Animal performance and meat quality characteristics from feedlot-finished steers fed increasing levels of wet distillers grain.

One hundred forty-four steers were group-housed in 24 pens that were randomly assigned to one of four dietary treatments defined by the proportion of wet distiller grain plus solubles (WDGS; 0, 15, 30, or 45%) and fed for 84 d pre-slaughter. Animal performance was evaluated using the pen as the experimental unit. Whereas for carcass and meat quality characteristics, meat oxidative stability, and the consumer sensory quality of longissimus thoracis muscle one animal from each pen was randomly selected and used as the experimental unit. No differences (P > 0.05) were observed for subcutaneous fat thickness, rib eye area, marbling score or pH, color parameters, proximate composition, sarcomere length, Warner Bratzler shear force, and cooking loss. Feeding WDGS linearly increased total PUFA (P = 0.05), C18:2 n-6 (P = 0.004) proportions, and n-6/n-3 ratio (P < 0.01) but reduced C16:1 to C18:0 ratio (P < 0.01). Lipid oxidation was greater in beef from steers fed 30% and 45% WDGS (P = 0.05). Dietary WDGS linearly improved (P < 0.05) flavor and overall linking score in the consumer sensory panel.

Life Cycle Assessment of a system for the extraction and transformation of Waste Water Treatment Sludge (WWTS)-derived lipids into biodiesel.

In recent years, the demand for biofuels has been growing exponentially, as has the interest in biodiesel produced from organic matrices. Particularly interesting, due to its economic and environmental advantages, is the use of the lipids present in sewage sludge as a raw material for the synthesis of biodiesel. The possible processes of this biodiesel synthesis, starting from lipid matter, are represented by the conventional process with sulfuric acid, by the process with aluminium chloride hexahydrate and by processes that use solid catalysts such as those consisting of mixed metal oxides, functionalized halloysites, mesoporous perovskite and functionalized silicas. In literature there are numerous Life Cycle Assessment (LCA) studies concerning biodiesel production systems, but not many studies consider processes that start from sewage sludge and that use solid catalysts. In addition, no LCA studies were reported on solid acid catalysts nor on those based on mixed metal oxides which present some precious advantages, over the homogeneous analogous ones, such as higher recyclability, prevention of foams and corrosion phenomena, and an easier separation and purification of biodiesel product. This research work reports the results of a comparative LCA study applied to a system that uses a solvent free pilot plant for the extraction and transformation of lipids from sewage sludge via seven different scenarios that differ in the type of catalyst used. The biodiesel synthesis scenario using aluminium chloride hexahydrate as catalyst has the best environmental profile. Biodiesel synthesis scenarios using solid catalysts are worse due to higher methanol consumption which requires higher electricity consumption. The worst scenario is the one using functionalized halloysites. Further future developments of the research require the passage from the pilot scale to the industrial scale in order to obtain environmental results to be used for a more reliable comparison with the literature data.

Low back pain among Italian runners: A cross-sectional survey.

BACKGROUND: Low Back Pain (LBP) is commonly reported as a very frequent disorder in sports, but its prevalence in runners remains unclear. OBJECTIVES: To determine the prevalence of LBP in a wide sample of Italian runners. DESIGN: A cross-sectional online survey. SETTING: A national survey, according to the CHERRIES and STROBE guidelines, was performed in 2019. PARTICIPANTS: 2539 Italian runners. METHODS: A sample of Italian runners registered with national running associations was recruited. The survey was conducted using an online survey development platform. The questionnaire was self-reported and included 38 questions. MAIN OUTCOME MEASURES: Descriptive statistics and frequencies were used to analyze results. Relationships between demographics, daily habits and running characteristics and the responses given was calculated with Cramer's V. Only correlation values higher >0.60 were deemed of interest. RESULTS: 2539 questionnaires (63.5%) were valid for analysis. In total, 22.6% of runners reported having experienced LBP in the past year. Most participants (77.0%) reporting episodes of LBP believed it was not caused by running. No significant correlations (Cramer's V < 0.60) were found between LBP and demographics, training characteristics or lifestyle habits. CONCLUSION: The prevalence of LBP among Italian runners was 22,57%. LBP was not associated with training, equipment or lifestyle.

Weight Regain and Diabetes Evolution After Sleeve Gastrectomy: a Cohort Study with over 5 Years of Follow-Up.

BACKGROUND: A number of meta-analyses have demonstrated the effectiveness of bariatric surgery in improving morbid obesity and its associated co-morbidities. The aim of the study was to evaluate at long term a cohort of obese patients with type 2 diabetes (T2DM) submitted to laparoscopic sleeve gastrectomy (LSG) analyzing the incidence of weight regain (WR) and the impact of the WR on T2DM evolution. METHODS: Seventy-eight morbid obese patients (54 females) with T2DM, aged 49.6 ± 8.7 years, weight 121.1 ± 24.4 kg, BMI 44.1 ± 7.2 kg/m2, underwent primary LSG. The trend over time of T2DM after LSG was analyzed in the different groups, subdivided on the basis of the absence or presence of WR and of its different degrees: no regain (NR), mild regain (MR), and severe regain (SR) groups. RESULTS: In the NR group, 54% show complete remission, 46% persistence, and no case of diabetes relapse; in the MR group, 59% show complete remission, 36% persistence, and 5% relapse; in the SR group, 61% show complete remission, 22% persistence, and 17% relapse. A statistically significant difference concerns the preoperative values of fasting glucose, glycosylated hemoglobin, and duration of diabetes, major in the group with diabetes relapse (respectively, p = 0.002, p = 0.001, and p < 0.0001). CONCLUSIONS: The results of this study showed no significant difference regarding the trend of diabetes remission comparing the "no regain," "mild regain," and "severe regain" groups and confirmed the importance of the duration of the illness and an early intervention towards surgical therapy.

Creatine supplementation exacerbates ethanol-induced hepatic damage in mice.

OBJECTIVE: The aim of this study was to investigate the effects of creatine supplementation on early stages of ethanol-induced hepatic damage. METHODS: Male Swiss mice were divided into three groups (n = 12/group): control (C), ethanol (E), and ethanol supplemented with creatine (EC). The control group received a diet containing 15.8% of total calories from proteins, 46.3% from carbohydrates, and 37.9% from lipids. The ethanol and ethanol and creatine groups received diets containing 15.8% of total calories from proteins, 16.2% from carbohydrates, and 34.5% from lipids; the remaining calories were obtained from the addition of 5% of 95% ethanol. Creatine (1%; weight/vol) was added to the diet of EC mice. After 14 and 28 d, six animals from each group were sacrificed, generating subdivisions in each group: C14 and C28, E14 and E28, EC14 and EC28. After sacrifice, the liver was removed, weighed, and prepared for histologic, biochemical, and molecular analysis, and blood was collected. RESULTS: Ethanol intake induced mild cell degeneration, liver damage, oxidative lesions, and inflammation. Surprisingly, ethanol intake combined with creatine exacerbated cell degeneration and fat accumulation, hepatic expression of genes related to ethanol metabolism, oxidative stress and inflammation, and promoted oxidative stress and elevated plasma alanine aminotransferase (P < 0.05). CONCLUSION: Creatine supplementation associated with ethanol is able to interfere in the alcohol metabolism and oxidative stress and to exacerbate ethanol-induced hepatic damage. These new findings are opposite to those observed in several studies where protective effects of creatine in a wide variety of injury models, including non-alcoholic fatty liver disease, were described.

Alterations in jaw clenching force control in people with myogenic temporomandibular disorders.

Isometric bite force control, via measures of force accuracy, force steadiness and force proprioception, was assessed in patients with myogenic temporomandibular disorders (TMDs) compared to healthy controls. Twelve people with myogenic TMDs and twelve age- and gender-matched asymptomatic controls performed maximal voluntary contractions (MVC) of unilateral jaw clenching followed by submaximal isometric contractions, with and without visual feedback of force, at 10, 30 50% and 70% MVC. Force performance was assessed with indices of accuracy (mean distance, MD) and precision (standard deviation, SD) and reported as a percentage of the MVC. A mixed-effect model was used to evaluate differences in MVC, MD and SD. The MVC was lower in the TMD group when clenching either ipsilateral or contralateral to the side of greatest pain (p < 0.05). No difference in MD was observed between groups. The SD depended on the interaction between group and painful side (p = 0.04) with the TMD group displaying higher SD when executing the task with the most painful side when compared to the ipsilateral or contralateral sides of the control group. The reduced maximal bite force and force steadiness observed in people with myogenic pain may interfere with masticatory function and should be considered when planning therapeutic interventions for TMDs.

Experimental assessment of proton dose calculation accuracy in inhomogeneous media.

PURPOSE: Proton therapy with Pencil Beam Scanning (PBS) has the potential to improve radiotherapy treatments. Unfortunately, its promises are jeopardized by the sensitivity of the dose distributions to uncertainties, including dose calculation accuracy in inhomogeneous media. Monte Carlo dose engines (MC) are expected to handle heterogeneities better than analytical algorithms like the pencil-beam convolution algorithm (PBA). In this study, an experimental phantom has been devised to maximize the effect of heterogeneities and to quantify the capability of several dose engines (MC and PBA) to handle these. METHODS: An inhomogeneous phantom made of water surrounding a long insert of bone tissue substitute (1×10×10 cm3) was irradiated with a mono-energetic PBS field (10×10 cm2). A 2D ion chamber array (MatriXX, IBA Dosimetry GmbH) lied right behind the bone. The beam energy was such that the expected range of the protons exceeded the detector position in water and did not attain it in bone. The measurement was compared to the following engines: Geant4.9.5, PENH, MCsquare, as well as the MC and PBA algorithms of RayStation (RaySearch Laboratories AB). RESULTS: For a γ-index criteria of 2%/2mm, the passing rates are 93.8% for Geant4.9.5, 97.4% for PENH, 93.4% for MCsquare, 95.9% for RayStation MC, and 44.7% for PBA. The differences in γ-index passing rates between MC and RayStation PBA calculations can exceed 50%. CONCLUSION: The performance of dose calculation algorithms in highly inhomogeneous media was evaluated in a dedicated experiment. MC dose engines performed overall satisfactorily while large deviations were observed with PBA as expected.

Evaluation of oral microbiota in undernourished and eutrophic children using checkerboard DNA-DNA hybridization.

The aim of this study was to evaluate the relationship among nutritional status, gingival health and the composition of oral microbiota in children of a public school from a very poor area of San Miguel de Tucuman. Forty-five children ranging in age from 6 to 14 years old, 13 males and 32 females were studied. Twenty of these children were undernourished (Lejarraga-Morasso Table) and twenty-five were eutrophic. A clinical study that included DMF and dmf indexes, Löe Silness Plaque Index and bleeding on probing was performed. For microbiological study, saliva samples without stimulation were taken; aliquots of them were immediately placed in TAE buffer pH 7.6, adding NaOH (N and keeping at -70 °C until processed by checkerboard DNA-DNA hybridization method to check the presence of 40 oral microorganism species. Positive bleeding on probing was present in more than 80% of children, without significant differences between eutrophic and undernourished groups. Same result were obtain for the other clinical indexes (p > 0.05, Two Way ANOVA). Significant differences were found for some oral microorganism species, with a higher percentage of undernourished children harboring them. That was the case of S. gordonii (p < 0.05), Capnocitophaga gingivalis and C. ochraceae (p < 0.01 and p < 0.10, respectively), F. nucleatum ss nucleatum (p < 0.05), P. nigrescens (p < 0.10), Campylobacter gracilis (p < 0,05), and T. denticola (p < 0.10, multiple logistic regression). Significant differences were also found between children groups for E. saborreum (p < 0.001), P. acnes (p < 0.10), G. morbillorum (p < 0.05) and L. buccalis (p < 0.10). Gingivitis and bleeding on probing would not be related to nutritional status in the groups of children studied. There were significant differences for the presence of some of the main periodontal pathogen species between eutrophic and undernourished children. It would be important to study the meaning of significant differences found for the other microorganisms more deeply.

An advanced image processing method to improve the spatial resolution of ion radiographies.

We present an optimization method to improve the spatial resolution and the water equivalent thickness (WET) accuracy of ion radiographies. The method is designed for imaging systems measuring for each actively scanned beam spot the lateral position of the pencil beam and at the same time the Bragg curve (behind the target) in discrete steps without relying on tracker detectors to determine the ion trajectory before and after the irradiated volume. Specifically, the method was used for an imaging set-up consisting of a stack of 61 parallel-plate ionization chambers (PPIC) interleaved with absorber plates of polymethyl methacrylate (PMMA) working as a range telescope. The method uses not only the Bragg peak position, but approximates the entire measured Bragg curve as a superposition of differently shifted Bragg curves. Their relative weights allow to reconstruct the distribution of thickness around each scan spot of a heterogeneous phantom. The approach also allows merging the ion radiography with the geometric information of a co-registered x-ray radiography in order to increase its spatial resolution. The method was tested using Monte Carlo simulated and experimental proton radiographies of a PMMA step phantom and an anthropomorphic head phantom. For the step phantom, the effective spatial resolution was found to be 6 and 4 times higher than the nominal resolution for the simulated and experimental radiographies, respectively. For the head phantom, a gamma index was calculated to quantify the conformity of the simulated proton radiographies with a digitally reconstructed radiography (DRR) obtained from an x-ray CT and properly converted into WET. For a distance-to-agreement (DTA) of 2.5 mm and a relative WET difference (RWET) of 2.5%, the passing ratio was 100%/85% for the optimized/non-optimized case, respectively. When the optimized proton radiography was merged with the co-registered DRR, the passing ratio was 100% at DTA = 1.3 mm and RWET = 1.3%. A special interpolation method allows to strongly reduce the dose by using a coarser grid of the measured beam spot position with a 5 times larger grid distance. We show that despite a dose reduction of 25 times (leading to a dose of 0.016 mGy for the current imaging set-up), the image quality of the optimized radiographies remains fairly unaffected for both the simulated and experimental case.

Technical Note: Experimental carbon ion range verification in inhomogeneous phantoms using prompt gammas.

PURPOSE: The purpose of this study was to experimentally assess the possibility to monitor carbon ion range variations--due to tumor shift and/or elongation or shrinking--using prompt-gamma (PG) emission with inhomogeneous phantoms. Such a study is related to the development of PG monitoring techniques to be used in a carbon ion therapy context. METHODS: A 95 MeV/u carbon ion beam was used to irradiate phantoms with a variable density along the ion path to mimic the presence of bone and lung in homogeneous humanlike tissue. PG profiles were obtained after a longitudinal scan of the phantoms. A setup comprising a narrow single-slit collimator and two detectors placed at 90° with respect to the beam axis was used. The time of flight technique was applied to allow the selection between PG and background events. RESULTS: Using the positions at 50% entrance and 50% falloff of the PG profiles, a quantity called prompt-gamma profile length (PGPL) is defined. It is possible to observe shifts in the PGPL when there are absolute ion range shifts as small as 1-2 mm. Quantitatively, for an ion range shift of -1.33 ± 0.46 mm (insertion of a Teflon slab), a PGPL difference of -1.93 ± 0.58 mm and -1.84 ± 1.27 mm is obtained using a BaF2 and a NaI(Tl) detector, respectively. In turn, when an ion range shift of 4.59 ± 0.42 mm (insertion of a lung-equivalent material slab) is considered, the difference is of 4.10 ± 0.54 and 4.39 ± 0.80 mm for the same detectors. CONCLUSIONS: Herein, experimental evidence of the usefulness of employing PG to monitor carbon ion range using inhomogeneous phantoms is presented. Considering the homogeneous phantom as reference, the results show that the information provided by the PG emission allows for detecting ion range shifts as small as 1-2 mm. When considering the expected PG emission from an energy slice in a carbon ion therapy scenario, the experimental setup would allow to retrieve the same PGPL as the high statistics of the full experimental dataset in 58% of the times. However, this success rate increases to 93% when using a better optimized setup by means of Monte Carlo simulations.

Patient-specific stopping power calibration for proton therapy planning based on single-detector proton radiography.

A simple robust optimizer has been developed that can produce patient-specific calibration curves to convert x-ray computed tomography (CT) numbers to relative stopping powers (HU-RSPs) for proton therapy treatment planning. The difference between a digitally reconstructed radiograph water-equivalent path length (DRRWEPL) map through the x-ray CT dataset and a proton radiograph (set as the ground truth) is minimized by optimizing the HU-RSP calibration curve. The function of the optimizer is validated with synthetic datasets that contain no noise and its robustness is shown against CT noise. Application of the procedure is then demonstrated on a plastic and a real tissue phantom, with proton radiographs produced using a single detector. The mean errors using generic/optimized calibration curves between the DRRWEPL map and the proton radiograph were 1.8/0.4% for a plastic phantom and -2.1/ - 0.2% for a real tissue phantom. It was then demonstrated that these optimized calibration curves offer a better prediction of the water equivalent path length at a therapeutic depth. We believe that these promising results are suggestive that a single proton radiograph could be used to generate a patient-specific calibration curve as part of the current proton treatment planning workflow.

Low back pain among Italian rowers: A cross-sectional survey.

BACKGROUND: Low Back Pain is commonly reported to be a very frequent disorder in rowing, but it is still unclear if its prevalence is higher than in other sports or even in a non-athletes group. OBJECTIVES: To determine prevalence of low back pain (LBP) with and without irradiated pain and possibly related risk factors in a group of elite Italian rowers. METHODS: The study was conducted during the 2010 Italian Indoor Rowing Championship held in Bari from 30th to 31st January. All the 415 rowers who qualified for the national championship were asked to complete a three-page questionnaire on LBP, assisted by a physiotherapist. RESULTS: One hundred and thirty-three athletes (32%) completed the assessment. LBP was very common, with a lifetime and 1 year prevalence of 64.7% and 40.6% respectively. During the last episode, the LBP intensity, measured by a numeric rating scale (NRS), presented a median value of 6/10, and 40% of rowers reported some limitation in daily living activities (ADL). Odds ratio (OR) to suffer from LBP was 2.62 in males compared to females; athletes who row both in sculling and sweep or only sweep showed an OR of 4.43 and 3.32 respectively. CONCLUSIONS: The prevalence of low back pain among rowers seems to be comparable to the one of the general population, even if the recovery appears to be faster. The risk of developing LBP is associated with the rowing typology and the gender, but a prospective study with an adequate sample size is necessary to clearly identify risk factors for LBP in rowers and to implement effective prevention strategies.

Absolute prompt-gamma yield measurements for ion beam therapy monitoring.

Prompt-gamma emission detection is a promising technique for hadrontherapy monitoring purposes. In this regard, obtaining prompt-gamma yields that can be used to develop monitoring systems based on this principle is of utmost importance since any camera design must cope with the available signal. Herein, a comprehensive study of the data from ten single-slit experiments is presented, five consisting in the irradiation of either PMMA or water targets with lower and higher energy carbon ions, and another five experiments using PMMA targets and proton beams. Analysis techniques such as background subtraction methods, geometrical normalization, and systematic uncertainty estimation were applied to the data in order to obtain absolute prompt-gamma yields in units of prompt-gamma counts per incident ion, unit of field of view, and unit of solid angle. At the entrance of a PMMA target, where the contribution of secondary nuclear reactions is negligible, prompt-gamma counts per incident ion, per millimetre and per steradian equal to (124 ± 0.7stat ± 30sys) × 10(-6) for 95 MeV u(-1) carbon ions, (79 ± 2stat ± 23sys) × 10(-6) for 310 MeV u(-1) carbon ions, and (16 ± 0.07stat ± 1sys) × 10(-6) for 160 MeV protons were found for prompt gammas with energies higher than 1 MeV. This shows a factor 5 between the yields of two different ions species with the same range in water (160 MeV protons and 310 MeV u(-1) carbon ions). The target composition was also found to influence the prompt-gamma yield since, for 300/310 MeV u(-1) carbon ions, a 42% greater yield ((112 ± 1stat ± 22sys) × 10(-6) counts ion(-1) mm(-1) sr(-1)) was obtained with a water target compared to a PMMA one.

The implantable cardioverter defibrillator in congestive heart failure patients in primary prevention: assessment of neuropsychological impact.

AIM: Cognitive impairment, anxiety and depression have been described in patients with congestive heart failure (CHF). The aim was to analyse the prevalence of cognitive impairment and anxiety-depression in an in-hospital CHF population before discharge attempting to correlate with the presence of an implantable cardioverter defibrillator (ICD). METHODS: All subjects underwent a mini mental state examination (MMSE), geriatric depression scale (GDS), hospital anxiety and depression scale test (HADS). RESULTS: Three-hundred and eighteen CHF patients (age 71.6 years, 195 males) were analysed. The mean New York Heart Association class (NYHA) was 2.9±0.8, left ventricular ejection fraction (LVEF) was 43.4±15.8%; brain natriuretic peptide (BNP) plasma level was 579.8±688.4 pg/mL. In 9.6% a pathological MMSE score emerged; a depression of mood in 18.2% and anxiety in 23.4% of patients were observed. An ICD was implanted in 43 (14.2%) CHF patients for primary prevention of cardiac sudden death. Patients in ICD group demonstrated a higher prevalence of renal impairment (creatinine 1.7±0.7 vs. 1.2±0.8 mg/dL; P=0.0001), lower LVEF (24.9±8.9 vs. 46.2±14.6% P=0.0001) and higher BNP (717.1±538 vs. 345.4±448.6 pg/ml; P=0.0001) but similar 6-minute walking test (338.6±81.3 vs. 345.3±114.9 m; P=0.8). An ICD intervention was registered in 9 (20.9%) patients. Although clinical parameters seemed to describe a sicker population in ICD implanted patients, from neuropsychological tests did not emerge any significant differences (P=NS for MMSE, GDS and HADS). CONCLUSION: ICD-implanted CHF patients for primary prevention did not reveal a worsening in anxiety and depression of mood demonstrating a similar cognitive performance in comparison with non-ICD implanted.

On the geometry of surface stress.

We present a fully general derivation of the Laplace-Young formula and discuss the interplay between the intrinsic surface geometry and the extrinsic one ensuing from the immersion of the surface in the ordinary Euclidean three-dimensional space. We prove that the (reversible) work done in a general surface deformation can be expressed in terms of the surface stress tensor and the variation of the intrinsic surface metric.

Experimental validation of the TOPAS Monte Carlo system for passive scattering proton therapy.

PURPOSE: TOPAS (TOol for PArticle Simulation) is a particle simulation code recently developed with the specific aim of making Monte Carlo simulations user-friendly for research and clinical physicists in the particle therapy community. The authors present a thorough and extensive experimental validation of Monte Carlo simulations performed with TOPAS in a variety of setups relevant for proton therapy applications. The set of validation measurements performed in this work represents an overall end-to-end testing strategy recommended for all clinical centers planning to rely on TOPAS for quality assurance or patient dose calculation and, more generally, for all the institutions using passive-scattering proton therapy systems. METHODS: The authors systematically compared TOPAS simulations with measurements that are performed routinely within the quality assurance (QA) program in our institution as well as experiments specifically designed for this validation study. First, the authors compared TOPAS simulations with measurements of depth-dose curves for spread-out Bragg peak (SOBP) fields. Second, absolute dosimetry simulations were benchmarked against measured machine output factors (OFs). Third, the authors simulated and measured 2D dose profiles and analyzed the differences in terms of field flatness and symmetry and usable field size. Fourth, the authors designed a simple experiment using a half-beam shifter to assess the effects of multiple Coulomb scattering, beam divergence, and inverse square attenuation on lateral and longitudinal dose profiles measured and simulated in a water phantom. Fifth, TOPAS' capabilities to simulate time dependent beam delivery was benchmarked against dose rate functions (i.e., dose per unit time vs time) measured at different depths inside an SOBP field. Sixth, simulations of the charge deposited by protons fully stopping in two different types of multilayer Faraday cups (MLFCs) were compared with measurements to benchmark the nuclear interaction models used in the simulations. RESULTS: SOBPs' range and modulation width were reproduced, on average, with an accuracy of +1, -2 and ±3 mm, respectively. OF simulations reproduced measured data within ±3%. Simulated 2D dose-profiles show field flatness and average field radius within ±3% of measured profiles. The field symmetry resulted, on average in ±3% agreement with commissioned profiles. TOPAS accuracy in reproducing measured dose profiles downstream the half beam shifter is better than 2%. Dose rate function simulation reproduced the measurements within ∼2% showing that the four-dimensional modeling of the passively modulation system was implement correctly and millimeter accuracy can be achieved in reproducing measured data. For MLFCs simulations, 2% agreement was found between TOPAS and both sets of experimental measurements. The overall results show that TOPAS simulations are within the clinical accepted tolerances for all QA measurements performed at our institution. CONCLUSIONS: Our Monte Carlo simulations reproduced accurately the experimental data acquired through all the measurements performed in this study. Thus, TOPAS can reliably be applied to quality assurance for proton therapy and also as an input for commissioning of commercial treatment planning systems. This work also provides the basis for routine clinical dose calculations in patients for all passive scattering proton therapy centers using TOPAS.

Low-flow venovenous CO2 removal in association with lung protective ventilation strategy in patients who develop severe progressive respiratory acidosis after lung transplantation.

BACKGROUND: Primary graft dysfunction (PGD) might occur after lung transplantation. In some severe cases, conventional therapies like ventilatory support, administration of inhaled nitric oxide (iNO), and intravenous prostacyclins are not sufficient to provide an adequate gas exchange. The aim of our study was to evaluate the use of a lung protective ventilation strategy associated with a low-flow venovenous CO2 removal treatment to reduce ventilator-associated injury in patients that develop severe PGD after lung transplantation. METHODS: From January 2009 to January 2011, 3 patients developed PGD within 24 hours after lung transplantation. In addition to conventional medical treatment, including hemodynamic support, iNO and prostaglandin E1 (PGE1), we initiated a ventilatory protective strategy associated with low-flow venovenous CO2 removal treatment (LFVVECCO2R). Hemodynamic and respiratory parameters were assessed at baseline as well as after 3, 12, 24, and 48 hours. RESULTS: No adverse events were registered. Despite decreased baseline elevated pulmonary positive pressures, application of a protective ventilation strategy with LFVVECCO2R reduced PaCO2 and pulmonary infiltrates as well as increased pH values and PaO2/FiO2 ratios. Every patient showed simultaneous improvement of clinical and hemodynamic conditions. They were weaned from mechanical ventilation and extubated after 24 hours after the use of the low-flow venovenous CO2 removal device. CONCLUSION: The use of LFVVECCO2R together with a protective lung ventilation strategy during the perioperative period of lung transplantation may be a valid clinical strategy for patients with PGD and severe respiratory acidosis occured despite adequate mechanical ventilation.

[PedsQL™ 4.0 Generic Core Infant Scales Parents Report for infants (ages 13-24 months). Linguistic validation from original US English version to Italian version]. / PedsQL™ 4.0 Generic Core Infant Scales Parents Report versione per i genitori di bambini in eta prescolare (eta 13-24 mesi): validazione linguistica della versione italiana.

AIM: The purpose of this research was to show the translation and linguistic validation of the PedsQL™ 4.0 Generic Core Infant Scales Parents Report for Infants (ages 13-24 months) from its original English version to Italian language. METHODS: The linguistic validation consists in three steps: a) different forward translations from the original US English instrument to Italian; this step includes the drawing of a "reconciliation" version (version 1); b) backward translations from the Italian reconciliation version to US English; c) patient testing: the second version of the questionnaire (obtained after the backward translations) has to be tested on a panel of a minimum of 5 respondents, throughout cognitive interviewing methodology, in order to obtain the final italian version of the PedsQL™ Parents Report for Infants (ages 13-24 months). In this report we summarize the third step of this process. To study the content validity, the applicability and comprehension of our questionnarie translation, we tested it through a qualitative methodology in a sample of parents whose children were hospitalized in Bambino Gesù Children's Hospital with two different kinds of interview: 4 parents responded to the questions posed through a "thinkaloud interview" and 3 parents responded to the questionnaire and to a "respondent debriefing" interview. RESULTS AND CONCLUSION: We modified the main question of each section and also one of the possible answer in order to maintain the Italian translation that appeared in others PedsQL™. We did not modify the questions of each section because respondents expressed that are clearly comprehensible and easy to understand.