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Discriminating acute respiratory distress syndrome (ARDS) from acute cardiogenic pulmonary edema (CPE) may be challenging in critically ill patients. Aim of this study was to investigate if gray-level co-occurrence matrix (GLCM) analysis of lung ultrasound (LUS) images can differentiate ARDS from CPE. The study population consisted of critically ill patients admitted to intensive care unit (ICU) with acute respiratory failure and submitted to LUS and extravascular lung water monitoring, and of a healthy control group (HCG). A digital analysis of pleural line and subpleural space, based on the GLCM with second order statistical texture analysis, was tested. We prospectively evaluated 47 subjects: 16 with a clinical diagnosis of CPE, 8 of ARDS, and 23 healthy subjects. By comparing ARDS and CPE patients’ subgroups with HCG, the one-way ANOVA models found a statistical significance in 9 out of 11 GLCM textural features. Post-hoc pairwise comparisons found statistical significance within each matrix feature for ARDS vs. CPE and CPE vs. HCG (P ≤ 0.001 for all). For ARDS vs. HCG a statistical significance occurred only in two matrix features (correlation: P = 0.005; homogeneity: P = 0.048). The quantitative method proposed has shown high diagnostic accuracy in differentiating normal lung from ARDS or CPE, and good diagnostic accuracy in differentiating CPE and ARDS. Gray-level co-occurrence matrix analysis of LUS images has the potential to aid pulmonary edemas differential diagnosis.

BACKGROUND: The aim of this study was to evaluate whether measurement of diaphragm thickness (DT) by ultrasonography may be a clinically useful noninvasive method for identifying patients at risk of adverse outcomes defined as need of invasive mechanical ventilation or death. METHODS: We prospectively enrolled 77 patients with laboratory-confirmed COVID-19 infection admitted to our intermediate care unit in Pisa between March 5 and March 30, 2020, with follow-up until hospital discharge or death. Logistic regression was used identify variables potentially associated with adverse outcomes and those P

Up to 50% of patients hospitalized for acute heart failure (AHF) show resistance to diuretics. This condition contributes to a prolonged hospital length of stay and a higher risk of death. This review aimed to investigate whether a diuretic therapeutic approach more effective than furosemide alone exists for patients with diuretic-resistant AHF.We identified all randomized controlled trials (RCTs) evaluating diuretic therapy in patients with diuretic-resistant AHF. We searched Pubmed, BioMed Central, and Cochrane CENTRAL databases.Six RCTs were identified, involving a total of 845 patients. The P-score ranges from 0.6663 for furosemide to 0.2294 for the tolvaptan-furosemide. We found no significant differences in efficacy for any drug comparison.None of the diuretics considered in RCTs performed to date (tolvaptan, metolazone, hydrochlorothiazide, indapamide) appear to be more effective than furosemide therapy alone for the treatment of patients with diuretic-resistant AHF.

Different applications of hydrochar produced from the sewage and food waste generated by a small town in the UK (Chirnside; 2,250 residents) are assessed. These are: as a solid biofuel used in domestic biomass boilers, use in combined heat and power, as a precusor to activated carbon, and as a soil conditioner. For each application, the process had a positive net energy when using part of hydrochar to power the HTC plant. As a biofuel for domestic combustion, hydrochar would only be able to supply the town with 2.18 % of its thermal energy demand. The highest potential revenues can be obtained when activating all the hydrochar produced (99.08 t yr-1), with revenues dependant on the characteristics of the final product. Application as a soil conditioner is not certifiable in the UK as of yet and is not the most profitable application. Aging or thermally treating hydrochar for soil conditioner applications should be used to remove phytotoxic compounds., Proceedings of the 29th European Biomass Conference and Exhibition, 26-29 April 2021, Online, pp. 986-999

Closed-loop reverse electrodialysis is a novel technology to convert low-grade heat directly into electricity. It consists of a reverse electrodialysis unit coupled with a regeneration unit in which the waste-heat is used to restore the initial conditions of the two solutions. One of the most impor- tant advantages of closed-loop system is the possibility to select an ad-hoc salt solution to obtain high efficiency. In this regard, it is important to assess how the salt solution properties affect the performance of the energy generation and solution regeneration processes. The aim of this study is to analyse the effect of thermodynamic properties of non-conventional salt solutions within a RED closed-loop with evaporative regeneration unit. New data for caesium and potassium acetate, in terms of activity and osmotic coefficients, in aqueous solutions at tem- perature between 20 and 90°C are reported as a function of molality. The data are correlated using Pitzer’s model which is then used to assess the performance in terms of Gibbs free energy of mix- ing, thermal power consumptions, thermal and exergy efficiency for different salt-water solutions (i.e. sodium chloride, lithium chloride, sodium acetate, caesium acetate and potassium acetate) are evaluated and compared considering single and multi-stage regeneration units. Results indicated that lithium chloride, potassium acetate and caesium acetate are the most promising salts among those screened.