Etiologies and Outcomes of Acute Respiratory Failure in Solid Organ Transplant Recipients: Insight Into the EFRAIM Multicenter Cohort

Background: Respiratory complications of solid organ transplant (SOT) are a diagnostic and therapeutic challenge when requiring intensive care unit (ICU) admission. We aimed at describing this challenge in a prospective cohort of SOT recipients admitted in the ICU. Methods: In this post hoc analysis of an international cohort of immunocompromised patients admitted in the ICU for an acute respiratory failure, we analyzed all SOT recipients and compared their severity, etiologic diagnosis, prognosis, and outcome according to the performance of an invasive diagnostic strategy (encompassing a fiber-optic bronchoscopy and bronchoalveolar lavage), the type of transplanted organ, and the need of invasive ventilation at day 1. Results: Among 1611 patients included in the primary study, 142 were SOT recipients (kidney, n = 73; 51.4%; lung, n = 33; 23.2%; liver, n = 29; 20.4%; heart, n = 7; 4.9%). Lung transplant recipients were younger than other SOT recipients, and severity did not differ across type of received organ. An invasive diagnostic strategy was more frequently performed in lung transplant recipients with a trend toward a higher rate of bacterial etiology in lung than kidney transplant recipients. Overall ICU survival of SOT recipients was 75.4%. Invasive diagnostic strategy, type of transplanted organ, and need of invasive mechanical ventilation at day 1 did not affect ICU prognosis. Conclusions: ICU management of hypoxemic acute respiratory failure in SOT recipients translated into a low ICU mortality rate, whatever the transplanted organ or the acute respiratory failure cause. The post-ICU burden of acute respiratory failure SOT recipients remains to be investigated

Gamma-ray astronomy and cosmic-ray physics with ARGO-YBJ

The ARGO-YBJ detector, located 4300 m a.s.l. on the Tibet plateau, is a ground-based, full- coverage array of Resistive Plate Chambers (RPCs) covering a surface of 78×74 m2, surrounded by a guard ring of RPCs enclosing a total surface of about 11000 m2. ARGO-YBJ was designed to detect extensive air showers generated by cosmic rays and gamma rays with primary energy greater than few hundred GeV, in order to study the region of the cosmic-ray spectrum out of the reach of both satellite-based experiments and traditional ground-based arrays. The experiment has been running with its complete layout since November 2007, collecting over 2:5×1011 events. The main results obtained by ARGO-YBJ will be presented here, and specifically: the monitoring of astronomical gamma-ray sources, such as the Crab nebula and the MRK 421 AGN, the moon shadow, the medium-scale anisotropy map, the proton-proton inelastic cross section at center-of- mass energy between 70 and 500 GeV where no accelerator data are available

Gamma-ray astronomy with ARGO-YBJ

ARGO-YBJ is a full coverage air shower array located at the YangBaJing Cosmic Ray Laboratory (Tibet, P.R. China, 4300 m a.s.l., 606 g/cm2) recording data with a duty cycle ≥85% and an energy threshold of a few hundred GeV. In this paper the latest results in Gamma-Ray Astronomy are summarized