Our experimental results demonstrated that the readout circuitry offers an ultrahigh spectral resolution (0.8 keV at 60 keV and 1.05 keV at 122 keV) with the Cd(Zn)Te/HEXITEC ASIC modules tested. This architecture was designed to allow easy expansion to accommodate a larger number of detector modules, and the flexibility of arranging the detector modules in a large and deformable detector array without degrading the excellent energy resolution.Objective  To evaluate and compare subscapular muscle function among patients undergoing subscapular tenotomy (Group A) and lesser tuberosity osteotomy (Group B), in patients treated with total and partial anatomic shoulder arthroplasty for primary osteoarthrosis. Methods  Retrospective study of patients with primary glenohumeral osteoarthrosis surgically undergoing total or partial anatomic shoulder prosthesis implant, evaluated by clinical examination, imaging exams, analogue pain scale and Constant and Murley functional score. A total of 28 patients were evaluated, totalizing a sample of 32 operated shoulders. The minimum follow-up was of 12 months (mean 47.45 months). Results  Among patients submitted to subscapularis tendon tenotomy, 10 had an ultrasound with total rupture of its thickness (56%). All of the patients of the group B showed lesser tuberosity healing. There was no difference between groups comparing strength evaluated by Belly press and Bear hug tests as well as clinical outcome, through the Constant and Murley score. Conclusions  We did not find differences between Groups A and B evidenciated by comparing strength in the Lift-off test, in the Belly press and Bear hug tests and through he Constant and Murley score.Objectives  To demonstrate the prevalence of depression and anxiety symptoms in patients with carpal tunnel syndrome treated at a hand surgery outpatient clinic and to describe the clinical and epidemiological characteristics of this population. Methods  People diagnosed with carpal tunnel syndrome at the initial visit were evaluated over a 6-month period for data collection. Clinical and epidemiological characteristics were noted, and patients diagnosed with anxiety and/or depression were evaluated. Results  In total, 101 people had carpal tunnel syndrome, including 38 diagnosed with depression and 29 with anxiety. Most patients were low-income women, with elementary school-level education. More than half of the patients had at least one associated systemic comorbidity. Conclusion  Independent characteristics that statistically influenced anxiety and depression symptoms in patients with carpal tunnel syndrome were gender, smoking, and family income ( p   less then  0.05).Diabetes is a systemic disease that has achieved epidemic proportions in modern society. Ulcers and infections are common complications in the feet of patients with advanced stages of the disease, and are the main cause of amputation of the lower limb. Peripheral neuropathy is the primary cause of loss of the protective sensation of the feet and frequently leads to plantar pressure ulcers and osteoarticular disruption, which in turn develops into Charcot neuropathy (CN). ACSS2inhibitor Common co-factors that add to the morbidity of the disease and the risk of amputation in this population are obesity, peripheral arterial disease, immune and metabolic disorders. Orthopedic surgeons must be aware that the early detection and prevention of these comorbidities, through diligent medical care and patient education, can avoid these amputations.Sublimation vapor pressures of nine pure perfluoroalkyl substances, including Ammonium perfluoro(2-methyl-3-oxahexanoate) (GenX), 1H,1H,2H,2H-Perfluoro-1-decanol (82 FTOH), 1H,1H,2H,2H-Perfluoro-1-dodecanol (102 FTOH) and C6 to C11 perfluorocarboxylic acids (PFCAs), were measured using the Knudsen technique at near ambient temperatures. Melting temperatures and fusion enthalpies of these compounds were also measured using differential scanning calorimetry. The vapor pressure of GenX ammonium salt is comparable to that of the much higher molecular weight perfluoroundecanoic acid. GenX ammonium salt also did not show actual melting behavior but instead decomposed at around 470 K. The measured near ambient temperature sublimation vapor pressures of the PFCAs and FTOHs were compared with some earlier reported liquid phase vapor pressures obtained at higher temperatures, and reasonable agreement exists between the data obtained in the different studies. The sublimation enthalpies of the PFCAs indicate that the contribution to the sublimation enthalpy of the CF2 group in the alkyl chain is comparable to that of the CH2 group in the corresponding non-fluorinated analogues, even though the PFCAs show consistently higher vapor pressures than do the corresponding carbon number alkanoic acids.The lack of quantitative risk assessment of airborne transmission of COVID-19 under practical settings leads to large uncertainties and inconsistencies in our preventive measures. Combining in situ measurements and computational fluid dynamics simulations, we quantify the exhaled particles from normal respiratory behaviors and their transport under elevator, small classroom, and supermarket settings to evaluate the risk of inhaling potentially virus-containing particles. Our results show that the design of ventilation is critical for reducing the risk of particle encounters. Inappropriate design can significantly limit the efficiency of particle removal, create local hot spots with orders of magnitude higher risks, and enhance particle deposition causing surface contamination. Additionally, our measurements reveal the presence of a substantial fraction of faceted particles from normal breathing and its strong correlation with breathing depth.Geometrically smooth spline surfaces, generalized to include n-sided facets or configurations of n ≠ 4 quads, can exhibit a curious lack of additional degrees of freedom for modelling or engineering analysis when refined. This paper establishes a minimal polynomial degree for smooth constructions of multi-sided surfaces that guarantees more flexibility in all directions under refinement. Degree bi-4 is both necessary and sufficient for flexibility-increasing G1-refinability within a bi-quadratic C1 spline complex. Sufficiency is proven by two alternative flexibly G1-refinable constructions exhibiting good highlight line distributions.In patients with cardiac implantable electronic devices (CIEDs) (implantable cardioverter-defibrillators [ICDs] and pacemakers [PMs]), the potential risk of suddenly being unable to drive, and hence of causing road accidents, is higher than in the general population. In ICD patients, this risk stems from the possibility that an arrhythmic event leading to loss of consciousness may occur while driving. In PM patients, it may be the result of a device malfunction in a PM-dependent patient. To determine a CIED patient’s ability to drive, two variables must be taken into account (i) the risk of events, which depends on the type of underlying heart disease (ICD patients have a higher risk than PM patients); (ii) the time spent driving and the type of vehicle driven (professional drivers are at higher risk than private drivers). This position paper reports the recommendations of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) regarding driving by patients with CIEDs, on the basis of the available literature and the European reference recommendations.Accidental lead misplacement in the left ventricle is a rare complication, which should be diagnosed early and treated with lead removal. In case of late diagnosis, chronic anticoagulant therapy or, if the patient needs cardiac surgery for other reasons, surgical lead removal are recommended. In the present case, lead misplacement occurred at the time of a traditional pacemaker implantation due to bradycardia.

The service strategy (same-day transfer between the spoke hospital and the hub center with catheterization laboratory facility to perform invasive procedures) has been shown to improve the management of patients with non-ST-elevation acute coronary syndrome admitted to spoke hospitals. However, few data exist about the safety of this strategy and, in particular, the safety of retransferring patients to spoke centers immediately after successful percutaneous coronary intervention.

We used data from a prospective registry to retrospectively describe the application, performance and outcome of the service strategy in the daily clinical practice in our province, organized in 5 spoke hospitals and a hub center in Reggio Emilia, Italy.

From January 2013 to December 2017, 1183 consecutive patients were admitted to the cath-lab in the hub center from spoke hospitals with a diagnosis of non-ST-elevation acute coronary syndrome. Mean age was 68 ± 12 years, with a mean GRACE risk score of 137 ± 3. Overall, 1063 pae strategy in our provincial network in patients with non-ST-elevation acute coronary syndrome admitted to spoke centers allowed an early access to the cath-lab as recommended by international guidelines. The safety of the service strategy is confirmed in our experience, with no major adverse events occurring during the back transfer.Inappropriate prescribing of diagnostic procedures and treatments should be avoided for good medical practice. Furthermore, the therapeutic plan of each patient should be regularly revised, activating deprescription procedures to reduce the dosage or to discontinue unnecessary drugs. It has widely been reported that the number of drugs taken by each patient increases over the years and adverse events caused by polypharmacy therapy are increasingly reported. Polypharmacy is due to multimorbidity related to longer life expectancy, but it is also induced by drug manufacturers‘ pressures, the practice of prescribing one product to counteract the adverse effects of another, the division into subspecialties inducing clinicians to solve the specific problem regardless of the patient therapeutic profile, and the uncritical implementation of current guidelines. The recommendations published by scientific societies for the international Choosing Wisely project allow to identify practices at risk of inappropriateness, and programs are available to help evaluating the risks of several drug associations, taking into consideration different aspects of pharmacology, drug interactions, potentially inappropriate in the elderly, according to different criteria from the scientific literature. The safety of reducing or withdrawing under strict medical supervision some cardiovascular treatments has been demonstrated, with documented benefits for the patients.In elderly patients with heart failure and an indication for implantable cardioverter defibrillator (ICD) implantation, the incidence of sudden cardiac death (SCD) increases progressively with age, up to 80-85 years. ICD implantation is a recognized therapy, included in the guidelines for the prevention of SCD in the general population, which is also applied to elderly patients, albeit in an uneven manner, given the lack of robust data in the literature. In fact, the average age of patients included in the main randomized trials on ICDs is about 60 years. All this brings to a series of doubts in this regard, compounded by recent studies that have raised the suspicion of therapeutic futility in the implantation of ICDs in primary prevention in subjects aged ≥70 years, especially in the absence of ischemic heart disease. In the elderly, although the risk of SCD does not vary, the mortality rate for other causes tends progressively to increase with age, as the main consequence of the simultaneous presence of situations such as frailty syndrome and comorbidity.