Tracheostomy in the COVID-19 pandemic

Purpose: The role of tracheostomy in COVID-19-related ARDS is unknown. Nowadays, there is no clear indication regarding the timing of tracheostomy in these patients. Methods: We describe our synergic experience between ENT and ICU Departments at University Hospital of Modena underlining some controversial aspects that would be worth discussing tracheostomies in these patients. During the last 2 weeks, we performed 28 tracheostomies on patients with ARDS due to COVID-19 infection who were treated with IMV. Results: No differences between percutaneous and surgical tracheostomy in terms of timing and no case of team virus infection. Conclusion: In our experience, tracheostomy should be performed only in selected patients within 7- and 14-day orotracheal intubation

Velocity-space sensitivity of the time-of-flight neutron spectrometer at JET

The velocity-space sensitivities of fast-ion diagnostics are often described by so-called weight functions. Recently, we formulated weight functions showing the velocity-space sensitivity of the often dominant beam-target part of neutron energy spectra. These weight functions for neutron emission spectrometry (NES) are independent of the particular NES diagnostic. Here we apply these NES weight functions to the time-of-flight spectrometer TOFOR at JET. By taking the instrumental response function of TOFOR into account, we calculate time-of-flight NES weight functions that enable us to directly determine the velocity-space sensitivity of a given part of a measured time-of-flight spectrum from TOFOR

Relationship of edge localized mode burst times with divertor flux loop signal phase in JET

A phase relationship is identified between sequential edge localized modes (ELMs) occurrence times in a set of H-mode tokamak plasmas to the voltage measured in full flux azimuthal loops in the divertor region. We focus on plasmas in the Joint European Torus where a steady H-mode is sustained over several seconds, during which ELMs are observed in the Be II emission at the divertor. The ELMs analysed arise from intrinsic ELMing, in that there is no deliberate intent to control the ELMing process by external means. We use ELM timings derived from the Be II signal to perform direct time domain analysis of the full flux loop VLD2 and VLD3 signals, which provide a high cadence global measurement proportional to the voltage induced by changes in poloidal magnetic flux. Specifically, we examine how the time interval between pairs of successive ELMs is linked to the time-evolving phase of the full flux loop signals. Each ELM produces a clear early pulse in the full flux loop signals, whose peak time is used to condition our analysis. The arrival time of the following ELM, relative to this pulse, is found to fall into one of two categories: (i) prompt ELMs, which are directly paced by the initial response seen in the flux loop signals; and (ii) all other ELMs, which occur after the initial response of the full flux loop signals has decayed in amplitude. The times at which ELMs in category (ii) occur, relative to the first ELM of the pair, are clustered at times when the instantaneous phase of the full flux loop signal is close to its value at the time of the first ELM

Model for End-Stage Liver Disease (MELD) score and organ allocation from cadaveric donors for 198 liver transplantation procedures performed in a single center.

Since February 2002, the United Network for Organ Sharing (UNOS) proposed to adopt a modified version of the Model for End-Stage Liver Disease (MELD) to assign priority on the waiting list for orthotopic liver transplantation (OLT). In this study, we evaluated the impact of MELD score on liver allocation in a single center series of 198 liver recipients (mean age of patients, 52.21+/-8.92 years), considering the relationship between clinical urgency derived from MELD score (overall MELD, 18.7+/-6.83; MELD or=15 in 129 patients) and geographical distribution of cadaveric donors (inside/outside Liguria Region, 125/73). The waiting time for OLT was 230+/-248 days, whereas the 3-month and 1-year patient survivals were 87.37% and 79.79%, respectively. No difference was observed for MELD score retrospectively calculated for patients who underwent OLT before February 2002 (n=71) compared with MELD score calculated for patients who received a liver thereafter (18.26+/-6.68 vs 18.94+/-6.92; P= .504). No significant difference was found in waiting time before and after adoption of MELD score (213+/-183 vs 238+/-278 days; P= .500), or by stratifying patients for MELD or=15 (225+/-234 vs 232+/-256 days; P= .851). Using the geographical distribution of donors as a grouping variable (outside vs inside Liguria Region), no significance occurred for MELD score (19.68+/-7.42 vs 18.17+/-6.42; P= .135) or waiting time (211+/-226 vs 242+/-261 days; P= .394). In our series, more OLTs were performed among sicker patients and no differences were found in the management of livers procured from cadaveric donors outside or inside Liguria Region. However, further efforts are needed to reduce the waiting time among patients with higher MELD scores

Differenze nella distribuzione delle categorie diagnostiche tra singolo centro e l'European Liver Transplant Registry (ELTR).

INTRODUZIONE - L'European Liver Transplant Registry (ELTR) costituisce la pi\uf9 ampia base dati europea inerente l'attivit\ue0 di trapianto (Tx) di fegato (46.530 Tx epatici effettuati su 41.522 pazienti presso 124 Centri di 21 nazioni \u2013 periodo: 01/05/1968-31/12/2001). Il nostro Dipartimento contribuisce dal 1996 al registro ELTR. METODI - I dati ELTR del periodo 01/01/1988-31/12/2001 (44.286 Tx, 39.196 pazienti) [1] sono stati analizzati in funzione delle indicazioni primarie al Tx, attribuendo a ciascuna di queste (n=46) i codici diagnostici ELTR [2]. Presso il nostro Dipartimento, in un periodo di 44 mesi consecutivi rappresentativo della tendenza centrale di distribuzione della casistica interna, sono stati effettuati 160 Tx epatici in 137 pazienti, per 15 diverse codifiche diagnostiche ELTR. RISULTATI - Nello studio ELTR, la sopravvivenza ad 1 anno di organi (S1aOrg) e pazienti (S1aPz) \ue8 risultata pari al 76% ed all'83%, rispettivamente. La casistica del nostro Dipartimento ha rivelato una S1aOrg e S1aPz del 72.99% e del 77.78%, rispettivamente. Le categorie diagnostiche ELTR e quelle del nostro Dipartimento hanno rivelato un modesto inter-rate agreement (Kappa di Cohen: 0.325; regressione di Passing e Bablock: P1% sul complesso delle indicazioni (88.26% e 53.2% dell\u2019intera casistica del nostro Dipartimento e dell\u2019ELTR, rispettivamente), non \ue8 stata osservata alcuna deviazione significativa dalla linearit\ue0 (Passing e Bablock: P>0.10). La casistica del nostro Dipartimento ha presentato una prevalenza delle codifiche E1 (27% vs. 7%), D7 (2.18% vs. 0.2%), D5 (8.75% vs. 2%) e D4 (31.38% vs. 15%), mentre nella casistica ELTR si sono rivelate prevalenti le codifiche A1-A4 (2% vs. 1.45%) e D1 (18% vs. 14.59%). La S1aOrg e S1aPz \ue8 risultata per la casistica ELTR del 79.65% e dell'82.25%, rispettivamente, contro l'81.38% e l'82.84% riscontrati nella casistica del nostro Dipartimento. CONCLUSIONI - Risultanze in termini di sopravvivenza da parte di un singolo Centro trapiantologico inferiori rispetto a quelle riportate nel registro ELTR non costituiscono necessariamente un indicatore negativo di qualit\ue0. Nel tentativo di rapportare la casistica ELTR a quella di un singolo Centro trapiantologico \ue8 necessario utilizzare appropriati strumenti di confronto tra le categorie diagnostiche al fine di limitare il rischio di comparazioni improprie e/o interpretazioni distorsive degli esiti. BIBLIOGRAFIA - [1]. Adam R. et al. Liver Transplantation 9:1231-1243 (2003). [2]. http://www.eltr.or

Hypothyroidism simulating polymyositis. Report of two cases

To report two cases of hypothyroidism simulating polymyositis

Oncological outcomes of parotid gland malignancies: a retrospective analysis of 74 patients

Introduction: Salivary gland malignancies are rare neoplasms whose management has been evolving over the last two decades. Nevertheless, patient outcomes have not improved accordingly. Objective: In the present paper, factors and variables that could influence Overall, Disease-Specific and Disease-Free Survival, and Loco-Regional Control were analyzed. Methods: Chart data from 74 patients who underwent parotid gland surgery were retrospectively analyzed and stratified for tumor histology, grading, size, pT stage, pN stage, extracapsular spread, involved salivary gland lobe, and age at diagnosis. Major outcomes were estimated at 5 years by Kaplan\u2013Meier curves. Results: Advanced stage, high grade, and lymph nodes involvement greatly impaired patient outcomes. Furthermore, in our cohort, the age at diagnosis 65 55 was a cause of poorer disease survival likely due to a different distribution in tumor histotypes between older and younger patients. Despite the two groups were homogeneous for the numerosity of squamous cell carcinomas, older patients were more rarely affected by mucoepidermoid and acinic cell carcinomas, which have generally better prognosis. Finally, patients aged 65 55 had a more frequent pathological involvement of the deep lobe of the parotid gland if compared to the younger counterpart. Conclusion: The rarity of some salivary gland tumor histotypes requires further high-number series to fully understand the prognostic factors for both patient survival and recurrence development. In our cohort, the age at diagnosis 65 55 raises concerns that play crucial roles in disease survival shortening

Reply to \u201cIndications and timing for tracheostomy in patients with SARS CoV2\u2010related\u201d by Ferri et al

..

Tracheostomy in the COVID-19 pandemic

Purpose: The role of tracheostomy in COVID-19-related ARDS is unknown. Nowadays, there is no clear indication regarding the timing of tracheostomy in these patients. Methods: We describe our synergic experience between ENT and ICU Departments at University Hospital of Modena underlining some controversial aspects that would be worth discussing tracheostomies in these patients. During the last 2 weeks, we performed 28 tracheostomies on patients with ARDS due to COVID-19 infection who were treated with IMV. Results: No differences between percutaneous and surgical tracheostomy in terms of timing and no case of team virus infection. Conclusion: In our experience, tracheostomy should be performed only in selected patients within 7- and 14-day orotracheal intubation

Autoimmune disease in hairy-cell leukemia: systemic vasculitis and anticardiolipin syndrome

To report a case of systemic vasculitis and anticardiolipin syndrome in hairy-cell leukemi