Ivabradine in Septic Shock: A Narrative Review.

In patients with septic shock, compensatory tachycardia initially serves to maintain adequate cardiac output and tissue oxygenation but may persist despite appropriate fluid and vasopressor resuscitation. This sustained elevation in heart rate and altered heart rate variability, indicative of autonomic dysfunction, is a well-established independent predictor of adverse outcomes in critical illness. Elevated heart rate exacerbates myocardial oxygen demand, reduces ventricular filling time, compromises coronary perfusion during diastole, and impairs the isovolumetric relaxation phase of the cardiac cycle, contributing to ventricular-arterial decoupling. This also leads to increased ventricular and atrial filling pressures, with a heightened risk of arrhythmias. Ivabradine, a highly selective inhibitor of the sinoatrial node's pacemaker current (If or "funny" current), mitigates heart rate by modulating diastolic depolarization slope without affecting contractility. By exerting a selective chronotropic effect devoid of negative inotropic properties, ivabradine shows potential for improving hemodynamics in septic shock patients with cardiac dysfunction. This review evaluates the plausible mechanisms and existing evidence regarding the utility of ivabradine in managing patients with septic shock.

Dry Addition of Recycled Waste Polyethylene in Asphalt Mixtures: A Laboratory Study.

The circular use of resources (i.e., reuse and recycling of materials) aiming for zero waste is also gaining increasing attention in pavement engineering. In this regard, the possible use of waste plastics in asphalt materials is of strategic importance since a considerable amount of plastic waste from construction and demolition waste and municipal solid waste is generated every year. Given this background, this experimental study aimed to investigate the feasibility of recycling waste polyethylene (PE) into asphalt mixtures. For this purpose, the dry addition of plastic shreds was evaluated to overcome the drawbacks observed in a previous interlaboratory research on PE-modified bituminous binder (i.e., instability/inhomogeneity of blend as well as the need for PE grinding). A comparative laboratory study was carried out on dense graded asphalt mixtures containing different amounts of waste plastics (i.e., 0%, 0.25%, and 1.5% by weight of the mixture). The selected asphalt mixes were investigated in terms of workability, linear visco-elastic characteristics, stiffness, strength, resistance to permanent deformation, and moisture sensitivity. Overall, the experimental findings show that the mixes prepared with the dry addition of plastic wastes were able to guarantee almost the same workability and moisture resistance as the reference material while leading to enhanced performance in terms of stiffness and permanent deformation resistance, with better responses for the higher investigated PE dosage.

Rutting Behavior of Asphalt Surface Layers Designed for Solar Harvesting Systems.

Solar harvesting systems applied to asphalt roads consist of pipes or coils installed a few centimeters below the asphalt pavement surface. They work thanks to a circulating fluid able to collect the heat coming from solar irradiation of the pavement surface and convert it into thermal gradients that can be used for electric energy supply. Specific attention must be paid to the design of the asphalt mixtures comprising the system. In this sense, the high in-service temperature rutting potential is one of the main issues to be assessed in such applications since the thermal optimization of asphalt mixes could lead to excessively deformable materials. The present study is a part of a wider research area aimed at developing an efficient asphalt solar collector. Here, a laboratory mixture-scale investigation is proposed to verify the anti-rutting potential of specific asphalt layers that were initially designed based on thermal properties only. Repeated load axial and wheel tracking tests are carried out on limestone- and steel slag-based bituminous mixtures. Overall, the tested layers were not fully able to satisfy the permanent deformation acceptance criteria; in this regard, possible improvements in terms of mix constituents and properties are ultimately addressed.

Long-term motor deficit in brain tumour surgery with preserved intra-operative motor-evoked potentials.

Muscle motor-evoked potentials are commonly monitored during brain tumour surgery in motor areas, as these are assumed to reflect the integrity of descending motor pathways, including the corticospinal tract. However, while the loss of muscle motor-evoked potentials at the end of surgery is associated with long-term motor deficits (muscle motor-evoked potential-related deficits), there is increasing evidence that motor deficit can occur despite no change in muscle motor-evoked potentials (muscle motor-evoked potential-unrelated deficits), particularly after surgery of non-primary regions involved in motor control. In this study, we aimed to investigate the incidence of muscle motor-evoked potential-unrelated deficits and to identify the associated brain regions. We retrospectively reviewed 125 consecutive patients who underwent surgery for peri-Rolandic lesions using intra-operative neurophysiological monitoring. Intraoperative changes in muscle motor-evoked potentials were correlated with motor outcome, assessed by the Medical Research Council scale. We performed voxel-lesion-symptom mapping to identify which resected regions were associated with short- and long-term muscle motor-evoked potential-associated motor deficits. Muscle motor-evoked potentials reductions significantly predicted long-term motor deficits. However, in more than half of the patients who experienced long-term deficits (12/22 patients), no muscle motor-evoked potential reduction was reported during surgery. Lesion analysis showed that muscle motor-evoked potential-related long-term motor deficits were associated with direct or ischaemic damage to the corticospinal tract, whereas muscle motor-evoked potential-unrelated deficits occurred when supplementary motor areas were resected in conjunction with dorsal premotor regions and the anterior cingulate. Our results indicate that long-term motor deficits unrelated to the corticospinal tract can occur more often than currently reported. As these deficits cannot be predicted by muscle motor-evoked potentials, a combination of awake and/or novel asleep techniques other than muscle motor-evoked potentials monitoring should be implemented.

Direct ink writing of porous titanium (Ti6Al4V) lattice structures.

Ti6Al4V components, for biomedical and aerospace sectors, are receiving a great interest especially after the advent of additive manufacturing technologies. The most used techniques are Selective Laser Sintering (SLS), Selective Laser Melting (SLM) and Electron Beam Melting (EBM). In the current research, we developed 3D-printed Ti6Al4V scaffolds by Direct Ink Writing (DIW) technology. Appropriate ink formulations, based on water-titanium powder suspensions, were achieved by controlling the rheological properties of the developed inks. After printing process, and drying, the printed components were sintered at 1400 °C under high vacuum for 3 h. Highly porous titanium scaffolds (with porosity up to 65 vol%) were produced and different geometries were printed. The influence of the porosity on the morphology, compression strength and biocompatibility of the scaffolds was investigated.

Optimization and Characterization of Preceramic Inks for Direct Ink Writing of Ceramic Matrix Composite Structures.

In a previous work, an ink based on a preceramic polymer, SiC fillers, and chopped carbon fibers was proposed for the production of Ceramic Matrix Composite (CMC) structures by Direct Ink Writing (DIW) and subsequent pyrolysis. Thanks to the shear stresses generated at the nozzle tip during extrusion, carbon fibers can be aligned along the printing direction. Fumed silica was added to the ink in order to enhance its rheological properties; however, the printed structures still showed some deformation in the Z direction. In this work, a second ink was successfully developed to limit deformation and at the same time avoid the addition of fumed silica, which limited the potential temperature of application of the composites. Instead, the positive role of the preceramic polymer on the ink rheology was exploited by increasing its concentration in the ink. Rheological characterization carried out on both inks confirmed that they possessed Bingham shear thinning behavior and fast viscosity recovery. Single filaments with different diameters (~310 µm and ~460 µm) were produced with the latter ink by DIW and subsequent pyrolysis. Tested under a four-point flexural test, the filaments showed a mean flexural strength above 30 MPa, graceful failure, and fiber pull-out. The results of this work suggest that CMC components can effectively be fabricated via DIW of a preceramic ink with embedded short fibers; the preceramic polymer is able to provide the desired rheology for the process and to develop a dense matrix capable of incorporating both fibers and ceramic particles, whereas the fibers addition contributes to an increase of the fracture toughness of the material and to the development of a graceful failure mode.

Experimental evaluation of high performance base course and road base asphalt concrete with electric arc furnace steel slags.

The paper presents the results of a laboratory study aimed at verifying the use of two types of electric arc furnace (EAF) steel slags as substitutes for natural aggregates, in the composition of base course and road base asphalt concrete (BBAC) for flexible pavements. The trial was composed of a preliminary study of the chemical, physical, mechanical and leaching properties of the EAF steel slags, followed by the mix design and performance characterization of the bituminous mixes, through gyratory compaction tests, permanent deformation tests, stiffness modulus tests at various temperatures, fatigue tests and indirect tensile strength tests. All the mixtures with EAF slags presented better mechanical characteristics than those of the corresponding asphalts with natural aggregate and satisfied the requisites for acceptance in the Italian road sector technical standards, thus resulting as suitable for use in road construction.