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This review highlights the pathophysiology and anesthesiologic management of pulmonary complications in minimally invasive cardiac surgery, emphasizing challenges of one-lung ventilation and cardiopulmonary bypass, to improve postoperative respiratory outcomes.

BackgroundTo date cardiac arrest (CA) remains a frequent cause of morbidity and mortality: despite advances in cardiopulmonary resuscitation (CPR), survival is still burdened by hypoxic–ischemic brain injury (HIBI), and poor neurological outcome, eventually leading to withdrawal of life sustaining treatment (WLST). The aim of CPR is cardiac pump support to preserve organ perfusion, until normal cardiac function is restored. However, clinical parameters of target organ end-perfusion during CPR, particularly brain perfusion, are still to be identified. In this context, electroencephalography (EEG) and its derivatives, such as processed EEG, could be used to assess brain function during CA. ObjectivesWe aimed to review literature regarding the feasibility of EEG and processed or raw EEG monitoring during CPR.MethodsA review of the available literature was performed and consisted of mostly case reports and observational studies in both humans and animals, for a total number of 22 relevant studies.ResultsThe research strategy identified 22 unique articles. 4 observational studies were included and 6 animal testing studies in swine models. The remaining studies were case reports. Literature regarding this topic consists of conflicting results, containing studies where the feasibility of EEG during CPR was positive, and others where the authors reached opposite conclusions. Furthermore, the level of evidence, in general, remains low.DiscussionEEG may represent a useful tool to assess CPR effectiveness. A multimodal approach including other non-invasive tools such as, quantitative infrared pupillometry and transcranial Doppler, could help to optimize the quality of resuscitation maneuvers.Take home messageFuture randomized trials are required to adopt EEG monitoring during CPR, also considering its possible role in a multiparametric assessment of cerebral function and perfusion.

Purpose The purpose of this randomized double-blind study was to investigate the effectiveness of the Videoinsight ® psychological enhancing method in promoting early recovery during rehabilitation following total knee arthroplasty. Methods One-hundred and ten patients treated with cemented total knee arthroplasty were randomly assigned to Group A or Group B, and both groups underwent the same rehabilitation programme. Group A (55 patients) received one art video selected according to Videoinsight ® concept. This art video promoting self-confidence and psychological support to the patient has been shown in the physical therapy department before any rehabilitation session, in the first 15 days after surgery and then three times a week for the next 4 weeks. Group B (55 patients) underwent the same rehabilitation protocol in the same setting, after TKA surgery, without the video support. Patients were evaluated pre-operatively and 3 months after surgery with Physical and Mental SF-36, State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Tampa Scale of Kinesiophobia (TSK), Knee Society Score (KSS), VAS, and WOMAC scores. Results Eight patients were lost to follow-up, and 102 patients (Group A: 52 patients; Group B: 50 patients) were available at mean 3.0 ± 0.2 months follow-up. Age at surgery was 69.1 ± 13.0 years. The two groups were homogeneous regarding pre-operative demographic data and clinical outcomes. Significant improvements were observed in both groups compared to baseline and in Group A compared to Group B at final follow-up for functional and psychological scores except for SF-36. Respectively, Group A and Group B showed WOMAC 79.9 ± 13.0 and 69.7 ± 9.5 ( p  < 0.005), VAS 2.8 ± 1.6 and 4.0 ± 1.5, ( p  < 0.005), KSS 87.8 ± 9.6 and 78.3 ± 8.2 ( p  < 0.005), BDI 5.1 ± 4.8 and 9.4 ± 3.9 ( p  < 0.005), STAI 30.8 ± 7.9 and 34.8 ± 7.8 ( p  < 0.005), and TSK 24.4 ± 5.5 and 29.3 ± 4.8 ( p  < 0.005). Conclusion The Videoinsight( ® ) psychological enhancing method, by the view of video art images, combined to an adequate rehabilitation protocol can be a means for further improving short-term clinical and functional outcomes by giving a psychological support to patients who underwent total knee arthroplasty. Level of evidence I.

Response to antiseizure medications (ASMs) can be influenced by several gene polymorphisms, causing either lower efficacy or higher occurrence of adverse drug reactions (ADRs). We investigated the clinical utility of salivary pharmacogenomic testing on epilepsy patients. A commercialized pharmacogenomic salivary test was performed in a cohort of epileptic patients. Genetic variants on five genes (i.e., CYP1A2, CYP2C9, CYP2C19, EPHX1, and ABCB1) involved in common ASMs metabolism were selected. Twenty‐one individuals (median age [Q1–Q3]: 15 [6.5–28] years) were enrolled. Six patients harboring the homozygous *1F allele in CYP1A2 could have reduced chance of response to stiripentol due to fast metabolism. CYP2C9 had reduced activity in 10 patients (alleles *2 and *3), potentially affecting phenytoin (PHT), phenobarbital (PB), primidone, lacosamide (LCM), and valproic acid metabolism. Seven patients, carrying the *2 allele of CYP2C19, had an increased risk of ADRs with clobazam (CLB), PB, PHT, LCM, brivaracetam; while one individual with the *17 allele in heterozygosity reported a CLB fast metabolism. Six patients showed a CC polymorphism of EPHX1 associated with the impaired efficacy of carbamazepine. ABCB1 polymorphisms related to drug‐resistance (3435 CC) or drug‐sensitive phenotype (CT or TT) were found in 6 out of 7 patients. Pharmacogenomic testing on saliva proved easy and safe in clinical practice to convey information for the management of epileptic patients, especially those resistant to treatment or sensitive to severe ADRs.

Purpose The purpose of this randomized double-blind study was to investigate the effectiveness of the Videoinsight psychological enhancing method in promoting early recovery during rehabilitation following total knee arthroplasty. Methods One-hundred and ten patients treated with cemented total knee arthroplasty were randomly assigned to Group A or Group B, and both groups underwent the same rehabilitation programme. Group A (55 patients) received one art video selected according to Videoinsight concept. This art video promoting self-confidence and psychological support to the patient has been shown in the physical therapy department before any rehabilitation session, in the first 15 days after surgery and then three times a week for the next 4 weeks. Group B (55 patients) underwent the same rehabilitation protocol in the same setting, after TKA surgery, without the video support. Patients were evaluated pre-operatively and 3 months after surgery with Physical and Mental SF-36, State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Tampa Scale of Kinesiophobia (TSK), Knee Society Score (KSS), VAS, and WOMAC scores. Results Eight patients were lost to follow-up, and 102 patients (Group A: 52 patients; Group B: 50 patients) were available at mean 3.0 ± 0.2 months follow-up. Age at surgery was 69.1 ± 13.0 years. The two groups were homogeneous regarding pre-operative demographic data and clinical outcomes. Significant improvements were observed in both groups compared to baseline and in Group A compared to Group B at final follow-up for functional and psychological scores except for SF-36. Respectively, Group A and Group B showed WOMAC 79.9 ± 13.0 and 69.7 ± 9.5 (p < 0.005), VAS 2.8 ± 1.6 and 4.0 ± 1.5, (p < 0.005), KSS 87.8 ± 9.6 and 78.3 ± 8.2 (p < 0.005), BDI 5.1 ± 4.8 and 9.4 ± 3.9 (p < 0.005), STAI 30.8 ± 7.9 and 34.8 ± 7.8 (p < 0.005), and TSK 24.4 ± 5.5 and 29.3 ± 4.8 (p < 0.005). Conclusion The Videoinsight() psychological enhancing method, by the view of video art images, combined to an adequate rehabilitation protocol can be a means for further improving short-term clinical and functional outcomes by giving a psychological support to patients who underwent total knee arthroplasty. Level of evidence I.

►Aim. The aim of the study was to identify children at risk of neurodevelopmental disorders through the use of validated instruments by family paediatricians and parents.►Methods. As part of the NASCITA cohort study, the development of 148 children was evaluated. Family pediatricians (FPs) conducted assessments using the CDC Learn the Signs, Act Early Milestones Checklist, while parents completed the Strengths and Difficulties Questionnaire (SDQ). Children were considered at risk if their total score was ≥ 12 on the CDC or > 14 on the SDQ. Univariate and multivariate analyses were performed to assess which variables were associated with a higher likelihood of warning signs (WS).►Results. In all, 14% of children showed WS for developmental disorders at 36 months, a lower percentage than the 24-month assessment (16%): for two out of three children, WS disappeared between 24 and 36 months of age. Persistent WS were observed in 5% of children. Key risk factors identified include older maternal age at delivery (OR 8.93, 95% CI: 1.87 - 42.62) and maternal unemployment (OR 4.75, 95% CI: 1.40 - 16.09), while reading aloud emerged as a protective practice, emphasizing its potential in early interventions.►Conclusions. These results highlight the need for continuous monitoring of WS and the importance of positive parental practices in mitigating developmental risks. Early identification by primary care pediatricians is crucial in addressing developmental concerns early and improving long-term outcomes.

Lo stato epilettico (SE) è una emergenza medica che può comportare danni neurologici permanenti, se non adeguatamente gestita.1 L’incidenza nella popolazione pediatrica è di circa 20 casi ogni 100.000 bambini/anno, con un picco nei bambini di età inferiore ai 2 anni. La nuova classificazione operativa proposta dalla Task Force dell’International League Against Epilepsy (ILAE)3 definisce lo SE “una condizione risultante dal fallimento dei meccanismi responsabili della cessazione della crisi o dall’avvio di meccanismi che determinano crisi prolungate” (Tabella 1) e suggerisce una gestione terapeutica basata sulle caratteristiche cliniche dello stato. A fini puramente pratici in questo documento si è operata una divisione del trattamento raccomandato in fasi successive (figura 1). See PDF] Inoltre, per il trattamento acuto delle crisi ripetute in cluster, la Food and Drug Administration ha approvato l’utilizzo del diazepam spray intranasale nei bambini di età pari o superiore a 6 anni: 0,2 mg/kg o 0,3 mg/kg, con schema dosaggio/numero di somministrazioni dipendente da età e peso.