Non-invasive estimation of cardiac index in healthy volunteers.

The primary objective was to non-invasively measure the cardiac index (CI) and associated haemodynamic parameters of healthy volunteers and their changes with age. This was a single centre, prospective, observational study of healthy volunteers aged between 20 and 59 years, using the ClearSight™ (Edwards Life Sciences, Irvine, CA, USA) device. We recorded 514 observations in 97 participants. The mean CI was 3.5 l/min/m2 (95% confidence interval [95% CI] 3.4 to 3.7 l/min/m2). The mean stroke volume index (SVI) was 47 ml/m2 (95% CI 45 to 49 ml/m2) and the mean systemic vascular resistance index was 2,242 dyne.s/cm5/m2 (95% CI 2,124 to 2,365 dyne.s/cm5/m2). There was an inverse linear relationship between increasing age and CI (P <0.0001), which decreased by 0.044 l/min/m2 (95% CI  -0.032 to -0.056 l/min/m2) per year. This change was mostly due to a decrease in SVI of 0.45 ml/m2 (95% CI 0.32 to 0.57 ml/m2) per year (P <0.0001). The mean CI of young healthy humans is approximately 3.5 l/min/m2 and declines by approximately 40 ml/min/m2 per year, mostly due to a decline in stroke volume (SV). These findings have significant implications regarding the clinical interpretation of haemodynamic parameters and the application of these results to individual patients.

Role of surgical setting and patients-related factors in predicting the occurrence of postoperative pulmonary complications after abdominal surgery.

OBJECTIVE: The aim of this retrospective study was to evaluate the role of surgical setting (urgent vs. elective) and approach (open vs. laparoscopic) in affecting postoperative pulmonary complications (PPCs) prevalence in patients undergoing abdominal surgery. PATIENTS AND METHODS: After local Ethical Committee approval, 409 patients who had undergone abdominal surgery between January and December 2014 were included in the final analysis. PPCs were defined as the development of one of the following new findings: respiratory failure, pulmonary infection, aspiration pneumonia, pleural effusion, pneumothorax, atelectasis on chest X-ray, bronchospasm or un-planned urgent re-intubation. RESULTS: PPCs prevalence was greater in urgent (33%) vs. elective setting (7%) (χ2 with Yates correction: 44; p=0.0001) and in open (6%) vs. laparoscopic approach (1.9%) (χ2 with Yates correction: 12; p=0.0006). PPCs occurrence was positively correlated with in-hospital mortality (Biserial Correlation r=0.37; p=0.0001). Logistic regression showed that urgent setting (p=0.000), Ariscat (Assess Respiratory Risk in Surgical Patients in Catalonia) score (p=0.004), and age (p=0.01) were predictors of PPCs. A cut-off of 23 for Ariscat score was also identified as determining factor for PPCs occurrence with 94% sensitivity and 29% specificity. CONCLUSIONS: Patients undergoing abdominal surgery in an urgent setting were exposed to a higher risk of PPCs compared to patients scheduled for elective procedures. Ariscat score fitted with PPCs prevalence and older patients were exposed to a higher risk of PPCs. Prospective studies are needed to confirm these results.

IN-VITRO evidence for the protective properties of the main components of the Mediterranean diet against colorectal cancer: A systematic review.

AIM: Epidemiological studies have shown that the incidence and mortality rates of colorectal cancer (CRC) vary over 10-fold worldwide where within Westernized societies lower rates are observed amongst populations living within the Mediterranean basin, suggesting a significant influence of environment and dietary style in CRC carcinogenesis. Interpretation of the data concerning the benefits of mediterranean (MD) diet is difficult in vivo because of the variability of alimentary regimens used, the differing compliance with dietary supplementation and because of the non-uniform duration of patient cohort observation. Therefore, the aim of this review is to evaluate the in-vitro effects on colorectal cancer cell lines. METHODS: the literature concerning the in-vitro effects of 4 of the principal components symbolizing the MD such as olive oil (polyphenol), red chili (capsaicin), tomato (lycopene) and red grapes (resveratrol) have been systematically reviewed. RESULTS: Several studies have demonstrated that polyphenols form olive oil, lycopene, resveratrol and capsaicin have multiple anticancer properties affecting several metabolic pathways involved in cancerogenesis, apoptosis, and metastasis in CRC cell lines. CONCLUSION: This review summarizes some of the most recent data potentially supportive of the use of MD in CRC chemoprevention, analyzing the in vitro effects of individual components of the MD on CRC cell development, progression, metastasis and apoptosis.

Update on post-traumatic stress syndrome after anesthesia.

BACKGROUND: Between 0.5% and 2% of surgical patients undergoing general anesthesia may experience awareness with explicit recall. These patients are at a risk for developing anxiety symptoms which may be transient or can lead to post-traumatic stress disorder (PTSD). AIM: The aim of this review was to assess the prevalence of PTSD after intraoperative awareness episodes and analyze patients' complaints, type and timing of assessment used. METHODS: PubMed, MEDLINE and The Cochrane Library were searched up until October 2012. Prospective and retrospective studies on human adult subjects describing prevalence of PTSD and/or psychological sequalae after awareness episodes were included. RESULTS: Seven studies were identified. Prevalence of PTSD ranged from 0 to 71%. Acute emotions such as fear, panic, inability to communicate and feeling of helplessness were the only patients' complaints that were significantly correlated to psychological sequelae including PTDS. There were cases that reported psychological symptoms after 2-6 hours from awakening (%) or 30 days after (%). Previous studies used psychological scales lacking of dissociation assessment. CONCLUSIONS: Whenever an awareness episode is suspected, a psychological assessment with at least three interviews at 2-6 h, 2-36 h and 30 days must be performed in order to collect symptoms associated with both early and delayed retrieval of traumatic event. As a dissociative state could hide the expression of reactive symptoms after intraoperative awareness, future studies should be focused on detecting dissociative symptoms in order to carry out a prompt and appropriate treatment aimed at avoiding long-term psychological disability.

Photoaffinity labeling and site-directed mutagenesis of rat squalene epoxidase.

Squalene epoxidase (SE) (EC 1.14.99.7) is a flavin-requiring, non-cytochrome P-450 oxidase that catalyzes the conversion of squalene to (3S)-2,3-oxidosqualene. Photolabeling and site-directed mutagenesis were performed on recombinant rat SE (rrSE) to elucidate the location and roles of active-site residues important for catalysis. Two new benzophenone-containing analogs of NB-598, a nanomolar inhibitor of vertebrate SE, were synthesized in tritium-labeled form. These photoaffinity analogs (PDA-I and PDA-II) became covalently attached to SE when irradiated at 360 nm. Lys-C digestion and HPLC purification of [3H]PDA-I-labeled rrSE resulted in isolation of a single major peptide. MALDI-TOF mass spectrometry of this peptide indicated a covalent adduct between PDA-I and a tripeptide, Asp-Ile-Lys, beginning at Asp-426 of rat SE. Based on the labeling results, three mutant constructs were made. First, the D426A and K428A constructs showed a 5- to 8-fold reduction in SE activity compared with wild-type enzyme, while little change was observed in the I427A mutant. Second, a set of five mutant constructs was prepared for the conserved region based on the structure of the flavoprotein p-hydroxybenzoate hydroxylase (PHBH). Compared with wild-type, D284A and D407A showed less than 25% SE activity. This reduction also appeared to correlate with reduced affinity of the mutant proteins for FAD. Finally, each of the seven Cys residues of rrSE were individually mutated to Ala. Three Cys substitutions had no effect on SE activity, and substitutions at Cys-500 and Cys-533 showed a 50% lower SE activity. Mutations at Cys-490 and Cys-557 produced proteins with negligible SE activity, implicating these residues as being either structurally or catalytically essential. Chemical modification of wildtype and Cys mutants with a thiol-modifying reagent support the existence of a disulfide bond between Cys-490 and Cys-557.