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Background: Robotic-assisted laparoscopic radical prostatectomy (RALP) requires pneumoperitoneum and steep Trendelenburg position. Our aim was to investigate the influence of the combination of pneumoperitoneum and Trendelenburg position on mechanical power and its components during RALP., Methods: Sixty-one prospectively enrolled patients scheduled for RALP were studied in supine position before surgery, during pneumoperitoneum and Trendelenburg position and in supine position after surgery at constant ventilatory setting. In a subgroup of 17 patients the response to increasing positive end-expiratory pressure (PEEP) from 5 to 10 cmH 2 O was studied., Results: The application of pneumoperitoneum and Trendelenburg position increased the total mechanical power (13.8 [11.6 - 15.5] vs 9.2 [7.5 - 11.7] J/min, p < 0.001) and its elastic and resistive components compared to supine position before surgery. In supine position after surgery the total mechanical power and its elastic component decreased but remained higher compared to supine position before surgery. Increasing PEEP from 5 to 10 cmH 2 O within each timepoint significantly increased the total mechanical power (supine position before surgery: 9.8 [8.4 - 10.4] vs 12.1 [11.4 - 14.2] J/min, p < 0.001; pneumoperitoneum and Trendelenburg position: 13.8 [12.2 - 14.3] vs 15.5 [15.0 - 16.7] J/min, p < 0.001; supine position after surgery: 10.2 [9.4 - 10.7] vs 12.7 [12.0 - 13.6] J/min, p < 0.001), without affecting respiratory system elastance., Conclusion: Mechanical power in healthy patients undergoing RALP significantly increased both during the pneumoperitoneum and Trendelenburg position and in supine position after surgery. PEEP always increased mechanical power without ameliorating the respiratory system elastance., (© 2024. The Author(s).)

Purpose: The Prone positioning in addition to non invasive respiratory support is commonly used in patients with acute respiratory failure. The aim of this study was to assess the accuracy of an impedance-based non-invasive respiratory volume monitor (RVM) in supine and in prone position., Methods: In sedated, paralyzed and mechanically ventilated patients in volume-controlled mode with acute respiratory distress syndrome scheduled for prone positioning it was measured and compared non-invasively tidal volume and respiratory rate provided by the RVM in supine and, subsequently, in prone position, by maintaining unchanged the ventilatory setting., Results: Forty patients were enrolled. No significant difference was found between measurements in supine and in prone position either for tidal volume (p = 0.795; p = 0.302) nor for respiratory rate (p = 0.181; p = 0.604). Comparing supine vs. prone position, the bias and limits of agreements for respiratory rate were 0.12 bpm (-1.4 to 1.6) and 20 mL (-80 to 120) for tidal volume., Conclusions: The RVM is accurate in assessing tidal volume and respiratory rate in prone compared to supine position. Therefore, the RVM could be applied in non-intubated patients with acute respiratory failure receiving prone positioning to monitor respiratory function., (© 2024. The Author(s).)

Acute dyspnea represents one of the most frequent symptoms leading to emergency room evaluation. Its significant prognostic value warrants a careful evaluation. The differential diagnosis of dyspnea is complex due to the lack of specificity and the loose association between its intensity and the severity of the underlying pathological condition. The initial assessment of dyspnea calls for prompt diagnostic evaluation and identification of optimal monitoring strategy and provides information useful to allocate the patient to the most appropriate setting of care. In recent years, accumulating evidence indicated that lung ultrasound, along with echocardiography, represents the first rapid and non-invasive line of assessment that accurately differentiates heart, lung or extra-pulmonary involvement in patients with dyspnea. Moreover, non-invasive respiratory support modalities such as high-flow nasal oxygen and continuous positive airway pressure have aroused major clinical interest, in light of their efficacy and practicality to treat patients with dyspnea requiring ventilatory support, without using invasive mechanical ventilation. This clinical review is focused on the pathophysiology of acute dyspnea, on its clinical presentation and evaluation, including ultrasound-based diagnostic workup, and on available non-invasive modalities of respiratory support that may be required in patients with acute dyspnea secondary or associated with respiratory failure., (© 2023. The Author(s).)

Purpose: To explore patterns of failure and postrelapse outcome of patients with retroperitoneal sarcoma primarily treated by extended resection., Methods: All consecutive patients with primary retroperitoneal sarcoma, treated between January 2002 and December 2011 at two European sarcoma centers were included. Five-year overall survival (OS) and crude cumulative incidence (CCI) of local recurrence (LR) and distant metastases (DM) were calculated. Multivariate analyses for OS and CCI of LR and DM were performed. Postrelapse OS was investigated., Results: A total of 377 patients were identified. Median follow-up from the time of primary surgery was 44 months [interquartile range (IQR) 27-82]. Five-year OS was 64 % [95 % confidence interval (CI) 0.588, 0710]. CCI of LR and DM were 23.6 % (95 % CI 18.9, 29.4) and 21.9 % (95 % CI 17.6, 27.3), respectively. OS, CCI of LR and DM were 87, 18 % and 0 for well-differentiated liposarcoma; 54, 44 and 9 % for grade II dedifferentiated liposarcoma; 41,33, and 44 % for grade III dedifferentiated liposarcoma; 58, 5, and 55 % for leiomyosarcoma; and 85, 4, and 17 % for solitary fibrous tumor, respectively. Seventy-six patients developed LR. Median postrelapse follow-up was 27 months (IQR 10-58). Twenty-one patients (27 %) underwent a second surgical resection (complete in 18), while 55 (73 %) did not (22 multifocal, 17 inoperable, 16 other causes). Median postrelapse OS was 17 months (IQR 7-31). Well-differentiated liposarcoma histology and disease-free interval predicted postrelapse OS, while surgical resection did not., Conclusions: When primary extended surgery limits LR, histologic subtype and grade determine the outcome. At recurrence, a second surgery is of limited benefit.

Objective: This study was designed to evaluate the impact of multimodal management on a series of epithelioid sarcoma (ES) patients treated with curative intent., Methods: Data were collected on 69 consecutive patients treated from 1982 to 2012. Univariate and multivariate analyses were performed for tumor control and overall survival (OS)., Results: In total, 54 (78 %) patients had localized ES (M0 group). In the M0 group, 85 % of patients received multimodal management (surgery n = 50, radiotherapy n = 37, chemotherapy n = 30). Among 42 patients with limb ES, 9 (21 %) underwent amputation, and isolated limb perfusion (ILP) was required in 17 (40.5 %) to allow conservative management. Among the 45 patients who underwent conservative surgery, flap reconstructions were required in 13 (28.8 %). The median follow-up was 5.7 years. The 5-year actuarial OS rates were 54, 62, and 24 % in the entire group and the M0 and M1 groups, respectively. In the M0 group, the 5-year actuarial distant control, local control (LC), and locoregional control rates were 67, 75, and 66 %, respectively. Prognostic factors for poor OS in the multivariate analysis were tumors that were deep to the fascia (p = 0.04) and grade 3 (p = 0.005). In the univariate analysis, age <30 years (p = 0.04), the T2 stage (p = 0.04), and mass presentation (p = 0.03) correlated with decreased LC, whereas patients who underwent ILP had a significantly higher LC rate (hazard ratio 3; 95 % confidence interval 0.9-9.4; p = 0.05)., Conclusions: Multimodal management including ILP and flap reconstruction is necessary to achieve optimal conservative LC. High rates of metastasis and lymphatic spread require innovative systemic treatments.

The very early events of the intrinsic, damage-induced apoptotic pathway, i.e., upstream to Bax activation, probably consist of physico-chemical alterations (i.e., redox, pH or Ca2+ changes) rather then subtle molecular interactions, and in spite of many studies they remain unclear. One problem is that cells undergo apoptosis in an asynchronous way, leading to heterogeneity in the cell population that impairs the results of bulk analyses. In this study, we present a flow cytometric approach for studying Ca2+ alteration in apoptosis at the single cell level. By means of a multiparametric analysis, we could discriminate different sub-populations, i.e., viable and apoptotic cells and cells in secondary necrosis, and separately analyse static as well as dynamic Ca2+ parameters in each sub-population. With this approach, we have identified a set of sequential Ca2+ changes; two very early ones occur prior to any other apoptotic alterations, whereas a later change coincides with the appearance of apoptosis. Interestingly, the two pre-apoptotic changes occur simultaneously in all treated cells, i.e., at fixed times post-treatment, whereas the later one occurs at varying times, i.e., within a wide time range, concomitantly with the other apoptotic events.

Isolated microperfused rabbit renal proximal tubule S2 segments, if incubated in conventional substrate containing HCO3- Ringer solution, exhibit lower cell membrane potentials (Vb) and elevated intracellular Na+ concentrations ([Na]i) compared to rat tubules in vivo. Assuming that these and other differences reflect insufficient metabolic and/or hormonal stimulation of the cells, we have used microelectrode techniques to test whether improving substrate supply and applying norepinephrine (NE, to compensate for the missing nerve supply) reverts Vb and [Na]i to values observed in vivo. Application of D-glucose (5.5 mmol/l) and additional application of pyruvate, lactate, or L-alanine (each 10 mmol/l), or bathing the tubules in Dulbecco's modified Eagle's tissue culture medium (DMEM) significantly increased Vb and, whenever tested, reduced [Na]i as compared to substrate-free or D-glucose-containing control solution and these effects could be prevented - as tested in the case of pyruvate - by inhibition of the Na/K pump with ouabain. However, high concentrations of acetate, beta-hydroxybutyrate, or L-glutamine had no significant effect. The largest effect was obtained with joint application of DMEM and NE (10 micromol/l) which increased Vb from -42.8 +/- 1.3 mV (SEM) to -55.3 +/- 2.5 mV (n = 11). Interestingly we noticed that under the latter conditions the Vb response to bath application of 1 mmol/l amiloride virtually disappeared, i.e. it changed from a depolarization of +14.6 +/- 1.4 mV (in D-glucose Ringer solution) to +0.6 +/- 0.7 mV (in DMEM plus NE) (n = 8), with some tubules showing even a small hyperpolarization. The latter implies partial restoration of the in vivo behaviour, since in experiments on rat proximal tubules in vivo amiloride regularly hyperpolarized the cells (by -3.4 +/- 0.76 mV, n = 5). Obviously under conventional in vitro conditions an amiloride-inhibitable K+ conductance is activated which is inactive in vivo and also inactivates under improved conditions in vitro. In agreement with observations reported in the subsequent publication our results demonstrate that isolated proximal tubules undergo functional alterations which may be largely prevented by improved metabolic and stimulatory incubation conditions.

In the present experiments we have made a new attempt to characterize the ion transport properties of H(+)-secreting cells of the gastric mucosa using electrophysiological techniques. Individual gastric glands of bullfrog fundus mucosa were manually dissected, mounted in holding pipettes and superfused with various test solutions while individual cells were punctured with conventional or H(+)-sensitive double-barrelled microelectrodes. All measurements were performed in the resting state (0.1 mmol/l cimetidine). In HCO3(-)-containing control Ringer solution the cell membrane potential (Vb) averaged -45.6 +/- 0.9 mV (+/- SEM, n = 54). From the fast initial Vb responses to changing bath K+, Na+, Cl- or HCO3- concentrations we deduced that the basolateral cell membrane contains conductances for K+, Na+, and Cl- but not for HCO3-, and that a Na(+)-HCO3- cotransporter is not present. The K+ conductance was inhibited by Ba2+ (3 mmol/l), but the Cl- conductance was not inhibited by 4,4' diisothiocyanato-stilbene-2,2' disulphonic acid (DIDS, 0.3 mmol/l), nor selectively inhibited by 5-nitro-2-(3)- phenylpropyl-aminobenzoate (NPPB, 10 mumol/l). In a great number of cells the Vb response to Cl- substitution revealed two components: an initial spiking depolarization which reflected conductive Cl- efflux and a secondary slow hyperpolarization, the origin of which was not immediately evident. Since the latter response could be mimicked by CO2-free perfusion, strongly depressed by Ba2+ and eliminated by DIDS, we conclude that it reflects HCO3- uptake into the cells via a DIDS sensitive Cl-/HCO3- exchanger which alkalinizes the cells and stimulates the basolateral K+ conductance. Our results confirm, revise and extend the results of previous, less direct, investigations of gastric cell ion transport.

Following the technical approach described in the preceding publication we have investigated if, and how, stimulation of gastric HCl secretion affects the basolateral ion transport properties of oxyntopeptic cells of Rana catesbeiana stomach. To this end microdissected gastric glands were punctured with conventional or H(+)-sensitive glass microelectrodes and the effects of changing bath ion concentrations on the cell membrane potential (Vb) and cell pH (pHi) were determined. Except for a transient alkalinization, histamine (0.5 mmol/l) did not significantly affect Vb or pHi. The latter averaged 7.18 +/- 0.03 (mean +/- SEM, n = 5) under resting conditions (0.1 mmol/l cimetidine) and 7.21 +/- 0.07 (n = 5) in the presence of histamine. In addition, neither the initial velocity nor the final steady-state value of the cell alkalinization following a 10:1 reduction of bath Cl- concentration changed in the presence of histamine, and the same holds true for the cell acidification following a 10:1 reduction of bath HCO3- concentration. These observations indicate that the basolateral Cl-/HCO3- exchanger was not stimulated by histamine, and that no other base transporters were activated. By contrast, the Vb response to elevation of bath K+ concentration decreased, and so did the initial depolarizing Vb response to bath Cl- substitution, while the secondary hyperpolarizing response increased. The latter observations are compatible with the notion that stimulation by histamine reduced a pH-insensitive part of the basolateral K+ conductance and reduced also the basolateral Cl- conductance.

The effect of picomolar concentrations of angiotensin II (AII) was investigated in isolated perfused rabbit renal proximal tubules using conventional or pH-sensitive intracellular microelectrodes. Under control conditions cell membrane potential (Vb) and cell pH (pHi) averaged -53.8 +/- 1.9 mV (mean +/- SEM, n = 49) and 7.24 +/- 0.01 (n = 10), respectively. AII (at 10(-11) mol/l), when applied from the bath (but not when applied from the lumen perfusate), produced the following effects: approximately 85% of the viable tubules responded with a small depolarization (+5.5 +/- 0.4 mV, n = 43) which was accompanied in half of the pHi measurements by a slow acidification (delta pHi = -0.03 +/- 0.01, n = 5). The remaining 15% responded with a small hyperpolarization (delta Vb = -3.1 +/- 0.4 mV, n = 6). All changes were fully reversible and repeatable. Experiments with fast changes in bath HCO3 or K concentrations, as well as measurements of the basolateral voltage divider fraction in response to transepithelial current flow, explain these observations as stimulation of a basolateral Na-HCO3 cotransporter and of a basolateral K conductance. Both counteract in their effect on Vb, but can be individuated by blocker experiments with 4,4'-diisothiocyanatostilbene-2,2'-disulphonic acid (DIDS) and barium. Both the stimulation of Na-HCO3 cotransport and the stimulation of the K conductance may result from down-regulation of the level of cyclic adenosine monophosphate in the cell.

In the first part of our study, we described the effect of picomolar concentrations of angiotensin II (AII) on cell membrane potential (Vb) and cell pH (pHi) of isolated perfused rabbit renal proximal tubules. In the present publication we summarize respective observations with micromolar concentrations of AII. With a few exceptions nearly all experiments showed mirror-image-like results. In the majority of the experiments 10(-6) mol/l AII, when applied from the bath (but not when applied from the lumen), slightly hyperpolarized the cells by -3.4 +/- 0.3 mV (mean +/- SEM, n = 20) and alkalinized them by up to 0.06 pH units, while the lower AII concentrations, which were applied in the previous study, depolarized and acidified. The present observations suggest that micromolar concentrations of AII inhibit basolateral Na-HCO3 cotransport. This conclusion was confirmed by a decreasing Vb response to step changes of basolateral HCO3 concentration. In addition, there was a tendency of the Vb response to K concentration steps to decrease, but measurements of the voltage divider ratio did not point to a significant inhibition of a basolateral K conductance. In spite of the almost perfect reciprocity of the results with 10(-6) and 10(-11) mol/l AII, some specific observations suggest that micromolar concentrations of AII do not simply cause mirror-image-like effects, but influence still further transport systems compared to picomolar concentrations.

All the relevant literature reports indicate that net rates of salt and water absorption and cell membrane potentials (Vb) are lower, but intracellular Na+ concentration is higher in rabbit renal proximal tubule in vitro than in rat proximal tubule in vivo. Since the different driving forces should influence basolateral Na(+)-HCO3- cotransport we have studied the operation of the cotransporter in isolated rabbit renal proximal tubule in vitro with special emphasis on the stoichiometry of flux coupling (q). Using conventional and ion-selective intracellular microelectrodes three series of experiments were performed: (a) we determined the Vb response to a 2:1 reduction of bath HCO3- or Na+ concentration, (b) we determined initial efflux rates of HCO3- or Na+ ions in response to a sudden 10:1 reduction of bath HCO3- concentration, and (c) we collapsed the tubules and determined electrochemical driving forces of Na+ and HCO3- across the basolateral cell membrane under conditions approaching zero net flux in the control state in the presence of Ba2+- and in Cl(-)-free solutions. All measurements concurrently yielded a coupling ratio of approximately two HCO3- ions to one Na+ ion (q = 2). This result contrasts with the ratio q = 3, which we have previously observed in similar experiments on rat renal proximal tubule in vivo [Yoshitomi et al. (1985) Pflügers Arch 405:360] and which was also observed on rabbit renal basolateral cell membrane vesicles in vitro [Soleimani et al. (1987) J Clin Invest 79:1276].(ABSTRACT TRUNCATED AT 250 WORDS)