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The incidence of sepsis is increasing, and the condition is now the leading cause of death in general intensive care units. Our review failed to identify studies of the causes of cardiac arrest among infected patients, even though non-cardiac causes represent 15% of out-of-hospital cardiac arrests and though one-third of events have positive blood cultures. Sudden cardiac arrest is the result of local damage to the heart and of the impact of systemic and pulmonary conditions on cardiac performance, and its danger is underestimated. Necropsy findings in sudden death often identify myocarditis as an unexpected cause. The role of hypoxaemia, severe pulmonary thromboembolism with subsequent pulseless cardiac activity, alterations of electrolytes and hydrogen concentrations, distort fluid distribution with reduced pre-load, direct myocyte damage and adverse cardiac effects related to antibiotic use need to be defined. Many cardiac arrests might be preventable. Because cardiopulmonary resuscitation is challenging and usually unsuccessful in patients with sepsis, research is needed to help predict which patients are at risk. Only half of pneumonia patients with cardiac arrest in the ward receive prior ECG monitoring. Telemedicine and non-invasive monitoring in the ward, avoidance of antibiotics associated with prolonged QT syndrome, and adequate haemodynamic resuscitation might be important in preventing in-hospital arrests among patients with infections.

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INTRODUCTION: Solid cancer patients are frequently admitted in intensive care units for critical events. Improving survival rates in this setting is considered an achievable goal today. Respiratory failure is the main reason for admission, representing a primary target for research. AREAS COVERED: This review presents a diagnostic and therapeutic algorithm for pneumonia and other severe respiratory events in the solid cancer population. It aims to increase awareness of the risk factors and the different etiologies in this changing scenario in which neutropenia no longer seems to be a decisive factor in poor outcome. Bacterial pneumonia is the leading cause, but opportunistic diseases and non-infectious etiologies, especially unexpected adverse effects of radiation, biological drugs and monoclonal antibodies, are becoming increasingly frequent. Options for respiratory support and diagnostics are discussed and indications for antibiotics in the management of pneumonia are detailed. Expert commentary: Prompt initiation of critical care to facilitate optimal decision-making in the management of respiratory failure, early etiological assessment and appropriate antibiotic therapy are cornerstones in management of severe pneumonia in oncologic patients.

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BACKGROUND: Pain drawings (PDs) are an important component of the assessment of a patient with pain. The aim of this work is to present the test-retest reliability of a novel method of quantifying the extent and location of pain. Additionally, the association between PD variables and clinical features in patients with chronic neck pain (CNP) and chronic low back pain (CLBP) was explored. METHODS: Fifty-one patients with CLBP and 56 patients with CNP participated. Each patient shaded two consecutive PDs using a digital tablet. Software was developed to quantify the pain extent, to analyse the pain overlap between PDs and to produce pain frequency maps. Correlations were obtained between pain extent and clinical features including the level of pain intensity, disability, and psychological distress and cognitive function. RESULTS: The intraclass correlation coefficients for pain extent in CLBP and CNP were very high: 0.97 (95% CI: 0.95-0.98) and 0.92 (95% CI: 0.87-0.98), respectively. The Bland Altman showed a mean difference close to zero: 5.4% pixels in CNP group and 3% pixels in the CLBP group. Significant correlations were observed between pain extent and pain intensity in CLBP and CNP and pain extent and disability in CNP. There was no relation between pain extent and the level of distress or cognitive function. CONCLUSIONS: A novel method for the acquisition of PD was presented. Test-retest reliability of reporting pain extent and pain location was supported in people with CNP and CLBP. Future research is needed to establish psychometric properties of PD.

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PURPOSE: A recent hypothesis ascribes dyslexia to a perceptual anchoring deficit. Supporting results have so far been obtained only in children with dyslexia and additional learning difficulties, but the hypothesis has been argued to apply to all individuals with dyslexia. METHOD: The authors measured auditory frequency discrimination thresholds in 54 young adults (native speakers of Dutch; 25 individuals with dyslexia; 29 age- and education-matched controls), with a 2-alternative forced-choice staircase paradigm. There were 2 conditions: 1 in which 1 tone in each pair had a fixed frequency across trials (standard), and 1 in which both tones varied in frequency (no standard). Presence of a standard stimulus allows the creation of a stimulus-specific representation in short-term-memory (perceptual anchor). RESULTS: The standard condition yielded significantly lower discrimination thresholds in both controls and individuals with dyslexia; both groups benefited equally from the presence of an invariant stimulus. CONCLUSION: There is no difference between this group of adults with dyslexia and controls in their capacity to form a perceptual anchor. The implication is that an anchoring deficit cannot be generalized to all cases of dyslexia.

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AIM: To investigate ex vivo, the root canal morphology of the MB root of maxillary first molar teeth by means of micro-computed tomography. METHODOLOGY: Thirty extracted intact human maxillary first molar teeth were selected for micro-tomographic analysis (SkyScan 1072, Aartselaar, Belgium) with a slice thickness of 38.0 mum. The following data regarding the MB root were analysed and recorded: number and type of root canals, prevalence of isthmuses, prevalence of intercanal connections, presence of accessory canals, presence of loops and number of apical foramina. RESULTS: The MB2 canal was present in 80% of specimens and was independent in 42% of these cases. When present, the MB2 canal merged with the MB1 canal in 58% of cases. Communications between the two canals were found in all specimens, with isthmuses in 71% of the cases. These communications and isthmuses were respectively in 42% and 54% of the cases in the coronal third, in 59% and 79% of the cases in the middle third and in 24% and 50% of the cases in the apical third. A single apical foramen was found in 37% of specimens, two apical foramina were present in 23% of the cases, with three or more separate apical foramina occurring in 40% of the specimens. CONCLUSIONS: The MB root canal anatomy was complex: a high incidence of MB2 root canals, isthmuses, accessory canals, apical delta and loops was found.

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Xanthine oxidase (xanthine: oxygen oxidoreductase, EC 1.1.3.22), a molybdenum-containing hydroxylase that produces superoxide and uric acid from purine substrates and molecular oxygen, is involved in the oxidative stress underlying several human pathologies including lung diseases. An enzymatic activity similar to xanthine oxidase was previously reported in bronchoalveolar lavage fluid of patients with chronic obstructive pulmonary disease (COPD-BAL), by fluorometric analysis of DNA unwinding and cytochrome c reduction kinetics. Here we report the detection of xanthine oxidase activity products by electron paramagnetic resonance (EPR) in presence of the spin-trap 5,5-dimethyl-1-pyrroline N-oxide (DMPO) and reversed-phase high-performance liquid chromatography (RP-HPLC) in COPD-BAL (n = 14, average age of patients 65 years, range 38-81) and BAL from healthy nonsmoker controls (n = 6, average age 64 years, range 44-73). Superoxide DMPO adducts were detected in COPD-BAL and in an in vitro system containing xanthine and xanthine oxidase (XA/XO), but not in BAL controls and when superoxide dismutase (SOD, 1000 I.U./ml) was added to COPD-BAL. The HPLC analyses after addition of xanthine showed production of uric acid in COPD-BAL and in the XA/XO system but not in BAL controls. These results support the involvement of xanthine oxidase in the mechanisms of superoxide production by BAL supernatant, which increases oxidative stress in chronic obstructive pulmonary disease.

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The College of Nurses of Trento (Collegio IPASVI) promoted a call for research works done by nurses, to award a prize to those judged worthy. The three best works were respectively on concordance on triage classification between doctors and nurses; on the results of organizational and educational interventions on the reduction of needle-stick injuries; and on the differences on postoperative pain assessment between nurses and patients. The final reports were later discussed as part of a training exercise aiming at improving the skill of scientific writing and they are published here, together with some comments that emphasize areas of improvement in data analysis and interpretation and some broader issues related to nursing research.

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Treating four comatose children with severe injuries of the brain stem, suffering from severe autonomic disorders without any indications for neurosurgery, we were led to increase gradually the doses of neuroleptics used as basis of treatment, the main one being Droperidol. The increase in dosage, often reaching very high doses, was rendered necessary owing to a phenomenon comparable to that of addiction, a steadily increasing dose was necessary each day to obtain the same beneficial effects of autonomic stabilization. A complete cure was obtained on each occasion, at the end of a coma varying between 20 days and two and a half months. The extreme case was the last case in which we were led to give in a single day, 7 grams of the drug to a 12 years old child, who completely recovered his motor and intellectual functions after a coma lasting thirty five days. Comparison of the four cases led us to suppose that the result is all the better when treatment with neuroleptics is started soon after the accident, in low dosage but regularly increased without fixing any other ceiling than the effect obtained, the toxicity of Droperidol seemed to us very low, even in very high dosage, provided the conditions of gradualness are respected. Although it is classical to say that the prognosis of trauma of the brain stem is more favourable in children than in adults, we are certain that such treatment contributed considerably to avoid a fatal issue or chronic invalidism.

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