Effectiveness and safety of a new helmet CPAP configuration allowing tidal volume monitoring in patients with COVID-19.

BACKGROUND: High generated tidal volumes (Vt) have been correlated with higher risk of self-induced lung injury and worse clinical outcome. This study aimed to evaluate the effectiveness and safety of a new helmet continuous positive airway pressure delivered (h-CPAP) configuration allowing Vt monitoring in patients affected by COVID-19. METHODS: This prospective observational study was performed in the respiratory intermediate care unit of University Hospital in Turin, Italy, between March 24th, and June 15th, 2020. Included patients were treated with CPAP via a single-limb intentional leak configuration by a turbine-driven ventilator, provided with a dedicated patch. Effectiveness and safety of the configuration and healthcare workers safety were the outcomes of the study. MAIN FINDINGS: Thirty-five patients were included in this study. Median age was 67 years (IQR 57-76 years), and 30 patients (85.7%) were men. Median value of overall leaks (intentional plus unintentional) was 68 L/min (IQR 63-75). Reliability of Vt measurements was 100%. An out of scale of Vt (above 50% compared to the previous values) was never recorded. Six patients (17.1%) needed more than two helmet replacements, due to leak test >10 l/min. Arm oedema and skin breakdowns were reported in sixteen (45.7%) and seven (20%) patients respectively. Among the 63 healthcare workers involved in the care of COVID-19 patients during the study only one was positive at RT-PCR nasopharyngeal swab testing. CONCLUSIONS: The use of h-CPAP for treating COVID-19 in this configuration allowed for reliable Vt monitoring. Further studies evaluating this configuration in larger patients' cohorts are needed.

A search for predictive factors for hypersensitivity reactions to paclitaxel and platinum salts in chemotherapy for gynecologic pelvic neoplasms.

AIMS: To investigate the frequency of and predictive factors for hypersensitivity reactions (HR) to taxanes and platinum salts in a cohort of patients treated for pelvic gynecologic malignancies. METHODS: The medical records of all patients with gynecologic pelvic neoplasms treated with chemotherapy at the Department of Gynecologic Oncology, AO Mauriziano Umberto I of Turin, from September 2007 through August 2008, were retrospectively reviewed. Two multivariate models, regarding carboplatin and taxane chemotherapy, respectively, were performed to evaluate the potential predictive value of various clinical features. RESULTS: The incidence of HR was 14% (22/157). Multivariate models showed that menopausal women had a significantly lower probability of HR (OR 0.12, CI 0.02-1.13, p = 0.06 for the carboplatin model and OR 0.05, CI 0.01-0.63, p = 0.02 for the taxane model) while a history of systemic hypersensitivity was associated with a higher but non-significant risk of HR (OR 2.64, CI 0.78-8.95, p = 0.11, for the carboplatin model and OR 3.42, CI 0.94-12.45, p = 0.06, for the taxane model). CONCLUSION: We confirmed a history of hypersensitivity as a risk factor for HR. Other larger cohorts should be analyzed: we need to find new predictive factors in order to select women who should be submitted to experimental prophylactic strategies.

Predicting tuberculosis treatment outcome in a low-incidence area.

SETTING: Based on the cohort of pulmonary tuberculosis (PTB) cases resident between 2001 and 2005 in the Piedmont region of Italy, this study estimated the effect of selected determinants on the success of standardised short-course chemotherapy (SSCC). OBJECTIVE: To identify predictors of unsuccessful treatment of PTB and to generate a nomogram to assist treating physicians and public health authorities with the identification of cases needing close follow-up. RESULTS: Overall, 1564 cases were identified. Among new cases, predictors of successful treatment outcome were sex (women vs. men, aOR 0.48, 95%CI 0.37-0.63), geographic origin (EU vs. non-EU countries, aOR 0.43, 95%CI 0.31-0.60) and treatment setting (out-patient vs. in-patient services and unknown setting, aOR 0.2, 95%CI 0.16-0.26). Predictors of unsuccessful outcome were long-term residency status (homeless vs. residential, aOR 9.91, 95%CI 4.38-22.38) and age (for each year, aOR 1.02, 95%CI 1.01-1.03). CONCLUSION: Using a limited number of predictors, the authors designed a nomogram predicting the individual probability of unfavourable SSCC. In principle, this approach is generalisable to other settings and the nomogram can be calibrated on local data to ensure appropriate case management and support targeted treatment follow-up.

[Cystic lymphangioma of the mediastinum. (presentation of 5 personal cases) (author's transl)]. / Il linfangioma cistico del mediastino. (presentazione di 5 casi personali).

168 mediastinal masses, 4 of which were cystic lymphangiomas, were operated in the Thoracic Surgery Department of 1st Surgical Special Pathology. After an analysis of the frequently and the pathogenetic theories of this rare disease, the Authors, with the aid of clinical cases, illustrate the clinical procedures and instrumental semeiotics which may sometimes lead to suspicion of this pathology, with particular regard to Computerised Axial Tomography (C.A.T.).

[Recent traumatic rupture of the diaphragm in patients with multiple injuries]. / Le rotture traumatiche recenti del diaframma nei politraumatizzati.

The authors report on 16 cases of recent traumatic diaphragmatic lesions in polytraumatized patients referred to them over the period 1979-86. After examining the diagnostic problems relating to this type of lesion, the authors describe the anatomico-topographical, clinical and therapeutic aspects. They conclude by stressing the need to explore the diaphragmatic cupulae systematically in the course of surgery for blunt abdominal trauma.

[Total amalgam reconstruction. Clinical evaluation after three years]. / Ricostruzioni totali in amalgama. Valutazione clinica a tre anni.

This study reports the results of the evaluation after three years of total amalgam restorations, made on molars and premolars vital and devitalized. The clinical parameters examinated were: 1) anatomic form and axial contour 2) marginal integrity 3) recurrent caries 4) occlusal contacts 5) interproximal contacts 6) pulpar or periodontal complication. To each of these parameters was given a degree of judgement expressed by Alpha, Bravo, Charlie, Delta. Alpha is the best evaluation, Bravo expresses a lower degree but clinically acceptable, Charlie and Delta are worse. Considering for each parameter the sum of the evaluations Alpha + Bravo, the clinically acceptable rate per cent of results has been quite good.

[Clinical use of GIC: indications and limits]. / Impiego clinico dei CVI: indicazioni e limiti.

Due to high cariostatic activity, glass ionomer are irreplaceable component in restorative armamentarium. Clinician needs to stock several types of material since characteristics (film thickness, radiopacity, viscosity, colors, ecc.) are adapted for specific uses.

Targeted DNA integration within different functional gene domains in yeast reveals ORF sequences as recombinational cold-spots.

The efficiency of gene targeting within different segments of genes in yeast was estimated by transforming yeast cells with double-stranded integrative plasmids, bearing functional gene domains [promoter (P), ORF (O) and terminator (T)] derived from the common genetic markers HIS3, LEU2, TRP1 and URA3. Transformation experiments with circular plasmids carrying a single gene domain demonstrated that the 5' and 3' flanking DNA regions (P and T) of the HIS3 and URA3 genes are preferred as sites for plasmid integration by several fold over the corresponding ORFs. Moreover, when plasmids bearing combinations of two or three regions were linearized to target them to a specific site of integration, three of the ORFs were found to be less preferred as sites for plasmid integration than their corresponding flanking regions. Surprisingly, in up to 50% of the transformants obtained with plasmids that had been linearized within coding sequences, the DNA actually integrated into neighbouring regions. Almost the same frequencies of ORF mis-targeting were obtained with plasmid vectors containing only two functional domains ("PO" or "OT") of the gene URA3, demonstrating that this event is not the consequence of competition between homologous DNA regions distal to the ORF. Therefore, we suggest that coding sequences could be considered to be "cold spots" for plasmid integration in yeast.