De-escalation of antimicrobial therapy in ICU settings with high prevalence of multidrug-resistant bacteria: a multicentre prospective observational cohort study in patients with sepsis or septic shock.

Background: De-escalation of empirical antimicrobial therapy, a key component of antibiotic stewardship, is considered difficult in ICUs with high rates of antimicrobial resistance.

Objectives: To assess the feasibility and the impact of antimicrobial de-escalation in ICUs with high rates of antimicrobial resistance.

Methods: Multicentre, prospective, observational study in septic patients with documented infections.

Complete Surgical Enucleation of a Giant Chylous Mesenteric Cyst.

Mesenteric cysts are rare benign abdominal tumors, and they can appear anywhere in the mesentery of the gastrointestinal tract, from the duodenum to the rectum. They are generally asymptomatic and may present as an incidental finding. The diagnosis is confirmed by the laparotomy findings and the results of the histopathological examination.

Changes in End-of-Life Practices in European Intensive Care Units From 1999 to 2016.

Importance: End-of-life decisions occur daily in intensive care units (ICUs) around the world, and these practices could change over time.

Objective: To determine the changes in end-of-life practices in European ICUs after 16 years.

Design, Setting, And Participants: Ethicus-2 was a prospective observational study of 22 European ICUs previously included in the Ethicus-1 study (1999-2000).

Leptomeningeal metastases originated from esophagogastric junction/gastric cancer: A brief report of two cases.

Leptomeningeal carcinomatosis is a very rare manifestation in patients diagnosed with esophagogastric junction and gastric cancer. Its prognosis is ominous and therapy outcomes are disappointing. Herein, we present two patients; one initially diagnosed with gastric cancer and leptomeningeal carcinomatosis but no other evidence of metastatic disease and the other one initially diagnosed with esophagogastric junction cancer, who recurred solitary with leptomeningeal seedings several years after the initial diagnosis and treatment.

Mechanical stress affects methylation pattern of GNAS isoforms and osteogenic differentiation of hAT-MSCs.

Mechanical stress exerts a substantial role on skeletal-cell renewal systems, whereas accumulating evidence suggests that epigenetic mechanisms induce changes and differential gene expression. Although the underlying mechanisms remain to be fully elucidated, our study suggests that the influence of the long term mechanical stimulation elicits epigenetic modifications controlling osteogenic differentiation of human adipose tissue multipotential stromal cells (hAT-MSCs) and contributes to an accelerating in vitro osteogenesis. GNAS imprinting gene acts as a critical regulator of osteoblast differentiation and is implicated in human genetic disorders with pathological formation of ectopic-skeletal bone.

Symptoms of Cardiac Anxiety in Family Members of Intensive Care Unit Patients.

Background: Studies have shown an association between intensive care unit environments and symptoms of psychological distress in family members of critically ill patients.

Objective: To investigate levels of cardiac anxiety in family members of intensive care unit patients.

Methods: From March 2012 to July 2013, on the third day after the patient's admission, 223 family members of 147 patients completed the Cardiac Anxiety Questionnaire.

Synchronous occurrence of appendiceal mucinous cystadenoma, with colon adenocarcinoma and tubulovillous rectal adenoma: Management and review of the literature.

Appendiceal mucocele (AM) is a rare clinical entity comprising 8% of all appendiceal tumors, and it is seen in 0.2-0.3% of all appendectomy specimens.

Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review.

Acute respiratory distress syndrome (ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mortality. The mainstay of treatment for ARDS is lung protective ventilation with low tidal volumes and positive end-expiratory pressure sufficient for alveolar recruitment.

Rectal neuroendocrine tumor with uncommon metastatic spread: A case report and review of literature.

Neuroendocrine tumors of the gastrointestinal tract are rare neoplasms. Rectal neuroendocrine tumors consist approximately the 5%-14% of all neuroendocrine neoplasms in Europe. These tumors are diagnosed in relatively young patients, with a mean age at diagnosis of 56 years.

Scalp metastasis as the first sign of small-cell lung cancer: management and literature review.

Cutaneous metastasis from primary visceral malignancy is a relatively uncommon clinical entity, with a reported incidence ranging from 0.22% to 10% among various series. However, the presence of cutaneous metastasis as the first sign of a clinically silent visceral cancer is exceedingly rare.

Synchronous occurrence of breast cancer and pulmonary sclerosing hemangioma: management and review of the literature.

Pulmonary sclerosing hemangioma (PSH) is a rare tumor accounting for 0.2-1% of all primary lung tumors. Simultaneous occurrence of PSH with breast cancer has very rarely been reported in the literature.

Rapidly growing myofibroblastoma of the breast diagnosed in a premenopausal woman: management and review of the literature.

Myofibroblastoma of the breast (MFB) is a rare benign tumor of mesenchymal origin with only 80 cases reported in the literature so far. It most commonly occurs in elderly males and postmenopausal females and grows slowly over a period of months to years. In this study we describe a very rare case of a MFB in a premenopausal woman who presented with a rapidly growing breast mass.

Treatment of toxic epidermal necrolysis with the combination of infliximab and high-dose intravenous immunoglobulin.

Background: Therapeutic evidence for toxic epidermal necrolysis (TEN) is indicative for high-dose intravenous immunoglobulin yet inconclusive for corticosteroids.

Objective: To describe the combination of corticosteroids, infliximab and a high-dose intravenous immunoglobulin course for TEN.

Patients And Methods: In three patients (SCORTEN survival probabilities: 41.

Comparison of Oligon catheters and chlorhexidine-impregnated sponges with standard multilumen central venous catheters for prevention of associated colonization and infections in intensive care unit patients: a multicenter, randomized, controlled study.

Objective: To evaluate silver-impregnated (Oligon) central venous catheters and chlorhexidine-gluconate-impregnated sponges for reducing catheter-related colonization and infection, nonbacteremic or bacteremic.

Design: Multicenter, prospective, randomized, controlled study.

Setting: Five general intensive care units in Greece.

Synchronous occurrence of neuroendocrine colon carcinoma and hairy cell leukemia.

Unlabelled: BACKGROUND-PURPOSE: The risk of secondary malignancy development in patients with hairy cell leukemia has been evaluated in several studies with varying results. The aim of this study is to describe a case of synchronous occurrence of neuroendocrine colon carcinoma and hairy cell leukemia.

Methods: A 69-year-old man presented with rectal bleeding.

Inhaled activated protein C protects mice from ventilator-induced lung injury.

Introduction: Activated Protein C (APC), an endogenous anticoagulant, improves tissue microperfusion and endothelial cell survival in systemic inflammatory states such as sepsis, but intravenous administration may cause severe bleeding. We have thus addressed the role of APC delivered locally by inhalation in preventing acute lung injury from alveolar overdistention and the subsequent ventilator-induced lung injury (VILI). We also assessed the effects of APC on the activation status of Extracellular- Regulated Kinase 1/2 (ERK) pathway, which has been shown to be involved in regulating pulmonary responses to mechanical stretch.

The role of apoptosis in the pathophysiology of Acute Respiratory Distress Syndrome (ARDS): an up-to-date cell-specific review.

ARDS pathophysiology is characterized by complex mechanisms that involve cells of inflammation, lung tissue cells, cytokines, chemokines, as well as apoptosis activators and inhibitors. There are two important theories that link apoptosis with ARDS and suggest that epithelial cell apoptosis, as well as the accumulation of neutrophils in the lung, may contribute to a cascade of events and, finally, ARDS. The activation of the Fas/FasL pathway is an important mechanism of alveolar epithelial injury in the lungs of patients with ALI.

Diffuse large B cell lymphoma of the mesentery: an unusual presentation and review of the literature.

Introduction: Diffuse large B cell lymphoma is the most commonly diagnosed non-Hodgkin's lymphoma, whereas lymphoma is the most common cause of mesenteric masses. We herein present a very rare case of a young male patient with a giant diffuse large B cell lymphoma of the mesentery that was incidentally diagnosed during his admission for a road traffic accident.

Materials And Methods: At laparotomy, a huge tumor measuring 18 x 14 x 10 cm was found originating from the jejunal mesentery.

Breast cancer associated with type 1 neurofibromatosis.

The association between breast cancer and type 1 neurofibromatosis (NF1) is a rare clinical entity. We herein present the case of a 59-year-old woman, with typical clinical manifestations of NF1, who presented with a painless lump in her right breast, which she had first noticed 8 months earlier. Clinical examination and diagnostic workup were suggestive of a breast carcinoma, and a modified radical mastectomy was performed.

Ventricular arrhythmias and antioxidative medication: experimental study.

Introduction: Reperfusion arrhythmias could be due to free radicals, while contraction excitation feedback is the cause of arrhythmias generated by blood pressure elevation (BPE). The aim of this study was to test the antiarrhythmic effects of an antioxidant (vitamin C [vit C], 1.5 g), an iron-binding agent (deferoxamine [Def], 1 g), and their combination in an experimental model of arrhythmia based on these 2 mechanisms.

Prone position augments recruitment and prevents alveolar overinflation in acute lung injury.

Rationale: Mechanical ventilation in the prone position may be an effective means of recruiting nonaerated alveolar units and minimizing ventilation-induced lung injury.

Objectives: To evaluate and quantify regional lung volume alterations when patients with lobar or diffuse acute lung injury (ALI) were turned prone after a recruitment maneuver.

Methods: In 21 patients with ALI, a recruitment maneuver was applied in the supine position followed by a multislice spiral computed tomography (CT) scan; then, patients were turned prone and a second CT scan was performed.