Sufentanil Sublingual Tablet System: from rationale of use to clinical practice.

The control of post-operative pain in Italy and other western countries is still suboptimal. In recent years, the Sufentanil Sublingual Tablet System (SSTS; Zalviso; AcelRx Pharmaceuticals, Redwood City, CA, USA), which is designed for patient-controlled analgesia (PCA), has entered clinical practice. SSTS enables patients to manage moderate-to-severe acute pain during the first 72 postoperative hours directly in the hospital setting. However, the role of SSTS within the current framework of options for the management of post-operative pain needs to be better established. This paper presents the position on the use of SSTS of a multidisciplinary group of Italian Experts and provides protocols for the use of this device.

A prolonged and successful heparin-free extracorporeal membrane oxygenation run in isolated thoracic trauma: A case report.

A 21-year-old patient has been treated in emergency with venovenous extracorporeal membrane oxygenation after severe thoracic trauma causing severe air leak and haemothorax. The extracorporeal assistance was managed without heparin for 10 days till the full recovery of the lung, and no side-effect was recorded.

Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock: a systematic review and meta-analysis.

BACKGROUND: Sepsis-induced myocardial dysfunction is associated with poor outcomes, but traditional measurements of systolic function such as left ventricular ejection fraction (LVEF) do not directly correlate with prognosis. Global longitudinal strain (GLS) utilizing speckle-tracking echocardiography (STE) could be a better marker of intrinsic left ventricular (LV) function, reflecting myocardial deformation rather than displacement and volume changes. We sought to investigate the prognostic value of GLS in patients with sepsis and/or septic shock. METHODS: We conducted a systematic review (PubMed and Embase up to 26 October 2017) and meta-analysis to investigate the association between GLS and mortality at longest follow up in patients with severe sepsis and/or septic shock. In the primary analysis, we included studies reporting transthoracic echocardiography data on GLS according to mortality. A secondary analysis evaluated the association between LVEF and mortality including data from studies reporting GLS. RESULTS: We included eight studies in the primary analysis with a total of 794 patients (survival 68%, n = 540). We found a significant association between worse LV function and GLS values and mortality: standard mean difference (SMD) - 0.26; 95% confidence interval (CI) - 0.47, - 0.04; p = 0.02 (low heterogeneity, I2 = 43%). No significant association was found between LVEF and mortality in the same population of patients (eight studies; SMD, 0.02; 95% CI - 0.14, 0.17; p = 0.83; no heterogeneity, I2 = 3%). CONCLUSIONS: Worse GLS (less negative) values are associated with higher mortality in patients with severe sepsis or septic shock, while such association is not valid for LVEF. More critical care research is warranted to confirm the better ability of STE in demonstrating underlying intrinsic myocardial disease compared to LVEF.

A standardized protocol for the perioperative management of myasthenia gravis patients. Experience with 110 patients.

BACKGROUND: Video-assisted thoracoscopic extended thymectomy (VATET) is well established in the treatment of myasthenia gravis; however, patient selection remains controversial. Perioperative management protocol is lacking, and concerns regarding post-operative myasthenic crisis still remain. We performed a retrospective observational study evaluating the impact of the introduction of a protocol in the perioperative management of patients with myasthenia gravis who underwent VATET. METHODS: The perioperative management protocol was developed by a team of neurologists and anesthesiologists who reviewed the literature and their previous experience on myasthenia gravis patients. Respiratory, clinical, and neurological patient features were included in the protocol evaluation. A retrospective review of patients who underwent VATET before and after introduction to the protocol was finally performed. RESULTS: The medical records of 66 patients (pre-protocol group) and 44 patients (protocol group) were available for the study. In the pre-protocol group, 17 patients (26%) were admitted to intensive care unit (ICU) during the post-operative period, while three patients (6.8%) of the protocol group met the criteria for ICU post-operative admission. This resulted in a reduction of 73.5% of patients admitted to ICU (P = 0.023) and in an 80% (P = 0.002) reduction of the use neuromuscular blocking agents. Two post-operative myasthenic crises preceded by bulbar symptoms (1.8%) were identified in the pre-protocol group patients. CONCLUSIONS: Although the application of our protocol results in a substantial reduction in the recovery of patients in the ICU and in hospital costs, there was no substantial difference in mortality and morbidity between patients admitted to the surgical ward or to ICU.

[Questionnaire of perceived quality (QQP): a study on the differences of gender]. / Questionario di qualità percepita (QQP): uno studio sulle differenze di genere.

In the present paper we analyze the psychometric properties of an Italian questionnaire measuring the perceived quality of health services (Questionnaire of Perceived Quality; Coluccia, Ferretti, Lorini, Calamai, 2002). Subjects answered 14 questions subdivided into four factors (i.e. Satisfaction regarding Medical Doctors, Nurses, Auxiliary Staff, and Hospital Structure). We administered the questionnaire to 1,600 patients in the "Le Scotte" Hospital of Siena. According to structural equation modeling, we studied the dimensionality of the questionnaire using confirmatory factor analysis and, successively, we studied differences in gender using Multi-sample analysis. Results show significant gender differences for two dimensions (i.e. Satisfaction regarding Nurses and Satisfaction regarding Hospital Structures). Females, compared to males, express more negative evaluations in these two factors.

A new project for rehabilitation and psychomotor disease analysis with virtual reality support.

This paper deals with the project DD1-97, developed inside European Project VREPAR, for the application of a new equipment for psychomotor disease analysis and rehabilitation. The small equipment presents a glove for one finger, with sensors, which detect the movement of the phalanges and the force of the finger tip on a button. Electromyographs are measuring the nervous signals from flexion and extension muscles of the finger. In a portable computer a program examines the signals and elaborates them. The commands for the patient are of 4 kinds: -dynamic motion of the finger; -motion with vision of the finger; -motion without vision of the finger; -control by the images from virtual reality which reproduces the "virtual finger". The results with healthy persons show a distribution in the foreseen range; with disabled person (with Parkinson's disease) show that virtual reality may support rehabilitation for neuromotor problems. The equipment is designed with reference to the most modern ergonomic concepts.

Demonstration of surgical telerobotics and virtual telepresence by Internet + ISDN from Monterey (USA) to Milan (Italy).

This paper deals with the connection which has been held on 8th July 1997 in collaboration with the JPL of the NASA, Pasadena, California, between the Eighth International Conference on the Advanced Robotics (ICAR '97) in course at Monterey, California and the Telerobotics Laboratory of Politecnico di Milano connected in a multipoint teleconference through the MCU of Rome with the Aula Magna of the same Politecnico and the Palace Business of the Giureconsulti of the Chamber of Commerce of Milan. The demonstration has allowed to telecontrol a scara robot of the Sankyo and an ABB robot, which have affected simulations of operations of biopsy to the prostate, to the liver and to the breast, a mechanical hand and a model of a car, disposed in a space destined to reproduce the Martian ground, from Monterey to Milan by means of the INTERNET+ISDN connection from. In fact the event has taken place four days after the landing on Mars happily successful of the spatial probe Pathfinder from which it has gone out the "Sojourner" robot, telecontrolled from the JPL of the NASA, which has begun to take photos of the Martian ground and also some of these images have been transmitted in the course of the connection.

Virtual reality in the assessment of neuromotor diseases: measurement of time response in real and virtual environments.

This paper deals with the design and the development of an equipment, called DDI, as acronym for Disease Detector, developed for the quantitative analysis of neuromotor diseases. It measures the reaction of a person evaluating in the motion of one finger of the hand the time response, the velocity of phalanxes, the force exerted from the finger against a button. The condition of motion are ballistic motion, controlled motion guided by vision, controlled motion without vision, motion with a virtual reality modelization on the computer screen. The system performs also the requirements for medical applications and with its portability and accordance to European normative for safety and quality, represents a new step towards the possibility of quantitative analysis of the performances of the human hand both of mechanical phenomenon and electromyographic of neuromotor diseases, which provoke a decrease in upper and lower limbs action.

Ventilation mode recognition using artificial neural networks.

This study investigated the capabilities of artificial neural networks to identify spontaneous and pressure support ventilation modes from gas flow and airway pressure signals. After receiving written informed consent, flow and pressure waveforms were recorded from 13 patients undergoing general anesthesia. During analysis, the inspiratory phase of each breath was extracted and normalized in amplitude and wavelength. Neural networks were configured to input flow, pressure, or both waveforms and to output the ventilatory mode. Neural network training was accomplished with data from 500 breaths obtained from 7 patients. Neural network performance was tested with 433 breaths from the remaining 6 patients. Networks using flow, pressure, and both waveforms recognized correctly 78% (337), 97% (423), and 100% (433) of the test waveforms, respectively. Results indicate that neural networks can be used effectively for breathing pattern recognition and encourage the application of neural networks in other types of respiratory pattern recognition problems.

[Transfusional needs and blood saving strategies during orthotopic heart transplantation]. / Necessità trasfusionali e strategie di risparmio di sangue durante trapianto cardiaco ortotopico.

It is difficult to evaluate transfusional needs during cardiac surgery. One hundred fifty patients undergoing orthotopic cardiac transplantation were divided into two groups (A and B) according to the blood saving strategies. (Group A: no important saving strategies; group B: all blood saving techniques utilized). A low blood, plasma and platelet consumption was observed, with good clinical results, in group B. During orthotopic cardiac transplantation, it would be suitable to use all the saving transfusional blood strategies and a correct use of hemocomponents as during all cardiac surgery.