Numerical Study of the Thermal Efficiency of a School Building with Complex Topology for Different Orientations

In this work a numerical model that simulates the thermal behavior of a building with complex topology and evaluates the indoor thermal and air quality, in transient conditions, is used for a school building thermal project. The program calculates the building surfaces solar radiation field, the building's temperatures, the internal environmental variables, and the occupant's comfort levels. Initially, after the numerical model is validated, the software is used to evaluate the school building's thermal response for four different orientations, either in winter or summer conditions. The work then aims to identify uncomfortable spaces in order to propose, as an example, several solutions that could be introduced for each orientation, that would improve the thermal comfort and air quality levels to which the occupants are subjected, and decrease the building's energy consumption levels. The information obtained from this study could be used to help a designer choose which thermal systems and solutions function best for a preferred school building orientation

Clinical Management of Acinic Cell Carcinoma of the Lacrimal Gland

To report a case of acinic cell carcinoma occurred in the lacrimal gland. A 59-year-old man was admitted because of sudden blurring of vision, progressive proptosis of the left eye, and mild double vision in left and down directions of the gaze (Hess-Lancaster test). His medical history detailed controlled bilateral keratoconus and open angle glaucoma. On examination, the best corrected visual acuity decreased from 8/20 till 1/50 in one week. There was a swelling of the left upper eyelid. A hard and tender mass was palpated in the superior temporal left orbit. Ultrasound scan showed an extraconal solid mass, situated in the superior lateral corner of the orbit. Computed tomography and magnetic resonance imaging (MRI) revealed a mass of two centimeters in diameter, with round well-defined outline, within the lacrimal gland. We per-formed an enucleoresection of the mass, via a coronal approach and a lateral orbitotomy by a piezosurgical device. The lesion appeared nodular, brownish, measuring about 2 7 1.5 cm. Histopathological findings were consistent with acinic cell carcinoma with a microcystic, focally papillary-cystic growth of pattern. Follow-up MRI outcomes led to removal of the residual lacrimal gland for suspicion of recurrence. No tumor recurrences where detected at 7-year follow-up

A radiological visual scale to predict the potentially recruitable lung in ALI/ARDS patients

Introduction In ALI/ARDS patients the amount of potentially recruitable lung is extremely variable and it is poorly predictable by the changes of oxygenation, carbon dioxide or compliance during a PEEP trial [1]. At the present time the gold standard to compute the lung recruitability is the quantitative lung CT scan, in which each lung image, after being manually drawn, is analyzed by dedicated software. However, this is both a laborious and time-consuming technique. The aim of this study was to evaluate the ability of a visual radiological scale compared with lung CT scan analysis to predict the lung recruitability in ALI/ARDS patients. Methods A whole lung CT scan was performed at 5 and 45 cmH2O airway pressure. For CT scan analysis each lung image was manually outlined and analyzed by a dedicated software. The potentially recruitable lung was defi ned as the proportion of the nonaerated lung tissue in which aeration was restored [1]. For radiological visual scale analysis, two radiologists performed a blinded evaluation of the consolidation/collapsed areas in each lobe by visual inspection [2]. The overall lung change in consolidation/collapsed was obtained by the sum of each lobe and computed as the diff erence between the two conditions. Results Twenty-four ALI/ARDS patients (age 59 \ub1 15 years, BMI 26 \ub1 4 kg/m2, PaO2/FiO2 170 \ub1 60, PEEP 10 \ub1 2 cmH2O) were enrolled. The percentage of potentially recruitable lung was 16.2 \ub1 7.1% and 14.7 \ub1 7.0%, computed by CT scan and by the visual radiological scale, respectively. The mean diff erence between CT scan analysis and visual radiological analysis was 3.3 \ub1 4.6% (median: 2.91, interquartile range: 0.38 to 6.56). The error of the visual method was lower than 5% in 14 patients (58.3%), between 5% and 10% in eight patients (33.3%) and between 10% and 15% in two patients (8.3%). Conclusions The application of a radiological visual scale is able to predict the amount of potentially recruitable lung similarly to those obtained by a dedicated software avoiding the need of manually drawing each lung image. References 1. Gattinoni L, et al.: N Engl J Med 2006, 354:1775-1786. 2. Pierce RJ, et al.: Thorax 1980, 35:773-780

Mortality and its risk factors in Malawian children admitted to hospital with clinical pneumonia, 2001–12: a retrospective observational study

Background Few studies have reported long-term data on mortality rates for children admitted to hospital with pneumonia in Africa. We examined trends in case fatality rates for all-cause clinical pneumonia and its risk factors in Malawian children between 2001 and 2012. Methods Individual patient data for children (<5 years) with clinical pneumonia who were admitted to hospitals participating in Malawi’s Child Lung Health Programme between 2001 and 2012 were recorded prospectively on a standardised medical form. We analysed trends in pneumonia mortality and children’s clinical characteristics, and we estimated the association of risk factors with case fatality for children younger than 2 months, 2–11 months of age, and 12–59 months of age using separate multivariable mixed eff ects logistic regression models. Findings Between November, 2012, and May, 2013, we retrospectively collected all available hard copies of yellow forms from 40 of 41 participating hospitals. We examined 113 154 pneumonia cases, 104 932 (92∧7%) of whom had mortality data and 6903 of whom died, and calculated an overall case fatality rate of 6·6% (95% CI 6·4–6·7). The case fatality rate signifi cantly decreased between 2001 (15·2% [13·4–17·1]) and 2012 (4·5% [4·1–4·9]; ptrend<0·0001). Univariable analyses indicated that the decrease in case fatality rate was consistent across most subgroups. In multivariable analyses, the risk factors signifi cantly associated with increased odds of mortality were female sex, young age, very severe pneumonia, clinically suspected Pneumocystis jirovecii infection, moderate or severe underweight, severe acute malnutrition, disease duration of more than 21 days, and referral from a health centre. Increasing year between 2001 and 2012 and increasing age (in months) were associated with reduced odds of mortality. Fast breathing was associated with reduced odds of mortality in children 2–11 months of age. However, case fatality rate in 2012 remained high for children with very severe pneumonia (11·8%), severe undernutrition (15·4%), severe acute malnutrition (34·8%), and symptom duration of more than 21 days (9·0%). Interpretation Pneumonia mortality and its risk factors have steadily improved in the past decade in Malawi; however, mortality remains high in specifi c subgroups. Improvements in hospital care may have reduced case fatality rates though a lack of suffi cient data on quality of care indicators and the potential of socioeconomic and other improvements outside the hospital precludes adequate assessment of why case-fatality rates fell. Results from this study emphasise the importance of eff ective national systems for data collection. Further work combining this with data on trends in the incidence of pneumonia in the community are needed to estimate trends in the overall risk of mortality from pneumonia in children in Malawi

Effects of systemic glucocorticosteroids on peripheral neutrophil functions in asthmatic subjects: an ex vivo study

In 21 asthmatic subjects, several functions of isolated peripheral neutrophils (chemokinesis and chemotaxis toward 10% E. coli; superoxide anion generation after PMA; leukotriene B4 (LTB4) release from whole blood and isolated neutrophtls, before and after different stimuli) were evaluated during an acute exacerbation of asthma, and after 14 – 54 days of treatment with systemic glucocorticosteroids (GCS). During acute exacerbation, superoxide anion generation was higher in asthmatics than in eleven normal subjects (39.2 ± 14.1 vs. 25.2 ± 7.3 nmol, p < 0.05); there was a significant correlation between FEV1 (% of predicted) and neutrophil chemotaxis (r = −0.52, p = 0.04). After treatment, there was no significant change in all neutrophil functions, except for a decrease in neutrophil chemotaxis in subjects who showed an FEV1 increase > 20% after GCS treatment (from 131 ± 18 to 117 ± 21 μm, p = 0.005). Chemokinesis sicantly decreased in all subjects, and the changes significantly correlated with an arbitrary score of the total administered dose of GCS (r = 0.57, p < 0.05). These data suggest that neutrophil activation plays a minor role in asthma, and that treatment with GCS is not able to modify most functions of peripheral neutrophils in asthmatic subjects; chemotaxis seems to be related only to the severity of the asthma and it could reflect the improvement of the disease

Mortality and its risk factors in Malawian children admitted to hospital with clinical pneumonia, 2001-12: a retrospective observational study.

BACKGROUND: Few studies have reported long-term data on mortality rates for children admitted to hospital with pneumonia in Africa. We examined trends in case fatality rates for all-cause clinical pneumonia and its risk factors in Malawian children between 2001 and 2012. METHODS: Individual patient data for children (<5 years) with clinical pneumonia who were admitted to hospitals participating in Malawi's Child Lung Health Programme between 2001 and 2012 were recorded prospectively on a standardised medical form. We analysed trends in pneumonia mortality and children's clinical characteristics, and we estimated the association of risk factors with case fatality for children younger than 2 months, 2-11 months of age, and 12-59 months of age using separate multivariable mixed effects logistic regression models. FINDINGS: Between November, 2012, and May, 2013, we retrospectively collected all available hard copies of yellow forms from 40 of 41 participating hospitals. We examined 113 154 pneumonia cases, 104 932 (92·7%) of whom had mortality data and 6903 of whom died, and calculated an overall case fatality rate of 6·6% (95% CI 6·4-6·7). The case fatality rate significantly decreased between 2001 (15·2% [13·4-17·1]) and 2012 (4·5% [4·1-4·9]; ptrend<0·0001). Univariable analyses indicated that the decrease in case fatality rate was consistent across most subgroups. In multivariable analyses, the risk factors significantly associated with increased odds of mortality were female sex, young age, very severe pneumonia, clinically suspected Pneumocystis jirovecii infection, moderate or severe underweight, severe acute malnutrition, disease duration of more than 21 days, and referral from a health centre. Increasing year between 2001 and 2012 and increasing age (in months) were associated with reduced odds of mortality. Fast breathing was associated with reduced odds of mortality in children 2-11 months of age. However, case fatality rate in 2012 remained high for children with very severe pneumonia (11·8%), severe undernutrition (15·4%), severe acute malnutrition (34·8%), and symptom duration of more than 21 days (9·0%). INTERPRETATION: Pneumonia mortality and its risk factors have steadily improved in the past decade in Malawi; however, mortality remains high in specific subgroups. Improvements in hospital care may have reduced case fatality rates though a lack of sufficient data on quality of care indicators and the potential of socioeconomic and other improvements outside the hospital precludes adequate assessment of why case-fatality rates fell. Results from this study emphasise the importance of effective national systems for data collection. Further work combining this with data on trends in the incidence of pneumonia in the community are needed to estimate trends in the overall risk of mortality from pneumonia in children in Malawi. FUNDING: Bill & Melinda Gates Foundation

Current trends on subtotal petrosectomy with cochlear implantation in recalcitrant chronic middle ear disorders Attualità in tema di petrosectomia subtotale con impianto cocleare nelle patologie croniche dellorecchio medio recalcitranti

Obiettivo. Stabilire la sicurezza ed efficacia dell’intervento di petrosectomia subtotale con posizionamento di impianto cocleare nei pazienti affetti da patologia cronica dell’orecchio medio refrattaria a precedenti trattamenti chirurgici. Metodi. È stato svolto uno studio retrospettivo multicentrico riguardante quei pazienti af- fetti da patologie croniche dell’orecchio medio recalcitranti, sottoposti a petrosectomia subtotale con posizionamento di impianto cocleare. Le informazioni sono state raccolte dai database di 11 centri di riferimento di III livello in Italia. A complemento, è stata svolta una revisione della più recente letteratura. Risultati. Nello studio sono stati inclusi 55 pazienti con un follow-up medio di 44 mesi. Il colesteatoma ha rappresentato la più comune pato- logia ricorrente dell’orecchio medio e il 50,9% dei pazienti aveva una cavità aperta. L’80% dei pazienti è stato sottoposto ad una chirurgia a singolo stadio. Sette pazienti hanno mostrato complicanze post-operatorie, di cui un caso di espianto. Conclusioni. L’intervento di petrosectomia subtotale con posizionamento di impianto cocleare rappresenta una tecnica chirurgica di riferimento per la gestione dei pazienti affetti da otite media cronica recalcitrante. L’intervento chirurgico a singolo stadio è la strategia più frequentemente raccomandata. Il follow-up ottimale è ancora ad oggi oggetto di dibattito. Sono richiesti ulteriori studi per stabilire il ruolo di questo intervento nei pazienti pediatrici.Objective. To establish the safety and effectiveness of subtotal petrosectomy with cochlear implantation in patients affected by chronic middle ear disorders to refractory to previous surgical treatments. Methods. A multicentre, retrospective study was conducted on patients affected by recalcitrant chronic middle ear disorders who underwent cochlear implantation in combination with subtotal petrosectomy. Patients’ details were collected from databases of 11 Italian tertiary referral centres. Additionally, a review of the most updated literature was carried out. Results. 55 patients were included with a mean follow-up time of 44 months. Cholesteatoma was the most common middle ear recurrent pathology and 50.9% of patients had an open cavity. 80% of patients underwent a single stage surgery. One case of explantation for device failure was reported among the 7 patients with post-operative complications. Conclusions. Subtotal petrosectomy with cochlear implantation is a benchmark for management of patients with recalcitrant chronic middle ear disorders. A single stage procedure is the most recommended strategy. Optimal follow-up is still debated. Further studies are required to investigate the role of this surgery in paediatric patients

Isolation of chromatin from dysfunctional telomeres reveals an important role for Ring1b in NHEJ-mediated chromosome fusions

When telomeres become critically short, DNA damage response factors are recruited at chromosome ends, initiating a cellular response to DNA damage. We performed proteomic isolation of chromatin fragments (PICh) in order to define changes in chromatin composition that occur upon onset of acute telomere dysfunction triggered by depletion of the telomere-associated factor TRF2. This unbiased purification of telomere-associated proteins in functional or dysfunctional conditions revealed the dynamic changes in chromatin composition that take place at telomeres upon DNA damage induction. On the basis of our results, we describe a critical role for the polycomb group protein Ring1b in nonhomologous end-joining (NHEJ)-mediated end-to-end chromosome fusions. We show that cells with reduced levels of Ring1b have a reduced ability to repair uncapped telomeric chromatin. Our data represent an unbiased isolation of chromatin undergoing DNA damage and are a valuable resource to map the changes in chromatin composition in response to DNA damage activation

C-Si hybrid photonic structures by full infiltration of conjugated polymers into porous silicon rugate filters

Loading of one-dimensional (1-D) porous silicon photonic crystals (PS-PhCs), known as rugate filters, with luminescent materials is generally limited by the potential for (undesired) “pore clogging,” in relation to the size of the nanoparticles (e.g. quantum dots) or molecular species, and so far mainly restricted to small molecular weight materials or small nanocrystals, or in situ polymerized dyes. Here we report the infiltration 1-D PS-PhCs with a green-emitting commercial luminescent polymer (F8BT, poly[(9,9-di-n-octylfluorenyl-2,7-diyl)-alt-(benzo[2,1,3]thiadiazol-4,8-diyl)]), with a molecular weight of approximately 46 kDa across their whole depth (approximately 7.5 μm), thereby showing that pore clogging is not a concern for these structures. We also characterize the modification of the photoluminescence (PL) and decay rates, and investigate the detailed inner morphology of the filters with the help of (scanning) transmission electron microscopy. We observe both suppression (in the stop-band) and enhancement (at the high-energy band-edge) of the PL. We also find that the photonic stop-band is red-shifted after polymer infiltration, due to the increased effective refractive index of the polymer-infiltrated nanostructured system. The presence of just one unbroadened peak in the reflectance spectra after infiltration confirms that infiltration extends for the whole depth of the rugate filters