Study of hybrid nanofluid flow in a stationary cone-disk system with temperature-dependent fluid properties

Cone-disk systems find frequent use such as conical diffusers,medical devices,various rheometric,and viscosimetry applications.In this study,we investigate the three-dimensional flow of a water-based Ag-Mg O hybrid nanofluid in a static cone-disk system while considering temperature-dependent fluid properties.How the variable fluid properties affect the dynamics and heat transfer features is studied by Reynolds's linearized model for variable viscosity and Chiam's model for variable thermal conductivity.The single-phase nanofluid model is utilized to describe convective heat transfer in hybrid nanofluids,incorporating the experimental data.This model is developed as a coupled system of convective-diffusion equations,encompassing the conservation of momentum and the conservation of thermal energy,in conjunction with an incompressibility condition.A self-similar model is developed by the Lie-group scaling transformations,and the subsequent self-similar equations are then solved numerically.The influence of variable fluid parameters on both swirling and non-swirling flow cases is analyzed.Additionally,the Nusselt number for the disk surface is calculated.It is found that an increase in the temperature-dependent viscosity parameter enhances heat transfer characteristics in the static cone-disk system,while the thermal conductivity parameter has the opposite effect.

Chemically Radiative MHD Flow of a Micropolar Nanofluid over a Stretching/ Shrinking Sheet with a Heat Source or Sink

This study examines the behavior of a micropolar nanofluidflowing over a sheet in the presence of a transverse magneticfield and thermal effects.In addition,chemical(first-order homogeneous)reactions are taken into account.A similarity transformation is used to reduce the system of governing coupled non-linear partial differ-ential equations(PDEs),which account for the transport of mass,momentum,angular momentum,energy and species,to a set of non-linear ordinary differential equations(ODEs).The Runge-Kutta method along with shoot-ing method is used to solve them.The impact of several parameters is evaluated.It is shown that the micro-rota-tional velocity of thefluid rises with the micropolar factor.Moreover,the radiation parameter can have a remarkable influence on theflow and temperature profiles and on the angular momentum distribution.

Does ergogenic effect of caffeine supplementation depend on CYP1A2 genotypes? A systematic review with meta-analysis

Background:The ergogenic effects of caffeine intake on exercise performance are well-established,even if differences exist among individuals in response to caffeine intake.The genetic variation of a specific gene,human cytochrome P450 enzyme 1A2(CYP1A2)(rs762551),may be one reason for this difference.This systematic review and meta-analysis aimed to comprehensively evaluate the influence of CYP1A2 gene types on athletes’exercise performance after caffeine intake.Methods:A literature search through 4 databases(Web of Science,PubMed,Scopus,and China National Knowledge Infrastructure)was conducted until March 2023.The effect size was expressed as the weighted mean difference(WMD)by calculating fixed effects meta-analysis if heterogeneity was not significant(I^(2)≤50%and p≥0.1).Subgroup analyses were performed based on AA and AC/CC genotype of CYP1A2.Results:The final number of studies meeting the inclusion criteria was 12(n=666 participants).The overall analysis showed that the cycling time trial significantly improved after caffeine intake(WMD=-0.48,95%confidence interval(95%CI):-0.83 to-0.13,p=0.007).In subgroup analyses,acute caffeine intake improved cycling time trial only in individuals with the A allele(WMD=-0.90,95%CI:-1.48 to-0.33,p=0.002),but not the C allele(WMD=-0.08,95%CI:-0.32 to 0.17,p=0.53).Caffeine supplementation did not influence the Wingate(WMD=8.07,95%CI:-22.04 to 38.18,p=0.60)or countermovement jump test(CMJ)performance(WMD=1.17,95%CI:-0.02 to 2.36,p=0.05),and these outcomes were not influenced by CYP1A2 genotype.Conclusion:Participants with the CYP1A2 genotype with A allele improved their cycling time trials after caffeine supplementation.However,compared to placebo,acute caffeine supplementation failed to increase the Wingate or CMJ performance,regardless of CYP1A2 genotype.

Effect of a triage course on quality of rating triage codes in a group of university nursing students:a before-after observational study

BACKGROUND:Most current triage tools have been tested among hospital nurses groups but there are not similar studies in university setting.In this study we analyzed if a course on a new fourlevel triage model,triage emergency method(TEM),could improve the quality of rating in a group of nursing students.METHODS:This observational study was conducted with paper scenarios at the University of Parma,Italy.Fifty students were assigned a triage level to 105 paper scenarios before and after a course on triage and TEM.We used weighted kappa statistics to measure the inter-rater reliability of TEM and assessed its validity by comparing the students' predictions with the triage code rating of a reference standard(a panel of five experts in the new triage method).RESULTS:Inter-rater reliability was K=0.42(95%Cl:0.37-0.46) before the course on TEM,and K=0.61(95%CI:0.56-0.67) after.The accuracy of students' triage rating for the reference standard triage code was good:81%(95%Cl:71-90).After the TEM course,the proportion of cases assigned to each acuity triage level was similar for the student group and the panel of experts.CONCLUSION:Among the group of nursing students,a brief course on triage and on a new inhospital triage method seems to improve the quality of rating codes.The new triage method shows good inter-rater reliability for rating triage acuity and good accuracy in predicting the triage code rating of the reference standard.

Mechanical stress and deformation analyses of pressurized cylindrical shells based on a higher-order modeling

In this research,mechanical stress,static strain and deformation analyses of a cylindrical pressure vessel subjected to mechanical loads are presented.The kinematic relations are developed based on higherorder sinusoidal shear deformation theory.Thickness stretching formulation is accounted for more accurate analysis.The total transverse deflection is divided into bending,shear and thickness stretching parts in which the third term is responsible for change of deflection along the thickness direction.The axisymmetric formulations are derived through principle of virtual work.A parametric study is presented to investigate variation of stress and strain components along the thickness and longitudinal directions.To explore effect of thickness stretching model on the static results,a comparison between the present results with the available results of literature is presented.As an important output,effect of micro-scale parameter is studied on the static stress and strain distribution.

Inchoative Apocalypses of the Human at the Time of the Anthropocene

In the Apocalypse,the chiliastic-eschatological meaning has been superimposed on the original literal meaning of dis-velation.A phenomenon,this one,seems to have favored the formation of neuralgic force fields between the end,the beginning,which in some way refer to each other,and precisely dis-velation.If the whole of history seems to be disseminated and sometimes informed by these fields,the Anthropocene temperament certainly does not seem to be an exception.The apocalyptic Anthropocene interstitial spaces are particularly crowded and lively and,among the many voices animating them,those of Serres,Latour,and the posthumanist perspective,to which the one and the other,so to speak,wink,are of particular interest.What the Serresian-Latourian posthuman apocalyptic Anthropocene force-field seems to be reviving is,so to speak,a new recognition of the already-since-ever-been,i.e.the recognition that the human has always been inchoative in and with the world in becoming in relationship,that the post has always been an engine,resistant to repetitiveness,obviousness and habit,that the new is this very recognition,and that the recognition of the already-since-ever-been is precisely action,dynamism,a process of construction(of human in and with the world).

Comparative Study of the Efficacy of Misoprostol and Oxytocin Im in the Prevention of Post-Partum haemorrhage in a Low-Resource Setting

Background: In developing countries, postpartum hemorrhage is responsible for 30% of maternal deaths. Although the World Health Organization recommends the use of oxytocin for the prevention of postpartum hemorrhage, the use of misoprostol is increasingly common. The objective of this study was to determine the frequency of postpartum hemorrhage in parturients delivering at Saint-Vincent Hospital and to compare the effectiveness of misoprostol use versus oxytocin in preventing postpartum hemorrhage. Material and Methods: We conducted a comparative longitudinal study at the Saint Vincent Hospital comparing 10 units of intramuscular oxytocin with 600 micrograms of sublingual misoprostol. The study was conducted from 01 January 2017 to 31 December 2019, a period of 3 years. The study population consisted of 2161 consenting women. Of these, 1289 received 10 IU of intramuscular oxytocin and 872 received 600 micrograms of misoprostol. The collected data were entered using Microsoft Excel 2013 and analysed using SPSS version 21 software. Results: The frequency of administration of Misoprostol and oxytocin in parturients was 40.4% and 59.6% respectively in this study. One hundred and fourteen cases of postpartum hemorrhage (114/2161 or 5.3%) were noted among the parturients. The average age of parturients who received oxytocin was 24.36 ± 4.45 years vs 24.63 ± 5.11 years among parturients who received Misoprostol;(p = 0.190). The mean parity was 2.52 ± 1.46 vs 2.66 ± 1.44;(p = 0.020). We noted a high proportion (78.3%) of postpartum hemorrhage from the oxytocin group vs. 21.7% from the Misoprostol group (OR 2.5-fold), with a statistically significant difference (p 0.001). We noted high proportions of uterine atony (92.3%) from the oxytocin group vs 7.7% from the Misoprostol group (p = 0.004). Uterine atony was the actual factor associated with postpartum hemorrhage (OR = 10.0895% CI: 1.78 - 57.10;p = 0.009). Conclusion: Misoprostol 600 Microgram administered sublingually immediately after neonatal expulsion and before delivery was 2.5 times more effective than oxytocin 10 IU/IM. Misoprostol is therefore a good alternative to oxytocin and offers more advantages in management, use and outcome than oxytocin.

Device-assisted enteroscopy: Are we ready to dismiss the spiral?

Motorized spiral enteroscopy(MSE)is the latest advance in device-assisted enteroscopy.Adverse events related to MSE were discussed in a recent large systematic review and meta-analysis and were directly compared with those of balloon enteroscopy in a case-matched study and a randomized controlled trial.Following the real-life application of MSE,an unexpected safety issue emerged regarding esophageal injury and the technique has been withdrawn from the global market,despite encouraging results in terms of diagnostic and therapeutic yield.We conducted an Italian multicenter real-life prospective study,which was prematurely terminated after the withdrawal of MSE from the market.The primary goals were the evaluation of MSE performance(both diagnostic and therapeutic)and its safety in routine endoscopic practice,particularly in the early phase of introduction in the endoscopic unit.A subanalysis,which involved patients who underwent MSE after unsuccessful balloon enteroscopy,demonstrated,for the first time,the promising performance of MSE as a rescue procedure.Given its remarkable performance in clinical practice and its potential role as a backup technique following a previously failed enteroscopy,it may be more appropriate to refine and enhance MSE in the future rather than completely abandoning it.

Caustic injury of the upper gastrointestinal tract: A comprehensive review

Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developingcountries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening.

From targeting the tumor to targeting the immune system: Transversal challenges in oncology with the inhibition of the PD-1/PD-L1 axis

After that the era of chemotherapy in the treatment of solid tumors have been overcome by the "translational era", with the innovation introduced by targeted therapies, medical oncology is currently looking at the dawn of a new "immunotherapy era" with the advent of immune checkpoint inhibitors(CKI) antibodies.The onset of PD-1/PD-L1 targeted therapy has demonstrated the importance of this axis in the immune escape across almost all human cancers.The new CKI allowed to significantly prolong survival and to generate durable response, demonstrating remarkable efficacy in a wide range of cancer types.The aim of this article is to review the most up to date literature about the clinical effectiveness of CKI antibodies targeting PD-1/PD-L1 axis for the treatment of advanced solid tumors and to explore transversal challenges in the immune checkpoint blockade.

Prevention of vertical transmission of hepatitis B virus infection

Hepatitis B virus(HBV)is the leading cause of chronic viral hepatitis.Annually,almost two million children younger than 5 years acquire the infection,mostly through vertical or horizontal transmission in early life.Vertical transmission of HBV is a high efficacy phenomenon ranging,in the absence of any preventive interventions,from 70%to 90%for hepatitis e antigen positive mothers and from 10%to 40%for hepatitis e antigen-negative mothers.Maternal viraemia is a preeminent risk factor for vertical transmission of HBV.Maternal screening is the first step to prevent vertical transmission of HBV.Hepatitis B passive and active immunoprophylaxis at birth together with antiviral treatment of highly viraemic mothers are the key strategies for global elimination of HBV infection.Strategies are needed to promote implementation of birth-dose vaccination and hepatitis B immunoglobulins in low-and middle-income countries where the prevalence of the infection is at the highest.

Short- and long-term efficacy of endoscopic balloon dilation in Crohn's disease strictures

AIM:To evaluate short- and long-term efficacy of endoscopic balloon dilation in a cohort of consecutive patients with symptomatic Crohn's disease (CD)-related strictures. METHODS:Twenty-six CD patients (11 men; median age 36.8 year, range 11-65 years) with 27 symptomatic strictures underwent endoscopic balloon dilation (EBD).Both naive and post-operative strictures, of any length and diameter, with or without associated fistula were included. After a clinical and radiological assessment, EBD was performed with a Microvasive Rigiflex through the scope balloon system. The procedure was considered successful if no symptom reoccurred in the following 6 mo. The long-term clinical outcome was to avoid surgery. RESULTS:The mean follow-up time was 40.7 ± 5.7 mo (range 10-94 mo). In this period, forty-six EBD were performed with a technical success of 100%. No procedure-related complication was reported. Surgery was avoided in 92.6% of the patients during the entire follow-up. Two patients, both presenting ileocecal strictures associated with fistula, failed to respond to the treatment and underwent surgical strictures resection. Of the 24 patients who did not undergo surgery, 11 patients received 1 EBD, and 13 required further dilations over time for the treatment of relapsing strictures (7 patients underwent 2 dilations, 5 patients 3 dilations, and 1 patient 4 dilations). Overall, the EBD success rate after the first dilation was 81.5%. No difference was observed between the EBD success rate for naive (n = 12) and post-operative (n = 15) CD related strictures (P > 0.05). CONCLUSION:EBD appears to be a safe and effective procedure in the therapeutic management of CD-related strictures of any origin and dimension in order to prevent surgery.

Lack of specific association between gastric autoimmunity hallmarks and clinical presentations of atrophic body gastritis

AIM: To investigate the possible relationships between gastric autoimmune phenomena and clinical presentations of this disorder, in consecutive atrophic body gastritis patients.METHODS: A total of 140 atrophic body gastritis patients,diagnosed as consecutive outpatients presenting with macrocytic or iron deficiency anemia, or longstanding dyspepsia underwent gastroscopy with antral and body biopsies, assay of intrinsic factor, parietal cells and Helicobacter pylori(H pylori) antibodies. Gastritis was assessed according to Sydney System.RESULTS: Parietal cell antibodies were equally distributed in all clinical presentations, whereas the positivity of intrinsic factor antibodies (49/140, 35%) was significantly higher in pernicious anemia patients (49.2%) than in iron deficiency (21.1%) and dyspeptic patients (27.8%). No specific pattern of autoantibodies was related to the clinical presentations of atrophic body gastritis. A positive correlation was obtained between the body atrophy score and the intrinsic factor antibody levels (r = 0.2216,P = 0.0085). Associated autoimmune diseases were present in 25/140 (17.9%) patients, but the prevalence of autoimmune diseases was comparable, irrespective of the clinical presentations.CONCLUSION: The so-called hallmarks of gastric autoimmunity, particularly in intrinsic factor antibody cannot be usefully employed in defining an autoimmune pattern in the clinical presentations of ABG.

Comparison of four proton pump inhibitors for the short-term treatment of esophagitis in elderly patients

AIM: To compare efficacy and tolerability of four proton pump inhibitors (PPIs) commonly used in the short-term therapy of esophagitis in elderly patients.METHODS: A total of 320 patients over 65 years with endoscopically diagnosed esophagitis were randomly assigned to one of the following treatments for 8 wk: (1) omeprazole 20 mg/d; (2) lansoprazole 30 mg/d; (3) pantoprazole 40 mg/d, or (4) rabeprazole 20 mg/d. Major symptoms, compliance, and adverse events were recorded. After 8 wk, endoscopy and clinical evaluation were repeated.RESULTS: Per protocol and intention to treat healing rates of esophagitis were: omeprazole = 81.0% and 75.0%, lansoprazole = 90.7% (P = 0.143 vs omeprazole) and 85.0%, pantoprazole = 93.5% (P = 0.04 vs omeprazole) and 90.0% (P = 0.02 vs omeprazole), rabeprazole = 94.6% (P = 0.02 vs omeprazole) and 88.8% (P = 0.04 vs omeprazole). Dividing patients according to the grades of esophagitis, omeprazole was significantly less effective than the three other PPIs in healing grade 1 esophagitis (healing rates: 81.8% vs 100%, 100% and 100%, respectively, P = 0.012). Pantoprazole and rabeprazole (100%) were more effective vs omeprazole (89.6%, P = 0.0001)and lansoprazole (82.4%, P = 0.0001) in decreasing heartburn. Pantoprazole and rabeprazole (92.2% and 90.1%, respectively) were also more effective vs lansoprazole (75.0%, P < 0.05) in decreasing acid regurgitation. Finally, pantoprazole and rabeprazole (95.2% and 100%) were also more effective vs lansoprazole (82.6%, P < 0.05) in decreasing epigastric pain.CONCLUSION: In elderly patients, pantoprazole and rabeprazole were significantly more effective than omeprazole in healing esophagitis and than omeprazole or lansoprazole in improving symptoms. H pylori infection did not influence the healing rates of esophagitis after a short-term treatment with PPI.

Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology

There are many causes of gastrointestinal bleeding(GIB) in children, and this condition is not rare, having a reported incidence of 6.4%. Causes vary with age, but show considerable overlap; moreover, while many of the causes in the pediatric population are similar to those in adults, some lesions are unique to children. The diagnostic approach for pediatric GIB includes definition of the etiology, localization of the bleeding site and determination of the severity of bleeding; timely and accurate diagnosis is necessary to reduce morbidity and mortality. To assist medical care providers in the evaluation and management of children with GIB, the "Gastro-Ped Bleed Team" of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition(SIGENP) carried out a systematic search on MEDLINE via Pub Med(http://www.ncbi.nlm.nih.gov/pubmed/) to identify all articles published in English from January 1990 to 2016; the following key words were used to conduct the electronic search: "upper GIB" and "pediatric" [all fields]; "lower GIB" and "pediatric" [all fields]; "obscure GIB" and "pediatric" [all fields]; "GIB" and "endoscopy" [all fields]; "GIB" and "therapy" [all fields]. The identified publications included articles describing randomized controlled trials, reviews, case reports, cohort studies, casecontrol studies and observational studies. References from the pertinent articles were also reviewed. This paper expresses a position statement of SIGENP that can have an immediate impact on clinical practice and for which sufficient evidence is not available in literature. The experts participating in this effort were selected according to their expertise and professional qualifications.

Red blood cell distribution width: A marker of anisocytosis potentially associated with atrial fibrillation

The incorporation of biomarkers in the actually used risk scores seem to be helpful for early identifying atrial fibrillation(AF)patients at higher risk.The aim of this critical review of the scientific literature is to investigate the potential clinical significance of red blood cell distribution width(RDW)in AF.A systematic electronic search was carried out to identify all articles describing an epidemiological association between RDW and AF in adult human populations.Data abstraction was conducted on a final number of 35 articles(13 crosssectional,12 prospective and 10 retrospective studies).The results of these epidemiological investigations were all virtually concordant to emphasize that an enhanced RDW value is not only a predictive factor and a marker of AF but its measurement may also be helpful for predicting the risk of developing many adverse complications in patients with AF,such as recurrence and duration of AF,hospitalization for heart failure,bleeding,left atrial thrombosis and stasis,thromboembolic events and mortality.AF patients with RDW values exceeding the local reference range may be more aggressively investigated and managed,in order to identify and attenuate the impact of possible underlying disorders causing both anisocytosis and AF.

Occupational exposures and colorectal cancers:A quantitative overview of epidemiological evidence

A traditional belief widespread across the biomedical community was that dietary habits and genetic predisposition were the basic factors causing colorectal cancer.In more recent times,however,a growing evidence has shown that other determinants can be very important in increasing(or reducing) incidence of this malignancy.The hypothesis that environmental and occupational risk factors are associated with colorectal cancer is gaining ground,and high risks of colorectal cancer have been reported among workers in some industrial branches.The aim of this study was to investigate the epidemiologic relationship between colorectal cancer and occupational exposures to several industrial activities,by means of a scientific literature review and meta-analysis.This work pointed out increased risks of colorectal cancer for labourers occupied in industries with a wide use of chemical compounds,such as leather(RR = 1.70,95%CI:1.24-2.34),basic metals(RR = 1.32,95%CI:1.07-1.65),plastic and rubber manufacturing(RR = 1.30,95%CI:0.98-1.71 and RR = 1.27,95%CI:0.92-1.76,respectively),besides workers in the sector of repair and installation of machinery exposed to asbestos(RR = 1.40,95%CI:1.07-1.84).Based on our results,the estimated crude excess risk fraction attributable to occupational exposure ranged from about 11% to about 15%.However,homogeneous pattern of association between colorectal cancer and industrial branches did not emerge from this review.

Applicability of tooth derived stem cells in neural regeneration

Within the nervous system, regeneration is limited, and this is due to the small amount of neural stem cells, the inhibitory origin of the stem cell niche and often to the development of a scar which constitutes a mechanical barrier for the regeneration. Regarding these aspects, many efforts have been done in the re- search of a cell component that combined with scaffolds and growth factors could be suitable for nervous regeneration in regenerative medicine approaches. Autologous mesenchymal stem cells represent nowa- days the ideal candidate for this aim, thank to their multipotency and to their amount inside adult tissues. However, issues in their harvesting, through the use of invasive techniques, and problems involved in their ageing, require the research of new autologous sources. To this purpose, the recent discovery of a stem cells component in teeth, and which derive from neural crest cells, has came to the light the possibility of using dental stem cells in nervous system regeneration. In this work, in order to give guidelines on the use of dental stem cells for neural regeneration, we briefly introduce the concepts of regeneration and regenerative medicine, we then focus the attention on odontogenesis, which involves the formation and the presence of a stem component in different parts of teeth, and finally we describe some experimental approaches which are exploiting dental stem cells for neural studies.

Comorbid bipolar disorder and obsessive-compulsive disorder: state of the art in pediatric patients

To the editor:Apparent comorbidity between bipolar disorder（BD）and anxiety disorders is a common condition in psychiatry,[1,2]one of the most difficult to manage being the co-occurrence of BD and obsessive-compulsive disorder（OCD）.[3,4]In 1860 French psychiatrist BénédictAugustin Morel first described patients with symptoms typical of what is now considered comorbid BD and OCD.[5]A century later,when categorizing