Early inspiratory effort assessment by esophageal manometry early predicts noninvasive ventilation outcome in de novo respiratory failure: a pilot study.

Rationale: The role of inspiratory effort has still to be determined as a potential predictors of non-invasive mechanical ventilation (NIV) failure in acute hypoxic de novo respiratory failure (AHRF). Objectives: We explore the hypothesis that inspiratory effort might be a major determinant of NIV failure in these patients. Methods: Thirty consecutive patients with AHRF admitted to a single center and candidates for a 24-hour NIV trial were enrolled. Clinical features, tidal changes in esophageal (ΔPes) and dynamic transpulmonary pressure (ΔPL), expiratory tidal volume, and respiratory rate were recorded on admission and 2-4-12-24 hours after NIV start, and were tested for correlation with outcomes. Measurements and Main Results: ΔPes and ΔPes/ΔPL were significantly lower 2 hours after NIV start in patients who successfully completed the NIV trial (n=18) compared to those who needed endotracheal intubation (n=12) [median=11 (IQR=8–15) cmH2O vs 31.5 (30–36) cmH2O, p<0.0001] while other variables differed later. ΔPes was not related to other predictors of NIV failure at baseline. NIV-induced reduction in ΔPes of 10 cmH2O or more after 2 hours of treatment was strongly associated to avoidance of intubation, and represented the most accurate predictor of treatment success (OR=15, 95%CI 2.8-110, p=0.001, AUC=0.97, 95%CI 0.91–1, p<0.0001). Conclusions: The magnitude of inspiratory effort relief as assessed by ΔPes variation within the first 2 hours of NIV was an early and accurate predictor of NIV outcome at 24 hours

Antibiotic Resistant Bloodstream Infections in Pediatric Patients Receiving Chemotherapy or Hematopoietic Stem Cell Transplant: Factors Associated with Development of Resistance, Intensive Care Admission and Mortality

Bloodstream infections (BSI) are a severe complication of antineoplastic chemotherapy or hematopoietic stem cell transplantation (HSCT), especially in the presence of antibiotic resistance (AR). A multinational, multicenter retrospective study in patients aged ≤ 18 years, treated with chemotherapy or HSCT from 2015 to 2017 was implemented to analyze AR among non-common skin commensals BSI. Risk factors associated with AR, intensive care unit (ICU) admission and mortality were analyzed by multilevel mixed effects or standard logistic regressions. A total of 1291 BSIs with 1379 strains were reported in 1031 patients. Among Gram-negatives more than 20% were resistant to ceftazidime, cefepime, piperacillin-tazobactam and ciprofloxacin while 9% was resistant to meropenem. Methicillin-resistance was observed in 17% of S. aureus and vancomycin resistance in 40% of E. faecium. Previous exposure to antibiotics, especially to carbapenems, was significantly associated with resistant Gram-negative BSI while previous colonization with methicillin-resistant S. aureus was associated with BSI due to this pathogen. Hematological malignancies, neutropenia and Gram-negatives resistant to >3 antibiotics were significantly associated with higher risk of ICU admission. Underlying disease in relapse/progression, previous exposure to antibiotics, and need of ICU admission were significantly associated with mortality. Center-level variation showed a greater impact on AR, while patient-level variation had more effect on ICU admission and mortality. Previous exposure to antibiotics or colonization by resistant pathogens can be the cause of AR BSI. Resistant Gram-negatives are significantly associated with ICU admission and mortality, with a significant role for the treating center too. The significant evidence of center-level variations on AR, ICU admission and mortality, stress the need for careful local antibiotic stewardship and infection control programs

Use of Terrestrial Laser Scanner for Rigid Airport Pavement Management

The evaluation of the structural efficiency of airport infrastructures is a complex task. Faulting is one of the most important indicators of rigid pavement performance. The aim of our study is to provide a new method for faulting detection and computation on jointed concrete pavements. Nowadays, the assessment of faulting is performed with the use of laborious and time-consuming measurements that strongly hinder aircraft traffic. We proposed a field procedure for Terrestrial Laser Scanner data acquisition and a computation flow chart in order to identify and quantify the fault size at each joint of apron slabs. The total point cloud has been used to compute the least square plane fitting those points. The best-fit plane for each slab has been computed too. The attitude of each slab plane with respect to both the adjacent ones and the apron reference plane has been determined by the normal vectors to the surfaces. Faulting has been evaluated as the difference in elevation between the slab planes along chosen sections. For a more accurate evaluation of the faulting value, we have then considered a few strips of data covering rectangular areas of different sizes across the joints. The accuracy of the estimated quantities has been computed too

Somatic Embryogenesis in Vitis for Genome Editing: Optimization of Protocols for Recalcitrant Genotypes

New Plant Breeding Techniques (NPBTs) protocols have been developed to produce new grape varieties with improved quantitative and qualitative characteristics. Reliable transformation protocols for grapes are based on the generation/induction of embryogenic callus cells that are then transformed. Varieties such as Italia have proven to be very recalcitrant to regeneration via somatic embryogenesis. In this work, the development of a protocol for improved production of embryogenic calluses is described. Two sterilization protocols were tested: (a) a lower active chlorine concentration for a longer time (LS); and (b) a higher chlorine concentration for a shorter time (HS), in combination with the absence or presence of citric acid in the growing substrate in the first growth media. The embryogenic calluses formation in Chardonnay, a cv. with a high embryogenic response, was significantly higher in presence of citric acid in the initial growing substrate regardless of the sterilization protocol. In Aglianico, a cv. with a lower embryogenic response, no significant differences were observed. Instead, in a recalcitrant cv. as Italia, we obtained a 13-fold increase in embryogenic calluses formation performing sterilization of flowers with the HS protocol compared to LS

Evolution of the Sele River coastal plain (southern Italy) during the Late Quaternary by inland and offshore stratigraphical analyses

The late Quaternary evolution of the Sele River coastal plain (Salerno Gulf, southern Italy) was investigated through integrated stratigraphical, chronological and palaeoecological analyses. The main environmental changes were ascribed to glacio-eustatic variations leading to rapid ingressions alternating with coastal progradations. The marked marine ingression of MIS 5.5 is testified by palaeoridges now cropping out 4 km inland at 11/13 m a.s.l. (Gromola palaeoridge). The eustatic minimum of MIS 2 is testified by lower shoreface deposits in the offshore core record and in the seismic profiles at 120/130 m below sea level. This prolonged sea-level fall was interrupted by at least three rapid sea-level rises, probably related to MIS 5.3, 5.1 and 3. The evidence of the first two sea level rises are represented by shoreface deposits in the inland S1 core (30 m thick, 3 m a.s.l., 1.5 km inland). The highstand of MIS 3 was identified by seismic profiles as onlapping marine deposits. The shore deposits at 100 m b.s.l were tentatively attributed to the lowstand of MIS 4. After the lowstand of MIS 2, the Sele Plain was newly flooded due to the rapid Post Glacial sea-level rise. This ingression caused the inland migration of a barrier-lagoon system and stopped at approximately 5.5 ky BP. From that moment the shoreline started prograding up to the present position probably due to the decrease in the sea-level rise rates and to the volcaniclastic supplies from the Neapolitan volcanoes, especially from the AD 79 Vesuvius eruption, also recorded in the subbottom chirp profiles

High-Risk Acute Myeloid Leukemia: A Pediatric Prospective

Pediatric acute myeloid leukemia is a clonal disorder characterized by malignant transformation of the hematopoietic stem cell. The incidence and the outcome remain inferior when compared to pediatric ALL, although prognosis has improved in the last decades, with 80% overall survival rate reported in some studies. The standard therapeutic approach is a combined cytarabine and anthracycline-based regimen followed by consolidation with allogeneic stem cell transplantation (allo-SCT) for high-risk AML and allo-SCT for non-high-risk patients only in second complete remission after relapse. In the last decade, several drugs have been used in clinical trials to improve outcomes in pediatric AML treatment