The PROVENT-C19 registry: A study protocol for international multicenter SIAARTI registry on the use of prone positioning in mechanically ventilated patients with COVID-19 ARDS

Background The worldwide use of prone position (PP) for invasively ventilated patients with COVID-19 is progressively increasing from the first pandemic wave in everyday clinical practice. Among the suggested treatments for the management of ARDS patients, PP was recommended in the Surviving Sepsis Campaign COVID-19 guidelines as an adjuvant therapy for improving ventilation. In patients with severe classical ARDS, some authors reported that early application of prolonged PP sessions significantly decreases 28-day and 90-day mortality. Methods and analysis Since January 2021, the COVID19 Veneto ICU Network research group has developed and implemented nationally and internationally the "PROVENT-C19 Registry", endorsed by the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care. . .'(SIAARTI). The PROVENT-C19 Registry wishes to describe 1. The real clinical practice on the use of PP in COVID-19 patients during the pandemic at a National and International level; and 2. Potential baseline and clinical characteristics that identify subpopulations of invasively ventilated patients with COVID-19 that may improve daily from PP therapy. This web-based registry will provide relevant information on how the database research tools may improve our daily clinical practice. Conclusions This multicenter, prospective registry is the first to identify and characterize the role of PP on clinical outcome in COVID-19 patients. In recent years, data emerging from large registries have been increasingly used to provide real-world evidence on the effectiveness, quality, and safety of a clinical intervention. Indeed observation-based registries could be effective tools aimed at identifying specific clusters of patients within a large study population with widely heterogeneous clinical characteristics. Copyright

Il traffico fra l'America e l'oriente attraverso il Mediterraneo : la linfa di una via internazionale

- Indice #13- L'America potente e l'Oriente da potenziare #19- Il Mediterraneo centro della nuova corrente di traffici; #89- Il porto di Palermo #16

Long-Term Efficacy of Shunt Therapy in Idiopathic Normal Pressure Hydrocephalus

Background: Idiopathic normal pressure hydrocephalus (iNPH) is one of the very few treatable types of dementia. Shunt therapy has been shown to be effective in improving symptoms. However, the long-term results of cerebrospinal fluid diversion are variable. The aim of this retrospective study was to investigate long-term outcomes of patients with idiopathic normal pressure hydrocephalus treated with ventriculoperitoneal shunt by using programmable valves. Methods: Symptoms before treatment were recorded. Clinical symptoms and outcome after ventriculoperitoneal shunt were assessed based on changes in gait, urinary incontinence, and cognitive dysfunction at yearly follow-up spanning at least 10 years. Results: Among 50 patients treated, 5 had died at the time of the evaluation. Median age was 71 years, and mean follow-up time of the surviving patients was 120.2 ± 2.3 years. Overall, there was a significant and lasting improvement among all symptoms compared with the baseline (P < 0.05). Gait showed better and sustained improvement compared with the baseline (P < 0.05). Cognitive impairment and urinary incontinence improved in the early follow-up (P < 0.05) followed by declines in long-term follow-up. Ten patients (20%) required surgical revisions for shunt malfunction. Change in valve pressure was performed in 20 patients (40%). Overall, 93.3% revisions resulted in clinical improvement. Conclusions: Surgical treatment for idiopathic normal pressure hydrocephalus by ventriculoperitoneal shunt is a safe modality that improves symptoms in most patients, including in the long-term. Strict follow-up is necessary for early diagnosis of shunt malfunction or need for valve adjustment. © 2019 Elsevier Inc

Formate dehydrogenase takes part in molybdenum and iron homeostasis and affects dark-induced senescence in plants

Formate is produced, in plants, by various biochemical pathways and it is degraded by Formate Dehydrogenase FDH, in presence of NAD+, into CO2 and NADH. FDH has been proposed as one of the enzymes regulating molybdenum (Mo) and iron (Fe) homeostasis. Here we explored the impact of FDH perturbation on Mo and Fe plant nutritional status and FDH relevance on the plant responses against abiotic stresses, by using in silico and experimental approaches. The characterization of different Arabidopsis thaliana and Nicotiana tabacum FDH transgenic lines suggests that FDH promoter activity is dependent on both Mo and Fe nutritional supply and that FDH overexpression alters Mo concentrations in seeds and Fe concentration in seeds, leaves and stems. Also, FDH overexpression delays the dark-induced senescence whereas the lack of FDH accelerates its progression. FDH is therefore a multifaceted enzyme with impact on Mo and Fe homeostasis and regulation of dark-induced senescence

Strongly curved super-conducting magnets: beam optics modeling and field quality

Superconducting (SC) dipoles with a strong curvature (radius smaller than 2 meters, for an aperture of about 100 mm and a length of 1-3 meters) are required for applications where compactness is key, such as the synchrotron and gantry for Carbon-ion therapy developed within the European program HITRIplus. Such magnets challenge several assumptions in the field description and put to the test the range of validity of beam optics codes. In particular, the equivalence that holds for the straight magnets between the transverse multipoles description obtained from the Fourier analysis (used for magnet design and measurements) and the Taylor expansion of the vertical field component along the horizontal axis (used in beam optics) is not valid any longer. Proper fringe field modelling also becomes important due to the curved geometry and the aperture being large compared to the magnetic length. We explore the feasibility and the limits of modelling such magnets with optics elements (such as sector bends and multipoles), which allows parametric optics studies for optimization, field quality definition and fast long-term multi-pass tracking.Superconducting dipoles with a strong curvature (radius smaller than 2 meters, for an aperture of about 100 mm and a length of 1-3 meters) are required for applications where compactness is key, such as the synchrotron and gantry for Carbon-ion therapy developed within the European program HITRIplus.Such magnets challenge several assumptions in the field description and put to the test the range of validity of beam optics codes. In particular, the equivalence that holds for the straight magnets between the transverse multipoles description obtained from the Fourier analysis (used for magnet design and measurements) and the Taylor expansion of the vertical field component along the horizontal axis (used in beam optics) is not valid any longer. A proper fringe field modelling also becomes important, due to the curved geometry and the aperture being large compared to the magnetic length.We explore the feasibility and the limits of modeling such magnets with optics elements (such as sector bends and multipoles), which allows parametric optics studies for optimization, field quality definition and fast long-term multi-pass tracking

Explorative studies of an innovative superconducting gantry

The Heavy Ion Therapy Research Integration plus (HITRIplus) is an European project that aims to integrate and propel research and technologies related to cancer treatment with heavy ion beams. Among the ambitious goals of the project, a specific work package includes the design of a gantry for carbon ions, based on superconducting magnets. The first milestone to achieve is the choice of the fundamental gantry parameters, namely the beam optics layout, the superconducting magnet technology, and the main user requirements. Starting from a reference 3 T design, the collaboration widely explored dozens of possible gantry configurations at 4 T, aiming to find the best compromise in terms of footprint, capital cost, and required R&D. We present here a summary of these configurations, underlying the initial correlation between the beam optics, the mechanics and the main superconducting dipoles design: the bending field (up to 4 T), combined function features (integrated quadrupoles), magnet aperture (up to 90 mm), and angular length (30° – 45°). The resulting main parameters are then listed, compared, and used to drive the choice of the best gantry layout to be developed in HITRIplus. © 2023 Institute of Physics Publishing

Explorative Studies of an Innovative Superconducting Gantry

The Heavy Ion Therapy Research Integration plus (HITRIplus) is a European project that aims to integrate and propel research and technologies related to cancer treatment with heavy ions beams. Among the ambitious goals of the project, a specific work package includes the design of a gantry for carbon ions, based on superconducting magnets. The first milestone to achieve is the choice of the fundamental gantry parameters, namely the beam optics layout, the superconducting magnet technology, and the main user requirements. Starting from a reference 3T design, the collaboration widely explored dozens of possible gantry configurations at 4T, aiming to find the best compromise in terms of footprint, capital cost, and required R&D.; We present here a summary of these configurations, underlying the initial correlation between the beam optics, the mechanics, and the main superconducting dipoles design: the bending field (up to 4 T), combined function features (integrated quadrupole), magnet aperture (up to 90 mm), and angular length (30°-45°). The resulting main parameters are then listed, compared, and used to drive the choice of the best gantry layout to be developed in HITRIplus