Publications by authors named "Matteo Paganini"

27 Publications

  • Page 1 of 1

Endothelial Nitric Oxide Production and Antioxidant Response in Breath-Hold Diving: Genetic Predisposition or Environment Related?

Front Physiol 2021 9;12:692204. Epub 2021 Jul 9.

DAN Europe Research Division, DAN Europe Foundation, Roseto degli Abruzzi, Italy.

Introduction: Nitric oxide (NO) is an essential signaling molecule modulating the endothelial adaptation during breath-hold diving (BH-diving). This study aimed to investigate changes in NO derivatives (NOx) and total antioxidant capacity (TAC), searching for correlations with different environmental and hyperbaric exposure.

Materials And Methods: Blood samples were obtained from 50 breath-hold divers (BH-divers) before, and 30 and 60 min after the end of training sessions performed both in a swimming pool or the sea. Samples were tested for NOx and TAC differences in different groups related to their hyperbaric exposure, experience, and additional genetic polymorphism.

Results: We found statistically significant differences in NOx plasma concentration during the follow-up (decrease at T30 and increase at T60) compared with the pre-dive values. At T30, we found a significantly lower decrease of NOx in subjects with a higher diving experience, but no difference was detected between the swimming pool and Sea. No significant difference was found in TAC levels, as well as between NOx and TAC levels and the genetic variants.

Conclusion: These data showed how NO consumption in BH-diving is significantly lower in the expert group, indicating a possible training-related adaptation process. Data confirm a significant NO use during BH-diving, compatible with the well-known BH-diving related circulatory adaptation suggesting that the reduction in NOx 30 min after diving can be ascribed to the lower NO availability in the first few minutes after the dives. Expert BH-divers suffered higher oxidative stress. A preliminary genetic investigation seems to indicate a less significant influence of genetic predisposition.
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http://dx.doi.org/10.3389/fphys.2021.692204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8300565PMC
July 2021

Emergency Medicine Cases in Underwater and Hyperbaric Environments: The Use of Simulation as a Learning Technique.

Front Physiol 2021 21;12:666503. Epub 2021 May 21.

Environmental and Respiratory Physiology Laboratory and Master Level II in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, Padua, Italy.

Introduction: Hyperbaric chambers and underwater environments are challenging and at risk of serious accidents. Personnel aiming to assist patients and subjects should be appropriately trained, and several courses have been established all over the world. In healthcare, simulation is an effective learning technique. However, there have been few peer-reviewed articles published in the medical literature describing its use in diving and hyperbaric medicine.

Methods: We implemented the curriculum of the Master's degree in hyperbaric and diving medicine held at the University of Padova with emergency medicine seminars created by the faculty and validated by external experts. These seminars integrated traditional lectures and eight simulation scenarios.

Results: For the hyperbaric medicine seminar, simulations were carried out inside a real hyperbaric chamber at the ATIP Hyperbaric Treatment Centre, only using air and reproducing compression noise without pressurization to avoid damages to the manikins. The four scenarios consisted of hyperoxic seizures, pneumothorax, hypoglycemia, and sudden cardiac arrest. Furthermore, we added a hands-on session to instruct participants to prepare an intubated patient undergoing hyperbaric oxygen treatment with a checklist and simulating the patient transfer inside and outside the hyperbaric chamber. The diving medicine seminar was held at the Y-40 The Deep Joy pool in Montegrotto Terme (Italy), also involving SCUBA/breath-hold diving (BHD) instructors to rescue subjects from the water. These diving medicine scenarios consisted of neurologic syndrome ("taravana/samba") in BHD, drowning of a breath-hold diver, pulmonary barotrauma in BHD, and decompression illness in a SCUBA diver.

Conclusion: With this experience, we report the integration of simulation in the curriculum of a teaching course in diving and hyperbaric medicine. Future studies should be performed to investigate learning advantages, concept retention, and satisfaction of participants.
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http://dx.doi.org/10.3389/fphys.2021.666503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8176206PMC
May 2021

Nitric Oxide and Oxidative Stress Changes at Depth in Breath-Hold Diving.

Front Physiol 2020 7;11:609642. Epub 2021 Jan 7.

Divers Alert Network (DAN) Europe Research Division, Roseto degli Abruzzi, Italy.

Background: Several mechanisms allow humans to resist the extreme conditions encountered during breath-hold diving. Available nitric oxide (NO) is one of the major contributors to such complex adaptations at depth and oxidative stress is one of the major collateral effects of diving. Due to technical difficulties, these biomarkers have not so far been studied while at depth. The aim of this study is to investigate nitrate and nitrite (NOx) concentration, total antioxidant capacity (TAC) and lipid peroxidation (TBARS) before, during, and after repetitive breath-hold dives in healthy volunteers.

Materials And Methods: Blood plasma, obtained from 14 expert breath-hold divers, was tested for differences in NOx, TAC, and TBARS between pre-dive, bottom, surface, 30 and 60 min post-dive samples.

Results: We observed a statistically significant increase of NOx plasma concentration in the "bottom blood draw" as compared to the pre-dive condition while we did not find any difference in the following samples We found a statistically significant decrease in TAC at the bottom but the value returned to normality immediately after reaching the surface. We did not find any statistically significant difference in TBARS.

Discussion: The increased plasma NOx values found at the bottom were not observed at surface and post dive sampling (T0, T30, T60), showing a very rapid return to the pre-dive values. Also TAC values returned to pre- diving levels immediately after the end of hyperbaric exposure, probably as a consequence of the activation of endogenous antioxidant defenses. TBARS did not show any difference during the protocol.
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http://dx.doi.org/10.3389/fphys.2020.609642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818785PMC
January 2021

Hyperbaric Oxygen Therapy and A-PRF Pre-Treated Implants in Severe Periodontitis: A Case Report.

Int J Environ Res Public Health 2021 01 7;18(2). Epub 2021 Jan 7.

Department of Biomedical Sciences, Environmental and Respiratory Physiology, University of Padova, Via Marzolo 3, 35131 Padova, Italy.

Implantation is currently the best option for tooth replacement in periodontitis. Some major contraindications for the immediate implant are acute periodontitis and active infection. We present the case of a 51-year-old female patient with the highest grade and stage periodontitis treated with advanced platelet-rich fibrin-enriched zirconia implants and with hyperbaric oxygen therapy (HBOT). In particular, HBOT before and after implantation promoted bone regeneration and implant integration, also providing an antiseptic effect. After six months, the implants were well established and fully healed from periodontal disease within 14 months. Further research could confirm a new indication for HBOT in treating periodontitis and dental implantation.
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http://dx.doi.org/10.3390/ijerph18020413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825644PMC
January 2021

Life-Saving Procedures Performed While Wearing CBRNe Personal Protective Equipment: A Mannequin Randomized Trial.

Simul Healthc 2021 Jan 8;Publish Ahead of Print. Epub 2021 Jan 8.

From the Department of Medicine (DIMED) (G.M., M.P., C.A., S.S., F.F.), University of Padova, Padova; Venice Emergency Medical Service Operations Center (N.B., D.P.), Venezia; and Istituto di Anestesia e Rianimazione-Azienda Ospedaliera Universitaria di Padova (A.G., P.N.), Padova, Italy.

Introduction: Chemical-biological-radiological-nuclear-explosive (CBRNe) are complex events. Decontamination is mandatory to avoid harm and contain hazardous materials, but can delay care. Therefore, the stabilization of patients in the warm zone seems reasonable, but research is limited. Moreover, subjects involved in biological events are considered infectious even after decontamination and need to be managed while wearing personal protective equipment (PPE), as seen with Ebola and COVID-19 pandemic. With this simulation mannequin trial, we assessed the impact of CBRNe PPE on cardiopulmonary resuscitation and combat casualty care procedures.

Methods: We compared procedures performed by emergency medicine and anesthesiology senior residents, randomized in 2 groups (CBRNe PPE vs. no PPE). Chest compression (CC) depth was defined as the primary outcome. Time to completion was calculated for the following: tourniquet application; tension pneumothorax needle decompression; peripheral venous access (PVA) and intraosseous access positioning; and drug preparation and administration. A questionnaire was delivered to evaluate participants' perception.

Results: Thirty-six residents participated. No significant difference between the groups in CC depth (mean difference = 0.26 cm [95% confidence interval = -0.26 to 0.77 cm, P = 0.318]), as well as for CC rate, CC complete release, and time for drugs preparation and administration was detected. The PPE contributed to significantly higher times for tourniquet application, tension pneumothorax decompression, peripheral venous access, and intraosseous access positioning. The residents found simulation relevant to the residencies' core curriculum.

Conclusions: This study suggests that cardiopulmonary resuscitation can be performed while wearing PPE without impacting quality, whereas other tasks requiring higher dexterity can be significantly impaired by PPE.Trial Registration Number: NCT04367454, April 29, 2020 (retrospectively registered).
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http://dx.doi.org/10.1097/SIH.0000000000000540DOI Listing
January 2021

Use of backboards in cardiopulmonary resuscitation: a systematic review and meta-analysis.

Eur J Emerg Med 2021 Jun;28(3):180-188

Centro Interdipartimentale di Didattica Innovativa e di Simulazione in Medicina e Professioni Sanitarie, Simnova, Università del Piemonte Orientale, Novara, Italy - Via Lanino 1, Novara, Italy.

To achieve optimal chest compression depth, victims of cardiac arrest should be placed on a firm surface. Backboards are usually placed between the mattress and the back of a patient in the attempt to increase cardiopulmonary resuscitation (CPR) quality, but their effectiveness remains controversial. A systematic search was performed to include studies on humans and simulation manikins assessing CPR quality with or without backboards. The primary outcome of the meta-analysis was the difference in chest compression depth between these two conditions. Out of 557 records, 16 studies were included in the review and all were performed on manikins. The meta-analysis, performed on 15 articles, showed that the use of backboards during CPR increases chest compression depth by 1.46 mm in manikins. Despite statistically significant, this increase could have a limited clinical impact on CPR, due to the substantial heterogeneity of experimental conditions and the scarcity of other CPR quality indicators.
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http://dx.doi.org/10.1097/MEJ.0000000000000784DOI Listing
June 2021

Quality Improvement Project of a Massive Transfusion Protocol (MTP) to Reduce Wastage of Blood Components.

Int J Environ Res Public Health 2021 01 1;18(1). Epub 2021 Jan 1.

TEAMHealth Anesthesia, Tampa General Hospital, Tampa, FL 33606, USA.

Massive transfusion protocols (MTPs) facilitate the organized delivery of blood components for traumatically injured patients. MTPs vary across institutions, and ratios of blood components can change during clinical management. As a result, significant amounts of components can be wasted. We completed a review of all MTP activations from 2015 to 2018, providing an in-depth analysis of waste in our single Level 1 trauma center. An interdepartmental group analyzed patterns of blood component wastage to guide three quality improvement initiatives. Specifically, we (1) completed a digital timeline for each MTP activation and termination, (2) improved communications between departments, and (3) provided yearly training for all personnel about MTP deployment. The analysis identified an association between delayed MTP deactivations and waste (RR = 1.48, CI 1.19-1.85, = 0.0005). An overall improvement in waste was seen over the years, but this could not be attributed to increased closed-loop communication as determined by the proportion of non-stop activations (F(124,3) = 0.98, not significant). Delayed MTP deactivations are the primary determinant of blood component waste. Our proactive intervention on communications between groups was not sufficient in reducing the number of delayed deactivations. However, implementing a digital timeline and regular repetitive training yielded a significant reduction in wasted blood components.
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http://dx.doi.org/10.3390/ijerph18010274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795105PMC
January 2021

Demographic and socio-economic factors, and healthcare resource indicators associated with the rapid spread of COVID-19 in Northern Italy: An ecological study.

PLoS One 2020 28;15(12):e0244535. Epub 2020 Dec 28.

Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padova, Padova, Italy.

Background: COVID-19 rapidly escalated into a pandemic, threatening 213 countries, areas, and territories the world over. We aimed to identify potential province-level socioeconomic determinants of the virus's dissemination, and explain between-province differences in the speed of its spread, based on data from 36 provinces of Northern Italy.

Methods: This is an ecological study. We included all confirmed cases of SARS-CoV-2 reported between February 24th and March 30th, 2020. For each province, we calculated the trend of contagion as the relative increase in the number of individuals infected between two time endpoints, assuming an exponential growth. Pearson's test was used to correlate the trend of contagion with a set of healthcare-associated, economic, and demographic parameters by province. The virus's spread was input as a dependent variable in a stepwise OLS regression model to test the association between rate of spread and province-level indicators.

Results: Multivariate analysis showed that the spread of COVID-19 was correlated negatively with aging index (p-value = 0.003), and positively with public transportation per capita (p-value = 0.012), the % of private long-term care hospital beds and, to a lesser extent (p-value = 0.070), the % of private acute care hospital beds (p-value = 0.006).

Conclusion: Demographic and socioeconomic factors, and healthcare organization variables were found associated with a significant difference in the rate of COVID-19 spread in 36 provinces of Northern Italy. An aging population seemed to naturally contain social contacts. The availability of healthcare resources and their coordination could play an important part in spreading infection.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244535PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769459PMC
January 2021

Critical Review and Meta-Analysis of Postoperative Sedation after Adult Cardiac Surgery: Dexmedetomidine Versus Propofol.

J Cardiothorac Vasc Anesth 2021 Apr 17;35(4):1134-1142. Epub 2020 Oct 17.

Team Health Research Institute, Tampa General Hospital, Tampa, FL. Electronic address:

Objective: To evaluate reports from the published literature of all randomized clinical trials (RCT) comparing postoperative sedation with dexmedetomidine versus propofol in adult patients, after open cardiac surgery.

Design: A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was completed through June 2020. Meta-analysis of all published RCT comparing dexmedetomidine versus propofol utilization in the postoperative phase, using the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.

Setting: Assemblage and critical discussion of 11 RCTs comparing postoperative sedation from standard published reports from 2003 to 2019.

Participants: The study comprised 1,184 patients and analyzed critical discussion of time-based parameters (time to extubation, intensive care unit length of stay, and hospital length of stay) and nontime-dependent factors (delirium, bradycardia, and hypotension).

Measurements And Main Results: Time to extubation was significantly reduced in the dexmedetomidine group (standardized mean difference [SMD] = -0.70, 95% confidence interval [CI] -0.98 to -0.42, p < 0.001); however, no difference in mechanical ventilation time was observed (SMD = -0.72, 95% CI -1.60 to 0.15, N.S.). Dexmedetomidine significantly reduced the intensive care unit length of stay (SMD = 0.23, 95% CI -1.06 to -0.16, p = 0.008), but this did not translate into a reduced hospital length of stay (SMD = -1.13, 95% CI -2.43 to 0.16, N.S). For nontime-dependent factors, incidence of delirium was unaffected between groups (odds ratio [OR]: 0.68, 95% CI 0.43-1.06, N.S), and higher rates of bradycardia (OR: 3.39, 95% CI: 1.20-9.55, p = 0.020) and hypotension (OR: 1.68, 95% CI 1.09-2.58, p = 0.017) were reported with propofol.

Conclusions: Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former did not seem to contribute to an overall reduction in hospital length of stay or improvement in postoperative outcomes of heart valve surgery and CABG patients.
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http://dx.doi.org/10.1053/j.jvca.2020.10.022DOI Listing
April 2021

Change in Oxidative Stress Biomarkers During 30 Days in Saturation Dive: A Pilot Study.

Int J Environ Res Public Health 2020 09 28;17(19). Epub 2020 Sep 28.

Department of Biomedical Sciences, Environmental and Respiratory Physiology, University of Padova, 35122 Padova, Italy.

Saturation diving allows divers to reduce the risk of decompression sickness while working at depth for prolonged periods but may increase reactive oxygen species (ROS) production. Such modifications can affect endothelial function by exacerbating oxidative stress. This study investigated the effects of saturation diving on oxidative stress damage. Redox status was evaluated through: ROS production; total antioxidant capacity (TAC); nitric oxide metabolites (NOx); nitrotyrosine (3-NT); and lipid peroxidation (8-iso-PGF2α) assessment. Creatinine and neopterin were analyzed as markers of renal function and damage. Measurements were performed on saliva and urine samples obtained at four time points: pre; deep; post; and 24 h post. Four divers were included in the study. After the saturation dive (post), significant ( < 0.05) increases in ROS (0.12 ± 0.03 vs. 0.36 ± 0.06 µmol.min), TAC (1.88 ± 0.03 vs. 2.01 ± 0.08 mM), NOx (207.0 ± 103.3 vs. 441.8 ± 97.3 µM), 3-NT (43.32 ± 18.03 vs. 18.64 ± 7.45 nM·L), and 8-iso-PGF2α (249.7 ± 45.1 vs. 371.9 ± 54.9 pg·mg creatinine) were detected. Markers of renal damage were increased as well after the end of the saturation dive (creatinine 0.54 ± 0.22 vs. 2.72 ± 1.12 g-L; neopterin 73.3 ± 27.9 vs. 174.3 ± 20.53 μmol·mol creatinine). These results could ameliorate commercial or military diving protocols or improve the understanding of symptoms caused by oxygen level elevation.
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http://dx.doi.org/10.3390/ijerph17197118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579105PMC
September 2020

The Role of Hyperbaric Oxygen Treatment for COVID-19: A Review.

Adv Exp Med Biol 2021 ;1289:27-35

Emergency Medicine, University of Maryland, Baltimore, MD, USA.

The recent coronavirus disease 2019 (COVID-19) pandemic produced high and excessive demands for hospitalizations and equipment with depletion of critical care resources. The results of these extreme therapeutic efforts have been sobering. Further, we are months away from a robust vaccination effort, and current therapies provide limited clinical relief. Therefore, several empirical oxygenation support initiatives have been initiated with intermittent hyperbaric oxygen (HBO) therapy to overcome the unrelenting and progressive hypoxemia during maximum ventilator support in intubated patients, despite high FiO2. Overall, few patients have been successfully treated in different locations across the globe. More recently, less severe patients at the edge of impending hypoxemia were exposed to HBO preventing intubation and obtaining the rapid resolution of symptoms. The few case descriptions indicate large variability in protocols and exposure frequency. This summary illustrates the biological mechanisms of action of increased O pressure, hoping to clarify more appropriate protocols and more useful application of HBO in COVID-19 treatment.
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http://dx.doi.org/10.1007/5584_2020_568DOI Listing
January 2021

Predicted Effects of Stopping COVID-19 Lockdown on Italian Hospital Demand.

Disaster Med Public Health Prep 2020 10 18;14(5):638-642. Epub 2020 May 18.

Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.

Objectives: Italy has been one of the first countries to implement mitigation measures to curb the coronavirus disease 2019 (COVID-19) pandemic. There is currently a debate on when and how such measures should be loosened. To forecast the demand for hospital intensive care unit (ICU) and non-ICU beds for COVID-19 patients from May to September, we developed 2 models, assuming a gradual easing of restrictions or an intermittent lockdown.

Methods: We used a compartmental model to evaluate 2 scenarios: (A) an intermittent lockdown; (B) a gradual relaxation of the lockdown. Predicted ICU and non-ICU demand was compared with the peak in hospital bed use observed in April 2020.

Results: Under scenario A, while ICU demand will remain below the peak, the number of non-ICU will substantially rise and will exceed it (133%; 95% confidence interval [CI]: 94-171). Under scenario B, a rise in ICU and non-ICU demand will start in July and will progressively increase over the summer 2020, reaching 95% (95% CI: 71-121) and 237% (95% CI: 191-282) of the April peak.

Conclusions: Italian hospital demand is likely to remain high in the next months. If restrictions are reduced, planning for the next several months should consider an increase in health-care resources to maintain surge capacity across the country.
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http://dx.doi.org/10.1017/dmp.2020.157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276503PMC
October 2020

Translating COVID-19 Pandemic Surge Theory to Practice in the Emergency Department: How to Expand Structure.

Disaster Med Public Health Prep 2020 08 27;14(4):541-550. Epub 2020 Mar 27.

CRIMEDIM - Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy.

Multiple professional societies, nongovernment and government agencies have studied the science of sudden onset disaster mass casualty incidents to create and promote surge response guidelines. The COVID-19 pandemic has presented the health-care system with challenges that have limited science to guide the staff, stuff, and structure surge response.This study reviewed the available surge science literature specifically to guide an emergency department's surge structural response using a translational science approach to answer the question: How does the concept of sudden onset mass casualty incident surge capability apply to the process to expand COVID-19 pandemic surge structure response?The available surge structural science literature was reviewed to determine the application to a pandemic response. The on-line ahead of print and print COVID-19 scientific publications, as well as gray literature were studied to learn the best available COVID-19 surge structural response science. A checklist was created to guide the emergency department team's COVID-19 surge structural response.
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http://dx.doi.org/10.1017/dmp.2020.57DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156581PMC
August 2020

Training of Italian emergency medicine residents in prehospital emergency medicine: state of the art and perspectives of improvement.

Intern Emerg Med 2020 04 25;15(3):519-522. Epub 2020 Jan 25.

Emergency Medicine Residency Program, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.

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http://dx.doi.org/10.1007/s11739-020-02280-9DOI Listing
April 2020

Hyperbaric Oxygen Treatment for Carbon Monoxide Poisoning in Italy: Retrospective Validation of a Data Collection Tool for the Italian Registry of Carbon Monoxide Poisonings (IRCOP).

Int J Environ Res Public Health 2020 01 16;17(2). Epub 2020 Jan 16.

Italian Association of Patients Treated with Hyperbaric Oxygen (ASPATI), 40036 Fidenza, Italy.

: Carbon Monoxide (CO) poisoning is a frequent cause of intoxication. However, CO poisoning incidence is globally underreported, as well as its features, especially in Italy. The aim of this study was to investigate such characteristics of CO intoxication and foster the creation of the Italian Registry of Carbon Monoxide Poisonings. : A data collection tool was developed and organized in five sections: Patient's characteristics; CO intoxication modality; emergency medical service and emergency department; hyperbaric facility; outcomes. The tool was validated through a retrospective analysis, including CO intoxicated patients treated in 14 Italian hyperbaric facilities between 2015 and 2016. : A total of 1383 patients were included. The high completion ratio (85%) of the collection tool suggests its feasibility in practical terms. CO intoxications were mostly accidental (93.64%) and caused by solid fuel (48.59%). There was not a uniform application of hyperbaric oxygen treatment protocols, but most of the patients were adequately treated at least at 2.5 ATA for more than 60 min (44.97%). : This analysis provided new information that was previously unavailable in this country. Furthermore, this tool proved to be a valid base for future registry aiming to consolidate the body of knowledge about CO intoxications in Italy.
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http://dx.doi.org/10.3390/ijerph17020574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013710PMC
January 2020

Arterial blood gases in divers at surface after prolonged breath-hold.

Eur J Appl Physiol 2020 Feb 7;120(2):505-512. Epub 2020 Jan 7.

Department of Anesthesiology, Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, NC, USA.

Purpose: Adaptations during voluntary breath-hold diving have been increasingly investigated since these athletes are exposed to critical hypoxia during the ascent. However, only a limited amount of literature explored the pathophysiological mechanisms underlying this phenomenon. This is the first study to measure arterial blood gases immediately before the end of a breath-hold in real conditions.

Methods: Six well-trained breath-hold divers were enrolled for the experiment held at the "Y-40 THE DEEP JOY" pool (Montegrotto Terme, Padova, Italy). Before the experiment, an arterial cannula was inserted in the radial artery of the non-dominant limb. All divers performed: a breath-hold while moving at the surface using a sea-bob; a sled-assisted breath-hold dive to 42 m; and a breath-hold dive to 42 m with fins. Arterial blood samples were obtained in four conditions: one at rest before submersion and one at the end of each breath-hold.

Results: No diving-related complications were observed. The arterial partial pressure of oxygen (96.2 ± 7.0 mmHg at rest, mean ± SD) decreased, particularly after the sled-assisted dive (39.8 ± 8.7 mmHg), and especially after the dive with fins (31.6 ± 17.0 mmHg). The arterial partial pressure of CO varied somewhat but after each study was close to normal (38.2 ± 3.0 mmHg at rest; 31.4 ± 3.7 mmHg after the sled-assisted dive; 36.1 ± 5.3 after the dive with fins).

Conclusion: We confirmed that the arterial partial pressure of oxygen reaches hazardously low values at the end of breath-hold, especially after the dive performed with voluntary effort. Critical hypoxia can occur in breath-hold divers even without symptoms.
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http://dx.doi.org/10.1007/s00421-019-04296-2DOI Listing
February 2020

Clinical and morphological effects of hyperbaric oxygen therapy in patients with interstitial cystitis associated with fibromyalgia.

BMC Urol 2019 Nov 5;19(1):108. Epub 2019 Nov 5.

TEAMHealth Research Institute, TGH, Tampa, Florida, USA.

Background: Interstitial Cystitis (IC) is a debilitating disorder of the bladder, with a multifactorial and poorly understood origin dealing with microcirculation repeated damages. Also Fibromyalgia (FM) is a persistent disorder whose etiology is not completely explained, and its theorized alteration of pain processing can compromise the quality of life. Both these conditions have a high incidence of conventional therapeutic failure, but recent literature suggests a significant beneficial response to Hyperbaric Oxygen Therapy (HBOT). With this study, this study we evaluated the effects of HBOT on quality of life, symptoms, urodynamic parameters, and cystoscopic examination of patients suffering from both IC and FM.

Methods: We structured an observational clinical trial design with repeated measures (questionnaires, urodynamic test, and cystoscopy) conducted before and 6 months after a therapeutic protocol with hyperbaric oxygen for the treatment of patients suffering from both IC and FM. Patients were exposed to breathing 100% oxygen at 2 atm absolute (ATA) in a multiplace pressure chamber for 90 min using an oro-nasal mask. Patients undertook a cycle of 20 sessions for 5 days per week, and a second cycle of 20 sessions after 1 week of suspension.

Results: Twelve patients completed the protocol. Changes after HBOT were not significant, except for hydrodistension tolerance (mean pre-treatment: 409.2 ml; mean post-treatment: 489.2 ml; p < 0.05). A regression of petechiae and Hunner's ulcers was also noted 6 months after the completion of HBOT.

Conclusions: Our study showed no improvement of symptoms, quality of life, and urodynamic parameters, except for hydrodistension, and a slight improvement in cystoscopic pattern. However, to date, we could not demonstrate the significance of overall results to justify the use of HBOT alone in patients with IC and FM. This observation suggests that additional studies are needed to better understand if HBOT could treat this subset of patients.

Trial Registration: NCT03693001 ; October 2, 2018. Retrospectively registered.
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http://dx.doi.org/10.1186/s12894-019-0545-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6833196PMC
November 2019

Oxidative stress assessment in breath-hold diving.

Eur J Appl Physiol 2019 Dec 13;119(11-12):2449-2456. Epub 2019 Sep 13.

Environmental and Respiratory Physiology, Department of Biomedical Sciences, University of Padova, Via Marzolo, 3, 35132, Padua, Italy.

Purpose: Breath-hold diving results in significant changes in blood gases' levels. Challenging variations in oxygen partial pressures may induce reactive oxygen species (ROS) production that exacerbate oxidative stress and, consequently, affect endothelial function. The aim of this study was to investigate the effects of breath-hold diving on oxidative stress damage, assessing ROS production. Nitric oxide metabolites, inducible nitric oxide synthase (iNOS), aminothiols, and renal function were evaluated too as markers of redox status and renal damage.

Methods: ROS production was assessed with electron paramagnetic resonance. Oxidative status values were measured at pre- and post-40 m dive in a deep swimming pool (Y-40) from six divers (mean age 46.6 ± 9.3 years; height 176 ± 4 cm; BMI 25 ± 2.9 kg/m).

Results: Significant (p < 0.05) increases at post-dive of ROS production rate (0.158 ± 0.003 vs 0.195 ± 0.006 μmol min), lipid peroxidation (8-isoprostane: 375.67 ± 195.62 vs 420.49 ± 232.31 pg mg creatinine), nitrate (27.91 ± 19.71 vs 30.80 ± 20.44 μM), iNOS (31.30 ± 4.52 vs 35.68 ± 6.72 IU mL) and neopterin concentration (96.20 ± 40.41 vs 118.76 ± 27.84 μmol mol creatinine) were recorded. Conversely, the antioxidant capacity significantly decreased (3.423 ± 0.089 vs 3.015 ± 0.284 mM) after immersion.

Conclusion: Overproduction of ROS and consequent oxidative damage to lipids of membrane and antioxidant capacity decreasing reflect also a hypoxic condition, which in the breath-hold diving typically occurs in the last few meters below the surface. iNOS produces NO in large quantities under the examined extreme conditions. Neopterin and creatinine concentration level increased, suggesting an "impairment of renal function" as a likely physiological response to PaO variations during dive activity.
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http://dx.doi.org/10.1007/s00421-019-04224-4DOI Listing
December 2019

The August 24, 2016, Central Italy Earthquake: Validation of the "Modified Utstein Template for Hospital Disaster Response Reporting" As a New Tool for Reporting Hospitals' Response to Disasters.

Disaster Med Public Health Prep 2020 04 25;14(2):236-247. Epub 2019 Jul 25.

CRIMEDIM, Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy.

Background: After-action reports analyze events and improve knowledge about how to prevent and react to unexpected situations. Anyway, there is no consensus among the templates developed for disaster events reporting, and there is not a specific model for reporting hospital disaster response.

Objective: The study was aimed to pilot the use of a new assessment tool for hospital response to natural disasters.

Methods: A data collection tool, focused on hospital disaster response to natural disasters, was created modifying the "Utstein-Style Template for Uniform Data Reporting of Acute Medical Response in Disasters" and tested the reaction of the nearest hospitals to the epicenter after the August 24, 2016, Central Italy earthquake.

Results: Four hospitals were included. The completion rate of the tool was 97.10%. A total of 613 patients accessed the 4 emergency departments, most of them in Rieti Hospital (178; 29.04%). Three hundred thirty-six (54.81%) patients were classified as earthquake-related, most with trauma injuries (260; 77.38%).

Conclusions: This template seemed to be a valid instrument for hospital disaster management reporting and could be used for better comprehension of hospital disaster reaction, debriefing activities, and hospital disaster plan revisions.
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http://dx.doi.org/10.1017/dmp.2019.54DOI Listing
April 2020

Carbon monoxide intoxication: prehospital diagnosis and direct transfer to the hyperbaric chamber.

Minerva Anestesiol 2019 08 2;85(8):920-922. Epub 2019 Apr 2.

Laboratory of Environmental and Respiratory Physiology, Department of Biomedical Sciences, University of Padua, Padua, Italy.

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http://dx.doi.org/10.23736/S0375-9393.19.13648-6DOI Listing
August 2019

Arterial Blood Gas Analysis in Breath-Hold Divers at Depth.

Front Physiol 2018 5;9:1558. Epub 2018 Nov 5.

Center for Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States.

The present study aimed to evaluate the partial pressure of arterial blood gases in breath-hold divers performing a submersion at 40 m. Eight breath-hold divers were enrolled for the trials held at "Y-40 THE DEEP JOY" pool (Montegrotto Terme, Padova, Italy). Prior to submersion, an arterial cannula in the radial artery of the non-dominant limb was positioned. All divers performed a sled-assisted breath-hold dive to 40 m. Three blood samplings occurred: at 10 min prior to submersion, at 40 m depth, and within 2 min after diver's surfacing and after resuming normal ventilation. Blood samples were analyzed immediately on site. Six subjects completed the experiment, without diving-related problems. The theoretically predicted hyperoxia at the bottom was observed in 4 divers out of 6, while the other 2 experienced a reduction in the partial pressure of oxygen (paO) at the bottom. There were no significant increases in arterial partial pressure of carbon dioxide (paCO) at the end of descent in 4 of 6 divers, while in 2 divers paCO decreased. Arterial mean pH and mean bicarbonate ( ) levels exhibited minor changes. There was a statistically significant increase in mean arterial lactate level after the exercise. Ours was the first attempt to verify real changes in blood gases at a depth of 40 m during a breath-hold descent in free-divers. We demonstrated that, at depth, relative hypoxemia can occur, presumably caused by lung compression. Also, hypercapnia exists at depth, to a lesser degree than would be expected from calculations, presumably because of pre-dive hyperventilation and carbon dioxide distribution in blood and tissues.
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http://dx.doi.org/10.3389/fphys.2018.01558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6230561PMC
November 2018

Effects of the Ketogenic diet in overweight divers breathing Enriched Air Nitrox.

Sci Rep 2018 02 8;8(1):2655. Epub 2018 Feb 8.

Environmental physiology & medicine Lab, Department of Biomedical Sciences, University of Padova, Padova, Italy.

Central Nervous System Oxygen Toxicity (CNS-OT) is one of the most harmful effects of Enriched Air Nitrox (EAN) diving. Protective factors of the Ketogenic Diet (KD) are antioxidant activity, the prevention of mitochondrial damage and anti-inflammatory mechanisms. We aimed to investigate if a short-term KD may reduce oxidative stress and inflammation during an hyperoxic dive. Samples from six overweight divers (mean ± SD, age: 55.2 ± 4.96 years; BMI: 26.7 ± 0.86 kg/m) were obtained a) before and after a dive breathing Enriched Air Nitrox and performing 20-minute mild underwater exercise, b) after a dive (same conditions) performed after 7 days of KD. We measured urinary 8-isoprostane and 8-OH-2-deoxyguanosine and plasmatic IL-1β, IL-6 and TNF-α levels. The KD was successful in causing weight loss (3.20 ± 1.31 Kgs, p < 0.01) and in limiting lipid peroxidation (3.63 ± 1.16 vs. 1.11 ± 0.22; p < 0.01) and inflammatory response (IL-1β = 105.7 ± 25.52 vs. 57.03 ± 16.32, p < 0.05; IL-6 = 28.91 ± 4.351 vs. 14.08 ± 1.74, p < 0.001; TNF-α = 78.01 ± 7.69 vs. 64.68 ± 14.56, p < 0.05). A short-term KD seems to be effective in weight loss, in decreasing inflammation and protective towards lipid peroxidation during hyperoxic diving.
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http://dx.doi.org/10.1038/s41598-018-20933-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805750PMC
February 2018

Evaluation of chest ultrasound integrated teaching of respiratory system physiology to medical students.

Adv Physiol Educ 2017 Dec;41(4):514-517

Department of Biomedical Sciences, Section Physiology, University of Padova, Padova, Italy.

Ultrasound imaging is a widely used diagnostic technique, whose integration in medical education is constantly growing. The aim of this study was to evaluate chest ultrasound usefulness in teaching respiratory system physiology, students' perception of chest ultrasound integration into a traditional lecture in human physiology, and short-term concept retention. A lecture about respiratory physiology was integrated with ultrasound and delivered to third-year medical students. It included basic concepts of ultrasound imaging and the physiology of four anatomic sectors of the body of a male volunteer, shown with a portable ultrasound device (pleural sliding, diaphragmatic movement, inferior vena cava diameter variations, cardiac movements). Students' perceptions of the integrated lecture were assessed, and attendance recorded. After 4 mo, four multiple-choice questions about respiratory physiology were administered during the normal human physiology examinations, and the results of students who attended the lesson and those of who did not were compared. One hundred thirty-four students attended the lecture. Most of them showed encouragement for the study of the subject and considered the ultrasound integrated lecture more interesting than a traditional one and pertinent to the syllabus. Exposed students achieved a better score at the examination and committed less errors than did nonexposed students. The chest ultrasound integrated lecture was appreciated by students. A possible association between the exposure to the lecture and short-term concept retention is shown by better performances of the exposed cohort at the examination. A systematic introduction of ultrasound into physiology traditional teaching will be promoted by the Ultrasound-Based Medical Education movement.
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http://dx.doi.org/10.1152/advan.00062.2017DOI Listing
December 2017

Cave canem: HBO₂ therapy efficacy on Capnocytophaga canimorsus infections: a case series.

Undersea Hyperb Med 2017 Mar-Apr;44(2):179-186

Master II Level in Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova.

Background: Dog bites are a frequent injury, but the incidence and type of lesions vary across countries. Although only few patients develop complications, the treatment of advanced injuries has a considerable medical, social and economic impact. A frequently isolated pathogen in dog bite wounds is Capnocytophaga canimorsus, a bacterium that can cause sepsis or meningitis. Hyperbaric oxygen (HBO₂) therapy has been shown to be useful in treating anaerobic infections, most likely because it creates an inhospitable environment for the bacterium and enhances the patient's immune response.

Aim: We present a case series of C. canimorsus infections treated with HBO₂ in adjunction to antibiotic therapy. Furthermore, we tested the in vitro activity of ceftaroline against C. canimorsus, alone and in association with hyperbaric oxygen therapy.

Methods: We included nine (9) patients admitted to the surgery department of "A. Cardarelli" Hospital (Naples) after dog bite, from 2010 to 2016. All were initially treated with antibiotics and required transfer to the intensive care unit due to worsening conditions. C. canimorsus was isolated from wounds, and HBO₂ therapy was administered in adjunction to antibiotics, until clinical improvement and microbiological test negativity. We tested the activity of hyperbaric oxygen therapy in adjunction to ceftaroline on cultured plates with C. canimorsus versus ceftaroline alone. Minimal inhibitory concentration was evaluated.

Conclusions: Our findings confirm the utility of HBO₂ therapy after biting injuries. Indeed, increased oxygen supply to the wound (as well as in vitro) may be toxic for bacteria, can improve healing and may improve the effectiveness of antibiotics.
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http://dx.doi.org/10.22462/3.4.2017.13DOI Listing
December 2017

Assessment of disaster preparedness among emergency departments in Italian hospitals: a cautious warning for disaster risk reduction and management capacity.

Scand J Trauma Resusc Emerg Med 2016 Aug 15;24(1):101. Epub 2016 Aug 15.

CRIMEDIM - Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Via Lanino 1, 28100, Novara, Piemonte, Italy.

Study Hypothesis: Since the 1990s, Italian hospitals are required to comply with emergency disaster plans known as Emergency Plan for Massive Influx of Casualties. While various studies reveal that hospitals overall suffer from an insufficient preparedness level, the aim of this study was to better determine the preparedness level of Emergency Departments of Italian hospitals by assessing the knowledge-base of emergency physicians regarding basic disaster planning and procedures.

Methods: A prospective observational study utilized a convenience sample of Italian Emergency Departments identified from the Italian Ministry of Health website. Anonymous telephone interviews were conducted of medical consultants in charge at the time in the respective Emergency Departments, and were structured in 3 parts: (1) general data and demographics, (2) the current disaster plan and (3) protocols and actions of the disaster plan.

Results: Eighty-five Emergency Departments met inclusion criteria, and 69 (81 %) agreed to undergo the interview. Only 45 % of participants declared to know what an Emergency Plan for Massive Influx of Casualties is, 41 % believed to know who has the authority to activate the plan, 38 % knew who is in charge of intra-hospital operations. In Part 3 physicians revealed a worrisome inconsistency in critical content knowledge of their answers.

Conclusions: Results demonstrate a poor knowledge-base of basic hospital disaster planning concepts by Italian Emergency Department physicians-on-duty. These findings should alert authorities to enhance staff disaster preparedness education, training and follow-up to ensure that these plans are known to all who have responsibility for disaster risk reduction and management capacity.
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http://dx.doi.org/10.1186/s13049-016-0292-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986169PMC
August 2016

What happened to a thrombus during apical ballooning syndrome: a case report.

Swiss Med Wkly 2013 17;143:w13797. Epub 2013 May 17.

Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria, San Martino-IST, Genoa, Italy.

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http://dx.doi.org/10.4414/smw.2013.13797DOI Listing
December 2013
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