Corrigendum: HLH as an additional warning sign of inborn errors of immunity beyond familial-HLH in children: a systematic review

[This corrects the article DOI: 10.3389/fimmu.2024.1282804.].

HLH as an additional warning sign of inborn errors of immunity beyond familial-HLH in children: a systematic review

Background

Hemophagocytic Lymphohistiocytosis (HLH) is a rare and life-threatening condition characterized by a severe impairment of the immune homeostasis. While Familial-HLH (FHL) is a known cause, the involvement of other Inborn Errors of Immunity (IEI) in pediatric-HLH remains understudied.

Objective

This systematic review aimed to assess the clinical features, triggers, laboratory data, treatment, and outcomes of pediatric HLH patients with IEI other than FHL (IEInotFHL), emphasizing the importance of accurate identification and management.

Methods

A systematic search for studies meeting inclusion criteria was conducted in PubMed, EMBASE, MEDLINE, and Cochrane Central. Quality assessment was performed through JBI criteria.

Results

A comprehensive search yielded 108 records meeting inclusion criteria, involving 178 patients. We identified 46 different IEI according to IUIS 2022 Classification. Combined immunodeficiencies, immune dysregulation disorders, and phagocyte defects were the IEI most frequently associated with HLH. In 75% of cases, HLH preceded the IEI diagnosis, often with an unrecognized history of severe infections. Triggers reflected the specific infection susceptibilities within IEI groups. Liver and central nervous system involvement were less common than in FHL cases. Treatment approaches and outcomes varied, with limited long-term follow-up data, limiting the assessment of therapeutic efficacy across IEI groups.

Conclusion

A comprehensive evaluation encompassing immunological, infectious, and genetic aspects is essential in pediatric-HLH. Relying solely on FHL or EBV susceptibility disorders tests is insufficient, as diverse other IEI can contribute to HLH. Early recognition of HLH as a potential warning sign can guide timely diagnostic investigations and facilitate tailored therapeutic interventions for improved outcomes.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=371425, PROSPERO, CRD42022371425.

Departures from perfect isomorph behavior in Lennard-Jones fluids and solids

Isomorphs are lines on a fluid or solid phase diagram along which the microstructure is invariant on affine density scaling of the molecular coordinates. Only inverse power (IP) and hard sphere potential systems are perfectly isomorphic. This work provides new theoretical tools and criteria to determine the extent of deviation from perfect isomorphicity for other pair potentials using the Lennard-Jones (LJ) system as a test case. A simple prescription for predicting isomorphs in the fluid range using the freezing line as a reference is shown to be quite accurate for the LJ system. The shear viscosity and self-diffusion coefficient scale well are calculated using this method, which enables comments on the physical significance of the correlations found previously in the literature to be made. The virial–potential energy fluctuation and the concept of an effective IPL system and exponent, n′, are investigated, particularly with reference to the LJ freezing and melting lines. It is shown that the exponent, n′, converges to the value 12 at a high temperature as ∼ T−1/2, where T is the temperature. Analytic expressions are derived for the density, temperature, and radius derivatives of the radial distribution function along an isomorph that can be used in molecular simulation. The variance of the radial distribution function and radial fluctuation function are shown to be isomorph invariant.

Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study

BACKGROUND

Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation.

AIM

We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project".

METHODS

We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale.

RESULTS

Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001).

CONCLUSION

This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.

Intrinsic viscuit probability distribution functions for transport coefficients of liquids and solids

A reformulation of the Green–Kubo expressions for the transport coefficients of liquids in terms of a probability distribution function (PDF) of short trajectory contributions, which were named “viscuits,” has been explored in a number of recent publications. The viscuit PDF, P, is asymmetric on the two sides of the distribution. It is shown here using equilibrium 3D and 2D molecular dynamics simulations that the viscuit PDF of a range of simple molecular single component and mixture liquid and solid systems can be expressed in terms of the same intrinsic PDF ( P0), which is derived from P with the viscuit normalized by the standard deviation separately on each side of the distribution. P0 is symmetric between the two sides and can be represented for not very small viscuit values by the same gamma distribution formulated in terms of a single disposable parameter. P0 tends to an exponential in the large viscuit wings. Scattergrams of the viscuits and their associated single trajectory correlation functions are shown to distinguish effectively between liquids, solids, and glassy systems. The so-called viscuit square root method for obtaining the transport coefficients is shown to be a useful probe of small and statistically zero self-diffusion coefficients of molecules in the liquid and solid states, respectively. The results of this work suggest that the transport coefficients have a common underlying physical origin, reflecting at a coarse-grained level the traversal statistics of the system through its high-dimensioned potential energy landscape.

The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017

Introduction

Delirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium.

Methods

The analyses were conducted employing the cross-sectional “Delirium Day” initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses.

Results

A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09–2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001].

Discussion and conclusion

Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-01950-8.

Fluid-solid interaction in the rate-dependent failure of brain tissue and biomimicking gels

Brain tissue is a heterogeneous material, constituted by a soft matrix filled with cerebrospinal fluid. The interactions between, and the complexity of each of these components are responsible for the non-linear rate-dependent behaviour that characterises what is one of the most complex tissue in nature. Here, we investigate the influence of the cutting rate on the fracture properties of brain, through wire cutting experiments. We also present a computational model for the rate-dependent behaviour of fracture propagation in soft materials, which comprises the effects of fluid interaction through a poro-hyperelastic formulation. The method is developed in the framework of finite strain continuum mechanics, implemented in a commercial finite element code, and applied to the case of an edge-crack remotely loaded by a controlled displacement. Experimental and numerical results both show a toughening effect with increasing rates, which is linked to the energy dissipated by the fluid-solid interactions in the region surrounding the crack tip.

Viscuit and the fluctuation theorem investigation of shear viscosity by molecular dynamics simulations: The information and the noise

The shear viscosity, η, of model liquids and solids is investigated within the framework of the viscuit and Fluctuation Theorem (FT) probability distribution function (PDF) theories, following Heyes et al. [J. Chem. Phys. 152, 194504 (2020)] using equilibrium molecular dynamics (MD) simulations on Lennard-Jones and Weeks-Chandler-Andersen model systems. The viscosity can be obtained in equilibrium MD simulation from the first moment of the viscuit PDF, which is shown for finite simulation lengths to give a less noisy plateau region than the Green-Kubo method. Two other formulas for the shear viscosity in terms of the viscuit and PDF analysis are also derived. A separation of the time-dependent average negative and positive viscuits extrapolated from the noise dominated region to zero time provides another route to η. The third method involves the relative number of positive and negative viscuits and their PDF standard deviations on the two sides for an equilibrium system. For the FT and finite shear rates, accurate analytic expressions for the relative number of positive to negative block average shear stresses is derived assuming a shifted Gaussian PDF, which is shown to agree well with non-equilibrium molecular dynamics simulations. A similar treatment of the positive and negative block average contributions to the viscosity is also shown to match the simulation data very well.

Normal Load and Counter Body Size Influence the Initiation of Microstructural Discontinuities in Copper during Sliding

Near the interface of two contacting metallic bodies in relative motion, the microstructure changes. This modified microstructure leads to changes in material properties and thereby influences the tribological behavior of the entire contact. Tribological properties such as the friction coefficient and wear rate are controlled by the microstructure, while the elementary mechanisms for microstructural changes are not sufficiently understood. In this paper, the influence of the normal load and the size of the counter body on the initiation of a tribologically induced microstructure in copper after a single sliding pass is revealed. A systematic variation in the normal load and sphere diameter resulted in maximum Hertzian contact pressures between 530 MPa and 1953 MPa. Scanning electron microscopy, focused ion beam, and transmission electron microscopy were used to probe the subsurface deformation. Irrespective of the normal load and the sphere diameter, a sharp line-like feature consisting of dislocations, the so-called dislocation trace line, was identified in the subsurface area at depths between 100 nm and 400 nm. For normal loads below 6.75 N, dislocation features are formed below this line. For higher normal loads, the microstructure evolution directly underneath the surface is mainly confined to the area between the sample surface and the dislocation trace line, which itself is located at increasing depth. Transmission Kikuchi diffraction and transmission electron microscopy demonstrate that the misorientation is predominantly concentrated at the dislocation trace line. The results disclose a material rotation around axes roughly parallel to the transverse direction. This study demonstrates the generality of the trace line phenomena over a wide range of loads and contact pressures and the complexity of subsurface processes under a sliding contact and provides the basis for modeling the early stages in the microstructure evolution.

Single trajectory transport coefficients and the energy landscape by molecular dynamics simulations

The Green-Kubo (GK) method is widely used to calculate the transport coefficients of model liquids by Molecular Dynamics (MD) simulation. A reformulation of GK was proposed by Heyes et al. [J. Chem. Phys. 150, 174504 (2019)], which expressed the shear viscosity in terms of a probability distribution function (PDF) of "single trajectory (ST) viscosities," called "viscuits." This approach is extended here to the bulk viscosity, thermal conductivity, and diffusion coefficient. The PDFs of the four STs expressed in terms of their standard deviations (calculated separately for the positive and negative sides) are shown by MD to be statistically the same for the Lennard-Jones fluid. This PDF can be represented well by a sum of exponentials and is independent of system size and state point in the equilibrium fluid regime. The PDF is not well reproduced by a stochastic model. The PDF is statistically the same as that derived from the potential energy, u, and other thermodynamic quantities, indicating that the transport coefficients are determined quantitatively by and follow closely the time evolution of the underlying energy landscape. The PDFs of out-of-equilibrium supercooled high density states are quite different from those of the equilibrium states.

Knowledge, attitude and disinformation regarding vaccination and immunization practices among healthcare workers of a third-level paediatric hospital

Background

Vaccination represents one of the most effective means of preventing infections for the population and for the public health in general. Recently there has been a decline in vaccinations, also among healthcare workers (HCWs). The aim of the study is to detect the knowledge, skills, attitudes and barriers of HCWs regarding vaccinations in a tertiary children’s hospital in order to support clinical management in immunisation practices.

Methods

An observational study was conducted on 255 subjects over a period of 8 months. The 31-item questionnaire considered profession, level of instruction and different ages. It included questions taken from a questionnaire used for a Canadian research and one used by the Bellinzona hospital. A 4-point Likert scale and closed-ended questions were used. A confidence interval of 95%, p value ≤ 0.05, Chi-square, ANOVA and the Kruskal-Wallis test were considered.

Results

In the last 5 years less than one third of the sample were vaccinated against flu. 77.8% (n.130) of nurses and 45.8% (n.19) of doctors were not vaccinated (p < 0.0001).

As for risk perception, 51.5% of nurses and 90.6% of doctors believe that their risk of contracting influenza is greater than that of the general population.

In relation to the injection site, in all the age ranges there was a high level of knowledge except for those aged over 61 who responded incorrectly. Doctors were more prepared (p < 0.0001).

50% of the sample used internet only as a source of information for vaccines. Generally, scientific sources were used infrequently. The higher the education level, the more frequent the utilisation of trustworthy scientific resources and literature. (p = 0.0002).

Conclusions

In line with the attitude observed in recent years, nurses are not inclined to get vaccinated themselves although they agree to having their children vaccinated. HCWs have a good level of knowledge about vaccines and immunisation practices.

With the nurses we found that the higher the education level, the greater the knowledge about vaccines which leads to the conclusion that low levels of adherence are not due to a lack of knowledge, but rather, to a low perception of risks. Hence the need to strengthen the vaccination strategies inside the companies.

Instabilities of High Speed Dislocations

Despite numerous theoretical models and simulation results, a clear physical picture of dislocations traveling at velocities comparable to the speed of sound in the medium remains elusive. Using two complementary atomistic methods to model uniformly moving screw dislocations, lattice dynamics and molecular dynamics, the existence of mechanical instabilities in the system is shown. These instabilities are found at material-dependent velocities far below the speed of sound. We show that these are the onset of an atomistic kinematic generation mechanism, which ultimately results in an avalanche of further dislocations. This homogeneous nucleation mechanism, observed but never fully explained before, is relevant in moderate and high strain rate phenomena including adiabatic shear banding, dynamic fracture, and shock loading. In principle, these mechanical instabilities do not prevent supersonic motion of dislocations.

Molecular Dynamics Studies of Overbased Detergents on a Water Surface

Molecular dynamics (MD) simulations are reported of model overbased detergent nanoparticles on a model water surface which mimic their behavior on a Langmuir trough or large water droplet in engine oil. The simulations predict that the structure of the nanoparticle on a water surface is different to when it is immersed in a bulk hydrophobic solvent. The surfactant tails are partly directed out of the water, while the carbonate core maximizes its extent of contact with the water. Umbrella sampling calculations of the potential of mean force between two particles showed that they are associated with varying degrees with a maximum binding free energy of ca. 10 k_BT for the salicylate stabilized particle, ca. 8 k_BT for a sulfurized alkyl phenate stabilized particle, and ca. 5 k_BT for a sulfonate stabilized particle. The differences in the strength of attraction depend on the proximity of nearest approach and the energy penalty associated with the disruption of the hydration shell of water molecules around the calcium carbonate core when the two particles approach. This is greatest for the sulfonate particle, which partially loses the surfactant ions to the solution, and least for the salicylate, which forms the weakest water "cage". The particles are separated by a water hydration layer, even at the point of closest approach.

Towards the Irving-Kirkwood limit of the mechanical stress tensor

The probability density functions (PDFs) of the local measure of pressure as a function of the sampling volume are computed for a model Lennard-Jones (LJ) fluid using the Method of Planes (MOP) and Volume Averaging (VA) techniques. This builds on the study of Heyes, Dini, and Smith [J. Chem. Phys. 145, 104504 (2016)] which only considered the VA method for larger subvolumes. The focus here is typically on much smaller subvolumes than considered previously, which tend to the Irving-Kirkwood limit where the pressure tensor is defined at a point. The PDFs from the MOP and VA routes are compared for cubic subvolumes, V=ℓ3. Using very high grid-resolution and box-counting analysis, we also show that any measurement of pressure in a molecular system will fail to exactly capture the molecular configuration. This suggests that it is impossible to obtain the pressure in the Irving-Kirkwood limit using the commonly employed grid based averaging techniques. More importantly, below ℓ≈3 in LJ reduced units, the PDFs depart from Gaussian statistics, and for ℓ=1.0, a double peaked PDF is observed in the MOP but not VA pressure distributions. This departure from a Gaussian shape means that the average pressure is not the most representative or common value to arise. In addition to contributing to our understanding of local pressure formulas, this work shows a clear lower limit on the validity of simply taking the average value when coarse graining pressure from molecular (and colloidal) systems.

On the effect of confined fluid molecular structure on nonequilibrium phase behaviour and friction

Atomistic simulations and tribology experiments uncover the effect of molecular structure on the flow and friction behaviour of confined films under extreme conditions.

Equilibrium fluctuations of liquid state static properties in a subvolume by molecular dynamics

System property fluctuations increasingly dominate a physical process as the sampling volume decreases. The purpose of this work is to explore how the fluctuation statistics of various thermodynamic properties depend on the sampling volume, using molecular dynamics (MD) simulations. First an examination of various expressions for calculating the bulk pressure of a bulk liquid is made, which includes a decomposition of the virial expression into two terms, one of which is the Method of Planes (MOP) applied to the faces of the cubic simulation cell. Then an analysis is made of the fluctuations of local density, temperature, pressure, and shear stress as a function of sampling volume (SV). Cubic and spherical shaped SVs were used within a spatially homogeneous LJ liquid at a state point along the melting curve. It is shown that the MD-generated probability distribution functions (PDFs) of all of these properties are to a good approximation Gaussian even for SV containing only a few molecules (∼10), with the variances being inversely proportional to the SV volume, Ω. For small subvolumes the shear stress PDF fits better to a Gaussian than the pressure PDF. A new stochastic sampling technique to implement the volume averaging definition of the pressure tensor is presented, which is employed for cubic, spherical, thin cubic, and spherical shell SV. This method is more efficient for less symmetric SV shapes.

Role of Deprotonation Free Energies in pKa Prediction and Molecule Ranking

A computationally efficient classical molecular simulation technique is derived for ranking the pKa values of a set of chemically similar congeneric molecules in an implicit solvent model of water. This uses the deprotonation free energy of the titratable group in the gas and aqueous phases obtained by thermodynamic integration (TI). For a series of alcohols and acids a strong linear correlation is demonstrated between the experimental pKa and the deprotonation free energy difference in the gas and liquid phases. These calculations also show that classical TI is more efficient than slow-growth TI in calculating deprotonation free energies for the series of molecules considered herein.

Rapid, automated imaging of mouse articular cartilage by microCT for early detection of osteoarthritis and finite element modelling of joint mechanics

OBJECTIVE

Mouse articular cartilage (AC) is mostly assessed by histopathology and its mechanics is poorly characterised. In this study: (1) we developed non-destructive imaging for quantitative assessment of AC morphology and (2) evaluated the mechanical implications of AC structural changes.

METHODS

Knee joints obtained from naïve mice and from mice with osteoarthritis (OA) induced by destabilization of medial meniscus (DMM) for 4 and 12 weeks, were imaged by phosphotungstic acid (PTA) contrast enhanced micro-computed tomography (PTA-CT) and scored by conventional histopathology. Our software (Matlab) automatically segmented tibial AC, drew two regions centred on each tibial condyle and evaluated the volumes included. A finite element (FE) model of the whole mouse joint was implemented to evaluate AC mechanics.

RESULTS

Our method achieved rapid, automated analysis of mouse AC (structural parameters in <10 h from knee dissection) and was able to localise AC loss in the central region of the medial tibial condyle. AC thickness decreased by 15% at 4 weeks and 25% at 12 weeks post DMM surgery, whereas histopathology scores were significantly increased only at 12 weeks. FE simulations estimated that AC thinning at early-stages in the DMM model (4 weeks) increases contact pressures (+39%) and Tresca stresses (+43%) in AC.

CONCLUSION

PTA-CT imaging is a fast and simple method to assess OA in murine models. Once applied more extensively to confirm its robustness, our approach will be useful for rapidly phenotyping genetically modified mice used for OA research and to improve the current understanding of mouse cartilage mechanics.

Boundary-controlled barostats for slab geometries in molecular dynamics simulations

Molecular dynamics simulation barostat schemes are derived for achieving a given normal pressure for a thin liquid or solid layer confined between two parallel walls. This work builds on the boundary-controlled barostat scheme of Lupkowski and van Swol [J. Chem. Phys. 93, 737 (1990)]. Two classes of barostat are explored, one in which the external load is applied to a virtual regular lattice to which the wall atoms are bound using a tethering potential. The other type of barostat applies the external force directly to the wall atoms, which are not tethered. The extent to which the wall separation distribution is Gaussian is shown to be an effective measure of the quality of the barostat. The first class of barostat can suffer from anomalous dynamical signatures, even resonances, which are sensitive to the effective mass of the virtual lattice, whose value lacks any rigorous definition. The second type of barostat performs much better under equilibrium and wall-sliding nonequilibrium conditions and in not being so prone to resonance instabilities in the wall separation and does not require so many largely arbitrary parameters. The results of exploratory simulations which characterize the dynamical response of the model systems for both dry and wet or lubricated systems using the different barostats are presented. The barostats which have an inherent damping mechanism, such as the ones analogous to a damped harmonic oscillator, reduce the occurrence of large fluctuations and resonances in the separation between the two walls, and they also achieve a new target pressure more quickly. Near a nonequilibrium phase boundary the attributes of the barostat can have a marked influence on the observed behavior.

Combinatorial scaffold morphologies for zonal articular cartilage engineering

Articular cartilage lesions are a particular challenge for regenerative medicine strategies as cartilage function stems from a complex depth-dependent organization. Tissue engineering scaffolds that vary in morphology and function offer a template for zone-specific cartilage extracellular matrix (ECM) production and mechanical properties. We fabricated multi-zone cartilage scaffolds by the electrostatic deposition of polymer microfibres onto particulate-templated scaffolds produced with 0.03 or 1.0mm(3) porogens. The scaffolds allowed ample space for chondrocyte ECM production within the bulk while also mimicking the structural organization and functional interface of cartilage's superficial zone. Addition of aligned fibre membranes enhanced the mechanical and surface properties of particulate-templated scaffolds. Zonal analysis of scaffolds demonstrated region-specific variations in chondrocyte number, sulfated GAG-rich ECM, and chondrocytic gene expression. Specifically, smaller porogens (0.03mm(3)) yielded significantly higher sGAG accumulation and aggrecan gene expression. Our results demonstrate that bilayered scaffolds mimic some key structural characteristics of native cartilage, support in vitro cartilage formation, and have superior features to homogeneous particulate-templated scaffolds. We propose that these scaffolds offer promise for regenerative medicine strategies to repair articular cartilage lesions.

Control-volume representation of molecular dynamics

A molecular dynamics (MD) parallel to the control volume (CV) formulation of fluid mechanics is developed by integrating the formulas of Irving and Kirkwood [J. Chem. Phys. 18, 817 (1950)] over a finite cubic volume of molecular dimensions. The Lagrangian molecular system is expressed in terms of an Eulerian CV, which yields an equivalent to Reynolds' transport theorem for the discrete system. This approach casts the dynamics of the molecular system into a form that can be readily compared to the continuum equations. The MD equations of motion are reinterpreted in terms of a Lagrangian-to-control-volume (LCV) conversion function ϑ(i) for each molecule i. The LCV function and its spatial derivatives are used to express fluxes and relevant forces across the control surfaces. The relationship between the local pressures computed using the volume average [Lutsko, J. Appl. Phys. 64, 1152 (1988)] techniques and the method of planes [Todd et al., Phys. Rev. E 52, 1627 (1995)] emerges naturally from the treatment. Numerical experiments using the MD CV method are reported for equilibrium and nonequilibrium (start-up Couette flow) model liquids, which demonstrate the advantages of the formulation. The CV formulation of the MD is shown to be exactly conservative and is, therefore, ideally suited to obtain macroscopic properties from a discrete system.

The equivalence between volume averaging and method of planes definitions of the pressure tensor at a plane

It is shown analytically that the method of planes (MOP) [Todd, Evans, and Daivis, Phys. Rev. E 52, 1627 (1995)] and volume averaging (VA) [Cormier, Rickman, and Delph, J. Appl. Phys. 89, 99 (2001)] formulas for the local pressure tensor, P(α, y)(y), where α ≡ x, y, or z, are mathematically identical. In the case of VA, the sampling volume is taken to be an infinitely thin parallelepiped, with an infinite lateral extent. This limit is shown to yield the MOP expression. The treatment is extended to include the condition of mechanical equilibrium resulting from an imposed force field. This analytical development is followed by numerical simulations. The equivalence of these two methods is demonstrated in the context of non-equilibrium molecular dynamics (NEMD) simulations of boundary-driven shear flow. A wall of tethered atoms is constrained to impose a normal load and a velocity profile on the entrained central layer. The VA formula can be used to compute all components of P(αβ)(y), which offers an advantage in calculating, for example, P(xx)(y) for nano-scale pressure-driven flows in the x-direction, where deviations from the classical Poiseuille flow solution can occur.

Mortality reduction in cardiac anesthesia and intensive care: results of the first International Consensus Conference

There is no consensus on which drugs/techniques/strategies can affect mortality in the perioperative period of cardiac surgery. With the aim of identifying these measures, and suggesting measures for prioritized future investigation we performed the first International Consensus Conference on this topic. The consensus was a continuous international internet-based process with a final meeting on 28 June 2010 in Milan at the Vita-Salute University. Participants included 340 cardiac anesthesiologists, cardiac surgeons, and cardiologists from 65 countries all over the world. A comprehensive literature review was performed to identify topics that subsequently generated position statements for discussion, voting, and ranking. Of the 17 major topics with a documented mortality effect, seven were subsequently excluded after further evaluation due to concerns about clinical applicability and/or study methodology. The following topics are documented as reducing mortality: administration of insulin, levosimendan, volatile anesthetics, statins, chronic β-blockade, early aspirin therapy, the use of pre-operative intra-aortic balloon counterpulsation, and referral to high-volume centers. The following are documented as increasing mortality: administration of aprotinin and aged red blood cell transfusion. These interventions were classified according to the level of evidence and effect on mortality and a position statement was generated. This International Consensus Conference has identified the non-surgical interventions that merit urgent study to achieve further reductions in mortality after cardiac surgery: insulin, intra-aortic balloon counterpulsation, levosimendan, volatile anesthetics, statins, chronic β-blockade, early aspirin therapy, and referral to high-volume centers. The use of aprotinin and aged red blood cells may result in increased mortality.

Mortality reduction in cardiac anesthesia and intensive care: results of the first International Consensus Conference

BACKGROUND

There is no consensus on which drugs/techniques/strategies can affect mortality in the perioperative period of cardiac surgery. With the aim of identifying these measures, and suggesting measures for prioritized future investigation we performed the first international consensus conference on this topic.

METHODS

The consensus was a continuous international internet-based process with a final meeting on June 28th 2010 in Milan at the Vita-Salute University. Participants included 340 cardiac anesthesiologists, cardiac surgeons and cardiologists from 65 countries all over the world. A comprehensive literature review was performed to identify topics that subsequently generated position statements for discussion, voting and ranking.

RESULTS

Of the 17 major topics with a documented mortality effect, seven were subsequently excluded after further evaluation due to concerns about clinical applicability and/or study methodology. The following topics are documented as reducing mortality: administration of insulin, levosimendan, volatile anesthetics, statins, chronic beta-blockade, early aspirin therapy, the use of preoperative intra-aortic balloon counterpulsation and referral to high-volume centers. The following are documented as increasing mortality: administration of aprotinin and aged red blood cell transfusion. These interventions were classified according to the level of evidence and effect on mortality and a position statement was generated.

CONCLUSION

This international consensus conference has identified the non-surgical interventions that merit urgent study to achieve further reductions in mortality after cardiac surgery: insulin, intra-aortic balloon counterpulsation, levosimendan, volatile anesthetics, statins, chronic beta-blockade, early aspirin therapy, and referral to high-volume centers. The use of aprotinin and aged red blood cells may result in increased mortality.

Most Care&reg;: a minimally invasive system for hemodynamic monitoring powered by the Pressure Recording Analytical Method (PRAM)

Invasive hemodynamic monitoring is a cornerstone of the care of critically ill and hemodynamically unstable patients in both intensive care units and operating rooms. The assessment of cardiac output by means of the pulmonary artery catheter has been considered the clinical gold standard. Nevertheless, several concerns have been raised regarding its invasiveness, usefulness, and associated complica-tions. These disadvantages have led to the development, during the last years, of a number of less invasive technologies for cardiac output determination. Among them, those based on the analysis of a peripheral arterial waveform have become commonly used. Most Care(®) is a minimally invasive arterial pressure based monitor powered by the Pressure Recording Analytical Method (PRAM), the only algorithm that does not require prior calibration or pre-calculated parameters and which is based of flow. PRAM provides the measurement of the main factors of hemodynamics, such as systemic blood pressures, stroke volume, cardiac output, and vascular resistances. Moreover, dynamic indices of fluid responsiveness are continuously displayed. In the present paper, we reviewed the current literature focusing on advantages and limitations of PRAM.

Hemodynamic goal-directed therapy. A review

Patients can show arterial pressure and cardiac index within the normal range and still be in circulatory shock if oxygen and metabolic demand is increased or blood flow distribution is altered.Lactate is produced in anaerobic environment to preserve cellular integrity and physicians use its blood concentration value as a reliable marker of tissue hypoxia and energy failure.The authors review the recent literature on the importance of mixed venous oxygen saturation (SvO(2)) as an early sign of inadequate DO(2) that precede the lactate production.

[Control of postoperative pain in children undergoing hypospadias surgery: quasi-experimental controlled trial]

BACKGROUND

Hypospadias is one of the most common congenital anomalies occurring in approximately (1/300) male births. If it is not surgically corrected the consequences may negatively impact on quality of life in adolescents. The surgery is very invasive and the post-operative phase very painful. To improve the control of post-operative pain, continuous analgesia via epidural catheter was implemented.

AIMS

To compare the effectiveness in controlling pain of two different regimens: continuous epidural catheter infusion vs oral and rectal non-steroidal pain-killers.

MATERIALS AND METHODS

Comparative study on children undergoing hypospadias surgery. Group A (catheter) was treated with continuous postoperative analgesia via epidural catheter and Group B (scheduled times) with rectal and oral analgesics at scheduled times and on demand, after caudal block. In both groups nurses measured pain with VAS and FLACC scales (score from 0 to 10) for 72 hours after surgery.

RESULTS

41 children were studied (average age 64.1 months, SD 47.3), with 332 post-operative pain recordings (Group A n = 161, Group B n = 171). Mean pain score of Group A was 0.13 (SD 0.3) and 0.45 (SD 0.8) in group B, p = 0.006. The median duration of the epidural catheter was 65 hours, mean 51.8 hours (SD 24.3). During the 1st post-operative medication, the mean pain score in Group A was 1.2 (SD 1.4), and 3.2 (SD 1.8) in group B, p = 0.003. In group A the number of pain scores indicating pain (> 0) where 3.1% while in group B were 10.5%, p = 0.0007.

CONCLUSIONS

In children undergoing hypospadias surgery, post-operative analgesia with continuous epidural catheter infusion seems to offer a better analgesic coverage than the traditional oral/rectal analgesic treatment at scheduled times and on demand.

Tetra-t-butyl magnesium phthalocyanine on gold: Electronic structure and molecular orientation

In this work we have investigated the electronic structure and the molecular orientation of (t-Bu)(4)PcMg (tetra-t-butyl magnesium phthalocyanine) on polycrystalline and single crystalline gold substrates using photoemission spectroscopy and x-ray absorption spectroscopy, and we compare the results to the unsubstituted PcCu (copper phthalocyanine). The C 1s photoemission spectrum is described similar to unsubstituted relatives with an additional component for the aliphatic substituents. The variation of the excitation energy causes distinct differences in the shape of the C 1s spectrum, which is very useful for the analysis of the molecular orientation in the uppermost layer. It is shown that despite of the sterically demanding substituents, ordered sublimed films of (t-Bu)(4)PcMg are accessible, the orientation of the molecules, however, is different from the orientation of the unsubstituted relatives.

The prognostic value of cytogenetics is reinforced by the kind of induction/consolidation therapy in influencing the outcome of acute myeloid leukemia--analysis of 848 patients

We studied the impact of cytogenetics and kind of induction/consolidation therapy on 848 adult acute myeloid leukemia (AML) patients (age 15-83). The patients received three types of induction/consolidation regimen: standard (daunorubicin and cytosine arabinoside (3/7); two cycles); intensive (idarubicin, cytosine arabinoside and etoposide (ICE), plus mitoxantrone and intermediate-dose Ara-C (NOVIA)); and low-dose (low-dose cytosine arabinoside). CR patients under 60 years of age, if an HLA-identical donor was available received allogeneic stem cell transplantation (allo-SCT); otherwise, as part of the program, they underwent autologous (auto)-SCT. CR rates significantly associated with 'favorable' (inv(16), t(8;21)), 'intermediate' ('no abnormality', abn(11q23), +8, del(7q)) and 'unfavorable' (del (5q), -7, abn(3)(q21q26), t(6;9), 'complex' (more than three unrelated cytogenetic abnormalities)) karyotypes (88% vs 65% vs 36%, respectively; P = 0.0001). These trends were confirmed in all age groups. On therapeutic grounds, intensive induction did not determine significant increases of CR rates in any of the considered groups, with respect to standard induction. Low-dose induction was associated with significantly lower CR rates. Considering disease-free survival (DFS), multivariate analysis of the factors examined (including karyotype grouping) showed that only age > 60 years significantly affected outcome. However, in cases where intensive induction was adopted, 'favorable' karyotype was significantly related to longer DFS (P = 0.04). This was mainly due to the favorable outcome of t(8;21) patients treated with intensive induction. Patients receiving allo-SCT had significantly longer DFS (P = 0.005); in particular, allo-SCT significantly improved DFS in the 'favorable' and 'intermediate' groups (P = 0.04 and P = 0.048, respectively). In conclusion our study could provide some guidelines for AML therapy: (1) patients in the 'favorable' karyotype group seem to have a longer DFS when treated with an intensive induction/consolidation regimen, adopted before auto-SCT instead of standard induction; this underlines the importance of reinforcement of chemotherapy, not necessarily based on repeated high-dose AraC cycles. Allo-SCT, independently of induction/consolidation therapy, should be considered an alternative treatment; (2) patients in the 'intermediate' karyotype group should receive allo-SCT; (3) patients in the 'unfavorable' karyotype group should be treated using investigational chemotherapy, considering that even allo-SCT cannot provide a significantly longer DFS, but only a trend to a better prognosis.

Effect of fenretinide on bone mineral density and metabolism in women with early breast cancer

Prolonged administration of natural or synthetic retinoids has been associated with significant skeletal abnormalities, including osteoporosis. We studied the effects of the synthetic retinoid fenretinide (N-4-hydroxyphenylretinamide, or 4-HPR) administered for a mean of 40 months on bone mineral density and metabolism in 66 consecutive women with early breast cancer belonging to a secondary prevention trial. The mean (+/-SD) bone mineral density at the distal and ultradistal forearm were, respectively, 0.61+/-0.08 and 0.30+/-0.05 g/cm2 in 33 treated women and 0.62+/-0.07 and 0.29+/-0.07 g/cm2 in 33 control women (p = ns for both). Also, no significant difference was observed in markers of bone formation such as bone alkaline phosphatase and osteocalcin, nor in urinary bone resorption markers such as calcium, hydroxyproline, and type I bone collagen cross-linked N-telopeptide (NTx). However, a border-line higher excretion of urinary calcium and NTx was found in the 4-HPR group after adjustment for menopausal status. We conclude that prolonged administration of 4-HPR is not associated with significant alterations of bone mineral density of the forearm. However, a trend towards an increase in bone resorption markers suggests the need for further assessment at different skeletal sites.

Efficacy of two different ProMACE-CytaBOM derived regimens in advanced aggressive non-Hodgkin's lymphoma. Final report of a multicenter trial conducted by GISL

BACKGROUND AND OBJECTIVE

To compare the efficacy of ProME(Epidoxorubicin)CE-CytaBOM (PE-C) and ProMI(Idarubicin)CE-CytaBOM (PI-C) in the treatment of adult patients with aggressive non Hodgkin's lymphoma in a multicenter randomized controlled trial performed by 18 centers of the Italian Lymphoma Study Group (GISL).

DESIGN AND METHODS

One hundred and twenty-eight and 122 patients were randomly assigned to receive either 6 courses of PE-C or PI-C, respectively. Some patients achieving complete remission with induction therapy participated in another randomized study comparing no further therapy versus maintenance therapy consisting of four blocks of two drugs.

RESULTS

The rate of CRs was 62% and 64% for patients treated with PE-C and PI-C, respectively (p = 0.51). The 5-year relapse-free survival was 60% for PE-C and 53% for PI-C (p = 0.29). The estimated relapse-free disease survival rates at 4 years were 75% for patients in the consolidation group and 57% for those in the observation group (p = 0.11). Patients alive in first complete remission 4 years after study entry were estimated to be 39% in the PE-C arm and 38% in the PI-C arm (p = 0.90). The 3-year and 5-year estimated survival rates were 61% and 55% for the PE-C group and 56% and 47% for the PI-C group (p = 0.26). Fatal toxicities occurred in 7 patients (2.9%) with active disease and in 4 patients (1.7%) in complete remission. Stage (p = 0.04), bulky disease (p = 0.02), serum LDH (p = 0.0006), serum albumin (p = 0.0051), hemoglobin (p = 0.0011), performance status (p = 0.0001), International prognostic index (p < 0.0001) and the index proposed by the French group G.E.L.A. (p < 0.0001) were of prognostic value. In a multivariate analysis (Cox regression model) alternatively IPI alone or G.E.L.A. index plus performance status emerged as independent prognostic factors.

INTERPRETATION AND CONCLUSIONS

The present study indicates that epirubicin and idarubicin in a combined chemotherapy regimen, have similar activities. The toxic profile also indicates the safety of both anthracyclines at the dosages employed, suggesting their possible dose escalation in a combined chemotherapy setting. PE-C and PI-C were both effective and feasible regimens in an outpatient setting, with acceptable cardiovascular toxicity. The trend toward a better outcome in patients undergoing consolidation therapy after the achievement of a complete remission, warrants further investigation.

The role of pneumatic compression in the treatment of postmastectomy lymphedema. A randomized phase III study

BACKGROUND

Pneumatic compression is a frequently prescribed physical therapy for patients affected by postmastectomy lymphedema but, despite its wide use, its efficacy has not been demonstrated in phase III studies. We performed a randomized study comparing pneumatic compression versus no treatment in patients with postmastectomy lymphedema.

PATIENTS AND METHODS

Patients with monolateral postmastectomy lymphedema were randomized to receive two cycles of intermittent pneumatic compression (PC group), i.e., five two-hour sessions per week for two weeks, to be repeated after a five-week interval, or to no treatment (control group). The patients in both groups were instructed as to the prophylactic hygienic care of the limb. Lymphedema was assessed by the sum of differences in circumference measurements between affected and normal limbs ('delta'). Response was defined as a > or = 25% reduction in delta value.

RESULTS

Eighty patients entered the study. No statistically significant differences in response rates between the two groups were observed: 20% in the control group (95% CI: 9%-36%), 25% in the PC group (95% CI: 13%-41%, P = 0.59). The absolute mean decrease in delta value was 1.9 +/- 3.7 cm in the PC group and 0.5 +/- 3.3 cm in the control group.

CONCLUSIONS

We demonstrated that intermittent pneumatic compression has a limited clinical role in the treatment of postmastectomy lymphedema. Efforts to prevent this complication should be undertaken.