Inspiratory muscle training and its effect on indices of physiological and perceived stress during incremental walking exercise in normobaric hypoxia

This study evaluated the effects of inspiratory muscle training (IMT) on inspiratory muscle fatigue (IMF) and physiological and perceptual responses during trekking-specific exercise. An 8-week IMT program was completed by 21 males (age 32.4 ± 9.61 years, VO2peak 58.8 ± 6.75 mL/kg/min) randomised within matched pairs to either the IMT group (n = 11) or the placebo group [(P), n = 9]. Twice daily, participants completed 30 (IMT) or 60 (P) inspiratory efforts using a Powerbreathe initially set at a resistance of 50% (IMT) or used at 15% (P) of maximal inspiratory pressure (MIP) throughout. A loaded (12.5 kg) 39-minute incremental walking protocol (3–5 km/hour and 1–15% gradient) was completed in normobaric hypoxia (PIO2 = 110 mmHg, 3000 m) before and after training. MIP increased from 164 to 188 cmH2O (18%) and from 161 to 171 cmH2O (6%) in the IMT and P groups (P = 0.02). The 95% CI for IMT showed a significant improvement in MIP (5.21±43.33 cmH2O), but not for P. IMF during exercise (MIP) was*5%, showing no training effect for either IMT or P (P = 0.23). Rating of perceived exertion (RPE) was consistently reduced (*1) throughout exercise following training for IMT, but not for P (P = 0.03). The mean blood lactate concentration during exercise was significantly reduced by 0.26 and 0.15 mmol/L in IMT and P (P = 0.00), with no differences between groups (P = 0.34). Rating of dyspnoea during exercise decreased (*0.4) following IMT but increased (*0.3) following P (P = 0.01). IMT may attenuate the increased physiological and perceived exercise stress experienced during normobaric hypoxia, which may benefit moderate altitude expedition

Stress in nursing staff: a comparative analysis between intensive care units and general medicine units

It's a current belief that stress is an outstanding feature of intensive care units, in particular within nursing staff. The aim of this study was to compare some variables belonging to stress (i.e. anxiety, depression and `Burnout' syndrome) between nurses working in intensive care units (ICUs) and general medicine units (GMUs). Materials and methods We studied a population of 883 nurses working in ICUs, distributed in 79 Italian hospitals (70.1 % female) and 509 nurses working in GMUs, distributed in 35 Italian hospitals (80.2 % female). We asked them to fill in a form including: 1) general data and his/her work environment; 2) different evaluation standardized scales - the Hospital Anxiety and Depression Scale, divided into anxiety (HAD A) and depression (HAD D) status 0-7 `non cases', 8-10 `doubtful cases', 11-21 `cases'; the S.T.A.I. scale, divided into acute anxiety (Y-1) and chronic anxiety (Y-2) status; the Maslach Burnout Inventory-Human Services Survey (MBI.) divided into Emotional Exhaustion (EE), 64 18 `low', 19-26 `average', 65 27 `high', Depersonalization (DP) and Personal Accomplishment (PA). We also evaluated the different reasons of anxiety through individual questions (higher value, more anxiety): A1, a critically ill patient; A2, a young patient; A3, an old patient; A4, a suicidal patient; A5, a terminal patient; A6, presence of mechanical supports; A7, relationship with patients' relatives. The comparison between the two groups was performed by the Mann-Whitney Rank Sum test and z-test; statistical significance was accepted as P<0.05. Results The results, expressed as median value, with 25th and 75th percentile in brackets, are shown in Tables 1 and 2. Table 1 also shows the proportions of nurses that had a highest value of HAD A and M.B.I. EE. Conclusions Pathologic anxiety and emotional exhaustion are more prevalent in nurses working in GMUs. Thus, contrary to a common belief, `stress' is a more distinctive peculiarity of general medicine units than intensive care units

The carotid wallstent for the endovascular treatment of carotid artery stenosis

Aim: To report a retrospective, 15-years single-center experience about Carotid Artery Stenting (CAS) using the Carotid Wallstent in high surgical risk patients. Methods: Primary outcomes were procedural success, 30-day mortality and cerebrovascular complications, and long-term survival, neurological complication and restenosis. P values< 0.05 were considered significant. Results: From January 2000 to June 2015, 560 patients underwent CAS using the Carotid Wallstent for either a symptomatic (22.6%) or an asymptomatic significant carotid stenosis. Primary success was achieved in 99.1% as 4 acute stent thrombosis occurred and in 1 case selective catheterization of the supra-aortic trunks was not possible due to extreme tortuosity. At 30 days, 7 TIAs and 9 strokes accounted for a 2.8% of neurological complication rate. There were 2 deaths unrelated to the procedure. At 10 years, survival was 71.2% +/- 2.5%. Freedom from cerebrovascular events (TIA/stroke) at 10 years was 91.2% +/- 1.9% for asymptomatic patients and 81.7% +/- 5% for symptomatic patients (P = 0.008). Freedom from a restenosis >30% was estimated to be of 93.9% +/- 1.3% at 10 years, being significantly affected by age (P = 0.01). Conclusion: In our experience the Carotid Wallstent was a safe and effective device for the treatment of both asymptomatic and symptomatic carotid stenosis in high surgical risk patients. Freedom from cerebrovascular events in the long term was worse in symptomatic patients

Modelling TGFbR and Hh pathway regulation of prognostic matrisome molecules in ovarian cancer

In a multi-level ‘deconstruction’ of omental metastases, we previously identified a prognostic matrisome gene expression signature in high-grade serous ovarian cancer (HGSOC) and twelve other malignancies. Here, our aim was to understand how six of these extracellular matrix, ECM, molecules, COL11A1, COMP, FN1, VCAN, CTSB and COL1A1, are up-regulated in cancer. Using biopsies, we identified significant associations between TGFβR activity, Hedgehog signalling and these ECM molecules and then studied the associations in mono-, co- and tri-culture. Activated omental fibroblasts produced more matrix than malignant cells, directed by TGFβR and Hedgehog signalling crosstalk. We ‘reconstructed’ omental metastases in tri-culture of HGSOC cells, omental fibroblasts and adipocytes. This combination was sufficient to generate all six ECM proteins and the matrisome expression signature. TGFβR and Hedgehog inhibitor combinations attenuated fibroblast activation, gel remodelling and ECM remodelling in these models. The tri-culture model reproduces key features of omental metastases and allows study of diseased-associated ECM

Ruptured hemiarch and descending thoracic aorta aneurysm : hybrid treatment

Ruptured aortic arch aneurysm is a life threatening disease. Surgical repair has an high perioperative mortality rate and totally endovascular treatment is a challenge. Hybrid repair has been proposed as a valuable approach. We report the case of a patient with a contained rupture of aortic arch aneurysm. We treated him with a debranching of supraortic vessels with carotid-carotid and carotid-subclavian bypass and deployment of two enodgrafts in two different times. We consider hybrid treatment for arch and hemiarch a feasible option for aortic arch aneurysms in non emergent and in an emergency setting with an improvement in perioperative morbidity and mortality

Weapons in the jungle of femoro-popliteal lesions

Best treatment for Superficial Femoral Artery (SFA) lesions is still the subject of some controversies in the literature. The paper offers a brief overview of all the techniques currently available for the treatment of SFA lesions

Electroactive Inherently Chiral Surfaces at Work: Clues Toward the Elucidation of the Enantioselection Mechanism

Chirality is a concept strictly related to life and to its evolution. Capability to discriminate antipodes and/or produce enantiopure chiral chemicals through cheap and efficient protocols is a crucial task for our modern civilization. So identification of increasingly effective and robust chiral selectors is a challenging task also for the electrochemical community [1,2]. In this frame our research group is working on the so called \u201cinherently chiral functional molecular materials\u201d, ICFMMs; the idea is simple: make the stereogenic element responsible for chirality coincident with the functional group responsible for the material specific property (Figure, left). This approach has constituted an actual breakthrough in chiral electrochemistry, resulting in the preparation of efficient chiral electroactive surfaces [3,4,5] (and chiral additives/media, too [6]) invariably characterized by outstanding enantiodiscrimination ability in quite different working conditions and with chemically different chiral electroactive analytes. Notwithstanding plenty of proofs pointing to a general validity of the ICFMMs concept, a clear rationalization of the enantiodiscrimination mechanism still lacks. To fill the gap a deeper knowledge of the behavior of our electrodeposited chiral films is mandatory. As a first step some of the most important experimental parameters governing the growth of the conductive coatings have been changed, one by one, to evaluate their impact on the morphological, optical and electronic properties of the final deposit. Results of the multi-technique characterization will be discussed, including profilometry, electrochemical impedance spectroscopy (Figure, right) and spectroelectrochemistry data, all aimed to collect clues useful to rationalize the way in which ICFMMs work. The support of Fondazione Cariplo/Regione Lombardia (Project 2016-0923) and SmartMatLab are gratefully acknowledged. References: [1] S. Arnaboldi, M. Magni, P. Mussini, Curr. Opin. Electrochem., 2018, 8, 60. [2] S. Arnaboldi, S. Grecchi, M. Magni, P. Mussini, Curr. Opin. Electrochem., 2018, 7, 188. [3] F. Sannicol\uf2, P.R. Mussini, T. Benincori, R. Martinazzo, S. Arnaboldi, G. Appoloni, M. Panigati, E. Quartapelle Procopio, V. Marino, R. Cirilli, S. Casolo, W. Kutner, K. Noworyta, A. Pietrzyk-Le, Z. Iskierko, K. Bartold, Chem. Eur. J., 2016, 22, 10839. [4] S. Arnaboldi, P.R. Mussini, M. Magni, F. Sannicol\uf2, T. Benincori, R. Cirilli, K. Noworyta, W. Kutner, Chem. Sci., 2015, 6, 1706. [5] F. Sannicol\uf2, S. Arnaboldi, T. Benincori, V. Bonometti, R. Cirilli, L. Dunsch, W. Kutner, G. Longhi, P.R. Mussini, M. Panigati, M. Pierini, S. Rizzo, Angew. Chem. Int. Ed., 2014, 53, 2623. [6] S. Rizzo S. Arnaboldi, V. Mihali, R. Cirilli, A. Forni, A. Gennaro, A.A. Isse, M. Pierini, P.R. Mussini, F. Sannicol\uf2, Angew. Chem. Int. Ed., 2017, 56, 2079

Straight aortic endograft in abdominal aortic disease

Background: We describe our 8-year experience with the use of endovascular techniques (ET) for the treatment of abdominal aortic aneurysms (AAA) through a straight endograft. Methods: We retrospectively reviewed data of all patients who were treated for AAA using ET in two centres from 1998 to 2012 and who received a single straight endograft (group A) or a double straight tube (group B). Outcomes were analyzed to assess survival, absence of endoleak and absence of reintervention for both groups. Log-rank and Chi-Square were used as appropriate to make comparison between the two groups. P values <.05 were considered statistically significant. Results: Fifty-three patients from 1998 to May 2012 were treated for AAA using a straight endograft. In 28 cases (52.8%) a single aortic straight tube was used (Group A), while in the remaining cases a "double trombone technique" was used (Group B). Primary success was obtained in 52 cases (98.1%). In one patient of group A immediately after the operation we observed a type Ia endoleak, which was correct with a proximal aortic cuff. Fluoroscopy time, operation time, amount of intraprocedural contrast medium and blood loss were slightly higher for group B, even if not significantly. Mortality at 30 days was nil for both groups. Mean follow-up was 49 months (range 2-153 months). Five patients died in group A, four of them for a neoplastic disease and the remaining for aortic rupture. No patients died in group B. Endoleaks occurred more frequently in patients of group A (5 type I endoleaks and 1 type II endoleak from a lumbar artery). Reintervention were more frequent for patients of group A, being type I endoleak the main cause. A stent fracture was observed in a patient who received EVAR by "trombone technique" 3 months later. Reintervention was then necessary and a third stent was successfully placed to cover the lesion. Conclusions: In our experience the endovascular repair of AAA using straight aortic endografts was a safe and effective technique. Reintervention and endoleaks were slightly more frequent in patients who had received a single endograft compared to patients who were treated using the "trombone technique"