Il dosaggio del lattato in neonati con distensione addominale come fattore prognostico di sindrome da compartimento addominale

L'ipertensione intraaddominale (IAH) e la risultante sindrome da compartimento addominale (ACS), caratterizzata da incremento della pressione >20 mmHg e insufficienza d’organo o multiorgano, sono state descritte in neonati con patologie addominali chirurgiche. La gestione effettiva e preventiva dell'IAH è associata a minore morbidità. In uno studio retrospettivo abbiamo analizzato 20 neonati con distensione addominale persistente per individuare fattori predittivi di IAH ed ACS. Il Gold-Standard della misurazione dell'IAH è la misurazione pressoria intravescicale ancora non standardizzata c/o le UTIN. Per definire l'IAH abbiamo quindi utilizzato il monitoraggio della saturazione di ossigeno (SpO2) prossimale e distale rispetto all’addome e 2 segni di compromissione d’organo (oliguria, ipotensione, insufficienza respiratoria, acidosi metabolica). Abbiamo riscontrato un rischio tendenzialmente elevato di disfunzione multiorgano e decesso in neonati di età gestazionale maggiore (p=0,09) e con una causa congenita di ACS (p<0,05), e in neonati in correzione con bicarbonati (p=0,05). Alti valori di lattato già al ricovero correlano con un deficit di basi maggiore nelle fasi avanzate di ACS (p<0,05) e con una distensione tardiva (p<0,05) associata, a sua volta, a valori di lattato più elevati nelle fasi di distensione ed acidosi (p<0,05) rispetto alla distensione precoce. Il lattato alla distensione è tendenzialmente più alto in chi avrà eventi più gravi (p=0,06) pur non correlando con il decesso (p=0,2). Solo nella fase successiva di acidosi i valori di lattato sono predittivi di decesso (p<0,05). In nessuna fase sono state riscontrate correlazioni con l’insufficienza respiratoria. L’unico fattore predittivo per un decorso sfavorevole è l’insulto tissutale perfusionale precoce misurato tramite il lattato che tuttavia non correla con il decesso perché probabilmente neonati, soprattutto con difetti della parete addominale, possono sopportare pressioni intraaddominali più elevate senza andare incontro ad insufficienza multiorgano. Al contrario sembra che neonati con ACS secondaria o con età gestazionale maggiore tollerino meno l’IAH sviluppando ACS a pressioni più basse poichè gli spazi intraaddominali sono già definiti

Penile Exogenous Pigmentation Mimicking Melanoma

Not presen

Effects of clinical and laboratory variables and of pretreatment with cardiovascular drugs in acute ischaemic stroke: a retrospective chart review from the GIFA study.

Background: Few studies have examined the role of cardiovascular drugs on acute ischaemic stroke prognosis. Aims: To evaluate the relationship between a favourable outcome in patients with acute ischaemic stroke and specific demographic, clinical and laboratory variables and cardiovascular drug pretreatment. Methods: The 1096 patients enrolled in the GIFA study (who had a main discharge diagnosis of ischaemic stroke) represent the final patient sample used in this analysis. Drugs considered in the analysis included angiotensin converting enzyme (ACE)-inhibitors, angiotensin II receptor blockers, statins, calcium channel blockers, anti-platelet drugs, vitamin K antagonists and heparins. The outcomes analyzed included in-hospital mortality, cognitive function evaluated by the Hodkinson Abbreviated Mental Test (HAMT), and functional status evaluated by activities of daily living (ADL). The definition of a good outcome was no in-hospital mortality, a HAMT score of >= 6 and no ADL impairment. Results: Patients with no in-hospital mortality, a HAMT score of >6 and no ADL impairment were more likely to be younger at baseline and have a lower blood glucose level and a systolic blood pressure (SBP) between 120 and 180 mmHg, a higher plasma total cholesterol level, a lower white blood cell count, and a lower Charlson Index (CI) score, a higher rate of pretreatment with ACE-inhibitors, calcium channel blockers and a lower rate of pretreatment with heparin. Conclusions: Predictors of good outcome, in terms of in-hospital mortality and cognitive and functional performance at discharge, included higher SBP at admission between 120 and 180 mmHg, a SBP plasma total cholesterol levels, a lower CI score, and pretreatment with ACE-inhibitors, calcium channel blockers and anti-platelets. (C) 2010 Elsevier Ireland Ltd. All rights reserved

Predictive Factors of Abdominal Compartment Syndrome in Neonatal Age

In the pediatric population, abdominal compartment syndrome (ACS) is a known complication of abdominal wall defect repair. However, there are only few reports on ACS in newborns and only a proposal of critical intra-abdominal pressure value (IAP) in term newborns, absent in preterm newborns. Although the prevalent clinical sign is tense abdominal distension, it may be difficult to distinguish ACS from pathologies that will not require decompression. The purpose of this study was to identify predictors for ACS and therefore morbidity or mortality indicators. We reviewed newborns presenting with tense abdominal distension and end organ failure. Anamnestic, clinical, laboratory, and instrumental investigations were analyzed to extrapolate predictors. Outcomes were compared with a control group. The incidence of ACS in our neonatal intensive care unit was 5% in the overall population of babies, 16% in tracheal-ventilated newborns, and 57% in infants with abdominal wall defects. We found that, with onset of acidosis or high gastric residuals, the lactate values will be predictive for mortality. We can also suggest paying particular attention to high lactate values just at the onset of distension, in infants with more advanced gestational age, with previously surgical repair, to determine early surgical intervention independently of a specific IAP measurement

Neutron star radius-To-mass ratio from partial accretion disk occultation as measured through fe kα line profiles

We present a new method to measure the radius-To-mass ratio (R/M) of weakly magnetic, disk-Accreting neutron stars by exploiting the occultation of parts of the inner disk by the star itself. This occultation imprints characteristic features on the X-ray line profile that are unique and are expected to be present in low-mass X-ray binary systems seen under inclinations higher than ∼65°. We analyze a Nuclear Spectroscopic Telescope Array observation of a good candidate system, 4U 1636-53, and find that X-ray spectra from current instrumentation are unlikely to single out the occultation features owing to insufficient signal-To-noise. Based on an extensive set of simulations we show that large-Area X-ray detectors of the future generation could measure R/M to ∼2 ÷ 3% precision over a range of inclinations. Such is the precision in radius determination required to derive tight constraints on the equation of state of ultradense matter and it represents the goal that other methods also aim to achieve in the future

Celery (Apium graveolens L.) Performances as Subjected to Different Sources of Protein Hydrolysates

The vegetable production sector is currently fronting several issues mainly connected to the increasing demand of high quality food produced in accordance with sustainable horticultural technologies. The application of biostimulants, particularly protein hydrolysates (PHs), might be favorable to optimize water and mineral uptake and plant utilization and to increase both production performance and quality feature of vegetable crops. The present study was carried out on celery plants grown in a tunnel to appraise the influence of two PHs, a plant-derived PH (P-PH), obtained from soy extract and an animal PH (A-PH), derived from hydrolyzed animal epithelium (waste from bovine tanneries) on yield, yield components (head height, root collar diameter, and number of stalks), mineral composition, nutritional and functional features, as well as the economic profitability of PHs applications. Fresh weight in A-PH and P-PH treated plants was 8.3% and 38.2% higher, respectively than in untreated control plants. However, no significant difference was found between A-PH treated plants and control plants in terms of fresh weight. Head height significantly increased by 5.5% and 16.3% in A-PH and P-PH treated plants, respectively compared with untreated control (p ≤ 0.05). N content was inferior in PHs treated plants than in untreated control. Conversely, K and Mg content was higher in A-PH and P-PH treated plants as compared to the untreated ones. Furthermore, A-PH and P-PH improved ascorbic acid content by 8.2% and 8.7%, respectively compared with the non-treated control (p ≤ 0.001). Our results confirmed, also, that PHs application is an eco-friendly technique to improve total phenolic content in celery plants. In support of this, our findings revealed that animal or plants PH applications increased total phenolics by 36.9% and 20.8%, respectively compared with untreated plants (p ≤ 0.001)

Efficacy and safety of N-acetyl-GED-0507-34-LEVO gel in patients with moderate-to severe facial acne vulgaris: A phase 2B randomised double-blind, vehicle-controlled trial.

Background: Preliminary in vitro and in vivo studies have supported the efficacy of the peroxisome proliferator-activated receptor-γ (PPARγ) modulator N-acetyl-GED-0507-34-LEVO (NAC-GED) for the treatment of acne-inducing sebocyte differentiation, improving sebum composition and controlling the inflammatory process. Objectives: To evaluate the efficacy and safety of NAC-GED (5% and 2%) in patients with moderate-to-severe facial acne vulgaris. Methods: This double-blind phase II randomized controlled clinical trial was conducted at 36 sites in Germany, Italy and Poland. Patients aged 12-30 years with facial acne, an Investigator Global Assessment (IGA) score of 3-4, and an inflammatory and noninflammatory lesion count of 20-100 were randomized to topical application of the study drug (2% or 5%) or placebo (vehicle), once daily for 12 weeks. The co-primary efficacy endpoints were percentage change from baseline in total lesion count (TLC) and IGA success at week 12; the safety endpoints were adverse events (AEs) and serious AEs. This study was registered with EudraCT (2018-003307-19). Results: Between Q1 in 2019 and Q1 in 2020 450 patients [n = 418 (92·9%) IGA 3; n = 32 (7·1%) IGA 4] were randomly assigned to NAC-GED 5% (n = 150), NAC-GED 2% (n = 150) or vehicle (n = 150). The percentage change in TLC reduction was statistically significantly higher in both the NAC-GED 5% [-57·1%, 95% confidence interval (CI) -60·8 to -53·4; P &lt; 0·001] and NAC-GED 2% (-44·7%, 95% CI -49·1 to -40·1; P &lt; 0·001) groups compared with vehicle (-33·9%, 95% CI -37·6 to -30·2). A higher proportion of patients treated with NAC-GED 5% experienced IGA success (45%, 95% CI 38-53) vs. the vehicle group (24%, 95% CI 18-31; P &lt; 0·001). The IGA success rate was 33% in the NAC-GED 2% group (P = not significant vs. vehicle). The percentage of patients who had one or more AEs was 19%, 16% and 19% in the NAC-GED 5%, NAC-GED 2% and vehicle groups, respectively. Conclusions: The topical application of NAC-GED 5% reduced TLC, increased the IGA success rate and was safe for use in patients with acne vulgaris. Thus, NAC-GED, a new PPARγ modulator, showed an effective clinical response. What is already known about this topic? Acne vulgaris, one of the most common dermatological diseases, affects more than 85% of adolescents. There is a medical need for innovative and safe treatment of acne vulgaris. The peroxisome proliferator-activated receptor-γ (PPARγ) is involved in lipid metabolism and specifically in cell differentiation, sebum production and the inflammatory reaction. What does this study add? N-acetyl-GED-0507-34-LEVO (NAC-GED 5%), a PPARγ modulator, significantly improves acne manifestations in patients with moderate-to-severe acne and is safe and well tolerated. The results suggest that the PPARγ receptor is a novel therapeutic target for acne. The results provide a basis for a large phase III trial to assess the effectiveness and safety profile of NAC-GED in combating a disease that afflicts 80-90% of adolescents

"It was the whole picture" a mixed methods study of successful components in an integrated wellness service in North East England

Background A growing number of Local Authorities (LAs) have introduced integrated wellness services as part of efforts to deliver cost effective, preventive services that address the social determinants of health. This study examined which elements of an integrated wellness service in the north east of England were effective in improving health and wellbeing (HWB). Methods The study used a mixed-methods approach. In-depth semi-structured interviews (IVs) were conducted with integrated wellness service users (n = 25) and focus groups (FGs) with group based service users (n = 14) and non-service users (n = 23) to gather the views of stakeholders. Findings are presented here alongside analysis of routine monitoring data. The different data were compared to examine what each data source revealed about the effectiveness of the service. Results Findings suggest that integrated wellness services work by addressing the social determinants of health and respond to multiple complex health and social concerns rather than single issues. The paper identifies examples of ‘active ingredients’ at the heart of the programme, such as sustained relationships, peer support and confidence building, as well as the activities through which changes take place, such as sports and leisure opportunities which in turn encourage social interaction. Wider wellbeing outcomes, including reduced social isolation and increased self-efficacy are also reported. Practical and motivational support helped build community capacity by encouraging community groups to access funding, helped navigate bureaucratic systems, and promoted understanding of marginalised communities. Fully integrated wellness services could support progression opportunities through volunteering and mentoring. Conclusions An integrated wellness service that offers a holistic approach was valued by service users and allowed them to address complex issues simultaneously. Few of the reported health gains were captured in routine data. Quantitative and qualitative data each offered a partial view of how effectively services were working

ASFISSIA PERINATALE:VALUTAZIONE CLINICO-EPIDEMIOLOGICA IN UN CAMPIONE DI NEONATI DI ≥ 34 SEG

Asfissia, late preterm, a termin

A systematic study of the sensitivity of triangular flow to the initial state fluctuations in relativistic heavy-ion collisions

Experimental data from the Relativistic Heavy Ion Collider (RHIC) suggests that the quark gluon plasma behaves almost like an ideal fluid. Due to its short lifetime, many QGP properties can only be inferred indirectly through a comparison of the final state measurements with transport model calculations. Among the current phenomena of interest are the interdependencies between two collective flow phenomena, elliptic and triangular flow. The former is mostly related to the initial geometry and collective expansion of the system whereas the latter is sensitive to the fluctuations of the initial state. For our investigation we use a hybrid transport model based on the Ultra-relativistic Quantum Molecular Dynamics (UrQMD) transport approach using an ideal hydrodynamic expansion for the hot and dense stage. Using UrQMD initial conditions for an Au-Au collision, particles resulting from a collision are mapped into an energy density distribution that is evolved event-by-event with a hydrodynamic calculation. By averaging these distributions over different numbers of events, we have studied how the granularity/smoothness of the distribution affects the initial eccentricity, the initial triangularity, and the resulting flow components. The average elliptic flow in non central collisions is not sensitive to the granularity, while triangular flow is. The triangularity might thus provide a good measure of the amount of initial state fluctuations that is necessary to reproduce the experimental data.Comment: 10 pages, 7 figure