Artery in Microgravity (AIM): Assembly, integration, and testing for a student payload for the ISS

The Artery in Microgravity (AIM) project was the first experiment to be selected for the “Orbit Your Thesis!” programme of the European Space Agency Academy. It is a 2U cube experiment that will be operated in the International Commercial Experiment (ICE) Cubes facility onboard the International Space Station. The experiment is expected to be launched on SpaceX-25 in mid-2022. The project is being developed by an international group of students from ISAE-SUPAERO and Politecnico di Torino. The objective of the experiment is to study haemodynamics in the space environment applied to coronary heart disease. The outcomes of this testbench will contribute to understanding the effects of radiation and microgravity on the circulatory system of an astronaut, specifically the behaviour in long-term human spaceflight. It will also help to ascertain the feasibility of individuals suffering from this kind of disease going to space someday. The cornerstones of the experiment are two models of 3D-printed artificial arteries, in stenotic and stented conditions respectively. Blood-mimicking fluid composed of water and glycerol is circulated through the arteries in a closed hydraulic loop, and a red dye is injected for flow visualisation. Drops of pressure and image analysis of the flow will be studied with the corresponding sensors and camera. The pH of the fluid will also be monitored to assess the effect of augmented radiation levels on the release of particles from the metallic stent. Some delays were experienced in the project due to the COVID-19 pandemic and to implement design improvements. Improvements were made to several aspects of the design including mechanics (e.g. remanufacturing the reservoir with surface treatment against corrosion, leak prevention measures), software (e.g. upgrading to Odroid-C4 and migrating the code to Python), and electronics (e.g. several iterations of the interface PCB design). This iterative process of identifying areas of concern and designing and implementing solutions has resulted in many lessons learned. The paper will outline in detail Phase D – Qualification and Production of the AIM experiment cube, with special insight on the implementation of the improvements. Previously, at the Symposium on Space Educational Activities in 2019 in Leicester, the initial phases of the design and development of the cube were presented. This year, the final flight model and the results of validation testing before launching on SpaceX-25 are presented. Lessons learned throughout the course of the project are also highlighted for students embarking on their own space-related educational activities

Monitoring the final orbital decay and the re-entry of Tiangong-1 with the Italian SST ground sensor network

The uncontrolled re-entry of spacecraft and upper stages is quite common, occurring nearly every week. Among them, intact objects having a mass greater than five metric tons re-enter, on average, 1–2 times per year. Therefore, the re-entry of the first Chinese Space Station, Tiangong-1, was far from unusual, but attracted anyway a great worldwide attention and some concerns. For these reasons, the Italian component of the European SST (Space Surveillance and Tracking) consortium took this opportunity for carrying out a national exercise. According to Chinese official sources, the ground control of Tiangong-1 was lost in March 2016, precluding the planned de-orbiting in the South Pacific Ocean Unpopulated Area (SPOUA). Tiangong-1 consisted of a cylindrical section, 10:5 m in length and 3:4 m in (maximum) diameter, with two rectangular solar panels of 3 m × 7 m. The mass was estimated to be around 7500 kg. The Italian network of sensors activated for the campaign included mono-static and bi-static radars, optical telescopes, a laser ranging station and a network of all-sky cameras, originally deployed for the observation of fireballs and bolides. In addition to providing complementary information, concerning the orbit, the attitude and the photometry of Tiangong-1, this quite heterogeneous collection of national assets provided also the occasion for testing, in an operational environment, the Italian sensor tasking preparedness and the data acquisition, exchange and processing capabilities within the European SST consortium. In this respect, it is important to remember that in 2014 the European Commission, well aware of the topic criticality, took the commitment to implement a European network of sensors for surveillance and tracking of objects in Earth's orbit by starting a dedicated SST support framework program. Italy, France, Germany, Spain and UK joined it and constituted, together with SatCent, the front desk for SST services, the EUSST Consortium. In this paper, a description of the Tiangong-1 monitoring activities and of the main observations results obtained by the Italian sensor network are reported. Attention is also devoted to the coordination aspects of several Italian entities (military, civil and research organizations) that worked together. Finally, a description of the re-entry prediction and alert procedure for the national civil protection authorities is presented

S2k guidelines on the management of paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome initiated by the European Academy of Dermatology and Venereology (EADV).

BACKGROUND Paraneoplastic pemphigus (PNP), also called paraneoplastic autoimmune multiorgan syndrome (PAMS), is a rare autoimmune disease with mucocutaneous and multi-organ involvement. PNP/PAMS is typically associated with lymphoproliferative or haematological malignancies, and less frequently with solid malignancies. The mortality rate of PNP/PAMS is elevated owing to the increased risk of severe infections and disease-associated complications, such as bronchiolitis obliterans. OBJECTIVES These guidelines summarize evidence-based and expert-based recommendations (S2k level) for the clinical characterization, diagnosis and management of PNP/PAMS. They have been initiated by the Task Force Autoimmune Blistering Diseases of the European Academy of Dermatology and Venereology with the contribution of physicians from all relevant disciplines. The degree of consent among all task force members was included. RESULTS Chronic severe mucositis and polymorphic skin lesions are clue clinical characteristics of PNP/PAMS. A complete assessment of the patient with suspected PNP/PAMS, requiring histopathological study and immunopathological investigations, including direct and indirect immunofluorescence, ELISA and, where available, immunoblotting/immunoprecipitation, is recommended to achieve a diagnosis of PNP/PAMS. Detection of anti-envoplakin antibodies and/or circulating antibodies binding to the rat bladder epithelium at indirect immunofluorescence is the most specific tool for the diagnosis of PNP/PAMS in a patient with compatible clinical and anamnestic features. Treatment of PNP/PAMS is highly challenging. Systemic steroids up to 1.5 mg/kg/day are recommended as first-line option. Rituximab is also recommended in patients with PNP/PAMS secondary to lymphoproliferative conditions but might also be considered in cases of PNP/PAMS associated with solid tumours. A multidisciplinary approach involving pneumologists, ophthalmologists and onco-haematologists is recommended for optimal management of the patients. CONCLUSIONS These are the first European guidelines for the diagnosis and management of PNP/PAMS. Diagnostic criteria and therapeutic recommendations will require further validation by prospective studies

Timing of initiation of oral anticoagulants in patients with acute ischemic stroke and atrial fibrillation comparing posterior and anterior circulation strokes

Background: The aim of this study in patients with acute posterior ischemic stroke (PS) and atrial fibrillation (AF) were to evaluate the risks of recurrent ischemic event and severe bleeding and these risks in relation with oral anticoagulant therapy (OAT) and its timing. Methods: Patients with PS were prospectively included; the outcome events of these patients were compared with those of patients with anterior stroke (AS) which were taken from previous registries. The primary outcome was the composite of: stroke recurrence, TIA, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding occurring within 90 days from acute stroke. Results: A total of 2,470 patients were available for the analysis: 473 (19.1%) with PS and 1,997 (80.9%) AS. Over 90 days, 213 (8.6%) primary outcome events were recorded: 175 (8.7%) in patients with AS and 38 (8.0%) in those with PS. In patients who initiated OAT within 2 days, the primary outcome occurred in 5 out of 95 patients (5.3%) with PS compared to 21 out of 373 patients (4.3%) with AS (OR 1.07; 95% CI 0.39-2.94). In patients who initiated OAT between days 3 and 7, the primary outcome occurred in 3 out of 103 patients (2.9%) with PS compared to 26 out of 490 patients (5.3%) with AS (OR 0.54; 95% CI 0.16-1.80). Conclusions: Patients with posterior or anterior stroke and AF appear to have similar risks of ischemic or hemorrhagic events at 90 days with no difference concerning the timing of initiation of OAT

Anticoagulation After Stroke in Patients With Atrial Fibrillation : To Bridge or Not With Low-Molecular-Weight Heparin?

Background and Purpose- Bridging therapy with low-molecular-weight heparin reportedly leads to a worse outcome for acute cardioembolic stroke patients because of a higher incidence of intracerebral bleeding. However, this practice is common in clinical settings. This observational study aimed to compare (1) the clinical profiles of patients receiving and not receiving bridging therapy, (2) overall group outcomes, and (3) outcomes according to the type of anticoagulant prescribed. Methods- We analyzed data of patients from the prospective RAF and RAF-NOACs studies. The primary outcome was defined as the composite of ischemic stroke, transient ischemic attack, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding observed at 90 days after the acute stroke. Results- Of 1810 patients who initiated oral anticoagulant therapy, 371 (20%) underwent bridging therapy with full-dose low-molecular-weight heparin. Older age and the presence of leukoaraiosis were inversely correlated with the use of bridging therapy. Forty-two bridged patients (11.3%) reached the combined outcome versus 72 (5.0%) of the nonbridged patients (P=0.0001). At multivariable analysis, bridging therapy was associated with the composite end point (odds ratio, 2.3; 95% CI, 1.4-3.7; P Conclusions- Our findings suggest that patients receiving low-molecular-weight heparin have a higher risk of early ischemic recurrence and hemorrhagic transformation compared with nonbridged patients.Peer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century