1,721,008 research outputs found
Studio dei meccanismi coinvolti nel "ventilator-induced lung injury"
Full text linkIntroduction. Mechanical ventilation (MV) represented a fundamental step forward in the care of patients in both intensive care and anesthesia. Unfortunately, it can exacerbate, or even initiate, acute lung injury. Many mechanically ventilated patients with Acute Respiratory Distress Syndrome (ARDS) go on to develop pulmonary fibrosis. We hypothesized that the MV may contribute to the development of this fibrosis through different mechanisms.
Materials and methods. In vitro. Human alveolar epithelial cells BEAS-2B were subjected to cyclic mechanical stretch for 24 or 48 hours, and then the expression of epithelial and mesenchymal markers was analyzed. In vivo. Mice C57 BL/6 were randomized to 4 treatments: healthy controls; inhalation of hydrochloric acid (HCl) inhalation of control solution followed 24 hours later by MV; inhalation of HCl followed 24 hours later by MV. Treated animals were then followed for periods of 3, 8 and 15 days after inhalation. We analyzed lung mechanics, lung histology, circulating fibrocytes, the quantities of hydroxyproline as well as the expression of epithelial and mesenchymal markers in the lungs.
Results. In vitro. The cyclic mechanical stretch in BEAS-2B cells resulted a in reduction in the expression of epithelial markers cytokeratin 8, E-cadherin and pro-surfactant protein B (proSPB), and increased expression of TGF-β1 and β-catenin and of the mesenchymal markers α-SMA and vimentin A. In vivo. MV, alone or in combination with the inhalation of HCl, resulted in altered lung mechanics, an increase of hydroxyproline content and expression of TGF-β1, β-catenin and the mesenchymal markers α-SMA and vimentin A, and a decrease in the expression of the epithelial markers cytokeratin 8, E-cadherin and proSPB. The circulating fibrocytes count was not affected by MV. Histological examination showed increased pulmonary fibrosis in treated animals and potential epithelial-mesenchymal transition after inhalation of HCl followed by MV.
Conclusions. Mechanical stress causes pulmonary fibrosis, and the phenomenon of epithelial-mesenchymal transition may play a role in this process. If the results of our work are confirmed, the modulation of the fibrotic response in patients who require MV may represent an important new therapeutic target to investigate.Introduzione. La ventilazione meccanica (MV) ha rappresentato un fondamentale passo avanti nell’assistenza dei pazienti sia in terapia intensiva sia in anestesia. Purtroppo però essa può esacerbare, o addirittura iniziare, un danno polmonare acuto. Molti pazienti con Acute Respiratory Distress Sindrome (ARDS) ventilati meccanicamente sviluppano fibrosi polmonare. Abbiamo ipotizzato che la MV possa contribuire mediante diversi meccanismi allo sviluppo di tale fibrosi.
Materiali e metodi. In vitro. Cellule epiteliali alveolari umane BEAS-2B sono state sottoposte ad allungamento meccanico ciclico per 24 o 48 ore, e quindi si è analizzata l’espressione di marcatori epiteliali e mesenchimali in esse. In vivo. Topi C57 Bl/6 sono stati randomizzati verso 4 trattamenti: controlli sani; inalazione di acido cloridrico (HCl); inalazione di soluzione di controllo seguita dopo 24 ore da MV; inalazione di HCl seguita dopo 24 ore da MV. Gli animali trattati sono stati quindi seguiti per periodi di 3, 8 e 15 giorni dopo l’inalazione. Si sono analizzate le meccaniche polmonari, l’istologia polmonare, i fibrociti circolanti, i quantitativi di idrossiprolina così come l’espressione di marcatori epiteliali e mesenchimali nei polmoni.
Risultati. In vitro. L’allungamento meccanico ciclico ha determinato nelle cellule BEAS-2B una riduzione nell’espressione dei marcatori epiteliali citocheratina 8, E-caderina e pro-proteina del surfattante B (proSPB), ed un aumento dell’espressione di TGF-β1 e β-catenina e dei marcatori mesenchimali α-SMA e vimentina A. In vivo. La MV, da sola o in associazione all’inalazione di HCl, ha determinato alterate meccaniche polmonari, un aumento del contenuto di idrossiprolina e dell’espressione di TGF-β1 e β-catenina e dei marcatori mesenchimali α-SMA e vimentina A, ed una diminuita espressione dei marcatori epiteliali citocheratina 8, E-caderina e proSPB. I fibrociti circolanti non sono stati influenzati dalla MV. L’istologia polmonare ha mostrato aumentata fibrosi negli animali trattati e potenziale transizione epitelio-mesenchimale dopo inalazione di HCl seguita da MV.
Conclusioni. Lo stress meccanico determina fibrosi polmonare, e il fenomeno della transizione epitelio-mesenchimale potrebbe giocare un ruolo in questo processo. Se i risultati del nostro lavoro saranno confermati, la modulazione della risposta fibrotica nei pazienti che necessitano di MV potrebbe rappresentare un nuovo, importante bersaglio terapeutico da investigare
Difficult proseal laryngeal mask airway placement in a child: made easy by bougie guided technique. Comment
No full textIF = 1.469; Q2; penultimo autore: 6 punti
Pharyngo-laryngeal discomfort after breast surgery: Comparison between orotracheal intubation and laryngeal mask
No full text
The new air-Q (TM) intubating laryngeal airway for tracheal intubation in children with anticipated difficult airway: comment
No full textDriving ability after conscious sedation: a systematic review
Full text linkIntroduction: Conscious sedation is widely used in medicine but may cause impairment of psychomotor and cognitive function that affect some aspects of a patient's life, such as car driving. This systematic review aims to summarize available evidence (direct or indirect) on driving ability after conscious sedation. Evidence acquisition: A comprehensive search was conducted including MEDLINE/PubMed, EMBASE, SCOPUS, clinicaltrials.gov and the Cochrane Database of Systematic Reviews through June 2022. Randomized and non-randomized controlled trials were included. PRISMA guidelines were followed. Risk of bias was appraised as reported in the Cochrane Handbook for Systematic Reviews of Interventions. Evidence synthesis: A narrative synthesis of 27 studies (962 subjects) was conducted, because the heterogeneity in terms of interventions and comparators, method and timing of assessment, and outcome measures precluded the feasibility of a meaningful meta-analysis. Conscious sedation was associated with different degrees of impairment in driving ability (real car driving, simulated driving, subjective perception), and psychomotor and cognitive functions (body sway, sleepiness, adaptive tracking, critical flicker fusion frequency, reaction/attention skills) at 0.5-10 hours after drug administration. Conclusions: The results obtained from this review should be interpreted as a renewed recommendation to avoid driving after conscious sedation is administered. Yet it is not possible to determine when this ability is recovered, leaving this crucial and essential information to future, well-designed and reproducible research
Three different approaches to fibreoptic-guided intubation via the Laryngeal Mask Airway Supreme
No full textGlidescope (TM)/gastric-tube guided technique: a back-up approach for ProScal (TM) LMA insertion
No full textI.F. 1,76
Conscious sedation for the management of dental anxiety in third molar extraction surgery: a systematic review
Full text linkAbstract
Background
Dental anxiety is a condition associated with avoidance of dental treatment and increased medical and surgical risks. This systematic review aims to summarize available evidence on conscious sedation techniques used for the management of Dental anxiety in patients scheduled for third molar extraction surgery, to identify best approaches and knowledge gaps.
Methods
A comprehensive search was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov and the Cochrane Database of Systematic Reviews through March 2019. Only randomized controlled trials were included. PRISMA guidelines were followed. Risk of bias was appraised as reported in the Cochrane Handbook for Systematic Reviews of Interventions.
Results
Seventeen RCTs with a total of 1788 patients were included. Some aspects limited the feasibility of a meaningful meta-analysis, thus a narrative synthesis was conducted. Conscious sedation was associated with improvement in Dental anxiety in six studies. One study reported lower cortisol levels with midazolam vs. placebo, while another study found significant variation in perioperative renin levels with remifentanil vs. placebo.
Conclusions
This review found inconclusive and conflicting findings about the role of Conscious sedation in managing Dental anxiety during third molar extraction surgery. Relevant questions remain unanswered due to the lack of consistent, standardized outcome measures. Future research may benefit from addressing these limitations in study design
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