Cardiac output: A central issue in patients with respiratory extracorporeal support

The iLA-activve® Novalung is a new extracorporeal device specifically designed for lung support in patients with hypercapnic and/or hypoxemic respiratory failure. To date, only low-flow applications for decompensated hypercapnic chronic obstructive pulmonary disease have been reported in the literature. Here, we briefly report three cases of iLA-activve use in patients with hypercapnic-hypoxemic acute lung failure assisted with mid-flow (up to 2.4 L/min) and different single/double venous cannulation. The main findings of our small case series were: firstly, extracorporeal blood flows over 2.0 L/min across the membrane provided clinically satisfying decarboxylation and improved oxygenation; secondly, the ratio between blood flow through the membrane and the patient's cardiac output (CO) was a major determinant for the oxygen increase. The latter could, therefore, be a useful indicator for understanding performance in the complex and multifactorial evaluation of patients with extracorporeal veno-venous lung support

Fournier's gangrene and intravenous drug abuse. An unusual case report and review of the literature

Fournier's gangrene is a potentially fatal emergency condition characterized by necrotizing fasciitis and supported by an infection of the external genital, perineal and perianal region, with a rapid and progressive spread from subcutaneous fat tissue to fascial planes.In this case report, a 52-year-old man, with a history of hepatitis C-virus (HCV)-related chronic liver disease and cocaine use disorder for which he was receiving methadone maintenance therapy, was admitted to the Emergency Department with necrotic tissue involving the external genitalia.Fournier's gangrene is usually due to compromised host immunity, without a precise cause of bacterial infection; here it is linked to a loco-regional intravenous injection of cocaine. A multimodal approach, including a wide surgical debridement and a postponed skin graft, was needed. Here we report this case, with a narrative review of the literature

Microenvironment expression in diffuse large B-cell lymphomas

Diffuse large B-cell lymphoma (DLBCL), the most common type of non-Hodgkin lymphoma, is recognized as a heterogeneous disease with distinct molecular subtypes derived from different stages of B-cell differentiation. The contribution of the tumor microenvironment to the pathogenesis and tumor survival of DLBCL is poorly understood. However, several recent studies have yielded intriguing findings and shed some light on the possible roles of the microenvironment. In this retrospective study, data from 29 patients diagnosed with DLBCL between 2009 and 2013 were reviewed. All patients had pathologically confirmed DLBCL and had been treated with the R-CHOP regimen. In these patients, we correlated the expression of CD3 staining for T cells, tryptase staining for mast cells, CD68 for tumor-associated macrophages (TAMs), and CD31 staining for blood vessels. CD68 and tryptase expression, as well as MVD, were increased in chemo-resistant patients compared to chemosensitive patients. Tryptase expression showed a positive correlation with MVD, supporting a role for mast cells in DLBCL tumor angiogenesis, while the CD68 correlation with MVD was not significant, indicating a different role for TAMs rather than angiogenesis in DLBCL. A statistically significant difference was observed in the expression of CD3 in patients with bulky disease. Specifically, a higher expression of CD3 was observed in nonbulky disease patients (mean expression 52.91%, n = 20) compared to bulky disease patients (mean expression 34.9%, n = 9), P value < .05. The reduction in T cells in bulky disease patients contributes to loosen the immune control over the tumor, resulting in an increased cell proliferation, leading to large tumor cell masses, which are predictive of poor prognostic and clinical outcomes. CD3 showed a positive correlation with tryptase and MVD, while multiple regression analysis efficaciously predicted MVD depending on CD3 and tryptase as predictors, supporting a complex interplay between these cells in sustaining tumor angiogenesis in DLBCL patients. The improved understanding of tumor biology and of the role of the tumor microenvironment has led to advances in the diagnosis, classification, prognostics, as well as novel treatments of patients with hematologic malignancies. In particular, translational research, leading to drugs that target the interaction between the tumor microenvironment and malignant cells, has provided many promising new approaches to cancer therapy. Ongoing dynamic and correlation studies of tumor biology and the contribution of the tumor microenvironment should be promoted in the context of novel drug development in order to identify optimal therapies for various lymphomas and improve the curability of these diseases

MULTIDISCIPLINARY STUDY OF SUBSIDENCE AND SINKHOLE OCCURRENCES IN THE ACQUE ALBULE BASIN (ROMA, ITALY)

Abstract We present the results of a combined analysis of remote sensing and geophysical‐geotechnical data carried out in the Acque Albule Basin, a sinkhole prone area located close to the city of Roma, where a wide travertine wedge is present. We carried out geophysical measurements and borehole drillings over two test areas to image the subsoil where paroxysmal surficial dynamics occur. One site is marked by subsidence occurring at least since the early 2000s, whereas the other site hosts the "La Regina" and "Colonnelle" sinkhole lakes, which discharge sulfur‐carbonated waters. The stability of these two sites threatens highway, railway, and airport facilities, and this study helps to assess the geological hazard. For example, InSAR and LiDAR data helped define wide scale subsidence over the last 20 years and previously undetected small‐scale morphologies. Geophysical measurements of the latter revealed shallow and deep dissolution affecting the travertine and driving surficial paroxysmal events. Both study sites were found to lie inside a large depression located at the junction between Jurassic carbonate and Plio‐Pleistocene units in association with paleo karst morphologies in the travertine deposits and affected by the present‐past spillage of sulfurous waters. Given these elements, multidisciplinary geophysical observations are crucial for assessing and mitigating the geological risk and guiding land use planning and management

Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications

This article reports the conclusions of the second part of a consensus expert conference on the nomenclature of renal replacement therapy (RRT) techniques currently utilized to manage acute kidney injury and other organ dysfunction syndromes in critically ill patients. A multidisciplinary approach was taken to achieve harmonization of definitions, components, techniques, and operations of the extracorporeal therapies. The article describes the RRT techniques in detail with the relevant technology, procedures, and phases of treatment and key aspects of volume management/fluid balance in critically ill patients. In addition, the article describes recent developments in other extracorporeal therapies, including therapeutic plasma exchange, multiple organ support therapy, liver support, lung support, and blood purification in sepsis. This is a consensus report on nomenclature harmonization in extracorporeal blood purification therapies, such as hemofiltration, plasma exchange, multiple organ support therapies, and blood purification in sepsis

“I luoghi di Mercalli”: a travelling exhibition as a tool for scientists to dialogue with the public on volcanoes and earthquakes

On March 19, 1914 Giuseppe Mercalli, a seismologist and volcanologist, well-known around the world for the Intensity scale of earthquakes bearing his name, died tragically. A hundred years after, the Istituto Nazionale di Geofisica e Vulcanologia (INGV) has promoted a variety of activities and cultural events that will take place under the Patronage of the President of the Italian Republic within a year, the so called “Anno Mercalliano” (the Year of Mercalli). The opening ceremony took place in Naples, Italy, on March 19, 2014, in the Convitto Nazionale Vittorio Emanuele II. A scientific conference was held with the participation of experts from INGV and the university of Milano – Bicocca, and presentations of students. On that day the exhibition entitled “I luoghi di Mercalli” (Mercalli's places) was also inaugurated, at the presence of local authorities. The exhibition, organized by INGV, was realized in collaboration with the high school Vittorio Emanuele II, where Mercalli has been teaching for 19 years, and the Università degli Studi Suor Orsola Benincasa, where he was professor of natural sciences. A biographical and geographical description of the places where Mercalli operated introduces the exhibition, which is organized in sections: - Mercalli educator (he taught at high schools in Reggio Calabria and Naples); - Mercalli volcanologist (Mercalli studied Vesuvius volcanic activity for more than twenty years, he was a scientific witness of the Vesuvius 1906 eruption, and of the eruptions occurred at Vulcano (1888-90) and Stromboli (1891) islands. - Mercalli seismologist (Mercalli Intensity scale definition, based on his experience as witness of catastrophic earthquakes, such as Casamicciola in 1883 and Messina in 1908). Another section deals with the Vesuvius Observatory, directed by Mercalli between 1911 and 1914, and the description of the three active volcanoes of the Campania region (Vesuvius, Campi Flegrei and Ischia island), which have been the subject of studies by the well-known scientist. The exhibition is enriched by documents, manuscripts, photos and field notebooks of Mercalli. It is not intended to be only a celebratory exhibition; rather it is designed as a tool for dissemination of scientific culture and to raise awareness about seismic and volcanic hazards. In the exhibition path a continuous thread between the figure of Mercalli as a researcher and the role of an Earth Science researcher today is highlighted, pointing to the development of scientific knowledge in the past century. The goal is to improve the capability of learning from the disasters occurred in the past to implement preventive actions to safely deal with future events. The exhibition is travelling and will be provided on request to institutions and schools.PublishedMilano, Italia1V. Storia e struttura dei sistemi vulcaniciope

System Test of the ATLAS Muon Spectrometer in the H8 Beam at the CERN SPS

An extensive system test of the ATLAS muon spectrometer has been performed in the H8 beam line at the CERN SPS during the last four years. This spectrometer will use pressurized Monitored Drift Tube (MDT) chambers and Cathode Strip Chambers (CSC) for precision tracking, Resistive Plate Chambers (RPCs) for triggering in the barrel and Thin Gap Chambers (TGCs) for triggering in the end-cap region. The test set-up emulates one projective tower of the barrel (six MDT chambers and six RPCs) and one end-cap octant (six MDT chambers, A CSC and three TGCs). The barrel and end-cap stands have also been equipped with optical alignment systems, aiming at a relative positioning of the precision chambers in each tower to 30-40 micrometers. In addition to the performance of the detectors and the alignment scheme, many other systems aspects of the ATLAS muon spectrometer have been tested and validated with this setup, such as the mechanical detector integration and installation, the detector control system, the data acquisition, high level trigger software and off-line event reconstruction. Measurements with muon energies ranging from 20 to 300 GeV have allowed measuring the trigger and tracking performance of this set-up, in a configuration very similar to the final spectrometer. A special bunched muon beam with 25 ns bunch spacing, emulating the LHC bunch structure, has been used to study the timing resolution and bunch identification performance of the trigger chambers. The ATLAS first-level trigger chain has been operated with muon trigger signals for the first time