La Ricerca in clinica e in laboratorio最新文献

Pediatric advanced life support (PALS) training is critical for pediatric residents. It is unclear how well PALS skills are developed during this course or maintained overtime. This study evaluated PALS skills of pediatric interns using a validated PALS performance score following their initial PALS certification. All pediatric interns were invited to a 45-minute rapid cycle deliberate practice (RCDP) training session following their initial PALS certification from July 2017 to June 2019. The PALS score and times for key events were recorded for participants prior to RCDP training. We then compared performance scores for those who took PALS ≥3 months, between 3 days to 3 months and 3 days after PALS. There were 72 participants, 30 (of 30) in 3 days, 18 in 3 days to 3 months, and 24 in ≥3 months groups (42 total of 52 residents, 81%). The average PALS performance score was 53 ± 20%. There was no significant difference between the groups (3 days, 53 ± 15%; 3 days-3 months, 51 ± 19%; ≥3 months, 54 ± 26%, p  = 0.922). Chest compressions started later in the ≥3 months groups compared with the 3 days or ≤3 months groups ( p  = 0.036). Time to defibrillation was longer in the 3 days group than the other groups ( p  = 0.008). Defibrillation was asked for in 3 days group at 97%, 73% in 3 days to 3 months and 68% in ≥3 months groups. PALS performance skills were poor in pediatric interns after PALS certification and was unchanged regardless of when training occurred. Our study supports the importance of supplemental resuscitation training in addition to the traditional PALS course.

The geometry of liver functional micro-units is described in the light of the immunohistologic features of human hepatocytes stained with a retinol-binding protein antibody. The stained cells were distributed into two ordered sets which provided a provisional representation of the law regulating both the motion and the alternation of the rest-work phases (homopoiesis and homorhesis configurations, respectively) which reflect bistable liver micro-unit equilibrium (auto-isodiasostasis). Oscillations between the HP and HR states generate a relaxation cycle that can be assumed to be shared by all micro-units and to be regulated by feedback mechanisms. A model illustrating the compactness of the liver's global action as a result of the activity of each micro-unit is also proposed.

In patients with liver cirrhosis, especially in the advanced stage, the coexistence of low clotting factor levels, hypofibrinogenemia, thrombocytopenia and elevated fibrin(ogen) degradation product (FDP) and D-dimer levels may suggest the presence of disseminated intravascular coagulation (DIC). In this study we evaluated, in 21 patients with decompensated liver cirrhosis and elevated FDP and D-dimer levels, the time sequence of their coagulation data during a follow-up period of 15 days after the first observation; our aim was to clarify if these patients tend to develop during this time interval a severe consumption coagulopathy as an expression of overt DIC. We evaluated serum fibrinogen, platelet count, prothrombin activity, serum FDP and plasma D-dimer levels at days 1, 3, 6, 10 and 15. The coagulation data were fairly stable during the study period in all patients, even in the two patients who had upper digestive tract bleeding during the study time. Only two patients affected by infectious diseases showed a decrease of D-dimer and FDP levels after healing. Our data suggest that in decompensated liver cirrhosis the detection of elevated FDP and D-dimer levels is seldom related to the occurrence of an overt DIC, at least during a short time interval; in this condition heparin therapy seems therefore not advisable and even potentially dangerous.

We previously reported that plasma thrombotic activity is transiently increased immediately after induced abortion. However, changes in the fibrinolytic system have not yet been studied. Plasma tissue-plasminogen activator (t-PA) antigen levels were studied before and after abortion induced during the first trimester of pregnancy. Compared with the preoperative level (1.68 +/- 0.15 ng/ml), t-PA level was significantly increased (2.78 +/- 0.55 ng/ml, p less than 0.01) 15 min after the induced abortion, while it almost returned to the preoperative values (2.09 +/- 0.40 ng/ml) 2h later. This finding suggests that fibrinolytic activity is transiently increased immediately after the induced abortion, acting as a defense mechanism against thrombosis.

Until recently the generation of antibodies to interferons (IFNs) was considered an unlikely event, while it is now clear that natural interferons (except IFN-beta) are practically nonimmunogenic, although recombinant interferons give rise to antibodies in about 30% of patients with occasional clinical complications. By realizing that normal individuals display spontaneously traces of IFN autoantibodies, in this review it is suggested that (if immunotherapy has to succeed) new generations of recombinant proteins should be the least antigenic as possible.

The liver function results from the interaction of anatomical, histological and biochemical aspects. Thus the concept of functioning liver mass must be related to the many biological aspects involved in the process under evaluation, and its measure can be viewed as a virtual parameter averaging the liver function. In the present review the functioning liver mass has been categorized with respect to the many aspects involved (biochemical transformations, membrane transports and passive intraluminal transports) and their interactions (intracellular, transcellular, transacinar and flow-dependent). Parameters reflecting the functioning liver mass (whether static or dynamic) have been considered with respect to the experimental conditions and characterized according to the type of estimate they provide (capacity or activity). Methods for evaluating the functioning liver mass have been presented and discussed, and a protocol has been proposed for clinical applications, based on the association of the galactose elimination capacity measuring the metabolic mass with the hepatic clearance of D-sorbitol evaluating the functional hepatic plasma flow.

Three human T cell clones (TCC) specific for purified protein derivative of Mycobacterium tuberculosis were incubated in the presence of polybrene and phytohemagglutinin with irradiated mononuclear cells from one individual exhibiting seropositivity for human immunodeficiency virus (HIV) and high levels of circulating p24 antigen. After three weeks, TCC showed HIV integration in their DNA, as shown by polymerase chain reaction analysis and Southern blot technique. All the three HIV-infected TCC maintained their ability to recognize the specific antigen, even if their proliferative ability was reduced. The ability of the HIV-infected TCC to produce IL-2, IL-4 and IFN-gamma in response to phorbol myristate acetate plus anti-CD3 monoclonal antibody was decreased, whereas their ability to produce TNF-alpha was unaffected or even enhanced. Two out of the three HIV-infected TCC showed the ability to provide helper function for polyclonal immunoglobulin production when cocultured with autologous B cells in the absence of any stimulant. These data suggest that in vitro infection of normal human TCC may provide a useful model for the study of immunological alterations induced by HIV.

The presence and titer of neutralizing antibodies against Coxsackie B viruses were investigated in 1,944 children under 15 years of age living in Bari and its area. In 1,781 out of 1,944 sera (91.6%), neutralizing antibodies were present against at least one of the strains tested: 333 (17.1%) samples were found to be positive for one serotype only, 412 (21.2%) for 2 serotypes, 394 (20.3%) for 3, 394 (18.0%) for 4, 199 (10.2%) for 5 and 94 (4.8%) for all 6 strains tested. Of the 1,944 serums examined, 1,043 (53.7%) were found to be positive for type 2, 1,073 (53.3%) for type 5, 991 (51.0%) for type 1, 858 (44.1%) for type 3, 760 (39.1%) for type 4 and 605 (31.1%) for type 6. The rate of positive responses, which was high at birth and in the first months of life (96.7%), diminished between 6 months and 1 year (81.7%) and then rose according to age until it reached 97.7% between 10 and 11 years. After that we observed a considerable reduction in the serological positivities (i.e. 82.3% between 11 and 12 years and 81.5% between 12 and 13 years, respectively).