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In the last few years prone positioning has been used increasingly in the treatment of patients with acute respiratory distress syndrome and this maneuver is now considered a simple and safe method to improve oxygenation. Hemodynamic monitoring by echocardiography may be required but prone positioning imposes certain challenges limiting standard examination. The article describes the application of the "trans-splenic retrocardiac view," a little-known echographic window for obtaining Doppler parameters from the back in prone-positioned patients., (© 2024 The Author(s). Journal of Clinical Ultrasound published by Wiley Periodicals LLC.)

Aim: To compare the efficacy of two remineralising toothpastes in children suffering from asthma and allergic rhinitis after a 6-month study., Methods: 40 patients aged between 6-14 years with enamel demineralisations were enrolled for the study at the Unit of Dental Hygiene of the University of Pavia (Italy). The following indices were collected: Schiff air index (SAI), plaque index (PI), bleeding on probing (BoP), salivary pH, Basic Erosive Wear Examination (BEWE), susceptibility index (SI) for hard and soft tissues' pathologies, and decayed missing filled teeth (DMFT). After mechanical debridement with piezoelectric instrumentation and glycine powder, patients were equally divided into two groups: Group 1 using a toothpaste with zinc hydroxyapatite, and Group 2 using a toothpaste containing calcium sodium phosphosilicate. The toothpaste had to be used twice a day. The time frames of the study were: baseline (T0), after 1 month (T1), after 3 months (T2), after 6 months (T3)., Conclusion: The tested toothpastes can be proposed for home use in children with asthma and allergic rhinitis as they significantly reduced dental sensitivity and periodontal indices.

Diastolic dysfunction is an underestimated feature in the context of the critically ill setting and perioperative medicine. Advances in echocardiography, its noninvasive, safe and easy use, have allowed Doppler echocardiography to become a cornerstone for diagnosing diastolic dysfunction in clinical practice. The diagnosis of diastolic dysfunction and increased filling pressures is nevertheless complex. Using an echocardiographic assessment and the routine application of preload stress maneuvers during echocardiographic examination can help identify early stages of diastolic dysfunction leading to better management of patients at risk of acute heart decompensation in the perioperative period or during ICU stay., (© 2023 Wiley Periodicals LLC.)

Aim: Early onset of adequate chest compression is mandatory for cardiopulmonary resuscitation (CPR) following cardiac arrest. Transmission of forces from chest strain to the heart may be variable between manual and mechanical chest compressions. Furthermore, automated mechanical chest devices can deliver an active decompression, thus improving the venous return to the heart. This pilot study investigated the kinetics of cardiac deformation during these two CPR methods., Methods: Transesophageal echocardiographic analysis of the right ventricular wall behind the sternum during CPR was assessed during manual and mechanical chest compression in adult patients admitted to the emergency department for out-of-hospital cardiac arrest., Results: 9 patients had manual and 11 mechanical chest compression. Mechanical chest compression was characterized by greater right ventricular lateral wall displacement [with a median (IQR) of 3.7 (3.12-4.27) vs. 2.53 (2.27-2.6) cm, p < 0.0001], and lower rising time [123 (102-169) vs. 187 (164-215) ms, p = 0.002], relaxing time [109 (102-127) vs. 211 (133-252) ms, p = 0.0003], compression rate [100.6 (99.6-102.2) vs. 131.9 (125.4-151.4) bpm, p < 0.0001], with compression-decompression time ratio of [1.04 (0.86-1.1) vs. 0.86 (0.78-0.96), p = 0.046]., Conclusion: Mechanical compared to manual chest compression delivered a more rapid compression and decompression of the cardiac structures at an adequate rate, with broader inward-outward movement of the ventricular walls suggesting greater emptying and filling of the ventricles. Transesophageal echocardiography may be a useful tool to assess the adequacy of chest compression without CPR interruption., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Survival after cardiac arrest depends on adequate cardiopulmonary resuscitation (CPR). Manual or mechanical external chest compression may be ineffective to restore circulation: structures subjected to external chest compression may differ in forces transfer to intrathoracic structures due to anatomic characteristics and physiological changes. This clinical study aims to assess the association of trans-oesophageal findings during CPR and successful resuscitation., Methods: Retrospective cohort study. Trans-oesophageal assessment of right ventricular fractional area change, right ventricular outflow tract fractional shortening, left ventricular volumes, ejection fraction, and aortic diameters were performed in refractory out-of-hospital cardiac arrest patients admitted to emergency department for extracorporeal CPR., Results: 19 patients were analyzed. 15 of 19 patients (79%) received venous-arterial extracorporeal membrane oxygenation support. Resuscitation was successful with return of spontaneous circulation or electromechanical activity in 7 patients (group-SUXX) and failed in 12 patients (group-FAIL). 6 patients (32%) were alive at 24 h from the cardiac arrest, one patient (5%) survived to hospital discharge. Left ventricular outflow tract (LVOT) was open during CPR in all patients in group-SUXX and in 1 patient in group-FAIL (p 0.0002). None of the patients with closed LVOT had successful resuscitation. Patients in group-SUXX had a higher ejection fraction (p 0.03), ascending aortic diameter (p 0.04), and survival rate than those in group-FAIL (p 0.015). In a multiple variable Cox's proportional model LVOT opening was the only variable associated with successful resuscitation., Conclusions: Trans-oesophageal echocardiography can be useful in the emergency setting of cardiopulmonary arrest for discriminating between successful and failing resuscitation., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Surgical stress affects the autonomic nervous system by increasing sympathetic outflow. One method of monitoring sympathetic activity is pulse photoplethysmographic analysis. From this two indices can be derived - autonomic nervous system state (ANSS) and ANSS index (ANSSi). It has recently been claimed that these indices can be used to measure sympathetic activity in anaesthetised patients, but their validity has not yet been demonstrated., Objective: To measure changes in pulse photoplethysmographic indices and determine any agreement with autonomic nervous system modulation of the cardiovascular system in healthy study participants during surgery under general anaesthesia., Design: Prospective observational study., Setting: Single-centre study based at a tertiary care centre in Milan, Italy., Patients: Healthy patients undergoing general anaesthesia for elective laparoscopic cholecystectomy., Interventions: ANSS, ANSSi, and heart rate variability (HRV) were analysed at three main times: baseline, after induction of general anaesthesia, and after pneumoperitoneum insufflation., Main Outcome Measures: The magnitude of changes in photoplethysmographic and HRV indices was measured. The agreement between pulse photoplethysmographic and HRV-derived indices was assessed by Bland-Altman plots., Results: In total, 52 patients were enrolled and their data analysed. Both pulse photoplethysmographic and HRV indices changed during the study phases. An agreement was found between ANSSi and low frequency spectral components of HRV [bias 10.2nu, 95% confidence interval (CI) -13 to 33.4], high frequency spectral components of HRV (bias 6.1 nu, 95% CI -16.3 to 28.6), and low frequency/high frequency ratio (bias 16.1nu, 95% CI -1.4 to 33.5). The agreement was weaker between ANSSI and HRV indices., Conclusion: The study endorses the use of pulse photoplethysmographic indices ANSS and ANSSi as surrogates to estimate changes of autonomic modulation of the cardiovascular system in healthy adults during surgery under general anaesthesia.Orcid ID: orcid.org/0000-0002-9616-803X.

The composition of the volatile fraction of Malva sylvestris var. mauritiana (L.) Boiss. (Malvaceae) was investigated. This plant species was cultivated in the southeastern Alps as an ingredient for herbal teas and infusions. Flowers and leaves were collected at the end of the summer season and separately steam- distilled to obtain two volatile oils, the yields of which were 0.019% for leaves and 0.012% for flowers. After GC-FID and GC-MS analyses, the two oils -revealed differences in the nature and especially in the proportion of their components, which were aldehydes, alcohols, phenolics, esters, hydrocarbons and acids. Eugenol was the single most abundant compound in the leaves, totalling 46.7% of the total oil, followed by phytol with 34.4%. Flowers showed a predominance of hydrocarbons, among which the anteiso branched-chain saturated hydrocarbon, 3-methyl tricosane, was the most abundant compound, accounting for 14.9% of the total volatiles. Eugenol ranked second with 10.3%, followed by the two linear-chain saturated hydrocarbons pentacosane and tricosane forming 8.2 and 7.7% of the total oil, respectively. The occurrence and the relative abundance of compounds from various chemical classes such as phenolics, hydrocarbons and aromatic aldehydes and alcohols are discussed, together with some of their ecological implications. The obtained volatile oils were than tested against two major honeybee (Apis mellifera) pathogens, namely Paenibacillus larvae and Melissococcus plutonius, the causative agents of the American and the European foulbrood, respectively.

Introduction: The heel-lance (HL) method for blood collection from the newborn is controversial for the pain it causes. This is the first randomized controlled trial on the management and reduction of pain using the music of Wolfgang Amadeus Mozart ("Sonata K. 448") in premature infants hospitalized in a neonatal intensive care unit (NICU). This study has compared nonpharmacological techniques with standard procedure for reducing pain during HL procedure., Methods: Thirty-five premature infants were enrolled, each for 3 HL procedures, of which each was randomized to 1 of the 3 study arms. Arms were then compared in terms of the Premature Infant Pain Profile (PIPP) changes by analysis of variance (ANOVA)., Results: One hundred five HL procedures were available for analysis (35 standard procedure, 35 music, 35 glucose). Median baseline PIPP was 3, and median PIPP after the HL procedure was 5. PIPP scale change was +3 in the control arm, +1 in the glucose arm, +2 in the music arm (p = .008)., Discussion: Both glucose and music were safe and effective in limiting pain increase when compared to standard procedure in HL procedures in preterm infants.

The composition of the volatile fraction of Trifolium pratense L. ssp. nivale (Sieber) Asch. et Gr. from the southwestern Alps was investigated. Fresh aerial parts were collected in the summer at three different growth stages, namely vegetative, flowering and fruiting. The oils obtained by steam-distillation accounted for 0.006 to 0.011% of the fresh plant material and their composition was determined by GC/FID and GC/MS. Several classes of compounds were found, with a predominance of alcohols in all phases, followed by aldehydes, hydrocarbons, terpenes, phenolics, ketones, acids and esters. The oil composition varied both in quantity and quality; the most abundant compounds were oct-1-en-3-ol and phenylacetaldehyde in the vegetative and flowering phases, and phenylacetaldehyde and 2-phenylethanol in the fruiting phase. The essential oils obtained were tested for activity against two major bee pests, i.e. Paenibacillus larvae and Melissococcus plutonius, and against a reference bacterial species, Bacillus subtilis.

The Stanford Health Assessment Questionnaire developed by Singh et al. to measure functional status in children with chronic arthritis (CHAQ) was translated into Italian (I-CHAQ), with minor modifications to obtain cross-cultural equivalence. This version was evaluated in a series of 96 patients with juvenile rheumatoid arthritis (JRA), both males and females ranging in age from 3 to 19 years (mean age 9.9 years). All three onset subtypes and all four classes of disability were represented in the sample. The questionnaire was filled in by the parents if the children were less than 8 years of age (23 cases), and by the children themselves in all other cases; a health professional was always present to provide assistance. As expected, JRA patients with a systemic or polyarticular disease onset had higher scores than those with a pauciarticular onset, and there were statistically significant differences in disability index values between patients from different Steinbrocker functional classes. The instrument showed good reproducibility in a test-retest over a two-week period, a high correlation between the child and parent scores, excellent internal reliability, and good convergent and discriminant validity.