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The only therapy for coeliac disease patients is to completely avoid foods containing gluten, a protein complex common in several small-grain cereals. However, many alternative gluten-free foods available on the market present nutritional deficiencies. Therefore, the aim of this research was to evaluate the composition and the antioxidant properties of gluten-free pasta enriched with 10% or 15% of tomato waste or linseed meal, two food industry by-products. The traits analysed were protein, lipid, ash and fibre content, heat damage, tocols, carotenoids and phenolics composition (by HPLC), antioxidant capacity, and pasta fracturability. The enriched pastas contained more fibre and lipids than the control, while the protein and ash values were similar. The addition of tomato and linseed waste improved tocols concentration but had no effect on carotenoids content. The free soluble polyphenols increase was similar for both by-products and proportional to the enrichment percentage, while the bound insoluble polyphenols were higher in linseed-enriched pastas. The samples with linseed meal showed the greatest antioxidant capacity and, at 10% addition, the highest fracturability value. In conclusion, the addition of tomato and linseed by-products significantly increases the presence of bioactive compounds (particularly polyphenols), improving the nutritional value of gluten-free pasta.

In this work, the analysis of TerraSAR-X satellite images combining both conventional and advanced Differential Synthetic Aperture Radar Interferometry (DInSAR) approaches has proven to be effective to detect and monitor fast evolving mining subsidence on urban areas in the Upper Silesian Coal Basin (Poland). This region accounts for almost three million inhabitants where mining subsidence has produced severe damage to urban structures and infrastructures in recent years. Conventional DInSAR approach was used to generate 28 differential interferograms between 5 July 2011 and 21 June 2012 identifying 31 subsidence troughs that account up to 245 mm of displacement in 54 days (equivalent to 1660 mm/year). SqueeSARTM processing yielded a very dense measurement point distribution, failing to detect faster displacements than 330 mm/year, which occur within the subsidence troughs detected with conventional DInSAR. Despite this limitation, this approach was useful to delimit stable areas where mining activities are not conducted and areas affected by residual subsidence surrounding the detected subsidence troughs. These residual subsidence mining areas are located approximately 1 km away from the 31 detected subsidence troughs and account for a subsidence rate greater than 17 mm/year on average. The validation of this methodology has been performed over Bytom City were underground mining activity produced severe damages in August 2011. Conventional DInSAR permitted to successfully map subsidence troughs between July and August 2011 that coincide spatially and temporally with the evolution of underground mining excavations, as well as with the demolition of 28 buildings of Karb district. Additionally, SqueeSARTM displacement estimates were useful to delimit an area of 8.3 km2 of Bytom city that is affected by a residual mining subsidence greater than 5 mm/year and could potentially suffer damages in the midterm. The comparison between geodetic data and SqueeSARTM for the common monitoring period yields and average absolute difference of 7 mm/year, which represents 14% of the average displacement rate measured by the geodetic benchmarks. These results demonstrate that the combined exploitation of high-resolution satellite SAR data through both conventional and advanced DInSAR techniques could be crucial to monitor fast evolving mining subsidence, which may severely impact highly populated mining areas such as the Upper Silesia Coal Basin (USCB).

Purpose The onset of the coronavirus disease 19 (COVID-19) pandemic in Italy induced a dramatic increase in the need for intensive care unit (ICU) beds for a large proportion of patients affected by COVID-19-related acute respiratory distress syndrome (ARDS). The aim of the present study was to describe the health-related quality of life (HRQoL) at 90 days after ICU discharge in a cohort of COVID-19 patients undergoing invasive mechanical ventilation and to compare it with an age and sex-matched sample from the general Italian and Finnish populations. Moreover, the possible associations between clinical, demographic, social factors, and HRQoL were investigated. Methods COVID-19 ARDS survivors from 16 participating ICUs were followed up until 90 days after ICU discharge and the HRQoL was evaluated with the 15D instrument. A parallel cohort of age and sex-matched Italian population from the same geographic areas was interviewed and a third group of matched Finnish population was extracted from the Finnish 2011 National Health survey. A linear regression analysis was performed to evaluate potential associations between the evaluated factors and HRQoL. Results 205 patients answered to the questionnaire. HRQoL of the COVID-19 ARDS patients was significantly lower than the matched populations in both physical and mental dimensions. Age, sex, number of comorbidities, ARDS class, duration of invasive mechanical ventilation, and occupational status were found to be significant determinants of the 90 days HRQoL. Clinical severity at ICU admission was poorly correlated to HRQoL. Conclusion COVID-19-related ARDS survivors at 90 days after ICU discharge present a significant reduction both on physical and psychological dimensions of HRQoL measured with the 15D instrument. Trial Registration: NCT04411459.

Background The contemporary management of mass casualty incidents (MCIs) relies on the effective application of predetermined, dedicated response plans based on current best evidence. Currently, there is limited evidence regarding the factors influencing the accuracy of first responders (FRs) in applying the START protocol and the associated prehospital times during the response to MCIs. The objective of this study was to investigate factors affecting FRs’ accuracy in performing prehospital triage in a series of simulated mass casualty exercises. Secondly, we assessed factors affecting triage-to-scene exit time in the same series of exercises. Methods This retrospective study focused on simulated casualties in a series of simulated MCIs Full Scale Exercises. START triage was the triage method of choice. For each Full-Scale Exercise (FSEx), collected data included exercise and casualty-related information, simulated casualty vital parameters, simulated casualty anatomic lesions, scenario management times, and responder experience. Results Among the 1090 casualties included in the primary analysis, 912 (83.6%) were correctly triaged, 137 (12.6%) were overtriaged, and 41 (3.7%) were undertriaged. The multinomial regression model indicated that increasing heart rate (RRR = 1.012, p  = 0.008), H-AIS (RRR = 1.532, p  < 0.001), and thorax AIS (T-AIS) (RRR = 1.344, p  = 0.007), and lower ISS (RRR = 0.957, p  = 0.042) were independently associated with overtriage. Undertriage was significantly associated with increasing systolic blood pressure (RRR = 1.013, p  = 0.005), AVPU class (RRR = 3.104 per class increase), and A-AIS (RRR = 1.290, p  = 0.035). The model investigating the factors associated with triage-to-scene departure time showed that the assigned prehospital triage code red (TR = 0.841, p  = 0.002), expert providers (TR = 0.909, p  = 0.015), and higher peripheral oxygen saturation (TR = 0.998, p  < 0.001) were associated with a reduction in triage-to-scene departure time. Conversely, increasing ISS was associated with a longer triage-to-scene departure time (TR = 1.004, 0.017). Conclusions Understanding the predictors influencing triage and scene management decision-making by healthcare professionals responding to a mass casualty may facilitate the development of tailored training pathways regarding mass casualty triage and scene management.

We found four patients with some characteristic phenotype in our ICU, characterized by focal hypotrophies of the shoulder girdle and the bilateral peroneal district and underlying critical illness neuro-myopathy. In our opinion, these hypotrophies are secondary to the prone position. Is our intention to start early treatment protocol with electrostimulation to evaluate the effectiveness in the prevention of critical illness and focal hypotrophies in ICU SARS-CoV-2 patients, to increase chances of returning to a preinfection functional status.

Background Assessment of fluid responsiveness is problematic in intensive care unit (ICU) patients, in particular for those undergoing modes of partial support, such as pressure support ventilation (PSV). We propose a new test, based on application of a ventilator-generated sigh, to predict fluid responsiveness in ICU patients undergoing PSV. Methods This was a prospective bi-centric interventional study conducted in two general ICUs. In 40 critically ill patients with a stable ventilatory PSV pattern and requiring volume expansion (VE), we assessed the variations in arterial systolic pressure (SAP), pulse pressure (PP) and stroke volume index (SVI) consequent to random application of 4-s sighs at three different inspiratory pressures. A radial arterial signal was directed to the MOSTCARE™ pulse contour hemodynamic monitoring system for hemodynamic measurements. Data obtained during sigh tests were recorded beat by beat, while all the hemodynamic parameters were averaged over 30 s for the remaining period of the study protocol. VE consisted of 500 mL of crystalloids over 10 min. A patient was considered a responder if a VE-induced increase in cardiac index (CI) ≥ 15% was observed. Results The slopes for SAP, SVI and PP of were all significantly different between responders and non-responders ( p  < 0.0001, p  = 0.0004 and p  < 0.0001, respectively). The AUC of the slope of SAP (0.99; sensitivity 100.0% (79.4–100.0%) and specificity 95.8% (78.8–99.9%) was significantly greater than the AUC for PP (0.91) and SVI (0.83) ( p  = 0.04 and 0.009, respectively). The SAP slope best threshold value of the ROC curve was − 4.4° from baseline. The only parameter found to be independently associated with fluid responsiveness among those included in the logistic regression was the slope for SAP ( p  = 0.009; odds ratio 0.27 (95% confidence interval (CI 95 ) 0.10–0.70)). The effects produced by the sigh at 35 cmH 2 0 (Sigh 35 ) are significantly different between responders and non-responders. For a 35% reduction in PP from baseline, the AUC was 0.91 (CI 95 0.82–0.99), with sensitivity 75.0% and specificity 91.6%. Conclusions In a selected ICU population undergoing PSV, analysis of the slope for SAP after the application of three successive sighs and the nadir of PP after Sigh 35 reliably predict fluid responsiveness. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12615001232527 . Registered on 10 November 2015.

Background Noninvasive ventilation (NIV) is commonly used in clinical practice to reduce intubation times and enhance patient comfort. However, patient-ventilator interaction (PVI) during NIV, particularly with helmet interfaces, can be challenging due to factors such as dead space and compliance. Neurally adjusted ventilatory assist (NAVA) has shown promise in improving PVI during helmet NIV, but limitations remain. A new mode, neural pressure support (NPS), aims to address these limitations by providing synchronized and steep pressurization. This study aims to assess whether NPS per se improves PVI during helmet NIV compared to standard pressure support ventilation (PSV). Methods The study included adult patients requiring NIV with a helmet. Patients were randomized into two arms: one starting with NPS and the other with PSV; the initial ventilatory parameters were always set as established by the clinician on duty. Physiological parameters and arterial blood gas analysis were collected during ventilation trials. Expert adjustments to initial ventilator settings were recorded to investigate the impact of the expertise of the clinician as confounding variable. Primary aim was the synchrony time (Time sync ), i.e., the time during which both the ventilator and the patient (based on the neural signal) are on the inspiratory phase. As secondary aim neural-ventilatory time index (NVT I ) was also calculated as Time sync divided to the total neural inspiratory time, i.e., the ratio of the neural inspiratory time occupied by Time sync . Results Twenty-four patients were enrolled, with no study interruptions due to safety concerns. NPS demonstrated significantly longer Time sync (0.64 ± 0.03 s vs. 0.37 ± 0.03 s, p  < 0.001) and shorter inspiratory delay (0.15 ± 0.01 s vs. 0.35 ± 0.01 s, p  < 0.001) compared to PSV. NPS also showed better NVT I (78 ± 2% vs. 45 ± 2%, p  < 0.001). Ventilator parameters were not significantly different between NPS and PSV, except for minor adjustments by the expert clinician. Conclusions NPS improves PVI during helmet NIV, as evidenced by longer Time sync and better coupling compared to PSV. Expert adjustments to ventilator settings had minimal impact on PVI. These findings support the use of NPS in enhancing patient-ventilator synchronization and warrant further investigation into its clinical outcomes and applicability across different patient populations and interfaces. Trial registration This study was registered on www.clinicaltrials.gov NCT06004206 Registry URL: https://clinicaltrials.gov/study/NCT06004206 on September 08, 2023.

Anesthesiologists play a pivotal role in mass-casualty incidents management. Disaster medicine is part of the anesthesiologist's core skills; however, dedicated training is still scarce and, often, it does not follow a standardized program. We designed and delivered a crash course in disaster medicine for Italian anesthesiology residents participating in the nationwide program, Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) Academy Critical Emergency Medicine 2019. Residents totaling 145, from 39 programs, participated in a 75-minute workstation on the principles of disaster management. Following this, each participant was involved in a full-scale mass-casualty drill. A plenary debriefing followed to present simulation data, maximize feedback, and highlight all situations needing improvement. Overall, participant performance was good: Triage accuracy was 85% prehospital and 84% in-hospital. Evacuation flow respected triage priority. During the debriefing, residents were very open to share and reflect on their experiences. A narrative qualitative analysis of the debriefing highlights that many participants felt overwhelmed by events during the exercise. Participants in coordination positions shared how they appreciated the need to switch from a clinical mindset to a managerial role. This was an invaluable experience for anesthesiology trainees, providing them with the skill set to understand the fundamental principles of a mass-casualty response.

In patients intubated for hypoxemic acute respiratory failure (ARF) related to novel coronavirus disease (COVID-19), we retrospectively compared two weaning strategies, early extubation with immediate non-invasive ventilation (NIV) versus standard weaning encompassing spontaneous breathing trial (SBT), with respect to IMV duration (primary endpoint), extubation failures and reintubations, rate of tracheostomy, intensive care unit (ICU) length of stay and mortality (additional endpoints). All COVID-19 adult patients, intubated for hypoxemic ARF and subsequently extubated, were enrolled. Patients were included in two groups, early extubation followed by immediate NIV application, and conventionally weaning after passing SBT. 121 patients were enrolled and analyzed, 66 early extubated and 55 conventionally weaned after passing an SBT. IMV duration was 9 [6–11] days in early extubated patients versus 11 [6–15] days in standard weaning group ( p  = 0.034). Extubation failures [12 (18.2%) vs. 25 (45.5%), p  = 0.002] and reintubations [12 (18.2%) vs. 22 (40.0%) p  = 0.009] were fewer in early extubation compared to the standard weaning groups, respectively. Rate of tracheostomy, ICU mortality, and ICU length of stay were no different between groups. Compared to standard weaning, early extubation followed by immediate NIV shortened IMV duration and reduced the rate of extubation failure and reintubation.

Background and Aims This study evaluated the impact of major elective surgery on performance status, defined as functional and cognitive status, in older adults 3 months postoperatively. Secondary endpoints included assessing the need for domiciliary care, rehospitalization, or institutionalization, and evaluating associations with anesthesia type. Methods In this observational prospective cohort study, 169 patients aged ≥ 70 underwent major elective surgery between May 2020 and June 2023; 150 had complete information at 3‐months (T3). Decline in performance status, either functional or cognitive, was defined as a ≥ 10‐point worsening in the Barthel Index (BI) or death, or a ≥ 3‐point decline in Mini‐Mental State Examination (MMSE), all measured 3 months after surgery. Results Mean (SD) age was 77 (5) years, with a mean (SD) Charlson Comorbidity Index (CCI) of 7 (2). Most surgeries (133, 79%) were performed for oncologic indications. Baseline median [IQR] BI was 100 [100‐100], and MMSE was 27 [25–28]. At T3, 44 (29%) patients showed a ≥ 10‐point BI decline (p < 0.001) and 7 died, while 14% exhibited a ≥ 3‐point MMSE decrease. Domiciliary care was required in 14 (9%) patients, while 26 (17%) were institutionalized. Fifty‐five (37%) patients reported health sequelae within 3 months post‐surgery. Multivariable regression analysis associated higher CCI and post‐discharge health issues with BI decline or death, but not with MMSE. Domiciliary care needs or rehospitalization was linked to elevated CCI and laparotomic approach. Conclusion Major elective surgery may compromise functional status in nearly one‐third of older patients, especially those with high comorbidity and post‐discharge sequelae. Cognitive decline was less prevalent, and the need for domiciliary or institutional care was relatively low. Trial Registration: URL: https://register.clinicaltrials.gov/prs/beta/studies/S000CLIN00000033/recordSummary; Clinicaltrials.gov identifier: NCT05594277.