Beam deflection due to axial channeling in a silicon crystal bent along the 111 axis was observed with 400 GeV/c protons at the CERN Super Proton Synchrotron. The condition for doughnut scattering of ...protons by the atomic strings of the crystal was attained. Such a condition allowed one to observe a beam deflection of 50 murad with about 30% efficiency. The contribution of hyperchanneled states of protons to the observed beam deflection was less than 2% according to simulation results.
Blood pressure has become one of the most important vital signs to monitor in the perioperative setting. Recently, the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care ...(SIAARTI) recommended, with low level of evidence, continuous monitoring of blood pressure during the intraoperative period. Continuous monitoring allows for early detection of hypotension, which may potentially lead to a timely treatment. Whether the ability to detect more hypotension events by continuous noninvasive blood pressure (C-NiBP) monitoring can improve patient outcomes is still unclear. Here, we report the rationale, study design, and statistical analysis plan of the niMON trial, which aims to evaluate the effect of intraoperative C-NiBP compared with intermittent (I-NiBP) monitoring on postoperative myocardial and renal injury.
The niMon trial is an investigator-initiated, multicenter, international, open-label, parallel-group, randomized clinical trial. Eligible patients will be randomized in a 1:1 ratio to receive C-NiBP or I-NiBP as an intraoperative monitoring strategy. The proportion of patients who develop myocardial injury in the first postoperative week is the primary outcome; the secondary outcomes are the proportions of patients who develop postoperative AKI, in-hospital mortality rate, and 30 and 90 postoperative days events. A sample size of 1265 patients will provide a power of 80% to detect a 4% absolute reduction in the rate of the primary outcome.
The niMON data will provide evidence to guide the choice of the most appropriate intraoperative blood pressure monitoring strategy.
Clinical Trial Registration: NCT05496322, registered on the 5
of August 2023.
À mesure que le déclassement a été perçu comme un problème contemporain, il est devenu un objet de premier plan pour la sociologie des inégalités et, dans une moindre mesure, pour les études ...historiques qui ont privilégié les formes de mobilité ascendante, celles qui sont aussi les plus productrices de sources. En prenant en compte l’Ancien Régime tout en englobant le moment révolutionnaire, cet ouvrage collectif observe, à partir des terrains français et italiens, le phénomène du déclassement dans le cadre d’un ordre hiérarchique, rigide, pensé comme naturel donc immuable, mais qui n’était pas immobile, alternant des périodes de plus ou moins grande ouverture ou fermeture, mais aussi dans une phase de rupture, de transition et de redéfinition où la perte de statut et de fortune a pu s’accompagner d’opportunités de reclassement. Les études ici réunies ont été guidées par un questionnaire commun : montrer la difficulté d’appréhender des situations de déclassement où se mêlaient, selon des degrés variables, appauvrissement, déshonneur, déchéance morale ; restituer la parole – rare - des acteurs historiques sur leur expérience du déclassement ; montrer la difficulté de mesurer le déclassement à partir de marqueurs objectifs tant il s’agissait d’un phénomène relatif, parfois paradoxal, conditionné par un environnement social lui-même mouvant ; envisager le déclassement comme un processus en s’attachant à l’interprétation de trajectoires personnelles et collectives ; interroger, enfin, le rôle joué par l’État dans l’ordonnancement des frontières sociales.
Purpose
Transfer of severely hypoxic patients is a high-risk procedure. Extracorporeal Membrane Oxygenation (ECMO) allows safe transport of these patients to tertiary care institutions. Our ECMO ...transportation program was instituted in 2004; here we report results after 5 years of activity.
Methods
This is a clinical observational study. Criteria for ECMO center activation were: potentially reversibile respiratory failure, PaO2 <50 mmHg with FiO2 >0.6 for >12 hours, PEEP >5 cmH20, Lung Injury Score (LIS) ≥3 or respiratory acidosis with pH <7.2, no intracranial bleeding, and no absolute contraindication to anticoagulation. If eligible, a skilled crew applied ECMO at the referral hospital. Transportation was performed with a specially equipped ambulance.
Results
Sixteen patients were possible candidates for ECMO transfer. Two patients were excluded while 14 (mean±SD, age 35.4±18.6, SOFA 8.4±3.7, Oxygenation Index 43.7±13.4) were transported to our institution (distance covered 102±114 km, global duration of transport 589±186 minutes). Two patients improved after iNO-trial and were transferred and subsequently managed without ECMO. The remaining 12 patients were transferred on veno-venous ECMO with extracorporeal blood flow 2.7±1 L·min−1, gas flow 3.8±1.8 L·min−1, and FiO2 1. Data were recorded 30 minutes before and 60 minutes after initiation of ECMO. ECMO improved PCO2 (75±23 vs. 53±9 mmHg, p<0.01) thus improving pH (7.28±0.13 vs. 7.39±0.05, p<0.01) and allowing a reduction in respiratory rate (35±14 vs. 10±4 breaths/min, p<0.01), minute ventilation (10.1±3.8 vs. 3.7±1.7 L·min−1, p<0.01), and mean airway pressure (26±6.5 vs. 22±5 cmH2O, p<0.01). No major clinical or technical complications were observed.
Conclusions
ECMO effectively enabled high-risk ground transfer of severely hypoxic patients.
Current European guidelines for the management of arterial hypertension introduce the assessment of arterial stiffness by pulse wave velocity (PWV) as an index of hypertension-related cardiovascular ...target organ damage. An increase in arterial stiffness is related to haemodynamic modifications at the level of the aorta, leading to a rise in cardiac afterload, a reduction in coronary perfusion and an overstretch of the aortic walls. An increasing number of studies have demonstrated the accuracy of PWV as an independent predictor of cardiovascular events and cardiovascular mortality in patients with different co-morbidities and cardiovascular risk. Many strategies have demonstrated their efficacy in preventing arterial stiffening; therapy of arterial hypertension is the mainstay in the management of patients with increased PWV and altered pulse wave reflection. Literature has clearly shown the specific efficacy of drugs interfering with the renin-angiotensin-aldosterone system and calcium-channel blockers in the control of central haemodynamics, particularly when compared with β-blockers (β-adrenoceptor antagonists). The same action has not yet been demonstrated on PWV. Further studies are needed to assess the real relative efficacy of different drug classes on the management of arterial stiffness and the clinical and prognostic relevance of these therapies.
The doubling of the angle of beam deflection due to volume reflection of protons by a sequence of two bent silicon crystals was experimentally observed at the 400 GeV proton beam of the CERN SPS. A ...similar sequence of short bent crystals can be used as an efficient primary collimator for the Large Hadron Collider.
Primary aldosteronism is the most frequent cause of secondary hypertension, accounting for up to 11% of cases in selected populations. Patients affected by primary aldosteronism have shown higher ...prevalence of cardiovascular and cerebrovascular events compared with patients with essential hypertension, despite similar blood pressure levels. Several studies have been performed over past years aiming to explain these data; many of these evaluated echocardiographic differences in hypertension-related cardiac organ damage between primary aldosteronism and essential hypertension. This article summarizes the present knowledge about structural and functional alteration of the human left heart in primary aldosteronism.
Quantum circuit simulations enable researchers to develop quantum algorithms without the need for a physical quantum computer. Quantum computing simulators, however, all suffer from significant ...memory footprint requirements, which prevents large circuits from being simulated on classical super-computers. In this paper, we explore different lossy compression strategies to substantially shrink quantum circuit tensors in the QTensor package (a state-of-the-art tensor network quantum circuit simulator) while ensuring the reconstructed data satisfy the user-needed fidelity.Our contribution is fourfold. (1) We propose a series of optimized pre- and post-processing steps to boost the compression ratio of tensors with a very limited performance overhead. (2) We characterize the impact of lossy decompressed data on quantum circuit simulation results, and leverage the analysis to ensure the fidelity of reconstructed data. (3) We propose a configurable compression framework for GPU based on cuSZ and cuSZx, two state-of-the-art GPU-accelerated lossy compressors, to address different use-cases: either prioritizing compression ratios or prioritizing compression speed. (4) We perform a comprehensive evaluation by running 9 state-of-the-art compressors on an NVIDIA A100 GPU based on QTensor-generated tensors of varying sizes. When prioritizing compression ratio, our results show that our strategies can increase the compression ratio nearly 10 times compared to using only cuSZ. When prioritizing throughput, we can perform compression at the comparable speed as cuSZx while achieving 3-4× higher compression ratios. Decompressed tensors can be used in QTensor circuit simulation to yield a final energy result within 1-5% of the true energy value.
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