Purpose
The high prevalence of incisional hernias and an average stay of 3–10 days for open procedures have made this pathology both a health problem and an economic issue. A protocol was developed ...for performing this procedure in an Ambulatory Surgery Center (ASC) with extended recovery.
Methods
From January 2000 to December 2011, data about all laparoscopic incisional hernia repairs were gathered prospectively. The patients’ clinical features, hernia type, intraoperative and postoperative complications and reasons for hospital admission are studied.
Results
A total of 259 patients have been operated for incisional hernia (185) or recurrent hernioplasty (74) in our ASC. Laparoscopic repair was successful in 254 patients (98.07 %). Conversion to open surgery was necessary in five patients (1.93 %). A total of 50 patients (19.69 %) in whom surgery was completed laparoscopically were discharged the same day of surgery, 179 (70.47 %) at 24 h and 25 (9.84 %) required a stay of over 24 h. Postoperative pain was severe in 10 % of patients, moderate in 40 %, and mild in 50 %. Complications, mostly minor and self-limiting, were observed in 25 patients (9.84 %) during hospital stay. Five major complications that occured were: bile peritonitis, an acute peritonitis, due to an inadvertent intestinal perforation, and one intestinal obstruction by partial detachment of the mesh, an intra-abdominal hematoma and a colo-cutaneous fistula. There were no deaths in the series. The mean follow-up of patients was 29.35 months (range 12–129 months). The recurrence rate was 7.03 % (
n
= 18). Four trocar-site hernias were detected.
Conclusions
It is essential to create a protocol with selection criteria that take into account the patient, his entourage, the anesthetic-surgical procedure, and a team dedicated to surgical laparoscopic surgery in an ASC with extended recovery to achieve good results in terms of morbidity and patient safety.
Integrated Ocean Drilling Program (IODP) Expedition 339 cored multiple sites in the Gulf of Cadiz in order to study contourite deposition resulting from Mediterranean Outflow water (MOW). One Hole, ...U1387C, was cored to a depth of 865.85m below seafloor (mbsf) with the goal of recovering the latest Miocene to Pliocene transition in order to evaluate the history of MOW immediately after the end of the Messinian Salinity Crisis. To understand this history, an accurate age model for the succession is needed, but is challenging to construct, because the Miocene–Pliocene boundary is not marked by a clear biostratigraphic event in the Atlantic and coring gaps occur within the recovered stratigraphic record. These limitations are overcome by combining a variety of chronostratigraphic datasets to construct an age-model that fits the currently available age indicators and demonstrates that coring in Hole U1387C did indeed recover the Miocene–Pliocene boundary at about 826mbsf. This boundary is associated with a distinct and abrupt change in depositional environment. During the latest Messinian, hemipelagic sediments exhibiting precession-induced climate variability were deposited. These are overlain by Pliocene sediments deposited at a much higher sedimentation rate, with much higher and more variable XRF core scanning Zr/Al ratios than the underlying sediment, and that show evidence of winnowing, particle sorting and increasing grain size, which we interpret to be related to the increasing flow of MOW. Pliocene sedimentary cyclicity is clearly visible in both the benthic δ18O record and the Zr/Al data and is probably also precessionally controlled. Two contouritic bigradational sandy-beds are revealed above the third sedimentary cycle of the Pliocene. On the basis of these results, we conclude that sedimentation associated with weak Mediterranean–Atlantic exchange, began in the Gulf of Cadiz virtually at or shortly after the Miocene–Pliocene boundary.
•Stratigraphic framework over the Miocene–Pliocene boundary at IODP Site U1387•Abrupt sedimentary changes over the Miocene–Pliocene boundary•Clear hints for onset of Mediterranean Outflow after the Messinian salinity crisis•Evidence of bottom water currents in contouritic sedimentation and elevated Zr/Al•Quiet, hemipelagic sediment deposition during the Messinian in the Gulf of Cadiz
Background and purpose
For patients with acute ischaemic stroke due to large‐vessel occlusion, it has recently been shown that mechanical thrombectomy (MT) with stent retrievers is better than ...medical treatment alone. However, few hospitals can provide MT 24 h/day 365 days/year, and it remains unclear whether selected patients with acute stroke should be directly transferred to the nearest MT‐providing hospital to prevent treatment delays. Clinical scales such as Rapid Arterial Occlusion Evaluation (RACE) have been developed to predict large‐vessel occlusion at a pre‐hospital level, but their predictive value for MT is low. We propose new criteria to identify patients eligible for MT, with higher accuracy.
Methods
The Direct Referral to Endovascular Center criteria were defined based on a retrospective cohort of 317 patients admitted to a stroke center. The association of age, sex, RACE scale score and blood pressure with the likelihood of receiving MT were analyzed. Cut‐off points with the highest association were thereafter evaluated in a prospective cohort of 153 patients from nine stroke units comprising the Madrid Stroke Network.
Results
Patients with a RACE scale score ≥ 5, systolic blood pressure <190 mmHg and age <81 years showed a significantly higher probability of undergoing MT (odds ratio, 33.38; 95% confidence interval, 12–92.9). This outcome was confirmed in the prospective cohort, with 68% sensitivity, 84% specificity, 42% positive and 94% negative predictive values for MT, ruling out 83% of hemorrhagic strokes.
Conclusions
The Direct Referral to Endovascular Center criteria could be useful for identifying patients suitable for MT.
The Dense Plasma Focus (DPF) is such a simple device that it has awakened deep interest as a source of neutrons and as a possible alternative to the generation of energy by nuclear fusion. In ...essence, a DPF consists of two concentric electrodes between which a plasma sheet is formed by the action of an electrical discharge. Then, this sheet is accelerated until it collapses at the end of the device, generating a hot and extremely dense plasma. One of the most widely theoretical models used for describing the physical processes taking place in the DPF is Lee’s as it fits very well to the experimental data. This model divides the operation of the DPF into five phases. On the other hand, the poisoning of the plasma by particles from the electrodes can be reduced by rotating the plasma through the presence of an axial magnetic field. However, this generates a series of processes that were not taken into account in Lee’s original model. In this work, a variant of the Lee Model describing the rotational effects of plasma is presented. The new model brings new parameters and phenomena to be analyzed, such as the angular velocity and the swirl acceleration effect. The reduction of plasma temperature and also the reduction in neutron yield as observed experimentally, are also explained.
A Fusion–Fission Hybrid Reactor (FFHR) is made of a subcritical reactor driven by the neutrons generated in a nuclear fusion device. The fast neutron spectrum produced by this system could be able to ...burn actinides from the spent nuclear fuel. Unfortunately, current fusion devices are unable to provide an adequate neutron yield with reasonable spending of energy. However, it is possible to design the subcritical set to multiply considerably the neutron flux by using the so-called multiplying cascades. In addition, given its simplicity, the Dense Plasma Focus (DPF) is an interesting candidate as a neutron source. In this work, we analyze a concept of a metallic-fuel hybrid reactor based on a subcritical set and driven by a DPF as a neutron source. Their spectra are evaluated to determine if they are compatible with the operation of a fast reactor. The energy balance is also studied to find its ability to be self-sufficient when using an existing DPF. Finally, its capability to generate tritium from its lithium blanket is also analyzed. The system is self-sustainable.
Display omitted
•A FFHR based on DPF and multiplicative cascade is able to sustain a fast spectrum.•The amplification factor M is big enough to generate energy when using U-Pu-Zr.•The energy-balance shows that the system is self-sufficient.•The system is capable of generating enough tritium in its breeding blanket.
In this work, we develop a theoretical quantum mechanical model for describing the plasmon excitations in nanostructures. This model is based on the electronic density according to the Density ...Functional Theory (DFT). We derive an expression for finding an approximation to the dispersion relation in a nanostructure from the complete Hamiltonian of the system. We apply this expression to an aluminium nanoring showing how great, and not negligible, the ionic-interaction term is.
Here, the larger foraminifera found in Middle Eocene-Early Miocene rocks from Dhofar (Oman) and Socotra Island (Yemen) are studied in detail. The architectural analysis leads to the description of ...five new genera and nine new species: five agglutinated foraminifera,
Pseudolituonella robineti
n. sp.,
Socotraella ashawqi
n. gen. n. sp.,
Pseudoaccordiella ayaki
n. gen. n. sp.,
Barattolites andhuri
n. sp., and
Rogerella aydimi
n. gen. n. sp.; and four porcellaneous foraminifera,
Idalina grelaudae
n. sp.,
Idalina pignattii
n. sp.,
Macetadiscus incolumnatus
n. gen. n. sp., and
Omanodiscus tenuissimus
n. gen. n. sp. The larger foraminifera identified in a composite section located in western Dhofar, in the Shuwaymiyah section located in eastern Dhofar, and in the Wadi Ayak section located on Socotra Island have facilitated the identification of the following larger foraminifera zones: SBZ 14–SBZ 15 (middle Lutetian), SBZ 16 (late Lutetian), SBZ 17 (Bartonian), SBZ 18 (latest Bartonian-earliest Priabonian), SBZ 19–SBZ 20 (Priabonian), SB 21–SB 22A (Rupelian), SB 22B–SB 23 (Chattian), and SB 24 (Aquitanian). All these data permit to assess the age of the following lithostratigraphic units: Dammam Fm.—Andhur Mb. lower Lutetian?-middle Lutetian age (SBZ 13?–SBZ 14
partim
), Qara Mb. middle Lutetian (SBZ 14–SBZ 15), and Uyun Mb. upper Lutetian (SBZ 16); Aydim Fm.—Heiron Mb. Bartonian (SBZ 17), Moosak Mb. upper Bartonian-Priabonian (SBZ 18–SBZ 20), Tagut Mb. Priabonian (SBZ 19–SBZ 20), and Haluf Mb. Priabonian (SBZ 19–SBZ 20) to lower Rupelian (SBZ 21) on Socotra Island; Ashawq Fm. Rupelian (SB 21–SB 22A); and Mughsayl Fm. Chattian-Aquitanian (SB 23–SB 24).
•The multiplicative channels (n,xn) are at 14 MeV neutrons.•The transmutation cycle shows the accumulation of Osmium and Rhenium.•Tungsten shows to be a good neutron reflector even in thin slabs.
...Monte-Carlo simulations were performed to study the behavior of Tungsten under 14 MeV neutron irradiation. At this energy, its multiplicative properties become relevant, especially due to the (n,2n) channel, but many other reactions are also present and a transmutation cycle can be drawn, showing the accumulation of metallic byproducts like Rhodium and Osmium. Also, a three-layer model was used to describe the interfaces within a schematic hybrid fusion-fission reactor to simulate the neutron transmission and reflection, showing that Tungsten can be a very useful material for a fission-breeding interface.
The Paleogene deposits on the northern passive margin of the Gulf of Aden record the transition from the pre-rift to the syn-rift stages of the southern Arabian plate margin. In southern Oman (Dhofar ...Region), the relative continuity of the sedimentary record offers the possibility to investigate the early deformation phases of the Aden rift system. A new detailed sedimentological and biostratigraphic analysis of the Cuisian to Rupelian deposits of the Dhofar region allows to define a second-order transgressive–regressive cycle, that can be further subdivided into four third-order sequences between the Late Cuisian and the Early Rupelian time. The sequence stratigraphy established in this study has major implications for the understanding of the time equivalent deposits described in the eastern Arabian plate and illustrates the polyphased history of the initiation of the Aden Gulf rift system. The first two depositional sequences are controlled by a phase of deformation that only affects the eastern Oman margin, in relation with the tectonic activity at the Arabian–Indian plate boundary, during the Late Cuisian–Middle Lutetian. The last two depositional sequences record a westward migration of the deformation within the eastern realm of the proto-Gulf of Aden from the Bartonian. Priabonian uplift resulted in the basinward shift of the depositional system followed by a phase of tectonic subsidence that is recorded by the aggradation of lacustrine deposits in localized fault bounded basins. A subsequent major regional relative sea level fall related to domal uplift is recorded by terrigenous deposits (lower part of the Ashawq Formation) prior to the main phase of syn-rift tectonic subsidence (upper part of the Ashawq and Mughsayl formations) in Rupelian–Chattian times.
•Sedimentological analysis of the Middle to Late Eocene deposits in southern Oman•Biostratigraphic calibration of the sedimentary succession•Sequential interpretations and correlations across the Dhofar area•Initiation of the rifting of the Gulf of Aden at the Lutetian–Bartonian boundary
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