Sarcoidosis, a systemic inflammatory disease of unknown etiology, can affect any site in the body. A bone lesion was unexpectedly detected by fluorodeoxyglucose position emission tomography/computed tomography (FDG PET/CT) in a patient with multiorgan sarcoidosis. FDG PET/CT should be considered for the detection of clinically silent lesions of sarcoidosis.

Often, the lithiasis is large and located at the junction of the middle and posterior third of the duct, in the hilum region. In such cases, transoral approach for submandibular lithiases (TASL) is useful treatment of choice in patients with large submandibular stones that can be palpated bimanually.

Biodiversity underpins all food production and strengthens agricultural resilience to crop failure. However, agricultural expansion is the primary driver of biodiversity loss, particularly in the tropics where crop production is increasing and intensifying rapidly to meet a growing global food demand. It is therefore crucial to ask, how do different crops and crop production systems impact biodiversity? Here we show the increasing intensification of tropical agriculture since 1961, along with a sharp rise in harvested area. Using meta-analysis, we find that crop type, rotation time and agricultural intensity, are important determinants of biodiversity assemblages. Perennial tropical crops that are grown in shaded plantations or agroforests (e.g., banana and coffee) support higher alpha-diversity, while those cultivated in unshaded and often homogeneous plantations (e.g., maize, sugarcane, and oil palm) have impoverished biodiversity communities, particularly annual crops. These findings inform our understanding of changes in the ecological contribution of biodiversity to tropical agriculture.

I processi legati ai trattamenti per migliorare la qualità delle acque sono in costante aumento e in costante evoluzione, a causa soprattutto dell'aumento delle acque reflue contaminate. In particolare riguardo il problema della separazione olio/acqua e la rimozione dei composti farmaceutici dalle acque reflue, si sta studiando ed implementando l’utilizzo di membrane multifunzionali. Tra le varie membrane multifunzionali considerate e i vari catalizzatori presi in riferimento, si è studiato più nel dettaglio una membrana multifunzionale in nanofibre elettrofilate di poli(vinilidene fluoruro-esafluoropropilene) (PVDF-HFP), selezionando adeguatamente come catalizzatore le nanoparticelle di WO3 (ossido di tungsteno) e come materiale adesivo i rivestimenti in PDA (polidopamina). Tale membrana ha mostrato diversi vantaggi, soprattutto riguardo vari aspetti multifunzionali (resistenze meccaniche, incrostazioni, filtrazione ecc.); d'altro canto vi sono delle problematiche da superare per perfezionare nel miglior modo possibile tale tecnologia innovativa (maggiore disponibilità dei materiali di rivestimento, maggior controllo del biofouling ecc.).

L’arsenico è considerato uno dei contaminanti più pericolosi per i corpi idrici. La contaminazione è dovuta ad una concentrazione eccessiva di arsenico nell’acqua potabile, nelle acque sotterranee e negli alimenti. L’esposizione all’arsenico da parte dell’uomo proviene sia da fonti naturali che antropiche; tale elemento è presente in natura nell’erosione delle rocce, nell’emissione vulcanica, ma anche in composti sintetici come i pesticidi, fertilizzanti, coloranti tessili, prodotti farmaceutici e soprattutto negli scarichi delle industrie. Inoltre, le proprietà cancerogene e tossiche dell’arsenico comportano notevoli rischi per la salute umana ed è per tale ragione che la contaminazione delle acque è considerata un grave problema di salute pubblica globale. Urge la necessità di implementare nuove soluzioni di purificazione delle acque, che siano sia efficienti che competitive dal punto di vista della sostenibilità ambientale e della convenienza economica. Viene presentato lo stato dell’arte delle tecnologie disponibili per il trattamento delle acque contaminate da arsenico,  ponendo particolare attenzione alla tecnologia a nanofibre elettrofilate a base di alginato di sodio funzionalizzate con chitosan.

Le acque reflue derivanti da giacimenti petroliferi rappresentano un serio rischio per l’ambiente e la salute umana. E' necessario, dunque,  sottoporle ad un trattamento, come il trattamento biologico, flottazione, adsorbimento, MBR. Recenti studi si stanno incentrando sul trattamento elettrochimico in quanto presenta numerosi vantaggi: minimizzazione dei rifiuti, facilità di applicazione, riduzione dei consumi energetici, maggiore economicità. In particolare, il presente lavoro analizza come una diversa configurazione di elettrodi possa condizionare il processo di rimozione dei contaminanti da tali acque reflue. Le configurazioni realizzate sono anodo-catodo-anodo-catodo (ACAC), anodo-catodo-catodo-anodo (ACCA) e catodo-anodo-anodo-catodo (CAAC). Gli esperimenti sono stati condotti per le tre diverse configurazioni variando il pH, la densità di corrente e il tempo di trattamento. È risultato che la configurazione ACAC con CD=100 A/m2, ph=7 e tempo di trattamento 90 min ha la migliore efficienza, pari all’82%.

The stability of relaxation techniques has been studied for strongly coupled fluid-structure interaction (FSI) with application to a cantilever immersed in channel flow. The fluid is governed by Navier-Stokes equations for incompressible flow condition using turbulence modelling and the solid is governed by the equation of motion with compressible material modelling. The applied kinematic description is Lagrangian for the solid and Eulerian for the fluid. The coupling of the state solvers is achieved by the Arbitrary Lagrange-Euler procedure which involves a mesh motion solver and the FSI procedure is stabilised by relaxation. It is shown that the stability can be related to the frequency shift caused by FSI and they follow the same rate for the shape factor of the structure with an offset. This correlates well to theoretical results but also show that for given mesh resolution, all relaxations fail for sufficient high-frequency shift. We also propose a continuation technique to stabilise the solution near the instability region, which also improves the efficiency and can be integrated easily for the black-box FSI solution procedure.

Morgagni’s hernia is a congenital diaphragmatic hernia, which represents only 3 % of all diaphragmatic hernias. Herein, we report a case of a 28-years old symptomatic female with Morgagni’s hernia who underwent a trans-abdominal surgery using a mesh placed.

ANAPHYLAXIS TO PANTOPRAZOLE IN A CHILDArriba-Méndez S2,3 MD PhD, Martin-Valbuena J2 MD, Sanz-Rueda L2 MD, Sobrino-García M1,3 MD PhD, Gallardo-Higueras A1 MD, Castillo-Loja R1 MD, Macías E,1,3 MD PhD Martín C1,3 MD PhD, Moreno E1,3,4 MD PhD, Muñoz-Bellido FJ1,3 MD PhD, Gracia-Bara MT1,3 MD, Laffond E1,3 MD PhD, Dávila I1,3,4MD PhD.Department of Allergy, University Hospital of Salamanca, Salamanca, SpainDepartment of Pediatrics, University Hospital of Salamanca, Salamanca, SpainInstitute for Biomedical Research of Salamanca, IBSAL, Salamanca, SpainAsthma, Allergic and Adverse Reactions (ARADyAL) Network for Cooperative Research in Health of Instituto de Salud Carlos III, Hospital Universitario de Salamanca, Salamanca, España.Key words: Proton pump inhibitors. Pantoprazole. Hypersensitivity. Child. Anaphylaxis.To the Editor,Pantoprazole and its analogs (omeprazole, esomeprazole, lansoprazole, rabeprazole) are potent proton pump inhibitors (PPIs), whose use is increasing in the pediatric population (1). They are prescribed for several gastrointestinal pathologies (2), particularly gastroesophageal reflux disease (GERD), but also duodenal ulcers, non-steroidal anti-inflammatory-induced ulcer-related prophylaxis, Helicobacter pylori infection, eosinophilic esophagitis, and other diseases. In general, they have an excellent safety profile, and adverse effects are mild and infrequent (1-3% of patients)(1).Hypersensitivity reactions to PPIs are mainly IgE-mediated, but non-IgE-mediated [contact dermatitis, toxic epidermal necrolysis, leukocytoclastic vasculitis or Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)] have been described. In children, immediate hypersensitivity reactions have only been exceptionally reported (3).We introduce the case of a five-year-old girl with a medulloblastoma diagnosed at the age of 3 years, undergoing radiotherapy treatment (last session ten days ago) who was referred to our Allergology Service after suffering an episode of anaphylaxis. Previously to each session, she received premedication with ondansetron plus pantoprazole. In the last session, she had just received ondansetron intravenously and a few minutes after starting the pantoprazole infusion, a generalized diffuse erythematous exanthema suddenly erupted. The event was followed by coughing, severe dyspnea, and inspiratory stridor. No consciousness decrease was reported, neither vomiting nor other gastrointestinal symptoms. Acute anaphylaxis was diagnosed, and the patient was treated with intramuscular epinephrine (0.01mg/kg), intravenous systemic corticosteroids (1mg/kg), and dexchlorpheniramine with gradual resolution in half an hour. The patient had previously received ondansetron and pantoprazole without presenting any adverse reaction. There was neither family nor personal background of hypersensitivity reactions or atopic disease.Skin prick-tests with solutions of non-irritating concentrations (4) of ondansetron (2mg/ml), pantoprazole (40mg/ml), omeprazole (40mg/ml) and lansoprazole (30 mg/ml) were all negative, i.e., the wheal maximum diameter was less than 3 mm over the saline control. Intradermal tests (IDTs) with ondansetron (0.002mg/ml and 0.01 mg/ml) were negative, but IDTs with pantoprazole (4mg/ml) and omeprazole (4 mg/ml) were positive. A single-blind placebo-controlled oral challenge test with ondansetron was performed, showing tolerance of a 3mg dose.A diagnosis of anaphylaxis for pantoprazole was established. Tolerance to lansoprazole was not considered, due to the previous life-threatening reaction, but, it could be considered in the future if required. All proton pumps inhibitors were formally contraindicated.Despite the increase in PPI prescription in pediatric patients, a rise in immune-mediated reactions has not been detected, but there are few studies evaluating PPI allergy in children (5). To date, three cases of PPI anaphylaxis have been described in the pediatric population. One of them was an adolescent studied at 16 who had had anaphylaxis with omeprazole three years earlier. Prick and intradermal tests with omeprazole (0.4 and 4 mg/ml), pantoprazole (0.4 and 4 mg/ml) were negative, but she had a positive challenge with pantoprazole, reproducing anaphylaxis (6).That same year, probable anaphylaxis due to omeprazole and esomeprazole was also described in a 4-month-old infant who presented several episodes of respiratory distress, alongside facial edema in some of them, after using these drugs; however, no allergy study was performed (7). The final described case (8) is a 14-year-old male that had anaphylaxis with omeprazole. Skin prick test were negative, but intradermal tests with omeprazole and lansoprazole were positive. The authors did not perform skin tests with pantoprazole.Ours is the fourth published case of PPI anaphylaxis in children, being the youngest reported patient in which intradermal tests demonstrated an IgE-mediated hypersensitivity reaction. In the literature, cross-reactivity patterns among PPIs have described (9): selective sensitization to a single PPI, whole-group hypersensitivity, omeprazole-esomeprazole-pantoprazole hypersensitivity, and lansoprazole-rabeprazole hypersensitivity. In addition, there are published cases that do not fit those patterns (10). Any case, in PPI-mediated IgE allergy, skin tests have proven useful for diagnosis as they have high specificity and positive predictive value, although low sensitivity (10).In a suspected allergy to a PPI, preventive withdrawal of all PPIs can be appropriate in managing these patients, but we consider that skin tests should always be performed. If negative, controlled oral provocation tests with the PPIs that displayed negative results should always be considered, acknowledging the risk-benefit ratio and possible cross-reactivity patterns.

Shape memory Nitinol has long been used for actuation. However, utilizing Nitinol to fabricate novel devices for various applications is a challenge, but has shown incredible promise and impacts. Bistable metal strips are widely adopted for shape morphing purposes (primarily in kid’s toys, e.g., snap bracelets) due to their easy and robust transformation between two states. In this paper, we combine Nitinol shape memory alloy and bistable metal strip to fabricate a swimming actuator with both slow moving and fast snapping capability, akin to an octopus swimming slowly in water, but quickly moving upon encountering a threat. The actuator developed here can also swim in multiple directions, all controlled by a wireless module. Furthermore, we demonstrate that an on-board sensor can be incorporated for potential environmental monitoring applications. Taken together, along with the fact that the device developed here has no mechanical parts, makes this  an interesting potential alternative to more expensive, and energy consuming boats.

Le acque reflue possono contenere vari metalli pesanti a seconda del tipo di attività da cui sono generate. Tra questi, uno dei più diffusi è il rame. I metodi comunemente utilizzati per il trattamento delle acque di processo sono la precipitazione chimica e i trattamenti biologici. Tuttavia, la presenza di leganti all’interno delle acque potrebbe rendere inefficienti i processi convenzionali con conseguenti rischi per la salute umana. Tra le diverse soluzioni proposte in letteratura, il presente lavoro analizza l’efficienza di un processo di sostituzione/precipitazione/deposizione/riduzione diretta (ERPDD) con scarti di ferro, recuperati da processi di lavorazione dei metalli, utilizzati come anodo sacrificale per il trattamento delle acque reflue contenenti complessi metallo-leganti. Sono state valutate le efficienze di rimozione del trattamento elettrochimico al variare dei principali parametri che influenzano il processo. Infine, è stato effettuato un confronto dei costi con un processo di sostituzione chimica e precipitazione.

Background: SARS-CoV-2 variation represents a serious challenge to current COVID-19 vaccines. Recent reports suggest that B.1.351 and other variants may escape the neutralization activity of the antibodies generated by current vaccines. Methods: Ninety-nine healthcare workers undertaking BNT162b2 mRNA vaccination were sampled at baseline, on the day of the second dose, and 14 days after the latter. Neutralization activity against SARS-CoV-2 B.1, B.1.1.7 and B.1.351 was investigated using a Vero-E6 model. Results: Eleven of the study participants had prior infection with SARS-CoV-2. Neutralization titers against the B.1 and the B.1.1.7 variants were not statistically different and were significantly higher than titers against the B.1.351 variant across pre-exposed and non-pre-exposed vaccinated individuals ( p<0.01). While all vaccinated individuals presented neutralizing antibodies against B.1 and B 1.1.7 after the second dose, 14% were negative against B.1.351, and 76% had low titers (1/20-1/80). Pre-exposed vaccinated individuals showed higher titers than non-pre-exposed after the first (median titers of 1/387 versus 1/28, respectively) and the second doses (1/995 versus 1/703, respectively). As high as 72% of the pre-exposed vaccinees presented titers >1/80 after a single dose, while only 11% of non-exposed vaccinated individuals had titers >1/80. Conclusions: BNT162b2 mRNA-induced antibodies show a lower in vitro neutralizing activity against B.1.351 variant compared to neutralization against B.1.1.7 or B.1 variants. Interestingly, for individuals pre-exposed to SARS-CoV-2, one dose of BNT162b2 mRNA may be adequate to produce neutralizing antibodies against B.1.1.7 and B.1, while two doses of BNT162b2 mRNA provide optimal neutralizing antibody response against B.1.351 too.

ABSTRACT: Culture is widely accepted as an important social factor present across a wide range of species. Bears have a culture as defined as behavioral traditions inherited though social learning usually from mothers to offspring. Successful bear cultures can enhance fitness and resource exploitation benefits. In contrast, some bear cultures related to response to humans and human-related foods can be maladaptive and result in reduced fitness and direct mortality. In environments with minimal human influence most bear culture has evolved over generations to be beneficial and well adapted to enhance fitness. However, most bears across the world do not live in areas with minimal human influence and in these areas, bear culture is often changed by bear interactions with humans, usually to the detriment of bear survival. We highlight the importance of identifying unique bear cultural traits that allow efficient use of local resources and the value of careful management to preserve these adaptive cultural behaviors. It is also important to select against maladaptive cultural behaviors that are usually related to humans inorder to reduce human-bear conflicts and high bear mortality. We use examples from Yellowstone National Park to demonstrate how long-term management to reduce maladaptive bear cultures related to humans has resulted in healthy bear populations and a low level of human-bear conflict in spite of a high number of Park visitors in close association with bears.

Background and Aim of the Study: Congenital heart disease is the most common congenital defect among infants born in the United States. Within the first year of life, 1 in 4 of these infants will need surgery. Only one generation removed from an overall mortality of 14%, many changes have been introduced into the field. Have these changes measurably improved outcomes? Methods: The literature search was conducted through PubMed MEDLINE and Google Scholar from inception to October 31, 2021. Ultimately, 78 publications were chosen for inclusion. Results: The outcome of overall mortality has experienced continuous improvements in the modern era of the specialty despite the performance of more technically demanding surgeries on patients with complex comorbidities. This modality does not account for case-mix, however. In turn, clinical outcomes have not been consistent from center to center. Furthermore, variation in practice between institutions has also been documented. A recurring theme in the literature is a movement towards standardization and universalization. Examples include mortality risk-stratification that has allowed direct comparison of outcomes between programs and improved definitions of morbidities which provide an enhanced framework for diagnosis and management. Conclusions: Overall mortality is now below 3%, which suggests that more patients are surviving their interventions than in any previous era in congenital cardiac surgery. Focus has transitioned from survival to improving the quality of life in the survivors by decreasing the incidence of morbidity and associated long-term effects. With the transformation towards standardization and interinstitutional collaboration, future advancements are expected.

Background: This study was conducted to evaluate the surgical results of the arterial switch operation for Taussig-Bing variants, at a single institution in a lower-middle income country. Methods: Between June 2010 and December 2018, all consecutive patients diagnosed with Taussig-Bing variants who underwent the arterial switch operation and ventricular septal defect closure were included in the study. Results: A total of 72 patients of Taussig-Bing variants who underwent arterial switch operation and ventricular septal defect closure. There were 10 early deaths (13.9%) and 2 late deaths (2.8%). Intraoperative ventricular septal defect enlargement [hazard ratio (HR) 7.23, 95% confidence interval (CI) 3.1294-16.7167; P < 0.001], secondary aortic cross clamping (HR 28.38, 95% CI 4.8427-166.3484; P < 0.001), post-operative pneumonia (HR 5.64, 95% CI 1.2724-24.9917; P = 0.023), and post-operative sepsis (HR 5.28, 95% CI 1.3512-20.6553; p = 0.017) were risk factors for overall mortality by competing risk analysis. Sixty patients (83.3%) required septoparietal trabeculation division/resection during the arterial switch operation in an attempt to avoid right ventricular outflow tract obstruction. The reoperation rate for right ventricular outflow tract obstruction at last follow up was 6% (3 patients). The estimated freedom from reoperation for right ventricular outflow tract obstruction at 1 year, 5 year and 9 year was 98.3%, 91.9% and 91.9 , respectively. Conclusions: The results of arterial switch operation for Taussig-Bing variants were satisfactory in the operative setting of a lower-middle income country, and performing extensive septoparietal trabeculation division might reduce the reintervention rate for right ventricular outflow tract obstruction in these patients.

Spontaneous rupture of abdominal wall herniaTakanobu Hirosawa1 MD, Taro Shimizu1 MD, PhD, MPH, MBA1. Department of Diagnostic and Generalist Medicine, Dokkyo Medical UniversityAll authors have no conflict of interest and grant to declare.Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.

Introduction: The extravascular ICD (EV ICD) system with substernal lead placement is a novel non-transvenous alternative to current commercially available ICD systems. The EV ICD provides defibrillation and pacing therapies without the potential long-term complications of endovascular lead placement. Methods: This paper summarizes the development of the EV ICD, including the pre-clinical and clinical evaluations that have contributed to system and procedural refinements to date. Results: Extensive pre-clinical research evaluations and 4 human clinical studies with >140 combined acute and chronic implants have enabled the development and refinement of the EV ICD system, currently in worldwide pivotal study. Conclusion: The EV ICD may represent a clinically valuable solution in protecting patients from sudden cardiac death while avoiding the long-term consequences of transvenous hardware. The EV ICD offers advantages over transvenous and subcutaneous systems by avoiding placement in the heart and vasculature; relative to subcutaneous systems, EV ICD requires less energy for defibrillation, enabling a smaller device, and provides pacing features such as anti-tachycardia and asystole pacing in a single system.

Introduction: Drug-drug interaction (DDI) warnings are employed in many institutions when more than one QTc-prolonging medication is prescribed; however, this leads to alert fatigue where alerts are frequently overridden by clinicians due to patient non-specificity or low risk. This study aimed at reducing alert fatigue through developing a custom alert triggered by a patient-specific QTc-prolongation risk score, and validating it against database-driven DDI warnings for QTc prolongation. Methods and Results: Between November 23, 2019 and January 31, 2020, inpatients with a baseline and a follow-up 12-lead ECG reading within 14 days were identified. Each time a QTc-prolonging medication order was signed or verified, the QTc-prolongation risk score was calculated in the electronic health record (EHR), triggering a custom alert in the background. Follow-up 12-lead ECG readings were used to calculate sensitivity and specificity for both the custom alert and the DDI warning. A total of 100 patients had a risk score calculation and were included in our analysis, representing 521 custom alerts and 449 DDI warnings. The preliminary QTc-prolongation risk score did not achieve a reduction in false positive alerts with a cutoff of 10 points. A multiple logistic regression was performed to re-arrange the components and optimize the risk score. Conclusion: Our adjusted QTc-prolongation risk score, with a cutoff of 5 points, achieved a specificity of 66% and a negative predictive value of 83%. These results will allow us to integrate the risk score into the EHR as a guidance tool to predict QTc-prolongation.

Pneumonia is a frequent manifestation of COVID-19 in hospitalized children. Methods The study involved 80 hospitals in the SARS-CoV-2 Spanish Pediatric National Cohort. Participants were children <18 years, hospitalized with SARS-CoV-2 community-acquired pneumonia (CAP). We compared the clinical characteristics of SARS-CoV-2-associated CAP with CAP due to other viral etiologies from 2012 to 2019. Results In total, 151 children with SARS-CoV-2-associated CAP and 138 with other viral CAP included. Main clinical features of SARS-CoV-2-associated CAP were cough 117/151(77%), fever 115/151(76%) and dyspnea 63/151(46%); 22/151(15%) patients were admitted to a pediatric intensive care unit (PICU), and 5/151(3%) patients died. Lymphopenia was found in 63/147(43%) patients. Chest X-ray revealed condensation (64/151[42%]) and other infiltrates (87/151[58%]). Compared with CAP from other viral pathogens, COVID-19 patients were older (8 vs.1 year; odds ratio [OR] 1.42 [95% confidence interval, CI 1.23;1.42]), with lower CRP levels (23 vs.48 mg/L; OR 1 [95%CI 0.99;1]), less wheezing (17 vs.53%; OR 0.18 [95%CI 0.11;0.31]) and greater need of mechanical ventilation, MV (7 vs.0.7%, OR 10.8 [95%CI 1.3;85). Patients with non-SARS-CoV-2-associated CAP had a greater need for oxygen therapy (77 vs.44%, OR 0.24 [95%CI 0.14;0.40]). There were no differences in the use of CPAP or HVF or PICU admission between groups. Conclusion SARS-CoV-2-associated CAP in children presents differently to other virus-associated CAP: children are older and rarely have wheezing or high CRP levels; they need less oxygen but more CPAP or MV. However, several features overlap, and differentiating the etiology may be difficult. The overall prognosis is good.

Introduction: It has been reported that ventricular tachycardia (VT) non-inducibility at the end of ablation is associated with less likely VT recurrence. However, it is not clear whether we should use VT non-inducibility as routine end point in VT ablation. The aim of this study was to evaluate VT recurrence in patients in whom VT non-inducibility could not be achieved at the end of the RF ablation and the factors attributing to the VT recurrence. METHODS and RESULTS: We analyzed 84 consecutive patients that underwent RF ablation, and 64 patients in whom VT non-inducibility could not be achieved were studied. The primary endpoint was recurrence of any sustained VT during the follow-up. During a median follow-up period of 1.4 years (IQR:0.3-2.0), 22 (34%) of the cases had VT recurrences. In the multivariate analysis showed that an LVEF≥35% (HR:0.21; 95% CI:0.07- 0.54; P<0.01) and successful identification and ablation of all clinical VT isthmuses (HR:0.21; 95% CI:0.03- 0.72; P=0.01) were independent predictors of fewer VT recurrences. RF ablation was associated with a 91.1% reduction in VT episodes. CONCLUSION: Even if VT non-inducibility could not be achieved, the patients with LVEF≥35% or in whom all clinical VT isthmuses could successfully be identify and ablated might be prevented from having VT recurrences. The validity of VT non-inducibility of any VT should be evaluated by each patient’s background and the results of the procedure.

Attualmente si è continuamente esposti a sostanze potenzialmente tossiche per la salute, come nel caso dei composti organici volatili (COV); in questo lavoro sono state individuate le origini di queste sostanze, i possibili danni derivati dall’esposizione con esse, oltre ad alcune tipologie di trattamento per il loro abbattimento. Ci si è soprattutto soffermati sul confronto tra una tecnologia biologica convenzionale, con filtro biotrickling (BTF) ed una innovativa, rappresentata da un fotobioreattore tubolare algale-batterico (TPBR), prendendo in esame l’abbattimento del toluene, uno dei COV più diffusi, appartenente alla famiglia dei BTEX. Il BTF ha supportato efficienze di rimozione medie vicine a quelle ottenute nel TPBR al carico in ingresso più elevato e al tempo di permanenza del gas più basso. Il BTF risulta influenzato dalla presenza di  metaboliti secondari, a questo proposito, integrazione fotosintetica di O2 e CO2 il consumo di microalghe ha migliorato le prestazioni di abbattimento del toluene e la stabilità del processo.

Per il trattamento delle acque reflue solitamente vengono impiegati gli impianti convenzionali a fanghi attivi, i quali si basano su un processo di degradazione biologica della biomassa. All’interno della materia organica presente nelle acque reflue troviamo composti contenenti azoto, principalmente ammoniaca, proteine, urea e nitriti, questi vengono decomposti mediante nitrificazione e denitrificazione da parte dei batteri presenti nella matrice a fanghi attivi. La nitrificazione avviene principalmente in condizioni aerobiche, mentre la denitrificazione si verifica comunemente in assenza di O2. La combinazione di alghe e batteri nei fanghi attivi è stata utilizzata per la degradazione degli inquinanti nelle acque reflue a causa della loro relazione simbiotica; i batteri nei fanghi attivi degradano la materia organica presente nelle acque reflue rilasciando sostanze nutritive e CO2 che vengono utilizzate dalle alghe per la fotosintesi. L'ossigeno rilasciato dalle alghe durante la fotosintesi, viene consumato dai batteri come agente ossidante per la degradazione della materia organica facendo ricominciare il ciclo. Inoltre le alghe, assorbendo CO2 durante la fotosintesi, riducono l’emissione di gas delle acque reflue.

Background: The treatment strategies for ovarian clear cell carcinoma (OCCC) are the same as those for epithelial ovarian cancer. Due to the rarity of OCCC, no prospective studies of its surgery have been reported. Therefore, the therapeutic significance of lymphadenectomy for OCCC needs to be further clarified. Objectives: To assess the effectiveness of lymphadenectomy in patients with ovarian clear cell carcinoma by a meta-analysis. Search Strategy: The Web of Science, Scopus, PubMed, and other sources (e.g. Google Scholar) were searched from each database’s earliest inception to June 2021. Selection Criteria: English-language publications of observational studies that investigated the role of lymphadenectomy in patients with OCCC were included. Data Collection and Analysis: The pooled hazard ratio (HR) and 95% confidence interval (CI) were calculated. Main Results: The analysis demonstrated that lymphadenectomy is associated with significantly improved disease-specific survival (DSS) (HR=0.76; 95%CI=0.60-0.95; P=0.02; I2= 0.0%) and disease-free survival (DFS) (HR=0.58; 95%CI=0.33-1.00; P=0.05; I2=61%), but not for overall survival (OS) (HR=0.80; 95%CI=0.60-1.06; P=0.12; I2= 19%) and progression-free survival (PFS) (HR=0.95; 95%CI=0.64-1.42; P=0.79; I2= 0.0%). But it is worth noting that several single studies indicated a tendency of improved OS, PFS, DFS, DSS with lymphadenectomy. Conclusions: Lymphadenectomy could not significantly improve OS and PFS for OCCC, but is associated with improved DFS and DSS. Gynecologic oncologists should tailor treatment to patients to achieve optimal outcomes. And further studies are necessary to validate the impact of lymphadenectomy on OCCC. Keywords: ovarian clear cell carcinoma, lymphadenectomy, survival, systematic review, meta- analysis

Optical artificial neural networks (ONNs) have significant potential for ultra-high computing speed and energy efficiency. We report a novel approach to ONNs that uses integrated Kerr optical micro-combs. This approach is programmable and scalable and is capable of reaching ultra-high speeds. We demonstrate the basic building block ONNs-a single neuron perceptron-by mapping synapses onto 49 wavelengths to achieve an operating speed of 11.9 x 10 9 operations per second, or Giga-OPS, at 8 bits per operation, which equates to 95.2 gigabits/s (Gbps). We test the perceptron on handwritten-digit recognition and cancer-cell detection-achieving over 90% and 85% accuracy, respectively. By scaling the perceptron to a deep learning network using off-the-shelf telecom technology we can achieve high throughput operation for matrix multiplication for real-time massive data processing.