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Hybrid engines are becoming more and more widespread. Electric energy instead is a valid help to reduce the environmental impact. In hybrid engines, the number of components is higher and this results in a decrease in reliability. With Engine Health Monitoring (EHM) we mean the set of techniques used to monitor the health status of a system based on the values assumed by some related parameters. Artificial Intelligence (AI) methods are widely used nowadays in this discipline. In this paper, an EHM approach was developed to monitor the health status of some components constituting an hybrid turboshaft. The dynamic model of the hybrid electric power system is described in an accompanying paper. Feed-Forward Neural Network (FFNN) is used as AI tool to built the just cited system. The engine modelled with Simulink, was used to perform a series of steady-state simulations implementing a degradation condition in some selected components. The degradation condition was simulated by changing the value of the Performance Parameters (PPs) related to each of the selected components. The results of the simulation were used to obtain a dataset useful to train the FFNN to predict the values of the same PPs in a degraded case.

The present study proposes a model for the simulation of the steady-state and transient behaviors of a Hybrid Electric Propulsive System (HEPS), in presence of several forms and degrees of performance degradation. The power system, which is made of a turboshaft engine coupled with an electric power source is intended for urban air mobility applications. The proposed model encompasses the capability of modeling battery aging effects, and, consequently, updating the performance of the system with battery life. Moreover, the versatility of the proposed model makes it suitable for the analysis of the dynamic behavior of the system, for example in presence of small perturbations around predefined operational settings or following a known mission profile. In this investigation the model is applied to the test of the HEPS under different operating conditions with different degradation criteria, affecting both the thermal and the electric drive with different levels of severity. The application of the model allowed the generation of relevant information concerning the propulsive system state of health which will be processed with the employment of machine learning algorithms in an accompanying paper.

The paper presents the results of the analysis of the geo-chemo-mechanical data gathered through an innovative multidisciplinary investigation campaign in the Mar Piccolo basin, a heavily polluted marine bay aside the town of Taranto (Southern Italy). The basin is part of an area declared at high environmental risk by the Italian government. The cutting-edge approach to the environmental characterization of the site was promoted by the Special Commissioner for urgent measures of reclamation, environmental improvements and redevelopment of Taranto and involved experts from several research fields, who cooperated to gather a new insight into the origin, distribution, mobility and fate of the contaminants within the basin. The investigation campaign was designed to implement advanced research methodologies and testing strategies. Differently from traditional investigation campaigns, aimed solely at the assessment of the contamination state within sediments lying in the top layers, the new campaign provided an interpretation of the geo-chemo-mechanical properties and state of the sediments forming the deposit at the seafloor. The integrated, multidisciplinary and holistic approach, that considered geotechnical engineering, electrical and electronical engineering, geological, sedimentological, mineralogical, hydraulic engineering, hydrological, chemical, geochemical, biological fields, supported a comprehensive understanding of the influence of the contamination on the hydro-mechanical properties of the sediments, which need to be accounted for in the selection and design of the risk mitigation measures. The findings of the research represent the input ingredients of the conceptual model of the site, premise to model the evolutionary contamination scenarios within the basin, of guidance for the environmental risk management. The study testifies the importance of the cooperative approach among researchers of different fields to fulfil the interpretation of complex polluted eco-systems.

Predictive maintenance is the latest frontier in the management and maintenance of many industrial assets, including aeroengines. Made possible by last decades advances in monitoring equipment and machine learning algorithms, it permits individual-based maintenance schedules, on the basis of performance monitoring and estimates resulting from the application of diagnostic and prognostic techniques, whether on ground or real time. Predictive maintenance results in operational cost reduction and asset usage optimization, if compared with traditional maintenance strategies, which instead may suffer from unanticipated failure or unnecessary maintenance and therefore higher operational costs. In the study, Remaining Useful Life (RUL) estimates will be carried out for different turbofan engines, based on historical individual and fleet data made available by the Prognostics Center of Excellence at NASA. The design of Prognostics and Health Management (PHM) algorithms requires at first an analysis of available data to identify which of them is effectively related to equipment degradation and hence could be useful in determining future system evolution and predicting failure. In particular, RUL prediction of test engines suffering from high pressure compressor fault with exponential degradation trend has been carried out with both regression and Artificial Neural Networks (ANNs). In turn, different regression models and neural network architectures have been compared, namely tree regression with different levels of tree depth, Gaussian Process Regression (GPR) with different kernel functions and Multilayer Perceptron (MLP) with one to three hidden layers and varying number of nodes. The objective is to demonstrate the capability of such machine learning algorithms to predict engine failure and thus their importance in supporting predictive maintenance planning, and to evaluate the quality of results in relation to the algorithm structure. Results show comparable performance in terms of Mean Absolute Error (MAE) and Root Mean Square Error (RMSE) of predicted with respect to actual RUL, in particular predictions obtained through recourse to multilayer perceptron reveal to be the most accurate, with a RMSE of 17.38 and a MAE of 12.50.

Seafood is recognized as a healthy food choice due to high contents of essential nutrients, including polyunsaturated fatty acids (PUFAs) of the n−3 family. However, seafood is often contaminated by toxic compounds, which have adverse effects on human health. The aim of this study was to provide information about the percentage of edible part, condition index and the benefit and risk for human consumers health associated to the consumption of eight bivalve species (Flexopecten glaber, Mimachlamys varia, Modiolus barbatus, Mytilus galloprovincialis, Ostrea edulis, Ruditapes philippinarum, Solen marginatus and Venus verrucosa) of high commercial value, purchased from Taranto local fish markets. High percentage of edibility and condition index were found in all analysed species. The relatively high protein content, low levels of lipid and high percentage of healthy n−3 PUFAs make M. varia, O. edulis, S. marginatus, M. galloprovincialis, M. barbatus more suitable for benefit to consumers. Provisional tolerable weekly intake and hazard index calculated on the basis of trace metals in edible tissues, indicated specific recommendations for a responsible daily consumption of shellfish. For the most part of studied species, the estimated balance between beneficial and risk for consumers recommend a daily portion (RDP) lesser of 60 g/person/day than M. galloprovincialis, O. edulis and R. philippinarum (≥60 g/person/day). Careful risk-benefit considerations should promote seafood consumption while minimizing exposure to toxic contaminants.

Summary Introduction. Healthcare associated infections (HAIs) are a cause of high morbidity, disability and reduced quality of life, as well as mortality and rising costs for health systems. Preventing the HAI risk by planning and implementing effective preventive strategies is important to safeguard patient health. Methods. The study aimed to evaluate the presence of procedures and protocols for infection control, to assess the adhesion to the different aspects of hand hygiene (HH) and hand washing technique by healthcare workers in six ICUs. A perspective observational study was conducted in six ICUs. In each ICU, the adherence by health care workers to both hand hygiene practices and standard precautions was assessed, as well as the presence of procedures and written protocols. Results. The findings showed that in all the involved ICUs, 73 of 142 required protocols and procedures were available. Specifically, 59 of 79 were available for general measure of risk control, 12 of 15 for hand hygiene, and 24 of 48 for standard precautions and isolation measures. Also, the results showed highly variable levels of adherence to the best hygiene practices in all the ICUs involved in the study, with compliance rates ranging from 3% to 100%, and 73 of 142 required protocols were available at the study time. Conclusions. Overall, the involved ICUs showed low levels of adherence to best hygiene practices. This suggests the need to implement immediate strategies for infection control in the ICUs. A multidisciplinary intervention could be effective in preventing and control the HAI risk.score was reached only by the third year students with regard to the proper HH. The level of knowledge about HAI was inadequate. A periodically check of nursing students' knowledge would be advisable in order to fill any gaps, improve training, reduce HAI and increase prevention measures compliance.

Pharmaceutical substances are synthetic compounds with very widespread usage due to their therapeutic biological effects. These compounds and their bioactive metabolites are continually introduced into the aquatic environment as complex mixtures via sewage treatment plants (incomplete destruction), animal farms or leaching from landfills. In this study, an analytical procedure involving solid-phase extraction and gas chromatography–mass spectrometry was developed to determine pharmaceutical compounds (caffeine, diclofenac, ketoprofen and ibuprofen) in aqueous samples (wastewater and surface water). The results demonstrated the suitability of the method at trace levels (ng·L −1) for multi-residue analysis of different types of water matrices.

Surface sediments collected from 10 stations of Taranto Gulf influenced by industrial waste waters were analysed for metals (Hg, Cd, Sn, As, Cu, Pb, Ni, V, Cr, Zn, Mn, Al and Fe), priority polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs). Data were compared with the published results from other coastal areas of the Mediterranean Sea and with Sediments Quality Guidelines (effect range low-effects range medium, threshold effects level-probable effects level indexes) for evaluation of probable toxic effects on marine organisms. Moreover, mean effects range medium (ERM) and mean probable effects level (PEL) quotients were used to evaluate the degree to which chemicals exceed guidelines. Results suggest an ecotoxicological risk for benthic organisms, mainly in sediments near ironed steel production plant of ILVA, where high concentrations of PAHs were found.

Within the complex of deep, hypersaline anoxic lakes (DHALs) of the Mediterranean Ridge, we identified a new, unexplored DHAL and named it 'Lake Kryos' after a nearby depression. This lake is filled with magnesium chloride (MgCl2 )-rich, athalassohaline brine (salinity 470 practical salinity units), presumably formed by the dissolution of Messinian bischofite. Compared with the DHAL Discovery, it contains elevated concentrations of kosmotropic sodium and sulfate ions, which are capable of reducing the net chaotropicily of MgCl2 -rich solutions. The brine of Lake Kryos may therefore be biologically permissive at MgCl2 concentrations previously considered incompatible with life. We characterized the microbiology of the seawater-Kryos brine interface and managed to recover mRNA from the 2.27-3.03 M MgCl2 layer (equivalent to 0.747-0.631 water activity), thereby expanding the established chaotropicity window-for-life. The primary bacterial taxa present there were Kebrit Deep Bacteria 1 candidate division and DHAL-specific group of organisms, distantly related to Desulfohalobium. Two euryarchaeal candidate divisions, Mediterranean Sea Brine Lakes group 1 and halophilic cluster 1, accounted for 85% of the rRNA-containing archaeal clones derived from the 2.27-3.03 M MgCl2 layer, but were minority community-members in the overlying interface-layers. These findings shed light on the plausibility of life in highly chaotropic environments, geochemical windows for microbial extremophiles, and have implications for habitability elsewhere in the Solar System.

Aims: Tissue transglutaminase (tTG) was recently identified as the major autoantigen in coeliac disease. The aim of this multicentre study was to evaluate the impact of a new immunoenzymatic assay for the detection of IgA anti-tGT antibodies. Methods: Seventy four Italian and French clinical laboratories participated in this study; anti-tTG IgA with an enzyme linked immunosorbent assay (ELISA) method using guinea pig liver extract as the coating antigen, anti-endomysium IgA autoantibodies (EMA), and total serum IgA were determined in 7948 patients, 1162 of whom had coeliac disease (737 untreated cases and 425 on a gluten free diet). A proportion of the sera were then sent to a reference laboratory for anti-tTG retesting with an ELISA method using recombinant human tTG antigen. Results: Seven thousand four hundred and fifty eight (93.8%) sera were EMA/antiguinea pig tTG concordant (positive or negative); 490 (6.2%) were non-concordant. The sensitivity of EMA and antiguinea pig tTG in the 737 untreated patients with coeliac disease was 92.1% and 94.8%, respectively, and the specificity was 99.8% and 99.2%, respectively. Retesting of the discordant sera showed that of the 162 sera classified as EMA negative/antiguinea pig tTG positive, only 49 were positive for human recombinant anti-tTG, and that 39 of these were also EMA positive. Furthermore, of the 36 sera classified as EMA positive/antiguinea pig tTG negative, only two were confirmed as EMA positive. Conclusions: The antiguinea pig tTG assay is more sensitive but less specific than EMA, whereas the antihuman recombinant tTG assay is far more specific and just as sensitive as antiguinea pig tTG. Testing for EMA presents considerable interpretative problems and is difficult to standardise.

Distribution of metals (Hg, Pb, Sn, Cu, Cd and Zn) was determined in sediments and in different tissues of Posidonia oceanica collected from San Pietro Island, Taranto Gulf (Ionian Sea, Southern Italy). In seagrass, results, compared with metal concentrations in sediments, showed that the highest concentrations of Hg, Pb, Sn and Cu were found in the roots, while in the green leaves were found the highest levels of Cd and Zn. Instead the lowest metal concentrations were found in the basal part of the leaf. Levels of metals in the leaves were similar to those found by other authors in uncontaminated areas of the Mediterranean Sea. Mercury levels in roots were correlated to levels in sediments. This could demonstrate the plant memorizes sediments contamination . This study reinforces the usefulness and the relevance of Posidonia oceanica as an indicator of spatial metal contamination and an interesting tool for environmental quality evaluation.

BACKGROUND AND OBJECTIVES: Clostridium difficile infection (CDI) accounts for the majority of nosocomial cases of diarrhea, and with recent upsurge of multidrug-resistant strains, morbidity and mortality have increased. Data on clinical impact of CDI come mostly from Anglo-Saxon countries, while in Italy only two studies address the issue and no economic data exist on costs of CDI in the in hospital setting. A retrospective cross-sectional study with pharmacoeconomic analysis was performed on the CDI series of the Policlinico Gemelli of Rome, a major 1400 bed Hospital. PATIENTS AND METHODS: The clinical charts of 133 patients in a 26 month period were reviewed. All costs of the involved resources were calculated and statistical analysis was carried out with means and standard deviations, and categorical variables as number and percentages. RESULTS: The results show the significant sanitary costs of CDI in an Italian hospital setting. The cost analysis of the various elements (exams, imaging studies, therapies, etc.) shows that none independently influences the high cost burden of CDI, but that it is the simple length of hospital stay that represents the most important factor. CONCLUSIONS: Prevention of CDI is the most cost-effective approach. The major break-through in cost reduction of CDI would be a therapeutical intervention or procedure that shortens hospital length of stay.

BACKGROUND--Smoking is the single most common cause of chronic bronchitis but the disease can also occur in non-smokers. Alterations in the lung responsible for the disease, such as oxidant/antioxidant and protease/antiprotease imbalance, have been investigated in smokers. The aim of our study was to evaluate local cellular and soluble factors (albumin, immunoglobulins, proteases, alpha 1-antitrypsin, and transferrin) that may be involved in the development of chronic bronchitis in subjects who have never smoked. METHODS--Sixteen clinically stable patients with chronic bronchitis who had never been smokers were studied and 17 healthy non-smokers served as controls. All subjects underwent bronchoalveolar lavage (BAL). Total and differential cell counts and concentrations of the main proteins (albumin, immunoglobulins, complement fractions, alpha 1-antitrypsin, and transferrin) were measured. Elastase-like activity was assessed in cells and supernatants. To estimate the oxidant burden the release of superoxide anion (O2-) from native cell populations was evaluated. RESULTS--Recovery of BAL fluid was reduced in older individuals in both the chronic bronchitis and control groups. There was no difference in total cell count, but neutrophil percentage count was higher in those with chronic bronchitis (median (range) 3.5 (1.6-14.2)) than in controls (1.3 (0.5-3.7)). These differences were most pronounced in the first recovery, representative of the bronchial lavage. There was no difference in bronchial epithelial cells. Total proteins and albumin levels were comparable and IgG, IgA, IgM, C3, C4, transferrin and alpha 1-antitrypsin values standardised to albumin did not show any significant differences. No differences in elastase-like levels in supernatants were detected. In cell lysates elastase-like activity x 10(7) cells (macrophages+neutrophils) was increased in patients with chronic bronchitis (0.25 (0.06-4.3) compared with controls 0.08 (0.03-0.9) micrograms PPEeq). The release of O2- both at baseline and after opsonised zymosan phagocytosis did not show any differences. Correlation analysis between FEV1 and BAL fluid data showed a negative correlation only with neutrophils/ml. CONCLUSIONS--Clinically stable non-smokers with chronic bronchitis show no alterations of local immune components, oxidant burden, and free elastase-like activity in BAL fluids, while the content of elastase-like activity in phagocytic cells is increased. As in smokers, bronchial neutrophilia is the most significant cellular modification which correlates with the degree of airflow obstruction.

Infection of pancreatic necrosis, although present in less than 10% of acute pancreatitis, carries a high risk of mortality; debridment and drainage of necrosis is the treatment of choice, followed by 'open' or 'close' abdomen management. We recently introduced the use of intra-abdominal vacuum sealing after a classic necrosectomy and laparostomy. Two patients admitted to ICU for respiratory insufficiency and a diagnosis of severe acute pancreatitis developed pancreatic necrosis and were treated by necrosectomy, lesser sac marsupialisation and posterior lumbotomic opening. Both of the patients recovered from pancreatitis and a good healing of laparostomic wounds was obtained with the use of the VAC system. Most relevant advantages of this technique seem to be: the prevention of abdominal compartment syndrome, the simplified nursing of patients and the reduction of time to definitive abdominal closure.

The present work reports on the preliminary results from a biota monitoring program, started during 2008 by the Apulian Regional Agency for Environmental Prevention and Protection (ARPA Puglia) in collaboration with the CNR-Institute for Coastal Marine Environment of Taranto. This project is mainly targeted toward the monitoring of the coastal water quality, using mussels as bioindicators, and the identification of contamination spatial trends. Mussels were sampled in 11 stations located along the marine coastal and transitional waters of the Apulian region, including both south-western Adriatic and Ionian areas. The analyzed contaminants were heavy metals, chlorinated pesticides, chlorinated solvents, organophosphate pesticides, polychlorinated biphenyls, polybrominated diphenyl ethers (PBDEs), alkylphenols, polycyclic aromatic hydrocarbons and organotin compounds. Results were also compared with national and international regulations. The maximum concentration of mercury (0.29 mg kg-1 d.w.) was found in the Mar Piccolo, near the mouth of Galeso River. The sum of PAH concentrations ranged from not detectable to 284.7 ìg kg-1 d.w. (Mar Piccolo). Concerning chlorinated pesticides, only 4,4' DDE was found with the maximum concentration in the Mar Piccolo (second inlet) and near the mouth of Ofanto River (26.9 and 18.7 ìg kg-1 d.w. respectively). The sum of PCB congeners ranged from 2.2 (mouth of Candelaro River) to 383.8 ìg kg-1 d.w. near the mouth of Galeso River. The results show that the "biota" is still a relevant target of exposure to contaminants and, for this reason, biomonitoring activities are very important tools for human health and ecosystem risk assessment.

The present study describes the specific content of ferritin iron, zinc and aluminium in four different groups: 1) hemodialysis hyperferritinemic patients; 2) septic patients; 3) iron overloaded patients with hematologic diseases; and 4) blood donors. In all four groups high levels of aluminium and zinc were found in addition to those of iron. However, the sum of the ferritin ions of the control group is significantly higher than that of the other three groups. Furthermore, while ferritin of hemodialysis patients has the same molecular ratio of metal ions as control group (high Al content vs. Fe and Zn), a lower Al/Fe ratio is found both in septic and hematological patients. The results of the present paper might help to explain the high percentage of hyperferritinemia found in hemodialysis patients also in presence of low transferrin saturation and in absence of inflammatory markers. Moreover, the high content of ions other than iron in the ferritin core leads us to believe that ferritin is not only an iron storage protein but rather a regulator of redox active ions.

The concentrations of Hg, Cd, Pb, Cu, Ni, V, and Sn were determined in marine sediments collected from Taranto Gulf (Ionian Sea, Southern Italy). The aim of this article is to study the methodological approach in order to evaluate total metal levels determined in marine sediments of a contaminated area (Taranto Gulf, Southern Italy), to identify contaminated areas and to predict adverse biological effects based on Sediment Quality Guidelines (SQGs). The results are discussed in relation to geological characteristics of sediments in order to define background levels and anthropogenic input. Experimental results were elaborated by multivariate statistical techniques and Geographical Information System (GIS) software. The geoaccumulation index Igeo and two sets of SQGs (in particular (a) the threshold effect level (TEL), the probable effect level (PEL) and (b) the effect range-low (ERL) and the effect range median (ERM)) have been used for environmental evaluation of metal concentrations. Results show that in Taranto coastal area, Mar Piccolo basin represents the most contaminated area. A comparison with results from other Mediterranean areas demonstrates that for some metals (such as Cd, Pb, and Hg) Taranto seas represent one of the most polluted areas in the Mediterranean Sea. A comparison of metal levels with SQGs also suggests an ecotoxicological risk for benthic organisms mainly in the first inlet of Mar Piccolo.

Objectives Hemodialysis (HD) population commonly show high plasma ferritin levels with a poor diagnostic value. The objective of this study is to elucidate the meaning of HD hyperferritinemia through the analysis of its ferritin iron content (FIC). Design and methods FIC (iron atoms/ferritin molecule) was measured by atomic emission spectrometry. Ferritin and FIC values were correlated with iron storage and inflammation markers and the results of HD patients compared to those of septic and hemochromatosis patients. Results 1) In the whole HD population, high ferritin levels were associated to low FIC values; 2) the correlation of ferritin with iron indices and inflammation markers in HD patients was intermediate in between that of septic and hemochromatosis patients; 3) the FIC level of HD patients was lower than that of the other two groups. Conclusions The high ferritin levels of HD patients are not synonymous with either inflammation or of high levels of iron storage. Their high levels and the low FIC values might be due to the presence inside the ferritin core of oligoelements other than iron.

A fronte di un'intensa e profonda attività di ricerca, in ambito petrologico, vulcanologico, geochimico e geodinamico, in relazione all'evoluzione e alle caratteristiche del vulcanismo nell'area mediterranea, poco sforzo è stato speso per un'adeguata comprensione dei processi idrotermali che interessano aree estremamente complesse, dal punto di vista geologico, come quella del mar Tirreno meridionale. In quest'area insistono sistemi di bacini di retroarco e sistemi di roll back in corrispondenza di noti seamounts (Marsili, Palinuro, Vavilov), nonché attività magmatica tipica di arco di isole (in corrispondenza del gruppo delle Eolie) con magmatismo assai diverso in evoluzione verso un sistema calcalino alto in potassio. Al fine di individuare potenziali flussi idrotermali in suddetta zona, è stata instaurata una collaborazione tra i ricercatori del nostro Istituto ( IAMC-CNR di Napoli), e dell'Osservatorio Vesuviano (INGV) di Napoli, con il gruppo di ricercatori del NOAA di Seattle e del GNS neozelandese, considerati leader nel campo delle ricerche di plumes idrotermali in aree geodinamicamente attive del pianeta (Arco delle Marianne, Arco Egeo, area di Tonga, etc.). È stata, quindi, pianificata una campagna oceanografica focalizzata su un survey sistematico delle attività idrotermali potenzialmente presenti nell'area meridionale del mar Tirreno.

Summary Background A potential approach to the treatment of morbid obesity is reduction of gastric emptying to achieve satiety. Botulinum toxin A (Btx-A) is a long-acting inhibitor of acetylcholine-mediated peristalsis, which is mainly responsible for gastric motility. Aim To investigate whether botulinum toxin A, injected in the antrum of obese patients, delays gastric emptying. Methods In a double_blind study, 18 healthy obese subjects (body mass index >30) were randomized into three groups (BTX133, BTX200 and Saline); they received Btx-A133U, Btx-A200U, or saline under endoscopic control. Gastric emptying was tested by scintigraphy before and 10 days after treatment. Body weight variations and appetite sensation were recorded after 5 weeks. Results Fourteen patients completed the study. The botulinum toxin A-treated groups showed weight reduction, which was not statistically significant. The effects on gastric emptying were variable. Most of the botulinum toxin A treated patients reported a reduced appetite. Conclusion This pilot clinical trial suggests potential activity of botulinum toxin A for the manipulation of appetite.

This article briefly identifies immigrant services that pertain to health and sexual matters in Italy. Italy has 683,600 foreigners who are officially registered as immigrants; 1.2% of total population. Most immigrants have limited tourist, student, or work visas. The Italian constitution provides for health care for all its citizens. A 1978 law spells out guarantees of adequate health care without discrimination. The Martinelli Law of 1990 provided for adequate health care for non-nationals living in Italy, who can show proof of employment and residence every December 31st. A new law in February 1998 guarantees regular health care to every non-national legally working or studying in Italy, living in a family context, and without a criminal record. The government has not been able to provide sufficient services for the 12,500 immigrants living in Genoa. Nongovernmental organizations (NGOs) try to fill the gap in services for immigrants by providing care to about 2000 women aged 18-30 years annually. At least 60% of immigrants receiving care from NGOs come from Latin America, 20% come from Eastern Europe, and 20% come from North and sub-Saharan Africa. Most are treated for emergency care due to violent accidents at home or work. Others desire reproductive health services, including contraception and abortion. The Italian Family Planning Association Clinic serves well-adjusted legal immigrants. The central hospital, in Genoa, served 1143 non-nationals in 1995. Almost 20% had psychiatric emergencies. Many immigrants are not official and thus miss out on primary health care.

The aim of the study was to investigate early graft function in terms of biological and radiological variables in a case series of lung transplant (Ltx).

Botulinum toxin is a powerful, long-acting inhibitor of muscular contractions in both voluntary and smooth muscle. It acts by blocking the release of the neurotransmitter acetylcholine. In the stomach, propulsive contractions of the antrum are necessary for the gastric contents to pass into the duodenum.To investigate whether intramuscular injections of botulinum toxin type A into the gastric antrum of rats would cause a reduction in food intake and hence body weight, by inhibition of gastric emptying.This was a prospective, randomized, 3-way parallel group study in rats. The first group was anaesthetized, laparotomized and given 20 U of botulinum toxin type A by intramuscular injection into the gastric antrum (botulinum toxin type A group, n=14). The second group was anaesthetized, laparotomized and injected with saline (sham group, n=14) and the third group did not have any intervention (control group, n=5). Food intake was measured daily for 7 weeks and body weight was measured daily for 10 weeks.There was a significant difference in loss of body weight between the two treated groups (14.0 +/- 8.2% botulinum toxin type A group, 4.4 +/- 2.7% sham group; P0.001). Further, the time to reach the weight nadir was significantly longer in the botulinum toxin type A group (8.7 +/- 3.9 days) compared with the sham group (5.3 +/- 3.8 days; P0.04). There were no significant differences between the sham and control groups for any of the body weight parameters. The minimum dietary intake was significantly lower in the botulinum toxin type A group than in the sham group (37.8 +/- 21.8% of the basal value in the botulinum toxin type A group, vs. 65.5 +/- 32.0 in the sham group, P0.05). In addition, the time to reach the nadir was significantly prolonged (8.2 +/- 3.5 days, botulinum toxin type A group vs. 4.9 +/- 1.7 days, sham group, P0.001).The parallel reduction of body weight and food intake in botulinum toxin type A treated animals is consistent with a long lasting inhibition of the antral pump. This is probably due to slowed gastric emptying leading to early satiety. Patients with morbid obesity might benefit from endoscopic injections of botulinum toxin type A into the stomach wall.

To investigate the mechanisms underlying ventilator-dependence in patients with chronic obstructive pulmonary disease (COPD), and to assess the effects of the combination of positive end-expiratory pressure (PEEP) and pressure-support ventilation (PSV) on inspiratory muscle effort, we investigated respiratory mechanics in eight ventilator-dependent COPD patients. The patients' breathing pattern, lung mechanics, diaphragmatic effort (PTPdi), diaphragmatic tension-time index (TTdi), and arterial blood gases were measured during both spontaneous breathing (SB) and ventilatory assistance consisting of PSV alone (15, 20, and 25 cm H2O) and PSV combined with a PEEP of 5 cm H2O (reducing PSV to 10, 15, and 20 cm H2O, respectively, to maintain equivalent inspiratory pressure). The different levels of ventilatory support were delivered in a randomized sequence. Maximal inspiratory (MIP), esophageal (PpImax) and transdiaphragmatic (Pdi(max)) pressures and respiratory drive (P(0.1)) were measured at the beginning of the procedure during SB. We found a high P(0.1) (6.1 +/- 1.7 cm H2O), which seemed to rule out an impairment of respiratory-center output. Apparently, inspiratory muscle strength was compatible with successful weaning (38.5 +/- 8.8, 50.9 +/- 9.7, and 51.8 +/- 9.5 cm H2O for MIP, PPImax and Pdi(max), respectively). However, abnormal respiratory mechanics (particularly an intrinsic positive end-expiratory pressure (PEEPi) of 8.3 +/- 1.9 cm H2O and pulmonary resistance 24.7 +/- 9.5 cm H2O/L/s imposed an excessive load on the inspiratory muscles, as indicated by a high PTPdi (499 +/- 122 cm H2O x s). Increasing levels of PSV progressively and significantly unloaded the patients' inspiratory muscles, although at pressures above 20 cm H2O uncoupling occurred between patient and ventilator respiratory frequency. Application of PEEP during PSV improved ventilatory assistance by further reducing the inspiratory effort (by 17% on average) and by ameliorating patient-ventilator interaction. We conclude that the excessive mechanical load, and in particular the high PEEPi, is the major determinant of ventilator-dependence in COPD patients. Application of PEEP improves the efficiency of PSV in unloading these patients' inspiratory muscles, and can sometimes improve patient-ventilator interaction.