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A Structured Method of Teaching Epidural Block reduces the incidence of accidental dural puncture in inexperienced trainees.

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Open Journal of Anesthesiology 2024年第4期14卷 131-135页

作者： marco Scorzoni Gianluigi Gonnella Emanuele Capogna Marina Campione Gaetano Draisci Matteo Velardo Giorgio Capogna Department of Anesthesiology Fondazione Policlinico Gemelli IRCCS Rome Italy Department of Economics and Law Enna Kore University Enna Italy European School of Obstetric Anesthesia Rome Italy

Background: The rate of accidental dural puncture is particularly high during the period of training, especially in novices. The structured epidural teaching model (SETM) includes three standardized video lessons, the construction of a 3D epidural module by trainees and practical training by using an epidural simulator with and without the CompuFlo™ Epidural instrument. In this study we report the retrospective analysis of the accidental dural puncture rate of inexperienced trainees during their 6 months clinical practice rotation in obstetrics before and after the introduction of the SETM in our Institution. Method: We evaluated the incidence of accidental dural puncture before the introduction of the SETM methodology and afterwards by analyzing our departmental database from February 2019 to January 2023. All epidural blocks were executed by trainees who had never previously performed an epidural block and were about to begin their obstetrics rotation. Results: We analyzed 7415 epidurals: 3703 were performed before the introduction of the SETM methodology (control group) and 3712 afterwards (study group). The incidence of accidental dural puncture was 0.37% for the control group and 0.13% for the study group (pdid not. Conclusions: After the introduction of the structured teaching method, we observed a significant reduction of accidental dural puncture during the training period. We hope that our observation will encourage a constructive discussion among experts about the need to use standardized and validated tools as a valuable aid in teaching epidural anesthesia.

关键词： teaching epidural Anesthesia obstetrical Anesthesia Anesthesia

Human leukocyte antigen compatibility and incidence of donorspecific antibodies in pediatric liver transplant recipients

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World Journal of Gastroenterology 2024年第33期30卷 3837-3845页

作者： Melina U Melere Flavia H Feier Jorge Neumann Antônio N Kalil Juliana de M Montagner Luiza S Nader Carolina S da Silva marco Aurélio F Junior Gabriela P Coral Guilherme P Bobsin Cristina T Ferreira Department of Hepatology and Liver Transplantation Santa Casa de Porto AlegrePorto Alegre 90050170Rio Grande do SulBrazil Department of Hepato-biliary-pancreatic Surgery and Liver Transplantation Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Rio Grande do SulBrazil Postgraduation Program in Medicine:Hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90050-170Rio Grande do SulBrazil Laboratory of Transplantation Immunology Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Rio Grande do SulBrazil

BACKGROUND Antibody-mediated rejection following liver transplantation(LT)has been increasingly recognized,particularly with respect to the emergence of de novo donor-specific antibodies(DSAs)and their impact on graft *** substantial evidence for adult populations exists,research focusing on pediatric LT outcomes remains *** To investigate the prevalence of human leukocyte antigen(HLA)mismatches and DSA and evaluate their association with rejection episodes after pediatric *** A cohort of pediatric LT recipients underwent HLA testing at Santa Casa de Porto Alegre,Brazil,between December 2013 and December *** patients who survived for>30 days after LT with at least one DSA analysis were *** classes I and II and cross-matches were *** presence of de novo DSA(dnDSA)was evaluated at least 3 months after LT using the Luminex®single antigen bead method,with a positive reaction threshold set at 1000 *** episodes were confirmed by liver *** Overall,67 transplanted children were analyzed;61 received grafts from living donors,85%of whom were related to ***-transplant DSA(class I or II)was detected in 28.3%of patients,and dnDSA was detected in 48.4%.The median time to DSA detection after LT was 19.7[interquartile range(IQR):4.3-35.6]*** rejection occurred in 13 patients at follow-up,with C4d positivity observed in 5/13 Liver *** median time to rejection was 7.8(IQR:5.7-12.8)*** presence of dnDSA was significantly associated with rejection(36%vs 3%,Pdings highlight the importance of incorporating DSA assessment into pre-and post-transplantation protocols for pediatric LT *** implications may include immunosuppression minimization strategies based on this analysis in pediatric LT recip

关键词： Human leukocyte antigens Donor-specific antibodies Liver transplantation Pediatric Rejection

Splanchnic vasodilation and hyperdynamic circulatory syndrome in cirrhosis

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World Journal of Gastroenterology 2014年第10期20卷 2555-2563页

作者： Massimo Bolognesi marco di Pascoli Alberto Verardo Angelo Gatta Department of Internal Medicine-diMED University of Padua Azienda Ospedaliera Università di Padova 35128 Padova Italy

Portal hypertension is a clinical syndrome which leads to several clinical complications, such as the formation and rupture of esophageal and/or gastric varices, ascites, hepatic encephalopathy and hepato-renal syndrome. In cirrhosis, the primary cause of the increase in portal pressure is the enhanced resistance to portal outflow. However, also an increase in splanchnic blood flow worsens and maintains portal hypertension. The vasodilatation of arterial splanchnic vessels and the opening of collateral circulation are the determinants of the increased splanchnic blood flow. Several vasoactive systems/substances, such as nitric oxide, cyclooxygenase-derivatives, carbon monoxide and endogenous cannabinoids are activated in portal hypertension and are responsible for the marked splanchnic vasodilatation. Moreover, an impaired reactivity to vasoconstrictor systems, such as the sympathetic nervous system, vasopressin, angiotensin II and endothelin-1, plays a role in this process. The opening of collateral circulation occurs through the reperfusion and dilatation of preexisting vessels, but also through the generation of new vessels. Splanchnic vasodilatation leads to the onset of the hyperdynamic circulatory syndrome, a syndrome which occurs in patients with portal hypertension and is characterized by increased cardiac output and heart rate, and decreased systemic vascular resistance with low arterial blood pressure. Understanding the pathophysiology of splanchnic vasodilatation and hyperdynamic circulatory syndrome is mandatory for the prevention and treatment of portal hypertension and its severe complications.

关键词： Portal hypertension Splanchnic flow Splenic circulation Nitric oxide Autonomic dysfunction Cirrhosis Hyperdynamic circulatory syndrome

Adherence to Pharmacotherapy in Post-Menopausal Women with Hypertension or Metabolic Syndrome: Real World Experience

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International Journal of Clinical Medicine 2024年第3期15卷 145-154页

作者： Maria Maiello Francesca Amati Vincenzo Ezio Santobuono Andrea Igoren Guaricci Cinzia Forleo marco Matteo Ciccone Pasquale Palmiero Department of Cardiology ASL BR SSN3 Brindisi Italy Cardiovascular diseases Section Interdisciplinary Department of Medicine (DIM) University of Bari “Aldo Moro” Bari Italy

Background: Adherence to medications is dependent upon a variety of factors, including individual characteristics of the patient, interactions with health care providers, and medication complexity. Even though several studies were conducted to test intervention strategies, results are uncertain. Aim: The aim of the study is to assess if a tailored combined intervention strategy improves medication adherence in a large population of post-menopausal women affected by hypertension or metabolic syndrome. Methods: We enrolled 6833 patients aged 50 to 69 years, 85.7% with hypertension, and 14.3% with metabolic syndrome. A network between patients, general practitioners, and cardiologists was established. Interventions included education, adequate information to patients, a simplified scheme of treatment, and periodic adherence assessment. These were either delivered as healthcare provider supports or using modern technology. Medication adherence was estimated by the proportion of days covered for all classes of drugs after the index date. Results: Non-adherent hypertensive women were 297 (5%), and those with metabolic syndrome were 73 (7.4%) (p Conclusions: The rate of non-adherence in both settings of postmenopausal women was 7.7%, much lower than that described in the literature. This rate was increased in patients with metabolic syndrome;probably it is related to the complexity of the therapeutic scheme or to a poor consciousness of the disease. Therefore, implementing a tailored combined intervention can improve significantly patients’ adherence to medical therapy.

关键词： Adherence Cardiovascular Prevention Postmenopausal Women Hypertensive Metabolic Syndrome

Herpes simplex keratitis:A brief clinical overview

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World Journal of Virology 2024年第1期13卷 5-32页

作者： Mutali Musa Ehimare Enaholo Gladness Aluyi-Osa George Nnamdi Atuanya Leopoldo Spadea Carlo Salati marco Zeppieri Department of Optometry University of BeninBenin 300283Nigeria Department of Ophthalmology Africa Eye Laser CentreKm 7Benin 300105Nigeria Department of Ophthalmology Centre for Sight AfricaNkpor 434101Nigeria Eye Clinic Policlinico Umberto I"Sapienza"University of RomeRome 00142Italy of Ophthalmology University Hospital of UdineUdine 33100Italy

The aim of our minireview is to provide a brief overview of the diagnosis,clinical aspects,treatment options,management,and current literature available regarding herpes simplex keratitis(HSK).This type of corneal viral infection is caused by the herpes simplex virus(HSV),which can affect several tissues,including the *** significant aspect of HSK is its potential to cause recurrent episodes of inflammation and damage to the *** the initial infection,the HSV can establish a latent infection in the trigeminal ganglion,a nerve cluster near the *** virus may remain dormant for extended *** reactivation of the virus can occur,leading to recurrent episodes of *** triggering reactivation include stress,illness,immunosuppression,or *** episodes can manifest in different clinical patterns,ranging from mild epithelial involvement to more severe stromal or endothelial *** severity and frequency of recurrences vary among *** cases of HSK,especially those involving the stroma and leading to scarring,can result in vision impairment or even blindness in extreme *** cornea's clarity is crucial for good vision,and scarring can compromise this,potentially leading to visual *** management of HSK involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings via *** medications,such as oral Acyclovir or topical Ganciclovir,may be prescribed for *** immune response to the virus can contribute to corneal ***,caused by the body's attempt to control the infection,may inadvertently harm the corneal *** should be informed about triggers and advised on measures to minimize the risk of *** summary,the recurrent nature of HSK underscores the importance of both acute and long-term management strategies to preserve corneal health and maintai

关键词： Herpes simplex virus Herpes simplex keratitis Acyclovir Neurotization Reactivation

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电能变革——卫生纸干燥中的能效提升

生活用纸 2024年第5期24卷 56-57页

作者： marco Cattani George Nowakowski 安德里茨Novimpianti 安德里茨加拿大Lachine工厂

安德里茨Novimpianti产品经理marco Cattani和安德里茨加拿大Lachine工厂卫生纸干燥业务副总裁George Nowakowski表示,随着卫生纸厂对能耗优化与出色可持续性的渴望愈发强烈,安德里茨电加热式气罩系统的出现可谓恰逢其时。

关键词：副总裁产品经理卫生纸能效提升可持续性能耗优化

Advancing prognostic understanding in hepatocellular carcinoma through the integration of genomic instability and lncRNA signatures: GILncSig model

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World Journal of Gastrointestinal Surgery 2024年第9期16卷 2774-2777页

作者： marco Bocchetti Gabriella Misso Silvia Zappavigna Marianna Scrima Michele Caraglia Francesca Pentimalli Alessia Maria Cossu Department of Precision Medicine University of Campania“Luigi Vanvitelli”Naples 80138Italy Department of Molecular and Precision Oncology Biogem ScarlInstitute of Genetic ResearchAriano Irpino 83031Italy Department of Medicine and Surgery LUM University Giuseppe De GennaroCasamassima 70010Italy

The recently published study by Duan et al introduces a promising method that combines genomic instability and long non-coding RNAs to improve the prognostic evaluation of hepatocellular carcinoma(HCC),a deadly cancer associated with considerable morbidity and *** editorial aims to analyze the methodology,key findings,and broader implications of the study within the fields of gastroenterology and oncological surgery,highlighting the shift towards precision medicine in the management of HCC.

关键词： Genomic instability Long non-coding RNA Hepatocellular carcinoma Prognosis

Pain management in acute musculoskeletal injury: Effect of opioid vs nonopioid medications

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World Journal of Orthopedics 2024年第9期15卷 882-890页

作者： marco Fiore Luigi Aurelio Nasto Eleni McCaffery Fannia Barletta Angela Visconti Francesca Gargano Enrico Pola Maria Caterina Pace Department of Women Child and General and Specialized SurgeryUniversity of Campania“Luigi Vanvitelli”Naples 80138Italy Department of Orthopaedics University of Campania“Luigi Vanvitelli”Naples 80138Italy Department of Emergency Medicine New York Presbyterian-Brooklyn Methodist HospitalNew YorkNY 11215United States Department of Anesthesia and Intensive Care “San Carlo”HospitalPotenza 85100Italy Department of Anaesthesia “San Giuliano”HospitalGiugliano 80014Italy Unit of Anesthesia and Intensive Care The Fondazione Policlinico Universitario Campus Bio-MedicoRome 00128Italy

BACKGROUND The use of opioids for pain is linked to an increased risk of developing opioid use disorder,and has resulted in the emergence of the opioid crisis over the last few *** The systematic review question is“How does the use of opioid medications in pain management,compared with non-opioid medications,affect pain intensity over the short,intermediate,and long-term in adults with acute traumatic pain?”.METHODS The protocol was prospectively registered on the International Prospective Re-gister of Systematic Reviews:*** and Google Scholar were electronically searched for controlled peer-reviewed studies published in full,with the PICO framework:P:Adult patients with traumatic injuries,I:Opioid medications,C:Non-opioid medi-cations,O:A minimum clinically important difference(MCID)in *** After full-text screening,we included 14 studies in the qualitative *** these 14 studies,12 were rando-mized clinical trials(RCTs)and 2 were pseudo-RCTs with a total of 2347 patients *** was heteroge-neity in both medication utilized and outcome in these studies;only two studies were homogeneous regarding the type of study conducted,the opioid used,its comparator,and the outcome *** MCID was evaluated in 8 studies,while in 6 studies,any measured pain reduction was considered as an *** 11 cases,the setting of care was the Emergency Department;in 2 cases,care occurred out-of-hospital;and in one case,the setting was not *** included studies were found to have a low-moderate risk of *** Non-opioids can be considered an alternative to opioids for short-term pain management of acute musculoskeletal *** ketamine may cause more adverse events than other routes of administration.

关键词： Acute musculoskeletal injury Acute traumatic pain Non-opioid analgesia Non-opioid pain control Opioid-sparing analgesia Opioid crisis Opioid disorder Systematic review

Uncommon late presentation of platypnea-orthodeoxia syndrome

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Journal of Geriatric Cardiology 2015年第6期12卷 687-689页

作者： Laura Toffetti marco Centola Laura Massironi Cristina Pipia Fabiano di marco Alessandro Colombo Emanuela Piccaluga division of Cardiology Ospedale San Paolo University of Milan Italy divison of Internal Medicine Ospedale San Paolo Italy division of Respiratory Medicine University of Milan Italy division of Cardiology Azienda Ospedaliera 'Luigi Sacco ' Milan Italy

A 79-year-old man presented with progressive dyspnea, gradually worsening over a period of several weeks. His past medical history included hypertension, chronic hepatitis C without cirrhosis, ischemic stroke occurred at the age of 68 and chronic obstructive pulmonary disease （COPD） caused by long-term cigarette smoking. The patient was alert and oriented and not in acute distress. The physical examination of the chest revealed decreased breath sounds at the bases of the lungs, without crackles or wheezes. Heart sounds were regular without murmurs. The respiration rate was normal.

关键词： Platypnea-orthodeoxia Patent foramen ovale The elderly