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Abstract The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has developed a good clinical practice to address the challenges of treating critically ill patients in resource-limited austere environments, exacerbated by recent pandemics, natural disasters, and conflicts. The methodological approach was based on a literature review and a modified Delphi method, which involved blind voting and consensus evaluation using a Likert scale. This process was conducted over two rounds of online voting. The document covers six critical topics: the overall impact of austere conditions on critical care, airway management, analgesia, bleeding control, vascular access, and medical devices and equipment. In these settings, it is vital to apply basic care techniques flexibly, focusing on immediate bleeding control, airway management, and hypothermia treatment to reduce mortality. For airway management, rapid sequence intubation with ketamine for sedation and muscle relaxation is suggested. Effective pain management involves a multimodal approach, including patient-controlled analgesia by quickly acting safe drugs, with an emphasis on ethical palliative care when other options are unavailable. Regarding hemorrhage, military-derived protocols like Tactical Combat Casualty Care significantly reduced mortality and influenced the development of civilian bleeding control devices. Establishing venous access is crucial, with intraosseous access as a swift option and central venous access for complex cases, ensuring aseptic conditions. Lastly, selecting medical equipment that matches the specific logistical and medical needs is essential, maintaining monitoring standards and considering advanced diagnostic tools like point-of-care ultrasounds. Finally, effective communication tools for coordination and telemedicine are also vital.

Abstract Introduction The usual interstitial pneumonia (UIP) pattern, hallmark of idiopathic pulmonary fibrosis (IPF), may induce harmful local overdistension during mechanical ventilation given the juxtaposition of different tissue elasticities. Mechanotransduction, linking mechanical stress and strain to molecular pro-fibrotic pathways, likely contributes to fibrosis progression. Understanding the mechanical forces and aeration patterns in the lungs of IPF patients is crucial for unraveling potential mechanisms of disease progression. Quantitative lung computed tomography (CT) can accurately assess the air content of lung regions, thus informing on zonal distension. This study aims to investigate radiological evidence of lung over aeration in spontaneously breathing UIP patients compared to healthy controls during maximal inspiration. Methods Patients with IPF diagnosis referred to the Center for Rare Lung Diseases of the University Hospital of Modena (Italy) in the period 2020–2023 who underwent High Resolution Computed Tomography (HRCT) scans at residual volume (RV) and total lung capacity (TLC) using standardized protocols were retrospectively considered eligible. Patients with no signs of lung disease at HRCT performed with the same image acquisition protocol nor at pulmonary function test (PFTs) served as controls. Lung segmentation and quantitative analysis were performed using 3D Slicer software. Lung volumes were measured, and specific density thresholds defined over aerated and fibrotic regions. Comparison between over aerated lung at RV and TLC in the two groups and according to lung lobes was sought. Further, the correlation between aerated lung and the extent of fibrosis was assessed and compared at RV and TLC. Results IPF patients (N = 20) exhibited higher over aerated lung proportions than controls (N = 15) both at RV and TLC (4.5% vs. 0.7%, p

This article investigates the extent to which context can impact the meaning of a construction. It focuses on the French expression en situation de (‘in situation of’) + NOUN, whose meaning is contested among language users when specifically applied to human referents (e.g., en situation de handicap ‘disabled’, en situation de pauvreté ‘poor’). Analyzed as a constructional idiom, its meaning is mapped out on the basis of corpus data. Although a clash is consistently observed between the “circumstantial characterization” meaning arising from the constituent parts of the construction and the “inherent characterization” interpretation it typically receives in context, I argue that contextual pressure has not resulted in the obliteration of constructional meaning. En situation de + NOUN is shown to retain semantic and pragmatic properties that distinguish it from referentially equivalent expressions and ensure its longevity. In addition to making a contribution to research on euphemism and so-called ‘politically correct’ language, the article demonstrates the necessity to uphold the semantics/pragmatics distinction in usage-based Contruction Grammar (CxG) studies of language and language change.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder, hallmarked by the gradual deterioration of motor neurons, culminating in muscle weakness and fatal paralysis. The exact etiology of ALS remains elusive, and there is a critical need for reliable biomarkers to aid in diagnosis and monitoring of disease progression. Extracellular vesicles (EVs) have emerged as promising candidates for biomarker discovery in neurodegenerative diseases such as ALS, giving access to pathologically relevant tissues otherwise typically challenging or invasive to sample. Indeed, EVs can derive by many cell types within the central nervous system, cross the blood-brain barrier and reach the blood, where they can be easily measured. One of the central mechanisms implicated in ALS pathology is glutamate excitotoxicity, which involves excessive glutamate accumulation due to impaired uptake by astrocytes and other glial cells, leading to neuronal damage. GLAST is a key glutamate transporter responsible for maintaining extracellular gluta-mate levels, and its dysregulation is thought to contribute significantly to ALS development and associated neuropathogenesis. Here, we applied a quick and validated method, to evaluate GLAST+ EVs in ALS patients’ plasma and age-matched healthy controls. We found an increase in GLAST+ EVs that holds promise for uncovering novel diagnostic and therapeutic avenues in ALS research.

ObjectivesThis study investigates how nurse supervisors’ Dark Triad personality traits (Machiavellianism, narcissism, psychopathy) influence nurses’ task performance, mediated by perceptions of enriched work design (autonomy, task variety, social support, safe work conditions, feedback quality) and psychological safety.MethodsA multisource approach was used to collect data from 256 manager-nurse dyads across various healthcare settings. Nurses completed surveys assessing their work design and psychological safety. Managers completed a self-assessment of Dark Triad traits and rated their nurse subordinates’ task performance. Confirmatory factor analysis and structural equation modeling (SEM) were used for analysis.ResultsSupervisors’ Dark Triad traits core component impacted nurses’ task performance indirectly, mediated by psychological safety and nurses’ perceptions of their enriched work design. Psychopathic traits revealed a significant direct negative effect on nurses’ performance, while other Dark Triad traits did not show direct effects.ConclusionThis study sheds light on key factors influencing nurses’ performance, offering insights for healthcare organizations aiming to optimize work environments and improve team effectiveness.

PurposeThe current primary hyperparathyroidism (PHPT) presents as a mild disease. We explored skeletal phenotypes in postmenopausal women affected by PHPT, focusing on fracture prevalence.MethodsPHPT women were retrospectively evaluated at four Italian centers for osteoporosis management (two centers in Milan, n = 244; Cuneo, n = 128; Pisa, n = 131). Data collected from clinical records were analyzed by hierarchical clusterization.ResultsConsidering the whole PHPT series [n = 503, aged 67.0 (61.0–74.0) years], 90% had low bone mineral density (BMD) and approximately 30% reported at least one fracture. Vertebral fractures were associated with older age and lower hypophosphatemia, while women with appendicular fractures were younger with less severe hypophosphatemia. Fractures were predicted by lumbar T-score. By using a clustering approach, we identified four different skeletal phenotypes (cluster, C): C1 (n = 53) and C2 (n = 172) included women with lumbar and femur neck osteopenia, with low prevalence of fractures (11.3%). Osteoporotic PHPT women were grouped into C3 (n = 142) and C4 (n = 136); all women in C4 experienced fractures, were older, and were more frequently affected with cardiovascular diseases. In contrast, women included in C3 never experienced fractures and had a lower body mass index (BMI), though they were characterized by severe reduction in BMD at both lumbar and femur sites. Ionized and total calcium, phosphate, 25hydroxyvitamin D levels, kidney function, and stone prevalence (range, 26.4%–29.0%) were similar among clusters C1, C2, and C4, while unfractured women in C3 showed slightly higher ionized hypercalcemia, lower hypophosphatemia, and higher hypercalciuria with a trend to more frequently develop kidney stones (38.7%) than women in the remaining clusters.ConclusionsSkeletal involvement in women with PHPT presented heterogeneous phenotypes with different prevalence of fractures. Fractures were not related to PHPT severity, suggesting that other factors besides PHPT, such as age, BMI, and lumbar and femur BMD, should be considered in the evaluation of bone involvement in postmenopausal women with PHPT.

IntroductionWhile titanium and its alloys exhibit excellent biocompatibility and corrosion resistance, their polished surfaces can hinder fast and effective osseointegration and other biological processes, such as angiogenesis, due to their inert and hydrophobic properties. Despite being commonly used for orthopedic implants, research focuses on developing surface treatments to improve osseointegration, promoting cell adhesion and proliferation, as well as increasing protein adsorption capacity. This study explores a chemical treatment intended for titanium-based implants that enhances tissue integration without compromising the mechanical properties of the Ti6Al4V substrate. However, recognizing that inflammation contributes to nearly half of early implant failures, we assessed the impact of this treatment on T-cell viability, cytokine production, and phenotype.MethodsTi6Al4V with extra low interstitial (ELI) content discs were treated with hydrofluoric acid followed by a controlled oxidation step in hydrogen peroxide that creates a complex surface topography with micro- and nano-texture and modifies the chemistry of the surface oxide layer. The acid etched surface contains an abundance of hydroxyl groups, crucial for promoting bone growth and apatite precipitation, while also enabling further functionalization with biomolecules.ResultsWhile cell viability remained high in both groups, untreated discs triggered an increase in Th2 cells and a decrease of the Th17 subset. Furthermore, peripheral blood mononuclear cells exposed to untreated discs displayed a rise in various pro-inflammatory and anti-inflammatory cytokines compared to the control and treated groups. Conversely, the treated discs showed a similar profile to the control, both in terms of immune cell subset frequencies and cytokine secretion.DiscussionThe dysregulation of the cytokine profile upon contact with untreated Ti6Al4V-ELI discs, namely upregulation of IL-2 could be responsible for the decrease in Th17 frequency, and thus might contribute to implant-associated bacterial infection. Interestingly, the chemical treatment restores the immune response to levels comparable to the control condition, suggesting the treatment’s potential to mitigate inflammation by enhancing biocompatibility.

Abstract Background Nutrition exerts a fundamental role in the prevention of obesity (OB). The aim of this study was to assess the extent to which well recognized risk factors for early OB can be associated to overweight (OW) or OB under a standardized nutritional approach and surveillance in toddlers. Methods The eligible population was represented by 676 toddlers aged 24–36 months, assigned to 18 primary care pediatricians trained on nutritional issues who shared a standardized nutritional approach. Six-hundred-twenty-nine children (333 boys), mean age 27.8 ± 4.2 months were effectively included in this observational study. Parents received nutritional advice with particular emphasis to proteins and sugar composition supported by leaflets and reinforced at each visit. Body mass index was assessed at the age of 24–36 months. The following individual and family risk factors were considered: gestational age, birth weight, eutocic/caesarean delivery, milk feeding history, household smoking or antibiotics exposure, parents’ weight, height and educational level. Prevalence of OW/OB was compared to a group of 742 toddlers (373 boys) under usual care. Results Under a standardized nutritional counselling, 28.1% toddlers were classified as OW/OB compared to 36.9% toddlers under usual care (p = 0.005). In unadjusted models, parental OW/OB was significantly associated to OW/OB in toddlers (p

Additive manufacturing, commonly referred to as 3D printing, is an exciting and versatile manufacturing technology that has gained traction and interest in both academic and industrial settings. Polymeric materials are essential components in a majority of the feedstocks used across the various 3D printing technologies. As the environmental ramifications of sole or primary reliance on petrochemicals as a resource for industrial polymers continue to manifest themselves on a global scale, a transition to more sustainable bioderived alternatives could offer solutions. In particular, cellulose is promising due to its global abundance, biodegradability, excellent thermal and mechanical properties, and ability to be chemically modified to suit various applications. Traditionally, native cellulose was incorporated in additive manufacturing applications only as a substrate, filler, or reinforcement for other materials because it does not melt or easily dissolve. Now, the exploration of all-cellulose 3D printed materials is invigorated by new liquid processing strategies involving liquid-like slurries, nanocolloids, and advances in direct cellulose solvents that highlight the versatility and desirable properties of this abundant biorenewable photosynthetic feedstock. This review discusses the progress of all-cellulose 3D printing approaches and the associated challenges, with the purpose of promoting future research and development of this important technology for a more sustainable industrial future.

Este artículo reúne reflexiones sobre la práctica de la investigación en el campo disciplinar del trabajo social a partir de nuestra experiencia docente en el Seminario de Integración y Trabajo Final de la Lic. en Trabajo Social dictada en la Facultad de Humanidades, Ciencias Sociales y de la Salud de la Universidad Nacional de Santiago del Estero. Buscaremos problematizar la agenda de temas que son investigados en el marco de la asignatura a partir de interrogantes que son trabajados en el aula como: ¿qué investigamos? ¿A dónde y con quiénes investigamos? ¿Para qué lo hacemos? La agenda de investigación analizada a lo largo de este trabajo es un emergente de los temas que fueron propuestos por los y las estudiantes para realizar su investigación para el trabajo final de grado entre los años 2020 y 2024. En base a esto nos propusimos reconocer las particularidades que adquiere la práctica investigativa dentro del campo disciplinar local, y sistematizar parte de los desafíos que demanda la consolidación de la disciplina.

The bacterial pathogen Staphylococcus aureus employs a thick cell wall for protection against physical and chemical insults. This wall requires continuous maintenance to ensure strength and barrier integrity, but also to permit bacterial growth and division. The main cell wall component is peptidoglycan. Accordingly, the bacteria produce so-called peptidoglycan hydrolases (PGHs) that cleave glycan strands to facilitate growth, cell wall remodelling, separation of divided cells and release of exported proteins into the extracellular milieu. A special class of PGHs contains so-called ‘cysteine, histidine-dependent amidohydrolase/peptidase’ (CHAP) domains. In the present study, we profiled the roles of 11 CHAP PGHs encoded by the core genome of S. aureus USA300 LAC. Mutant strains lacking individual CHAP PGHs were analysed for growth, cell morphology, autolysis, and invasion and replication inside human lung epithelial cells. The results show that several investigated CHAP PGHs contribute to different extents to extracellular and intracellular growth and replication of S. aureus, septation of dividing cells, daughter cell separation once the division process is completed, autolysis and biofilm formation. In particular, the CHAP PGHs Sle1 and SAUSA300_2253 control intracellular staphylococcal replication and the resistance to β-lactam antibiotics like oxacillin. This makes the S. aureus PGHs in general, and the Sle1 and SAUSA300_2253 proteins in particular, attractive targets for future prophylactic or therapeutic anti-staphylococcal interventions. Alternatively, these cell surface-exposed enzymes, or particular domains of these enzymes, could be applied in innovative anti-staphylococcal therapies.

Background: Heart transplantation and left ventricular assist device (LVAD) implementation are effective treatments for advanced heart failure (HF), although their use is limited by organ availability and the high incidence of adverse events. The efficacy of mitral transcatheter edge-to-edge repair (TEER) as a bridge to transplantation or as a destination therapy in advanced HF is still debated. Methods: A total of 63 patients with INTERMACS class 3 or 4 with contraindications for LVAD and severe functional mitral regurgitation (FMR) were evaluated for TEER implantation eligibility. The primary endpoint was a composite of death, urgent heart transplantation and LVAD implantation at 12 months. Results: A total of 36 patients underwent TEER, while 27 patients received optimal medical therapy (MT) alone. In the intervention group, 35 patients (97%) were discharged alive. In the MT group, two in-hospital deaths occurred, two patients underwent urgent heart transplantation, and three patients were discharged on inotropes. At the 12-month follow-up, the incidence of the primary endpoint occurring was lower in the TEER group (25% vs. 70%, HR 0.25, 95% CI 0.11–0.60, p < 0.01) and the tolerance to neurohormonal therapy was higher (53% vs. 30%, p = 0.03). Conclusions: In advanced HF patients with INTERMACS profile 3 or 4 and severe FMR, TEER on top of optimal MT was associated with a lower incidence of death, urgent heart transplantation or LVAD implantation at 12 months compared to optimal MT alone.

The demand for integrated photonic chips combining the generation and manipulation of quantum states of light is steadily increasing, driven by the need for compact and scalable platforms for quantum information technologies. While photonic circuits with diverse functionalities are being developed in different single material platforms, it has become crucial to realize hybrid photonic circuits that harness the advantages of multiple materials while mitigating their respective weaknesses, resulting in enhanced capabilities. Here, we demonstrate a hybrid III-V/silicon quantum photonic device combining the strong second-order nonlinearity and direct band gap of the III-V semiconductor platform with the high maturity and CMOS compatibility of the silicon photonic platform. Our device embeds the spontaneous parametric down-conversion (SPDC) of photon pairs into an AlGaAs source and their vertical routing to an adhesively bonded silicon-on-insulator circuitry, within an evanescent coupling scheme managing both polarization states. This enables the on-chip generation of broadband (>40 nm) telecom photons by type-0 and type-2 SPDC from the hybrid device, at room temperature and with internal pair generation rates exceeding 10^{5}s^{−1} for both types, while the pump beam is strongly rejected. Two-photon interference with 92% visibility (and up to 99% upon 5-nm spectral filtering) proves the high energy-time entanglement quality of the produced quantum state, thereby enabling a wide range of quantum information applications on chip, within a hybrid architecture compliant with electrical pumping and merging the assets of two mature and highly complementary platforms in view of out-of-the-lab deployment of quantum technologies.

Abstract Recent studies on exceptional points (EPs) in non-Hermitian optical systems have revealed unique traits, including unidirectional invisibility, chiral mode switching and laser self-termination. In systems featuring gain/loss components, EPs are commonly accessed below the lasing threshold, i.e., in the linear regime. In this work, we experimentally demonstrate that EP singularities in coupled semiconductor nanolasers can be accessed above the lasing threshold, where they become branch points of a nonlinear dynamical system. Contrary to the common belief that unavoidable cavity detuning impedes the formation of EPs, here we demonstrate that such detuning is necessary for compensating the carrier-induced frequency shift, hence restoring the EP. Furthermore, we find that the pump imbalance at lasing EPs varies with the total pump power, enabling their continuous tracking. This work uncovers the unstable nature of EPs above laser threshold in coupled semiconductor lasers, offering promising opportunities for the realization of self-pulsing nanolaser devices and frequency combs.

Abstract Understanding the development of humoral immune responses of children and adolescents to SARS-CoV-2 is essential for designing effective public health measures. Here we examine the changes of humoral immune response in school-aged children and adolescents during the COVID-19 pandemic (June 2020 to July 2022), with a specific interest in the Omicron variant (beginning of 2022). In our study “Ciao Corona”, we assess in each of the five testing rounds between 1874 and 2500 children and adolescents from 55 schools in the canton of Zurich with a particular focus on a longitudinal cohort (n=751). By July 2022, 96.9% (95% credible interval 95.3–98.1%) of children and adolescents have SARS-CoV-2 anti-spike IgG (S-IgG) antibodies. Those with hybrid immunity or vaccination have higher S-IgG titres and stronger neutralising responses against Wildtype, Delta and Omicron BA.1 variants compared to those infected but unvaccinated. S-IgG persist over 18 months in 93% of children and adolescents. During the study period one adolescent was hospitalised for less than 24 hours possibly related to an acute SARS-CoV-2 infection. These findings show that the Omicron wave and the rollout of vaccines boosted S-IgG titres and neutralising capacity. Trial registration number: NCT04448717. https://clinicaltrials.gov/ct2/show/NCT04448717 .

Bloodstream infections (BSIs) and sepsis are a major cause of morbidity and mortality. Appropriate early antibiotic therapy is crucial for improving the survival of patients with sepsis and septic shock. T2 magnetic resonance (T2MR®) technology may enable fast and sensitive detection of ESKAPEc pathogens directly from whole-blood samples. We aimed to evaluate concordance between the T2Bacteria® Panel and standard blood culture and its impact on antibiotic therapy decisions. We conducted a single-centre retrospective study on patients with sepsis-induced hypotension or septic shock admitted to general, post-operative/neurosurgical, and cardiothoracic Intensive Care Units who were tested with the T2Bacteria® Panel from January 2021 to December 2022. Eighty-five consecutively admitted patients were included, for a total of 85 paired tests. A total of 48 ESKAPEc pathogens were identified by the T2Bacteria® Panel. The concordance rate between the T2Bacteria® Panel and blood cultures was 81% (69/85), with 20 concordant-positive and 49 concordant-negative cases. For the 25 microorganisms grown from accompanying blood cultures, blood pathogen coverage by the T2Bacteria® Panel was 88%. In this cohort of severely ill septic patients, the T2Bacteria® Panel was highly concordant and was able to detect more ESKAPEc pathogens, with a significantly shorter turn-around time compared to conventional blood cultures. The T2Bacteria® Panel also significantly impacted decisions on antibiotic therapy.