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Background: Internuclear ophthalmoplegia (INO) is a disorder of eye movements caused by a lesion involving the medial longitudinal fasciculus (MLF) within the brainstem, and it is characterized by adduction impairment combined with contralateral dissociated abduction nystagmus. The frequency of acute ischemic stroke (AIS) presenting with INO as a predominant symptom is very low, and many patients suffering from this brainstem AIS are precluded from intravenous thrombolysis (IVT). Objective: To provide for the first time a magnetic resonance imaging (MRI) evidence of response to the IVT in brainstem wake-up stroke presenting with INO as an isolated symptom. Methods: Here, we described a rare case of pons AIS presenting with INO as a unique symptom of awakening. In order to differentiate an ischemic stroke from other stroke mimics, and to determine whether the patient was within the therapeutic window for IVT (wake-up stroke), brain MRI including DWI and FLAIR sequences was acquired. Results: A left paramedian pontine DWI/FLAIR mismatch was detected and the patient was considered eligible for IVT. After IVT, the patient made a full recovery with complete resolution of INO. Follow-up MRI at 1 month demonstrates the absence of ischemic lesions. Conclusion: Our case provides neuroradiological evidence of IVT efficacy in brainstem stroke, and it should prompt clinicians to rapidly perform MRI in wake-up onset INO and to just as quickly administer IVT, since INO is a functionally disabling deficit. Finally, this case demonstrates the value of MRI in diagnostic, prognostic, and therapeutic workup of posterior circulation wake-up stroke.

The growing interest in quantum technologies, from fundamental physics experiments to quantum computing, demands for extremely performing electronics only adding the minimum amount of noise admitted by quantum mechanics to the input signal (i.e. quantum-limited electronics). Superconducting microwave amplifiers, due to their dissipationless nature, exhibit outstanding performances in terms of noise (quantum limited), and gain. However, bandwidth and saturation power still show space for substantial improvement. Within the DARTWARS* collaboration, we are developing state-of-the-art microwave superconducting amplifiers based on Josephson junction arrays and on distributed kinetic inductance transmission lines. Here we report the realization of a setup for the characterization of the performances of Josephson Traveling-Wave Parametric Amplifiers (JTWPA) at a temperature of 300 mK. Although in the final experimental setup these amplifiers will operate at a base temperature of about 20 mK, their characterization at 300 mK allows to evidence the main aspects of their performances, but the ultimate noise level. This represents a quick and relatively inexpensive way to test these superconductive devices that can be of help to improve their design and fabrication. IEEE

The recent developments in quantum technologies, as well as advanced detection experiments, have raised the need to detect extremely weak signals in the microwave frequency spectrum. To this aim, the Josephson travelling wave parametric amplifier, a device capable of reaching the quantum noise limit while providing a wide bandwidth, has been proposed as a suitable cryogenic front-end amplifier. This work deals with the numerical study of a Josephson travelling wave parametric amplifier, without approximations regarding the nonlinearity of the key elements. In particular, we focus on the investigation of the system of coupled nonlinear differential equations representing all the cells of the Josephson travelling wave parametric amplifier, with proper input and output signals at the boundaries. The investigation of the output signals generated by the parametric amplification process explores the phase-space and the Fourier spectral analysis of the output voltage, as a function of the parameters describing the pump and signal tones that excite the device. Beside the expected behavior, i.e., the signal amplification, we show that, depending on the system operation, unwanted effects (such as pump tone harmonics, incommensurate frequency generation, and noise rise), which are not accounted for in simple linearized approaches, can be generated in the whole nonlinear system. IEEE

Left atrial intramural hematoma (LAIH) is an uncommon entity for which a timely diagnosis is critical for decision making. Cardiac surgical or catheter-based procedures are potential causing factors. Though cardiac computerized tomography and magnetic resonance are highly accurate diagnostic modalities, their role is limited by the lack of widespread availability. The present clinical case illustrates the diagnostic features of LAIH that can be obtained using echocardiography at the bedside in critically ill patients. We report a case of LAIH, that followed a catheter ablation procedure and was complicated by cardiac and cerebral ischemia. Cardiac surgical management was required.

BACKGROUND To document the evolution of cranial asymmetries in infants with signs of nonsynostotic occipital plagiocephaly (NSOP) who were undergo to many functional manual therapy treatments (in addition to the standard positioning recommendations) as well as to determine the feasibility of this methodology to conduct an outcome research investigating the impact of this intervention for infants with NSOP. METHODS Pilot clinical standardization project using pre-post design in which 10 infants participated. Nine infants presented an initial Oblique Diameter Difference Index (ODDI) over 104%, three an initial Ear Deviation Index (EDI) over 4%, and three a Cranial Proportional Index (CPI) over 90%. INTERVENTIONS Infants received three functional manual therapy treatments for week during the first month of intervention and two ones for week during the second month. RESULTS Plagiocephalometric measurememts were administered at the first assessment pre-intervention (T0), after 30 days (+/-5) (T1) and at a third time after 60 days (+/5) of treatment (T2). RESULTS 9/10 participants showed a significant decrease in ODDI under 104% between T0 and T2 assessments. 5/10 infants showed an EDI under 4%, and 3/10 showed a value about 0%. 3/10 maintained their CPI over 90% with a considerable decrease. CONCLUSIONS These clinical findings support the hypothesis that functional manual therapy treatments contribute to the improvement of cranial asymmetries in infants younger than 6.5 months old presenting with NSOP.

BACKGROUND The standard approach to subcutaneous defibrillator (S-ICD) implantation often requires general anesthesia or anesthesiologist-delivered deep sedation. Ultrasound-guided serratus anterior plane block (SAPB) combined with parasternal block (PSB) has been proposed in order to provide anesthesia/analgesia and to reduce the need for sedation during S-ICD implantation. In this pilot study, we compared the double-block approach (SAPB + PSB) with the single-block approach (SAPB only) and with the standard approach involving local anesthesia and sedation. METHODS We prospectively enrolled 22 patients undergoing S-ICD implantation: in 10, the single-block approach was adopted; in 12, the double-block approach. As a control group, we retrospectively enrolled 14 consecutive patients who had undergone S-ICD implantation under standard local anesthesia and sedation in the previous 6 months. Intra- and postprocedural data, including patient-reported pain intensity, were collected and compared in the three study groups. RESULTS The double-block approach was associated with a shorter procedure duration than the single-block and standard approaches (63.3 ± 7.9 vs 70.1 ± 6.8 vs 76.9 ± 7.8 min; P

Antimicrobial peptides (AMPs) are widely studied as therapeutic agents due to their broad-spectrum efficacy against infections. However, their clinical use is hampered by the low in vivo bioavailability and systemic toxicity. Such limitations might be overcome by using appropriate drug delivery systems. Here, the preparation of a drug delivery system (DDS) by physical conjugation of an arginine-rich peptide and hydrothermal carbon nanoparticles (CNPs) has been explored, and its antimicrobial efficacy against

In this paper, we propose a novel kind of Josephson-Energy Suppression Pump (JESP) controlled by a fully magnetic flux drive. The device presented here is composed of two superconducting loops interrupted at one side by superconducting nanowires which are joined together by a superconducting island. The phase difference developed at the edges of the nanowires by means of the magnetic flux threading the loops can collapse their Cooper condensates, leading to complete suppression of the Josephson energies. This mechanism allows to greatly reduce the leakage current when performing Cooper pair pumping by a pure magnetic pumping cycle without involving any gate modulation. The pumping capability of the JESP is studied through a master equation approach in the non-adiabatic case.

Fuel variability plays a major role in biogas combustion utilisation, where modelling and simulation can be used to provide guidelines. The construction of a flamelet generated manifold (FGM) is an important step for the simulation of complex turbulent flames. The FGM is made from premixed laminar flames and the limited literature on biogas combustion has led to this study on the effects of the fuel composition on biogas combustion in a freely propagating laminar premixed flame. The results have shown that methane concentration has a significant impact on the combustion process. There was no major difference observed among fuel mixtures with a fixed CH 4 volume concentration of 50%, with CO 2 varied from 40%, 49% to 50% and completed with either 10% of N 2 or 1% H 2 . The study can be further extended for numerical simulations under more realistic and practical conditions in order to develop guidelines for industrial combustors.

In the last few years, several groups have proposed and developed their own platforms demonstrating quantum-limited linear parametric amplification, with evident applications in quantum information and computation, electrical and optical metrology, radio astronomy and basic physics concerning axion detection. Here we propose a short review on the physics behind parametric amplification via metamaterials composed by coplanar wave-guides embedding several Josephson junctions. We present and compare different schemes that exploit the nonlinearity of the Josephson current-phase relation to mix the so-called signal, idler and pump tones. The chapter then presents and compares three different theoretical models, developed in the last few years, to predict the dynamics of these nonlinear systems in the particular case of a 4-Wave Mixing process and under the degenerate undepleted pump assumption. We will demonstrate that, under the same assumption, all the results are comparable in terms of amplification of the output fields.

Lithium-ion (Li-ion) battery cooling using a phase change material (PCM)/compressed expanded natural graphite (CENG) composite is investigated, for a cylindrical battery cell and for a battery module scale. An electrochemistry model (average model) is coupled to the thermal model, with the addition of a one-dimensional model for the solution and solid diffusion using the nodal network method. The analysis of the temperature distribution of the battery module scale has shown that a two-dimensional model is sufficient to describe the transient temperature rise. In consequence, a two-dimensional cell-centred finite volume code for unstructured meshes is developed with additions of the electrochemistry and phase change. This two-dimensional thermal model is used to investigate a new and usual battery module configurations cooled by PCM/CENG at different discharge rates. The comparison of both configurations with a constant source term and heat generation based on the electrochemistry model showed the superiority of the new design. In this study, comparisons between the predictions from different analytical and computational tools as well as open-source packages were carried out, and close agreements have been observed.

Thanks to its excellent mechanical properties, graphene is particularly suited for the realization of suspended membranes. The present paper deals with one possible application of such membranes that is the realization of suspended lithographic masks for shadow evaporation onto a substrate. This technique, which is largely used for realizing mesoscopic devices, where the quality requirements for the junctions prevent the exposure to ambient air and the occurrence of quantum phenomena requires highly defined structures, can be improved by the use of pure 2-dimensional masks, like graphene ones. Advantages and differences of this material with respect to commonly employed polymers are presented and discussed.

The thermal management of a cylindrical battery cell by a phase change material (PCM)/compressed expanded natural graphite (CENG) is investigated in this study. The transient thermal behaviour of both the battery and the PCM/CENG is described with a simplified one-dimensional model taking into account the physical and phase change properties of the PCM/CENG composite. The 1D analytical/computational model yielded nearly identical results to the three-dimensional simulation results for various cooling strategies. Therefore, the 1D model is sufficient to describe the transient behaviour of the battery cooled by a PCM/CENG composite. Moreover, the maximum temperature reached by the PCM/CENG cooling strategy is much lower than that by the forced convection in the same configuration. In the test case studied, the PCM showed superior transient characteristics to forced convection cooling. The PCM cooling is able to maintain a lower maximum temperature during the melting process and to extend the transient time for temperature rise. Furthermore, the graphite-matrix bulk density is identified as an important parameter for optimising the PCM/CENG cooling strategy.

A simplified one-dimensional transient computational model of a prismatic lithium-ion battery cell is developed using thermal circuit approach in conjunction with the thermal model of the heat pipe. The proposed model is compared to an analytical solution based on variable separation as well as three-dimensional (3D) computational fluid dynamics (CFD) simulations. The three approaches, i.e. the 1D computational model, analytical solution, and 3D CFD simulations, yielded nearly identical results for the thermal behaviours. Therefore the 1D model is considered to be sufficient to predict the temperature distribution of lithium-ion battery thermal management using heat pipes. Moreover, a maximum temperature of 27.6 °C was predicted for the design of the heat pipe setup in a distributed configuration, while a maximum temperature of 51.5 °C was predicted when forced convection was applied to the same configuration. The higher surface contact of the heat pipes allows a better cooling management compared to forced convection cooling. Accordingly, heat pipes can be used to achieve effective thermal management of a battery pack with confined surface areas.

Introduction A case of massive facial edema and airway obstruction secondary to an acute sialadenitis is described that occurred a few hours after a neurosurgical procedure performed in the prone position. Literature on this topic is reviewed. Case presentation A 73-year-old Caucasian woman underwent a right parieto-occipital craniotomy to remove a meningioma. The procedure was performed in the prone position and lasted for 7 hours. One hour after the end of surgery, left submandibular gland swelling was clearly visible and in a few hours, she developed massive facial edema. Imaging (computed tomography and magnetic resonance) showed inflammatory swelling of the submandibular and parotid glands and of the periglandular tissues, undilated excretory ducts, and complete obliteration of the pharynx lumen (pharyngeal mucosa adhered to the endotracheal tube). Analgesics, corticosteroids, and antibiotics were administered. Edema regressed from the 4th postoperative day and the endotracheal tube could be removed on the 7th postoperative day. The patient was discharged from the surgical intensive care unit on the 14th postoperative day and from hospital on the 28th postoperative day. Conclusion This is the first case report in which acute postoperative sialadenitis caused complete upper airway obstruction: only the presence of a tracheal tube avoided the need for an emergency tracheostomy. Since edema evolves insidiously, we recommend caution when removing the endotracheal tube in patients who are acutely developing postoperative sialadenitis.

The majority of patients with acute coronary syndromes are elderly subjects. They are at a high risk of events; in fact, they usually arrive to hospital late and this delay nullifies the advantages of reperfusion; they often present with a large and complicated acute myocardial infarction and the short-term mortality for such patients is 3-5 times higher than that observed for younger subjects. Although they are a high-risk population, paradoxically they receive thrombolytic therapy, beta-blocker drugs and acetyl salicylic acid less frequently than younger patients and they are rarely submitted to interventional procedures. In this overview, we analyze the reasons of this paradox and we suggest some management guidelines. The risk of bleeding associated with thrombolytic drugs is the main reason justifying the limited use of reperfusion therapy in elderly patients. The identification, in each patient, of the risk factors for bleeding permits stratification of such patients into different classes of risk. This may be of help to the physician in distinguishing those patients who are candidates for thrombolytic therapy from those who are not, reserving for the latter other therapeutic strategies such as primary coronary angioplasty. In elderly patients with unstable angina or myocardial infarction, a careful and early risk stratification should serve as a guide when establishing the indication for interventional procedures. The latter should be encouraged in those patients in whom the risk of bleeding is high and whose overall clinical picture does not contraindicate such a therapeutic strategy. In such cases, invasive therapy can really improve the patient's quality of life.

Takotsubo syndrome is characterized by transient and regional left ventricular dysfunction, which does not correspond anatomically to coronary distribution, without obstructive coronary lesions and frequently follows episodes of emotional or physical stress. The authors present a case of takotsubo syndrome, complicated by acute heart failure and functional severe mitral regurgitation, in a newborn after fetal distress caused by the umbilical cord being twisted around the chest and neck. In newborns after birth asphyxia, left ventricular dysfunction has been reported as global and due to ischemia. In this case, the transient and regional left ventricular dysfunction involving segments of multiple epicardial coronary territories, with associated hyperkinesis of the ventricular septum and basal segments of other walls, could have been caused by delivery stress with catecholamine-mediated cardiac toxicity.