Chest Ultrasound Helps to Diagnose Pulmonary Consolidations in Pediatric Patients

The diagnosis of pneumonia in pediatric patients relies on physical examination, blood tests, and chest X-rays. Physical examination, blood tests, and chest X-rays have a low accuracy, that is even greater in the critically ill. These limitations along with the risk of ionizing radiations, mandate the search for a safe diagnostic tool for patients with suspected pneumonia. Ultrasound (US) imaging offers several advantages over traditional radiographic techniques: it is non-invasive, painless, and involves minimal contact. In case of pulmonary parenchymal lesions, US is useful for differentiating pulmonary consolidation or atelectasis from lung masses and pleural lesions. Detection of air or fluid bronchograms at US and of pulmonary vessels with color flow imaging, is essential for the differential diagnosis of parenchymal consolidations. Furthermore US has a role in the evaluation of mediastinal masses and characterization of pleural fluid collection. Chest US is an ideal modality for serial examinations in rapidly evolving disease processes

Atomic-Level Description of Thermal Fluctuations in Inorganic Lead Halide Perovskites

A comprehensive microscopic description of thermally induced distortions in lead halide perovskites is crucial for their realistic applications, yet still unclear. Here, we quantify the effects of thermal activation in CsPbBr3 nanocrystals across length scales with atomic-level precision, and we provide a framework for the description of phase transitions therein, beyond the simplistic picture of unit-cell symmetry increase upon heating. The temperature increase significantly enhances the short-range structural distortions of the lead halide framework as a consequence of the phonon anharmonicity, which causes the excess free energy surface to change as a function of temperature. As a result, phase transitions can be rationalized via the soft-mode model, which also describes displacive thermal phase transitions in oxide perovskites. Our findings allow to reconcile temperature-dependent modifications of physical properties, such as changes in the optical band gap, that are incompatible with the perovskite time- and space-average structures

First Results of the 140^{140}Ce(n,γ)141^{141}Ce Cross-Section Measurement at n_TOF

An accurate measurement of the $^{140}$Ce(n,γ) energy-dependent cross-section was performed at the n_TOF facility at CERN. This cross-section is of great importance because it represents a bottleneck for the s-process nucleosynthesis and determines to a large extent the cerium abundance in stars. The measurement was motivated by the significant difference between the cerium abundance measured in globular clusters and the value predicted by theoretical stellar models. This discrepancy can be ascribed to an overestimation of the $^{140}$Ce capture cross-section due to a lack of accurate nuclear data. For this measurement, we used a sample of cerium oxide enriched in $^{140}$Ce to 99.4%. The experimental apparatus consisted of four deuterated benzene liquid scintillator detectors, which allowed us to overcome the difficulties present in the previous measurements, thanks to their very low neutron sensitivity. The accurate analysis of the p-wave resonances and the calculation of their average parameters are fundamental to improve the evaluation of the $^{140}$Ce Maxwellian-averaged cross-section

First Results of the 140^{140}Ce(n,γ)141^{141}Ce Cross-Section Measurement at n_TOF

An accurate measurement of the $^{140}$Ce(n,γ) energy-dependent cross-section was performed at the n_TOF facility at CERN. This cross-section is of great importance because it represents a bottleneck for the s-process nucleosynthesis and determines to a large extent the cerium abundance in stars. The measurement was motivated by the significant difference between the cerium abundance measured in globular clusters and the value predicted by theoretical stellar models. This discrepancy can be ascribed to an overestimation of the $^{140}$Ce capture cross-section due to a lack of accurate nuclear data. For this measurement, we used a sample of cerium oxide enriched in $^{140}$Ce to 99.4%. The experimental apparatus consisted of four deuterated benzene liquid scintillator detectors, which allowed us to overcome the difficulties present in the previous measurements, thanks to their very low neutron sensitivity. The accurate analysis of the p-wave resonances and the calculation of their average parameters are fundamental to improve the evaluation of the $^{140}$Ce Maxwellian-averaged cross-section

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Transcriptional and post-transcriptional regulation of ferritin: modulation by oxalomalate.

With rare exceptions, virtually all studied organisms from Archaea to man are dependent on iron for survival. Despite the ubiquitous distribution and abundance of iron in the biosphere, iron-dependent life must contend with the paradoxical hazards of iron deficiency and iron overload, each with its serious or fatal consequences. Homeostatic mechanisms regulating the absorption, transport, storage, and mobilization of cellular iron are therefore of critical importance in iron metabolism, and a rich biology and chemistry underlie all of these mechanisms. Ferritins are among the most ancient proteins of iron metabolism, found substantially conserved in species from bacteria to plants to man. Ferritin is required for intracellular iron storage; its biosynthesis is regulated both transcriptionally, through iron–dependent and iron-independent factors, and translationally by the action of iron-regulatory proteins (IRP1 and IRP2). These regulations prevent iron excess from promoting the formation of reactive oxygen species (ROS). We have recently demonstrated that oxalomalate (OMA, -hydroxy--oxalosuccinic acid), a competitive inhibitor of aconitase, an enzyme of the citric acid cycle, remarkably decreases the RNA-binding activity of IRP1. The aim of the present study has been to investigate the effect of OMA on the translation of ferritin. In an attempt to verify this hypothesis, we evaluated the levels of ferritin in various cell types cultured with OMA and we found that this compound increases the intracellular ferritin content. In addition, we analyzed whether the OMA effect on the modulation of ferritin expression may result also from a transcriptional regulation. We observed an increase in ferritin mRNA levels and an enhanced transcription of H-ferritin gene induced by OMA. We suppose that OMA could play a role in controlling ferritin expression both at post-transcriptional and at transcriptional level, leading to a major amount of protein. Finally, the OMA-induced ferritin overexpression decreases ROS formation and cellular lipid peroxidation, thus protecting cells from iron-dependent oxidative injury. In conclusion, these data show that an inhibitor of aconitase, OMA, besides being involved in energetic metabolism, is able to control ferritin expression, probably through molecular mechanisms of either post-transcriptional regulation or transcriptional modulation, with advantageous consequences for the cell

Alterations of iron metabolism during hearth ischemia/reperfusion injury. Cytoprotective effects of simvastatin

Ischemic heart disease, the main cause of mortality and morbidity in industrialized countries, is a metabolic phenomenon due to an inadequate oxygenation of heart tissue caused by the closing or narrowing of the coronary arteries. However, the ischemic condition and the subsequent tissue reperfusion, lead to several functional and metabolic changes that globally define the so-called “ischemia/reperfusion injury”. This injury leads to metabolic and functional alterations, in particular due to the production of the Oxygen Reactive Species (ROS) that are able to promote cell damage. Because iron is involved in the ROS production by the Haber-Weiss-Fenton reaction, the aim of this study was to elucidate the molecular mechanisms underlying the iron metabolism during the cardiac ischemia/reperfusion. To this aim it has been analyzed the activity and the expression of the main proteins involved in iron homeostasis, such as the Iron Regulatory Proteins, Transferrin Receptor 1 (TfR1), and ferritin in an in vivo model of cardiac ischemia/reperfusion. The results show that in rats hearts subjected to the ischemic/reperfusion injury, the activity of IRP1 was altered without changing its cellular content. The evaluation of the TfR1 levels showed an evident decrease of the expression of this protein during ischemia followed by a marked increase after the reperfusion phase, while regarding the ferritin expression it was observed a considerable decrease of the cytosolic levels of this protein only after the reperfusion phase. Moreover, using rat cardyomyoblasts (H9c2 cell line) in an in vitro model of hypoxia and reoxygenation, it was evaluated the cellular levels of the “Labile Iron Pool” (LIP), showing a “free iron” increase after the reoxygenation phase, in accordance with the observed changes of the TfR1 and ferritin expression. In addition, it was observed an increased ROS production after the hypoxia/reoxygenation damage and, using the iron chelator SIH (Salicylaldehyde Isonicotinoyl Hydrazone), it was showed that a significant part of these ROS depend by the higher levels of the LIP, strongly suggesting that iron is involved in the development of the cardiac damage induced by ischemia/reperfusion conditions. Other aim of this study has been to evaluate the cytoprotective role of the cholesterol-lowering drug Simvastatin, during the ischemic/reperfusion injury, because of its anti-inflammatory and antioxidant effects (“pleiotropic effects”). Simvastatin, at concentration of 0,01µM, reduced the reactive nitrogen species levels and ROS productions in rat cardyomyoblasts (H9c2 cell line) subjected to hypoxia/reoxygenation conditions and also was able to reduce the cellular levels of the “Labile Iron Pool”, justifying the reduced production of the ROS and the resulting increased cell viability, observed after the drug treatment. Moreover, Simvastatin increased the ferritin levels, in particular during hypoxia conditions, thus explaining the LIP reduction after treatment with this drug. In conclusion, these results not only clarify the crucial role that iron plays in the progression of ischemic damage, but also show that proteins regulating the homeostasis of this metal, such as ferritin, may be a target of the Simvastatin, which could be used for the prevention of oxidative damage induced by cardiac ischemic conditions. Should this be the case, a new horizon as an antioxiodant opens for Simvastatin