Search

Since the outbreak of the Covid-19 pandemic, progressive social movements have been engaged in an incredibly intense period of contestation. Confronted with the unprecedented extent of the crisis, the current wave of mobilization brought together both older and newer actors, bridging generations and movement sectors, building on past experiences of previous mobilizations while also innovating in important ways. The Covid-19 pandemic provides an opportunity to contextualize the role of past mobilizations in contemporary struggles, singling out continuities and innovation in the forms of resistance, collective frames, and organizational models. This paper focuses on the framing of health rights and analyzes the emergence of care as a bridging frame in the movement campaigns developed during the Covid-19 crisis. In examining the processes of cross-temporal diffusion, it considers the legacy of the Global Justice Movement and its offspring in the current mobilization in Italy. Through the analysis of key documents produced by social movements triangulated with in-depth interviews with activists, we observe the ways in which some collective frames migrate from past mobilizations to new ones, and are adapted through the reactivation of old organizational networks and the emergence of new organizations. [ABSTRACT FROM AUTHOR]

The article examines the gender politics of populist parties in two countries historically marked by cultural traditionalism – Italy and Spain. It defines and compares the articulation of gender issues cross-nationally and intra-ideologically to understand how populist parties contest the politics of gender in the two countries. Drawing on computer-assisted qualitative content analyses of programmatic documents, it assesses the framing and salience of gender by the populist radical left (the Spanish Podemos) and right (Lega and Fratelli d'Italia in Italy; VOX in Spain), while also accounting for an ideologically ambiguous populist party (the Italian Movimento 5 Stelle). It concludes ascertaining the different salience of gender politics among Italian and Spanish populist parties and evinces multiple axes of programmatic proximity and distance – not only cross-nationally, but also intra-ideologically among parties akin. [ABSTRACT FROM AUTHOR]

This study investigated the relationship between three respiratory support approaches on lung volume recruitment during the first 2 h of postnatal life in preterm lambs. We estimated changes in lung aeration, measuring respiratory resistance and reactance by oscillometry at 5 Hz. We also measured intratracheal pressure in subsets of lambs. The first main finding is that sustained inflation (SI) applied noninvasively (Mask SI; n = 7) or invasively [endotracheal tube (ETT) SI; n = 6] led to similar rapid lung volume recruitment (∼6 min). In contrast, Mask continuous positive airway pressure (CPAP) without SI (n = 6) resuscitation took longer (∼30–45 min) to reach similar lung volume recruitment. The second main finding is that, in the first 15 min of postnatal life, the Mask CPAP without SI group closed their larynx during custom ventilator-driven expiration, leading to intratracheal positive end-expiratory pressure of ∼17 cmH2O (instead of 8 cmH2O provided by the ventilator). In contrast, the Mask SI group used the larynx to limit inspiratory pressure to ∼26 cmH2O (instead of 30 cmH2O provided by the ventilator). These different responses affected tidal volume, being larger in the Mask CPAP without SI group [8.4 mL/kg; 6.7–9.3 interquartile range (IQR)] compared to the Mask SI (5.0 mL/kg; 4.4–5.2 IQR) and ETT SI groups (3.3 mL/kg; 2.6–3.7 IQR). Distinct physiological responses suggest that spontaneous respiratory activity of the larynx of preterm lambs at birth can uncouple pressure applied by the ventilator to that applied to the lung, leading to unpredictable lung pressure and tidal volume delivery independently from the ventilator settings. NEW & NOTEWORTHY: We compared invasive and noninvasive resuscitation on lambs at birth, including or not sustained inflation (SI). Lung volume recruitment was faster in those receiving SI. During noninvasive resuscitation, larynx modulation reduced tracheal pressure from that applied to the mask in lambs receiving SI, while it led to increased auto-positive end-expiratory pressure and very large tidal volumes in lambs not receiving SI. Our results highlight the need for individualizing pressures and monitoring tidal volumes during resuscitation at birth. [ABSTRACT FROM AUTHOR]

Novel therapies are needed for bronchopulmonary dysplasia (BPD) because no effective treatment exists. Mesenchymal stromal cell extracellular vesicles (MSC-sEVs) have therapeutic efficacy in a mouse pup neonatal hyperoxia BPD model. We tested the hypothesis that MSC-sEVs will improve lung functional and structural development in mechanically ventilated preterm lambs. Preterm lambs (∼129 days; equivalent to human lung development at ∼28 wk gestation) were exposed to antenatal steroids, surfactant, caffeine, and supported by mechanical ventilation for 6–7 days. Lambs were randomized to blinded treatment with either MSC-sEVs (human bone marrow MSC-derived; 2 × 1011 particles iv; n = 8; 4 F/4 M) or vehicle control (saline iv; 4 F/4 M) at 6 and 78 h post delivery. Physiological targets were pulse oximetry O2 saturation 90–94% (P⁢aO2 60–90 mmHg), P⁢aC⁢O2 45–60 mmHg (pH 7.25–7.35), and tidal volume 5–7 mL/kg. MSC-sEVs-treated preterm lambs tolerated enteral feedings compared with vehicle control preterm lambs. Differences in weight patterns were statistically significant. Respiratory severity score, oxygenation index, A-a gradient, distal airspace wall thickness, and smooth muscle thickness around terminal bronchioles and pulmonary arterioles were significantly lower for the MSC-sEVs group. S/F ratio, radial alveolar count, secondary septal volume density, alveolar capillary surface density, and protein abundance of VEGF-R2 were significantly higher for the MSC-sEVs group. MSC-sEVs improved respiratory system physiology and alveolar formation in mechanically ventilated preterm lambs. MSC-sEVs may be an effective and safe therapy for appropriate functional and structural development of the lung in preterm infants who require mechanical ventilation and are at risk of developing BPD. NEW & NOTEWORTHY This study focused on potential treatment of preterm infants at risk of developing bronchopulmonary dysplasia (BPD), for which no effective treatment exists. We tested treatment of mechanically ventilated preterm lambs with human mesenchymal stromal cell extracellular vesicles (MSC-sEVs). The results show improved respiratory gas exchange and parenchymal growth of capillaries and epithelium that are necessary for alveolar formation. Our study provides new mechanistic insight into potential efficacy of MSC-sEVs for preterm infants at risk of developing BPD. [ABSTRACT FROM AUTHOR]

The purpose of this study is to test the hypothesis that higher consumption of human milk (HM) in preterm infants with birth weight (BW) <1000 g is associated with improved lung function in a dose-dependent manner over the first 2 years of corrected age (CA). This retrospective study at an academic medical center included infants with BW <1000g. They had lung function assessment by the tidal breathing flow-volume loop (TBFVL) follow-up visits at 0–3-, 3–6-, 6–12-, 12–18-, and 18–24-month CA. One hundred eighty infants were included in the study with a mean (SD) gestational age 26.5 (1.90) weeks and BW 772.4 (147.0) g, 50% were female, and 60% developed BPD. 62.8% of infants received HM during the NICU stay. According to a general linear model (including GA, being small for GA (SGA), sex, human milk percentage, sepsis, and BPD), on average, each week of GA resulted in a higher tPTEF/tE of 1.24 (p = 0.039) and being SGA in a lower tPTEF/tE of 5.75 (p = 0.013) at 0–3-month CA. A higher percentage of human milk out of the total enteral intake was associated with better tPTEF/tE z-scores at 0–3 months (p = 0.004) and 18–24 months of CA (p = 0.041). BPD diagnosis was associated with a relevantly worse tPTEF/tE z-score at 6–12 months of CA (p = 0.003). Conclusion: Preterm infants with higher consumption of HM had significantly less airway obstruction across the first 2 years, suggesting that human milk may contribute in a dose-dependent manner to improve lung function in early childhood in former preterm infants born ELBW. What is Known: • Human milk feeding reduces the risk of prematurity-related morbidities, including necrotizing enterocolitis, sepsis, lower respiratory tract infections, and BPD. Both exclusive and partial human milk feeding appear to be associated with a lower risk of BPD in preterm infants. What is New: • This cohort study of 180 preterm infants with birth weight < 1000 g found that exposure to human milk during hospitalization improves airway obstruction markers tPTEF/tE z-score over the first 2 years of corrected age in a dose-dependent manner. [ABSTRACT FROM AUTHOR]

Engaging with research on protest participation and gender inequalities, we examine how gender dynamics play a crucial role in shaping patterns of protest participation across the rural/urban divide. We argue that moving from a rural toward an urban setting leads to an increase in protest participation for women, but not for men. Using an original two-wave panel survey dataset collected for the same individuals between 2018 and 2019 and covering nine European countries, we are able to go beyond traditional correlation analyses and measure our key variables over time, thus developing a dynamic approach that links differences in gender, socio-geographical positioning and protest participation. Our findings demonstrate that the rural/urban divide as a driver of protest participation affects women and men differently, because it might be shaped by different experiences of political socialization, socio-economic status and structures of domination and discrimination, leading to different opportunities and incentives for mobilization. [ABSTRACT FROM AUTHOR]

While there is extensive literature about public concern about climate change, most studies rely on cross-sectional static data. Based on a unique panel survey conducted in nine European countries in 2018 and 2019, we make a rare investigation of factors that explain why some young people (age: 18–34 years) are, have become or have lost their concern about climate and environmental issues at times of widespread discussions about the climate emergency. The analysis tests argument about the importance of individual-level factors such as values and political orientations and consider the role of cross-national variations, the experience of extreme weather events and youth-led climate strikes. Our results support prior studies as we find that young people with libertarian rather than authoritarian values, with more positive views towards immigration and redistribution policies, tend to be more concerned about climate change and the environment. We find little effect of contextual factors. Young people who have experienced economic hardship and have a right-wing political orientation are less likely to become concerned for climate and environmental issues. Socio-economic conditions, values and political orientations are crucial to understanding climate concern among young Europeans, affecting youth climate engagement at times of increasing inequalities and polarization. [ABSTRACT FROM AUTHOR]

Contemporary anti-gender movements mobilize against gender and sexual equality for which feminist and LGBTQI+ movements have been advocating for decades. We propose the term 'contentious gender politics' to capture this clash of opposing movements concerning bodily integrity, kinship structures, sexual morality, and institutionalization of gender equality. Existing literature has recognized the transnational character of anti-gender movements and identified matching tactics, frames, and allies across different countries. We examine how these transnational movements used similar campaigns to 'localize'. Localization is conceptualized in this research as the process of adapting frames and tactics to different national contexts. To do so, this study examines the diffusion of social movements and anti-gender campaigns by comparing anti-gender movements in Italy and Croatia through critical events between 2013 and 2019. We demonstrate that the localization of these anti-gender movements occurred through a three-step pathway: first, by adapting frames and tactics of left-liberal civil society and progressive movements; second, by forging alliances with existing right-wing parties; and third, by embedding its agenda within formal political and administrative bodies. [ABSTRACT FROM AUTHOR]

Introduction: We evaluate the accuracy of postnatal biochemical and lung function tests performed within 3 h from birth for predicting surfactant need in preterm infants ≤34 weeks' gestation receiving noninvasive respiratory support for respiratory distress syndrome (RDS). Methods: We systematically searched MEDLINE, Embase, The Cochrane Library, PROSPERO, and clinicaltrials.gov databases for studies published from 2000 to November 10, 2021, cross-referencing relevant literature and contacting experts. We included diagnostic accuracy studies and systematic reviews of biochemical or lung function tests identifying the need for surfactant in preterm neonates ≤34 weeks' with RDS not intubated at birth. The authors individually assessed the risk of bias following a tailored QUADAS-2 tool. Results: Eight studies, including 810 infants, met the inclusion criteria. Four tests were included: the click test, the stable microbubble test, the lamellar body count on gastric aspirates, and the forced oscillation technique. The reference standards were transparent criteria for distinguishing the infants according to oxygen requirement, which reflected the current criteria for surfactant therapy. The risk of bias was judged high because of the population selection and exclusion of participants from the analysis. There were no serious concerns regarding blinding and applicability. The individual study sensitivity and specificity range from 0.60 to 1 and from 0.51 to 0.91, respectively. It was not appropriate to combine the accuracy estimates in a meta-analysis because of the heterogeneity of the study characteristics. Conclusions: Current evidence is insufficient to recommend biochemical and lung function tests for tailoring surfactant therapy. [ABSTRACT FROM AUTHOR]

Following the death of George Floyd on May 25, 2020 and inspired by the actions of the Black Lives Matter movement in the United States, in June 2020 a wave of protest events spread across Europe as well. Based on in‐depth interviews with key informants involved in the BLM campaign and a systematic mapping of protest events, the article analyses the diffusion of the Black Lives Matter movement campaign in Italy. We investigate the conditions for the diffusion, by considering the resonance of the protests in a time of backlash and pandemic; the channels of diffusion, namely mechanisms of thin diffusion linked to the instantaneous exchange of protest content; and the effects of diffusion, in terms of recontextualization of ideas and narratives from the United States to the Italian context, the emergence of new antiracist organizations and intersectional frames that point at Italian colonialism and structural racism. [ABSTRACT FROM AUTHOR]

Prompt and stable control of hyperthyroidism is fundamental to avoid the detrimental effects of thyroid hormone excess, and antithyroid drugs, mainly methimazole (MMI), represent the first-line treatment for Graves' disease (GD) hyperthyroidism. Decreased serum concentrations of selenium (Se) and calcifediol (25(OH)D, VitD) have been reported in newly diagnosed GD patients in observational studies. Low Se levels might exacerbate oxidative stress by compromising the antioxidant machinery's response to reactive oxygen species, and low VitD levels might hamper the anti-inflammatory immune response. We performed a randomized controlled clinical trial (EudraCT 2017-00505011) to investigate whether Se and cholecalciferol (VitD) addition to MMI is associated with a prompter control of hyperthyroidism. Forty-two consecutive patients with newly-onset GD and marginal/insufficient Se and VitD levels were randomly assigned to treatment with either MMI monotherapy or MMI combined with Se and VitD. Se treatment was withdrawn after 180 days, while the other treatments were continued. Combination therapy resulted in a significantly greater reduction in serum FT4 concentration at 45 days (-37.9 pg/ml, CI 95%, -43.7 to -32.2 pg/ml) and 180 days (-36.5 pg/ml, CI 95%, -42 to -30.9 pg/ml) compared to MMI monotherapy (respectively: -25.7 pg/ml, CI 95%, -31.6 to -19.7 pg/ml and -22.9 pg/ml, CI 95%, -28 to -17.3 pg/ml, p 0.002). Data at 270 days confirmed this trend (-37.8 pg/ml, CI 95%, -43.6 to -32.1 pg/ml vs -24.4 pg/ml, CI 95%, -30.3 to -18.4 pg/ml). The quality of life (QoL) score was investigated by the validated "Thyroid-related Patient-Reported Outcome" questionnaire (ThyPRO). ThyPRO composite score showed a greater improvement in the intervention group at 45 days (-14.6, CI 95%, -18.8 to -10.4), 180 (-9, CI 95%, -13.9 to -4.2) and 270 days (-14.3, CI 95%, -19.5 to -9.1) compared to MMI group (respectively, -5.2, CI 95%, -9.5 to -1; -5.4, CI 95%, -10.6 to -0.2 and -3.5, CI 95%, -9 to -2.1, p 0-6 months and 6-9 months <0.05). Our results suggest that reaching optimal Se and VitD levels increases the early efficacy of MMI treatment when Se and VitD levels are suboptimal. [ABSTRACT FROM AUTHOR]

This paper draws on a study of the life course of 40 young people (aged 18–35) in Bologna (Italy), who are active in eight different political organizations. It explores whether the political organization, given that the city's political context is the same for all participants, affects the variation of their pathways. It does so by answering the following question: which phases in the lives of young participants are interconnected with the political organizations they are engaged in? To evaluate the impact of the organizational context on young participants, we will take into consideration three dimensions: the degree of bureaucratization, forms of action, and political orientation. Situated at the intersection of youth and social movement studies, this paper aims to advance our understanding of the connections between primary and political socialization processes in shaping young participants' mobilization and sustained participation within different political organizations. Our empirical findings show that, if the degree of bureaucratization was constantly salient in the two phases, on the other hand political orientation was more salient during participants' mobilization and the forms of action during participants' sustained participation. In the conclusion, the paper critically discusses the empirical findings of our analysis of the respondents' narratives. [ABSTRACT FROM AUTHOR]

High-flow nasal cannula (HFNC) is a non-invasive respiratory support (NRS) modality to treat premature infants with respiratory distress syndrome (RDS). The delivery of nebulized surfactant during NRS would represent a truly non-invasive method of surfactant administration and could reduce NRS failure rates. However, the delivery efficiency of nebulized surfactant during HFNC has not been evaluated in vitro or in animal models of respiratory distress. We, therefore, performed first a benchmark study to compare the surfactant lung dose delivered by commercially available neonatal nasal cannulas (NCs) and HFNC circuits commonly used in neonatal intensive care units. Then, the pulmonary effect of nebulized surfactant delivered via HFNC was investigated in spontaneously breathing rabbits with induced respiratory distress. The benchmark study revealed the surfactant lung dose to be relatively low for both types of NCs tested (Westmed NCs 0.5 ± 0.45%; Fisher & Paykel NCs 1.8 ± 1.9% of a nominal dose of 200 mg/kg of Poractant alfa). The modest lung doses achieved in the benchmark study are compatible with the lack of the effect of nebulized surfactant in vivo (400 mg/kg), where arterial oxygenation and lung mechanics did not improve and were significantly worse than the intratracheal instillation of surfactant. The results from the present study indicate a relatively low lung surfactant dose and negligible effect on pulmonary function in terms of arterial oxygenation and lung mechanics. This negligible effect can, for the greater part, be explained by the high impaction of aerosol particles in the ventilation circuit and upper airways due to the high air flows used during HFNC. [ABSTRACT FROM AUTHOR]

This article investigates the impact of intolerance on online political participation among young Europeans. Based on the theoretical insights of (in)tolerance, political participation, youth, and media studies, we explore whether and to what extent intolerant attitudes drive young people's online political participation. In doing this, we draw on original survey data with booster samples for young people, covering nine European countries. Our results show that intolerance leads to more online political activities among young people. However, these individuals are not socially isolated and marginalised; in fact, the effect of intolerant attitudes on online political engagement is reinforced by participation in offline unconventional forms of participation and social capital. Our findings bear important consequences for the understanding of intolerant attitudes, youth politics, and (online) political participation. [ABSTRACT FROM AUTHOR]

Background: Current criteria for surfactant administration assume that hypoxia is a direct marker of lung-volume de-recruitment. We first introduced an early, non-invasive assessment of lung mechanics by the Forced Oscillation Technique (FOT) and evaluated its role in predicting the need for surfactant therapy.Objectives: To evaluate whether lung reactance (Xrs) assessment by FOT within 2 h of birth identifies infants who would need surfactant within 24 h; to eventually determine Xrs performance and a cut-off value for early detection of infants requiring surfactant.Methods: We conducted a prospective, observational, non-randomized study in our tertiary NICU in Milan. Eligible infants were born between 27+0 and 34+6 weeks' gestation, presenting respiratory distress after birth.Exclusion Criteria: endotracheal intubation at birth, major malformations participation in other interventional trials, parental consent denied. We assessed Xrs during nasal CPAP at 5 cmH2O at 10 Hz within 2 h of life, recording flow and pressure tracing through a Fabian Ventilator for off-line analysis. Clinicians were blinded to FOT results.Results: We enrolled 61 infants, with a median [IQR] gestational age of 31.9 [30.3; 32.9] weeks and birth weight 1490 [1230; 1816] g; 2 infants were excluded from the analysis for set-up malfunctioning. 14/59 infants received surfactant within 24 h. Xrs predicted surfactant need with a cut-off - 33.4 cmH2O*s/L and AUC-ROC = 0.86 (0.76-0.96), with sensitivity 0.85 and specificity 0.83. An Xrs cut-off value of - 23.3 cmH2O*s/L identified infants needing surfactant or respiratory support > 28 days with AUC-ROC = 0.89 (0.81-0.97), sensitivity 0.86 and specificity 0.77. Interestingly, 12 infants with Xrs < - 23.3 cmH2O*s/L (i.e. de-recruited lungs) did not receive surfactant and subsequently required prolonged respiratory support.Conclusion: Xrs assessed within 2 h of life predicts surfactant need and respiratory support duration in preterm infants. The possible role of Xrs in improving the individualization of respiratory management in preterm infants deserves further investigation. [ABSTRACT FROM AUTHOR]

Aim: To assess the agreement of heart rate (HR) between the new device – a fabric jacket for neonates, with integrated sensors detecting ECG signals and a Bluetooth connection to a computer (ComfTech, HOWDY) – and the clinical reference, ECG, during the skin‐to‐skin contact (SSC) in the first 2 h after birth, for the potential use of early detection of Sudden and Unexpected Postnatal Collapse (SUPC). Methods: We enrolled newborns ≥35+0 weeks of gestation, with Apgar score >8 at 5 min in a prospective, observational study in the delivery room, excluding infants with need for resuscitation, clinical instability or major malformations. We assessed HR within 20 min after birth by both devices simultaneously: the index test ComfTech HOWDY and the standard ECG (Vita Guard VG 3100, Getemed). We compared HR between the two methods at 0, 15, 30, 45, 60, 90 and 120 min by the Bland–Altman plot. Results: We included 60 infants. The mean difference between the methods was −1.3 bpm, 95%LoA −12.4 to 9.7 bpm. Spearman rank correlation coefficient ρ = −0.06. Conclusion: ComfTech HOWDY presents reliable agreement with the ECG and might assist in identifying infants at risk for SUPC. [ABSTRACT FROM AUTHOR]

Recent scientific studies have reached the near-unanimous conclusion that the media produce a stereotypical representation of young people. However, research in this area has not often scrutinized whether there are any significant differences in the coverage of the subject matter. Notably, this article examines whether the political leaning of newspapers has any impact on the levels of plurality in the news coverage of youth. On the basis of political claim analyses of six newspapers from three countries (Greece, Italy, and Spain), we find that the coverage of youth in the public debate is very similar if we compare center-right to center-left newspapers. This suggests that the social construction of the concept of youth dominates in the adult world, regardless of any political differences. Nonetheless, differences emerge when young people are given the opportunity to speak for themselves; center-left newspapers are more likely to recognize the agency of, and give a voice to, young people. [ABSTRACT FROM AUTHOR]

Looking at the French approach to migration in four key political moments between 2014 and 2018, three main narratives can be seen as dominating the French debate on migration, namely the Westphalian, the humanitarian and the multilateral, each related to various justice claims. Surprisingly, a securitarian approach was not as dominant as expected. However, different justice claims were used to support various political interests, often in a clearly instrumental way. In France today, the politics of migration are still important for the country's foreign policy and are not just a domestic issue. [ABSTRACT FROM AUTHOR]

Between 2013 and 2016, a broad range of Catholic groups following pro-life and pro-family agendas has conducted a large anti-gender campaign, whose main result was the definition of a Catholic anti-gender movement in Italy. The anti-gender movement, opposed to the approval of the bill on civil unions for same-sex couples and the introduction of gender education programs in schools, has grown in popularity, becoming a source of participation and protest for politically committed Catholic and social conservative actors. The emergence and consolidation of the movement has marked a new phase of political Catholicism characterized, on the one hand, by an intensification of protest and lobbying activities in the public and political arenas and, on the other, by a descent into the electoral arena of a part of the movement with the constitution of an autonomous political subject, the People of the Family party. This article proposes to analyze the dynamics of politicization of the anti-gender cause, with the aim of advancing the argument that long-lasting dilemmas are still affecting Catholic politics concerning the best strategies to combine religious coherence, political representation and consensus for the Italian Catholic militancy in an increasingly complex post-secular society. [ABSTRACT FROM AUTHOR]

Ferroelectric (FE) hafnium oxide is a promising candidate for memory applications. In this paper, endurance, imprint, and retention tests are carried out on FE aluminum-doped hafnium oxide thin films with different electrodes: 1) metal–insulator–metal (MIM) and 2) silicon–insulator–silicon(SIS). MIM devices exhibit higher endurance than SIS devices. However, SIS devices show superior imprint and retention, with an extrapolated retention time-to-failure larger than 10 years at 85 °C. These results are very promising to integrate FE-HfO2 in 3-D structures, either for dynamic random access memory or for NAND applications. [ABSTRACT FROM PUBLISHER]

Respiratory transition at birth involves rapidly clearing fetal lung liquid and preventing efflux back into the lung while aeration is established. We have developed a sustained inflation (SIOPT) individualized to volume response and a dynamic tidal positive end-expiratory pressure (PEEP) (open lung volume, OLV) strategy that both enhance this process. We aimed to compare the effect of each with a group managed with PEEP of 8 cmH2O and no recruitment maneuver (No-RM), on gas exchange, lung mechanics, spatiotemporal aeration, and lung injury in 127 ± 1 day preterm lambs. Forty-eight fetal-instrumented lambs exposed to antenatal steroids were ventilated for 60 min after application of the allocated strategy. Spatiotemporal aeration and lung mechanics were measured with electrical impedance tomography and forced-oscillation, respectively. At study completion, molecular and histological markers of lung injury were analyzed. Mean (SD) aeration at the end of the SIOPT and OLV groups was 32 (22) and 38 (15) ml/kg, compared with 17 (10) ml/kg (180 s) in the No-RM (P = 0.024, 1-way ANOVA). This translated into better oxygenation at 60 min (P = 0.047; 2-way ANOVA) resulting from better distal lung tissue aeration in SIOPT and OLV. There was no difference in lung injury. Neither SIOPT nor OLV achieved homogeneous aeration. Histological injury and mRNA biomarker upregulation were more likely in the regions with better initial aeration, suggesting volutrauma. Tidal ventilation or an SI achieves similar aeration if optimized, suggesting that preventing fluid efflux after lung liquid clearance is at least as important as fluid clearance during the initial inflation at birth. [ABSTRACT FROM AUTHOR]

A sustained first inflation (SI) at birth may aid lung liquid clearance and aeration, but the impact of SI duration relative to the volume-response of the lung is poorly understood. We compared three SI strategies: 1) variable duration defined by attaining volume equilibrium using real-time electrical impedance tomography (EIT; SIplat); 2) 30 s beyond equilibrium (SIlong); 3) short 30-s SI (SI30); and 4) positive pressure ventilation without SI (no-SI) on spatiotemporal aeration and ventilation (EIT), gas exchange, lung mechanics, and regional early markers of injury in preterm lambs. Fifty-nine fetal-instrumented lambs were ventilated for 60 min after applying the allocated first inflation strategy. At study completion molecular and histological markers of lung injury were analyzed. The time to SI volume equilibrium, and resultant volume, were highly variable; mean (SD) 55 (34) s, coefficient of variability 59%. SIplat and SIlong resulted in better lung mechanics, gas exchange and lower ventilator settings than both no-SI and SI30. At 60 min, alveolar-arterial difference in oxygen was a mean (95% confidence interval) 130 (13, 249) higher in SI30 vs. SIlong group (two-way ANOVA). These differences were due to better spatiotemporal aeration and tidal ventilation, although all groups showed redistribution of aeration towards the nondependent lung by 60 min. Histological lung injury scores mirrored spatiotemporal change in aeration and were greatest in SI30 group (P < 0.01, Kruskal-Wallis test). An individualized volume-response approach to SI was effective in optimizing aeration, homogeneous tidal ventilation, and respiratory outcomes, while an inadequate SI duration had no benefit over positive pressure ventilation alone. [ABSTRACT FROM AUTHOR]

Objective: To compare the effect of heated, humidified, high-flow nasal cannula (HHHFNC) and nasal continuous positive airways pressure (NCPAP) on lung function and mechanics in preterm infants with respiratory distress syndrome (RDS) at the same level of retropharyngeal pressure (Prp). Design Randomised: crossover trial. Setting: Neonatal intensive care unit, Ospedale Maggiore Policlinico, Milan, Italy. Patients: 20 preterm infants (gestational age: 31±1 wks) with mild-moderate RDS requiring non-invasive respiratory support within 96 h after birth. Interventions: Infants were exposed to a randomised sequence of NCPAP and HHHFNC at different settings (2, 4 and 6 cmH2O for NCPAP and 2, 4, 6 L/min for HHHFNC) to enable comparison at the same level of Prp. Main outcome measures: Tidal volume by respiratory inductance plethysmography, pleural pressure estimated by oesophageal pressure, and gas exchange were evaluated at each setting and used to compute breathing pattern parameters, lung mechanics and work of breathing (WOB). Results: A poor linear regression between flow and Prp was found during HHHFNC (Prp=0.3+0.7*flow; r²=0.37). Only in 15 out of 20 infants it was possible to compare HHHFNC and NCPAP at a Prp of 2 and 4 cmH2O. No statistically significant differences were found in breathing pattern, gas exchange, lung mechanics and total WOB. Resistive WOB in the upper airways was slightly but significantly higher during HHHFNC (0.65 (0.49;1.09) vs 1.57 (0.85;2.09) cmH2O median (IQR)). Conclusions: Despite differing mechanisms for generating positive airway pressure, when compared at the same Prp, NCPAP and HHHFNC provide similar effects on all the outcomes explored. [ABSTRACT FROM AUTHOR]

The purpose of this investigation was to collect information regarding rhinovirus (RV) circulation in children with lower respiratory tract infections (LRTIs) in Burundi, Central Africa. We enrolled all of the children aged between 1 month and 14 years who were admitted to the hospital of Kiremba, North Burundi, with fever and signs and symptoms of LRTI (i.e., cough, tachypnea, dyspnea or respiratory distress, and breathing with grunting or wheezing sounds with rales) between 1 November 2010 and 31 October 2011, and obtained nasopharyngeal swabs for RV detection by means of polymerase chain reaction (PCR). The VP4/VP2 region of the positive samples was sequenced to determine the species of RV (A, B, or C). Four hundred and sixty-two children were enrolled: 160 (34.6 %) with bronchitis, 35 (7.6 %) with infectious wheezing, and 267 (57.8 %) with community-acquired pneumonia (CAP). RV infection was demonstrated in 186 patients [40.3 %; mean age ± standard deviation (SD) 1.77 ± 2.14 years]. RV infection was detected in 78 patients aged <12 months (40.0 %), 102 aged 12-48 months (44.3 %), and six aged >48 months (16.7 %; p < 0.01 vs. the other age groups). The most frequently identified RV was RV-A (81 cases, 43.5 %), followed by RV-C (47, 25.3 %) and RV-B (18, 9.7 %); subtyping was not possible in 40 cases (21.5 %). RV-A was significantly associated with bronchitis and CAP ( p < 0.01) and RV-C with wheezing ( p < 0.05). In Burundi, RVs are frequently detected in children with LRTIs. RV-A seems to be the most important species and is identified mainly in patients with bronchitis and CAP. [ABSTRACT FROM AUTHOR]