Numerical results

Abstract

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Abstract

Immature platelet fraction as predictive index of sepsis

Introduction The incidence of sepsis is reported around 37% in European ICUs [1]. The mortality rate depends on the severity of organ failure, up to 65% if four or more organs are involved. Multiple organ failure (MOF) is due to microcirculatory dysfunction with microthrombosis resulting from coagulation disorders including platelets’ activation. An early diagnosis should identify the microcirculatory dysfunction before MOF became clinically evident. The diagnosis of sepsis is commonly based on clinical criteria, pathogen identifi cation and use of markers like procalcitonin (PCT) and C-reactive protein (PCR) associated with infection. The aim of our study is to evaluate whether the routine measurement of immature platelet fraction (IPF), considered a precocious marker of platelet production, is associated with sepsis and its severity and/or whether it could be used as a predicting marker of sepsis. Methods We enrolled 66 consecutive patients admitted to the ICU, dividing them into two groups: septic (n = 44) and no septic (n = 22). The severity of sepsis was evaluated. The exclusion criterion was a platelet count <150,000/mm3. Blood count, coagulation, PCR, PCT, and IPF were collected every day. Results The IPF values between septic (4.6 ± 3.1) and no septic patients (3.3 ± 1.5) did not diff er (P = 0.16). No correlation was found between IPF values and the severity of septic condition (no sepsis 11.7 ± 10.1; sepsis 14.3 ± 10.5; severe sepsis 10.5 ± 9.1; septic shock 19.5 ± 12.4; P = 0.3). When we considered only subjects who did not have sepsis at the ICU admission we found that patients who developed sepsis during the recovery had IPF values higher than patients who did not develop sepsis (Table 1). Conclusions From our results IPF cannot be considered a marker of sepsis. Conversely it could be used as predictive index of sepsis because it can identify patients who will develop sepsis. References 1. Vincent et al.: Sepsis in European intensive care units: results of the SOAP study. Intensive Care Med 2006, 34:344-353

The prognostic importance of chronic end-stage diseases in geriatric patients admitted to 163 Italian ICUs

BACKGROUND: The number of elderly patients undergoing major surgical interventions and then needing admission to intensive care unit (ICU) grows steadily. We investigated this issue in a cohort of 232,278 patients admitted in five years (2011-2015) to 163 Italian general ICUs. METHODS: Surgical patients older than 75 registered in the GiViTI MargheritaPROSAFE project were analyzed. The impact on hospital mortality of important chronic conditions (severe COPD, NYHA class IV, dementia, end-stage renal disease, cirrhosis with portal hypertension) was investigated with two prognostic models developed yearly on patients staying in the ICU less or more than 24 hours. RESULTS: 44,551 elderly patients (19.2%) underwent emergency (47.3%) or elective surgery (52.7%). At least one severe comorbidity was present in 14.6% of them, yielding a higher hospital mortality (32.4%, vs. 21.1% without severe comorbidity). In the models for patients staying in the ICU 24 hours or more, cirrhosis, NYHA class IV, and severe COPD were constant independent predictors of death (adjusted odds ratios [ORs] range 1.67-1.97, 1.54-1.91, and 1.34-1.50, respectively), while dementia was statistically significant in four out of five models (adjusted ORs 1.23-1.28). End-stage renal disease, instead, never resulted to be an independent prognostic factor. For patients staying in the ICU less than 24 hours, chronic comorbidities were only occasionally independent predictors of death. CONCLUSIONS: Our study confirms that elderly surgical patients represent a relevant part of all ICUs admissions. About one of seven bear at least one severe chronic comorbidity, that, excluding end-stage renal disease, are all strong independent predictors of hospital death

Observables in Topological Yang-Mills Theories

Using topological Yang-Mills theory as example, we discuss the definition and determination of observables in topological field theories (of Witten-type) within the superspace formulation proposed by Horne. This approach to the equivariant cohomology leads to a set of bi-descent equations involving the BRST and supersymmetry operators as well as the exterior derivative. This allows us to determine superspace expressions for all observables, and thereby to recover the Donaldson-Witten polynomials when choosing a Wess-Zumino-type gauge.Comment: 39 pages, Late

Early pathological gambling in co-occurrence with semantic variant primary progressive aphasia: A case report

We have comprehensively documented a case of semantic variant of primary progressive aphasia (sv-PPA) presenting with early-onset pathological gambling (PG). While a growing number of studies have shown the presence of behavioral alterations in patients with sv-PPA, PG has been observed only in the behavioral variant of frontotemporal dementia (bv-FTD). To date, no case of PG with the co-occurrence of prominent semantic deficits at the onset of the disease has been reported in the literature. Impulse disorders at onset may wrongly lead to a misdiagnosis (ie, psychiatric disorders). Therefore, a wider characterization of cognitive/aphasia symptoms in patients presenting impulse disorders and predominant language dysfunctions is recommended

Age-Specific 18F-FDG Image Processing Pipelines and Analysis Are Essential for Individual Mapping of Seizure Foci in Paediatric Patients with Intractable Epilepsy

Fluoro-18-deoxyglucose positron emission tomography (FDG-PET) is an important tool for the pre-surgical assessment of children with drug-resistant epilepsy. Standard assessment is carried out visually and this is often subjective and highly user-dependent. Voxel-wise statistics can be used to remove user-dependent biases by automatically identifying areas of significant hypo/hyper-metabolism, associated to the epileptogenic area. In the clinical settings, this analysis is carried out using commercially available software. These software packages suffer from two main limitations when applied to paediatric PET data: 1) paediatric scans are spatially normalised to an adult standard template and 2) statistical comparisons use an adult control dataset. The aim of this work is to provide a reliable observer-independent pipeline for the analysis of paediatric FDG-PET scans, as part of pre-surgical planning in epilepsy. METHODS: A pseudo-control dataset (n = 19 for 6-9y, n = 93 for 10-20y) was used to create two age-specific FDG-PET paediatric templates in standard paediatric space. The FDG-PET scans of 46 epilepsy patients (n = 16 for 6-9y, n = 30 for 10-17y) were retrospectively collated and analysed using voxel-wise statistics. This was implemented with the standard pipeline available in the commercial software Scenium and an in-house Statistical Parametric Mapping v.8 (SPM8) pipeline (including age-specific paediatric templates and normal database). A kappa test was used to assess the level of agreement between findings of voxel-wise analyses and the clinical diagnosis of each patient. The SPM8 pipeline was further validated using post-surgical seizure-free patients. RESULTS: Improved agreement with the clinical diagnosis was reported using SPM8, in terms of focus localisation, especially for the younger patient group: kScenium=0.489 versus kSPM=0.805. The proposed pipeline also showed a sensitivity of ~70% in both age ranges, for the localisation of hypo-metabolic areas on paediatric FDG-PET scans in post-surgical seizure-free patients. CONCLUSION: We show that by creating age-specific templates and using paediatric control databases, our pipeline provides an accurate and sensitive semi-quantitative method for assessing FDG-PET scans of patients under 18y

Characterization of CdTe with photoelectronic techniques

Thermally stimulated current (TSC) and space-charge limited current (SCLC) measurements have been performed in CdTe grown by Bridgman method with various In dopings and grown from Te-rich solution with Cl doping. Hole traps have been evidenced at 0.07, 0.14, 0.25 and 0.36 eV from valence band, while electron traps are at 0.05, 0.34, 0.52 and 0.62 eV from conduction band. Measurements of activation energies of resistivity vs temperature curves indicate which of these should correspond to donors or acceptors centers. Various methods of analysis were used both for TSC and for SCLC results, in order to determine the more suitable ones. Finally TSC and SCLC are compared and discussed as methods for CdTe characterization.Des mesures de courants thermostimulés ou limités par charge d'espace ont été employées pour caractériser des cristaux de tellurure de cadmium préparés soit par la méthode de Bridgman (avec différents niveaux de dopage à l'In) soit par le procédé THM sous solvant tellure (avec dopage au C1). Les pièges suivants ont été identifiés : pour les trous, des niveaux localisés à 0,07, 0,14, 0,25, 0,36 eV de la bande de valence, pour les électrons à 0,05, 0,34, 052 et 0,62 eV de la bande de conduction. A partir des mesures de résistivité en fonction de la température il a été possible de déterminer les niveaux donneurs et accepteurs, respectivement. L'analyse des courbes de courants thermostimulés et de charge d'espace a été effectuée de plusieurs façons, afin de déterminer les conditions optimales d'analyse. Finalement, les mérites respectifs de ces deux procédés de caractérisation seront discutés dans le cas où elles sont mises en œuvre sur CdTe

La psichiatria di consultazione e collegamento nell’ospedale generale: l’esperienza perugina

Objective - This study describes the Consultation-Liaison Service of the Perugia University and investigates the significant associations between a many variables of the assessed population. Results - During the time from July 2008 to June 2009, 722 consultations were performed at the general hospital in Perugia. First examinations were 605. Most consultations involved European patients (95,2%) of female gender (56.3%); mean age was 55.77 (SD ± 21.27). Emergencies were 22.5%; one fifth of patients were not informed of having been referred to our service and half of interventions were requested by departments of internal medicine. The primary reasons for the referral were depression (18.6%), unexplained physical symptoms (12.3%) and anxiety (10.4%); most patients were already taking psychotropic medication before our intervention (58.8%).The significant associations are the following: associations between gender and social status (p < 0.01), social condition (p < 0.01), work (p < 0.01) and advice about the need of the consultation (p < 0.05). The area (medical, surgical and specialized area) are related with the advice (p < 0.05), the reason (p < 0.01) and the type of the consultation (p < 0.01), the diagnostic explanations (p < 0.01), the liaison investigations (p < 0.01) and, at last, with the longrange plan after discharge (p < 0.01)

Excitation of low-lying states in 144Nd by means of (e,e') scattering

Abstract The low-lying states of 144Nd have been investigated up to an excitation energy of 3.1 MeV by means of high-resolution inelastic electron scattering. Transition charge densities have been extracted for natural-parity states. The experimental data have been compared with the predictions of the quasiparticle-phonon model. The calculations show that both collective and single-particle degrees of freedom are important for describing the low-lying states of 144Nd. A comparison of the present data with data for 142Nd and 142Ce emphasizes the role played by the two valence neutrons outside the N = 82 closed shell