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Abstract Iodine and bromine play central roles in polar atmospheric chemistry: iodine influences the atmospheric oxidative capacity and can generate cloud condensation nuclei, while bromine participates in ozone depletion reactions, known as bromine explosions. Here we present a very sensitive analytical method for Br and I speciation by coupling the ion chromatography system (IC) with an inductively coupled plasma sector field mass spectrometer (ICP-SFMS). We achieved sub-picogram-per gram (pg g−1) as limits of detection (LODs) ranging from 0.4 pg g−1 for I−, 0.8 pg g−1 for IO3 −, 4 pg g−1 for Br−, and 1 pg g−1 for BrO3 −, respectively. These values represent a decrease of up to 30 times compared to the LODs reported in other studies. The method was validated using deep snow samples from the Svalbard Islands, collected at the end of the polar night to quantify various oxidized compounds during their seasonal minimum. In the future, this method could prove useful in the paleoclimatic study of ice cores and snow, as well as in ice chemistry research.

Background: Limited data exist on postoperative acute kidney injury (AKI) in patients who have undergone esophageal cancer surgery. The purpose of this study was to evaluate the incidence, risk factors, and consequences of postoperative acute kidney after esophagectomy. Methods: This was a retrospective cohort study. The study was conducted in a tertiary specialized cancer center in Italy. All patients undergoing elective esophageal cancer surgery between 2016 and 2021 were included in the study. AKI was defined according to Kidney Disease Improving Global Outcomes criteria (both serum creatinine and urine output), within 48 h after surgery. Preoperative and intraoperative data were registered. We also collected data concerning progression of AKI, need for renal replacement therapy, mortality, and medical (pulmonary, cardiovascular, septic) and surgical complications within 30 days from surgery, as well as length of hospital stay. Results: Incidence of postoperative AKI was 32%. The independent risk factors were body mass index and the use of an invasive surgical approach. Persistent AKI accounted for 15% of the cases and it was associated with increased risk of major cardiovascular events (odds ratio 4.14, 95% CI 1.05–15.8, p-value 0.036), pulmonary complications (OR 3.67, 95% CI 1.04–14.9, p-value 0.050), and increased length of hospital stay (AME 7.2, 0.5–13.9, p-value 0.035). Conclusions: Postoperative AKI is common after esophageal cancer surgery. BMI and a totally invasive surgical approach are independent risk factors. Persistent AKI lasting more than 48 h increased the risk for any cardiovascular or pulmonary complications, with prolonged length of hospital stay.

The study of aerosols in high mountain regions is essential because particulate matter can play a role in altering the energy balance of high mountain regions, and aerosols can accelerate glacier melting in high mountain areas by darkening the ice surface, reducing its reflectivity (albedo). Studying aerosols in high mountain areas provides insights into long-range transport of pollutants, atmospheric dynamics, and climate change impacts. These regions can serve as valuable observatories for studying atmospheric processes. The main aim of this paper is to define the main sources of aerosols over an entire year of sampling at the Col Margherita Atmospheric Observatory (MRG; 46°22′0.059′′ N, 11°47′30.911′′ E; 2543 m a.s.l.), a high-altitude background site in the eastern Italian Alps. Here, we discuss the potential origins of more than 100 chemical markers (major ions, water-soluble organic compounds, trace elements, and rare earth elements) using different approaches. Some diagnostic ratios were applied, but source apportionment using positive matrix factorization (PMF) was used to define the main inputs of PM10 collected at this high-altitude site, resulting in the identification of four factors: (1) Saharan dust events, (2) long-range marine/anthropogenic influence, (3) biogenic sources, and (4) biomass-burning and anthropogenic emissions. It can be inferred that, despite the distant location of the Col Margherita site, both regional pollution and long-range anthropogenic pollution have discernible effects on this area.

Alpine ice core research has long focused on a few suitable drilling sites at high elevation in the Western European Alps, assuming that the counterparts at lower elevation in the eastern sector are unsuitable for paleoenvironmental studies, due to the presence of melting and temperate basal conditions. However, it has been demonstrated that even in the Eastern Alpine range, below 4,000 m a.s.l., cold ice frozen to bedrock can exist. In fact, millennial-old ice has been found at some locations, such as at the Weißseespitze (WSS) summit ice cap (Ӧtztal Alps, 3,499 m a.s.l.), where about 6 kyrs appear locked into 10 m of ice. In this work, we present a full profile of the stable water isotopes (δ18O, δ2H), major ions (Na+, K+, Mg2+, Ca2+, NH4+, Cl−, NO3−, SO42−), levoglucosan, and microcharcoal for two parallel ice cores drilled at the Weißseespitze cap. We find that, despite the ongoing ice loss, the chemical and isotopic signatures appear preserved, and may potentially offer an untapped climatic record. This is especially noteworthy considering that chemical signals of other archives at similar locations have been partially or full corrupted by meltwater (i.e., Silvretta glacier, Grand Combin glacier, Ortles glacier). In addition, the impurity concentration near the surface shows no signs of anthropogenic contamination at WSS, which constrains the age at the surface to fall within the pre-industrial age.

The use of plant protection products (PPPs) has become fundamental to guarantee excellent field productivity. Nevertheless, their usage presents critical issues, such as the quantity of substances used, the relative toxicity, and the contamination of nearby fields caused by atmospheric drift. This study focuses on the characterization of aerosol droplets of PPPs produced by spraying a chemical marker, fluorescein, with an orchard airblast sprayer equipped with conventional hollow cone (HC) and anti-drift air inclusion (AI) nozzles, using a wind tunnel as a controlled environment. A particle/droplet image analysis was employed to study the droplet production of the nozzles, while a liquid chromatography tandem mass spectrometry (HPLC-MS/MS) analysis allowed us to evaluate samples collected using a cascade impactor located at 5 m, 10 m, and 20 m from the emission point. Overall, HC nozzles are very accurate at producing specific drop size distributions (DSDs), while AI nozzles produce a much wider DSD, concentrating the largest part of the distributed volume into droplets of a larger size. The marker concentration was much lower for the AI nozzles compared to the HC nozzles; moreover, the two nozzles show a similar trend in the coarse droplet range, while significantly differing in the fine droplet spectrum.

Background & Aims: Bacterial infections are frequent in patients with cirrhosis and increase the risk of death and drop-out from liver transplant (LT) waiting list. In patients with bacterial infections, LT is frequently delayed because of the fear of poor outcomes. We evaluated the impact of pre-LT infections on post-LT complications and survival. Methods: From 2012 to 2018, consecutive patients transplanted at the Hospital of Padua were identified and classified in two groups: patients surviving an episode of bacterial infection within 3 months before LT (study group) and patients without infections before LT (control group). Post-LT outcomes (complications, new infections, survival) were collected. Results: A total of 466 LT recipients were identified (study group n = 108; control group n = 358). After LT, the study group had a higher incidence of new bacterial (57% vs. 20%, p

This paper presents the results of simultaneous high time-resolution measurements of biogenic aerosol (methane sulfonic acid (MSA), non-sea salt sulfate nssSO42-) with its gaseous precursor dimethylsulfide (DMS), performed at the Italian coastal base Mario Zucchelli Station (MZS) in Terra Nova Bay (MZS) during two summer campaigns (2018–2019 and 2019–2020). Data on atmospheric DMS concentration are scarce, especially in Antarctica. The DMS maximum at MZS occurs in December, one month earlier than at other Antarctic stations. The maximum of DMS concentration is connected with the phytoplanktonic senescent phase following the bloom of Phaeocystis antarctica that occurs in the polynya when sea ice opens up. The second plankton bloom occurs in January and, despite the high dimethylsufoniopropionate (DMSP) concentration in seawater, atmospheric DMS remains low, probably due to its fast biological turnover in seawater in this period. The intensity and timing of the DMS evolution during the two years suggest that only the portion of the polynya close to the sampling site produces a discernible effect on the measured DMS. The closeness to the DMS source area and the occurrence of air masses containing DMS and freshly formed oxidation products allow us to study the kinetic of biogenic aerosol formation and the reliable derivation of the branch ratio between MSA and nssSO42- from DMS oxidation that is estimated to be 0.84±0.06. Conversely, for aged air masses with low DMS content, an enrichment of nssSO42- with respect to MSA, is observed. We estimate that the mean contribution of freshly formed biogenic aerosol to PM10 is 17 % with a maximum of 56 %. The high contribution of biogenic aerosol to the total PM10 mass in summer in this area highlights the dominant role of the polynya on biogenic aerosol formation. Finally, due to the regional and year-to-year variability of DMS and related biogenic aerosol formation, we stress the need for long-term measurements of seawater and atmospheric DMS and biogenic aerosol along the Antarctic coast and in the Southern Ocean.

Abstract Background The impact of sugammadex in patients with end-stage renal disease undergoing kidney transplantation is still far from being defined. The aim of the study is to compare sugammadex to neostigmine for reversal of rocuronium- and cisatracurium-induced neuromuscular block (NMB), respectively, in patients undergoing kidney transplantation. Methods A single-center, 2014-2017 retrospective cohort case-control study was performed. A total of 350 patients undergoing kidney transplantation, equally divided between a sugammadex group (175 patients) and a neostigmine group (175 patients), were considered. Postoperative kidney function, evaluated by monitoring of serum creatinine and urea and estimated glomerular filtration rate (eGFR), was the endpoint. Other endpoints were anesthetic and surgical times, post-anesthesia care unit length of stay, postoperative intensive care unit admission, and recurrent NMB or complications. Results No significant differences in patient or, with the exception of drugs involved in NMB management, anesthetic, and surgical characteristics, were observed between the two groups. Serum creatinine (median [interquartile range]: 596.0 [478.0-749.0] vs 639.0 [527.7-870.0] μmol/L, p = 0.0128) and serum urea (14.9 [10.8-21.6] vs 17.1 [13.1-22.0] mmol/L, p = 0.0486) were lower, while eGFR (8.0 [6.0-11.0] vs 8.0 [6.0-10.0], p = 0.0473) was higher in the sugammadex group than in the neostigmine group after surgery. The sugammadex group showed significantly lower incidence of postoperative severe hypoxemia (0.6% vs 6.3%, p = 0.006), shorter PACU stay (70 [60-90] min vs 90 [60-105] min, p < 0.001), and reduced ICU admissions (0.6% vs 8.0%, p = 0.001). Conclusions Compared to cisatracurium-neostigmine, the rocuronium-sugammadex strategy for reversal of NMB showed a better recovery profile in patients undergoing kidney transplantation.

Abstract Introduction Anesthetic care in patients undergoing thoracic surgery presents specific challenges that necessitate standardized, multidisciplionary, and continuously updated guidelines for perioperative care. Methods A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, comprising 24 members from 19 Italian centers, was established to develop recommendations for anesthesia practice in patients undergoing thoracic surgery (specifically lung resection for cancer). The project focused on preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and PubMed and Embase literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventative Services Task Force criteria. Results Recommendations for preoperative care focus on risk assessment, patient preparation (prehabilitation), and the choice of procedure (open thoracotomy vs. video-assisted thoracic surgery). Conclusions These recommendations should help pulmonologists to improve preoperative management in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.

Abstract Introduction Anesthetic care in patients undergoing thoracic surgery presents specific challenges that require a multidisciplinary approach to management. There remains a need for standardized, evidence-based, continuously updated guidelines for perioperative care in these patients. Methods A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, was established to develop recommendations for anesthesia practice in patients undergoing elective lung resection for lung cancer. The project addressed three key areas: preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventive Services Task Force criteria. Results Recommendations for intraoperative care focus on airway management, and monitoring of vital signs, hemodynamics, blood gases, neuromuscular blockade, and depth of anesthesia. Recommendations for postoperative care focus on the provision of multimodal analgesia, intensive care unit (ICU) care, and specific measures such as chest drainage, mobilization, noninvasive ventilation, and atrial fibrillation prophylaxis. Conclusions These recommendations should help clinicians to improve intraoperative and postoperative management, and thereby achieve better postoperative outcomes in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.

Abstract Purpose: Kidney transplantation is the gold-standard treatment for end stage renal disease. Although different hemodynamic variables, like central venous pressure and mean arterial pressure, have been used to guide volume replacement during surgery, the best strategy still ought to be determined. Respiratory arterial Pulse Pressure Variation (PPV) is recognized to be a good predictor of fluid responsiveness for perioperative hemodynamic optimization in operating room settings. The aim of this study was to investigate whether a PPV guided fluid management strategy is better than a liberal fluid strategy during kidney transplantation surgeries. Identification of differences in urine output in the first postoperative hour was the main objective of this study. Methods: We conducted a prospective, single blind, randomized controlled trial. We enrolled 40 patients who underwent kidney transplantation from deceased donors. Patients randomized in the “PPV” group received fluids whenever PPV was higher than 12%, patients in the “free fluid” group received fluids following our institutional standard care protocol for kidney transplantations (10 mL.kg-1. h-1). Results: Urinary output was similar at every time-point between the two groups, urea was statistically different from the third postoperative day with a peak at the fourth postoperative day and creatinine showed a similar trend, being statistically different from the second postoperative day. Urea, creatinine and urine output were not different at the hospital discharge. Conclusion: PPV guided fluid therapy during kidney transplantation significantly improves urea and creatinine levels in the first week after kidney transplantation surgery.

The development of liver metastases in colon rectal cancer has a strong impact on the overall survival (OS) of the patient, with a 5-year survival rate of 5% with palliative treatment. Surgical resection combined with pharmacological treatment can achieve a 5-year OS rate of 31–58%. However, in only 20% of patients with colon rectal liver metastases (CRLMs), liver resection is feasible. In highly selected patients, recent trials and studies proved that liver transplantation (LT) for non-resectable CRLM is a surgical option with an excellent long-term OS. The paper aims to review the indications and outcome of LT for CRLMs, with a special focus on immunosuppressive therapy and the management of local and extrahepatic recurrence after LT.

Delayed Cerebral Ischemia (DCI) is a major contributor to morbidity and mortality after SAH. Currently the prevention of vasospasm and DCI relies on nimodipine administration and on maintaining an adequate cerebral perfusion pressure. We report a patient with initial DCI after SAH in which stellate ganglion block (SGB) was performed after nimodipine administration. Firstly the procedure was characterized by a iv and intra-arterial nimodipine administration which did not result into a normal perfusion pattern. Therefore a single-shot stellate ganglion block was performed, as suggested in literature. Because of the not sufficient but promising perfusion improvement, we decided to deliver a continuous ganglion block (cSGB) for 5 days. Consequently a further improvement of the cerebral perfusion on CTPerfusion and Real Time Angiographic Perfusion Assessment was registered. In order to treat cerebral vasospasm, SGB is known to be a further valuable treatment, despite its temporary effect. However the continuous use of SGB during initial DCI has never been described before.

Abstract Background Clinical trials management can be studied using project management theory. The CYCLE pilot randomized controlled trial (RCT) was conducted to determine the feasibility of a future rehabilitation trial of early in-bed cycling in the intensive care unit (ICU). In-bed cycling is a novel intervention, not typically available in ICUs. Implementation of this intervention requires personnel with specialized clinical expertise caring for critically ill patients and use of the in-bed cycle. Our objective was to describe the implementation and conduct of our pilot RCT using a project management approach. Methods We retrospectively reviewed activities, timelines, and personnel involved in the trial. We organized activities into four project management phases: initiation, planning, execution, and monitoring and controlling. Data sources included Methods Centre documents used for trial coordination and conduct, and the trial data set. We report descriptive statistics as counts and proportions and also medians and quartiles, and we summarize the lessons learned. Results Seven ICUs in Canada participated in the trial. Time from research ethics board and contracts submission to first enrolment was a median (first quartile, third quartile) of 185 (146, 209) and 162 (114, 181) days, respectively. We trained 128 personnel on the CYCLE pilot RCT protocol, and 80 (63%) completed trial-related activities. Four sites required additional training after start-up due to staff turnover and leaves of absence. Over 15 months, we screened 864 patients: 256 were eligible and 66 were enrolled. Despite an 85% consent rate, 74% (190/256) of eligible patients were not randomized, largely (80% [152/190]) due to physiotherapist availability. Thirteen percent of recruitment weeks were lost due to physiotherapist staffing shortages. We highlight five key lessons learned: (1) prepare and anticipate site needs; (2) communicate regularly; (3) proactively analyse and act on process measure data; (4) develop contingency plans; (5) express appreciation to participating sites. Conclusions Our analysis highlights the scope of relevant activities, rigorous training and monitoring, number and types of required personnel, and time required to conduct a multicentre ICU rehabilitation intervention trial. Our lessons learned can help others interested in implementing complex intervention trials, such as rehabilitation. Trial registration ClinicalTrials.gov, NCT02377830. Registered prospectively on 4 March 2015.

A verb argument position can be described by the semantic type that characterizes the words filling that position. We investigate a number of linguistic issues underlying the tagging of an Italian corpus with the semantic types provided by the T-PAS (Typed Predicate-Argument Structure) resource. Our main interest is to evaluate whether our annotation methodology can be employed effectively for the extension of the annotation of the corpus associated with the resource. In order to achieve this goal we compare quantitative data about the tagging and qualitative data derived from the Inter-Annotator Agreement.

Introduction In patients with septic shock, low levels of circulating immunoglobulins are common and their kinetics appear to be related to clinical outcome. The pivotal role of immunoglobulins in the host immune response to infection suggests that additional therapy with polyclonal intravenous immunoglobulins may be a promising option in patients with septic shock. Immunoglobulin preparations enriched with the IgM component have largely been used in sepsis, mostly at standard dosages (250 mg/kg per day), regardless of clinical severity and without any dose adjustment based on immunoglobulin serum titres or other biomarkers. We hypothesised that a personalised dose of IgM enriched preparation based on patient IgM titres and aimed to achieve a specific threshold of IgM titre is more effective in decreasing mortality than a standard dose.Methods and analysis The study is designed as a multicentre, interventional, randomised, single-blinded, prospective, investigator sponsored, two-armed study. Patients with septic shock and IgM titres

The COVID-19 disease spread at different rates in the different countries and in different regions of the same country, as happened in Italy. Transmission by contact or at close range due to large respiratory droplets is widely accepted, however, the role of airborne transmission due to small respiratory droplets emitted by infected individuals (also asymptomatic) is controversial. It was suggested that outdoor airborne transmission could play a role in determining the differences observed in the spread rate. Concentrations of virus-laden aerosol are still poorly known and contrasting results are reported, especially for outdoor environments. Here we investigated outdoor concentrations and size distributions of virus-laden aerosol simultaneously collected during the pandemic, in May 2020, in northern (Veneto) and southern (Apulia) regions of Italy. The two regions exhibited significantly different prevalence of COVID-19. Genetic material of SARS-CoV-2 (RNA) was determined, using both real time RT-PCR and ddPCR, in air samples collected using PM10 samplers and cascade impactors able to separate 12 size ranges from nanoparticles (diameter D 18 µm). Air samples tested negative for the presence of SARS-CoV-2 at both sites, viral particles concentrations were

This study presents the year-round variability of the water-soluble fraction of trace elements (wsTE) and rare earth elements (wsREE) among size segregated airborne particulate matter samples collected at Ny-Ålesund in the Svalbard Archipelago from 26 February 2018 to 26 February 2019. Six different aerosol dimensional fractions were collected using a multi-stage Andersen impactor to better understand local and global circulation with the aim of disentangling the source of inorganic tracers from specific natural or anthropogenic sources. The wsTE and wsREE content, especially in the finest fractions in remote areas, is primarily related to long-range transport and it gives valuable information on (1) the global circulation, (2) the natural sources and (3) the contribution of human activities to aerosol composition. A Factor Analysis was applied to the dataset, including levoglucosan and methanesulfonic acid (MSA), to assess the possibility of using certain inorganic tracers as indicators of specific transport events or circulation regimes. We also investigate back-trajectories to determine potential source areas.

Questo contributo presenta alcune caratteristiche della risorsa T-PAS, una raccolta di strutture argomentali per verbi della lingua italiana, acquisite attraverso l'osservazione di un corpus. In particolare, descriviamo la risorsa e il processo di acquisizione delle strutture, evidenziamo le principali caratteristiche della risorsa che derivano dalla metodologia adottata per la sua creazione e infine presentiamo alcuni possibili sviluppi della risorsa.

Following publication of the original article [1], we have been notified that one of the authors’ names is spelled incorrectly. In this Correction the incorrect and correct author name are shown.

Plant protection products (PPPs) play a fundamental role in the maintenance of agricultural fields and private/public green areas, however they can contaminate zones nearby the application point due to wind drift, resuspension, and evaporation. Several studied have deepened the relationship between PPPs and living beings' health, suggesting that these products might have a negative influence. Some PPPs belong to the class of Emergent Contaminants, which are compounds whose knowledge on the environmental distribution and influence is limited. These issues are even more stressed in urban aerosol, due to the high residential density that characterizes this area. Therefore, this study assessed the contamination caused by polar PPPs, such as herbicides (i.e., Glyphosate), fungicides (i.e., Fosetyl Aluminium), and growth regulators (i.e. Maleic Hydrazide), in size-segregated urban aerosol and evaluated their concentration variability with respect to atmospheric parameters (humidity, temperature, rain). Moreover, hypotheses on possible sources were formulated, exploiting also back-trajectories of air masses. A total of six PPPs were found in the samples: glyphosate was more present in the coarse fraction (2.5–10 μm), Fosetyl Aluminium, chlorate and perchlorate were more present in the coarse/fine fractions (10-1 μm), while cyanuric acid and phosphonic acid were mostly concentrated in the fine/ultrafine fractions (<1 μm). While for the first four we suspect of local sources, such as private gardening, the two latter might derive from the entire Po Valley, a highly polluted area in the North of Italy, and from degradation of other substances. [Display omitted] • Size-segregated urban aerosol was sampled with a cascade impactor for two months. • Glyphosate, Fosetyl Aluminium, Chlorate and Perchlorate were in the 10-1 μm range. • Cyanuric acid and Phosphonic acid were most in the fine/ultrafine range (<1 μm). • Sources are hypotized to be local for Glyphosate and Fosetyl Aluminium. • A strong contributor is expected to be the Po Valley for the fine fractions. [ABSTRACT FROM AUTHOR]

Among extreme environments, bioaerosol includes a wide range of primary atmospheric organic particles associated with and emitted by living and dead organisms. Bioaerosol samples were collected along two transects at a subArctic Atlantic spatial scale, including the eastern Fram Strait and the Greenland, Norwegian, and North Seas. This study was aimed at first estimating microscopically the prokaryotic abundance, biomass and phenotypic traits, along with the number of potential viable and respiring cells. Moreover, physiological profiles at community level were assessed. Prokaryotic abundance ranged from 104 to 107 cells m−3, with the predominance of small sized cells (0.1 μm3). Prokaryotic biomass reached higher values (mean value 233 μg C m−3) in relation to the occurrence of large sized rods. Overall, the percentage of the viable cells was lower than the dead ones, while respiring cells were in lower abundance than total cells. The physiological profiles revealed various potential metabolic pathways among the samples, highlighting the utilization of phosphate-carbon, carboxylic and amino acids. These first results on the metabolism and physiology of microbes, which survived transport in the atmosphere of the Northern Hemisphere, suggest that bioaerosol constitutes an extremely dynamic environment of remarkable ecological interest, also considering future global warming scenarios. [ABSTRACT FROM AUTHOR]