Articles: cations.
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Objectives: Nosocomial pneumonia is a common complication in critically ill patients. The goal of this study was to examine the efficacy of the Toll-like receptor 4 agonist 3-deacyl phosphorylated hexacyl disaccharide (3D PHAD), in a clinically relevant murine model of pneumonia, and assess the cellular mechanisms that mediate the protective response. Design: Mice received intrapulmonary 3D PHAD (20 μg) or vehicle for 2 consecutive days before challenge with intrapulmonary Klebsiella pneumoniae (2.3 × 10 3 colony-forming units). ⋯ Lung innate leukocytes from 3D PHAD-treated mice had increased phagocytic capacity. Treatment with 3D PHAD alone increased cytokines in the lungs but decreased cytokines in plasma during K. pneumoniae pneumonia as compared with control. Conclusions: Intrapulmonary treatment with 3D PHAD augments innate immunity in the lung and facilitates resistance to K. pneumoniae pneumonia.
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After microvascular decompression (MVD) for hemifacial spasm (HFS), a minority of patients realize little to no relief of spasms. In some patients, the absence of relief of spasms results from incomplete or inadequate decompression of vascular compression of the facial nerve, and these patients represent excellent candidates for repeat MVD. However, in other patients, repeat MVD is not appropriate because adequate decompression and resolution of neurovascular compression, as determined by postoperative high-resolution MRI, was achieved with the initial operation. ⋯ After FNM, durable and, at least, partial relief of spasms with a relatively low complication rate was observed in most patients with HFS with incomplete relief of spasms after technically adequate prior MVD.
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Despite formal cardiac clearance, a subset of 3-column osteotomy (3CO) patients still experience cardiac complications (CCs). ⋯ RCRI and MET functional ability are limited risk assessment tools in ASD 3CO patients with formal cardiac clearance. Patients older than 81 years are at high risk for CC. In younger patients, cardiac EF and blood loss are significant components to risk stratify for CC.
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Anesthesia, perioperative and critical care medicine are specific areas where registries, biobanks and big data are gaining a leading role in increasing knowledge and improving patients' care. The adoption of these robust data infrastructures - aimed at bridling, manipulating, aggregating, and linking patients' multiparametric data - supports anesthesiologists and intensive care physicians in several aspects of bedside practice and clinical research. Indeed, registries-integrated calculators may promote the concept of personalized medicine acting as "sniffers," electronic alarm systems, or decision support systems. ⋯ In a different way, the role of biobanks primarily relies on translational medical research. These allow rapidly creating pools of biological samples available for epidemiological description, pathophysiological definition, and treatment effectiveness verification, basically acting as an accelerator of knowledge production in critical care and perioperative medicine. Nowadays, registries and biobanks are thus routine tools for anesthesiologists and critical care physicians.