Out-of-plane performance of structurally and energy retrofitted masonry walls: geopolymer versus cement-based textile-reinforced mortar combined with thermal insulation.

This paper examines the out-of-plane performance of masonry walls (representative of infills in reinforced concrete frames) which have been upgraded with an outer skin of integrated structural and an energy retrofitting system. The benefits of such an integrated system are mainly cost-related. Nevertheless, before moving to full-scale applications, additional benefits to the structural performance need to be investigated. In this study, the examined configurations of this composite system comprised either thermal insulation boards bonded directly to the wall followed by layers of textile-reinforced mortar (TRM), or thermal insulation boards bonded in-between two TRM layers. Other than the retrofitting layers configuration, the following parameters were also investigated: a) the binder type (cement-based versus geopolymer-based mortars), and b) the textile type (open mesh glass fibre textile versus basalt fibre textile). The results of this experimental study are discussed in terms of failure modes, post-cracking stiffness and ultimate capacities. Overall, this study highlights the mechanical benefits of the TRM plus thermal insulation system while providing insights on the bond performance between the different materials selected. An important finding is that the integrated system is even more effective than a standard TRM application. Finally, the geopolymer mortar seems to be equivalent in terms of performance to the commercially available cement-based mortars.

The research presented herein deals with novel composite materials for structurally and energy deficient masonry buildings. The paper offers practical insights into integration of standard energy retrofitting and structural retrofitting using innovative and sustainable materials such as geopolymer mortars reinforced with basalt or glass textiles. Geopolymers, which belong to the family of alkali-activated materials (AAM), are innovative inorganic polymers, which can be used as binding materials in construction. Geopolymer-based mortars have the potential to reduce the construction sector's CO ₂ emissions by replacing Ordinary Portland Cement (OPC). Such mortars can be used as binders for open mesh textiles and their production is associated with less CO ₂ emissions compared to OPC-based binders. The use of low-cost basalt and glass textiles allows for good balance between cost and efficiency. Such advanced composite systems combined with thermal insulation and applied to the envelopes of buildings can tackle both structural and energy deficiencies and yet offer a low carbon footprint at a reasonable cost.

Environmental and Psychophysical Heat Stress in Adolescent Tennis Athletes.

PURPOSE: We investigated the environmental conditions in which all outdoor International Tennis Federation (ITF) junior tournaments (athlete ages: <18 y) were held during 2010-2019. Thereafter, we performed a crossover trial (ClinicalTrials.gov: NCT04197375) assessing the efficacy of head-neck precooling for mitigating the heat-induced psychophysical and performance impacts on junior athletes during tennis match play. METHODS: ITF junior tournament information was collected. We identified meteorological data from nearby (13.6 [20.3] km) weather stations for 3056 (76%) tournaments. RESULTS: Overall, 30.1% of tournaments were held in hot (25°C-30°C wet-bulb globe temperature [WBGT]; 25.9%), very hot (30°C-35°C WBGT; 4.1%), or extremely hot (>35°C WBGT; 0.1%) conditions. Thereafter, 8 acclimatized male junior tennis athletes (age = 16.0 [0.9] y; height = 1.82 [0.04] m; weight = 71.3 [11.1] kg) were evaluated during 2 matches: one with head-neck precooling (27.7°C [2.2°C] WBGT) and one without (27.9°C [1.8°C] WBGT). Head-neck precooling reduced athletes' core temperature from 36.9°C (0.2°C) to 36.4°C (0.2°C) (P = .001; d = 2.4), an effect reduced by warm-up. Head-neck precooling reduced skin temperature (by 0.3°C [1.3°C]) for the majority of the match and led to improved (P < .05) perceived exertion (by 13%), thermal comfort (by 14%), and thermal sensation (by 15%). Muscle temperature, heart rate, body weight, and urine specific gravity remained unaffected (P ≥ .05; d < 0.2). Small or moderate improvements were observed in most performance parameters assessed (d = 0.20-0.79). CONCLUSIONS: Thirty percent of the last decade's ITF junior tournaments were held in hot, very hot, or extremely hot conditions (25°C-36°C WBGT). In such conditions, head-neck precooling may somewhat lessen the physiological and perceptual heat strain and lead to small to moderate improvements in the match-play performance of adolescent athletes.

Prevalence of "distressed" personality in patients with coronary artery disease and its correlation with morbidity after coronary surgery.

INTRODUCTION: The "distressed" (Type-D) personality is an emerging risk factor in cardiovascular diseases and is associated with an increased risk of impaired quality of life, morbidity and mortality. The purpose of this study was to explore the prevalence of Type-D personality among patients with coronary artery disease (CAD) and its association with the development of complications following coronary artery bypass grafting surgery. METHODS: A Greek version of the Type-D Personality Scale-14 (DS14), along with the Hospital Anxiety and Depression Scale (HADS) as well as the Ways of Coping Questionnaire (WCQ), were used. A cohort of 323 patients with CAD was examined. RESULTS: The prevalence of Type-D personality among Greek patients with CAD was found to be 18.24%. Type-D patients showed a higher rate of anxiety and depression compared to non Type-D patients. Type-D was also associated with passive coping and negatively correlated with active coping. Regarding postoperative morbidity, type-D patients were at an increased risk of developing postoperative atrial fibrillation, while no significant differences were found in the development of any other complication. CONCLUSIONS: The impact of Type-D personality on health outcomes should be studied further, both in clinical samples and in the general population.

Granulomas Formation in Lymph Nodes, Liver and Spleen in Adult-Onset Still's Disease: A Case Report.

Tissue granulomas formation in adult-onset Still's disease (AOSD) is extremely rare. We describe a case of AOSD associated with formation of granulomatous lesions in lymph nodes, liver and presumably spleen. The high dose steroid-dependent nature of our patient's illness, characterized by disease relapses when methylprednisolone dose was reduced below 10 mg/d, was overwhelmed with institution of anakinra (100 mg/d). The histologic finding of granulomas formation in lymph nodes, liver or spleen should not deter the consideration of AOSD as a potential diagnosis in a compatible clinical context; however, other more common etiologies of tissue granulomas formation should be first excluded.

Use of minimal extracorporeal circulation improves outcome after heart surgery; a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: The question whether use of minimal extracorporeal circulation (MECC) influences patients' outcome remains unanswered. We performed a systemic review of the literature and a meta-analysis of randomized controlled trials to evaluate the impact of MECC compared to conventional extracorporeal circulation (CECC) on mortality and major adverse cardiovascular events in patients undergoing heart surgery. METHODS: We independently conducted a systemic review of English and non-English articles using Medline, Embase and Cochrane database. Random allocation to treatment with a minimum of 40 patients in both groups was considered mandatory for inclusion in the meta-analysis. Primary outcomes were operative mortality and major adverse cardiac and cerebrovascular events comprising death before discharge, myocardial infarction and neurologic damage. RESULTS: We included 24 studies comparing MECC vs. CECC with a total of 2770 patients. Use of MECC was associated with a significant decrease in mortality (0.5% vs. 1.7%, P=0.02), in the risk of postoperative myocardial infarction (1.0% vs. 3.8%, P=0.03) and reduced rate of neurologic events (2.3% vs. 4.0%, P=0.08). Additionally, MECC was associated with reduced systemic inflammatory response as measured by polymorphonuclear elastase, hemodilution as calculated by hematocrit drop after procedure, need for red blood cell transfusion, reduced levels of peak troponin release, incidence of low cardiac output syndrome, need for inotropic support, peak creatinine level, occurrence of postoperative atrial fibrillation, duration of mechanical ventilation and intensive care unit stay. CONCLUSIONS: Use of MECC in heart surgery resulted in improved short-term outcome as reflected by reduced mortality and morbidity compared with conventional extracorporeal circulation.

Elevated levels of anti inflammatory IL-10 and pro inflammatory IL-17 in malignant pleural effusions.

BACKGROUND: Pleural effusions can be caused by highly different underlying diseases and are characterized by complex interactions of various local and circulating cells as well as numerous soluble parameters like interleukins (IL). Knowledge of this complex network can be helpful in order to make the differential diagnosis in known malignant pleural effusions and understand the underlying immunochemistry of each disease or condition. METHODS: We investigated immunoreactive concentrations of Interleukin 10 (IL-10) and Interleukin 17 (IL-17) in malignant pleural effusions and peripheral blood from patients with bronchial carcinomas and other carcinomas, excluding other conditions such as congestive heart failure (CHF) and pneumonias in twenty four (24) patients (9 men/15 women), 37-74 years (mean:61) with already diagnosed malignant pleural effusions applying the ELISA method. RESULTS: The SPSS 15 program for Windows was used. Quantitative analysis showed high concentrations of IL-10 and IL-17 in pleural fluid and blood. Even though IL-17 levels -both blood and pleural- were lower than IL-10's, statistical correlation between blood and pleural concentations was proven, confirming once more the systematic action of these cytokines. At the same time high IL-17 levels in malignant effusions shows maybe a new perspective in understanding the pathophysiology of malignant pleural effusions. CONCLUSIONS: Our results confirm the pathogenetic role of these cytokines in malignant pleural effusions combining for the first time a pro- and an anti- inflammatory cytokine. The observation that IL-17 is elevated in malignant pleural effusions may give a new meaning in Virchow's remarks 100 years ago. Larger number of patients is needed to confirm our hypothesis.

Suppurative necrotizing granulomatous lymphadenitis in adult-onset Still's disease: a case report.

INTRODUCTION: Lymphadenopathy is found in about 65% of patients with adult-onset Still's disease and is histologically characterized by an intense, paracortical immunoblastic hyperplasia. Adult-onset Still's disease has not been previously described as an etiology of suppurative necrotizing granulomatous lymphadenitis. CASE PRESENTATION: We describe a 27-year-old Greek man who manifested prolonged fever, abdominal pain, increased inflammatory markers, episodic skin rash and mesenteric lymphadenopathy histologically characterized by necrotizing granulomatous adenitis with central suppuration. Disease flares were characterized by systemic inflammatory response syndrome with immediate clinico-laboratory response to corticosteroids but the patient required prolonged administration of methylprednisolone at a dose of above 12mg/day for disease control. After an extensive diagnostic work-up, which ruled out any infectious, malignant, rheumatic or autoinflammatory disease the patient was diagnosed as having adult-onset Still's disease. The patient is currently treated with 4mg of methylprednisolone, 100mg of anakinra daily and methotrexate 7.5mg for two consecutive days per week and exerts full disease remission for six months. CONCLUSION: To the best of our knowledge this is the first report of suppurative necrotizing granulomatous lymphadenitis attributed to adult-onset Still's disease. This case indicates that the finding of a suppurative necrotizing granulomatous lymphadenitis should not deter the consideration of adult-onset Still's disease as a potential diagnosis in a compatible clinical context; however, the exclusion of other diagnoses is a prerequisite.

Pericardial patch tracheoplasty for the repair of a long, multisegmental postintubation tracheal damage.

A 64-year-old man was admitted with a postintubation, multisegmental tracheal damage comprising of two stenotic lesions, below and above a tracheotomy. The patient underwent resection of the damaged anterolateral tracheal wall through a combined collar-cuff and median sternotomy incision and tracheoplasty with autologous pericardium around a Silastic T-tube that was fixed to the cricoid cartilage, healthy distal trachea, and the remaining membranous wall. The postoperative period was complicated with a deep sternal wound infection that was successfully treated with vacuum-assisted closure for 2 weeks. Removal of the T-tube 9 months later resulted in a patent and well-functioning airway. Pericardial patch tracheoplasty and T-tube stenting of the repair for several months is a good alternative to extended tracheal resection for the treatment of the rare long, postintubation multisegmental tracheal damage. The pericardial patch is highly resistant to infection and allows the formation of a neotrachea.

A modified two-port thoracoscopic technique versus axillary minithoracotomy for the treatment of recurrent spontaneous pneumothorax: a prospective randomized study.

BACKGROUND: Currently, most thoracic surgeons perform surgical pleurodesis for recurrent spontaneous pneumothorax (RSP) by video-assisted thoracic surgery (VATS). However, the superiority of VATS over axillary minithoracotomy is not been established in prospective studies to date. A modified two-port VATS technique and axillary minithoracotomy were prospectively evaluated for possible differences in the short- and long-term outcome for patients. METHODS: In this study, 66 consecutive patients underwent surgical pleurodesis for RSP through either a modified two-port VATS procedure (group A, 33 patients) or axillary minithoracotomy (group B, 33 patients). According to the study design (NCT01192217), the patients were randomly assigned to the two groups, which were similar in terms of age and body mass index. One-lung ventilation time, histology of the available lung parenchyma specimens, early postoperative complications, length of chest tube drainage and hospital stay, recurrence rate, and a score for patient satisfaction with treatment based on the sum of postoperative pain, dependent-arm mobilization, and return to full activity subscores were evaluated. The follow-up period varied from 3 to 53 months (median, 30 months). RESULTS: The one-lung ventilation and operating times were significantly longer (p < 0.001) in group A than in group B. The overall detection of blebs, bulla, or both was 51.5% in group A and 63.8% in group B. The recurrence rate, complication rate, postoperative chest tube drainage duration, postoperative hospital stay, and incidence of chronic pain did not differ between the two groups. The score for patient satisfaction with treatment was significantly higher in group A than in group B (p < 0.001) according the subscores for better dependent-arm mobilization and return to full activity. CONCLUSIONS: Axillary minithoracotomy and VATS are equally effective for the treatment of RSP, although the rate for resection of blebs, bulla, or both is higher with the axillary minithoracotomy procedure. Although VATS is more time consuming, it offers to the patient more satisfaction with treatment.

Left ventricular decompression during peripheral extracorporeal membrane oxygenation support with the use of the novel iVAC pulsatile paracorporeal assist device.

Extracorporeal membrane oxygenation (ECMO) has become a widely accepted short-term mechanical circulatory support device in patients with refractory cardiogenic shock. A major drawback of the peripheral venoarterial extracorporeal membrane oxygenation is that in patients with profoundly reduced left ventricular contractility associated with high left-heart filling pressure, there is always concern for venting the failing ventricle. We describe a minimally invasive technique for decompressing the left ventricle in this setting using a novel pulsatile paracorporeal assist device, the iVAC 3L (PulseCath, Groningen, The Netherlands). It is implanted through the right axillary artery and provides hemodynamic support while directly off-loading the left ventricle.

Use of minimal extracorporeal circulation circuit for left ventricular assist device implantation.

We describe successful use of a minimal extracorporeal circulation circuit (MECC) as an alternative to conventional cardiopulmonary bypass (CPB) for the implantation of left ventricular assist device (LVAD) in a 65-year-old patient with ischemic dilated cardiomyopathy. A Jarvik 2000 was implanted through a median sternotomy with the outflow graft anastomosed to the ascending aorta. MECC circuit provides optimal circulatory support throughout the procedure and prevents hemodynamic instability caused by marked displacement of the heart for exposure of the left ventricular apex, while minimizing the adverse effects of conventional CPB.

Use of minimized extracorporeal circulation system in noncoronary and valve cardiac surgical procedures-a case series.

The aim of this report is to explore application of minimized cardiopulmonary bypass (CPB) circuits in areas of cardiac surgery other than coronary bypass grafting and aortic valve surgery. We report three cases operated under minimal extracorporeal circulation support. Replacement of the descending thoracic aorta was performed in two patients; one with a descending aortic aneurysm and one with pseudoaneurysm formation after previous coarctation repair. We have also implanted a left ventricular assist device for destination therapy. The minimized extracorporeal circulation system provides optimal circulatory support, while it is associated with reduced postoperative morbidity, minimizing the side effects from the use of CPB. Moreover, when off-pump technique is attempted, it can be used as a standby circuit connected to the patient so as to enhance safety of the procedure. Minimized extracorporeal circulation systems can be used with safety and efficacy in a wide range of cardiac surgeries including descending aorta pathology and assist device implantation.

Neurocognitive outcome after coronary artery bypass surgery using minimal versus conventional extracorporeal circulation: a randomised controlled pilot study.

OBJECTIVE: Neurocognitive impairment can be a debilitating complication after cardiac surgery. The aim of this study was to assess the effect of minimal extracorporeal circulation (MECC) versus conventional extracorporeal circulation (CECC) on neurocognitive function after elective coronary artery bypass grafting (CABG) and whether this can be attributed to improved cerebral perfusion intraoperatively. METHODS AND RESULTS: 64 patients scheduled for elective CABG surgery were prospectively randomly assigned to surgical revascularisation with MECC versus CECC. All patients were continuously monitored for changes in cerebral oxygenation with near-infrared spectroscopy during the procedure. Neurocognitive assessment was performed before surgery, on the day of discharge and at 3 months postoperatively using a battery of standardised neurocognitive tests. Both groups were comparable in terms of demographic and clinical data. MECC was associated with improved cerebral perfusion during cardiopulmonary bypass (CPB). Eleven patients operated on with MECC and 17 with CECC experienced at least one episode of cerebral desaturation (38% vs 55%, p=0.04) with similar duration (10 vs 12.3 min, p=0.1). At discharge patients operated on with MECC showed a significantly improved performance on complex scanning, visual tracking, focused attention and long-term memory. At 3 months significantly improved performance was also evident on visuospatial perception, executive function, verbal working memory and short-term memory. Patients operated on with MECC experienced a significantly lower risk of early cognitive decline both at discharge (41% vs 65%, p=0.03) and at 3-month evaluation (21% vs 61%, p<0.01). CONCLUSIONS: Use of MECC attenuates early postoperative neurocognitive impairment after coronary surgery compared with conventional CPB. This finding may have important implications on the surgical management strategy for coronary artery disease. CLINICAL TRIAL REGISTRATION NUMBER: The study is registered at ClinicalTrials.gov, number NCT01213511.

The management of post-intubation tracheal stenoses with self-expandable stents: early and long-term results in 11 cases.

OBJECTIVE: The optimal management of post-intubation tracheal stenoses is surgical reconstruction of the airway. Stenting of the trachea using silastic T-tubes or one of the various types of tracheal stents are the alternative ways to surgical reconstruction for the management of post-intubation tracheal stenoses. The early and long-term results of 11 patients with post-intubation tracheal stenosis, who underwent tracheal stenting with self-expandable metallic stents (SEMSs), are presented. METHODS: Twelve patients (10 men, mean age: 47.8±20.4 years) with post-intubation tracheal stenosis were referred for tracheal stenting with SEMS (2000-2004). In three cases, the upper tracheal stenosis extended within the subglottic larynx. Stenting was successful in 11 patients, while, in one patient with involvement of the subglottic larynx, the attempt to insert the stent failed. Follow-up time varied from 6 to 96 months, and it was made with virtual and fiberoptic bronchoscopy. RESULTS: Immediate relief of obstructive symptoms was observed in all the 11 patients, where an SEMS was successfully inserted. Stent dislodgement occurred shortly after the procedure in two patients, and it was treated with insertion of a new stent in the first case and a stent-on-stent insertion in the second. Good patency of the stent was observed in three patients for 60-96 months. Three patients with good patency of the stent died from other reasons 24-48 months after stent insertion. Four patients developed obstructive granulation tissue at the ends of the stent after 12-43 months, requiring further treatment with thermal lasers and/or tracheostomy. One patient underwent stent removal and successful laryngotracheal reconstruction 6 months after stent insertion. CONCLUSIONS: The application of SEMS in post-intubation tracheal stenoses results in immediate improvement of obstructive symptoms without significant perioperative complications. SEMSs have the potential risks of migration and of granulation tissue formation at the end of the stent. SEMS should be applied only in strictly selected patients with post-intubation tracheal stenosis, who are considered unfit for surgery and/or with limited life expectancy.

Hybrid approach of ventricular assist device and autologous bone marrow stem cells implantation in end-stage ischemic heart failure enhances myocardial reperfusion.

We challenge the hypothesis of enhanced myocardial reperfusion after implanting a left ventricular assist device together with bone marrow mononuclear stem cells in patients with end-stage ischemic cardiomyopathy. Irreversible myocardial loss observed in ischemic cardiomyopathy leads to progressive cardiac remodelling and dysfunction through a complex neurohormonal cascade. New generation assist devices promote myocardial recovery only in patients with dilated or peripartum cardiomyopathy. In the setting of diffuse myocardial ischemia not amenable to revascularization, native myocardial recovery has not been observed after implantation of an assist device as destination therapy. The hybrid approach of implanting autologous bone marrow stem cells during assist device implantation may eventually improve native cardiac function, which may be associated with a better prognosis eventually ameliorating the need for subsequent heart transplantation. The aforementioned hypothesis has to be tested with well-designed prospective multicentre studies.