1,731,237 research outputs found
Sue Vap Interview, January 11, 2014
Get PDFSue Vap discusses her time in the University of Montana’s School of Forestry from 1968 to 1972. She talks about what it was like to be one of the few women in the school. She comments on the lack of gender equality at the time and how that affected her first few jobs with the U.S. Forest Service. Vap briefly describes her career in the Forest Service and her time as the Fire Director for the National Park Service at the Boise Inter-Agency Fire Center, from which she retired at the age of 55. She talks about the value of civil service, as well as her love for the outdoors. Vap also discusses the importance of fire to an ecosystem.https://scholarworks.umt.edu/collegeofforestry_oralhistory/1016/thumbnail.jp
VAP e non solo: proposta per una nuova strategia di sorveglianza.
No full textLe Polmoniti Associate a Ventilazione meccanica (VAP) sono le Infezioni delle Organizzazioni Sanitarie (IOS) più frequenti nelle Unità di Terapia Intensiva (UTI). La sorveglianza è ampiamente accettata quale strumento primario per il controllo delle IOS; alla base di una sorveglianza efficace ci deve essere una definizione del fenomeno agevole e condivisa a livello internazionale, in modo da consentire il confronto con altre realtà. Nel caso della VAP, la sorveglianza risulta problematica per la difficoltà di raggiungere una diagnosi di certezza. La definizione proposta dall'NHSN dei Centers for Disease Control and Prevention (CDC) infatti, richiede la presenza di criteri radiologici, sistemici e polmonari, la cui applicazione risulta complessa, richiede tempo ed è soggetta a significativa variabilità fra osservatori. Per tale motivo diversi Autori hanno provato ad identificare una strategia alternativa. Klompas ha proposto l'utilizzo di una definizione VAP basata sui criteri CDC modificati; inoltre ha suggerito di includere anche il monitoraggio delle Complicanze Associate a Ventilazione (VAC), defini-te in base all'alterazione dei parametri respiratori FI02 e PEEP.
L'obiettivo di questo studio è stato valutare l'applicabilità di un programma si sorveglianza VAP/VAC nelle UTI dell'Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona.
METODI: Il gruppo di lavoro multidisciplinare ha pianificato e condiviso l'attività di sorveglianza e la metodologia di rilevamento: la popolazione target è costituita dai pazienti ricoverati nelle UTI con degenza >48 ore; la scheda di sorveglianza cartacea viene compilata al letto del paziente; l'informatizzazione dei dati e l'elaborazione del report finale è effettuata dalla SOD di Igiene Ospedaliera.
RISULTATI: La nuova strategia di sorveglianza VAP/VAC è stata implementata con successo nel II semestre del 2011 ed è attualmente ancora in corso. La partecipazione delle UTI al gruppo di lavoro per l'istituzione del programma, è stata attiva e determinante; lo strumento di sorveglianza proposto è stata condiviso e accettato con elevata compliance.
CONCLUSIONI: Utilizzando la nuova definizione di VAP, la sorveglianza è risultata molto più semplice e praticabile. L'inclusione delle VAC nel monitoraggio, inoltre, si è dimostrata vantaggiosa non solo perché consente la prevenzione di tutte le complicanze connesse con la ventilazione meccanica e non della sola polmonite, ma anche perchè facilita la raccolta dei dati attraverso l'utilizzo di una definizione oggettiva basata sui parametri respiratori
"Predisposing factors for the acquisition of ventilator-associated pneumonia (VAP). An observational study conducted in the Intensive Care Units of Aulss 3, Veneto Region"
No full textopenBackground: La polmonite associata alla ventilazione meccanica (VAP) rappresenta una delle principali complicanze nei pazienti sottoposti a ventilazione assistita, con significative ricadute in termini di morbilità e mortalità. L’incidenza riportata in letteratura varia dal 5% al 40%.
La diagnosi, pur non disponendo di una definizione univoca e condivisa, si basa sull’integrazione di criteri clinici, microbiologici e di imaging.
Obiettivo: Individuare i fattori predisponenti allo sviluppo di VAP attraverso un’analisi retrospettiva condotta nelle Terapie Intensive degli ospedali di Mestre, Mirano e Dolo presso l’AULSS 3 Serenissima in Regione Veneto.
Materiali e metodi: È stato condotto uno studio osservazionale retrospettivo con l’obiettivo di confrontare i fattori predisponenti risultati dalla revisione della letteratura con i dati clinici raccolti presso le Unità Operative di Anestesia e Rianimazione di Mestre, Mirano e Dolo. La raccolta dati è stata effettuata nei mesi di luglio e agosto 2025 e ha coinvolto 121 pazienti affetti da VAP.
Risultati: La VAP è stata diagnosticata in 121 pazienti (28,3%), con incidenza media pari al 28,27%, più elevata a Mestre (31,36%), seguita da Dolo (27,50%) e Mirano (23,44%). Non sono state osservate differenze significative tra i sessi (p = 0,172), mentre l’età >48 anni è risultata significativamente associata a maggiore incidenza di VAP (p < 0,001). Inoltre, le patologie cardiovascolari croniche risultano significativamente associate alla VAP (p = 0,008), mentre l’ipertensione, pur rappresentando la condizione più diffusa, non mostra un’associazione statisticamente significativa (p = 0,928). L’infezione è risultata inoltre associata a sedazione prolungata (p < 0,001) e valori elevati di PCR (p < 0,001) e leucociti (p < 0,001). La tipologia di intubazione è risultata significativamente associata all’insorgenza di VAP (p < 0,001): la maggior parte dei pazienti era intubata con tubo endotracheale (89,3%), con incidenza maggiore rispetto alla tracheostomia (10,7%). La durata della ventilazione mostra un picco di VAP tra l’11° e il 16° giorno (p = 0,003). Tra i patogeni prevalgono Pseudomonas aeruginosa (26,7%, p < 0,001) e Klebsiella pneumoniae (13,0%), con microrganismi multiresistenti nel 40,5% dei casi (p = 0,037). Pur non essendo direttamente associata a mortalità (p < 0,001), la VAP ha determinato un significativo prolungamento della degenza (78,5%), con aumento del carico assistenziale e dei costi correlati.
Conclusione: I principali fattori predisponenti identificati, tra cui ventilazione meccanica prolungata, intubazione endotracheale, età avanzata, sovrappeso, sedazione prolungata, comorbidità cardiovascolari e presenza di microrganismi multiresistenti, risultano coerenti con la letteratura. Tuttavia, alcune peculiarità locali, come l’insorgenza precoce della VAP, l’associazione con patologie neurologico-emorragiche e la maggiore complessità delle cure assistenziali, evidenziano differenze operative significative. I risultati sottolineano l’importanza di interventi preventivi mirati, monitoraggio costante, gestione razionale degli antibiotici e protocolli strutturati per ottimizzare la ventilazione meccanica e favorire l’estubazione precoce. Si propone l’introduzione o l’aggiornamento di un protocollo per l’estubazione precoce, basato sulle migliori evidenze scientifiche e sulla buona pratica clinica, come misura preventiva contro la VAP.
Keywords: “VAP”, “VAM”, “Risk factor”, “Ventilators Mechanical", “Intensive Care Units", “Pneumonia, Ventilator-Associated”, “complications”
VAP-PLGA microspheres (VAP-PLGA) promote adipose-derived stem cells (ADSCs)-induced wound healing in chronic skin ulcers in mice via PI3K/Akt/HIF-1α pathway
No full textChronic skin ulcers are a primary global health problem. Velvet antler polypeptide (VAP) regulates endothelial cell migration and angiogenic sprout. Adipose-derived stem cells (ADSCs) are reported to make pivotal impacts upon wound healing. This study aimed to explore the role of VAP combined with ADSCs in wound healing of chronic skin ulcers. The effect of VAP on phenotypes of ADSCs, and VAP (PLGA microspheres) combining with ADSCs on wound healing of chronic skin ulcers in vivo was evaluated. VAP generally promoted the proliferation, migration and invasion of ADSCs, and ADSC-induced angiogenesis in human umbilical vein endothelial cells (HUVECs) through PI3K/Akt/HIF-1α pathway. VAP-PLGA (PLGA microspheres) enhanced the promoting effect of ADSCs on wound healing, pathological changes, and angiogenesis in chronic skin ulcers in vivo. VAP-PLGA intensified the effect of ADSCs on up-regulating the levels of p-PI3K/PI3K, p-Akt/Akt, HIF-1α, vascular endothelial growth factor (VEGF), stromal cell-derived factor-1 (SDF-1), C-X-C motif chemokine receptor 4 (CXCR4), angiopoietin-4 (Ang-4), VEGF receptor (VEGFR), and transforming growth factor-β1 (TGF-β1), and down-regulating the levels of interleukin-1 β (IL-1β), IL-18 and IL-6 in wound tissues in chronic skin ulcers in vivo. Collectively, VAP promoted the growth, migration, invasion, and angiogenesis of ADSCs through activating PI3K/Akt/HIF-1α pathway, and VAP-PLGA enhanced the function of ADSCs in promoting wound healing in vivo, which was associated with angiogenesis, inflammation inhibition, and dermal collagen synthesis.</p
Paper de l'Amino-Oxidasa Sensible a Semicarbazida, SSAO/VAP-1, del teixit adipós en la diabetis "mellitus"
Get PDF[cat] L'SSAO/VAP-1 és una proteïna amb una dualitat de funció; d'una banda, presenta activitat enzimàtica amino-oxidasa i, de l'altra, presenta propietats d'adhesió que la impliquen en l'extravasació de limfòcits en processos inflamatoris. Aquesta proteïna es troba altament expressada en el teixit adipós. En els darrers anys, s'ha passat de considerar el teixit adipós com un òrgan d'emmagatzematge energètic a considerar-lo un teixit de vital importància per al control del metabolisme glucídic de l'organisme implicat en la patologia diabètica. El transport de glucosa al teixit adipós i al múscul esquelètic és un pas limitant en l'ús de glucosa i la resistència a la insulina es manifesta en una disminució de la capacitat de la insulina per estimular el transport de glucosa en aquests teixits. Amb la intenció d'avaluar el possible paper fisiològic de l'abundància d'SSAO al teixit adipós, treballs previs d'aquest grup de recerca havien demostrat que substrats de l'SSAO en combinació amb vanadat podien estimular el transport de glucosa per via de l'estimulació de la translocació dels transportadors de glucosa GLUT4 a la membrana de la cèl·lula en adipòcits aïllats de rata. Així, el primer objectiu va ser: 1. Estudiar el mecanisme molecular d'acció de la combinació de benzilamina i vanadat a les cèl·lules adiposes i determinar la molècula activa generada responsable dels efectes observats. Un cop demostrat l'efecte insulinomimètic de la combinació de benzilamina i vanadat sobre cèl·lules adiposes, calia passar a estudis in vivo en models animals; així els següents objectius van ser: 2. Estudiar l'efecte de l'administració aguda o crònica de la combinació de benzilamina i vanadat sobre animals no diabètics i en models de diabetis de tipus 1 i tipus 2. 3. Estudiar l'efecte del tractament crònic amb benzilamina i vanadat sobre el metabolisme del teixit adipós i del múscul esquelètic, així com sobre l'activitat dels illots pancreàtics. Atesa la importància del teixit adipós en la patologia diabètica, l'elevada activitat SSAO present en aquest teixit i el fet que l'activitat SSAO present en el plasma està augmentada en la diabetis mellitus, un altre objectiu va ser: 4. Analitzar la participació del teixit adipós en l'alliberament de la forma soluble de l'SSAO/VAP-1. Els resultats obtinguts en la tesi han estat publicats en tres articles originals més un article de revisió, a més hi ha un article pendent d'acceptació. Les conclusions derivades són les següents. 1. Els substrats de l'SSAO en combinació amb vanadat estimulen el transport de glucosa als adipòcits en condicions en les quals es produeix peroxovanadat, s'inhibeix l'activitat proteïna tirosina-fosfatasa i s'activa l'IRS-1, l'IRS-3, la PI3K i la PKB. 2. L'administració aguda de benzilamina i vanadat augmenta la tolerància a la glucosa de rates no diabètiques i en rates diabètiques de tipus 1 i 2; així mateix, estimula el transport de glucosa al múscul. 3. L'administració crònica de benzilamina i vanadat normalitza la glucèmia en rates diabètiques. 4. En rates diabètiques per estreptozotocina, l'administració crònica de benzilamina i vanadat augmenta el transport de glucosa basal i l'estimulat per insulina i la quantitat total de GLUT4, als adipòcits. En rates Goto-Kakizaki, augmenta el transport de glucosa i la quantitat de GLUT4 present a la membrana plasmàtica als adipòcits no estimulats i el transport estimulat per insulina al múscul. 5. En rates Goto-Kakizaki, la combinació de benzilamina i vanadat estimula la secreció d'insulina en illots pancreàtics. 6. La generació local de peroxovanadat basada en l'activitat SSAO pot representar una nova estratègia terapèutica per al tractament de la diabetis mellitus. 7. Les cèl·lules adiposes alliberen SSAO soluble al medi de cultiu, en un procés dependent de metal·loproteases de matriu i regulat per factors implicats en la resistència a la insulina
Analysis of antibiotic use in vap (ventilator-association pneumonia) patients
Get PDFVAP is a nosocomial infection that most often occurs in the ICU. VAP increases morbidity, mortality, treatment costs andhospitalization time in the ICU. Antibiotic is primary therapy in VAP. The initial selection of antibiotic is very important todetermind outcome in VAP patients, as well as a main factor that plays a role in the development of antibiotic resistance. Availabilityof bacterial pattern and bacterial sensitivity pattern is very important to make consideration on empirical antibiotic treatment inVAP patients. The purpose is to identify bacterial pattern, bacterial sensitivity pattern and to analyze antibiotic therapy in VAPpatients. An observational prospective analysis was carried out in the ICU Dr. Soetomo Hospital. Data was collected from Januaryto March 2013. Patients who met the inclusion criteria were observed prospectively. Bacterial pattern and bacterial sensitivitypattern were identified based on the results of culture test and sensitivity test. Quality of antibiotic usage could be assessed withGyssen’s flowchart. From 158 patients with ventilator, nine patients met the inclusion criteria with thirty specimens (13 sputum, 17blood). Pseudomonas aeruginosa was the common bacteria found in the sputum. Blood culture, revealed that Staphylococcuscoagulase-negative was the common bacteria. Antibiotics that are still sensitive against Pseudomonas aeruginosa are Piperacillintazobaktam,Cefoperazon-sulbactam, Meropenem, Tobramycin, Levofloxacin. Pseudomonas aeruginosa is the common cause ofpneumonia in adult patient who used ventilator that susceptible with various antibiotic spectrums.(FMI 2013;49:168-172
Acrolein Production by VAP-1/SSAO
Get PDFPurpose/Aim of the study: To explore the possible role of vascular adhesion protein-1 (VAP-1) via its enzymatic function as a semicarbazide-sensitive amine oxidase (SSAO) in the pathogenesis of proliferative diabetic retinopathy (PDR). Materials and Methods: The levels of soluble VAP-1/SSAO and the unsaturated aldehyde acrolein (ACR)-conjugated protein, Nε-(3-formyl-3, 4-dehydropiperidino) lysine adduct (FDP-Lys), were measured in vitreous fluid samples of PDR and non-diabetic patients using ELISA. Recombinant human VAP-1/SSAO (rhVAP-1/SSAO) was incubated with spermine, with or without semicarbazide or RTU-1096 (a specific inhibitor for VAP-1/SSAO). Immunofluorescence assays were performed to assess the localization of VAP-1/SSAO and FDP-Lys in fibrovascular tissues from patients with PDR. The impact of ACR on cultured retinal capillary endothelial cells was assessed using a cell viability assay and total glutathione (GSH) measurements. Results: The levels of sVAP-1/SSAO and FDP-Lys were elevated in the vitreous fluid of patients with PDR. Incubation of rhVAP-1 with spermine resulted in the generation of hydrogen peroxide and FDP-Lys and the production was inhibited by semicarbazide and RTU-1096. In fibrovascular tissues, FDP-Lys and VAP-1/SSAO were present in endothelial cells. ACR stimulation reduced GSH levels in the cultured endothelial cells in a dose-dependent manner and caused cellular toxicity. Conclusions: Our results indicate the pathological role of sVAP-1/SSAO to generate hydrogen peroxide and toxic aldehyde ACR, both of which are associated with oxidative stress, as a consequence of spermine oxidation in eyes with PDR
Bacteriological Profile of Ventilator Associated Pneumonia (VAP) and Their Antibiotic Susceptibility-A Prospective Study
No full textTo determine the causative pathogens of the patients diagnosed with Ventilator Associated Pneumonia (VAP) and to find out their antibiotic sensitivity by standard Kirby-Bauer disc diffusion method. A prospective cohort study was conducted over a period of one year six months in the ICU of our hospital.All the patients on mechanical ventilation were eligible,among them only clinically suspected VAP cases were enrolled excluding those patients with preexisting pulmonary infection at the time of admission or patients with multiple trauma or evidence of sepsis at the time of admission.Endotracheal aspirate was collected as sample in our study.Quantitative culture threshold of ≥105CFU/ml was considered to diagnose VAP in our study.Out of the total 60 patients enrolled,≥105CFU/ml was obtained from 28 patients who were categorized under VAP group.Growth of <105CFU/ml was obtained from 30 patients and 2 patients showed no growth,both of them being categorized under NO-VAP group. The most common bacteria isolated were Acinetobacter species(12),Klebsiella species(9),Pseudomonas species(5)followed less commonly by Staphylococcus aureus(1), Escherichia coli(1) and Coagulase negative Staphylococcus aureus(1).In our study most of the commonly isolated bacteria were sensitive to imipenem,cefoperazone-sulbactem followed by others.
Multicenter randomized clinical trial of lateral-trendelenburg vs. semi recumbent position for the prevention of ventilatorassociated pneumonia - the gravity-VAP trial
No full textIntroduction: Gravity plays a pivotal role in the pathogenesis of ventilator-associated pneumonia (VAP) (1). In previous laboratory studies (2) the semi-lateral Trendelenburg position (LTP) hindered gravity-driven pulmonary aspiration and avoided VAP.
Objectives: To determine whether the LTP vs. the semi-recumbent position (SRP) would reduce the incidence of microbiologically confirmed VAP and to appraise patient's compliance and safety.
Methods: We conducted a randomized, single-blind, controlled study in 17 European centers and 1 in North America. A total of 2019 adult patients were screened between 2010 and 2015. 395 patients were randomized - 194 in LTP and 201 in SRP - and analyzed in an intention to treat approach. Patients in LTP were placed in semi-lateral (60°) - Trendelenburg position to achieve an orientation, from the sternal notch toward the mouth, slightly below horizontal, and turned from one side to the other every 6 hours. LTP was encouraged during the first days of mechanical ventilation, but always in compliance with the patient's wish. In the SRP group, the head of the bed was elevated ≥ 30°. Primary outcome was VAP incidence rate, based on quantitative bronchoalveolar lavage fluid culture with ≥ 104 colonyforming units/mL. Secondary outcomes were compliance to the randomized position, length of intubation, duration of intensive care unit and hospital stay, mortality, and adverse events.
Results: The trial was stopped after the planned interim analysis for achieving efficacy endpoints and owing to safety concerns. Patients in the LTP and SRP group were kept in the randomized position for 38 % and 90 % of the study time, respectively (p = 0.001). Yet, during the first 48 hours, LTP patients were kept in the randomized position for 50 % of the study time, and SRP patients for 88 % (p = 0.001). In the LTP, the bed was angulated 5.6° in Trendelenburg; while, the head of the bed was elevated 34.1° in the SRP group. Incidence rates of microbiologically confirmed VAP were 0.88 (1/1136 patient-days; 95 % confidence interval [CI], 0.12-6.25) in the LTP group, and 7.19 (8/1113 patient-days; CI 95 %, 3.60-14.37) in the SRP (p = 0.020), relative risk reduction of 0.12 (95 % CI, 0.01-0.91). No statistically significant differences were observed in durations of mechanical ventilation, intensive care unit and hospital stay, and mortality. Vomiting was more common in LTP patients (8.3 % vs. 2.5 % in the SRP, p = 0.013).
Conclusions: Critically ill patients positioned in the LTP had a statistically significant reduction in the incidence of VAP, compared with those positioned in the SRP. A comprehensive evaluation of potential LTP contraindications is warranted to enhance safety
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