How best to capture the respiratory consequences of prematurity?

Chronic respiratory morbidity is a common complication of premature birth, generally defined by the presence of bronchopulmonary dysplasia, both clinically and in trials of respiratory therapies. However, recent data have highlighted that bronchopulmonary dysplasia does not correlate with chronic respiratory morbidity in older children born preterm. Longitudinally evaluating pulmonary morbidity from early life through to childhood provides a more rational method of defining the continuum of chronic respiratory morbidity of prematurity, and offers new insights into the efficacy of neonatal respiratory interventions. The changing nature of preterm lung disease suggests that a multimodal approach using dynamic lung function assessment will be needed to assess the efficacy of a neonatal respiratory therapy and predict the long-term respiratory consequences of premature birth. Our aim is to review the literature regarding the long-term respiratory outcomes of neonatal respiratory strategies, the difficulties of assessing dynamic lung function in infants, and potential new solutions

High Flow Nasal Cannulae in preterm infants

Despite of improved survival of premature infants, the incidence of long term pulmonary complications, mostly associated with ventilation-induced lung injury, remains high. Non invasive ventilation (NIV) is able to reduce the adverse effects of mechanical ventilation. Although nasal continuous positive airway pressure (NCPAP) is an effective mode of NIV, traumatic nasal complications and intolerance of the nasal interface are common. Recently high flow nasal cannula (HFNC) is emerging as an efficient, better tolerated form of NIV, allowing better access to the baby's face, which may improve nursing, feeding and bonding. The aim of this review is to discuss the available evidence of effectiveness and safety of HFNC in preterm newborns with respiratory distress syndrome (RDS). It is known that distending pressure generated by HFNC increases with increasing flow rate and decreasing infant size and varies according to the amount of leaks by nose and mouth. The effects of HFNC on lung mechanics, its clinical efficacy and safety are still insufficiently investigated. In conclusion, there is a growing evidence of the feasibility of HFNC as an alternative mode of NIV. However, further larger randomized trials are required, before being able to recommend HFNC in the treatment of moderate respiratory distress of preterm infants

Comparison between two different modes of non-invasive ventilatory support in preterm newborn infants with respiratory distress syndrome mild to moderate: preliminary data

Despite of improved survival of premature infants, the incidence of long term pulmonary complications, mostly associated with ventilation-induced lung injury, remains high. Non invasive ventilation (NIV) is able to reduce the adverse effects of mechanical ventilation. Although nasal continuous positive airway pressure (NCPAP) is an effective mode of NIV, traumatic nasal complications and intolerance of the nasal interface are common. Recently high flow nasal cannula (HFNC) is emerging as a better tolerated form of NIV, allowing better access to the baby's face, which may improve nursing, feeding and bonding. HFNC may be effective in the treatment of some neonatal respiratory conditions while being more user-friendly for care-givers than conventional NCPAP. Limited evidence is available to support the specific role, efficacy and safety of HFNC in newborns and to demonstrate efficacy compared with NCPAP; some studies suggest a potential role for HFNC in respiratory care of the neonate as a distinct non invasive ventilatory support. We present the preliminary data of a randomized clinical trial; the aim of this study was to assess efficacy and safety of HFNC compared to NCPAP in preterm newborns with mild to moderate respiratory distress syndrome (RDS)

[Assessment of pulmonary function in a follow-up of premature infants: our experience].

Respiratory diseases are a major cause of morbidity in neonates, especially preterm infants; a long term complication of prematurity such as bronchopulmonary dysplasia (BPD) is particularly relevant today. The exact role of the Pulmonary Function Test (PFT) in this area is not yet well defined; the PFT in newborns and infants - in contrast to what happens in uncooperative children and adults - are routinely used only in a few centers. The assessment of pulmonary function in newborns and infants, however, is nowadays possible with the same reliability that in cooperative patients with the possibility to extend the assessment of polmonary function from bench to bed. The assessment of pulmonary function must be carried out with non invasive and safe methods, at the bedside, with the possibility of continuous monitoring and providing adequate calculation and management of data. The ability to assess lung function helps to define the mechanisms of respiratory failure, improving the treatment and its effects and is therefore a useful tool in the follow-up of newborn and infant with pulmonary disease

New perspective in steelmaking activity to increase competitiveness and reduce enviromental impact

The competitiveness of the European steel industry is strictly related to the introduction of high performanceproducts and to the increase in process efficiency and to the reduction in environmental impact. Thesechallenges can be faced to ensure a future to the area’s important industrial assets and some actions need to beidentified. Several aspects about steelmaking plants, processes and steel products have been highlighted andnowadays, they may become the object of innovative action and efforts in order to achieve and maintain a highlevel of competitiveness and to solve this serious industrial crisis

Sustained seizure freedom with adjunctive brivaracetam in patients with focal onset seizures

The maintenance of seizure control over time is a clinical priority in patients with epilepsy. The aim of this study was to assess the sustained seizure frequency reduction with adjunctive brivaracetam (BRV) in real-world practice. Patients with focal epilepsy prescribed add-on BRV were identified. Study outcomes included sustained seizure freedom and sustained seizure response, defined as a 100% and a ≥50% reduction in baseline seizure frequency that continued without interruption and without BRV withdrawal through the 12-month follow-up. Nine hundred ninety-four patients with a median age of 45 (interquartile range = 32–56) years were included. During the 1-year study period, sustained seizure freedom was achieved by 142 (14.3%) patients, of whom 72 (50.7%) were seizure-free from Day 1 of BRV treatment. Sustained seizure freedom was maintained for ≥6, ≥9, and 12 months by 14.3%, 11.9%, and 7.2% of patients from the study cohort. Sustained seizure response was reached by 383 (38.5%) patients; 236 of 383 (61.6%) achieved sustained ≥50% reduction in seizure frequency by Day 1, 94 of 383 (24.5%) by Month 4, and 53 of 383 (13.8%) by Month 7 up to Month 12. Adjunctive BRV was associated with sustained seizure frequency reduction from the first day of treatment in a subset of patients with uncontrolled focal epilepsy

Adjunctive Brivaracetam in Focal Epilepsy: Real-World Evidence from the BRIVAracetam add-on First Italian netwoRk STudy (BRIVAFIRST)

Background: In randomized controlled trials, add-on brivaracetam (BRV) reduced seizure frequency in patients with drug-resistant focal epilepsy. Studies performed in a naturalistic setting are a useful complement to characterize the drug profile. Objective: This multicentre study assessed the effectiveness and tolerability of adjunctive BRV in a large population of patients with focal epilepsy in the context of real-world clinical practice. Methods: The BRIVAFIRST (BRIVAracetam add-on First Italian netwoRk STudy) was a retrospective, multicentre study including adult patients prescribed adjunctive BRV. Patients with focal epilepsy and 12-month follow-up were considered. Main outcomes included the rates of seizure‐freedom, seizure response (≥ 50% reduction in baseline seizure frequency), and treatment discontinuation. The incidence of adverse events (AEs) was also considered. Analyses by levetiracetam (LEV) status and concomitant use of strong enzyme-inducing antiseizure medications (EiASMs) and sodium channel blockers (SCBs) were performed. Results: A total of 1029 patients with a median age of 45 years (33–56) was included. At 12 months, 169 (16.4%) patients were seizure-free and 383 (37.2%) were seizure responders. The rate of seizure freedom was 22.3% in LEV-naive patients, 7.1% in patients with prior LEV use and discontinuation due to insufficient efficacy, and 31.2% in patients with prior LEV use and discontinuation due to AEs (p < 0.001); the corresponding values for ≥ 50% seizure frequency reduction were 47.9%, 29.7%, and 42.8% (p < 0.001). There were no statistically significant differences in seizure freedom and seizure response rates by use of strong EiASMs. The rates of seizure freedom (20.0% vs. 16.6%; p = 0.341) and seizure response (39.7% vs. 26.9%; p = 0.006) were higher in patients receiving SCBs than those not receiving SCBs; 265 (25.8%) patients discontinued BRV. AEs were reported by 30.1% of patients, and were less common in patients treated with BRV and concomitant SCBs than those not treated with SCBs (28.9% vs. 39.8%; p = 0.017). Conclusion: The BRIVAFIRST provided real-world evidence on the effectiveness of BRV in patients with focal epilepsy irrespective of LEV history and concomitant ASMs, and suggested favourable therapeutic combinations

Use of an automatic optical inspection system for the detection of defects arising from continuous casting processes, based on Machine Learning algorithms, for the analysis of incidence of oscillation marks on AISI 316L and 316LI austenitic stainless-steel slabs

Nowadays, continuous casting is the technology for the solidification of steel that is prevailing throughout the world. It has established itself thanks to the high productivity, the metallurgical high-quality of the products and the elevated degree of automation that distinguishes it from other processes. However, defects arising from continuous casting can compromise the structural integrity of the semi-finished products as well as affect the quality of the final product. For this reason, automatic slab inspection systems have been developed in recent years to monitor the surface of the semi-finished casting products, in order to limit further processing of products with critical and dangerous defects. By exploiting the potential of the inspection system installed on one of the casting lines of Acciai Speciali Terni S.p.A., it was possible to evaluate the impact of oscillation marks on AISI 316L and 316LI austenitic stainless-steel slabs. The aim of this research is to correlate marks distribution and their depth to the main process parameters. The analysis showed that the casting speed is a critical parameter that proportionally affects the oscillation marks distribution along the slab. In addition, the analysis revealed a lower lubrication of the edges, as oscillation marks increase in terms of frequency and depth in this position, especially on the bottom side, because of the weight of the semi-finished product itself. The preferential occurrence of this defect on one side of the slabs is associated with a slight misalignment of the casting machine. The different nitrogen content of the two steel grades analysed contributes to modify the casting powder lubricating behaviour on such edges. The results show that the AISI 316L stainless-steel transition slabs (i.e., those at the beginning and at the end of the sequence) are far more affected by the presence of edge oscillation marks than AISI 316LI. The trend is reversed for the central slabs of the sequence, for which the greater availability of nitrogen in AISI 316L leads to an increase of the kinematic viscosity of casting powder, resulting in improved lubrication

Track access charge algorithms in EU railways: a dynamic benchmarking

In this paper an overview on Track Access Charge systems in Europe is presented. tac systems from 15 countries are compared from the point of view of the algorithm used to calculate the fee that Railway Undertaking has to pay to the Infrastructure Manager, to use the infrastructure with a specific train, in a specific time and on a specific route of the network. The aim of the benchmark and comparison analysis is to highlight the diversity, analogies and typical features of different systems, allowing a comprehension of existing pricing logics of railway infrastructure. Method and some results of the analysis are presented in the paper. The analysis starts from our own Network Statement’s interpretation and leads to set them in a common framework, through the identification of a general formula. The classification of the system in homogeneous groups is therefore proposed together with a graphical synthetic representation in a three-dimensional space. In the research framework two different dynamic tools have been developed and presented in the paper: 1) a synoptic dynamic table, capable to facilitate comparison and understanding of different systems, providing a synthetic vision of pricing elements; 2) a dynamic tool, allowing comparison in a charging level, for any network and services classification