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BackgroundLack of adherence with continuous positive airway pressure (CPAP) therapy is the major cause of treatment failure in patients with obstructive sleep apnea syndrome. We evaluated the effectiveness of our intensive educational program on adherence in the short term and the long term.MethodsThe educational program consisted of: intensive training, whereby each patient performed individual and collective sessions of three hours receiving information about obstructive sleep apnea syndrome, familiarizing themselves with CPAP tools, on six consecutive days; long-term training; and support meetings, with reassessment at three months and one year.ResultsIn 202 patients with obstructive sleep apnea syndrome, the mean (standard deviation) apnea/hypopnea index was 45 ± 22, the Epworth Sleepiness Scale score was 14 ± 5, and the average titration pressure was 10 ± 2 cm H2O. At three months, 166 patients (82%) used CPAP for an average of 7.3 hours per night. At one year, 162 (80%) used CPAP for about seven hours per night. At two years, 92 patients (43%) used CPAP for about five hours per night. The level of satisfaction remained higher in patients in ventilation.ConclusionOur data show strong adherence to CPAP at three months and one year, with a decrease at two years. The initial educational program seems to play an important role in adherence. This effect is lost in the long term, suggesting that periodic reinforcement of educational support would be helpful.

Groundwater table rising (GTR) represents a well-known issue that affects several urban and agricultural areas of the world. This work addresses the link between GTR and the formation of solute plumes from contaminant sources that are located in the vadose zone, and that water table rising may help mobilize with time. A case study is analyzed in the stratified pyroclastic-alluvial aquifer near Naples (Italy), which is notoriously affected by GTR. A dismissed chemical factory generated a solute plume, which was hydraulically confined by a pump-and-treat (P&T) system. Since 2011, aqueous concentrations of 1,1-dichloroethene (1,1-DCE) have been found to exceed regulatory maximum concentration levels in monitoring wells. It has been hypothesized that a 1,1-DCE source may occur as buried waste that has been flushed with time under GTR. To elucidate this hypothesis and reoptimize the P&T system, flow and transport numerical modeling analysis was developed using site-specific data. The results indicated that the formulated hypothesis is indeed plausible. The model shows that water table peaks were reached in 2011 and 2017, which agree with the 1,1-DCE concentration peaks observed in the site. The model was also able to capture the simultaneous decrease in the water table levels and concentrations between 2011 and 2014. Scenario-based analysis suggests that lowering the water table below the elevation of the hypothesized source is potentially a cost-effective strategy to reschedule the pumping rates of the P&T system.

Pulmonary complications (PPC) are still reported in 30% of patients also after minimally-invasive esophagectomy in high volume centers. 1–2. Prehabilitation programs are promising in ERAS protocols. 3 Open esophagectomy (OE) has the lowest anastomotic leakage rate but higher PPC.4,5. The combination of pre-habilitation and the application of High-Flow Nasal Cannula (HFNC) after OE has not been investigated yet. This is a feasibility study evaluating a pre-habilitation program and the post-operative application of HFNC on PPC after OE. We prospectively included patients undergoing OE from May 2021 to February 2022. A preoperative multimodal prehabilitation program was applied to all patients. Within 4 hours after surgery, patients were extubated and put under HFNC (50–60 lt/min with FIO2 0.4, humidifier temperature at 34°C) for the following 5 days. Chest physiotherapist applied daily post-operative respiratory exercise to all patients. Hospital stay outcomes, feasibility of HFNC and PPC were recorded by 30 days after surgery. We compared this group with an historic cohort (January 2016–March 2021) where HFNC was not applied to determine differences in baseline characteristics and post-operative complications. We included 45 patients for the final analysis, 12 in the HFNC and 33 in the historic cohort. Baseline characteristics comparisons are shown in table 1. No interruption of post-operative HFNC was recorded due to patient’s complain. PPC in the two groups were statistically comparable. No adverse event was related to HFNC application. The overall leakage rate was 9%. A prehabilitation program and HFNC use after OE seems feasible, safe and well tolerated by patients. PPC were lower in the treatment group without statistically significant difference. Pneumonia was recorded in less than 20% of patients; in the study group there weren’t severe pulmonary complications (ARDS, reintubations). HFNC looks like an interesting tool for post-operative respiratory support. Larger randomized controlled trials should be designed to evaluate HFNC efficacy after esophagectomy.