Acute respiratory distress syndrome

Since its first description, the acute respiratory distress syndrome (ARDS) has been acknowledged to be a major clinical problem in respiratory medicine. From July 2015 to July 2016 almost 300 indexed articles were published on ARDS. This review summarises only eight of them as an arbitrary overview of clinical relevance: definition and epidemiology, risk factors, prevention and treatment. A strict application of definition criteria is crucial, but the diverse resource-setting scenarios foster geographic variability and contrasting outcome data. A large international multicentre prospective cohort study including 50 countries across five continents reported that ARDS is underdiagnosed, and there is potential for improvement in its management. Furthermore, epidemiological data from low-income countries suggest that a revision of the current definition of ARDS is needed in order to improve its recognition and global clinical outcome. In addition to the well-known risk-factors for ARDS, exposure to high ozone levels and low vitamin D plasma concentrations were found to be predisposing circumstances. Drug-based preventive strategies remain a major challenge, since two recent trials on aspirin and statins failed to reduce the incidence in at-risk patients. A new disease-modifying therapy is awaited: some recent studies promised to improve the prognosis of ARDS, but mortality and disabling complications are still high in survivors in intensive care

Upward Refinement for Conceptual Blending in Description Logic — An ASP-based Approach and Case Study in EL++—

Conceptual blending is understood to be a process that serves a variety of cognitive purposes, including creativity, and has been highly influential in cognitive linguistics. In this line of thinking, human creativity is modeled as a blending process that takes different mental spaces as input and combines them into a new mental space, called a blend. According to this form of combinatorial creativity, a blend is constructed by taking the existing commonalities among the input mental spaces—known as the generic space—into account, and by projecting their structure in a selective way. Since input spaces for interesting blends are often initially incompatible, a generalisation step is needed before they can be blended. In this paper, we apply this idea to blend input spaces specified in the description logic EL++ and propose an upward refinement operator for generalising EL++ concepts. We show how the generalisation operator is translated to Answer Set Programming (ASP) in order to implement a search process that finds possible generalisations of input concepts. We exemplify our approach in the domain of computer icons.COINVENT European Commission FP7 - 611553Peer reviewe

LUISA (Library User Interface for Sensitivity Analysis): a generic software component for sensitivity analysis of bio-physical models

Abstract: Sensitivity analysis is crucial to better understand the behavior of models, both for developers and users. Developers can be supported in avoiding overparameterizations and in focusing their attention only in the processes with a significant impact on the output(s) of interest. Model users can benefit of sensitivity analysis by identifying the most relevant parameters in a particular biophysical context and, therefore, in optimizing the available resources for determining their value, through direct measurements or via calibration. When biophysical, deterministic models are run in a stochastic fashion using weather series, and when other inputs of a model vary substantially, the results of sensitivity analysis may differ, suggesting different, site specific strategies, for operational use. The availability of a generic software component able to be integrated in modeling and simulation environments would hence allow the estimate of differences in the behavior of models in different soil-plant-climate-management scenarios. It is possible to classify the methods for sensitivity analysis developed in the last decades in three groups: the one-factor-at-a-time method, the methods based on regression and the variance-based Monte-Carlo methods. The first group is represented by Morris� method, which calculates two metrics: the average (µ) and the standard deviation (s) of the population of the incremental ratios according to an opportune generation of a sample of the possible combination of parameters. The most famous methods belonging to the second group are the Latin Hypercube, the Random and the Quasi-random Lp-Tau. They differ in the method used for generating the sample, while are all based on a linear regression between the differences in the output and those in the values of parameters to calculate sensitivity indices. The third group is based on the decomposition of the total variance in summands of increasing dimensionality and it is able to quantify the effect of the interactions among parameters. The methods based on this principle are Fourier Amplitude Sensitivity Test (FAST), Extended FAST, and Sobol�s. The last group, and in particular the Sobol�s method, is considered the most powerful and precise in identifying the output sensitivity to the model parameters. Their drawback is the computational cost since they involve the estimation of k-dimensional integrals. On the other hand, the Morris� method is the one requiring the smaller sample for ranking the parameters according to their relevance and it is considered particularly suitable for preliminary screenings of models with several parameters. This paper describes the LUISA (Library User Interface for Sensitivity Analysis) component, based on the SimLab (http://simlab.jrc.ec.europa.eu/) C++ DLL. LUISA has been developed in C# under the .NET platform, with the goal of facilitating implementing sensitivity analysis capabilities on bio-physical model frameworks. As illustrative case studies, spatially distributed sensitivity analysis of two different biophysical models were carried out using the MARS database (http://mars.jrc.ec.europa.eu/), in order to cover the pedo-climatic conditions of Europe. The two models used are the WARM model for rice simulations and the generic crop simulator CropSyst. Results are presented and discussed according to the spatial variability of their relevance and to the identification of clusters based on the parameters ranks.JRC.DG.G.3 - Monitoring agricultural resource

Higher, but Not Too High, Dose Is Only One Determinant of Corticosteroid Treatment Success in Severe COVID-19

We read with interest the study from Pitre and colleagues, who systematically reviewed 20 randomized controlled trials published through August 2022, concluding that higher doses of corticosteroids (CSs) probably reduce mortality (relative risk, 0.92; 95% confidence interval [CI], 0.85–0.98) and the need for mechanical ventilation (relative risk, 0.91; 95% CI, 0.87–1.03) compared with lower doses in severe-to-critical coronavirus disease (COVID-19), without significantly impacting either the duration of hospitalization or the incidence of nosocomial infections (1)

A novel technique for conducting flexible bronchoscopy cryobiopsy under conscious sedation: An observational study

Transbronchial lung cryobiopsy (TBCB) is a reliable method for obtaining histopathological findings in interstitial lung diseases. TBCB is traditionally performed during rigid bronchoscopy, positioning an endobronchial balloon blocker to facilitate bleeding management. Therefore, it can be challenging to implement in Centers without access to anesthesiologic support or dedicated beds for endoscopic procedures. We present a series of 11 patients who underwent 12 TBCBs using a flexible bronchoscope and a 5 Fr endobronchial blocker passing through an uncuffed endotracheal tube, under moderate sedation and spontaneous breathing. All procedures were carried out in an endoscopy suite, using fluoroscopy guidance but without requiring anesthesiologic assistance. TBCB was feasible in all cases, and it demonstrated similar or improved diagnostic yield (90.1%) and safety compared to rigid bronchoscopy. In 1 case, it was successfully repeated due to an inconclusive histological definition at the first attempt. The size of the samples was consistent with the literature, as it was the incidence of pneumothorax (16.6%). Four cases of moderate bleeding and 4 cases of severe bleeding were managed without further complications. To our knowledge, this is the first description of a technique allowing to perform TBCB through an artificial airway without need for either rigid bronchoscopy or general anesthesia. We believe this technique could make TBCB faster, cost-effective, and feasible even in resource-limited settings without compromising on safety. However, further studies are needed to validate these findings

Pulmonary fibrosis: one manifestation, various diseases

This research topic collection entitled “Pulmonary Fibrosis: one manifestation, various diseases”, involving authors from different countries, confirms that this disease is a hot topic (Confalonieri P et al.,2022, Orlandi M et al., 2022). There are over 200 different types of pulmonary fibrosis (PF), the most common is the idiopathic pulmonary fbrosis (IPF), called idiopathic because it has no known cause. Another rare form is familial PF, for which several studies reported correlation with few genes. An important group of PF are due to other diseases, for example, autoimmune diseases such as rheumatoid arthritis, systemic sclerosis or Sjogren’s syndrome (Ruaro et al., 2022, Trombetta AC et al., 2017, Bernero Eet al., 2013). PF could correlate to viral infections (e.g. COVID-19), gastroesophageal reflux disease (GERD) (Baratella E et al, 2021, Ruaro et al., 2018), and the exposure to various materials (including naturally occurring such as bird or animal droppings, and occupational such as asbestos or silica). Furthermore, smoking, radiation treatments, and certain drugs can increase risk of developing PF. In the first article (Saketkoo et al.) of the collection, the authors evaluate the use of International Classification of Functioning, Disability, and Health (ICF) approved by World Health Organization (WHO) in patients affected by interstitial lung diseases (ILD)

Editorial: Pulmonary fibrosis: One manifestation, various diseases

This research topic collection entitled “Pulmonary Fibrosis: one manifestation, various diseases”, involving authors from different countries, confirms that this disease is a hot topic (Confalonieri P et al.,2022, Orlandi M et al., 2022). There are over 200 different types of pulmonary fibrosis (PF), the most common is the idiopathic pulmonary fbrosis (IPF), called idiopathic because it has no known cause. Another rare form is familial PF, for which several studies reported correlation with few genes. An important group of PF are due to other diseases, for example, autoimmune diseases such as rheumatoid arthritis, systemic sclerosis or Sjogren’s syndrome (Ruaro et al., 2022, Trombetta AC et al., 2017, Bernero Eet al., 2013). PF could correlate to viral infections (e.g. COVID-19), gastroesophageal reflux disease (GERD) (Baratella E et al, 2021, Ruaro et al., 2018), and the exposure to various materials (including naturally occurring such as bird or animal droppings, and occupational such as asbestos or silica). Furthermore, smoking, radiation treatments, and certain drugs can increase risk of developing PF

Pregnancy in patients with tuberculosis: A TBNET cross-sectional survey

BACKGROUND: Objectives: To determine whether the incidence of tuberculosis with pregnancy is more common than would be expected from the crude birth rate; to see whether there is significant delay in the diagnosis of tuberculosis during pregnancy. METHOD: Design: A cross-sectional survey. SETTING: 13 tuberculosis clinics within different European countries and the USA. POPULATION/SAMPLE: All patients with tuberculosis seen at these clinics for a period\u2009>\u20091 year. INSTRUMENT: Questionnaire survey based on continuous data collection. MAIN OUTCOME MEASURES: number and proportion of women with tuberculosis who were pregnant; timing of diagnosis in relation to pregnancy, including those who were pregnant or delivered in the 3 months prior to the diagnosis of TB and those who developed TB within 3 months after delivery. RESULTS: Pregnancy occurred in 224 (1.5 %) of 15,217 TB patients and followed the expected rate predicted from the crude birth rate for the clinic populations. TB was diagnosed more commonly in the 3 months after delivery (n\u2009=\u2009103) than during pregnancy (n\u2009=\u200968; \u3c7 2\u2009=\u200925.1, P\u2009<\u20090.001). CONCLUSIONS: TB is diagnosed more frequently after delivery, despite variations in local TB incidence and healthcare systems