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Coronavirus disease 2019 (COVID-19) represents a major health problem in terms of deaths and long-term sequelae. We conducted a retrospective cohort study at Montichiari Hospital (Brescia, Italy) to better understand the determinants of outcome in two different COVID-19 outbreaks. A total of 634 unvaccinated patients admitted from local emergency room to the Internal Medicine ward with a confirmed diagnosis of SARS-CoV-2 infection and a moderate-to-severe COVID-19 were included in the study. A group of 260 consecutive patients during SARS-CoV-2 first wave (from February to May 2020) and 374 consecutive patients during SARS-CoV-2 2nd/3rd wave (from October 2020 to May 2021) were considered. Demographic data were not significantly different between waves, except a lower prevalence of female sex during first wave. Mortality was significantly higher during the 1st wave than in the following periods (24.2% vs. 11%; p p p

Nociceptive innervation of the thoracolumbar fascia (TLF) has been investigated over the past few decades; however, these studies have not been compiled or collectively appraised. The purpose of this scoping review was to assess current knowledge regarding nociceptive innervation of the TLF to better inform future mechanistic and clinical TLF research targeting lower back pain (LBP) treatment. PubMed, ScienceDirect, Cochrane, and Embase databases were searched in January 2021 using relevant descriptors encompassing fascia and pain. Eligible studies satisfied the following: (a) published in English; (b) preclinical and clinical (in vivo and ex vivo) studies; (c) original data; (d) included quantification of at least one TLF nociceptive component. Two-phase screening procedures were conducted by a pair of independent reviewers, after which data were extracted and summarized from eligible studies. The search resulted in 257 articles of which 10 met the inclusion criteria. Studies showed histological evidence of nociceptive nerve fibers terminating in lower back fascia, suggesting a TLF contribution to LBP. Noxious chemical injection or electrical stimulation into fascia resulted in longer pain duration and higher pain intensities than injections into subcutaneous tissue or muscle. Pre-clinical and clinical research provides histological and functional evidence of nociceptive innervation of TLF. Additional knowledge of fascial neurological components could impact LBP treatment.

The aim of the study was to assess the short-term consequences of SARS-CoV-2-related pneumonia, also in relation to radiologic/laboratory/clinical indices of risk at baseline. This prospective follow-up cohort study included 94 patients with confirmed COVID-19 admitted to a medical ward at the Montichiari Hospital, Brescia, Italy from February 28th to April 30th, 2020. Patients had COVID-19 related pneumonia with respiratory failure. Ninety-four patients out of 193 survivors accepted to be re-evaluated after discharge, on average after 4 months. In ¼ of the patients an evidence of pulmonary fibrosis was detected, as indicated by an altered diffusing capacity of the lung for carbon monoxide (DLCO); in 6–7% of patients the alteration was classified as of moderate/severe degree. We also evaluated quality of life thorough a structured questionnaire: 52% of the patients still lamented fatigue, 36% effort dyspnea, 10% anorexia, 14% dysgeusia or anosmia, 31% insomnia and 21% anxiety. Finally, we evaluated three prognostic indices (the Brixia radiologic score, the Charlson Comorbidity Index and the 4C mortality score) in terms of prediction of the clinical consequences of the disease. All of them significantly predicted the extent of short-term lung involvement. In conclusion, our study demonstrated that SARS-CoV-2-related pneumonia is associated to relevant short-term clinical consequences, both in terms of persistence of symptoms and in terms of impairment of DLCO (indicator of a possible development of pulmonary fibrosis); some severity indices of the disease may predict short-term clinical outcome. Further studies are needed to ascertain whether such manifestations may persist long-term.

Long term sustainability of the high energy physics (HEP) research software ecosystem is essential for the field. With upgrades and new facilities coming online throughout the 2020s this will only become increasingly relevant throughout this decade. Meeting this sustainability challenge requires a workforce with a combination of HEP domain knowledge and advanced software skills. The required software skills fall into three broad groups. The first is fundamental and generic software engineering (e.g. Unix, version control,C++, continuous integration). The second is knowledge of domain specific HEP packages and practices (e.g., the ROOT data format and analysis framework). The third is more advanced knowledge involving more specialized techniques. These include parallel programming, machine learning and data science tools, and techniques to preserve software projects at all scales. This paper dis-cusses the collective software training program in HEP and its activities led by the HEP Software Foundation (HSF) and the Institute for Research and Innovation in Software in HEP (IRIS-HEP). The program equips participants with an array of software skills that serve as ingredients from which solutions to the computing challenges of HEP can be formed. Beyond serving the community by ensuring that members are able to pursue research goals, this program serves individuals by providing intellectual capital and transferable skills that are becoming increasingly important to careers in the realm of software and computing, whether inside or outside HEP, For CHEP 2021 conference,sent for publication to CSBS Springer

The aim of the present study was to simultaneously assess several potential predictors of outcome (co-morbidity, previous and in-hospital treatment, radiologic Brixia score) in patients with COVID-19. This retrospective cohort study included 258 consecutive patients with confirmed COVID-19 admitted to a medical ward at Montichiari Hospital, Brescia, Italy from February 28th to April 30rd, 2020. Patients had SARS-CoV-2 related pneumonia with respiratory failure, and were treated with hydroxychloroquine and lopinavir plus ritonavir. In some patients, additional treatment with tocilizumab, dexamethasone and enoxaparin was adopted. Outcomes (death or recovery) were assessed at the end of the discharge period or at the end of the follow-up (August 2020). During hospitalization, 59 patients died, while 6 died after discharge. The following variables were demonstrated to be associated with a worse prognosis: Radiologic Brixia score higher than 8, presence at baseline of hypertension, diabetes, chronic obstructive pulmonary disease, heart disease, cancer, previous treatment with ACE-inhibitors or anti-platelet drugs. Anticoagulant treatment during hospital admission with enoxaparin at a dose higher than 4000 U once daily was associated with a better prognosis. In conclusion, our study demonstrates that some co-morbidities and cardiovascular risk factors may affect prognosis. The radiologic Brixia score may be a useful tool to stratify the risk of death at baseline. Anticoagulant treatment with enoxaparin might be associated to a clinical benefit in terms of survival in patients with COVID-19.

Objective: Patients affected by novel pandemic SARS-CoV-2 may develop COVID-19 related pneumonia, which is potentially fatal. To date, the role of ongoing treatments for different conditions (such as hypertension) has been clarified in terms of their impact on survival and there is no established specific therapy for the disease, although many molecules are under investigation. Aim of the present study was testing those two issues in a population of 258 consecutive patients admitted from 29 February to 30 April 2020 to General Medicine ward of the Hospital of Montichiari (Brixia). Design and method: A group of 258 patients (173 males and 85 females, aged 71 ± 14) was enrolled. Their medical record and ongoing treatment were assessed. Patients were treated according to emerging information with oxygen, anti-malarian agents, anti-viral drugs, different antibiotics (azithromycin and others), tocilizumab and low molecular weight heparin (LMWH) at different doses. As of June 10th, 65 deaths had been observed. Survival curves were calculated according to Kaplan-Meier method. Comparison between groups was performed with Breslow and Mantel-Cox test Results: Ongoing therapy with ACE-inhibitors at the time of admission was associated with a worse prognosis (p=0.004), while no difference in survival was observed in patients under treatment with ARBs (p=0.68). Ongoing treatment with statins (p

Objective: COVID-19 is a new disease caused by pandemic SARS-CoV-2, that involves multiple organs and can cause a potentially fatal respiratory distress syndrome. Accumulating evidence point out that an “endothelitis” due to a cytokines storm causes intravascular thrombosis, especially in the lungs, and is related to the poor outcome. We tested possible relationships between anticoagulant treatment and/or administration of low molecular weight heparin (LMWH) at different doses and outcome in a population of 258 COVID-19 patients admitted from February 28th to April 30th, 2020 to General Medicine ward of the Hospital of Montichiari (Brixia, Italy). Design and method: A group of 258 consecutive patients (174 males and 84 females, mean age 71 years +/-14) was included in the present study. In 168 patients, high-flow oxygen was required (Venturi mask), 6 patients needed orotracheal intubation and 20 were given continuous positive pressure oxygen therapy (CPAP). Patient were treated (unless a pulmonary embolism was detected) with different doses of prophylactic LMWH, according to emerging evidence during pandemic period. As of June 10th, 65 deaths had been observed. Survival curves were calculated according to Kaplan-Meier method. Comparison between groups was performed with Breslow and Mantel-Cox test. Results: LMWH at standard dose (4000 IU once daily) didn't reduce mortality compared to no treatment (p=ns), while LMWH at a higher dose than usual prophylactic dose (enoxaparin 6000 IU once daily or 4000 IU bid) was associated with better outcome (p

Objective: Emerging data show that hypertension as well as other cardiovascular risk factors may have a major role on outcome in terms of death on patients with COVID-19. We analysed a population of 258 consecutive patients admitted to General Medicine ward of the Hospital of Montichiari (Brixia, Italy) from 29 February to 30 April 2020. Design and method: A group of 258 consecutive patients (173 males and 85 females, aged 71 ± 14) was enrolled. In 168 patients, high-flow oxygen was required (Venturi mask), 20 patients needed orotracheal intubation and 11 were given continuous positive pressure oxygen therapy (CPAP). Patients were treated with the best approach according to available evidence during pandemic period: anti-malaria agents, anti-viral drugs, antibiotics (azithromycin and others), tocilizumab and low molecular weight heparin (LMWH). As of June 10th, 65 deaths had been observed. Survival curves were calculated according to Kaplan-Meier method. Comparison between groups was performed with Breslow and Mantel-Cox test. Results: As shown in the table, a significant raise in mortality was observed in patients older than 65 years (p

In the present paper, all the activities carried out by Avio S.p.A in order to define, qualify, manufacture and integrate the IXV Ablative TPS will be presented. In particular the extensive numerical simulation in both small and full scale testing activities will be overviewed. Wide-ranging testing activity has been carried out in order to verify, confirm and correlate the numerical models used for TPS sizing. Tests ranged from classical thermo-mechanical characterization traction specimens to tests in plasma wind tunnels on dedicated prototypes. Finally manufacturing and integration activities will be described emphasizing technological aspects solved in order to meet the stringent requirements in terms of shape accuracy and integration tolerances.

The aim of this study was to pinpoint the cerebral regions implicated during swallowing by comparing the brain activation areas associated with two different volitional movements: tongue protrusion and tongue elevation. Twenty-four healthy subjects (11&mdash, males 22 &plusmn, 2.9 y, 13&mdash, females 23 &plusmn, 4.1 y, were examined through functional magnetic resonance imaging (fMRI) while performing two different swallowing tasks: with tongue protrusion and with tongue elevation. The study was carried out with the help of fMRI imaging which assesses brain signals caused by changes in neuronal activity in response to sensory, motor or cognitive tasks. The precentral gyrus and the cerebellum were activated during both swallowing tasks while the postcentral gyrus, thalamus, and superior parietal lobule could be identified as large activation foci only during the protrusion task. During protrusion tasks, increased activations were also seen in the left-middle and medial frontal gyrus, right thalamus, inferior parietal lobule, and the superior temporal gyrus (15,592-voxels, Z-score 5.49 &plusmn, 0.90). Tongue elevation activated a large volume of cortex portions within the left sub-gyral cortex and minor activations in both right and left inferior parietal lobules, right postcentral gyrus, lentiform nucleus, subcortical structures, the anterior cingulate, and left insular cortex (3601-voxels, Z-score 5.23 &plusmn, 0.52). However, the overall activation during swallowing tasks with tongue elevation, was significantly less than swallowing tasks with tongue protrusion. These results suggest that tongue protrusion (on inferior incisors) during swallowing activates a widely distributed network of cortical and subcortical areas than tongue elevation (on incisor papilla), suggesting a less economic and physiologically more complex movement. These neuromuscular patterns of the tongue confirm the different purpose of elevation and protrusion during swallowing and might help professionals manage malocclusions and orofacial myofunctional disorders.

The aim of this study was to investigate the impact of different periodization models on strength and local muscle endurance. Twenty trained men (25.45 ± 2.984 years, 75.34 ± 6.05 kg, 177.25 ± 4.92 cm, 23.96 ± 1.64 kg . m-2) were randomly assigned in two groups: undulling periodization (UPG) and traditional periodization group (TPG), respectively. All the subjects performed one repetition maximum (1-RM) strength test and a local muscle endurance test (60% of 1-RM to failure) before, during and after experimental period. The UPG executed 30 workout sessions with daily modifications regarding intensity, volume and rest period length. The TGP was divided into 3 phases (10 workout sessions in each phase) with the same changes executed by the other group in distinct methodological variables (intensity, volume and rest period length). After the ANCOVA analysis, no significant differences were found in both maximum strength attempts, bench press (p = 0.878) and triceps pull-down (p = 0.967). The same results occurred for local muscular endurance on the bench press (p = 0.777) or triceps pull-down (p = 0.494). However, the effect size presented moderate post-test strength gains (ESs = 0,352) and local muscular endurance (ESs = 0.367). Our results indicated that daily undulling periodization seems to be more influent in increasing muscular strength and local muscular endurance according to effect size evidence.

Background: A wide pulse pressure (PP) can provide important risk assessment information about myocardial infarction, carotid artery atherosclerosis, and global cardiovascular risk. Ambulatory pulse pressure (APP) does not have a well-known prognostic value in hypertensive patients. Methods: To evaluate the relationship among high APP, atrial volumes, and cardiac function, an observational study was performed on 108 untreated nonelderly hypertensive patients (mean age 54.23 ± 7.12). Twenty-four-hour ambulatory blood pressure monitoring, Doppler and echocardiographic measurements of systolic, diastolic function, left and right atrial volumes, left ventricular mass index and dimensions, were performed in subjects with both clinic and APP > 60 mmHg (APP1 Group). A control group of hypertensive selected subjects with both clinic and APP < 60 mmHg was chosen (APP 2 Group). Results: The APP1 group showed left atrial volume enlargement, high left ventricular mass index, and impaired diastolic function. A positive correlation was found in the APP1 group results among left ventricular end diastolic diameter (r = 0.39, P < 0.01), left atrial volume (0.38, P < 0.05), and left ventricular mass index (r = 0.33, P < 0.05); clinic PP showed a statistically significant correlation with left atrial volume, left ventricular end diastolic diameter, and left ventricular mass index only in the APP1 group. Conclusions: These results suggest that elevated APP can be considered an effective predictor of cardiovascular risk in hypertensive subjects. In these patients echocardiographic evaluation of left ventricular function and morphology can increase the prognostic value of PP. (ECHOCARDIOGRAPHY, Volume 21, January 2004)

A 76-year-old man suffered a stroke with global aphasia and right hemiplegia. The ischemic infarction was demonstrated by computed tomography. After 2 months, multiple brain abscesses developed at the site of the original infarction. Blood and abscess aspiration cultures yielded a methicillin-resistant Staphylococcus aureus (MRSA). Infection was probably caused by hematogenous dissemination from aspiration pneumonia. Secondary localization in a previous hemorrhage or infarction area, as a consequence of a bloodstream infection, is rarely documented, with only a few cases reported in the medical literature. To our knowledge, this is the first case with this antibiotic-resistant organism.

A highly metastatic (4R) and a nonmetastatic (RE4) transformed rat embryo fibroblast cell line were incubated with lipid-soluble Zn(II)-phthalocyanine (ZnPc) and its water-soluble tetrasulphonated derivative (ZnPcTS) and compared for phthalocyanine uptake. The hydrophobic liposome-delivered ZnPc showed a significantly greater uptake by both cell lines than did ZnPcTS. Moreover, the two phthalocyanines appear to interact with cells according to different pathways, as suggested by the different temperature-dependence of the binding process and the different inhibitory action exerted by selected serum proteins, such as lipoproteins and heavy proteins. Under all experimental conditions, the two cell lines exhibited similar interactions with ZnPc and ZnPcTS, suggesting that heterogeneity of the tumor cell population has a minor influence on the accumulation of photosensitizers.

Several phthalocyanines exhibit a high affinity for tumour tissues and upon red-light irradiation originate a photosensitized process leading to tumour necrosis. This study was designed to define the role of different liposomal formulations in modulating the affinity of Zn(II)-phthalocyanine (ZnPc) for isolated low- and high-density lipoproteins (LDL, HDL). This information is important as the uptake of hydrophobic photosensitizers by tumour tissues can be enhanced by their association with LDL. The kinetics and efficiency of ZnPc association with LDL and HDL as well as the redistribution of ZnPc between the lipoproteins were studied by salt gradient ultracentrifugation and spectrophotometric analyses of the isolated lipoproteins. The formation of the photosensitizer-lipoprotein complexes in the plasma is affected by the vehicle utilized for the drug delivery. ZnPc in 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine/1,2-dioleoyl-snglycero-3-L-serine and 1,2-dimyristoyl-sn-glycero-3-phosphocholine liposomes is transferred to lipoproteins within a few minutes, while the transfer of ZnPc from 1,2-dipalmitoyl-sn-glycero-3-phosphocholine liposomes reaches a steady state value in a time scale of 5–6 hr. The binding capacity of LDL for ZnPc can be as high as about 60 phthalocyanine molecules per protein particle, although the final value is affected by the phospholipid composition of the liposomes and the liposome/lipoprotein ratio. HDL have a lower binding capacity (max. about 3 ZnPc/protein) as shown by studies of interlipoprotein transfer of the photosensitizer. The present findings indicate that the association of photosensitizers with lipid-based delivery systems, besides being necessary for water-insoluble compounds, affects their distribution among lipoproteins. Liposomes which are in a fluid state at the temperature of 37°C enhance the binding of ZnPc to LDL, which should increase the selectivity of tumour targeting by the phthalocyanine owing to the efficient receptor-mediated endocytosis of LDL by several types of malignant cells.

The ability of trimetazidine (2,3,4, trimethoxybenzylpiperazine dihydrochloride, TMZ) to protect the myocardium against anthracycline (ANT)-induced cardiotoxicity during chemotherapy has been evaluated in female patients with breast cancer. A clinical trial was conducted in 61 patients subdivided into three groups: group 1 (n = 15, G1) treated with standard ANT protocol and cardioprotection by dexrazoxane (DEX) plus TMZ (60 mg, daily dose); group 2 (n = 22, G2) treated with ANT and cardioprotection by TMZ only; and group 3 (n = 24, G3) scheduled to receive ANT therapy and DEX. All the patients submitted to an echocardiographic evaluation of diastolic function (E wave velocity, A wave velocity, isovolumetric relaxation time [IVRT], deceleration time [DT]) at enrollment (TO), at T1 time, at T2 time, and at T3 time. After a 12- month follow-up period, the patients showed a good conservation of diastolic function both in G1 and G2 groups. No statistically significant difference was observed in E wave and A wave velocity and E/A ratio after ANT treatment. TMZ produced a cardioprotective effect, compa rable to DEX protection, against subacute and chronic subclinical cardiotoxicity with no signif icant changes in diastolic function after 1 year of follow-up.

Cardiac rehabilitation (CR) can improve cardiac hemodynamic performance in patients after myocardial infarction (MI). Little evidence is provided concerning the consequences of CR on atrial wave duration, and less is known about the link between pre-arrhythmogenic patterns and the cardiovascular performance improvement in these subjects. Twenty-six patients, post- MI 0 to 7 days, underwent a complete CR cycle and a signal-averaged electrocardiogram (SAECG) for the evaluation of atrial activation parameters (group 1) to appreciate if physical training can promote parallel improvement in cardiovascular and intra-atrial conduction para meters. A control group of 24 well-matched nonischemic subjects (group 2) was chosen for data comparison. Resting heart rate (p

Minimum inhibitory concentrations of penicillin, ceftriaxone, ciprofloxacin, and moxifloxacin (BAY 12-8039), a new 8-methoxyquinolone, were determined for 60 cerebrospinal fluid isolates of Streptococcus pneumoniae collected during January 1997-April 1998 at Italian medical centres. Three reference isolates with predetermined MIC values (two penicillin- and multidrug-resistant isolates, one uniformly susceptible to all antibiotics) were also tested with the same antibiotics. The MIC90 of penicillin was < or = 0.03 mg/L (range < or = 0.03-2 mg/L), of ceftriaxone 0.06 mg/L (range < or = 0.03-0.5 mg/L), of ciprofloxacin 2 mg/L (range 0.5-8 mg/L) and of moxifloxacin 0.06 mg/L (range 0.03-0.12 mg/L). Moxifloxacin was effective against all the penicillin-resistant isolates tested, with an MIC of 0.06 mg/L. Moxifloxacin was 32-fold more active than ciprofloxacin and was not affected by penicillin and cephalosporin resistance. These results indicate that moxifloxacin could be useful for the treatment of both penicillin-sensitive and -resistant S. pneumoniae meningitis.

We recently observed (February 1999) a 68-year old patient with endocarditis on a prosthetic biologic valve caused by a vancomycin-resistant Enterococcus faecalis. Broth dilution tests showed susceptibility to ampicillin (MIC=0.5 microg/ml), no high resistance to aminoglycosides (MIC for gentamicin500 microg/ml) and resistance to vancomycin (MIC256 microg/ml) and teicoplanin (MIC16 microg/ml). A PCR assay detected vanA gene in this strain. A transthoracic echocardiogram did not show valvular vegetations. A possible endocarditis was diagnosed and the patient received ampicillin for 8 weeks and gentamicin for 6 weeks. The patient remained afebrile after a 4-month follow-up when he underwent surgical replacement of the dysfunctional bioprosthetic valve. Mitral valve was sterile on culture, but histology confirmed the diagnosis of previous endocarditis. This is the third case of endocarditis caused by vancomycin-resistant E. faecalis reported to date.