Feasibility and safety of low-flow extracorporeal carbon dioxide removal to facilitate ultra-protective ventilation in patients with moderate acute respiratory distress sindrome

BACKGROUND: Mechanical ventilation with a tidal volume (V(T)) of 6 mL/kg/predicted body weight (PBW), to maintain plateau pressure (P(plat)) lower than 30 cmH(2)O, does not completely avoid the risk of ventilator induced lung injury (VILI). The aim of this study was to evaluate safety and feasibility of a ventilation strategy consisting of very low V(T) combined with extracorporeal carbon dioxide removal (ECCO(2)R). METHODS: In fifteen patients with moderate ARDS, V(T) was reduced from baseline to 4 mL/kg PBW while PEEP was increased to target a plateau pressure – (P(plat)) between 23 and 25 cmH(2)O. Low-flow ECCO(2)R was initiated when respiratory acidosis developed (pH < 7.25, PaCO(2) > 60 mmHg). Ventilation parameters (V(T), respiratory rate, PEEP), respiratory compliance (C(RS)), driving pressure (DeltaP = V(T)/C(RS)), arterial blood gases, and ECCO(2)R system operational characteristics were collected during the period of ultra-protective ventilation. Patients were weaned from ECCO(2)R when PaO(2)/FiO(2) was higher than 200 and could tolerate conventional ventilation settings. Complications, mortality at day 28, need for prone positioning and extracorporeal membrane oxygenation, and data on weaning from both MV and ECCO(2)R were also collected. RESULTS: During the 2 h run in phase, V(T) reduction from baseline (6.2 mL/kg PBW) to approximately 4 mL/kg PBW caused respiratory acidosis (pH < 7.25) in all fifteen patients. At steady state, ECCO(2)R with an average blood flow of 435 mL/min and sweep gas flow of 10 L/min was effective at correcting pH and PaCO(2) to within 10 % of baseline values. PEEP values tended to increase at V(T) of 4 mL/kg from 12.2 to 14.5 cmH(2)O, but this change was not statistically significant. Driving pressure was significantly reduced during the first two days compared to baseline (from 13.9 to 11.6 cmH(2)O; p < 0.05) and there were no significant differences in the values of respiratory system compliance. Rescue therapies for life threatening hypoxemia such as prone position and ECMO were necessary in four and two patients, respectively. Only two study-related adverse events were observed (intravascular hemolysis and femoral catheter kinking). CONCLUSIONS: The low-flow ECCO(2)R system safely facilitates a low volume, low pressure ultra-protective mechanical ventilation strategy in patients with moderate ARDS

The Monitoring of Urban Environments and Built-Up Structures in a Seismic Area: Web-Based GIS Mapping and 3D Visualization Tools for the Assessment of the Urban Resources

In this paper, a non-invasive infrastructural system called MASSIMO is presented for the monitoring and the seismic vulnerability mitigation of cultural heritages. It integrates ground-based, airborne and space-borne remote sensing tools with geophysical and in situ surveys to provide a multi-spatial (regional, urban and building scales) and multi-temporal (longterm, short-term and near-real-time scales) monitoring of test areas and buildings. The measurements are integrated through web-based Geographic Information System (GIS) and 3-dimensional visual platforms to support decision-making stakeholders involved in urban and structural requalification planning. An application of this system is presented over the Calabria region for the town of Cosenza and a test historical complex.The present work is supported and funded by the Italian Ministry of Education, University and Research (MIUR) under the research project PON01-02710 "MASSIMO" - "Monitoraggio in Area Sismica di SIstemi MOnumentali".Published9-134T. Sismologia, geofisica e geologia per l'ingegneria sismicaN/A or not JC

Una metodologia di indagine basata su tecniche NDT per la mitigazione del rischio sismico di beni storici soggetti a tutela

Sommario In questo lavoro viene presentata una metodologia di indagine NDT (acronimo inglese di Non Destructing Testing), basata su tecniche classiche di misura, telerilevamento prossimale e satellitare ad alta risoluzione spaziale, analisi sismogenetiche ed indagini geofisiche, per la mitigazione del rischio sismico di edifici storici monumentali soggetti a tutela. I risultati sperimentali, ottenuti per il caso di studio del complesso monumentale di Sant’Agostino ubicato nella città di Cosenza, dimostrano l’efficacia dell’approccio proposto sia per applicazioni correnti (il monitoraggio materiale e strutturale di un manufatto), sia per applicazioni emergenti (mitigazione del rischio sismico di beni storici)

Lopinavir/Ritonavir and Darunavir/Cobicistat in Hospitalized COVID-19 Patients: Findings From the Multicenter Italian CORIST Study

Background: Protease inhibitors have been considered as possible therapeutic agents for COVID-19 patients. Objectives: To describe the association between lopinavir/ritonavir (LPV/r) or darunavir/cobicistat (DRV/c) use and in-hospital mortality in COVID-19 patients. Study Design: Multicenter observational study of COVID-19 patients admitted in 33 Italian hospitals. Medications, preexisting conditions, clinical measures, and outcomes were extracted from medical records. Patients were retrospectively divided in three groups, according to use of LPV/r, DRV/c or none of them. Primary outcome in a time-to event analysis was death. We used Cox proportional-hazards models with inverse probability of treatment weighting by multinomial propensity scores. Results: Out of 3,451 patients, 33.3% LPV/r and 13.9% received DRV/c. Patients receiving LPV/r or DRV/c were more likely younger, men, had higher C-reactive protein levels while less likely had hypertension, cardiovascular, pulmonary or kidney disease. After adjustment for propensity scores, LPV/r use was not associated with mortality (HR = 0.94, 95% CI 0.78 to 1.13), whereas treatment with DRV/c was associated with a higher death risk (HR = 1.89, 1.53 to 2.34, E-value = 2.43). This increased risk was more marked in women, in elderly, in patients with higher severity of COVID-19 and in patients receiving other COVID-19 drugs. Conclusions: In a large cohort of Italian patients hospitalized for COVID-19 in a real-life setting, the use of LPV/r treatment did not change death rate, while DRV/c was associated with increased mortality. Within the limits of an observational study, these data do not support the use of LPV/r or DRV/c in COVID-19 patients

Experimental analysis and numerical modeling of the seismic site response at Santa Maria di Collemaggio Basilica in L'Aquila

The Basilica of Santa Maria di Collemaggio is an important cultural heritage site, considered as an extraordinary example of Romanic Art in the Abruzzo Region (Italy). Erected in the second half of the XII century, it suffered numerous transformations partly due to the damages incurred as result of several earthquakes. During the April 6, 2009 L’Aquila earthquake (MW = 6.3), the Basilica was strongly dam-aged and in particular the area of the transept collapsed causing the fall of the dome. Recently the Eni Company launched the financing project “Ripartire da Collemaggio” for the restoration of this historical building. The project includes a deep geological, geotechnical and geophysical in-vestigations, still ongoing (AA.VV., 2013), that complete the infor-mation on L’Aquila subsoil already provided by numerous studies car-ried on in downtown L'Aquila (MS–AQ Working Group, 2010; Amo-roso et al., 2010; Cardarelli e Cercato, 2010; Amoroso et al., 2014; Monaco et al., 2013; Santucci de Magistris et al., 2013; Monaco et al., 2012; Milana et al., 2011). This paper illustrates the preliminary results of seismic response anal-yses carried out at Santa Maria di Collemaggio Basilica, by using EE-RA (Bardet et al., 2000), a monodimensional (1D) code, and QUAD4M (Hudson et al., 1994), a bi-dimensional (2D) software. Both programs are dedicated to model the seismic response of a site also tacking into account for non-linear soil behaviour.PublishedRome3T. Pericolosità sismica e contributo alla definizione del rischiorestricte

Experimental analysis and numerical modeling of the seismic site response at Santa Maria di Collemaggio Basilica in L'Aquila

The Basilica of Santa Maria di Collemaggio is an important cultural heritage site, considered as an extraordinary example of Romanic Art in the Abruzzo Region (Italy). Erected in the second half of the XII century, it suffered numerous transformations partly due to the damages incurred as result of several earthquakes. During the April 6, 2009 L’Aquila earthquake (MW = 6.3), the Basilica was strongly dam-aged and in particular the area of the transept collapsed causing the fall of the dome. Recently the Eni Company launched the financing project “Ripartire da Collemaggio” for the restoration of this historical building. The project includes a deep geological, geotechnical and geophysical in-vestigations, still ongoing (AA.VV., 2013), that complete the infor-mation on L’Aquila subsoil already provided by numerous studies car-ried on in downtown L'Aquila (MS–AQ Working Group, 2010; Amo-roso et al., 2010; Cardarelli e Cercato, 2010; Amoroso et al., 2014; Monaco et al., 2013; Santucci de Magistris et al., 2013; Monaco et al., 2012; Milana et al., 2011). This paper illustrates the preliminary results of seismic response anal-yses carried out at Santa Maria di Collemaggio Basilica, by using EE-RA (Bardet et al., 2000), a monodimensional (1D) code, and QUAD4M (Hudson et al., 1994), a bi-dimensional (2D) software. Both programs are dedicated to model the seismic response of a site also tacking into account for non-linear soil behaviour

2D site response analysis of a cultural heritage: the case study of the site of Santa Maria di Collemaggio Basilica (L’Aquila, Italy)

Abstract The Santa Maria di Collemaggio Basilica is an important cultural heritage site and exemplifies Romanesque-Gothic art in the Abruzzo region (central Italy). Erected in the second half of the XII century, the Basilica was severely damaged during the April 6, 2009 L’Aquila earthquake (MW 6.1). In particular, the area of the transept collapsed causing the dome to fall. A refined two-dimensional (2D) geotechnical model was built representing a section that includes the Basilica, in order to better understand the soil response of the Basilica site. The subsoil model was constrained using the geophysical and geotechnical data collected from the seismic microzonation studies, the reconstruction of private damaged buildings and other technical and scientific studies realized in the L’Aquila basin and in the area of the Basilica before and after L’Aquila earthquake. 2D site response analyses were performed to verify the presence of local site effects by comparing simulated versus experimental transfer functions. Moreover, a frequency–wavenumber (f– k) analysis was executed with the aim of evaluating the occurrence of surface waves generated within the basin. 2D seismic effects involve significant amplification in the period range of engineering interest, therein providing an appropriate elastic response spectrum for the restoration of the Basilica.Published4443-44665T. Sismologia, geofisica e geologia per l'ingegneria sismicaJCR Journa