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Rapid antigen diagnostic (RAD) tests have been developed for the identification of the SARS-CoV-2 infection. However, they require nasopharyngeal or nasal swab, which is invasive, uncomfortable, and aerosolising. The use of saliva test was also proposed but has not yet been validated. Trained dogs may efficiently smell the presence of SARS-CoV-2 in biological samples of infected people, but further validation is needed both in laboratory and in field. The present study aimed to (1) assess and validate the stability over a specific time period of COVID-19 detection in humans’ armpit sweat by trained dogs thanks to a double-blind laboratory test–retest design, and (2) assess this ability when sniffing people directly. Dogs were not trained to discriminate against other infections. For all dogs (n. 3), the laboratory test on 360 samples yielded 93% sensitivity and 99% specificity, an 88% agreement with the Rt-PCR, and a moderate to strong test–retest correlation. When sniffing people directly (n. 97), dogs’ (n. 5) overall sensitivity (89%) and specificity (95%) were significantly above chance level. An almost perfect agreement with RAD results was found (kappa 0.83, SE 0.05, p = 0.001). Therefore, sniffer dogs met appropriate criteria (e.g., repeatability) and WHO's target product profiles for COVID-19 diagnostics and produced very promising results in laboratory and field settings, respectively. These findings support the idea that biodetection dogs could help reduce the spread of the virus in high-risk environments, including airports, schools, and public transport.

Background Intrauterine fetal death (IUFD) is a tragic event and, despite efforts to reduce rates, its incidence remains difficult to reduce. The objective of the present study was to examine the etiological factors that contribute to the main causes and conditions associated with IUFD, over an 11-year period in a region of North-East Italy (Friuli Venezia Giulia) for which reliable data in available. Methods Retrospective analysis of all 278 IUFD cases occurred between 2005 and 2015 in pregnancies with gestational age ≥ 23 weeks. Results The incidence of IUFD was 2.8‰ live births. Of these, 30% were small for gestational age (SGA), with immigrant women being significantly over-represented. The share of SGA reached 35% in cases in which a maternal of fetal pathological condition was present, and dropped to 28% in the absence of associated pathology. In 78 pregnancies (28%) no pathology was recorded that could justify IUFD. Of all IUFDs, 11% occurred during labor, and 72% occurred at a gestational age above 30 weeks. Conclusion The percentage of IUFD cases for which no possible cause can be identified is quite high. Only the adoption of evidence-based diagnostic protocols, with integrated immunologic, genetic and pathologic examinations, can help reduce this diagnostic gap, contributing to the prevention of future IUFDs.

BACKGROUND:: Extracorporeal carbon dioxide removal has been proposed to achieve protective ventilation in patients at risk for ventilator-induced lung injury. In an acute study, the authors previously described an extracorporeal carbon dioxide removal technique enhanced by regional extracorporeal blood acidification. The current study evaluates efficacy and feasibility of such technology applied for 48 h. METHODS:: Ten pigs were connected to a low-flow veno-venous extracorporeal circuit (blood flow rate, 0.25 l/min) including a membrane lung. Blood acidification was achieved in eight pigs by continuous infusion of 2.5 mEq/min of lactic acid at the membrane lung inlet. The acid infusion was interrupted for 1 h at the 24 and 48 h. Two control pigs did not receive acidification. At baseline and every 8 h thereafter, the authors measured blood lactate, gases, chemistry, and the amount of carbon dioxide removed by the membrane lung (VCO2ML). The authors also measured erythrocyte metabolites and selected cytokines. Histological and metalloproteinases analyses were performed on selected organs. RESULTS:: Blood acidification consistently increased VCO2ML by 62 to 78%, from 79 ± 13 to 128 ± 22 ml/min at baseline, from 60 ± 8 to 101 ± 16 ml/min at 24 h, and from 54 ± 6 to 96 ± 16 ml/min at 48 h. During regional acidification, arterial pH decreased slightly (average reduction, 0.04), whereas arterial lactate remained lower than 4 mEq/l. No sign of organ and erythrocyte damage was recorded. CONCLUSION:: Infusion of lactic acid at the membrane lung inlet consistently increased VCO2ML providing a safe removal of carbon dioxide from only 250 ml/min extracorporeal blood flow in amounts equivalent to 50% production of an adult man.

Objectives: The authors describe the enucleation of a nasopalatine duct cyst in a patient receiving oral bisphosphonate therapy, which can influence the outcome of dental treatments by altering the physiological tissue healing process. Materials and methods: A surgical approach was used to remove a nasopalatine duct cyst in a patient receiving oral bisphosphonate therapy. Management requires a holistic view of the case in collaboration with the patient's physicians. Results: Ten days after surgery, the patient was reassessed, and the mucous membrane was found to be healing normally. The patient was monitored with a specific follow-up protocol. Conclusions: Non-healing of hard and soft tissues is a risk in patients receiving oral bisphosphonate who undergo invasive oral surgery procedures. Thus, an appropriate antibiotic prophylaxis is essential before and after surgery. © 2012 Elsevier Srl. All rights reserved.

In precedenti studi abbiamo dimostrato che l’inalazione di monossido di carbonio (CO, 250 ppm in aria) un’ora prima dell’infusione di LPS è in grado di prevenire le alterazioni respiratorie e di attenuare le caratteristiche dello shock endotossico iperacuto. In questo lavoro abbiamo voluto verificare l’efficacia dell’inalazione di CO somministrata al picco effetto dell’infusione di LPS. Il protocollo sperimentale ha previsto l’uso di 8 suini SPF Large White, del peso di 23.0 ± 2.54 kg (Media ± d.s.), sedati, anestetizzati e ventilati meccanicamente. Gli animali sono stati suddivisi in due gruppi (n.4/gruppo): LPS- infusi con lipopolisaccaridi di E. Coli (40g/kg/h i.v. per 240 minuti); LPS+CO (inalazione CO 30’ dopo l’inizio dell’infusione di LPS alla dose di 250 ppm in aria per 60 minuti). In tutti gli animali, ogni 30’ è stato monitorato il flusso respiratorio, il volume tidalico e la pressione tracheale, mentre la compliance e le resistenze del sistema respiratorio sono state calcolate con formule standard. Per quanto riguarda i parametri cardiocircolatori, sono state rilevate la pressione arteriosa sistemica e polmonare media e la gettata cardiaca. Inoltre, è stata valutata la quantità di acqua extravascolare polmonare (EVLW), mediante il metodo della termodiluizione. Su prelievi ematici è stata eseguita l’emogasanalisi arteriosa e sono stati valutati l’esame emocromocitometrico ed il profilo biochimico e coagulativo. Al termine del periodo sperimentale, si è proceduto all’escissione del parenchima polmonare, per l’analisi wet/dry. La significatività statistica della differenza tra i valori rilevati al momento del controllo e durante il trattamento è stata calcolata mediante il T-Test. Un valore di P < 0.05 è stato considerato statisticamente significativo. Negli animali del gruppoLPS+CO la carbossiemoglobinemia raggiungeva il 13.08 ± 0.55% dopo l’ora di inalazione di CO, e tornava ai valori di controllo (4.28 ± 0.18%) 90’ dopo la fine del trattamento. Secondo i nostri dati, l’inalazione di CO si è mostrata in grado di prevenire la diminuzione della compliance e l’aumento delle resistenze polmonari e dell’EVLW, quale riflesso di una minore formazione di edema polmonare. Questo risultato è avvalorato sia dal rapporto wet/dry del parenchima polmonare che dalla percentuale di ematocrito, entrambi significativamente inferiori negli animali trattati con CO. Inoltre, il trattamento con CO ha migliorato lo stato di acidosi evocato dall’infusione di LPS. Il nostro studio è uno dei primi lavori che dimostra come l’inalazione controllata di CO sia in grado di esercitare un effetto benefico anche se somministrata dopo l’induzione dello stimolo nocivo.

The aim of this study was to investigate and quantify respiratory mechanical dysfunctions in Standardbred horses with both poor performance and bronchoalveolar lavage .uid cytology characteristic of in.ammatory airway disease (IAD). A control group of healthy Standardbred horses was compared. Respiratory mechanics and breathing pattern were examined at rest and during hyperventilation induced using a rebreathing method. At rest, respiratory mechanics and breathing pattern were superimposable in both groups. In IAD horses, rebreathing increased ventilation, with larger tidal volumes and lower respiratory frequencies. During hyperventilation, IAD animals showed frequency-dependent dynamic lung compliance, and had greater viscous lung resistance and rate of dynamic work of breathing. As IAD alters pulmonary mechanics, the ventilatory load increases and horses requiring signi.cantly higher energy for breathing may su.er restrictions in their athletic performance. This rebreathing method permits early evaluation of respiratory mechanical dysfunction in poorly performing horses with sub-clinical IAD.

OBJECTIVES: Extracorporeal carbon dioxide removal is used to treat patients suffering from acute respiratory failure. However, the procedure is hampered by the high blood flow required to achieve a significant CO2clearance. We aimed to develop an ultralow blood flow device to effectively remove CO2combined with continuous renal replacement therapy (CRRT). DESIGN: Preclinical, proof-of-concept study. SETTING: An extracorporeal circuit where 200 mL/min of blood flowed through a hemofilter connected to a closed-loop dialysate circuit. An ion-exchange resin acidified the dialysate upstream, a membrane lung to increase Pco2and promote CO2removal. PATIENTS: Six, 38.7 ± 2.0-kg female pigs. INTERVENTIONS: Different levels of acidification were tested (from 0 to 5 mEq/min). Two l/hr of postdilution CRRT were performed continuously. The respiratory rate was modified at each step to maintain arterial Pco2at 50 mm Hg. MEASUREMENTS AND MAIN RESULTS: Increasing acidification enhanced CO2removal efficiency of the membrane lung from 30 ± 5 (0 mEq/min) up to 145 ± 8 mL/min (5 mEq/min), with a 483% increase, representing the 73% ± 7% of the total body CO2production. Minute ventilation decreased accordingly from 6.5 ± 0.7 to 1.7 ± 0.5 L/min. No major side effects occurred, except for transient tachycardia episodes. As expected from the alveolar gas equation, the natural lung Pao2dropped at increasing acidification steps, given the high dissociation between the oxygenation and CO2removal capability of the device, thus Pao2decreased. CONCLUSIONS: This new extracorporeal ion-exchange resin-based multiple-organ support device proved extremely high efficiency in CO2removal and continuous renal support in a preclinical setting. Further studies are required before clinical implementation.

Riassunto Obiettivi Scopo del lavoro e descrivere un caso clinico di rimozione chirurgica di un osteoma centrale localizzato distalmente al 47. Materiali e metodi Il caso clinico presentato illustra la metodica di rimozione di un osteoma localizzato a livello mandibolare, situato distalmente rispetto al secondo molare di destra. Avvalendosi della chirurgia piezoelettrica, l’approccio a questa lesione e avvenuto nel modo meno invasivo possibile, attraverso il quale sono state eseguite l’asportazione della lesione e la toilette chirurgica del sito operatorio. Risultati Il controllo radiografico sei mesi dopo l’intervento evidenziava segni di guarigione con ossificazione della lacuna ossea residua. Conclusioni L’approccio chirurgico minimamente invasivo e l’utilizzo della chirurgia piezoelettrica rappresentano una metodica che lo specialista in chirurgia deve considerare per la risoluzione dei casi clinici che manifestano un elevato rischio di lesione per le strutture neurovascolari circostanti.