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1. Potential serotype coverage of three pneumococcal conjugate vaccines against invasive pneumococcal infection in Italian children

Author

Azzari, Chiara, Moriondo, Maria, Cortimiglia, Martina, Valleriani, C, Canessa, C, Indolfi, G, Ricci, S, De Martino, Maurizio, Resti, M, Collaborators: Agostiniani R, Italian group for the study of Invasive Pneumococcal D. i. s. e. a. s. e., Allievi, P, Allù, G, Amigoni, A, Bernardi, P, Bernardini, R, Biban, P, Bigi, M, Boldrini, A, Bossi, G, Bottone, U, Cardinale, A, Cardona, A, Castronari, R, Celandroni, A, Chiossi, M, Colleselli, P, Correra, A, D'Ascola, G, D'Aquino, A, De Benedictis FM, Dini, E, Dollfus, L, Domenici, R, Flacco, V, Furbetta, M, Gaetti, Mt, Gagliardi, L, Giani, I, Giglio, P, Guala, A, Lanari, M, Lippi, F, Lizzoli, C, Lombardi, E, Macchia, Pa, Magnini, M, Memmini, G, Mesirca, P, Micheletti, E, Migliozzi, L, Nunziata, F, Pecile, P, Pepe, G, Perferi, G, Peris, A, Perri, Pf, Pescollderungg, L, Pezzati, M, Poggi, Giovanni Maria, Prato, R, Principi, N, Rapisardi, G, Regoli, M, Riva, A, Rizzo, L, Roman, B, Toffolo, A, Strano, M, Trapani, Sandra, Vasarri, P, Vascotto, M, Vecchi, V, Ventura, A, Verini, M, Zorzi, C., Azzari, Chiara, Moriondo, Maria, Cortimiglia, Martina, Valleriani, Claudia, Canessa, Clementina, Indolfi, Giuseppe, Ricci, Silvia, Nieddu, Francesco, de Martino, Maurizio, Resti, Massimo, Italian group for the study of Invasive Pneumococcal Disease [, Lanari, Marcello, and ]

Subjects
Pneumococcal Vaccine, Male, Serotype, medicine.medical_specialty, Adolescent, Sepsi, Vaccination schedule, Longitudinal Studie, Bacteremia, Real-Time Polymerase Chain Reaction, medicine.disease_cause, Pneumococcal Vaccines, Sepsis, Internal medicine, Streptococcus pneumoniae, medicine, Humans, Longitudinal Studies, Serotyping, Child, Vaccines, Conjugate, Bacterial disease, General Veterinary, General Immunology and Microbiology, Meningitis, Pneumococcal, business.industry, Public Health, Environmental and Occupational Health, Infant, medicine.disease, Pneumonia, Infectious Diseases, Italy, Child, Preschool, Pneumococcal pneumonia, Immunology, Molecular Medicine, Female, business, Meningitis, Human
Abstract

Background and aim of the work Since the introduction of the 7-valent vaccine, invasive pneumococcal disease have greatly decreased; however, changes in the distribution of pneumococcal serotypes have recently highlighted the need for vaccines with wider coverage. The aim of the work was to assess the potential serotype coverage of three pneumococcal conjugate vaccines (7-, 10- and 13-valent) against bacteremic pneumococcal pneumonia and meningitis/sepsis in Italian children. Patients and methods We determined pneumococcal serotypes in immunocompetent patients who had been admitted to hospital with suspicion of invasive bacterial disease and had confirmed bacteremic pneumococcal pneumonia or meningitis/sepsis determined by molecular detection of Streptococcus pneumoniae in a normally sterile site. Positive samples were serotyped using Realtime-PCR. Results Between April 2008 and March 2011, a total of 144 patients (age median 4.1 years; Interquartile range 1.8–5.6) with pneumococcal meningitis/sepsis (n = 43) or pneumonia (n = 101) from 83 participating centers located in 19 of 20 Italian regions were serotyped. The 10 most prevalent serotypes were 1 (29.9%), 3 (16.0%), 19A (13.2%), 7F (8.3%), 5 (4.2%), 14 (4.2%), 6A (3.5%), 6B (3.5%), 18C (3.5%), 19F (3.5%). Overall, serotype coverage for PCV-7, -10 and -13 were respectively 19.4%, 61.8% and 94.4% with no statistical difference between pneumonia and meningitis/sepsis. Potential coverage was similar for children 0–2 or 2–5 years of age. Cultures resulted positive in 35/99 (35.4%) samples simultaneously obtained for both culture and RT-PCR. Conclusion These findings indicate that increasing the potential serotype coverage by introducing PCV13 in the vaccination schedule for infancy could provide substantial added benefit for protection from pneumococcal pneumonia or meningitis/sepsis in Italy in children below 2 years as well in older children. The importance of molecular methods for diagnosis and serotyping of invasive pneumococcal disease was confirmed.

Published
2012

2. Variability in protein binding of teicoplanin and achievement of therapeutic drug monitoring targets in critically ill patients: Lessons from the DALI Study

Author

Roberts, J. A., Stove, V., De Waele, J. J., Sipinkoski, B., McWhinney, B., Ungerer, J. P. J., Akova, M., Bassetti, M., Dimopoulos, G., Kaukonen, K. -M., Koulenti, D., Martin, C., Montravers, P., Rello, J., Rhodes, A., Starr, T., Wallis, S. C., Lipman, J., Paul, S., Ribas, A. M., DeCrop, L., Spapen, H., Wauters, J., Dugernier, T., Jorens, P., Dapper, I., De Backer, D., Taccone, F. S., Ruano, L., Afonso, E., Alvarez-Lerma, F., Gracia-Arnillas, M. P., Fernández, F., Feijoo, N., Bardolet, N., Rovira, A., Garro, P., Colon, D., Castillo, C., Fernado, J., Lopez, M. J., Fernandez, J. L., Arribas, A. M., Teja, J. L., Ots, E., Montejo, J. C., Catalan, M., Prieto, I., Gonzalo, G., Galvan, B., Blasco, M. A., Meyer, E., Nogal, F. D., Vidaur, L., Sebastian, R., Garde, P. M., Velasco Mdel, M., Crespo, R. Z., Esperatti, M., Torres, A., Baldesi, O., Dupont, H., Mahjoub, Y., Lasocki, S., Constantin, J. M., Payen, J. F., Albanese, J., Malledant, Y., Pottecher, J., Lefrant, J. Y., Jaber, S., Joannes-Boyau, O., Orban, C., Ostermann, M., McKenzie, C., Berry, W., Smith, J., Lei, K., Rubulotta, F., Gordon, A., Brett, S., Stotz, M., Templeton, M., Ebm, C., Moran, C., Pettilä, V., Xristodoulou, A., Theodorou, V., Kouliatsis, G., Sertaridou, E., Anthopoulos, G., Choutas, G., Rantis, T., Karatzas, S., Balla, M., Papanikolaou, M., Myrianthefs, P., Gavala, A., Fildisis, G., Koutsoukou, A., Kyriakopoulou, M., Petrochilou, K., Kompoti, M., Michalia, M., Clouva-Molyvdas, F. M., Gkiokas, G., Nikolakopoulos, F., Psychogiou, V., Malliotakis, P., Akoumianaki, E., Lilitsis, E., Koulouras, V., Nakos, G., Kalogirou, M., Komnos, A., Zafeiridis, T., Chaintoutis, C., Arvaniti, K., Matamis, D., Kydona, C., Gritsi-Gerogianni, N., Giasnetsova, T., Giannakou, M., Soultati, I., Chytas, I., Antoniadou, E., Antipa, E., Lathyris, D., Koukoubani, T., Paraforou, T., Spiropoulou, K., Bekos, V., Spring, A., Kalatzi, T., Nikolaou, H., Laskou, M., Strouvalis, I., Aloizos, S., Kapogiannis, S., Soldatou, O., Adembri, C., Villa, G., Giarratano, A., Raineri, S. M., Cortegiani, A., Montalto, F., Strano, M. T., Ranieri, V. M., Sandroni, C., De Pascale, G., Molin, A., Pelosi, P., Montagnani, L., Urbino, R., Mastromauro, I., DeRosa, F. G., Cardoso, T., Afonso, S., Gonçalves-Pereira, J., Baptista, J. P., Özveren, A., Roberts JA, Lipman J, Starr T, Wallis SC, Paul S, Ribas AM, De Waele JJ, DeCrop L, Spapen H, Wauters J, Dugernier T, Jorens P, Dapper I, De Backer D, Taccone FS, Rello J, Ruano L, Afonso E, Alvarez-Lerma F, Gracia-Arnillas MP, Fernández F, Feijoo N, Bardolet N, Rovira A, Garro P, Colon D, Castillo C, Fernado J, Lopez MJ, Fernandez JL, Arribas AM, Teja JL, Ots E, Montejo JC, Catalan M, Prieto I, Gonzalo G, Galvan B, Blasco MA, Meyer E, Nogal FD, Vidaur L, Sebastian R, Garde PM, Velasco Mdel M, Crespo RZ, Esperatti M, Torres A, Montravers P, Baldesi O, Dupont H, Mahjoub Y, Lasocki S, Constantin JM, Payen JF, Martin C, Albanese J, Malledant Y, Pottecher J, Lefrant JY, Jaber S, Joannes-Boyau O, Orban C, Ostermann M, McKenzie C, Berry W, Smith J, Lei K, Rubulotta F, Gordon A, Brett S, Stotz M, Templeton M, Rhodes A, Ebm C, Moran C, Kaukonen KM, Pettilä V, Dimopoulos G, Koulenti D, Xristodoulou A, Theodorou V, Kouliatsis G, Sertaridou E, Anthopoulos G, Choutas G, Rantis T, Karatzas S, Balla M, Papanikolaou M, Myrianthefs P, Gavala A, Fildisis G, Koutsoukou A, Kyriakopoulou M, Petrochilou K, Kompoti M, Michalia M, Clouva-Molyvdas FM, Gkiokas G, Nikolakopoulos F, Psychogiou V, Malliotakis P, Akoumianaki E, Lilitsis E, Koulouras V, Nakos G, Kalogirou M, Komnos A, Zafeiridis T, Chaintoutis C, Arvaniti K, Matamis D, Kydona C, Gritsi-Gerogianni N, Giasnetsova T, Giannakou M, Soultati I, Chytas I, Antoniadou E, Antipa E, Lathyris D, Koukoubani T, Paraforou T, Spiropoulou K, Bekos V, Spring A, Kalatzi T, Nikolaou H, Laskou M, Strouvalis I, Aloizos S, Kapogiannis S, Soldatou O, Bassetti M, Adembri C, Villa G, Giarratano A, Raineri SM, Cortegiani A, Montalto F, Strano MT, Ranieri VM, Sandroni C, De Pascale G, Molin A, Pelosi P, Montagnani L, Urbino R, Mastromauro I, DeRosa FG, Cardoso T, Afonso S, Gonçalves-Pereira J, Baptista JP, Akova M, Özveren A, Hôpital Nord [CHU - APHM], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Diderot - Paris 7 (UPD7), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Roberts, J.A., Stove, V., De Waele, J.J., Sipinkoski, B., McWhinney, B., Ungerer, J.P.J., Akova, M., Bassetti, M., Dimopoulos, G., Kaukonen, K.-M., Koulenti, D., Martin, C., Montravers, P., Rello, J., Rhodes, A., Starr, T., Wallis, S.C., Lipman, J., Paul, S., Ribas, A.M., DeCrop, L., Spapen, H., Wauters, J., Dugernier, T., Jorens, P., Dapper, I., De Backer, D., Taccone, F.S., Ruano, L., Afonso, E., Alvarez-Lerma, F., Gracia-Arnillas, M.P., Fernández, F., Feijoo, N., Bardolet, N., Rovira, A., Garro, P., Colon, D., Castillo, C., Fernado, J., Lopez, M.J., Fernandez, J.L., Arribas, A.M., Teja, J.L., Ots, E., Montejo, J.C., Catalan, M., Prieto, I., Gonzalo, G., Galvan, B., Blasco, M.A., Meyer, E., Nogal, F.D., Vidaur, L., Sebastian, R., Garde, P.M., Velasco Mdel, M., Crespo, R.Z., Esperatti, M., Torres, A., Baldesi, O., Dupont, H., Mahjoub, Y., Lasocki, S., Constantin, J.M., Payen, J.F., Albanese, J., Malledant, Y., Pottecher, J., Lefrant, J.Y., Jaber, S., Joannes-Boyau, O., Orban, C., Ostermann, M., McKenzie, C., Berry, W., Smith, J., Lei, K., Rubulotta, F., Gordon, A., Brett, S., Stotz, M., Templeton, M., Ebm, C., Moran, C., Pettilä, V., Xristodoulou, A., Theodorou, V., Kouliatsis, G., Sertaridou, E., Anthopoulos, G., Choutas, G., Rantis, T., Karatzas, S., Balla, M., Papanikolaou, M., Myrianthefs, P., Gavala, A., Fildisis, G., Koutsoukou, A., Kyriakopoulou, M., Petrochilou, K., Kompoti, M., Michalia, M., Clouva-Molyvdas, F.M., Gkiokas, G., Nikolakopoulos, F., Psychogiou, V., Malliotakis, P., Akoumianaki, E., Lilitsis, E., Koulouras, V., Nakos, G., Kalogirou, M., Komnos, A., Zafeiridis, T., Chaintoutis, C., Arvaniti, K., Matamis, D., Kydona, C., Gritsi-Gerogianni, N., Giasnetsova, T., Giannakou, M., Soultati, I., Chytas, I., Antoniadou, E., Antipa, E., Lathyris, D., Koukoubani, T., Paraforou, T., Spiropoulou, K., Bekos, V., Spring, A., Kalatzi, T., Nikolaou, H., Laskou, M., Strouvalis, I., Aloizos, S., Kapogiannis, S., Soldatou, O., Adembri, C., Villa, G., Giarratano, A., Raineri, S.M., Cortegiani, A., Montalto, F., Strano, M.T., Ranieri, V.M., Sandroni, C., De Pascale, G., Molin, A., Pelosi, P., Montagnani, L., Urbino, R., Mastromauro, I., DeRosa, F.G., Cardoso, T., Afonso, S., Gonçalves-Pereira, J., Baptista, J.P., Özveren, A., and İç Hastalıkları

Subjects
Male, validity, validation proce, International Cooperation, Settore MED/41 - Anestesiologia, drug protein binding, Gastroenterology, law.invention, Plasma, Staphylococcus infection, Critically ill patients, Interquartile range, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Antibiotics, antibiotic therapy, Pharmacology (medical), Pharmacology & Pharmacy, Glycopeptides, Hypoalbuminaemia, ICU, Pharmacokinetics, Adult, Aged, Anti-Bacterial Agents, Chromatography, Critical Illness, Female, Humans, Middle Aged, Protein Binding, Teicoplanin, Young Adult, Drug Monitoring, Microbiology (medical), Infectious Diseases, clinical article, medicine.diagnostic_test, drug dose regimen, critical illne, Medicine (all), article, clinical trial, General Medicine, trough time concentration, drug protein binding variability, Intensive care unit, Glycopeptides, Antibiotics, Critically ill patients, Pharmacokinetics, Hypoalbuminaemia, ICU, 3. Good health, antiinfective agent, drug distribution, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, priority journal, multicenter study (topic), Vancomycin, blood sampling, Critically ill patient, Human, medicine.drug, medicine.medical_specialty, high performance liquid chromatography, area under the curve, ultraviolet spectroscopy, mid dose concentration, chemistry, Glycopeptide, Microbiology, teicoplanin, adult, enterococcal infection, young adult, Adult, drug clearance, Therapeutic index, Internal medicine, Anti-Bacterial Agent, medicine, steady state, Dosing, business.industry, drug half life, Antibiotic, recommended drug dose, calibration, Surgery, multicenter study, Therapeutic drug monitoring, drug blood level, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, free plasma drug concentration, business, metabolism
Abstract

The aims of this study were to describe the variability in protein binding of teicoplanin in critically ill patients as well as the number of patients achieving therapeutic target concentrations. This report is part of the multinational pharmacokinetic DALI Study. Patients were sampled on a single day, with blood samples taken both at the midpoint and the end of the dosing interval. Total and unbound teicoplanin concentrations were assayed using validated chromatographic methods. The lower therapeutic range of teicoplanin was defined as total trough concentrations from 10 to 20 mg/L and the higher range as 10-30 mg/L. Thirteen critically ill patients were available for analysis. The following are the median (interquartile range) total and free concentrations (mg/L): midpoint, total 13.6(11.2-26.0) and free 1.5 (0.7-2.5); trough, total 11.9 (10.2-22.7) and free 1.8 (0.6-2.6). The percentage free teicoplanin for the mid-dose and trough time points was 6.9% (4.5-15.6%) and 8.2% (5.5-16.4%), respectively. The correlation between total and free antibiotic concentrations was moderate for both the midpoint (rho=0.79, P = 0.0021) and trough (rho = 0.63, P = 0.027). Only 42% and 58% of patients were in the lower and higher therapeutic ranges, respectively. In conclusion, use of standard dosing for teicoplanin leads to inappropriate concentrations in a high proportion of critically ill patients. Variability in teicoplanin protein binding is very high, placing significant doubt on the validity of total concentrations for therapeutic drug monitoring in critically ill patients. (C) 2014 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Published
2014

3. Distribution of invasive meningococcal B disease in Italian pediatric population: implications for vaccination timing

Author

Azzari, Chiara, Canessa, Clementina, Lippi, Francesca, Moriondo, Maria, Indolfi, Giuseppe, Nieddu, Francesco, Martini, Marco, de Martino, Maurizio, Castiglia, Paolo, Baldo, Vincenzo, Resti, Massimo, Agostiniani, R., Allievi, P., Allù, G., Amigoni, A., Bartolini, E., Bernardi, Francesco, Bernardini, SOFIA ROBERTA, Biban, P., Bigi, M., Bossi, G., Bottone, U., Cardinale, A., Cardona, A., Castronari, R., Celandroni, A., Chiossi, M., Colleselli, P., Correra, A., Cortimiglia, M., D'Ascola, G., De Benedictis, F. M., de Martino, M., Dini, E., Dollfus, L., Domenici, R., Flacco, V., Verrotti, A., Gaetti, M. T., Gagliardi, L., Galli, Lorenzo, Giglio, P., Guala, A., Lanari, M., Lasagni, D., Lizzoli, C., Lombardi, E., Magnini, M., Mattei, R., Memmini, G., Mesirca, P., Gragnani, S., Migliozzi, L., Nunziata, F., Pecile, P., Pepe, G., Perferi, G., Peris, A., Perri, P. F., Pescollderungg, L., Pezzati, M., Poggi, G. M., Poggiolesi, C., Rapisardi, G., Ratta, L., Ricci, S., Ridi, F., Riva, MARCO ANDREA, Rizzo, L., Roman, B., Romano, F., Toffolo, A., Strano, M., Trapani, S., Valleriani, C., Vasarri, P., Vascotto, M., Vergine, G., Verini, M., Zorzi, C., Azzari, Chiara, Canessa, Clementina, Lippi, Francesca, Moriondo, Maria, Indolfi, Giuseppe, Nieddu, Francesco, Martini, Marco, de Martino, Maurizio, Castiglia, Paolo, Baldo, Vincenzo, Resti, Massimo, Italian Group for the Study of Invasive Bacterial Disease [, Lanari M., and ]

Subjects
Pediatrics, Children, Incidence, Neisseria meningitidis group B, Realtime PCR, Sensitivity, Vaccine, Adolescent, Age Distribution, Child, Child, Preschool, Hospitals, Pediatric, Humans, Immunization Schedule, Infant, Infant, Newborn, Italy, Meningitis, Meningococcal, Meningococcal Vaccines, Real-Time Polymerase Chain Reaction, Retrospective Studies, Sepsis, Neisseria meningitidis, Serogroup B, Molecular Medicine, Immunology and Microbiology (all), Veterinary (all), Public Health, Environmental and Occupational Health, Infectious Diseases, Disease, Neisseria meningitidis, medicine.disease_cause, Group B, Epidemiology, Medicine, Pediatric, Meningococcal, Incidence (epidemiology), Hospitals, Vaccination, Public Health, Meningitis, medicine.medical_specialty, Serogroup B, Immunology and Microbiology(all), MED/42 Igiene generale e applicata, Preschool, General Veterinary, General Immunology and Microbiology, business.industry, Environmental and Occupational Health, medicine.disease, Newborn, veterinary(all), business
Abstract

Neisseria meningitidis group B (MenB) is a leading cause of meningitis and sepsis. A new vaccine has been recently licensed. The aim of the present study was to evaluate the epidemiology of MenB disease in pediatric age and define the optimal age for vaccination. All patients aged 0–18 years admitted with a diagnosis of meningitis or sepsis to the 83 participating Italian pediatric hospitals were included in the study. Blood and/or cerebrospinal fluid (CSF) samples were tested by Realtime-PCR and/or culture. One hundred and thirty-six cases (mean age 5.0 years, median 2.7) of MenB disease were found. Among these, 96/136 (70.6%) were between 0 and 5 years, 61/136 (44.9%) were between 0 and 2 years. Among the latter, 39/61 (63.9%) occurred during the first year of life with highest incidence between 4 and 8 months. A case-fatality rate of 13.2% was found, with 27.8% cases below 12 months. Sepsis lethality was 24.4%. RT-PCR was significantly more sensitive than culture: 82 patients were tested at the same time by both methods, either in blood or in CSF; MenB was found by RT-PCR in blood or CSF in 81/82 cases (98.8%), culture identified 27/82 (32.9%) infections (Cohen's Kappa 0.3; McNemar's: p < 10−5). The study shows that the highest incidence of disease occurs in the first year of age, with a peak between 4 and 8 months of life; 30% of deaths occur before 12 months. The results suggest that the greatest prevention could be obtained starting MenB vaccination in the first months of life; a catch-up strategy up to the fifth year of life could be considered. Our results also confirm that Realtime PCR is significantly more sensitive than culture. In those countries where only isolate positive infections are counted as cases, the incidence of MenB infection results highly underestimated.

Published
2013

4. Community‐acquired bacteremic pneumococcal pneumonia in children: diagnosis and serotyping by real‐time polymerase chain reaction using blood samples

Author

Resti, M., Moriondo, M., Cortimiglia, M., Indolfi, G., Canessa, C., Becciolini, L., Bartolini, E., De Benedictis, F. M., De Martino, M., Azzari, C., Agostiniani, R, Allievi, P, Allù, G, Amigoni, A, Baldo, E, Barlocco, G, Bernardi, P, Bernardini, R, Biban, P, Bossi, G, Bottone, U, Cardinale, A, Cardona, A, Castelli Gattinara, G, Celandroni, A, Chiossi, M, Colleselli, P, Correra, A, D'Ascola, G, D'Aquino, A, Dollfus, L, Domenici, R, Flacco, V, Furbetta, M, Gaetti, Mt, Gagliardi, L, Ghiori, F, Giani, I, Giglio, P, Guala, A, Icardi, G, Lanari, M, Lippi, F, Lizzoli, C, Lombardi, E, Macchia, Pa, Magnini, M, Memmini, G, Mesirca, P, Micheletti, E, Migliozzi, L, Nunziata, F, Osimani, P, Paravati, D, Pecile, P, Pepe, G, Peris, A, Perri, Pf, Pescollderungg, L, Pezzati, M, Poggi, Gm, Poggiolesi, C, Prato, R, Principi, N, Rapisardi, G, Ridi, F, Riva, A, Rizzo, L, Roman, B, Toffolo, A, Strano, M, Trapani, S, Vasarri, P, Vascotto, M, Vecchi, V, Ventura, A, Verini, M, Zorzi, C., Resti, Massimo, Moriondo, Maria, Cortimiglia, Martina, Indolfi, Giuseppe, Canessa, Clementina, Becciolini, Laura, Bartolini, Elisa, de Benedictis, Fernando Maria, de Martino, Maurizio, Azzari, Chiara, Italian Group for the, Study of Invasive Pneumococcal Disease, and Lanari, M.

Subjects
Microbiology (medical), Male, medicine.medical_specialty, Adolescent, Bacteremia, medicine.disease_cause, Polymerase Chain Reaction, Parapneumonic effusion, Community-acquired pneumonia, Bacterial Typing Technique, Internal medicine, Streptococcus pneumoniae, medicine, Humans, Community-Acquired Infection, Serotyping, Preschool, Child, business.industry, Bacterial pneumonia, Infant, Newborn, Infant, Odds ratio, Pneumonia, Pneumonia, Pneumococcal, medicine.disease, Newborn, Bacterial Typing Techniques, Community-Acquired Infections, Infectious Diseases, Blood, Italy, Child, Preschool, Pneumococcal pneumonia, Immunology, Pneumococcal, Female, business, Human
Abstract

Background. The aim of this study was to use real-time polymerase chain reaction (RT-PCR) on blood samples to diagnose and serotype pneumococcal infection in a large cohort of Italian children hospitalized for community-acquired pneumonia. Methods. We conducted an observational study from April 2007 through June 2009 of children aged 0-16 years with a diagnosis of community-acquired pneumonia admitted to 83 pediatric hospitals in Italy. Results. Seven hundred fifty-three children were studied. RT-PCR found pneumococcal infection in 80 (10.6%) of 753 patients. In 292 patients, culture and RT-PCR were simultaneously performed. Streptococcus pneumoniae was identified in 47 of 292 patients; 45 (15.4%) tested positive by RT-PCR and 11 (3.8%) tested positive by culture. RT-PCR was significantly more sensitive than culture in revealing bacteremic pneumonia (odds ratio, 30.6; 95% confidence interval, 5.8-97.5; P < .001). Complicated pneumonia was found in 162 (21.5%) of 753 children; 152 (93.8%) of these 162 had parapneumonic effusion, and 51 (33.6%) had empyema. Children with complicated pneumonia were significantly older. Pneumococcal bacteremia was found by RT-PCR to occur significantly more frequently in children with complications (38 [23.5%] of 162) than in children with uncomplicated pneumonia (44 [7.4%] of 591; odds ratio, 3.8; 95% confidence interval, 2.30-6.30; P

Published
2010

5. THE USE OF FEA PACKAGES IN THE SIMULATION OF A DRAWING OPERATION WITH SPRINGBACK, IN THE PRESENCE OF RANDOM UNCERTAINTY

Author

Teresa Primo, Matteo Strano, Antonio Del Prete, DEL PRETE, Antonio, Primo, Teresa, and Strano, M.

Subjects
Engineering, Engineering drawing, Computer simulation, business.industry, Applied Mathematics, General Engineering, CPU time, Process design, Computer Graphics and Computer-Aided Design, Finite element method, Reliability engineering, springback, Robustness (computer science), deep drawing, visual_art, visual_art.visual_art_medium, Measurement uncertainty, CAE, Process simulation, Sheet metal, business, uncertainty, Analysis
Abstract

The springback response on a stamped part, calculated by finite element analysis, has been evaluated taking into account the uncertainty of some process conditions. In fact, in the simulation of sheet metal forming and springback, a traditional deterministic approach is not able to take into account the uncertain physical variations related to material characteristics, friction conditions, tools active surfaces status, etc. During sheet metal forming operations many different sources of non-controllable process variations usually display their effect leading to a degree of uncertainty in the final parts' quality. For this reason, statistical tools and methods are increasingly being used in combination with FE numerical simulation. Then, if one of the purposes of process design is to study and model robustness or reliability of a given process in aleatory conditions, a CAE study might become a feasible way to do it. Today, the evaluation of the performances of a sheet metal stamping process, under uncertainty of the main variables, is possible using several commercial FEA packages. These software tools automatically allow the pre-emptive evaluation of the robustness of technological decisions and the process sensitivity to a random variation of uncontrollable parameters or conditions. For accurate calculations these innovative numerical approaches usually require a considerable amount of computational work both in terms of CPU time and in terms of number of CPUs. A specific experimental and numerical activity has been developed in order to better understand the technical capabilities in terms of process simulation in stochastic conditions.

Published
2010

6. The Effect of the Punch Radius in Dieless Incremental Forming

Author

M. Strano, Luigi Carrino, Gillo Giuliano, Carrino, Luigi, Giuliano, G., and Strano, M.

Subjects
Engineering, business.product_category, business.industry, Computer Science (all), Metallurgy, Mechanical engineering, Forming processes, Pure shear, Shear (sheet metal), visual_art, visual_art.visual_art_medium, Formability, Die (manufacturing), Deformation (engineering), Sheet metal, business, Spinning
Abstract

Publisher Summary The dieless incremental forming process is an innovative sheet metal working technology where a considerable amount of knowledge and intelligence is required, in order to obtain accurate and efficient operations. In conventional forming process, the final shape is mostly determined by the die shape. In dieless incremental forming, however, the final shape must be predicted and controlled only by means of a proper process design. For this reason, several issues of this process must still be investigated on a scientific base. This chapter discusses the dieless forming process as an aid towards an intelligent process planning. In most sheet metal incremental forming processes (shear spinning, flow forming, and dieless forming), the deformation occurs by pure shear. The main process parameters are the feed rate, the part conicity, and the punch radius r. Formability in incremental forming has been often investigated and it is well recognized that severe strain may occur before fracture. Thinning and fracture largely depend on the part conicity. Besides, decreasing the feed rate has a positive effect. On the contrary, the effect of the punch radius r has been seldom explored in quantitative terms. The chapter investigates the effect of r on the formability of thin sheet metals, when plastically deformed by incremental forming.

Published
2006

7. Adaptive Selection of Loads During FEM Simulation of Sheet Forming Processes

Author

Luigi Carrino, Matteo Strano, Carrino, Luigi, and Strano, M.

Subjects
Pressing, State variable, Engineering, Adaptive control, business.industry, Process (computing), Mechanical engineering, Forming processes, Structural engineering, Deformation (meteorology), Deep drawing, business, Finite element method
Abstract

The concept of adaptive loading by FEM simulation can be described as the attempt of generating a reasonably good solution for loading paths in metal forming, by adaptively controlling the value of process parameters as long as the simulation proceeds, reacting to the instantaneous results of the simulation itself, i.e. by monitoring the values of one or more state variables. Therefore, a state variable is an indicator of the quality of the part undergoing the deformation. The method has been proposed in a few previous publications, and is further investigated in the present paper, by applying it to a non axis‐symmetrical deep drawing process where the blankholder force (BHF) is controlled vs. the punch stroke (s). In this case, the loading curve BHF vs. s is adaptively built during a single simulation run of a commercial explicit FEM code.

Published
2004

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