Despite the numerous modeling efforts of the past, our knowledge on the radiation-induced physical and chemical processes in Europa’s tenuous atmosphere and on the exchange of material between the ...moon’s surface and Jupiter’s magnetosphere remains limited. In lack of an adequate number of in situ observations, the existence of a wide variety of models based on different scenarios and considerations has resulted in a fragmentary understanding of the interactions of the magnetospheric ion population with both the moon’s icy surface and neutral gas envelope. Models show large discrepancy in the source and loss rates of the different constituents as well as in the determination of the spatial distribution of the atmosphere and its variation with time. The existence of several models based on very different approaches highlights the need of a detailed comparison among them with the final goal of developing a unified model of Europa’s tenuous atmosphere. The availability to the science community of such a model could be of particular interest in view of the planning of the future mission observations (e.g., ESA’s JUpiter ICy moons Explorer (JUICE) mission, and NASA’s Europa Clipper mission). We review the existing models of Europa’s tenuous atmosphere and discuss each of their derived characteristics of the neutral environment. We also discuss discrepancies among different models and the assumptions of the plasma environment in the vicinity of Europa. A summary of the existing observations of both the neutral and the plasma environments at Europa is also presented. The characteristics of a global unified model of the tenuous atmosphere are, then, discussed. Finally, we identify needed future experimental work in laboratories and propose some suitable observation strategies for upcoming missions.
Background
Achieving gender equality is one of the most important Sustainable Development Goals to guarantee health and wellbeing worldwide. Here, we aimed to assess gender-differences in risk ...factors and outcomes among patients admitted to Italian Intensive Care Units (ICUs).
Methods
Here, we included 12,534 patients from the “Italian Nosocomial Infections Surveillance in Intensive Care Units” (SPIN-UTI) project, who stayed in ICU for more than 48 hours. Firstly, characteristics at ICU admission were compared between males and females using the Mann-Whitney U or the Chi-Squared tests. Next, we compared the probability of death between genders by applying a logistic regression analysis. Results were adjusted for covariates (i.e., age, patient's origin, trauma, non-surgical treatment for acute coronary disease, surgical intervention and presence of intubation) and reported as Odds ratio (OR) and 95% Confidence Interval (CI). Finally, the Kaplan-Meier analysis was applied to assess gender difference in survival.
Results
Compared with male patients, females were older, more likely to come from other wards or healthcare facilities and to undergo a surgical intervention (p-values<0.05). By contrast, they were less likely to be intubated or traumatized and to undergo non-surgical treatment for acute coronary disease (p-values<0.05). Interestingly, a higher proportion of deaths was reported in female patients (p < 0.001), so that their odds of dying was 13% higher than males (OR = 1.13; 95%CI=1.00-1.28; p = 0.046) after adjusting for covariates. Accordingly, females reported lower survival in ICU than males (median= 32.0 days vs. median= 34.0 days; p < 0.001).
Conclusions
Our results pointed out gender-differences in patients' characteristics at ICU admission, which resulted into a higher risk of death and lower survival among females. In a Public Health point of view, these findings underline that is still important to sustain gender equality in ICUs and other hospital wards.
Key messages
There are several gender-differences in risk factors and outcomes among patients admitted to ICUs.
Gender poses per se a higher risk for death in ICU, also considering other risk factors.
We investigated the association between environmental exposure to radiofrequency electromagnetic fields (RF-EMF) and risk of lymphoma subtypes in a case-control study comprised of 322 patients and ...444 individuals serving as controls in Sardinia, Italy in 1998–2004. Questionnaire information included the self-reported distance of the three longest held residential addresses from fixed radio-television transmitters and mobile phone base stations. We georeferenced the residential addresses of all study subjects and obtained the spatial coordinates of mobile phone base stations. For each address within a 500-meter radius from a mobile phone base station, we estimated the RF-EMF intensity using predictions from spatial models, and we performed RF-EMF measurements at the door in the subset of the longest held addresses within a 250-meter radius. We calculated risk of lymphoma and its major subtypes associated with the RF-EMF exposure metrics with unconditional logistic regression, adjusting by age, gender and years of education. In the analysis of self-reported data, risk associated with residence in proximity (within 50 meters) to fixed radio-television transmitters was likewise elevated for lymphoma overall odds ratio = 2.7, 95% confidence interval = 1.5–4.6, and for the major lymphoma subtypes. With reference to mobile phone base stations, we did not observe an association with either the self-reported, or the geocoded distance from mobile phone base stations. RF-EMF measurements did not vary by case-control status. By comparing the self-reports to the geocoded data, we discovered that the cases tended to underestimate the distance from mobile phone base stations differentially from the controls (P = 0.073). The interpretation of our findings is compromised by the limited study size, particularly in the analysis of the individual lymphoma subtypes, and the unavailability of the spatial coordinates of radio-television transmitters. Nonetheless, our results do not support the hypothesis of a link between environmental exposure to RF-EMF from mobile phone base stations and risk of lymphoma subtypes.
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► N-Succinyl-chitosan has proven to exhibit excellent pharmaceutical properties. ► 5-ASA loaded N-succinyl-chitosan microparticles were prepared using spray-drying. ► Acceptable ...spherical non porous and negatively charged microparticles were obtained. ► In vitro studies showed the highest swelling ratio and drug release at colonic pH.
The objective of this study was to prepare NS-chitosan microparticles for the delivery of 5-aminosalicylic acid (5-ASA) to the colon. Microparticles can spread out over a large area of colon allowing a more effective local efficacy of 5-ASA. N-Succinyl-chitosan was chosen as carrier system because of its excellent pharmaceutical properties in colon drug targeting such as poor solubility in acid environment, biocompatibility, mucoadhesive properties, and low toxicity. It was prepared by introducing succinic group into chitosan N-terminals of the glucosamine units. 5-ASA loaded NS-chitosan microparticles were prepared using spray-drying. As a control, a matrix obtained by freeze-drying technique was also prepared and tested. Fourier transform infrared (FT-IR), differential scanning calorimetry (DSC) and X-ray diffraction studies show the 5-ASA/NS-chitosan electrostatic interactions in both the systems. Mean size of the microparticles was around 5μm, zeta potential value of both systems was always negative. Scanning electron microscopy (SEM) images show an acceptable spherical non porous structure of microparticles. In vitro swelling and drug release studies were in accordance with the polymer properties, showing the highest swelling ratio and drug release at pH=7.4 (colonic pH) where microparticles were able to deliver more than 90% of 5-ASA during 24h experiments. Rheological studies are in accordance with the swelling and release studies.
Cases of severe unexplained liver disease in HIV-infected individuals have recently been reported and are often associated with exposure to didanosine (ddl) and nodular regenerative hyperplasia. ...Herein, we examine the clinical outcome following ddl removal.
From 3,300 HIV-infected patients attending three clinics since 2004, all who exhibited persistently elevated aminotransferases and/or significant liver fibrosis in the absence of any known cause of liver damage were identified.
Thirty-two individuals (prevalence approximately 1%) met the inclusion criteria - all were on antiretroviral therapy. Of these, 84% were male and 68% had acquired HIV through homosexual contact. Liver biopsy was performed in 12, of whom three showed nonspecific advanced liver fibrosis, two nodular regenerative hyperplasia and three showed only periportal fibrosis. On follow up, nine patients developed episodes of hepatic decompensation, mainly as a consequence of portal hypertension; in eight cases (25%) portal thrombosis was diagnosed. No association was found with plasma HIV RNA or CD4+ T-cell count. All patients but three had been exposed to ddl for a median of 44 months; removal of ddl in 27 was followed 12 months later by improvement in clinical and laboratory parameters in 13 (48%) patients. Finally, a trend towards liver fibrosis improvement was recognised using FibroScan.
Idiopathic persistent liver enzyme elevations in HIV-infected individuals are often associated with cirrhotic and non-cirrhotic portal hypertension. Although this is a relatively rare condition, prolonged exposure to ddl seems to play a pathogenic role and removal of the drug is associated with clinical and laboratory improvements.
We observed the evolution of Jupiter's polar cyclonic structures over two years between February 2017 and February 2019, using polar observations by the Jovian InfraRed Auroral Mapper, JIRAM, on the ...Juno mission. Images and spectra were collected by the instrument in the 5‐μm wavelength range. The images were used to monitor the development of the cyclonic and anticyclonic structures at latitudes higher than 80° both in the northern and the southern hemispheres. Spectroscopic measurements were then used to monitor the abundances of the minor atmospheric constituents water vapor, ammonia, phosphine, and germane in the polar regions, where the atmospheric optical depth is less than 1. Finally, we performed a comparative analysis with oceanic cyclones on Earth in an attempt to explain the spectral characteristics of the cyclonic structures we observe in Jupiter's polar atmosphere.
Plain Language Summary
The Jovian InfraRed Auroral Mapper (JIRAM) is an instrument on‐board the Juno NASA spacecraft. It consists of an infrared camera, for mapping both Jupiter's auroras and atmosphere, and a spectrometer. In February 2017, the complex cyclonic structures that characterize the Jupiter's polar atmospheres were discovered. Here, we report the evolution of those cyclonic structures during the 2 years following the discovery. We use for this purpose infrared maps built by the JIRAM camera images collected at wavelengths around 5 μm. The cyclones have thick clouds that obstruct most of the view of the deeper atmosphere. However, some areas, near the cyclones, are only covered by thin clouds allowing the spectrometer to see deeper in the atmosphere. In those areas, the instrument was able to detect spectral signatures that permitted estimation of abundances of water vapor, ammonia, phosphine, and germane. Those gases are minor but significant constituents of the atmosphere. Finally, the dynamics of the Jupiter's polar atmosphere are not well understood and are still under study. Here, to suggest possible mechanisms that governs the polar dynamics, we attempted a comparative analysis with some Earth oceanic cyclones that show similarities with the Jupiter ones.
Key Points
The Jupiter's polar cyclonic structures did not change much in two years of observations from February 2017 to February 2019
Abundances of some atmospheric minor constituents measured in the hottest spots of the polar regions, higher values registered in the south
Earth oceanic cyclones analogies suggest a well‐mixed upper boundary layer on Jupiter's Poles
Antidepressants are currently the treatment of choice for major depressive disorder (MDD). Nevertheless, a high percentage of patients do not respond to a first-line antidepressant drug, and ...combination treatments and augmentation strategies increase the risk of side effects. Moreover, a significant proportion of patients are treatment-resistant. In the last 30 years, a number of studies have sought to establish whether exercise could be regarded as an alternative to antidepressants, but so far no specific analysis has examined the efficacy of exercise as an adjunctive treatment in combination with antidepressants. We carried out a systematic review to evaluate the effectiveness of exercise as an adjunctive treatment with antidepressants on depression. A search of relevant papers was carried out in PubMed/Medline, Google Scholar, and Scopus with the following keywords: "exercise," "physical activity," "physical fitness," "depressive disorder," "depression," "depressive symptoms," "add-on," "augmentation," "adjunction," and "combined therapy." Twenty-two full-text articles were retrieved by the search. Among the 13 papers that fulfilled our inclusion criteria, we found methodological weaknesses in the majority. However, the included studies showed a strong effectiveness of exercise combined with antidepressants. Further analyses and higher quality studies are needed; nevertheless, as we have focused on a particular intervention (exercise in adjunction to antidepressants) that better reflects clinical practice, we can hypothesize that this strategy could be appropriately and safely translated into real-world practice.
Abstract
Surgical access to the middle fossa can be technically challenging. As neurosurgery evolves to minimally invasive approaches, the objective of this study is to demonstrate the extension of ...the Minipterional approach to access the middle fossa. We present a new surgical approach to the middle fossa for the treatment of secondary trigeminal neuralgia. Three cases are reported to illustrate the following techniques: a patient with petrotentorial meningioma and trigeminal neuralgia, a patient with an arachnoid cyst compressing the fifth nerve, and a patient with a middle cerebral artery aneurysm and a long history of TN (trigeminal neuralgia) refractory to medical and surgical treatments. All three experienced full symptom controls with no permanent neurological deficits. Therefore, the Minipterional technique might represent a feasible, effective, and safe option to treat refractory secondary TN. It also allows approaching these lesions when the posterior fossa approach is compromised by anatomical distortion and enables the simultaneous treatment of secondary trigeminal neuralgia and other lesions, such as aneurysms and meningiomas.
Abstract
Study question
Do maternal AMH and basal FSH profiles impact embryo morphokinetics and does this relationship change with maternal age?
Summary answer
Embryo morphokinetics varies with basal ...FSH and AMH levels and this relationship changes in advanced maternal age (AMA).
What is known already
Basal FSH and AMH levels have been utilised as markers of ovarian reserve/response and IVF/ICSI outcomes. Basal FSH better reflects post-IVF/ICSI live birth occurrence in pre-AMA patients, while AMH appears more robust in AMA patients. Whilst plasma AMH levels reflect oocyte yield, recent data suggest that plasma basal FSH and intrafollicular AMH levels specifically reflect oocyte quality. Oocyte and embryo developmental competence is associated with faster fertilisation and embryonic morphokinetics. The assessment of the relationship between developmental morphokinetics and maternal basal FSH and AMH plasma profiles shall contribute for a better understanding of their roles as fertility markers and regulators.
Study design, size, duration
Retrospective cohort study including 1961 first autologous ICSI cycles performed from 2014 to 2020, providing 10774 embryos grouped according to maternal AMH and basal FSH levels in: CF concordant favourable; AMH>1 (ng/mL), FSH≤10 (IU/L); n = 8055); DFA (discordant with favourable AMH; AMH>1, FSH>10; n = 768); DFF (discordant with favourable FSH; AMH≤1, FSH≤10; n = 1362) and CU (concordant unfavourable; AMH≤1, FSH>10; n = 589). Morphokinetic parameters were compared among groups in total, ≤35 (pre-AMA) and >35 (AMA) years old patients, separately.
Participants/materials, setting, methods
Patients aged 20 to 45 with FSH and AMH levels measured on menstrual cycle day 2 underwent ovarian stimulation, ovum pick-up and ICSI. Embryos were cultured in a time-lapse incubator (Embryoscope). Fertilisation and cleavage morphokinetic parameters tPNa (time of pronuclei appearance, tPNf (time of pronuclei fading), t2, t3, t4, t5 and t8 were annotated and compared among AMH/FSH groups with the Kruskal-Wallis nonparametric test, followed by a post hoc multiple comparison with Bonferroni correction.
Main results and the role of chance
In overall embryos, tPNa, tPNf, t2 and t3 varied between AMH/FSH groups. CF were faster than CU embryos for all these parameters (mean±SEM; hours); tPNa: 6.8±0.02 vs. 7.1±0.08; tPNf: 24.13±0.04 vs. 24.49±0.14; t2: 27.05±0.05 vs. 27.36±0.16; t3: 36.94±0.07 vs. 37.54±0.22 (p < 0.001). In addition, CF were faster than DFA (p < 0.001), but not than DFF embryos, for tPNf (CF: 24.13±0.04; DFF: 24.23±0.14; DFA: 24.57±0.14) and t2 (CF: 27.05±0.05; DFF: 27.22±0.12, DFA: 27.42±0.15). In AMA patients, faster morphokinetics was observed when one or both hormonal values were favourable; tPNf, t2 and t3 were reached earlier in CF compared to CU (tPNf: 24.17±0.05 vs. 24.52±0.15; t2: 27.13±0.06 vs. 27.43±0.17; t3: 37.09±0.08 vs. 37.63±0.24; p < 0.05), but not to DFF (tPNf: 24.22±0.12; t2: 27.27±0.14, t3: 36.92±0.19) or DFA embryos (tPNf: 24.39±0.14; t2: 27.34±0.17, t3: 37.26±0.23). Differently, in pre-AMA patients, faster morphokinetics was associated with favourable basal FSH regardless of AMH levels; tPNa and tPNf were reached earlier in CF compared to DFA and CU (p < 0.005), but not to DFF embryos (tPNA: 6.68±0.03, 6.96±0.13, 7.13±0.14, 7.12±0.19; tPNf: 24.05±0.07, 24.27±0.21, 25.14±0.34, 24.37±0.36; for CF, DFF, DFA and CU, respectively).
Limitations, reasons for caution
Our study is subjected to the intrinsic limitations of a retrospective analysis and the results could have been affected by variables that were not controlled for.
Wider implications of the findings: The findings suggest that lower basal FSH levels are associated with faster early morphokinetics likely reflecting superior oocyte quality in pre-AMA patients. The present data may contribute to improve ART prognostic strategies and provide valuable clues for a better understanding of hormonal regulation of oocyte developmental competence.
Trial registration number
Not applicable
Pain represents the most frequent cause for patient admission to emergency departments (EDs). Oligoanalgesia is a common problem in this field. The aims of this study were to assess prevalence and ...intensity of pain in patients who visited a second-level urban ED and to evaluate the efficacy of pharmacological treatment administered subsequent to variations in pain intensity.
A 4-week prospective observational study was carried out on 2,838 patients who visited a second-level urban ED. Pain intensity was evaluated using the Numeric Rating Scale at the moment of triage. The efficacy of prescribed analgesic therapy was evaluated at 30 and 60 minutes, and at discharge. Data concerning pain intensity were classified as absent, slight, mild, or severe. Pain was evaluated in relation to the prescribed therapy.
Pain prevalence was 70.7%. Traumatic events were the primary cause in most cases (40.44%), followed by pain linked to urologic problems (13.52%), abdominal pain (13.39%), and nontraumatic musculoskeletal pain (7.10%). Only 32.46% of patients were given pharmacological therapy. Of these, 76% reported severe pain, 19% moderate, and 5% slight, and 66% received nonsteroidal anti-inflammatory drugs or paracetamol, 4% opioids, and 30% other therapies. A difference of at least 2 points on the Numerical Rating Scale was observed in 84% of patients on reevaluation following initial analgesic therapy.
Pain represents one of the primary reasons for visits to EDs. Although a notable reduction in pain intensity has been highlighted in patients who received painkillers, results show that inadequate treatment of pain in ED continues to be a problem.
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