Diagnostic Protocol for Thermal Performance of District Heating Pipes in Operation. Part 2: Estimation of Present Thermal Conductivity in Aged Pipe Insulation

Buried and operating district heating (DH) pipes are exposed to thermal degradation of their polyurethane (PUR) insulation over time, and their status is hard to assess without excavation. By using DH pipe valves in manholes as measurement points during a shutdown with an ensuing cooling period, non-destructive assessments can be performed. This study compares new improved field measurements with numerical simulations of the temperature decline in drainage valves and shutdown valves. The drainage valve measurements were used to thermally assess part of a buried DH network. Results indicate that by using the drainage valves as measurement points in a cooling method, the thermal conductivity of the buried DH network could be predicted with an accuracy of >95%. In addition, a general diagnostic protocol has been established for assessing the thermal status of a DH network, ready for network owners to use.

Audiological and vestibular evaluations in vitiligo patients

The aim of this paper was to investigate audiological abnormalities and potential vestibular injury in a sample of vitiligo subjects. Thirty-five patients with non-segmental vitiligo (NSV) were enrolled in the study. They underwent pure tonal audiometry (PTA), vestibular Fitzgerald-Hallpike caloric test, C-VEM, and O-VEMP testing. The χ2 test and multiple regression analysis were performed. At PTA, 69% of patients presented with bilateral hearing loss, 8% monaural hearing loss, and 23% normal values. Bilateral caloric stimulations were performed and demonstrated that 14% of patients had a monolateral and 9% had a bilateral pathological response. VEMPs analysis showed that 20% of patients had no O-VEMPs response and 3% had no C-VEMPs response. Comparison between the normal values of healthy subjects and NSV patients showed an alteration of VEMPs in 44%. Multiple regression showed no statistical differences. We propose a specific diagnostic protocol employing PTA, bithermal caloric tests, C-VEMP, and O-VEMP testing to evaluate audio-vestibular damage. Our data were concordant with the anatomic-physiological melanocytic distribution and their possible degeneration linked with NSV.

Adherence to a reliable PJI diagnostic protocol minimizes unsuspected positive cultures rate

Background The aim of the present study was to evaluate the incidence of unsuspected PJI when prosthetic revisions are thoroughly evaluated by PJI dedicated orthopedic surgeon before surgery. The hypothesis is that the incidence of unsuspected PJI is reduced by applying this protocol. Methods This is a historical cohort study carried out in one university hospital. The prosthetic revision assessment was carried out in January 2019. From that date on, all patients that were programmed for hip or knee revision (either by an orthopedic surgeon specialized or not in septic revisions) were scheduled for a preoperative visit with the same orthopedic surgeon specialized in septic revisions. The diagnostic algorithm applied was based on the Pro-Implant Foundation diagnostic criteria. Prior to the revision assessment, the indication for joint aspiration was done at the surgeons’ discretion (non-specialized in septic revisions) and the preoperative identification of PJI was also done by a hip or knee surgeon (not specialized in septic surgery). Results Based on the PIF criteria, there were 15 infections among the revisions in group 1 and 18 PJI in group 2 (p > 0.05). The most interesting finding was that there were 7 patients with unsuspected positive cultures in group 1. That represents 11% of all revisions. No patient in group 2 was found with unsuspected positive cultures (p < 0.001). Conclusion A thorough PJI diagnostic algorithm should be implemented before prosthetic revision to avoid unsuspected positive cultures.

Forensic Post-Mortem Investigation in AAS Abusers: Investigative Diagnostic Protocol. A Systematic Review

Anabolic-androgenic steroids (AASs) are a group of synthetic molecules derived from testosterone and its precursors. AASs are widely used illicitly by adolescents and athletes, especially by bodybuilders; AASs are among the most used drugs for improving physical performance, as well as for aesthetic purposes. The use of AASs by professional and recreational athletes is increasing worldwide. This review focused on deaths related to AAS abuse and to investigation of the autopsy results and histopathological findings using a rigorous methodology protocol covering: a complete autopsy, histological analysis, and a broad toxicological investigation. Moreover, we aimed to define an investigative diagnostic protocol supporting forensic pathologists during the post-mortem investigation of AAS abusers. This review was conducted using PubMed Central and Google Scholar databases to find articles published between 1 January 1968 and 30 June 2021, using the following key terms: “(anabolic-androgenic steroids) AND (autopsy); (anabolic-androgenic steroids) AND (forensic)”. A total of 939 articles were screened and 926 did not meet the inclusion criteria. In conclusion, 14 articles were included in this systematic review, reporting 137 fatal cases of AAS abuse in total. The histopathologic studies showed myocardial damage characterized by myocyte hypertrophy, focal myocyte damage with myofibrillar loss, interstitial fibrosis, mostly subepicardial, and small vessel disease. Indeed, in AAS-related cases, autopsy plays a pivotal role in the study of AAS adverse effects and organ damage related to their use or abuse. This systematic review aimed to define a specific workflow in death cases related to AASs, suggesting important future insights to better clarify sudden deaths related to AASs, such as the use of miRNAs. The forensic community needs a unified approach in cases of suspected death related to the use of AASs. There are several occasions to apply this workflow, for example in cases of death of bodybuilders and of young people who die in gymnasiums or during sports activities.

Comparative Evaluation of Adenoids and Airway Space in 12 to 14-Year-Old Children With Different Growth Patterns Using Cephalometric Methods Commonly Used by ENT Specialists

Introduction: Altered airway and growth are interrelated; hence, a study was planned to develop a diagnostic protocol that may help in diagnosing difficult airway by utilizing routine radiographic assessment. Material and Methods: Lateral cephalograms of 60 children aged 12 to 14 years who were grouped based on the growth pattern into 3 groups with 20 cases each (Group 1—normodivergent cases; Group 2—hypodivergent cases; Group 3—hyperdivergent cases) were observed. The diagnostic protocol included 3 diagnostic methods (Handelman–Osborne area method, Maw et al method, and Holmberg et al method) routinely used by ENT surgeons for altered airway evaluation, and their diagnostic efficacy was correlated with McNamara’s airway analysis. Results: Highest specificity and diagnostic accuracy were found with Holmberg et al method followed by Maw et al method. Poor specificity was observed with Handelman–Osborne area method. Conclusion: The new diagnostic protocol which includes commonly used cephalometric methods by ENT surgeons can be helpful for orthodontists in early evaluation of altered airways, so that preventive and interceptive procedures can be carried out to normalize the altered craniofacial growth. Among the methods used in this diagnostic protocol, Holmberg et al and Maw et al methods had better sensitivity and specificity.