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BACKGROUND: Recently, the first report of lung ultrasound (LUS) guided recruitment during open lung ventilation in neonates has been published. LUS guided recruitment can change the approach to open lung ventilation, which is currently performed without any measure of lung function/lung expansion in the neonatal population. METHODS: We included all the newborn infants that underwent a LUS-guided recruitment maneuver during mechanical ventilation as a rescue attempt for an extremely severe respiratory condition with oxygen saturation/fraction of inspired oxygen (SpO2/FIO2) ratio below 130 or the inability to wean off mechanical ventilation. RESULTS: We report a case series describing 4 LUS guided recruitment maneuvers, underlying crucial aspects of this technique that can improve the effectiveness of the procedure. In particular, we describe a novel pattern (the S-pattern) that allows us to distinguish the recruitable from the unrecruitable lung and guide the pressure titration phase. Additionally, we describe the optimal LUS-guided patient positioning. CONCLUSIONS: We believe that the inclusion of specifications regarding patient positioning and the S-pattern in the LUS-guided protocol may be beneficial for the success of the procedure.

This chapter examines a couple of examples of cannibalism in fairy tales and their adaptations, highlighting the links between past and present portrayals of anthropophagical plots and characters. Dorothy Thelander postulates that cannibalism may have been excised from oral tales in order to make less odious the identification with the rich landlords it might have represented, but it is indubitable that the fabrication of the ogre race allowed anthropophagy to persist in fairy-tale narratives. Charles Perrault penned his Sleeping Beauty along with other tales at the end of the 17th century, putting his secondary villain in line with Thelander’s analysis. Perrault’s ‘les inclinations des Ogres’ is translated as the ‘inclinations of an ogress’, which seems to imply a more human queen mother than the French text; even Carter, in her own version, gives it as ‘the queen still had ogrish instincts’.

Point-of-care clinical ultrasound (PoCUS) is ultrasonography brought to the patients in multiple settings and performed by the provider in real time; it is a multi-goal, dynamic, problem-based approach that allows the integration of images directly in the clinical evaluation, granting the recognition of specific patterns of disease.

OBJECTIVE To describe the technique and findings of the 'veterinary focused assessment with sonography for trauma-airway, breathing, circulation, disability and exposure' protocol in dogs suffering from trauma. MATERIALS AND METHODS Prospective observational study on a new point-of-care ultrasound protocol on 64 dogs suffering from trauma and comparison of findings with radiology. RESULTS Comparison of the results of this new ultrasound protocol for trauma patients with radiography findings for pneumothorax, pleural effusion, alveolar-interstitial syndrome and abdominal effusion revealed positive agreement of 89, 83, 100 and 87% and negative agreement of 76, 83, 76 and 92%, respectively. Novel findings of the 'veterinary focused assessment with sonography for trauma-airway, breathing, circulation, disability and exposure' exam, which were not previously reported for dogs undergoing focused assessment with sonography for trauma, included alveolar-interstitial syndrome (suggestive of pulmonary contusions), diaphragmatic hernia, retroperitoneal effusion and tracheal injury. Our new technique may also help identify increased intracranial pressure via changes in optic nerve sheath diameter and haemodynamic instability through the evaluation of the caudal vena cava and cardiac function. CLINICAL SIGNIFICANCE The described ultrasound examination protocol can be rapidly performed on dogs suffering from trauma during resuscitation and it may detect injuries previously undetectable using other veterinary point-of-care ultrasound protocols.

Endothelial cells and endothelial progenitor cells (EPCs) play a key role in the pathogenesis of vascular disease. Both cell types are affected by the oxidative stress but their susceptibility may be different. This study aimed to investigate the antioxidative enzymes activated in EPCs after high constant glucose exposure as compared to endothelial cells (HUVECs). Both cells were incubated in the presence of normal (5mM) and high constant (25mM) d-glucose, as well as l-glucose as osmotic control for 48 and 96h. After a 48-hour exposure to high d-glucose, cell viability was significantly decreased both in EPCs and HUVECs as compared with normal d-glucose (p

To evaluate the impact of decreased fluid resuscitation on multiple-organ dysfunction after severe burns. This approach was referred to as "permissive hypovolaemia".Two cohorts of patients with burns20% BSA without associated injuries and admitted to ICU within 6 h from the thermal injury were compared. Patients were matched for both age and burn severity. The multiple-organ dysfunction score (MODS) by Marshall was calculated for 10 days after ICU admission. Permissive hypovolaemia was administered by a haemodynamic-oriented approach throughout the first 24-h period. Haemodynamic variables, arterial blood lactates and net fluid balance were obtained throughout the first 48 h.Twenty-four patients were enrolled: twelve of them received the Parkland Formula while twelve were resuscitated according to the permissive hypovolaemic approach. Permissive hypovolaemia allowed for less volume infusion (3.2+/-0.7 ml/kg/% burn versus 4.6+/-0.3 ml/kg/% burn; P0.001), a reduced positive fluid balance (+7.5+/-5.4 l/day versus +12+/-4.7 l/day; P0.05) and significantly lesser MODS Score values (P=0.003) than the Parkland Formula. Both haemodynamic variables and arterial blood lactate levels were comparable between the patient cohorts throughout the resuscitation period.Permissive hypovolaemia seems safe and well tolerated by burn patients. Moreover, it seems effective in reducing multiple-organ dysfunction as induced by oedema fluid accumulation and inadequate O2 tissue utilization.

Aim. The morphology of permanent and primary enamel surface merits further analysis. The objective of this study was to illustrate a method of SEM digital image processing able to quantify and discriminate between the morphological characteristics of primary and permanent tooth enamel. Methods. Sixteen extracted teeth, 8 primary teeth and 8 permanent teeth, kept in saline solution, were analyzed. The teeth were observed under SEM.The SEM images were analyzed by means of digitally processed algorithms.The two algorithms used were: local standard deviation to measure surface roughness with the roughness index (RI); Hough’s theorem to identify linear structures with the linear structure index (LSI).Results. The SEM images of primary enamel show smooth enamel with little areas of irregularity. No linear structures are apparent. The SEM images of permanent enamel show a not perfectly smooth surface; there are furrows and irregularities of variable depth and width.Conclusions. In the clinical practice a number of different situations require the removal of thin layer of enamel. Only a good morphological knowledge of permanent and primary enamel gives the opportunity to identify and exploit the effects of rotary tools on enamel, thus allowing for a correct finishing technique.

Regular home care by the patient in addition to professional removal of subgingival plaque is generally very effective in controlling most inflammatory periodontal diseases. The purpose of this study is to evaluate the effectiveness in removing plaque, a new tool for oral hygiene, suitable for any type of population, associating it to the patient's motivation in the early stages of a session of occupational hygiene.The experiment involved a total of 120 patients. In the initial stages of the professional oral hygiene treatment, there were the values for the percentage of plaque index in all 120 subjects, after application of the agent detector plate, containing erythrosin, in liquid solution. Subsequently, the same operator, used for about two minutes with a woven gauze roller movement toward apico-coronal (Digital Brush, Mycerium, SpA, Avegno, Ge) on all teeth. Soon after it was re-applied the same detector that has enabled us to evaluate the plaque index, after using the digital brush. A statistical analysis has been carried out.Results show a statistically significant decrease of the averages of plaque index before and after treatment. At the end of the study the 120 patients showed an average index of plaque equal to 74.2, which after the use of the Digital Brush was reduced to 44.3.The research has shown a very simple and effective treatment's procedure, therefore it should be widely employed in oral hygiene practice.

Cleidocranial dysplasia (CCD) is a congenital hereditary condition caused by a dominant autosomal mutation. The orthodontic management of CCD patients is often complicated by the manifestations associated with the condition. The aim of this study was to evaluate the oral manifestations of patients suffering from CCD. The subjects underwent a thorough clinical evaluation that examined both hard and soft tissue. The subjects also underwent an X-ray examination in order to isolate possible anomalies in the stomach region related to the condition. Case 1 presented with a bilateral cross-bite, retention of deciduous teeth, presence of supernumerary teeth and agenesis. Case 2 presented with bilateral cross-bite, retention of deciduous teeth, and the presence of supernumerary teeth. The individuals in this study represent a broad range of typical CCD manifestations and confirm the close correlation between the mutation at CBFA1 level and the presence or oral-dental alterations. An early diagnosis of CCD is essential and based on clinical manifestations, x-ray evidence and genetic tests. Diagnosing the condition can be difficult in cases where there are no evident morphological signs; however, in most cases, an alteration in the rhythm of deciduous tooth loss is immediately apparent, making a closer collaboration between dentists and geneticists fundamental in achieving early diagnosis. As stated above, the timing of the treatment is crucial in establishing a correct course of treatment that involves extractions, orthodontic surgery and the use of prosthetics.

Imaging has greatly contributed to the understanding of lung disease in the critically ill and currently serves as a tool to diagnose lung pathology, monitor its course, and guide clinical management. Lung ultrasound is a real-time imaging modality that is simple, non-invasive, potentially ubiquitous, and free of ionizing radiation. Its increasing popularity and supporting research data substantiate its role as an emerging technique for bedside chest imaging in critical care. Furthermore, the International Consensus Conference on Lung ultrasound (ICC-LUS) promoted by the World Interactive Network Focused on Critical UltraSound (WINFOCUS) recently standardized the nomenclature and technique for lung ultrasound, and provided recommendations supporting its use in clinical practice. While the utility of lung ultrasound in the emergency setting is unquestioned, its potential role in the more complex and resource-rich intensive care environment is still under investigation. The purpose of this paper was to describe current and potential uses of lung ultrasound in the specific setting of adult intensive care, with an emphasis on respiratory monitoring, and to provide a framework for the practical application of this tool at the bedside.

The morphology of permanent and primary enamel surface merits further analysis. The objective of this study was to illustrate a method of SEM digital image processing able to quantify and discriminate between the morphological characteristics of primary and permanent tooth enamel.Sixteen extracted teeth, 8 primary teeth and 8 permanent teeth, kept in saline solution, were analysed. The teeth were observed under SEM. The SEM images were analysed by means of digitally processed algorithms. The two algorithms used were: Local standard deviation to measure surface roughness with the roughness index (RI); Hough's theorem to identify linear structures with the linear structure index (LSI).The SEM images of primary teeth enamel show smooth enamel with little areas of irregularity. No linear structures are apparent. The SEM images of permanent enamel show a not perfectly smooth surface; there are furrows and irregularities of variable depth and width.In the clinical practice a number of different situations require the removal of a thin layer of enamel. Only a good morphological knowledge of both permanent and primary tooth enamel gives the opportunity to identify and exploit the effects of rotary tools on enamel, thus allowing for a correct finishing technique.

Endothelial progenitor cells (EPCs) play a role in angiogenesis during pregnancy. The aim of this study was to evaluate circulating EPCs in pregnant women with gestational alterations of glucose tolerance. Glucose tolerance, insulin sensitivity and β-cell function were derived from oral glucose tolerance tests in 23 women with normal glucose tolerance (NGT), 18 with gestational impaired glucose tolerance (GIGT) and 24 with gestational diabetes mellitus (GDM). Circulating cells expressing CD34 in combination with CD133, kinase insert domain receptor (KDR) or both were quantified by flow cytometry. Women with GIGT and GDM had lower CD34+KDR+ and CD34+CD133 +KDR+ cells at 27±3.2 weeks’ gestation compared with NGT (ANOVA p+KDR+ and CD34+CD133+KDR+ cells were inversely correlated with the area-under-the-glucose-curve ( p

With the aim of dissecting host-parasite interaction processes in the system Lycopersicon aesculentum-Fusarium oxysporum f. sp. lycopersici we have isolated plant cell mutants having single-step alterations in their defense response. A previous analysis of the physiological phenotypes of mutant cell clones suggested that recognition is the crucial event for active defence, and that polysaccharide content, fungal growth inhibition, peroxidase induction in in vitro dual culture and ion leakage induced by cultural filtrates of the pathogen can be markers of resistance. In this paper we present the results of a similar analysis carried out on cell cultures from one susceptible ('Red River'), one tolerant ('UC 105') and three resistant ('Davis UC 82', 'Heinz', 'UC 90') tomato cultivars. Our data confirm that the differences in the parameters considered are correlated with resistance versus susceptibility in vivo. Therefore, these parameters can be used for early screening in selection programmes. These data, together with those obtained on isolated cell mutants, suggest that the selection in vitro for altered fungal recognition and/or polysaccharide or callose content may lead to in vivo - resistant genotypes. The data are thoroughly discussed with particular attention paid to the importance of polysaccharides in active defense initiation.

In a preliminary study on the interaction between an Alternaria alternata pathotype and Solanum tuberosum a series of parameters, indicative of active and passive defence processes, was investigated in vitro using tolerant (Chiquita) and susceptible (Superior) cultivars. Ion leakage experiments along with growth of suspension cultures and plating efficiencies in the presence of fungal culture filtrates suggest that toxin tolerance is a valuable character in distinguishing between resistant and susceptible genotypes. As far as active defence was concerned, although TLC patterns suggested the synthesis of different fluorescent compounds, probably phenolic acid, when fungal elicitors were applied to Chiquita or susceptible tissue,cultures, no consistent pattern suggesting a relationship with defence could be observed. On the other hand, peroxidase isozyme analysis after different dual culture periods showed the activation of ionically and covalently bound peroxidases in the prese,nce of the pathogen only in cv. Chiquita.

Protected specimen brush (PSB), broncho-alveolar lavage (BAL), mini-BAL, protected BAL, telescopic catheter, are all sample techniques requiring bronchoscopy and therefore an instrument with proper disinfection/sterilization, a skilled operator, anesthesia, and additional surveillance during and after the procedure [1].

The clinical course of C1-INH deficiency is presently well established. There is an inherited form (Hereditary Angioedema) characterized by recurrence of cutaneous and mucous swellings appearing early in life and usually accompanied by substantial family history, and an acquired form (Acquired Angioedema) where identical symptoms start after the fourth decade of life without family history. The acquired form can be associated with other diseases, mainly B cell disorders, and/or with autoantibodies to C1-INH. The biochemical characteristic is the functional deficiency of C1-INH and of C4 and C2. Moreover a marked deficiency of C1 is present in most acquired forms, but never in the inherited ones. C1-INH deficiency can be corrected by attenuated androgens that increase C1-INH levels in a few days and are effective in the prophylaxis of attacks, or by substitutive therapy with C1-INH plasma concentrate that is the life-saving drug in laryngeal edema. Patients with the inherited form have a uniformly good response to both these treatments which are otherwise effective only in a minority of patients with the acquired deficiency. In these subjects C1-INH concentrate needs to be given in higher doses and prevention of attacks is obtained with antifibrinolytic agents (Tranexamic acid).

Plant cell walls play a major role in the outcome of host-parasite interactions. Wall fragments released from the plant, and/or the fungal pathogen, can act respectively as endogenous and exogenous elicitors of the defence response, and other wall components, such as callose, lignin, or hydroxyproline-rich glycoproteins, can inhibit pathogen penetration and/or spreading. We have previously demonstrated that calli from tomato cultivars resistant in vivo to Fusarium oxysporum f.sp. lycopersici show a high amount of polysaccharides in vitro. The aim of the present work was to assess the possible role of polysaccharide content and/or synthetic capacity in determining the competence of plant cells for active defence. For this purpose, tomato cell clones with increased and decreased polysaccharide (FL(+), FL(-)) and callose (A(+), A(-)) content have been selected by means of specific stains as visual markers and tested for the effect of these changes on the extent of response to Fusarium. The analysis of several parameters known to be indicative of active defence (cell browning after elicitor treatment, peroxidase and β-glucanase induction and inhibition of fungal growth in dual culture) clearly shows that FL(+) and A(+) clones have acquired an increased competence for the activation of defence response. The results are thoroughly discussed in terms of an evaluation of the relative importance of constitutive and/or inducible polysaccharide synthetic capacity for plant response to pathogens, and their possible regulation by plant physiological backgrounds.

We have studied the effect of a change in the endogenous hormone equilibria on the competence of tomato (Lycopersicon esculentum) cells to defend themselves against the fungal pathogen Fusarium oxysporum f. sp. lycopersici. Calluses from cvs ‘Davis’ and ‘Red River’, respectively resistant and susceptible to Fusarium and transgenic for an auxin- or cytokinin-synthesizing gene from Agrobacterium tumefaciens, were used. The integration of Agrobacterium hormone-related genes into susceptible cv ‘Red River’ can bring the activation of defense processes to a stable competence as assessed by the inhibition of mycelial growth in dual culture and gem-tube elongation of Fusarium conidia, the determination of callose contents, peroxidase induction and ion leakage in the presence of fusaric acid. This is particularly true when the transformation results in a change of phytohormone equilibria towards an higher cytokin in concentration. On the contrary, in resistant cv ‘Davis’ the inhibition of both fungal growth in dual culture and conidia germination is higher when the hormone balance is modified in favour of the auxins. No significant effect was observed for ion leakage and peroxidase induction, probably because of a constitutive overproduction of cytokinins in ‘Davis’ cells.

Host — pathogen interactions in plants are controlled by a complex network of processes, probably induced by recognition events, whose quantitative modulation is critical for the choice between susceptibility and resistance. Although a gene-for-gene system probably has a trigger effect on the timing and the intensity of the active response, the modulation by exogenous and endogenous factors may affect the outcome of the interaction.

Variations in DNA amplification of repeated sequences were analyzed in a compatible and incompatible interaction between tomato (Lycopersicon aesculentum) and the phytopathogenic fungus Fusarium oxysporum f. sp. lycopersici race 1 grown in vitro in dual cultures. Changes in multiplicity of both ribosomal and anonymous repeated sequences were found to occur in both the host and the pathogen, and to differ in timing and copy number depending on the susceptible or resistant outcome of the interaction.

A case of severe acute rhabdomyolysis (RML) is reported which was caused by marked hypokalemia associated with long-lasting diarrhea. Since the patient not only had severe muscular symptoms but also intense hemorrhagic diathesis and anemia, the first diagnosis on admission was acute leukemia. Due to the increasing occurrence of acute RML associated with different clinical conditions, including hematologic disorders, the hematologist should keep in mind the possibility of RML, both as a primitive disorder or complication, and require CPK and myoglobin assay routinely.

Hypersensitive browning, host cell death and phytoalexins (rishitin) synthesis in both callus cultures and cotyledons have been observed in a susceptible tomato cultivar following treatment with high molecular weight cell wall components from Phytophthora infestans race 1B. The growth of the pathogen was restricted on both elicited differentiated and undifferentiated tomato tissues. Subtance(s) released by germinating sporangia, but not by the mycelium, suppressed the hypersensitive reaction. Zusammenfassung Ein potentieller Verteidigungsmechanismus der Tomate gegen die Kraut- und Knollenfaule wird durch Substanzen, die von auskeimenden Phytophthora infestans-Sporangien gewonnen werden, unterdruckt Hypersensitive braune Verfarbimg, das Absterben der Wirtszellen und Phytoalexin(Rishitin)- Synthese in Kalluskulturen und Keimblattern wurde bei einer anfalUgen Tomatensorte nach einer Behandlung mit Zellwandkomponenten von hohem Molekulargewicht der Phytophthora infestans-Rasse 1B beobachtet. Das Wachstum des Pathogens wurde auf behandelten differenzierten und nicht differenzierten Tomatengeweben eingeschrankt. Substanzen, die von auskeimenden nicht aber vom Myzel freigesetzt werden, unterdruckten die Hypersensitivitatsreaktion.

Der Verfasser nimmt eine Reihe von experimentellen Versuchen an Kaninchen vor, in der Absicht, zu unseren Kenntnissen uber den pathogenetischen Mechanismus der Hypocalcamie bei Nephritikern und Uramiker beizutragen, und um festzustellen, bis zu welchem Punkt die Oxalsaureretention (vonBecher festgestellt) die Hypocalcamie erklaren kann. Diesen Kaninchen wurden wechselnde Mengen von Natriumoxalat intravenos zugefuhrt und daraufhin die entsprechenden quantitativen Veranderungen des Blutkalkspiegels festgestellt. Der Verfasser stellt eine deutliche und regelmasige Erniedrigung des Blutkalkspiegels fest, welche in enger zeitlicher Beziehung zu der eingefuhrten Oxalatmenge steht und bis 50% des Ausgangswertes erreichen kann. Der Blutkalkspiegel kann mit dem Aufhoren der Oxalatzufuhr wieder steigen. Die tetanischen Krampfe stehen in enger zeitlicher Beziehung zu der Erniedrigung des Blutkalkspiegels und treten mit dem Sinken des Calciums unter einen bestimmten Wert (8 mg-%) auf.

By studying the behavior of the resistance of leukocytes to hypotonic saline solution we have found that leukocytes leaving the spleen are much less resistant than those entering it. It is felt that the change in resistance affecting leukocytes on their passage through the spleen is in all probability the manifestation of one of the mechanisms by which the spleen regulates the life span of leukocytes.

Bei Kaninchen wurde das Verhalten der Resistenz der Leukozyten gegen eine hypotonische Kochsalzlosung im rechten Herzen, im linken Herzen und im Korperkreislauf untersucht. Es konnte festgestellt werden, das die Leukozyten, die aus der Lunge kommen, resistenter sind als die, die in die Lunge eintreten.

Haemophilic synovial membranes obtained by synovectomy have been histochemically studied for the locausation of plasminogen activator. In the two histological types of synovial membrane (vascular and fibrous type), different degrees of fibrinolysis were detected. Higher fibrinolytic activity was found in the vascular type of haemophilic synovial membrane as compared to the normal synovial tissues. Activity was low or absent in the synovial membrane undergoing a process of fibrosis. These results may help to explain the mechanism of bleeding in haemophilic joints.

In 3 female patients withRaynaud's disease affecting the upper extremities, the skin temperature and plethysmographic measurements of the fingers were taken before and after thei.v. injection of 250 mg heparin (Liquemin “Roche”). The vasomotor effect thus observed was expressed by increase in skin temperature, pulse frequency and arterial supply, and also by decrease in duration and severity of experimentally induced ischemic attacks. After prolonged treatment with 250 mg heparini.v. daily, the skin temperature increased and the attacks decreased in frequency, duration and severity.

With the aim of better understanding in vitro host-parasite interactions, tomato cell lines selected for altered response to Fusarium oxysporum f. sp. lycopersici cell wall components were further characterized. Particularly, their behaviour in dual culture in regard to both fungal inhibition and peroxidase activation was analysed and selected, and control cell clones were screened for esopolysaccharide content and toxin tolerance. Interclonal differences in growth response to 2,4-D and DMSO and the capacity to grow on a medium devoid of hormones (habituation) were taken as parameters representative of physiological variability not directly correlated with the response to pathogens. Significant differences between clones selected for increased (F+) and decreased (F-) response to fungal elicitors were found for pathogen inhibition, peroxidase and esopolysaccharide content, toxin tolerance being reduced in F but not significantly different from the control in F+. As expected, clonal variability for the response to 2,4-D and DMSO, although significant, was not connected with hostparasite interactions. The data reported thus show that selection for a character (response to elicitors), probably critical for the response to pathogens, may lead to the recovery of genotypes showing a set of modifications suggestive of a cascade of events leading to active defense.