Indici per la valutazione della qualit? ecologica dei laghi

Collection of methods to evaluate lake quality using biological element

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Atmospheric aerosols in Amazonia and land use change: From natural biogenic to biomass burning conditions

In the wet season, a large portion of the Amazon region constitutes one of the most pristine continental areas, with very low concentrations of atmospheric trace gases and aerosol particles. However, land use change modifies the biosphere-atmosphere interactions in such a way that key processes that maintain the functioning of Amazonia are substantially altered. This study presents a comparison between aerosol properties observed at a preserved forest site in Central Amazonia (TT34 North of Manaus) and at a heavily biomass burning impacted site in south-western Amazonia (PVH, close to Porto Velho). Amazonian aerosols were characterized in detail, including aerosol size distributions, aerosol light absorption and scattering, optical depth and aerosol inorganic and organic composition, among other properties. The central Amazonia site (TT34) showed low aerosol concentrations (PM2.5 of 1.3 ± 0.7 μg m-3 and 3.4 ± 2.0 μg m-3 in the wet and dry seasons, respectively), with a median particle number concentration of 220 cm-3 in the wet season and 2200 cm-3 in the dry season. At the impacted site (PVH), aerosol loadings were one order of magnitude higher (PM2.5 of 10.2 ± 9.0 μg m-3 and 33.0 ± 36.0 μg m-3 in the wet and dry seasons, respectively). The aerosol number concentration at the impacted site ranged from 680 cm-3 in the wet season up to 20000 cm-3 in the dry season. An aerosol chemical speciation monitor (ACSM) was deployed in 2013 at both sites, and it shows that organic aerosol account to 81% to the non-refractory PM1 aerosol loading at TT34, while biomass burning aerosols at PVH shows a 93% content of organic particles. Three years of filter-based elemental composition measurements shows that sulphate at the impacted site decreases, on average, from 12% of PM2.5 mass during the wet season to 5% in the dry season. This result corroborates the ACSM finding that the biomass burning contributed overwhelmingly to the organic fine mode aerosol during the dry season in this region. Aerosol light scattering and absorption coefficients at the TT34 site were low during the wet season, increasing by a factor of 5, approximately, in the dry season due to long range transport of biomass burning aerosols reaching the forest site in the dry season. Aerosol single scattering albedo (SSA) ranged from 0.84 in the wet season up to 0.91 in the dry. At the PVH site, aerosol scattering coefficients were 3-5 times higher in comparison to the TT34 site, an indication of strong regional background pollution, even in the wet season. Aerosol absorption coefficients at PVH were about 1.4 times higher than at the forest site. Ground-based SSA at PVH was around 0.92 year round, showing the dominance of scattering aerosol particles over absorption, even for biomass burning aerosols. Remote sensing observations from six AERONET sites and from MODIS since 1999, provide a regional and temporal overview. Aerosol Optical Depth (AOD) at 550 nm of less than 0.1 is characteristic of natural conditions over Amazonia. At the perturbed PVH site, AOD550 values greater than 4 were frequently observed in the dry season. Combined analysis of MODIS and CERES showed that the mean direct radiative forcing of aerosols at the top of the atmosphere (TOA) during the biomass burning season was -5.6 ± 1.7 W m-2, averaged over whole Amazon Basin. For high AOD (larger than 1) the maximum daily direct aerosol radiative forcing at the TOA was as high as -20 W m-2 locally. This change in the radiation balance caused increases in the diffuse radiation flux, with an increase of Net Ecosystem Exchange (NEE) of 18-29% for high AOD. From this analysis, it is clear that land use change in Amazonia shows alterations of many atmospheric properties, and these changes are affecting the functioning of the Amazonian ecosystem in significant ways. © 2014 The Royal Society of Chemistry

Il Monitor Facilitatore: ruolo attivo nella clinical governance e nella creazione di una cultura di farmacovigilanza, intesa come strumento per la tutela della salute pubblica e strategia di razionalizzazione della spesa ospedaliera .

The constant growth of public health expenditure is mainly due to population aging, scientific and technological innovation, increasing demand for health. Adverse drug reactions (ADRs) lower patients quality of life and increase costs of care, mainly in hospitals. Active pharmacovigilance projects - as already being implemented in the USA - may contribute to cut such avoidable costs. The present project innovation consists in employing pharmacovigilance as an additional tool to reduce health expenditure, in a collaborative way. It is therefore necessary - also in our country - to join resources and competencies at various levels (local, regional, national) to reach the common target of public health protection. Our project considers 4 phases: fact-finding, engagement of 8 hospital wards in Verona, expansion at regional level, national expansion. The “Facilitating Monitor” should be the specific professional figure - funded by the hospital administration - dedicated to pharmacovigilance at the hospital wards, to monitor and therefore prevent/decrease ADRs, reducing the resulting length of stay. Prof. Minuz conducted a pivotal study to estimate the number of ADRs due to medication errors, their causes, the preventability of the ADRs and the consequent lengths of stay. We used the raw data coming from the study to calculate the costs for 229 in-patients who reported at least one ADR during a 146 days observation period. The total avoidable cost, due to the increased length of stay for in-patients who experienced at least one preventable ADR, was € 212,700 i.e. 8% of the hospitalization cost for in-patients who experienced an ADR and 2% of the total cost of hospitalization. The results were extrapolated to obtain the total annual saving in Verona university hospitals, which could be around € 8-9 millions

Alginate/Gelatin Hydrogels to Coat Porous Tubular Scaffolds for Vascular Tissue Engineering

To perfuse porous tubular scaffolds for vascular tissue engineering (VTE) with a controlled flow rate, there is the need to prevent leakage from the scaffold lumen. A gel coating made of 8% w/v alginate and 6% w/v gelatin, at different volumetric proportions (50/50, 70/30 and 90/10), functionalized with fibronectin, was produced using a custom-made bioreactor-based method. Gel swelling and stability, and rheological and uniaxial stretch tests on different percentages of alginate and gelatin demonstrate the gel ability to resist to biochemical microenvironment, to well withstand physiological deformations (~10%) and wall shear stresses (5-20 dyne/cm2). These are prerequisites to stimulate tubular scaffolds with the proper mechanical stimuli able to maintain the physiological phenotype of vascular smooth muscle cells and endothelial cells (ECs), as in blood vessels. Cytocompatibility shows gel capability to induce ECs proliferation and colonization within the gel, especially in presence of fibronectin and higher gelatin percentage. The custom-designed bioreactor is suitable to create reproducible and homogeneous tubular gel coating, independently from alginate percentage. Permeability test shows the effectiveness of 70/30 alginate/gelatin gel to occlude wadding pores, and therefore prevent leakages. In this regard, the synthetized tubular alginate/gelatin gel with fibronectin represents a promising substrate for ECs, as well as leakproof when the scaffold is submitted to pulsatile perfusion for VTE applications

MANAGEMENT OF ENDOCRINE DISEASE: Risk of overtreatment in patients with adrenal insufficiency: current and emerging aspects

The effects of long-term replacement therapy of adrenal insufficiency (AI) are still a matter of controversy. In fact, the established glucocorticoid replacement regimens do not completely reproduce the endogenous hormonal production and the monitoring of AI treatment may be a challenge for the lack of reliable clinical and biochemical markers. Consequently, several AI patients are frequently exposed to relative glucocorticoid excess potentially leading to develop chronic complications, such as diabetes mellitus, dyslipidemia, hypertension and fragility fractures with consequent impaired QoL and increased mortality risk. This review deals with the pathophysiological and clinical aspects concerning the over-replacement therapy of primary and secondary AI

Morphometric vertebral fractures in breast cancer patients treated with adjuvant aromatase inhibitor therapy: A cross-sectional study

BACKGROUND: The impact of long-term adjuvant therapy with aromatase inhibitors (AIs) on vertebral fracture (VF) risk is still unclear. OBJECTIVE: In this cross-sectional study, we explored the prevalence and determinants of VFs in breast cancer (BC) patients before and during AI therapy. Each woman underwent a dual-energy X-ray absorptiometry (DXA) to evaluate bone mineral density (BMD) and identify VFs by a quantitative morphometric approach. Blood samples were collected to measure serum hormone and calcium levels. RESULTS: We consecutively included 263 postmenopausal women with hormone receptor-positive early BC. One-hundred-sixty-nine women were AI-naïve, and 94 were AI-treated. AI-treated patients had lower BMD at total hip (p=0.01) and lumbar spine (p=0.03), higher serum vitamin D (p<0.001) and parathyroid hormone (p=0.006) values as compared to AI-naïve patients. The prevalence of VFs was 18.9% in AI-naïve patients, and 31.2% in those assessed during AI therapy (odds ratio 1.90, 95% CI 1.1-3.5, p=0.03). In AI-naïve patients, VFs were associated with older age (p=0.002) and lower BMD values at femoral neck (p=0.04) and total hip (p=0.007), whereas VFs occurred without association with any parameter analyzed in AI-treated patients. In AI-treated group, the prevalence of VFs was not significantly different between patients with osteoporosis and those with normal BMD (36.7% vs. 20.0%; p=0.31). CONCLUSIONS: In women with early BC, AI therapy is associated with high prevalence of radiological VFs, which were shown to be independent of BMD values during the adjuvant treatment. These findings may be clinically relevant since they may lead to a change in management of AI-induced skeletal fragility. Specifically, the results of this study provide a rationale for performing a morphometric evaluation of VFs in all women undergoing treatment with AIs

Acute and chronic effects of hypercalcaemia on cortical excitability as studied by 5 Hz repetitive transcranial magnetic stimulation

We designed the present study to disclose changes in cortical excitability in humans with hypercalcaemia, by delivering repetitive transcranial magnetic stimulation (rTMS) over the primary motor area (M1). In 22 patients with chronic hypercalcaemia related to primary hyperparathyroidism and 22 age-matched healthy subjects 5 Hz-rTMS was delivered at rest and during a sustained voluntary contraction of the target muscle. Changes in the resting motor threshold (RMT), motor evoked potential (MEP) amplitudes and cortical silent period (CSP) duration were measured and compared in patients and healthy controls. Two of the 22 patients were re-tested after parathyroidectomy when serum calcium had normalized. In a subgroup of healthy subjects, changes in the rTMS parameters were tested before and after acute hypercalcaemia. No significant difference between healthy normocalcaemic subjects and chronic hypercalcaemic patients was found in the RMT values and MEP amplitude and CSP duration evoked by the first stimulus of the trains. During the course of 5 Hz-rTMS trains, MEP size increased significantly less in patients with chronic hypercalcaemia than in healthy subjects, whereas the CSP duration lengthened to a similar extent in both groups. In the two patients studied after parathyroidectomy, rTMS elicited a normal MEP amplitude facilitation. Our findings indicate that acute hypercalcaemia significantly decreased the MEP amplitude facilitation. Given that 5 Hz-rTMS modulates cortical excitability through mechanisms resembling short-term synaptic enhancement, the reduction of MEP amplitude facilitation by hypercalcaemia may be related to Ca2+-dependent changes in synaptic plasticity