Uterine fibroids morcellation: a puzzle topic.

The laparoscopic approach for the treatment of uterine leiomyoma is increasingly practiced. The necessity to remove large specimens from the small laparoscopic incision has always been one of the main limits of this procedure. The unrestricted use of morcellation, to overtake this weak point of minimally invasive surgery, has opened in recent years a broad debate, especially on the risk of unintended dissemination of cells that could in some cases lead to extremely negative repercussions. This review analyzes these aspects and the principal recommendations from the major gynecological society on this topic surveying their effects. Furthermore, the purpose of this article is to provide an overview of the different morcellation techniques and how they are performed, evaluating their advantages and disadvantages. Contained morcellation seems to overcome many limits; however, based on recent data, an appropriate evaluation and selection of patients, as well as complete counseling before the surgery, are mandatory.

Low-voltage bridge strategy to guide cryoablation of typical and atypical atrioventricular nodal re-entry tachycardia in children: mid-term outcomes in a large cohort of patients.

AIMS: In the current literature, results of the low-voltage bridge (LVB) ablation strategy for the definitive treatment of atrioventricular nodal re-entry tachycardia (AVNRT) seem to be encouraging also in children. The aims of this study were (i) to prospectively evaluate the mid-term efficacy of LVB ablation in a very large cohort of children with AVNRT, and (ii) to identify electrophysiological factors associated with recurrence. METHODS AND RESULTS: One hundred and eighty-four children (42% male, mean age 13 ± 4 years) with AVNRT underwent transcatheter cryoablation guided by voltage mapping of the Koch's triangle. Acute procedural success was 99.2% in children showing AVNRT inducibility at the electrophysiological study. The overall recurrence rate was 2.7%. The presence of two LVBs, a longer fluoroscopy time and the presence of both typical and atypical AVNRT, were found to be significantly associated with an increased recurrence rate during mid-term follow-up. Conversely, there was no significant association between recurrences and patient's age, type of LVB, lesion length, number of cryolesions or catheter tip size. CONCLUSION: The LVB ablation strategy is very effective in AVNRT treatment in children. Recurrences are related to the complexity of the arrhythmogenic substrate.

Kinetic Rate Constants of Gold Nanoparticle Deposition on Silicon.

We fabricated gold nanoparticles on nanoporous silicon microparticles using electroless deposition in a hydrofluoric acid solution containing gold chloride. The reaction was followed by UV spectrometer analysis of the absorbance of the solution (proportional to the nanoparticle concentration) for two temperatures (20 and 50 °C). The results indicate that the process is autocatalytic, described by a pseudo-first-order reaction, the apparent rate constant kobs of which was determined by utilizing UV spectrometer data. We found that the reaction rate constant at 20 °C is 7 × 10-3 s-1 and that at 50 °C is 2.9 × 10-2 s-1. Scanning electron microscope (SEM) analysis of samples and diffusion-limited aggregation (DLA) simulations were used to validate the results. This study aims to resolve the kinetics of the electroless deposition of gold on silicon at the nanoscale, in the present state of art missing a quantitative characterization, for certain conditions of growth and given values of temperature and concentration of the reagents. Results may have applications to the synthesis of gold nanoparticles and their use as nanosensors, drug delivery systems, or metal nanometamaterials with advanced optical properties.

Health technology assessment (HTA) of optoelectronic biosensors for oncology by analytic hierarchy process (AHP) and Likert scale.

BACKGROUND: The multicriteria decision method (MCDM) aims to find conflicts among alternatives by comparing and evaluating them according to various criteria to reach the best compromise solution. The evaluation of a new health technology is extremely important in the health sciences field. The aim of this work is to evaluate a new health technology to assay thyroglobulin in patients with differentiated thyroid cancer to improve its service from an organizational point of view, by planning new and appropriate training activities, ensuring proper use of resources and satisfying the needs of different users. METHODS: The evaluation was performed using two methodologies: the analytic hierarchy process (AHP) and the Likert scale. The AHP is a multicriteria decision approach that assigns a weight to each evaluation criterion according to the decision maker's pairwise comparisons of the criteria. The Likert scale is a psychometric scale employed to study the degree of user satisfaction by measuring opinions. RESULTS: Results show the need of particularly improving clinical efficiency, effectiveness, and return on sales (ROS) related to the technology; technological safety, human resources and other parameters do not need to be improved because of the high satisfaction results of the users. CONCLUSIONS: The application of both methods provided the necessary information to improve the quality of the service, allowing the decision maker to identify the most valuable service features and to improve these to ensure user satisfaction and to identify possible service improvements.

Phenolic acids variability and grain quality of organically and conventionally fertilised old wheats under a warm climate.

BACKGROUND: We investigated three old wheats (Triticum dicoccum, Triticum durum, Triticum spelta) for effects of organic and conventional cultivation under equivalent nitrogen fertilisation (100 kg ha-1 ) on antioxidant content and composition, and on quality traits. RESULTS: Compared to conventional cultivation, organic cultivation had positive effects on test weight, while grain quality traits of protein content, gluten content and sodium dodecyl sulphate microsedimentation volume were 19.2%, 9.3% and 22.7% lower, respectively. Despite lower protein content with organic cultivation, this was still high (147 g kg-1 ); thus with adequate organic nitrogen fertilisation, the quality traits related to the technological properties of flour were maintained. Total phenolic content (TPC) was significantly higher for organic versus conventional cultivation, although free and bound phenolic acids were not significantly different. With discriminant analysis, only durum wheat differentiated the qualitative and compositional traits according to cultivation system. Separation of organic versus conventional cultivation in durum wheat and emmer was strongly affected by antioxidants (antioxidant capacity, TPC, yellow pigment content), dietary fibre, protein content and test weight. CONCLUSIONS: With adequate organic nitrogen fertilisation, protein and gluten contents remain high enough for good quality pasta. However, except for TPC, organic cultivation did not affect phenolic acids profile and antioxidant activity. © 2019 Society of Chemical Industry.

Voltage gradient mapping and electrophysiologically guided cryoablation in children with AVNRT.

Aims: Recently, voltage gradient mapping of Koch's triangle to find low-voltage connections, or 'voltage bridges', corresponding to the anatomic position of the slow pathway, has been introduced as a method to ablate atrioventricular nodal reentry tachycardia (AVNRT) in children. Thus, we aimed to assess the effectiveness of voltage mapping of Koch's triangle, combined with the search for the slow potential signal in 'low-voltage bridges', to guide cryoablation of AVNRT in children. Methods and results: From June 2015 to May 2016, 35 consecutive paediatric patients (mean age 12.1 ± 4.5 years) underwent 3D-guided cryoablation of AVNRT at our Institution. Fifteen children were enrolled as control group (mean age 14 ± 4 years). A voltage gradient mapping of Koch's triangle was obtained in all patients, showing low-voltage connections in all children with AVNRT but not in controls. Prior to performing cryoablation, we looked for the typical 'hump and spike' electrogram, generally considered to be representative of slow pathway potential within a low-voltage bridge. In all patients the 'hump and spike' electrogram was found inside bridges of low voltage. Focal or high-density linear lesions, extended or not, were delivered guided by low-voltage bridge visualization. Acute success rate was 100%, and no recurrence was reported at a mean follow-up of 8 ± 3 months. Conclusions: Voltage gradient mapping of Koch's triangle, combined with the search for the slow potential signal in low-voltage bridges, is effective in guiding cryoablation of AVNRT in paediatric patients, with a complete acute success rate and no AVNRT recurrences at mid-term follow-up.

Simultaneous determination of organophosphorus pesticides and phthalates in baby food samples by ultrasound-vortex-assisted liquid-liquid microextraction and GC-IT/MS.

Baby foods are either a soft, liquid paste or an easily chewed food since babies lack developed muscles and teeth to chew effectively. Babies typically move to consuming baby food once nursing or formula is not sufficient for the child's appetite. Some commercial baby foods have been criticized for their contents. This article focuses on the simultaneous determination of organophosphorus pesticides and phthalates by means of a method based on ultrasound-vortex-assisted liquid-liquid microextraction coupled with gas chromatography-ion trap mass spectrometry (GC-IT/MS). The protocol developed allowed the determination of six phthalates [dimethyl phthalate, diethyl phthalate, dibutyl phthalate, isobutyl cyclohexyl phthalate, benzyl butyl phthalate, bis(2-ethylhexyl) phthalate] and 19 organophosphorus pesticides. Freeze-dried product samples (0.1-0.2 g) were dissolved in 10 mL of warm distilled water along with 5 µL of an internal standard (anthracene at 10 mg mL-1 in acetone): the choice of extraction solvent was studied, with the most suitable being n-heptane, which is used for phthalate determination in similar matrices. The solution, held for 5 min in a vortex mixer and for 6 min in a 100-W ultrasonic bath to favor solvent dispersion and consequently analyte extraction, was centrifuged at 4000 rpm for 30 min. Then 1 µL was injected into the GC-IT/MS system (SE-54 capillary column; length 30 m, inner diameter 250 µm, film thickness 0.25 µm). All analytical parameters investigated are discussed in depth. The method was applied to real commercial freeze-dried samples: significant contaminant concentrations were not found. Graphical abstract Simultaneous and sensitive determination of organophosphorus pesticides and phthalates in baby foods by the ultrasound-vortex-assisted liquid-liquid microextraction Öªgas chromatography-ion trap mass spectrometry procedure. 1 methacrifos, 2 pirofos, 3 phorate, 4 seraphos, 5 diazinon, 6 etrimphos, 7 dichlofenthion, 8 chlorpyrifos-methyl, 9 pirimiphos-methyl, 10 malathion, 11 chlorpyrifos, 12 parathion-ethyl, 13 pirimiphos-ethyl, 14 bromophos, 15 chlorfenvinphos, 16 bromophos-ethyl, 17 stirophos, 18 diethion, 19 coumaphos, A dimethyl phthalate, B diethyl phthalate, C dibutyl phthalate, D butyl cyclohexyl phthalate, E benzyl butyl phthalate, F bis(2-ethylhexyl) phthalate, IS internal standard.

Landfill siting based on optimisation, multiple decision analysis, and geographic information system analyses.

Sanitary landfill remains the most common methodology for final treatment and disposal of municipal solid waste worldwide, the cost per tonne depends on its scale. The bigger the landfill, the cheaper the cost of treatment, so the consortium of municipalities is the solution to achieve an economic scale. However, the growth of waste production introduces pressure for adequate solutions and therefore has been increasing sanitary landfill site selection studies. This study proposes a methodology for siting sanitary landfills and optimising the transport of municipal solid waste for a locality in the state of São Paulo, Brazil. Environmental, social, and economic criteria were established. Their correlated attributes were categorised into suitability levels and weighted according to multiple decision analysis. The data were organised and mapped within a geographic information system. Considering sites where landfills are prohibited, two scenarios were generated. The Mixed-Integer Quadratic Programming mathematical model is used to minimise the costs of transporting municipal solid waste and operating sanitary landfills. In Scenario 1, the results indicated that 64% of the area was suitable as a potential sanitary landfill site, 9% of the area exhibited medium suitability, and 27% of the area was classified as restricted. In Scenario 2, the results indicated that 25% of the area was suitable as a potential sanitary landfill site, 4% of the area had medium suitability, and 71% of the area was classified as restricted. The optimal solutions for Scenario 1 and Scenario 2 enabled sites to be determined for five landfills and four landfills, respectively.

Radiofrequency catheter ablation of left-sided accessory pathways in children using a new fluoroscopy integrated 3D-mapping system.

Introduction: Advances in 3D electroanatomic-mapping technologies have resulted in a safe and effective profile of radiofrequency (RF) catheter ablation. The aim of this study was to evaluate a different catheter ablation approach in patients with left-sided accessory pathways (APs). Methods and results: From January 2015 to December 2015, 30 patients (median age 11 years, median weight 45 kg) with manifest or concealed left-sided APs underwent RF catheter ablation with a new protocol. All procedures were performed with the CARTO UNIVU™ system, integrating electroanatomic maps with fluoroscopic views. A 7 Fr ablation catheter was inserted into the right femoral vein and advanced into the right atrium. Geometrical reconstruction and activation map of the right atrium, tricuspid annulus, and coronary sinus were acquired. The ablation catheter was then inserted into the left femoral artery and advanced through the aorta and aortic valve, creating an activation map of the mitral annulus. Catheter ablation was targeted to the site of the earliest activation. No complications occurred. The median procedure and fluoroscopy times were 130 min and 6 s, with a median fluoroscopy dose 0.5 mGy. An average of two catheters was used. Long-term success rate was 97% (29/30) at a median follow-up of 9.6 months. This approach reduced fluoroscopy time, dose and number of catheters used compared with manifest or concealed left-sided AP ablation using CARTO 3™ (P < 0.05). Conclusions: This new ablation protocol seems to be promising in reducing fluoroscopy exposure and number of catheters used during left-sided AP ablation in children.

Group assessment of key indicators of sustainable waste management in developing countries.

Decision makers in developing countries are struggling to solve the present problems of solid waste management. Prioritisation and ranking of the most important indicators that influence the waste management system is very useful for any decision maker for the future planning and implementation of a sustainable waste management system. The aim of this study is to evaluate key indicators and their related sub-indicators in a group decision-making environment. In order to gain insight into the subject it was necessary to obtain the qualified opinions of decision makers from different countries who understand the situation in the sector of waste management in developing countries. An assessment is performed by 43 decision makers from both developed and developing countries, and the applied methodology is based on a combined use of the analytic hierarchy process, from the multi-criteria decision-making set of tools, and the preferential voting method known as Borda Count, which belongs to social choice theory. Pairwise comparison of indicators is performed with the analytic hierarchy process, and the ranking of indicators once obtained is assessed with Borda Count. Detailed analysis of the final results showed that the Institutional-Administrative indicator was the most important one, with the maximum weight as derived by both groups of decision makers. The results also showed that the combined use of the analytic hierarchy process and Borda Count contributes to the credibility and objectivity of the decision-making process, allowing its use in more complex waste management group decision-making problems to be recommended.

The Need for a Lengthier Cryolesion Can Predict a Worse Outcome in 3D Cryoablation of AV Nodal Slow Pathway in Children.

BACKGROUND: Transcatheter cryoablation is a well-established technique for the treatment of atrioventricular nodal reentry tachycardia (AVNRT) in children. Nevertheless, atrioventricular nodal slow-pathway conduction may recur after an acutely successful procedure. The aim of this study was to evaluate the long-term outcome of acutely successful AVNRT cryoablations in pediatric patients in case of focal cryolesion and in case of need for High-Density Linear Lesion (HDLL) cryoablation due to focal failure. METHODS: Sixty-nine consecutive pediatric patients (30 males, mean age 12.4 ± 3.2 years; range: 5.4-18.0 years) underwent 3D-guided cryoablation for AVNRT at our institution from July 2013 to November 2014. When a focal cryoablation was acutely unsuccessful, a 3D-guided HDLL was created delivering multiple overlapping cryolesions/cryoenergy applications from the ventricular side of the tricuspid annulus to the atrial side, including the site of focal cryoablation if transiently successful. RESULTS: No permanent cryoablation-related complications occurred. Acute success rate was 98.5% (68 out of 69): in 55.9% (38 out of 68) with focal-lesion and in 44.1% (30 out of 68) with HDLL. Mean follow-up was 25.3 months and AVNRT recurrence rate was 13.2% (nine out of 68): 5.2% (two out of 38) with focal lesion and 23.3% (seven out of 30) with HDLL (P = 0.036). CONCLUSIONS: In cryoablation of AVNRT in children, the need for a more aggressive protocol (HDLL), due to the failure of focal ablation, is strictly related to higher recurrence rates. Indeed, AVNRT recurrences after cryoablation in children seem to be due to a larger and deeper substrate rather than due to the type of energy used.

Miniaturized Implantable Loop Recorder in Small Patients: An Effective Approach to the Evaluation of Subjects at Risk of Sudden Death.

BACKGROUND: The etiological diagnosis of syncope and/or palpitations in children is often challenging. However, when noninvasive conventional examinations are inconclusive, the subcutaneous miniaturized implantable loop recorder (ILR) is recommended. The aim of our study was to evaluate the efficacy of miniaturized cardiac implantable devices in the early diagnosis of arrhythmias in children ≤6 years. METHODS: From March 2014 to May 2015, 21 patients (median age 5 years) underwent implantation of miniaturized ILR at our Institution after a complete cardiac work up. Median follow-up was 10 months. RESULTS: One patient underwent device removal for pocket infection and one needed a pocket revision. Eleven (52%) patients did not show any symptom and/or arrhythmia. Eight patients experienced symptoms during ILR monitoring: six had no electrocardiographic abnormalities, two had significant sinus pauses. Two patients had significant arrhythmias without symptoms and in one of these a pacemaker was implanted. The overall diagnostic yield was 47%. CONCLUSIONS: Miniaturized ILR could be very useful to make a diagnosis and to decide future management strategies in small patients with undefined symptoms or severe cardiac diseases. Considering its characteristics, miniaturized ILR could start a new era in the diagnosis and follow-up of young patients with symptomatic and/or malignant arrhythmias.

Comparison of cryoablation with 3D mapping versus conventional mapping for the treatment of atrioventricular re-entrant tachycardia and right-sided paraseptal accessory pathways.

UNLABELLED: Aim Transcatheter cryoablation is a well-established technique for the treatment of atrioventricular nodal re-entry tachycardia and atrioventricular re-entry tachycardia in children. Fluoroscopy or three-dimensional mapping systems can be used to perform the ablation procedure. The aim of this study was to compare the success rate of cryoablation procedures for the treatment of right septal accessory pathways and atrioventricular nodal re-entry circuits in children using conventional or three-dimensional mapping and to evaluate whether three-dimensional mapping was associated with reduced patient radiation dose compared with traditional mapping. METHODS: In 2013, 81 children underwent transcatheter cryoablation at our institution, using conventional mapping in 41 children - 32 atrioventricular nodal re-entry tachycardia and nine atrioventricular re-entry tachycardia - and three-dimensional mapping in 40 children - 24 atrioventricular nodal re-entry tachycardia and 16 atrioventricular re-entry tachycardia. RESULTS: Using conventional mapping, the overall success rate was 78.1 and 66.7% in patients with atrioventricular nodal re-entry tachycardia or atrioventricular re-entry tachycardia, respectively. Using three-dimensional mapping, the overall success rate was 91.6 and 75%, respectively (p=ns). The use of three-dimensional mapping was associated with a reduction in cumulative air kerma and cumulative air kerma-area product of 76.4 and 67.3%, respectively (p<0.05). CONCLUSIONS: The use of three-dimensional mapping compared with the conventional fluoroscopy-guided method for cryoablation of right septal accessory pathways and atrioventricular nodal re-entry circuits in children was associated with a significant reduction in patient radiation dose without an increase in success rate.

Evaluation of key driver categories influencing sustainable waste management development with the analytic hierarchy process (AHP): Serbia example.

The problems of waste management have become increasingly complex in recent decades. The increasing amount of generated waste, adopted legislation in the field of waste management, administrative issues, economic impacts and social awareness are important drivers in achieving a sustainable waste management system. However, in practice, there are many other drivers that are often mutually in conflict. The purpose of this research is to define the precise driver and their corresponding sub-drivers, which are relevant for developing a waste management system and, on the basis of their importance, to determine which has the predominant influence on the slow development of a waste management system at the national and regional level, within the Republic of Serbia and similar countries of southeast Europe. This research presents two levels of decision making: the first is a pair-wise comparison of the drivers in relation to the goal and the second is a pair-wise comparison of the sub-drivers in relation to the driver and in relation to the goal. Results of performed analyses on the waste management drivers were integrated via the decision-making process supported by an analytic hierarchy process (AHP). The final results of this research shows that the Institutional-Administrative driver is the most important for developing a sustainable waste management system.

Visible light caffeic acid degradation by carbon-doped titanium dioxide.

The removal of the phenolic compound, caffeic acid, by photodegradation has been investigated using carbon-doped titanium dioxide particles as a photocatalyst under visible light. UV-vis absorption spectroscopy and gas chromatography-ion trap mass spectrometry analyses revealed a substrate concentration dependence of the removal of caffeic acid from a water solution. The k2 and t(0.5) parameters of each reaction were calculated by fitting kinetics data to a second-order kinetic adsorption model. To evaluate the photodegradation event, the effect of the adsorption process on the whole degradation was also monitored in the absence of light. Adsorption isotherm studies supported by ζ potential and scanning electron microscopy data demonstrated the pivotal role of the absorption mechanism. It was found that the whole photodegradation process is governed by a synergic mechanism in which adsorption and photodegradation are involved. This study, centered on the removal of caffeic acid from aqueous solutions, highlights the potential application of this technology for the elimination of phenolic compounds from olive mill wastewater, a fundamental goal in both the agronomical and environmental fields.

Ventricular pre-excitation: symptomatic and asymptomatic children have the same potential risk of sudden cardiac death.

AIMS: Children and adolescents with ventricular pre-excitation (VPE) are at increased risk for sudden cardiac death (SCD). Although antiarrhythmic therapy and catheter ablation are well established temporary or definitive treatments for patients with Wolff-Parkinson-White (WPW) syndrome, the optimal management of children with asymptomatic VPE remains to be clearly defined. On the basis of the most recent guidelines and recommendations, the aim of this study was to determine the electrophysiological characteristics of young patients with VPE and WPW syndrome to assess and compare their potential risk of SCD. METHODS AND RESULTS: We retrospectively investigated 124 consecutive young patients with VPE (51 with WPW syndrome and 73 asymptomatic) who underwent transoesophageal electrophysiological study. At baseline, atrioventricular reentrant tachycardia (AVRT) was induced in 13 WPW vs. 10 asymptomatic patients (25.5 vs. 13.7%, P = NS). Atrial fibrillation (AF) was induced in 13 WPW vs. 15 asymptomatic patients (25.5 vs. 20.5%, P = NS). A shortest pre-excited R-R interval (SPERRI) ≤250 ms during AF was found in four WPW vs. six asymptomatic patients (30.8 vs. 40%, P = NS). During isoproterenol infusion or stress testing, AVRT was induced in 31 of 44 WPW vs. 33 of 69 asymptomatic patients (70.4 vs. 47.8%, P = 0.018). Atrial fibrillation was induced in 12 of 44 WPW vs. 21 of 69 asymptomatic patients (27.3 vs. 30.4%, P = NS). A SPERRI ≤ 210 ms was found in 6 of 12 WPW vs. 10 of 21 asymptomatic patients (50 vs. 47.6%, P = NS). No statistically significant correlation was observed between accessory pathway location and symptoms, AVRT/AF inducibility, or mean APERP/SPERRI values. CONCLUSION: Children and adolescents with WPW syndrome have a higher rate of AVRT inducibility than asymptomatic patients. However, no differences between the two groups were found in atrial vulnerability and parameters related to the risk of SCD.

Thrombocytosis after hip and knee surgery in the rehabilitation setting: is it an occasional phenomenon? Relationship with deep venous thrombosis and functional outcome.

BACKGROUND: Thrombocytosis can follow surgery and has occasionally been observed after major orthopaedic surgery. The aim of the present study was to ascertain the platelet count (PLTC) change in patients admitted to a rehabilitation unit after major joint surgery and whether deep venous thrombosis (DVT) and poor outcomes occurred in those who had thrombocytosis. METHOD: PLTC, red blood cells (RBC), haemoglobin (Hb), fibrinogen, and D-dimers were assessed in patients on admission and at discharge after major joint surgery. Functional outcomes were ascertained using the Barthel Scale (BS), the Functional Independence Measure (FIM) and gait evaluation. Thrombocytosis was considered to have occurred when PLTC was greater than or equal to 500 × 100(9)/L. All subjects with thrombocytosis had ultrasonography to assess DVT occurrence. The patients were divided into "young" and "old" groups according to an age cut-off of 75 years to investigate potential age-related differences. RESULTS: Two hundred and seventy-five patients were identified and 142 (36 M and 106 F, mean age 77.2 ± 10.7) were enrolled. Seventy-six (53.5%) underwent total hip arthroplasty (THA), 40 (51.1%) underwent hip internal fixation and 26 (18.3%) subjects underwent total knee arthroplasty (TKA). The young and old groups included 60 and 82 patients, respectively. Fifty-nine (42.4%) patients had PLTC above 400 × 100(9)/L. Of these, 28 (20.1%) had thrombocytosis with PLTC above 500 × 100(9)/L, and 15 of them (10.7%) had very high values above 600 × 100(9)/L. Increased levels of fibrinogen and D-dimers were also detected. No subject with thrombocytosis had DVT. Outcome was not affected by PLTC. At discharge, significant improvement in all functional assessments was observed in young compared to old people; gait: 2.9 ± 0.2 vs. 2.2 ± 0.8; BS: 97 ± 6.9 vs. 70.5 ± 25.6; and FIM: 116.4 ± 10.9 vs. 83.6 ± 31.2 (p < 0.004), respectively. BS and FIM mean scores were positively correlated with Hb level. CONCLUSION: Elevated PLTC and thrombocytosis were not uncommon in patients after major joint surgery, but no subject developed DVT. Platelet count change did not affect the outcome. Higher age and lower haemoglobin level correlated with poorer functional recovery.

Cryoablation of AVNRT in children and adolescents: early intervention leads to a better outcome.

INTRODUCTION: Currently, transcatheter cryoablation is a well-established technique for the treatment of atrioventricular nodal reentry tachycardia (AVNRT) in children. In the past decade, many studies have focused on identifying factors that may affect acute and long-term outcome, but none has been shown to be strongly predictive of treatment success. The aim of our study was to determine whether patient age and cryoablation method correlate with acute and long-term success. METHODS AND RESULTS: We retrospectively reviewed 202 consecutive patients (98 male, mean age 11.5 years; range: 4-20 years) who underwent cryoablation for AVNRT at our institution from October 2002 to August 2012. Patients were divided into 2 groups according to age: group A <12 years (n = 101) and group B ≥12 years (n = 101). A single lesion or linear lesion technique was employed. A total of 217 cryoablation procedures were performed: 106 (49%) in group A and 111 (51%) in group B. All patients were evaluated in our postoperative follow-up program. The overall recurrence rate was 10.9% (22/202). AVNRT recurrence was significantly lower in group A than in group B (4.95% vs 16.8%, P = 0.000). No significant differences in recurrence rate were observed between groups when using the single lesion versus linear lesion technique. There were no permanent cryoablation-related complications. CONCLUSION: Our findings show that cryoablation had no complications and a very good success rate. Type of cryolesion is not predictive of long-term success, whereas lower recurrence rate is achieved when cryoablation is performed at a younger age.

GC models for separation optimization in pressure-tunable tandem capillary columns operated isothermally: part 2: control experiments using a new capillary column interface.

In the previous part of this study, a significant improvement of the fundamental relationships that control GC resolution in a pressure-tunable assembly operating in isothermal conditions inside a single oven was made. A theoretical approach for the correct choice of the working temperature was proposed for the first time. In this second part of our report, a new interfacing device has been proposed for a rapid and reliable alignment of the two columns at the midpoint junction. Moreover, the results of a series of experimental tests have confirmed the validity of the proposed mathematical models.

Transient cardiac effects in a child with acute cholinergic syndrome due to rivastigmine poisoning.

BACKGROUND: We report a case of rivastigmine poisoning resulting in a full cholinergic syndrome with nicotinic, muscarinic, and central effects requiring supportive or intensive care in a pediatric patient. CASE REPORT: A 3-year-old girl was admitted to the Emergency Department suspected of having ingested one or two pills of rivastigmine. The child was hyporeactive, with symptoms of altered mental status, sialorrhea, sweating, and diarrhea. Subsequently, she started showing signs of respiratory failure, severe tracheobronchial involvement, and gastric and abdominal distension. An electrocardiogram recorded frequent monomorphic ventricular ectopic beats with bigeminy and trigeminy. Long-term follow-up showed a transient dysrhythmia. CONCLUSION: Poisoning with rivastigmine can be a life-threatening condition. Timely identification and appropriate management of the toxic effects of this drug are essential and often life-saving. This is particularly true in cases of cholinergic syndrome subsequent to drug poisoning. Patients with cholinergic syndrome should also be assessed for possible cardiac complications such as dysrhythmias. The main factors predisposing to the development of such complications are autonomic disorder, hypoxemia, acidosis, and electrolyte imbalance.