Objective:
Fluid responsiveness is the ability to increase the cardiac output in response to a fluid challenge. Only about 50% of patients receiving fluid resuscitation for acute circulatory failure ...increase their stroke volume, but the other 50% may worsen their outcome. Therefore, predicting fluid responsiveness is needed. In this purpose, in recent years, the assessment of the inferior vena cava (IVC) through ultrasound (US) has become very popular. The aim of our work was to systematically review all the previously published studies assessing the accuracy of the diameter of IVC or its respiratory variations measured through US in predicting fluid responsiveness.
Data Sources:
We searched in the MEDLINE (PubMed), Embase, Web of Science databases for all relevant articles from inception to September 2017.
Study Selection:
Included articles specifically addressed the accuracy of IVC diameter or its respiratory variations assessed by US in predicting the fluid responsiveness in critically ill ventilated or not, adult or pediatric patients.
Data Extraction:
We included 26 studies that investigated the role of the caval index (IVC collapsibility or distensibility) and 5 studies on IVC diameter.
Data Synthesis:
We conducted a meta-analysis for caval index with 20 studies: The pooled area under the curve, logarithmic diagnostic odds ratio, sensitivity, and specificity were 0.71 (95% confidence interval CI: 0.46-0.83), 2.02 (95% CI: 1.29-2.89), 0.71 (95% CI: 0.62-0.80), and 0.75 (95% CI: 0.64-0.85), respectively.
Conclusion:
An extreme heterogeneity of included studies was highlighted. Ultrasound evaluation of the diameter of the IVC and its respiratory variations does not seem to be a reliable method to predict fluid responsiveness.
Estimating a conventional effect size of 10% between at least one of the comparisons made, for a desired power of 97%, we calculated a sample size of 30 operators in each group.Young attending ...physicians: physicians with less than three years of working experience; EM residents: residents in Emergency Medicine; IM residents: resident in Internal medicine; Nurses: nurses with retrieval and pre-hospital competence but no or very scarce experience in advanced airway management (<10 intubations per year).Category Amount Airway ALS/ACLS Macintosh Airtraq King Vision Bonfils Young attending physicians 2 (7%)a 1 (50%) 2 (100%) 2 (100%) 2 (100%) 2 (100%) 2 (100%) EM residents 4 (13%)a 1 (25%) 1 (25%) 4 (100%) 2 (50%) 1 (25%) 1 (25%) IM residents 1 (3%)a 0 0 1 0 0 0 Nurses 23 (77%)a 8 (35%) 20 (86%) 23 (100%) 19 (83%) 18 (78%) 8 (35%) Total 30 10 (33%) 23 (77%) 30 (100%) 23 (77%) 21 (70%) 11 (37%) Table 2 Results for each considered outcome for every device in the scenario without a cervical spine collar.Col w.o. col L A B K KN L 0.6830 1.0000 0.1810 <0.001⁎ A 0.8123 0.6410 0.7330 <0.001⁎ B 0.0771 0.0177⁎ 0.1621 <0.001⁎ K 0.9855 0.5891 0.3311 <0.001⁎ KN <0.001⁎ <0.001⁎ <0.001⁎ <0.001⁎ 1 K. Hasegawa, K. Shigemitsu, Y. Hagiwara, T. Chiba, H. Watase, C.A. Brown III, Japanese Emergency Medicine Research Alliance Investigators, Association between repeated intubation attempts and adverse events in Emergency Departments: an analysis of a multicenter prospective observational study, Ann Emerg Med, Vol. 60, 2012, 749-754 2 T.C. Mort, Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts, Anesth Analg, Vol. 99, 2004, 607-613 3 R.M. Levitan, J.W. Heitz, M. Sweeney, R.M. Cooper, The complexities of tracheal intubation with direct laryngoscopy and alternative intubation devices, Ann Emerg Med, Vol. 57, 2011, 240-247 4 B.M.A. Pieters, N.E.R. Wilbers, M. Huijzer, B. Winkens, A.A.J. van Zundert, Comparison of seven videolaryngoscopes with the Mcintosh laryngoscope in manikins by experienced and novice personnel, Anaesthesia, Vol. 71, 2016, 556-564 5 L. Liu, K. Tanigawa, S. Kusunoki, Tracheal intubation of a difficult airway using Airway Scope, Airtraq, and Macintosh laryngoscope: a comparative manikin study of inexperienced personnel, Anesth Analg, Vol. 110, 2010, 1049-1055 6 D.W. Healy, O. Maties, D. Hovord, S. Kheterpal, A systematic review of the role of videolaryngoscopy in successful orotracheal intubation, BMC Anesthesiol, Vol. 12, 2012, 32 7 Y. Akihisa, K. Maruyama, Y. Koyama, R. Yamada, A. Ogura, T. Andoh, Comparison of intubation performance between the King Vision and Macintosh laryngoscopes in novice personnel: a randomized, crossover manikin study, J Anesth, Vol. 28, 2014, 51-57 8 P. Schoettker, J. Corniche, The AirView study: comparison of intubation conditions and ease between the Airtraq-Air View and the King Vision, Biomed Res Int, Vol. 2015, 2015, 284142 9 L.D. Murphy, G.J. Kovacs, P.M. Reardon, J.A. Law, Comparison of the King Vision video laryngoscope with the Macintosh laryngoscope, J Emerg Med, Vol. 47, 2014, 239-246 10 T. Gaszynski, K. Toker, M. Carassiti, A. Chalkias, J.N. Carlson, Advances in airway management and ventilation strategies in Emergency Medicine, Biomed Res Int, Vol. 2015, 2015, 425715 11 L.E. Wolf, J.A. Aguirre, C. Vogt, C. Keller, A. Borgeat, H.R. Bruppacher, Transfer of skills and comparison of performance between King Vision® video laryngoscope and Macintosh blade following an AHA airway management course, BMC Anesthesiol, Vol. 17, 2017, 5
The responses of CD8
T cells to hepatotropic viruses such as hepatitis B range from dysfunction to differentiation into effector cells, but the mechanisms that underlie these distinct outcomes remain ...poorly understood. Here we show that priming by Kupffer cells, which are not natural targets of hepatitis B, leads to differentiation of CD8
T cells into effector cells that form dense, extravascular clusters of immotile cells scattered throughout the liver. By contrast, priming by hepatocytes, which are natural targets of hepatitis B, leads to local activation and proliferation of CD8
T cells but not to differentiation into effector cells; these cells form loose, intravascular clusters of motile cells that coalesce around portal tracts. Transcriptomic and chromatin accessibility analyses reveal unique features of these dysfunctional CD8
T cells, with limited overlap with those of exhausted or tolerant T cells; accordingly, CD8
T cells primed by hepatocytes cannot be rescued by treatment with anti-PD-L1, but instead respond to IL-2. These findings suggest immunotherapeutic strategies against chronic hepatitis B infection.
Most, if not all, aspects of carcinogenesis are influenced by the tumor microenvironment (TME), a complex architecture of cells, matrix components, soluble signals, and their dynamic interactions in ...the context of physical traits of the tissue. Expanding application of technologies for high‐dimensional analyses with single‐cell resolution has begun to decipher the contributions of the immune system to cancer progression and its implications for therapy. In this review, we will discuss the multifaceted roles of tumor‐associated macrophages and neutrophils, focusing on factors that subvert tissue immune homeostasis and offer therapeutic opportunities for TME reprogramming. By performing a critical analysis of available datasets, we elaborate on diversification mechanisms and unifying principles of myeloid cell heterogeneity in human tumors.
Tight control of inflammatory gene expression by antagonistic environmental cues is key to ensure immune protection while preventing tissue damage. Prostaglandin E2 (PGE2) modulates macrophage ...activation during homeostasis and disease, but the underlying mechanisms remain incompletely characterized. Here we dissected the genomic properties of lipopolysaccharide (LPS)-induced genes whose expression is antagonized by PGE2. The latter molecule targeted a set of inflammatory gene enhancers that, already in unstimulated macrophages, displayed poorly permissive chromatin organization and were marked by the transcription factor myocyte enhancer factor 2A (MEF2A). Deletion of MEF2A phenocopied PGE2 treatment and abolished type I interferon (IFN I) induction upon exposure to innate immune stimuli. Mechanistically, PGE2 interfered with LPS-mediated activation of ERK5, a known transcriptional partner of MEF2. This study highlights principles of plasticity and adaptation in cells exposed to a complex environment and uncovers a transcriptional circuit for IFN I induction with relevance for infectious diseases or cancer.
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•PGE2 suppresses IFN I induction by activated macrophages•PGE2 targets a set of poorly permissive inflammatory gene enhancers marked by MEF2A•Loss of MEF2A causes functional inactivation of inflammatory gene enhancers•MEF2A is required for IFN I induction in response to multiple innate immune stimuli
Prostaglandin E2 (PGE2) modulates macrophage activation during homeostasis and disease, but the underlying mechanisms remain incompletely characterized. Cilenti, Barbiera, et al. reveal that PGE2 suppresses inflammatory gene expression by targeting a set of inflammatory gene enhancers marked by MEF2A, a critical regulator of type I interferon induction.
The responses of CD8.sup.+ T cells to hepatotropic viruses such as hepatitis B range from dysfunction to differentiation into effector cells, but the mechanisms that underlie these distinct outcomes ...remain poorly understood. Here we show that priming by Kupffer cells, which are not natural targets of hepatitis B, leads to differentiation of CD8.sup.+ T cells into effector cells that form dense, extravascular clusters of immotile cells scattered throughout the liver. By contrast, priming by hepatocytes, which are natural targets of hepatitis B, leads to local activation and proliferation of CD8.sup.+ T cells but not to differentiation into effector cells; these cells form loose, intravascular clusters of motile cells that coalesce around portal tracts. Transcriptomic and chromatin accessibility analyses reveal unique features of these dysfunctional CD8.sup.+ T cells, with limited overlap with those of exhausted or tolerant T cells; accordingly, CD8.sup.+ T cells primed by hepatocytes cannot be rescued by treatment with anti-PD-L1, but instead respond to IL-2. These findings suggest immunotherapeutic strategies against chronic hepatitis B infection.
The contribution of non-indigenous species to the transfer of contaminants in invaded food webs represents an active research area. Here we measured trace metals and CN stable isotopes in five ...populations of the invasive Atlantic blue crab Callinectes sapidus and in baseline bivalve species from Spain, Italy and Greece. They were used to estimate trophic transfer effects and the trophic position and isotopic niche of C. sapidus. Maximum trophic transfer effects occurred where the crab showed the largest isotopic niches and highest trophic positions; furthermore, the consistency of trace metal profiles between bivalves and crabs co-varied with the trophic position of the latters. Omnivory may influence the success of an invasive species, but also limit its effectiveness for biomonitoring. However, our results indicated that stable isotopes analysis provides a clarifying background where to cast patterns of contamination of the blue crab as well as of other omnivorous biomonitor species.
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•Callinectes sapidus is invasive in the Mediterranean Sea.•Metals content was analyzed in five populations from Italy, Greece, and Spain.•Variations in trophic position reflected on metals trophic transfer.•Omnivory may hamper the use of a species for biomonitoring.•Stable isotope analysis may provide clarifying information.
•Domus Apicii is affected by a damage ranging from moderate to very severe.•Biodeterioration is mainly related to the rural environmental conditions.•Towers and the NW façade show poor structural ...conditions.•Superfetations severely altered the aesthetical features of the monument.•An ethically acceptable making-decision process should be proposed.
A stratigraphic analysis applied to the architectural remains of the medieval domus Apicii (Calvi, Benevento) allowed to define four main building periods characterized by different materials and masonry techniques. Intense biological colonization and other damage pathologies affect the building geomaterials. A quantitative evaluation of the conservation state of the monument accounts for a moderate to a very severe damage, with a progressive damage index (DIprog) up to 3.3 value.
The results of this multidisciplinary investigation represent an important starting point for an ethically acceptable making-decision process within a modern restoration and conservation of the monument.
ped/pea-15 is a ubiquitously expressed 15-kDa protein featuring a broad anti-apoptotic function. In a yeast two-hybrid screen,
the pro-apoptotic Omi/HtrA2 mitochondrial serine protease was identified ...as a specific interactor of the ped/pea-15 death
effector domain. Omi/HtrA2 also bound recombinant ped/pea-15 in vitro and co-precipitated with ped/pea-15 in 293 and HeLa cell extracts. In these cells, the binding of Omi/HtrA2 to ped/pea-15
was induced by UVC exposure and followed the mitochondrial release of Omi/HtrA2 into the cytoplasm. Upon UVC exposure, cellular
ped/pea-15 protein expression levels decreased. This effect was prevented by the ucf-101 specific inhibitor of the Omi/HtrA2
proteolytic activity, in a dose-dependent fashion. In vitro incubation of ped/pea-15 with Omi/HtrA2 resulted in ped/pea-15 degradation. In intact cells, the inhibitory action of ped/pea-15
on UVC-induced apoptosis progressively declined at increasing Omi/HtrA2 expression. This further effect of Omi/HtrA2 was also
inhibited by ucf-101. In addition, ped/pea-15 expression blocked Omi/HtrA2 co-precipitation with the caspase inhibitor protein
XIAP and caspase 3 activation. Thus, in part, apoptosis following Omi/HtrA2 mitochondrial release is mediated by reduction
in ped/pea-15 cellular levels. The ability of Omi/HtrA2 to relieve XIAP inhibition on caspases is modulated by the relative
levels of Omi/HtrA2 and ped/pea-15.
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