The use of head helmets to deliver noninvasive ventilatory support: a comprehensive review of technical aspects and clinical findings

A helmet, comprising a transparent hood and a soft collar, surrounding the patient’s head can be used to deliver noninvasive ventilatory support, both as continuous positive airway pressure and noninvasive positive pressure ventilation (NPPV), the latter providing active support for inspiration. In this review, we summarize the technical aspects relevant to this device, particularly how to prevent CO₂ rebreathing and improve patient–ventilator synchrony during NPPV. Clinical studies describe the application of helmets in cardiogenic pulmonary oedema, pneumonia, COVID-19, postextubation and immune suppression. A section is dedicated to paediatric use. In summary, helmet therapy can be used safely and effectively to provide NIV during hypoxemic respiratory failure, improving oxygenation and possibly leading to better patient-centred outcomes than other interfaces.

Antiemetic prophylaxis in patients undergoing hematopoietic stem cell transplantation: a multicenter survey of the Gruppo Italiano Trapianto Midollo Osseo (GITMO) transplant programs

A survey within hematopoietic stem cell transplant (HSCT) centers of the Gruppo Italiano Trapianto Midollo Osseo (GITMO) was performed in order to describe current antiemetic prophylaxis in patients undergoing HSCT. The multicenter survey was performed by a questionnaire, covering the main areas on chemotherapy-induced nausea and vomiting (CINV): antiemetic prophylaxis guidelines used, antiemetic prophylaxis in different conditioning regimens, and methods of CINV evaluation. The survey was carried out in November 2016, and it was repeated 6 months after the publication of the Multinational Association of Supportive Care in Cancer (MASCC)/European Society for Medical Oncology (ESMO) specific guidelines on antiemetic prophylaxis in HSCT. The results show a remarkable heterogeneity of prophylaxis among the various centers and a significant difference between the guidelines and the clinical practice. In the main conditioning regimens, the combination of a serotonin₃ receptor antagonist (5-HT₃-RA) with dexamethasone and neurokin₁ receptor antagonist (NK1-RA), as recommended by MASCC/ESMO guidelines, increased from 0 to 15% (before the publication of the guidelines) to 9-30% (after the publication of the guidelines). This study shows a lack of compliance with specific antiemetic guidelines, resulting mainly in under-prophylaxis. Concerted strategies are required to improve the current CINV prophylaxis, to draft shared common guidelines, and to increase the knowledge and the adherence to the current recommendations for CINV prophylaxis in the specific field of HSCT.

A new case report of severe mucopolysaccharidosis type VII: diagnosis, treatment with haematopoietic cell transplantation and prenatal diagnosis in a second pregnancy

A new patient with severe mucopolysaccharidosis (MPS) type VII is reported. Non-immune hydrops fetalis (NIHF) was diagnosed during pregnancy. At birth, he showed generalized hydrops and dysmorphic features typical of MPS. Many diagnoses were excluded before reaching the diagnosis of MPS VII at 8 months of life. During the first year of life he had frequent respiratory infections associated with restrictive and obstructive bronchopneumopathy and underwent three surgical interventions: decompression of the spinal cord at the craniocervical junction, bilateral inguinal hernia, and bilateral clubfoot. At 14 months of life he underwent successful haematopoietic cell transplantation (HCT). During the following 10 months, his bronchopneumopathy progressively worsened, needing chronic pharmacological treatment and O₂ administration. The patient died of respiratory insufficiency during a respiratory syncytial virus infection at 25 months of age. Molecular analysis showed the homozygous variant c.1617C > T, leading to the synonymous mutation p.Ser539=. This caused aberrant splicing with partial skipping of exon 10 (r.1616_1653del38) and complete skipping of exon 9 (r.1392_1476del85; r.1616_1653del38). No transcript of normal size was evident. The parents were both confirmed to be carriers. In a subsequent pregnancy, a prenatal diagnosis showed an affected fetus. Ultrasound examination before abortion showed NIHF. The skin and placenta examination by electron microscopy showed foamy intracytoplasmic vacuoles with a weakly electron-dense substrate. MPS VII is a very rare disease but it is possible that some cases go undiagnosed for several reasons, including that MPS VII, and other lysosomal storage diseases, are not included in the work-up for NIHF in many institutions, and the presence of anasarca at birth may be confounding for the recognition of the typical facial characteristics of the disease. This is the eighth patient affected by MPS VII who has undergone HCT. It is not possible to draw conclusions about the efficacy of HCT in MPS VII. Treatment with enzyme replacement is now available and will probably be beneficial for the patients who have a milder form with no or little cognitive involvement. Increased awareness among clinicians is needed for prompt diagnosis and to offer the correct treatment as early as possible.

Pentraxin 3 plasma levels at graft-versus-host disease onset predict disease severity and response to therapy in children given haematopoietic stem cell transplantation

Acute Graft-versus-Host Disease (GvHD) remains a major complication of allogeneic haematopoietic stem cell transplantation, with a significant proportion of patients failing to respond to first-line systemic corticosteroids. Reliable biomarkers predicting disease severity and response to treatment are warranted to improve its management. Thus, we sought to determine whether pentraxin 3 (PTX3), an acute-phase protein produced locally at the site of inflammation, could represent a novel acute GvHD biomarker. Using a murine model of the disease, we found increased PTX3 plasma levels after irradiation and at GvHD onset. Similarly, plasma PTX3 was enhanced in 115 pediatric patients on day of transplantation, likely due to conditioning, and at GvHD onset in patients experiencing clinical symptoms of the disease. PTX3 was also found increased in skin and colon biopsies from patients with active disease. Furthermore, PTX3 plasma levels at GvHD onset were predictive of disease outcome since they resulted significantly higher in both severe and therapy-unresponsive patients. Multiple injections of rhPTX3 in the murine model of GvHD did not influence the disease course. Taken together, our results indicate that PTX3 constitutes a biomarker of GvHD severity and therapy response useful to tailor treatment intensity according to early risk-stratification of GvHD patients.

Mortality of Eggs and Newly Hatched Larvae of Lobesia botrana (Lepidoptera: Tortricidae) Exposed to High Temperatures in the Laboratory

The hypothesis that bunch-zone leaf removal reduces infestations of the European grapevine moth, Lobesia botrana (Denis & Schiffermüller) (Lepidoptera: Tortricidae), by increasing egg and larval mortality owing to sunlight exposure was evaluated in the laboratory by subjecting different egg stages (white, red-eyes, and black-head) and newly hatched larvae to high temperatures. Based on temperatures recorded in a northern Italian vineyard on sun-exposed berries belonging to south-west facing bunches, eggs were subjected to constant temperatures of 40 °C and 37 °C for one or two periods of 3 or 6 h, and to 24-h temperature cycle with peak of 40 °C. Larvae were exposed to 24-h high-temperature cycles with peaks of 35, 37, and 40 °C. The results showed partial egg mortality at 40 °C, increasing with exposure hours and periods, and as eggs matured. Egg mortality was not affected by exposure to 37 °C. Larval survival already decreased significantly at 37 °C and was even lower at 40 °C. These laboratory data are in agreement with the hypothesis that temperatures reached by berries exposed to sunlight cause egg and larval mortality. Data on egg and larval susceptibility to high temperatures have also implications for species distribution and effects of climate change.

Should Posterior Reversible Encephalopathy Syndrome Be Mainly Considered an Epileptic Disorder? Results of a Sequential Neurophysiological Study in a Pediatric Cohort

Despite a wide number of studies trying to define clinical, physiopathological, and neuroradiological features of posterior reversible encephalopathy syndrome (PRES), the true nature of symptoms is still not fully understood. We studied a standard cohort of 24 pediatric patients, affected by hemato-oncological diseases, with a neuroradiological diagnosis consistent with PRES identified from 2006 to 2013. Ten of them developed PRES after hematopoietic stem cell transplantation. We analyzed the sequence of clinical, radiological, and electrophysiological data. In all the patients who were recorded at the onset of the first symptoms, electroencephalograms showed focal nonconvulsive seizures or status epilepticus (SE). We found a sensitivity of 100% for electroencephalogram (EEG) with a good correlation between clinical signs and the localization of seizures, whereas computed tomography scans showed a sensitivity of 50% only. Following prompt treatment, intensive care unit admission rate was only 8%. PRES is a multifactorial neurologic event with focal nonconvulsive seizures or SE as the main feature in pediatric patients. Clinical manifestations are epileptic in nature, and prompt EEG recording is useful for diagnosis and supports an earlier treatment, potentially preventing the appearance of complications such as generalized seizures or refractory SE.

Morphological and Molecular Identification of Anagrus 'atomus' Group (Hymenoptera: Mymaridae) Individuals from Different Geographic Areas and Plant Hosts in Europe

Morphological identification and molecular study on the COI gene were simultaneously conducted on Anagrus Haliday 'atomus' group individuals collected in the field in Italy or supplied from a UK biofactory. Females were morphologically identified as A. atomus L. and A. parvus Soyka sensu Viggiani (=A. ustulatus sensu Chiappini). Alignment of COI gene sequences from this study permitted recognition of a total of 34 haplotypes. Phylogenetic and network analyses of molecular data not only confirmed that A. atomus is a species distinct from A. parvus, but also suggested that two species may be included within morphologically identified A. parvus. Different geographical distribution and frequency of haplotypes were also evidenced. For males considered in this study, morphometric analyses revealed a character that could be useful to discriminate A. atomus from A. parvus Both species were found in vineyards and surrounding vegetation, confirming the potential role of spontaneous vegetation as a source of parasitoids for leafhopper control in vineyards.

Vineyard Colonization by Hyalesthes obsoletus (Hemiptera: Cixiidae) Induced by Stinging Nettle Cut Along Surrounding Ditches

Stinging nettle (Urtica dioica L.) is the most important host plant for both phytoplasma associated with Bois noir disease of the grapevine and its vector Hyalesthes obsoletus Signoret (Hemiptera: Cixiidae). Vector abundance in vineyards is favored by stinging nettle growing in surrounding areas. Nettle control by herbicides or cutting can reduce vector population in vineyards. However, chemical weeding can cause environmental problems. Many authors suggest that stinging nettle control applied during H. obsoletus flight could force adults to migrate into vineyards. We evaluate if cutting of nettle growing along ditches during adult flight favors vineyard colonization by H. obsoletus. Three different weed management regimes ("no cuts," "one cut" just before the beginning of adult flight, and "frequent cuts" over the whole vegetative season) were applied to the herbaceous vegetation in ditches bordering two vineyards. The flight dynamics of H. obsoletus were recorded by placing yellow sticky traps on the vegetation along the ditches and at different positions in the vineyards. Frequent stinging nettle cuts (compared with a single cut) in surrounding areas favored the dispersion of vectors inside the vineyards. Stinging nettle control should be based on an integration of a single herbicide application before H. obsoletus emergence followed by frequent cuts to minimize negative side effects of chemical weeding. In organic viticulture, a frequent-cuts strategy should avoid cuts during H. obsoletus flight period, at least in the first year of adoption.

Relative Infestation Level and Sensitivity of Grapevine Cultivars to the Leafhopper Empoasca vitis (Hemiptera: Cicadellidae)

The leafhopper Empoasca vitis (Göthe) (Hemiptera: Cicadellidae) feeds on veins of grapevine leaves, mainly on the phloem, causing physiological injury, color change and drying of leaf margins, yield and sugar content reduction. The relative infestation level (i.e., the probability that a plant is attacked by herbivores) of E. vitis on different grapevine cultivars and their sensitivity (i.e., the incidence of symptoms expression in response to herbivore feeding or other stimuli) to this pest were studied over four years in two vineyards located in northeastern Italy. Some cultivars (e.g., Carménère and Sauvignon Blanc) were usually more infested than others (e.g., Cabernet Sauvignon and Pinot Gris), although some differences were observed among years and sites. The sensitivity varied among cultivars, i.e., some of them showed more symptoms than expected on the basis of infestation levels (e.g., Carménère and Merlot), in contrast with others (e.g., Rhine Riesling and Chardonnay). Information obtained can be used within the framework of integrated pest management in vineyards. Action thresholds should differ on the basis of sensitivity. Sampling must first be carried out on the most susceptible cultivar and, if the action threshold is exceeded, it should be extended to the remaining cultivars based on their decreasing relative infestation level.

Treatment of graft versus host disease with mesenchymal stromal cells: a phase I study on 40 adult and pediatric patients

This phase I multicenter study was aimed at assessing the feasibility and safety of intravenous administration of third party bone marrow-derived mesenchymal stromal cells (MSC) expanded in platelet lysate in 40 patients (15 children and 25 adults), experiencing steroid-resistant grade II to IV graft-versus-host disease (GVHD). Patients received a median of 3 MSC infusions after having failed conventional immunosuppressive therapy. A median cell dose of 1.5 × 10(6)/kg per infusion was administered. No acute toxicity was reported. Overall, 86 adverse events and serious adverse events were reported in the study, most of which (72.1%) were of infectious nature. Overall response rate, measured at 28 days after the last MSC injection, was 67.5%, with 27.5% complete response. The latter was significantly more frequent in patients exhibiting grade II GVHD as compared with higher grades (61.5% versus 11.1%, P = .002) and was borderline significant in children as compared with adults (46.7 versus 16.0%, P = .065). Overall survival at 1 and 2 years from the first MSC administration was 50.0% and 38.6%, with a median survival time of 1.1 years. In conclusion, MSC can be safely administered on top of conventional immunosuppression for steroid resistant GVHD treatment. Eudract Number 2008-007869-23, NCT01764100.

Identification and phenology of Hyalesthes obsoletus (Hemiptera: Auchenorrhyncha: Cixiidae) nymphal instars

Urtica dioica and Convolvulus arvensis are the main host plants of Hyalesthes obsoletus and play an important role in the epidemiology of Bois noir of grapevines. The earliest survey, which was carried out to compare the phenology of nymphal instars on U. dioica and C. arvensis, had highlighted some problems in the identification of the instars. Therefore, the correct identification of nymphs to species and instar level became a preliminary aim of this research. Adults and nymphs attributable to H. obsoletus were collected during 2008-2010 in three flatland vineyard habitats of northern Italy on U. dioica, C. arvensis and Artemisia verlotorum. Nymphs and morphologically identified adults of H. obsoletus were submitted to molecular identification. Morphometric and morphological studies were carried out on nymphs collected in the field or obtained in laboratory rearings. Molecular methods not only confirmed the identity of adults, but also allowed the assignment of the nymphs to this species. Morphometric and morphological characteristics (e.g. body and head-thoracic lengths, number of thoracic pits) showed the existence of five nymphal instars. Morphometric differences between newly hatched and older first-instar nymphs were observed. A key to distinguish the five instars was proposed. Evident differences between H. obsoletus nymphs studied here and elsewhere were identified. According to differences in adult-flight period, an earlier phenology of nymphs on C. arvensis than on U. dioica was observed. In particular, the typical overwintering instar was the second on U. dioica and the third on C. arvensis.

Course and management of allogeneic stem cell transplantation in patients with mitochondrial neurogastrointestinal encephalomyopathy

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disorder caused by mutations in the gene encoding thymidine phosphorylase (TP). Allogeneic hematopoietic stem cell transplantation (HSCT) has been proposed as a treatment for patients with MNGIE and a standardized approach to HSCT in this condition has recently been developed. We report on the transplant course, management and short-term follow-up in two MNGIE patients who underwent HSCT. The source of stem cells was bone marrow taken from an HLA 9/10 allele-matched unrelated donor in the first patient and from an HLA 10/10 allele-matched sibling donor in the second. Both patients achieved full donor chimerism, and we observed restoration of buffy coat TP activity and lowered urine nucleoside concentrations in both of them. The post-transplant clinical follow-up showed improvement in gastrointestinal dysmotility, abdominal cramps and diarrhea. Neurological assessment remained unchanged. However, the first patient died 15 months after HSCT due to gastrointestinal obstruction and shock; the second patient died 8 months after the procedure due to respiratory distress following septic shock. Although HSCT corrects biochemical abnormalities and improves gastrointestinal symptoms, the procedure can be risky in subjects already in poor medical condition as are many MNGIE patients. Since transplant-related morbidity and mortality increases with progression of the disease and number of comorbidities, MNGIE patients should be submitted to HSCT when they are still relatively healthy, in order to minimize the complications of the procedure. Anyway, there is still incomplete knowledge on the natural history of the disease in many affected patients and it is not yet clear when the best time to do a transplant is. Further clues to the therapeutic potential of HSCT could result from a prolonged observation in a greater number of non-transplanted and transplanted patients, which would allow us to answer the questions of if, how and when MNGIE patients require HSCT treatment.

Effects of irrigation on the seasonal abundance of Empoasca vitis in north-Italian vineyards

The effect of irrigation on the abundance of Empoasca vitis (Göthe) populations was investigated in four vineyards located in northeastern Italy. In two experiments, we compared leafhopper population densities in plots irrigated (micro-spray irrigation system) or nonirrigated. In another experiment, we studied the effect of various irrigation systems on E. vitis populations over two successive seasons. In particular, five treatments were compared: control (not irrigated), traditional drip system, three types of subirrigation varying in distance from the row (40, 135, and 95 cm). In this vineyard, stem water potential was monitored with a pressure chamber. E. vitis population densities were affected by irrigation, with higher densities of this pest recorded on irrigated vines. Highest E. vitis densities were detected in drip irrigation plots compared with nonirrigated plots where water stress was highest. Moderate water stress (subirrigation plots) was associated with intermediate leafhopper densities. Implications for integrated pest management are discussed.

DNA-Dependent Detection of the Grapevine Fungal Endophytes Aureobasidium pullulans and Epicoccum nigrum

Aureobasidium pullulans and Epicoccum nigrum are frequently reported as endophytes of various crops, including grapevine (Vitis vinifera). Because of their potential role as biological control agents against grapevine pathogens, we examined the occurrence of A. pullulans and E. nigrum in two grapevine varieties (Merlot and Prosecco) in Italian vineyards where spontaneous recovery from phytoplasma disease is recurrent. Species-specific primers for A. pullulans and two genetically distinct strains of E. nigrum were designed in variable regions of ITS1 and ITS2. Primer specificity was confirmed by polymerase chain reaction using purified DNA from other fungal endophytes that are usually encountered during isolation attempts from grapevine tissues and from several other strains of A. pullulans and E. nigrum isolated from other sources. In order to determine the occurrence of the two endophytes in grapevine plants, DNA was extracted from shoots of 44 grapevines collected in six vineyards from different localities of northeast Italy. Both endophytes were detected and their identity was confirmed by restriction fragment length polymorphism (RFLP) patterns obtained from reference strains. RFLP analyses confirmed the presence of two E. nigrum strains belonging to different RFLP groups in grapevine. The molecular methods described allowed a sensitive, specific, and reliable identification of the two endophytes in grapevine.

Urinary pharmacokinetics and theoretical pharmacodynamics of intravenous levofloxacin in intensive care unit patients treated with 500 mg b.i.d. for ventilator-associated pneumonia

This study assessed the urinary pharmacokinetics and theoretical pharmacodynamics of levofloxacin in ICU patients treated with 500 mg b.i.d. i.v. for ventilator associated pneumonia to evaluate if this high dosage regimen might ensure appropriate exposure in the treatment of severe UTIs in ICU patients. Nineteen patients (11M, 8F; age, 52 +/- 21 years; weight, 75 +/- 16 kg) presenting with normal renal function (estimated creatinine clearance, 1.83 +/- 0.61 ml/min/kg; diuresis, 1709 +/- 643ml / 24h) were assessed. In steady-state conditions, urine samples were collected at 0-2h, 2-4h, 4-8h and 8-12h during a dosing interval, and urinary concentrations of levofloxacin were assayed by HPLC. Mean (+/- SD) levofloxacin urinary concentrations were 329.1 +/- 159.9, 388.6 +/- 143.5, 266.0 +/- 102.8 and 168.1 +/- 93.3mg/L at 0-2h, 2-4h, 4-8h and 8-12h, respectively, with urinary AUC0-tau of 3171.4 +/- 1192.1mg/L x h. Mean (+/- SD) levofloxacin excretion rates were 44.1 +/- 20.7, 42.8 +/- 8.2, 31.7 +/- 5.8 and 19.8 +/- 4.2 mg/h during the 0-2h, 2-4, 4-8h and 8-12h interval, respectively. Our findings suggest that, consistently with levofloxacin showing high renal excretion as unmodified drug, 500mg b.i.d. i.v. of levofloxacin ensure and maintain urinary concentrations at least 50-fold higher than the MIC90 of most sensitive uropathogens during the overall dosing interval in ICU patients with normal renal function. Considering the major pharmacodynamic determinants for the concentration-dependent bactericidal activity of levofloxacin as applicable at the urinary level (CU/MIC of >12.2 and/or AUC24h U /MIC of >125h), this high dosage regimen may ensure optimal exposure for the treatment of catheter-related and severe lower UTIs not only against sensitive microorganisms, but probably also whenever microorganisms usually considered as intermediate susceptible or resistant to levofloxacin may be involved.

Histological techniques and microscopic analysis of biological agents for preservation of human bone remains

Microscopy and histology techniques can be applied to morphological study of fungi and bacteria contaminating ancient human osteological remains. Undecalcified samples are cut with a diamond rotary blade microtome and an original technique was applied using adhesive tape to prevent damage to the bone surface during sectioning. We used light microscopy, polarized light microscopy, and epi-illumination fluorescence systems. Common dyes can be applied to 80 microm sections using classic staining techniques to reveal the architecture of bone and the presence of infecting biological agents.

Patient anesthesia and monitoring at a 1.5-T MRI installation

This paper describes the facilities successfully used to provide patient monitoring and anesthesia support in a 1.5-T imaging installation. The requirements for the MRI site for anesthetic gases, shielded power, and radiofrequency ports are outlined. Specific modifications in anesthesia machines, anesthesia cart, laryngoscope, mercury sphygmomanometer, oximeter, and remote blood pressure devices are described. Additional aspects of patient monitoring and support, e.g., electrocardiogram and pressure infusion, are also discussed.

A critical approach to prophylactic use of lithium in therapy for manic-depressive patients

During a follow-up study of 120 cases of recurrent affective disorders treated prophylactically with lithium, the authors considered certain aspects of this treatment from a psychologic point of view. In particular, they examined the problems connected with prolonged administration of the drug, the relationship between drug therapy and psychotherapy, and the significance of pharmacologic prevention of the crisis by modifying the underlying individual, familial, and social conditions that the crisis manifests.

Notes on experiments with drugs in psychiatry

In this paper I develop some observations on the methods used for therapeutic experiments with drugs in a psychiatric department. After a general introduction I deal with the following points. 1. The researcher confronted with the problem of intra- and inter-disciplinary collaboration. 2. The operators and the question of the choice of subjects. 3. Some aspects of the insurance and rewards in favor of the patient. 4. Remarks on the application phase. 5. Summarizing methodological proposals.