The importance of a diagnostic pathway in the diagnosis of haemoptysis.

The role of interventional pulmonology in both the diagnostic and therapeutic aspects of haemopthysis is far to be completely defined. Even if we have to differentiate massive from mild and moderate bleeding it seems to be reasonable to asses that a bronchoscopy (fiberoptic or rigid) can be safely proposed in skilled centers with a wide range of immediate therapeutical interventional options, whether pneumological, either radiological or surgica

Triple Therapy in COPD: Can We Welcome the Reduction in Cardiovascular Risk and Mortality?

Chronic obstructive pulmonary disease (COPD) is a complex disease which consists in the reduction of the airflow and leads to the disruption of the pulmonary tissue due to a chronic inflammation. The progression of the disease is characterized by an exacerbation of the symptoms and the presence of life-threatening systemic complications, such as stroke and ischemic heart disease, with a progressive decline in lung function which can deeply impact the quality of life. Mortality represents the most important COPD outcome, with an increased risk in patients with cardiovascular comorbidities. The efficacy and safety of triple inhaled therapy were demonstrated by numerous controlled trials. Above all, many robust data are now available on the effectiveness of the triple therapy to reduce mortality in COPD patients

Estimating the value of carbon sequestration ecosystem services in the Mediterranean Sea: An ecological economics approach

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Merging bio-optical data from Biogeochemical-Argo floats and models in marine biogeochemistry

In numerical models for marine biogeochemistry, bio-optical data, such as measurements of the light field, may be important descriptors of the dynamics of primary producers and ultimately of oceanic carbon fluxes. However, the paucity of field observations has limited the integration of bio-optical data in such models so far. New autonomous robotic platforms for observing the ocean, i.e., Biogeochemical-Argo floats, have drastically increased the number of vertical profiles of irradiance, photosynthetically available radiation (PAR) and algal chlorophyll concentrations around the globe independently of the season. Such data may be therefore a fruitful resource to improve performances of numerical models for marine biogeochemistry. Here we present a work that integrates into a 1-dimensional model 1314 vertical profiles of PAR acquired by 31 BGC-Argo floats operated in the Mediterranean Sea between 2012 and 2016 to simulate the vertical and temporal variability of algal chlorophyll concentrations. In addition to PAR as input, alternative light and vertical mixing models were considered. We evaluated the models\u2019 skill to reproduce the spatial and temporal variability of deep chlorophyll maxima as observed by BGC-Argo floats. The assumptions used to set up the 1-D model are validated by the high number of co-located in-situ measurements. Our results illustrate the key role of PAR and vertical mixing in shaping the vertical dynamics of primary produces in the Mediterranean Sea. Moreover, we demonstrate the importance of modeling the diel cycle to simulate chlorophyll concentrations in stratified waters at the surface

Chronic obstructive lung disease \u201cexpert system\u201d: Validation of a predictive tool for assisting diagnosis

Purpose: The purposes of this study were development and validation of an expert system (ES) aimed at supporting the diagnosis of chronic obstructive lung disease (COLD). Methods: A questionnaire and a WebFlex code were developed and validated in silico. An expert panel pilot validation on 60 cases and a clinical validation on 241 cases were performed. Results: The developed questionnaire and code validated in silico resulted in a suitable tool to support the medical diagnosis. The clinical validation of the ES was performed in an academic setting that included six different reference centers for respiratory diseases. The results of the ES expressed as a score associated with the risk of suffering from COLD were matched and compared with the final clinical diagnoses. A set of 60 patients were evaluated by a pilot expert panel validation with the aim of calculating the sample size for the clinical validation study. The concordance analysis between these preliminary ES scores and diagnoses performed by the experts indicated that the accuracy was 94.7% when both experts and the system confirmed the COLD diagnosis and 86.3% when COLD was excluded. Based on these results, the sample size of the validation set was established in 240 patients. The clinical validation, performed on 241 patients, resulted in ES accuracy of 97.5%, with confirmed COLD diagnosis in 53.6% of the cases and excluded COLD diagnosis in 32% of the cases. In 11.2% of cases, a diagnosis of COLD was made by the experts, although the imaging results showed a potential concomitant disorder. Conclusion: The ES presented here (COLDES) is a safe and robust supporting tool for COLD diagnosis in primary care settings