Hysteroscopic removal of intrauterine device in early pregnancy

Background: Intrauterine devices (IUDs) are commonly used as contraceptives worldwide. However, pregnancies in patients carrying this kind of device may occur. IUD removal when the woman wishes to continue their pregnancy may be very challenging. Only 9 manuscripts in literature reported such similar procedure. Case presentation: We report the case of an hysteroscopic removal of IUD in a young woman at 6 weeks of gestation. Discussion: The case reported highlights safety and efficacy of operative hysteroscopy as a method of IUD removal in early pregnancy, although other different methods have been reported in literature. In our opinion, maintaining a low infusion pressure during the procedure may help avoiding potential gestational sac damage and IUD displacement for better grasping

Sub-luminous X-ray Bursters Unveiled with INTEGRAL

In 2005 March 22nd, the INTEGRAL satellite caught a type-I X-ray burst from the unidentified source XMMU J174716.1-281048, serendipitously discovered with XMM-Newton in 2003. Based on the type-I X-ray burst properties, we derived the distance of the object and suggested that the system is undergoing a prolonged accretion episode of many years. We present new data from a Swift/XRT campaign which strengthen this suggestion. AX J1754.2-2754 was an unclassified source reported in the ASCA catalogue of the Galactic Centre survey. INTEGRAL observed a type-I burst from it in 2005, April 16th. Recently, a Swift ToO allowed us to refine the source position and establish its persistent nature.Comment: To be published in AIP Proceedings - Conference 'A Population Explosion: The Nature and Evolution of X-ray Binaries in Diverse Environments', 28 Oct - 2 Nov, St. Petersburg Beach, F

Intensive physiotherapic respiratory care in critically ill patients with tracheostomy after cardiac surgery

Background. Patients following major cardiac surgery are increasingly elderly and present many comorbidities. For these reasons their post-operative phase is often burdened by several complications requiring a long stay in Critical Care and prolonged mechanical ventilation. Most of these patients, when transferred to our Intensive Cardiac Rehabilitation Unit, still have a percutaneous tracheostomy due to respiratory mechanical dysfunction. The aim of our work is to present new rehabilitative care strategies in such compromised patients. Methods and materials. We studied 27 elderly critically ill tracheostomized patients who were split into 2 Groups (A = 11 and B = 16). The Groups were homogeneous for age and for left ventricular ejection fraction. Group A received a standard treatment including cautious mobilisation and respiratory unspecific physiotherapy. Group B received an earlier and more aggressive treatment with a specific respiratory physiotherapy including Positive Expiration Pressure (PEP) directly connected to the tracheostomy cannula. A protocol for tracheostomy decannulation by assessment of the Peak Expiratory Flow during cough (PCEF≥ 180 L/min.) has been defined in order to verify the patients ability to develop a mechanically effective cough to obtain weaning from tracheostomy. Besides, in the patients of Group B, we carried out a screening of the swallowing dysfunction. Results. Four patients of Group A deceased while in Group B there were no deaths. Furthermore patients of Group B showed a statistically significant improvement of mobility and respiratory indexes. In Group B only one patient was discharged with tracheostomy cannula in site because he did not reach standard criteria for decannulation and his PCEF value was not satisfactory. This patient underwent percutaneous gastrostomy. Conclusions. A precocious and intensive rehabilitation, based on specific respiratory physiotherapy, significantly improves mobility and respiratory indexes of patients with tracheostomy. The PCEF and the swallowing deficit evaluation allows an earlier tracheostomy decannulation with lower risk of complications

Atypical face shape and genomic structural variants in epilepsy

Many pathogenic structural variants of the human genome are known to cause facial dysmorphism. During the past decade, pathogenic structural variants have also been found to be an important class of genetic risk factor for epilepsy. In other fields, face shape has been assessed objectively using 3D stereophotogrammetry and dense surface models. We hypothesized that computer-based analysis of 3D face images would detect subtle facial abnormality in people with epilepsy who carry pathogenic structural variants as determined by chromosome microarray. In 118 children and adults attending three European epilepsy clinics, we used an objective measure called Face Shape Difference to show that those with pathogenic structural variants have a significantly more atypical face shape than those without such variants. This is true when analysing the whole face, or the periorbital region or the perinasal region alone. We then tested the predictive accuracy of our measure in a second group of 63 patients. Using a minimum threshold to detect face shape abnormalities with pathogenic structural variants, we found high sensitivity (4/5, 80% for whole face; 3/5, 60% for periorbital and perinasal regions) and specificity (45/58, 78% for whole face and perinasal regions; 40/58, 69% for periorbital region). We show that the results do not seem to be affected by facial injury, facial expression, intellectual disability, drug history or demographic differences. Finally, we use bioinformatics tools to explore relationships between facial shape and gene expression within the developing forebrain. Stereophotogrammetry and dense surface models are powerful, objective, non-contact methods of detecting relevant face shape abnormalities. We demonstrate that they are useful in identifying atypical face shape in adults or children with structural variants, and they may give insights into the molecular genetics of facial development

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Valutazione dell’indice di erosività mensile da serie pluviometriche giornaliere.

Questa nota presenta un modello di regressione a quattro parametri per la stima dell’erosività media mensile (Rm) dai valori medi mensili delle massime piogge giornaliere (d) e dai cumulati mensili (m). Il modello è stato calibrato e validato utilizzando serie storiche registrate in 106 pluviometri automatici distribuiti nella Regione Campania. Il modello proposto ha una struttura lineare in scala logaritmica, con una intercetta variabile di mese in mese secondo una funzione periodica a due parametri. Questa funzione è stata introdotta per rappresentare la diversa occorrenza delle piogge intense di breve durata nel corso dell’anno rispetto ai massimi mensili di pioggia a scala giornaliera e può essere interpretata come una legge di scala mensile tra i valori medi della pioggia massima giornaliera ed oraria. Il modello nel complesso offre stime soddisfacenti dell’erosività a scala mensile, stagionale ed annuale

Caratterizzazione stagionale dell'erosività della pioggia in Regione Campania

L’erosione idrica del suolo dipende sia da fattori naturali sia da azioni antropiche ed è notevolmente influenzata dalla aggressività della precipitazione (la cosiddetta erosività, R). Per valutazioni accurate di questo fattore climatico è necessario disporre di ampie serie storiche di dati di pioggia con aggregazione sub-oraria che, purtroppo, sono invece disponibili solo per un numero ridotto di stazioni, peraltro spesso distribuite in modo poco uniforme su un territorio di interesse. L’ammodernamento delle reti pluviometriche con sensori automatici ha reso più agevole disporre di tali informazioni, ma solo per gli ultimi 10-15 anni. Pertanto, soprattutto per scopi tecnico-applicativi, è necessario ricorrere a metodi di stima semplificati che utilizzano principalmente dati di pioggia giornaliera, solitamente più numerosi e rilevati in stazioni ben distribuite spazialmente. Dal punto di vista operativo, è altresì necessario fornire indicazioni circa il grado di incertezza associata all’uso di relazioni empiriche semplificate rispetto a metodi più rigorosi. In questo studio sono stati utilizzati dati di pioggia giornaliera in Regione Campania aggiornati al 2017 e sono state utilizzate tre diverse espressioni empiriche per stimare l’indice R. I risultati ottenuti sono stati confrontati con quelli che derivano da un metodo di stima più accurato e hanno confermato l’importanza di analizzare i caratteri di erosività in termini stagionali. Le analisi hanno anche consentito di identificare i periodi dell’anno in cui sono da attendersi maggiori incertezze nelle stime semplificate dell’aggressività della precipitazione

Ejection fraction/velocity ratio identifies prosthesis-patient mismatches in patients with aortic bioprosthetic valves and left ventricular dysfunction

Recently, a new echocardiographic nonflow corrected index (ejection fraction/velocity ratio [EFVR] = percent left ventricular ejection fraction [EF]/maximum aortic gradient) has been introduced and has shown excellent accuracy in quantifying the effective orifice area (EOA) in native aortic valves and bio-prostheses. The objective of this study was to assess the utility of the EFVR to quantify the indexed EOA in patients with an aortic bioprosthesis and left ventricular dysfunction considering an indexed EOA value of 0.85 cm(2)/m(2) or less to be indicative of a prosthesis-patient mismatch (PPM), defined as an EOA of the inserted prosthetic valve of less than that of the normal human valve

Protection of dinosaur footprints in carbonate deposits: the case of Sezze (Latium, central Italy) ichnosite

More than 200 dinosaur footprints were found on three stratigraphic surfaces in the abandoned quarry “Cava Petrianni”, about 70 km south of Rome, nearby the town of Sezze (Latium, central Italy). The ichnosite is located in the westernmost sector of the Lepini Mts., with an exposed carbonate succession belonging to the Lepini-Ausoni-Aurunci Unit. Three distinct trampled surfaces were recognised in a 250-m-thick succession referred to the “Laziale-Abruzzese-Campano domain” deposited in a persistent shallow carbonate platform setting from the Late Triassic to the Late Cretaceous. The footprints, preserved on carbonate platform limestones, are exposed to natural environment degradation (especially karst processes), that can irreversibly modify track morphology, resulting in the loss of details in a site of unique paleontological and paleobiogeographic value (Antonelli et al., 2023). The aim of the present project is to find an appropriate solution in the long-term preservation of dinosaur footprints produced in carbonate deposits from the environmental degradation naturally occurring in paleoichnological and geological sites. The final purpose is both enhancing this palaeontological heritage and proposing a possible solution applicable to other ichnosites with similar conditions. Several consolidants have been tested on the trampled surfaces to evaluate the better in terms of application, costs and results. In particular, a mineral consolidant based on the sol-gel technology (SIOX-5 RE50), a nano-sized silicon dioxide fixative/consolidant in colloidal aqueous dispersion (Nano ESTEL) and TEOS with chitosan were applied. In addition, a bioconsolidation process was tested, applying several bacterial strains, taking advantage from the natural bacterial ability to induce carbonate precipitation (Nigro et al., 2022). Antonelli M., Romano M., De Sario F., Pignatti J., Sacco E. & Petti F.M. (2023) - Inferred oviraptorosaur footprints in the Apenninic Carbonate Platform: New tools for the identification of trackmakers from the Sezze ichnosite (lower-middle Cenomanian; central Italy). Cretaceous Res., 141, 105362. https://doi.org/10.1016/j.cretres.2022.105362. Nigro L., Mura F., Toti M.P., Cirigliano A. & Rinaldi T. (2022) - Carbonatogenic bacteria on the ‘Motya Charioteer’ sculpture. J. Cult. Herit., 57, 256-264. https://doi.org/10.1016/j.culher.2022.09.009