Midazolam increases preload dependency during endotoxic shock in rabbits by affecting venous vascular tone.

Background: Septic patients often require sedation in intensive care unit, and midazolam is one of the most frequently used sedatives among them. But the interaction between midazolam and septic shock is not known. The aim of this study is to investigate the effects of midazolam on preload dependency in an endotoxic shock model by evaluating systemic vascular tone and cardiac function.

Notch signaling and progenitor/ductular reaction in steatohepatitis.

Background And Objective: Persistent hepatic progenitor cells (HPC) activation resulting in ductular reaction (DR) is responsible for pathologic liver repair in cholangiopathies. Also, HPC/DR expansion correlates with fibrosis in several chronic liver diseases, including steatohepatitis. Increasing evidence indicates Notch signaling as a key regulator of HPC/DR response in biliary and more in general liver injuries.

SerpinB3 Promotes Pro-fibrogenic Responses in Activated Hepatic Stellate Cells.

SerpinB3 is a hypoxia- and hypoxia-inducible factor-2α-dependent cystein protease inhibitor that is up-regulated in hepatocellular carcinoma and in parenchymal cells during chronic liver diseases (CLD). SerpinB3 up-regulation in CLD patients has been reported to correlate with the extent of liver fibrosis and the production of transforming growth factor-β1, but the actual role of SerpinB3 in hepatic fibrogenesis is still poorly characterized. In the present study we analyzed the pro-fibrogenic action of SerpinB3 in cell cultures and in two different murine models of liver fibrosis.

Endotoxemia accelerates diaphragm dysfunction in ventilated rabbits.

Background: Ventilators may induce diaphragm dysfunction, and most of the septic population who are admitted to the intensive care unit require mechanical ventilation. However, there is no evidence that sepsis accelerates the onset of ventilator-induced diaphragm dysfunction or affects the microcirculation. Our study investigated whether lipopolysaccharide (LPS)-induced endotoxemia accelerated diaphragm dysfunction in ventilated rabbits by evaluating microcirculation, lipid accumulation, and diaphragm contractility.

New Setting of Neurally Adjusted Ventilatory Assist during Noninvasive Ventilation through a Helmet.

Background: Compared to pneumatically controlled pressure support (PSP), neurally adjusted ventilatory assist (NAVA) was proved to improve patient-ventilator interactions, while not affecting comfort, diaphragm electrical activity (EAdi), and arterial blood gases (ABGs). This study compares neurally controlled pressure support (PSN) with PSP and NAVA, delivered through two different helmets, in hypoxemic patients receiving noninvasive ventilation for prevention of extubation failure.

Methods: Fifteen patients underwent three (PSP, NAVA, and PSN) 30-min trials in random order with both helmets.

Combination of C-reactive protein, procalcitonin and sepsis-related organ failure score for the diagnosis of sepsis in critical patients.

Objective: To measure the ability of a new bioscore to diagnose sepsis in a general critical care population.

Methods: The study was done at an intensive care unit (ICU) from April to December 2012. Demographic and clinical patient information were recorded on admission to the ICU with blood samples taken for C-reactive protein (CRP), procalcitonin (PCT), interleukin-6, white blood cell count, as well as body temperature, age and the sepsis-related organ failure (SOFA) score.

Feasibility and usefulness of ultrasonography in idiopathic intracranial hypertension or secondary intracranial hypertension.

Background: Transorbital sonography (TOS) has been proven to be able to non-invasively detect elevated intracranial pressure. In this condition TOS shows an increase in optic nerve sheath diameter (ONSD). It has been suggested that internal jugular vein valve insufficiency (IJVVI) may represent a factor contributing to the pathogenesis of idiopathic intracranial hypertension (IIH).

Preoperative risk factors for prolonged postoperative ventilation following thymectomy in myasthenia gravis.

Unlabelled: Adequate preoperative evaluation and preparation for surgery are required to prevent prolonged mechanical ventilation after thymectomy, and facilitate the recovery of patients with myasthenia gravis (MG). The objective of this study was to identify the preoperative risk factors for extubation failure after thymectomy in patients with MG.

Methods: A retrospective study was conducted on 61 patients with MG who underwent extended thymectomy.

New versus Conventional Helmet for Delivering Noninvasive Ventilation: A Physiologic, Crossover Randomized Study in Critically Ill Patients.

Background: The helmet is a well-tolerated interface for noninvasive ventilation, although it is associated with poor patient-ventilator interaction. A new helmet (NH) has proven to attenuate this limitation of the standard helmet (SH) in both bench study and healthy volunteers. The authors compared a NH and a SH in intensive care unit patients receiving noninvasive ventilation for prevention of postextubation respiratory failure; both helmets were also compared with the endotracheal tube in place before extubation.

Ultrasonography of the Optic Nerve Sheath Diameter for Diagnosis and Monitoring of Acute Mountain Sickness: A Systematic Review.

Aims: Despite extensive research on acute mountain sickness (AMS), the underlying pathophysiology remains unclear. Ultrasonography studies have shown that optic nerve sheath diameter (ONSD) correlates with intracranial pressure (ICP) in critical care patients, and recent studies report elevated ONSD values at high altitude. The aim of this review was to elucidate whether 1.

Platelet GP IIb-IIIa Receptor Antagonists in Primary Angioplasty: Back to the Future.

Coronary artery disease and acute myocardial infarction still represent the leading cause of mortality in developed countries. Therefore, great efforts have been made in the last decades to improve reperfusion strategies and adjunctive antithrombotic therapies. In fact, despite optimal epicardial recanalisation, a large proportion of patients still experience impaired reperfusion and in-stent thrombosis.

Different effects of propofol and dexmedetomidine on preload dependency in endotoxemic shock with norepinephrine infusion.

Background: To clarify whether propofol (PROP) and dexmedetomidine (DEX) differentially affect preload dependency in an endotoxemic model based on evaluations of the systemic vascular system and cardiac function.

Methods: Animals were prepared under PiCCO monitoring (BL), and endotoxemic shock was induced using an intravenous bolus of lipopolysaccharide (055:B5) in 16 New Zealand ketamine-anesthetized rabbits. After fluid resuscitation and norepinephrine infusion (SD0), the animals were randomized to PROP (n = 8) or DEX (n = 8) sedation at two incremental doses (SD1 and SD2).

Neural versus pneumatic control of pressure support in patients with chronic obstructive pulmonary diseases at different levels of positive end expiratory pressure: a physiological study.

Introduction: Intrinsic positive end-expiratory pressure (PEEPi) is a "threshold" load that must be overcome to trigger conventional pneumatically-controlled pressure support (PSP) in chronic obstructive pulmonary disease (COPD). Application of extrinsic PEEP (PEEPe) reduces trigger delays and mechanical inspiratory efforts. Using the diaphragm electrical activity (EAdi), neurally controlled pressure support (PSN) could hypothetically eliminate asynchrony and reduce mechanical inspiratory effort, hence substituting the need for PEEPe.

B-mode transorbital ultrasononography for the diagnosis of acute optic neuritis. A systematic review.

Objective: In patients with acute optic neuritis (AON) transorbital sonography may reveal a thickening of the retrobulbar portion of the optic nerve. Our aim was to systematically review the diagnostic accuracy of ultrasonography of optic nerve diameter (OND) for assessment of AON.

Methods: MEDLINE, EMBASE (1966-October 2014) was searched to identify studies reporting data on patients with AON (with/without multiple sclerosis) assessed by B-mode transorbital ultrasonography.

The role of the induction of mild hypothermia in adult patient outcomes after cardiac arrest: Systematic review and meta-analysis of randomized controlled studies.

Objective: To determine whether patients with return of spontaneous circulation (ROSC) following cardiac arrest who received mild hypothermia have improved mortality and neurological outcomes compared with those who do not receive mild hypothermia.

Methods: Online database searches were performed for English-language randomized controlled trials published before March 2014, comparing mild hypothermia (32-34℃) with normothermia or hypothermia other than mild hypothermia after cardiac arrest, in adults with ROSC. Data were independently extracted using a dedicated form.

Bench Comparative Assessment of Mechanically Assisted Cough Devices.

Background: Mechanically assisted cough devices are used in patients with impaired cough to avoid secretion accumulation. We compared 5 mechanically assisted cough devices by bench testing using a breathing simulator and assessed their user-friendliness.

Methods: We measured inspiratory and expiratory airway pressures and peak expiratory flow, the strongest indicator of cough efficacy.

Multicenter Semiquantitative Evaluation of (123)I-FP-CIT Brain SPECT.

Aims: The aims of this study were: (1) to cross-compare data from semiquantitative, software-assisted, and phantom-corrected evaluations of (123)I-ioflupane [(123)I]N-ω-fluoropropyl-2β-carbomethoxy-3β-{4-iodophenyl}nortropane FP-CIT brain single-photon emission computed tomography (SPECT) acquired in three centers; (2) to assess the accuracy of semiquantitative evaluation; and (3) to identify the threshold with the best accuracy, sensitivity, and specificity in patients with suspected Parkinsonian Syndrome.

Material And Methods: Two-hundred-twenty patients, acquired in three centers, were included. All of them underwent (123)I-FP-CIT brain SPECT.

Neurokinin (NK)-1 receptor expression in monocytes from bipolar disorder patients: a pilot study.

Background: Neurokinin 1 receptors (NK-1R) have been involved in several psychiatric disorders including major depression, but less is known for bipolar disorder (BD).

Method: We compared NK-1R expression and Substance P (SP) ability to induce NF-κB activation in monocytes from BD patients and healthy donors (HD), also looking for the effects of tobacco smoke. After informed written consent, 20 euthymic BD patients, either bipolar type 1 (BDI) or type 2 (BDII), and 14 age-matched healthy donors (HD) were enrolled.

Characterization of the anti-inflammatory properties of NCX 429, a dual-acting compound releasing nitric oxide and naproxen.

Aims: Cyclooxygenase (COX)-inhibiting nitric oxide donors (CINODs) are a new class of drugs that structurally combine a COX inhibitor with a nitric oxide (NO) donating moiety. This combination reduces potential toxicity of the non-steroidal anti-inflammatory drugs (NSAIDs) whilst maintaining the analgesic and anti-inflammatory effects. The present study was undertaken to investigate the anti-inflammatory effects of NCX 429, a naproxen-based CINOD, and to assess the additional properties of NO donation beyond those related to naproxen.

Recent Advances in Optimal Adjunctive Antithrombotic Therapy in STEMI Patients Undergoing Primary Angioplasty: An Overview.

There has been a considerable effort to improve adjunctive antithrombotic therapies to reperfusion strategies in the treatment of ST-segment elevation Myocardial Infarction (STEMI). Therefore, the aim of this article is to provide a critical and updated overview of recent advances on adjunctive antithrombotic therapies in patients undergoing primary angioplasty for STEMI. Due to very low costs, early Unfractionated Heparin (UFH) plus additional periprocedural administration should still be regarded as the gold standard in antithrombotic therapy, whereas subsequent subcutaneous administration of Low Molecular Weight Heparins (LMWHs) or fondaparinux should be considered, especially in patients at higher risk of thromboembolic complications.

Oronasal mask versus helmet in acute hypercapnic respiratory failure.

The choice of the interface for noninvasive ventilation (NIV) is a key factor in NIV success. We hypothesised that a new helmet specifically design to improve performance in hypercapnic patients would be clinically equivalent to a standard oronasal mask. In a multicentre, short-term, physiological, randomised trial in chronic obstructive pulmonary disease patients facing an acute hypercapnic respiratory failure episode, we compared the changes in arterial blood gases (ABGs) and tolerance score obtained using the helmet or mask, and, as secondary end-points, dyspnoea, vital signs, early NIV discontinuation and rate of intubation.