Model-based Estimators of QT Series Time Delay in Following Heart-Rate Changes

Sudden cardiac death is the leading cause of death among cardiovascular diseases. Markers for patient risk stratification focusing on QT-interval dynamics in response to heart-rate (HR) changes can be characterized in terms of parametric QT to RR dependence and QT/RR hysteresis. The QT/RR hysteresis can be quantified by the time delay the QT interval takes to accommodate for the HR changes. The exercise stress test has been proposed as a proper test, with large HR dynamics, to evaluate the QT/RR hysteresis. The present study aims at evaluating several time-delay estimators based on noise statistic (Gaussian or Laplacian) and HR changes profile at stress test (gradual transition change). The estimator's performance was assessed on a simulated QT transition contaminated by noise and in a clinical study including patients affected by coronary arteries disease (CAD). As expected, the Laplacian and Gaussian estimators yield the best results when noise follows the respective distribution. Further, the Laplacian estimator showed greater discriminative power in classifying different levels of cardiac risk in CAD patients, suggesting that real data fit better the Laplacian distribution than the Gaussian one. The Laplacian estimator appears to be the choice for time-delay estimation of QT/RR hysteresis lag in response to HR changes in stress test.Clinical Relevance-The proposed time-delay estimator of QT/RR hysteresis lag improves its significance as biomarkers for coronary artery diseases risk stratification.

Ratio Indexes Based on Spectral Electroencephalographic Brainwaves for Assessment of Mental Involvement: A Systematic Review

BACKGROUND

This review systematically examined the scientific literature about electroencephalogram-derived ratio indexes used to assess human mental involvement, in order to deduce what they are, how they are defined and used, and what their best fields of application are. (2) Methods: The review was carried out according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. (3) Results: From the search query, 82 documents resulted. The majority (82%) were classified as related to mental strain, while 12% were classified as related to sensory and emotion aspects, and 6% to movement. The electroencephalographic electrode montage used was low-density in 13%, high-density in 6% and very-low-density in 81% of documents. The most used electrode positions for computation of involvement indexes were in the frontal and prefrontal cortex. Overall, 37 different formulations of involvement indexes were found. None of them could be directly related to a specific field of application. (4) Conclusions: Standardization in the definition of these indexes is missing, both in the considered frequency bands and in the exploited electrodes. Future research may focus on the development of indexes with a unique definition to monitor and characterize mental involvement.

Physiological and Biomechanical Monitoring in American Football Players: A Scoping Review

American football is the sport with the highest rates of concussion injuries. Biomedical engineering applications may support athletes in monitoring their injuries, evaluating the effectiveness of their equipment, and leading industrial research in this sport. This literature review aims to report on the applications of biomedical engineering research in American football, highlighting the main trends and gaps. The review followed the PRISMA guidelines and gathered a total of 1629 records from PubMed (n = 368), Web of Science (n = 665), and Scopus (n = 596). The records were analyzed, tabulated, and clustered in topics. In total, 112 studies were selected and divided by topic in the biomechanics of concussion (n = 55), biomechanics of footwear (n = 6), biomechanics of sport-related movements (n = 6), the aerodynamics of football and catch (n = 3), injury prediction (n = 8), heat monitoring of physiological parameters (n = 8), and monitoring of the training load (n = 25). The safety of players has fueled most of the research that has led to innovations in helmet and footwear design, as well as improvements in the understanding and prevention of injuries and heat monitoring. The other important motivator for research is the improvement of performance, which has led to the monitoring of training loads and catches, and studies on the aerodynamics of football. The main gaps found in the literature were regarding the monitoring of internal loads and the innovation of shoulder pads.

Wearable and Portable Devices for Acquisition of Cardiac Signals while Practicing Sport: A Scoping Review

Wearable and portable devices capable of acquiring cardiac signals are at the frontier of the sport industry. They are becoming increasingly popular for monitoring physiological parameters while practicing sport, given the advances in miniaturized technologies, powerful data, and signal processing applications. Data and signals acquired by these devices are increasingly used to monitor athletes' performances and thus to define risk indices for sport-related cardiac diseases, such as sudden cardiac death. This scoping review investigated commercial wearable and portable devices employed for cardiac signal monitoring during sport activity. A systematic search of the literature was conducted on PubMed, Scopus, and Web of Science. After study selection, a total of 35 studies were included in the review. The studies were categorized based on the application of wearable or portable devices in (1) validation studies, (2) clinical studies, and (3) development studies. The analysis revealed that standardized protocols for validating these technologies are necessary. Indeed, results obtained from the validation studies turned out to be heterogeneous and scarcely comparable, since the metrological characteristics reported were different. Moreover, the validation of several devices was carried out during different sport activities. Finally, results from clinical studies highlighted that wearable devices are crucial to improve athletes' performance and to prevent adverse cardiovascular events.

Review on Cardiorespiratory Complications after SARS-CoV-2 Infection in Young Adult Healthy Athletes

This review analyzes scientific data published in the first two years of the COVID-19 pandemic with the aim to report the cardiorespiratory complications observed after SARS-CoV-2 infection in young adult healthy athletes. Fifteen studies were selected using PRISMA guidelines. A total of 4725 athletes (3438 males and 1287 females) practicing 19 sports categories were included in the study. Information about symptoms was released by 4379 (93%) athletes; of them, 1433 (33%) declared to be asymptomatic, whereas the remaining 2946 (67%) reported the occurrence of symptoms with mild (1315; 45%), moderate (821; 28%), severe (1; 0%) and unknown (809; 27%) severity. The most common symptoms were anosmia (33%), ageusia (32%) and headache (30%). Cardiac magnetic resonance identified the largest number of cardiorespiratory abnormalities (15.7%). Among the confirmed inflammations, myocarditis was the most common (0.5%). In conclusion, the low degree of symptom severity and the low rate of cardiac abnormalities suggest that the risk of significant cardiorespiratory involvement after SARS-CoV-2 infection in young adult athletes is likely low; however, the long-term physiologic effects of SARS-CoV-2 infection are not established yet. Extensive cardiorespiratory screening seems excessive in most cases, and classical pre-participation cardiovascular screening may be sufficient.

Systematic review of clinical evidence on postoperative delirium: literature search of original studies based on validated diagnostic scales

BACKGROUND

Postoperative delirium is a serious complication that can occur within the 5th postoperative day. In 2017, the European Society of Anesthesiologists delivered dedicated guidelines that reported the need for routine monitoring using validated scales.

OBJECTIVE

Aim of this systematic review is to identify clinical studies related to postoperative delirium that included postoperative monitoring with validated scales.

DESIGN

Systematic review METHODS: Searched keywords included the following terms: postoperative, postsurgical, post anesthesia, anesthesia recovery, delirium, and confusion. Two researchers independently screened retrieved studies using a data extraction form.

RESULTS

Literature search led to retrieve 6475 hits; of these, 260 studies (5.6% of the retrieved), published between 1987 and 2021, included in their methods a diagnostic workup with the use of a postoperative delirium validated scale and monitored patients for more than 24 h, therefore are qualified to be included in the present systematic review.

CONCLUSION

In conclusion, available clinical literature on postoperative delirium relies on a limited number of studies, that included a validated diagnostic workup based on validated scales, extracted from a large series of studies that used inconsistent diagnostic criteria. In order to extract indications based on reliable evidence-based criteria, these are the studies that should be selectively considered. The analysis of these studies can also serve to design future projects and to test clinical hypothesis with a more standardized methodological approach.

Antibiotic-free farming for poultry meat production: impact on animal welfare

Background

Multidrug-resistant zoonotic pathogens represent a risk for human health. The irrational use of antibiotics in production animals has contributed to the spread of antibiotic resistance (AMR) also in humans. The search for alternative systems to the use of antibiotics, including the study of ‘animal welfare-friendly' management tools, should be encouraged. The reduction of the use of antibiotics should be a controlled process, as their absence could have a negative impact on animal welfare, if not accompanied by adequate structural and managerial interventions.

Methods

Welfare Quality® protocol was used to measure the level of welfare in 14 batches of broiler chickens from 6 farms of an integrated poultry company and the results were compared (antibiotic-free vs conventional). The number of animals per batch ranged from 9,000 to 41,700. Assessments were made throughout a 9-month period, from 2018 to 2019, at-farm the day before slaughtering (age from 42 to 48 days old).

Results

No statistically significant differences between antibiotic-free and conventional in the general ‘welfare score' were reported. Stocking density was higher in antibiotic-free batches, and the ‘good feeding' principle was averagely higher in conventional batches (74.7 vs 63), with statistical significance (t=-2.45; p < 0.05). Other welfare principles (good housing, good health and appropriate behaviour) were slightly higher for antibiotic-free batches, without statistical significance. The absence of antibiotics did not affect the ‘good health' principle, ranging from 24.1 to 44.7, with the minimum in a conventional batch and the maximum detected in an antibiotic-free batch. The highest mortality (3.9%) was found in a conventional batch.

Conclusions

The absence of antibiotics in broiler farming doesn't affect animal health and welfare if associated with good management practices. Antibiotic-free farming should be standardized in order to protect both animal welfare and consumers' health.

Key messages

The absence of antibiotic use does not impact on broiler chicken general welfare score. High stocking density due to the high demand of antibiotic-free meat should be avoided and specific guidelines for antibiotic-free farming should be produced.

Resumption of ovarian activity following removal of a 4.7 mg deslorelin implant in queens

Deslorelin implants are widely used in felines. Due to their prolonged duration cat breeders frequently request early implant removal. The interval between deslorelin implant removal and resumption of ovarian function in queens is unknown. The aim of this study was to evaluate the interval between the removal of a deslorelin implant and the resumption of ovarian activity in adult queens. Twenty-three queens were treated with a 4.7 mg deslorelin implant placed in the periumbilical area. In the 16 queens completing the study implants were surgically removed at 3, 6 or 9 months (n = 6, 4 and 6 queens, respectively). Queens received a GnRH stimulation test as part of their pre-treatment general and reproductive health check. Following implantation treatment, all queens in inter-oestrus-anoestrus at the time of treatment came in oestrus within 2-5 days. Starting 7-14 days following implant removal queens were checked every 1-2 weeks with reproductive ultrasonography, a vaginal smear and blood collection. The interval to resumption of ovarian function ranged from 3 to 7 weeks irrespective of treatment length and age of the queen but was longer when the implant was removed at decreasing photoperiod (p < .05). In conclusion, at least 3 weeks post-removal are needed during increasing photoperiod to achieve follicular development and oestrogen production sufficient to support oestrous behaviour in queens following removal of a 4.7 mg deslorelin implant, while this time may increase up to 7 weeks during decreasing photoperiod. Further studies are needed to assess the interval between removal of a deslorelin implant and occurrence of ovulation as well as fertility at the first oestrus after a deslorelin treatment.

Initial Investigation of Athletes’ Electrocardiograms Acquired by Wearable Sensors during the Pre-exercise Phase

Aim:

The aim of this study is to support large-scale prevention programs fighting sport-related sudden cardiac death by providing a set of electrocardiographic features representing a starting point in the development of normal reference values for the pre-exercise phase.

Background:

In people with underlying, often unknown, cardiovascular abnormalities, increased cardiovascular load during exercise can trigger sport-related sudden cardiac death. Prevention remains the only weapon to contrast sport-related sudden cardiac death. So far, no reference values have been proposed for electrocardiograms of athletes acquired with wearable sensors in the pre-exercise phase, consisting of the few minutes immediately before the beginning of the training session.

Objective:

To perform an initial investigation of athletes’ electrocardiograms acquired by wearable sensors during the pre-exercise phase.

Methods:

The analyzed electrocardiograms, acquired through BioHarness 3.0 by Zephyr, belong to 51 athletes (Sport Database and Cycling Database of the Cardiovascular Bioengineering Lab of the Università Politecnica delle Marche, Italy). Preliminary values consist of interquartile ranges of six electrocardiographic features which are heart rate, heart-rate variability, QRS duration, ST level, QT interval, and corrected QT interval.

Results:

For athletes 35 years old or younger, preliminary values were [72;91]bpm, [26;47]ms, [85;104]ms, [-0.08;0.08]mm, [326;364]ms and [378;422]ms, respectively. For athletes older than 35 years old, preliminary values were [71;94]bpm, [16;65]ms, [85;100]ms, [-0.11;0.07]mm, [330;368]ms and [394;414]ms, respectively.

Conclusion:

Availability of preliminary reference values could help identify those athletes who, due to electrocardiographic features out of normal ranges, are more likely to develop cardiac complications that may lead to sport-related sudden cardiac death.

Progesterone-responsive vaginal leiomyoma and hyperprogesteronemia due to ovarian luteoma in an older bitch

Background

This is the first report about a vaginal leiomyoma concomitant with an ovarian luteoma in a bitch.

Case presentation

A 11-year-old intact female Labrador retriever was referred because of anuria, constipation and protrusion of a vaginal mass through the vulvar commissure. The bitch had high serum progesterone concentration (4.94 ng/ml). Because of the possibility of progesterone responsiveness causing further increase of the vaginal mass and since the bitch was a poor surgical candidate a 10 mg/kg aglepristone treatment was started SC on referral day 1. A computerized tomography showed a 12.7 × 6.5 × 8.3 cm mass causing urethral and rectal compression, ureteral dilation and hydronephrosis. A vaginal leiomyoma was diagnosed on histology. As serum progesterone concentration kept increasing despite aglepristone treatment, a 0.02 ng/mL twice daily IM alfaprostol treatment was started on day 18. As neither treatment showed remission of clinical signs or luteolysis, ovariohysterectomy was performed on referral day 35. Multiple corpora lutea were found on both ovaries. On histology a luteoma was diagnosed on the left ovary. P4 levels were undetectable 7 days after surgery. Recovery was uneventful and 12 weeks after surgery tomography showed a reduction of 86.7% of the vaginal mass. The bitch has been in good health and able to urinate without any complication ever since.

Conclusions

This case demonstrates the importance of identifying progesterone related conditions as well as the importance of judiciously using a combined medical and surgical approach.

Annotation dataset of the cardiotocographic recordings constituting the "CTU-CHB intra-partum CTG database"

The proposed dataset provides annotations for the 552 cardiotocographic (CTG) recordings included in the publicly available "CTU-CHB intra-partum CTG database" from Physionet (https://physionet.org/content/ctu-uhb-ctgdb/1.0.0/). Each CTG recording is composed by two simultaneously acquired signals: i) the fetal heart rate (FHR) and ii) the maternal tocogram (representing uterine activity). Annotations consist in the detection of starting and ending points of specific CTG events on both FHR signal and maternal tocogram. Annotated events for the FHR signal are the bradycardia, tachycardia, acceleration and deceleration episodes. Annotated events for the maternal tocogram are the uterine contractions. The dataset also reports classification of each deceleration as early, late, variable or prolonged, in relation to the presence of a uterine contraction. Annotations were obtained by an expert gynecologist with the support of CTG Analyzer, a dedicated software application for automatic analysis of digital CTG recordings. These annotations can be useful in the development, testing and comparison of algorithms for the automatic analysis of digital CTG recordings, which can make CTG interpretation more objective and independent from clinician's experience.

Enhanced recovery pathways in colorectal surgery: a consensus paper by the Associazione Chirurghi Ospedalieri Italiani (ACOI) and the PeriOperative Italian Society (POIS)

Enhanced Recovery After Surgery (ERAS) pathway is a multi-disciplinary, patient-centered protocol relying on the implementation of the best evidence-based perioperative practice. In the field of colorectal surgery, the application of ERAS programs is associated with up to 50% reduction of morbidity rates and up to 2.5 days reduction of postoperative hospital stay. However, widespread adoption of ERAS pathways is still yet to come, mainly because of the lack of proper information and communication. Purpose of this paper is to support the diffusion of ERAS pathways through a critical review of the existing evidence by members of the two national societies dealing with ERAS pathways in Italy, the PeriOperative Italian Society (POIS) and the Associazione Italiana Chirurghi Ospedalieri (ACOI), showing the results of a consensus development conference held at Matera, Italy, during the national ACOI Congress on June 10, 2019.

Aortic pseudoaneurysm after endarterectomy for small aorta syndrome

INTRODUCTION

Small Aorta Syndrome (SAS) or hypoplastic aorto-iliac syndrome is a rare pathology of the aorta that affects almost exclusively young or middle-aged women and is characterized by smaller dimension of the aorta and iliac axes. Etiopathogenesis is unclear and many factors have been invoked. The smaller caliber of the aorta and iliac arteries may predispose to aorto-iliac occlusive disease development. In the past aorto-iliac endarterectomy (AE) with patch closure was utilized as an alternative to surgical bypass in order to correct steno-obstructive syndromes affecting carriers of SAS. Little is known about long term outcomes of this type of surgery.

PRESENTATION OF THE CASE

During investigations for acute colecystitis, an aortic pseudoaneurysm (PA) was diagnosed by ultrasound in a 73 old year woman. She was submitted twenty-two years ago for SAS with disabling claudication to aortic endarterectomy (AE) with patch graft insertion. Considering all the vascular options available she was submitted to open surgery with replacement of the aortic bifurcation.

DISCUSSION

Aortic PA is a relatively common complication after bypass surgery but is rarely observed after AE. It requires prompt intervention to prevent subsequent complications such as rupture, thrombosis, distal embolism or aorto-enteric fistula.

CONCLUSION

Endovascular treatment for aortic PA should be always considered the treatment of choice but the open surgical option was preferred in this particular case because of the small diameters of the iliac accesses, making them unsuitable for an endovascular approach.

Use of the gonadotropin-releasing hormone (GnRH) stimulation test to monitor gonadal function in intact adult male cats

The gonadotropin-releasing hormone (GnRH) stimulation test is a common procedure used to investigate normality of the pituitary-gonadal axis in mammals. There is very little information on the technique, its efficacy and side effects in small animals and in particular no information for male cats. In dogs, such test is performed by intravenous (IV) administration. With cats, the number of times the animal needs to be restrained for blood sampling should be the least possible. The purpose of this study was to assess efficacy and side effects of the GnRH stimulation test in tomcats comparing the IV with the intramuscular (IM) route of administration. A GnRH stimulation test was performed in eight adult tomcats through IM or IV administration of 50 μg gonadorelin. The response of the pituitary-gonadal axis was assessed by measuring serum testosterone on blood samples collected prior to and 1 hr following treatment. When considering each single group of cats, the post-stimulation serum testosterone values were significantly higher than the pre-treatment ones (p < .05). When comparing the two groups of cats, basal testosterone concentrations did not differ, and also post-GnRH testosterone concentrations did not differ. In conclusion, in the cats of our study, the GnRH stimulation test produced the same results following the IM or the IV route of administration. Therefore, in tomcats, the IM route can be considered as effective as the IV one and should be preferred when doing a GnRH test.

Plasma endocannabinoid behaviour in total knee and hip arthroplasty

Endocannabinoids are a class of lipid mediators involved in a wide range of physiological pathways including pain perception, and immunological defences. In particular, the involvement of endocannabinoids in bone metabolism and bone resorption has recently been studied. Moreover, one study on total knee arthroplasty describes the probable role of endocannabinoids in pain perception after surgery. The aim of the present study was to evaluate variations of endocannabinoid concentrations in patients undergoing total hip or total knee arthroplasty before and after surgery. Sera from 23 patients were collected at three different times: before surgery and at two different times during rehabilitation, and endocannabinoids were quantified by HPLC-MS/MS analysis. Mean values of endocannabinoids in presurgical serum samples were: 6.11±0.5 ng/ml for N-palmitoylethanolamide, 1.39±0.08ng/ml for N-stearoylethanolamide, 4.84±0.04 ng/ml for N-oleoylethanolamide, 0.44±0.03ng/ml for N-arachidonoylethanolamide, 0.84±0.05ng/ml for N-linoleoylethanolamide, 0.17±0.01ng/ml for N-α-linolenoylethanolamide. Statistical analysis showed a significant decrease of all the endocannabinoids after surgery, while there were no remarkable differences between total hip and total knee arthroplasties or between genders. Moreover, the results show no significant correlation between endocannabinoid concentrations and C-reactive protein and Erythrocyte sedimentation rate. The present study shows for the first time a specific and univocal behaviour of six endocannabinoids and N-acylethanolamides in orthopaedic surgery, suggesting the endocannabinoid system as a possible pharmacological target for presurgical therapeutics.

Resonance artefacts in modern pressure monitoring systems

Resonance in pressure monitoring catheters is a well-known problem which was studied several years ago. Current piezoelectric devices have mechanical properties providing a resonance frequency and damping factor that theoretically assure resonance-free data. However, in particular cases, the coupling between the device, the catheter, and the vascular compliance of the patient could introduce artefacts in clinical settings leading to wrong pressure waveforms and values displayed in the monitor. In this research work we study a laboratory model of a clinical setting to evaluate in which cases the compound (catheter and device) could cause resonances in an unacceptable range. The classical pop-test is expanded for analysing the effect of the catheter. Results indicate that the presence of different catheters may alter significantly the acquired signal, up to an unacceptable level. Particular care should be used in the selection of the appropriate catheter. In particular, smaller diameters introduce higher damping coefficient that could help in avoiding undesired oscillations.

Postoperative acute kidney injury

Acute kidney injury (AKI) represents 18-47% of all causes of hospital-acquired AKI and it is associated with a high incidence of morbidity and mortality especially in patients requiring dialysis. Only recently, with the application of new AKI classifications and guidelines (RIFLE, AKIN and KDIGO), a more accurate evaluation of the real incidence of kidney dysfunction in patients undergoing surgery has been detailed. In patients undergoing non-cardiac, non-vascular and non-thoracic surgery several independent preoperative and intraoperative predictors of AKI have been identified. Nonetheless, no measure for AKI prevention reached a high level of recommendation, although hemodynamic monitoring and goal-directed fluid management may limit perioperative AKI. Cardiac surgery-related AKI and cardiopulmonary bypass-related AKI have been extensively evaluated and several preventive and treatment strategies have been developed. Open and endovascular surgery-related AKI have been compared and hydration is currently the only preventive strategy with a substantial level of efficacy. In addition, AKI in thoracic surgery, overlooked in the past, has been evaluated, showing that it frequently complicates postoperative course of patients undergoing elective lung cancer resection. Multi-hit mechanisms (ischemia, inflammation, toxins) co-act on patients' predisposition (susceptibility). A multi-step approach is probably necessary to limit the incidence and the severity of postsurgery AKI patients, such as careful risk stratification, adoption of preventive measures and goal directed intraoperative algorithms. The present review will summarize the current literature about the epidemiology of postoperative AKI focusing on patient-related and technical-related risk factors, outcome and prevention strategies in different groups of surgeries.

Prescription of dialysis in pediatric acute kidney injury

Renal replacement therapy (RRT) is the most effective way of managing severe acute kidney injury (AKI) in critically ill patients. RRT application in children is currently increasing due to the progressive rise of severity of critical illness in these patients. The burden of mortality in RRT children with AKI significantly outweights 50% of the dialized patients (depending also on the diagnosis and on the presence of multiple organ dysfunction). Many aspects of pediatric AKI requiring RRT are currently uncertain or have never been investigated. Whereas much of the clinical information applied to the adult patients is commonly reported to pediatric critically ill children, recently a significant evolution of RRT technology and novel research on pediatric dialysis warranted interesting evidence and important innovation in this field. In particular, it is currently a matter of debate how pediatric dialysis should be prescribed, when it is indicated and which modality should be utilized. This review will describe different modalities currently available for pediatric RRT, the main mechanisms of solute and water removal, standard and innovative technology specifically relased for neonatal dialysis, the most common prescriptions applicable to dialized children, indications to start and stop RRT.

Effects of hydrogen sulfide (H2S) on mesenteric perfusion in experimental induced intestinal ischemia in a porcine model

INTRODUCTION

Insufficient mesenteric perfusion is a dramatic complication in critically ill patients. Hydrogen sulfide, a newly recognized endogenous gaseous mediator, acts as an intestinal vasoactive agent and seems to protect against mesenteric ischemic damage. We investigated whether sodium hydrogen sulfide, a hydrogen sulfide donor, can improve mesenteric perfusion in an experimental model of pigs, both in physiological and ischemic conditions.

METHODS

The study was conducted at Careggi University Hospital (Florence, IT). Fourteen male domestic pigs (≈10 Kg) were anesthetized and mechanically ventilated. Animals were randomized in control and ischemia groups. Mesenteric ischemia was induced with a positive end-expiratory pressure of 15 cmH2O. After mini-laparotomy, each animal received incremental doses of sodium hydrogen sulfide every 20 minutes. Perfusion of both the jejunal mucosa and sternal skin were measured by laser Doppler flowmeter, and systemic hemodynamic parameters were monitored.

RESULTS

In the control group, sodium hydrogen sulfide was able to significantly improve the mesenteric perfusion, showing a 50% increase from the baseline blood flow. In the ischemia group, NaHS-induced a two-fold increase of the mesenteric post-ischemic perfusion with a recovery up to 70% of pre- positive end-expiratory pressure mesenteric blood flow. Sodium hydrogen sulfide did not directly or indirectly (by blood flow redistribution) affect the sternal skin microcirculation, heart rates, or mean arterial pressure, suggesting a tissue-specific micro-vascular action.

CONCLUSIONS

In a porcine model, we observed a mesenteric perfusion recovery mediated by administration of hydrogen sulfide donor without affecting general hemodynamic.

A histological procedure to study fungal infection in the wax moth Galleria mellonella

The invertebrate model Galleria mellonella is a widely used factitious host to study the microbial pathogenesis in vivo. However, a specific procedure for the recovery and the processing of the infected tissues, important for a better understanding of the host-pathogen interactions, has not been reported to our knowledge. In the present study we describe a new procedure of fixation and processing of larval tissue that allows studying the larval topographic anatomy and assessing the morphological changes due to the fungal infection. Lepidopteran larvae were infected with Candida albicans strains displaying various biofilm-forming abilities. The whole larvae were then examined for tissue changes by histological techniques. We show that comparing cutting planes, serial transversal sections of paraffin-embedded larva result in better accuracy and information recovering. Using this technique, it was possible to preserve the integrity of G. mellonella internal structures allowing the detailed analysis of morphological differences in different experimental groups (i.e., healthy vs infected larvae). We were also able to study strain-related differences in the pathogenesis of C. albicans by observing the immune response elicited and the invasiveness of two isolates within the larval tissues. In general, by processing the whole larva and optimizing routinely histochemical stainings, it is possible to visualize and analyse infected tissues. Various degrees of pathogenicity (strain- or inoculum-related), and the infection time course can be described in details. Moreover, the host immune response events can be followed throughout the infectious process leading to a comprehensive picture of the studied phenomenon.

A solitary polypoid gastric metastasis 20 years after renal cell carcinoma: an event to be considered, and a brief review of the literature

BACKGROUND

The incidence of gastric metastasis is 2.6%. Although all primary neoplasms can metastasize to the stomach, most originate from melanoma or breast and lung cancer. Their most common endoscopic appearance is a "volcano-like" polypoid mass covered by normal mucosa that may show a central ulceration. Renal cell carcinoma, clear cell type, is known to spread hematogenously, and isolated metastasis to the stomach is a rare event.

CASE PRESENTATION

In this report, we describe a gastric recurrence of RCC, clear-cell type, in a 80-year-old patient who had undergone nephrectomy 20 years before. We also performed a brief review of the literature to update the number of cases described to date.

CONCLUSION

Metastatic involvement of the stomach should be suspected in any patient with a previous history of renal cell carcinoma, clear cell type, presenting with gastrointestinal symptoms, even if many years after nephrectomy. The peculiarity of our case is due to the very late presentation of the gastric metastasis. Only two cases of very late gastric metastases from RCC, clear cell type, have been described in the literature, to date.

Leiomyomatosis peritonealis disseminata: pregnancy, contraception and myomectomy of its pathogenesis

Leiomyomatosis peritonealis disseminata (LPD) is a rare smooth muscle tumour characterized by multiple small nodules on the omentum and peritoneal surface, composed of benign smooth muscle cells with minimal mitotic activity, frequently admixed with decidual cells. The possible pathogenetic mechanisms include hormonal dysfunction, differentiation of subperitoneal mesenchymal stem cells, myofibroblastic metaplasia and genetic and iatrogenic causes (resection of myomas during laparoscopic surgery). Diagnosis is easily made on biopsy specimens. Reduction of oestrogen exposure, surgical castration or gonadotrophin releasing hormone agonists are generally sufficient to cause regression of LPD. We report a case of an asymptomatic 36-year-old pregnant woman with long-term use of oral contraceptives, and previous myomectomy, who had a mass of uncertain origin which was, histopathologically, diagnosed as leiomyomatosis peritonealis diffusa with foci of ectopic decidua. Ectopic decidua was also present in a pelvic lymph node. To the best of our knowledge, this is the first case of LPD containing foci of ectopic decidua in a pregnant woman with a past history of myomectomy and use of oral contraception for three years; ectopic decidua was also detected in a pelvic lymph node.

Role of biopsy in low-grade laryngeal chondrosarcoma: report of two cases

Laryngeal chondrosarcomas are rare tumours that account for less than 1% of all sarcomas and originate principally from the crycoid cartilage. We report two cases: the former arising from thyroid cartilage in an 85-year-old male presenting with a palpable neck mass and hoarseness, dyspnoea and dysphagia; the other in a 54-year-old male with a mass growing from crycoid cartilage, who underwent biopsy followed by total laryngectomy. We discuss the peculiarity of the site of origin and the role of biopsy, the clinical presentation of the former case and the diagnostic and therapeutic procedures of the latter. Since it is a rare form of sarcoma arising in the larynx, we discuss the role of biopsy as a crucial although still controversial diagnostic tool.

Renal support

Renal support, intended as a refined and context-sensitive form of severe acute kidney injury management, might be achieved by administering renal replacement therapy with the correct timing and indication, correct prescription and, also, by the expertise and capacity of clinicians to tailor different RRTs to different patients. Furthermore, technical evolution and extended indications for extracorporeal treatments, currently allow the support of multiple organs, other than the isolated kidney failure. Unfortunately, current literature in the field of optimal management of severe acute kidney injury is controversial and lacks a standard of care. This review aims to describe the recent clinical, scientific and technical evolution of renal replacement therapy and the potential suggestive concept of multiple organ support therapy.

Effect of an injectable cabergoline formulation on serum prolactin (PRL) and milk secretion in early postpartum Beagle bitches

This study was conducted in order to evaluate effects on prolactin (PRL) concentration and mammary milk secretion of an injectable cabergoline formulation administered to five lactating Beagle bitches during early postpartum (PP). Bitches were bled twice daily (from PP day 3 to PP day 12) and then daily (from PP day 13 to PP day 16) to assay serum PRL. On PP day 6, a subcutaneous (SC) injection of 0.1 ml/kg of placebo was administered. On PP day 9, a SC 0.1 ml/kg dose of injectable cabergoline was administered. All bitches were checked for milk production, using a clinical scoring in order to quantify milk expression from each teat. A circadian variation of serum PRL was evident during the 6 days of pre-treatment monitoring. The day after cabergoline injection, an 80% decrease of PRL serum concentration was observed (p < 0.05). The circadian oscillatory pattern of PRL secretion disappeared after administration of cabergoline, and PRL values remained significantly lower than in the previous days for the first 60 h following treatment (p < 0.001). Milk production was drastically reduced when comparing pre-treatment to post-treatment scores (p < 0.001). A single dose of injectable cabergoline caused a significant reduction in serum PRL concentration and a significant reduction in milk flow. The injectable formulation of cabergoline appeared to be safe and well tolerated.

Glucose metabolism in cardiovascular surgery

During the past few years, it has become evident that metabolic control is a major determinant of postoperative outcomes, not only for diabetic patients but for all patients undergoing surgery.In cardiac and vascular surgery, myocardial ischemia is a common challenge and the management of hyperglycemia should be part of the strategy aimed at optimizing cardiac protection during these types of surgery, since performed in high risk patients. Little informations are available on the relation between glucose substrate and the type of anesthesia and few studies have been performed on glucose metabolism in the perioperative risk assessment as well as on intraoperative and post surgical management of hyperglycemia in patients submitted to cardiac and vascular surgery. Evidence exists that even slight increased in glycemia are detrimental for patients (diabetic and non) elective for cardiac and vascular surgery, though the precise details of the timing of insulin therapy, the desired target serum glucose level, and the duration of therapy are so far to be completely elucidated. Anesthestiologists can therefore affect outcome by simply preserving a normal blood glucose concentration initiating in the operating room. The challenge to optimize glucose control should begin during preoperative evaluation.

Metabolic and cardiovascular profile in patients with Addison's disease under conventional glucocorticoid replacement

OBJECTIVE

Although two studies have shown that Addison's disease (AD) is still a potentially lethal condition for cardiovascular, malignant, and infectious diseases, a recent retrospective study showed a normal overall mortality rate. Differently from secondary hypoadrenalism, scanty data exist on the role of conventional glucocorticoid replacement on metabolic and cardiovascular outcome in AD.

SUBJECTS AND METHODS

In 38 AD under conventional glucocorticoid replacement (hydrocortisone 30 mg/day or cortisone 37.5 mg/day) ACTH, plasma renin activity (PRA), DHEAS, fasting glucose and insulin, 2-h glucose after oral glucose tolerance test, serum lipids, 24-h blood pressure and intima-media thickness (IMT) were evaluated and compared with 38 age-, sex- and body mass index (BMI)-matched controls (CS).

RESULTS

AD had ACTH and PRA higher and DHEAS lower (p<0.0005) than CS. Mean waist was higher (p<0.05) in AD than in CS. Although no differences were found for mean gluco-lipids levels, a higher percentage of AD compared to CS were IGT (8 vs 0%), hypercholesterolemic (18 vs 8%), and hypertriglyceridemic (18 vs 8%); none of the AD and CS showed either HDL<40 mg/dl or LDL>190 mg/dl. At the multiple regression analysis, in both AD and CS, BMI was the best predictor of 2-h glucose and age of total and LDL cholesterol; in AD, no significant correlation was found between the above mentioned metabolic parameters and either hormone levels or disease duration. In both AD and CS 24-h blood pressure and IMT were normal.

CONCLUSIONS

Our study shows a higher prevalence of central adiposity, impaired glucose tolerance and dyslipidemia in AD patients.

Measuring fecal progestogens as a tool to monitor reproductive activity in captive female bottlenose dolphins (Tursiops truncatus)

The objective was to develop and test radioimmunoassays (RIAs) to measure fecal progestogens (P) and estrogens (E) to monitor ovarian activity in the bottlenose dolphin (Tursiops truncatus). Fecal samples were collected at least once a week for 20 mo from three peripubertal female bottlenose dolphins. Blood samples were collected at least once a month to compare serum and fecal steroid concentrations. Moreover, random fecal samples from three pregnant females, one lactating female, and one sexually mature female receiving oral altrenogest treatment were also collected. Fecal samples were collected behaviorally with a probe to avoid water contamination and extracted with petroleum ether (for P analysis) or diethyl ether (for E analysis). When possible, vaginal cytology and ovarian ultrasonography were used to monitor the estrous cycle. The RIA for fecal P had good reproducibility and negligible matrix effect. In addition, when fecal samples (N=25) were extracted with ethanol, the results with the two methods of extraction were highly correlated (r=0.923). Therefore, extraction of fecal samples with petroleum ether represented a valid alternative to other, more time-consuming methods of determining fecal P concentrations. In the absence of luteal activity, fecal P concentrations were consistently < 10 pmol/g feces, although they never decreased below 10 pmol/g during pregnancy. Thus, the threshold to confirm the presence of an active corpus luteum was provisionally set at 10 pmol/g. Around the onset of puberty, luteal phases appeared shorter and irregular in the bottlenose dolphin, as in other mammalian species. Additional HPLC-MS studies should be performed to identify predominant P metabolites to be used as fecal indicators of luteal activity in this species.