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Aims: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support stabilizes patients with cardiogenic shock. Despite improved oxygenation and peripheral circulation, LV unloading may be impeded due to the increased afterload, resulting in a failing static left ventricle and in high mortality. Methods and results: We describe for the first time a large series of patients treated with the combination of VA-ECMO and Impella® compared with patients with VA-ECMO only. We retrospectively collected data on patients from two tertiary critical care referral centres. We enrolled 157 patients treated with VA-ECMO from January 2013 to April 2015: 123 received VA-ECMO support and 34 had concomitant treatment with VA-ECMO and Impella. A propensity-matching analysis was performed in a 2:1 ratio, resulting in 42 patients undergoing VA-ECMO alone (control group) compared with 21 patients treated with VA-ECMO and Impella. Patients in the VA-ECMO and Impella group had a significantly lower hospital mortality (47% vs. 80%, P < 0.001) and a higher rate of successful bridging to either recovery or further therapy (68% vs. 28%, P < 0.001) compared with VA-ECMO patients. A higher need for continuous veno-venous haemofiltration (48% vs. 19%, P = 0.02) and increased haemolysis (76% vs. 33%, P = 0.004) were reported in the study group due to higher survival. There was no difference in major bleeding rates between the two groups (VA-ECMO and Impella 38% vs. VA-ECMO 29%, P = 0.6). Conclusions: Concomitant treatment with VA-ECMO and Impella may improve outcome in patients with cardiogenic shock compared with VA-ECMO only. Nevertheless, randomized studies are needed to validate these promising results further.

Objective: Beside the well-known evidences of the additional cardiovascular risk linked to a chronic increase of the pressure values, it is also likely that their variability may play a role as a risk factor. The blood pressure variability (BPV) is usually estimated using the Standard Deviation (SD) from the mean; our study allowed to elaborate a new method to assess the BPV as the average of the absolute difference between subsequent blood pressure measures; this method of calculating BPV was applied to the BP values measured routinely with standard ambulatory blood pressure monitoring (ABPM). Design and method: The ABPM data gathered by means of the Spacelab devices were used to calculate the BPV and the BPV% (corrected by average blood pressure values) for each patient. The BPV% was calculated for daytime and nightime separately and the range of BPV% was compared with the range of SD for the entire group of patients and the relation of BPV% with other common variables such as age and sex, normal or above normal blood pressure and Dippers or Non Dippers conditions, was analysed.. Results: 196 ABPMs of male and female patients have been examined; average age = 59 years (38% of the ABPM were obtained in patients > 65 yrs); in 23% of the cases the average blood pressure values measured by ABPM was above normal. The average BPV% taken during the day, for the entire group of the examined patients, was 6,8%, 9% and 8,1 % respectively for SBP, DBP and MBP; BPV% during nightime was excluded for methodollogical reasons (limited number of measures and overlap with values obtaine while awake). Comparisons between the subgroups has shown an increased variability for the women, the elders and the Non Dippers. Conclusions: The BPV% is only partially related to the SD (which is more commonly used as variability index) and could be more informative; it is easy to perform and if its usefulness and reliability will be confirmed, it could even be used routinely for the evaluation of ABPM.

BACKGROUND: One of the most commonly used hypnotics is propofol. Several studies performed in cardiac surgery suggested an increased mortality in patients receiving a propofol-based total intravenous anaesthesia. Furthermore, the possibility of infections and the 'propofol syndrome' have suggested that propofol might be dangerous. Nonetheless, propofol is widely used in different settings because of its characteristics: fast induction, rapid elimination, short duration of action, smooth recovery from anaesthesia, few adverse effects, no teratogenic effects, characteristics that have undoubtedly contributed to its popularity. The effect of propofol on survival is unknown. We decided to carry out a meta-analysis of all randomized controlled studies ever performed on propofol vs. any comparator in any clinical setting.; METHODS: Pertinent studies were independently searched in BioMedCentral, PubMed, Embase, Clinicaltrial.gov, and Cochrane Central Register of Clinical Trials by expert investigators. The following inclusion criteria were used: random allocation to treatment, comparison between propofol and any comparator in any clinical setting.; RESULTS: One hundred thirty-three studies randomizing 14,516 patients were included. No differences in mortality between patients receiving propofol [349/6957 (5.0%)] vs. any comparator [340/7559 (4.5%)] were observed in the overall population [risk ratio=1.05, 95% confidence interval (0.93 to 1.18), P=0.5] and in several sub-analyses.; CONCLUSION: Inspite of theoretical concerns, propofol has no detrimental effect on survival according to the largest meta-analysis of randomized trials ever performed on hypnotic drug. 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Because of outstanding optical properties and non-vacuum solution processability of colloidal quantum dot (QD) semiconductors, many researchers have developed various light emitting diodes (LEDs) using QD materials. Until now, the Cd-based QD-LEDs have shown excellent properties, but the eco-friendly QD semiconductors have attracted many attentions due to the environmental regulation. And, since there are many issues about the reliability of conventional QD-LEDs with organic charge transport layers, a stable charge transport layer in various conditions must be developed for this reason. This study proposes the organic/inorganic hybrid QD-LEDs with Cd-free InP QDs as light emitting layer and inorganic ZrO2 nanoparticles as electron transport layer. The QD-LED with bottom emission structure shows the luminescence of 530 cd m-2 and the current efficiency of 1 cd/A.

BACKGROUND: Single dilator technique (SDT) and guide wire dilating forceps (GWDF) are the two most commonly used techniques of percutaneous dilatational tracheostomy (PDT) in critically ill adult patients. We performed a meta-analysis of randomised, controlled trials comparing intraoperative, mid-term and late complications of these two techniques.METHODS: Pertinent studies were searched in BioMedCentral, PubMed, Embase and the Cochrane Central Register of clinical trials. We selected all randomised studies comparing SDT and GWDF techniques in adult critically ill patients published in a peer-reviewed journal.RESULTS: Among 1040 retrieved studies, five eligible studies randomising 363 patients (181 to GWDF, 182 to SDT) were identified. The incidence of the composite outcome difficult cannula insertion/difficult dilation or failure was higher with the GWDF technique (15.5% vs. 4.9 %, P = 0.02). Moreover, intraprocedural bleeding was more common in the GWDF group (19.3% vs. 7.6% in SDT group, P = 0.018). A trend towards an increased incidence of fracture of tracheal rings was noted in the SDT group (6.5% vs. 0.5% in the GWDF group, P = 0.13). No difference in mid-term or long-term complications was observed.CONCLUSION: GWDF technique is associated with a higher incidence of intraprocedural bleeding and of technical difficulties in completing the procedure (difficult cannula insertions/difficult dilations or failures) compared with the SDT technique. No differences were identified in mid-term and long-term complications. Further studies comparing SDT and GWDF in the general population and in subgroups of high-risk patients (like obese or hypoxaemic patients) are warranted.

"The present work is an overview of the main pitfalls which may occur when a researcher performs a meta-analysis. The main goal is to help clinicians evaluate published research results. Organizing and carrying out a meta-analysis is hard work, but the findings can be significant. Meta-analysis is a powerful tool to cumulate and summarize the knowledge in a research field, and to identify the overall measure of a treatment's effect by combining several conclusions. However, it is a controversial tool, because even small violations of certain rules can lead to misleading conclusions. In fact, several decisions made when designing and performing a meta-analysis require personal judgment and expertise, thus creating personal biases or expectations that may influence the result. Meta-analysis' conclusions should be interpreted in the light of various checks, discussed in this work, which can inform the readers of the likely reliability of the conclusions. Specifically, we explore the principal steps (from writing a prospective protocol of analysis to results' interpretation) in order to minimize the risk of conducting a mediocre meta-analysis and to support researchers to accurately evaluate the published findings.. . "

PURPOSE: The decision to start venovenous extracorporeal membrane oxygenation (VV ECMO) is commonly based on the severity of respiratory failure, with little consideration of the extrapulmonary organ function. The aim of the study was to identify predictors of mortality and to develop a score allowing a better stratification of patients at the time of VV ECMO initiation. METHODS: This was a prospective multicenter cohort study on 60 patients with influenza A (H1N1)-associated respiratory distress syndrome participating in the Italian ECMOnet data set in the 2009 pandemic. Criteria for ECMO institution were standardized according to national guidelines. RESULTS: The survival rate in patients treated with ECMO was 68%. Significant predictors of death before ECMO institution by multivariate analysis were hospital length of stay before ECMO institution (OR=1.52, 95% CI 1.12-2.07, p=0.008); bilirubin (OR=2.32, 95% CI 1.52-3.52, p&nbsp

Semiconductor quantum dots (QDs) promise facile color tuning and high color saturation in quantum-dot light-emitting devices (QD-LEDs) by controlling nanoparticle size and size distribution. Here, we demonstrate how this promise can be practically realized for the cadmium-free InP/ZnSe/ZnS multishell quantum dots. We developed a set of synthesis conditions and core/shell compositions that result in QDs with green, yellow, and red emission color. The QD-LEDs employing these QDs show efficient electroluminescence (EL) with luminance up to 1800 cd/m2 and efficiency up to 5.1 cd/A. The color coordinates calculated from the EL spectra clearly demonstrate the outstanding color saturation as an outcome of the narrow particle size distribution. These results prove that the performance gap between cadmium-free and cadmium-based QDs in QD-LEDs is shrinking rapidly.

Two types of white wheat bread (high- and low-type loaves) were investigated for rope spoilage. Thirty of the 56 breads tested developed rope spoilage within 5 days; the high-type loaves were affected by rope spoilage more than the low-type loaves. Sixty-one Bacillus strains were isolated from ropy breads and were characterized on the basis of their phenotypic and genotypic traits. All of the isolates were identified as Bacillus subtilis by biochemical tests, but molecular assays (randomly amplified polymorphic DNA PCR assay, denaturing gradient gel electrophoresis analysis, and sequencing of the V3 region of 16S ribosomal DNA) revealed greater Bacillus species variety in ropy breads. In fact, besides strains of B. subtilis, Bacillus licheniformis, Bacillus cereus, and isolates of Bacillus clausii and Bacillus firmus were also identified. All of the ropy Bacillus isolates exhibited amylase activity, whereas only 32.4% of these isolates were able to produce ropiness in bread slices after treatment at 96°C for 10 min. Strains of lactic acid bacteria previously isolated from sourdough were first selected for antirope activity on bread slices and then used as starters for bread-making experiments. Prevention of growth of approximately 104 rope-producing B. subtilis G1 spores per cm2 on bread slices for more than 15 days was observed when heat-treated cultures of Lactobacillus plantarum E5 and Leuconostoc mesenteroides A27 were added. Growth of B. subtilis G1 occurred after 7 days in breads started with Saccharomyces cerevisiae T22, L. plantarum E5, and L. mesenteroides A27.