Role of meteorological, hydrological and biogeochemical forcings on carbonate system variability at PALOMA station (Gulf of Trieste)

The Gulf of Trieste is the Northernmost area of the Adriatic Sea and, as other shallow shelf areas, is more influenced by exchanges with the atmosphere than deep seas. Hence, it is thought to be highly sensitive to the effects due to the increase of CO2 dissolved in seawater induced by global atmospheric CO2 increase. The most concerning consequence of CO2 dissolution in marine waters is the decrease of pH: a process commonly referred to as "ocean acidification". On the other hand, the dynamics of carbonate system in this coastal zone are also influenced by the variability of oceanographic conditions, mainly induced by meteorological and hydrological forcings, and by production and regeneration processes. We present preliminary results of a monitoring activity started in January 2008, addressed to a better comprehension of the effects of meteorological forcings and biogeochemical processes on the carbonate system and pH in the Gulf of Trieste. Real-time meteorological data, hydrological and biogeochemical monthly sampling were collected in the site of the mast PALOMA, located in the centre of the gulf (25 m of depth). During 2008, the highest values of pHT, (spectrophotometric method, Total scale, 25?C), were measured in the upper layer during summer (pHT=8.120), as a result of a event of production. A strong thermohaline stratification of the water column occurred from June to beginning of August, when remineralization processes in the deeper waters (AOU>142.87 μM -O2) released CO2 (fCO2=1044 μatm) and caused a decrease of pHT (7.648). This process was probably interrupted by one unusually storm event with strong wind (up to 163 km/h) that occurred on 08/08/2008, since in September the water column appeared well ventilated. Total alkalinity (TA) concentrations were modulated both by river inputs and by biogeochemical processes, as the remineralization of organic nitrogen coupled to ammonia production, which determined the maximum values of TA in August and November (up to 2693 μmol/kg)

lanreotide 60 mg a new long acting formulation effectiveness in the chronic treatment of acromegaly

Lanreotide (LAN) 60 mg (LAN60), a new long-acting formulation of LAN alleged to suppress GH/IGF-I hypersecretion for 28 d in acromegalic patients, was administered in a prospective open multicenter study to 92 patients with active acromegaly (61 women and 31 men, aged 20–79 yr). LAN60 was given as adjuvant treatment (AT) in 62 patients; the other 30 patients [primary treatment (PT)] were de novo (n = 20) or previously treated only by pharmacotherapy (n = 10). After wash-out from previous treatments, LAN60 was started im every 28 d for 3 injections; the dose was then individually tailored, aiming at lowering GH to less than 2.5 μg/liter and IGF-I to the normal range. After a median follow-up of 24 months (range, 6–48 months), IGF-I normalized in 65% of patients, decreasing from 199 ± 8% (expressed as a percentage of the upper limit of normal range; mean ± se) to 87 ± 4% (P < 0.0001). GH fell to less than 2.5 μg/liter in 63% of patients and to less than 1 μg/liter in 25%, decreasing from 20 ± 3 to 3 ± 0.4 μ..

Increased use of high-flow nasal cannulas after the pandemic in bronchiolitis: a more severe disease or a changed physician's attitude?

After the SARS-CoV-2 pandemic, we noticed a marked increase in high-flow nasal cannula use for bronchiolitis. This study aims to report the percentage of children treated with high-flow nasal cannula (HFNC) in various seasons. The secondary outcomes were admissions for bronchiolitis, virological results, hospital burden, and NICU/PICU need. We conducted a retrospective study in four Italian hospitals, examining the medical records of all infants (< 12 months) hospitalized for bronchiolitis in the last four winter seasons (1 September-31 March 2018-2022). In the 2021-2022 winter season, 66% of admitted children received HFNC versus 23%, 38%, and 35% in the previous 3 years. A total of 876 patients were hospitalized in the study periods. In 2021-2022, 300 infants were hospitalized for bronchiolitis, 22 in 2020-2021, 259 in 2019-2020, and 295 in 2018-2019. The percentage of patients needing intensive care varied from 28.7% to 18%, 22%, and 15% in each of the four considered periods (p < 0.05). Seventy-seven percent of children received oxygen in the 2021-2022 winter; vs 50%, 63%, and 55% (p < 0.01) in the previous 3 years. NIV/CPAP was used in 23%, 9%, 16%, and 12%, respectively. In 2021-2020, 2% of patients were intubated; 0 in 2020-2021, 3% in 2019-2020, and 1% in 2018-2019

The carbonate system in the Gulf of Trieste: a two years time series at PALOMA station

In the framework of VECTOR project (activity 6.2.2), pH, Total Alkalinity (AT) and physical/chemical parameters were acquired on a monthly basis since January 2008, in the water column at the PALOMA site (Advanced Oceanic Laboratory PlatforM for the Adriatic sea, Gulf of Trieste, 25m depth ). The pH was measured by the spectrophotometric method (precision ? 0.003) and the results expressed on "total scale" at 25?C (pHT@25?C). AT was measured by potentiometric titration at 25?C (precision ? 3 Qmol/kg) and the results were checked against sea water certified as reference material. The other parameters of the carbonate system (pCO2, DIC, CO3 =, lAr, lCa) were computed from pH, AT, salinity, temperature, SiO2, PO4. To our knowledge this is the first time series of these parameters collected in the North Adriatic Sea. These data allowed an initial identification of roles played by biological ad physical factors in controlling the carbonate system dynamics and the pH annual cycle. During the stratified period (April to September), CO2 uptake by primary producers in the upper layer (DO sat > 100 %, Fig 1) determined the highest annual values of pHT@25?C in both years (Fig 1). By contrast, remineralization processes generally prevailed in the deeper waters undersaturated of oxygen (DO down to 48%, Fig 1) and the minima annual values of pHT@25?C were reached. From January to March of both years the water column was homogeneous and cold, reaching the lowest annual temperatures (down to 8.8 ?C). The pHT@25?C values were generally low and constant and the oxygen saturation was around 100 %. These characteristics indicated that biological processes were playing a minor role in determining the observed values of pHT@25?C while physical factors as temperature induced CO2 solubilization were more important. AT concentrations (median value 2633 Qmol/kg) were higher than in open Mediterranean sea (~ 2600 Qmol/Kg ) due to the inflow of rivers with a carbonatic drainage basin. AT variability was mainly modulated by riverine inputs with variable AT concentrations and by the occurrence of strong remineralization processes in the bottom layer (Aug.- Nov. 2008, up to 2658 Qmol/kg, S=37.5) as shown by the relationship with AOU. The seasonal evolution of in situ pCO2 was deeply influenced by the variations of temperature that modulated not only CO2 solubility but also the chemical equilibria between carbonate species. Despite the production processes in the upper water column during summer, pCO2 values were higher than 400 Qatm on the whole water column, from July to December 2008 and from August to October 2009. During these months the Gulf of Trieste was thus acting as a potential CO2 source. In contrast, from January to June of both years, pCO2 values were always lower than 400 Qatm and the Gulf was a CO2 sink (up to -19.0 mmol C m-2 d-1, on 14 Jan 2009) especially during high wind events. An exception to this trend were the high pCO2 value (up to 606 Qatm) observed in April 2009 and May 2008, in surface low salinity waters (S down to 27.6 psu), which were ascribed to the ventilation of CO2 from supersaturated riverine waters

Efficacy of pasireotide LAR for acromegaly: a prolonged real-world monocentric study

BackgroundAcromegaly is caused by excessive growth hormone (GH) and insulin-like growth factor 1 (IGF1). Medical therapy plays a role as a treatment option for persistent disease after non-curative surgery or as a first-line therapy when surgery is not feasible. Pasireotide-LAR (Pas-LAR) is recommended for patients with acromegaly as second-line treatment.AimTo evaluate the patients characteristics predictive of an adequate response to Pas-LAR and the long-term efficacy and safety of the Pas-LAR treatment.MethodsData from 19 patients with active acromegaly, who were and resistant or intolerant to first-line medical therapy and were switched to pas-LAR have been retrospectively collected. We compared the baseline clinical and biochemical characteristics of patients who were found to respond to Pas-LAR therapy (responders, n=14) with those of patients who did not respond (non-responders, n=5). We then evaluated the Pas-LAR efficacy and safety during long-term follow-up in responders.ResultsIGF1 normalization occurred in 71.4% of responders after one injection. IGF1 levels, [median(interquartile range) of the upper limit of the normal range (ULN) fold increase] were higher in non-responders compared to responders within the initial month of therapy [1.40(1.30-2.34) vs 0.70(0.55-1.25), respectively, p=0.009] and after three [1.77(1.74-2.29) vs 0.94(0.82-1.13), respectively, p=0.029] and six months [1.68(1.33-1.72) vs 1.00(0.65 -1.28), respectively, p=0.002]. Out of 6 patients with symptomatic headache (all in responder group), 5 and 1 reported the resolution and improvement of headache, respectively, already after the first injection. Median HbA1c levels tended to increase from baseline to 6 months both in responder (36 mMol/Mol to 42 mMol/Mol) and non-responder patients (45 mMol/Mol to 48 mMol/Mol). During long term follow up, in the responder group 2 new patients developed diabetes. Tumor shrinkage was observed in 6 out of 7 evaluated responders, with no cases of size increase during the long-term follow-up.ConclusionPas-LAR is effective and safe and the early identification of responders is possible just after the first administration

Effects of somatostatin analogues on muscle sympathetic nerve activity in acromegaly

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A pharmacoeconomic analysis from Italian guidelines for the management of prolactinomas

Background: Prolactinoma, the most common pituitary adenoma, is usually treated with dopamine agonist (DA) therapy like cabergoline. Surgery is second-line therapy, and radiotherapy is used if surgical treatment fails or in relapsing macroprolactinoma. Objective: This study aimed to provide economic evidence for the management of prolactinoma in Italy, using a cost-of-illness and cost-utility analysis that considered various treatment options, including cabergoline, bromocriptine, temozolomide, radiation therapy, and surgical strategies. Methods: The researchers conducted a systematic literature review for each research question on scientific data- bases and surveyed a panel of experts for each therapeutic procedure's specific drivers that contributed to its total cost. Results: The average cost of the first year of treatment was euro2,558.91 and euro3,287.40 for subjects with micro- prolactinoma and macroprolactinoma, respectively. Follow-up costs from the second to the fifth year after ini- tial treatment were euro798.13 and euro1,084.59 per year in both groups. Cabergoline had an adequate cost-utility profile, with an incremental cost-effectiveness ratio (ICER) of euro3,201.15 compared to bromocriptine, based on a willingness-to-pay of euro40,000 per quality-adjusted life year (QALY) in the reference economy. Endoscopic sur- gery was more cost-effective than cabergoline, with an ICER of euro44,846.64. Considering a willingness-to-pay of euro40,000/QALY, the baseline findings show cabergoline to have high cost utility and endoscopic surgery just a tad above that. Conclusions: Due to the favorable cost-utility profile and safety of surgical treatment, pituitary surgery should be considered more frequently as the initial therapeutic approach. This management choice could lead to better outcomes and an appropriate allocation of healthcare resources

Hyponatremia after anticoagulant treatment: a rare cause of adrenal failure

A 69-year-old male was admitted for severe hyponatremia disclosed after an accidental fall. He was anticoagulated from 2 months after the implantation of a biologic aortic valve prosthesis. The work-up disclosed adrenal failure and MRI showed bilateral adrenal hemorrhage. Clinical picture and lab parameters normalized quickly after the appropriate replacement treatment. Anticoagulation excess should be added to the list of drugs potentially causing hyponatremia