101,923 research outputs found
”Fluvastatin treatment inhibits leucocyte adhesion and extravasation in models of complement-mediated acute inflamation”F.Fischetti, R. Carretta, G. Borotto, P. Durigutto, R. Bulla, P.L. Meroni, F. Tedesco.
No full textAbstract
Complement activation plays a relevant role in the development of tissue damage under inflammatory conditions, and clinical and experimental observations emphasize its contribution to inflammatory vasculitides. Statins have recently been shown to reduce cardiovascular morbidity independently of plasma cholesterol lowering and in vitro studies support a direct anti-inflammatory action of these drugs. The aim of this study was to verify the in vivo effect of fluvastatin on complement-mediated acute peritoneal inflammation. The effect of oral treatment with fluvastatin was investigated in normo-cholesterolaemic rats that received intraperitoneal injection of either yeast-activated rat serum (Y-act RS) or lipopolysaccharide to induce peritoneal inflammation monitored by the number of PMN recruited in peritoneal fluid washes. In addition, vascular adherence and extravasation of leucocytes were evaluated by direct videomicroscopy examination on mesentery postcapillary venules topically exposed to Y-act RS. The number of PMN in the peritoneal washes of rats treated with fluvastatin was 38% lower than that of untreated animals (P < 0.05) 12 h after LPS injection, and was even lower (56%) in rats treated with Y-act RS already 8 h after injection (P < 0.02). Firm adhesion to endothelium and extravasation of leucocytes evaluated under direct videomicroscopy observation were significantly inhibited in fluvastatin treated rats (77% and 72%, respectively; P < 0.01), 120 min after treatment with Y-act RS. Our results demonstrate that fluvastatin inhibits in vivo complement-dependent acute peritoneal inflammation and suggest a role for statins in preventing the inflammatory flares usually associated with complement activation in chronic diseases, such as SLE or rheumatoid arthritis
Scoring system for the selection of high-risk patients in the intensive care unit
No full textObjective. Patients admitted to the intensive care unit greatly differ in severity and intensity of care. We devised a system for selecting high-risk patients that reduces bias by excluding low-risk patients and patients with an early death irrespective of the treatment. Design: A posteriori analysis of a multiple-center prospective observational trial. Setting: A total of 89 units from 12 European countries, with 12,615 patients. Intervention: Demographic and clinical data: severity of illness at admission, daily score of nursing workload, length of stay, and hospital mortality. Methods: We enrolled patients with intensive care unit length of stay of > 24 hrs. Three groups of high-risk patients were created: a) Severity group, those with Simplified Acute Physiology Score (SAPS II) over the median; b) Intensity-of-care group, patients with > 1 day of high level of care (assessed by logistic analysis); and c) MIX group, patients fulfilling both Severity and Intensity-of-care criteria. The groups were included in a logistic regression model (random split-sample design) to identify the characteristics associated with hospital mortality. We compared the outcome prediction of the SAPS II model (unsplit sample) against our model. Main Results. Out of 8,248 patients, the Severity method selected 3,838 patients, Intensity-of-care selected 4,244, and both methods combined selected 2,662 patients. There were 2,828 low-risk patients. Significant associations with hospital mortality were observed for: age, sites of admission, medical/unscheduled surgical admission, acute physiologic score of SAPS II, and the indicator variable "only Severity," "only Intensity-of-care," or MIX (developmental sample: calibration chi-square test, p = .205; area under the receiver operation characteristic curve, 0.814). Calibration and discrimination were better in our model than with the SAPS II model (unsplit sample). Conclusion: All three indicator variables select high-risk patients, the Severity/Intensity-of -care MIX being the most robust. These stratification criteria can improve case-mix selection for clinical and organizational studies
Evaluation of Oxidative Stress in Serum of Critically Ill Patients by a Commercial Assay and Gas Chromatography–Mass Spectrometry
No full textAnafilassi da allergia alle proteine del latte vaccino: clinica, storia naturale, challenge e desensibilizzazione orale
No full textFood allergy represents a major problem for children and the first cause of anaphylaxis in pediatric age. Cow milk and egg are the main offending in Europe both for allergy and anaphylaxis. Limited evidence from the literature suggests that protracted antigen avoiding may delay the acquisition of tolerance and that oral desensitization may be effective in children with food allergy. We describe our experience with oral desensitization in two groups of children. A group of 30 children with recent very severe episodes underwent to an original oral desensitization protocol during a 10 days permanence in the ward. Of these, 22 children reached a normal diet, 5 reached a limited amount of milk (3.5-45 ml), and 3 children could not proceed with the protocol because of persistent respiratory symptoms. No child experienced a very severe or life threatening reaction. A second group of 20 children with less severe allergy underwent to a standardized oral desensitization protocol at home after an open challenge. In group two, 10 of children reached a normal diet, 7 could tolerate reasonable amounts of milk, one developed a specific food aversion and 2 failed to proceed with the protocol. In conclusion, oral desensitization to milk was achieved in a significant percentage of children with a history of severe reactions or with moderate allergy. Symptomatic episodes during desensitization were almost the rule but were all easily managed both in hospital and at home. The cost benefit ratio of this approach in comparison to the actual standard recommendations is still to be determined
Performance determinants and flexible ICU organisation
No full textWe faced some of the most important aspects of the problem of the appropriateness of ICU resources use, that are the relationship between volume of activity and mortality, the analysis of cost-effectiveness in intensive care medicine, and the monitoring of the human resource use in ICU. For this aim three different surveys were utilized: one at European level, the second at country level and, third, a regional survey. After developing a new measure of volume called “high-risk volume”, we explored the relationship between outcome and volume, founding that such association was very strong (from 3 to 17–19% decrease in ICU/hospital mortality every five extra high-risk patients treated per bed per year), and that an occupancy rate larger than 80% was associated with higher mortality. Therefore, patients in all levels of risk are better treated in high-risk volume ICUs with a reasonable occupancy rate. Analysing cost-effectiveness in intensive care medicine using a national case-mix categorized in different diagnostic groups, we identified brain haemorrhage, ALI/ARDS and surgical unscheduled patients as users a high volume of monetary resources less efficiently, while the scheduled abdominal surgery patients admitted to receive intensive care and patients on the ICU for minor organ support made the best use of the fewer resources spent. Finally, we designed a new approach to measure the rate and appropriateness of nursing resource use in ICU on a daily basis. Testing this approach on a group of general non-specialist ICUs, we found that the method was powerful enough to adequately distinguish between “over” and “under-utilization” and to identify all the theoretical scenarios of nurse/resource utilization
Dimethylarginines (Asymmetric : ADMA, Symmetric : SDMA) metabolism and role in severe sepsis
No full textBibliographie Hilarion G. Petzold 1958 – 2009 mit Anhang als Einführung
No full textDieses Archiv enthält die Gesamtbibliographie der Werke des Autors nebst einiger Texte „Über H. G. Petzold“ im Schlussteil der Bibliographie sowie einen Anhang mit einer Einführung in die Architektur des Werkes in seinem wissenslogischen Aufbau als Ausarbeitung seines „Tree of Science Modells“ (2007).This archive contains the complete bibliography of the author and some texts about H. G. Petzold, moreover an epilogue with an introduction to the architecture of the works in its epistemological structure and composition and as an elaborations of Petzold’s „Tree of Science Modell (2007).https://www.fpi-publikation.de/polyloge/01-2009-petzold-h-g-gesamtbibliographie-h-g-petzold-1958-2009-updating-november2009/peerReviewedpublishedVersio
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