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Chronic Obstructive Pulmonary Disease (COPD) represents a major health concern, that causes a significant morbidity, a high risk of death and important health-care costs. The real dimension of this chronic disease is probably understimated both in its early and advanced stages and its prevalence is progressively rising in the general populations, because of both increase of elderly subjects and raised rates of smoke. To date it was estimated that COPD-related deaths represent the sixth leading cause of mortality worldwide. Acute exacerbations (AE) represent major events in the clinical course of COPD and negatively affect its outcomes, leading to lung function decrease, quality life worsening, high risks of hospital readmission, disability and death. Severe exacerbations of COPD are associated with acute respiratory failure (ARF), impairment of hypoxemia, various degree of carbon dioxide retention and acidosis. The ARF in COPD may occur as acute, chronic or acute-on-chronic failure. This condition worsens significantly the prognosis of these patients and may require an intensive treatment with ventilatory assistance combined with routine medical management. This therapeutic approach may be performed by means of invasive (IMV) or noninvasive mechanical ventilation (NIMV). The latter form is defined as the delivery of mechanical ventilation that avoids airway invasion. Two types of NIMV have been studied and applied to clinical practice in the last decades, they are represented by both external negative pressure and positive pressure ventilation modalities. In the last years noninvasive mechanical ventilation with positive pressure (NPPV) has been increasingly used as adjunctive therapeutic approach in these subjects. In addition several controlled trials and meta-analysis showed that this form of assisted ventilation is effective in the treatment of different diseases, including: COPD exacerbations, acute cardiogenic pulmonary edema, weaning from ventilator in COPD patients. The use of noninvasive mechanical ventilation in patients with COPD exacerbated and hypercapnic ARF is associated, in some instances, with a decreased need of endotracheal intubation, with lower incidence of adverse outcomes, as well as with reduced in hospital-mortality, length of hospitalisation and overall costs. This therapeutic approach is generally feasible, well-tolerated and may be successfully performed in different healthcare settings including: Emergency Departments, Intensive Care Units (ICUs), but also in Intermediate Respiratory Care Units (IRCUs) and, in selected cases, in non intensive units, such as General Wards. This report is a comprehensive review of the available studies, concerning the use of NIMV in the management of COPD patients with AE and respiratory failure and it describes its indications, limitations, proper locations and costs

Context Hepatitis B (HBV) and hepatitis C virus (HCV) possess well-known oncogenic properties and may promote carcinogenesis in liver. However antigens and replicative sequences of HBV/HCV have been also detected in different extra-hepatic tissues, including the pancreas. Although epidemiological studies and meta-analyses have recently suggested that HBV/HCV may be also risk factors for pancreatic cancer and several researches have investigated the possible mechanisms and intra-/extra-cellular paths involved in pancreatic and hepatic carcinogenesis, to date, these complex processes remain largely unexplained. Objectives In our paper, we aimed to propose a comprehensive and qualitative hypothetical model, describing how HBV/HCV may exert their oncogenic role. Methods We performed a systematic research of scientific literature, by searching MEDLINE, the Cochrane Library and EMBASE databases. The used keywords were: “chronic HBV/HCV”, “pancreatic cancer”, “liver carcinoma”, “carcinogenesis mechanisms”, “tensional integrity”, “cytoskeleton”, and “extracellular matrix”. Results Taking advantage from available studies, we suggest an unifying hypothesis based on results and data, obtained from different areas of research. In particular we considered the well-defined model of tensional integrity and correlated it to changes induced by HBV/HCV in viscoelastic properties/stiffness of cellular/extracellular microenvironments. These events perturb the tightly-regulated feedback loop, which usually couples the intracellular-generated forces to substrate rigidity of extracellular compartments. Therefore, such a change strongly affects intracellular functions and cellular fate, by promoting a substantial deregulation of critical intracellular biochemical activities and genome expression. Conclusions Our hypothesis might provide for the first time a reliable system, which correlates tensional integrity model with intra-/extra-cellular modifications, occurring in liver and pancreas during HBV/HCV-induced carcinogenesis. This approach might improve our understanding of pathogenetic mechanisms involved in the development of pancreatic and hepatic carcinogenesis , enhancing the possibility of their treatment. Furthermore, should the usefulness of this model be definitively confirmed, it might be also helpful to extend its field of application to other viruses-related cancers.Image: Signaling pathways (Figure 1), JOP. Journal of the Pancreas, Vol 15, No 2 (2014): March - p. 84-218