Changes in quality of life and functional capacity after lung transplantation: A single-center experience

Lung transplantation (LT) increases the life expectancy of patients affected by end stage pulmonary disease; specifically, its ultimate aims are to improve survival and health related quality of life (HRQoL). The aim of the present longitudinal study was to determine the HRQoL trajectory and changes in functional capacity from time of entry in the waiting list for LT to 2 year after LT. The study included sixty-nine outpatients enrolled in a single medical center when they entered the waiting list for LT and who subsequently received it. They were then followed up over 2 years after LT. HRQoL was assessed by the physical and mental component summary (PCS and MCS) scores of the 36-item Short Form Health Survey (SF-36) and Saint George's Respiratory Questionnaire (SGRQ). Psychological distress was evaluated with the General Health Questionnaire (GHQ), and functional capacity was investigated using the six-minute walk test (6MWT) and forced expiratory volume (FEV1). Patients showed low SF-36 PCS (30.5±7.8) and SGRQ total (61.8±17.5) scores at entry in the waiting list, but exhibited significant changes over time after LT (p<0.001). Furthermore, patients who showed an increase of at least 50% in SF36 PCS and SGRQ scores at 6 months survived longer. Both FEV1 and 6MWT distance as well as GHQ scores significantly changed over time, with improvements occurring in the first 6 months after LT but no major changes thereafter. Out of the 69 patients enrolled, 32 died over a median follow-up of 51 months. Although mortality tended to be slightly higher for patients with lower HRQoL at the baseline assessment, this difference was not statistically significant. HRQoL evaluations appear critical in the follow-up of LT candidates, in particularly SGRQ, because of its specificity in targeting respiratory symptoms and functional wellbeing

Early rehabilitation after elective total knee arthroplasty

Outcomes after TKA surgery are supposed to be related to the intensity and type of post-operative rehabilitation. Aim of this paper is to describe our early rehabilitation protocol following TKA with mini-invasive surgery in the immediate post-operative period and analyze functional recovery and changes in pain scores in these patients

Trattamento con tossina botulinica delle sincinesie dopo paralisi del VII nervo cranico

Scopo dello studio è valutare l’evoluzione clinica di pazienti con sincinesie in esiti di paralisi di faciale trattati con infiltrazione di tossina botulinica. Complessivamente sono state effettuate 143 sedute di infiltrazione in 44 pazienti, con una dose di tossina compresa tra 2.5 e 3.5 U.I. per ogni punto di inoculazione. I muscoli infiltrati sono stati: orbicolare delle palpebre, platisma, mentoniero, frontale e zigomatico. La valutazione del quadro clinico è stata effettuata prima del trattamento e dopo 15 giorni utilizzando la versione italiana della Scala di Valutazione Facciale Sunnybrook. Dopo il trattamento con tossina si riducono le sincinesie e migliorano la simmetria a riposo e del movimento volontario, con un significativo incremento del punteggio globale Sunnybrook (test Wilcoxon, p<0.001). Il nostro studio conferma la riduzione delle sincinesie postparalitiche e il miglioramento della simmetria del volto dopo infiltrazione di tossina botulinic

Randomized, multicenter trial of lateral Trendelenburg versus semirecumbent body position for the prevention of ventilator-associated pneumonia

Purpose: The lateral Trendelenburg position (LTP) may hinder the primary pathophysiologic mechanism of ventilator-associated pneumonia (VAP). We investigated whether placing patients in the LTP would reduce the incidence of VAP in comparison with the semirecumbent position (SRP). Methods: This was a randomized, multicenter, controlled study in invasively ventilated critically ill patients. Two preplanned interim analyses were performed. Patients were randomized to be placed in the LTP or the SRP. The primary outcome, assessed by intention-to-treat analysis, was incidence of microbiologically confirmed VAP. Major secondary outcomes included mortality, duration of mechanical ventilation, and intensive care unit length of stay. Results: At the second interim analysis, the trial was stopped because of low incidence of VAP, lack of benefit in secondary outcomes, and occurrence of adverse events. A total of 194 patients in the LTP group and 201 in the SRP group were included in the final intention-to-treat analysis. The incidence of microbiologically confirmed VAP was 0.5% (1/194) and 4.0% (8/201) in LTP and SRP patients, respectively (relative risk 0.13, 95% CI 0.02â1.03, pÂ&nbsp;=Â&nbsp;0.04). The 28-day mortality was 30.9% (60/194) and 26.4% (53/201) in LTP and SRP patients, respectively (relative risk 1.17, 95% CI 0.86â1.60, pÂ&nbsp;=Â&nbsp;0.32). Likewise, no differences were found in other secondary outcomes. Six serious adverse events were described in LTP patients (pÂ&nbsp;=Â&nbsp;0.01 vs. SRP). Conclusions: The LTP slightly decreased the incidence of microbiologically confirmed VAP. Nevertheless, given the early termination of the trial, the low incidence of VAP, and the adverse events associated with the LTP, the study failed to prove any significant benefit. Further clinical investigation is strongly warranted; however, at this time,Â&nbsp;the LTP cannot be recommended as a VAP preventive measure. ClinicalTrials.gov identifier: NCT01138540