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BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation.METHODS: EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic-from March 1 to Sept 13, 2020-at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing.FINDINGS: Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46-60]) were included in the study. Median ECMO duration was 15 days (IQR 8-27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms.INTERPRETATION: Patient's age, timing of cannulation (FUNDING: None.

Rib fractures are a frequent occurrence in trauma victims. Patients with a “flail chest” pattern of injury, defined as two fractures per rib in three (or more) consecutive ribs, often struggle with hypoxemic respiratory failure related to inefficient ventilatory mechanics, inability to expectorate, underlying pulmonary contusion and subsequent pneumonia. The operative indications for rib fracture repair have not been established and are considered to be an issue of debate. Over the last ten years, surgical stabilization of rib fractures has emerged as a promising therapy for patients with severe chest wall injuries. When surgical treatment is performed for patients with rib fracture, general anesthesia is the gold standard but, considered the patients clinical condition, we decided to perform the surgery with regional anesthesia and awake patients to avoid risk of ventilator-induced lung injury. Epidural anesthesia, thoracic paravertebral block and erector spinae plane block for analgesia in patients with rib fractures have been reported. In our report, we discussed the use of ultrasound-guided thoracic paravertebral block with administration of local anesthetic posteriorly to superior costo-transverse ligament and erector spinae plane block to perform surgical stabilization of rib fractures.

Subarachnoid hemorrhage (SAH) represents a medical emergency. Unfortunately, diagnosis can be delay due to cardiogenic abnormalities often associated with SAH. Cardiac manifestations are heterogeneous and common in patients with SAH. This phenomenon has not to be underestimated taking into account the devastating consequences of misdiagnosis and delay in the correct diagnosis and in a specific treatment, with serious and life-threatening consequences. We present a case report of an out of hospital ST elevation in a patient with Glasgow coma score of 6. He was primarily managed as an acute coronary syndrome case. However, coronary angiography was normal. After performing a computed tomography scan, the diagnosis of SAH was made.

The evidence suggests that antiplatelet agents (APA) slightly increase the risk of death and disease progression in patients with traumatic brain injury or spontaneous intracranial hemorrhage (ICH). There is little evidence that APA reversal with platelet (PLT) transfusion may improve the outcome. In this systematic review and meta-analysis, our goal was to evaluate the differences in mortality, severe disability, and hematoma expansion related to PLT transfusion. We retrieved randomized or cohort studies comparing adult patients on APA with traumatic brain injury or ICH who were treated with PLT or not. We calculated the standardized risk difference and 95% confidence interval. A random-effects model was applied to analyze the data. The heterogeneity of the retrieved trials was evaluated through the I2 statistic. Our review included 16 clinical trials. We observed a significant difference between the 2 groups only for hematoma expansion: risk difference was –0.10 (10%; 95% confidence interval, –0.14 to –0.05; P

Background Thymic epithelial tumors (TET) are the most frequent human primary mediastinal tumors in adults. A deep biological characterization of the processes at the basis of the transformed phenotype could strongly improve our understanding of the morphological and clinical heterogeneity of these diseases. MicroRNAs (miRNAs) are non-coding RNAs involved in post-transcriptional regulation and their altered expression accounts for the pathogenesis of several tumors. Objectives The aim of this study was to identify the miRNAs that are differentially expressed in tumor vs normal thymic tissues or among the different tumor histotypes and that could impact on the biology of TET. Materials and methods microRNAs expression profiling was performed by microarray analysis of formalin-fixed paraffin embedded (FFPE) tissue from 54 thymic tumor samples and 12 normal counterparts, derived from two patient cohorts. Results and conclusion We identified groups of miRNAs differentially expressed between: (i) TET and normal thymic tissues, (ii) thymomas and thymic carcinomas, (iii) histotype groups. Moreover, we identified putative molecular pathways targeted by these differentially expressed miRNAs that could be involved in thymic carcinogenesis and in the maintenance and spreading of this tumor.

Direct numerical simulation is used to assess the importance of compressibility in turbulent channel flow of a mixture of air and water vapor with dispersed water droplets. The dispersed phase is allowed to undergo phase transition, which leads to heat and mass transfer between the phases. We compare simulation results obtained with an incompressible formulation with those obtained for compressible flow at various low values of Mach number. We discuss differences in fluid flow, heat- and mass transfer and dispersed droplet properties. Results for flow properties such as mean velocity obtained with the compressible model converge quickly to the incompressible results in case the Mach number is reduced. In contrast, thermal properties such as the heat transfer, characterized by the Nusselt number, display a systematic difference between the two formulations on the order of 15%, even in the low-Mach limit. This shows the necessity of the use of a compressible formulation for accurate prediction of heat transfer, even in case of an initial relative humidity of 100%. Mass transfer properties display a difference between the models on the order of 5%, for example in the prediction of the droplet mean diameter near the walls.

In this paper we present a multi-country, multi-industry agent-based model investigating the different growth patterns of interdependent economies. Each country features a Schumpeterian engine of endogenous technical change which interacts with Keyneasian/Kaldorian demand generation mechanisms. National trajectories are driven by firms’ accumulation of technological knowledge, which in turn also leads to emergent specialization patterns in different industries. Interactions among economies occur via trade flows, stemming from the competition of firms in international markets. Simulation results show the emergence of persistent income divergence among countries leading to polarization and club formation. Moreover, each country experiences a structural transformation of its productive structure during the development process. Such dynamics results from firm-level virtuous (or vicious) cycles between knowledge accumulation, trade performances, and growth dynamics. The model accounts for a rich ensemble of empirical regularities at macro, meso and micro levels of aggregation.

Background Sepsis-associated encephalopathy (SAE) is defined as a diffuse cerebral dysfunction induced by the systemic response to infection without any clinical or laboratory evidence of direct infectious involvement of the central nervous system. The astroglial protein S100B has been used as a marker of severity of brain injury and as a prognostic index in trauma patients and cardiac arrest survivors. We measured S100B serum levels in patients with severe sepsis to investigate if the severity of SAE correlated with an increase in S100B levels. Methods Twenty-one patients, with a diagnosis of severe sepsis, were included in this study. S100B levels were measured at intensive care unit (ICU) admission, 72 h and 7 days after admission. Their association with markers of brain dysfunction such as Glasgow coma scale (GCS), and EEG, and with sepsis-related organ failure assessment score (SOFA) and ICU mortality was investigated. Results Fourteen patients had elevated S100B levels. The levels did not correlate with GCS at admission, EEG pattern, or SOFA scores. Also, S100B levels did not differ between patients who recovered neurologically and those who did not (P = 0.62). Conclusions In severe sepsis, an increase in S100B does not allow the physicians to distinguish patients with severe impairment of consciousness from those with milder derangements or to prognosticate neurological recovery.