Platypnoea-Orthodeoxia Syndrome in COVID-19.

Platypnoea-orthodeoxia syndrome (POS) is a rare disorder and its pathophysiology has puzzled clinicians for years. Few cases of POS are described in COVID-19 patients in the literature, with a high variability of conditions related to the syndrome. In this article, we report the case of a patient admitted to our hospital for SARS-CoV-2 interstitial pneumonia, who developed POS during the hospitalization. LEARNING POINTS: Platypnoea-orthodeoxia syndrome (POS) is a possible and rare condition associated with SARS-CoV-2 pneumonia.A prompt diagnosis of POS is important in order to start careful and adequate oxygen supplementation.Clinical data on COVID-19 evolution in patients with POS and possible therapeutic and rehabilitative strategies are not available in the literature.

Constraining LQG Graph with Light Surfaces: Properties of BH Thermodynamics for Mini-Super-Space, Semi-Classical Polymeric BH.

This work participates in the research for potential areas of observational evidence of quantum effects on geometry in a black hole astrophysical context. We consider properties of a family of loop quantum corrected regular black hole (BHs) solutions and their horizons, focusing on the geometry symmetries. We study here a recently developed model, where the geometry is determined by a metric quantum modification outside the horizon. This is a regular static spherical solution of mini-super-space BH metric with Loop Quantum Gravity (LQG) corrections. The solutions are characterized delineating certain polymeric functions on the basis of the properties of the horizons and the emergence of a singularity in the limiting case of the Schwarzschild geometry. We discuss particular metric solutions on the base of the parameters of the polymeric model related to similar properties of structures, the metric Killing bundles (or metric bundles MBs), related to the BH horizons' properties. A comparison with the Reissner-Norström geometry and the Kerr geometry with which analogies exist from the point of their respective MBs properties is done. The analysis provides a way to recognize these geometries and detect their main distinctive phenomenological evidence of LQG origin on the basis of the detection of stationary/static observers and the properties of light-like orbits within the analysis of the (conformal invariant) MBs related to the (local) causal structure. This approach could be applied in other quantum corrected BH solutions, constraining the characteristics of the underlining LQG-graph, as the minimal loop area, through the analysis of the null-like orbits and photons detection. The study of light surfaces associated with a diversified and wide range of BH phenomenology and grounding MBs definition provides a channel to search for possible astrophysical evidence. The main BHs thermodynamic characteristics are studied as luminosity, surface gravity, and temperature. Ultimately, the application of this method to this spherically symmetric approximate solution provides us with a way to clarify some formal aspects of MBs, in the presence of static, spherical symmetric spacetimes.

Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy.

A hyperinflammatory syndrome (HIS) may cause a life-threatening acute respiratory distress syndrome (ARDS) in patients with COVID-19 pneumonia. A prospective series of 100 consecutive patients admitted to the Spedali Civili University Hospital in Brescia (Italy) between March 9th and March 20th with confirmed COVID-19 pneumonia and ARDS requiring ventilatory support was analyzed to determine whether intravenous administration of tocilizumab (TCZ), a monoclonal antibody that targets the interleukin 6 (IL-6) receptor, was associated with improved outcome. Tocilizumab was administered at a dosage of 8 mg/kg by two consecutive intravenous infusions 12 h apart. A third infusion was optional based on clinical response. The outcome measure was an improvement in acute respiratory failure assessed by means of the Brescia COVID Respiratory Severity Score (BCRSS 0 to 8, with higher scores indicating higher severity) at 24-72 h and 10 days after tocilizumab administration. Out of 100 treated patients (88 M, 12 F; median age: 62 years), 43 received TCZ in the intensive care unit (ICU), while 57 in the general ward as no ICU beds were available. Of these 57 patients, 37 (65%) improved and suspended noninvasive ventilation (NIV) (median BCRSS: 1 [IQR 0-2]), 7 (12%) patients remained stable in NIV, and 13 (23%) patients worsened (10 died, 3 were admitted to ICU). Of the 43 patients treated in the ICU, 32 (74%) improved (17 of them were taken off the ventilator and were discharged to the ward), 1 (2%) remained stable (BCRSS: 5) and 10 (24%) died (all of them had BCRSS≥7 before TCZ). Overall at 10 days, the respiratory condition was improved or stabilized in 77 (77%) patients, of whom 61 showed a significant clearing of diffuse bilateral opacities on chest x-ray and 15 were discharged from the hospital. Respiratory condition worsened in 23 (23%) patients, of whom 20 (20%) died. All the patients presented with lymphopenia and high levels of C-reactive protein (CRP), fibrinogen, ferritin and IL-6 indicating a HIS. During the 10-day follow-up, three cases of severe adverse events were recorded: two patients developed septic shock and died, one had gastrointestinal perforation requiring urgent surgery and was alive at day 10. In conclusion, our series showed that COVID-19 pneumonia with ARDS was characterized by HIS. The response to TCZ was rapid, sustained, and associated with significant clinical improvement.

Behavior of thin disk crystalline morphology in the presence of corrections to ideal magnetohydrodynamics.

We analyze an axisymmetric magnetohydrodynamics configuration, describing the morphology of a purely differentially rotating thin plasma disk, in which linear and nonlinear perturbations are triggered associated with microscopic magnetic structures. We study the evolution of the nonstationary correction in the limit in which the corotation condition (i.e., the dependence of the disk angular velocity on the magnetic flux function) is preserved and the poloidal velocity components are neglected. The main feature we address here is the influence of ideal (finite electron inertia) and collisional (resistivity, viscosity, and thermal conductivity) effects on the behavior of the flux function perturbation and of the associated small-scale modifications in the disk. We analyze two different regimes in which resistivity or viscosity dominates and study the corresponding linear and nonlinear behaviors of the perturbation evolution, i.e., when the backreaction magnetic field is negligible or comparable to the background one, respectively. We demonstrate that when resistivity dominates, a radial oscillating morphology (crystalline structure) emerges and it turns out to be damped in time, in both the linear and nonlinear regimes, but in such a way that the resulting transient can be implemented in the description of relevant astrophysical processes, for instance, associated with jet formation or cataclysmic variables. When the viscosity effect dominates the dynamics, only the nonlinear regime is available and a very fast instability is triggered.

Self-collimated axial jet seeds from thin accretion disks.

We show how an appropriate stationary crystalline structure of the magnetic field can induce a partial fragmentation of the accretion disk, generating an axial jet seed composed of hot plasma twisted in a funnel-like structure due to the rotation of the system. The most important feature we outline is the high degree of collimation, naturally following from the basic assumptions underlying the crystalline structure. The presence of nonzero dissipative effects allows the plasma ejection throughout the axial jet seed and the predicted values of the accretion rate are in agreement with observations.

Counterexample of the magnetorotational instability in two-dimensional axial symmetry.

We analyze a linear perturbation scheme for a two-dimensional background plasma, which is rotating at a differential frequency and is embedded in a poloidal magnetic field. The main two assumptions of the present study, which in turn are related, are (i) that the plasma profile is axially symmetric, both in the background and in the perturbation approximation, where the azimuthal magnetic field is requested to vanish identically, and (ii) that the angular frequency depends on the magnetic surface function only, still holds in the nonstationary regime, which, in the steady background equilibrium, is ensured by the validity of the corotation theorem [V. C. A. Ferraro, Mon. Not. R. Astron. Soc. 97, 458 (1937)]. Indeed, such a restriction of the model is rather natural and it implies that the azimuthal component of the linear plasma shift is reabsorbed in the expression for the nonstationary electric field (in principle, at any order of approximation) and can no longer provide a nonzero azimuthal component of the magnetic tension field. As a result, the magnetorotational instability is suppressed and the magnetic field has the effect to stabilize the plasma configuration with respect to the pure hydrodynamical case.

Nonstationary magnetic microstructures in stellar thin accretion disks.

We examine the morphology of magnetic structures in thin plasma accretion disks, generalizing a stationary ideal magnetohydrodynamics model for the time-dependent viscoresistive case. Our analysis deals with small-scale perturbations to a central dipolelike magnetic field, which give rise-as in the ideal case-to the periodic modulation of magnetic flux surfaces along the radial direction, corresponding to the formation of a toroidal current channel's sequence. These microstructures suffer an exponential damping in time because of the nonzero resistivity coefficient, allowing us to define a configuration lifetime which mainly depends on the midplane temperature and on the length scale of the structure itself. By means of this lifetime, we show that the microstructures can exist within the inner regions of stellar disks in a defined range of temperatures, precisely for radii of R

Crystalline structure of accretion disks: features of a global model.

In this paper, we develop the analysis of a two-dimensional magnetohydrodynamical configuration for an axially symmetric and rotating plasma (embedded in a dipolelike magnetic field), modeling the structure of a thin accretion disk around a compact astrophysical object. Our study investigates the global profile of the disk plasma, in order to fix the conditions for the existence of a crystalline morphology and ring sequence, as outlined by the local analysis pursued in Coppi [Phys. Plasmas 12, 7302 (2005)] and Coppi and Rousseau [Astrophys. J. 641, 458 (2006)]. In the linear regime, when the electromagnetic back-reaction of the plasma is small enough, we show the existence of an oscillating radial behavior for the flux surface function, which very closely resembles the one outlined in the local model, apart from a radial modulation of the amplitude. In the opposite limit, corresponding to a dominant back-reaction in the magnetic structure over the field of central object, we can recognize the existence of a ringlike decomposition of the disk, according to the same modulation of the magnetic flux surface, and a smoother radial decay of the disk density, with respect to the linear case. In this extreme nonlinear regime, the global model seems to predict a configuration very close to that of the local analysis, but here the thermostatic pressure, crucial for the equilibrium setting, is also radially modulated. Among the conditions requested for the validity of such a global model, the confinement of the radial coordinate within a given value sensitive to the disk temperature and to the mass of the central objet, stands; however, this condition corresponds to dealing with a thin disk configuration.

Emergence of high peaks in the axial velocity for an ideal magnetohydrodynamic disk configuration.

We study the profile of a thin disk configuration as described by an axisymmetric ideal magnetohydrodynamics steady equilibrium. We consider the disk like a differentially rotating system dominated by the Keplerian term, but allowing for a nonzero radial and vertical matter flux. As a result, the steady state allows for the existence of local peaks for the vertical velocity of the plasma particles, though it prevents the radial matter accretion rate. This ideal magnetohydrodynamics scheme is therefore unable to solve the angular momentum-transport problem, but we suggest that it provides a mechanism for the generation of matter-jet seeds.

Towards loop quantum gravity without the time gauge.

The Hamiltonian formulation of the Holst action is reviewed and it provides a solution of second-class constraints corresponding to a generic local Lorentz frame. Within this scheme the form of rotation constraints can be reduced to a Gauss-like one by a proper generalization of Ashtekar-Barbero-Immirzi connections. This result emphasizes that the loop quantum gravity quantization procedure can be applied when the time-gauge condition does not stand.