PENG block and LIA as a possible anesthesia technique for total hip arthroplasty

The aim of this study is to evaluate the efficacy of the pericapsular nerve group block and local infiltration analgesia (LIA) combination as the only anesthesia technique for the total hip arthroplasty (THA). We considered the anesthetic plan, postoperative analgesia, hospital length of stay, functional recovery, bleeding, complications and the adverse events. We reported 10 ASA I-II patients admitted for elective primary THA, receiving LIA during (5) and at the end of surgery (5). For the PENG block we used a single injection of 40 ml levobupivacaine 0.25% and dexamethasone 4 mg. For LIA, a mixture of 0.25% levobupivacaine, ketorolac, epinephrine, and morphine was injected into periarticular tissues. The pain intensity was evaluated with a numeric rating scale. All patients were fully satisfied and improvement in pain relief, symptoms, and functional activity was remarkable. Intraoperative blood losses ranged 100-600 ml. No intraoperative complications or signs of toxicity occurred. The median duration of surgery was 59.5 ± 4.5 min and the hospital stay ranged between 2 and 3 days. PENG block and LIA could be hypothesized as an effective and safety anesthesia technique for the THA surgery, facilitating hip functional recovery and limit intraoperative blood losses and adverse events

Recurrent patterns in fluid geochemistry data prior to phreatic eruptions

Not all volcanic eruptions are magma-driven: the sudden evaporation and expansion of heated groundwater may cause phreatic eruptions, where the magma involvement is absent or negligible. Active crater lakes top some of the volcanoes prone to phreatic activity. This kind of eruption may occur suddenly, and without clear warning: on September 27, 2014 a phreatic eruption of Ontake, Japan, occurred without timely precursors, killing 57 tourists near the volcano summit. Phreatic eruptions can thus be as fatal as higher VEI events, due to the lack of recognised precursory signals, and because of their explosive and violent nature. In this study, we tackle the challenge of recognising precursors to phreatic eruptions, by analysing the records of two phreatically” active volcanoes in Costa Rica, i.e. Poás and Turrialba, respectively with and without a crater lake. These volcanoes cover a wide range of time scales in eruptive behaviour, possibly culminating into magmatic activity, and have a long-term multi-parameter dataset mostly describing fluid geochemistry. Such dataset is suitable for being analysed by objective pattern recognition techniques, in search for recurrent schemes. The aim is to verify the existence and nature of potential precursory patterns, which will improve our understanding of phreatic events, and allow the assessment of the associated hazard at other volcanoes, such as Campi Flegrei or Vulcano, in Italy. Quantitative forecast of phreatic activity will be performed with BET_UNREST, a Bayesian Event Tree tool recently developed within the framework of FP7 EU VUELCO project. The study will combine the analysis of fluid geochemistry data with pattern recognition and phreatic eruption forecast on medium and short-term. The study will also provide interesting hints on the features that promote or hinder phreatic activity in volcanoes that host well-developed hydrothermal circulation.PublishedVienna, Austria4V. Dinamica dei processi pre-eruttivi6V. Pericolosità vulcanica e contributi alla stima del rischi

Multi-variate analysis of the monitoring data at Vulcano and Campi Flegrei

This contribution describes the work-in-progress within the project FREAPROB, funded by INGV. The ultimate goal is to seek signals or recurrent patterns within data of different nature (from geochemistry, geodesy, gravity and seismology), which are recorded at two of the best monitored volcanoes in the world, Vulcano and Campi Flegrei (Italy). In fact, despite the strong monitoring effort, the multivariate and objective analysis of the monitoring observations from different disciplines is still uncommon. The first step of our work has been the collection, collation and homogeneization of some of the available data. At Campi Flegrei, the dataset features all published geochemical data from the two main fumaroles (Bocca Grande and Bocca Nuova), gravity residuals, ground displacement and seismic activity, all recorded by Osservatorio Vesuviano in the last decades. This dataset is being analysed in search for recurrent patterns describing periods of higher fumarolic temperature or characterized by greater deformation rate. For the case of Vulcano, data from the continuous monitoring of the crater rim's fumaroles were collated with the records from the monthly surveys that have been carried out in the last 25 years to monitor the largest and most persistent fumaroles at the La Fossa crater. The fumarole observations (consisting of temperature and geochemical variables) were further merged with the observations from the seismic network to constitute the base for a multivariate analysis. Aim of the analysis is the identification of patterns capable of discriminating periods of high and low temperature at the fumaroles, or periods characterized by more intense seismic activity. This contribution underlines and encourages the development of multivariate datasets and databases that allow searching, through objective statistical analysis, signals and patterns that are difficult to extract “by eye”.IAVCEIPublishedPuerto Varas, Chile4V. Dinamica dei processi pre-eruttiv

Immature platelet fraction in predicting sepsis in critically ill patients

Purpose: To establish whether in critically ill patients without sepsis at intensive care unit (ICU) admission the percentage immature platelet fraction (IPF%) is a cellular marker predicting sepsis to verify a possible correlation between IPF% changes and manifest sepsis and describe the IPF% time course after ICU admission. Methods: Prospective, observational 7-day study of 64 adult patients admitted to a general ICU at a University Hospital with no sepsis criteria. We measured daily IPF%, procalcitonin (PCT), C-reactive protein, platelets, white blood cell count and coagulation variables. Thirty-one patients with sepsis at ICU admission were studied as controls. Results: The only variable we tested at ICU admission that predicted sepsis was plasma IPF% (p 4.7 %: sensitivity 56.2 % IC 37.7-73.6; specificity 90.0 % IC 73.4-97.8). IPF% and PCT values were higher for the patients who had sepsis at admission and during the study than in patients in whom sepsis never developed (IPF%: p = 0.017; PCT: p = 0.030). Among the outcome variables, logistic regression was identified as the only variable related to the development of sepsis, IPF% (r = 0.51; p = 0.004). In patients who developed sepsis IPF% was inversely correlated with platelet count (r = -0.60; p < 0.001) and had high values before sepsis became manifest, decreasing significantly on the 2nd day thereafter. Conclusions: In patients without sepsis at ICU admission IPF% increases before sepsis becomes manifest. Measuring IPF% through an easily available technology can therefore provide an early cellular marker predicting the development of sepsis. © 2012 Springer-Verlag Berlin Heidelberg and ESICM