Surgery for esophageal achalasia. long-term results with three different techniques

BACKGROUND/AIMS: In surgery for achalasia, the length of the myotomy and the opportunity of associating an antireflux procedure are still debated. Prospective and comparative studies on different techniques are few. The aims of this work is to compare the long term results of three different techniques successively adopted by the same surgical group. MATERIALS AND METHODS: Between January 1955 and December 1991, 185 achalasic patients were submitted to myotomy by using in temporal sequence three different techniques. The first technique utilized (1955-1972) was a long esophagogastric abdominal myotomy (83 patients), secondly (1973-1978) a limited transthoracic myotomy (30 patients) and at last (1979-1991) a long esophagogastric abdominal myotomy associated to the Dor gastroplasty (72 patients). Since 1972, patients were prospectively followed up according to a protocol which included a clinical interview, x-rays, manometry and endoscopy at given dates. Post-operative esophagogastric transit and gastro-esophageal reflux were assessed to verify the therapeutical outcome. Results obtained with the three different techniques were analyzed and compared by using the actuarial Kaplan-Meier curves. RESULTS: The mean follow up was 193.3 months for the patient group that underwent abdominal myotomy (62/83 patients), 137.3 months for the thoracic myotomy group (30/30 patients) and 86.9 months for the abdominal myotomy plus Dor gastroplasty group (69/72 patients). Long-term results in the abdominal myotomy and in the thoracic myotomy groups were respectively poor in 51.6% and in 46.6% of patients. Major causes of failure were insufficient myotomy (6.5%), periesophageal scarring (9.6%) and reflux esophagitis (22.6%) for the abdominal myotomy group; insufficient myotomy (20%) and reflux esophagitis (23%) for the thoracic myotomy group. In the abdominal myotomy plus Dor gastroplasty group long-term results were excellent or good in 87% of patients and poor in 13%. Reflux esophagitis (10% of cases) was the principal cause of failure. CONCLUSIONS: The comparison of the actuarial curves shows a significantly better long term outcome for the abdominal myotomy plus Dor antireflux procedure than for the abdominal myotomy (p = 0.01) and for the thoracic myotomy (p = 0.002) techniques.     

A Joint Numerical-Experimental Study on Impact Induced Intra-laminar and Inter-laminar Damage in Laminated Composites

The investigation of the mechanical response of fibre-reinforced composite laminates under impact loads can be very difficult due to the occurrence of simultaneous failure phenomena. Indeed, as a consequence of low velocity impacts, intra-laminar damages, like fibre and matrix cracking, and inter-laminar damages, such as delaminations, can take place simultaneously. These damage mechanisms can lead to significant reductions in strength and stability of the composite structure. In this paper a joint numerical-experimental study is proposed which, by means of non-destructive testing techniques (Ultra-sound and thermography) and non-linear explicit FEM analyses, aims to completely characterise the impact induced damage in composite laminates under low velocity impacts. Indeed the proposed numerical tool has been used to improve the understanding of the experimental data obtained by Non-Destructive Techniques. Applications on samples tested according to the AECMA (European Association of Aerospace Manufacturers) prEn6038 standard at three different impact energies are presented. The interaction between numerical and experimental investigation allowed to obtain an exhaustive insight on the different phases of the impact event considering the inter-laminar damage formation and evolution.     

An Analytical Model to Measure the Effectiveness of Safety Management Systems: Global Safety Improve Risk Assessment (G-SIRA) Method

The ever-increasing complexity of production systems, together with the need to obtain efficient processes with limited costs, has led companies to develop custom tools for process control and management. Even for risk assessment, the traditional models often are overcome by methods that are best suited to specific needs. In this context, the aim of this paper was to propose a new model, which we call the global safety improve risk assessment (G-SIRA). This model can classify risks and identify corrective actions that allow the best risk reduction at the lowest cost. The proposed model, which is based on improvements to previous research, uses the analytic hierarchy process approach to develop a valid and simple tool for risk management. The G-SIRA method has been tested in a real-world application, i.e., it was applied to all of the processes of a textile company, and the results were compared with those obtained from the classical approach failure mode, effects, and criticality analysis. The comparison clearly showed the effectiveness of the proposed model.     

Recommendation of RILEM Technical Committee 250-CSM: Test method for Textile Reinforced Mortar to substrate bond characterization

Textile Reinforced Mortar (TRM), also known as Fabric Reinforced Mortar or Fabric Reinforced Cementitious Matrix, composites are an emerging technology for the external repair and strengthening of existing structures. For most applications, the effectiveness of the TRM reinforcement relies on its bond performance. This recommendation identifies the best practice to characterize the bond behaviour of TRM. A shear bond test method is proposed to determine the peak axial stress (associated with the maximum load that can be transferred from the structural member to the externally bonded TRM reinforcement), the stress–slip relationship and the failure mode that controls the TRM-to-substrate load transfer capacity. Guidelines on specimen manufacturing, experimental setup, test execution, and determination of test results are provided.     

Re-electrospraying splash-landed proteins and nanoparticles

FITC-albumin, Lsr-F, or fluorescent polystyrene latex particles were electrosprayed from aqueous buffer and subjected to dispersion by differential electrical mobility at atmospheric pressure. A resulting narrow size cut of singly charged molecular ions or particles was passed through a condensation growth tube collector to create a flow stream of small water droplets, each carrying a single ion or particle. The droplets were splash landed (impacted) onto a solid or liquid temperature controlled surface. Small pools of droplets containing size-selected particles, FITC-albumin, or Lsr-F were recovered, re-electrosprayed, and, when analyzed a second time by differential electrical mobility, showed increased homogeneity. Transmission electron microscopy (TEM) analysis of the size-selected Lsr-F sample corroborated the mobility observation.     

A model combining structure and properties of a 160/220 bituminous binder modified with polymer/clay nanocomposites. A rheological and morphological study

The present contribution focuses on the modification of a 160/220 bituminous binder with clay and polymer/clay nanocomposites. Bitumen/polymer/clay ternary blends were prepared using styrene–butadiene–styrene, ethylene vinyl acetate and ethylene methylacrylate copolymers mixed with an organomodified montmorillonite. Dynamic mechanical analyses were performed in the extended domain of stress, temperature and frequency to analyse the thermorheological behaviour of the blends. The time–temperature superposition principle was applied to shift the experimental data recorded at different temperatures and generate master curves of the linear viscoelastic functions. For all blends, the mechanical response of the system was found to be strongly and intimately influenced by the nanocomposite modification. In some cases, a solid-like behaviour appears and delays the Newtonian transition. Morphological analyses performed with fluorescence microscopy allowed to associate the binder properties with the presence of clay silicates, which alter the colloidal equilibrium of the bitumen and enhances the compatibility between bitumen and polymers. Based on the morphological and rheological results, a structural model of the prepared blends is proposed.