The impact of SARS-COV2 pandemic on the management oF IPF patients: Our narrative experience.

BACKGROUND: The SARS-CoV-2 pandemic has changed the health-care systems around the world in a remarkable way. We describe the strategies adopted to cope with the limitations imposed by the pandemic to the access to health care by patients diagnosed with idiopathic Pulmonary Fibrosis (IPF). MATERIAL AND METHODS: We conducted a retrospective observational analysis including IPF patients under antifibrotic drugs (nintedanib and pirfenidone) that accessed to the Outpatient clinic of the University of Palermo, Italy. Patients received a phone number and an email address in case of any urgency and a virtual meeting was settled up monthly. RESULTS: 40 patients (M/F: 30/10) were followed up, 33 under nintedanib treatment, 7 under pirfenidone. Among patients under nintedanib, 1 patient reported high fever (T max 39 °C) and purulent sputum with no sign of infections, 1 had hemoptysis that was spontaneously resolved. 2 patients accessed to the emergency department for the worsening of dyspnea; 5 patients had diarrhea that resolved with symptomatic drugs in few days. 3 patients had an increase of alkaline phosphatase levels, leading to the withdrawal of the antifibrotic drug for 15 days, and subsequent normalization of the plasmatic levels. Among patients under pirfenidone, one subject had an increase of ferritin serum levels with no symptoms. The remaining subjects were in stable clinical conditions. None of the patients reported hospitalization or exacerbations, and did not experience antifibrotic withdrawal. CONCLUSIONS: We were able to demonstrate that by implementing alternative ways to monitor the disease, patients did not incur in increased rates of acute exacerbations or higher frequency of side effects and antifibrotic treatment withdrawal.

Strong geometry dependence of the Casimir force between interpenetrated rectangular gratings.

Quantum fluctuations give rise to Casimir forces between two parallel conducting plates, the magnitude of which increases monotonically as the separation decreases. By introducing nanoscale gratings to the surfaces, recent advances have opened opportunities for controlling the Casimir force in complex geometries. Here, we measure the Casimir force between two rectangular silicon gratings. Using an on-chip detection platform, we achieve accurate alignment between the two gratings so that they interpenetrate as the separation is reduced. Just before interpenetration occurs, the measured Casimir force is found to have a geometry dependence that is much stronger than previous experiments, with deviations from the proximity force approximation reaching a factor of ~500. After the gratings interpenetrate each other, the Casimir force becomes non-zero and independent of displacement. This work shows that the presence of gratings can strongly modify the Casimir force to control the interaction between nanomechanical components.

Management of suspected COVID-19 patients in a low prevalence region.

The spread of the SARS-CoV-2 infection among population has imposed a re-organization of healthcare services, aiming at stratifying patients and dedicating specific areas where patients with suspected COVID-related respiratory disease could receive the necessary health care assistance while waiting for the confirmation of the diagnosis of COVID-19 disease. In this scenario, the pathway defined as a "grey zone" is strongly advocated. We describe the application of rules and pathways in a regional context with low diffusion of the infection among the general population in the attempt to provide the best care to respiratory patients with suspected COVID-19. To date, this process has avoided the worst-case scenario of intra-hospital epidemic outbreak.

Saturation of radiative heat transfer due to many-body thermalization.

Radiative heat transfer between two bodies saturates at very short separation distances due to the nonlocal optical response of the materials. In this work, we show that the presence of radiative interactions with a third body or external bath can also induce a saturation of the heat transfer, even at separation distances for which the optical response of the materials is purely local. We demonstrate that this saturation mechanism is a direct consequence of a thermalization process resulting from many-body interactions in the system. This effect could have an important impact in the field of nanoscale thermal management of complex systems and in the interpretation of measured signals in thermal metrology at the nanoscale.

Scalable radiative thermal logic gates based on nanoparticle networks.

We discuss the design of the thermal analog of logic gates in systems made of a collection of nanoparticles. We demonstrate the possibility to perform NOT, OR, NOR, AND and NAND logical operations at submicrometric scale by controlling the near-field radiative heat exchanges between their components. We also address the important point of the role played by the inherent non-additivity of radiative heat transfer in the combination of logic gates. These results pave the way to the development of compact thermal circuits for information processing and thermal management.

Giant Casimir Torque between Rotated Gratings and the θ=0 Anomaly.

We study the Casimir torque between two metallic one-dimensional gratings rotated by an angle θ with respect to each other. We find that, for infinitely extended gratings, the Casimir energy is anomalously discontinuous at θ=0, due to a critical zero-order geometric transition between a 2D- and a 1D-periodic system. This transition is a peculiarity of the grating geometry and does not exist for intrinsically anisotropic materials. As a remarkable practical consequence, for finite-size gratings, the torque per area can reach extremely large values, increasing without bounds with the size of the system. We show that for finite gratings with only ten period repetitions, the maximum torque is already 60 times larger than the one predicted in the case of infinite gratings. These findings pave the way to the design of a contactless quantum vacuum torsional spring, with possible relevance to micro- and nanomechanical devices.

Fever and dyspnoea in a tracheostomised patient.

Pneumonia of unknown origin in tracheostomised patient https://bit.ly/3hZHBA0.

Interstitial Lung Disease in Elderly Rheumatoid Arthritis Patients.

The increase in life expectancy together with better care of rheumatoid arthritis (RA) has led to higher proportions of elderly individuals with RA. This has challenged the treatment of the disease in older aged patients, usually characterized by comorbid conditions and polypharmacy. Overall, the lung involvement in RA is present in up to 80% of patients, depending on the assessment tools used, and interstitial abnormalities are among the most common; when present, interstitial lung disease (ILD) worsens the prognosis of RA, and is the second most common cause of mortality. The aged lung undergoes functional and structural changes termed immunosenescence and inflammaging, which facilitate the occurrence of fibrosis of the lung. Therefore, ILD tends to occur more frequently in older patients with RA. The age at onset of RA distinguishes patients as having young-onset RA (YORA, < 60 years) or late-onset RA (LORA, > 60 years); the latter are characterized by more severe features of the disease and higher rates of lung involvement. The most frequent RA-related ILD radiological pattern is usual interstitial pneumonia (UIP); this includes peripheral and basal predominant reticulation and honeycombing with or without associated traction bronchiectasis. Patients with the UIP pattern are usually older and have more rapid decline in lung function and a worse prognosis. Treatment with corticosteroids in elderly patients carries the risk of adverse effects, such as osteoporosis, infections, diabetes, peptic ulcers, and cataract. The use of disease-modifying antirheumatic drugs (DMARDs) is generally well-tolerated by the elderly. The current narrative review aims at elucidating the association between ILD and RA in older individuals.

Antimicrobial efficacy of cordless sonic or ultrasonic devices on Enterococcus faecalis-infected root canals.

AIM: The aim of the present study was to evaluate the immediate and residual antimicrobial activity of cordless sonic or ultrasonic devices on Enterococcus faecalis (E faecalis)-infected teeth. METHODS: A total of 140 single-rooted extracted teeth with E faecalis were grouped as follows (N = 15): conventional syringe irrigation with 3% sodium hypochlorite activated by ultrasonic device (group 1) or cordless ultrasonic device (group 2), EndoActivator (group 3) or without activation (group 4), conventional syringe irrigation with sterile bi-distilled water and ultrasonic device (group 5), EndoUltra (group 6), EndoActivator (group 7), or without activation (group 8). The remaining 20 teeth were used for positive and negative controls. Colony-forming units (CFU) and turbidity were recorded from bacteriological samples taken before and after irrigation and after 24 hours of re-incubation. Data were statistically analyzed using Student's t test, Mann-Whitney test, Kruskal-Wallis test, and Dunn's multiple comparison tests (P < .05). RESULTS: Groups 1 and 2 showed higher antimicrobial efficacy than groups 3 and 4 (P < .05). No bacteria reduction was found in groups 5-8 (P > .05). After 24 hours, regrowth of bacteria was not significantly different for all groups (P > .05). CONCLUSIONS: Ultrasound produced lower CFU and turbidity after treatment and after re-incubation of 24 hours than sonic or no activation.

Radiative Heat Shuttling.

We demonstrate the existence of a shuttling effect for the radiative heat flux exchanged between two bodies separated by a vacuum gap when the chemical potential of photons or the temperature difference is modulated. We show that this modulation typically gives rise to a supplementary flux which superimposes to the flux produced by the mean gradient, enhancing the heat exchange. When the system displays a negative differential thermal resistance, however, the radiative shuttling contributes to insulate the two bodies from each other. These results pave the way for a novel strategy for an active management of radiative heat exchanges in nonequilibrium systems.

Inhalation therapy in the next decade: Determinants of adherence to treatment in asthma and COPD.

Proceedings of the European Seminars in Respiratory Medicine course, Inhalation therapy in the next decade: Determinants of adherence to treatment in asthma and COPD, held in Taormina, Italy, on 3-4 March, 2017.

Serum surfactant protein D and exhaled nitric oxide as biomarkers of early lung damage in systemic sclerosis.

BACKGROUND: Interstitial lung disease (ILD) complicates the course of systemic sclerosis (SSc), representing the main cause of death in these patients. The identification of parameters that can predict the early onset and progression of ILD in SSc represents an unmet need in clinical practice. The study was designed to explore whether the surfactant proteins (SP) A and D may be used as noninvasive tools for the early identification of ILD in SSc. Alveolar exhaled nitric oxide (NO) was investigated as a surrogate marker of distal inflammation. METHODS: Unselected consecutive subjects newly diagnosed with scleroderma and subjects free of respiratory and systemic diseases were recruited. All patients underwent clinical, lung functional, radiological and biological assessments. RESULTS: 15 individuals affected by SSc (M/F: 3/12), and 10 healthy subjects (M/F: 3/7) participated to the study. The serum SP-D values were 115.3±81.36 ng/mL in SSc subjects and 32±11.9 ng/mL in healthy controls (P=0.004). The concentrations of serum SP-A were not statistically different between groups. Serum SP-D inversely correlated with FEV1% predicted (rs=-0.29; P=0.004), FVC% predicted (rs=-0.20; P=0.02) and DLCO% predicted (rs=-0.36; P=0.001). Alveolar NO concentrations were significantly different between SSc and control subjects (6.5±2.9 ppb vs. 2.2±1.3 ppb, respectively; P=0.001), and positively associated with the levels of serum SP-D (r=0.60, P=0.03). CONCLUSIONS: These findings suggest that, in patients with scleroderma, SP-D and exhaled alveolar NO could represent novel non-invasive markers of early detection and activity of lung involvement.

Overcoming limits to near-field radiative heat transfer in uniform planar media through multilayer optimization.

Radiative heat transfer between uniform plates is bounded by the narrow range and limited contribution of surface waves. Using a combination of analytical calculations and numerical gradient-based optimization, we show that such a limitation can be overcome in complicated multilayer geometries, allowing the scattering and coupling rates of slab resonances to be altered over a broad range of evanescent wavevectors. We conclude that while the radiative flux between two inhomogeneous slabs can only be weakly enhanced, the flux between a dipolar particle and an inhomogeneous slab-proportional to the local density of states-can be orders of magnitude larger, albeit at the expense of increased frequency selectivity. A brief discussion of hyperbolic metamaterials shows that they provide far less enhancement than optimized inhomogeneous slabs.

How to unveil chronic respiratory diseases in clinical practice? A model of alliance between general practitioners and pulmonologists.

INTRODUCTION: Asthma and COPD are under-diagnosed and undertreated in adult populations, mainly due to the discrepancy between guideline recommendations and clinicians' practices. One of the reasons of this discrepancy is the difficulty encountered in real life in sharing the management of chronic respiratory diseases between general practitioners (GPs) and respiratory physicians. METHODS: An explorative, population-based investigation was performed to test whether, and to what extent, an active collaboration between GPs and pulmonologists increases the diagnosis and proper treatment of chronic obstructive airway diseases. The "COPD action" involved an in-house intervention by pulmonologists who trained GPs on how to diagnose the disease and interpret the spirometry, yielding a final agreed diagnosis. RESULTS: A total of 210 subjects (M/F: 156/54; age: 62.5 ± 13.8, mean ± SD) were consecutively invited by 20 GPs and classified in a) healthy, b) symptomatic with no airway obstruction, and 3) affected by chronic respiratory diseases. 11% of previously defined "healthy" subjects were diagnosed with COPD, and symptomatic subjects were diagnosed with asthma (20%) or COPD (23%). In addition, in those who already carried a diagnosis of chronic respiratory diseases as judged by GPs, the diagnosis of COPD decreased significantly after respiratory specialist intervention (p = 0.001), in favor of asthma and chronic bronchitis. Furthermore, following the clinical and lung function assessments performed by the respiratory physicians, changes in inhaled treatments were statistically significant for each therapeutic category (test-retest reliability: r = 0.42; p < 0.001). CONCLUSION: In conclusion, the collaboration between GPs and pulmonologists based on a pro-active approach to the individuals attending the primary care offices followed by an in-house intervention by specialists may largely improve the diagnosis and management of chronic respiratory diseases.

Quantum thermal machine acting on a many-body quantum system: Role of correlations in thermodynamic tasks.

We study the functioning of a three-level thermal machine when acting on a many-qubit system, the entire system being placed in an electromagnetic field in a stationary out-of-thermal-equilibrium configuration. This realistic setup stands between the two so-far-explored cases of single-qubit and macroscopic object targets, providing information on the scaling with system size of purely quantum properties in thermodynamic contexts. We show that, thanks to the presence of robust correlations among the qubits induced by the field, thermodynamic tasks can be delivered by the machine both locally to each qubit and collectively to the many-qubit system: This allows a task to be delivered also on systems much bigger than the machine size.

Heat superdiffusion in plasmonic nanostructure networks.

The heat transport mediated by near-field interactions in networks of plasmonic nanostructures is shown to be analogous to a generalized random walk process. The existence of superdiffusive regimes is demonstrated both in linear ordered chains and in three-dimensional random networks by analyzing the asymptotic behavior of the corresponding probability distribution function. We show that the spread of heat in these networks is described by a type of Lévy flight. The presence of such anomalous heat-transport regimes in plasmonic networks opens the way to the design of a new generation of composite materials able to transport heat faster than the normal diffusion process in solids.

Graphene-based photovoltaic cells for near-field thermal energy conversion.

Thermophotovoltaic devices are energy-conversion systems generating an electric current from the thermal photons radiated by a hot body. While their efficiency is limited in far field by the Schockley-Queisser limit, in near field the heat flux transferred to a photovoltaic cell can be largely enhanced because of the contribution of evanescent photons, in particular for a source supporting a surface mode. Unfortunately, in the infrared where these systems operate, the mismatch between the surface-mode frequency and the semiconductor gap reduces drastically the potential of this technology. In this paper we propose a modified thermophotovoltaic device in which the cell is covered by a graphene sheet. By discussing the transmission coefficient and the spectral properties of the flux, we show that both the cell efficiency and the produced current can be enhanced, paving the way to promising developments for the production of electricity from waste heat.

Three-body amplification of photon heat tunneling.

Resonant tunneling of surface polaritons across a subwavelength vacuum gap between two polar or metallic bodies at different temperatures leads to an almost monochromatic heat transfer which can exceed by several orders of magnitude the far-field upper limit predicted by Planck's blackbody theory. However, despite its strong magnitude, this transfer is very far from the maximum theoretical limit predicted in the near field. Here we propose an amplifier for the photon heat tunneling based on a passive relay system intercalated between the two bodies, which is able to partially compensate the intrinsic exponential damping of energy transmission probability thanks to three-body interaction mechanisms. As an immediate corollary, we show that the exalted transfer observed in the near field between two media can be exported at larger separation distances using such a relay. Photon heat tunneling assisted by three-body interactions enables novel applications for thermal management at nanoscale, near-field energy conversion and infrared spectroscopy.