Caso clínico pneumológico

Post-extubation acute pulmonary edema (PEAPE) is an uncommon complication of tracheal extubation, occurring in 0.1% of patients undergoing general anesthesia. It has rarely been described in pediatric age, but its incidence is thought to be underestimated, as many cases of post-operative respiratory distress may be misdiagnosed or unrecognized. A formerly healthy 15-year-old male diagnosed with acute appendicitis was submitted to a laparoscopic appendectomy under general anesthesia. Immediately after extubation, he developed signs and symptoms of respiratory distress, and chest radiograph was compatible with acute pulmonary edema. Due to suspicion of PEAPE, supplementary oxygen and intravenous furosemide were administered, with favorable outcome. PEAPE is a major anesthesia-related emergency, which may worsen the prognosis of low-risk surgical procedures. A high degree of suspicion should be maintained in children and adolescents presenting with signs of respiratory distress and hypoxia after general anesthesia, as prompt diagnosis and treatment are crucial for a favorable outcome.info:eu-repo/semantics/publishedVersio

Metastates in mean-field models with random external fields generated by Markov chains

We extend the construction by Kuelske and Iacobelli of metastates in finite-state mean-field models in independent disorder to situations where the local disorder terms are are a sample of an external ergodic Markov chain in equilibrium. We show that for non-degenerate Markov chains, the structure of the theorems is analogous to the case of i.i.d. variables when the limiting weights in the metastate are expressed with the aid of a CLT for the occupation time measure of the chain. As a new phenomenon we also show in a Potts example that, for a degenerate non-reversible chain this CLT approximation is not enough and the metastate can have less symmetry than the symmetry of the interaction and a Gaussian approximation of disorder fluctuations would suggest.Comment: 20 pages, 2 figure

Meson Exchange Currents in (e,e'p) recoil polarization observables

A study of the effects of meson-exchange currents and isobar configurations in $A(\vec{e},e'\vec{p})B$ reactions is presented. We use a distorted wave impulse approximation (DWIA) model where final-state interactions are treated through a phenomenological optical potential. The model includes relativistic corrections in the kinematics and in the electromagnetic one- and two-body currents. The full set of polarized response functions is analyzed, as well as the transferred polarization asymmetry. Results are presented for proton knock-out from closed-shell nuclei, for moderate to high momentum transfer.Comment: 44 pages, 18 figures. Added physical arguments explaining the dominance of OB over MEC, and a summary of differences with previous MEC calculations. To be published in PR

Spherical Model in a Random Field

We investigate the properties of the Gibbs states and thermodynamic observables of the spherical model in a random field. We show that on the low-temperature critical line the magnetization of the model is not a self-averaging observable, but it self-averages conditionally. We also show that an arbitrarily weak homogeneous boundary field dominates over fluctuations of the random field once the model transits into a ferromagnetic phase. As a result, a homogeneous boundary field restores the conventional self-averaging of thermodynamic observables, like the magnetization and the susceptibility. We also investigate the effective field created at the sites of the lattice by the random field, and show that at the critical temperature of the spherical model the effective field undergoes a transition into a phase with long-range correlations $\sim r^{4-d}$.Comment: 29 page

The scientific potential of space-based gravitational wave detectors

The millihertz gravitational wave band can only be accessed with a space-based interferometer, but it is one of the richest in potential sources. Observations in this band have amazing scientific potential. The mergers between massive black holes with mass in the range 10 thousand to 10 million solar masses, which are expected to occur following the mergers of their host galaxies, produce strong millihertz gravitational radiation. Observations of these systems will trace the hierarchical assembly of structure in the Universe in a mass range that is very difficult to probe electromagnetically. Stellar mass compact objects falling into such black holes in the centres of galaxies generate detectable gravitational radiation for several years prior to the final plunge and merger with the central black hole. Measurements of these systems offer an unprecedented opportunity to probe the predictions of general relativity in the strong-field and dynamical regime. Millihertz gravitational waves are also generated by millions of ultra-compact binaries in the Milky Way, providing a new way to probe galactic stellar populations. ESA has recognised this great scientific potential by selecting The Gravitational Universe as its theme for the L3 large satellite mission, scheduled for launch in ~2034. In this article we will review the likely sources for millihertz gravitational wave detectors and describe the wide applications that observations of these sources could have for astrophysics, cosmology and fundamental physics.Comment: 18 pages, 2 figures, contribution to Gravitational Wave Astrophysics, the proceedings of the 2014 Sant Cugat Forum on Astrophysics; v2 includes one additional referenc

Extension of the sum rule for the transition rates between multiplets to the multiphoton case

The sum rule for the transition rates between the components of two multiplets, known for the one-photon transitions, is extended to the multiphoton transitions in hydrogen and hydrogen-like ions. As an example the transitions 3p-2p, 4p-3p and 4d-3d are considered. The numerical results are compared with previous calculations.Comment: 10 pages, 4 table

Novel Druggable Hot Spots in Avian Influenza Neuraminidase H5N1 Revealed by Computational Solvent Mapping of a Reduced and Representative Receptor Ensemble

The influenza virus subtype H5N1 has raised concerns of a possible human pandemic threat because of its high virulence and mutation rate. Although several approved anti-influenza drugs effectively target the neuraminidase, some strains have already acquired resistance to the currently available anti-influenza drugs. In this study, we present the synergistic application of extended explicit solvent molecular dynamics (MD) and computational solvent mapping (CS-Map) to identify putative ‘hot spots’ within flexible binding regions of N1 neuraminidase. Using representative conformations of the N1 binding region extracted from a clustering analysis of four concatenated 40-ns MD simulations, CS-Map was utilized to assess the ability of small, solvent-sized molecules to bind within close proximity to the sialic acid binding region. Mapping analyses of the dominant MD conformations reveal the presence of additional hot spot regions in the 150- and 430-loop regions. Our hot spot analysis provides further support for the feasibility of developing high-affinity inhibitors capable of binding these regions, which appear to be unique to the N1 strain

Star Formation and Dynamics in the Galactic Centre

The centre of our Galaxy is one of the most studied and yet enigmatic places in the Universe. At a distance of about 8 kpc from our Sun, the Galactic centre (GC) is the ideal environment to study the extreme processes that take place in the vicinity of a supermassive black hole (SMBH). Despite the hostile environment, several tens of early-type stars populate the central parsec of our Galaxy. A fraction of them lie in a thin ring with mild eccentricity and inner radius ~0.04 pc, while the S-stars, i.e. the ~30 stars closest to the SMBH (<0.04 pc), have randomly oriented and highly eccentric orbits. The formation of such early-type stars has been a puzzle for a long time: molecular clouds should be tidally disrupted by the SMBH before they can fragment into stars. We review the main scenarios proposed to explain the formation and the dynamical evolution of the early-type stars in the GC. In particular, we discuss the most popular in situ scenarios (accretion disc fragmentation and molecular cloud disruption) and migration scenarios (star cluster inspiral and Hills mechanism). We focus on the most pressing challenges that must be faced to shed light on the process of star formation in the vicinity of a SMBH.Comment: 68 pages, 35 figures; invited review chapter, to be published in expanded form in Haardt, F., Gorini, V., Moschella, U. and Treves, A., 'Astrophysical Black Holes'. Lecture Notes in Physics. Springer 201

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362