Showing papers by "Marche Polytechnic University published in 2022"

Preeclampsia and severe acute respiratory syndrome coronavirus 2 infection: a systematic review

Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the coronavirus disease 2019 (COVID-19) disease that has rapidly spread worldwide, causing hundreds of thousand deaths. Normal placentation is characterized by many processes strictly regulated during pregnancy. If placentation is impaired, it can lead to gestational disorders, such as preeclampsia that is a multisystem disorder that occurs in 2-8% of pregnancies worldwide.We performed a systematic search to understand the potential involvement of SARS-CoV-2 in preeclampsia onset using the databases, PubMed and Web of Science until 31 January 2022.SARS-CoV-2 infection not only causes damage to the respiratory system but also can infect human placenta cells impairing pivotal processes necessary for normal placenta development. The inflammatory response trigged by COVID-19 disease is very similar to that one found in preeclampsia pregnancies suggesting a possible link between SARS-CoV-2 infection and preeclampsia onset during pregnancy.Some studies showed that pregnancies affected by COVID-19 had higher incidence of preeclampsia compared with SARS-CoV-2-negative ones. However, increased blood pressure found in COVID-19 pregnancies does not allow to associate COVID-19 to preeclampsia as hypertension is a common factor to both conditions. At present, no diagnostic tools are available to discriminate real preeclampsia from preeclampsia-like syndrome in patients with SARS-CoV-2 infection. Thus, new specific diagnostic tools are necessary to assure an appropriate diagnosis of preeclampsia in these patients, especially in case of severe COVID-19 disease.

Airway Ultrasound as Predictor of Difficult Direct Laryngoscopy: A Systematic Review and Meta-analysis

Abstract: Despite several clinical index tests that are currently applied for airway assessment, unpredicted difficult laryngoscopy may still represent a serious problem in anesthesia practice. The aim of this systematic review and meta-analysis was to evaluate whether preoperative airway ultrasound can predict difficult direct laryngoscopy in adult patients undergoing elective surgery under general anesthesia.We searched the Medline, Scopus, and Web of Science databases from their inception to December 2020. The population of interest included adults who required tracheal intubation for elective surgery under general anesthesia without clear anatomical abnormalities suggesting difficult laryngoscopy. A bivariate model has been used to assess the accuracy of each ultrasound index test to predict difficult direct laryngoscopy.Fifteen studies have been considered for quantitative analysis of summary receiver operating characteristic (SROC). The sensitivity for distance from skin to epiglottis (DSE), distance from skin to hyoid bone (DSHB), and distance from skin to vocal cords (DSVC) was 0.82 (0.74-0.87), 0.71 (0.58-0.82), and 0.75 (0.62-0.84), respectively. The specificity for DSE, DSHB, and DSVC was 0.79 (0.70-0.87), 0.71 (0.57-0.82), and 0.72 (0.45-0.89), respectively. The area under the curve (AUC) for DSE, DSHB, DSVC, and ratio between the depth of the pre-epiglottic space and the distance from the epiglottis to the vocal cords (Pre-E/E-VC) was 0.87 (0.84-0.90), 0.77 (0.73-0.81), 0.78 (0.74-0.81), and 0.71 (0.67-0.75), respectively. Patients with difficult direct laryngoscopy have higher DSE, DSVC, and DSHB values than patients with easy laryngoscopy, with a mean difference of 0.38 cm (95% confidence interval [CI], 0.17-0.58 cm; P = .0004), 0.18 cm (95% CI, 0.01-0.35 cm; P = .04), and 0.23 cm (95% CI, 0.08-0.39 cm; P = .004), respectively.Our study demonstrates that airway ultrasound index tests are significantly different between patients with easy versus difficult direct laryngoscopy, and the DSE is the most studied index test in literature to predict difficult direct laryngoscopy. However, it is not currently possible to reach a definitive conclusion. Further studies are needed with better standardization of ultrasound assessment to limit all possible sources of heterogeneity.

Acute Intoxications and Fatalities Associated With Benzimidazole Opioid (Nitazene Analog) Use: A Systematic Review

Abstract: Synthetic benzimidazole opioids (BOs) are highly potent µ-opioid receptor agonists with heroin-like effects. Isotonitazene was first available in 2019 in the drug market, although new analogs have multiplied recently. The authors aimed to identify BO use trends and gather toxicological data from BO-related cases to assist in clinical and forensic investigations.A systematic literature search was conducted according to the PRISMA guidelines. PubMed and Scopus databases were accessed in October 2021 to identify scientific reports of BO-related intoxication and fatalities. Publication dates, case descriptions, symptoms, autopsy findings, and concentrations of BOs and metabolites in biological matrices were compiled.Data from 8 case reports with 93 fatalities involving isotonitazene ( n = 65), metonitazene ( n = 20), etonitazepyne ( N -pyrrolidino etonitazene) ( n = 8), flunitazene ( n = 4), and/or butonitazene ( n = 1), and 1 acute intoxication involving etonitazepyne were collected. Autopsy findings included pulmonary congestion/high lung weight (66%), cardiomegaly/high cardiac weight (39%), cerebral edema (22%), gastric contents in the airways (22%), and organ congestion (22%). Median peripheral blood concentrations were 1.7 ng/mL for isotonitazene (0.4-9.5 ng/mL, n = 13), 5.4 ng/mL for metonitazene (0.52-33 ng/mL, n = 17), 5.4 ng/mL for etonitazepyne (2.4-8.3 ng/mL, n = 2), 1.3 ng/mL for flunitazene (0.58-2.1 ng/mL, n = 2), and 3.2 ng/mL for butonitazene ( n = 1). Central nervous system depressants were almost always coadministered.Isotonitazene was predominant in cases from 2019 to mid-2020 and was replaced by metonitazene after scheduling in the United States. Typical findings on opioid overdoses have been reported. Peripheral blood concentrations were consistent with a potency similar to that of fentanyl. These results must be interpreted carefully, considering the scarcity of reports on BO-related cases and drug co-exposures.

Optimal Management of Asymptomatic Carotid Stenosis in 2021: The Jury is Still Out. An International, Multispecialty, Expert Review and Position Statement

Abstract: Objectives The recommendations of international guidelines for the management of asymptomatic carotid stenosis (ACS) often vary considerably and extend from a conservative approach with risk factor modification and best medical treatment (BMT) alone, to a more aggressive approach with a carotid intervention plus BMT. The aim of the current multispecialty position statement is to reconcile the conflicting views on the topic. Materials and methods A literature review was performed with a focus on data from recent studies. Results Several clinical and imaging high-risk features have been identified that are associated with an increased long-term ipsilateral ischemic stroke risk in patients with ACS. Such high-risk clinical/imaging features include intraplaque hemorrhage, impaired cerebrovascular reserve, carotid plaque echolucency/ulceration/ neovascularization, a lipid-rich necrotic core, a thin or ruptured fibrous cap, silent brain infarction, a contralateral transient ischemic attack/stroke episode, male patients Conclusions Although aggressive risk factor control and BMT should be implemented in all ACS patients, several high-risk features that may increase the risk of a future cerebrovascular event are now documented. Consequently, some guidelines recommend a prophylactic carotid intervention in high-risk patients to prevent future cerebrovascular events. Until the results of the much-anticipated randomized controlled trials emerge, the jury is still out regarding the optimal management of ACS patients.

Systemic Sclerosis: From Pathophysiology to Novel Therapeutic Approaches

Abstract: Systemic sclerosis (SSc) is a systemic, immune-mediated chronic disorder characterized by small vessel alterations and progressive fibrosis of the skin and internal organs. The combination of a predisposing genetic background and triggering factors that causes a persistent activation of immune system at microvascular and tissue level is thought to be the pathogenetic driver of SSc. Endothelial alterations with subsequent myofibroblast activation, excessive extracellular matrix (ECM) deposition, and unrestrained tissue fibrosis are the pathogenetic steps responsible for the clinical manifestations of this disease, which can be highly heterogeneous according to the different entity of each pathogenic step in individual subjects. Although substantial progress has been made in the management of SSc in recent years, disease-modifying therapies are still lacking. Several molecular pathways involved in SSc pathogenesis are currently under evaluation as possible therapeutic targets in clinical trials. These include drugs targeting fibrotic and metabolic pathways (e.g., TGF-β, autotaxin/LPA, melanocortin, and mTOR), as well as molecules and cells involved in the persistent activation of the immune system (e.g., IL4/IL13, IL23, JAK/STAT, B cells, and plasma cells). In this review, we provide an overview of the most promising therapeutic targets that could improve the future clinical management of SSc.

Light controlled bending of a holographic transmission phase grating

Abstract: Abstract We recorded a permanent phase transmission grating on a thin film made by using a recently developed holographic photomobile mixture. The recorded grating pitch falls in the visible range and can be optically manipulated by using an external coherent or incoherent low power light source. When the external light source illuminates the grating the entire structure bends and, as a consequence, the optical properties of the grating change. This peculiarity makes it possible to use the recorded periodic structure as an all-optically controlled free standing thin colour selector or light switch depending on the source used to illuminate the grating itself. Additionally, it could open up new possibilities for stretchable and reconfigurable holograms controlled by light as well as thin devices for optically reconfigurable dynamic communications and displays.

Retirement and health outcomes in a meta‐analytical framework

Abstract: This paper presents a meta-analysis on the effects of retirement on health. We selected academic papers published between 2000 and 2021 and studying the impact of retirement on physical and mental health, self-assessed general health, healthcare utilization and mortality. Our search resulted in a dataset consisting of 308 observations from 85 articles. Using meta-regression analysis and after checking for the presence of publication bias, we found that the average effect of retirement on health outcomes is very small and barely significant, under the assumption of a common true effect. We applied model averaging techniques to explore possible sources of heterogeneity of the true effect. Our findings suggest that effect heterogeneity across results is explained by the differences in both health measurements and retirement schemes. In particular, mandatory or involuntary retirement is associated with a negative impact of retirement on health, although it is small in magnitude.

Procedural time reduction associated with active esophageal cooling during pulmonary vein isolation

Abstract: Abstract Background Active esophageal cooling is increasingly utilized as an alternative to luminal esophageal temperature (LET) monitoring for protection against thermal injury during pulmonary vein isolation (PVI) when treating atrial fibrillation (AF). Published data demonstrate the efficacy of active cooling in reducing thermal injury, but impacts on procedural efficiency are not as well characterized. LET monitoring compels pauses in ablation due to heat stacking and temperature overheating alarms that in turn delay progress of the PVI procedure, whereas active esophageal cooling allows avoidance of this phenomenon. Our objective was to measure the change in PVI procedure duration after implementation of active esophageal cooling as a protective measure against esophageal injury. Methods We performed a retrospective review under IRB approval of patients with AF undergoing PVI between January 2018 and February 2020. For each patient, we recorded age, gender, and total procedure time. We then compared procedure times before and after the implementation of active esophageal cooling as a replacement for LET monitoring. Results A total of 373 patients received PVI over the study period. LET monitoring using a multi-sensor probe was performed in 198 patients, and active esophageal cooling using a dedicated device was performed in 175 patients. Patient characteristics did not significantly differ between groups (mean age of 67 years, and gender 37.4% female). Mean procedure time was 146 ± 51 min in the LET-monitored patients, and 110 ± 39 min in the actively cooled patients, representing a reduction of 36 min, or 24.7% of total procedure time ( p < .001). Median procedure time was 141 [IQR 104 to 174] min in the LET-monitored patients and 100 [IQR 84 to 122] min in the actively cooled patients, for a reduction of 41 min, or 29.1% of total procedure time ( p < .001). Conclusions Implementation of active esophageal cooling for protection against esophageal injury during PVI was associated with a significantly large reduction in procedure duration.

SEM and FT-MIR Analysis of Human Demineralized Dentin Matrix: An In Vitro Study

Abstract: Recently, the demineralized dentin matrix has been suggested as an alternative material to autologous bone grafts and xenografts for clinical purposes. The aim of this study was to investigate the effect of different times of demineralization on the chemical composition and the surface morphology of dentinal particles. Extracted teeth were ground and divided into 5 groups based on demineralization time (T0 = 0 min, T2 = 2 min, T5 = 5 min, T10 = 10 min, and T60 = 60 min) with 12% EDTA. The analysis was performed using Fourier-Transform Mid-Infrared spectroscopy (FT-MIR) and Scanning Electron Microscopy (SEM) (p < 0.05). The FT-MIR analysis showed a progressive reduction of the concentration of both PO43− and CO32− in the specimens (T0 > T2 > T5 > T10 > T60). On the contrary, the organic (protein) component did not undergo any change. The SEM examination showed that increasing the times of demineralization resulted in a smoother surface of the dentin particles and a higher number of dentinal tubules.

Testing graphene versus classical soil improvers in a sandy calcisol

Abstract: In this study for the first time, Graphene was tested in a leaching batch experiment on a calcareous sandy soil (Calcisol) to assess its capacity to ameliorate soil’s properties in comparison with traditional soil improvers (Compost, Biochar, and Zeolites). A first set of experiments was performed in triplicates using the saturation soil extraction method (5:1 liquid–solid ratio) with deionized water as liquid phase and two different rates (minimum and maximum) of each improver. A second set of experiments (5:1 liquid–solid ratio) was performed to understand the fate of fertilizers, using the maximum amount of soil improvers and two different liquid phases: NPK solution from a synthetic fertilizer and fertigation water from a wastewater treatment plant. EC, pH, ORP and dissolved O2 were monitored daily for two weeks, and water samples were obtained at the end of the experiment to analyze DOC, major ions, and trace elements. Results showed that Graphene neither altered the physical–chemical parameters nor released nutrients and heavy metals in the solution in comparison to control and other improvers. Biochar increased EC and pH beyond recommended limits for some plants growth, while Compost released NO3– above threshold limits. Batches with the NPK solution showed NH4+ accumulation in the solute for controls, and to a less extent for Zeolites, Graphene and Biochar, while no accumulation was recorded for Compost. NH4+ accumulation was triggered by microbial N remineralization in absence of a C source. Batches with fertigation water showed NO2– accumulation in the solute due to incomplete nitrification in all the improvers and control batches, since the available C source consumed O2 that in turn hampered the nitrification process. Despite the above-mentioned limitations, Graphene performed well in comparison to the other soil improvers in reducing nutrients and metals leaching.

Dynamic monitoring of buildings as a diagnostic tool during construction phases

Abstract: The paper discusses the usefulness of the dynamic characterization of buildings based on the use of ambient vibration tests at different construction phases. The proposed experimental procedure, integrated with more conventional non-destructive in-situ tests for the estimation of the material mechanical properties, foresees the monitoring of the evolution of the building modal properties during the main construction phases. The monitoring makes it possible to assess the correctness of the construction through comparison with expected trends, and to consider possible countermeasures in case of unexpected behaviours. A case study, monitored during its construction, is presented to show the additional value of information obtained from the proposed experimental approach: (i) tests on the bare frame can be adopted to validate the design numerical model of the structure, in which non-structural elements are neglected in performing ultimate limit state verifications, (ii) the proposed monitoring allows the identification of the infills contribution on the building dynamics, providing useful information to address the interaction problem between structural and non-structural elements that may be detrimental at ultimates, and (iii) trends of resonance frequencies during the construction, validated through numerical applications, constitute an important tool for interpreting data from structural health monitoring system, as well as to establish alert thresholds of demand parameters (e.g. relevant to the building occupancy or structural damage).