COVID-19 and pulmonary rehabilitation: preparing for phase three.

Considering the expected high burden of respiratory, physical and psychological impairment following the acute phase of COVID-19, a huge number of patients should be referred early to a rehabilitation program. Pulmonary rehabilitation is an evidence-based, well recognized and widely accepted and available to cover these needs

Multiple Parton Interactions, top--antitop and W+4j production at the LHC

The expected rate for Multiple Parton Interactions (MPI) at the LHC is large. This requires an estimate of their impact on all measurement foreseen at the LHC while opening unprecendented opportunities for a detailed study of these phenomena. In this paper we examine the MPI background to top-antitop production, in the semileptonic channel, in the early phase of data taking when the full power of $b$--tagging will not be available. The MPI background turns out to be small but non negligible, of the order of 20% of the background provided by W+4j production through a Single Parton Interaction. We then analyze the possibility of studying Multiple Parton Interactions in the W+4j channel, a far more complicated setting than the reactions examined at lower energies. The MPI contribution turns out to be dominated by final states with two energetic jets which balance in transverse momentum, and it appears possible, thanks to the good angular resolution of ATLAS and CMS, to separate the Multiple Parton Interactions contribution from Single Parton Interaction processes. The large cross section for two jet production suggests that also Triple Parton Interactions (TPI) could provide a non negligible contribution. Our preliminary analysis suggests that it might be indeed possible to investigate TPI at the LHC.Comment: Typos fixed. Published in JHE

Inspiratory muscle training improves breathing pattern during exercise in COPD patients (letter).

The addition of IMT to a PR programme for selected COPD patients changes breathing pattern during exercise

Electro-oxidative depolymerisation of technical lignin in water using platinum, nickel oxide hydroxide and graphite electrodes

In order to improve the lignin exploitation to added-value bioproducts, a mild chemical conversion route based on electrochemistry was investigated. For the first time, soda lignin Protobind™ 1000 (technical lignin from the pulp & paper industry) was studied by cyclic voltammetry to preliminarily investigate the effect of the main reaction parameters, such as the type of electrode material (platinum, nickel oxide hydroxide, graphite), the pH (12, 13, 14), the scan rate (10, 50, 100, 250 mV s-1), the substrate concentration (2, 20 g L-1) and the oxidation/reduction potential (from -0.8 to +0.8 V). Under the optimal reaction conditions among those tested (NiOOH electrode, pH 14, lignin 20 g L-1, 0.4 V), the electro-oxidative depolymerisation of lignin by electrolysis was performed in a divided cell. The reaction products were identified and quantified by ultra-pressure liquid chromatography coupled with mass spectrometry. The main products were sinapic acid, vanillin, vanillic acid, and acetovanillone. The obtained preliminary results demonstrated the potential feasibility of this innovative electrochemical route for lignin valorisation for the production of bio-aromatic chemicals

Pro-inflammatory cytokines in cryptoglandular anal fistulas

Background: Sphincter-preserving procedures for the treatment of transsphincteric fistulas fail in at least one out of every three patients. It has been suggested that failure is due to ongoing disease in the remaining fistula tract. Cytokines play an important role in inflammation. At present, biologicals targeting cytokines are available. Therefore, detection and identification of cytokines in anal fistulas might have implications for future treatment modalities. The objective of the present study was to assess local production of a selected panel of cytokines in anal fistulas, including pro-inflammatory interleukin (IL)-1β and tumor necrosis factor α (TNF-α). Methods: Fistula tract tissue was obtained from 27 patients with a transsphincteric fistula of cryptoglandular origin who underwent flap repair, ligation of the intersphincteric fistula tract or a combination of both procedures. Patients with a rectovaginal fistula or a fistul

Surviving critical illness: what is next? An expert consensus statement on physical rehabilitation after hospital discharge

Background: The study objective was to obtain consensus on physical therapy (PT) in the rehabilitation of critical illness survivors after hospital discharge. Research questions were: what are PT goals, what are recommended measurement tools, and what constitutes an optimal PT intervention for survivors of critical illness? Methods: A Delphi consensus study was conducted. Panelists were included based on relevant fields of expertise, years of clinical experience, and publication record. A literature review determined five themes, forming the basis for Delphi round one, which was aimed at generating ideas. Statements were drafted and ranked on a 5-point Likert scale in two additional rounds with the objective to reach consensus. Results were expressed as median and semi-interquartile range, with the consensus threshold set at ≤0.5. Results: Ten internationally established researchers and clinicians participated in this Delphi panel, with a response rate of 80 %, 100 %, and 100 % across three rounds. Consensus was reached on 88.5 % of the statements, resulting in a framework for PT after hospital discharge. Essential handover information should include information on 15 parameters. A core set of outcomes should test exercise capacity, skeletal muscle strength, function in activities of daily living, mobility, quality of life, and pain. PT interventions should include functional exercises, circuit and endurance training, strengthening exercises for limb and respiratory muscles, education on recovery, and a nutritional component. Screening tools to identify impairments in other health domains and referral to specialists are proposed. Conclusions: A consensus-based framework for optimal PT after hospital discharge is proposed. Future research should focus on feasibility testing of this framework, developing risk stratification tools and validating core outcome measures for ICU survivors

Long-term follow-up of retrograde colonic irrigation for defaecation disturbances

Objective. Irrigation of the distal part of the large bowel is a nonsurgical alternative for patients with defaecation disturbance. In our institution, all patients with defaecation disturbances, not responding to medical treatment and biofeedback therapy, were offered retrograde colonic irrigation (RCI). This study is aimed at evaluating the long-term feasibility and outcome of RCI. Methods. Between 1989 and 2001, a consecutive series of 267 patients was offered RCI. All patients received instructions about RCI by one of our enterostomal therapists. Twenty-eight patients were lost to follow-up. A detailed questionnaire was sent by mail to 239 patients. The total response rate was 79% (190 patients). Based on the returned questionnaires it became clear the 21 (11%) patients never started RCI. The long-term feasibility and outcome of RCI was therefore assessed in the remaining group of 169 patients. Thirty-two patients were admitted with soiling, 71 patints with faecal incontinence, 37 patients with obstructed defaecation and 29 had defaecation disturbance after low anterior resection or pouch surgery. Results. According to the returned questionnaires, RCI was considered effective by 91 (54%) patients. Among patients with soling and faecal incontinence, RCI was found to be effective in, respectively, 47 and 41% of the subjects. Despite of the reported effectiveness, 10 (67%) patients with soiling and 5 (17%) patients with faecal incontinence decide to stop. Among patients with obstructed defaecation and those with defaecation disturbances after low anterior resection or pouch surgery the effectiveness of RCI was found to be 65 and 79%, respectively. None of these patients ceased their therapy. The overall succes-rate of long-term RCI was therefore 45%. Conclusions. Long-term RCI is beneficial for 45% of patients with defaecation disturbance. In the group of patients who considered RCI effective and beneficial, discontinuation of therapy was only observe among those with soiling and faecal incontinence