Atraumatic splenic rupture is an uncommon but important clinical entity. We report a case of young healthy male who had pain abdomen secondary to atraumatic rupture of spleen. On thorough workup, no conditions affecting the spleen was found and the patient was suspected to have idiopathic rupture.

Three-dimensional (3D) cell culture systems mimic the structural complexity of the tissue microenvironment that includes the extracellular matrix (ECM) in addition to the cellular components Thus, 3D culture systems are increasingly important as they resemble the ECM-cell and cell-cell physical interactions occurring in vivo. So far, several scaffold-based culture systems and techniques have been proposed as valuable approaches for large-scale production of spheroids, but often suffering of poor reproducible conditions or high costs of production. In this work we present a reliable 3D culture system based on collagen I-blended agarose hydrogels and show how the variation of the agarose weight percentage affects the physical and mechanical properties of the resulting hydrogel, being that with a lower amount of agarose more permeable, softer and more prone to degradation compared to hydrogels with higher agarose concentrations. We have also evaluated the effect of the different physical and mechanical properties of the agarose hydrogels on the growth, size, morphology and cell motility of spheroids obtained by culturing three different breast cancer cell lines (MCF-7, MDA-MB-361and MDA-MB-231). As proof of concept, the cisplatin penetration and its cytotoxic effect on the tumor spheroids was evaluated as function of the hydrogel stiffness. Noteworthy, the possibility to recover the spheroids from the hydrogels for further processing and other biological studies has been also considered.

La depurazione delle acque reflue rappresenta una delle principali esigenze per la tutela dell'ambiente e della salute dell'uomo. L'attenzione del legislatore, del mondo tecnico e delle imprese è sempre più rivolta alle possibilità di riutilizzare le acque depurate tramite tecnologie sostenibili per l’ambiente e per l’uomo.I bioreattori a membrane (MBR) rappresentano una soluzione tecnologica del futuro in quanto consentono il raggiungimento di elevati rendimenti depurativi tali da permettere il riutilizzo delle acque trattate. La principale novità di questa tecnologia, consiste nell’uso di uno o più moduli di membrana a ultrafiltrazione o microfiltrazione capaci di separare da un fluido sostanze contenute in forma sospesa o disciolta sotto l’azione di una forza motrice. L’attraversamento della membrana comporta un meccanismo di filtrazione con la produzione di permeato di elevata qualità e un concentrato che si accumula all’interno del reattore stesso, e da cui viene allontanato periodicamente. Tuttavia, la realizzazione di impianti a scala reale dei bioreattori a membrane è ostacolata da diversi problemi tra cui quello principale riguardante la formazione del fouling ossia lo sporcamento della membrana, principale responsabile degli elevati costi causati dalla necessità di pulire e/o sostituire le membrane. Negli ultimi anni la ricerca scientifica ha proposto nuove soluzioni, atte a mitigare il fouling di membrana, tra queste l’applicazione di processi elettrochimici, come elettrocoagulazione, elettrosmosi ed elettroforesi, combinati ai bioreattori a membrane (eMBR). Tali meccanismi migliorano la rimozione degli inquinanti e regolano la mobilità e la deposizione di agenti contaminanti sulla superficie della membrana. Tale soluzione rappresenta un approccio tecnologico promettente con ottime prospettive nella mitigazione del fouling e nell’incremento delle efficienze di depurazione del sistema. Solo di recente l’attenzione è stata rivolta verso l’utilizzo di membrane dinamiche autoformanti, in sostituzione delle tradizionali membrane, che consentono una riduzione considerevole in termini di investimento e dei costi operativi associati al processo, un facile controllo del fouling, un alto flusso di permeato, un basso fabbisogno di energia ed un’elevata capacità di trattamento.La formazione della membrana dinamica avviene per mezzo di sostanze presenti nella miscela liquida che durante la filtrazione si depositano sulla superficie di supporto, costituita da materiali a basso costo, come ad esempio dacron o nylon con elevate porosità, incrementando le capacità depurative del sistema quando la membrana dinamica raggiunge la sua completa formazione. Di contro però l’efficienza del sistema dipende dalle proprietà dei fanghi quali viscosità e idrofobicità e dalla velocità di areazione che causano un aumento dell’incrostazione della membrana e a seconda del materiale di supporto utilizzato si ha che la pulizia potrebbe essere accompagnata da una temporanea perdita di qualità dell’effluente.L’attività di tirocinio, svolta presso il Laboratorio di Ingegneria Sanitaria Ambientale (SEED) dell’Università degli Studi di Salerno e presso l’impianto di depurazione di Battipaglia (Sa) in località Tavernola e gestito dall’ Asis Spa., si è concentrata sull’analisi delle efficienze depurative di un elettro bioreattore a membrane a scala pilota operante con refluo reale che utilizza per la fase di filtrazione una membrana dinamica autoformante.Sono stati analizzati i meccanismi di formazione della membrana dinamica autoformante, le efficienze di rimozione dei contaminanti, l’andamento dei precursori del fouling, l’andamento della pressione di transmembrana nel tempo e la concentrazione dei solidi nella miscela areata, al fine di valutare la fattibilità tecnica ed economica per l’applicazione a scala reale dell’innovativo sistema proposto.

Objective: The present study investigated the acute effects of a mixed-modality, long-duration adventure race on pulmonary function in adolescent athletes. Methods: Twenty male adolescents aged 14 to 17 years volunteered to participate in a simulated competitive wilderness adventure race of 68.5-km. Expiratory function was evaluated by spirometry with an Ergocard CPX Clinical system before, immediately after, and 24 h after race completion. Measurements included forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flows at 25%, 50% and 75% of FVC (FEF25, FEF50, FEF75, respectively) and peak expiratory flow (PEF). Maximal inspiratory and expiratory mouth static pressures (MIP and MEP, respectively) were also measured using a portable hand-held mouth pressure meter across the same time points. Results: The mean completion time of the race was 05:38 ± 00:20 hours. A significant post-race decrease in FVC was observed immediately after the race (-5.2%, p < 0.05). However, no significant changes were observed for FEV1, PEF or the FEV1/FVC and FEV1/PEF ratios. The results also showed no significant modifications in the maximal expiratory flow-volume curves irrespectively of FVC percentages (FEF25, FEF50, FEF75). In addition, estimates of respiratory muscle strength (MIP and MEP) were unaffected by the race. Conclusion: The long-duration adventure race induced no substantial reduction in expiratory pulmonary function and this response was associated with no apparent respiratory muscle fatigue. Therefore, the pulmonary system of trained adolescent athletes was sufficiently robust to endure the mixed-modality, long-duration adventure race of ∼5-6 h.

OBJECTIVE To compare postoperative and long-term results (angina, myocardial and cerebrovascular events and coronary re-intervention) using single versus bilateral internal mammary arteries (SIMA vs. BIMA) in the setting of off-pump revascularisation (OPCAB) within a single-surgeon practice. METHODS Retrospective analysis of all isolated OPCAB performed in our institution by a single surgeon in the last 12 years.Two groups were analysed: SIMA (n = 681) and BIMA (n = 342). A propensity score matching was performed to compare the groups, reducing the sample to 684 patients.Follow-up (mean 6.5 ± 3.5 years) was done by telephone interviews or clinical visits, registering also late mortality and coronary re-intervention. Outcomes were compared to literature. RESULTS Demographic characteristics differed between groups, with BIMA offered predominantly to non-diabetic younger males (mean 59.4 years) with less comorbidity. In-hospital mortality was 2% for the SIMA group and 1% for BIMA (p = 0.18). Long-term mortality was also higher for the SIMA group (2% vs. 1% at 1 year, p = 0.22 and 16% vs. 5% at 5 years, p < 0.001). Sternal wound infection was similar in both groups (2-3%). Long-term follow-up revealed good freedom from angina (94%) with low rates of neurological and myocardial events (3%) or need for repeated revascularisation (3%) in both groups. CONCLUSION BIMA offers long-term survival benefit with similar postoperative complications. Rates of deep sternal wound infection were comparable between the two groups.Excellent outcomes can be achieved with OPCAB BIMA in real world practice with adequate patient selection.

Objective: To describe the occurrence, clinical presentation and management, of pediatric nasal foreign bodies, and to assess various risk factors for complications. Methods: A retrospective analysis of a computerized patient directory of 562 children admitted to the emergency department (ED) in a tertiary pediatric hospital during a 10-year period (Jan 2010-Dec 2019), with a witnessed NFB upon physical examination. Results: Upon admittance to the ED, most of the children (82%) were asymptomatic. Among the symptomatic children (18%), the primary symptoms were nasal discharge (10%), epistaxis (8%) and pain (4%). Younger children (under age 4 years) were more likely to insert organic materials, compared to older children. Younger children were also admitted sooner to the ED and were more likely to present with nasal discharge. The overall complication rate was 5%. None of the children had aspirated the NFB. Complications included infection (2%), necrosis (0.7%), septal perforation (0.5%), deep mucosal laceration (1.5%) and loss of NFB (1.9%). Significantly higher rates of symptoms and complications were associated with button batteries. Increased risk for complications were observed according to NFB-type, multiple attempts to remove NFB, posterior insertion of NFB and left-side insertion. Conclusions: NFB in children are common. Mostly, patients are asymptomatic, therefore a high index of suspicion is required, for quick diagnosis and safe removal, without complications.

Transesophageal echocardiography is mandatory if you do suspect infective endocarditis. By approaching via a small right thoracotomy, vegetectomy and mitral valvuloplasty following severe mediastinitis were successfully accomplished without any complications. 

Aims: We have previously shown that 2-dimentional strain is not a useful tool for ruling out acute coronary syndrome (ACS) in the emergency department (ED). The aim of the present study was to determine whether in patients with suspected ACS, global longitudinal strain (GLS), measured in the ED using 2-dimensional strain imaging, can predict long-term outcome. Methods: Long-term (median 7.7 years [IQR 6.7-8.2]) major adverse cardiac events (MACE; cardiac death, ACS, revascularization, hospitalization for heart failure or atrial fibrillation) and all-cause mortality data was available in 525/605 patients (87%) enrolled in the Two-Dimensional Strain for Diagnosing Chest Pain in the Emergency Room (2DSPER) study. The study prospectively enrolled patients presenting to the ED with chest pain and suspected ACS but without a diagnostic ECG or elevated troponin. GLS was computed using echocardiograms performed within 24 hours of chest pain. MACE of patients with worse GLS (> median GLS) was compared to patients with better GLS ( median GLS). Results: Median GLS was -18.7%. MACE occurred in 47/261 (18%) of patients with worse GLS as compared with 45/264 (17%) with better GLS, adjusted HR 0.87 (95% CI 0.57-1.33, P=0.57). There was no significant difference in all-cause mortality or individual end-points between groups. GLS did not predict MACE even in patients with optimal 2-dimensional image quality (n=164, adjusted HR=1.51, 95% CI 0.76-3.0). Conclusions: GLS did not predict long-term outcome in patients presenting to the ED with chest pain and suspected ACS, supporting our findings in the 2DSPER study.

Herein, we present a new surgical approach for vibrant soundbridge implantation in advance of the plastic reconstruction of the auricle in patient with unilateral microtia-atresia and highlight the importance of cooperation between otologists and plastic surgeons in the performance of this technique.

Exothermic methanation reaction from syngas to synthetic natural gas (SNG) in fixed-bed reactor suffers from hot-spot formation caused by limited heat transfer area and relatively poor radial heat transfer of catalyst particle packings. To address this issue, monolithic catalyst with excellent transport and mechanical properties is under development. In this contribution, CFD simulations of methanation reaction from syngas to SNG over three types of 3D-printed monolithic catalysts were performed. The simulation results are in good agreement with experimental ones. Compared with monolithic catalyst with honeycomb-shaped straight-channel structure or tetrahedral periodic structure, bio-inspired monolithic catalyst having the same characteristic of cancellous bone was found to be promising due to its lower pressure drop, better heat transfer, superior mass transfer and thus higher conversion of syngas. The mechanism and promising applications of 3D-printing bio-inspired monolithic catalyst are discussed.

Distillation reactor is one of the important equipment to improve the reaction conversion limited by the chemical equilibrium, however, the design of distillation reactor in industrial scale is still challenging due to the lack of efficient catalytic packing with corresponding kinetics. This work developed the novel catalytic packing consists of the structured ZSM-5@SiC foam catalyst and corrugated sheet, which used in distillation reactor for synthesis of ethyl levulinate (EL). The kinetic of structured ZSM-5@SiC foam catalyst was measured and model regarding the “structure factor” of ZSM-5@SiC catalyst and fluid flow conditions. Furthermore, the design of distillation reactor in industrial scale has been performed based on the developed kinetics, which demonstrated an excellent performance in the designed distillation reactor (EL yield 37.65% with energy consumption 3695 kJ/kg) are achieved. X-ray CT characterization revealed that the ZSM-5 coating thickness has the significantly effects on the kinetics and performances of distillation reactor.

Microwave reactors equipped with microwave absorbent as high-temperature bed are effective for the pyrolysis reactions. The uniformity and stability of temperature distribution on the microwave absorbent bed surface is important to the microwave pyrolysis reactor especially in the large-scale reactor. Herein, the temperature distribution on the SiC microwave absorbent bed in a large-scale microwave pyrolysis reactor without feeding was examined by both infrared thermography and simulation. Considering the economics of using multiple low-power magnetrons in large-scale reactor, the effect of the working magnetrons location on the heating rate of bed surface and the COV of temperature distribution was investigated. The results showed that more uniform and stable temperature distribution of bed surface in the large-scale reactor was obtained when the magnetrons located at the bottom of the reactor were in use. This study provides guidance for the scale-up of microwave-assisted pyrolysis reactor with multiple low-power magnetrons.

Cutibacterium acnes (C. acnes), previously known as Propionibacterium acnes (although likely underreported), is a rare cause of infective endocarditis (IE) and often difficult to diagnose. We describe three cases from a single centre over a five-year period to provide insight into the various clinical presentations, progression and management of patients with this infection. The primary objective of our series is to highlight the difficulty in the initial assessment of these patients with an aim to improve the time and accuracy of diagnosis and expedite subsequent treatment. There are currently no guidelines in the literature for the management of IE caused by Cutibacterium acnes. Our secondary objectives are to disseminate information about the indolent course of the disease and add to the growing body of evidence around this rare yet complex cause of IE.

Objective To explore the prognostic factors of hospital mortality for unplanned re-exploration after cardiovascular surgery. Methods We retrospectively analyzed the data of 100 patients who underwent unplanned re-exploration after cardiovascular surgery in our hospital between May 2010 and May 2020. There were 77 males and 23 females, aged (55.1±15.2) years. Demographic characteristics, operation information, perioperative complications were collected to set up a database. The patients were divided into survival group and non-survival group according to hospital mortality. Logistic regression was used for multivariable analysis to explore the prognostic factors of hospital mortality. These statistically significant indicators were selected for drawing the receiver operating characteristic curve of the evaluation model, calculating the area under the curve(AUC) and evaluating the effectiveness of the new model with Hosmer-Lemeshow C-statistic. Results Hospital mortality was 26.0% (26/100). Multivariate logistics regression revealed that the operation time of unplanned re-exploration, the worst blood creatinine within 48h before the re-exploration, the worst lactate within 24h after the re-exploration, cardiac insufficiency, respiratory insufficiency, and acute kidney injury were independent prognostic factors (p<0.05). The AUC of the new assessment model constituted by these prognostic factors was 0.910, and the Hosmer-Lemeshow C-statistic was 4.153 (P= 0.762). Conclusions The operation time of unplanned re-exploration, the worst blood creatinine value within 48h before the re-exploration, the worst lactate value within 24h after the re-exploration, cardiac insufficiency, respiratory insufficiency, and acute kidney injury were independent prognostic factors of hospital mortality for unplanned re-exploratio after cardiovascular surgery.

During geographical expansion of a species individual colonizers have to confront different ecological challenges, and the capacity of the species to broaden its range may depend on the total amount of adaptive genetic variation supplied by evolution. We set out to test whether the distribution of loci under selection along a contrasting environmental gradient can be turned into a model that accurately predicts a species' range. If positive, this may shed light on the genetic source of adaptive limits that shape range boundaries. We sampled five populations of the western Mediterranean lizard Psammodromus algirus that inhabit a noticeable environmental gradient of temperature and precipitation. We used 21 SNPs putatively under selection to correlate the genotypes of 95 individuals with environmental variation among their populations, using 1x1 km2 grid cells as sampling units. By extrapolating the resulting model to all possible combinations of alleles, we inferred the locations that were theoretically suitable for the species. The inferred distribution range overlapped to a large extent with the realized range of the species, including an accurate prediction of internal gaps and range borders. Our results suggest an adaptability threshold determined by the amount of genetic variation available that would be required to warrant adaptation beyond a certain limit of environmental variation. These results support the idea that the expansion of a species' range may be ultimately linked to the arising of new variants under selection.

The aim of this systematic review was to identify articles on prevalence of leptospirosis in stray and sheltered dogs worldwide and access the methodological quality of the recovered papers. Six databases (CABI, Cochrane, Pubmed, Scielo, Scopus and Web of Science) were searched, without restriction on year or location where the studies were performed. The search recovered 476 articles and 60 were selected for analysis according to quality criteria. None of the selected articles showed a complete explanation for the sample size adopted (probabilistic sampling), leading to the impossibility of recalculation of leptospirosis prevalence for stray or sheltered dogs. Among the analyzed papers 43.33% (26/60) showed five of the ten quality criteria analyzed, 16.67% (10/60) three, 15.00% (9/60) four, 10.00% (6/60) six, 6.67% (4/60) eight, only 5.00% (3/60) showed nine of the ten criteria analyzed, whereas two papers showed two [1.67% (1/60)] and seven [1.67% (1/60)] of the ten criteria assessed. The majority of the papers were published in the Americas [45.00% (27/60)] and in the last sixteen years (2003 to 2019) [81.67% (49/60)], and most of the sampled dogs were stray dogs [65.00% (39/60)]. The leptospirosis diagnostic test used more frequently was Micro Agglutination Test (MAT) [78.33% (47/60)] followed by polymerase Chain Reaction (PCR) [23.33% (14/60)], whereas the most common serovars identified were Canicola [71.43% (35/49)], Icterohaemohrragiae [65.31% (32/49)], Grippotyphosa [40.82% (20/49)] and Pomona [40.82% (20/49)]. In conclusion, our results showed that Leptospira spp. is present in stray and sheltered dogs worldwide, but the complete comprehension of the prevalence of leptospirosis in these populations could not be achieved due to the low methodologic quality of the recovered studies about leptospirosis in stray and sheltered dogs.

Tricuspid atresia (TA) is a rare cyanotic congenital heart disease. A persistent left superior vena cava (LSVC) may be associated with TA. The presence of LSVC raises important considerations for eventual repair, in that it may lead to persistent arterial desaturation even after corrective surgery, if associated with an unroofed coronary sinus. Here, we present the case of a 4-month-old child who was diagnosed with TA type 1B, LSVC and a dilated coronary sinus by transthoracic echocardiography.

In this paper, we study a fractional order time delay for nonlinear financial system. By using Laplace transformation, stability and Hopf bifurcation analysis have been done for the model. Furthermore, numerical simulation has been carried out for better understanding of our results.

Clinical ImagesTitle: Twenty-years’ use of expanded polytetrafluoroethylene sheet for an artificial cardiac pacemakerKenji Yorita1*, Junichi Takahashi2, Kazutoshi Tano3, Yoichi Ichikawa3, Nobumasa Hamaguchi4, Wataru Yasui51Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, Kochi-city, Kochi, Japan2Department of Internal Medicine, Japanese Red Cross Kochi Hospital, Kochi-city, Kochi, Japan3Department of Cardiovascular Surgery, Japanese Red Cross Kochi Hospital, Kochi-city, Kochi, Japan4Department of Thoracic Surgery, Japanese Red Cross Kochi Hospital, Kochi-city, Kochi, Japan5Department of Internal Medicine, Yusuhara Hospital, Kochi-city, Kochi, JapanThe authors report no conflict of interest, financial or otherwise.＊Corresponding Author: Kenji Yorita, M.D., Ph.D.,Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, 1-4-63-11, Hadaminamimachi, Kochi-city, Kochi 780-8562, JapanTel: +81-88-822-1201Fax: +81-88-822-1056E-mail: kenjiyorita@gmail.comKeywords : expanded polytetrafluoroethylene sheet, cardiac pacemaker, foreign body

Background: Enterovirus (EV) infections, being among the most prevalent viruses worldwide, have been associated with reduced risk of allergic diseases. We sought to determine the association of EVs with allergic sensitization and disease in early childhood. Methods: The study was carried out in a nested case-control setting within a prospective birth cohort in Finland. We included 138 case children who had specific IgE (s-IgE) sensitization at the age of 5 years and 138 control children without s-IgE sensitization. Allergic disease was recorded at study visits and asked with ISAAC questionary. We screened for the presence of serotype specific antibodies against 41 EVs at 1 to 5 years of age and assessed their association with allergic sensitization and disease. Results: The overall number of EV infections did not differ between s-IgE-sensitized children and non-sensitized control children. However, there was a tendency of case children with an allergic disease having less EV infections than their controls. This observation was statistically significant for species A EVs in case children with atopic dermatitis vs. control children: OR 0.6 (95 % CI 0.36-0.99), P = 0.048. Conclusion: This study supports the evidence that EV exposure and development of allergic disease are inversely associated. Interestingly, the inverse association was not observed for bare atopic IgE sensitization, but for IgE sensitization coupled with clinical atopic disease. This suggests that environmental factors influencing IgE sensitization may differ from those influencing progression to clinical allergic disease.

In this article, a numerical scheme is introduced for solving the fractional partial differential equation (FPDE) arising from electromagnetic waves in dielectric media (EMWDM) by using an efficient class of finite difference methods. The numerical scheme is based on the Hermite formula. The Caputo’s fractional derivatives in time are discretized by a finite difference scheme of order O((k^(4-alpha)) & O(k^(4-beta)), 1

In this paper, a conserved domain decomposition method for solving convection-diffusion equations with variable coefficients is analyzed. The interface fluxes over the sub-domains are firstly obtained by the explicit fluxes scheme. Secondly, the interior solutions and fluxes over each sub-domains are computed by the modified upwind implicit scheme. Then, the interface fluxes are corrected by the obtained solutions. We prove rigorously that our scheme is mass conservative, unconditionally stable and of second-order convergence in spatial step. Numerical examples test the theoretical analysis and efficiencies. Lastly, we extend our scheme to the nonlinear convection-diffusion equations and give the error estimate.

A middle aged female presented with a large flank mass, was initially reported to be a renal cell carcinoma of the sarcomatoid variant. Discordant presentation lead to further pathological work-up and a primary renal synovial sarcoma was diagnosed. We present our journey in images.

Disseminated tuberculosis (TB) in the pediatric population is relatively rare in the United States with variable nonspecific presentations. In this letter we discuss the case of 2-year-old child with a lung mass and central neurogenic hyperventilation with primary respiratory alkalosis as a rare pediatric presentation of disseminated tuberculosis with TB meningitis and pulmonary tuberculosis.