Time-resolved transcriptomic profiling of the developing rabbit's lungs: impact of premature birth and implications for modelling bronchopulmonary dysplasia.

BACKGROUND: Premature birth, perinatal inflammation, and life-saving therapies such as postnatal oxygen and mechanical ventilation are strongly associated with the development of bronchopulmonary dysplasia (BPD); these risk factors, alone or combined, cause lung inflammation and alter programmed molecular patterns of normal lung development. The current knowledge on the molecular regulation of lung development mainly derives from mechanistic studies conducted in newborn rodents exposed to postnatal hyperoxia, which have been proven useful but have some limitations. METHODS: Here, we used the rabbit model of BPD as a cost-effective alternative model that mirrors human lung development and, in addition, enables investigating the impact of premature birth per se on the pathophysiology of BPD without further perinatal insults (e.g., hyperoxia, LPS-induced inflammation). First, we characterized the rabbit's normal lung development along the distinct stages (i.e., pseudoglandular, canalicular, saccular, and alveolar phases) using histological, transcriptomic and proteomic analyses. Then, the impact of premature birth was investigated, comparing the sequential transcriptomic profiles of preterm rabbits obtained at different time intervals during their first week of postnatal life with those from age-matched term pups. RESULTS: Histological findings showed stage-specific morphological features of the developing rabbit's lung and validated the selected time intervals for the transcriptomic profiling. Cell cycle and embryo development, oxidative phosphorylation, and WNT signaling, among others, showed high gene expression in the pseudoglandular phase. Autophagy, epithelial morphogenesis, response to transforming growth factor ß, angiogenesis, epithelium/endothelial cells development, and epithelium/endothelial cells migration pathways appeared upregulated from the 28th day of gestation (early saccular phase), which represents the starting point of the premature rabbit model. Premature birth caused a significant dysregulation of the inflammatory response. TNF-responsive, NF-κB regulated genes were significantly upregulated at premature delivery and triggered downstream inflammatory pathways such as leukocyte activation and cytokine signaling, which persisted upregulated during the first week of life. Preterm birth also dysregulated relevant pathways for normal lung development, such as blood vessel morphogenesis and epithelial-mesenchymal transition. CONCLUSION: These findings establish the 28-day gestation premature rabbit as a suitable model for mechanistic and pharmacological studies in the context of BPD.

Surfactant lung delivery with LISA and InSurE in adult rabbits with respiratory distress.

BACKGROUND: In preterm infants, InSurE (Intubation-Surfactant-Extubation) and LISA (less invasive surfactant administration) techniques allow for exogenous surfactant administration while reducing lung injury associated with mechanical ventilation. We compared the acute pulmonary response and lung deposition of surfactant by LISA and InSurE in surfactant-depleted adult rabbits. METHODS: Twenty-six spontaneously breathing surfactant-depleted adult rabbits (6-7 weeks old) with moderate RDS and managed with nasal continuous positive airway pressure were randomized to 3 groups: (1) 200 mg/kg of surfactant by InSurE; (2) 200 mg/kg of surfactant by LISA; (3) no surfactant treatment (Control). Gas exchange and lung mechanics were monitored for 180 min. After that, surfactant lung deposition and distribution were evaluated monitoring disaturated-phosphatidylcholine (DSPC) and surfactant protein C (SP-C), respectively. RESULTS: No signs of recovery were found in the untreated animals. After InSurE, oxygenation improved more rapidly compared to LISA. However, at 180' LISA and InSurE showed comparable outcomes in terms of gas exchange, ventilation parameters, and lung mechanics. Neither DSPC in the alveolar pool nor SP-C signal distributions in a frontal lung section were significantly different between InSurE and LISA groups. CONCLUSIONS: In an acute setting, LISA demonstrated efficacy and surfactant lung delivery similar to that of InSurE in surfactant-depleted adult rabbits. IMPACT: Although LISA technique is gaining popularity, there are still several questions to address. This is the first study comparing LISA and InSurE in terms of gas exchange, ventilation parameters, and lung mechanics as well as surfactant deposition and distribution. In our animal study, three hours post-treatment, LISA method seems to be as effective as InSurE and showed similar surfactant lung delivery. Our findings provide some clarifications on a fair comparison between LISA and InSurE techniques, particularly in terms of surfactant delivery. They should reassure some of the concerns raised by the clinical community on LISA adoption in neonatal units.

Tracing exogenous surfactant in vivo in rabbits by the natural variation of 13C.

BACKGROUND: Respiratory Distress Syndrome (RDS) is a prematurity-related breathing disorder caused by a quantitative deficiency of pulmonary surfactant. Surfactant replacement therapy is effective for RDS newborns, although treatment failure has been reported. The aim of this study is to trace exogenous surfactant by 13C variation and estimate the amount reaching the lungs at different doses of the drug. METHODS: Forty-four surfactant-depleted rabbits were obtained by serial bronchoalveolar lavages (BALs), that were merged into a pool (BAL pool) for each animal. Rabbits were in nasal continuous positive airway pressure and treated with 0, 25, 50, 100 or 200 mg/kg of poractant alfa by InSurE. After 90 min, rabbits were depleted again and a new pool (BAL end experiment) was collected. Disaturated-phosphatidylcholine (DSPC) was measured by gas chromatography. DSPC-Palmitic acid (PA) 13C/12C was analyzed by isotope ratio mass spectrometry. One-way non-parametric ANOVA and post-hoc Dunn's multiple comparison were used to assess differences among experimental groups. RESULTS: Based on DSPC-PA 13C/12C in BAL pool and BAL end experiment, the estimated amount of exogenous surfactant ranged from 61 to 87% in dose-dependent way (p < 0.0001) in animals treated with 25 up to 200 mg/kg. Surfactant administration stimulated endogenous surfactant secretion. The percentage of drug recovered from lungs did not depend on the administered dose and accounted for 31% [24-40] of dose. CONCLUSIONS: We reported a risk-free method to trace exogenous surfactant in vivo. It could be a valuable tool for assessing, alongside the physiological response, the delivery efficiency of surfactant administration techniques.

[The evaluation of qualitative research published in nursing journals: protocol of a cross-sectional study]. / La valutazione della ricerca qualitativa pubblicata nelle riviste infermieristiche: protocollo di studio.

INTRODUCTION: The nature of nursing has prompted researchers nurses to use a large number of qualitative methodology research. The trend showed a substantial increase in its production between 1997 and 2000 to settle back down in the following years although until recently the qualitative methodology was considered a non-scientific research. The growing number of publications with qualitative design is paid concern to verify the rigor and credibility of studies using this method. The use of the quality assessment tools showed that the methodological precision of studies with a qualitative design has grown over time. AIM: Assessing, using the tool Critical Appraisal Skills Programme, the quality of qualitative studies published in the last five years by international nursing journals with higher impact factor. METHOD: We will search the qualitative articles published on the ten most influential nursing journals that will be submitted by two independent researchers at the Critical Appraisal Skills Programme tool in its original version. EXPECTED RESULTS: The results make it possible to observe whether the qualitative research produced in the field of nursing uses a rigorous methodology in the drafting of the report, assuming that the quality has grown in the past five years than in previous years. CONCLUSION: The study will help researchers assess which level reached nurses in the development of qualitative research.

[Unidimensional scales for dementia: a cross-sectional study in elderly Italian retirement houses residents]. / Valutazione del dolore in soggetti con deterioramento cognitivo lieve-moderato: uno studio trasversale su anziani italiani istituzionalizzati.

BACKGROUND: The pain in instituzionalized elderly people with cognitive impairment is common. This symptom is severely under-reported and under-treated within this population. Evaluation of pain intensity is an essential component of pain assessment. Self-report approach to pain assessment is generally regarded as the gold standard of pain measurement in people with mild and moderate cognitive decay. The literature demonstrated more different unidimensional self-report scales but the conclusions of the studies suggested often the utilization of different scales. AIM: The goal of this study was to compare three different unidimensional pain assessment scales to be used with 84 instituzionalized elderly people with an average Mini-Mental State Examination score of 18. METHOD: This was a descriptive cross-sectional study. The pain assessment was carried out by administering the three scales Faces Pain Scale (FPS), Numeric Rating Scale (NRS), Verbal Rating Scale (VRS). RESULTS: The results showed that the prevalence of pain was 60-70%. All three pain intensity scales had good reliability and validity (p=0.0001); The compilation time of Faces Pain Scale most above than the other two scales (p=0.0001). CONCLUSION: The findings of this article support the implementation of these scales in operative protocols considering the compilation time and preferences of the patients.

[The measurement of pain in patients with dementia: a review of the most appropriate tools]. / La misurazione del dolore nel paziente affetto da demenza: una rassegna degli strumenti più appropriati.

Pain is one of the most frequent symptom in elderly people with dementia and despite of this, it is still under-acknowledged and under-treated. The best approach to pain assessment is to evaluate it with the most appropriate scale. While in the elderly suffering mild-moderate cognitive impairment, it's possible to use self-report scales, in the elderly with severe cognitive impairment the use of observational scales is recommended. The objective of this review is to analyze the various types of pain assessment tools used in patients with cognitive impairment. Literature review was carried out through consultation of the most important bio-medical databases: Medline (PubMed), KT+, Trip Database, Cinahl, Cochrane Library, Embase. The keywords used were: "pain measurement", "pain assessment", "dementia", "validation study", "aged". All keywords were linked using AND and OR boolean operators. Altogether 5 self-report scales and 17 observational scales were retrieved, 7 of which available in Italian validated versions. The review analyzes potential and limitations of each assessment tool, in order to assist the clinician to make the most appropriate choice when using it in health care contexts.

[Nurse-performed FAST ultrasound in the emergency department: a systematic review]. / L'utilizzo della tecnica ad ultrasuoni FAST eseguita dagli infermieri del Dipartimento di Emergenza: una revisione sistematica.

Focused Assessment with Sonography for Trauma (commonly abbreviated as FAST) is considered for patients with blunt abdominal trauma as the gold standard for accident assessment in site. This method is increasingly used even by not radiologists professionals, as well as by nurses who works in emergency settings. This systematic review is aimed at evaluating the effectiveness of ultrasound FAST performed by nurses in emergencies department. Seven databases of primary and secondary literature as well as three national journals relevant to the field were consulted. The review was conducted between March and August 2011 developing 9 search strings. Articles have been critically reviewed by two authors independently. No restriction on language or time of publication have been used. A total of 4767 documents were displayed, of those only 4 were considered to be reviewed. A total of 1035 FAST ultrasound performed by nurses were included. The results show that the use of ultrasound FAST performed by trained nurses is very effective, with a sensitivity of 84% (95% CI 72.1-92.2) and a specificity of 97.37% (95% CI 92.55-99.10) . Practice execution time was an average of 156 seconds (2.6 minutes), median time of 138 seconds (range = 76 to 357). Just one study specified the training course that nurses were required to attend. To sum up, FAST ultrasound performed by nurses have an important role in emergencies management as well as in triage setting as valid screening tool.

Preterm rabbit-derived Precision Cut Lung Slices as alternative model of bronchopulmonary dysplasia in preclinical study: a morphological fine-tuning approach.

Bronchopulmonary dysplasia (BPD) is the most common complication of preterm delivery, with significant morbidity and mortality in a neonatal intensive care setting. Research in this field aims to identify the mechanisms of late lung development with possible therapeutic targets and the improvement of medical management. Rabbits represent a suitable lab preclinical tool for mimicking the clinical BPD phenotype. Rabbits are born at term in the alveolar phase as occurs in large animals and humans and in addition, they can be delivered prematurely in contrast to mice and rats. Continuous exposure to high oxygen concentration (95% O2) for 7 days induces functional and morphological lung changes in preterm rabbits that resemble those observed in BPD-affected babies. The preclinical research pays great attention to optimize the experimental procedures, reduce the number of animals used in experiments and, where possible, replace animal models with alternative assays, following the principle of the 3 Rs (Replace, Reduce and Refine). The use of in vitro assays based on the ex vivo culture of Precision Cut Lung Slices (PCLS) goes in this direction, representing a good compromise between controlled and flexible in vitro models and the more physiologically relevant in vivo ones. This work aims to set up morphological analyses to be applied in preclinical tests using preterm rabbits derived PCLS, cultured up to 7 days in different oxygen conditions, as a model. After a preliminary optimization of both lung preparation and histological processing methods of the lung slices of 300 µm, the morphological analysis was conducted evaluating a series of histomorphometric parameters derived from those widely used to follow the phases of lung development and its alterations in vivo. Our histomorphometric results demonstrated that the greatest differences from pseudo-normoxia and hyperoxia exposed samples at day 0, used as starting points to compare changes due to treatments and time, are detectable after 4 days of in vitro culture, representing the most suitable time point for analysis in preclinical screening. The combination of parameters suitable for evaluating PCLS morphology in vitro resulted to be Tissue Density and Septal Thickness. Shape Factor and Roughness, evaluated to highlight the increasing complexity of the airspaces, due to the formation of septal crests, gave useful information, however, without significant differences up to day 4. Other parameters like Mean Linear Intercept and Septal Density did not allow to highlight significant differences between different oxygen conditions and time points. Instead, Radial Alveolar Count, could not be applied to PCLS, due to the tissue changes following agar infusion and culture conditions.

Physicians' and nurses' experiences of end-of-life decision-making in geriatric settings.

BACKGROUND AND AIMS: In Italy there is a paucity of empirical data on practices concerning end-of-life decisions (ELDs) in geriatrics. We aimed to investigate the frequency and characteristics of ELDs made by Italian physicians and nurses in the geriatric setting. METHODS: In 2009, an anonymous questionnaire was sent to 54 geriatric units, 21 hospices, and 382 nursing homes in the Veneto and Trentino Alto Adige regions, and to professionals in the area who are members of the Italian Gerontology and Geriatrics Association. RESULTS: This paper reports the results of 552 questionnaires answered by 171 physicians, 368 nurses and 13 professionals who did not state their profession. Death was preceded by decisions to start or continue treatments likely to prolong the patients' life in 51.3% of cases. The proportion of deaths preceded by a decision to end life (DEL) was 20.8%; 18% of DELs concerned non-treatment decisions. There were 9 cases of ending of life without patient's explicit request. No cases of doctor-assisted suicide were reported, while there were 2 cases of euthanasia, one reported by a physician and one by a nurse. CONCLUSION: In geriatrics, DELs often precede the deaths of terminally-ill Italian patients. Nurses report making DELs more often than physicians, especially in incompetent patients. Continuous deep sedation was adopted by 39.5% of the Italian physicians for deaths not occurring suddenly and unexpectedly. Our report on physicians' and nurses' experiences of ELD making in geriatric settings can offer a valuable contribution to the current debate on end-of-life treatment, an issue that goes beyond national borders.

[Institutionalized elderly and depression: a multicenter observational study]. / Anziano istituzionalizzato e depressione: uno studio osservazionale multicentrico.

Scientific literature recommends nurses to use the Geriatric Depression Scale (GDS) in the assessment of symptoms of depression among elderly with no cognitive deficits. The first purpose of this observational study was to determine the prevalence of depressive symptoms and the related antidepressant therapy in a sample of institutionalized elderly people administering the 30 questions GDS (GDS 30). The second aim was to estimate the time to complete the test. The survey is a cross-sectional multicenter study. 115 cognitively intact elderly residents in 5 retirement houses in the province of Vicenza (Italy) were administered the 30 items GDS by nursing staff: 80 females with a median age of 83 years (Inter Quartile Range RIQ: 80-85) and 35 males with a median age of 79 years (RIQ: 73-85). The prevalence of depression was 46% (95% Confidence Interval: 37-55%). The difference in depression between males and females was not significant (p=0.646). The median of the total answering time was equal to 306 seconds (RIQ: 257-315). The answering time of the GDS in people taking antidepressants is higher with respect to those who do not take them. The GDS 30 is an useful tool for nurses to identify in a fairly short amount of time institutionalised individuals with no cognitive deficit and risk of depression.

Deuterium-depleted water: A new tracer to label pulmonary surfactant lipids in adult rabbits.

Stable isotope tracing can be safely used for metabolic studies in animals and humans. The endogenous biosynthesis of lipids (lipogenesis) is a key process throughout the entire life but especially during brain and lung growth. Adequate synthesis of pulmonary surfactant lipids is indispensable for life. With this study, we report the use of deuterium-depleted water (DDW), suitable for human consumption, as metabolic precursor for lipogenesis. We studied 13 adult rabbits for 5 days. Four rabbits drank tap water (TW) and served as controls; in four animals, DDW was substituted to drinking water, whereas five drank deuterium-enriched water (DEW). After 5 days, a blood sample and a bronchoalveolar lavage (BAL) sample were collected. The 2 H/1 H (δ2 H) of BAL palmitic acid (PA) desaturated phosphatidylcholine (DSPC), the major phospholipid of pulmonary surfactant, and of plasma water was determined by high-resolution mass spectrometry. We found that the δ2 H values of DDW, DEW and TW were -984 ± 2‰, +757 ± 2‰ and -58 ± 1‰, respectively. After 5 days, plasma water values were -467 ± 87‰, +377 ± 56‰ and -53 ± 6‰, and BAL DSPC-PA was -401 ± 27‰, -96 ± 38‰ and -249 ± 9‰ in the DDW, DEW and TW, respectively. With this preliminary study, we demonstrated the feasibility of using DDW to label pulmonary surfactant lipids. This novel approach can be used in animals and in humans, and we speculate that it could be associated with more favourable study compliance than DEW in human studies.

A novel deuterium-based model for measurement of exogenous surfactant using deuterium-depleted water.

Stable isotope tracers, like 13 C, can be used for the measurement of the partition between the endogenous and exogenous pulmonary disaturated-phosphatidylcholine (DSPC). Deuterium labeling methods are still not fully explored. Our aim was to investigate the feasibility of using deuterium-depleted water (DDW) and deuterium-enriched water (DEW) to measure endogenous and exogenous pulmonary DSPC in a rabbit model of surfactant depletion. Data obtained from the 13 C dilution method were used as a reference. We studied 9 adult rabbits: 4 drank DDW and 5 DEW for 5 days. Lung surfactant depletion was induced at Day 5 by repeated saline bronchoalveolar lavages (BAL), which were stored as a pool (BAL pool). After endogenous surfactant depletion, rabbits received exogenous surfactant followed by a second BAL depletion procedure (End-Experiment Pool). DSPC quantity, and palmitic acid (PA)-DSPC 2 H/1 H (δ2 H) and 13 C/12 C ratios (δ13 C) of exogenous surfactant batches and of BAL pools were measured by High-Resolution Mass Spectrometry. The amount of exogenous surfactant recovered from the lungs ranged from 45% to 81% and, it was highly correlated with those obtained with the use of the 13 C (r = 0.9844, p < 0.0001). We demonstrated that commercially available purified DDW and even low doses of DEW can be used to modify the deuterium background of endogenous surfactants with the purpose of measuring the contribution of exogenous surfactants to the endogenous alveolar surfactant pool.

Preclinical Assessment of Nebulized Surfactant Delivered through Neonatal High Flow Nasal Cannula Respiratory Support.

High-flow nasal cannula (HFNC) is a non-invasive respiratory support (NRS) modality to treat premature infants with respiratory distress syndrome (RDS). The delivery of nebulized surfactant during NRS would represent a truly non-invasive method of surfactant administration and could reduce NRS failure rates. However, the delivery efficiency of nebulized surfactant during HFNC has not been evaluated in vitro or in animal models of respiratory distress. We, therefore, performed first a benchmark study to compare the surfactant lung dose delivered by commercially available neonatal nasal cannulas (NCs) and HFNC circuits commonly used in neonatal intensive care units. Then, the pulmonary effect of nebulized surfactant delivered via HFNC was investigated in spontaneously breathing rabbits with induced respiratory distress. The benchmark study revealed the surfactant lung dose to be relatively low for both types of NCs tested (Westmed NCs 0.5 ± 0.45%; Fisher & Paykel NCs 1.8 ± 1.9% of a nominal dose of 200 mg/kg of Poractant alfa). The modest lung doses achieved in the benchmark study are compatible with the lack of the effect of nebulized surfactant in vivo (400 mg/kg), where arterial oxygenation and lung mechanics did not improve and were significantly worse than the intratracheal instillation of surfactant. The results from the present study indicate a relatively low lung surfactant dose and negligible effect on pulmonary function in terms of arterial oxygenation and lung mechanics. This negligible effect can, for the greater part, be explained by the high impaction of aerosol particles in the ventilation circuit and upper airways due to the high air flows used during HFNC.

ERS International Congress 2021: highlights from the Paediatric Assembly.

In this review, Early Career Members of the European Respiratory Society (ERS) and the Chairs of the ERS Assembly 7: Paediatrics present the highlights in paediatric respiratory medicine from the ERS International Congress 2021. The eight scientific Groups of this Assembly cover respiratory physiology and sleep, asthma and allergy, cystic fibrosis (CF), respiratory infection and immunology, neonatology and intensive care, respiratory epidemiology, bronchology, and lung and airway development. We here describe new developments in lung function testing and sleep-disordered breathing diagnosis, early life exposures affecting pulmonary function in children and effect of COVID-19 on sleep and lung function. In paediatric asthma, we present the important role of the exposome in asthma development, and how biologics can provide better outcomes. We discuss new methods to assess distal airways in children with CF, as some details remain blind when using the lung clearance index. Moreover, we summarise the new ERS guidelines for bronchiectasis management in children and adolescents. We present interventions to reduce morbidity and monitor pulmonary function in newborns at risk of bronchopulmonary dysplasia and long-term chronic respiratory morbidity of this disease. In respiratory epidemiology, we characterise primary ciliary dyskinesia, identify early life determinants of respiratory health and describe the effect of COVID-19 preventive measures on respiratory symptoms. Also, we describe the epidemiology of interstitial lung diseases, possible consequences of tracheomalacia and a classification of diffuse alveolar haemorrhage in children. Finally, we highlight that the characterisation of genes and pathways involved in the development of a disease is essential to identify new biomarkers and therapeutic targets.

Daily Intraperitoneal Administration of Rosiglitazone Does Not Improve Lung Function or Alveolarization in Preterm Rabbits Exposed to Hyperoxia.

Thiazolidinediones (TZDs) are potent PPARγ agonists that have been shown to attenuate alveolar simplification after prolonged hyperoxia in term rodent models of bronchopulmonary dysplasia. However, the pulmonary outcomes of postnatal TZDs have not been investigated in preterm animal models. Here, we first investigated the PPARγ selectivity, epithelial permeability, and lung tissue binding of three types of TZDs in vitro (rosiglitazone (RGZ), pioglitazone, and DRF-2546), followed by an in vivo study in preterm rabbits exposed to hyperoxia (95% oxygen) to investigate the pharmacokinetics and the pulmonary outcomes of daily RGZ administration. In addition, blood lipids and a comparative lung proteomics analysis were also performed on Day 7. All TZDs showed high epithelial permeability through Caco-2 monolayers and high plasma and lung tissue binding; however, RGZ showed the highest affinity for PPARγ. The pharmacokinetic profiling of RGZ (1 mg/kg) revealed an equivalent biodistribution after either intratracheal or intraperitoneal administration, with detectable levels in lungs and plasma after 24 h. However, daily RGZ doses of 1 mg/kg did not improve lung function in preterm rabbits exposed to hyperoxia, and daily 10 mg/kg doses were even associated with a significant lung function worsening, which could be partially explained by the upregulation of lung inflammation and lipid metabolism pathways revealed by the proteomic analysis. Notably, daily postnatal RGZ produced an aberrant modulation of serum lipids, particularly in rabbit pups treated with the 10 mg/kg dose. In conclusion, daily postnatal RGZ did not improve lung function and caused dyslipidemia in preterm rabbits exposed to hyperoxia.

[Risk analysis in the process of administering drugs in the emergency departments care: a multicenter observational study]. / Analisi dei rischi nel processo di somministrazione dei farmaci nei dipartimenti di emergenza: uno studio osservazionale multicentrico.

Mistakes in providing medication are amongst main problems in National Health Service. The literature shows that drug's errors administration occur much more frequently in emergency departments than in other care settings. Main objective is to identify most commonly mistakes, recorded in nursing clinical practice, occurring during drugs administration. A secondary objective is to identify factors that may contribute to errors and possible preventive measures. A multicentre survey was conducted, administering an anonymous questionnaire to 206 nurses of 7 wards of 4 health services in Lombardia and Veneto region of Italy. The self-compiled questionnaire is composed by 15 questions. Informations were collected by a third-party nurse. Responders to test were 150 (72.8%). Main results show that 81 nurses (54%) administered a wrong drug dose, as well as 80 health care professional (53.3%) gave one or more drug at a different time from what was prescribed. It was also found a statistically significant association between improper performance of diagnostic tests and health care professionals age. Moreover, a strong linear association between medication error reporting and nurses was found. Educating nurses about accident reporting system to enhance patient safety culture is highly recommended. Our results could be used in programs aimed to promote medication error recognition and reduce or eliminate barriers to communication.

Lung ultrasound features and relationships with respiratory mechanics of evolving BPD in preterm rabbits and human neonates.

Evolving bronchopulmonary dysplasia (BPD) is characterized by impaired alveolarization leading to lung aeration inhomogeneities. Hyperoxia-exposed preterm rabbits have been proposed to mimic evolving BPD; therefore, we aimed to verify if this model has the same lung ultrasound and mechanical features of evolving BPD in human neonates. Semiquantitative lung ultrasound and lung mechanics measurement was performed in 25 preterm rabbits (28 days of gestation) and 25 neonates (mean gestational age ≈ 26 wk) with evolving BPD. A modified rabbit lung ultrasound score (rLUS) and a validated neonatal lung ultrasound score (LUS) were used. Lung ultrasound images were recorded and evaluated by two independent observers blinded to each other's evaluation. Lung ultrasound findings were equally heterogeneous both in rabbits as in human neonates and encompassed all the classical lung ultrasound semiology. Lung ultrasound and histology examination were also performed in 13 term rabbits kept under normoxia as further control and showed the absence of ultrasound and histology abnormalities compared with hyperoxia-exposed preterm rabbits. The interrater absolute agreement for the evaluation of lung ultrasound images in rabbits was very high [ICC: 0.989 (95%CI: 0.975-0.995); P < 0.0001], and there was no difference between the two observers. Lung mechanics parameters were similarly altered in both rabbits and human neonates. There were moderately significant correlations between airway resistances and lung ultrasound scores in rabbits (ρ = 0.519; P = 0.008) and in neonates (ρ = 0.409; P = 0.042). In conclusion, the preterm rabbit model fairly reproduces the lung ultrasound and mechanical characteristics of preterm neonates with evolving BPD.NEW & NOTEWORTHY We have reported that hyperoxia-exposed preterm rabbits and human preterm neonates with evolving BPD have the same lung ultrasound appearance, and that lung ultrasound can be fruitfully applied on this model with a brief training. The animal model and human neonates also presented the same relationship between semiquantitative ultrasound-assessed lung aeration and airway resistances. In conclusion, this animal model fairly reproduce evolving BPD as it is seen in clinical practice.

[The validation of a pain assessment scale for patients with cognitive impairment: the Italian version of Abbey's scale]. / La validazione di una scala di accertamento del dolore in pazienti con decadimento cognitivo: la scala Abbey nella versione italiana.

The cognitive impairment is the main obstacle for a nurse in the recognition of the patient's pain; moreover, the nurse needs valid scales which can be daily adopted during the phase of testing. Recently, a pain assessment scale for patients with cognitive impairment has been setted in Australia. Our aim is the validation of the Abbey scale in the Italian medical circle so as to allow the nurse to use it in the clinical practice. The original scale was validated in the Italian version and afterwards it was tested on 110 institutionalized elderly patients coming from three retirement houses of Vicenza, Italy. The results prove that the Italian version of Abbey scale is a valid tool, considering the content and reliability.

[A comparison study between two pain assessment scales for hospitalized and cognitively impaired patients with advanced dementia]. / Confronto fra due scale di valutazione del dolore in pazienti ospedalizzati affetti da grave demenza e non verbalizzanti.

The management of pain in a elderly patients with advanced dementia is a very frequently problem in geriatric wards. The pain in patients with advanced dementia whose verbal fluency is declining is underestimated and poorly treated and this is mainly due to the lack of availability of proper tools able to recognise and to assess this disease symptom in those patients. During recent years major progress has taken place, and valid scales that allow for the assessment of the pain also in those kind of patients have been developed. The objective of this research is to verify the pertinence of the PAINAD and ABBEY scales throughout the assessment of pain in a 30 resident patients in care of a geriatric setting. The thirty elderly were average age 86 years (18 female and 12 male) with vascular dementia or late stage Alzheimer's disease, completely dependant on ADLs and with global aphasia. After 48 hours from the acceptance to hospital the pain has been identified. The pain assessment was carried out by administering the PAINAD (already validate in italian) and ABBEY scales by the nurse responsible for the patient and by a second nurse, for an amount of four surveys for each patients. Results show that both scales give equivalent results for the pain assessment (K=0.68), with concordance asset moderately good between the exams taken by the two nurses (Cohen K rate between 0.49 and 0.58). The PAINAD scale requires an administering time far lower than the ABBEY scale (p 0.001) and both can be used for the assessment of pain in those patients, also in the hospital.