How to measure respiratory mechanics during controlled mechanical ventilation

Bedside measurement of respiratory mechanics allows to closely monitor the lung function in critically ill patients. The two fundamental parameters describing the respiratory system mechanics are resistance and compliance. Resistance of the respiratory system describes the opposition to gas flow during inspiration. During volume-controlled ventilation, resistance can be calculated as the ratio between the peak to plateau pressure drop and the resulting flow rate. Compliance describes the elastic property of the respiratory system, comprising the lung and the chest wall. It is the ratio between a change in volume (i.e. tidal volume) and the corresponding change in pressure, calculated as the difference between plateau pressure and total positive end-expiratory pressure, measured by end-inspiratory and end-expiratory manual occlusion, respectively. In this review, we describe how to measure respiratory mechanics at the bedside, starting from the physiological background of the equation of motion of the respiratory system. (Intensive care

Banca dati idrogeologica TANGRAM©: strumento per elaborazioni quantitative di dati per la valutazione delle acque sotterranee - The hydrogeological well database TANGRAM©: a tool for data processing to support groundwater assessment

At the Department of Earth and Environmental Sciences of the University of Milano-Bicocca (DISAT-UNIMIB), a hydrogeological well database, called TANGRAM©, has been developed and published on line at www.TANGRAM.samit.unimib.it, developing an earlier 1989 DOS version. This package can be used to store, display, and process all data related to water wells, including administrative information, well characteristics, stratigraphic logs, water levels, pumping rates, and other hydrogeological information. Currently, the database contains more than 39.200 wells located in the Italian region of Lombardy (90%), Piedmont (9%) and Valle d'Aosta (1%). TANGRAM© has been created both as a tool for researches and for public administration's administrators who have projects in common with DISAT-UNIMIB. Indeed, transferring wells data from paper into TANGRAM© offers both an easier and more robust way to correlate hydrogeological data and a more organized management of the administrative information. Some Administrations use TANGRAM© regularly as a tool for wells data management (Brescia Province, ARPA Valle Aosta). An innovative aspect of the database is the quantitative extraction of stratigraphic data. In the part of the software intended for research purposes, all well logs are translated into 8-digit alphanumeric codes and the user composes the code interpreting the description at each stratigraphic level. So the stratigraphic well data can be coded, then quantified and processed. This is made possible by attributing a weight to the digits of the code for textures. The program calculates the weighted percentage of the chosen lithology, as related to each individual layer. These extractions are the starting point for subsequent hydrogeological studies: well head protection area, reconstruction of the dynamics of flow, realization of the quarry plans and flux and transport hydrogeological models. The results of a two-dimensional distribution of coarse, medium and fine sized material in the first 80 meters of depth are presented here for a study area located within the Province of Brescia (Italy)

Adult mild encephalitis with reversible splenial lesion associated with delirious mania: a case report

Mild encephalitis with reversible splenial lesion is a rare clinic-radiological entity presenting with neurological and neuropsychiatric symptoms associated with cerebral lesion/s. Delirious mania is a severe psychiatric syndrome characterized by acute onset of delirium, excitement, and psychosis with a high mortality rate. In this paper, we present a case report of mild encephalitis with reversible splenial lesion clinically presenting as delirious mania and evolving into life-threatening multi-organ failure. The patient was treated with aripiprazole and benzodiazepine with poor effect and, after 4 days, the patient's condition significantly worsened requiring transfer to the intensive care unit where deep sedation with propofol was started. Our findings are in contrast with the traditional literature description of self-resolving and harmless mild encephalitis with reversible splenial lesion. Moreover, rapid clinical recovery and the progressive improvement of psychiatric symptoms after deep sedation with propofol in this case-considering propofol's neuroprotective and anti-inflammatory effects-supports the notion of propofol-mediated deep sedation for the treatment of severe manic symptoms associated with life-threatening conditions. Little is known about neural markers of the manic state, and the corpus callosum has been described to be involved in bipolar disorder. Abnormalities in this structure may represent a marker of vulnerability for this disorder

Synthesis of modified fullerenes for oxygen reduction reactions

In the search for carbon based catalysts for Oxygen Reduction Reactions (ORR), two different classes of fullerene hybrids and metal free fullerene derivatives have been prepared by highly selective metal- and organo-catalyzed synthetic methods. They were included as both electron acceptors and catalysts in polymer-based photo-electrochemical cell,fully demonstrating electrocatalytic activity. Remarkably, the activity of the metal free fullerenes proved to be as high as that observed for metallofullerenes based on noble metals, and up to ten-fold higher than by using PCBM

Characterization of very-large-scale motions in high-Re pipe flows

Very-large-scale structures in pipe flows are characterized using an extended Proper Orthogonal Decomposition (POD)-based estimation. Synchronized non-time-resolved Particle Image Velocimetry (PIV) and time-resolved, multi-point hot-wire measurements are integrated for the estimation of turbulent structures in a pipe flow at friction Reynolds numbers of 9500 and 20000. This technique enhances the temporal resolution of PIV, thus providing a time-resolved description of the dynamics of the large-scale motions. The experiments are carried out in the CICLoPE facility. A novel criterion for the statistical characterization of the large-scale motions is introduced, based on the time-resolved dynamically-estimated POD time coefficients. It is shown that high-momentum events are less persistent than low-momentum events, and tend to occur closer to the wall. These differences are further enhanced with increasing Reynolds number

Language production impairments in patients with a first episode of psychosis

Language production has often been described as impaired in psychiatric diseases such as in psychosis. Nevertheless, little is known about the characteristics of linguistic difficulties and their relation with other cognitive domains in patients with a first episode of psychosis (FEP), either affective or non-affective. To deepen our comprehension of linguistic profile in FEP, 133 patients with FEP (95 non-affective, FEP-NA; 38 affective, FEP-A) and 133 healthy controls (HC) were assessed with a narrative discourse task. Speech samples were systematically analyzed with a well-established multilevel procedure investigating both micro- (lexicon, morphology, syntax) and macro-linguistic (discourse coherence, pragmatics) levels of linguistic processing. Executive functioning and IQ were also evaluated. Both linguistic and neuropsychological measures were secondarily implemented with a machine learning approach in order to explore their predictive accuracy in classifying participants as FEP or HC. Compared to HC, FEP patients showed language production difficulty at both micro- and macro-linguistic levels. As for the former, FEP produced shorter and simpler sentences and fewer words per minute, along with a reduced number of lexical fillers, compared to HC. At the macro-linguistic level, FEP performance was impaired in local coherence, which was paired with a higher percentage of utterances with semantic errors. Linguistic measures were not correlated with any neuropsychological variables. No significant differences emerged between FEP-NA and FEP-A (p≥0.02, after Bonferroni correction). Machine learning analysis showed an accuracy of group prediction of 76.36% using language features only, with semantic variables being the most impactful. Such a percentage was enhanced when paired with clinical and neuropsychological variables. Results confirm the presence of language production deficits already at the first episode of the illness, being such impairment not related to other cognitive domains. The high accuracy obtained by the linguistic set of features in classifying groups support the use of machine learning methods in neuroscience investigations

Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries

IMPORTANCE: Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS). OBJECTIVES: To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts-for example prone positioning-in routine clinical practice for patients fulfilling the ARDS Berlin Definition. DESIGN, SETTING, AND PARTICIPANTS:The Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents. EXPOSURES:Acute respiratory distress syndrome. MAIN OUTCOMES AND MEASURES: The primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS. RESULTS: Of 29,144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H2O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS. CONCLUSIONS AND RELEVANCE: Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS

The influence of 5-HTTLPR, BDNF Rs6265 and COMT Rs4680 polymorphisms on impulsivity in bipolar disorder: the role of gender

Impulsivity has been proposed as an endophenotype for bipolar disorder (BD); moreover, impulsivity levels have been shown to carry prognostic significance and to be quality-of-life predictors. To date, reports about the genetic determinants of impulsivity in mood disorders are limited, with no studies on BD individuals. Individuals with BD and healthy controls (HC) were recruited in the context of an observational, multisite study (GECOBIP). Subjects were genotyped for three candidate single-nucleotide polymorphisms (SNPs) (5-HTTLPR, COMT rs4680, BDNF rs6265); impulsivity was measured through the Italian version of the Barratt Impulsiveness Scale (BIS-11). A mixed-effects regression model was built, with BIS scores as dependent variables, genotypes of the three polymorphisms as fixed effects, and centers of enrollment as random effect. Compared to HC, scores for all BIS factors were higher among subjects with euthymic BD (adjusted β for Total BIS score: 5.35, p < 0.001). No significant interaction effect was evident between disease status (HC vs. BD) and SNP status for any polymorphism. Considering the whole sample, BDNF Met/Met homozygosis was associated with lower BIS scores across all three factors (adjusted β for Total BIS score: -10.2, p < 0.001). A significant 5-HTTLPR x gender interaction was found for the SS genotype, associated with higher BIS scores in females only (adjusted β for Total BIS score: 12.0, p = 0.001). Finally, COMT polymorphism status was not significantly associated with BIS scores. In conclusion, BD diagnosis did not influence the effect on impulsivity scores for any of the three SNPs considered. Only one SNP-the BDNF rs6265 Met/Met homozygosis-was independently associated with lower impulsivity scores. The 5-HTTLPR SS genotype was associated with higher impulsivity scores in females only. Further studies adopting genome-wide screening in larger samples are needed to define the genetic basis of impulsivity in BD

Liquid-phase exfoliation of bismuth telluride iodide (BiTeI): structural and optical properties of single-/few-layer flakes

Bismuth telluride halides (BiTeX) are Rashba-type crystals with several potential applications ranging from spintronics and nonlinear optics to energy. Their layered structures and low cleavage energies allow their production in a two-dimensional form, opening the path to miniaturized device concepts. The possibility to exfoliate bulk BiTeX crystals in the liquid represents a useful tool to formulate a large variety of functional inks for large-scale and cost-effective device manufacturing. Nevertheless, the exfoliation of BiTeI by means of mechanical and electrochemical exfoliation proved to be challenging. In this work, we report the first ultrasonication-assisted liquid-phase exfoliation (LPE) of BiTeI crystals. By screening solvents with different surface tension and Hildebrandt parameters, we maximize the exfoliation efficiency by minimizing the Gibbs free energy of the mixture solvent/BiTeI crystal. The most effective solvents for the BiTeI exfoliation have a surface tension close to 28 mN m(-1) and a Hildebrandt parameter between 19 and 25 MPa0.5. The morphological, structural, and chemical properties of the LPE-produced single-/few-layer BiTeI flakes (average thickness of & SIM;3 nm) are evaluated through microscopic and optical characterizations, confirming their crystallinity. Second-harmonic generation measurements confirm the non-centrosymmetric structure of both bulk and exfoliated materials, revealing a large nonlinear optical response of BiTeI flakes due to the presence of strong quantum confinement effects and the absence of typical phase-matching requirements encountered in bulk nonlinear crystals. We estimated a second-order nonlinearity at 0.8 eV of |chi((2))| & SIM; 1 nm V-1, which is 10 times larger than in bulk BiTeI crystals and is of the same order of magnitude as in other semiconducting monolayers (e.g., MoS2)

Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE Study

Abstract RATIONALE: Noninvasive ventilation (NIV) is increasingly used in patients with acute respiratory distress syndrome (ARDS). The evidence supporting NIV use in patients with ARDS remains relatively sparse. OBJECTIVES: To determine whether, during NIV, the categorization of ARDS severity based on the PaO2/FiO2 Berlin criteria is useful. METHODS: The LUNG SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) study described the management of patients with ARDS. This substudy examines the current practice of NIV use in ARDS, the utility of the PaO2/FiO2 ratio in classifying patients receiving NIV, and the impact of NIV on outcome. MEASUREMENTS AND MAIN RESULTS: Of 2,813 patients with ARDS, 436 (15.5%) were managed with NIV on Days 1 and 2 following fulfillment of diagnostic criteria. Classification of ARDS severity based on PaO2/FiO2 ratio was associated with an increase in intensity of ventilatory support, NIV failure, and intensive care unit (ICU) mortality. NIV failure occurred in 22.2% of mild, 42.3% of moderate, and 47.1% of patients with severe ARDS. Hospital mortality in patients with NIV success and failure was 16.1% and 45.4%, respectively. NIV use was independently associated with increased ICU (hazard ratio, 1.446 [95% confidence interval, 1.159-1.805]), but not hospital, mortality. In a propensity matched analysis, ICU mortality was higher in NIV than invasively ventilated patients with a PaO2/FiO2 lower than 150 mm Hg. CONCLUSIONS: NIV was used in 15% of patients with ARDS, irrespective of severity category. NIV seems to be associated with higher ICU mortality in patients with a PaO2/FiO2 lower than 150 mm Hg. Clinical trial registered with www.clinicaltrials.gov (NCT 02010073)