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Nasotracheal intubation was advocated to increase patients comfort and tube tolerance, but no study showed a clear benefit of nasotracheal intubation over orotracheal intubation. Neurocritically ill patients are a fragile group with specific requirements regarding ventilation and sedation. The aim of this study was to evaluate whether nasotracheal intubation might reduce length of mechanical ventilation in neurocritically ill patients.We conducted a retrospective cohort study with propensity matched analysis including all patients who underwent prolonged mechanical ventilation in the neurocritical Intensive Care Unit.A total of 4030 patients were admitted during the period of interest and 312 entered the final analysis. Propensity score analysis identified 74 matched couples. Length of mechanical ventilation in patients who underwent early nasotracheal intubation resulted to be statistically significantly shorter than patients who underwent orotracheal intubation. Accordingly, length of sedation was significantly lower in patients with nasotracheal intubation, while no difference in complications occurred with similar length of stay.In critical care units using nasotracheal intubation in the standard management of patients, the nasotracheal route was associated with lesser need for sedatives leading to shorter mechanical ventilation in neurocritical patients. However, causality has to be proven by future randomized controlled trials.

In this paper we present a spectroscopic study of six double-lined binaries, five of which were recently discovered in a high-resolution spectroscopic survey of optical counterparts of stellar X-ray sources. Thanks to high-resolution spectra acquired with CAOS spectropolarimeter during seven years, we were able to measure the radial velocities of their components and determine their orbital elements. We have applied our code COMPO2 to determine the spectral types and atmospheric parameters of the components of these spectroscopic binaries and found that two of these systems are composed of main sequence stars, while the other four contain at least one evolved (giant or subgiant) component, similar to other well-known RS CVn systems. The subtraction of a photospheric template built up with spectra of non-active stars of the same spectral type as those of the components of each system has allowed us to investigate the chromospheric emission that fills in the H$\alpha$ cores. We found that the colder component is normally the one with the largest H$\alpha$ emission. None of the systems show a detectable LiI$\lambda$6708 line, with the exception of TYC 4279-1821-1, which exhibits high photospheric abundances in both components. Photometric time series from the literature allowed us to assess that the five systems with a nearly circular orbit have also photometric periods close or equal to the orbital ones, indicating spin-orbit synchronization. For the system with a highly eccentric orbit, a possible pseudo-synchronization with the periastron velocity is suggested., Comment: Accepted for publication in MNRAS. 13 pages, 12 figures

Montasio is a typical protected designation of origin (PDO) Italian semi-hard and semi-cooked cheese produced in northeast Italy from raw or thermized cow's milk. The PDO label implies that the product has distinctive characteristics that are connected to traditional production methods. The aim of this work was to precisely characterize the volatile fraction of this Italian cheese. The volatile profile can be considered a fingerprint because the flavor of a cheese variety is the result of a specific balance between the volatile compounds produced during the ripening process. Analysis of the volatile profile of Montasio cheese was performed by solid-phase microextraction–gas chromatography. Six cheesemaking trials were performed, each in a different dairy located within the Montasio cheese production area. Cheeses were analyzed at 5 stages of ripening (60, 90, 170, 300, and 365 d). Only 11 compounds were identified and measured: 5 fatty acids, 3 alcohols, 2 ketones, and 1 ester. The limited number of volatile compounds measured in the headspace of the Montasio cheese is probably due to the specific making process of this cheese, which affects evolution of the microflora and the biochemical processes of ripening. The total volatile fraction profile progressively increased from 60 to 170 d, after which time it remained almost steady. The most important contributors were found to be ethanol, short-chain fatty acids (C 2 to C 6 ), diacetyl, and ethyl hexanoate. Ethanol and short-chain fatty acids increased up to 170 d, diacetyl increased up to 300 d and then declined, and ethyl hexanoate increased until the final stage.

Stretching of the internal carotid artery during percutaneous transluminal angioplasty (PTA) may be associated with transient neck, facial or cranial pain. We report a series of 53 cases who received PTA. Cervical pain occurred in 51% of patients, with a radiation to face and scalp in 33%. Analysis focused on: (a) description of pain intensity, quality, timing and location; (b) investigation about the role of individual and technical parameters that could influence the relative risk of pain onset during PTA; (c) comparison with other available data on pain syndromes related to the carotid artery. Intimal flapping on post-angioplasty angiograms, bradycardia during the procedure and previous history of AMI were associated with a higher risk of painful angioplasty. PTA may also serve as a tool to investigate carotid pain and may add further knowledge to the evidence available about the role of the carotid wall in the pathogenesis of facial and cranial pain.

Gli autori presentano i risultati di uno studio randomizzato eseguito al fine di valutare le indicazioni e l'efficacia della discectomia percutanea secondo Onik nei confronti della microdiscectomia e del trattamento medico nella cura dell'ernia discale contenuta sintomatica. Sono stati studiati 40 pazienti lombosciatalgici, divisi in due gruppi in base alla sede della protrusione: mediana o laterale. Nel gruppo di soggetti con protrusione discale mediana veniva confrontata la discectomia percutanea con il trattamento medico. Nel gruppo dei pazienti portatori di protrusione laterale l'efficacia della metodica di Onik era messa a confronto con il trattamento microchirurgico. Il controllo è stato effettuato a sei mesi dal trattamento ed è stata valutata sia l'entità della regressione algica che il grado di soddisfazione del paziente. I dati emersi dallo studio permettono le seguenti conclusioni: 1) la discectomia percutanea trova indicazione sia nel trattamento delle protrusioni discali mediane che laterali. 2) La microdiscectomia ha fornito la migliore risposta terapeutica, mentre il trattamento conservativo ha dimostrato essere il meno valido. 3) La tendenza del dolore alla cronicizzazione richiede un trattamento precoce. 4) Il grado di soddisfazione del paziente per le cure ricevute è direttamente proporzionale al grado di invasività del trattamento. 5) La necessità di uno studio finale, di più ampia portata, con due soli bracci di trattamento: terapia medica, completata dalla fisiatria, e discectomia percutanea.

Preliminary reports on percutaneous transluminal angioplasty (PTA) of the internal carotid artery are promising. Our experience on 32 patients with symptomatic carotid stenoses is reviewed here. Successful dilation was obtained in 33 of 35 procedures, with an estimated patency rate of 85% at 1 year. In 3 cases, transient neurologic symptoms occurred within 2 days of angioplasty. Transient neck pain and bradycardia were the most commonly observed complications during carotid dilation. Carotid PTA may be considered as a valid alternative to endarterectomy, at least in selected cases.

In a randomised, prospective multi-centre study, we compared the intraoperative and postoperative effects of two opioids: sufentanil and remifentanil, in combination with propofol in two groups of patients undergoing neurosurgery.After Local Ethics Committee approval and informed consent obtaining, 69 patients undergoing neurosurgery for supratentorial tumours, between 18 and 75 years of age were randomised to receive either sufentanil or remifentanil in combination with propofol. Intraoperative and postoperative haemodynamic variables, recovery times (time to eye opening and to extubation), the incidence of postoperative respiratory depression, pain, nausea and vomiting were also evaluated. The Short Orientation-Memory-Concentration Test was used to evaluate cognitive function at 15, 45 and 180 min after emergence from anesthesia.There were no significant differences between the groups in the duration of surgery and anesthesia, mean arterial pressure, heart rate, time to eye opening or extubation. The incidence of vomiting, respiratory depression and shivering was similar in both groups. Postoperative pain requiring supplemental analgesics was significantly lower in the sufentanil group (P0.05). Although there were no significant differences between the groups in postoperative behavioural examinations by Rancho Los Amigos Test, patients anesthetised with sufentanil had significantly better Short Orientation-Memory-Concentration Test values at 15 and 180 min postoperatively (P0.05). CONCLUSION. We conclude that remifentanil and sufentanil are suitable adjunct to propofol for total intravenous anesthesia (TIVA). Patients receiving sufentanil have reduced analgesic requirements and better cognitive function postoperatively than those who received remifentanil.

Intraoperative monitoring of neuronal function, cerebral haemodynamics and cerebral oxygenation provides information to guide anaesthetic and surgical procedures in individual patients. The aim of neuroanaesthesia is to provide optimal intracranial operating conditions, maintain cerebral perfusion pressure (CPP), protect against ischaemic insults and prevent postoperative complications. The anaesthetic techniques and the anaesthetics used in neuroanaesthesia are all geared to these objectives. A neurophysiologically monitored surgical approach can decrease neuronal injury and neurological deficit related to cerebral ischaemia and improve long-term neurological outcome. Traditionally, electrocardiography, arterial blood pressure, pulse oximetry, end-tidal CO2 (ETCO2), body temperature and urine output are monitored during neuroanaesthesia in the operating room.

After the 1993 healthcare reform, all public hospitals in Italy were changed into public firms. The increasing commitment to pursue efficiency has introduced the need for a managerial responsibility in healthcare organizations. However, activities and resource use in hospitals driven by professionals and senior management often has a limited insight on business processes. We developed a three-dimensional evaluation system based on: (a) personal support to the overall team output, (b) assessment of organizational behavour and (c) individual goals setting (MBO). According to the position held, personal goals are negotiated with direct reports across three domains: managerial attitude, professional skills and organizational behaviours.

Ochratoxin A is a mycotoxin produced mainly by Penicillium verrucosum and Aspergillus ochraceus. Although typically considered a cereal contaminant, it has also been detected in dried fruit, nuts, meat and derivatives. To estimate the quantity of ochratoxin A that might be ingested by Italian consumers from these foods, 211 cereal derivatives (flours and bakery products) were analysed by high-performance liquid chromatography. Products were from conventional and organic agriculture and from integrated pest management agriculture. All commercial flours and derivatives examined contained ochratoxin A at concentrations very much below the legal limit (3 microg kg(-1)): the highest value, 0.816 microg kg(-1), was detected in a sample of spelt whole flour from organic agriculture. In many samples, the ochratoxin content was below the limit of detection; only rarely did values exceed 0.5 microg kg(-1). In baby foods, four samples were above the particularly restrictive Italian legal limit of 0.5 microg kg(-1). Although some significant differences were found between samples from conventional and organic agriculture when some product categories were examined (namely, baby foods as semolina and rice creams), no important difference was found between the two types of agricultural practice when all types of cereal derivatives were considered together.

BACKGROUND Some clinical data have shown that glatiramer acetate (Copaxone), a synthetic amino acid polymer empirically found to suppress experimental allergic encephalomyelitis (EAE), an animal model of MS, might help improve the outcome of patients with multiple sclerosis (MS). OBJECTIVES We performed a Cochrane review of all randomised, placebo-controlled trials of glatiramer acetate in MS, whatever the disease course. SEARCH STRATEGY We searched the Cochrane MS Group trials register (June 2003), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2003), MEDLINE (PubMed) (January 1966 to June 2003), EMBASE (January 1988 to June 2003) and hand searching of symposia reports (1990-2002) from the neurological Associations and MS Societies in both Europe and America. SELECTION CRITERIA All randomised controlled trials (RCTs) comparing glatiramer acetate and placebo in patients with definite MS, whatever the administration schedule and disease course, were eligible for this review. DATA COLLECTION AND ANALYSIS Both patients with relapsing-remitting (RR) and chronic progressive (CP) MS were analysed. Study protocols were comparable across trials as to patient entry criteria and outcome definition. No major flaws were found in methodological quality. However, efficacy of blinding should be balanced against well-known side effects, including injection-site reactions in glatiramer acetate-treated patients. MAIN RESULTS A total of 646 patients contributed to this review, as it is summarised in Table 01. Glatiramer acetate did not show any significant effect on disease progression, measured as a sustained worsening in the Expanded Disability Status Scale (EDSS). On the other hand, a slight decrease in the mean EDSS score, driven by a major study, should be considered in the light of the limited validity of this outcome measure. No benefit was shown in CP MS patients (progression at two years: RR=0.69, 95% CI [0.33 to 1.46]). The frequency of reported adverse events does not support any major toxicity associated with glatiramer acetate administration. The most common systemic adverse event was a transient and self-limiting patterned reaction of flushing, chest tightness, sweating, palpitations, anxiety (relative risk = 3.40 (95% CI [2.22 to 5.21], p

For a fast return of investment, network providers have to offer new services for the upcoming 3G mobile communication systems. Unfortunately 3G systems suffer by high installation costs and low quality of services in terms of high delays and low bandwidth. These drawbacks exclude many promising services such as real-time video conferences and multiplayer gaming. Furthermore, high network installation costs inhibit quick growth and in turn slow down the recruiting of new customers. Therefore the convergence of 3G technologies with the beneficial wireless local area networks gained a lot of interest lately. Different architectures were introduced to combine these two technologies. The architectures differ in their security concepts. In this paper we give an overview of the discussed architectures and extend them by multihop capability in the WLAN network. Multihop will decrease the network installation costs furthermore and ease the installation of network components.

BACKGROUND Recombinant interferons have been shown to suppress both the clinical and magnetic resonance imaging (MRI) measures of disease activity in patients with relapsing remitting multiple sclerosis (RRMS). OBJECTIVES We performed a Cochrane review of all randomised, placebo-controlled trials of recombinant interferons in RRMS. SEARCH STRATEGY Of 208 articles identified by a predefined search strategy, seven of these, reporting randomised trials, met all the selection criteria and form the subject of this review. SELECTION CRITERIA The trials selected were double-blind, placebo-controlled, randomised trials of RRMS patients who were treated with recombinant interferon, given by the subcutaneous or the intramuscular route. DATA COLLECTION AND ANALYSIS The quality of the trials was variable, with substantial methodological inadequacies in allocation concealment, high proportion and incomplete description of dropouts and failure to adhere to the principles of intention to treat analysis. The baseline characteristics were largely comparable between treatment and placebo groups. Because of prominent treatment-associated side effects, which could be easily identified by patients, these trials could be considered as single blind rather than double-blind. MAIN RESULTS Although 1215 patients were included in this review, only 919 (76%) contributed to the results concerning exacerbations and progression of the disease at two years. Specifically interferon significantly reduced the occurrence of exacerbations (RR =0.80, 95% CI [0.73,0.88], p

Awareness during anesthesia is revealed by explicit or implicit memory of intraoperative events. Although large clinical surveys indicate an incidence of explicit awareness of less than 0.3% during anesthesia for general surgery, the possibility of awareness is still a major concern, because patients may develop posttraumatic stress disorder by the experience of being awake during surgery [1]. Successful litigation against the anesthesia professional has been increasing in number as failure to provide adequate anesthesia can be considered a breach of the unwritten contract between patient and anesthetist [2].