Complications of unintentional dural puncture during labour epidural analgesia: a 10-year retrospective observational study.

INTRODUCTION: Unintentional dural puncture (UDP) occurs in 0.5-1.5% of labour epidural analgesia cases. To date, little is known about evidence of UDP-related complications. This work aimed to assess the incidence of intrapartum and postpartum complications in parturients who experienced UDP. METHODS: This is a 10-year retrospective observational study on parturients admitted to our centre who presented UDP. Data collection gathered UDP-related complications during labour and postpartum. All women who displayed UDP received medical therapy and bed rest. An epidural blood patch (EBP) was not used in this population. Once asymptomatic, patients were discharged from the hospital. RESULTS: Out of 7718 neuraxial analgesia cases, 97 cases of UDP occurred (1.25%). During labour, complications appeared in a small percentage of analgesia procedures performed, including total spinal anaesthesia (1.0%), extended motor block (3%), hypotension (4.1%), abnormal foetal heart rate (2%), inadequate analgesia (14.4%), and general anaesthesia following neuraxial anaesthesia failure (33.3% of emergency caesarean sections). During the postpartum period, 53.6% of parturients exhibited a postdural puncture headache, 13.4% showed neurological symptoms, and 14.4% required neurological consultation and neuroimaging. No patient developed subdural hematoma or cerebral venous sinus thrombosis; one woman presented posterior reversible encephalopathy syndrome associated with eclampsia. Overall, 82.5% of women experienced an extension of hospital stay. CONCLUSION: Major complications occurred in a small percentage of patients during labour. However, since they represent high-risk maternal and neonatal health events, a dedicated anaesthesiologist and a trained obstetric team are essential. No major neurological complications were registered postpartum, and EBP was not performed. Nevertheless, all patients with UDP were carefully monitored and treated until complete recovery before discharge, leading to an extension of their hospitalization.

SARS-CoV-2-related pneumonia can be successfully managed in patients with metastatic neuroendocrine tumors: a critical point of view.

Primary neuroendocrine tumors of the thymus are extremely rare. In patients with advanced disease, tumor growth control, and sometimes also syndrome control are the main goals of systemic therapy. Unfortunately, no standard therapies are available in clinical practice; therefore, clinical studies are strongly recommended. Axitinib (AXI) is a tyrosine kinase inhibitor, currently under investigation in an international phase II/III trial including thymic neuroendocrine tumors. Over the past 5 months, the entire world has been facing a devastating medical emergency brought about by a pandemic due to a novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which emerged in Wuhan, China, in late 2019. Since then, health professionals have been expending all their efforts on trying to provide the best available treatments for patients involved. Patients with cancer, especially those with thoracic involvement, are at higher risk of coronavirus disease 19 (COVID-19) and its complications because of their immunosuppressive status caused by the cancer and the anticancer therapies. As it remains unclear how to optimally manage such patients, we wished to report our experience with a patient with a metastatic neuroendocrine tumor of the thymus infected with SARS-CoV-2 in the hope that it may provide some insights and reflections on the management of cancer patients during this challenging time in our history.

[Territorial emergency: physician or nurse?]. / Emergenza territoriale: medico o infermiere?

This study was conceived to assess a pattern of Italian prehospital critical care team, especially referring to the advanced life support (ALS) rescue team. Function and management of ALS rescue team and its relationship with other members of the emergency medical system (intra hospital physician, basic life support team, general practitioner) are analysed; stress is laidon the knowledge, the background and the complexity of the emergency procedures. The benefit of 2 major prehospital options of the ALS team, composed by 1 physician and 1 nurse staffing or by 2 trained nurse staffing, is discussed; the importance of educational programs for ambulance teams, a comparison of cost-effectiveness and the number of emergency teams availability is underlined. The authors, finally emphasize the advantages of a territorial coverage with an integrated system of ambulances staffed with specially trained rescuers or technicians, ambulances with rescuers and nurses, and ALS teams staffed with emergency physician and 1 nurse (integrated or not with ambulances with 2 trained nurses), being perfectly capable to face up any background in pre-hospital emergency medicine setting.

Spectral properties of the Shroud of Turin.

Spectrophotometric results from the 1978 investigation of the Shroud of Turin are presented. The goals of the investigation were to characterize spectrally the body image in a region extending from the near UV to the near IR, to determine if the blood stains are actually blood, and to recommend storage parameters to prevent further degradation of the image. The bloodstained areas have the spectral characteristics of human hemoglobin. The image shows monotonically increasing (featureless) absorption with decreasing wavelength. The contrast is low: R(550 nm) = 0.85 of that for the background linen. Simulated aging by air baking reproduced the color of the background linen. Simultaneously, an invisible deposit of perspiration plus skin oils became visible and displayed a reflection spectrum closely resembling that of the body image. Lightly scorched areas on the Shroud are also somewhat similar spectrally, suggesting that a similar resultant chemistry is possible for dissimilar causes. A likely cause for the bo y image is cellulose degradation stimulated locally by natural or applied substances transferred to the Shroud.

Scattering defects in silver mirror coatings.

Scatter centers common to protected silver have been investigated on a variety of space flight quality mirrors. The defects have been characterized as to number density, size, location within the film layer structure, and dependence on illumination angle. In addition the total integrated scatter values as a function of wavelength, humidity test soak time, and temperature have been determined for some mirrors. These submicrometer sized defects are believed to be the precursors of silver corrosion spots. A mechanism for their generation is proposed, and measures to reduce their occurrence are suggested.

Beam splitter and reflection reducing coatings on ZnSe for 3-14 microm.

Achromatic coatings to provide wideband amplitude division and reflection reduction at 45 degrees incidence have been developed for the 3-14-microm region on CVD ZnSe. The application is directed toward interferometer spectrometers operating in environments that include spaceflight as well as laboratory. Results in good agreement with theoretical designs have been obtained.

Radiation induced transmission loss in optical materials.

Results are presented for a number of window materials, color filter glasses, birefringent crystals, and optical fibers. The transmission loss caused by exposure to Co(60) gamma or 10-MeV electron radiation is tabulated over the 400-900-nm wavelength region. The transmission loss is greatest at the shorter wavelengths, and its rate is maximum for most materials at dosages greater than 10(5) rad (Si).

Pioneer imaging photopolarimeter optical system.

The imaging photopolarimeter aboard the Pioneer 10 spacecraft en route to the vicinity of Jupiter is described. This instrument is capable of moderate resolution spin-scan imaging and high precision polarimetric and photometric mapping of Jupiter in red and blue light. The field of view can be selectively changed from 0.50 mrad square to 40 mrad square to accommodate resolution and radiance combinations ranging from the zodiacal background to that of Jupiter. The dynamic range (radiance) of the instrument is greater than 10(8). Optical materials were chosen to survive, with minimum degradation, the rigors of a nearly 2-year journey to Jupiter including transit through the Jovian trapped radiation belts. The optics are described in detail, and the operational system is outlined. The procedures for preflight and in-flight calibration are described, and some performance characteristics and preliminary flight results are presented.

Polarizing properties of pulverized materials with special reference to the lunar surface.

A review is presented of the application of polarimetry to the determination of the properties of the lunar surface layer by comparison with laboratory surfaces, from the time of Arago to the Apollo 11 sampling. The polarizing properties of pulverized volcanogenic products and chemicals, as they are determined by wavelength, particle size, phase angle, state of compaction, and composition, are studied. It is learned, through the study of the slope of the polarization/wavelength curve in the near uv, that the lunar surface must contain a large component of translucent rather than totally opaque particles. The lunar particles are basalt in composition, are less than 50 microm in size, and comprise a loosely arranged surface structure. Earth-based determinations are in good agreement with the Apollo 11 sampling results; thus these remote-sensing techniques are applicable to the studies of other planetary surfaces. Comparison between the surfaces of Mercury, some asteroids, and the moon is made.

An automatic polarimeter for space applications.

Under a NASA contract, a compact automatic polarimeter was developed as a pilot model for lunar and planetary missions by spacecraft. The polarimeter simultaneously analyzes linearly polarized light into four intensities from which the Stokes parameters I, Q, and U can be determined. The measurements are made automatically by an electronic observation sequencer and an automatic gain selector. Five wavelength bands between 1900 A and 6000A can be used, and each measurement is calibrated automatically. The successful operation during three high altitude balloon flights indicates that the design is sound, and that with modifications for rocket vibration it can be used in space missions. The feature of making simultaneous measurements makes it particularly useful on planetary scans with fly-by probes. Preliminary results on the wavelength dependence of the polarization of the whole lunar disk, obtained ground-based, between 2850 A and 5100 A are presented.

Solid organic filters for 2000 A to 3000 A.

Earlier work on the development of organic, narrow bandpass solution filters with transmittance maxima in the 2000-3000-A range is extended to the fabrication of solid filters using a polymethyl siloxane resin as the host material. Three transmission filters are described having maxima at 2250 A, 2265 A, and 2840 A, respectively, with bandwidths