Lethal Hydrogen Sulfide poisoning in open space: an atypical case of asphyxiation of two workers

Hydrogen sulfide is one of the most dangerous toxic gases that has led to the deaths in confined spaces of many workers. We report an atypical case of a fatal accident of H2S poisoning in an open space when two workers dide during the opening of a hatch on a tanker truck filled with leachate water. Despite being utdoors, the two workers, were suddenly and quickly overhelmed by a lethal cloud of H2S,which escaped like a geyser from the hatch and hovered over the top of the tanker making it impossible for them to survive. the first operator was engulfed by the sudden flow of lethal gas near the hatch while the second worker, who came to his aid, immediately lopst consciousness and fell off the tanker onto the ground. Environmental toxicological analyses were carried out on the air near the hatch and inside the tanker 2h, 20 days and 70 days after the accident. Toxicological analyses on the blood were also carried out but unfortunately, no urine samples was available. The thiosulfate, detected by GC/MS analysis after derivatization of PFBBr, was found to be 0.01 and 0.04mM/L. These values are included in the medium-low lethal values of occupational fatalities involving H2S reported in the literature

Neural sentiment analysis for a real-world application

In this paper, we describe our neural network models for a commercial application on sentiment analysis. Different from academic work, which is oriented towards complex networks for achieving a marginal improvement, real scenarios require flexible and efficient neural models. The possibility to use the same models on different domains and languages plays an important role in the selection of the most appropriate architecture. We found that a small modification of the state-of-the-art network according to academic benchmarks led to a flexible neural model that also preserves high accuracy. In questo lavoro, descriviamo i nostri modelli di reti neurali per un'applicazione commerciale basata sul sentiment analysis. A differenza del mondo accademico, dove la ricerca è orientata verso reti anche complesse per il raggiungimento di un miglioramento marginale, gli scenari di utilizzo reali richiedono modelli neurali flessibili, efficienti e semplici. La possibilitá di utilizzare gli stessi modelli per domini e linguaggi variegati svolge un ruolo importante nella scelta dell'architettura. Abbiamo scoperto che una piccola modifica della rete allo stato dell'arte rispetto ai benchmarks accademici produce un modello neurale flessibile che preserva anche un'elevata precisione

A novel missense mutation for Fabry disease detected by echocardiographic screening in left ventricular hypertrophy patients

Fabry disease is an X-linked lysosomal storage disease caused by mutations in the a-galactosidase A gene (GLA), leading to the absence or a reduction of the enzymatic activity of the encoded enzyme and subsequent progressive tissue accumulation of glycosphingolipids through-out all the body, with consequent multiorgan failure. Here, we report the case of a 57-year-old woman with Fabry disease due to a novel GLA gene mutation

The EARTHCRUISERS project (EARTH CRUst Imagery for investigating SEismicity, volcanism and marine natural Resources in the Sicilian offshore)

The EARTHCRUISERS project was developed for the MIUR’s call “Progetti Premiali 2015” by the “Istituto Nazionale di Oceanografia e di Geofisica Sperimentale” (Trieste, Italy) in collaboration with the “Istituto Nazionale di Geofisica e Vulcanologia, Osservatorio Etneo” (Catania, Italy) and “Stazione Zoologica Anton Dohrn” (Naples, Italy). The main goals of the project are: (i) to identify and characterize the main crustal tectonic structures offshore Sicily and the Aeolian Islands, (ii) to better understand the geodynamic processes controlling seismicity and volcanism affecting this region, and (iii) to furnish a useful tool to estimate seismic, tsunamigenic and volcanic hazard in the highly populated coastal sectors. Furthermore, in order to contribute at the Blue Growth objectives, the project aims to analyze some relevant issues related to mineral prospecting offshore, such as the characterization of the hydrothermal systems in the Tyrrhenian Sea and the impact of the exploitation of oil and gas fields on the marine environment in the Sicily Channel. To achieve these objectives the acquisition of multibeam and sidescan sonar, multichannel seismic reflection, magnetic and gravimetric data is planned. Nearly 2500 km of multichannel seismic reflection lines will be acquired during the project in the Marsili Basin (Tyrrhenian Sea) and Mt. Etna offshore. This large amount of data will allow to: better understand the relationship between tectonics and evolution of volcanism; identify active faults and volcanic bodies; better constrain the seismostratigraphic and structural setting of the study areas, and investigate the eventual occurrence of unstable volcanic slopes which could lead to landslide and tsunami. Finally, the deployment offshore southeastern Sicily of a temporary Ocean Bottom Seismometer (OBS) network will carry out for monitoring the natural seismicity in the area of VEGA platform, the largest oil extraction site in Italian seas. Data collected will be used to study the eventual correlation between local seismicity and oil extractive activities.PublishedRome2T. Deformazione crostale attiv

Real-World Six- and Twelve-Month Drug Retention, Remission, and Response Rates of Secukinumab in 2,017 Patients With Psoriatic Arthritis in Thirteen European Countries

Objective There is a lack of real-life studies on interleukin-17 (IL-17) inhibition in psoriatic arthritis (PsA). We assessed real-life 6- and 12-month effectiveness (i.e., retention, remission, low disease activity [LDA], and response rates) of the IL-17 inhibitor secukinumab in PsA patients overall and across 1) number of prior biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs), 2) years since diagnosis, and 3) European registries. Methods Thirteen quality registries in rheumatology participating in the European Spondyloarthritis Research Collaboration Network provided longitudinal, observational data collected as part of routine care for secondary use. Data were pooled and analyzed with Kaplan-Meier plots, log rank tests, Cox regression, and multiple linear and logistic regression analyses. Results A total of 2,017 PsA patients started treatment with secukinumab between 2015 and 2018. Overall secukinumab retention rates were 86% and 76% after 6 and 12 months, respectively. Crude (LUNDEX adjusted) 6-month remission/LDA (LDA including remission) rates for the 28-joint Disease Activity Index for Psoriatic Arthritis, the Disease Activity Score in 28 joints using the C-reactive protein level, and the Simplified Disease Activity Index (SDAI) were 13%/46% (11%/39%), 36%/55% (30%/46%), and 13%/56% (11%/47%), and 12-month rates were 11%/46% (7%/31%), 39%/56% (26%/38%), and 16%/62% (10%/41%), respectively. Clinical Disease Activity Index remission/LDA rates were similar to the SDAI rates. Six-month American College of Rheumatology 20%/50%/70% improvement criteria responses were 34%/19%/11% (29%/16%/9%); 12-month rates were 37%/21%/11% (24%/14%/7%). Secukinumab effectiveness was significantly better for b/tsDMARD-naive patients, similar across time since diagnosis (4 years), and varied significantly across the European registries. Conclusion In this large real-world study on secukinumab treatment in PsA, 6- and 12-month effectiveness was comparable to that in previous observational studies of tumor necrosis factor inhibitors. Retention, remission, LDA, and response rates were significantly better for b/tsDMARD-naive patients, were independent of time since diagnosis, and varied significantly across the European countries.Peer reviewe

Interval debulking surgery in advanced epithelial ovarian cancer

Cytoreductive surgery and chemotherapy are the mainstay for the treatment of advanced epithelial ovarian cancer. In order to minimize the tumour burden before chemotherapy, cytoreductive surgery is usually performed first. The importance of the amount of residual disease as the main prognostic factor for patients suffering from advanced disease has been almost universally accepted even in the absence of prospective randomized trials addressing the benefit of cytoreductive surgery. In the last decade, the value of debulking surgery after induction chemotherapy - interval debulking surgery, IDS - has been widely debated, especially after the completion of a prospective randomized study from the EORTC addressing the introduction of a surgical procedure with debulking intent preceded and followed by cytoreductive chemotherapy. The rationale of such a strategy in the context of the primary treatment of advanced ovarian cancer lies in a higher cytoreductibility to the 'optimal' status forwarded, and possibly facilitated, by chemotherapy. The results demonstrated a prolongation of both progression-free survival and median survival in favour of patients randomized to IDS (5 and 6 months, respectively). Multivariate analysis revealed IDS to be an independent prognostic factor which reduced the risk of death by 33% at 3 years and by 48% in subsequent re-evaluation after more than 6 years of observation. Despite the above, results have been questioned by many, leading the GOG to perform a similar study which has been concluded very recently. Nevertheless, the main concern regarding the application of IDS in all instances relates to the morbidity of two major surgical procedures integrated within a short period during which cytotoxic chemotherapy is also administered. Neoadjuvant chemotherapy has been recently proposed to avoid a non-useful surgical procedure in patients considered 'optimally unresectable' after diagnosis of advanced ovarian cancer. Whether or not this newer approach will translate into a longer survival with a better quality of life is going to be addressed by a novel EORTC study. Finally, the concept of a 'chemical' cytoreduction preceding and facilitating a subsequent 'surgical' effort has been recently introduced also in the treatment of recurrent disease. The EORTC has recently initiated a prospective randomized study (LOROCSON - Late Onset Recurrent Ovarian Cancer: Surgery or Not) to validate the importance of such an approach to be balanced with medical treatment alone not only in terms of survival but also as far as quality of life is concerned

Common presentation of rare diseases: Aortic aneurysms & valves

The concept "common presentation of rare diseases" implies that rare diseases are masked by common phenotypic manifestations. This concept applies to both aneurysmal and valvular diseases that can be syndromic and non-syndromic. Syndromic disorders include genetic connective tissue diseases and chromosomal disorders that are diagnosed independently from the aneurysm or valve disease. Non-syndromic diseases, on the other hand, are defined by the presence of aneurysm or valve disease or both. The reasons for suspecting these rare diseases include young age, the absence of risk factors, a positive family history for aortic or valvular disease/event, and extra-cardiovascular traits for syndromes. The probands should receive genetic counseling, genetic testing [single gene in case of precise phenotyping addressing the gene to be tested, or multigene panels, in case of diseases with genetic heterogeneity], post-test counseling, clinical family screening and cascade genetic testing in relatives after the identification of a causative mutation. Segregation studies are essential in case of novel mutations, in particular non-truncation predicting variants. Clinical family screening of syndromic diseases is facilitated by the evaluation of non-cardiovascular traits; this supports early diagnosis and geno-phenotype correlation. Vice versa, family screening studies in non-syndromic aneurysmal and valvular diseases exclusively relies on CV imaging screening of relatives. In this context, conditions such as BAV and related aortopathy are easy to diagnose because BAV is present at birth while aortopathy usually develops during the life course

Occupational Lethal Asphyxiation by Toxic Gas in Unconfined Spaces: Hydrogen Sulphide Poisoning

After attending this presentation, attendees will better understand specific aspects of Hydrogen Sulphide poisoning, an important cause of work-related death.The goal of this presentation is to recount the story of the deaths of two men who, while working in a truck tank which transported leachate, were poisoned by H2S in an open air. Introduction: Hydrogen sulphide (H2S) is a toxic gas generated by non-specific and anaerobic bacterial reduction of sulphates and sulphur-containing organic compounds at the temperature >20°C. Severe or fatal H2S intoxications are very uncommon in locations which lack the characteristics of confined spaces. The case reports an accidental death of two workers during the hatch opening on a truck-tank filled of leachate water. The first worker (P.R.) was hit by a massive gas flow therefore he fell on the tank. A fellow worker (L.F.), rushed to his aid, but also lost consciousness and rushed to the ground. Environmental toxicological analyses were carried out on the air outside the tank with both closed and open porthole, inside the tank at various depths, on liquid samples of the tank, and during the collection of the leachate. Toxicological and chemical-physical analyses (pH, etc.) were also carried out on leachate samples. Air monitoring was performed at 2 hours, 20 days and 70 days after the incident using Gastec Color Dosimeter Tubes. Elemental analysis, Gas chromatography/Mass-spectrometry (GC/MS) analysis and potentiometric titration was performed on leachate samples. Toxicological analyses on biological samples were carried out about 2 months after the autopsy. Thiosulfate (H2S metabolite) was quantified using a GC/MS technique after derivatization with pentafluorobenzyl bromide. These environmental findings were confirmed by toxicological analyses on biological samples through the measurement of thiosulfate,4.5 mg/ml for the first worker and 1.21 mg/l for the second one. Despite the possible loss of H2S from the tank during rescue operations even at the time elapsed from the accident (seventy days), there was still a lethal concentration of the gas 750 ppm.The two workers were wrapped by a H2S bubble gas leaked from truck-tank; therefore it is occurred a unconfined space gas death. Prolonged inhalation of this concentration causes sudden loss of cosciousness that can lead to fatal respiratory paralysis if rescue operations are not rapid. These enviromental findings were confirmed by toxicological analyses through the measurement of thiosulfate, which is one of the main H2S metabolite