Minor head injury in anticoagulated patients: performance of biomarkers S100B, NSE, GFAP, UCH-L1 and Alinity TBI in the detection of intracranial injury. A prospective observational study.

OBJECTIVES: Data in literature indicate that in patients suffering a minor head injury (MHI), biomarkers serum levels could be effective to predict the absence of intracranial injury (ICI) on head CT scan. Use of these biomarkers in case of patients taking oral anticoagulants who experience MHI is very limited. We investigated biomarkers as predictors of ICI in anticoagulated patients managed in an ED. METHODS: We conducted a single-cohort, prospective, observational study in an ED. Our structured clinical pathway included a first head CT scan, 24 h observation and a second CT scan. The outcome was delayed ICI (dICI), defined as ICI on the second CT scan after a first negative CT scan. We assessed the sensitivity (SE), specificity (SP), negative predictive value (NNV) and positive predictive value (PPV) of the biomarkers S100B, NSE, GFAP, UCH-L1 and Alinity TBI in order to identify dICI. RESULTS: Our study population was of 234 patients with a negative first CT scan who underwent a second CT scan. The rate of dICI was 4.7 %. The NPV for the detection of dICI were respectively (IC 95 %): S100B 92.7 % (86.0-96.8 %,); ubiquitin C-terminal hydrolase-L1 (UCH-L1) 91.8 % (83.8-96.6 %); glial fibrillary protein (GFP) 100 % (83.2-100 %); TBI 100 % (66.4-100 %). The AUC for the detection of dICI was 0.407 for S100B, 0.563 for neuron-specific enolase (NSE), 0.510 for UCH-L1 and 0.720 for glial fibrillary acidic protein (GFAP), respectively. CONCLUSIONS: The NPV of the analyzed biomarkers were high and they potentially could limit the number of head CT scan for detecting dICI in anticoagulated patients suffering MHI. GFAP and Alinity TBI seem to be effective to rule out a dCI, but future trials are needed.

The prognostic value of lung ultrasound score (LUSS) in patients with COVID-19 admitted in Emergency Department: a prospective observational study.

BACKGROUND: The Lung Ultrasound (LUS) is routinely used as a point-of-care imaging tool in Emergency Department (ED) and its role in COVID-19 is being studied. The Lung UltraSound Score (LUSS) is a semi quantitative score of lung damage severity. Alongside instrumental diagnostic, the PaO2/FiO2 (P/F) ratio, obtained from arterial blood gas analysis, is the index used to assess the severity of the acute respiratory distress syndrome (ARDS), according to the Berlin definition. OBJECTIVES: The primary objective of the study was to evaluate a possible correlation between the LUSS score and the P/F Ratio, obtained from the arterial sampling in COVID-19 positive patients. MATERIALS AND METHODS: This was a cross-perspective monocentric observational study and it was carried out in the Emergency Department of the "AOU delle Marche" (Ancona, Italy), from 1 January 2023 to 28 February 2023. The study foresaw, once the patient was admitted to the ED, the execution of the LUS exam and the subsequent calculation of the LUSS score. RESULTS: The sample selected for the study was of 158 patients. The proportion of LUSS ≤4 was statistically higher in those with a P/F >300 (76.2%), compared to those with a P/F ≤300 (13.2%). On the other end, the proportion of LUSS >4 was lower in those who have P/F >300 (23.8%), while it was higher in those who have P/F ≤300 (86.8%). Those patients with a LUSS >4 were 1.76 (95% CI: 1.57 - 1.99) times more likely to have a P/F ≤300, compared to those with LUSS ≤4. The Odds Ratio of having a P/F ≤300 value in those achieving a LUSS >4, compared to those achieving a LUSS ≤4, was 21.0 (95% CI: 8.4 - 52.4). The study identified pO2, Hb and dichotomous LUSS as predictors of the level of P/F ≤300 or P/F >300. DISCUSSION: We found that the LUSS score defined by our study was closely related to the P/F ratio COVID-19 positive patients. Our study presented provides evidence on the potential rule of the LUSS for detecting the stage of lung impairment and the need for oxygen therapy in COVID-19 positive patients.

Deriving lessons learned from monitoring adaptation activities in projects under the EU mission on adaptation.

Actions to strengthen climate resilience are gaining more traction. In order to ensure effective adaptation, it is important to monitor the outcomes and impacts of these actions. However, there are numerous challenges and a multitude of approaches when it comes to monitoring adaptation to climate change. This paper addresses challenges in setting up mechanisms for monitoring climate resilience and adaptation projects. Drawing from three EU Horizon 2020 projects under the EU Mission on Adaptation to Climate Change, it synthesizes challenges and insights to support future initiatives in their monitoring endeavors for other projects to learn from. Findings, acquired through workshops with experts who shared learnings and challenges, highlight four key themes: the challenge of tailoring global frameworks to local needs, data availability and evaluation of data, interdisciplinary collaboration in monitoring, and stakeholder engagement for monitoring endeavors.

Vagal stimulation, through its nicotinic action, limits infarct size and the inflammatory response to myocardial ischemia and reperfusion.

Vagal activity has protective effects in ischemic heart disease. We tested whether vagal stimulation (VS) could modulate the inflammatory reaction, a major determinant of cardiac injury after ischemia/reperfusion. Four groups of male rats underwent myocardial ischemia (30 minutes) and reperfusion (24 hours). One group underwent VS (40 minutes), 1 VS plus atrial pacing (VS + Pacing), and 1 VS plus nicotinic inhibition by mecamylamine (VS + MEC). After 24 hours, the area at risk, infarct size, inflammation parameters, and apoptosis were quantified. Infarct size was reduced in all VS-treated rats (controls, 53 ± 18%; VS, 6.5 ± 3%; VS + Pacing, 23 ± 6%; VS + MEC, 33 ± 9%; P < 0.005 vs. controls). The infarct size in the VS + MEC group was larger than that in VS-treated animals, despite similar heart rate, suggesting partial loss of protection. The number of macrophages, neutrophils, and apoptotic cells in the area at risk and the plasma cytokines levels were significantly reduced in all VS-treated animals. In conclusion, VS decreases infarct size and inflammatory markers during ischemia/reperfusion independent of the heart rate. The anti-inflammatory and antiapoptotic properties of the nicotinic pathway are the primary underlying mechanism. The vagally mediated modulation of inflammatory responses may prove valuable in the clinical management of acute coronary syndromes and of heart failure.

Time trends of 1,1,1-trichloroethane, trichloroethylene, and perchloroethylene in confined and unconfined aquifers of a groundwater system in northern Italy.

The concentrations of 1,1,1-trichloroethane, trichloroethylene, and perchloroethylene were recorded in a groundwater system of Northern Italy over the period 1985-1997. In the unconfined recharging aquifer these chemicals showed a remarkable overall decline which was accompanied by a five-fold reduction in their consumption (from approx. 250 to approx. 50 tons year-1) over the same period. The time trends for the confined aquifers indicated a steady decline for 1,1,1-trichloroethane which was accompanied by a constant concentration of trichloroethylene and an increasing presence of perchloroethylene. It is suggested that the confined aquifers are recording a contamination which took place in the unconfined recharging aquifer before monitoring period (1982) started. At present, in most of the study area 1,1,1-trichloroethane contamination is below the detection limit (0.1 microgram/L). For trichloroethylene and perchloroethylene, the average unconfined aquifer contamination accounts for approx. 1 +/- 1 and approx. 4 +/- 3 micrograms/L, respectively, while in the confined aquifers the average concentrations are approx. 8 +/- 3 and approx. 35 +/- 5 micrograms/L, respectively.