Processing and properties of large-sized ceramic slabs

Large-sized ceramic slabs - with dimensions up to 360x120 cm2 and thickness down to 2 mm - are manufactured through an innovative ceramic process, starting from porcelain stoneware formulations and involving wet ball milling, spray drying, die-less slow-rate pressing, a single stage of fast drying-firing, and finishing (trimming, assembling of ceramic-fiberglass composites). Fired and unfired industrial slabs were selected and characterized from the technological, compositional (XRF, XRD) and microstructural (SEM) viewpoints. Semi-finished products exhibit a remarkable microstructural uniformity and stability in a rather wide window of firing schedules. The phase composition and compact microstructure of fired slabs are very similar to those of porcelain stoneware tiles. The values of water absorption, bulk density, closed porosity, functional performances as well as mechanical and tribological properties conform to the top quality range of porcelain stoneware tiles. However, the large size coupled with low thickness bestow on the slab a certain degree of flexibility, which is emphasized in ceramic-fiberglass composites. These outstanding performances make the large-sized slabs suitable to be used in novel applications: building and construction (new floorings without dismantling the previous paving, ventilated fa?ades, tunnel coverings, insulating panelling), indoor furnitures (table tops, doors), support for photovoltaic ceramic panelsSe han fabricado piezas de gran formato, con dimensiones de hasta 360x120 cm, y menos de 2 mm, de espesor, empleando m?todos innovadores de fabricaci?n, partiendo de composiciones de gres porcel?nico y utilizando, molienda con bolas por v?a h?meda, atomizaci?n, prensado a baja velocidad sin boquilla de extrusi?n, secado y cocci?n r?pido en una sola etapa, y un acabado que incluye la adhesi?n de fibra de vidrio al soporte cer?mico y el rectificado de la pieza final. Se han seleccionado piezas en verde y cocidas, caracteriz?ndolas desde el punto de vista tecnol?gico, composicional (FRZ, DRX) y microestructural (MEB). Los productos semiacabados muestran una destacada uniformidad microestructural y estabilidad dimensional, dentro de un amplio margen de temperaturas de cocci?n. La composici?n de las fases y la compacidad de la microestructura, son muy semejantes a las que presentan las baldosas de gres porcel?nico convencionales. Los valores de la capacidad de absorci?n de agua, densidad aparente, porosidad cerrada, propiedades funcionales as? como las propiedades tribol?gicas y mec?nicas se sit?an en los mejores valores de las piezas de gres porcel?nico. No obstante las grandes dimensiones, unidas al reducido espesor dotan a las piezas de una cierta flexibilidad, que refuerza el empleo de la capa de fibra de vidrio. Estas destacadas propiedades hacen utilizables, a los grandes formatos, en nueva s aplicaciones, construcci?n y edificaci?n (sin desmontar los pavimentos preexistentes, fachadas ventiladas, revestimiento de t?neles, paneles aislantes etc.) muebles ( encimeras y puertas), soporte de paneles fotovoltaico

Aurea diagnosis of pneumomediastinum. A case report

Pericarditis and spontaneous pneumomediastinum are among the pathologies that are in differential diagnoses when a patient describes dorsal irradiated chest pain: if the patient is young, male, and long-limbed, it is necessary to exclude an acute aortic syndrome firstly. We present the case of a young man who arrived at the Emergency Department for chest pain: an echocardiogram performed an immediate diagnosis of pericarditis. However, if the patient had performed a chest X-ray, this would have enabled the observation of pneumomediastinum, allowing a correct diagnosis of pneumomediastinum and treatment. The purpose of this report is to highlight the importance of the diagnostic process

Rapidly fatal West Nile virus meningoencephalitis in an immunocompetent patient: a case report

Abstract Background West Nile virus (WNV) is a Flaviviridae most often transmitted by mosquitos. Clinical manifestations vary from no symptoms to neuroinvasive disease. Mortality is rare, but patients with neuroinvasive disease have a fatality rate of 4-14%. Diagnosis is made on epidemiological, clinical and serological criteria. Treatment is based on symptomatic and support therapy. WNV neuroinvasive disease seems associated to advancing age and diabetes, but poor prognosis risk factors are still not clearly recognized. During 2017-2018 10 patients affected by WNV infection were admitted to our Hospital (Policlinico of Modena): 3 patients had a rapid fatal outcome and 3 needed intensive care transfer. We report the most representative case. Case Report A 81-yr-old man from Emilia-Romagna was admitted to our unit with a 6 days history of fever (>38℃), fatigue, nausea, vomiting, hiccough and mild cognitive impairment treated with amoxicillin. Past medical history: type 2 diabetes mellitus, arterial hypertension, permanent pacemaker for type 3 atrioventricular block. Referred exposure to farm animals. No recent travels abroad. Chest x-ray showed a retrocardiac opacity, so empiric levofloxacin was started for suspected community acquired pneumonia. After two days the patient began lethargic with a Glasgow Come Score < 8. Neuroinvasive WNV disease was confirmed by electroencephalogram and rachicentesis. Before serologic results acyclovir and dexamethasone were initiated without benefit and patient diedon the fifth day after admission. Conclusions Risk factors for poor prognosis related to WNV Infection are still not clearly identified. Our patient underwent unexpected rapid clinical deterioration before invasive treatment could positively affect prognosis. This underlines the importance of clinical alert to WNV infections during transmission season in endemic areas and the necessity of more data on fatal WNV cases to define criteria to promptly recognize high-risk patients. Keywords encephalitis; meningoencephalitis; neuroinvasive disease; West Nile virus; fatal meningoencephalitis

DIGItal Health Literacy after COVID-19 Outbreak among Frail and Non-Frail Cardiology Patients: The DIGI-COVID Study

Background: Telemedicine requires either the use of digital tools or a minimum technological knowledge of the patients. Digital health literacy may influence the use of telemedicine in most patients, particularly those with frailty. We aimed to explore the association between frailty, the use of digital tools, and patients' digital health literacy. Methods: We prospectively enrolled patients referred to arrhythmia outpatient clinics of our cardiology department from March to September 2022. Patients were divided according to frailty status as defined by the Edmonton Frail Scale (EFS) into robust, pre-frail, and frail. The degree of digital health literacy was assessed through the Digital Health Literacy Instrument (DHLI), which explores seven digital skill categories measured by 21 self-report questions. Results: A total of 300 patients were enrolled (36.3% females, median age 75 (66-84)) and stratified according to frailty status as robust (EFS ≤ 5; 70.7%), pre-frail (EFS 6-7; 15.7%), and frail (EFS ≥ 8; 13.7%). Frail and pre-frail patients used digital tools less frequently and accessed the Internet less frequently compared to robust patients. In the logistic regression analysis, frail patients were significantly associated with the non-use of the Internet (adjusted odds ratio 2.58, 95% CI 1.92-5.61) compared to robust and pre-frail patients. Digital health literacy decreased as the level of frailty increased in all the digital domains examined. Conclusions: Frail patients are characterized by lower use of digital tools compared to robust patients, even though these patients would benefit the most from telemedicine. Digital skills were strongly influenced by frailty

Renal infarction as an uncommon cause of abdominal pain. A case report

Renal infarction is a rare cause of abdominal pain whose diagnosis is often misunderstood or severely delayed. The difficulty in identifying this time-dependent condition greatly limits the possibilities of therapeutic intervention and determines the loss of renal parenchyma that could have been saved with prompt diagnosis. It is, therefore, essential to include renal infarction in the differential diagnosis in case of abdominal pain and to identify this pathology beforehand. We present a case of a 65-yearold male with atrial fibrillation in therapy with Edoxaban who was admitted to the hospital for acute onset of widespread abdominal pain with nausea, vomit, and a worsening of renal function according to the laboratory tests. An abdominal computed tomography with contrast confirmed the presence of a bilateral renal infarction. The patient developed chronic kidney disease and was discharged on anticoagulant therapy. The aim of this paper is, therefore, to increase physician awareness towards this condition, the best opportunity to diagnose early renal infarction and to establish acute and long-term therapy

Dissecting the Role of Mesenchymal Stem Cells in Idiopathic Pulmonary Fibrosis:Cause or Solution

Idiopathic pulmonary fibrosis (IPF) is one of the most aggressive forms of idiopathic interstitial pneumonias, characterized by chronic and progressive fibrosis subverting the lung’s architecture, pulmonary functional decline, progressive respiratory failure, and high mortality (median survival 3 years after diagnosis). Among the mechanisms associated with disease onset and progression, it has been hypothesized that IPF lungs might be affected either by a regenerative deficit of the alveolar epithelium or by a dysregulation of repair mechanisms in response to alveolar and vascular damage. This latter might be related to the progressive dysfunction and exhaustion of the resident stem cells together with a process of cellular and tissue senescence. The role of endogenous mesenchymal stromal/stem cells (MSCs) resident in the lung in the homeostasis of these mechanisms is still a matter of debate. Although endogenous MSCs may play a critical role in lung repair, they are also involved in cellular senescence and tissue ageing processes with loss of lung regenerative potential. In addition, MSCs have immunomodulatory properties and can secrete anti-fibrotic factors. Thus, MSCs obtained from other sources administered systemically or directly into the lung have been investigated for lung epithelial repair and have been explored as a potential therapy for the treatment of lung diseases including IPF. Given these multiple potential roles of MSCs, this review aims both at elucidating the role of resident lung MSCs in IPF pathogenesis and the role of administered MSCs from other sources for potential IPF therapies

Nasal pressure swings as the measure of inspiratory effort in spontaneously breathing patients with de novo acute respiratory failure.

Background- Excessive inspiratory effort could translate into self-inflicted lung injury, thus worsening clinical outcomes of spontaneously breathing patients with acute respiratory failure (ARF). Although esophageal manometry is a reliable method to estimate the magnitude of inspiratory effort, procedural issues significantly limit its use in daily clinical practice. The aim of this study is to describe the correlation between esophageal pressure swings (\u394P es ) and nasal (\u394P nos ) as a potential measure of inspiratory effort in spontaneously breathing patients with de novo ARF. Methods- From January 1 st , 2021 to September 1 st , 2021, 61 consecutive patients with ARF (83.6% related to COVID-19) admitted to the Respiratory Intensive Care Unit (RICU) of the University Hospital of Modena (Italy) and candidate to escalation of noninvasive respiratory support (NRS) were enrolled. Clinical features and tidal changes in esophageal and nasal pressure were recorded on admission and 24 hours after starting NRS. Correlation between \u394P es and \u394P nos served as primary outcome. The effect of \u394P nos measurements on respiratory rate and \u394P es was also assessed. Results- \u394P es and \u394P nos were strongly correlated at admission (R 2 =0.88, p<0.001) and 24 hours apart (R 2 =0.94, p<0.001). The nasal plug insertion and the mouth closure required for \u394P nos measurement did not result in significant change of respiratory rate and \u394P es . The correlation between measures at 24 hours remained significant even after splitting the study population according to the type of NRS (high-flow nasal cannulas [R 2 =0.79, p<0.001] or non-invasive ventilation [R 2 =0.95, p<0.001]). Conclusions- In a cohort of patients with ARF, nasal pressure swings did not alter respiratory mechanics in the short term and were highly correlated with esophageal pressure swings during spontaneous tidal breathing. \u394P nos might warrant further investigation as a measure of inspiratory effort in patients with ARF

Off-label long acting injectable antipsychotics in real-world clinical practice: a cross-sectional analysis of prescriptive patterns from the STAR Network DEPOT study

Introduction Information on the off-label use of Long-Acting Injectable (LAI) antipsychotics in the real world is lacking. In this study, we aimed to identify the sociodemographic and clinical features of patients treated with on- vs off-label LAIs and predictors of off-label First- or Second-Generation Antipsychotic (FGA vs. SGA) LAI choice in everyday clinical practice. Method In a naturalistic national cohort of 449 patients who initiated LAI treatment in the STAR Network Depot Study, two groups were identified based on off- or on-label prescriptions. A multivariate logistic regression analysis was used to test several clinically relevant variables and identify those associated with the choice of FGA vs SGA prescription in the off-label group. Results SGA LAIs were more commonly prescribed in everyday practice, without significant differences in their on- and off-label use. Approximately 1 in 4 patients received an off-label prescription. In the off-label group, the most frequent diagnoses were bipolar disorder (67.5%) or any personality disorder (23.7%). FGA vs SGA LAI choice was significantly associated with BPRS thought disorder (OR = 1.22, CI95% 1.04 to 1.43, p = 0.015) and hostility/suspiciousness (OR = 0.83, CI95% 0.71 to 0.97, p = 0.017) dimensions. The likelihood of receiving an SGA LAI grew steadily with the increase of the BPRS thought disturbance score. Conversely, a preference towards prescribing an FGA was observed with higher scores at the BPRS hostility/suspiciousness subscale. Conclusion Our study is the first to identify predictors of FGA vs SGA choice in patients treated with off-label LAI antipsychotics. Demographic characteristics, i.e. age, sex, and substance/alcohol use co-morbidities did not appear to influence the choice towards FGAs or SGAs. Despite a lack of evidence, clinicians tend to favour FGA over SGA LAIs in bipolar or personality disorder patients with relevant hostility. Further research is needed to evaluate treatment adherence and clinical effectiveness of these prescriptive patterns

The Role of Attitudes Toward Medication and Treatment Adherence in the Clinical Response to LAIs: Findings From the STAR Network Depot Study

Background: Long-acting injectable (LAI) antipsychotics are efficacious in managing psychotic symptoms in people affected by severe mental disorders, such as schizophrenia and bipolar disorder. The present study aimed to investigate whether attitude toward treatment and treatment adherence represent predictors of symptoms changes over time. Methods: The STAR Network \u201cDepot Study\u201d was a naturalistic, multicenter, observational, prospective study that enrolled people initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centers were assessed at three time points: baseline, 6-month, and 12-month follow-up. Psychopathological symptoms, attitude toward medication and treatment adherence were measured using the Brief Psychiatric Rating Scale (BPRS), the Drug Attitude Inventory (DAI-10) and the Kemp's 7-point scale, respectively. Linear mixed-effects models were used to evaluate whether attitude toward medication and treatment adherence independently predicted symptoms changes over time. Analyses were conducted on the overall sample and then stratified according to the baseline severity (BPRS < 41 or BPRS 65 41). Results: We included 461 participants of which 276 were males. The majority of participants had received a primary diagnosis of a schizophrenia spectrum disorder (71.80%) and initiated a treatment with a second-generation LAI (69.63%). BPRS, DAI-10, and Kemp's scale scores improved over time. Six linear regressions\u2014conducted considering the outcome and predictors at baseline, 6-month, and 12-month follow-up independently\u2014showed that both DAI-10 and Kemp's scale negatively associated with BPRS scores at the three considered time points. Linear mixed-effects models conducted on the overall sample did not show any significant association between attitude toward medication or treatment adherence and changes in psychiatric symptoms over time. However, after stratification according to baseline severity, we found that both DAI-10 and Kemp's scale negatively predicted changes in BPRS scores at 12-month follow-up regardless of baseline severity. The association at 6-month follow-up was confirmed only in the group with moderate or severe symptoms at baseline. Conclusion: Our findings corroborate the importance of improving the quality of relationship between clinicians and patients. Shared decision making and thorough discussions about benefits and side effects may improve the outcome in patients with severe mental disorders

Retinol and tocopherol content in primary and metastatic digestive neoplasms.

Purpose: Recent controlled and randomized trials in patients at risk of lung and upper or lower digestive-tract cancer have produced conflicting and uncertain results regarding the protective role of liposoluble vitamin supplementation, mainly when retinol was employed in the prevention of upper and lower digestive tract neoplasms. Accordingly, we have undertaken an extensive appraisal of the behaviour of retinol and tocopherol in both human upper and lower digestive neoplasms. Experimental Design: One hundred and twenty inpatients were enrolled: 43 with viral chronic active hepatitis (CAH), 21 with cholelithiasis (CHOL), 17 with gastric neoplasms (GN) and 21 with colo-rectal neoplasms (CRN) and 18 with digestive neoplasms and liver metastases (DN+LM). Levels of retinol and tocopherol both in the plasma and in tissue taken from non-malignant portions and secondary malignant nodules of the liver, as well as from the primitive malignant mass, were determined following a well-tried HPLC technique. Results: Plasma concentration of retinol was significantly reduced in both GN and DM groups with respect to the non-neoplastic groups. Tocopherol levels were significantly lower only in the GN; surprisingly, they were higher even in the DM patients and in relation to total serum lipids (E/TSL ratio). There was a sharp decrease in the liver tissue levels of total, mainly esterified, retinol in both CHOL and neoplastic groups; tocopherol, on the other hand, remained more or less unchanged, except in the liver metastatic nodules and primary colonic tumor mass, where it increased.Conclusions: Levels of plasma vitamin and tissue retinol and tocopherol therefore appear to be unpredictable, and this must be taken into account when prescribing dietary and therapeutic régimes