The High Energy Modular Ensemble of Satellites (HERMES) project is aimed to realize a modular X/gamma-ray monitor for transient events, to be placed on-board of a nano-satellite bus (e.g. CubeSat). ...This expandable platform will achieve a significant impact on Gamma Ray Burst (GRB) science and on the detection of Gravitational Wave (GW) electromagnetic counterparts: the recent LIGO/VIRGO discoveries demonstrated that the high-energy transient sky is still a field of extreme interest. The very complex temporal variability of GRBs (experimentally verified up to the millisecond scale) combined with the spatial and temporal coincidence between GWs and their electromagnetic counterparts suggest that upcoming instruments require sub-microsecond time resolution combined with a transient localization accuracy lower than a degree. The current phase of the ongoing HERMES project is focused on the realization of a technological pathfinder with a small network (3 units) of nano-satellites to be launched in mid 2020. We will show the potential and prospects for short and medium-term development of the project, demonstrating the disrupting possibilities for scientific investigations provided by the innovative concept of a new “modular astronomy” with nano-satellites (e.g. low developing costs, very short realization time). Finally, we will illustrate the characteristics of the HERMES Technological Pathfinder project, demonstrating how the scientific goals discussed are actually already reachable with the first nano-satellites of this constellation. The detector architecture will be described in detail, showing that the new generation of scintillators (e.g. GAGG:Ce) coupled with very performing Silicon Drift Detectors (SDD) and low noise Front-End-Electronics (FEE) are able to extend down to few keV the sensitivity band of the detector. The technical solutions for FEE, Back-End-Electronics (BEE) and Data Handling will be also described.
True superficial femoral artery aneurysms (SFAAs) are rare and traditionally treated by open repair. However, the endovascular approach excluding the aneurysm sac with a covered stent may be an ...alternative. This study aimed to compare the outcomes of the open and endovascular repair of SFAAs.
This is a retrospective, observational, monocentric study. The main endpoints were: technical success, limb salvage and primary patency rate, and hospitalisation time.
We identified 49 SFAAs in 40 patients; the mean age was 73.3±10.1 years, the mean diameter of SFAAs was 5.41±3.64cm, and 61.2% were symptomatic for ischaemic or compression-related signs. The indication for open repair was given mainly for complex SFAAs involving the distal third of the superficial femoral artery and with an ipsilateral popliteal aneurysm. Among the 36 open-repair patients, 33 underwent ligation and revascularisation via bypass or graft interposition, and 3 patients underwent simple ligation without revascularisation. The endovascular approach was adopted mainly for aneurysms located in the medial third of the SFAA, which underwent covered stenting in 12 patients and coil embolisation in 1 patient. The technical success was 100% in all cases. There were no statistical differences in terms of primary patency and limb salvage rate between groups at two and four years. The mean hospitalisation time was 10±4 and 3±1 days after open and endovascular treatment, respectively.
The endovascular approach may be a valid alternative for isolating SFAAs offering good results and shorter hospitalisation. Open repair remains a valid approach, particularly in complex aneurysms.
The FAMU experiment aims to measure for the first time the hyperfine splitting of the muonic hydrogen ground state. From this measurement the proton Zemach radius can be derived and this will shed ...light on the determination of the proton charge radius. In this paper, we describe the scientific goal, the method and the detailed preparatory work. This includes the outcome of preliminary measurements, subsequent refined simulations and the evaluation of the expected results. The experimental setup being built for the measurement of the hyperfine splitting to be performed at the RAL laboratory muon facility is also described.
Deep infiltrating endometriosis (DIE) is a complex disease that impairs the quality of life and the fertility of women. Since a medical approach is often insufficient, a minimally invasive approach ...is considered the gold standard for complete disease excision. Robotic-assisted surgery is a revolutionary approach, with several advantages compared with traditional laparoscopic surgery.
METHODS
From March 2010 to May 2011, we performed 22 consecutive robotic-assisted complete laparoscopic excisions of DIE endometriosis with colorectal involvement. All clinical data were collected by our team and all patients were interviewed preoperatively and 3 and 6 months post-operatively and yearly thereafter regarding endometriosis-related symptoms. Dysmenorrhoea, dyschezia, dyspareunia and dysuria were evaluated with a 10-point analog rating scale.
RESULTS
There were 12 patients, with a median larger endometriotic nodule of 35 mm, who underwent segmental resection, and 10 patients, with a median larger endometriotic nodule of 30 mm, who underwent complete nodule debulking by colorectal wall-shaving technique. No laparotomic conversions were performed, nor was any blood transfusion necessary. No intra-operative complications were observed and, in particular, there were no inadvertent rectal perforations in any of the cases treated by the shaving technique. None of the patients had ileostomy or colostomy. No major post-operative complications were observed, except one small bowel occlusion 14 days post-surgery that was resolved in 3 days with medical treatment. Post-operatively, a statistically significant improvement of patient symptoms was shown for all the investigated parameters.
CONCLUSIONS
To our knowledge, this is the first study reporting the feasibility and short-term results and complications of laparoscopic robotic-assisted treatment of DIE with colorectal involvement. We demonstrate that this approach is feasible and safe, without conversion to laparotomy.
Background
The enhanced recovery after surgery (ERAS) is nowadays a widely accepted multimodal programme of care in colorectal surgery, but still there is some reluctance in its application to very ...elderly patients.
Aim
The aim of this study is to investigate short-term outcomes of laparoscopic resection for colorectal cancer in octogenarian patients within the ERAS programme.
Methods
Data on 162 consecutive patients aged ≥ 80 years receiving elective minimally invasive colorectal resections within ERAS programme were collected in a multicentre, retrospective database in the period 2008–2017 in Italy. Univariate and multivariate analyses were performed to assess possible risk factors for poor clinical outcomes.
Results
The postoperative minor morbidity rate (Clavien–Dindo 1 and 2) was 25.9%. The incidence of postoperative major morbidity rate (severe medical and surgical complications defined as Clavien–Dindo 3 and 4) accounted 6.1% and only 1.8% had an anastomotic leakage. Reoperation rate was 5.5%, perioperative 30-day mortality was 1.8%, and 30-day readmission rate was 6.8%. On average, patients were released after 6 days. A univariate analysis showed that possible risk factors for severe medical complications were: low preoperative albumin level, high Charlson Age Comorbidity Index Score and number of days in the intensive care unit (ICU); risk factors for severe surgical complications were: low preoperative albumin level; risk factors for late hospital discharge were: multivisceral resections, number of days in ICU and body mass index (BMI) > 25 kg/m
2
. The multivariate analysis confirmed a low level of preoperative albumin and a longer ICU stay as independent risk factors for both postoperative severe surgical complications and late hospital discharge.
Discussion
The minimal invasive nature of the laparoscopic approach together with a multimodal analgesia therapy, the early resumption to oral diet and mobilisation could minimize the surgical stress and play an essential role in order to reduce medical morbidity in high-risk patients.
Conclusion
Colorectal surgery within ERAS programme in octogenarians is a safe and flexible treatment in high-volume centres.
Background
Laparoscopic lavage was proposed in the 1990s to treat purulent peritonitis in patients with perforated acute diverticulitis. Prospective randomized trials had mixed results. The aim of ...this study was to determine the success rate of laparoscopic lavage in sepsis control and to identify a group of patients that could potentially benefit from this treatment.
Methods
This retrospective multicentre international study included consecutive patients from 24 centres who underwent laparoscopic lavage from 2005 to 2015.
Results
A total of 404 patients were included, 231 of whom had Hinchey III acute diverticulitis. Sepsis control was achieved in 172 patients (74·5 per cent), and was associated with lower Mannheim Peritonitis Index score and ASA grade, no evidence of free perforation, absence of extensive adhesiolysis and previous episodes of diverticulitis. The operation was immediately converted to open surgery in 19 patients. Among 212 patients who underwent laparoscopic lavage, the morbidity rate was 33·0 per cent; the reoperation rate was 13·7 per cent and the 30‐day mortality rate 1·9 per cent. Twenty‐one patients required readmission for early complications, of whom 11 underwent further surgery and one died. Of the 172 patients discharged uneventfully after laparoscopic lavage, a recurrent episode of acute diverticulitis was registered in 46 (26·7 per cent), at a mean of 11 (range 2–108) months. Relapse was associated with younger age, female sex and previous episodes of acute diverticulitis.
Conclusion
Laparoscopic lavage showed a high rate of successful sepsis control in selected patients with perforated Hinchey III acute diverticulitis affected by peritonitis, with low rates of operative mortality, reoperation and stoma formation.
Successful in the majority
After surgical treatment of Charcot neuro-osteoarthropathy (CNO) complicated by plantar ulcer and midtarsal osteomyelitis, offloading is mandatory to protect the surgical site. Total contact casting ...is, to date, the standard-of-care to offload the foot during the postoperative period. We have compared the application of external circular fixator, to the standard of care, with regard to surgical wound healing and time to healing. During the time period from January 2020 to December 2021, 71 consecutive patients admitted to our unit with diabetes and CNO complicated by plantar ulceration and midtarsal osteomyelitis were enrolled in our study. All patients were classified as stage 2, according to the Frykberg & Sanders classification. Wifi wound stage was W2 I0 FI2 in 43 of 71 patients (60.6%) and W2 I2 FI2 in 28 of 71 patients (39.4%). In cases where critical limb ischemia occurred, we performed an endovascular procedure to obtain patency in at least one of the tibial arteries. Localization of osteomyelitis was carried out with magnetic resonance imaging studies, and the degree of deformity was assessed using plain X-ray or computed tomography. A localized ostectomy through the ulceration was carried out with a fasciocutaneous flap to cover the surgical site. In 36 patients, an external circular fixator was applied intraoperatively (exfix+ group); the remaining 35 patients received fiberglass cast in the postoperative period (exfix− group). Complete healing of the surgical site was achieved in 36 of 36 patients in the exfix+ arm and in 22 of 35 in the exfix− arm (P < .02). Time to healing was 68 ± 28 days in exfix+ and 102 ± 88 days in exfix− (P = .05). Circular external frames should be considered as an effective offloading device that enhances the healing rate and reduces time to healing after surgical treatment of midfoot osteomyelitis in subjects affected by CNO.
The idea of the CHNET-TANDEM experiment is to develop and optimize a non-destructive technique, which allows analysis deep inside the sample with a good spatial resolution, using a negative muon ...beam. By selecting the primary muon energies appropriately, bulk analysis can be performed without destructing the sample. The experimental setup used for this experiment, made by 2 hodoscopes and 5 HpGe, allowed us to collect very interesting preliminary data concerning scan momentum, positioning and centering of the samples by means of two hodoscopes, analysis of standard material targets and elemental characterization of Nuragic “Bronze Age” votive ship fragments.
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