Antibiotic therapy, supportive treatment and management of immunomodulation-inflammation response in community acquired pneumonia: review of recommendations

Community-acquired pneumonia is a common and serious disease, with high rates of morbidity and mortality. Management and treatment of community-acquired pneumonia are described in three main documents: the 2007 American Thoracic Society guidelines, the 2011 European Respiratory Society guidelines, and the 2009 British Thoracic Society guidelines, updated by the NICE in 2015. Despite the validity of current guidelines in improving prognosis and management of patients with community-acquired pneumonia, not all recommendations have high levels of evidence and there are still some controversial issues. In particular, there are some areas of low evidence such as the efficacy of an antibiotic molecule or scheme in patients with same risk factors; duration of antibiotic treatment, supportive therapy for acute respiratory failure and immunomodulation molecules. This review will summarize the main recommendations with high level of evidence and discuss the recommendations with lower evidence, analyzing the studies published after the guidelines' release

Coupling Experiment and Simulation in Electromagnetic Forming Using Photon Doppler Velocimetry

Modeling electromagnetic forming processes is in many ways simpler than modeling traditional metal forming processes. In electromagnetic forming the problem is often dominated by inertial acceleration by a magnetic field. This is a much better posed problem than the more traditional ones that are often dominated by complex three dimensional constitutive behavior and frictional effects. However, important aspects of the problem are dominated by the constitutive properties of the material, and often electromagnetic forming is performed in a regime where there is little reliable material strength data. Strain rates are often high (102 to 104 s-1 is the typical range for electromagnetic forming). Also, heat is generated both by ohmic heating as well as by plastic deformation, and peak temperatures can be quite high. Also, while hightemperature, high-strain-rate data is scarce, there is little or no data in cases where temperature rises significantly over very short times (tens of micro-seconds) as happens in electromagnetic metal forming. This rapid temperature rise is very important to the material response because the short time scales largely preclude the material from recovery and recrystallization processes and precipitates cannot dissolve as they normally would in an age-hardening alloy in these time scales. This presentation will show how advanced instrumentation, particularly the Photon Doppler Velocimeter (PDV) can be coupled with electromagnetic forming and provide both avenues to characterize material as well as to provide very critical tests of numerical models of the process

Trapianto di polmone e disordini linfoproliferativi post trapianto (PTLD) ebv-correlati

I disordini linfoproliferativi post trapianto sono un\u2019importate causa di morbidit\ue0 soprattuto nel primo anno dal trapianto. Tale possibilit\ue0 diagnostica andrebbe sempre tenuta in considerazione in casi di lesioni polmonari di difficile interpretazione. Essendoci una stretta correlazione con Ebstein-Barr virus si ritiene mandatorio il monitoraggio di EBV-DNA nel siero nel follow up post trapianto. Introduzione: I trapianti di organo solido, a causa dell\u2019immunosoppressione, comportano un alto rischio di sviluppo di malattie linfoproliferative. Spesso questi disordini sono correlati ad Ebstein-Barr Virus. Pochi studi sono attualmente disponibili nell\u2019ambito dell\u2019incidenza nel trapianto di polmone. Metodologia: \uc8 stata condotta una analisi retrospettiva sui pazienti sottoposti a trapianto polmonare presso il nostro centro che abbiano sviluppato un linfoma EBV-correlato. Risultati: Dal Gennaio 2009 al Gennaio 2017 sono stati eseguiti 100 trapianti polmonari. Di questi, 2 pazienti hanno sviluppato PTLD EBV correlata. Entrambi i pazienti sono stati trapiantati in regime di urgenza per Fibrosi Cistica, con necessit\ue0 di supporto respiratorio extracorporeo. La diagnosi \ue8 stata effettuata nei primi mesi post trapianto mediante biopsia di lesioni polmonari, in quadro infettivo non responsivo alla terapia antibiotica ad ampio spettro, in presenza di elevata carica di EBV-DNA su siero. La malattia ha interessato prevalentemente il parenchima e linfonodi polmonari in un caso mentre nel secondo caso si \ue8 resa evidente un\u2019estensione anche extrapolmonare (epatica e linfonodale). I pazienti sono stati sottoposti a chemioterapia secondo schema specifico. Entrambi i pazienti sono vivi a 24 e 14 mesi dal trapianto, in remissione completa (1\ub0 caso) e parziale (2\ub0 caso). Conclusioni: I disordini linfoproliferativi post trapianto sono un\u2019importate causa di morbidit\ue0 soprattuto nel primo anno dal trapianto. Tale possibilit\ue0 diagnostica andrebbe sempre tenuta in considerazione in casi di lesioni polmonari di difficile interpretazione. Essendoci una stretta correlazione con Ebstein-Barr virus si ritiene mandatorio il monitoraggio di EBV-DNA nel siero nel follow up post trapianto

Uso delle resistenze specifiche per la stima della risposta al broncodilatatore in pazienti BPCO

Nei pazienti affetti da broncopneumopatia cronica ostruttiva (BPCO), i broncodilatatori migliorano la funzione polmonare e alleviano la sintomatologia respiratoria nella misura in cui riducono la resistenza delle vie aeree durante la respirazione tidalica, prevenendo o riducendo l\u2019iperinflazione dinamica (Barnes et al., 1981). Inoltre, la riduzione del tono broncomotore a livello delle piccole vie aeree pu\uf2 ridurre il volume residuo (RV) e aumentare la capacit\ue0 vitale (VC). Secondo le linee guida ATS/ERS (Pellegrino et al., 2005), un paziente BPCO risponde a un broncodilatatore se, dopo somministrazione del farmaco, l\u2019aumento del volume espirato forzatamente in un secondo (FEV1) e/o della capacit\ue0 vitale forzata (FVC) \ue8 uguale o maggiore del 12% del valore di controllo, e comunque uguale o maggiore di 200 ml. Tuttavia \ue8 noto che a) FEV1 riflette solo parzialmente le resistenze polmonari (Pride, 1971;Skinner and Palmer, 1974), b) la misurazione di FEV1 e di FVC \ue8 ottenuta con una manovra di per s\ue8 in grado di modificare il calibro delle vie aeree (Barnes et al., 1981), c) FEV1 e FVC sono altamente correlate (Schermer et al., 2007), e d) le variazioni di FEV1 e di FVC nei pazienti BPCO di grado severo possono essere molto piccole (Deesomchok et al., 2010). E\u2019 possibile che le variazioni delle resistenze specifiche pletismografiche (sRAW), un parametro che riflette accuratamente le resistenze delle vie aeree periferiche (Bassiri et al., 1997), possano evidenziare l\u2019azione dei broncodilatatori nei pazienti BPCO meglio di quanto possano fare le variazioni di FEV1 o di FVC

Effect of fertilizer rate and water irrigation quality on the recovery of 15N-labeled fertilizer applied to Sudangrass

Wastewaters are increasingly used for irrigation of cropping systems in Tunisia. However, to develop environmentally sound practices the contribution of wastewater to crop N nutrition needs to be clarified, especially in cropping systems already receiving mineral fertilizers. For a better understanding of the interaction between fertilizer N and N originating from wastewater, experiments using 15N were conducted. 15N-labeled fertilizer was applied at different rates (0, 60, 100 and 140 kg N·ha–1) and with different water irrigation qualities (tap water or treated wastewater) to sorghum grown in lysimeters during 1998 and 1999. Recovery of 15N-labeled fertilizer in the above-ground crop at final harvest in treated wastewater irrigation was higher at the lowest rate of fertilizer application (54%), with the amount recovered in the crop increasing as the rate of 15N-labeled fertilizer application increased up to the rate of 100 kg N·ha–1. Nevertheless, in spite of this increase in 15N-labeled fertilizer in the crop, total plant N uptake did not differ between rates. Treated wastewater irrigation had no negative effect on the recovery of 15N-labeled fertilizer. About 62 and 55% of 15N-labeled fertilizer was removed by Sudangrass in either tap water or treated wastewater. Neither fertilizer N rate nor water quality had an effect on the 15N-labeled fertilizer remaining in the soil at final harvest. On average 20% in the wastewater treatment (19–24%) and 30% in the tap water treatment (26–31%) of the 15N fertilizer applied were in the 0–60 cm layer of soil at final harvest in 1998 and 1999, respectively, and mostly present in the 0–20 cm layer. The proportion of applied 15N-labeled fertilizer remaining in the soil at final harvest increased with increasing N rates. About 60, 69 and 72% of 15N left in the soil at final harvest was in the surface 0–20 cm layer. Residual 15N was greatly higher in soil following the first harvest than after the final harvest, with the greatest value (38%) measured at the lowest rate of 15N-labeled fertilizer (30 kg N·ha–1). Losses of 15N-labeled fertilizer increased with application rate, but were unaffected by water quality irrigation. Approximately 13% of the applied 15N fertilizer was lost following the application of 100 kg N·ha–1 with either treated wastewater or tap water irrigation

Variables de parcela, arbol y copa que afectan la produccion de piñas y piñones en bosques de pino carrasco de Tunez

In Tunisia, the Aleppo pine seed has a great importance, since in the last decades human consumption has risen considerable. Thus its regeneration and seed production capacities are important factors to take into account to reach the necessities of the country. To study the production of cones and seeds of Aleppo pine, Tunisia’s native Aleppo pine forests were surveyed in summer 2006, using 79 plots (40 × 25 m: 1,000 m²) spread over four bioclimatic zones. Stand and tree characteristics, crown dimensions and cone/seed variables were measured from an average tree of each plot (i.e. a total of 79 trees). Recorded data were submitted to simple and multiple regression analyses for explaining the variability in crown volume and crown surface, cone number and seed yield per average tree. Results showed a negative correlation between the stand density, crown characteristics and number of cones and seeds harvested from the average tree. For crown volume and surface, age, stand density, tree height, diameter at breast height, crown diameter and crown height were important explanatory variables under multiple regression analyses. For cone number per tree, only the age, stand density and total height were the most determinant variables. Matures cone number per tree and cone mass per tree were the most informative parameters for the total seed yields per tree. Finally, forest managers should know that crown size affects cone and seed crop of the Aleppo pine individual tree grown in Tunisia, but has no effects on seed number per cone and seed mass per cone

Assessment of acute bronchodilator effects from specific airway resistance changes in stable COPD patients

BACKGROUND: In COPD patients, reversibility is currently evaluated from the changes of forced expiratory volume at 1s (\u394FEV1) and forced vital capacity (\u394FVC). By lowering peripheral airway smooth muscle tone, bronchodilators should decrease dynamic hyperinflation, gas trapping, and possibly dyspnea at rest. Hence, we hypothesize that specific airway resistance changes (\u394sRAW) should better characterize the acute response to bronchodilators. METHODS: On two days, 60 COPD patients underwent dyspnea evaluation (VAS score) and pulmonary function testing at baseline and one hour after placebo or 300\u3bcg indacaterol administration. RESULTS: Spirographic and \u394sRAW-based criteria identified as responders 24 and 45 patients, respectively. \u394sRAW correlated with changes of intrathoracic gas volume (\u394ITGV) (r=0.61; p<0.001), residual volume (\u394RV) (r=0.60; p<0.001), \u394FVC (r=0.44; p=0.001), and \u394VAS (r=0.73; p<0.001), while \u394FEV1 correlated only with \u394FVC (r=0.34; p=0.008). Significant differences in terms of \u394ITGV (p=0.002), \u394RV (p=0.023), and \u394VAS (p<0.001) occurred only if patients were stratified according to \u394sRAW. CONCLUSIONS: In assessing the acute functional effect of bronchodilators, \u394sRAW-based criterion is preferable to FEV1-FVC-based criteria, being more closely related to bronchodilator-induced improvements of lung mechanics and dyspnea at rest

Auto-efficacia e qualit\ue0 di vita in pazienti con BPCO: risultati preliminari

La capacit\ue0 dell\u2019individuo di gestire efficacemente i comportamenti in ambito di salute \ue8 una variabile importante nei programmi di riabilitazione polmonare. La comprensione dei meccanismi di compromissione della Qualit\ue0 di Vita dovrebbe aiutare ad identificare gli obiettivi di riabilitazione polmonare. La ricerca ha mostrato correlazioni positive tra auto-efficacia e l'outcome riabilitativo in pazienti con BPCO. Questo studio ha cercato di valutare il ruolo relativo dell\u2019 auto-efficacia e delle variabili socio-demografiche nel predire la QdV in pazienti con BPCO. SOGGETTI: 103 ( 62 M, 41F, Et\ue0 media 70) con BPCO. STRUMENTI: Perceived Health Competence Scale (PHCS, 8 item, Smith, 1995); Airways Questionnaire 20 (AQ 20, Quick & Jones, 1994). RISULTATI: Autoefficacvia e et\ue0 predicono la qualit\ue0 di vita (R quadro corretto=0,27). I risultti incorggiano la riabilitazione polmonare (Moullec, 2011) con varie componenti, tra cui incontri psico-educativi e di self-management volti al potenziamento delle risorse positive dell\u2019individuo per favorire una migliore gestione della malattia e qualit\ue0 di vita