Rehabilitation in COPD patients admitted for exacerbation

Recovery of lung function is delayed up to 2 months following acute exacerbation (AE) of COPD patients. After AE, even with optimal medical therapy, it takes considerable time for COPD patients to recover to baseline ability to perform usual physical activity.Despite pulmonary rehabilitation (PR) has been so far considered a useful non-pharmacological therapy in stable COPD individuals, still few studies have examined the effect of rehabilitation during and/or early after AE.The present review updates the application of early PR and main physical therapies both during hospital acute care and following discharge of COPD patients undergoing exacerbation.Only recently, literature has shown feasibility and effectiveness of early PR in COPD patients undergoing AE. Notwithstanding, it clearly appears a treatment indicated just after or even during an acute episode in hospital.Future studies should be able to clarify the practical role and effects of a timely application of rehabilitation to acute COPD, as well as the preferred modalities, duration and techniques to apply in this condition

Financial Crisis and New Dimensions of Liquidity Risk: Rethinking Prudential Regulation and Supervision

This paper aims to stress the importance of market liquidity for the stability of the financial system, emphasizing the pivotal role played by liquidity risk in the development of the current financial crisis, pointing out the flaws of regulation and supervision and stressing the need for their reform. We first investigate the evolution of the concept of liquidity and the nexus between the transformations of financial systems and their increased vulnerability to liquidity risks. Then we focus on the causes of the emergence of liquidity risk in the ongoing financial crisis. We point out two intertwined processes: firstly, the huge increase in financial assets stemming from the shift to an \u201coriginate-to-distribute\u201d intermediation model; secondly, the growth of a parallel financial circuit. After this, we focus on the main lessons for regulation and supervision: first of all we address the case for adjustments to or reform of Basel 2 in view of the nexus between solvency and liquidity. Further crucial points relate to market liquidity and OTC markets, scale and scope of LLR function, architecture of supervisory authorities and perimeter of controls. Finally we stress the need for harmonization, or at least coordination, of national liquidity regimes, at least for cross-border group

Adjunctive therapy with vitamin c and thiamine in patients treated with steroids for refractory septic shock: A propensity matched before-after, case-control study

Purpose: Triple therapy with steroids, vitamin C and thiamine has been recently proposed as a safe and beneficial in patients with sepsis. In 2017, we added the use of intravenous vitamin C and thiamine in septic shock patients receiving low dose hydrocortisone because poorly responsive to vasopressors. Aim of this study is to verify whether triple therapy rather than steroids alone can improve outcome in patients with refractory shock. Materials and methods: In this before-after retrospective analysis, we compared septic shock patients admitted to our intensive care unit (ICU) who received triple therapy from June 2017 to November 2019 to septic shock patients who received only hydrocortisone from January 2015 to June 2017. Patients of the two study periods were matched 1:1 using a propensity score model. Results: A final cohort of 56 patients treated with triple therapy were matched to 56 patients treated only with steroids. Triple therapy reduced the length of mechanical ventilation (p = 0,01) and showed a trend in lowering the 30-day and hospital mortality compared to therapy with only hydrocortisone. Conclusions: Although with significant limitations, our experience indicated that triple therapy seems to provide an improvement of clinical outcomes in patients with refractory septic shock

Reversible myocardial injury aggravated by complex arrhythmias in three Toxoplasma gondii-positive dogs

Although Toxoplasma gondii represents an oft-cited cause of myocarditis in veterinary medicine, the existing literature on the pre-mortem demonstration of T. gondii-associated myocardial injury (MI) in dogs is scant. In this case series, we provide detailed clinical, laboratory, echocardiographic and electrocardiographic description of three T. gondii-positive dogs diagnosed with MI. In all cases, etiological diagnosis was based on the antibody screening test (all dogs had IgM titres ≥1:64) and MI was demonstrated by a concomitant increase of the serum concentration of cardiac troponin I (0.25-9.6 ng/ml, upper hospital limit <0.15 ng/ml). In all dogs, MI was aggravated by complex arrhythmias (ventricular in two dogs, and either ventricular and supraventricular in the remaining dog). In one case, left ventricular systolic dysfunction was also present. All dogs underwent an extensive diagnostic work-up aimed at excluding additional comorbidities, either cardiac and extra-cardiac, possibly able to contribute to MI, arrhythmias and systolic dysfunction. All dogs received appropriate antiprotozoal (i.e., clindamycin) and antiarrhythmic (i.e., amiodarone, sotalol) therapy. This was systematically followed by a simultaneous decline in T. gondii serology titres, normalisation of troponin level and left ventricular systolic function, and the resolution of clinical and electrocardiographic abnormalities. In light of this result, therapies were interrupted and subsequent controls ruled out any disease relapse. In these cases, the clinical and instrumental findings obtained at admission and rechecks strongly supported the clinical suspicion of toxoplasmic myocarditis

Elastic precession of electronic spin states in interacting integer quantum Hall edge channels

We consider the effect of Coulomb interactions in the propagation of electrons, prepared in arbitrary spin states, on chiral edge channels in the integer quantum Hall regime. Electrons are injected and detected at the same energy at different locations of the Hall bar, which is modeled as a chiral Tomonaga-Luttinger liquid. The current is computed perturbatively in the tunneling amplitudes, within a non-crossing approximation using exact solutions of the interacting Green's functions. In the case of different channel velocities, the spin precession effect is evaluated, and the role of interaction parameters and wavevectors is discussed.Comment: 5 pages, 3 figure

Action minimizing orbits in the n-body problem with simple choreography constraint

In 1999 Chenciner and Montgomery found a remarkably simple choreographic motion for the planar 3-body problem (see \cite{CM}). In this solution 3 equal masses travel on a eight shaped planar curve; this orbit is obtained minimizing the action integral on the set of simple planar choreographies with some special symmetry constraints. In this work our aim is to study the problem of $n$ masses moving in \RR^d under an attractive force generated by a potential of the kind $1/r^\alpha$, $\alpha >0$, with the only constraint to be a simple choreography: if $q_1(t),...,q_n(t)$ are the $n$ orbits then we impose the existence of x \in H^1_{2 \pi}(\RR,\RR^d) such that q_i(t)=x(t+(i-1) \tau), i=1,...,n, t \in \RR, where $\tau = 2\pi / n$. In this setting, we first prove that for every d,n \in \NN and $\alpha>0$, the lagrangian action attains its absolute minimum on the planar circle. Next we deal with the problem in a rotating frame and we show a reacher phenomenology: indeed while for some values of the angular velocity minimizers are still circles, for others the minima of the action are not anymore rigid motions.Comment: 24 pages; 4 figures; submitted to Nonlinearit