The prognostic importance of chronic end-stage diseases in geriatric patients admitted to 163 Italian ICUs

BACKGROUND: The number of elderly patients undergoing major surgical interventions and then needing admission to intensive care unit (ICU) grows steadily. We investigated this issue in a cohort of 232,278 patients admitted in five years (2011-2015) to 163 Italian general ICUs. METHODS: Surgical patients older than 75 registered in the GiViTI MargheritaPROSAFE project were analyzed. The impact on hospital mortality of important chronic conditions (severe COPD, NYHA class IV, dementia, end-stage renal disease, cirrhosis with portal hypertension) was investigated with two prognostic models developed yearly on patients staying in the ICU less or more than 24 hours. RESULTS: 44,551 elderly patients (19.2%) underwent emergency (47.3%) or elective surgery (52.7%). At least one severe comorbidity was present in 14.6% of them, yielding a higher hospital mortality (32.4%, vs. 21.1% without severe comorbidity). In the models for patients staying in the ICU 24 hours or more, cirrhosis, NYHA class IV, and severe COPD were constant independent predictors of death (adjusted odds ratios [ORs] range 1.67-1.97, 1.54-1.91, and 1.34-1.50, respectively), while dementia was statistically significant in four out of five models (adjusted ORs 1.23-1.28). End-stage renal disease, instead, never resulted to be an independent prognostic factor. For patients staying in the ICU less than 24 hours, chronic comorbidities were only occasionally independent predictors of death. CONCLUSIONS: Our study confirms that elderly surgical patients represent a relevant part of all ICUs admissions. About one of seven bear at least one severe chronic comorbidity, that, excluding end-stage renal disease, are all strong independent predictors of hospital death

The Link of the Prion Protein with Ca2+ Metabolism and ROS Production, and the Possible Implication in A\u3b2 Toxicity

The cellular prion protein (PrPC) is an ubiquitous cell surface protein mostly expressed in neurons, where it localizes to both pre- and post-synaptic membranes. PrPC aberrant conformers are the major components of mammalian prions, the infectious agents responsible for incurable neurodegenerative disorders. PrPC was also proposed to bind aggregated misfolded proteins/peptides, and to mediate their neurotoxic signal. In spite of long-lasting research, a general consensus on the precise pathophysiologic mechanisms of PrPC has not yet been reached. Here we review our recent data, obtained by comparing primary neurons from PrP-expressing and PrP-knockout mice, indicating a central role of PrPC in synaptic transmission and Ca2+ homeostasis. Indeed, by controlling gene expression and signaling cascades, PrPC is able to optimize glutamate secretion and regulate Ca2+ entry via store-operated channels and ionotropic glutamate receptors, thereby protecting neurons from threatening Ca2+ overloads and excitotoxicity. We will also illustrate and discuss past and unpublished results demonstrating that A\u3b2 oligomers perturb Ca2+ homeostasis and cause abnormal mitochondrial accumulation of reactive oxygen species by possibly affecting the PrP-dependent downregulation of Fyn kinase activity

Investigation of the influence of vacuum venting on mould surface temperature in micro injection moulding

YesThe application of vacuum venting for the removal of air from mould cavity has been introduced in injection moulding with the intent to enhance micro/nano features replication and definition. The technique is adopted to remove air pockets trapped in the micro-features, which are out of reach for conventional venting technologies and can create considerable resistance to the melt filling flow. Nonetheless, several studies have revealed a negative effect on replication that could possibly arise from the application of vacuum venting. Although the incomplete filling of micro-scale features has often been attributed to poor venting, the limited research examining the application of vacuum venting has produced mixed results. In this work, the effect of air evacuation was experimentally investigated, monitoring mould and polymer temperature evolution during the micro injection moulding process by means of a high speed infrared camera and a sapphire window, which forms part of the mould wall. The results show that air evacuation removes a mould surface heating effect caused by rapid compression of the air ahead of the flow front and subsequent conduction of that heat into the mould surface. Hence, with the increase of the surface-to-volume ratio in micro-cavities, air evacuation has a detrimental effect on the cavity filling with polymers that are sensitive to changes of the mould temperature

Potencial de economia de energia elétrica através do uso da luz natural e da ventilação híbrida em edifícios comerciais em Florianópolis

O objetivo deste estudo é estimar o potencial de economia de energia elétrica com o uso da luz natural integrada ao sistema de iluminação artificial e a utilização da ventilação híbrida em edifícios comerciais localizados em Florianópolis, SC. O trabalho foi baseado em simulações computacionais nos programas EnergyPlus e Daysim. Foram simulados modelos de ambientes de edificações comerciais, com três geometrias, três dimensões de sala por geometria, dez áreas de janela por modelo e quatro orientações. Os modelos foram examinados por meio de quatro estudos de caso. No Caso 1 (referência), a edificação opera com sistemas de iluminação e de condicionamento artificiais; no Caso 2, ocorre a integração da iluminação natural com a artificial, com condicionamento artificial; já no Caso 3, utilizam-se a ventilação híbrida e a iluminação artificial; no Caso 4, adotam-se a iluminação natural integrada com a artificial e a ventilação híbrida. Os consumos de eletricidade do Caso 1 foram comparados com os demais casos. Assim, foi estimado o potencial de economia de energia elétrica gerado pelo uso da luz natural e ventilação híbrida. Conclui-se que a utilização da iluminação natural e da ventilação híbrida em edificações comerciais localizadas em Florianópolis apresenta potencial de economia de energia elétrica de até 64,9% e que essas estratégias podem ser utilizadas para aumentar a eficiência energética desse tipo de edificação

Otimização multiobjetivo das dimensões dos ambientes de uma residência unifamiliar baseada em simulação energética e estrutural

Resumo O desenvolvimento da tecnologia computacional nas últimas décadas levou a otimização associada à parametrização a possibilitar o desenvolvimento de projetos de melhor desempenho, com ou sem integração com a simulação. O intuito deste trabalho foi aplicar a otimização baseada em simulação na forma de uma edificação residencial unifamiliar com o objetivo de encontrar a composição que apresentasse o melhor desempenho térmico com o menor custo dos materiais construtivos, considerando-se restrições estruturais. Foram utilizados os programas Rhinoceros e Energy Plus, além de plug-ins para modelagem paramétrica, o intercâmbio de informações entre os programas e a condução da otimização. Foram realizadas duas simulações, a primeira considerando os custos dos componentes construtivos e os graus-hora de aquecimento e resfriamento combinados e a segunda considerando os custos e graus-hora de aquecimento, que produziu resultados mais relevantes. Dois casos de cada solução de Pareto foram selecionados para análise, dentre 19,8 mil e 27,4 mil casos obtidos com uso de algoritmos evolucionários. Apesar das limitações de algumas das ferramentas, foi verificado um grande potencial de aplicação deste método no desenvolvimento de projetos arquitetônicos

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Chloride channels of intracellular membranes

Proteins implicated as intracellular chloride channels include the intracellular ClC proteins, the bestrophins, the cystic fibrosis transmembrane conductance regulator, the CLICs, and the recently described Golgi pH regulator. This paper examines current hypotheses regarding roles of intracellular chloride channels and reviews the evidence supporting a role in intracellular chloride transport for each of these proteins