Search Results (43)

Background/Objectives: Anastomotic leakage is one of the most frightening and potentially fatal complications after esophagectomy. The collaboration between the surgical team, interventional gastroenterologists, and radiologists has the potential to improve the hospital stay, as well as morbidity and mortality. The aim of this study is to present our experience and evaluate the results of the multimodal management of anastomotic leak following esophagectomy in our unit. Methods: This is a retrospective study analyzing a single referral center’s prospectively maintained database of all patients diagnosed with anastomotic leak between March 2019 and March 2025 using the definition of the Esophageal Complications Consensus Group. The treatment pathways and the patient outcomes are presented. The primary endpoint was 90-day mortality and in-hospital mortality. Results: A total of 241 esophageal resections were performed between March 2019 and March 2025. Lymphadenectomy of the mediastinum was performed in 88.4% of the patients. Cervical and intrathoracic anastomosis were performed in 143 (59.3%) and 98 (40.7%) cases, respectively. Twenty-nine patients (12%) with a mean age of 59.1 years developed anastomotic leak. Anastomotic leak occurred in 14.3% of intrathoracic anastomoses and 10.5% of cervical anastomoses. The median day of leak diagnosis was the sixth postoperative day. Leak management involved conservative strategies, wound exploration, endoscopic stent placement or vacuum therapy, drainage of effusions under radiologic guidance, and reoperation. The 90-day and in-hospital mortality rate was 3.4%. No cases of conduit necrosis or mediastinitis were reported. Endoscopic management was employed in 18 patients (62.1%) as a first- or second-line treatment, while reoperation was required in 6 patients (20.7%). The median interval from diagnosis to anastomosis healing was 21 days and the median duration of hospital stay 32 days. The management was successful in 27 patients (93.1%) except for 1 who developed tracheoesophageal fistula and 1 who died due to hemorrhagic complication of anticoagulant treatment. Conclusions: Anastomotic leak after esophagectomy is considered a complex, diversified, and morbid clinical entity. The evolving potential of multidisciplinary management encompassing surgical and interventional radiological and endoscopic treatment addresses the mortality rates and heralds a new era of minimizing morbidity. Full article

Background/Objectives: Esophageal anastomotic leaks (EALs) are among the most feared complications following upper gastrointestinal surgery, particularly esophagectomy, given their profound impact on patient outcomes and healthcare resource utilization. This study aims to synthesize the evidence and determine the most effective interventions for achieving leak closure in patients with esophageal anastomotic leaks. Methods: This umbrella review followed PRISMA guidelines. A comprehensive search was conducted in PubMed, the Web of Science, Scopus, Google Scholar, Cochrane, and PROSPERO. Systematic reviews/meta-analyses on esophageal anastomotic leak management were included. The outcomes analyzed included leak closure success, mortality, complications, hospital stay, and costs. Data were synthesized narratively, with disagreements resolved by a third reviewer. Results: A systematic search identified 730 records, from which six systematic reviews and meta-analyses (evaluating 65 studies and 2186 patients) met the inclusion criteria. Most studies compared endoscopic vacuum therapy (EVT) and self-expanding metal stents (SEMSs) for EALs, with Germany contributing the majority. EVT consistently demonstrated superior leak closure rates and lower mortality compared to SEMSs, with pooled odds ratios favoring EVT. EVT also showed reduced complication rates, particularly fewer major adverse events, although with a slightly higher risk of post-therapy strictures. Hospital stay durations varied, with some studies reporting shorter treatment periods for EVT but no significant differences in the overall hospitalization length. Limited data suggested that EVT incurs higher treatment costs, largely due to intensive care unit stays. Conclusions: EVT is the most effective intervention for EALs, offering superior leak closure, lower mortality, and fewer complications. However, its economic impact requires further evaluation. Full article

The FLASH-COMP project aims to introduce novel inspection and monitoring technologies to develop a digital solution to predict defects during manufacturing, aiming to reach a zero-waste approach in composites manufacturing. Particularly, it’s studied the integration of two different Fiber Optic Sensor (FOS) technologies: Fiber Bragg Grating (FBG) and distributed All Grating Fiber (AGF^®), to retrieve relevant data during the preforming stage and later resin infusion process for aero-space materials. During the study, both FOS technologies were introduced into the materials, varying process conditions and the introduction of some artificial defects to evaluate the sensors response to correlate them after with their signals. Both systems can retrieve relevant information during the process such as vacuum, leaks and temperature changes, presence of voids and air bubbles, detection of dry zones, and resin flow monitoring. Further developments have to be focused on the scalability in the implementation, since FOS are fragile to handle and need specific training to use it in a more industrial field. Full article

Anastomotic leakage (AL) remains a major complication after esophagectomy, especially in patients with esophagogastric cancers who have undergone neoadjuvant therapies, which can impair tissue healing. Endoscopic vacuum-assisted closure (EndoVAC) is an innovative approach aimed at managing AL by facilitating wound drainage, reducing infection, and promoting granulation tissue formation, thus supporting effective healing. This review explores the role and effectiveness of EndoVAC in treating AL post-esophagectomy in esophageal cancer patients. We present an overview of its physiological principles, including wound contraction, enhanced tissue perfusion, and optimized microenvironment, which collectively accelerate wound closure. In addition, we examine clinical outcomes from recent studies, which indicate that EndoVAC is associated with improved leak resolution rates and potentially shorter hospital stays compared to traditional methods. Overall, this review highlights EndoVAC as a promising tool for AL management and underscores the need for continued investigation to refine its protocols and broaden its accessibility. By optimizing EndoVACs use, multidisciplinary teams can improve patient outcomes and advance esophageal cancer care. Full article

Rapid industrial development has led to increased crude oil extraction and oily wastewater discharge. Achieving oil–water separation and marine oil adsorption in a cost-effective, efficient, and environmentally friendly manner remains a global challenge. In this work, natural wood was chemically treated to prepare a degradable and environmentally friendly wood sponge structure. In situ polymerization and spraying methods were used to produce an environmentally friendly oil–water separation sponge with superhydrophobic and superoleophilic properties (Fe₃O₄@P-P@WS). Fe₃O₄@P-P@WS had excellent superhydrophobicity (WCA = 154.2°) and self-cleaning properties. Additionally, Fe₃O₄@P-P@WS could convert solar and electrical energy into thermal energy, reaching a surface temperature of 74 °C under sunlight irradiation with an intensity of 1.0 kW m⁻². When a voltage of 9 V was applied, the surface temperature reached 120.5 °C. Moreover, under the suction of a vacuum pump or the action of gravity, the continuous separation of highly fluid oil substances was achieved. The designed Fe₃O₄@P-P@WS offers advantages such as easily obtained raw materials, energy efficiency, simple preparation, and the ability to solve secondary pollution issues, providing a new technology for cleaning organic matter in industrial wastewater discharge and for round-the-clock cleaning of high-viscosity crude oil leaked during offshore oil exploitation. Full article

This paper introduces a cost-effective, high-performance approach to achieving wafer level vacuum packaging (WLVP) for MEMS-based uncooled infrared sensors. Reliable and hermetic packages for MEMS devices are achieved using a cap wafer that is formed using two silicon wafers, where one wafer has precise grating/moth-eye structures on both sides of a double-sided polished wafer for improved transmission of over 80% in the long-wave infrared (LWIR) wavelength region without the need for an AR coating, while the other wafer is used to form a cavity. The two wafers are bonded using Au-In transient liquid phase (TLP) bonding at low temperature to form the cap wafer, which is then bondelectrical and Electronics d to the sensor wafer using glass frit bonding at high temperature to activate the getter inside the cavity region. The bond quality is assessed using three methods, including He-leak tests, cap deflection, and Pirani vacuum gauges. Hermeticity is confirmed through He-leak tests according to MIL-STD 883, yielding values as low as 0.1 × 10⁻⁹ atm·cc/s. The average shear strength is measured as 23.38 MPa. The package pressure varies from 133–533 Pa without the getter usage to as low as 0.13 Pa with the getter usage. Full article

Esophagectomy, while a pivotal treatment for esophageal cancer, is not without adverse events. Among these, anastomotic leak (AL) is the most feared complication, threatening patient lives and incurring significant healthcare costs. The management of AL is complex and lacks standardization. Given the high morbidity and mortality rates associated with redo-surgery, which poses risks for already fragile patients, various endoscopic treatments have been developed over time. Self-expandable metallic stents (SEMSs) were the most widely used treatment until the early 2000s. The mechanism of action of SEMSs includes covering the wall defect, protecting it from secretions, and promoting healing. In 2010, endoscopic vacuum therapy (EVT) emerged as a viable alternative for treating ALs, quickly gaining acceptance in clinical practice. EVT involves placing a dedicated sponge under negative pressure inside or adjacent to the wall defect, aiming to clear the leak and promote granulation tissue formation. More recently, the VAC-Stent entered the scenario of endoscopic treatment of post-esophagectomy ALs. This device combines a fully covered SEMS with an integrated EVT sponge, blending the ability of SEMSs to exclude defects and maintain the patency of the esophageal lumen with the capacity of EVT to aspirate secretions and promote the formation of granulation tissue. Although the literature on this new device is not extensive, early results from the application of VAC-Stent have shown promising outcomes. This review aims to synthesize the preliminary efficacy and safety data on the device, thoroughly analyze its advantages over traditional techniques and disadvantages, explore areas for improvement, and propose future directions. Full article

Anastomotic insufficiencies are severe complications of abdominal surgery, often leading to prolonged hospitalization, serious tissue inflammation, and even sepsis, along with the need for recurrent surgery. Current non-surgical treatments such as self-expanding metal stents (SEMSs) and endoscopic vacuum therapy (EVT) have limitations, including stent migration or perforation. This review evaluates the effectiveness of the VacStent GI^TM (Möller Medical GmbH, Fulda, Germany), a novel medical device combining SEMS and negative-pressure wound therapy in treating gastrointestinal leaks. Data were gathered from four prospective studies and compared with existing treatments. Studies on the VacStent GI^TM application demonstrate technical success and competitive closure rates in upper gastrointestinal leaks, with minimal complications reported. Comparative analyses with SEMS and EVT reveal promising and most importantly equally good outcomes while maintaining the possibility for sustained enteral nutrition and reducing the risk of stent migration. The VacStent GI^TM presents a promising alternative to current non-surgical treatments. Ongoing research aims to validate its efficacy in lower gastrointestinal leaks and comprehensively establish its role in leak management. Further investigation is necessary to confirm these findings and optimize treatment protocols. Future usages of the VacStent GI^TM in colonic anastomotic insufficiencies promise an effective approach and might be able to lower the rates of necessary implementations of a stoma. Full article

This paper presents the long-term, holistic results of research into an innovative heat accumulator based on an organic phase-change material in the form of a mixture of aliphatic alkanes, molecular silica sieves, carbon recyclate and epoxy and cement matrices. The research included chemical testing of vacuum soaking of molecular silica sieves with a liquid phase-change material. The results proved an improvement in the heat storage efficiency of the heat accumulators due to the addition of carbon recyclate by 28%, while increasing the heat storage time by 134 min, and a reduction in PCM leakage due to the use of molecular silica sieves. In addition to its cognitive scientific value, another research objective of the work achieved was to obtain response functions in the form of approximating polynomials. They provide a useful, validated and verified tool to predict the physical and chemical characteristics of heat accumulators with different contents of individual components. As part of the ongoing research, technical problems related to leak-proofing assurance and matrix selection for organic phase-change materials were also solved. The solution presented is in line with the issues of efficient use of renewable energy, low-carbon and energy-efficient circular economy. Full article

In this work, passive cooling systems for the revamping of existent silicon photovoltaic (PV) cells were developed and analysed in order to mitigate the efficiency loss caused by temperature rise in the hot season. For this purpose, expanded graphite (EG) was used to stabilize a phase change material (PCM) with a melting temperature close to 53 °C in order to realize thermal management systems (TMSs) able to store heat at constant temperature during melting and releasing it in crystallization. In particular, stearic and palmitic acid mixture (PA-SA) was shape-stabilized in EG at different concentrations (10, 12 and 14 part per hundred ratio) under vacuum into a rotary evaporation apparatus followed by cold compaction; PA-SA leakage was reduced due to its intercalation between the graphite lamellae, and the thermal conductivity necessary to maximize the heat transfer to a bulk TMS was improved via powder cold compaction, which minimizes voids and creates preferential thermal conductive patterns. The composite materials, stable till 150 °C, were tested by differential scanning calorimetry (DSC) at 1 °C/min to precisely determine the phase transition temperatures and the enthalpic content, which was only slightly reduced from 196 J/g of the neat PCM to 169 J/g due to the very low EG fraction necessary for the stabilization. Despite only the 14:100 EG-to-PA-SA ratio, the system’s thermal conductivity was enhanced 40 times with respect to the neat PCM (from 0.2 to 8.3 W/(m K), value never reached in works present in the literature), with a good convergence of the values evaluated through hot disk tests and laser flash analysis (LFA), finding correlation with both graphitic content and density. In order to completely avoid leaking with the consequent dispersion of PCM in the environment during the final application, all the samples were encapsulated in a PE-made film. The mechanical properties were evaluated with compression tests at 30 °C and 80 °C simulating a possible compressive stress deriving from the contact needed to maintain the TMS position on the rear of the PV cells. Finally, the material response was simulated by imposing thermal cycles into a climatic chamber and reproducing the three hottest and coldest days of summer 2022 of two Italian locations, Verona (Veneto, 45° N, 11° E) and Gela (Sicily, 37° N, 14° E), thus highlighting the thermal management effects with delays in temperature increase and daily peak temperature smoothing. The role of EG is strategic for the processing and the properties of the resulting composites in order to realize a proper compromise between the melting enthalpy of PCM and the thermal conductivity enhancement given by EG. Full article

We propose a non-exotic electromagnetic solution (within the standard model of particle physics) to the cosmological ⁷Li problem based upon a narrow 2 MeV photo-emission line from the decay of light glueballs (LGBs). These LGBs form within color superconducting quark clusters (SQCs), which are tens of Fermi in size, in the radiation-dominated post-BBN epoch. The mono-chromatic line from the $LGB\to \gamma +\gamma$ decay reduces Big Bang nucleosynthesis (BBN) ⁷Be by $2/3$ without affecting other abundances or the cosmic microwave background (CMB) physics, provided the combined mass of the SQCs is greater than the total baryonic mass in the universe. Following the LGB emission, the in-SQC Quantum ChromoDynamics (QCD) vacuum becomes unstable and “leaks” (via quantum tunneling) into the external space-time (trivial) vacuum, inducing a decoupling of SQCs from hadrons. In seeking a solution to the ⁷Li problem, we uncovered a solution that also addresses the Dark Energy (DE) and dark matter (DM) problem, making these critical problems intertwined in our model. Being colorless, charge-neutral, optically thin, and transparent to hadrons, SQCs interact only gravitationally, making them a viable cold DM (CDM) candidate. The leakage (i.e., quantum tunneling) of the in-SQC QCD vacuum to the trivial vacuum offers an explanation of DE in our model and allows for a cosmology that evolves into a $\Lambda$CDM universe at a low redshift with a possible resolution of the Hubble tension. Our model distinguishes itself by proposing that the QCD vacuum within SQCs possesses the ability to tunnel into the exterior trivial vacuum, resulting in the generation of DE. This implies the possibility that DM and hadrons might represent distinct phases of quark matter within the framework of QCD, characterized by different vacuum properties. We discuss SQC formation in heavy-ion collision experiments at moderate temperatures and the possibility of detection of MeV photons from the $LGB\to \gamma +\gamma$ decay. Full article

This case report underscores the importance of utilizing E-VAC (endoscopic vacuum-assisted closure) in the treatment of a perforated duodenal ulcer complicated by the formation of a subphrenic abscess and septic shock. It showcases how E-VAC can effectively mitigate the risk of further complications, such as leakage, bleeding, or rupture, which are more commonly associated with traditional methods like stents, clips, or sutures. As a result, there is a significant reduction in mortality rates. A perforated duodenal ulcer accompanied by abscess formation represents a critical medical condition that demands prompt surgical intervention. The choice of the method for abscess drainage and perforation closure plays a pivotal role in determining the patient’s chances of survival. Notably, in patients with a high ASA (American Association of Anesthesiologists) score of IV-V, the mortality rate following conventional surgical intervention is considerably elevated. The management of perforated duodenal ulcers has evolved from open abdominal surgical procedures, which were associated with high mortality rates and risk of suture repair leakage, to minimally invasive techniques like laparoscopy and ingestible robots. Previously, complications arising from peptic ulcers, such as perforations, leaks, and fistulas, were primarily addressed through surgical and conservative treatments. However, over the past two decades, the medical community has shifted towards employing endoscopic closure techniques, including stents, clips, and E-VAC. E-VAC, in particular, has shown promising outcomes by promoting rapid and consistent healing. This case report presents the clinical scenario of a patient diagnosed with septic shock due to a perforated duodenal ulcer with abscess formation. Following an exploratory laparotomy that confirmed the presence of a subphrenic abscess, three drainage tubes were utilized to evacuate it. Subsequently, E-VAC therapy was initiated, with the kit being replaced three times during the recovery period. The patient exhibited favorable progress, including weight gain, and was ultimately discharged as fully recovered. In the treatment of patients with duodenal perforated ulcers and associated abscess formation, the successful and comprehensive drainage of the abscess, coupled with the closure of the perforation, emerges as a pivotal factor influencing the patient’s healing process. The positive outcomes observed in these patients underscore the efficacy of employing a negative pressure E-VAC kit, resulting in thorough drainage, rapid patient recovery, and low mortality rates. Full article

The current study focused on creating natural hydrogels consisting of mixtures of avocado seed proteins dried with different techniques and locust bean gum. Proteins were extracted from avocado seed by alkali and isoelectric precipitation methods. Avocado seed proteins were dried by five different drying methods, namely ambient drying, oven drying, vacuum drying, freeze drying, and spray drying. FT-IR spectra were used to analyze the chemical structure of proteins dried using various techniques. Additionally, hydrogel models were constructed in the presence of avocado seed proteins and locust bean gum to clarify the effect of drying techniques on their hydrogelling ability. The impact of drying techniques on the functional behavior of hydrogels was notable. The maximum water holding capacity values were detected in the hydrogel system containing spray-dried proteins (93.79%), followed by freeze-dried (86.83%), vacuum-dried (76.17%), oven-dried (72.29%), and ambient-dried (64.8%) counterparts. The swelling ratio was 34.10, 33.51, 23.05, 18.93, and 14.39% for gels in the presence of freeze-dried, spray-dried, vacuum-dried, oven-dried, and ambient-dried proteins, respectively. Additionally, the desirable values for the amount of protein leaking from the systems prepared using spray-dried (7.99%) and freeze-dried (12.14%) proteins were obtained compared to others (ambient-dried: 24.03%; oven-dried: 17.69%; vacuum-dried: 19.10%). Superior results in terms of textural properties were achieved in hydrogel models containing spray-dried and freeze-dried proteins. In general, hydrogel models exhibited elastic behavior rather than viscous properties; however, the magnitudes of elasticity varied. Furthermore, the success of gels containing hydrogel models containing spray-dried protein and locust bean gum in the bioactive compound delivery system was obvious compared with protein ones alone. Full article

Membrane distillation (MD) is a thermal desalination technique proposed for the valorization of residual brines that other operations such as reverse osmosis cannot treat. Previous studies have shown that vacuum-assisted air gap (V-AGMD) operation in commercial multi-envelope modules improves the performance of MD noticeably. However, the permeate quality at pilot scale has not been thoroughly characterized so far. The aim of this study is, therefore, to assess and model the effect of the main operating conditions (feed flow rate, inlet temperatures, and feed salinity) on the permeate quality. Results from different steady-state experiments allowed to estimate descriptive metrics such as the salt rejection factor (SRF) and the membrane leak ratio (MLR). Given their non-linear behavior, these metrics were subsequently modeled using artificial neural networks (ANN) to estimate the permeate quality in the whole scope of operating conditions. Acceptable SRF results with MLR values lower than 0.2% confirmed the validity of MD as an operation for the treatment of concentrated brines, although the salinity of the resulting permeate does not comply in all cases with that permitted for human consumption. Full article

Background: Anastomotic leakage, which is defined as a defect in the integrity of a surgical join between two hollow viscera leading to communication between the intraluminal and extraluminal compartments, continues to be of high incidence and one of the most feared complications following gastrointestinal surgery, with a significant potential for a fatal outcome. Surgical options for management are limited and carry a high risk of morbidity and mortality; thus, surgeons are urged to look for alternative options which are minimally invasive, repeatable, non-operative, and do not require general anesthesia. Methods: A narrative review of the international literature took place, including PubMed, Scopus, and Google Scholar, utilizing specific search terms such as “Digestive Surgery AND Anastomotic Leakage OR leak OR dehiscence”. Results: In the present review, we try to describe and analyze the pros and cons of the various endoscopic techniques: from the very first (and still available), fibrin gluing, to endoclip and over-the-scope clip positioning, stent insertion, and the latest suturing and endoluminal vacuum devices. Finally, alongside efforts to improve the existing techniques, we consider stem cell application as well as non-endoscopic, and even endoscopic, attempts at intraluminal microbiome modification, which should ultimately intervene pre-emptively, rather than therapeutically, to prevent leaks. Conclusions: In the last three decades, this search for an ideal device for closure, which must be safe, easy to deploy, inexpensive, robust, effect rapid and stable closure of even large defects, and have a low complication rate, has led to the proposal and application of a number of different endoscopic devices and techniques. However, to date, there is no consensus as to the best. The literature contains reports of only small studies and no randomized trials, failing to take into account both the heterogeneity of leaks and their different anatomical sites. Full article