VECTOR: An algorithm for the detection of COVID-19 pneumonia from velcro-like lung sounds.

The coronavirus disease 2019 (COVID-19) has severely stressed the sanitary systems of all countries in the world. One of the main issues that physicians are called to tackle is represented by the monitoring of pauci-symptomatic COVID-19 patients at home and, generally speaking, everyone the access to the hospital might or should be severely reduced. Indeed, the early detection of interstitial pneumonia is particularly relevant for the survival of these patients. Recent studies on rheumatoid arthritis and interstitial lung diseases have shown that pathological pulmonary sounds can be automatically detected by suitably developed algorithms. The scope of this preliminary work consists of proving that the pathological lung sounds evidenced in patients affected by COVID-19 pneumonia can be automatically detected as well by the same class of algorithms. In particular the software VECTOR, suitably devised for interstitial lung diseases, has been employed to process the lung sounds of 28 patient recorded in the emergency room at the university hospital of Modena (Italy) during December 2020. The performance of VECTOR has been compared with diagnostic techniques based on imaging, namely lung ultrasound, chest X-ray and high resolution computed tomography, which have been assumed as ground truth. The results have evidenced a surprising overall diagnostic accuracy of 75% even if the staff of the emergency room has not been suitably trained for lung auscultation and the parameters of the software have not been optimized to detect interstitial pneumonia. These results pave the way to a new approach for monitoring the pulmonary implication in pauci-symptomatic COVID-19 patients.

Lower limb deep vein thrombosis in COVID-19 patients admitted to intermediate care respiratory units.

COVID-19 has been associated with an increased risk of thrombotic events; however, the reported incidence of deep vein thrombosis varies depending, at least in part, on the severity of the disease. Aim of this prospective, multicenter, observational study was to investigate the incidence of lower limb deep vein thrombosis as assessed by compression ultrasound in consecutive patients admitted to three pulmonary medicine wards designated to care for patients with COVID-19 related pneumonia, with or without respiratory failure but not requiring admission to an intensive care unit. Consecutive patients admitted between March 27 and May 6, 2020 were enrolled. Patients were excluded if they were less than 18-year-old or if compression ultrasound could not be performed for any reason. Patients were assessed at admission (t0) and after 7 days (t1). Major and non-major clinically relevant bleedings were recorded. Sixty-eight patients were enrolled. Two were excluded due to anatomical abnormalities that prevented compression ultrasound; sixty patients were retested at (t1). All patients were started on antithrombotic prophylaxis, unless therapeutic anticoagulation was required. Deep vein thrombosis as assessed by compression ultrasound was observed in 2 patients (3%); one of them was later deemed to represent a previous episode. No new episodes were detected at t1. One major and 2 non-major clinically relevant bleedings were observed. In the setting of patients with COVID-related pneumonia not requiring admission to an intensive care unit, the incidence of deep vein thrombosis is low and our data support not screening asymptomatic patients.

NUtraceutical TReatment for hYpercholesterolemia in HIV-infected patients: The NU-TRY(HIV) randomized cross-over trial.

BACKGROUND AND AIMS: Despite hypercholesterolemia has been recognized to increase cardiovascular risk in human immunodeficiency virus (HIV)-infected patients, cholesterol-lowering therapy is underused in this population, due to fear of drug-drug interactions with antiretroviral therapy (ART). We investigated the effects of a nutraceutical combination (NC) on lipid profile, proprotein convertase subtilisin/kexin type 9 (PCSK9), subclinical inflammation and arterial stiffness in ART-treated HIV-infected patients. METHODS: This was a prospective randomized open-label trial with a cross-over design including 30 stable HIV-infected patients on ART with low-density lipoprotein cholesterol (LDL-C) >115 mg/dL, not taking lipid-lowering treatment. After a 3-week lipid stabilization period, the effects associated with 3 months of an oral NC containing red yeast rice and berberine vs. no active treatment (noNC) were assessed for plasma total cholesterol (TC), LDL-C, high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), lipoprotein(a), PCSK9, high-sensitivity C-reactive protein (hs-CRP) levels and aortic pulse wave velocity (aPWV). RESULTS: At baseline, significant correlations between PCSK9 levels, age (rho = -0.51, p=0.004), waist circumference (rho = 0.36, p=0.005) and CD4+ cell count (rho = -0.40, p=0.027) were observed. NC treatment effects corrected for noNC were significant for TC (-14%, p<0.001), LDL-C (-19%, p<0.001), PCSK9 (-12%, p=0.02), hs-CRP (-14%, p=0.03) and aPWV (-6%, p=0.005). No significant effects were observed for HDL-C, TG and lipoprotein(a). NC treatment was safe and no significant alterations in muscle, liver and immunovirological parameters were observed. No carry over effect was recorded. CONCLUSIONS: The tested NC significantly reduced plasma cholesterol and PCSK9 levels, attenuated subclinical inflammation and improved arterial stiffness in stable HIV-infected patients on ART.

Simulation of photoreactive transients and of photochemical transformation of organic pollutants in sunlit boreal lakes across 14 degrees of latitude: A photochemical mapping of Sweden.

Lake water constituents, such as chromophoric dissolved organic matter (CDOM) and nitrate, absorb sunlight which induces an array of photochemical reactions. Although these reactions are a substantial driver of pollutant degradation in lakes they are insufficiently understood, in particular on large scales. Here, we provide for the first time comprehensive photochemical maps covering a large geographic region. Using photochemical kinetics modeling for 1048 lakes across Sweden we simulated the steady-state concentrations of four photoreactive transient species, which are continuously produced and consumed in sunlit lake waters. We then simulated the transient-induced photochemical transformation of organic pollutants, to gain insight into the relevance of the different photoreaction pathways. We found that boreal lakes were often unfavorable environments for photoreactions mediated by hydroxyl radicals (OH) and carbonate radical anions (CO3-), while photoreactions mediated by CDOM triplet states (3CDOM*) and, to a lesser extent, singlet oxygen (1O2) were the most prevalent. These conditions promote the photodegradation of phenols, which are used as plastic, medical drug and herbicide precursors. When CDOM concentrations increase, as is currently commonly the case in boreal areas such as Sweden, 3CDOM* will also increase, promoting its importance in photochemical pathways even more.

Photochemical Formation of Nitrite and Nitrous Acid (HONO) upon Irradiation of Nitrophenols in Aqueous Solution and in Viscous Secondary Organic Aerosol Proxy.

Irradiated nitrophenols can produce nitrite and nitrous acid (HONO) in bulk aqueous solutions and in viscous aqueous films, simulating the conditions of a high-solute-strength aqueous aerosol, with comparable quantum yields in solution and viscous films (10-5-10-4 in the case of 4-nitrophenol) and overall reaction yields up to 0.3 in solution. The process is particularly important for the para-nitrophenols, possibly because their less sterically hindered nitro groups can be released more easily as nitrite and HONO. The nitrophenols giving the highest photoproduction rates of nitrite and HONO (most notably, 4-nitrophenol and 2-methyl-4-nitrophenol) could significantly contribute to the occurrence of nitrite in aqueous phases in contact with the atmosphere. Interestingly, dew-water evaporation has shown potential to contribute to the gas-phase HONO levels during the morning, which accounts for the possible importance of the studied process.

Phototransformation of the Herbicide Propanil in Paddy Field Water.

When irradiated in paddy-field water, propanil (PRP) undergoes photodegradation by direct photolysis, by reactions with •OH and CO3•-, and possibly also with the triplet states of chromophoric dissolved organic matter. Irradiation also inhibits the nonphotochemical (probably biological) degradation of PRP. The dark- and light-induced pathways can be easily distinguished because 3,4-dichloroaniline (34DCA, a transformation intermediate of considerable environmental concern) is produced with almost 100% yield in the dark but not at all through photochemical pathways. This issue allows an easy assessment of the dark process(es) under irradiation. In the natural environment, we expect PRP photodegradation to be important only in the presence of elevated nitrate and/or nitrite levels, e.g., [NO3-] approaching 1 mmol L-1 (corresponding to approximately 60 mg L-1). Under these circumstances, •OH and CO3•- would play a major role in PRP phototransformation. Because flooded paddy fields are efficient denitrification bioreactors that can achieve decontamination of nitrate-rich water used for irrigation, irrigation with such water would both enhance PRP photodegradation and divert PRP dissipation processes away from the production of 34DCA, at least in the daylight hours.

The nature of the light absorption and emission transitions of 4-hydroxybenzophenone in different solvents. A combined computational and experimental study.

The photophysics and photochemistry of 4-hydroxybenzophenone (4HOBP) are interesting because they can give some insight into the behavior of humic material. Here we show that 4HOBP has a number of fluorescence peaks: (i) an intense one at excitation/emission wavelengths Ex/Em ∼ 200-230/280-370 nm, likely due to an excitation transition from S0 to S5 or S6, followed by S2 → S0 in emission (Sn denotes the singlet states of 4HOBP); (ii) a minor peak at Ex/Em ∼ 270-300/320-360 nm (S0 → S2 in absorption and S2 → S0 in emission), and (iii) very interesting signals in the typical emission region of humic substances, most notably at Ex/Em ∼ 200-220/400-500 nm and Ex/Em ∼ 260-280/400-470 nm (in both cases the emission corresponded to an S1 → S0 transition). The peak (i) (Ex/Em ∼ 200-230/280-370 nm) is quite intense at low 4HOBP concentration values, but it undergoes an effective inner-filter phenomenon. Remarkably, 4HOBP shows fluorescence peaks that arise from S2 → S0 transitions and that do not follow Kasha's rule. Fluorescence is observed in aprotic or poorly protic solvents, and to a lesser extent in aqueous solution. The excited states of 4HOBP, and most notably 4HOBP-S1, are much stronger acids than 4HOBP-S0. Therefore, excited 4HOBP is quickly deprotonated to 4OBP--S0 in ∼neutral solution, with a considerable loss of the fluorescence properties. Higher fluorescence intensity can be observed under acidic conditions, where excited-state deprotonation is less effective, and in basic solution where the dissociated 4OBP--S0 form prevails as the ground state. The excited states of 4OBP- are formed directly upon radiation absorption, and being weak bases they do not undergo important acid-base equilibria. Therefore, they can undergo radiational deactivation to produce significant fluorescence emission.

Photochemical processes induced by the irradiation of 4-hydroxybenzophenone in different solvents.

The singlet and triplet excited states of 4-hydroxybenzophenone (4BPOH) undergo deprotonation in the presence of water to produce the anionic ground-state, causing fluorescence quenching and photoactivity inhibition. The same process does not take place in an aprotic solvent such as acetonitrile. In acetonitrile, 4BPOH is fluorescent (interestingly, one of its fluorescence peaks overlaps with peak C of humic substances), it yields singlet oxygen upon irradiation and induces the triplet-sensitised transformation of phenol (with a rate constant of (6.6 ± 0.3) × 10(7) M(-1) s(-1) (µ ± σ) between phenol itself and a triplet 4BPOH). The 4BPOH shows an intermediate behaviour in a partially protic solvent such as 2-propanol, where some deprotonation of the excited states is observed. In acetonitrile/2-propanol mixtures (at least up to 50% of 2-propanol) there is also some evidence of alcohol oxidation by the 4BPOH triplet state, while the experimental data are silent concerning such a possibility in pure 2-propanol. Considering that benzophenones are important components of chromophoric dissolved organic matter (CDOM) in surface waters, the present findings could have significance for the photoactivity of the hydrophilic surface layers vs. the hydrophobic cores of CDOM.