Technical, economic and environmental analysis of solar thermochemical production of drop-in fuels

This study analyzes the technical performance, costs and life-cycle greenhouse gas (GHG) emissions of the production of various fuels using air-captured water and CO2, and concentrated solar energy as the source of high-temperature process heat. The solar thermochemical fuel production pathway utilizes a ceria-based redox cycle for splitting water and CO2 to syngas - a tailored mixture of H2 and CO - which in turn is further converted to liquid hydrocarbon fuels. The cycle is driven by concentrated solar heat and supplemented by a high-temperature thermal energy storage for round-the-clock continuous operation. The study examines three locations with high direct normal irradiation using a baseline heliostat field reflective area of 1 km2 for the production of six fuels, i.e. jet fuel and diesel via Fischer-Tropsch, methanol, gasoline via methanol, dimethyl ether, and hydrogen. Two scenarios are considered: near-term future by the year 2030 and long-term future beyond 2030. In the near-term future in Sierra Gorda (Chile), the minimum fuel selling price is estimated at around 76 €/GJ (2.5 €/L) for jet fuel and diesel, 65 €/GJ for methanol, gasoline (via methanol) and dimethyl ether (DME), and 42 €/GJ for hydrogen (excluding liquefaction). In the long-term future, with advancements in solar receiver, redox reactor, high-temperature heat recovery and direct air capture technologies, the industrial-scale plant could achieve a solar-to-fuel efficiency up to 13-19 %, depending on the target fuel, resulting in a minimum fuel selling price of 16-38 €/GJ (0.6-1.3 €/L) for jet fuel and diesel, and 14-32 €/GJ for methanol, gasoline, and DME, making these fuels synthesized from sunlight and air cost-competitive vis-à-vis e-fuels. To produce the same fuels in Tabernas (Spain) and Ouarzazate (Morocco) as in Sierra Gorda, the production cost would increase by 22-33 %. Greenhouse gas savings can be over 80 % already in the near-term future.

Functional imaging through scattering medium via fluorescence speckle demixing and localization

Recently, fluorescence-based optical techniques have emerged as a powerful tool to probe information in the mammalian brain. However, tissue heterogeneities prevent clear imaging of deep neuron bodies due to light scattering. While several up-to-date approaches based on ballistic light allow to retrieve information at shallow depths inside the brain, non-invasive localization and functional imaging at depth still remains a challenge. It was recently shown that functional signals from time-varying fluorescent emitters located behind scattering samples could be retrieved by using a matrix factorization algorithm. Here we show that the seemingly information-less, low-contrast fluorescent speckle patterns recovered by the algorithm can be used to locate each individual emitter, even in the presence of background fluorescence. We test our approach by imaging the temporal activity of large groups of fluorescent sources behind different scattering phantoms mimicking biological tissues, and through a brain slice with a thickness of ∼200 µm.

The physiological sonographic features of the ovary in healthy subjects: a joint systematic review and meta-analysis by the Italian Society of Gynecology and Obstetrics (SIGO) and the Italian Society of Endocrinology (SIE)

PURPOSE

There is a lack of uniformity in the definition of normal ovary ultrasound parameters. Our aim was to summarize and meta-analyze the evidence on the topic. Full-text English articles published through December 31, 2020 were retrieved via MEDLINE and Embase. Data available for meta-analysis included: ovarian follicular count, ovarian volume, and ovarian Pulsatility Index (PI) assessed by Doppler ultrasound.

METHODS

Cohort, cross-sectional, prospective studies with a single or double arm were considered eligible. Interventional studies were included when providing baseline data. Both studies on pre- and post-menopausal women were screened; however, data on menopausal women were not sufficient to perform a meta-analysis. Studies on pre-pubertal girls were considered separately. Eighty-one papers were included in the meta-analysis.

RESULTS

The mean ovarian volume was 6.11 [5.81-6.42] ml in healthy women in reproductive age (5.81-6.42) and 1.67 ml [1.02-2.32] in pre-pubertal girls. In reproductive age, the mean follicular count was 8.04 [7.26-8.82] when calculated in the whole ovary and 5.88 [5.20-6.56] in an ovarian section, and the mean ovarian PI was 1.86 [1.35-2.37]. Age and the frequency of the transducers partly modulated these values. In particular, the 25-30-year group showed the higher mean follicular count (9.27 [7.71-10.82]), followed by a progressive age-related reduction (5.67 [2.23-9.12] in fertile women > 35 years). A significant difference in follicular count was also found according to the transducer's upper MHz limit.

CONCLUSION

Our findings provide a significant input to improve the interpretation and diagnostic accuracy of ovarian ultrasound parameters in different physiological and pathological settings.

Functional imaging through scattering medium via fluorescence speckle demixing and localization

Recently, fluorescence-based optical techniques have emerged as a powerful tool to probe information in the mammalian brain. However, tissue heterogeneities prevent clear imaging of deep neuron bodies due to light scattering. While several up-to-date approaches based on ballistic light allow to retrieve information at shallow depths inside the brain, non-invasive localization and functional imaging at depth still remains a challenge. It was recently shown that functional signals from time-varying fluorescent emitters located behind scattering samples could be retrieved by using a matrix factorization algorithm. Here we show that the seemingly information-less, low-contrast fluorescent speckle patterns recovered by the algorithm can be used to locate each individual emitter, even in the presence of background fluorescence. We test our approach by imaging the temporal activity of large groups of fluorescent sources behind different scattering phantoms mimicking biological tissues, and through a brain slice with a thickness of ~200 micron.

Reflecting on the environmental impact of the captured carbon feedstock

Climate change mitigation potentials of carbon capture and utilization (CCU) closely depend on the energy and chemicals used to capture the chemically inert CO2. The potential environmental benefits of CCU are typically assessed using Life Cycle Assessment (LCA) methodology. Although LCA is a standardized method, modelling CO2 as a carbon feedstock instead of an emission introduces an ambiguous "multifunctionality issue". Inconsistent multifunctionality practices have been applied to deal with this methodological complexity in LCAs of CCU technologies. Using one method instead of another can lead to highly positive or negative carbon footprints for the same carbon source and CO2 capture process. A comprehensive guideline to clarify the best practices to conduct LCAs of CCU technologies was published in 2020 (and updated in March 2022) in a collaborative process involving over 40 experts. In this guideline and linked scientific articles from experts involved in its development, a so-called "substitution method" is recommended to avoid suboptimal choices of CO2 sources, improve comparability and harmonize decision-making. This article critically reviews the methodological formulation of the recommended method and suggests corrections to possible inaccuracies in a future update of the guideline. Furthermore, various illustrative examples of common CO2 feedstocks were used to illustrate the meaning of adopting such a method in practice. Economic-based benchmarking of the environmental impacts of CO2 feedstocks calculated with such a method was also broadly illustrated.

P20 CARDIOMIOPATHY INDUCED BY ATRIAL FIBRILLATION: WHAT’S BEHIND IT?

Sustained chronic tachyarrhythmias often cause a deterioration of cardiac function known as tachycardiomyopathy. We report the case of a 69 years old male patient, who was sent to the Emergency Department by his general practitioner for worsening dyspnoea and the discovery of previously unknown atrial fibrillation. His personal history included only arterial hypertension in treatment with ARBs, with no family or personal history of coronary artery disease. At a previous echocardiogram performed in 2019, systolic and diastolic functions were normal. The ECG confirmed the diagnosis of atrial fibrillation with rapid ventricular response, and blood chemistry showed a suppressed level of TSH (< 0,005 mcUI/ml), high FT3/FT4 (4.47 pg/ml/2.34 pg/ml) without any other alterations. A chest X–Ray was normal. The echocardiography evidenced a mildly dilated and hypertrophic left ventricle with severe, global systolic dysfunction, EF 25%, an enlargement of both atria, a mild mitral and tricuspid regurgitation and pulmonary artery mean systolic pressure of 35 mmHg. He was admitted to our Cardiology Department for further investigations. The patient was asymptomatic for dyspnoea at rest, only symptomatic with exertion and NYHA III, and hemodynamically stable. A coronarography excluded critical coronary stenosis. We made diagnosis of autoimmune Grave’s disease, with multiple not vascularized nodules at echography. In addition to betablockers and diuretics, an appropriate therapy for hyperthyroidism was prescribed, with an improvement of dyspnoea and a reduction of mean cardiac frequency. The patient was discharged with the indication to elective atrial cardioversion, only after thyroid function stabilization. In conclusion, we report a case of a severe systolic dysfunction in an atrial fibrillation induced cardiomyopathy, connected to an unknown thyrotoxicosis in Grave’s disease.

P305 ACUTE MYOPERICARDITIS IN 2021: COVID19 RELATED?

The term myopericarditis is used when there are primarily pericarditis symptoms with myocardium involvement as evidenced by cardiac biomarker elevation or imaging studies revealing normal wall motion. We report a case of a young 23–years old man, who presented to the Emergency Department with fever and diarrhea lasting 5 days followed by acute chest pain, modified by trunk position. The electrocardiogram (ECG) showed diffuse inferior and anterolateral ST–segment elevation. No signs of hemodynamic instability were detected. Laboratory tests showed WBC 8840/mmc, CRP 53,2 mg/L, TnT 986 ng/L, a mildly altered liver function with AST 92 UI/L, ALT 88 UI/L, GGT 82 UI/L and an altered pancreatic function with amylase 190 UI/L, lipase 267 UI/L. Naso–pharyngeal swab was negative. The patient received COVID–19 mRNA vaccination 4 months before symptoms, with high immune response, detected with IgG dosage (465 BAU/ml). Ecocardiography showed a left ventricle with normal size, function, and segmental contractility. Valvular apparatus in normal range. Hyper–refraction of the posterior pericardium with minimal effusion. The diagnosis of acute myopericarditis was glaring and we treated the patient with high dosage of non–steroidal anti–inflammatory drugs, colchicine and ACE Inhibitors, based on the increased troponin levels (nadir 1439 nl/L), in order to prevent the possible cardiovascular remodeling. On laboratory testing, the deepening of the main causes of viral or autoimmune myopericarditis did not clarify the etiopathogenesis. No arrhythmias occurred on ECG monitoring. Cardiac MRI showed multiple areas of altered signal (T2) and altered uptake in lateral and inferior ventricular segments and in adjacent pericardium. The pain was gone in two days and left ventricle function was still preserved upon discharge. In conclusion we report a successful treatment of acute myopericarditis of unknown pathogenesis, in a healthy young man. As there are described cases of myopericarditis and myositis associated with COVID–19 in the absence of respiratory symptoms, and others related to SARSCoV2 mRNA vaccination, we dutifully excluded both.

P385 SYNCOPAL VENTRICULAR TACHYCARDIA IN HEALTHY HEART: AN UNUSUAL ORIGIN!

Torsade de pointes is a particular type of ventricular tachycardia, characterized by QRS complexes that vary progressively in amplitude and morphology, giving the impression of oscillating around the isoelectric line. Causes include long QT syndrome (congenital or drug–induced) or severe hypomagnesemia. We report the case of a 57–year–old woman, a smoker, with a history of weight loss in the last 6 months, hospitalized in Medicine for marked asthenia and an episode of fleeting loss of consciousness, from sitting. She was asymptomatic for chest pain. The physical examination showed a pathological thinness, with BMI 15 kg/m2, rhythmic cardiac activity, no murmurs, no signs of decompensation, flat abdomen, not enlarged liver. Pale, dry skin was observed. On ECG: sinus rhythm, HR 70 bpm, QTc slightly increased 0.47 sec, flat T wave in lateral. Blood exams evidenced: hypokalemia, hypomagnesemia, rise of the amylase. On the MRI abdomen we found large inhomogeneous areas on the head and body of the pancreas, referable to the picture of focal pancreatitis. For syncopal episode during hospitalization in Medicine, she was transferred in Cardiology, where, during electrocardiographic monitoring, paroxysmal ventricular tachycardias torsade de pointes–like, symptomatic, self–resolved was registered. We diagnosed an acute pancreatitis with typical radiological characteristics of an autoimmune form, determining severe electrolyte imbalance and consequent symptomatic paroxysmal ventricular tachycardias. Oral magnesium supplement and corticosteroid therapy allowed the resolution of the arrhythmic problem, monitored over time through the implantation of a loop recorder.

Attributional and consequential LCAs of a novel bio-jet fuel from Dutch potato by-products

To mitigate the climate change impact of aviation, jet fuels from bio-based by-products are considered a promising alternative to conventional jet fuels. Life cycle assessment (LCA) is a commonly applied tool to determine the environmental impacts of bio-jet fuels. This article presents both attributional and consequential LCA models to assess an innovative bio-jet fuel produced from potato by-products in the Netherlands. The two models led to opposite conclusions regarding the overall environmental performance of this bio-jet fuel. The attributional LCA showed that this bio-jet fuel could offer about a 60% GHG emissions reduction compared to conventional jet fuel. In comparison, the consequential LCA estimated either a much lower climate change benefit (5-40%) if the potato by-products taken from the animal feed market are replaced with European animal feed or a 70% increase in GHG emissions if also imported soybean meals are used to replace the feed. Contrasting conclusions were also obtained for photochemical ozone formation. Conversely, the attributional and consequential LCAs agree on acidification, terrestrial eutrophication and depletion of fossil fuels. Although the consequential LCA was affected by higher uncertainties related to the determination of the actual product displaced, it allowed understanding the consequence of additional animal feed production. This process was not included in the system boundaries of the attributional LCA.

Kraft lignin as a bio-based ingredient for Dutch asphalts: An attributional LCA

In the last decade, lignin has received much attention as a feedstock to produce bio-based products. This study investigates the potential benefits of using lignin to mitigate the environmental impact of the road construction sector. An environmental life cycle assessment (LCA) of various top-layer bio-based asphalts using kraft lignin was conducted. From a cradle-to-grave perspective, lignin-based asphalts were compared with conventional asphalts. The results of the LCA revealed that the climate change impact of lignin-based asphalts could be 30-75% lower than conventional asphalts. For the other ten impact categories, trade-offs were observed. Overall, two key factors to make the environmental impact of lignin-based asphalts lower than conventional asphalts are 1) increasing the amount of bitumen-substituted and 2) using low-grade biomass fuels for process steam in the pulp mill. The substitution of weak filler with lignin was beneficial only for climate change and could lead to a worse overall environmental performance than conventional asphalts. Similarly, higher environmental impacts for lignin-based asphalts could be obtained if the pulp mill consumed natural gas to complete the energy balance to replace the part of the black liquor from which lignin is extracted. This study also includes an in-depth discussion on methodological choices such as the allocation methods for lignin, functional units, and asphalt layers considered. We believe that such a methodological discussion could be helpful to support future Product Category Rules for asphalt mixtures.

Comparative cradle-to-grave life cycle assessment of bio-based and petrochemical PET bottles

This article presents a life cycle assessment of bio-based polyethylene terephthalate (PET) bottles with a cradle to grave scope and provides a comparison with petrochemical PET bottles for 13 environmental impact categories. Besides the baseline bio-based PET bottles, which are produced from Brazilian sugarcane reflecting status-quo, two alternative hypothetical bio-based product systems were considered: European wheat straw and European crops market mix composed of maize, wheat and sugar beet. The land-use change (LUC) impacts were assessed based on a deterministic model. The end-of-life impact was assessed using the EASETECH model. Baseline bio-based PET bottles performed overall worse than conventional petrochemical PET bottles, offering only better performance (about 10%) in abiotic depletion (fossil fuels). Comparable performance is observed for climate change (2% difference without the LUC, and 7% with LUC impacts). Using European crops for ethanol production (alternative 1) instead of Brazilian sugarcane resulted in a worse environmental performance, due to lower yields attained compared to Brazilian sugarcane. When wheat straw was considered as biomass feedstock for ethanol production (alternative 2), similar environmental performance with petrochemical PET bottles was seen.

Comparative cradle-to-grave life cycle assessment of bio-based and petrochemical PET bottles

This article presents a life cycle assessment of bio-based polyethylene terephthalate (PET) bottles with a cradle to grave scope and provides a comparison with petrochemical PET bottles for 13 environmental impact categories. Besides the baseline bio-based PET bottles, which are produced from Brazilian sugarcane reflecting status-quo, two alternative hypothetical bio-based product systems were considered: European wheat straw and European crops market mix composed of maize, wheat and sugar beet. The land-use change (LUC) impacts were assessed based on a deterministic model. The end-of-life impact was assessed using the EASETECH model. Baseline bio-based PET bottles performed overall worse than conventional petrochemical PET bottles, offering only better performance (about 10%) in abiotic depletion (fossil fuels). Comparable performance is observed for climate change (2% difference without the LUC, and 7% with LUC impacts). Using European crops for ethanol production (alternative 1) instead of Brazilian sugarcane resulted in a worse environmental performance, due to lower yields attained compared to Brazilian sugarcane. When wheat straw was considered as biomass feedstock for ethanol production (alternative 2), similar environmental performance with petrochemical PET bottles was seen.

Efecto de los factores de riesgo psicosociales relacionados al trabajo en el desarrollo de enfermedades cardiovasculares

Durante los últimos años, las enfermedades cardiovasculares (en adelante ECVs) en Chile se han situado como la primera causa de muerte y discapacidad. Frente a esta situación, el Mi¬nisterio de Salud ha generado programas de control de los factores de riesgo comunes para el desarrollo de enfermedades cardiovasculares. Sin embargo, no se ha considerado los factores de riesgo psicosociales relacionados con el trabajo, los que según la tendencia internacional se han validado como parte de los factores causantes de enfermedades cardiovasculares. Este documento tiene por objetivo evidenciar la importancia que tienen los factores de riesgos psicosociales laborales (en adelante FRPSL) para el desarrollo de ECVs, reflexionando sobre la experiencia en otros países y comparando esas realidades con la mirada actual en el control de las enfermedades cardiovasculares en Chile. Las experiencias revisadas validan a los factores de riesgo comunes como los principales para el desarrollo de enfermedades cardiovasculares, pero avalan que los factores de riesgo psicosociales de origen laboral mantienen una relación tanto directa como indirecta con el desarrollo y/o agravamiento de estas patologías, pese a que en Chile esto aún no se reconozca en términos legales.

Review of life cycle assessments of lignin and derived products: Lessons learned

In the last decade, the use of lignin as a bio-based alternative for fossil-based products has attracted significant attention, and the first LCAs of lignin and derived products have been conducted. Assessing side-stream products like lignin and potential benefits compared to their fossil counterparts presents complex methodological issues. This article provides a critical review of forty-two peer-reviewed LCAs regarding lignin and derived products. Methodological issues and their influence on the LCA results include the choice of the modeling approach and system boundaries, functional unit definition, impact categories considered, type of data used, handling multifunctionality and biogenic carbon modeling. The review focused on climate change impacts, as this is also the main impact category considered in most studies. Other impact categories in the comparison between lignin-based products and counterparts were also discussed with examples from the studies. Based on ten lessons learned, recommendations were provided for LCA practitioners to increase future consistency of environmental claims made about lignin and lignin-based products. The finding suggest that the environmental performance of lignin-based products is significantly affected by both 1) LCA methodological problems such as allocation practices and biogenic carbon modeling and 2) technical aspects such as the percentage of lignin in the composition of products and the selection of the fuel to replace lignin in internal energy uses. Beyond this, the reviewed LCAs showed that often lignin-based products offer better environmental performances than fossil-based products, especially for climate change.

The novel Mechanical Ventilator Milano for the COVID-19 pandemic

This paper presents the Mechanical Ventilator Milano (MVM), a novel intensive therapy mechanical ventilator designed for rapid, large-scale, low-cost production for the COVID-19 pandemic. Free of moving mechanical parts and requiring only a source of compressed oxygen and medical air to operate, the MVM is designed to support the long-term invasive ventilation often required for COVID-19 patients and operates in pressure-regulated ventilation modes, which minimize the risk of furthering lung trauma. The MVM was extensively tested against ISO standards in the laboratory using a breathing simulator, with good agreement between input and measured breathing parameters and performing correctly in response to fault conditions and stability tests. The MVM has obtained Emergency Use Authorization by U.S. Food and Drug Administration (FDA) for use in healthcare settings during the COVID-19 pandemic and Health Canada Medical Device Authorization for Importation or Sale, under Interim Order for Use in Relation to COVID-19. Following these certifications, mass production is ongoing and distribution is under way in several countries. The MVM was designed, tested, prepared for certification, and mass produced in the space of a few months by a unique collaboration of respiratory healthcare professionals and experimental physicists, working with industrial partners, and is an excellent ventilator candidate for this pandemic anywhere in the world.

Wrist circumference is a biomarker of adipose tissue dysfunction and cardiovascular risk in children with obesity

PURPOSE

To evaluate the relationship between wrist circumference, markers of adipose dysfunction, and cardiovascular risk in youths with obesity.

METHODS

In this cross-sectional study, we measured body mass composition by dual-energy X-ray absorptiometry, wrist circumference, waist-to-height ratio, fasting blood insulin, glucose, lipid profile, adiponectin, and leptin in 280 children with overweight/obesity and without diabetes (age: 7-18 years). Cardiovascular risk was estimated by "metabolic syndrome score" (MetS score).

RESULTS

Study participants had median [25th-75th percentile] wrist circumference of 17.5 [16.7-18.5] cm and waist-to-height ratio of 0.62 [0.59-0.67]. Lower adiponectin-leptin ratio was found among subjects in the upper 50th percentiles of wrist circumference [0.17 (0.09-0.36) vs. 0.38 (0.16-0.79); p < 0.001]. Wrist circumference was independently associated with MetS score (r = 0.5 p < 0.001). Among MetS score components, an independent association between wrist circumference HDLc, triglycerides, and systolic blood pressure was found (r = - 0.253 p < 0.001; r =+ 0.204 p < 0.001; r = + 0.403 p = < 0.001, respectively). The coefficient of determination for MetS score was nominally higher when considering wrist circumference as independent variable (Adj-R² = 0.30) then when considering body mass index SD (Adj-R² = 0.28), waist-to-height ratio (Adj-R² = 0.26) or truncal fat percentage (Adj-R² = 0.01). The addition of wrist circumference in age and gender adjusted models, accounting to any other anthropometric parameters, resulted in a significant improvement of the Adj-R² (p < 0.001 for all).

CONCLUSIONS

Our study shows that wrist circumference independently relates to adiponectin-leptin ratio and to the prediction of cardiovascular risk, suggesting it as an efficient and adjunctive anthropometric marker of cardiometabolic risk in children with obesity.

Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the "SERENA study", a randomized, double-blind, placebo-controlled trial

PURPOSE

Selenium is frequently in nutraceuticals for pregnancy, given its role on fertility and thyroid metabolism. However, most evidence rise from non-controlled studies. We aimed to evaluate the protective effect of selenium against thyroid autoimmunity during and after pregnancy.

METHODS

A multicenter, randomized, double-blind, placebo-controlled trial was performed and promoted by the Young Italian Endocrinologists Group (EnGioI)-Italian Society of Endocrinology. Forty-five women with thyroiditis in pregnancy were enrolled and randomly assigned to L-selenomethionine (L-Se-Met) 83 mcg/day or placebo (PLB) and evaluated at 10 ± 2 (T1), 36 ± 2 weeks of gestation (T2) and 6 months after delivery (postpartum, PP).

RESULTS

We measured a significant reduction of autoantibodies after pregnancy in L-Se-Met group [at PP: TgAb 19.86 (11.59-52.60), p < 0.01; TPOAb 255.00 (79.00-292.00), p < 0.01], and an antibodies titer's rebound in PLB group (TgAb 151.03 ± 182.9, p < 0.01; TPOAb 441.28 ± 512.18, p < 0.01). A significant increase in selenemia was measured in L-Se-Met group at T2 (91.33 ± 25.49; p < 0.01) and PP (93.55 ± 23.53; p = 0.02). Two miscarriage occurred in PLB. No differences were found in thyroid volume, echogenicity, quality of life, maternal/fetal complications.

CONCLUSIONS

SERENA study demonstrated a beneficial effect of L-Se-Met supplementation on autoantibody titer during pregnancy and on postpartum thyroiditis recurrence.

P4355Echocardiographic estimation of right ventricle wall tension: hemodynamic comparison and long term follow up

Introduction

Prognosis in pulmonary hypertension (PH) is strictly linked to right ventricle (RV) failure, which results from uncoupling between RV and the superimposed pressure load; in first phases, coupling between these two actors still be preserved, at the price of augmented right ventricle wall tension (RVWT).

Purpose

We sought to describe how to estimate RVWT with echocardiography, how it correlates with RV hemodynamics and if it may predict prognosis.

Methods

A total of 190 patients without overt RV failure, with suspected pulmonary hypertension (PH) to a previous echocardiography, underwent to right heart catheterization (RHC) and nearly-simultaneous echocardiography. We estimated RVWT according to Laplace law (RV length × tricuspid regurgitation peak gradient [TRPG]), in order to predict initial RV stress, and was correlated with RV hemodynamic profile; its potential prognostic impact was tested along with canonical RV function parameters.

Results

In patients enrolled in our study, RVWT correlated significantly with invasive estimation of right ventricle end diastolic pressure (R 0.343, p<0.001); a significant relationship between RVWT and several hemodynamic variables was observed (mean pulmonary artery pressure, pulmonary artery compliance, transpulmonary gradient, pulmonary vascular resistance, RV telediastolic pressure, right atrial pressure, RV stroke work index; all p<0.001). At a mean follow up of five years and three months, only RVWT predicted all-cause mortality (p 0.036), while TAPSE, TAPSE/TRPG, RV fractional area change and RV S' wave did not.

Correlation: RWVT and RV hemodynamic Hemodynamic variable R R2 p value Mean pulmonary artery pressure 0.742 0.550 <0.001 RV differential pressure 0.794 0.630 <0.001 Pulmonary artery pulsatory pressure 0.740 0.547 <0.001 Mean right atrium pressure 0.326 0.106 <0.001 Cardiac index/right atrial pressure 0.209 0.044 0.012 RV stroke work index 0.588 0.346 <0.001 Pulmonary artery compliance 0.449 0.202 <0.001 Pulmonary vascular resistance 0.531 0.282 <0.001

Prognosis: different RV variables

Discussion

We identified a novel bedside echocardiographic predictor of altered RV hemodynamic, which results precociously altered in patients without overt RV failure, and able to predict all cause mortality at a long term follow up. Further studies are needed to confirm its role in PH patients.

Cytokines in the Nasal Washes of Children with Respiratory Syncytial Virus Bronchiolitis

Although respiratory syncytial (RS) virus is the major cause of bronchiolitis and pneumonia in young children, the factors that regulate the associated lung inflammation have not been defined. The levels of interleukin (IL)10, IL-12, and interferon (IFN) were determined in the nasal wash samples from 20 infants with a clinical diagnosis of bronchiolitis, seven with confirmed RS virus infections and 9 control children without respiratory illnesses. IL-10 levels were significantly higher in acute nasal wash samples (1–4 d post-hospitalization) from RS virus- infected infants than in convalescent samples from these children (14–21 d post-hospitalization), from children with other forms of bronchiolitis and from control children. In contrast, only one RS virus-infected infant had detectable IL-12 in an acute nasal wash sample. IFN activity was not detected in any samples from RS virus-infected children. RS virus infection stimulates IL-10 expression but not IL-12 and IFN, possibly contributing to an ineffective cell-mediated immune response.

Recombinant Human Deoxyribonuclease Treatment in Hospital Management of Infants with Moderate-Severe Bronchiolitis

Bronchiolitis is the main cause of respiratory insufficiency in infants, characterized by acute inflammation, edema, necrosis of epithelial cells and increased mucus production. Mucus is mainly purulent and consequently rich in DNA, as derived from nuclei of degenerating neutrophils and epithelial debris. The treatment is mainly supportive; bronchodilators and systemic steroids are often used but do not reduce the length of hospital stay. The aim of our study is to evaluate the efficacy of recombinant human DNase (rhDNase), in infants affected by moderate-severe bronchiolitis. In a randomized double-blind placebo-controlled study, twenty-two infants (12 males) under 6 months of age (median age 1.6 months) were enrolled and randomly assigned to receive either nebulized rhDNase or placebo (saline) at a dose of 2.5 ml once a day for three days. All infants were evaluated, based on a clinical assessment score, on admission and four times daily during the hospitalization. Placebo and study groups were sex- and age-matched and were similar in terms of clinical severity on admission. No differences were observed between the two groups of patients with regard to the length of hospitalization and clinical score during the days observed. Two out of four infants, all in the study group, presenting atelectasis on chest radiographs, showed a rapid improvement on the first day. RhDNase is not an effective routine therapy in treating infants hospitalized for bronchiolitis and it is not useful in preventing severe forms of the disease. On the contrary, it may be an effective, safe and cost-benefit treatment only in infants with bronchiolitis and massive atelectasis.

Difficult diagnosis of atypical kawasaki disease in an infant younger than six months: a case report

Background

Kawasaki disease (KD) is an acute inflammatory vasculitis of unknown origin.

Case presentation

We report the case of a 5-month-old child with an atypical form of KD, characterized by undulating symptoms, who developed an aneurysm of the right coronary artery and an ectasia of the left anterior descending coronary artery.

Conclusion

This case report underlines the difficulties in recognizing incomplete forms of the illness in young infants, who are at higher risk of cardiac complications.

Interindividual variability in the expression of surfactant protein A and B in the human lung during development

The surfactant complex, thanks to its multiple actions including decrease of surface- tension and antimicrobial activity, plays a fundamental role in newborn survival, lowering the risk of respiratory distress syndrome. The aim of this work was to determine if the synthesis of two surfactant proteins (SP), SPA and pro-SPB, shows some inter-individual variability during lung development in the intrauterine life. Immunoreactivity for SPA and pro-SPB was investigated in the lungs of  40 subjects, including 15 fetuses, ranging from 14 to 22 weeks of gestation, and 25 neonates, from 24 to 41 weeks. Lung samples were formalin fixed, paraffin-embedded and routinely processed. SPA and pro-SPB were detected utilizing commercial antibodies.  A semi-quantitative grading system (1 to 4) was applied, based on the number of reactive cells and the intensity of immunostaining. Surfactant protein immunostaining was found in  three compartments: bronchi, bronchioles and alveoli, starting from 14 weeks of gestation in the bronchial epithelium and from the 21st week in the alveolar spaces. Differences were found regarding SPA and pro-SPB expression in the vast majority of subjects: in some lungs, SPA was more expressed whereas in others pro-SPB showed an higher degree of immunoreactivity. The expression of both surfactant proteins was not strictly correlated with gestational age. Whereas the highest levels of reactivity were detected in at term neonates, on the other hand one case with grade 3 was detected at 22 weeks and one negative case for both proteins was observed at 31 weeks. Our data clearly show a marked inter-individual variability regarding the production of SPA and pro-SPB and suggest the existence of other epigenetic factors, acting during gestation, that might influence surfactant production and, consequently, the survival potential of  neonates at birth.

The Role of Terlipressin in Pediatric Septic Shock: A Review of the Literature and Personal Experience

Vasopressin and its synthetic analog terlipressin are potent vasopressors that could be useful in vasodilatory septic shock. In septic adults, vasopressin/terlipressin have been shown to increase mean arterial pressure and to decrease the necessity for catecholamines. Moreover, low doses of vasopressin (or terlipressin) increase urine output and ameliorate oxygenation. Although pediatric septic shock is more often hypodynamic, both vasopressin and terlipressin have proved to be effective in restoring blood pressure or increasing the diuresis in this setting. The purpose of this review is to summarize the physiology of vasopressin and to report the available evidence for the use of vasopressin or terlipressin in pediatric septic shock in order to make best use in this population. We also report our experience with the continuous infusion of terlipressin in two pediatric patients who developed catecholamine refractory septic shock.

Herbal medicine in the Marquesas Islands

ETHNOPHARMACOLOGICAL RELEVANCE

This manuscript reports data on medicinal plants used in Marquesas Islands traditional medicine. The subject is interesting due to the extreme geographical isolation of this archipelago and the scarcity of data on this subject. The hypothesis of the authors was that traditional knowledge in this area should be consequently largely preserved. The usual ethnobotanical collection of use/symptom was completed by an additional quantitative ethnobotany analysis providing two indices: the relative frequency of plant uses for a given affliction (RF) and the Informant Consensus Factor (ICF).

MATERIALS AND METHODS

Our ethnopharmacological study was carried out between 2009 and 2012 in several parts of the archipelago by collecting the accurate names of the medicinal plants, their uses, the methods of preparation of the remedies and the associated traditional nosology. Two methods were applied: ex situ focus groups with scientists and local association partners, using fresh plant specimens, dried specimens, and photographs, guided by an outline of simple questions, and in situ semi-structured interviews of informants during walk in the woods or homegarden sampling.

RESULTS

96 plant species were pointed out as medicine for which we collected 1774 use reports; 77 of these species cited by more than 1 informant are listed with their frequency of use. Three species account for one-third of use reports: Cocos nucifera (coconut), Gardenia taitensis (tiare Tahiti) and Microsorum grossum. Native species (either indigenous or endemic) represent only one quarter of all used species. The Polynesian introductions (plants introduced during Polynesian migrations) represent 42% of the Marquesan medicinal plants. On the other hand, one-third are modern introductions, introduced, for most of them, less than 200 years ago. Diseases are analyzed according to Marquesan concepts. In the present study, a special attention was focused on the descriptions of the local diseases. Their translation in French was discussed and verified in focus groups involving both scientists and Marquesan language specialists from the "Académie des Marquises". 40 plant species showed a high frequency of citation for a given affliction (RF>20). Despite the complex nosology the ICF to Marquesan traditional illness categories showed generally high ICF values, suggesting their strong coherence.

CONCLUSIONS

An overview of the Marquesan pharmacopoeia, linked with ethnomedicinal practices, is presented in this paper. Marquesan traditional medicine survived until now despite the culture shock faced by the Marquesan population switching to numerous introduced plants commonly found in their close environment and easily gathered. Marquesan herbal medicine appears to draw its inspiration from a common Polynesian root. However further investigations on Marquesan nosologies are necessary to appreciate the originality of the Marquesan pharmacopoeia. Finally, the crossing of ICF and RF indices shows that 36 species have at least one significant use (frequencies>20%) with high ICF value (>0.5). This suggests that some key phytochemical ingredients may be present in these plants which require further phytopharmacological studies to a better knowledge of their medicinal properties.

Terapia ocupacional y paciente crítico

El presente estudio fue realizado en la Unidad de Pacientes Críticos adultos, del Hospital Clínico de la Pontificia Universidad Católica de Chile (UPC-HCPUC), durante el año 2012, donde se exploraron las características del paciente crítico, para obtener un perfil de salud global durante su estadía en la UPC, con el fin de determinar si sería posible realizar una intervención desde la Terapia Ocupacional que fuese un aporte a esta unidad. Se realizó un estudio prospectivo, observacional en la UPC médico–quirúrgica durante 25 días. Los resultados obtenidos permitieron caracterizar al paciente crítico de esta unidad, como un sujeto con alta probabilidad de presentar compromiso de conciencia, edema en mano, limitación de rango de movimiento articular (ROM) en muñeca y dedos, y carencia de estímulos que evoquen su realidad previa a la hospitalización. Finalmente, a partir del análisis del perfil del paciente crítico de la UPC-HCPUC y del contexto al que se encuentra expuesto, se concluye que la intervención temprana de Terapia Ocupacional podría disminuir y prevenir la aparición de algunos signos asociados al paciente crítico, comprobándose la hipótesis, que dadas las características de este paciente, sería posible realizar una intervención desde la Terapia Ocupacional.

Weaning of infants from non invasive ventilation

Non invasive ventilation (NIV) is commonly used to treat RDS in preterm infants. Although less risky than invasive ventilation, NIV has some potential side effects and appropriate weaning is therefore desirable. However, criteria for the definition of stability prior to attempting NIV weaning as well as the best weaning strategies need to be more investigated. The aim of this review is to identify criteria and interventions that can facilitate correct weaning from NIV.

Appraising failure of surgical and percutaneous revascularization: long term outcomes from an observational registry

AIM

Many randomized trials have compared coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) in terms of efficacy, but data comparing outcomes of patients in which these two techniques have failed are lacking.

METHODS

We included patients undergoing PCI at our center between July 2002 and December 2004. Subjects were distinguished in 2 groups: those with at least one occluded or stenotic saphenous vein graft (CABG failure), and those with at least one stent with angiographically documented restenosis (PCI failure). The primary endpoint was the long-term rate of major adverse clinical events.

RESULTS

Two hundred and thirthy four patients were included, with a medium follow up of 61±13 months; 134 were assigned to the CABG failure group, and 104 to the PCI failure group, sharing high rates of baseline risk factors. At long term rates of death were higher in post CABG group (22.1% vs. 9.9%; P=0.015, RR 2.24 C.I. 95% 1.14-4.40) while death rates in patients with diagnosis of diabetes mellitus (24.0% vs. 23.5%; P=0.969, RR 1.020 C.I. 95% 0.38-2.74) were not different

CONCLUSION

PCI can be safely offered to both these kinds of patients: as recently demonstrated post CABG outcomes seem to be more favorable in patients with diabetes mellitus.

Outcomes after tongue-lip adhesion or mandibular distraction osteogenesis in infants with Pierre Robin sequence and severe airway obstruction

The objective was to review and compare outcomes after tongue-lip adhesion (TLA) and mandibular distraction osteogenesis (MDO) in infants with severe breathing difficulties related to Pierre Robin sequence (PRS). A single-centre retrospective (2002-2012) study was carried out; 18 infants with severe breathing difficulties related to PRS resistant to conservative treatment, who underwent TLA or MDO to correct airway obstruction, were enrolled. The primary outcome measures were successful weaning from respiratory support and resumption of full oral feeding. Nine underwent TLA and nine MDO. Eight of the nine infants who underwent MDO and all those treated with TLA were successfully weaned from respiratory support. After discharge, residual respiratory distress was diagnosed more commonly after TLA than after MDO (6/9 vs 1/9, P=0.050). Infants resumed oral feeding sooner after MDO than after TLA (mean days after surgery to full oral feeds 44±24 vs 217±134, P<0.003). The length of hospital stay was longer for infants treated with MDO than for those treated with TLA. The rate of complications was similar. Infants with severe airway obstruction related to PRS can benefit safely from either TLA or MDO. Although MDO lengthens the time to discharge, this option stabilizes airway patency of infants with PRS more efficiently and achieves full oral feeding more rapidly than TLA.

The dual Aurora kinase inhibitor ZM447439 prevents anaplastic thyroid cancer cell growth and tumorigenicity

The anaplastic thyroid cancer (ATC) is among the most aggressive human tumors which fail to respond to all the currently available therapeutic approaches. As a consequence most patients die within a few months from diagnosis. In the present preclinical study, the effects of the ZM447439, a functional inhibitor of Aurora kinases, on the growth and tumorigenicity of a panel of ATC derived cell lines (CAL-62, 8305C, 8505C and BHT-101) were evaluated. The treatment of the different ATC cells with ZM447439 inhibited proliferation in a time- and dose-dependent manner, with IC50 comprised between 0.5 mM and 5 mM. Moreover, the drug remarkably impaired the formation of colonies in soft agar of all the cell lines. Consistently with Aurora inhibition, immunofluorescence and immunoblotting experiments demonstrated that Aurora auto-phosphorylation following drug treatment was completely abrogated, and treated cells were characterized by the presence of multiple spindles with short microtubules. In the same experiments we observed the loss of histone H3 phosphorylation on Ser10, specifically due to Aurora-B, after ZM447439 treatment. Time-lapse videomicroscopy and flow cytometric analysis demonstrated that in presence of ZM447439 the cells were able to enter mitosis but not to complete it, becoming polyploid. Almost all the ATC cell lines studied showed increased apoptosis after only 48 h of treatment. In conclusion, our data demonstrate that ZM447439 is effective in reducing cell growth and tumorigenicity of different ATC derived cell lines, and further investigations are needed to exploit its potential therapeutic value for ATC treatment.