Minerva anestesiologica
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Minerva anestesiologica · Mar 2016
Observational StudyDynamic view of postoperative pain evolution after total knee arthroplasty: a prospective observational study.
Having a dynamic view of postoperative pain resolution allows a better understanding of the transition towards chronic pain. Sleep and quality of life are important determinants of satisfaction after total knee arthroplasty (TKA), besides functional recovery and pain. ⋯ The trajectories of the different types of pain after TKA show their non-linear evolution, highlighting the need of a better pain control at precise moments. Sleep disturbances and alterations of quality of life are still present one year after the surgery.
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Minerva anestesiologica · Mar 2016
ReviewHow to optimize and use predictive models for postoperative pulmonary complications.
Pulmonary complications are a source of greater postoperative morbidity and mortality and longer hospital stays. Although many factors have been implicated as predictors, few models have been developed with the rigorous methodology required for clinically useful tools. ⋯ Above all, we stress that we still lack evidence for the clinical and cost effectiveness of many measures proposed for reducing risk or for managing complications perioperatively. For a good predictive model to truly prove its utility in clinical decision-making, such evidence is required.
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Minerva anestesiologica · Mar 2016
Dynamic view of postoperative pain and quality of life evolution after total knee arthroplasty - a prospective observational study.
Systemic response to cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) causes the activation of endocrine, metabolic, hemodynamic and inflammatory processes. The aim of this work is to describe and analyze the time course of the inflammatory markers concentration during CRS+HIPEC in plasma and peritoneal fluids and the association with hemodynamic and metabolic parameters. ⋯ The most significant variations were in IL-6 and PCT levels. The cytokines level parallels the hemodynamic derangements. Treatment during HIPEC should mimic the established treatment during sepsis and septic shock.
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Minerva anestesiologica · Mar 2016
Review'Why can't I give you my organs after my heart has stopped beating?' An overview of the main clinical, organisational, ethical and legal issues concerning organ donation after circulatory death (DCD) in Italy.
Donation after circulatory death (DCD) is a valuable option for the procurement of functioning organs for transplantation. Clinical results are promising and public acceptance is quite good in most western countries. Yet, although DCD is widespread in Europe, several problems still persist in Italy as well as in some other countries. ⋯ Currently, as regards DCD, Italy is somewhat different from other countries. Therefore, every effort should be made for the safe and effective implementation of DCD programs: uncontrolled DCD programs should be promoted and encouraged, within the framework of shared and authoritative rules. At the same time, we need to tackle the question of controlled DCD, promoting debate among all involved subjects regarding the fundamental issues of end-of-life care within protocols that best integrate the highest standard of care for the dying and the legitimate interests of those awaiting a life-saving organ.
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Minerva anestesiologica · Mar 2016
ReviewThe role of genomics to identify biomarkers and signaling molecules during severe sepsis.
Early strategies to diagnose, manage and predict outcome of sepsis are essential to further improve morbidity and mortality of sepsis. Whereas biomarkers have become mainstay in other fields of medicine, their clinical utility in sepsis remains generally much less proven and so biomarkers are much less used clinically. The Human Genome Project embellished genomics, transcriptomics, proteomics and metabolomics and continues to expand our knowledge of the genetic, gene expression, protein translational and metabolic discoveries that could lead to clinical biomarker tests related to sepsis thereby allowing insight into the disease as never seen before. We explore the genomic approach to biomarker identification and validation by reviewing pertinent studies related to the diagnosis (diagnostic biomarkers), prediction of response to therapies (predictive biomarkers) and (prognostic biomarkers) outcomes of sepsis.