18 research outputs found
Relationship between Early Inflammatory Response and Clinical Evolution of the Severe Multiorgan Failure in Mechanical Circulatory Support-Treated Patients
Get PDFBackground. The mechanical circulatory support (MCS) is an effective treatment in critically ill patients with end-stage heart failure (ESHF) that, however, may cause a severe multiorgan failure syndrome (MOFS) in these subjects. The impact of altered inflammatory response, associated to MOFS, on clinical evolution of MCS postimplantation patients has not been yet clarified. Methods. Circulating cytokines, adhesion molecules, and a marker of monocyte activation (neopterin) were determined in 53MCStreated patients, at preimplant and until 2 weeks. MOFS was evaluated by total sequential organ failure assessment score (tSOFA). Results. During MCS treatment, 32 patients experienced moderate MOFS (tSOFA< 11; A group), while 21 patients experienced severe MOFS (tSOFA? 11) with favorable (B group) or adverse (�� = 13, C group) outcomes. At preimplant, higher values of left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR) were the only parameter independently associated with A group. In C group, during the first postoperative week, high levels of interleukin-8 (IL-8) and tumor necrosis factor (TNF)-��, and an increase of neopterin and adhesionmolecules, precede tSOFA worsening and exitus. Conclusions.TheMCS patients of C group show an excessive release to IL-8 and TNF-��, and monocyte-endothelial activation after surgery, that might contribute to the unfavourable evolution of severe MOFS
Relationship between Early Inflammatory Response and Clinical Evolution of the Severe Multiorgan Failure in Mechanical Circulatory Support-Treated Patients
Full text linkSigh in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: the PROTECTION pilot randomized clinical trial
Get PDFBackground: Sigh is a cyclic brief recruitment manoeuvre: previous physiological studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity and increase release of surfactant.
Research question: Is the clinical application of sigh during pressure support ventilation (PSV) feasible?
Study design and methods: We conducted a multi-center non-inferiority randomized clinical trial on adult intubated patients with acute hypoxemic respiratory failure or acute respiratory distress syndrome undergoing PSV. Patients were randomized to the No Sigh group and treated by PSV alone, or to the Sigh group, treated by PSV plus sigh (increase of airway pressure to 30 cmH2Ofor 3 seconds once per minute) until day 28 or death or successful spontaneous breathing trial. The primary endpoint of the study was feasibility, assessed as non-inferiority (5% tolerance) in the proportion of patients failing assisted ventilation. Secondary outcomes included safety, physiological parameters in the first week from randomization, 28-day mortality and ventilator-free days.
Results: Two-hundred fifty-eight patients (31% women; median age 65 [54-75] years) were enrolled. In the Sigh group, 23% of patients failed to remain on assisted ventilation vs. 30% in the No Sigh group (absolute difference -7%, 95%CI -18% to 4%; p=0.015 for non-inferiority). Adverse events occurred in 12% vs. 13% in Sigh vs. No Sigh (p=0.852). Oxygenation was improved while tidal volume, respiratory rate and corrected minute ventilation were lower over the first 7 days from randomization in Sigh vs. No Sigh. There was no significant difference in terms of mortality (16% vs. 21%, p=0.342) and ventilator-free days (22 [7-26] vs. 22 [3-25] days, p=0.300) for Sigh vs. No Sigh.
Interpretation: Among hypoxemic intubated ICU patients, application of sigh was feasible and without increased risk
La valutazione delle partecipazioni nel bilancio
No full textNel nostro paese, e più in generale in una visione internazionale, il contesto competitivo odierno è stato la ragione principale che ha spinto le imprese a rimarcare un carattere sempre più strategico e speculativo, rendendo sempre più importante il quadro degli investimenti al capitale di altre imprese.
La Partecipazione è definita dalla normativa civilistica come un qualsiasi pacchetto di titoli rappresentativi del capitale sociale di un’altra impresa. La partecipazione è riconducibile alla durevole detenzione di quote di capitale di rischio in altre imprese in maniera tale da permettere un’influenza dominante o significativa sulla gestione delle politiche societarie.
Il processo di globalizzazione così come la crisi finanziaria dell’ultimo decennio hanno cambiato e in parte modificato l’assetto normativo che ruota attorno alla posta di bilancio in oggetto.
Nel presente lavoro si è preso in esame, dapprima la parte meramente oggettiva, passando poi a concentrare l’attenzione sulla volontà degli stessi amministratori nel classificare la partecipazione. Poiché è compito di questi identificare se la voce dell’attivo patrimoniale debba essere classificata come immobilizzazione, assumendo carattere duraturo, oppure, come attivo circolante, assumendo così un carattere volto a una pronta negoziazione. Ci si sofferma sia alla dottrina civilistica sia ai principi contabili nazionali che non fanno altro che arricchire e armonizzare i principi già dettati dal legislatore. Principi contabili nazionali che sempre più hanno dovuto modificare il carattere (impronta) nazionalistico per somigliare quanto più possibile ai principi contabili internazionali IAS/IFRS.
Con riguardo ai principi contabili internazionali sarà posta l’attenzione alla valutazione delle partecipazioni in imprese collegate, controllate e a controllo congiunto.
Dopo una disamina sui diversi criteri di valutazione all’ interno del bilancio, si è voluto dare effettivo rilievo alla realtà odierna considerando la valutazione delle partecipazioni nelle ultime due annualità (anno 2016 e 2017) e da un analisi numerica si è potuto constatare come la realtà delle Partecipazioni sia sempre più diffusa. L’analisi ha dato spazio agli aspetti più critici sulla scelta che i redattori di bilancio hanno effettuato in merito alla valutazione delle Partecipazioni stesse
Vitamin D and Cardiovascular Disease: Current Evidence and Future Perspectives
No full textVitamin D deficiency is a prevalent condition, occurring in about 30–50% of the population, observed across all ethnicities and among all age groups. Besides the established role of vitamin D in calcium homeostasis, its deficiency is emerging as a new risk factor for cardiovascular disease (CVD). In particular, several epidemiological and clinical studies have reported a close association between low vitamin D levels and major CVDs, such as coronary artery disease, heart failure, and atrial fibrillation. Moreover, in all these clinical settings, vitamin deficiency seems to predispose to increased morbidity, mortality, and recurrent cardiovascular events. Despite this growing evidence, interventional trials with supplementation of vitamin D in patients at risk of or with established CVD are still controversial. In this review, we aimed to summarize the currently available evidence supporting the link between vitamin D deficiency and major CVDs in terms of its prevalence, clinical relevance, prognostic impact, and potential therapeutic implications
Relationship Between Myocardial Redox State and Matrix Metalloproteinase Activity in Patients on Left Ventricular Assist Device Support
No full textBackground:  Redox aminothiols have been reported to modulate the activity of recombinant metalloproteinases  (MMP). The aim of the present study was to investigate the effects of myocardial redox state on the activities of  MMP-2 and -9 implicated in cardiac remodeling in end-stage heart failure patients supported by left ventricular assist  device (LVAD). Methods and Results:  During heart transplant (HT) surgery, myocardial specimens (MS) from right ventricular  walls and LV walls were obtained from 7 LVAD recipients (LVAD group, MS n=35) and from 7 stable HT candidates  on medical therapy (MT group, MS n=35). Myocardial MMP-2 and -9 activities and expression, tissue inhibitor of  MMP (TIMP)-1 and -4, transforming growth factor (TGF)-β1 and aminothiol concentrations were measured. MMP-2  and -9 activities were evaluated also by incubating MS with different amounts of reduced and oxidized glutathione  (GSH). MMP-2 and -9 activities and expression were lower in the LVAD group, whereas myocardial TIMP-1 and -4  concentrations were comparable to those of MT patients. Higher GSH  and TGF-β1 concentrations were found   in LVAD-recipients. Only GSH concentrations were inversely related to MMP-2 and -9 activities. In vitro, GSH had  an inhibitory effect on MMP-2 and -9 activities. Conclusions:  LVAD recipients show reduced myocardial MMP-2 and -9 activities and expression when compared  to medically treated patients. Changes of myocardial redox state, predominantly GSH-dependent, appear to modu- late MMP-2 and -9 activities by an inhibitory effect dependent on thiol content. These data support a role of GSH  cycle in modulating the extracellular matrix in end-stage heart failure patients supported by LVAD.   
The Effects of Module Temperature on the Energy Yield of Bifacial Photovoltaics: Data and Model
No full textBifacial photovoltaics (BPVs) are emerging with large momentum as promising solutions to improve energy yield and cost of PV systems. To reach its full potential, an accurate understanding of the physical characteristics of BPV technology is required. For this reason, we collected experimental data to refine a physical model of BPV. In particular, we simultaneously measured the module temperature, short circuit current (Isc), open-circuit voltage (Voc), power at the maximum power point (Pmpp), and the energy yield of a bifacial and a monofacial minimodule. Such minimodules, realised with the same geometry, cell technology, and module lamination, were tested under the same clear sky outdoor conditions, from morning to afternoon, for three days. The bifacial system experimentally shows higher module temperatures under operation, about 10 °C on a daily average of about 40 °C. Nevertheless, its energy yield is about 15% larger than the monofacial one. We propose a physical quantitative model that fits the experimental data of module temperature, Isc, Voc, Pmpp, and energy yield. The model was then applied to predict the annual energy yield of PV module strings. The effect of different PV module temperature coefficients on the energy yield is also discussed
Reduced myocardial MMP-2, MMP-9 and gluatione peroxidase activities and elevated cytokine levesl in patients supported by left ventricular assist device
No full textTo asssess the effects of LVAD implant in end-stage heart failure patients on the extracellular matrix oxidative stress and inflammatory sat
Relationship between Early Inflammatory Response and Clinical Evolution of the Severe Multiorgan Failure in Mechanical Circulatory Support-Treated Patients
No full textBackground. The mechanical circulatory support (MCS) is an effective treatment in critically ill patients with end-stage heart failure (ESHF) that, however, may cause a severe multiorgan failure syndrome (MOFS) in these subjects. The impact of altered inflammatory response, associated to MOFS, on clinical evolution of MCS postimplantation patients has not been yet clarified. Methods. Circulating cytokines, adhesion molecules, and a marker of monocyte activation (neopterin) were determined in 53 MCS-treated patients, at preimplant and until 2 weeks. MOFS was evaluated by total sequential organ failure assessment score (tSOFA). Results. During MCS treatment, 32 patients experienced moderate MOFS (tSOFA < 11; A group), while 21 patients experienced severe MOFS (tSOFA ≥ 11) with favorable (B group) or adverse (n=13, C group) outcomes. At preimplant, higher values of left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR) were the only parameter independently associated with A group. In C group, during the first postoperative week, high levels of interleukin-8 (IL-8) and tumor necrosis factor (TNF)-α, and an increase of neopterin and adhesion molecules, precede tSOFA worsening and exitus. Conclusions. The MCS patients of C group show an excessive release to IL-8 and TNF-α, and monocyte-endothelial activation after surgery, that might contribute to the unfavourable evolution of severe MOFS
Myocardial redox state alterations and elevated cytokines levels in patients with end stage heart failure (ESHF) supported by left ventricular assist device (LVAD)
No full textTo assess the effects of mechanical unloading by LVAD on the interplay between redox pathways and inflammatory status in ESHF
