Osservatorio territoriale droga e tossicodipendenze. Il Fenomeno delle dipendenze sul territorio della ASL MI 3. Anno 2007.

Report on the state of legal and illegal substances use in the territory of the Local Healthcare Service-Mi 3, Province of Milan.Il report analizza il fenomeno delle dipendenze nel territorio della ASL Milano 2. La descrizione del fenomeno si sviluppa intorno all\u27analisi degli indicatori individuati dall\u27Osservatorio Europeo delle Dipendenze di Lisbona (OEDT): 1-uso di sostanze nella popolazione generale (questo indicatore va a rilevare i comportamenti nei confronti di alcol e sostanze psicoattive da parte della popolazione generale); 2-prevalenza d\u27uso problematico delle sostanze psicoattive; 3-domanda di trattamento degli utilizzatori di sostanze; 4-mortalit? degli utilizzatori di sostanze; 5-malattie infettive. Altri due importanti indicatori che si stanno sviluppando, e che vengono qui illustrati, sono l\u27analisi delle Schede di Dimissione Ospedaliera (SDO) e gli indicatori relativi alle conseguenza sociali dell\u27uso di droghe (criminalit? droga correlata). Inoltre sono state applicate diverse metodologie standard di stima sia per quantificare la quota parte sconosciuta di utilizzatori di sostanze che non afferiscono ai servizi, sia per identificarne alcune caratteristiche

Optimum support by high-flow nasal cannula in acute hypoxemic respiratory failure: effects of increasing flow rates

Purpose: Limited data exist on the correlation between higher flow rates of high-flow nasal cannula (HFNC) and its physiologic effects in patients with acute hypoxemic respiratory failure (AHRF). We assessed the effects of HFNC delivered at increasing flow rate on inspiratory effort, work of breathing, minute ventilation, lung volumes, dynamic compliance and oxygenation in AHRF patients. Methods: A prospective randomized cross-over study was performed in non-intubated patients with patients AHRF and a PaO2/FiO2(arterial partial pressure of oxygen/fraction of inspired oxygen) ratio of ≤300 mmHg. A standard non-occlusive facial mask and HFNC at different flow rates (30, 45 and 60 l/min) were randomly applied, while maintaining constant FiO2(20 min/step). At the end of each phase, we measured arterial blood gases, inspiratory effort, based on swings in esophageal pressure (ΔPes) and on the esophageal pressure–time product (PTPPes), and lung volume, by electrical impedance tomography. Results: Seventeen patients with AHRF were enrolled in the study. At increasing flow rate, HFNC reduced ΔPes (p < 0.001) and PTPPes(p < 0.001), while end-expiratory lung volume (ΔEELV), tidal volume to ΔPes ratio (VT/ΔPes, which corresponds to dynamic lung compliance) and oxygenation improved (p < 0.01 for all factors). Higher HFNC flow rate also progressively reduced minute ventilation (p < 0.05) without any change in arterial CO2tension (p = 0.909). The decrease in ΔPes, PTPPesand minute ventilation at increasing flow rates was better described by exponential fitting, while ΔEELV, VT/ΔPes and oxygenation improved linearly. Conclusions: In this cohort of patients with AHRF, an increasing HFNC flow rate progressively decreased inspiratory effort and improved lung aeration, dynamic compliance and oxygenation. Most of the effect on inspiratory workload and CO2clearance was already obtained at the lowest flow rate

Angiotensin 1-7 as the possible universal panacea of human systemic diseases And potentially the best anti-aging molecule of human body

Abstract: The recent advances in the immunobiological knowledges have shown that the immune system is not involved in the only defence against infections and tumours, but also in the regulation of cardiovascular, endocrine, and nervous functions. Moreover, the activity of the immune system mainly depends on the cytokine network. However, most cytokines play an inflammatory action, with a consequent unbalance between inflammatory and anti-inflammatory responses. Then, the prevalent inflammatory action of cytokines is counterbalanced by an anti-inflammatory neuroendocrine central system, mainly mediated by the pineal gland, cannabinoid system, and ACE2-angiotensin 1-7 (Ang 1-7). In fact, the pineal hormone melatonin (MLT), the cannabinoid agents, and Ang 1-7, produced by the enzymatic activity of ACE2 on angiotensin II (Ang II), have appeared to exert an anti-inflammatory activity due to the inhibition of the secretion of several inflammatory cytokines. Moreover, their anti-inflammatory activity is constantly associated with an antitumoral action, by constituting a fundamental anti-inflammatory anticancer functional system. One of the main connections between cytokine network and neuroendocrine system would be IL-17, which has appeared to inhibit Ang 1-7 secretion and to stimulate that of Ang II, and whose secretion may be inhibited by MLT, cannabinoids and Ang 1-7 itself. Most human systemic inflammatory diseases have appeared to present an endogenous Ang 1-7 deficiency. In addition, aging itself is characterized by a progressive decline in the secretion of both pineal hormone MLT and Ang 1-7. Therefore, because of their anti-inflammatory anticancer activity, the progressive decline in MLT and Ang1-7 production may explain age-related increase in the incidence of tumours and other systemic pathologies. Moreover, Ang 1-7 deficiency has been shown to be associated with a concomitant enhanced production of Ang II, which exerts hypertensive, inflammatory, protumoral, pro-thrombotic and profibrotic effects, being responsible for several biological damages. Then, a substitutive treatment with MLT and Ang 1-7 might opposite age-related human diseases and counteract aging itself. Both MLT and Ang 1-7 have appeared to exert anti-aging antioxidant anti-inflammatory effects. However, the anti-aging biological properties of Ang 1-7 would be superior to those of MLT itself, since MLT may only slow down aging mechanisms, while Ang 1-7 could also regenerate the human body by reversing the atherosclerotic and fibrotic processes, which are responsible for the progressive organ failure