Saturated Critical Heat Flux in a Multi-Microchannel Heat Sink Fed by a Split Flow System

An extensive experimental campaign has been carried out for the measurement of saturated critical heat flux in a multi-microchannel copper heat sink. The heat sink was formed by 29 parallel channels that were 199 μm wide and 756 μm deep. In order to increase the critical heat flux and reduce the two-phase pressure drop, a split flow system was implemented with one central inlet at the middle of the channels and two outlets at either end. The base critical heat flux was measured using three HFC Refrigerants (R134a, R236fa and R245fa) for mass fluxes ranging from 250 to 1500 kg/m2 s, inlet subcoolings from −25 to −5 K and saturation temperatures from 20 to 50 °C. The parametric effects of mass velocity, saturation temperature and inlet subcooling were investigated. The analysis showed that significantly higher CHF was obtainable with the split flow system (one inlet–two outlets) compared to the single inlet–single outlet system, providing also a much lower pressure drop. Notably several existing predictive methods matched the experimental data quite well and quantitatively predicted the benefit of higher CHF of the split flow

Characterizing the tissue of apple air-dried and osmo-air-dried rings by X-CT and OCT and relationship with ring crispness and fruit maturity at harvest measured by TRS

Air-dried apple rings were prepared from ‘Golden Delicious’ apples selected at harvest as less mature and more mature according to the absorption coefficient measured at 670 nm by time-resolved reflectance spectroscopy (TRS), stored in air for 5 months, and subjected to air-drying with (OSMO) and without (noOSMO) osmodehydration pre-treatment (60% sucrose syrup). Selected rings were submitted to microstructural analysis by X-ray computed tomography (X-CT), to subsurface structure analysis by optical coherence tomography (OCT) and to texture and sound emission analysis by bending–snapping test. Higher crispness index, higher number of sound events and higher average sound pressure level (SPL) characterized the OSMO rings. Total porosity was related to SPLav 60, pore fragmentation index to fracturability and specific surface area to the work required to snap the ring. A differentiation of the drying treatments, as well as of the products according to the TRS maturity class at harvest was obtained analyzing by principal component analysis (PCA) microstructure parameters and texture and acoustic parameters. The differences in mechanical and acoustic characteristics between OSMO and noOSMO rings were due to the different subsurface structure as found with OCT analysis

Factors affecting adherence to guidelines for antithrombotic therapy in elderly patients with atrial fibrillation admitted to internal medicine wards

Current guidelines for ischemic stroke prevention in atrial fibrillation or flutter (AFF) recommend Vitamin K antagonists (VKAs) for patients at high-intermediate risk and aspirin for those at intermediate-low risk. The cost-effectiveness of these treatments was demonstrated also in elderly patients. However, there are several reports that emphasize the underuse of pharmacological prophylaxis of cardio-embolism in patients with AFF in different health care settings. AIMS: To evaluate the adherence to current guidelines on cardio-embolic prophylaxis in elderly (> 65 years old) patients admitted with an established diagnosis of AFF to the Italian internal medicine wards participating in REPOSI registry, a project on polypathologies/polytherapies stemming from the collaboration between the Italian Society of Internal Medicine and the Mario Negri Institute of Pharmacological Research; to investigate whether or not hospitalization had an impact on guidelines adherence; to test the role of possible modifiers of VKAs prescription. METHODS: We retrospectively analyzed registry data collected from January to December 2008 and assessed the prevalence of patients with AFF at admission and the prevalence of risk factors for cardio-embolism. After stratifying the patients according to their CHADS(2) score the percentage of appropriateness of antithrombotic therapy prescription was evaluated both at admission and at discharge. Univariable and multivariable logistic regression models were employed to verify whether or not socio-demographic (age >80years, living alone) and clinical features (previous or recent bleeding, cranio-facial trauma, cancer, dementia) modified the frequency and modalities of antithrombotic drugs prescription at admission and discharge. RESULTS: Among the 1332 REPOSI patients, 247 were admitted with AFF. At admission, CHADS(2) score was ≥ 2 in 68.4% of patients, at discharge in 75.9%. Among patients with AFF 26.5% at admission and 32.8% at discharge were not on any antithrombotic therapy, and 43.7% at admission and 40.9% at discharge were not taking an appropriate therapy according to the CHADS(2) score. The higher the level of cardio-embolic risk the higher was the percentage of antiplatelet- but not of VKAs-treated patients. At admission or at discharge, both at univariable and at multivariable logistic regression, only an age >80 years and a diagnosis of cancer, previous or active, had a statistically significant negative effect on VKAs prescription. Moreover, only a positive history of bleeding events (past or present) was independently associated to no VKA prescription at discharge in patients who were on VKA therapy at admission. If heparin was considered as an appropriate therapy for patients with indication for VKAs, the percentage of patients admitted or discharged on appropriate therapy became respectively 43.7% and 53.4%. CONCLUSION: Among elderly patients admitted with a diagnosis of AFF to internal medicine wards, an appropriate antithrombotic prophylaxis was taken by less than 50%, with an underuse of VKAs prescription independently of the level of cardio-embolic risk. Hospitalization did not improve the adherence to guideline

Is Cardiorespiratory Fitness Related to Cardiometabolic Health and All-Cause Mortality Risk in Patients with Coronary Heart Disease? A CARE CR Study

Background: Higher cardiorespiratory fitness (CRF) is associated with lower morbidity and mortality in patients with coronary heart disease (CHD). The mechanisms for this are not fully understood. A more favourable cardiometabolic risk factor profile may be responsible, however few studies have comprehensively evaluated cardiometabolic risk factors in relation to CRF, among patients with CHD. Objective: To explore differences in cardiometabolic risk and 5-year all-cause mortality risk in patients with CHD who have low, moderate, and high levels of CRF. Methods: Patients with CHD underwent maximal cardiopulmonary exercise testing (CPET), echocardiogram, carotid intima-media thickness measurement, spirometry, and dual X-ray absorptiometry assessment. Full blood count, biochemical lipid pro-files, high sensitivity (hs)- C-reactive protein and NT-proBNP were analysed. Pa-tients were defined as having low, moderate, or high CRF based on established prognostic thresholds. Results: 70 patients with CHD (age 63.1 ± 10.0 years, 86% male) were recruited. Patients with low CRF had a lower ventilatory anaerobic threshold, peak oxygen pulse, post-exercise heart rate recovery and poor ventilatory efficiency. The low CRF group also had higher NT pro-BNP, hs-CRP, non-fasting glucose concentrations and lower haemoglobin and haematocrit. Five-year mortality risk (CALIBER risk score) was also greatest in the lowest CRF group (14.9%). Conclusion: Practitioners should interpret low CRF as an important clinical risk factor associated with adverse cardiometabolic health and poor prognosis. Study registry; researchregistry.com (researchregistry3548). Key Words: Coronary Heart Disease, Cardiac Rehabilitation, Cardiometabolic Health, Exercise Training, Atherosclerosis, VO2peak, Maximal Cardiopulmonary Exercise Testing, Caliber 5-year ris

Application of light shelves in a refurbished student dormitory: Energy, lightings and comfort aspects

The transparent elements of the building envelope have a crucial role not only in term of heat and mass transfers control, but also for natural light penetration, sound insulation, thermal and visual comfort of the occupants and their health. Among passive technologies, the light shelves could be architectural solutions for improving daylight penetration and for controlling thermal loads. The available research papers usually focus on one aspect. For this reason, the aim of the present study is to analyse the application of the light shelves with multidisciplinary approach and thus, taking into account: daylight, electricity for lighting, cooling and heating needs and thermo-hygrometric comfort. The case study is a real dormitory building placed in Athens and subject to a deep energy renovation toward the nearly zero energy building target. EnergyPlus, by means of DesignBuilder interface, has been used as dynamic simulation tool. Among ten different configurations, the optimal one turns out to be the internal horizontal light shelf placed at 50 cm from the top of the window with a depth of 90 cm or 60 cm. It has been found that in some cases the reduction of electricity for lighting cannot balance the variation in heating and cooling needs

Multi-disciplinary analysis of light shelves application within a student dormitory refurbishment

The achievement of sustainable cities and communities is closely linked to an accurate design of the buildings. In this context, the transparent elements of the building envelope have a crucial role since, on one hand, they are a bottleneck in regards to heat and mass transfers and sound propagation, while, on the other hand, they must allow daylight penetration. Thus, they are responsible for occupants' thermal and visual comfort and their health. Considering passive solutions for windows, the light shelves can improve natural light penetration, reducing the lights' electricity demand and controlling windows' related thermal aspects. The scientific literature is characterized by several studies that analyze this topic, which, however, focus only on the daylight field and sometimes the energy saving for lights. Moreover, they often refer to fixed sky type for the simulations. The aim of the present study is to analyze the application of the light shelves with a multi-disciplinary approach, by means of dynamic simulations, in the EnergyPlus engine, for a whole year. A new methodological approach is presented in order to investigate the technology under different fields of interest: daylight, lighting energy, cooling and heating needs, and thermo-hygrometric comfort. The case study chosen is an existing building, a student dormitory belonging to the University of Athens. It is subject to a deep energy renovation to conform to the "nearly Zero Energy Building" target, in the frame of a European research project called Pro-GET-onE (G.A No. 723747). By means of the calibrated numerical model of this HVAC-building system, ten different configurations of light shelves have been investigated. The best solution is given by the application of an internal horizontal light shelf placed at 50 cm from the top of the window with a depth of 90 or 60 cm. It has been found that despite the reduction in electricity demand for lighting, the variation in heating and cooling needs does not always lead to a benefit

Multifocality and multicentricity are not contraindications for sentinel lymph node biopsy in breast cancer surgery

Background: After the availability of the results of validation studies, the sentinel lymph node biopsy (SLNB) has replaced routine axillary dissection (AD) as the new standard of care in early unifocal breast cancers. Multifocal (MF) and multicentric (MC) tumors have been considered a contraindication for this technique due to the possible incidence of a higher false-negative rate. This prospective study evaluates the lymphatic drainage from different tumoral foci of the breast and assesses the accuracy of SLNB in MF-MC breast cancer. Patients and methods: Patients with preoperative diagnosis of MF or MC infiltrating and clinically node-negative (cN0) breast carcinoma were enrolled in this study. Two consecutive groups of patients underwent SLN mapping using a different site of injection of the radioisotope tracer: a) "2ID" Group received two intradermal (ID) injections over the site of the two dominant neoplastic nodules. A lymphoscintigraphic study was performed after each injection to evaluate the route of lymphatic spreading from different sites of the breast. b) "A" Group had periareolar (A) injection followed by a conventional lymphoscintigraphy. At surgery, both radioguided SLNB (with frozen section exam) and subsequent AD were planned, regardless the SLN status. Results: A total 31 patients with MF (n = 12) or MC (n = 19) invasive, cN0 cancer of the breast fulfil the selection criteria. In 2 ID Group (n = 15) the lymphoscintigraphic study showed the lymphatic pathways from two different sites of the breast which converged into one major lymphatic trunk affering to the same SLN(s) in 14 (93.3%) cases. In one (6.7%) MC cancer two different pathways were found, each of them affering to a different SLN. In A Group (n = 16) lymphoscintigraphy showed one(93.7%) or two (6.3%) lymphatic channels, each connecting areola with one or more SLN(s). Identification rate of SLN was 100% in both Groups. Accuracy of frozen section exam on SLN was 96.8% (1 case of micrometastasis was missed). SLN was positive in 13 (41.9%) of 31 patients, including 4 cases (30.7%) of micrometastasis. In 7 of 13 (53.8%) patients the SLN was the only site of axillary metastasis. SLNB accuracy was 96.8% (30 of 31), sensitivity 92.8 (13 of 14), and false-negative rate 7.1% (1 of 14). Since the case of skip metastasis was identified by the surgeon intracoperatively, it would have been no impact in the clinical practice. Conclusion: Our lymphoscintigraphic study shows that axillary SLN represents the whole breast regardless of tumor location within the parenchyma. The high accuracy of SLNB in MF and MC breast cancer demonstrates, according with the results of other series published in the literature, that both MF and MC tumors do not represent a contraindication for SLNB anymore

Unfavourable gender effect of high body mass index on brain metabolism and connectivity

The influence of Body Mass Index (BMI) on neurodegeneration in dementia has yet to be elucidated. We aimed at exploring the effects of BMI levels on cerebral resting-state metabolism and brain connectivity, as crucial measures of synaptic function and activity, in a large group of patients with Alzheimer\u2019s Dementia (AD) (n = 206), considering gender. We tested the correlation between BMI levels and brain metabolism, as assessed by18F-FDG-PET, and the modulation of the resting-state functional networks by BMI. At comparable dementia severity, females with high BMI can withstand a lower degree of brain metabolism dysfunction, as shown by a significant BMI-brain metabolism correlation in the temporal-parietal regions, which are typically vulnerable to AD pathology (R = 0.269, p = 0.009). Of note, high BMI was also associated with reduced connectivity in frontal and limbic brain networks, again only in AD females (p < 0.05 FDR-corrected, k = 100 voxels). This suggests a major vulnerability of neural systems known to be selectively involved in brain compensatory mechanisms in AD females. These findings indicate a strong gender effect of high BMI and obesity in AD, namely reducing the available reserve mechanisms in female patients. This brings to considerations for medical practice and health policy

Molecular Landscape and Association with Crohn Disease of Poorly Cohesive Carcinomas of the Nonampullary Small Bowel

Objectives: Poorly cohesive carcinomas (PCCs) are neoplasms defined by a predominantly dyshesive growth pattern with single cell or cord-like stromal infiltration. The -distinctive clinicopathologic and prognostic features of small bowel PCCs (SB-PCCs) in comparison with conventional-type small intestinal adenocarcinomas have only recently been characterized. However, as SB-PCCs' genetic profile is still unknown, we aimed to analyze the molecular landscape of SB-PCCs. Methods: A next-generation sequencing analysis through Trusight Oncology 500 on a series of 15 nonampullary SB-PCCs was performed. Results: The most frequently found gene alterations were TP53 (53%) and RHOA (13%) mutations and KRAS amplification (13%), whereas KRAS, BRAF, and PIK3CA mutations were not identified. Most SB-PCCs (80%) were associated with Crohn disease, including both RHOA-mutated SB-PCCs, which featured a non-SRC-type histology, and showed a peculiar appendiceal-type, low-grade goblet cell adenocarcinoma (GCA)-like component. Rarely, SB-PCCs showed high microsatellite instability, mutations in IDH1 and ERBB2 genes, or FGFR2 amplification (one case each), which are established or promising therapeutic targets in such aggressive cancers. Conclusions: SB-PCCs may harbor RHOA mutations, which are reminiscent of the diffuse subtype of gastric cancers or appendiceal GCAs, while KRAS and PIK3CA mutations, commonly involved in colorectal and small bowel adenocarcinomas, are not typical of such cancers

Simultaneous PET-MRI Studies of the Concordance of Atrophy and Hypometabolism in Syndromic Variants of Alzheimer's Disease and Frontotemporal Dementia: An Extended Case Series

Background: Simultaneous PET-MRI is used to compare patterns of cerebral hypometabolism and atrophy in six different dementia syndromes. Objectives: The primary objective was to conduct an initial exploratory study regarding the concordance of atrophy and hypometabolism in syndromic variants of Alzheimer’s disease (AD) and frontotemporal dementia (FTD). The secondary objective was to determine the effect of image analysis methods on determination of atrophy and hypometabolism. Method: PET and MRI data were acquired simultaneously on 24 subjects with six variants of AD and FTD (n = 4 per group). Atrophy was rated visually and also quantified with measures of cortical thickness. Hypometabolism was rated visually and also quantified using atlas- and SPM-based approaches. Concordance was measured using weighted Cohen’s kappa. Results: Atrophy-hypometabolism concordance differed markedly between patient groups; kappa scores ranged from 0.13 (nonfluent/agrammatic variant of primary progressive aphasia, nfvPPA) to 0.49 (posterior cortical variant of AD, PCA). Heterogeneity was also observed within groups; the confidence intervals of kappa scores ranging from 0–0.25 for PCA to 0.29–0.61 for nfvPPA. More widespread MRI and PET changes were identified using quantitative methods than on visual rating. Conclusion: The marked differences in concordance identified in this initial study may reflect differences in the molecular pathologies underlying AD and FTD syndromic variants but also operational differences in the methods used to diagnose these syndromes. The superior ability of quantitative methodologies to detect changes on PET and MRI, if confirmed on larger cohorts, may favor their usage over qualitative visual inspection in future clinical diagnostic practic