Casting is the first step toward the production of majority of metal products whether the final processing step is casting or other thermomechanical processes such as extrusion or forging. The high shear melt conditioning provides an easily adopted pathway to producing castings with a more uniform fine-grained microstructure along with a more uniform distribution of the chemical composition leading to fewer defects as a result of reduced shrinkage porosities and the presence of large oxide films through the microstructure. The effectiveness of high shear melt conditioning in improving the microstructure of processes used in industry illustrates the versatility of the high shear melt conditioning technology. The application of high shear process to direct chill and twin roll casting process is demonstrated with examples from magnesium melts. The light weighting has become more important for increased fuel efficiencies, with the increase in the weight of automobiles as a result of the weight of batteries or fuel cells associated with electric vehicles. The development of high-strength alloys and composites requires a refined microstructure with a reduced defect distribution together with a homogeneous composition profile in the final product. Solidification and casting is essential for processing metallic materials regardless of whether the final product is used in the cast or wrought form. The quality of the casting and in turn the quality of the melt is crucial in determining the final properties. Oxides, gas and other inclusion usually deteriorate the quality of the melt and in turn the properties and quality of the castings. The presence of micro- and macro-scale defects, such as gas porosity, and oxide defects in the solidified billets can lead to reduced property profiles in castings and wrought products. The presence of pores and other defects would reduce the strength and ductility of the castings. Thus, the yield strength used for design process is significantly lower than the average yield strength of the alloy to account for these defects. In applications where light weighting is of importance, such increments reduce the weight savings envisaged and, in the case of automotive or aerospace applications, reduce fuel efficiencies and consequently increase the CO2 emission. The reduction in defect density and the resultant increase in strength would contribute to the lighter parts, and this may be achieved through melt conditioning, especially with intensive melt shearing.Light alloys based on aluminum and magnesium are used in many industrial applications where light weighting is of paramount interest.Melt treatment ensures a high-quality melt through treating the liquid metal prior to casting. There are numerous existing methods including electromagnetic stirring, mechanical stirring with an impeller, melt filtering, and rotary degassing, which are used to treat the liquid metals. Recently, melt conditioning of Al and Mg melts in liquid and semisolid states, using a twin-screw device, refined the microstructure and improved the mechanical properties of both cast and wrought alloys.5 s−1. The rotor–stator high shear device provides macro-flow in a volume of melt for distributive mixing and intensive shearing near the tip of the device for dispersive mixing. The enhanced kinetics associated with chemical reactions and phase transformations, uniform dispersion and reduction of particle size and gas bubbles, uniform distribution of composition and temperature fields, and forced wetting of solid particles in the liquid metal are some of the main advantages associated with the rotor stator. Thus, the high shear device is used effectively for the grain refinement by dispersing native oxides or grain refiners, for degassing aluminum melts, for the preparation of metal-matrix composites, and for preparation the of semisolid slurries. As a result of its size and versatility, the rotor–stator high shear device can be used for many different industrial casting processes for both aluminum and magnesium alloys, including direct chill casting and twin roll casting. The rotor–stator device can be inserted into a crucible containing molten metal and could be used to apply intensive shearing without disturbing the melt surface  casting process is shown in Fig. To understand the grain refining via intensive melt shearing, temperatures were recorded during DC casting by attaching thermocouples to the head of the high shear device.Twin roll casting is an important industrial process used in producing magnesium alloy sheets economically. TRC alloys generally contain relatively large grains and contain defects such as center line segregation and inverse segregation along the cast strip. Center line segregation combined with large grain sizes prevent further processing of the TRC sheet without further rolling, which introduce strong basal textures and associated asymmetries between tensile and compressive yield strength. Figure ,The addition of reinforcing particles to develop high-strength metal-matrix composites has been investigated for the light metals for specialist applications. Achieving a uniform distribution of reinforcing particles in the melt is difficult and mechanical stirringThe intensive melt shearing was used to engineer the melt pool through the dispersion of oxides and other inclusions through the melt using a rotor–stator device to achieve the high quality of melt that in turn resulted in improved quality of castings. The rotor–stator high shear device provides distributive and dispersive mixing that significantly enhances the kinetics of phase transformations; improves uniform dispersion, distribution, and size reduction of particles; improves uniformity of composition and temperature in the melt pool; and most importantly, provides physical grain refinement through the dispersion of naturally occurring oxides. Therefore, the rotor–stator high shear device may be used to condition light alloy melts, and it may be implemented with various conventional casting processes such as direct chill casting and twin roll casting.


PLOS ONE article. The Journal of Health and Development article [PLOS ONE article [PLOS ONE article provides additional validation information including the following: detailed question items, scoring protocols, and an explanation of the interpretation method.There is some overlap between work reported in this article  and a pr article  presents article  reports PLOS ONE uses the same participants as the earlier study reported previously.Both articles report use of the same study sites, sampling method, and number of participants in describing validation and intervention aspects of this work. The authors confirm that they used an independent cohort of participants for questionnaire development and validation ,2; the pPLOS ONE publication.The authors apologize for not citing the earlier article in the S1 FilePLOS ONE article and the Journal of Health and Development article.This flowchart illustrates the relationship and overlap between the (PDF)Click here for additional data file.


The purpose of this study was to compare the stress and fatigue index between the demented older adults and the non-demented older adults and to identify the correlation between the behavioral psychological symptoms of the demented older adults and the pain of the main caregiver. A total of 100 participants(80 demented older adults and 20 non-demented older adults) were selected. The demented older adults, who visited hospital neurology as an outpatient, were paired up with the caregivers who provided the care for the demented older adults. The non-demented older adults who had normal cognitive function without limitation in a daily life and scored MMSE of 24 or higher were selected. The stress and fatigue index were measured by using an autonomic nervous system analyzer that measures heart rate variability(HRV), and structured questionnaires were used to examine behavioral psychological symptoms. The collected data were analyzed by using Independent t-test and Pearson’s correlations analysis. The result of the analysis showed that average score of the demented older adults had higher stress index than the control group(non-demented older adults), which was statistically significant. In addition, the result indicated the statistically significant positive correlation between the behavioral psychological symptoms of demented older adults and the level of pain of main caregivers . The results of this study suggest that managing both the physical and psychological aspects of the stress in the main caregivers is necessary, as well as the development of stress management program for the demented older adults.


This review emphasizes the events that take place after the chylomicrons are secreted by the enterocytes through exocytosis. First, we will discuss the journey of how chylomicrons cross the basement membrane to enter the lamina propria. Then the chylomicrons have to travel across the lamina propria before they can enter the lacteals. To understand the factors affecting the trafficking of chylomicron particles across the lamina propria, it is important to understand the composition and properties of the lamina propria. With different degree of hydration, the pores of the lamina propria (sponge) changes. The greater the hydration, the greater the pore size and thus the easier the diffusion of the chylomicron particles across the lamina propria to enter the lacteals. The mechanism of the entry of lacteals is discussed in considerable details. We and others have demonstrated that intestinal fat absorption, but not the absorption of protein or carbohydrates, activates the intestinal mucosal mast cells to release many products including mucosal mast cell protease II in the rat. The activation of intestinal mucosal mast cells by fat absorption involves the process of chylomicron formation since the absorption of both medium and short-chain fatty acids do not activate the mast cells. Fat absorption has been associated with increased intestinal permeability. We hypothesize that there is a link between fat absorption, activation of mucosal mast cells, and the leaky gut phenomenon . Microbiome may also be involved in this chain of events associated with fat absorption. This review is presented in sequence under the following headings: (1) Introduction; (2) Structure and properties of the gut epithelial basement membrane; (3) Composition and physical properties of the interstitial matrix of the lamina propria; (4) The movement of chylomicrons across the interstitial matrix of the lamina propria and importance of the hydration of the interstitial matrix of the lamina propria and the movement of chylomicrons; (5) Entry of the chylomicrons into the intestinal lacteals; (6) Activation of mucosal mast cells by fat absorption and the metabolic consequences; and (7) Link between chylomicron transport, mucosal mast cell activation, leaky gut, and the microbiome. The absorption and transport of lipids by the gastrointestinal tract involve the uptake of digested lipids by the enterocytes and the formation and secretion of chylomicrons. These different steps of intestinal fat absorption have been so ably reviewed by a number of reviews over the past few years . In mostvia exocytosis by the enterocytes to the final entry of the chylomicrons into the lymph lacteals of the intestinal villi. After exiting from the enterocytes, the chylomicrons accumulate in the intercellular space. The basement membrane with which the enterocytes are attached to offers considerable resistance for the passage of chylomicrons from the intercellular space into the lamina propria. We will discuss how we think the chylomicrons cross the basement membrane to enter into the lamina propria. We will also discuss the properties of the lamina propria and the factors  influencing the diffusion of the chylomicrons across the lamina propria and how the chylomicrons subsequently enter the lacteals located in the central core of the villus. The lacteals transporting the chylomicrons drain initially into the intestinal lymph duct, then the thoracic duct, and finally empty into the left subclavian vein.In fact, many events are involved from the secretion of the chylomicrons by the enterocytes to the subsequently transport of these triglyceride-rich lipoproteins by the lymphatic system. One of the goals of this review is to cover those events that occur from the secretion of chylomicrons Interest in the lymphatic system increased dramatically recently in its role in lipid metabolism and gastrointestinal function. We and others have demonstrated that in addition to chylomicrons, the lymphatics of the gastrointestinal tract also carry molecules secreted by the mucosal mast cells [mucosal mast cell protease II in the rat ] and mucDuring active lipid absorption, monoglycerides and fatty acids produced from the digestion of triglycerides are taken up by enterocytes. Here, they are re-esterified to produce triglycerides and are packaged into chylomicrons for export into the lymphatic system. For a more comprehensive discussion of these processes, readers are referred to the following excellent treatises on the subject .α, β, and γ laminin subunits and the formation of laminin heterotrimers  through the intercellular space. During fluid absorption, the volume of the interstitium increases, resulting in the expansion and disentanglement of the matrix components. Under these conditions, the average porosity increases to 1,000 Å  which liIt has also been proposed that chylomicron transport could be facilitated by the convective fluid movement of lymph associated with fluid absorption. During lipid absorption, the subsequent increase in fluid uptake results in an increase in interstitial fluid formation and lymph flow. Previous studies have suggested that the rate of lymph formation has a major effect on chylomicron transport . Tso et It is still unclear if the increase in chylomicron transport associated with fluid absorption is a result of increased permeability of the interstitial matrix or the convective fluid movement. However, in both cases, it is apparent that hydration of the interstitial matrix plays an important role in the movement of chylomicrons across the lamina propria.There is some controversy regarding the mechanism of chylomicron entry into the intestinal lacteals . The firThese conclusions were challenged by Dobbins . With ovA more recent study by In addition to its role in the digestion and absorption of nutrients , the gut also serves an important function in host defense. The gastrointestinal tract, a tube-like structure that is covered by mucosa from the oral cavity to the anus, is continuous with the external environment. Therefore, the gastrointestinal tract is a major entry site for many bacterial and viral pathogens and has a vastly diverse microbial community . Despitede novo synthesized mediators in a conscious lymph fistula rat model (via the hepatic portal vein, while LCFAs are preferentially packaged into chylomicrons in the enterocytes and transported through the lymphatic system (Previous studies have suggested a close link between these intestinal immune cells and dietary fat absorption . In partat model . They foat model . MCFAs aat model . Furtherc system .The difference in the intestinal handling of LCFAs and MCFAs and their differential effect on MMC activation suggest that the formation and secretion of chylomicrons is potentially linked to MMC activation. To test this possibility, Ji et al. administered L-81, an inhibitor of chylomicron formation. As expected, lymphatic transport of chylomicrons was completely abolished when L-81 was present in the intestinal lumen. However, eliminating the formation and transport of chylomicrons did not completely abolish the release of mediators by MMC . It is iin vitro studies have shown that mast cell mediator RMCPII directly increases epithelial permeability by decreasing the expression of the tight junction-associated proteins occludin and zonula occludens-1 (Although results from Ji et al. demonstrated that fat absorption stimulates MMC activation, evidence from previous studies suggest that MMC activation is also important in enhancing the absorption and transport of lipids. It has been reported that intestinal permeability is increased during fat absorption, which would facilitate uptake of fluid and electrolytes . This coludens-1 . It has ludens-1 . Thus, Mludens-1 . The undIn conscious lymph fistula rats, we demonstrated that treating the animals with antibiotics greatly suppressed the lymphatic transport of chylomicrons as well as the activation of mucosal mast cells normally associated with fat absorption . The antin vitro, as there are less variables to content with than in the in vivo scenario. Of course, we cannot rule out in our experiment whether there is a direct effect of microbiome on apolipoprotein synthesis and secretion. In our study (It is not clear how antibiotic treatment affects apolipoprotein output in enterocytes because our dose of penicillin and streptomycin is not known to affect mammalian cells. The question of antibiotics treatment on the transcriptional and the translational production and secretion of apolipoproteins is probably best studied ur study , when wePT provided guidance on the overall direction of the manuscript. AZ and PT wrote the manuscript. JQ, ML, and PT edited and proofread the manuscript. All authors critically reviewed the final version of the paper.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Astrocytes have historically been considered structural supporting cells for neurons. Thanks to new molecular tools, allowing specific cell ablation or over-expression of genes, new unexpected astrocytic functions have recently been unveiled. This review focus on emerging groundbreaking findings showing that hypothalamic astrocytes are pivotal for the regulation of whole body energy homeostasis. Hypothalamic astrocytes sense glucose and fatty acids, and express receptors for several peripheral hormones such as leptin and insulin. Furthermore, they display striking sexual dimorphism which may account, at least partially, for gender specific differences in energy homeostasis. Metabolic alterations have been shown to influence the initiation and progression of many neurodegenerative disorders. A better understanding of the roles and interplay between the different brain cells in regulating energy homeostasis could help develop new therapeutic strategies to prevent or cure neurodegenerative disorders. The brain is the organ responsible for the centralized control of the other organs’ functions and, in higher vertebrates, of reasoning. Such tasks are achieved thanks to the interconnections of billions of neurons and glia cells. Due to their role in receiving, processing, and transmitting information neurons are considered to be the primary cell types of the central nervous system, and the only repository of reasoning and awareness. Astrocytes are the most abundant type of glial cells 321517181920The hypothalamus is the portion of the brain that integrates sensory inputs from the external environment with hormonal and neural signals from the body, allowing ad hoc short- and long-term homeostatic adjustments 2324262819203841The possibility that astrocytes may participate in the regulation of body homeostasis in other ways than direct nutrient sensing is inferred by the fact that they express receptors for hormones involved in energy homeostasis such as leptin 455252545555596163A receptors 8082828485In vitro experiments show different responses to saturated fatty acids in astrocytes isolated from males and females 86In vivo, long term high fat diet increases the levels of estradiol in females, while in males its levels are unchanged and associated with a significant decrease of ERa in the hypothalamus 808689929394958297A receptors Neurological and neurodegenerative disorders are often characterized by sexual dimorphism in terms of either incidence or severity and progression of the pathology 666771727276Metabolic alterations influence the initiation and progression of many neurodegenerative disorders


The use of passive samplers in extensive monitoring, such as that used in national forest health monitoring plots, indicates that these devices are able to determine both spatial and temporal differences in ozone exposure of the plots. This allows for categorisation of the plots and the potential for cause-effect analysis of certain forest health responses. Forest exposure along a gradient of air pollution deposition demonstrates large variation in accumulated exposures. The efficacy of using passive samplers for in situ monitoring of forest canopy exposure was also demonstrated. The sampler data produced weak relationships with ozone values from the nearest "continuous" monitor, even though data from colocated samplers showed strong relationships. This spatial variation and the apparent effect of elevation on ozone exposure demonstrate the importance of topography and tree canopy characteristics in plant exposure on a regional scale. In addition, passive sampling may identify the effects of local pollutant gases, such as NO, which may scavenge ozone locally only to increase the production of this secondary pollutant downwind, as atmospheric reactions redress the equilibrium between concentrations of this precursor and those of the generated ozone. The use of passive samplers at the stand level is able to resolve vertical profiles within the stand and edge effects that are important in exposure of understorey and ground flora. Recent case studies using passive samplers to determine forest exposure to ozone indicate a great potential for the development of spatial models on a regional, landscape, and stand level scale.


Resection of all tumor implants with the aim of maximal cytoreduction is the main predictor of overall survival in ovarian carcinoma. However, there are high risk sites of tumor recurrence, and the perihepatic region, especially the point where the ligamentum teres hepatis enters the liver parenchyma under the hepatic bridge (pont hepatique), is one of them. This video demonstrates the resection of the ligamentum teres hepatis both in a cadaveric model and in a patient with ovarian cancer. The falciform ligament divides the liver into the right and left lobes on the antero-superior part of portoumbilical fissure where the ligamentum teres hepatis  attaches to the visceral surface. Due to the distribution pattern of the portal vein and hepatic veins, the liver is divided into eight functional segments . The umbMucinous ovarian or gastrointestinal carcinoma, appendiceal carcinoma, mesothelioma or a serous ovarian cancer may have a widely disseminated recurrence on the peritoneal surfaces. The complicated surgical anatomy of the liver and perihepatic tissues limits the easy detection of tumor implants; eventually, good exposure of the abdominal cavity is needed to excise all the visible tumor implants, especially on high-risk fields such as the end part of the ligamentum teres hepatis under the hepatic bridge . There is no risk of injuring any structures while cutting the hepatic bridge. However, if the ligament is deeply attached to the bottom of the liver parenchyma, while dissecting the end point, care should be taken not to damage the left hepatic artery or the left hepatic duct over the hepatoduodenal ligament, which is covered by the peritoneal lining of lesser sac ,5. RoutiThis video consists a cadaveric surgical demonstration of ligamentum teres hepatis resection over the portoumbilical fissure and a live patient video of 56 years old woman who had a recurrent high-grade serous ovarian cancer with widespread peritoneal implants. There were tumor implants at the perihepatic region on the umbilical ligament, which were resected.


InAction. It emerged from a series of presentations delivered during a workshop in Cascais , and from the research activities carried out during Short Term Scientific Missions supported through the COST Action FA1301. The overall aim is to fill some lacunae in knowledge of the digestive tract of cephalopod molluscs. In contrast to other areas of cephalopod biology such as the central nervous system and behavior  and the visual system (see Hanke and Osorio), relatively little research has been done on this topic during the last 30 years.The collection of papers included in this Research Topic represents the outcome of some of the activities of the COST Action FA1301, CephsCephalopods are active marine predators counting more than 800 species. Understanding the physiological adaptations of these fascinating and complex molluscs poses important challenges for several disciplines. Knowledge of the normal functioning  of the digestive system has wide ranging implications for fisheries, aquaculture, and for the care and welfare of cephalopods in the laboratory and in public displays. Alterations in digestive tract functionality are also a sensitive indicator of gastrointestinal and systemic infections, disease, and external stressors in the broadest sense. Most of the available knowledge on the cephalopod “gut” and physiology of digestion is based on assumptions by analogy with the vertebrate digestive system.This Research Topic includes 17 papers from more than 70 authors representing a contribution to the outcomes of COST FA1301. The papers present original data and/or reviews on: nutritional requirements and challenges offered by early-life stages, predatory behavior, anatomy and physiology of the cephalopod digestive system, and possible implications with animal care and welfare.Octopus vulgaris, is a prime species for cephalopod aquaculture but its potential is limited by poor survival during the paralarval stage. Limited knowledge of feeding habits and the digestive tract physiology are considered major barriers to progress and these areas are reflected by the nine paralarvae papers included here.Among other species, the common octopus, Nande et al. studied the predatory behavior and related movements of the digestive tract in 3-days post hatching (dph) O. vulgaris paralarvae hatched in the laboratory and fed on eighteen different types of wild caught prey. Capture and ingestion of decapod prey was less efficient (60%) than cladocerans or copepods (100%). Overall, paralarvae spent only ~5 min in contact with prey. The temporal sequence of digestive tract motility changes  following food ingestion was quantified and pigmented food particles appeared in the digestive gland ~5 min after the crop had reached maximum volume.Fernández-Gago et al. provide a 3D reconstruction of the digestive tract during the first 35 days of life, identifying four developmental periods , suggesting that the radula and digestive gland may take longer to mature than other regions. Despite the limitations of a morphological study, this paper provides background information against which the more functional studies can be considered.Estefanell et al. of wild caught with captive bred hatchlings highlights the potential utility of measurement of fatty acids such as n−3 highly unsaturated fatty acids from neutral and polar lipids in elucidating the nutritional requirements of O. vulgaris paralarvae. Lourenço et al. analyzed the lipid class content and fatty acid profiles of wild paralarvae and their potential prey and proposed that monounsaturated fatty acids (particularly C18:1n7) and the DHA:EPA ratio are trophic markers of the diet of paralarvae. The search for nutritional imbalance biomarkers is explored further by Morales et al. who measured changes in anaerobic and aerobic metabolism, fatty acid oxidation, and gluconeogenesis (from glycerol and amino acids) in O. vulgaris paralarvae during an extended part of this life-stage. Authors' findings suggest that phospholipid and n-3 HUFA-enriched Artemia reduced mortality and increased paralarval growth, thus contributing to the understanding of the ontogeny of metabolic pathways, an essential requirement for optimizing the diet of paralarvae in culture. A similar dietary enrichment was used by García-Fernández et al. to investigate the epigenetic regulation by diet and age of octopus paralarvae. An age-related demethylation was observed during the first 28 days of life and was accelerated by dietary n-3 HUFA enrichment. A proteomic approach allowed authors to identify specificity in the diet , and allowed comparison of fed and food deprived paralarvae suggesting that arginine kinase, NAD+ specific isocitrate dehydrogenase and S-crystallin 3 may be useful as biomarkers of nutritional stress . Metagenomics provided a different approach to assessing diet in wild paralarvae, by analysis of DNA from the dissected digestive gland  to identify Molecular Taxonomic Units recognizing decapods, copepods, euphausiids, amphipods, echinoderms, molluscs, and hydroids as part of the natural diet. Some paralarvae showed a preference for cladocerans  and ophiuroids and overall seasonal variability was shown in the presence of copepods and ophiuroids in the diet.A comparison by Roura et al. investigated the paralarval microflora (microbiome). Both wild caught paralarvae and those newly hatched in captivity had similar microbial communities which the authors termed the “Core Gut Microflora,” the presence of which they considered indicative of healthy O. vulgaris paralarvae. A finding of particular relevance to aquaculture was that after 5 dph, in comparison to newly hatched paralarvae the number of bacterial species was reduced by ~50% with two families (Mycoplasmataceae and Vibrionacea) dominating. The importance of the microbial diversity provided by zooplankton in the wild in contrast to the typically used Artemia diet in captivity is discussed by the Authors.Villanueva et al.) including an account of the relative roles of photo-, mechano-, and chemo-reception in the detection of diverse prey types in relation to living habits . A variety of hunting strategies  are employed by different cephalopod species and the authors make an interesting comparison with marine and terrestrial vertebrates. Attention is drawn to the neglected area of the ontogeny of predation by reference to the feeding behavior of both hatchlings and senescent cephalopods.A short overview of cephalopod predatory habits is also included in this Research Topic  and digestion (by enzymes). The subsequent steps in digestion are described in detail in Octopus maya and Octopus mimus by Gallardo et al. by highlighting novel data on the temporal pattern of absorption and assimilation, and providing preliminary evidence that lipid mobilization is dependent upon habitat water temperature.A contribution to the anatomy and physiology of the digestive system of cephalopods is given by five papers. Rodrigo and Costa. High concentrations of both essential  and non-essential  metals with metal homeostasis involving spherulae formation, chelation and metallothionins characterize the DG. The authors also discuss the involvement of the DG in the storage and metabolism of organic toxicants including amnesic shellfish toxins , polycyclic aromatic hydrocarbons and polychlorinated biphenyls, and comparisons made with the mechanisms operating in the vertebrate liver including biotransformation, conjugation and elimination with a focus on the cytochrome P450 system.The digestive gland in cephalopods is the main organ of metabolism and is analogous to the vertebrate liver. It secretes a range of digestive enzymes into the lumen of the digestive tract, receives digested nutrients from the caecum which it assimilates and subsequently transfers to the haemolymph (glucose and lipids). The digestive gland (DG) is also the main site of detoxification and storage of ingested marine pollutants as reviewed by Capaz et al. reported that exposure of adult cuttlefish to sea water with a 50% decreased oxygen for 1 h markedly increased breathing frequency (85%) and reduced oxygen consumption (37%), but there was only a small increase in mantle muscle octopine levels indicative of anaerobic metabolism. Complementary in vitro studies of protein turnover and Na+/K+ATPase activity (responsible for ionic gradient maintenance) enabled the authors to hypothesize that the reduced oxygen consumption in hypoxic animals was primarily due to reduced protein synthesis and Na+/K+ATPase activity.Understanding the metabolic adaptations of cephalopods to environmental changes is of growing importance because of predicting the effects of climate change and the consequences of coastal eutrophication and assessing the impact of intensive aquaculture. O. vulgarisBaldascino et al. utilized RT-PCR to reveal the neurochemical complexity of the gastric ganglion with evidence for putative peptide and non-peptide neurotransmitters  and/or their receptors . A comparison of gene expression in the gastric ganglion of animals with relatively high or low levels of infection with the common digestive tract parasite Aggregata octopiana showed differential gene expression .In The regulation in European Union states of scientific research utilizing cephalopods has necessitated the development of guidelines for their care and welfare in the laboratory  are challenges that can possibly be overcome by using tools such as ultrasound to monitor movements of the digestive tract or fecal analysis as a “reporter” of digestive tract function.Sykes et al. Authors discuss the challenges of feeding cephalopods in captivity and particularly issues around: live food and prepared diets, feeding frequency and quantity, the impact of a range of experimental interventions  on the digestive tract, and a discussion of the impact of food deprivation on the overall health and welfare of the animal.A wide-ranging overview of the relevance of understanding digestive tract functionality to the welfare of cephalopods in the laboratory and aquaculture is given by All authors have made a substantial, direct and intellectual contribution to the editorial.The authors of this editorial are co-authors of one or more of the publications discussed in this Editorial. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


We report an unusual case of fatal air embolism into the superior mesenteric artery in a patient, who underwent replacement of the ascending aorta for aortic dissection type A. CT performed twice on the first postoperative day showed abundant air in the superior mesenteric artery and its branches  indicating air embolism with no signs of bowel necrosis. On the second postoperative day, the patient underwent extensive bowel resection due to bowel ischemia and died on the third postoperative day on MODS/SIRS. A 50-year-old male patient with aortic dissection originating just above the aortic valve and extending down to the common iliac arteries  and signs of acute renal insufficiency (creatinine 292 μmol/l). CT showed good postoperative result in the ascending aorta, but large amount of air in the branches of the superior mesenteric artery up to the arcades was found . The CT showed distribution of the intra-arterial gas more into the periphery and into the wall of the bowel loops that still did not display signs of ileus Figure . The nexVascular air embolism, however rare this event is, can be potentially fatal . It is a3Air embolism into the SMA is a very rare event that results in mesenteric hypoperfusion. Signs of bowel paralysis and gas in the portal vein may be absent due to residual perfusion of the bowel that may be grossly insufficient. Unfortunately, because of extensive distribution of gas in the mesenteric arteries up to the arcades and later in the bowel wall, endovascular aspiration cannot be expected to yield any results.


A non-ossified unilateral subcutaneous fibroma was diagnosed in the distal femoral region of a 5-year-old Nooitgedacht mare. Histopathological examination of the excised mass revealed long interweaving bundles of semi-mature monotonous collagenous connective tissue with fusiform nuclei without mitotic figures. The mare made an uneventful recovery following surgical removal of the neoplasm. Subcutaneous fibromas should be considered in the differential diagnosis of skin swellings associated with the limbs of horses. Neoplasia of the appendicular skeleton in the horse is unusual .A radiographic examination of the distal right femur was unremarkable and ultrasonographic evaluation revealed a well-defined subcutaneous homogenous mass with moderate echodensity. No abnormalities were palpable or visualised ultrasonographically at the local or regional lymph nodes to indicate metastasis.The mass, which was of firm consistency and grey to white on cut surface as previously reported Hendrick , was surImmunohistochemical examination was performed by the avidin–biotin complex technique  into the proliferating immature dermal fibroblasts   in the horse. Subcutaneous fibromas should be considered in the differential diagnosis of skin swellings associated with the limbs of horses. Surgical excision of the mass in this case report resulted in a full resolution of the clinical signs and is recommended in the treatment of this form of benign neoplastic mass in horses.


Background: The availability of a number of agents that are efficacious in patients with metastatic prostate cancer (mPC) has led to them being used sequentially, and this has prolonged patient survival. However, in order to maximize their efficacy, clinicians need to be able to obtain a reliable picture of disease evolution by means of monitoring procedures. Methods: As the intensive monitoring protocols used in pivotal trials cannot be adopted in everyday clinical practice and there is no agreement among the available guidelines, a multidisciplinary panel of Italian experts met to develop recommendations for monitoring mPC patients using a modified Delphi method. Results: The consensus project considered methods of clinically, radiographically, and biochemically monitoring patients with metastatic hormone-sensitive and metastatic castration-resistant prostate cancer undergoing chemotherapy and/or hormonal treatment. The panelists also considered the methods and timing of monitoring castration levels, bone health, and the metabolic syndrome during androgen deprivation therapy. Conclusions: The recommendations, which were drawn up by experts following a formal and validated consensus procedure, will help clinicians face the everyday challenges of monitoring metastatic prostate cancer patients. The prognosis of patients with metastatic prostate cancer (mPC) has dramatically improved over the last 10 years as a result of the introduction of a number of agents that are capable of significantly improving the overall survival of castration-resistant patients in everyday clinical practice. Patients with metastatic castration-resistant prostate cancer (mCRPC) can now be managed using two chemotherapeutic agents, docetaxel ; two newIn addition, the sequential use of these therapeutic options has further prolonged patient survival in comparison with both historical and current therapies ,11,12, tThe intensive monitoring protocols used in pivotal trials clearly cannot be adopted in everyday clinical practice, but there is still no agreement concerning the frequency or methods of monitoring CSPC and CRPC patients on and off treatment during the evolution of their disease treatment among the guidelines issued by the European Association of Urology (EAU), the American Urology Association (AUA), the European Society of Medical Oncology (ESMO), the Italian Association of Medical Oncology (AIOM), and the National Comprehensive Cancer Network (NCCN).The situation is further complicated by the growing use of new imaging methods such as choline or PSMA positron emission tomography (PET) and whole-body magnetic resonance imaging (wbMRI). These seem to be more sensitive than traditional bone scintigraphy (BS) and computed tomography (CT), which are significantly limited in assessing disease burden particularly in the case of skeletal involvement. The new imaging methods could therefore improve our ability to detect and quantify the burden of bone and soft tissue metastases, but there is still no agreement as to how they can be used to evaluate and classify treatment responses, and the effective management of patients with advanced prostate cancer requires accurate, reproducible and validated methods.In this complex clinical scenario, and with the participation of the Italian Association of Medical Oncology (AIOM), the Italian Association of Radiobiology (AIRB), the Italian Association for Radiation Oncology (AIRO), the Italian Society of Community Urologists (AURO.it), the Italian College of Chief Medical Oncologists (CIPOMO), and the Italian Society of Urology (SIU), the Italian Society of Uro-Oncology (SIUrO) organized a multidisciplinary expert consensus project with the aims of reviewing the available guidelines and evidence-based data, and making practical recommendations concerning the monitoring of patients with mCSPC and mCRPC.In this section the results are described via the statements discussed by the consensus panelists, which were summarized in the With a consensus of 86%, the panelists recommended that:The standard monitoring plan for an mCSPC patient who is a candidate for ADT alone should include a clinical ± biochemical assessment every 12 weeks for the first 12 months, and every 24 weeks thereafter.With a consensus of 84%, the panelists recommended that:Imaging assessments (preferably CT and BS) of an mCSPC patients who is a candidate for ADT alone should only be made in the case of a biochemical and/or clinical relapse.With a consensus of 90%, the panelists agreed that:The factors that can individually change the initial monitoring plan of an mCSPC patient who is a candidate for ADT alone are age at the time of diagnosis, Gleason score, symptoms, the number and site(s) of metastases, the time of onset of metastases , and the time interval between radical local treatment and the onset of metastases.With a consensus of 90%, the panelists agreed that:The factors that may modify the monitoring schedule of an mCSPC patient being treated with ADT alone are the trend of PSA levels and disease-related symptoms, such as a worsening in performance status, the occurrence of a skeletal event, or a change in analgesic treatment.Published evidence concerning the monitoring of such patients has been provided by the CHAARTED and LATITUDE trials ,13. CHAAWith a consensus of 93%, the panelists therefore recommended that:An mCSPC patient who is a candidate for treatment with ADT + docetaxel should be clinically evaluated at of each treatment cycle , whereas PSA levels should be repeated after at least the third and sixth treatment cycle.The CHAARTED trial did not provide any indications concerning imaging assessments during or after chemotherapy , but theWith a consensus of 91%, the panelists therefore recommended that:An imaging assessment of a patient with mCSPC who is a candidate for treatment with docetaxel and ADT should be made at the end of docetaxel treatment using the same methods as those used at the time of the initial evaluation (preferably CT and BS).There is very little evidence indicating whether there are factors that can be assessed before the start of treatment that could change previously planned biochemical, radiographic and clinical monitoring procedures. Disease volume is a well-established prognostic factor, as is the definition of high risk used in the LATITUDE trial, which was based on the number of bone metastases, Gleason score, and the presence of visceral metastases . A retroWith a consensus of 81%, the panelists therefore agreed that:That there is no factor that should modify the standard monitoring schedule of an mCSPC patient who is a candidate for treatment with ADT + docetaxel.Published evidence, which mainly relates to mCRPC patients, indicates that an increase in PSA levels alone is not sufficient to indicate disease progression  as a sigWith a consensus of 85%, the panelists therefore agreed that:Increasing PSA levels and worsening disease-related symptoms  may require an earlier re-evaluation of an mCSPC patient being treated with ADT + docetaxel than that laid down in the initial monitoring plan.The rate of progression in the STAMPEDE study, which tested the benefit of adding docetaxel to ADT alone in patients with mCSPC, was about 25% after 12 months of treatment and 40% after 24 months of treatment . After cWith a consensus of 92%, the panelists consequently recommended that:The standard monitoring plan of an mCSPC patient without progressive disease who has concluded docetaxel treatment but is continuing ADT should include clinical and biochemical assessments at least every 12 weeks.In accordance with the strategy adopted in the CHAARTED trial and with a consensus of 89%, the panelists recommended that:A radiographic assessment (preferably CT and BS) of an mCSPC patient who has concluded docetaxel treatment but is continuing ADT is only required in the case of clinical and/or biochemical progression.On the basis of experience and with a consensus of 92%, the panelists agreed that:The factors that may modify the monitoring schedule of an mCSPC patient who has concluded docetaxel but is continuing ADT are PSA level, the appearance of symptoms, and the biological/clinical aggressiveness of the disease.The occurrence of events such as an increase in PSA levels and/or the onset of pain in an mCSPC patient undergoing ADT who has been previously treated with docetaxel should obviously lead to the timing of the initially scheduled assessments being brought forward. At the same time, the presence of features indicating particularly aggressive disease, such as low PSA values in the presence of a tumour with a high Gleason score, should suggest regular radiographic as well as clinical and biochemical assessments.With a consensus of 85%, the panelists accordingly agreed that:The factors that may modify the monitoring schedule of an mCSPC patient undergoing ADT who has been previously treated with docetaxel are an increase in PSA levels and/or the onset or worsening of disease-related symptoms such as a worsening performance status, the occurrence of a skeletal event, an increase in pain therapy.On the basis of experience and with a consensus of 85%, the panelists recommended that:The standard monitoring plan of an mCRPC patient who is a candidate for chemotherapy should include a clinical assessment at every cycle.On the basis of experience and with a consensus of 85%, the panelists recommended that:The standard monitoring plan of an mCRPC patient who is a candidate for chemotherapy should include a PSA assessment at least every 6–8 weeks.On the basis of experience and with a consensus of 85%, the panelists recommended that:The first imaging assessment of an mCRPC patient who is a candidate for chemotherapy should be made after about 12 weeks using the same methods as those used for the baseline assessment (preferably CT and BS).On the basis of experience and with a consensus of 93%, the panelists agreed that:The factors that can modify the monitoring schedule of a patient with mCRPC receiving docetaxel treatment are an increase in PSA levels and the onset or worsening of disease-related symptoms such as a worsening performance status, the occurrence of a skeletal event, and an increase in pain therapy.On the basis of experience and with a consensus of 84%, the panelists recommended that:Imaging assessments of an mCRPC patient who has completed chemotherapy and shows no signs of progression should not be pre-planned, but depend on the results of clinical/biochemical assessments; in any case, it is recommended to use the same methods as those used for the baseline assessment (preferably CT and BS).ARTA-treated patients with mCRPC are usually clinically evaluated every four weeks in order to monitor toxicity and assess the onset of treatment-related adverse symptoms. In relation to biochemical monitoring, the two pivotal studies of ARTAs in this setting ,18 plannWith a consensus of 89%, the panelists accordingly recommended that:The standard follow-up schedule of an mCRPC patient who is candidate for ARTA should include a PSA assessment every 12 weeks and a clinical evaluation every four weeks.The two pivotal trials ,18 plannThe need for imaging assessments should be based on the findings of clinical/biochemical assessments.Evidence of more aggressive disease can certainly change the initially planned monitoring schedule of an mCRPC patient undergoing systemic ARTA treatment. The benefits of ARTA in docetaxel-naïve mCRPC patients are generally greater than those recorded in patients who have previously received docetaxel ,4,5,20. The site of metastases and disease-related symptoms should be considered factors that may modify an initial monitoring schedule.The frequency of assessments initially planned during systemic ARTA treatment may be changed in the case of suspected disease progression in order to stop potentially ineffective treatment. In this regard, the EAU guidelines highlight the importance of the presence of disease-related symptoms. In addition, the panelists at the 2017 St. Gallen Consensus Conference stressed that, regardless of its kinetics, rapid PSA progression combined with other factors may indicate a worse prognosis . For theWhen deciding on changes in the frequency of assessments of an ARTA-treated mCRPC patient, the trend of PSA levels and the onset of disease-related symptoms should be considered.The aim of ADT is to maintain suppressed testosterone levels of <50 ng/dL (1.7 nmol/L). The initial phase of chemical castration is closely related to the reduction in PSA levels and so, as underlined by the EAU guidelines, testosterone suppression should be assessed in the case of biochemical progression. With a consensus of 89%, the panelists recommended that:The standard monitoring plan of a patient with advanced prostate cancer undergoing ADT should include a testosterone evaluation every time there is an increase in PSA levels.All mPC patients undergo ADT, which may have adverse effects on bone health and the cardiovascular system. It is estimated that a patient undergoing ADT may have a lumbar mineral density loss of 4.6% per year, and that there is a possibility of developing a bone fracture in up to 14% of cases . With a The standard monitoring plan of a patient with advanced prostate cancer (mCSPC/mCRPC) should include regular bone health assessments.Hypogonadism secondary to ADT may lead to insulin resistance and the consequent onset of metabolic syndrome . FurtherWith a consensus of 94%, the panelists therefore recommended that: Patients with advanced prostate cancer (mCSPC-mCRPC) treated with ADT should undergo regular metabolic assessments, particularly those at increased cardiovascular risk.Disease monitoring is one of the greatest challenges facing the clinicians who treat mPC patients because the possibility of sequentially administering the agents that have proved to be efficacious requires monitoring methods capable of providing a reliable picture of disease evolution. The ability to detect disease progression is crucial to enabling clinicians to stop an ineffective treatment that could lead to unnecessary side effects, and allowing them to propose a further treatment line that may be more efficacious in controlling the disease.The concept of disease progression in patients with mCRPC has been clearly defined by the Prostate Cancer Working Group, which has modified its definition over time in order to keep up with advances in our knowledge of disease biology and the introduction of new therapeutic options . The PCWThe disease status of an mCRPC patient is defined on the basis of three factors: clinical status , PSA levels (the trends of which need to be cautiously interpreted), and radiographic changes (which require the definition of clear progression criteria).Over the last 20 years, the assessment of PSA levels has been the mainstay of the management of prostate cancer patients, and biochemical responses or progression have driven the therapeutic choices of clinicians. It has already been established that changes in PSA levels reflect changes in the disease during the early stages of prostate cancer, but this is questionable in the castration-resistant phase. Previous editions of the PCWG guidelines have highlighted the fact that PSA flares may occur during the early courses of chemotherapy, and it is recommended that discontinuing treatment on the basis of increasing PSA levels alone should be avoided during the first 12 weeks . More reAs a result, clinical and imaging assessments have taken on a greater role in defining disease status. The latest version of the PCWG guidelines distinguishes the first evidence of progression from a clinical need to change or discontinue treatment by introducing the concept of clinical benefit; moreover, they also underline the importance of separating progression in existing lesions from the development of new lesions .In this complex scenario, planning careful and regular monitoring is a crucial means of ensuring that patients receive active agents for as long as they really control the disease, and that clinicians view the monitoring of progression status in the light of adopting new therapeutic options.Unfortunately, the PCWG guidelines do not provide any indications concerning the optimal timing of planned monitoring assessments, and the same is true of the prostate cancer guidelines issued by the main scientific societies. Furthermore, the monitoring plans used in the pivotal trials of agents active in mCSPC and mCRPC were designed to respond to trial and regulatory needs, and cannot be directly translated into everyday clinical practice. Finally, as the evidence provided in the literature is very limited and often confusing, clinician choices are frequently only based on their personal experience, which clearly does not guarantee optimal patient management as it may lead to the early discontinuation of a treatment in the absence of true progression, or the needless continuation of ineffective treatment because true progression is not recognized.The use of a formal method of developing recommendations on the basis of the consensus of experts is therefore one of the best ways of addressing some aspects of a scenario devoid of evidence, such as that of monitoring mPC patients.The experts’ recommendations concerning the evaluation of clinical status and PSA levels varied mainly on the basis of treatment: it is suggested that patients with mCSPC treated with ADT alone (at least in the first year of treatment) or receiving ADT after docetaxel treatment should undergo a clinical assessment every 12 weeks, whereas patients receiving docetaxel should be clinically evaluated at each treatment course and undergo less frequent biochemical assessments.There were similar differences in the recommendations made for mCRPC patients treated with an ARTA or docetaxel. In the case of chemotherapy, the recommendations clearly reflect the everyday practice of clinically evaluating patients at each course in order to assess not only disease-related symptoms, but also treatment-related side effects. In the case of ARTA-based treatment, the suggestions underline the need to avoid the risk of monitoring the disease simply on the basis of serial PSA assessments, and indicate that, albeit less frequently, clinical assessments should be regularly planned in order to be able to capture signs of progressive disease.The recommendations concerning imaging monitoring also depend on the therapeutic context. No pre-planned imaging monitoring was recommended in the case of mCSPC patients treated with ADT (as the only treatment or after docetaxel administration) or mCRPC patients treated with an ARTA or after having received docetaxel because such monitoring was considered necessary only if a patient experiences a clinical and/or biochemical relapse. The possibility of using regular twice yearly imaging monitoring in order to capture the best imaging response to treatment of ARTA-treated mCRPC patients was discussed, but the degree of consensus did not reach the threshold of acceptance. It was recommended that an imaging assessment should only be repeated at the end of docetaxel treatment in patients with mCSPC, and after 12 weeks’ treatment in patients with mCRPC. It is worth noting that, regardless of therapeutic context, it was always strongly recommended to use the same imaging techniques as those used at baseline, and all of the recommendations indicate that the preferred techniques are CT and BS. This preference reflects caution concerning new imaging techniques that are expected to be more sensitive than traditional techniques, but do not have standardized criteria for evaluating response. In any case, PET-PSMA and wbMRI are still only available at very few centers and are not widely used.It is also worth noting that, in all but one clinical context, a number of factors were identified whose presence at baseline may indicate a different degree of disease aggressiveness, and should therefore be considered when planning monitoring frequency because some modifications to standard monitoring programs may be necessary. The only situation in which no such variables were identified was in the case of mCSPC patients who were candidates for docetaxel treatment, meaning that the presence of de novo metastases is per se a sign of aggressiveness and that no other factors need to be considered.There are also some statements concerning the factors that may change an initially defined monitoring schedule: regardless of disease status (mCSPC or mCRPC) or the therapeutic context , these always included biochemical progression and the appearance or worsening of disease-related symptoms such as a worsening performance status, the occurrence of a skeletal event, and an increase in pain therapy.Other aspects of mPC patient monitoring that are not strictly related to evaluating the course of the disease were also discussed, and there was strong agreement that testosteronemia should be evaluated whenever PSA levels increase, that standard monitoring plans should include regular assessments of bone health, and that metabolic factors should be regularly assessed, particularly in the case of patients at increased cardiovascular risk.Clearly the clinical settings and treatment options addressed by the present Consensus are not able to fully cover all therapies that the quick evolution of PC management is progressively making disposable, requiring new editions of the Consensus. For example, monitoring procedures of treatment with abiraterone, which is approved for mCSPC in several European Countries but still not in Italy, or apalutamide and enzalutamide, which should have the same indication in the next future, will require specific discussions. Additionally, the use of apalutamide, darolutamide, and enzalutamide in a new disease setting, such as non metastatic CRPC, will open new challenges for the clinicians in defining the optimal monitoring procedures, which should be specifically addressed by new specific statements.Considering the fields that were not addressed by the Consensus statements, the present paper is to be considered as having limitations. These limitations will be overcame by a new edition of the Consensus able to cover the fields, which the introduction of new active agents in PC landscape will open.To this end, the results of the present Consensus Conference may be of help the clinicians in managing their PC patients. For example, the different approach followed in evaluating the monitoring of patients treated with docetaxel, and of those who receive an ARTA, could be valuable. From this point of view, for example, the St. Gallen Consensus considered the monitoring strategies regardless of the treatment strategy.As shown in The Delphi technique  and the On the basis of the questions deserving clarification/in-depth analysis identified in phase 1, the Board members:Undertook a systematic review of the literature in the Medline, Embase and Cochrane databases, the ASCO, EAU, AIOM, and NCCN guidelines, and the St. Gallen Consensus Conference recommendations. Carried out an on-line survey of Urologists, and Medical and Radiation Oncologists, who were asked to choose from among various mPC management strategies.A specific statement was produced for each of the previously defined questions deserving clarification/in-depth analysis. Using a modified mini-Delphi approach, the statements were independently developed by each Board member, harmonized, and discussed during a final face-to-face meeting.Selected clinicians belonging to the involved scientific societies took part in a Consensus Conference panel to which the Board members presented the final statements and explained the reasons for their choices on the basis of evidence or experience. All of the panelists then voted  on each statement with the aim of reaching a consensus threshold of 80%; if this threshold was not reached, the statement was discussed, revised, and voted on again up to four times until it was.The Consensus Conference panel included experts covering all of the specialties involved in treating mPC patients . The ConOver the last ten years, the increasing availability of efficacious agents that can be sequentially used has made the management of mPC highly complex. In this scenario, clinicians have very little evidence on which to base the planning of an efficient monitoring program capable of capturing real disease progression in everyday clinical practice.It is hoped that the recommendations made above, which were drawn up by experts following a formal and validated consensus procedure, will help clinicians face the everyday challenges of monitoring mPC patients.


The presence of endoleaks remains one of the main drawbacks of endovascular repair of abdominal aortic aneurysms leading to the increase of the size of the aneurysmal sac and in most of the cases to repeated interventions. A variety of devices and percutaneous techniques have been developed so far to prevent and treat this phenomenon, including sealing of the aneurysmal sac, endovascular embolisation, and direct sac puncture. The aim of this review is to analyse the indications, the effectiveness, and the future perspectives for the prevention and treatment of endoleaks after endovascular repair of abdominal aortic aneurysms. The detection rate of endoleaks depends on the imaging modalities usedOnly a small percentage of endoleaks will require re-interventionTreatment may include both endovascular or percutaneous routeThe endovascular aortic repair (EVAR) of abdominal aortic aneurysms was first described nearly three decades ago and has offered a crucial management shift of patients with aortic disease, particularly when open repair was not an option –3.A variety of EVAR devices were developed over the years offering a range of outcomes. There has been a substantial evolution in design and technology, from the initial tube grafts to the custom-made fenestrated and branched devices that are used today. EVAR has offered some benefits over the traditional open surgical repair; however, there is a cost to pay and this is mainly the need of closer patient follow-up and sometimes the necessity of re-interventions –9. FolloType I occurs due to incomplete proximal (Ia) or distal (Ib) seal. This could be due to either inappropriate device selection, incorrect graft deployment, or disease progression . Th. Th67]. Imaging modalities, mainly for the early detection of and characterisation endoleaks, aiming for radiation-free modalities like contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging. The version 1.3 of the study on the early detection of endoleaks with CEUS (NCT02688751) is recently completed. The primary outcome is to assess the ability of CEUS to detect type I/III endoleaks on CEUS as defined by presence/absence on time-resolved CTA. The secondary outcome is the detection of type II endoleaks and the ability of CEUS to predict the likelihood of a secondary intervention. The study has also assessed healthcare costs related to each imaging modality, considering that EVAR follow-up carries an important economic impact. The results have not been made public yet.Considering the impact that endoleak prevention and treatment have for health economics, there is continuous research on the field with a prediction for an exponential increase in the next 5 years. The main areas that will be developed are the following:Biomarkers that would predict the aneurysm evolution. The best example is the matrix metalloproteinase (MMP) activity that has been associated with the process of aneurysm development. In essence, if there is a lack of balance between the MMP and its inhibitors, degeneration of the aortic wall is induced. It was previously proved that the serum level of MMP-9 is significantly higher in patients with abdominal aortic aneurysm and in patients with inadequate aneurysm exclusion after EVAR. A multicentre trial of serum levels of MMP-9 as a biomarker of endoleak (NCT01965717) has recently been completed. The aim of the study was to establish the correlation of MMP-9 with specific types of endoleaks and the requirement for re-intervention. The results have not been made public yet.Endostaples have offered satisfactory results after the completion of the pivotal study of the Aptus Endovascular AAA Repair System (NCT00507559). The ANCHOR  study is currently recruiting patients (NCT01534819) aiming for a primary completion date in 2020. The primary outcome measures are the prevention of graft migration and the treatment of Type Ia endoleak.Navigation systems in CT offer more accurate needle placement and as the number of direct sac interventions will increase accurate needle placement under CT fluoroscopy will be necessary. The Endoleak Repair Guided by Navigation Technology study (NCT01843322) is a small study of 27 patients that is recently completed and is aiming to delineate whether the treatment of type II endoleaks can be improved by adding navigation technology in terms of precision and reduction of radiation exposure.Novel polymers will be developed after the Nellix system, regardless of the fact that the results until today have not been as expected. The novel ANEUFIX system in the treatment of endoleaks is assessed in a feasibility study (NCT02487290). The study is a non-randomised, multi-centre safety and feasibility trial of Aneufix ACP-T5 to treat patients with isolated type II endoleaks in the presence of a non-shrinking AAA sac following an EVAR procedure; however, it has only recruited 4 patients at the moment.Radiation reduction can also be achieved with dual-energy CT that acquires two different photon spectra in a single acquisition. It can be used to detect endoleaks with good accuracy and at a reduced radiation exposure and some preliminary data is already available .BiomarkWe may conclude that as the treatment options for endovascular repair of abdominal aortic aneurysms and the complexity of devices increase, there will be an increased necessity of prevention and management of endoleaks. Radiology is crucial in the management of such a phenomenon and needs to offer a number of solutions in the endoleak prevention and management.


In total, within a period of 4.5 years of the plant operation, 1853 Mg of fuel was produced and successfully co-combusted with coal in a power plant. The research demonstrated that in the waste water treatment sector there exists energy potential in terms of calorific value which translates into tangible benefits both in the context of energy generation as well as environmental protection. Over 700,000 Mg of bio-sewage sludge is generated annually in Poland. According to findings of the study presented in the paper, the proposed solution could give 970,000 Mg of dry mass of biomass qualified as energy biomass replacing fossil fuels.This paper aims to analyze the economic feasibility of generating a novel, innovative biofuel—bioenergy—obtained from deposit bio-components by means of a pilot installation of sewage sludge bio-conversion. Fuel produced from sewage sludge biomass bears the potential of being considered a renewable energy source. In the present study, 23 bioconversion cycles were conducted taking into consideration the different contents, types of high carbohydrate additives, moisture content of the mixture as well as the shape of the bed elements. The biofuel was produced using post fermentation sewage sludge for industrial energy and heat generation. Based on the presented research it was concluded that the composite biofuel can be co-combusted with hard coal with the optimal percentage share within the range of 20–30% w/w. Sewage sludge stabilized by means of anaerobic digestion carried out in closed fermentation chambers is the final product. The average values of the CO The development of sewerage infrastructure and household sewage connections has become a priority objective in addressing the issue of preventing soil and water pollution in Poland. Households, along with other sources of sewage, are connected to sewerage systems which route the effluents to a waste water treatment facility in order to remove the contaminants. Sewage sludge is a by-product generated in the process of industrial and municipal waste water treatment. However, with the development of sewage infrastructure, the volume of sewage sludge increases and, as a consequence, there arises the problem of its proper management.Sewage sludge is a dispersive system in which the non-dispersive phase is a liquid phase in the form of water with dissolved substances while the dispersed phase constitutes a solid phase in the form of insoluble parts or a gaseous phase in the form of a gas dissolved in liquid . Sewage Currently, sewage sludge can be utilized also as a soil improver or for engineering purposes in degraded land reclamation after determining the permissible level of heavy metals concentrations in compliance with the regulation of the Minister of Environment on municipal sewage sludge . MoreoveIn light of biding legal regulations, the landfilling of sewage sludge is the least desirable method of its management. Due to its changeable content, the sludge generated during the process of wastewater treatment constitutes a major problem in terms of its stabilization and utilization. So far, there does not exist a single optimal method of sewage sludge management. The selection of the technology is made on an individual basis and depends on the size of the particular wastewater treatment facility as well as on the characteristic of the processed sewage .A construction of an incineration plant on the premises of the wastewater treatment facility in Rybnik Orzepowice, Poland, would be a capital-intensive project. Besides, the combustion process produces ash of a high concentration of heavy metals which is considered hazardous waste .In addition, the incineration process is accompanied by heat generation for which there is no demand on the premises of the wastewater treatment facility. It is biogas combustion that provides the heat necessary for technological purposes, central heating and hot water. Excess heat would have to be released to the atmosphere.The activities aiming at reducing the volume of landfilled sewage sludge and increasing the degree of sewage sludge conversion as well as the development of thermal conversion technologies are in accordance with the preferred European standards and legal regulations .Fuel produced from sewage sludge biomass bears the potential of being considered a renewable energy source (RES) ,18,19,20The aim of this paper is to analyze the economic feasibility of biofuel production using an innovative technology of sewage sludge management which may constitute an alternative to thermal utilization of sewage sludge.In light of the existing limitations concerning natural management of sewage sludge which result from legal regulations and the scarcity of potential areas suitable for alternative utilization, thermal disposal acquires more and more importance. The thermal methods of sludge stabilization and utilization include incineration, co-incineration as well as pyrolysis ,18,19. OThe research was focused on the development and implementation of a cost-effective environmentally safe technology of waste recycling and utilization, including energy recovery, by means of thermal and biochemical conversion processes ,22. In t2 combustion process and, in consequence, the emission of dioxins and NOx.The physical and chemical parameters which characterized the stabilized sewage sludge are presented in The bioconversion installation processes sewage sludge to produce a surrogate to be used for the purpose of professional energy generation see . The obtWithin the research framework, 23 bioconversion cycles were conducted taking into consideration the different contents, the types of high carbohydrate additives, moisture content of the mixture as well as the shape of the bed elements. The research was conducted for an optimal content of the mixture presented in The analyses of bioconversion, stabilization , combustion and emissions confirmed that a sphere of 20 mm diameter constitutes an optimal shape and size of the surrogate. Moldings of such shape and size characterize of optimum porosity of the bed within the bioconversion and stabilization processes, good mechanical resistance, uniform combustion and the size of the molding fitting into the pea coal category, which in the case of co-combustion with hard coal has a beneficial effect on the bed structure.Based on the research findings, it was observed that the composite biofuel can be co-combusted with hard coal while the optimal percentage share is within the range of 20–30%. 2 emission and absorption in the process of photosynthesis and combustion. As distinct from simple forms of biomass, the only difference is the location of the said biomass in the food chain.The obtained results contributed to the development of a new generation, composite biofuel technology dedicated for industrial energy generation and district heating, including various forms of energy co-generation. Sewage sludge stabilized by means of anaerobic digestion carried out in closed fermentation chambers is the final product. The organic substance in the municipal waste water is an element of food chain; therefore, it must be classified as biomass of zero COBiogas mainly composed of methane, carbon dioxide, hydrogen sulfide and water vapor used directly for the purpose of heating or energy co-generation; Post fermentation biomass which after dewatering forms sewage sludge categorized as waste;Filtrate rerouted to the preliminary node of waste water purification.As a result of anaerobic digestion of waste water the following three streams are produced:Streams 1 and 3 are not classified as waste. Stream 2 which does not have a direct application is classified as waste according to traditional technology of waste water treatment. The obtained research results enabled to redefine the categorization of the sewage sludge into “post fermentation biomass” which in the innovative waste water treatment technology is utilized as a component of a composite biofuel constituting a final fuel product dedicated for the energy and energy co-generation sectors. The sequential bioconversion of post fermentation biomass allowed to yield a market value composite biofuel.The primary objective of the research was the production of a fuel suitable for green energy generation by means of energy biomass combustion in industrial power plants and heating plants. Equally important was the issue of complying with the requirements stipulated in the EU Directive 2009/28/EC of the European Parliament and of the Council of 23 April 2009 on the promotion of the use of energy from renewable sources.Nationwide implementation of the method enabled the production of approximately 830–950 thousand Mg of dry energy biomass with calorific value in the range of 14–18 GJ/Mg. The implementation of the technology significantly improved the available schemes of obtaining plant biomass for energy purposes and at the same time mitigated the sequestrated fuel balance in Poland. Additionally, the novel product, as an alternative to traditional plant biofuels, has tremendous environmental implications because it replaces monoculture farming and contributes to sustaining forest resources which are scarce in Poland. Other important benefits include the improvement of local ecosystems in the context of sewage sludge management, the elimination of interim repository sites characterizing of odor nuisance as well as the necessity of hygienization. Research projects which aim at improving the thermal methods of sewage sludge management bear the potential of decreasing its volumes discharged to the environment. The fact that the above activities also result in producing electricity and heat, reducing in this way the combustion of conventional energy carriers, for example hard coal, creates a synergy effect which can be translated into tangible economic as well as environmental profits .The profitability analysis of the product encompasses cost savings resulting from decreasing the expenditures connected with hygienization and transportation of sewage sludge and the income from selling the final product of bioconversion as well as the costs of energy biomass production. The analysis is based on the assumption that the final product will be contracted by a major industrial electricity and/or heat generation plant. The form of the fuel allows long distance transportation; however, it has an impact on the price.In regard to the calculation of operational costs, it was assumed that 5475 Mg/year of sewage sludge characterized by 80% moisture content is placed in the homogenizer together with a total volume of 471 Mg/year of deposit biomass, activated bacteria cultures as well as reactive components. The ingredients are next mixed in the homogenizer; the obtained mixture of 5946 Mg/year is routed to the bio-converter where the process of an effective maceration takes place. After the bioconversion process has been completed, the biomass is subject to shaping and thermo inclusion to achieve the final energy biomass in the volume of 2245 Mg/year. 2 emissions through the production of energy biomass dedicated for professional electricity and heat generation.Within the framework of the development phase, risk assessment and sensitivity analyses were carried out against the changes of market and economic conditions concerning the sale of the bioconversion product. A reassessment demonstrated that the variability of market parameters falls within the predetermined range, which proves the economic viability of the project. The conducted analyses also confirm the beneficial environmental impact due to eliminating the need of repository and transportation. Another important aspect is the compliance with the requirements of the EU Directive of reducing COThe method may be applied in any waste water treatment facility with a modest capital expenditure. Energy biomass constitutes the final product to be used in the energy sector obliged to co-firing of biomass with fossil fuels in accordance with the EU policy.The volume of bio-sewage sludge currently generated in Poland converted to dry mass accounts for over 700,000 Mg. Using the proposed method, it is possible to produce, on the national level, biomass in the amount of 970,000 Mg of dry mass qualified as energy biomass replacing fossil fuels and directly dedicated for professional electricity and heat generation.At the same time, the processed sewage sludge is not landfilled. The fact that renewable resources of sewage sludge biomass are utilized for energy purposes instead of exploiting crop and forest cultivations may be considered as yet another advantage. The product is not a competitor in relation to agricultural food production.The research demonstrated that in the waste water treatment sector there exists energy potential in terms of calorific value which translates into tangible benefits both in the context of environmental protection and professional energy generation.The conducted economic analysis confirmed that the sewage sludge bioconversion product may constitute an alternative biofuel to achieve the optimal composition of the required energy mix, and most importantly, a product which does not increase the unit cost of producing 1 MWh of electrical energy.


Patellar tendinopathy (PT) is an overuse injury of the knee. The mechanism of injury is associated with repetitive stress on the patellar tendon of the knee as a result of explosive movement. Patellar tendinopathy is prevalent in all populations and is associated with intrinsic and extrinsic risk factors.Primarily, the objective was to report on the intrinsic and extrinsic risk factors for PT, entailing a systematic review of the literature; the secondary objective was to use these risk factors to compile a proposed PT screening tool from the review and standard outcome measures.A systematic review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Elimination criteria of the articles included duplicates, titles, abstracts and methodological quality. The evidence was collected, characterised with regard to the intrinsic and extrinsic risk factors and summarised descriptively.The search yielded 157 feasible articles prior to commencement of article elimination. Six articles were included with a mean methodological quality score of 69%. Eight intrinsic and five extrinsic risk factors were identified. These identified risk factors are all relevant to the pathology and formed the basis for a proposed PT screening tool. The Victorian Institute of Sports Assessment for Patellar Tendinopathy Questionnaire, Visual Analog Scale and the Pain Provocation Test are also included in the proposed test.Intrinsic and extrinsic risk factors for PT were identified, and consequently, the proposed PT screening tool was formulated for possible future testing in appropriate studies.Prevention of PT through intrinsic and extrinsic risk factor identification, and implementation in the clinical setup as a possible outcome measurement tool with which to verify functional improvement in PT rehabilitation. Patellar tendinopathy (PT), an overuse injury Reinking  often reThe physical diagnosis of PT is based on clinical and predominantly ultrasound examination, although findings may not necessarily be associated with the severity of the symptoms  by Brukner and Khan  between the searches by the authors. This ensured that results cross-referenced and that all eligible articles were included in the review. This interval was chosen to be a supplementary addition to a previously published systematic review on the causative risk factors and rehabilitation for PT in which articles were selected only up to October 2015  AND (rehab* or ‘return to sport’ or ‘return to play’ or ‘motor re-educat*’) and (exercise* or train* or sport*)Each author undertook the study selection process according to the inclusion and exclusion criteria in Methods for the Development of NICE Public Health Guidance checklists. The individual methodology scoring for each article is displayed in The eligibility and quality of the articles were appraised by the authors using two checklists . More thThe methodological quality scoring was performed on 13 articles that met the inclusion criteria, with 6 articles remaining for the systematic review.The data contained in the eligible articles were extracted and incorporated into a customised Microsoft Excel data spread- sheet developed by the authors  and 3. TCombining of the data for the formulation of a meta-analysis was not the intention of this systematic review because of the differences of the results in terms of the variety of articles with different study populations. All the empirical evidence was collected, characterised with regard to the intrinsic and extrinsic risk factors for PT and summarised descriptively.Ethics approval was obtained from the Ethics Committee of the Faculty of Health Sciences, University of the Free State .The collective results of both independent searches yielded 157 feasible articles for inclusion prior to the commencement of article elimination . Six artn = 5) of the included articles provided detail on the level of participation. A combination of elite (66%) and recreational participants (50%) was described in four articles, with one article having a general study participant population.The demographic information obtained from the systematic review shows that all six of the included articles described the study population. Two articles consisted of exclusively either male or female participants, whilst the other four articles described both male and female participants. Eighty-three per cent , impaired lower limb muscle flexibility and muscle strength. The other identified intrinsic risk factors were body composition, leg length variances, anatomy of the foot, lower patellar pole and age of the study participants.Five extrinsic risk factors for PT were identified with the main extrinsic risk factor being the common prevalence of PT in sports that involve jumping (50%). The additional four extrinsic risk factors were heavy physical work in combination with jumping sports, level of sport participation , physical activity and type of sport.PT is a well-recognised pathology with an inclusive aetiology of intrinsic non-modifiable and intrinsic and extrinsic modifiable risk factors that are directly linked to overloading of the patellar tendon . The rationale behind this is that lower leg muscle strength, especially weakness surrounding the knee joint, contributes to patellar tendon strain by the abnormal distribution of load and malalignment of patellar tracking  are all potentially relevant to the pathology and were used as the basis for the proposed PT screening tool . To broaInclusion of a pain provocation test (Malliaras et al. According to the authors’ knowledge, there are no other PT screening tools. The proposed PT screening tool may possibly be useful in rehabilitation, as it includes a dual function of outlining likely intrinsic and extrinsic risk factors for the development of PT, the estimation of pain and functional impairments and is not indicated for any specific population. The value of the proposed PT screening tool will only be verified if properly tested in appropriate studies Bishop .The strength of this systematic review is that the intrinsic and extrinsic risk factors for PT have been identified. Risk factor identification promotes the development and implementation of prevention strategies in the management of this condition. The evidence on the risk factors was used to suggest a proposed PT screening tool which will need to be tested in appropriate studies. A limitation of this systematic review was the limited number of included articles and a probable reason might be the explicit exclusion of youth populations. Another limitation was the lack of randomised clinical trials to validate the results.Intrinsic and extrinsic risk factors for PT were identified in this systematic review. This evidence, as well as appropriate literature, formed the basis for the formulation of a proposed PT screening tool which will require testing to determine its usefulness.


The blunt edges of worn molds can cause the edge of the sheet metal to form a burr, which can seriously impede assembly and reduce the efficiency of the resulting motor. The overuse of molds without sufficient maintenance leads to wasted sheet material, whereas excessive maintenance shortens the life of the punch/die plate. Diagnosing the mechanical performance of die molds requires extensive experience and fine-grained sensor data. In this study, we embedded polyvinylidene fluoride (PVDF) films within the mechanical mold of a notching machine to obtain direct measurements of the reaction forces imposed by the punch. We also developed an automated diagnosis program based on a support vector machine (SVM) to characterize the performance of the mechanical mold. The proposed cyber-physical system (CPS) facilitated the real-time monitoring of machinery for preventative maintenance as well as the implementation of early warning alarms. The cloud server used to gather mold-related data also generated data logs for managers. The hyperplane of the CPS-PVDF was calibrated using a variety of parameters pertaining to the edge characteristics of punches. Stereo-microscopy analysis of the punched workpiece verified that the accuracy of the fault classification was 97.6%.The geometric tolerance of notching machines used in the fabrication of components for induction motor stators and rotators is less than 50  Notched workpieces with jagged edges (burrs) can seriously undermine the assembly of the stator and rotor [N) as well as the cutting shear force (S), which is a product of the shear strength of the sheet metal (G), the thickness of the steel workpiece (T), and the geometry of the cutting edge (L). The speed of the stroke (V) and the geometry of the punch (P) can also affect the life of a mechanical mold. Sampling inspections and scheduled maintenance require downtime, particularly for the estimation of the mechanical performance of the die. Researchers have used mathematical models, numerical simulations, and experimental procedures to investigate the mechanical deformation of sheet metal [In the fabrication of induction motors, the mechanical tolerance for component variation is very low  due to the customized physical layer, cyber layer, and application layer. The notching machine provided 290 strokes per minutes (SPM), and the sampling rate of the PVDF film was 10,000 points per s. The embedded PVDF sensors could sustain over 10,000 strokes and demonstrated the potential of industrial measurement. This work upgraded the mechanical mold from a sensorless device to an Internet of things (IoT) component. The edge computer evaluated the performance of the die mold instead of manual diagnosis. The CPS-PVDF system cooperated with different language environments: MATLAB collected spectrum data from the PVDF sensor; LabVIEW recorded waveform from the PVDF films; and Python encrypted, compressed, and uploaded the experimental results. The customized format of the experiment data provides high flexibility for various sensors and the database on the cloud server is expandable for streaming data. The Internet can create active server pages (ASP) and would allow the calculation of the gross productivity of a factory located in a suburban region. This would allow general users to subscribe to standard information with limited conditions, and authorized analysists all around the world to receive rapid and complete information, even in different time zones.Hz. The drift ratio of the first three peaks obtained from the measured frequencies was small and was related to the mechanical performance of the punch/die during operations. We employed evidence-based features for fault detection as an alternative to multiple layers of invalid features, which would have required extensive training data and would have imposed a heavy computational burden. The program classified the condition of the mold in terms of sharpness or abrasion. The SVM function was designed to extract waveforms from the contact force measurements F denotes the operation of feature extraction:k denotes the notable features related to contact force in the temporal domain and in the frequency spectrum as well. The sizes of i, j, and k are indicated by I, J, and K, respectively. Edge/fog computation was conducted using zero mean normalized cross-correlation (ZNCC) to compute the degree of similarity between the measured signals and optimal/sub-optimal signals. The mathematical model of ZNCC is written as follows:b is the distance between selected points and the SVM hyperplane. The SVM-PVDF can be used for the online monitoring of a variety of mechanical molds.The results obtained under optimal and sub-optimal conditions yielded In this study, we customized PVDF sensors and retrieved contact force measurements during the stamping of a steel workpiece. A cam mechanism in the notching machine controlled the working displacement in the cutting of the sheet metal. An SVM program extracted patterns from this raw data to differentiate between situations involving sharp cutting tools and those performed using blunt cutting tools. Steel workpieces are core components of induction motors, and the geometric tolerance of the notched workpieces dominates the gross performance of the electromechanical machines. This research proposed a CPS-PVDF system with SVM criteria to evaluate the mechanical performance of notching machines. The in situ measurement of contact force enabled the classification of the shape/blunt status of the punching molds. The contribution of the article was to provide cost-effective metrologies for the production lines. The peak-to-peak values corresponded to the physical features of the contact force. The feature used in the SVM program was based on the direct measurement of contact force and this study decrypt the physical meaning related to sharp or blunt punch for the industrial applications. The high accuracy and small differences detected in the frequency domain were subsequently used in the SVM program. Each experiment involved 42 strokes; therefore, the SVM program sliced the measured waveforms into 42 individual segments for the computation of ZNCC. This work contributes to the early detection of abrasion seen in the mechanical molds and avoids downtime costs from unexpected failures. The ultimate objective was to maintain cutting quality while optimizing maintenance schedules. Stereo microscopy verified that the accuracy of the proposed scheme exceeded 95%. The proposed system is a highly cost-effective approach to real-time inspections and the long-term monitoring of industrial machinery.