Cell Therapy for Critical Limb Ischemia: Advantages, Limitations, and New Perspectives for Treatment of Patients with Critical Diabetic Vasculopathy

Abstract Purpose of Review To provide a highlight of the current state of cell therapy for the treatment of critical limb ischemia in patients with diabetes. Recent Findings The global incidence of diabetes is constantly growing with consequent challenges for healthcare systems worldwide. In the UK only, NHS costs attributed to diabetic complications, such as peripheral vascular disease, amputation, blindness, renal failure, and stroke, average £10 billion each year, with cost pressure being estimated to get worse. Although giant leaps forward have been registered in the scope of early diagnosis and optimal glycaemic control, an effective treatment for critical limb ischemia is still lacking. The present review aims to provide an update of the ongoing work in the field of regenerative medicine. Recent advancements but also limitations imposed by diabetes on the potential of the approach are addressed. In particular, the review focuses on the perturbation of non-coding RNA networks in progenitor cells and the possibility of using emerging knowledge on molecular mechanisms to design refined protocols for personalized therapy. Summary The field of cell therapy showed rapid progress but has limitations. Significant advances are foreseen in the upcoming years thanks to a better understanding of molecular bottlenecks associated with the metabolic disorders

A rare case report of hypertrophic cardiomyopathy induced by catecholamine-producing tumor

RATIONALE: Catecholamine-producing tumors are rare, occurring in less than 0.2% of patients with hypertension, but can have relevant cardiovascular morbidity and mortality. PATIENT CONCERNS: A 37-year-old woman presented with a history of dyspnea, chest pain, palpitations, and paroxysmal hypertension. Electrocardiogram, echocardiogram, and cardiac magnetic resonance showed severe LVH with a prevalent involvement of the anterior portion of interventricular septum. Endomyocardial biopsy found severe hypertrophy with disarray of cardiomyocytes and ultrastructural evidence of contraction and necrosis of myocytes. Hormone investigations revealed high values of 24-hours urinary metanephrines. Abdominal computed tomography (CT) showed an enlarged left adrenal gland with a strong uptake of I-metaiodobenzylguanidine at scintigraphy scan. INTERVENTIONS:Thus, the adrenal tumor was surgically removed. OUTCOMES: At follow-up examination, the patient's metanephrines levels were normalized and the transthoracic echocardiogram showed a reduction of LVH. DIAGNOSIS AND LESSONS: We report a rare case of catecholamine-induced cardiomyopathy due to an adrenal adenoma mixed with nodules enriched in epinephrine-types secreting granules

Postoperative analgesia after pulmonary resection with a focus on video-assisted thoracoscopic surgery

Video-assisted thoracoscopic surgery is a widespread technique that has been linked to improved postoperative respiratory function, reduced hospital length of stay and a higher level of tolerability for the patients. Acute postoperative pain is of considerable significance, and the late development of neuropathic pain syndrome is also an issue. As anaesthesiologists, we have investigated the available evidence to optimize postoperative pain management. An opioid-sparing multimodal approach is highly recommended. Loco-regional techniques such as the thoracic epidural and peripheral blocks can be performed. Several adjuvants have been employed with varying degrees of success both intravenously and in combination with local anesthetics. Opioids with different pharmacodynamic and pharmacokinetic profiles can be used, either through continuous infusion or on demand. Non-opioid analgesics are also beneficial. Finally, perioperative gabapentinoids may be implemented to prevent the onset of chronic neuropathic pain

Conscious Sedation for Dental Treatments in Subjects with Intellectual Disability: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis was aimed to investigate the conscious sedation efficiency in patients with intellectual disability undergoing dental treatment (PROSPERO CRD42022344292). Four scientific databases were searched by ad-hoc prepared strings. The literature search yielded 731 papers: 426 were selected, 42 were obtained in full-text format, and 4 more were added after hand searching. Fourteen studies were finally included, 11 of which were included in the meta-analysis (random effect model). A high heterogeneity in the drugs used and route of administration was retrieved. Success rate, occurrence of side effects, and deep sedation occurrence were combined to give an overall efficiency of each drug. N2O/O2 reported the highest efficiency (effect size = 0.90; p < 0.01) and proved to be more efficient when used alone. Nine papers reported a success rate of sedation of 80% or more. The prevalence of side effects (6 studies) ranged from 3% to 40%. Enteral and parenteral benzodiazepines showed the same overall efficiency (effect size = 0.86). No meta-analysis has yet been conducted to define the most effective and safest way to achieve conscious sedation in patients with intellectual disability; nitrous oxide appears to be the best choice to perform conscious sedation in patients with intellectual disability undergoing dental treatment

A PERCEPÇÃO DO SECRETÁRIO EXECUTIVO EM RELAÇÃO À RESPONSABILIDADE SOCIAL

This study aimed to analyze the perception of the Executive Secretary in relation to social responsibility. As for the purpose, the research is characterized as an exploratory-descriptive research, and as to the means is characterized as a field research. The approach of the study was quantitative and the instrument used for data collection was the questionnaire. For data analysis we used descriptive statistics and exploratory factor analysis using the SPSS software version 20. As a result of the research it was found that the Executive Secretary sees social responsibility as improvement in quality of life, behavior change, respect for the individual and the environment, commitment to the welfare, investment, image enhancement and cooperation. To conclude, one realizes that the Executive Secretaries are not outdated on the subject.Este estudio tuvo como objetivo analizar la percepci&oacute;n del Secretario Ejecutivo en relaci&oacute;n a la responsabilidad social. Como el prop&oacute;sito, la investigaci&oacute;n se caracteriza como un estudio exploratorio-descriptivo, y cuanto a los medios se caracteriza como una investigaci&oacute;n de campo. El enfoque del estudio fue cuantitativo y el instrumento utilizado para la recolecci&oacute;n de datos fue un cuestionario. Para el an&aacute;lisis de los datos se utiliz&oacute; estad&iacute;stica descriptiva y an&aacute;lisis factorial exploratorio utilizando el software SPSS versi&oacute;n 20. Como resultado de la investigaci&oacute;n se encontr&oacute; que el Secretario Ejecutivo se da cuenta de la Responsabilidad Social como la mejora de la calidad de vida, el cambio de comportamiento, el respeto por el individuo y el medio ambiente, el compromiso con el bienestar, la inversi&oacute;n, mejora de la imagen, y la cooperaci&oacute;n. Para concluir, se puede ver que los secretarios ejecutivos no son anticuadas sobre el tema.O presente estudo teve como objetivo analisar a percep&ccedil;&atilde;o do Secret&aacute;rio Executivo em rela&ccedil;&atilde;o &agrave; Responsabilidade Social. Quanto aos fins, &agrave; pesquisa se caracteriza como uma pesquisa explorat&oacute;rio-descritiva, e quanto aos meios se caracteriza como uma pesquisa de campo. A abordagem do estudo foi quantitativa e o instrumento utilizado para coleta de dados foi o question&aacute;rio. Para an&aacute;lise dos dados foram utilizadas a estat&iacute;stica descritiva e a an&aacute;lise fatorial explorat&oacute;ria por meio do software SPSS vers&atilde;o 20. Como resultado da pesquisa foi constatado que o Secret&aacute;rio Executivo percebe a Responsabilidade Social como melhoria da qualidade de vida, mudan&ccedil;a de comportamento, respeito ao indiv&iacute;duo e ao meio ambiente, compromisso com o bem-estar, investimento, valoriza&ccedil;&atilde;o da imagem, e coopera&ccedil;&atilde;o. Para concluir, percebe-se que os Secret&aacute;rios Executivos n&atilde;o est&atilde;o desatualizados quanto ao tema

Post-mortem computed tomography (PMCT) radiological findings and assessment in advanced decomposed bodies.

PURPOSE: The aim of the study is to report radiological findings and features in advanced decomposed bodies obtained by post-mortem computed tomography (PMCT) with autopsy correlation. MATERIALS AND METHODS: This retrospective descriptive multicentric study included 41 forensic cases examined between May 2013 and November 2016. All the bodies were PMCT-scanned prior to autopsy, and internal putrefactive state was determined using the radiological alteration index (RAI) by a radiologist with expertise in forensic radiology and a forensic pathologist trained in forensic imaging. After PMCT scans, grade of external putrefaction (GEP) was assigned during the external examination and the complete autopsy was performed by forensic pathologists. RESULTS: The PMCT images evaluation revealed that the RAI index was > 61 in all bodies, corresponding to a moderate-massive presence of putrefactive gas. The gas grade was > II in correspondence of the major vessels, heart cavities, liver parenchyma, vertebra L3 and subcutaneous pectoral tissues, and varied from I to III in correspondence of the kidney. Cadaveric external examination revealed the presence of advanced transformative phenomena, with a GEP3 and GEP4 in most of the cases, with body swelling, eyes and tongue protrusion, body fluids expulsion and fat liquefaction. CONCLUSION: Radiological imaging by PMCT as an adjunct to autopsy in advanced decomposed bodies represents a useful tool in detecting post-mortem gas, even in very small amounts. A correct interpretation process of the PMCT data is essential to avoid images pitfalls, due to natural decomposition that can be mistaken for pathologic processes