La NIV nel paziente con insufficienza respiratoria cronica, la gestione domiciliare - Competenza specialistica nelle patologie pneumologiche pure

Questo capitolo ha lo scopo di revisionare la letteratura in merito ai meccanismi dell’insufficienza respiratoria cronica e gli effetti fisiologici e l’efficacia della ventilazione meccanica non invasiva nei pazienti affetti da BPCO in fase di stabilità clinica, cercando di dare indicazioni sulla selezione dei pazienti che potrebbero maggiormente beneficiare di questo trattamento

On the biology of some rice-field weeds in Sardinia : Cotula and Heteranthera

The biology and ecology of Cotula coronopifolia L. (Compositae), Heteranthera rotundifolia (Kunth) Griseb. and Heteranthera reniformis Ruiz & Pavon (Ponte- deriaceae), three new weeds naturalized in rice-fields of central-southern Sardinia, are described. Attention is focussed on the degree of propagation of these "taxa", as a consequence of their suitability for the environmental conditions of Sardinian rice- fields, where it seems that marked convergences exist with regard to the original habitat of these species.peer-reviewe

Covid-19 and ENT practice: Our experience: ENT outpatient department, ward and operating room management during the SARS-CoV-2 pandemic

Coronavirus COVID-19 SARS-CoV-2 ENT Otolaryngolog

Chronic critical illness: the price of survival

BACKGROUND: The evolution of the techniques used in the intensive care setting over the past decades has led on one side to better survival rates in patients with acute conditions and severely impaired vital functions. On the other side, it has resulted in a growing number of patients who survive an acute event, but who then become dependent on one or more life support techniques. Such patients are called chronically critically ill patients. MATERIALS & METHODS: No absolute definition of the disease is currently available, although most patients are characterized by the need for prolonged mechanical ventilation. Mortality rates are still high even after dismissal from intensive care unit (ICU) and transfer to specialized rehabilitation care settings. RESULTS: In recent years, some studies have tried to clarify the pathophysiological characteristics underlying chronic critical illness (CCI), a disease that is also characterized by severe endocrine and inflammatory impairments, partly accounting for the almost constant set of symptoms. DISCUSSION: Currently, no specific treatment is available. However, a strategic early therapeutic approach on ICU admission might try to prevent the progress of the acute disease towards chronic critical illness

Expanded Endoscopic Approach for Anterior Skull Base Tumors: Experience of a Multidisciplinary Skull Base Team

Abstract: The aim of this study is to describe the experience of a multidisciplinary skull base team with transnasal endoscopic surgery for anterior cranial base tumors. A retrospective chart review was conducted on patients who underwent an exclusive expanded transnasal approach to the anterior skull base in the period from December 2014 to November 2015. Data on patient demographics, tumor characteristics, surgical information, imaging, and postoperative complications were collected and analyzed. From a total of 120 patients with skull base diseases managed by the skull base team, 36 were admitted to this study. The overall complication rate in this series was 16.7%, gross total resection was achieved in 32 cases (88.9%) and postoperative CSF leakage occurred in 5 cases (13.9%). Our preliminary results confirm that an exclusive endoscopic transnasal approach to the anterior cranial base

Subspace Energy Monitoring for Anomaly Detection @Sensor or @Edge

The amount of data generated by distributed monitoring systems that can be exploited for anomaly detection, along with real time, bandwidth, and scalability requirements leads to the abandonment of centralized approaches in favor of processing closer to where data are generated. This increases the interest in algorithms coping with the limited computational resources of gateways or sensor nodes. We here propose two dual and lightweight methods for anomaly detection based on generalized spectral analysis. We monitor the signal energy laying along with the principal and anti-principal signal subspaces, and call for an anomaly when such energy changes significantly with respect to normal conditions. A streaming approach for the online estimation of the needed subspaces is also proposed. The methods are tested by applying them to synthetic data and real-world sensor readings. The synthetic setting is used for design space exploration and highlights the tradeoff between accuracy and computational cost. The real-world example deals with structural health monitoring and shows how, despite the extremely low computations costs, our methods are able to detect permanent and transient anomalies that would classically be detected by full spectral analysis

A Deep Learning Method for Optimal Undersampling Patterns and Image Recovery for MRI Exploiting Losses and Projections

Compressed Sensing was recently proposed to reduce the long acquisition time of Magnetic Resonance Imaging by undersampling the signal frequency content and then algorithmically reconstructing the original image. We propose a way to significantly improve the above method by exploiting a deep neural network to tackle both problems of frequency sub-sampling and image reconstruction simultaneously, thanks to the introduction of a new loss function to drive the training and the addition of a post-processing non-neural stage. Furthermore, we highlight how some of the quantities along the processing chain can be used as a proxy of the quality of the recovered image, thus allowing a self-assessment of the whole technique. All improvements hinge on the possibility of identifying constraints to which the final image must obey and suitably enforce them. The effectiveness of our approach is tested on real-world MRI acquisitions from the fastMRI public database and achieves an appreciable improvement in Peak Signal-to-Noise Ratio with respect to the original CS-based proposal with speed-up factors 4 and 8

Extensive tracheal injuries: a reasoned multi-step approach to guarantee mechanical ventilatory support developed during COVID-19 pandemic.

COVID-19 pandemic has notably increased the need for prolonged mechanical ventilation (MV) in patients with respiratory failure. This has increased the risk of extensive tracheal injuries (ETI) associated with life-threatening complications in very complex patients. Furthermore, tracheal injury treatment in COVID-19 patients has not been described yet. Three COVID-19 patients with ETI who required MV treated between April and November 2020 were included. A multi-step approach was performed in order to restore tracheal integrity with a custom remodeled stent and tracheostomy tube placement to allow ventilatory support. Efficient MV with no residual air leaks was obtained in all cases. One patient died six weeks after the procedure due to COVID-19 lung damage. Two patients have completely been weaned from MV. This multi-step procedure could be used in order to maintain ventilatory support in case of ETI, working as a bridge to subsequent surgery when clinical conditions improve

Frequency reallocation based on cochlear place frequencies in cochlear implants: a pilot study

Purpose: The aim of this study is to evaluate speech perception outcomes after a frequency reallocation performed through the creation of an anatomically based map obtained with Otoplan®, a tablet-based software that allows the cochlear duct length to be calculated starting from CT images. Methods: Ten postlingually deafened patients who underwent cochlear implantation with MED-EL company devices from 2015 to 2019 in the Tertiary referral center University Hospital of Verona have been included in a retrospective study. The postoperative CT scans were evaluated with Otoplan®; the position of the intracochlear electrodes was obtained, an anatomical mapping was carried out and then it was submitted to the patients. All patients underwent pure tonal and speech audiometry before and after the reallocation and the audiological results were processed considering the Speech Recognition Threshold (SRT), the Speech Awareness Threshold (SAT) and the Pure Tone Average (PTA). The differences in the PTA, SAT and SRT values before and after the reallocation were determined. The results were statistically processed using the software Stata with a significance value of α < 0.05. Results: The mean values of SRT (61.25 dB versus 51.25 dB) and SAT (49 dB versus 41 dB) were significantly lower (p: 0.02 and p: 0.04, respectively) after the reallocation. No significant difference was found between PTA values (41.5 dB versus 39.25 dB; p: 0.18). Conclusions: Our preliminary results demonstrate better speech discrimination and rapid adaptation in implanted postlingually deaf patients after anatomic mapping and subsequent frequency reallocation