9 research outputs found
Molecular Mechanisms and Physiological Changes behind Benign Tracheal and Subglottic Stenosis in Adults
Laryngotracheal stenosis (LTS) is a complex and heterogeneous disease whose pathogenesis remains unclear. LTS is considered to be the result of aberrant wound-healing process that leads to fibrotic scarring, originating from different aetiology. Although iatrogenic aetiology is the main cause of subglottic or tracheal stenosis, also autoimmune and infectious diseases may be involved in causing LTS. Furthermore, fibrotic obstruction in the anatomic region under the glottis can also be diagnosed without apparent aetiology after a comprehensive workup; in this case, the pathological process is called idiopathic subglottic stenosis (iSGS). So far, the laryngotracheal scar resulting from airway injury due to different diseases was considered as inert tissue requiring surgical removal to restore airway patency. However, this assumption has recently been revised by regarding the tracheal scarring process as a fibroinflammatory event due to immunological alteration, similar to other fibrotic diseases. Recent acquisitions suggest that different factors, such as growth factors, cytokines, altered fibroblast function and genetic susceptibility, can all interact in a complex way leading to aberrant and fibrotic wound healing after an insult that acts as a trigger. However, also physiological derangement due to LTS could play a role in promoting dysregulated response to laryngo-tracheal mucosal injury, through biomechanical stress and mechanotransduction activation. The aim of this narrative review is to present the state-of-the-art knowledge regarding molecular mechanisms, as well as mechanical and physio-pathological features behind LTS
Effects of cytokine blocking agents on hospital mortality in patients admitted to ICU with acute respiratory distress syndrome by SARS-CoV-2 infection: Retrospective cohort study
Background: The use of cytokine-blocking agents has been proposed to modulate the inflammatory response in patients with COVID-19. Tocilizumab and anakinra were included in the local protocol as an optional treatment in critically ill patients with acute respiratory distress syndrome (ARDS) by SARS-CoV-2 infection. This cohort study evaluated the effects of therapy with cytokine blocking agents on in-hospital mortality in COVID-19 patients requiring mechanical ventilation and admitted to intensive care unit. Methods: The association between therapy with tocilizumab or anakinra and in-hospital mortality was assessed in consecutive adult COVID-19 patients admitted to our ICU with moderate to severe ARDS. The association was evaluated by comparing patients who received to those who did not receive tocilizumab or anakinra and by using different multivariable Cox models adjusted for variables related to poor outcome, for the propensity to be treated with tocilizumab or anakinra and after patient matching. Results: Sixty-six patients who received immunotherapy (49 tocilizumab, 17 anakinra) and 28 patients who did not receive immunotherapy were included. The in-hospital crude mortality was 30,3% in treated patients and 50% in non-treated (OR 0.77, 95% CI 0.56-1.05, p=0.069). The adjusted Cox model showed an association between therapy with immunotherapy and in-hospital mortality (HR 0.40, 95% CI 0.19-0.83, p=0.015). This protective effect was further confirmed in the analysis adjusted for propensity score, in the propensity-matched cohort and in the cohort of patients with invasive mechanical ventilation within 2 hours after ICU admission. Conclusions: Although important limitations, our study showed that cytokine-blocking agents seem to be safe and to improve survival in COVID-19 patients admitted to ICU with ARDS and the need for mechanical ventilation
On the effect of slotted blades on Savonius wind generator performances by CFD analysis
In this paper a new bucket configuration for Savonius wind generator is proposed. With the
aim to increase the effect of the overlap ratio RS on the wind turbine performances and to increase the
amount of lift force able to produce torque and power, slotted blades are investigated by means of the
Computational Fluid Dynamics analysis. The numerical analyses are performed by Comsol
MultiphysicsÂŽ and the results obtained for a Savonius wind turbine with overlap only are compared to
numerical and experimental benchmarks. Parametric analyses are performed, for fixed overlap ratio,
by varying the slot angle β and the results show that for low angle β the Savonius rotor exploits
improved performance at low tip speed ratio Îť, evidencing a better starting torque. This circumstance
is confirmed by the static analyses performed on the slotted blades in order to investigate the starting
characteristic of the proposed Savonius wing generator configuration
Rituximab for the treatment of acute onset interstitial lung disease in primary Sjogrenâs Syndrome.
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Blood Lipids, homocysteine, stress factors, and vitamins in clinically stable multiple sclerosis patients
Multiple Sclerosis (MS) patients present a decrease of antioxidants and neuroprotective and immunoregulatory vitamins and an increase of total homocysteine (tHcy), cholesterol (CHL), HDLcholesterol,
and of cellular stress markers, variably associated with the different phases of the
disease. We compared the blood levels of uric acid, folic acid, vitamins B12, A, and E, tHcy, CHL,
HDL-cholesterol, and triglycerides in forty MS patients during a phase of clinical inactivity with
those of eighty healthy controls, matched for age and sex. We found higher levels of tHcy (p =
0.032) and of HDL-cholesterol (p = 0.001) and lower levels of vitamin E (p = 0.001) and the ratio
vitamin E/CHL (p = 0.001) in MS patients. In conclusion, modifications of some biochemical
markers of cell damage were detected in MS patients during a phase of clinical inactivity
Endobronchial valve positioning for alveolar-pleural fistula following ICU management of severe COVID-19 pneumonia.
Background- Since December 2019 the outbreak of novel Coronavirus (Severe Acute Respiratory
Sindrome-2, SARS-CoV2) has spread across the world. The main clinical
consequences are respiratory failure even requiring mechanical ventilation, and
pneumonia frequently sharing clinical and radiologic similarities to Acute Respiratory
Distress Syndrome (ARDS). In this context the lung parenchyma is highly prone to
ventilator-related injury, with pneumothorax and persistent air leak as the most serious
adverse events. So far, endobronchial valve (EBV) positioning has proved efficacy in
treating air leaks with high success rate.
Case presentation- We report, for the first time, two cases of patients affected by SARS-CoV2-related
pneumonia suffering from pneumothorax and persistent air leaks after invasive
mechanical ventilation, and successfully treated through EBV positioning.
Conclusions- Persistent air leaks may result from lung tissue damage due to a complex interaction
between inflammation and ventilator-related injury (VILI), especially in the advanced
stages of ARDS. EBV positioning seems to be a feasible and effective least-invasive
therapeutic option for caring this subset of patients
Cytomegalovirus blood reactivation in COVID-19 critically ill patients: risk factors and impact on mortality
Purpose: Cytomegalovirus (CMV) reactivation in immunocompetent critically ill patients is common and relates to a worsening outcome. In this large observational study, we evaluated the incidence and the risk factors associated with CMV reactivation and its effects on mortality in a large cohort of patients affected by coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU).
Methods: Consecutive patients with confirmed SARS-CoV-2 infection and acute respiratory distress syndrome admitted to three ICUs from February 2020 to July 2021 were included. The patients were screened at ICU admission and once or twice per week for quantitative CMV-DNAemia in the blood. The risk factors associated with CMV blood reactivation and its association with mortality were estimated by adjusted Cox proportional hazards regression models.
Results: CMV blood reactivation was observed in 88 patients (20.4%) of the 431 patients studied. Simplified Acute Physiology Score (SAPS) II score (HR 1031, 95% CI 1010â1053, p = 0.006), platelet count (HR 0.0996, 95% CI 0.993â0.999, p = 0.004), invasive mechanical ventilation (HR 2611, 95% CI 1223â5571, p = 0.013) and secondary bacterial infection (HR 5041; 95% CI 2852â8911, p < 0.0001) during ICU stay were related to CMV reactivation. Hospital mortality was higher in patients with (67.0%) than in patients without (24.5%) CMV reactivation but the adjusted analysis did not confirm this association (HR 1141, 95% CI 0.757â1721, p = 0.528). Conclusion: The severity of illness and the occurrence of secondary bacterial infections were associated with an increased risk of CMV blood reactivation, which, however, does not seem to influence the outcome of COVID-19 ICU patients independently