Short- and Long-Term Neuroadrenergic Effects of Moderate Dietary Sodium Restriction in Essential Hypertension

Background— In essential hypertension, marked restrictions in dietary sodium intake cause in the short-term period an increase in muscle sympathetic nerve traffic (MSNA) and a baroreflex impairment. The present study was set out to assess on a long-term basis the neuroadrenergic and reflex effects of moderate sodium restriction. Methods and Results— In 11 untreated mild to moderate essential hypertensive patients (age 42.0±2.6 years, mean±SEM), we measured beat-to-beat blood pressure (Finapres), heart rate (ECG), and MSNA (microneurography) at rest and during stepwise intravenous infusions of phenylephrine and nitroprusside. Measurements were performed at regular sodium intake, after 1 and 8 weeks of low-sodium diet (80 mmol NaCl/d), and repeated again at regular sodium intake. After 1 week, urinary sodium excretion was markedly reduced. This was accompanied by a slight blood pressure reduction, no heart rate change, and a significant increase in plasma renin activity, aldosterone, and MSNA (+23.0±4.6% P <0.05). Whereas baroreflex heart-rate control was unchanged, baroreflex modulation of MSNA was reduced by 46.8±5.1% ( P <0.01). At the end of the 8-week low-sodium diet, the neurohumoral and baroreflex responses were similar to the ones observed after 1 week of the dietary intervention. All changes disappeared when regular sodium diet was restored. Conclusions— Thus, a moderate dietary sodium restriction triggers a sympathetic activation and a baroreflex impairment. Maintenance of low-sodium diet for several weeks does not attenuate these adverse adrenergic and reflex effects

Application of Electrospun Water-Soluble Synthetic Polymers for Multifunctional Air Filters and Face Masks

The worsening of air quality is an urgent human health issue of modern society. The outbreak of COVID-19 has made the improvement of air quality even more imperative, both for the general achievement of major health gains and to reduce the critical factors in the transmission of airborne diseases. Thus, the development of solutions for the filtration of airborne pollutants is pivotal. Electrospinning has gained wide attention as an effective fabrication technique for preparing ultrafine fibers which are specifically tailored for air filtration. Nevertheless, the utilization of harmful organic solvents is the major barrier for the large-scale applicability of electrospinning. The use of water-soluble synthetic polymers has attracted increasing attention as a ‘green’ solution in electrospinning. We reported an overview of the last five years of the scientific literature on the use of water-soluble synthetic polymers for the fabrication of multifunctional air filters layers. Most of recent studies have focused on polyvinyl alcohol (PVA). Various modifications of electrospun polymers have been also described. The use of water-soluble synthetic polymers can contribute to the scalability of electrospinning and pave the way to innovative applications. Further studies will be required to fully harness the potentiality of these ‘greener’ electrospinning processes

Health technology assessment of MRgFUS for the treatment of essential tremor in the Italian setting

OBJECTIVES: MRgFUS has emerged as a life-changing solution for patients with essential tremor (ET). The aim of the study was a multi-dimensional evaluation of the benefits concerning MRgFUS introduction, in comparison with the standard of care, Deep Brain Stimulation (DBS), in Italy. METHODS: In 2017, an Health Technology Assessment was conducted assuming the hospital perspective. Information was retrieved via literature review and collected using qualitative/quantitative questionnaires, covering the 9 EUnetHTA Core Model dimensions and applying a final MCDA approach. RESULTS: In the Italian setting, 48,923 ET patients emerged to be eligible for MRgFUS or DBS treatments, because of the failure of pharmacological treatment. In the comparison between the two alternative technologies, the efficacy profile would be superimposable, in terms of relief from hand tremor, whereas MRgFUS would be the preferable technology from a safety point of view, because of less-invasiveness. Its implementation into the clinical practice would generate economic advantages, ranging from -34% to -67%, on the basis of the use of MRgFUS that consumes fewer economic resources per patient, than DBS (V9,669 vsV30,686, p=0.000). The innovative technology would also have a positive organizational impact, considering: operating capacity (time release in minutes from -25% to -49%), and the length of stay (3 vs 7.70 days, p=0.000). Patients treated with MRgFUS would experience i) a reduction in their "out-of-pocket" expenditure related to hospitalization (V404 vsV1,036, p=0.000) and ii) a quicker return to regular activities (2/3 vs 30/40 days after discharge). CONCLUSIONS: The results suggested that MRgFUS could be considered an advantageous technological alternative for the treatment of patients with essential tremor, paving the way for the definition of a dedicated national reimbursement tariff, making the health service more efficient and effective. Furthermore, hospital could acquire the innovative technology, covering the initial investment cost by implementing 57-63 procedures per year.10-14 November 201

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London