evaluate cases of treatment failure or relapse.

Computational fluid dynamic simulation to assess flow characteristics of an in vitro aneurysm model.

BACKGROUND: Modifications of in vitro aneurysm modeling to study the effects of morphology on flow dynamics are time consuming, costly and analysis tends to be more qualitative than quantitative. This study develops a virtual two-dimensional flow model replicating an in vitro aneurysm model and analyzes how changes in morphology modify flow characteristics. METHODS: Using finite volume analysis, a two-dimensional saccular aneurysm model was created with a configuration matching a published, experimental, in vitro model. Qualitative comparisons were made determining whether a two-dimensional fluid dynamic model can replicate the results of an in vitro model. Quantitative changes in flow patterns, wall shear stress, dynamic pressure and maximum velocities were assessed by modifying the shape of the neck and proximal dome without modifying the overall size of the aneurysm. RESULTS: A two-dimensional computational fluid dynamic model reproducing the shape of a published aneurysm demonstrated excellent qualitative fidelity to an in vitro flow model. Additional information regarding dynamic pressure, shear stress and velocity along the aneurysm neck and within the aneurysm dome were determined. Although all dimensions were kept constant, slight modifications of the neck and proximal dome resulted in quantitative changes in studied parameters, such as wall shear stress and dynamic pressure. CONCLUSIONS: Computer generated aneurysm flow models, when carefully developed, reproduce flow events within in vitro aneurysms providing objective data on biophysical parameters. Effective flow modeling of aneurysms depends on flow input, size of the parent vessel and aneurysm, and other factors. These data suggest that neck and proximal dome configuration, independent of size, are important characteristics of flow.

[Emergent pathology in occupational medicine: the mobbing]. / Patologie emergenti in Medicina del Lavoro: il mobbing.

Mobbing constitutes a phenomenon not yet clearly defined. The activity, located in the II Faculty of Medicine and Surgery, is specifically dedicated to such phenomenon, which is the outcome of cooperation. The examined population is composed by a light prevalence of men (51.3%) respect to women (48.6%), aged around 42 years and employees (71.6%), workers (28.4%). All patients have been submitted to working anamnesis before being subjected to a psychiatric examination and psycodiagnostic tests. The emerged data underline a trouble of adaptation 55.4% of the cases, 40.5% is affected by psychiatric pathologies, 4.1% of the patients do not show mental disorders. A certification of compatibility with mobbing has been possible to be verified in 49% of the cases. Nevertheless, it is necessary a connection between a physician and business medical service. We hope a necessary enactment of a specific regulation.

[Moral and psychological violence at work: assessment and certification]. / Violenza morale e psichica sul lavoro: valutazione e certificazione.

Mobbing constitutes a phenomenon not yet clearly defined. The activity, located in the H Faculty of Medicine and Surgery, is specifically dedicated to such phenomenon, which is the outcome of cooperation. The examined population is composed by a light prevalence of women (54%) respect to men (46%), aged around 44 years and employees (73%), workers (27%). All patients have been submitted to working anamnesis before being subjected to a psychiatric examination and psycodiagnostic tests. The emerged data underline a trouble of adaptation 63% of the cases (to which we have released a certification of compatibility with mobbing), 28% is affected by psychiatric pathologies, 9% of the patients do not show mental disorders. Nevertheless, it is necessary a connection between a physician and business medical service.

Anti-Ri-associated paraneoplastic opsoclonus-ataxia syndrome in a man with transitional cell carcinoma.

BACKGROUND: There are several case reports describing paraneoplastic syndromes in patients with various forms of bladder carcinoma. Current immunologic analyses have enabled the identification of the antineuronal autoantibodies associated with specific syndromes. METHODS: A patient with a history of bladder carcinoma presented with opsoclonus and myoclonus. RESULTS: Workup confirmed the presence of anti-Ri antibodies in the patient's serum and cerebrospinal fluid. The target Ri antigen was found to be expressed by the tumor. CONCLUSIONS: To the authors' knowledge, there are few reports in the literature describing the long-term clinical follow-up and postmortem evaluation in a patient with this form of paraneoplastic syndrome. More important, the authors believe the current study represents the first time that the presence of anti-Ri antibodies has been noted in a paraneoplastic syndrome associated with transitional cell carcinoma of the bladder.

Management of residual dysplastic vessels after cerebral arteriovenous malformation resection: implications for postoperative angiography.

OBJECTIVE: The verification of surgical resection of cerebral arteriovenous malformations (AVMs) relies on angiography. Abnormal vasculature often is identified after removal of the AVM. Differentiation of dysplastic feeding vessels that resemble the neovascularity of moyamoya disease, as distinct from residual AVM, is crucial for preserving critical brain areas. We review a large experience with immediate postoperative angiography after AVM resection and discuss the implications for management of abnormal dysplastic vessels discovered after AVM resection. METHODS: Beginning in 1992, 86 consecutive patients with AVMs underwent operations by standard protocol for immediate postoperative angiography under the same general anesthetic. Angiographic interpretation dictated admission to the intensive care unit or return to the operating room for further resection. RESULTS: In 78 patients, the angiogram revealed complete resection. Two patients were returned to the operating room, one for residual malformation with an early draining vein, and one for resection of residual dysplastic vessels. There was one postoperative hemorrhage in a patient whose postoperative angiogram was falsely negative for AVM. Six patients with residual dysplastic vessels mimicking residual AVM, but without an early draining vein, were managed conservatively. Delayed follow-up angiography demonstrated spontaneous involution of these abnormal vessels in all of these patients. CONCLUSION: Residual dysplastic feeding vessels resembling the neovascularity of moyamoya disease but not associated with an early draining vein do not necessarily represent residual malformation after AVM resection. The abnormal vessels will proceed to complete spontaneous resolution. Given the difficulty of interpreting intraoperative angiography, immediate postoperative angiography may be a viable alternative after AVM resection.

Dysarthria during basilar artery balloon occlusion.

A 49-year-old woman presenting with recurrent, reversible brainstem symptoms and a distal basilar artery aneurysm underwent balloon test occlusion. Five minutes after balloon inflation she developed a reversible isolated dysarthria. Despite failing the test occlusion (and after an additional brainstem event), the patient underwent surgery with placement of a clip across the basilar artery. The operation was tolerated without complication. The authors conclude that 1) pure dysarthria may be a symptom of temporary basilar artery occlusion and 2) balloon testing may overestimate the risk of basilar artery clipping.

Ventricular volume following third ventriculostomy.

OBJECT: Ventricular size often shows no obvious change following third ventriculostomy, particularly in the early postoperative period, making postoperative evaluation difficult without expensive and often invasive testing in patients with equivocal clinical responses. The authors hypothesized that performing careful volumetric measurements would show decreases in size within the first 3 weeks after surgery. METHODS: Volumetric measurements were calculated from standard 3 x 3-mm axial computerized tomography (CT) scans obtained immediately before and 3 and 21 days after surgery. Two independent investigators measured third ventricular volume in a series of 16 patients and lateral ventricular volume in 10 of the patients undergoing stereotactically guided endoscopic third ventriculostomy for noncommunicating hydrocephalus. Fifteen patients were symptomatically improved at the time the follow-up scan was obtained. Third ventricular volume decreased in all patients by a mean of 35% (range 7.8-95.1%) and lateral ventricular volume decreased in all patients by a mean of 33% (range 4.5-80.3%). The degree of change correlated with the length of preoperative symptoms (p < 0.005). The one patient who experienced no improvement showed no decrease in third ventricular volume. In seven of 10 patients, the decrease in third ventricular volume exceeded the decrease in lateral ventricular volume. Repeated measurements indicated that the 95% confidence interval for the authors' calculations varied around the mean by 2.5% for third ventricular volume and 1.2% for lateral ventricular volume. Long-term outcome was excellent, with only one case of delayed failure. The mean follow-up duration was 12 months. CONCLUSIONS: Volumetric measurements calculated from standard CT scans will show a demonstrable decrease in ventricular volume soon after successful third ventriculostomy and can be helpful in assessing patients postoperatively. Although the third ventricle may exhibit a greater decrease, the lateral ventricular measurements are more accurate. Patients with more indolent symptoms show the smallest change.

Adenosine-induced cardiac pause for endovascular embolization of cerebral arteriovenous malformations: technical case report.

OBJECTIVE: Extremely high flow through arteriovenous malformations (AVMs) may limit the safety and effectiveness of endovascular glue therapy. To achieve a more controlled deposition of glue, we used transient but profound systemic hypotension afforded by an intravenously administered bolus of adenosine to induce rapidly reversible high-degree atrioventricular block. METHODS AND CASE REPORT: A patient with a large high-flow occipital AVM fed primarily by the posterior cerebral artery underwent n-butyl cyanoacrylate glue embolization. Nitroprusside-induced systemic hypotension did not adequately reduce flow through the nidus, as determined by contrast injection in the feeding artery. In a dose-escalation fashion, boluses of adenosine were administered to optimize the dose and verify that there was no flow reversal in the AVM and no other unexpected hemodynamic abnormalities by arterial pressure measurements and transcranial Doppler monitoring of the posterior cerebral artery feeding the AVM. Thereafter, 64 mg of adenosine was rapidly injected as a bolus to provide 10 to 15 seconds of systemic hypotension (approximately 20 mm Hg). Although there were conducted beats and some residual forward flow through the AVM during this time, the mean systemic and feeding artery pressures were roughly similar and remained relatively constant. A slow controlled injection of n-butyl cyanoacrylate glue was then performed, with excellent filling of the nidus. CONCLUSION: Adenosine-induced cardiac pause may be a viable method of partial flow arrest in the treatment of cerebral AVMs. Safe, deep, and complete embolization with a permanent agent may increase the likelihood of endovascular therapy's being curative or may further improve the safety of microsurgical resection.

Diagnosis and monitoring of cerebral hyperfusion after carotid endarterectomy with single photon emission computed tomography: case report.

OBJECTIVE AND IMPORTANCE: Focal neurological deficits after carotid endarterectomy may result from ischemia or hyperperfusion. The usefulness of single photon emission computed tomography (SPECT) for differentiating between these two mechanisms has not been previously emphasized. CLINICAL PRESENTATION: An 83-year-old man experienced dysarthria and left-sided weakness immediately after undergoing endarterectomy of the right internal carotid artery. The results of computed tomography of the head were normal, and transcranial Doppler sonography showed symmetrically elevated velocities in both middle cerebral arteries. On the 1st postoperative day, the patient's deficits worsened in parallel with spontaneous increases in blood pressure, and blood pressure reduction with labetalol resulted in clinical improvement. INTERVENTION: On the 2nd postoperative day, technetium-99-hexametazime SPECT demonstrated markedly increased flow in the right basal ganglia and inferior frontal cortex, confirming the diagnosis of cerebral hyperperfusion. The patient's deficits continued to improve with antihypertensive therapy, and SPECT performed 7 and 48 days after surgery showed gradual normalization of the focal hyperemia. CONCLUSION: SPECT can be used to diagnose and monitor cerebral hyperperfusion after carotid endarterectomy and may be of particular value for differentiating hyperperfusion from ischemia when characteristic computed tomographic and transcranial Doppler sonographic findings are absent.