87 research outputs found
LUNCH—Lung Ultrasound for early detection of silent and apparent aspiratioN in infants and young CHildren with cerebral palsy and other developmental disabilities: study protocol of a randomized controlled trial
No full textBACKGROUND: Children with neurological impairment may have dysphagia and/or gastro-esophageal reflux disease (GERD), which predispose to complications affecting the airways, increasing risk for aspiration-induced acute and chronic lung disease, or secondarily malnutrition, further neurodevelopmental disturbances, stressful interactions with their caregivers and chronic pain. Only multidisciplinary clinical feeding evaluation and empirical trials are applied to provide support to the management of feeding difficulties related to dysphagia or GERD, but no standardized feeding or behavioral measure exists at any age to assess aspiration risk and support the indication to perform a videofluoroscopic swallowing study (VFSS) or a fibre-optic endoscopic examination of swallowing (FEES), in particular in newborns and infants with neurological impairments. Lung ultrasound (LUS) has been proposed as a non-invasive, radiation-free tool for the diagnosis of pulmonary conditions in infants, with high sensitivity and specificity. METHODS: A RCT will be conducted in infants aged between 0 and 6 years having, or being at risk for, cerebral palsy, or other neurodevelopmental disease that determines abnormal muscular tone or motor developmental delay assessed by a quantitative scale for infants or if there is the suspicion of GERD or dysphagia based on clinical symptoms. Infants will be allocated in one of 2 groups: 1) LUS-monitored management (LUS-m); 2) Standard care management (SC-m) and after baseline assessment (T0), both groups will undergo an experimental 6-months follow-up. In the first 3 months, infants will be evaluated a minimum of 1 time per month, in-hospital, for a total of 3 LUS-monitored meal evaluations. Primary and secondary endpoint measures will be collected at 3 and 6 months. DISCUSSION: This paper describes the study protocol consisting of a RCT with two main objectives: (1) to evaluate the benefits of the use of LUS for monitoring silent and apparent aspiration in the management of dysphagia and its impact on pulmonary illness and growth and (2) to investigate the impact of the LUS management on blood sample and bone metabolism, pain and interaction with caregivers. TRIAL REGISTRATION: Trial registration date 02/05/2020; ClinicalTrials.gov Identifier: NCT04253951
Methylmethacrylate-based polymeric nanoparticles as platform for multimodal imaging
No full textCancer therapy using nanomaterials has progressed significantly over the years. Radiation therapy, chemotherapy, or combination of these is used to deal with the serious threats of malignancy. However, surgical resection is the most effective therapy since it reduces the probability of tumor recurrence. While some tumors can be resected easily, others may be in hard-to-reach locations. Radioguided surgery (RGS) is a technique that may enable the surgeon to evaluate in real time the completeness of the tumor lesion resection [1]. With high development in nanoscience, nanostructured polymers have attracted high interest especially in cancer diagnosis and therapy due to their unique properties, such as porous structure, and high surface than their bulk counterparts [2,3]. This work concerns the preparation and characterization of methylmethacrylate-based copolymeric nanoparticles via surfactant-free emulsion polymerization using radical initiator at 80°C. Acrylic acid and N,N-dimethylacrylamide were used as comonomer to obtain P(MMA-co-AA) and P(MMA-co-DMAA) polymeric NPs. The effects of monomers ratio and initiator were studied to optimize average particle hydrodynamic diameter and polydispersity index of the final particles. Then, the obtained polymeric nanoparticles were loaded with 89Y, as a model of β- radioisotope 90Y, by addition of an aqueous solution of YCl3. NPs as imaging probe were obtained by physical encapsulation of xanthene dye fluorescein isothiocyanate isomer I (FITC) into the inner core of the copolymeric NPs. The obtained NPs were used for in vitro biocompatibility evaluation in human glioblastoma cell line. The copolymers were characterized by FTIR, and the composition was determined by 1H-NMR and XPS spectroscopies. The morphology and particle size distribution were determined through dynamic light scattering (DLS), atomic force microscopy (AFM) and electron microscopies (SEM/TEM). As a proof of concept, bright fluorescence of FITC encapsulated NPs was studied via fluorescence microscopy.
[1] F. Collamati, D. Maccora, S. Alfieri, V. Bocci, A. Cartoni, A. Collarino, M. De Simoni, M. Fischetti, I. Fratoddi, A. Giordano, C. Mancini-Terracciano, R. Mirabelli, S. Morganti, G. Quero, D. Rotili, T. Scotognella, E. Solfaroli Camillocci, G. Traini, I. Venditti, R. Faccini, Sci. Rep. 2020, 10, 4015.
[2] I. Venditti, A. Cartoni, L. Fontana, G. Testa, F.A. Scaramuzzo, R. Faccini, C. Mancini-Terracciano, E. Solfaroli Camillocci, S. Morganti, A. Giordano, T. Scotognella, D. Rotili, V. Dini, F. Marini, I. Fratoddi, Colloids Surf. A 2017, 532, 125-131.
[3] P. Guang-Yu, J. Hao-Ran, Z. Ya-Xuan, S. Wei, C. Xiao-Tong, W. Fu-Gen, ACS Appl. Nano Mater. 2018, 1, 2885-2897
Variation of poorly ventilated lung units (silent spaces) measured by electrical impedance tomography to dynamically assess recruitment
No full textBackground: Assessing alveolar recruitment at different positive end-expiratory pressure (PEEP) levels is a major clinical and research interest because protective ventilation implies opening the lung without inducing overdistention. The pressure-volume (P-V) curve is a validated method of assessing recruitment but reflects global characteristics, and changes at the regional level may remain undetected. The aim of the present study was to compare, in intubated patients with acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS), lung recruitment measured by P-V curve analysis, with dynamic changes in poorly ventilated units of the dorsal lung (dependent silent spaces [DSSs]) assessed by electrical impedance tomography (EIT). We hypothesized that DSSs might represent a dynamic bedside measure of recruitment. Methods: We carried out a prospective interventional study of 14 patients with AHRF and ARDS admitted to the intensive care unit undergoing mechanical ventilation. Each patient underwent an incremental/decremental PEEP trial that included five consecutive phases: PEEP 5 and 10 cmH2O, recruitment maneuver+PEEP 15 cmH2O, then PEEP 10 and 5 cmH2O again. We measured, at the end of each phase, recruitment from previous PEEP using the P-V curve method, and changes in DSS were continuously monitored by EIT. Results: PEEP changes induced alveolar recruitment as assessed by the P-V curve method and changes in the amount of DSS (p<0.001). Recruited volume measured by the P-V curves significantly correlated with the change in DSS (rs=0.734, p<0.001). Regional compliance of the dependent lung increased significantly with rising PEEP (median PEEP 5 cmH2O=11.9 [IQR 10.4-16.7] ml/cmH2O, PEEP 15 cmH2O=19.1 [14.2-21.3] ml/cmH2O; p<0.001), whereas regional compliance of the nondependent lung decreased from PEEP 5 cmH2O to PEEP 15 cmH2O (PEEP 5 cmH2O=25.3 [21.3-30.4] ml/cmH2O, PEEP 15 cmH2O=20.0 [16.6-22.8] ml/cmH2O; p <0.001). By increasing the PEEP level, the center of ventilation moved toward the dependent lung, returning to the nondependent lung during the decremental PEEP steps. Conclusions: The variation of DSSs dynamically measured by EIT correlates well with lung recruitment measured using the P-V curve technique. EIT might provide useful information to titrate personalized PEEP
Technical realization of a sensorized neonatal intubation skill trainer for operators' retraining and a pilot study for its validation
No full textBackground In neonatal endotracheal intubation, excessive pressure on soft tissues during laryngoscopy can determine permanent injury. Low-fidelity skill trainers do not give valid feedback about this issue. This study describes the technical realization and validation of an active neonatal intubation skill trainer providing objective feedback. Methods We studied expert health professionals' performances in neonatal intubation, underlining chance for procedure retraining. We identified the most critical points in epiglottis and dental arches and fixed commercial force sensors on chosen points on a ©Laerdal Neonatal Intubation Trainer. Our skill trainer was set up as a grade 3 on Cormack and Lehane's scale, i.e. a model of difficult intubation. An associated software provided real time sound feedback if pressure during laryngoscopy exceeded an established threshold. Pressure data were recorded in a database, for subsequent analysis with non-parametric statistical tests. We organized our study in two intubation sessions (5 attempts each one) for everyone of our participants, held 24 h apart. Between the two sessions, a debriefing phase took place. In addition, we gave our participants two interview, one at the beginning and one at the end of the study, to get information about our subjects and to have feedback about our design. Results We obtained statistical significant differences between consecutive attempts, with evidence of learning trends. Pressure on critical points was significantly lower during the second session (p < 0.0001). Epiglottis' sensor was the most stressed (p < 0.000001). We found a significant correlation between time spent for each attempt and pressures applied to the airways in the two sessions, more significant in the second one (shorter attempts with less pressure, r s = 0.603). Conclusions Our skill trainer represents a reliable model of difficult intubation. Our results show its potential to optimize procedures related to the control of trauma risk and to improve personnel retraining
Micro-extraction by packed sorbent combined with UHPLC-ESI-MS/MS for the determination of prostanoids and isoprostanoids in dried blood spots
No full textThis work presents a reliable analytical procedure combining micro-extraction by packed sorbent (MEPS) and ultra-high performance liquid chromatography-electrospray ionization tandem mass spectrometry to determine 8-iso prostaglandin F2α, 8-iso prostaglandin E2 and prostaglandin E2 in dried blood spots (DBSs). To reach this goal, we optimized a fast semi-automated MEPS procedure for the clean-up and pre-concentration of the analytes extracted from a single DBS (50 μL) by a 70:30 v/v methanol:water mixture. Limits of detection of about 20 pg mL−1, satisfactory recoveries (90–110%) and very good intra- and inter-day precisions (RSD ≤10%) were obtained for all the analytes. The innovative addition of internal standards on the filter paper before DBS sampling allowed to compensate changes in the amount of analyte during storage. Since prostanoids and isoprostanoids are biomarkers involved in the pathogenesis and progression of many diseases (e.g. ductal patency, diabetic nephropathy, and acute lung injury), our analytical method offers interesting diagnostic and prognostic opportunities in the medical field. The present method is currently used for the analysis of such biomarkers in DBSs from preterm newborns collected in the clinical setting
Personalized Positive End-Expiratory Pressure in Acute Respiratory Distress Syndrome : Comparison between Optimal Distribution of Regional Ventilation and Positive Transpulmonary Pressure
No full textObjectives: Different techniques exist to select personalized positive end-expiratory pressure in patients affected by the acute respiratory distress syndrome. The positive end-expiratory transpulmonary pressure strategy aims to counteract dorsal lung collapse, whereas electrical impedance tomography could guide positive end-expiratory pressure selection based on optimal homogeneity of ventilation distribution. We compared the physiologic effects of positive end-expiratory pressure guided by electrical impedance tomography versus transpulmonary pressure in patients affected by acute respiratory distress syndrome. Design: Cross-over prospective physiologic study. Setting: Two academic ICUs. Patients: Twenty ICU patients affected by acute respiratory distress syndrome undergoing mechanical ventilation. Intervention: Patients monitored by an esophageal catheter and a 32-electrode electrical impedance tomography monitor underwent two positive end-expiratory pressure titration trials by randomized cross-over design to find the level of positive end-expiratory pressure associated with: 1) positive end-expiratory transpulmonary pressure (PEEPPL) and 2) proportion of poorly or nonventilated lung units (Silent Spaces) less than or equal to 15% (PEEPEIT). Each positive end-expiratory pressure level was maintained for 20 minutes, and afterward, lung mechanics, gas exchange, and electrical impedance tomography data were collected. Measurements and Main Results: PEEPEIT and PEEPPL differed in all patients, and there was no correlation between the levels identified by the two methods (Rs = 0.25; p = 0.29). PEEPEIT determined a more homogeneous distribution of ventilation with a lower percentage of dependent Silent Spaces (p = 0.02), whereas PEEPPL was characterized by lower airway-but not transpulmonary-driving pressure (p = 0.04). PEEPEIT was significantly higher than PEEPPL in subjects with extrapulmonary acute respiratory distress syndrome (p = 0.006), whereas the opposite was true for pulmonary acute respiratory distress syndrome (p = 0.03). Conclusions: Personalized positive end-expiratory pressure levels selected by electrical impedance tomography- A nd transpulmonary pressure-based methods are not correlated at the individual patient level. PEEPPL is associated with lower dynamic stress, whereas PEEPEIT may help to optimize lung recruitment and homogeneity of ventilation. The underlying etiology of acute respiratory distress syndrome could deeply influence results from each method
Epidemiologia ambientale e molecolare delle malformazioni congenite dei genitali esterni: valutazione anamnestica dell’esposizione a endocrine disruptors e ricerca di polimorfismi genici in un campione di pazienti con difetti minori
No full textCirculating Skeletal Troponin During Weaning From Mechanical Ventilation and Their Association to Diaphragmatic Function: A Pilot Study
No full textBackground: Patients with acute respiratory failure (ARF) may need mechanical ventilation (MV), which can lead to diaphragmatic dysfunction and muscle wasting, thus making difficult the weaning from the ventilator. Currently, there are no biomarkers specific for respiratory muscle and their function can only be assessed trough ultrasound or other invasive methods. Previously, the fast and slow isoform of the skeletal troponin I (fsTnI and ssTnI, respectively) have shown to be specific markers of muscle damage in healthy volunteers. We aimed therefore at describing the trend of skeletal troponin in mixed population of ICU patients undergoing weaning from mechanical ventilation and compared the value of fsTnI and ssTnI with diaphragmatic ultrasound derived parameters. Methods: In this prospective observational study we enrolled consecutive patients recovering from acute hypoxemic respiratory failure (AHRF) within 24 h from the start of weaning. Every day an arterial blood sample was collected to measure fsTnI, ssTnI, and global markers of muscle damage, such as ALT, AST, and CPK. Moreover, thickening fraction (TF) and diaphragmatic displacement (DE) were assessed by diaphragmatic ultrasound. The trend of fsTnI and ssTnI was evaluated during the first 3 days of weaning. Results: We enrolled 62 consecutive patients in the study, with a mean age of 67 ± 13 years and 43 of them (69%) were male. We did not find significant variations in the ssTnI trend (p = 0.623), but fsTnI significantly decreased over time by 30% from Day 1 to Day 2 and by 20% from Day 2 to Day 3 (p < 0.05). There was a significant interaction effect between baseline ssTnI and DE [F(2) = 4.396, p = 0.015], with high basal levels of ssTnI being associated to a higher decrease in DE. On the contrary, the high basal levels of fsTnI at day 1 were characterized by significant higher DE at each time point. Conclusions: Skeletal muscle proteins have a distinctive pattern of variation during weaning from mechanical ventilation. At day 1, a high basal value of ssTnI were associated to a higher decrease over time of diaphragmatic function while high values of fsTnI were associated to a higher displacement at each time point
Disorders of Sexual Development.
No full textA difficulty to recognize at birth a male from a female newborn due to the presence of “ambiguous genitalia” is a rare event, but abnormalities of the external genitalia that need further investigation may occur in about 1 in 4000 birth. Terms as intersex, hermaphroditism or pseudohermaphroditism have been considered unacceptable by affected individuals and support groups. Thus, a new nomenclature has been proposed. According to karyotype, DSD are divided in disorders with normal or abnormal sex chromosomes. DSD with karyotype abnormalities include diseases in which the number of sex chromosome is impaired. In 46, XX DSD three different groups of disorders may be described: a) disorders of ovarian development, b) disorders of androgen excess, including congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21-OHD), which is the commonest cause of ambiguous genitalia of the newborn and c) other conditions affecting sex development (some syndromic associations that can cause developmental genital abnormalities in 46,XX girls). 46,XY DSD are divided into: (1) disorders of gonadal development, (2) disorders of testosterone byosinthesis, metabolism or action, (3) other conditions. Initial management of DSD depends on establishing an early diagnosis, which is just as important as in other chronic medical conditions leading to life-long consequences. However, reaching a certain diagnosis may be difficult in many cases. To this purpose, discussion between a multidisciplinary medical team and the parents must be open, and parents’ participation in decision-making should be encouraged
An active one-lobe pulmonary simulator with compliance control for medical training in neonatal mechanical ventilation.
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