In many countries, assessment programmes are carried out to identify areas where people may be exposed to high radon levels. These programmes often involve detailed mapping, followed by spatial ...interpolation and extrapolation of the results based on the correlation of indoor radon values with other parameters (e.g., lithology, permeability and airborne total gamma radiation) to optimise the radon hazard maps at the municipal and/or regional scale. In the present work, Geographical Weighted Regression and geostatistics are used to estimate the Geogenic Radon Potential (GRP) of the Lazio Region, assuming that the radon risk only depends on the geological and environmental characteristics of the study area. A wide geodatabase has been organised including about 8000 samples of soil-gas radon, as well as other proxy variables, such as radium and uranium content of homogeneous geological units, rock permeability, and faults and topography often associated with radon production/migration in the shallow environment. All these data have been processed in a Geographic Information System (GIS) using geospatial analysis and geostatistics to produce base thematic maps in a 1000 m × 1000 m grid format. Global Ordinary Least Squared (OLS) regression and local Geographical Weighted Regression (GWR) have been applied and compared assuming that the relationships between radon activities and the environmental variables are not spatially stationary, but vary locally according to the GRP. The spatial regression model has been elaborated considering soil-gas radon concentrations as the response variable and developing proxy variables as predictors through the use of a training dataset. Then a validation procedure was used to predict soil-gas radon values using a test dataset. Finally, the predicted values were interpolated using the kriging algorithm to obtain the GRP map of the Lazio region. The map shows some high GRP areas corresponding to the volcanic terrains (central-northern sector of Lazio region) and to faulted and fractured carbonate rocks (central-southern and eastern sectors of the Lazio region). This typical local variability of autocorrelated phenomena can only be taken into account by using local methods for spatial data analysis. The constructed GRP map can be a useful tool to implement radon policies at both the national and local levels, providing critical data for land use and planning purposes.
•Geogenic Radon Potential (GRP) measures what Earth delivers in term of radon.•The estimation of the Geogenic Radon Potential map of the Lazio region is proposed.•Geological and geochemical data are used as proxies and response variables.•Geographically Weighted Regression and geostatistics are applied to construct GRP map.
Since some years ago in Abruzzo (Central Italy), through a number of monitoring campaigns, a set of more than 1900 indoor radon measures has been acquired by the Regional Agency for the environmental ...protection. Thus, on the basis of these public experimental data, different statistical approaches, aimed to estimate the probability to exceed the level of 200 Bq/m3 (lower than 300 Bq/m3, threshold value currently recommended by the Euratom commission for indoor radon risk acceptability), taken just as a working reference value, have been selected and discussed in this paper. Essentially, 'Monte Carlo Empirical Bayesian approach', 'Bootstrap' and 'Gibbs samplers' methods have been applied and the results have been partially compared. Moreover, some insights on the minimum number of samples, needed to assess the probability distribution as reasonable as possible, are provided.
A proper maternal cardiovascular adaptation to the pregnancy plays a key role for promoting an adequate uteroplacental perfusion, for ensuring normal fetal development and for preventing gestational ...hypertensive complications such as preeclampsia. This study aims to evaluate hemodynamic measurements obtained by noninvasive methods among preclamptic women with and without fetal growth restriction (FGR) and the relationship with plasma levels of natriuretic peptides.
The study compared 98 pregnant women (n=48 with preeclampsia; n=50 normotensive pregnant women) and 50 nonpregnant normotensive control subjects undergoing anultrasonic cardiac output monitor (USCOM) and plasma assessment of atrial N-terminal pro B-type natriuretic peptide (NT-proBNP). The statistical analysis was carried out by analysis of variance and correlation analysis.
Preeclampsia state is associated with increased vascular resistance (mean 1587±236 vs 978±153 dyn s cm
) and lower cardiac output (mean 5.7±1.1 vs 6.78±0.8 l) and this hemodynamic state is associated with higher levels of NT-proBNP (mean 121.2±26.3 vs 42.5±11.4 pg ml
); furthermore, we found an inverse correlation between maternal cardiac output and plasma levels of NT-proBNP only if preeclampsia is associated with FGR.
The elevated NT-proBNP in preeclampsia may reflect ventricular stress and subclinical cardiac dysfunction worsening if FGR is present. This may have implications for the acute management of the preeclampsia and FGR women and for appropriately timed therapeutic interventions later in life.
Purpose
This retrospective comparative study analyzes the outcome of patients affected by incisional hernia in potentially contaminated or contaminated field, treated by three operative techniques.
...Methods
152 patients (62 M:90 F; mean age 65 ± 14 years) underwent incisional hernia repair (January 2002–January 2012) in complicated settings. Criteria of inclusion in the study were represented by the following causes of admission: mesh rejection/infection, obstruction without gangrene but with possible peritoneal bacterial translocation, obstruction with gangrene, enterocutaneous fistula or simultaneous presence of ileo- or colostomy. The patients were divided into three groups: A (
n
= 76), treated with primary closure technique; B and C (
n
= 38 each), with reinforcement by synthetic or pericardium bovine mesh (Tutomesh
®
), respectively. The prosthetic groups were divided into Onlay and Sublay subgroups.
Results
Significant decreases in C vs A were observed for wound infection (3 vs 37 %) and recurrence (0 vs 14 %), and in C vs B for wound infection (3 vs 53 %), seroma (0 vs 34 %) and recurrence (0 vs 16 %). Patients with concomitant bowel resection (BR) (43 %) showed (all
P
< 0.05) an increase of overall morbidity (55 vs 33 %) and wound infection rate (42 vs 24 %) compared to cases without BR. Morbidity presented no significant differences in C-Onlay or Sublay subgroups. B-Sublay subgroup has (all
P
< 0.05) lower overall morbidity (20 vs 75 %), wound infection (10 vs 68 %) and seroma (0 vs 46 %) than B-Onlay.
Conclusions
The pericardium bovine patch seems to be safe and effective to successfully repair ventral hernia in potentially contaminated operative fields, especially in association with bowel resection.
Hyperthyroidism, goiter and thyroiditis have been associated with complex thyroidectomy. Difficult thyroidectomies may implicate longer operating times and higher complication rates, while literature ...on quantification and prediction of difficulty in thyroidectomy is scant. We aim at assessing the impact of preoperative and intraoperative factors on the technical difficulty of total thyroidectomy (TT) and on the incidence of postoperative complications. We conducted a retrospective study on 197 TT from 343 thyroidectomies performed with intraoperative neuromonitoring between October 2019 and June 2022 (excluding lobectomies, nodal dissection, extra-thyroidal procedures). Operating time (surrogate of TT difficulty), postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding were assessed in relation to pre- and intraoperative characteristics. Vocal fold palsy(VFP) was defined as recovering < 12 months postoperatively. There were 87 thyroid cancers and 110 multinodular goiters (21 hyperfunctioning, 51 mediastinal). Median operating time was 136 min (range 51–310). Within 17.4 months overall median follow-up we recorded two transient VFPs and 12% symptomatic transient hypocalcaemia. At univariable analysis male sex (
p
= 0.005), BMI (
p
< 0.001), thyroiditis (
p
< 0.05), hypervascular goiter (
p
= 0.003) and thyroid adhesions to surrounding anatomical structures (
p
< 0.001) were associated with longer operating time. At multivariable analysis male male sex (
p
= 0.01), obesity (
p
= 0.001) and thyroid adhesions (
p
= 0.008) were factors for prolonged operating time. Above-normal anti-thyroid peroxidase antibodies correlated to transient symptomatic hypocalcemia (
p
< 0.001). Risk factors for complex TT were identified and did not correlate with morbidity rates. Results from this study may help optimizing operating room schedule and inform case selection criteria for training programs in thyroid surgery. Further research is required to confirm these findings.
The surgical treatment of the intermediate-risk DTC (1–4 cm) remains still controversial. We analyzed the current practice in Italy regarding the surgical management of intermediate-risk unilateral ...DTC to evaluate risk factors for recurrence and to identify a group of patients to whom propose a total thyroidectomy (TT) vs. hemithyroidectomy (HT). Among 1896 patients operated for thyroid cancer between January 2017 and December 2019, we evaluated 564 (29.7%) patients with unilateral intermediate-risk DTC (1–4 cm) without contralateral nodular lesions on the preoperative exams, chronic autoimmune thyroiditis, familiarity or radiance exposure. Data were collected retrospectively from the clinical register from 16 referral centers. The patients were followed for at least 14 months (median time 29.21 months). In our cohort 499 patients (88.4%) underwent total thyroidectomy whereas 65 patients (11.6%) underwent hemithyroidectomy. 151 (26.8%) patients had a multifocal DTC of whom 57 (10.1%) were bilateral. 21/66 (32.3%) patients were reoperated within 2 months from the first intervention (completion thyroidectomy). Three patients (3/564) developed regional lymph node recurrence 2 years after surgery and required a lymph nodal neck dissection. The single factor related to the risk of reoperation was the histological diameter (HR = 1.05 (1.00–1-09),
p
= 0.026). Risk stratification is the key to differentiating treatment options and achieving better outcomes. According to the present study, tumor diameter is a strong predictive risk factor to proper choose initial surgical management for intermediate‐risk DTC.
PDF
