Effetti cardiovascolari in pazienti con iperaldosteronismo primario dopo trattamento chirurgico e terapia medica

Oggetto: I dati sul follow-up cardiovascolare a lungo termine nei pazienti con iperaldosteronismo primario sono scarsi. Per confrontare l’outcome dei pazienti con iperaldosteronismo primario sottoposti a rimozione chirurgica dell’adenoma corticale o a farmacoterapia, è stato eseguito uno studio prospettico che include 60 pazienti consecutivi. Metodi: La valutazione clinica, biochimica e cardiovascolare (ecocardiografia, ecodoppler carotideo) è stata eseguita prima e dopo (31,5 ± 4,4 mesi) trattamento chirurgico o terapia medica (32,1±5,0 mesi) con antagonisti del recettore dell’aldosterone (ALD) e altri farmaci antiipertensivi in 19 e 41 pazienti rispettivamente. Risultati: La pressione arteriosa sistolica e diastolica si era ridotta (p<0,001 o meno) dopo entrambi i trattamenti. Tuttavia, la riduzione sia assoluta che percentuale era significativamente più marcata (p<0,01 o meno) nei pazienti operati rispetto a quelli non operati. La massa ventricolare sinistra si era ridotta dopo il trattamento chirurgico (massa ventricolare sinistra g/m2, p<0,0007; massa ventricolare sinistra g/m2,7, p<0,01), mentre la stessa non era variata dopo terapia medica. Pertanto le differenze dei valori assoluti e percentuali al follow-up erano statisticamente significative (p<0,01 o meno) fra i 2 gruppi. La massa ventricolare sinistra basale era positivamente associata con età (p<0,0009), BMI (p<0,0008), numero di farmaci (p<0,03), IMT carotideo (p<0,02) e rapporto ALD/PRA (p<0,05). Distribuendo i pazienti in base ai livelli di ALD plasmatico e ai parametri cardiaci, quei pazienti che presentavano una riduzione dell’ALD durante lo studio avevano anche un decremento della massa cardiaca. (p<0,04). Conclusioni: I nostri dati indicano che nei pazienti con iperaldosteronismo primario la rimozione dell’eccesso di ALD tramite intervento chirurgico è più efficace nel ridurre la pressione arteriosa e migliorare i parametri cardiaci rispetto alla terapia antiipertensiva

DECONTAMINAZIONE INTESTINALE CON GENTAMICINA ORALE NEI PAZIENTI INTERNISTICI COLONIZZATI DA KLEBSIELLA PNEUMONIAE PRODUTTORE DI CARBAPENEMASI KPC

La colonizzazione intestinale da Klebsiella pneumoniae produttore di carbapenemasi KPC (KPC-Kp) rappresenta la maggior fonte di epidemie ospedaliere ed è associata al rischio di sviluppare infezione da KPC-Kp. Può inoltre essere causa di controindicazione a procedure interventistiche, al trasferimento del paziente e necessita dell’attuazione di procedure di infection-control. In assenza di trattamento il tasso di decontaminazione stimato riportato in letteratura risulta essere tra il 10% ed il 20%. Scopo dello studio è quello di valutare la decontaminazione intestinale dopo trattamento con gentamicina orale in una popolazione selezionata di pazienti internistici. Sono stati valutati retrospettivamente 48 pazienti consecutivi (30 maschi, età media 75,5 ± 10,1 anni) ricoverati presso la U.O. di Medicina Generale dell’Ospedale “Versilia” con tampone rettale positivo per KPC-Kp. 34 pazienti selezionati sulla base di un progetto clinico sono stati sottoposti a trattamento con gentamicina orale (80 mg qid). Il tampone rettale è stato ripetuto ogni 4 giorni in tutti i pazienti colonizzati e la decontaminazione è stata definita come il riscontro di due tamponi negativi consecutivi. Nei pazienti trattati con gentamicina orale il tasso di decontaminazione è stato del 73 % (22/30); tra i pazienti non trattati si è osservata una decontaminazione spontanea del 7% (1/14), p<0,001. Quattro pazienti sono stati esclusi per mancata possibilità di valutare l’end-point decontaminazione. La durata media della terapia con gentamicina orale è stata di 13,5 ± 5,9 giorni. Tra i pazienti non decontaminati non si è osservato nessun caso di sviluppo di resistenza alla gentamicina. Nessun paziente ha manifestato effetti collaterali dovuti al trattamento con gentamicina orale. Il trattamento con gentamicina orale è risultato efficace nella decontaminazione del paziente colonizzato da KPC-Kp. Allo scopo di evitare l’insorgenza di resistenza alla gentamicina, tale decontaminazione dovrebbe essere utilizzata solo in caso di un progetto clinico ed in genere non prolungato oltre le tre settimane

Market complexity evaluation to enhance the effectiveness of TRIZ outputs

In the context of innovation consulting activity, it may happen working in technical fields characterized by a high competitiveness level. Although TRIZ allows reaching innovative ideas in any kind of industry, it does not suggest any tool in order to evaluate the success rate of the invention in the reference market. During the last years, TRIZ got methodological contributes to sharpen the matching between the inventive idea and the actual needs of the market, for example the market potential tool. In order to support TRIZ experts in selecting the best innovation strategy, this paper introduces a new tool for the TRIZ toolbox that takes into account the competitiveness level of the market. Several economics works disclose the correlation between the patent-citation triadic relationships and the presence of dominant positions of few competitors. A patent analysis, focused on triads in patent citation, can inform the TRIZ expert about potential critical situation able to prevent the success of an inventive solution. It can generate an important indicator that helps him in selecting the most promising innovation strategy. The method could be integrated in a classic TRIZ activity, using commercial patent searching tools. The case study shows how to extract this kind of indicator from patent citation environment in Machine Learning field

Smart portable pen for continuous monitoring of anaesthetics in human serum with machine learning

Continuous monitoring of anaesthetics infusion is demanded by anaesthesiologists to help in defining personalized dose, hence reducing risks and side effects. We propose the first piece of technology tailored explicitly to close the loop between anaesthesiologist and patient with continuous drug monitoring. Direct detection of drugs is achieved with electrochemical techniques, and several options are present in literature to measure propofol (widely used anaesthetics). Still, the sensors proposed do not enable in-situ detection, they do not provide this information continuously, and they are based on bulky and costly lab equipment. In this paper, we present a novel smart pen-shaped electronic system for continuous monitoring of propofol in human serum. The system consists of a needle-shaped sensor, a quasi digital front-end, a smart machine learning data processing, in a single wireless battery-operated embedded device featuring Bluetooth Low Energy (BLE) communication. The system has been tested and characterized in real, undiluted human serum, at 37°C. The device features a limit of detection of 3.8µM, meeting the requirement of the target application, with an electronics system 59% smaller and 81% less power consuming w.r.t. the state-of-the-art, using a smart machine learning classification for data processing, which guarantees up to twenty continuous measure

Cholecalciferol administration blunts the systemic renin–angiotensin system in essential hypertensives with hypovitaminosis D:

Introduction: Vitamin D plasma levels are negatively associated with blood pressure and cardiovascular mortality, and vita- min D supplementation reduces cardiovascular events. Renin-angiotensin system (RAS) suppression may be one of the mechanisms involved. However, there are no interventional prospective studies demonstrating a reduction in circulating RAS components after vitamin D treatment. Methods: Fifteen consecutive drug-free patients with essential hypertension and hypovitaminosis D underwent therapy with an oral dose of 25000 I.U. of cholecalciferol once a week for two months, while maintaining a constant-salt diet. In basal conditions and at the end of the study, RAS activity (plasma angiotensinogen, renin, PRA, angiotensin II, aldosterone and urinary angiotensinogen) was investigated, in addition to blood pressure and plasma vitamin D levels (25(OH)D). Results: After cholecalciferol administration, all patients exhibited normalized plasma 25(OH)D values. At the end of the study, a reduction (p < 0.05) in plasma renin and aldosterone, and a decrement, although not significant, of PRA and angiotensin II, was observed. No difference was found in plasma and urinary angiotensinogen or blood pressure values. Conclusions: Our data indicate that in essential hypertensives with hypovitaminosis D, pharmacological correction of vitamin D levels can blunt systemic RAS activity

Memristive Devices Fabricated with Silicon Nanowire Schottky Barrier Transistors

This paper reports on the memory and memristive effects of Schottky barrier field effect transistors (SBFET) with gate-all-around (GAA) configuration and Si nanowire (SiNW) channel. Similar behavior has also been investigated for SBFETs with poly-Si nanowire (poly-SiNW) channel in back-gate configuration. The memristive devices presented here have the potential of a very high integration density, and they are suitable for hybrid CMOS co-fabrication with a CMOS-compatible process. We show that 2 different regimes are possible, making these devices suitable either for volatile ambipolar memory or resistive random access memory (RRAM) applications. In addition, frequency- and amplitude- dependence of the memristive behavior are reported

Ecological effects of multiple stressors on a deep lake (Lago Maggiore, Italy) integrating neo and palaeolimnological approaches

To understand interactions of lake physical characteristics, trophic dynamics and climate in Lago Maggiore, we compare longterm limnological and meteorological monitoring data and results from sediment cores. We include analyses of nutrients, pigments, diatoms and cladoceran microfossils. Over the past decades, caloric content increased. Eutrophication from the 1960s to early 1980s was followed by oligotrophication. DDTs, PCBs and Hg showed high contamination in the \u2760s, compared to point source inputs in the \u2790s. Algal biomass was predicted by total pigments and some algal specific carotenoids. Following nutrient enrichment, Chydorus sphaericus, and total abundance of cladocerans changed inversely with trophic status. Fewer large Daphnia since the late \u2780s matched an increase in with subfossil Eubosmina mucro lengths. Both were explained by the 10-fold increase in Bythotrephes longimanus from 1987 to 1993, when an increase of its mean annual population density occurred during warmer winter and springs. Bythotrephes remained abundant and further increased during the following 10 years as water temperature increased. We conclude that warmer water affects food chains indirectly by changing habitat use and predator-prey interactions. Relative abundances of Daphnia and its peak population density in the warm year of the oligotrophic period (2003) were close to the record from the mesotrophic period in 1982, supporting the hypothesis that warming can produce a eutrophication-like signal. The study illustrates the complexity of biological responses to synchronous changes in multiple drivers (e.g., eutrophication, fish introduction, ban of fish harvesting, chemical pollution, and climate) and, despite this complexity, how Lago Maggiore responded to multiple stressors

Study of the Application of CCUS in a WtE Italian Plant

Municipal Solid Waste (MSW) contains materials of biogenic and non-biogenic origin. When incinerated, the biogenic component produces CO2, which does not lead to an increase in atmospheric CO2 levels. For WtE plants operating on MSW with a significant biogenic component, Carbon Capture Utilization and Storage (CCUS) can provide a path to negative CO2 emissions by producing energy and managing locally produced waste. This work focuses on the study of a process for treating a flue gas stream from WtE in an Italian context, i.e. the incinerator plant located in Como, to remove CO2 that is, then, planned to be utilized. The CO2 capture process is based on chemical absorption by two different amine solvents: MonoEthanolAmine and Piperazine. The design of the CO2 removal section has been carried out specifically for the considered flue gas to be treated, containing about 7 mol % CO2, by selecting the main process parameters (e.g., absorber packing height, regenerator packing height, lean loading, gas inlet temperature, solvent inlet temperature, regenerator pressure) in order to optimize the reboiler duty and the water requirement. The performances of the two processes have been compared for the same 90 % removal of CO2

Memristive-Biosensors: A New Detection Method by Using Nanofabricated Memristors

This paper proposes a new detection methodology based on memristive-effect registered on silicon nanowire. The nano-wires are fabricated by a lithographic technique that allows precise and selective etching at the nanoscale. The wires are obtained in three main steps. Initially, a photoresist line defines the wire position. In a second step, silicon deep reactive ion etching is performed to obtain a scalloped trench. In the final step, the trench is reduced to a suspended nanowire after wet oxidation. The obtained wires present Schottky barrier contacts and are used for bio-molecular detection on dried samples. The memristive silicon nanowire devices are functionalized with rabbit antibodies in order to sense antigens. The sensitivity and detection limit of this new kind of nano-bio-sensors are estimated equal to 37 ± 1 mV/fM and 3.4 ± 1.8 fM, respectively

Applications of Multi-Terminal Memristive Devices: A Review

Memristive devices have the potential for a complete renewal of the electron devices landscape, including memory, logic and sensing applications. This is especially true when considering that the memristive functionality is not limited to two-terminal devices, whose practical realization has been demonstrated within a broad range of different technologies. For electron devices, the memristive functionality can be generally attributed to a state modification, whose dynamics can be engineered to target a specific application. In this review paper, we show examples of two-terminal Resistive RAMs (ReRAM) for standalone memory and Field Programmable Gate Arrays (FPGA) applications. Moreover, a Generic Memory Structure (GMS) utilizing two ReRAMs for 3D-FPGA is discussed. In addition, we show that trap charging dynamics can explain some of the memristive effects previously reported for Schottky-barrier field-effect Si nanowire transistors (SB SiNW FETs). Moreover, the SB SiNW FETs do show additional memristive functionality due to trap charging at the metal/semiconductor surface. The combination of these two memristive effects into multi-terminal MOSFET devices gives rise to new opportunities for both memory and logic applications as well as new sensors based on the physical mechanism that originate memristance. Finally, the multi-terminal memristive devices presented here have the potential of a very high integration density, and they are suitable for hybrid CMOS co-fabrication with a CMOS-compatible process