Extracorporeal CO2 removal in hypercapnic patients who fail noni nvasive ventialtion and refuse endotracheal intubation. a case series

Noninvasive ventilation (NIV) represents the standard of care for patients with exacerbation of chronic obstructive pulmonary disease. However, NIV fails in almost 40% of the most severe forms of acute hypercapnic respiratory failure and patients must undergo endotracheal intubation and invasive ventilation. Such transition from NIV to invasive ventilation is associated to increased mortality. Under these circumstances, patients may express a clear intention not to be intubated

Temperature‑induced changes in dough elasticity as a useful tool in defining the firmness of cooked pasta

Semolina with high protein content and strong gluten is recognized as the best raw-material for pasta-products with a good cooking quality, while little consideration has been given to semolina dough elasticity when heating is applied. In this research, a new technique was developed by adapting the Glutograph (Brabender GmbH&Co., Duisburg, Germany) to measure the changes in elasticity induced by heating on a sheeted dough. The information obtained by this procedure was related to the firmness of cooked pasta. Starting from semolina of four durum wheat varieties with differences in protein quantity and quality, dough samples were prepared in a Farinograph at a hydration level of 35 %. Each dough was sheeted by a home-made pasta machine, obtaining disks of 5 cm diameter and 2.1 mm thickness. Stretching (10 s) and relaxation (30 s) cycles were applied repeatedly during the test time, while dough temperature was increased from 30 to 90 °C at 1.2 °C/min. For each peak recorded, stretching and recovery values were calculated and plotted against sample temperature. Both stretching and recovery curves were integrated and the loss of elasticity was calculated. Results showed as high elasticity loss during heating is related to low firmness of the related cooked pasta

Functional assessment of cancer therapy questionnaire for breast cancer (FACT-B+4): Italian version validation

BACKGROUND: Improvements in breast cancer diagnosis and treatment led to an increased incidence of survivors' rate. The healthcare system has to face new problems related not only to the treatment of the disease, but also to the management of the quality of life after the diagnosis. The aim of this study was to validate the Italian version of the Functional Assessment of Cancer Therapy - Breast (FACT-B+4) questionnaire and to evaluate its reliability. METHODS: The questionnaire was administered twice, with an interval of three days between each administration, to a cohort of women of the Breast Surgical Unit, PoliclincoUmberto I. Cronbach's alpha was used as a measure of the internal consistency of the Italian version. RESULTS: The Italian version of the tool was administered to 55 subjects. The Cronbach's alpha for most scores registered values >0.7, both at baseline and at the follow-up analysis, therefore the subscale showed good internal consistency. CONCLUSIONS: The Italian version of FACT-B+4 demonstrated acceptable reliability properties in the Breast Unit patients. The use of this questionnaire seemed to be effective and in line with the results derived from the English and Spanishversions. Internal consistency and validity had similar performance results

Gastaut type-idiopathic childhood occipital epilepsy and childhood absence epilepsy: a clinically significant association?

We report an unusual association between idiopathic occipital epilepsy and childhood absence epilepsy in 2 pediatric patients. At first clinical and electroencephalographic evaluation, the patients presented the peculiar signs of idiopathic occipital epilepsy Gastaut type: focal sensory visual seizures, migrainelike symptoms (only in one patient) and unilateral spike–wave discharges over occipital regions. Both children were treated with valproic acid and their seizures were rapidly controlled. After a seizure-free period, the patients presented typical absence with ictal electroencephalographies showing 3 cycles/s generalized and symmetrical spike–wave complexes. We discuss the possible association between these two epileptic syndromes and its common pathophysiological mechanisms

Effect of soil tillage and crop sequence on grain yield and quality of durum wheat in Mediterranean areas

Conservation agriculture (CA) can be very strategic in degradation prone soils of Mediterranean environments to recover soil fertility and consequently improve crop productivity as well as the quality traits of the most widespread crop, durum wheat, with reference to protein accumulation and composition. The results shown by two years of data in a medium long-term experiment (7-year experiment; split-plot design) that combined two tillage practices (conventional tillage (CT) and zero tillage (ZT)) with two crop sequences (wheat monocropping (WW) and wheat-faba bean (WF)) are presented. The combination ZT + WF (CA approach) induced the highest grain yields (617 and 370 g m(-2) in 2016 and 2017, respectively), principally due to an increased number of ears m(-2); on the other hand, the lowest grain yield was recorded under CT + WW (550 and 280 g m(-2) in 2016 and 2017, respectively). CA also demonstrated significant influences on grain quality because the inclusion of faba bean in the rotation favored higher N-remobilization to the grains (79.5% and 77.7% in 2017). Under ZT and WF, all gluten fractions (gliadins (Glia), high molecular-weight glutenins (GS), and low molecular-weight GS) as well as the GS/Glia ratio increased. In durum wheat-based farming systems in Mediterranean areas, the adoption of CA seems to be an optimal choice to combine high quality yields with improved soil fertility

Are there effective interventions to increase physical activity in children and young people? An umbrella review

Background: Obesity and physical inactivity among children and young people are public health concerns. While numerous interventions to promote physical activity are available, little is known about the most effective ones. This study aimed to summarize the existing evidence on interventions that aim to increase physical activity. Methods: A systematic review of reviews was conducted. Systematic reviews and meta-analyses published from January 2010 until November 2017 were identified through PubMed, Scopus and the Cochrane Library. Two reviewers independently assessed titles and abstracts, performed data extraction and quality assessment. Outcomes as level of physical activity and body mass index were collected in order to assess the efficacy of interventions. Results: A total 30 studies examining physical activity interventions met the inclusion criteria, 15 systematic reviews and 15 meta-analyses. Most studies (N = 20) were implemented in the school setting, three were developed in preschool and childcare settings, two in the family context, five in the community setting and one miscellaneous context. Results showed that eight meta-analyses obtained a small increase in physical activity level, out of which five were conducted in the school, two in the family and one in the community setting. Most promising programs had the following characteristics: included physical activity in the school curriculum, were long-term interventions, involved teachers and had the support of families. Conclusion: The majority of interventions to promote physical activity in children and young people were implemented in the school setting and were multicomponent. Further research is needed to investigate nonschool programs

HCV Prevalence in Italy an Epidemiological, Observational, Cross-Sectional, Multicenter Study Participating Centers.

There is a lack of updated nationwide records regarding hepatitis C virus (HCV) infection among drug addicts in Italy. The prevalence and characteristics of HCV infection in a national sample of drug addicts in Italy were determined. Five hundred forty-three drug addicts (mean age 35.3 years, 85.1% males), selected from 25 Italian Centers for Substance Dependence were enrolled to be evaluated for anti-HCV, HCV-RNA, HCV genotype, HBV markers, anti-HDV, and anti-HIV during the period of April-November 2009. Anti-HCV prevalence was 63.9%. HCV-RNA was detected in 68.3% of patients positive for anti-HCV. Genotypes 1 and 3 prevailed (49.3% and 39.7%, respectively). However, 9.3% of the subjects had genotype 4, a rate over threefold higher than the one observed in 1996 among drug addicts in central Italy. Needle sharing was the strongest independent predictor of the likelihood to contract an HCV infection (OR 8.9; 95% CI: 5.0-16.0). Only 19.3% of subjects received antiviral treatment for HCV. The prevalence of HBsAg and HIV positivity was 2.8% and 3.1%, respectively. The pattern of HBV markers showed that nearly one-third of subjects had been vaccinated, while 42.3% were negative for any marker of HCV. The prevalence of HCV infection is high among drug addicts in Italy. The incidence of Genotype 4 is increasing and this may lead to the spreading of the disease to the general population in the near future. Efforts should be made to improve the rate of antiviral treatment for drug addicts with HCV infection and vaccination against hepatitis B

Effectiveness of a training course on smoking cessation knowledge and behaviour for health profession students. The SISMA project

Introduction. University students are at risk of starting smoking or continuing and increasing the consumption of tobacco products. The aim of the study was to assess the impact of the training course, Sisma Project, about smoking in healthcare degree courses, in terms of knowledge, behaviour and to evaluate the course. Methods. SISMA project was a pre- post study about an intervention delivered to healthcare profession students about smoking and smoking cessation. It had a before-after design and was an online optional course available on the eLearning platform Moodle 2. The course was structured in four lessons of sixty minutes, a debate among experts and a final test of evaluation. The McNemar test was used to measure the effectiveness of Sisma on smoking behaviour of students after the intervention. Students rated the course assigning a score from one to ten, and expressed free comments about point of strength and weakness of Sisma project. Results. The participants were 365 students, 28.5% males and 71.5% females, most were nursing 194 (53.2%) and dental hygienists students 105 (28.8%). Current smokers were 161 (44.1%) before and 142 (38.9%) after the course, there was statistical significant difference in smoking status after attending the course (p < 0.001). Students evaluated the course giving a high score with a mean of 8.13 (SD: 1.1); the main points of strength were the content (33.2%), the structure (15.6%) and knowledge given by the course (12.6%). The main point of weakness were the online structure 62 (37%), problem related to length and time 17 (10%) and the final test 15 (9%). Discussion. Given the central role health professionals play in patient care, students need to be aware and trained in tobacco cessation techniques. Our results indicate that smoking behaviour significantly changed after attending a university course for smoking cessation and students appreciated its contents and structure