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L’épidémiologie de l’hypertension pulmonaire associée à une maladie pulmonaire et/ou une hypoxie (HTP-MPC), incluant l’HTP associée à une pneumopathie interstitielle diffuse (HTP-PID), est peu connue en France. Cette étude longitudinale rétrospective a pour objectif de caractériser la prévalence et l’incidence de ces deux situations à partir de la base de données des demandes de remboursement des hôpitaux français (Programme de médicalisation des systèmes d’information, PMSI).

The constant growth of solid and hazardous waste production is increasing the European concerns about the protection of the environment and natural resources. It is estimated that Europe produces up to 3 billion tons of waste every year. EU is promoting several waste management policies aiming to reduce the environmental impacts of waste and improve Europe's resource efficiency. In this context, public administration of numerous Italian regions are showing more attention in order to reducing the environmental impacts related to solid and hazardous waste management. Life cycle assessment (LCA) is a powerful tool to quantify environmental impacts and determine the potential management strategies to reduce these impacts. Nevertheless, the identification of Life Cycle Inventory (LCI) modelling framework to model multifunctionality could be a very critical point. This study analyzed the environmental performance of the waste management, including municipal solid waste and industrial waste, in the Emilia Romagna region (Italy) adopting attributional and consequential approaches. The influence of LCI modelling frameworks on the environmental results has been investigated.

Evaluating and testing hydration status is increasingly requested by rehabilitation, sport, military and performance-related activities. Besides commonly used biochemical hydration assessment markers within blood and urine, which have their advantages and limitations in collection and evaluating hydration status, there are other potential markers present within saliva, sweat or tear. This literature review focuses on body fluids saliva, sweat and tear compared to blood and urine regarding practicality and hydration status influenced by fluid restriction and/or physical activity. The selected articles included healthy subjects, biochemical hydration assessment markers and a well-described (de)hydration procedure. The included studies (n=16) revealed that the setting and the method of collecting respectively accessing body fluids are particularly important aspects to choose the optimal hydration marker. To obtain a sample of saliva is one of the simplest ways to collect body fluids. During exercise and heat exposures, saliva composition might be an effective index but seems to be highly variable. The collection of sweat is a more extensive and time-consuming technique making it more difficult to evaluate dehydration and to make a statement about the hydration status at a particular time. The collection procedure of tear fluid is easy to access and causes very little discomfort to the subject. Tear osmolarity increases with dehydration in parallel to alterations in plasma osmolality and urine-specific gravity. But at the individual level, its sensitivity has to be further determined.

Several guidelines have been published about management of chronic GvHD (cGvHD), but the clinical practice still remains demanding. The Gruppo Italiano Trapianto di Midollo Osseo (GITMO) has planned a prospective observational study on cGvHD, supported by a dedicated software, including the updated recommendations. In view of this study, two surveys have been conducted, focusing the management of cGvHD and ancillary therapy in cGvHD, to address the current ‘real life’ situation. The two surveys were sent to all 57 GITMO centers, performing allografting in Italy; the response rate was 57% and 66% of the interviewed centers, respectively. The first survey showed a great disparity especially regarding steroid-refractory cGvHD, although extracorporeal photo-apheresis resulted as the most indicated treatment in this setting. Another challenging issue was the strategy for tapering steroid: our survey showed a great variance, and this disagreement could be a real bias in evaluating outcomes in prospective studies. As for the second survey, the results suggest that the ancillary treatments are not standardized in many centers. All responding centers reported a strong need to standardize management of cGvHD and to participate in prospective trials. Before starting observational and/or interventional studies, a detailed knowledge of current practice should be encouraged.

Nowadays the reliable modeling of real fluid flows is of paramount importance in many industrial applications, especially in the energy field with the growing diffusion of Organic Rankine Cycles, supercritical CO 2 compressors, and advanced refrigeration systems. In these applications the assumption of flow ideality is profoundly inaccurate and may lead to erroneous physical interpretations. As a consequence thereof, various thermodynamic models have been recently developed for real gases and a number of tools are by now available to accurately predict the thermodynamic properties of fluids in presence of relevant non-ideal effects. However, these thermodynamic libraries are frequently computationally inefficient when coupled with existing simulation codes, such as in process modeling and computational fluid-dynamics (CFD). An effective alternative is proposed in this paper. The equations of state embedded in the thermodynamic programs are used, at preliminary level, to construct a grid of nodes storing a subset of thermo-physical properties, i.e. v , s , e , k , μ , required by the method for a given region of interest. Then, an interpolation-based method is conceived for determining the remaining properties in any other point. A key feature is as follows: the nodal values of the basic thermodynamic quantities are used to locally construct, i.e., within each cell of the table, a model of the fundamental relation, assuming a differentiable functional form of at least C 2 class. The presented Look-up Table (LuT) approach is intrinsically consistent and guarantees thermodynamic stability, with inherent high accuracy and very limited computational costs, as demonstrated by the quantitative examples reported in the paper. As a final step, the LuT method is coupled with two in-house flow solvers and applied to simulate real gas transonic flow in Organic Rankine Cycle turbines; a comprehensive assessment of the approach is provided by comparison with direct equations of state implementation. [ABSTRACT FROM AUTHOR]

Background: The management of venous thromboembolism (VTE) requires an initial treatment with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH), followed by oral anticoagulants (OA) for at least 3 months. OA treatment however, requires laboratory monitoring of anticoagulation, carries a definite risk of bleeding, and may be contraindicated in some patients. As an alternative to vitamin K antagonists, subcutaneous LMWH has been proposed and evaluated in randomized clinical trials, but they are all small studies that lack the power to establish if these two treatment modalities are equivalent in efficacy or safety. Objectives: The objective of this review was to evaluate the efficacy (VTE recurrence) and safety (bleeds and deaths) of long-term treatment of VTE with LMWH compared with OA. A secondary endpoint was to evaluate the effect of LMWH on cancer mortality. Methods: Computerized searches of MedLine and EmBase were performed. In addition, randomized clinical trials were located through personal communication with colleagues, and through the manual scanning of meeting proceedings and reference lists of relevant studies. When necessary, the authors of the selected papers were called to obtain additional information. Two reviewers (AI and FG) reviewed and extracted data independently using a standard form. The primary analysis was performed for efficacy and safety endpoints on an intention-to-treat basis for the study period of randomized treatment. A meta-regression analysis was used to investigate the relationship between daily dose and clinical outcome. Results: Seven studies that fulfillled our predefined criteria were identified, for a total of 1379 patients. When all studies were combined, a statistically non-significant reduction in the risk of VTE (OR 0.66; 95% confidence interval [CI] 0.41, 1.07) and in the risk of major bleeding (OR 0.45; 95% CI 0.18, 1.11) in favor of LMWH treatment was found. No difference in total mortality (OR 1.19; 95% CI 0.78, 1.83) or in cancer-related mortality was observed between the LMWH and the OA treatment. Conclusions: The results of this meta-analysis indicate that a 3-month course of LMWH is as effective and safe as a corresponding period of OA treatment, and may thus be considered as a valuable alternative option for patients in whom OA treatment appears contraindicated or problematic.

Heparin administration for operations with extracorporeal circulation (ECC) usually is performed following prefixed, standardized protocols. These regimens secure an adequate level of anticoagulation, hut they often involve prolonged periods of overheparinization associated with an undue risk of hemorrhage. The predictive value of preoperative studies on the anticoagulant effect of heparin was investigated in 10 patients. The study was performed both in vitro and in vivo using the Xa inhibitor assay as an index of the anticoagulation induced by heparin. Adding variable amounts of heparin in vitro to patient’s plasma resulted in straight (at least up to 7 U. per milliliter) and parallel, but not coincident, dose/response curves, so confirming a different individual sensitivity to heparin. Disappearance curves of the anticoagulant effect in plasma following intravenous administration of a single standard dose of heparin in the same patients showed an even greater patient-to-patient variability, with “half-life” times ranging from 30 to 150 minutes. No relationship was found between the two parameters (in vitro sensitivity to heparin and clearance rate from plasma in vivo). Moreover, neither of them could be correlated with the response to heparin, subsequently observed during ECC in the same patients. Preoperative investigations with the methods presently available are not adequate to choose individual heparin administration regimens for cardiac operations.

The possibility of evaluating the susceptibility of B-cell chronic lymphocytic leukemia (B-CLL) cells to chemotherapeutic agents pre-clinically, was assessed using the MTT colorimetric assay. The results so far obtained suggest that this rapid 3-4 days' test is accurate and reliable and may allow the physician to recognize individual B-CLL cases in which the neoplastic clone is resistant to Chlorambucil. Furthermore, the high efficacy of Fludarabine clearly emerges from these in vitro analyses. The possibility of employing Chlorambucil in combination with alpha Interferon is suggested and the relevance of using this simple test for better drug selection in B-CLL patients is discussed.

Gli Autori valutano it ruolo della tomografia computerizzata nello studio della patologia encefalica neonatale; viene presentata una casistica di quadri TC riguardanti le malformazioni, la patologia emorragica ed ipossico-ischemica e le forme tumorali.Pur non volendo confrontare in tale sede la TC con le altre tecniche a disposizione, viene ricordato l'impiego sempre maggiore degli ultrasuoni nell'approccio diagnostico alla patologia encefalica neonatale. Viene sottolineata l'attuale validità della TC, e per lo studio dell'anatomia dell'encefalo del neonato a termine e pretermine, e per il riconoscimento dei quadri patologici, quali le emorragie della fossa cranica posteriore e negli spazi subaracnoidei, la patologia ipossico-ischemica e alcune forme malformative.

To extent our knowledge on the cytokines possibly involved in the pathophysiology of B-cell chronic lymphocytic leukemia (B-CLL), the mRNA expression of a panel of 10 cytokines was investigated on purified B-CLL cells using a reverse-transcriptase polymerase chain reaction method. Whereas negative RT-PCR signals were recorded for interleukin-1 alpha (IL-1 alpha), IL-2, IL-3, IL-4, IL-5, IL-7, tumor necrosis factor beta (TNF beta), and granulocyte-macrophage colony-stimulating factor, we detected the expression of IL-1 beta, IL-6 and TNF alpha. Furthermore, the constitutive expression of IL-8 mRNA was observed in all 17 B-CLL samples analyzed. mRNA expression was associated with the capacity of the leukemic cells to release IL-8 both constitutively (4.6 +/- 8.1 SD ng/mL) and, to a further extent, after stimulation (14.5 +/- 19.4 ng/mL). The circulating levels of IL-8 were also evaluated in 12 untreated B-CLL sera samples and the overall mean level was significantly higher (P <.01) than in normal sera. In addition, supernatants of purified B-CLL cells cultured in the presence of 12-O- tetradecanoylphorbol-13-acetate showed chemotactic activity towards neutrophils; this activity was neutralized in the presence of an anti- IL-8 antiserum. The mRNA for IL-8 was absent in five B-cell preparations from hairy cell leukemia cases and in four B-cell lines. Normal tonsil CD5+ B cells showed a low expression of IL-8 mRNA only in two of the nine preparations tested and the overall quantity of IL-8 released by these cells after 3 days' incubation was significantly lower compared with that released by B-CLL cells (0.4 +/- 0.3 and 1.6 +/- 0.9 ng/mL under basal and stimulated conditions, respectively). These findings point to an involvement of a member of the proinflammatory chemokine supergene family in human CD5+ B lymphocytes. The different IL-8 behavior observed between B-CLL cells and their normal counterpart is likely to reflect an activation state of the leukemic population.

Two-spin light scattering in the disordered phase of rutile antiferromagnets MnF2and NiF2is investigated by means of a previously developed long-time approximation for the continued-fraction representation of the shape function. The procedure requires the evaluation of the lower-order frequency moments: the first frequency moment of the overall spectrum is found to be in good agreement with the experimental data for both compounds in the whole paramagnetic phase. Also the theoretical shapes are in fair agreement with the experimental spectra of MnF2at various temperatures.

A case of congenital factor V deficiency is reported. Despite this defect in blood coagulation, the patient had experienced recurrent thrombophlebitis and was referred to us because of deep venous thrombosis of the lower limbs associated with pulmonary embolism. Both functional and immunological assays documented a deficiency of factor V (12 and < 10%, respectively). The available family members were investigated and the same defect was found in 2 brothers of the propositus, who also suffered from thrombotic diseases (recurrent thrombophlebitis and myocardial infarction). The propositus has been treated with long-term oral anticoagulant therapy, no hemorrhagic complications or thrombotic recurrences being recorded in 2 years’ time.

The effects of standardized venous occlusion (VO) on factor VIII-von Willebrand factor (F VIII-VWF) components (F VIIL·C, F VIIIR:AG, F VIIIR:RCof) and on fibrinolytic activity were investigated in 45 healthy subjects, in 28 women on oral contraceptives, and in 78 patients with various chronic diseases (28 with peripheral arterial disease, 19 with liver cirrhosis, 13 with rheumatoid arthritis, and 18 with diabetes). All the three F VIII-VWF components showed highly significant increases, although not of the same magnitude, with consequent variations in the ratios between them. A significant activation of fibrinolysis was also demonstrated with both euglobulin lysis time (ELT) and diluted blood clot lysis time (DBCLT). A strong linear correlation between pre- and post-stasis values was recorded for all the F VIII-VWF components and for the two fibrinolysis tests. No significant relationship was, on the contrary, found between F VIII-VWF and fibrinolytic parameters.

To establish if an association exists between use of oral contraceptives (OC) and the occurrence of cerebral arterial thromboembolism, cerebral venous thrombosis and retinal vein/artery thrombosis, we identified all women aged 15–44 years resident in the province of Parma, Italy, who were hospitalized because of a documented cerebral or retinal thromboembolic event during the period 1989–1993. The numbers of users and nonusers of OC were estimated from drug sale data and demographic statistics for the province.

In a randomised trial we compared the effects of two different antithrombotic regimens on the incidence of venographically established deep venous thrombosis (DVT) in 83 patients undergoing surgery for fracture of the femoral neck. Group A received dextran 40 peroperatively plus 0.5 g aspirin a day beginning before operation and continuing for 10 days after. Group B received heparin calcium 5000 iu subcutaneously plus dihydroergotamine (DHE) 0.5 mg intramuscularly, given 8-hourly, beginning before operation and continuing for 10 days after. Two patients in Group A and three in Group B developed proximal DVT, while the incidence of all DVT was 33% in Group A and 29% in Group B, a difference which was not significant. Haemorrhagic complications were much more common in the dextran/aspirin group: the volume of drainage fluid, the number of patients transfused and quantity of blood transfused, and the drop in haemoglobin level were all significantly greater in Group A. We conclude that the DHE/heparin regime is preferable to dextran/aspirin because it is safer and no less effective.

This paper presents a fully turbulent two-phase discrete adjoint method for metastable condensing flows targeted to turbomachinery applications. The method is based on a duality preserving algorithm and implemented in the open-source CFD tool SU2. The optimization framework is applied to the shape optimization of two canonical steam turbine cascades, commonly referred to as White cascade and Dykas cascade. The optimization were carried out by minimizing either the liquid volume fraction downstream of the cascade or the total entropy generation due viscous effects and heat transfer. In the first case, the amount of condensate turned out to be reduced by as much as 24%, but without reduction of the generated entropy, while the opposite resulted in the second case. The outcomes demonstrate the capability and computational efficiency of adjoint-based automated design for the shape optimization of turbomachinery operating with phase change flow.

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