Nowadays, in the definition of effective approaches for the sustainable management of water pressurized systems, the assessment of water leakages in water supply and distribution systems represents a ...key aspect. Indeed, the large water volumes dispersed yearly provoke relevant environmental, technical and socio-economic costs. Worldwide, many water systems show alarming levels of water losses, due to both the poor sealing of joints and the presence of cracks, enhanced by a high pressure level greater than that strictly required for assuring a proper service level to users. With the aim of analysing the correlation between pressure and leakages, in this work the results of an experimental and a numerical Computational Fluid Dynamics (CFD) investigation are provided and discussed. With reference to a drilled PVC-A (Polyvinyl Chloride-Alloy) pipe, a new-generation plastic material for water systems use, an experimental investigation was first carried out at the Laboratory of Hydraulics of the University of Naples Federico II, aimed at assessing the leakage-pressure relation for transversal rectangular orifices. A CFD model was then implemented and calibrated with experimental results, to different geometric configurations of the orifice, with the aim of assessing the dependence of the orifice geometry and orientation on the calibration of leakage law parameters.
Urbanization and population growth have been responsible for a significant increase in consumption of water and energy at a global scale. A careful management of water resource and infrastructures is ...crucial for Energy Transition, as well as for achieving a sustainable efficiency of these systems. High pressure values along with the ageing of the systems contribute to high leakage levels of Water Distribution Networks (WDN). The simultaneous control of excess pressure and containment of water losses are mainly performed by using Pressure Reducing Valves (PRVs) in WDN, which dissipate the surplus of hydraulic energy. Instead of being dissipated, energy can be recovered by the transformation of the excess pressure into electrical energy with the use of Pump as Turbines (PAT), which results in an increased reliability, reduction of cost and an overall improvement in the efficiency of WDN. The work aims on presenting an integrated efficiency management methodology in terms of Effectiveness (E), capability (ηpi), reliability (μpi) and sustainability (χpi) with values between 47 to 98%, also associated with the pressure and leakage management, and energy recovery. This research presents a modelling of a real WDN of a District Metering Areas (DMA) of Beloura endowed with seasonal consumption variability to better show its applicability. Additionally, an economic analysis to assess the solution’s feasibility is presented concluding an annual energy recovered of 9.8 MWh and a saving of about 30% of water leakage, which correspond, in the analyzed case study, to about 3523 m3. The payback period found is around 9 or 12 years, for only one PAT or two different PATs installed, due to the small available energy of the analyzed case study. Acknowledging the synergy between water and energy efficiency and taking advantage of these integrated smart management methodology exemplification, it resulted in more efficient systems to achieve both effectiveness solutions, digital and energy transition in the water sector.
Abstract Intravenous (IV) infusion of adenosine represents the gold standard for measuring Fractional Flow Reserve (FFR). However, IV adenosine is more expensive and time-consuming as compared to ...intracoronary (IC) boluses of adenosine. We conducted a meta-analysis of studies comparing IC to IV adenosine for FFR assessment in the same coronary lesions. We searched for studies comparing IC to IV adenosine and reporting absolute FFR values or rate of abnormal FFR for both routes. Pre-specified subgroup analysis was performed in order to appraise studies using low dose (<100 μg) or high dose IC adenosine (≥100 μg). We retrieved 11 studies amounting to 587 patients and 621 lesions. Six studies evaluated low-dose IC boluses (15-80 μg) and 5 studies high-dose boluses (120-600 μg). Absolute FFR values were slightly, yet significantly lower with IV adenosine as compared to IC adenosine (mean difference 0.02, 95% CI 0.00 – 0.03; p=0.02). This difference, however, did not translate into a significant difference in the rate of abnormal FFR between IC and IV adenosine (HR 0.93, 95% CI 0.76 – 1.13; p=0.57); moreover, no statistically significant difference was observed between low-dose and high-dose IC adenosine subgroups. Adverse events were less frequent with IC adenosine as compared to IV adenosine (RR 0.17, 95% CI 0.07, 0.43; p<0.001). In conclusion, IC administration of adenosine, although inducing a slightly lower amount of hyperemia as compared to IV infusion of adenosine, yields a similar diagnostic accuracy in identifying hemodynamically significant coronary stenosis and is better tolerated by the patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Nowadays, the implementation of complementary virtual approaches to the in situ visit of archaeological sites is a preeminent topic in the field of the fruition of cultural heritage, even more today ...following the pandemic restrictions.The aim of this work is thus to present a comprehensive framework for the fruition and the digital knowledge of the archaeological traces composing the Augustan Aqueduct, the Aqua Augusta Campaniae and its terminal reservoir, the Piscina Mirabilis in Bacoli (Italy). This model aims to be not only informative, but also as both a tool supporting learners and an archive gathering the information collected during the research activities. The traces composing the route of the Augustan Aqueduct are not completely accessible to public visitors, being the Roman infrastructure built almost entirely underground, across tuffaceous banks. Within the framework of this work, specific attention was thus paid to the communication language to be adopted for all the implemented digital tools. The vision was to conceive the framework as a complementary instrument of the physical visit, capable of providing exclusively the information that cannot be learnt directly in situ. The tool was based on the development of an applied game working in a virtual environment, as well as applications running in augmented reality (AR). The instrumental workflow was based on the interface of different commercial software and apps, such as Rhinoceros3D for 3D modelling, Augment for the augmented reality and Unreal Engine for game engines.DOI: https://doi.org/10.20365/disegnarecon.27.2021.18
Background: Vulvodynia is defined in this international consensus as persistent vulvar pain that occurs for >3 months without an identifiable cause and with several potential associated factors. At ...present there is no univocal consensus in the therapeutic treatment of vulvodynia. The methods of intervention are based on various aspects including, above all, the management of painful symptoms. Methods: a research on scientific database such as “Pubmed”, “Medline Plus”, “Medscape” was conducted, using the words “women’s genital pain” and “vulvodynia” for the review of the scientific evidence on the assessment and treatment of women’s genital pain. Results: Among the drugs with pain-relieving action, the most effective in the treatment of vulvodynia would seem to be those with antidepressant and anticonvulsant action, even if their mechanisms of action are not known and there are still insufficient studies able to demonstrate their real validity. Among the least effective are non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. However, the ideal would seem to use a combined treatment with multiple types of drugs. Conclusions: Future studies are needed to draw up a unique therapeutic action plan that considers the stratification of patients with vulvodynia and the variability of the symptom.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background: We previously reported that severe COVID-19 patients had higher chances of survival and a reduced risk of developing respiratory failure when administered with the probiotic formulation ...SLAB51. This study aimed to investigate further bacteriotherapy mechanisms and how early they are activated. Methods: We performed an analysis on the blood oxygenation parameters collected in sixty-nine severe COVID-19 patients requiring non-invasive oxygen therapy and presenting a CT lung involvement ≥50%. Twenty-nine patients received low-molecular-weight heparin, azithromycin and Remdesivir. In addition, forty subjects received SLAB51. Blood gas analyses were performed before the beginning of treatments and at 24 h. Results: The patients receiving only standard therapy needed significantly increased oxygen amounts during the 24 h observation period. Furthermore, they presented lower blood levels of pO2, O2Hb and SaO2 than the group also supplemented with oral bacteriotherapy. In vitro data suggest that SLAB51 can reduce nitric oxide synthesis in intestinal cells. Conclusions: SARS-CoV-2 infected patients may present lesions in the lungs compromising their gas exchange capability. The functionality of the organs essential for these patients’ survival depends mainly on the levels of pO2, O2Hb and SaO2. SLAB51 contains enzymes that could reduce oxygen consumption in the intestine, making it available for the other organs.
This monocentric, retrospective, two-stage observational study aimed to recognize the risk factors for a poor outcome in patients hospitalized with SARS-CoV-2 infection, and to develop and validate a ...risk score that identifies subjects at risk of worsening, death, or both. The data of patients with SARS-CoV-2 infection during the first wave of the pandemic were collected and analyzed as a derivation cohort. Variables with predictive properties were used to construct a prognostic score, which was tried out on a validation cohort enrolled during the second wave. The derivation cohort included 494 patients; the median age was 62 and the overall fatality rate was 22.3%. In a multivariable analysis, age, oxygen saturation, neutrophil-to-lymphocyte ratio, C-reactive protein and lactate dehydrogenase were independent predictors of death and composed the score. A cutoff value of 3 demonstrated a sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of 93.5%, 68.5%, 47.4% and 97.2% for death, and 84.9%, 84.5%, 79.6% and 87.9% for worsening, respectively. The validation cohort included 415 subjects. The score application showed a Se, Sp, PPV and NPV of 93.4%, 61.6%, 29.5% and 98.1% for death, and 81%, 76.3%, 72.1% and 84.1% for worsening, respectively. We propose a new clinical, easy and reliable score to predict the outcome in hospitalized SARS-CoV-2 patients.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Ustekinumab is a monoclonal antibody targeting the p40 subunit of IL-12 and IL-23, approved for treating psoriasis, psoriatic arthritis, and inflammatory bowel disease. Despite a remarkable success ...in treating chronic inflammatory conditions and a generally favorable safety profile, its role in inducing rare adverse events, such as interstitial pneumonia and acute respiratory distress syndrome (ARDS), remains largely uncharted. We report a case of a 66-year-old male patient treated with Ustekinumab for severe psoriasis who, after almost two years of treatment, developed dyspnea, asthenia, and fever progressing to non-infectious pneumonia and ARDS leading to ICU admission. Moreover, we conducted a literature review on Ustekinumab-associated pulmonary complications. Our case underscores the importance of appropriate and long-term clinical monitoring in patients on Ustekinumab treatment, particularly considering the potential lung complications. The possibility of non-infectious pneumonitis should be considered alongside infectious causes, facilitating prompt management in the case of negative infectious screening. Additionally, the severity of ARDS underscores the importance of timely recognition and proper management. Further investigations are recommended to investigate the immunological basis of Ustekinumab-induced ARDS for designing appropriate monitoring strategies.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
In nonalcoholic steatohepatitis animal models, an increased lipid droplet size in hepatocytes is associated with fibrogenesis. Hepatocytes with large droplet (Ld-MaS) or small droplet (Sd-MaS) ...macrovesicular steatosis may coexist in the human liver, but the factors associated with the predominance of one type over the other, including hepatic fibrogenic capacity, are unknown. In pre-ischemic liver biopsies from 225 consecutive liver transplant donors, we retrospectively counted hepatocytes with Ld-MaS and Sd-MaS and defined the predominant type of steatosis as involving ≥50% of steatotic hepatocytes. We analyzed a donor Patatin-like phospholipase domain-containing protein 3 (PNPLA3) rs738409 polymorphism, hepatic expression of proteins involved in lipid metabolism by RT-PCR, hepatic stellate cell (HSC) activation by α-SMA immunohistochemistry and, one year after transplantation, histological progression of fibrosis due to Hepatitis C Virus (HCV) recurrence. Seventy-four livers had no steatosis, and there were 98 and 53 with predominant Ld-MaS and Sd-MaS, respectively. In linear regression models, adjusted for many donor variables, the percentage of steatotic hepatocytes affected by Ld-MaS was inversely associated with hepatic expression of Insulin Induced Gene 1 (INSIG-1) and Niemann-Pick C1-Like 1 gene (NPC1L1) and directly with donor PNPLA3 variant M, HSC activation and progression of post-transplant fibrosis. In humans, Ld-MaS formation by hepatocytes is associated with abnormal PNPLA3-mediated lipolysis, downregulation of both the intracellular cholesterol sensor and cholesterol reabsorption from bile and increased hepatic fibrogenesis.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background: The existing recommendations for after open liver surgery, published in 2019, contains limited evidence on the use of regional analgesia techniques. The aim of this systematic review is ...to summarize available clinical evidence, published after September 2013, on systemic or blended postoperative analgesia for the prevention or treatment of postoperative pain after open liver surgery. Methods: The PUBMED and EMBASE registries were used for the literature search to identify suitable studies. Keywords for the literature search were selected, with the authors’ agreement, using the PICOS approach: participants, interventions, comparisons, outcomes, and study design. Results: The literature search led to the retrieval of a total of 800 studies. A total of 36 studies including 25 RCTs, 5 prospective observational, and 7 retrospective observational studies were selected as suitable for this systematic review. Conclusions: The current evidence suggests that, in these patients, optimal postoperative pain management should rely on using a “blended approach” which includes the use of systemic opioids and the infusion of NSAIDs along with regional techniques. This approach warrants the highest efficacy in terms of pain prevention, including the lower incretion of postoperative “stress hormones”, and fewer side effects. Furthermore, concerns about the potential for the increased risk of wound infection related to the use of regional techniques have been ruled out.
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