Efficacy of a new technique - INtubate-RECruit-SURfactant-Extubate - "IN-REC-SUR-E" - in preterm neonates with respiratory distress syndrome: Study protocol for a randomized controlled trial

Background: Although beneficial in clinical practice, the INtubate-SURfactant-Extubate (IN-SUR-E) method is not successful in all preterm neonates with respiratory distress syndrome, with a reported failure rate ranging from 19 to 69 %. One of the possible mechanisms responsible for the unsuccessful IN-SUR-E method, requiring subsequent re-intubation and mechanical ventilation, is the inability of the preterm lung to achieve and maintain an "optimal" functional residual capacity. The importance of lung recruitment before surfactant administration has been demonstrated in animal studies showing that recruitment leads to a more homogeneous surfactant distribution within the lungs. Therefore, the aim of this study is to compare the application of a recruitment maneuver using the high-frequency oscillatory ventilation (HFOV) modality just before the surfactant administration followed by rapid extubation (INtubate-RECruit-SURfactant-Extubate: IN-REC-SUR-E) with IN-SUR-E alone in spontaneously breathing preterm infants requiring nasal continuous positive airway pressure (nCPAP) as initial respiratory support and reaching pre-defined CPAP failure criteria. Methods/design: In this study, 206 spontaneously breathing infants born at 24+0-27+6 weeks' gestation and failing nCPAP during the first 24 h of life, will be randomized to receive an HFOV recruitment maneuver (IN-REC-SUR-E) or no recruitment maneuver (IN-SUR-E) just prior to surfactant administration followed by prompt extubation. The primary outcome is the need for mechanical ventilation within the first 3 days of life. Infants in both groups will be considered to have reached the primary outcome when they are not extubated within 30 min after surfactant administration or when they meet the nCPAP failure criteria after extubation. Discussion: From all available data no definitive evidence exists about a positive effect of recruitment before surfactant instillation, but a rationale exists for testing the following hypothesis: a lung recruitment maneuver performed with a step-by-step Continuous Distending Pressure increase during High-Frequency Oscillatory Ventilation (and not with a sustained inflation) could have a positive effects in terms of improved surfactant distribution and consequent its major efficacy in preterm newborns with respiratory distress syndrome. This represents our challenge. Trial registration: ClinicalTrials.gov identifier: NCT02482766. Registered on 1 June 2015

La Provincia di Sassari: ambiente, storia, civiltà

Essere cittadino di una provincia non significa soltanto abitarvi. Significa anche lavorarvi, esercitarvi una attività che vada a vantaggio del benessere individuale e insieme del benessere della collettività. Per fare questo, per raggiungere meglio questo obiettivo, la realtà in cui si vive e si lavora bisogna conoscerla meno superficialmente di quanto normalmente non succeda. E' una constatazione che si può fare per tutti coloro che abitano in un luogo, ma che si deve fare in modo particolare quando lo strumento di conoscenza che si propone è un libro come questo

Immunoreactivity of the salivary protein statherin in human male accessory sex glands

BACKGROUND: Statherin is a small phosphoprotein chiefly studied for its protective roles towards teeth and oral tissues. Although generally considered as exclusively secreted by salivary glands, circumstantial evidences suggested that other tissues also produce it. This article first demonstrates statherin immunoreactivity in human prostate and seminal vesicles. METHODS: Surgical samples of prostate and seminal vesicles were fixed in a mixture of paraformaldehyde and glutaraldehyde, and embedded in Epon resin without previous osmication. Ultrathin sections were treated for the intracellular localization of statherin by means of an immunogold staining method. RESULTS: Reactive statherin was revealed in secreting cells of both seminal vesicle and prostate epithelia: labeling was found in secretory granules of seminal vesicle cells and in cytoplasmic vesicles of prostatic cells. CONCLUSIONS: The different staining patterns suggested that the two glands secrete statherin through different pathways

Identification of Mycobacterium avium subsp. paratuberculosis in Biopsy Specimens from Patients with Crohn's Disease Identified by In Situ Hybridization

Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract of unknown etiology. We report on the presence of cell wall-deficient Mycobacterium avium subsp. paratuberculosis in 35 of 48 paraffin-embedded tissue specimens from 33 patients with Crohn's disease by in situ hybridization with IS900 as a probe

Identification of <i>Mycobacterium avium</i> subsp. <i>paratuberculosis</i> in biopsy specimens from patients with Crohn's disease identified by <i>in situ</i> hybridization

Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract of unknown etiology. We report on the presence of cell wall-deficient Mycobacterium avium subsp. paratuberculosis in 35 of 48 paraffin-embedded tissue specimens from 33 patients with Crohn's disease by in situ hybridization with IS900 as a probe. An erratum to this article can be found in: J. Clin. Microbiol. 2002, 40(2), p. 739

The Morra Game: Developing an Automatic Gesture Recognition System to Interface Human and Artificial Players

Morra is an ancient hand game still played nowadays. In its more popular variant, two players simultaneously extend one hand in front of the opponent to show a number of fingers, while uttering a number from 2 to 10. The player who successfully guesses the total number of fingers scores a point. Morra can be defined as a serious game, as it has the potential to positively affect cognition and to improve cognitive and perceptual skills. Moreover, with its involvement of many perceptual, cognitive and motor skills, morra is ideal to test several cognitive processes. This paper describes aspects of Gavina 2121, an artificial Morra player that successfully predicts the numbers of human opponents taking advantage of the limited ability of humans in random sequence generation. This study focuses on automatic gesture recognition. We developed and tested a system to allow Gavina 2121 to detect and count in real time the number of extended fingers in a human hand. The system is based on the open source MediaPipe Hand framework developed by Google. Our tests indicate that the system is able to accurately recognize the number of fingers extended by a human hand in real time, both in prone and supine positions. The system is still imprecise in semi-naturalistic conditions of an actual morra game, where the fingers of two hands need to be computed simultaneously. Our test, still in its pilot phase, shows promising results towards a flexible implementation of an artificial morra player that can sensibly expand the educational, rehabilitation and research applications of Morra

Twenty-four novel mutations in Wilson disease patients of predominantly Italian origin

Herein we report the results of mutation analysis of the ATP7B gene in a group of 134 Wilson disease (WD) families (268 chromosomes) prevalently of Italian origin. Using the SSCP and sequencing methods we identified 71 disease-causing mutations. Twenty-four were novel, while 19 more mutations already described, were identified in new populations in this study. A known mutation G591D showed a regional distribution, since it was only detected in 38.5% of the analyzed chromosomes in WD patients originating from Apulia, a region of South Italy. Detection of new mutations in the ATP7B gene increases our capability of molecular analysis that is essential for early diagnosis and treatment of WD