Search

Background: Long-term outcomes of patients treated with helmet noninvasive ventilation (NIV) are unknown: safety concerns regarding the risk of patient self-inflicted lung injury and delayed intubation exist when NIV is applied in hypoxemic patients. We assessed the 6-month outcome of patients who received helmet NIV or high-flow nasal oxygen for COVID-19 hypoxemic respiratory failure. Methods: In this prespecified analysis of a randomized trial of helmet NIV versus high-flow nasal oxygen (HENIVOT), clinical status, physical performance (6-min-walking-test and 30-s chair stand test), respiratory function and quality of life (EuroQoL five dimensions five levels questionnaire, EuroQoL VAS, SF36 and Post-Traumatic Stress Disorder Checklist for the DSM) were evaluated 6months after the enrollment. Results: Among 80 patients who were alive, 71 (89%) completed the follow-up: 35 had received helmet NIV, 36 high-flow oxygen. There was no inter-group difference in any item concerning vital signs (N = 4), physical performance (N = 18), respiratory function (N = 27), quality of life (N = 21) and laboratory tests (N = 15). Arthralgia was significantly lower in the helmet group (16% vs. 55%, p = 0.002). Fifty-two percent of patients in helmet group vs. 63% of patients in high-flow group had diffusing capacity of the lungs for carbon monoxide < 80% of predicted (p = 0.44); 13% vs. 22% had forced vital capacity < 80% of predicted (p = 0.51). Both groups reported similar degree of pain (p = 0.81) and anxiety (p = 0.81) at the EQ-5D-5L test; the EQ-VAS score was similar in the two groups (p = 0.27). Compared to patients who successfully avoided invasive mechanical ventilation (54/71, 76%), intubated patients (17/71, 24%) had significantly worse pulmonary function (median diffusing capacity of the lungs for carbon monoxide 66% [Interquartile range: 47–77] of predicted vs. 80% [71–88], p = 0.005) and decreased quality of life (EQ-VAS: 70 [53–70] vs. 80 [70–83], p = 0.01). Conclusions: In patients with COVID-19 hypoxemic respiratory failure, treatment with helmet NIV or high-flow oxygen yielded similar quality of life and functional outcome at 6months. The need for invasive mechanical ventilation was associated with worse outcomes. These data indicate that helmet NIV, as applied in the HENIVOT trial, can be safely used in hypoxemic patients. Trial registration Registered on clinicaltrials.gov NCT04502576 on August 6, 2020

This paper investigates 3-years mortality after discharge in patients residing in Sicily (Italy) diagnosed with cancer among: colon, stomach, liver, and lungs, between 1/1/2010 - 31/12/2011. The effect of mobility and socio-economic status on mortality is evaluated through survival analysis approach. Results shows that out-of-region hospitalization is associated with higher survival time; no association of mortality with socio-economic status appears. The extent of patients’ mobility, and its relation with mortality raises regional policy considerations

The ForBioEnergy project, funded within the INTERREG MED Programme 2014-2020, involved a Lead Partner (Regional Department for the Rural and Territorial Development, Sicily Region), 8 project partners from 4 Mediterranean countries (Italy, Spain, Slovenia and Croatia) and 4 Associate Partners from Italy (Ente Parco delle Madonie, AIEL, Enviland, Petralia Sottana) and Croatia. It is an innovative project which bets on the chance to favor the sustainable development of the rural areas through the exploitation of the forest biomass for the production of bioenergy. However, most of the Mediterranean forests are within protected areas, where the current regulatory restrictions and the lack of management plans impede and slow down the possibility to exploit woody biomass. The main objective of the project was to fostering the bioenergy production in the protected areas, providing trans-national solutions for reducing barriers that currently hinder the development of the biomass sector, planning models in order to exploit the potential of biomass, whereas preserving the forest biodiversity. To achieve these goals the project includes an Action Plan for shaping new regulatory framework and permit route aimed at removing the administrative, technical and socio-economic barriers that hinder the use of biomass, a multi-level planning process, a set of sustainability requirements and quality standards of forest biomass. The key actors and stakeholders involved with bioenergy and biodiversity issues were identified, including institutions, and social and productive organization at regional and local level. A permanent technical panel has been established in each involved country to promote the exchange of knowledge and information between private and public key actors. The project provides a three-level approach to the planning process for the use of forest biomass: sub-regional (useful for the connections with the large scale energy planning), local (useful for the development of best practices for sustainable forest management), operating (useful for planning and management of the supply chain). The main results achieved by the project are: GIS applications for implementing the planning activities and for identifying the Biomass Districts; Decision Support Systems (DSS) to guide the competent public authorities in the choice of the best solutions to increase the sustainable production of biomass according with sustainability objectives established for protected areas; a methodology for evaluating threats and benefits deriving from biomass harvesting and extraction; the drawing up of a forest management plan at biomass district scale; the definition of a traceability system and quality standards for woody biomass in order to ensure the respect of the sustainability criteria necessary for the development of the biomass chain in protected areas. A set of specific indicators has been defined to evaluate the positive and negative impacts that the forestry interventions could have on the biotic, abiotic, and socio-economic components, in the short, medium and long period. The transferring activities, as well as the communicative ones, contributed to spread the know-how and the results gained during the project implementation not only at a local level but also at a regional and national level, in order to favor high levels of replicability all over the MED Programme cooperation area.

Scurvy is a well-known clinical condition caused by vitamin C deficiency. Although considered a rare disease in high-income countries, it has been recently increasingly reported in children, especially in those with abnormal dietary habits, mental or physical disabilities. We performed an extensive review of the literature analyzing studies published in the last 20 years focusing on clinical features, differential diagnosis and diagnostic delay. Fifteen articles were selected, collectively reporting a total of 166 children. Because of the wide clinical spectrum (musculoskeletal complaints and/or mucocutaneous lesions or systemic symptoms), scurvy can mimic several conditions, including autoimmune diseases, infections, and neoplasia. In addition, frequent findings such as normal nutritional status, anemia or elevated inflammatory markers may guide clinicians towards the abovementioned misdiagnoses. Scurvy should be considered in patients presenting with musculoskeletal complaints, not only in those with risk factors but also in healthy children. A focused dietary history and a careful physical examination, assessing other signs of vitamin C deficiency, are mandatory in these patients. When suspected, the dosage of serum vitamin C is the diagnostic gold standard; furthermore, imaging studies, performed by an expert radiologist, can reveal the typical features of scurvy. Only early diagnosis can avoid unnecessary investigations and potentially fatal complications of the disease.

Background Cutaneous malignant melanoma (CMM) is one of the most common skin cancers worldwide. Limited information is available in the current scientific literature on the concordance of genetic alterations between primary and metastatic CMM. In the present study, we performed next-generation sequencing (NGS) analysis of the main genes participating in melanoma pathogenesis and progression, among paired primary and metastatic lesions of CMM patients, with the aim to evaluate levels of discrepancies in mutational patterns. Methods Paraffin-embedded tumor tissues of the paired lesions were retrieved from the archives of the institutions participating in the study. NGS was performed using a specific multiple-gene panel constructed by the Italian Melanoma Intergroup (IMI) to explore the mutational status of selected regions (343 amplicons; amplicon range: 125–175 bp; coverage 100%) within the main 25 genes involved in CMM pathogenesis; sequencing was performed with the Ion Torrent PGM System. Results A discovery cohort encompassing 30 cases, and a validation cohort including eleven Sardinian patients with tissue availability from both the primary and metachronous metastatic lesions were identified; the global number of analyzed tissue specimens was 90. A total of 829 genetic non-synonymous variants were detected: 101 (12.2%) were pathogenic/likely pathogenic, 131 (15.8%) were benign/likely benign, and the remaining 597 (72%) were uncertain/unknown significance variants. Considering the global cohort, the consistency in pathogenic/pathogenic like mutations was 76%. Consistency for BRAF and NRAS mutations was 95.2% and 85.7% respectively, without statistically significant differences between the discovery and validation cohort. Conclusions Our study showed a high level of concordance in mutational patterns between primary and metastatic CMM, especially when pathogenic mutations in driver genes were considered.

Background : In French Polynesia, thyroid cancer mortality and incidence is reported to be the highest in the world. Excessive levels of non-essential trace elements (nETE) in the body are associated with several types of cancer. Objective: The present study aims to provide quantitative information on food contamination by mercury (Hg), lead (Pb), arsenic (As) and cadmium (Cd) in French Polynesia and its potential correlation with measurements performed in fingernails of Polynesians, and then to investigate the potential association between these nETE and different thyroid cancer risks. Methods: The study population included 229 interviewed cases and 373 interviewed controls We performed a descriptive analysis of Polynesian food and examined the association between thyroid cancer risk and daily intake levels of nETE and with fingernail nETE levels. Results : Hg contamination was mainly present in sea products, Pb contamination was present in almost all samples, Cd was detectable in starchy food and As was detectable in all sea products. No patient exceeded dietary contamination WHO limits for Pb, 2 participants exceeded it for Hg and 3 individuals (0.5%) for cadmium. In fingernail clippings, the most detectable pollutant was Pb (553 participants), then Hg (543 participants) then Cd (only in 130 participants). Thyroid cancer risk was increased more than 4 times by Pb daily intake in patients with a history of cancer in first-degree relatives than in ones without (p for interaction =0.01), and 2 times more in women with more than 3 pregnancies than in those with none or less (p for interaction =0.005); it was also increased following As intake by more than 30% in patients with a history of cancer in first-degree relatives than in ones without (p for interaction =0.05). Conclusion : Locally produced foods are not a source of nETE exposure in French Polynesia. Dieatry nETE exposure and fingernail nETE concentration are not associated to differentiated thyroid cancer risk. No correlation found between nETE dietary exposure and fingernail nETE concentration.

© 2017 by the authors.Water vapour (H2O) is the dominant species in volcanic gas plumes. Therefore,measurements of H2O fluxes could provide valuable constraints on subsurface degassing and magmatic processes. However, due to the large and variable concentration of this species in the background atmosphere, little attention has been devoted to monitoring the emission rates of this species from volcanoes. Instead, the focus has been placed on remote measurements of SO2, which is present in far lower abundances in plumes, and therefore provides poorer single flux proxies for overall degassing conditions. Here, we present a new technique for the measurement of H2O emissions at degassing volcanoes at high temporal resolution (≈1 Hz), via remote sensing with low cost digital cameras. This approach is analogous to the use of dual band ultraviolet (UV) cameras for measurements of volcanic SO2 release, but is focused on near infrared absorption by H2O. We report on the field deployment of these devices on La Fossa crater, Vulcano Island, and the North East Crater of Mt. Etna, during which in-plume calibration was performed using a humidity sensor, resulting in estimated mean H2O fluxes of ≈15 kg·s-1 and ≈34 kg·s-1, respectively, in accordance with previously reported literature values. By combining the Etna data with parallel UV camera and Multi-GAS observations, we also derived, for the first time, a combined record of 1 Hz gas fluxes for the three most abundant volcanic gas species: H2O, CO2, and SO2. Spectral analysis of the Etna data revealed oscillations in the passive emissions of all three species, with periods spanning ≈40-175 s, and a strong degree of correlation between the periodicity manifested in the SO2 and H2O data, potentially related to the similar exsolution depths of these two gases. In contrast, there was a poorer linkage between oscillations in these species and those of CO2, possibly due to the deeper exsolution of carbon dioxide, giving rise to distinct periodic degassing behaviour.