The Communicative-Relational Operating Model of the Italian National Institute of Health for an Effective Telephone Intervention in Public Health, Structured on Basic Counselling Skills.

Introduction: Communication has a crucial role in public health, because it becomes an essential component of prevention; it is also a proactive tool in health promotion. From a planning perspective, it is appropriate to use communication means that can help the bidirectional communication process, such as face-to-face communication and telephone communication. Materials and methods: In relation to this, the Italian National Institute of Health has developed the "Modello Operativo Comunicativo-Relazionale" (the "Communicative-Relational Operating Model"). It is based on the fundamental skills of the counselling, this gives a protocol to the health professionals that is replicable and organized and it allows health professionals to carry out a telephone communication that is efficient with the user through technical-scientific and communication-relational skills. The goal is to answer in a customized way to the various users' health needs. The Operating Model was created by experts of the National AIDS and Sexually Transmitted Infections Helpline of the Operational Unit of Psycho-Socio-Behavioural Research, Communication, Training, of the Infectious Diseases Department. Later, the Operating Model was proposed to the experts of the Helplines in the National Centre on Addictions and Doping and the National Helpline of the National Centre for Rare Diseases in the National Institute of Health that integrated this method into their telephone approach. Results: The Operating Model illustrated above was applied to several helplines of the National Institute of Health as an example of correct scientific information, updated and customized on sexual transmitted infections, addictions and rare diseases. Conclusions: This article aims to illustrate the Operating Model, the theoretical prerequisites that subtend it and its possible application in the different public health structures that use the telephone for a profes-sional relationship with their users.

Early and systematic administration of fibrinogen concentrate in postpartum haemorrhage following vaginal delivery: the FIDEL randomised controlled trial.

OBJECTIVE: To assess the benefits and safety of early human fibrinogen concentrate in postpartum haemorrhage (PPH) management. DESIGN: Multicentre, double-blind, randomised placebo-controlled trial. SETTING: 30 French hospitals. POPULATION: Patients with persistent PPH after vaginal delivery requiring a switch from oxytocin to prostaglandins. METHODS: Within 30 minutes after introduction of prostaglandins, patients received either 3 g fibrinogen concentrate or placebo. MAIN OUTCOME MEASURES: Failure as composite primary efficacy endpoint: at least 4 g/dl of haemoglobin decrease and/or transfusion of at least two units of packed red blood cells within 48 hours following investigational medicinal product administration. Secondary endpoints: PPH evolution, need for haemostatic procedures and maternal morbidity-mortality within 6 ± 2 weeks after delivery. RESULTS: 437 patients were included: 224 received FC and 213 placebo. At inclusion, blood loss (877 ± 346 ml) and plasma fibrinogen (4.1 ± 0.9 g/l) were similar in both groups (mean ± SD). Failure rates were 40.0% and 42.4% in the fibrinogen and placebo groups, respectively (odds ratio [OR] = 0.99) after adjustment for centre and baseline plasma fibrinogen; (95% CI 0.66-1.47; P = 0.96). No significant differences in secondary efficacy outcomes were observed. The mean plasma FG was unchanged in the Fibrinogen group and decreased by 0.56 g/l in the placebo group. No thromboembolic or other relevant adverse effects were reported in the Fibrinogen group versus two in the placebo group. CONCLUSIONS: As previous placebo-controlled studies findings, early and systematic administration of 3 g fibrinogen concentrate did not reduce blood loss, transfusion needs or postpartum anaemia, but did prevent plasma fibrinogen decrease without any subsequent thromboembolic events. TWEETABLE ABSTRACT: Early systematic blind 3 g fibrinogen infusion in PPH did not reduce anaemia or transfusion rate, reduced hypofibrinogenaemia and was safe.

Alcohol and tobacco consumption affect the oral carriage of Candida albicans and mutans streptococci.

UNLABELLED: This study sought to determine if there is a relationship between the consumption of alcohol and tobacco and oral colonization by mutans streptococci and Candida species. Subjects were recruited from the University Dental Clinic of CEU Cardenal Herrera University (Moncada, Valencia). Information on alcohol and tobacco consumption was obtained by questionnaire. Individual stimulated saliva samples from 105 patients were obtained and selective media was used to isolate and quantify mutans streptococci and Candida spp. colony forming units per millilitre of saliva (CFU ml(-1) ). Samples were stratified by duration and quantity of alcohol and tobacco consumption. Alcohol consumption statistically significantly decreased oral carriage of mutans streptococci, whereas there was no effect on Candida albicans colonization levels. Tobacco users were found to harbour elevated levels of C. albicans; however, there was no observed effect on bacterial colonization by mutans streptococci. The carriage of other species investigated, such as Candida krusei, Candida tropicalis and lactobacilli, do not show a response to the consumption of the stimulants analysed. Microbial colonization of the oral cavity changes in a species-specific manner in response to dietary and social habits such as drinking alcohol and smoking. SIGNIFICANCE AND IMPACT OF THE STUDY: In this paper, we evaluate the effect of alcohol and tobacco consumption on key species of the oral microflora. Our results show species-specific changes in two major opportunistic pathogens, such as Candida albicans and mutans streptococci, whereas other members of oral microflora are not affected by the consumption of the stimulants studied. We believe this original paper will contribute to raise awareness among the dental community towards a more personalized oral health assessment, taking in consideration alcohol and tobacco consumption in the prevention of specific oral and systemic pathologies.

Drug cutaneous side effect: focus on skin ulceration.

Skin ulcers are defined as tissue loss interesting the deeper layers of the dermis and hypodermis, with low tendency to spontaneous healing. They cause disability related to pain, risk of infection and amputation, chronic management, requiring working absence with notably economic burden. The major cause is often related to underlying vascular disease, infections, tumors, autoimmunity, trauma, even if literature occasionally reported several cases of drug inducing skin ulceration. Most of drugs involved are chemotherapy agents and more recently molecular target therapies. Evidences supporting these drugs as the major cause of skin ulcers include delay of onset after therapy initiation, improvement after withdrawal of the drug, recurrence after its reintroduction and, sometimes, simultaneous occurrence of other skin lesions that have previously been reported to be associated with these agents. Attention should be reserved to patients undergoing antineoplastic agents, especially if previously affected by predisposing comorbidities, considering such side effect as possible differential diagnosis for skin ulceration in neoplastic patients.

Metabolomics signature improves the prediction of cardiovascular events in elderly subjects.

AIMS: Age is one of the most important determinants of cardiovascular health, therefore the management of cardiovascular diseases (CVD) in elderly people entails great challenge. A possible explanation of vascular senescence process is the mitochondrial damage and dysfunction. We hypothesized that metabolomic profiling would identify biomarkers predicting major cardiovascular events (MACEs) in elderly people, improving the clinical standard cardiovascular risk factors. METHODS AND RESULTS: Targeted-mass-spectrometry-based profiling of 49 metabolites was performed in a group of very old participants (n = 67, mean age = 85 ± 3 years) with a high rate of previous CVD (68%). Principal Component Analysis, Random Survival Forest analysis and Cox proportional hazards regression modeling were used to evaluate the relation between the metabolite factors and recurring MACEs. We tested discrimination ability and reclassification of clinical and metabolomic models. At follow-up (median = 3.5 years), 17 MACEs occurred (5 cardiovascular deaths, 1 nonfatal myocardial infarction, 7 nonfatal strokes and 4 peripheral artery surgeries) (incidence = 7.3% person-years). Metabolite factor 1, composed by medium- and long-chain acylcarnitines, and factor 7 (alanine) were independently associated with MACEs, after adjustment for clinical CV covariates [HR = 1.77 (95%CI = 1.11-2.81, p = 0.016) and HR = 2.18 (95%CI = 1.17-4.07, p = 0.014), respectively]. However, only factor 1 significantly increases the prediction accuracy of the Framingham Recurring-Coronary-Heart-Disease-Score, with a significant improvement in discrimination (integrated discrimination improvement = 7%, p = 0.01) and correctly reclassifying 41% of events and 37% of non-events resulting in a cNRI = 0.79 (p = 0.005). CONCLUSIONS: Aging mitochondrial dysfunction evaluated by metabolomic profiling is associated with MACEs, independently of standard predictors.

High mobility group box 1 is a novel substrate of dipeptidyl peptidase-IV.

AIMS/HYPOTHESIS: High mobility group box 1 (HMGB1) is a cytokine with a key role in tissue regeneration and angiogenesis. Previous studies have shown that topical application of HMGB1 to skin wounds of mouse models of diabetes enhanced vessel density and accelerated wound healing, suggesting that diabetes may affect endogenous HMGB1 functions. Dipeptidyl peptidase IV (DPP-IV/CD26) is a protease whose activity is increased in diabetes and whose inhibition improves glucose tolerance. Since HMGB1 contains potential DPP-IV cleavage sites, we determined whether HMGB1 may be a substrate for DPP-IV and whether DPP-IV-mediated cleavage may alter the biological activity of HMGB1. METHODS: Reversed phase HPLC, mass spectrometry and western blot analyses were performed to analyse and identify HMGB1 peptides generated following DPP-IV digestion. HMGB1 angiogenic functions in the presence of DPP-IV were evaluated in vitro and in vivo. HMGB1 protein was detected in the serum of type 2 diabetic patients before and after treatment with DPP-IV inhibitors. RESULTS: DPP-IV cleaved HMGB1 at its N-terminal region and affected its angiogenic functions. Specifically, DPP-IV inhibited HMGB1-induced endothelial cell migration and capillary-like structure formation, as well as HMGB1-mediated vascular network formation in Matrigel implants in mice. We had previously found that HMGB1 promoted endothelial cell migration through activation of extracellular regulated kinase signalling pathway. Here we showed that such an effect was abolished in the presence of DPP-IV. Finally, the N-terminal truncated form of HMGB1 was detected in the serum of type 2 diabetic patients, in whom DPP-IV inhibitors enhanced the levels of full-length HMGB1. CONCLUSIONS/INTERPRETATION: DPP-IV cleaves HMGB1 and, via this mechanism, inhibits HMGB1 angiogenic activity. Treatment with DPP-IV inhibitors may enhance HMGB1 activity in diabetic patients, thereby improving angiogenesis in this condition.

Formulación de políticas públicas a través de experiencias de ayuda al desarrollo: la salud pública intercultural en el contexto de la cooperación sanitaria entre Bolivia e Italia / Public policy formulation through development aid experience: public health in the context of intercultural health cooperation between Bolivia and Italy

La visión de quienes formularon el programa de cooperacion entre Italia y Bolivia denominado Ayuda al desarrollo del sistema socio sanitario dle departamento de Potosí, pretendía la realización de una experiencia a nivel local que sentara las bases para un cambio en las políticas nacionales.

Anatomía del sistema de conductos de premolares mandibulares / No disponible

Objetivo. El objetivo de este trabajo fue estudiar la anatomía del sistema de conductos de primeros y segundos premolares mandibulares. Material y Métodos: comparamos los datos que se pueden obtener de radio grafías, con la observación directa del sistema de conductos de 60 primeros y 20 segundos premolares mandibulares, tras su tinción y transparentización. Resultados: Según los resultados obtenidos de la diafanización, en los primeros premolares mandibulares hay un 78,6% de casos en los que se encuentra un conducto y un foramen, en el reto de ocasiones podemos estar enfrentándonos a variaciones mucho más complicadas o a dientes con más de una raíz (14% de los casos de nuestro estudio); en los segundos premolares el porcentaje de un conducto y de un foramen es del 90,3%, pero un 6,5% de los casos acaban en dos conductos. La concordancia entre la radiografía y los datos obtenidos de la observación de los premolares transparentizados en cuanto al número de raíces es del 94,7% en los primeros premolares y del 100% en los segundos, mientras que la coincidencia en el tipo de conductos, es menor, del 89,5% en los primeros y del 90,7% en los segundos, y esto gracias a las radiografías realizadas con una proyección mesiodistal. Conclusiones. Es importante no confiar en los patrones morfológicos aceptados, sobre todo de los primeros premolares mandibulares y como vemos la radiografía se muestra fundamental para el análisis de la morfología del sistema de conductos de estos clientes (AU)

Objective: The purpose of this work was to study the morphology of the first and second mandibular premolars root canal system. Material and methods: We compare the results of 60 first and 70 second mandibular premolar after a diaphanization with those gotten by radiographical images. Results: With the first technique, there is mainly (78,6%) 1 canal and 1 foramen in first premolars, the rest of the roots has other anatomical organization and even, there are more than 1 root in the 14% of the cases. Second premolars have 1 canal with 1 foramen in the 90,3% of the cases, 6,5% en with a double canal. We got a 94,7% and 100% agreement between both observation techniques in first and second premolars root number, and 89,5% and 90,7% agreement related to the canal Vertucci type (in this case, radiographs were taken with a mesiodistal inclination). Conclusions. It is important not to hope certain number of canals, overall in first mandibular premolars, and as we can see, radiographs are fundamentals (AU)

Mtwo: un nuevo sistema rotatorio para la instrumentación de los conductores radiculares / Mtwo: a new endodontic rotary system for root canal treatment

La introducción de las limas rotatorias de níquel-titanio en el mercado, y la constante aparición de nuevos y instrumentos han despertado el interés de muchos clínicos en aprender a manejar estos sistemas y en usuarlos en la práctica diaria en sus clínicas. Desde los años 90 hasta la actualidad han surgido varios sistema rotatorios para la instrumentación de conductos, lo que le da más opciones y comodidad al endodoncista, pero esto obliga a estar al día en la literatura científica y en las últimas novedades del mercado, para mejorar el trabajo clínico y para dar al paciente un mejor servicio. Últimamente se han desarrollado las limas rotatorias Mtwo (VDW GMBH, Munich, alemania), con unas características especiales que lo hacen diferente a otros sistemas rotatorios. Nuestra primera impresión tras el uso de éste sistema que se configura como una alternativa interesante, para el tratamiento endodoncico por su facilidad de uso y su eficacia

The introduction in the market of the endodontic nickel-titanium rotary instruments, the apparition of the new nickel-titanium rotary instruments, had waked up the interest of many clinicians to learn using these instruments and apply this knowledge in the clinical practice. Since the early´90s, several instruments systems manufactured from nickel-titanium have been introduced into endodontic practice, this give more option and commodity to the endodontic, but at the same time obligate to be in contact with the literature and with last newness in the market making the clinical effort more efficient and easy, and to give to patients a better service. In 2002 had been introduced a new nickel-titanium rotary system Mtwo (VDW GMBH, Munich, Germany. that offer some special characteristics, which make it different from other rotary systems. The first impression after it´s use is that it is an interesting alternative in the root canal treatment for the facility of use and it´s efficacy

Knowledge and attitudes regarding preventative HIV vaccine clinical trials in Italy: results of a national survey.

We carried out a telephone survey to assess willingness to participate in HIV vaccine trials. The survey was conducted by interviewing randomly selected callers to the Italian National AIDS Help line. The questionnaire consisted of four sections: demographic information, knowledge about HIV vaccines and vaccines in general, factors related to participation in HIV vaccine trials, and acceptability of a future HIV vaccine. Over 50% of the sample had adequate knowledge about HIV and vaccines. Among the individuals interviewed, 37% would volunteer for a vaccine trial; those reporting high-risk behaviours were more likely to volunteer. Of the participants, 83% would agree to be vaccinated with a highly effective vaccine, and 92% would pay for the vaccine. Although the limits of telephone surveys should not be neglected, the results of this survey are encouraging.

[Accidents among ambulance employees: epidemiologic features]. / Infortuni nel personale d'autoambulanza: aspetti epidemiologici.

The accidents have been esteemed that are verified in four years in a group of 824 employees. The study has underlined a meaningful percentage (30.1%) of road accidents. This suggests the opportunity of contemplate preventive actions: corrected maintenance of the ambulance, control of the conditions of environmental comfort, organization of the job, individualization of conditions that reduces the attention and the concentration, as the use of alcohol and of other substances.

Acute effects of aflatoxins on guinea pig isolated ileum.

Previous studies on the aflatoxins have focused mainly on their chronic toxic effects. In this study we investigated the acute gastrointestinal effects of four common aflatoxins on isolated guinea pig ileum. AFB(1) (EC(50) 4.6+/-0.4 microM) and AFB(2) (EC(50)17+/-4.4 microM) contracted isolated guinea pig ileum in a dose-dependent manner, whereas AFG(1) and AFG(2) evoked no contractions. Atropine (5.9 nM 11.8 and 23.6 nM) antagonized AFB(1)-induced contractions in a dose-dependent manner. Pretreatment with the nicotinic ganglionic blocker, hexamethonium (up to 55 microM), left AFB(1)-induced contractions unchanged. In contrast, tetrodotoxin (0.3 microM), blocked AFB(1) contractile activity. The two inhibitors of ACh release, morphine (0.3 microM) and clonidine (0.4 microM), antagonized EC(50) AFB(1)-induced contractions, and apamin, a drug that increases neuronal excitability, facilitated the EC(50) AFB(1)-induced contractile effect. The choline uptake blocker, hemicholinium (17.4 microM) markedly reduced AFB(1)-induced contractions. These results suggest that aflatoxins induce their contractile effect indirectly through the cholinergic system by stimulating acetylcholine release from the postganglionic parasympathetic nerve endings. The acute actions of aflatoxins on isolated guinea pig ileum could explain their acute gastrointestinal effects in humans and animals.

Immigration and health: the Italian National Focal Point experience.

This report is a description of the situation of migrant populations in Italy. It was written by a committed team of experts from public institutions, non-governmental organisations (NGO) and volunteer associations that for three years have been part of the Italian National Focal Point (NFP) within the European Project "AIDS & Mobility", which is being co-ordinated by the Netherlands Institute for Health Promotion and Disease Prevention (the Netherlands) and financed by the European Commission DG/V. This year the Italian National Focal Point, co-ordinated by the Telefono Verde AIDS of the Istituto Superiore di Sanità, has produced a second report (the first one was published in 1998) on health issues related to migrant populations. Besides providing an updated picture on the presence of foreigners in Italy, such report illustrates the present legislative situation within the sanitary area and some interventions regarding prevention, treatment and rehabilitation provided by each structure in the Italian NFP to foreign citizens. The initiatives carried out during the year 1999 by public institutions, NGO and volunteer associations are also reported in order to detect the psycho-social-sanitary needs of immigrants and target prevention programmes to their particular and specific needs.

Immigration and health: the Italian situation. Italian National Focal Point (NFP) of the AIDS & Mobility Project.

This report is a description of the situation of migrant populations in Italy. It was written as part of the European project "AIDS & Mobility", which is being co-ordinated by the Netherlands Institute for Health Promotion and Disease Prevention and financed by the European Union (EU). The report was written by the Italian National Focal Point (NFP) of the AIDS & Mobility Project, which consists of a committed team of experts from public institutions, non-governmental organizations, volunteer associations, and researchers from the Telefono Verde AIDS (National AIDS Help-line of Italy) of the Centro Operativo AIDS (COA, National AIDS Unit of Italy) of the Istituto Superiore di Sanità. The report illustrates the phenomenon of immigration in Italy, with demographic data (updated at 31 December 1997) on the presence of non-Italians and a review of the current laws pertinent to this phenomenon, with particular reference to health care laws. Moreover, epidemiological data on HIV/AIDS and on sexually transmitted diseases are provided, particularly as they relate to drug addiction and prostitution. Finally, following an accurate analysis of the situation and in light of the experience gained, the report includes proposals for identifying needs, objectives to pursue, and strategies to adopt, with respect to confronting the issue of immigration.

[A proposal for training in integrated counseling]. / Proposta di un percorso formativo sul counselling integrato.

The relationship between socio-health care workers and individuals seeking help has traditionally considered the individual seeking help as a "case" rather than an "individual". To change this attitude, counselling professionals must focus their attention on the individual's personality, through individualised interventions focussing on the "here and now", with the goal of overcoming any feelings of unease that the individual may have and of ultimately resolving the problem at hand. For this change to occur, knowledge and practical experience ("to know" and "to know how") are fundamental, but they do not suffice: reception, listening, empathy and relational skills ("to know how to be") must be given equal importance in the culture and training of the socio-health care worker. At present, to ensure that existing services and the interventions conducted are efficient and effective, it is fundamental to integrate the normal training and updating activities of socio-health care workers with training in integrated counselling and for improving the specific communication skills and strategies necessary in creating a "help relationship". The present document describes a proposal for organising courses on integrated counselling for socio-health workers.

[Intraoperative lactic acidosis, can it be treated? Clinico-experimental, prospective, sequential study]. / A proposito di acidosi lattica intraoperatoria, è possibile trattarla? Studio clinico-sperimentale, prospettico, sequenziale.

OBJECTIVE: To verify the efficacy and absence of risk attributable to therapy with alkaline solutions for correction of lactic acidosis and to demonstrate the usefulness of L-carnitine in converting lactate into pyruvate in conditions of good blood oxygenation. DESIGN: Prospective study on a consecutive series of patients subdivided into three groups following the use of: alkalinizing therapy (group I), L-carnitine (group II), or saline solution (group III). Groups 1 and 2 were further subdivided into subgroups "a" and "b" according to the type of alkalinizing agent and of L-carnitine somministration. SETTING: Teaching Hospital-Torrette di Ancona. PATIENTS: 65 patients submitted to major vascular surgery with aortic clamping in the time period between January 1992 and August 1993. INTERVENTIONS: During aortic clamping patients of: group I received 2 mEq:kg of bicarbonate or tromentamolo according to the specific subgroup. Group II received a bolus of 2 g of L-carnitine, patients of group IIb received further 2 g of carnitine in continuous perfusion until the end of surgery. Group III received no pharmacological intervention. MEASUREMENTS: HR BP, arterial blood gases and lactic acid levels were measured at 12 pre-determined times. RESULTS: Only a neutralizing effect of alkalinizing therapy was observed, whereas the lactic acid measurements demonstrated no significant differences between the different groups. CONCLUSIONS: These results confirm the data of other Authors concerning the good compliance of alkalinizing therapy, however, there was demonstrated no clear evidence of its effective usefulness. No metabolic stimulation due to L-canitina could be demonstrated in our experimental conditions.

Expression of mouse brain soluble guanylyl cyclase and NO synthase during ontogeny.

The spatial and temporal distribution of soluble guanylyl cyclase and nitric oxide synthase mRNA was determined during embryonic and postnatal development of the mouse brain. This was achieved by in situ hybridization of specific probes for soluble beta 1 guanylyl cyclase subunit and nitric oxide synthase mRNA on mouse brain sections at late fetal development (19-day embryo) and different stages of postnatal development (3, 7, 15 days, and adult). In the embryo, soluble guanylyl cyclase transcripts are weakly expressed in the central nervous system. Following birth their expression increases in the striatum and neocortex, and they are widely distributed in the adult brain (layer II and V-VI of the cortex, olfactory bulb, striatum, Purkinje cell layer of the cerebellum). In contrast, nitric oxide synthase mRNA was expressed in several embryonic structures of the brain (different layers of the cortical neuroepithelium, colliculi neuroepithelium, pons), and markedly reduced at early postnatal stage, except in the accessory olfactory bulb and pediculopontine nuclei. Nitric oxide synthase transcripts progressively appear, within two weeks following birth, in the striatum and the cerebral cortex but they were specifically confined to isolated cells. During this period, this mRNA also increased in hippocampus, in discrete nuclei (hypothalamus, pontine) and in the molecular layer of the cerebellum. The situation in the adult was similar to the one observed at 15 days. These results show a general lack of regional colocalization of soluble guanylyl cyclase and NOS mRNA during ontogeny, thus suggesting an independent regulation of the related genes.

An ultrastructural study of epithelium differentiation in the human fetal fallopian tube.

The epithelial structure of the developing human fetal Fallopian tube has been studied systematically by parallel light, transmission and scanning electron microscopy. The specimens for this study were collected from spontaneous abortions at the 14th, 18th, 20th and 22nd weeks and from cases of intrauterine fetal death at the 24th and 31st weeks (hydrocephalus). The epithelium lining the wall of the female genital ducts was pseudostratified in a columnar fashion. It consisted of differentiating ciliated and microvillous cells and some degenerating elements. Microvillous cells-by far the most abundant in the early phases of tubal development-often showed a solitary cilium. Ciliated elements, though always less numerous than microvillous cells, were more densely concentrated on the developing fimbriae and at the uterotubal junction than in the ampulla. On the mucosal surface of the same regions, rounded intercellular holes delimited many crypts, from which ciliated elements sometimes sprouted. Notable aspects of cell proliferation and ciliogenesis were commonly observed and are likely to be related to circulating estrogens. These ultrastructural data indicate that the typical pattern of the adult oviduct is already sketched in fetal life. Furthermore, a strategic gathering of cilia was noted primarily at the sites of the developing oviduct, which will serve to mediate the passage of sperm and/or ova and promote fertilization in adult life.

[Validity of the V/Q index in the monitoring of critical patients]. / Validità dell'indice V/Q nel monitoraggio dei pazienti critici.

The Authors have controlled the validity of VQI to quantify pulmonary shunt (Qs/Qt). The survey involved (group A) patients who had undergone major surgery and (group B) patients hospitalized in ICU for cardiorespiratory failure. Four subgroups were identified in both the groups according to different values of SaO2. A good correlation, already described by Räsänen, was comproved in the groups and subgroups. However a progressive reduction of the coefficient of correlation from the lower to the higher values of SaO2 was noted. Finally the differences observed between group A and group B, are supposed to be dependent on a greater variability of haemoglobin, in the surgical group, in relation to the time of evaluation.