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The IL-1 receptor antagonist, anakinra, may represent a therapeutic option for acute respiratory distress syndrome (ARDS) associated with coronavirus disease 2019 (COVID-19). In this study, COVID-19 ARDS patients admitted to the Azienda Socio Sanitaria Territoriale of Lecco, Italy, between March 5th to April 15th, 2020, and who had received anakinra off-label were retrospectively evaluated and compared with a cohort of matched controls who did not receive immunomodulatory treatment. The primary end point was survival at day 28. The population consisted of 112 patients (56 treated with anakinra and 56 controls). Survival at day 28 was obtained in 69 patients (61.6%) and was significantly higher in anakinra-treated patients than in the controls (75.0 versus 48.2%, p = 0.007). When stratified by continuous positive airway pressure support at baseline, anakinra-treated patients' survival was also significant compared with the controls ( p = 0.008). Univariate analysis identified anakinra usage (odds ratio, 3.2; 95% confidence interval, 1.47-7.17) as a significant survival predictor. This was not supported by multivariate modeling. The rate of infectious-related adverse events was similar between groups. In conclusion, anakinra improved overall survival and invasive ventilation-free survival and was well tolerated in patients with ARDS associated with COVID-19., (Copyright © 2021 by The American Association of Immunologists, Inc.)

Purpose: In this study we investigated in observers with low myopia: (i) the pattern of lateral interactions between stimuli activating early cortical analyzers and its modulation by perceptual learning (PL), and (ii) whether PL transferred to untrained stimuli and tasks and whether it exhibits interocular transfer., Method: Participants (seven adults with low myopia) performed 12 training sessions. Participants were trained on a contrast detection task of a central Gabor target flanked by two co-oriented and co-aligned high contrast Gabor patches. Target-to-flankers separation along the vertical axis was varied from 2 wavelengths (λ) to 8λ., Results: The results showed that before PL facilitatory lateral interactions in the myopic eye were reduced in strength, but PL increased contrast sensitivity and improved facilitatory lateral interactions. However, PL did not transfer to different local/global orientations and lower spatial frequencies. On the other hand, PL resulted in an enhancement of the contrast sensitivity function (CSF) and of the uncorrected visual acuity (UCVA) both in the trained and untrained eye., Conclusions: Such improvements seem to be associated to a modulation of lateral interactions between target and flankers and it is likely to take place at a level in which the inputs from the two eyes converge.

The effect of visual experience is usually investigated through active (task dependent) training in a discrimination task. In contrast, the current work explored the psychophysical and electrophysiological correlates of passive (task independent) visual experience in texture segmentation by using an inattentional blindness-like paradigm (Mack et al., 1992). The psychophysical and electrophysiological responses to a segmented line-texture bar, with texture elements oriented either congruently (parallel) or noncongruently (orthogonal) to bar orientation, were collected after both short and long passive experience, with the texture presented on the background while subjects performed a primary task. Subjects were not able to distinguish the orientation of the bar (psychophysical results) after either short or long passive experience. However, the short experience produced an electrophysiological correlate of texture segmentation (N150), and the amplitude of this component was greater for the parallel bar, demonstrating that it reflected not simply local orientation discontinuities but also texture boundary-surface orientation congruency. This configurational effect in texture segmentation, which occurred without awareness during passive viewing, disappeared when the subjects had previously discriminated the orientation of the bar and when experience was lengthened, probably as a consequence of adaptation. Our study provides the first ERP evidence that boundary-surface relations are available during short passive visual experiences of very salient texture images and are suppressed by long experience, probably because of adaptation., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Working memory decay in advanced age has been attributed to a concurrent decrease in the ability to control interference. The present study contrasted a form of interference control in selective attention that acts upon the perception of external stimuli (access) with another form that operates on internal representations in working memory (deletion), in order to determine both of their effects on working memory efficiency in younger and older adults. Additionally, we compared memory performance under these access and deletion functions to performance in their respective control conditions. The results indicated that memory accuracy improved in both age groups from the access functions, but that only young adults benefited from the deletion functions. In addition, intrusion effects in the deletion condition were larger in older than in younger adults. The ability to control the irrelevant perception- and memory-elicited interference did not decline in general with advancing age; rather, the control mechanisms that operate on internal memory representations declined specifically.

To find the diagnostic spatial frequency information in different painting styles (cubism, impressionism and realism), we have compared sensitivity (d') in distinguishing signal (subject of the painting) from noise with normal, high-pass and low-pass filtered images at long (150 ms) and short (30 ms) exposure. We found that for cubist-style images, d' increases with high-pass filtering compared with normal and low-pass filtered images, but decreases with low-pass filtering compared with normal images. These results indicate that channels with high spatial resolution provide the diagnostic information to solve the binding problem. Sensitivity for images in impressionist style was instead reduced by both low- and high-pass filtering. This indicates that both high and low spatial frequency channels play a role in solving the binding problem, suggesting the involvement of large collator units that group the response of small channels tuned to the same orientation. The difference between realism, which shows higher sensitivity for low-frequency filtering at short durations and cubism in which the binding problem is solved by high spatial frequency channels, has a corresponding difference in aesthetic judgment: the probability of judging a painting as 'intriguing' is larger with low-pass filtering than with high-pass filtering in realism, while the opposite is true for cubism. This suggests that the aesthetic experience is available during early processing of an image, and could preferentially influence high-level categorization of the subject of a painting.

This paper describes the transesophageal echocardiographic "oblique transgastric" view to assess the right ventricular inflow-outflow tract. With this approach it is possible to view the right atrium, tricuspid valve, right ventricular inflow and outflow tracts, and the main pulmonary artery. In 2 clinical cases we evaluated the clinical feasibility of this approach in the diagnostic phase; in 31 patients who underwent cardiac transplantation we examined the advantages of this noninvasive hemodynamic monitoring. An advantage of transgastric view compared with esophageal standard views at 30-60 degrees, is the feasibility to obtain the velocity-time integral of the outflow tract systolic flow to calculate cardiac output by the pulsed Doppler sample volume orientation, which in this view is parallel to pulmonary arterial flow; moreover, it is possible to evaluate pulmonary artery pressures from pulmonary and tricuspid regurgitation.

Objective: Since excessive fibrinolysis during cardiac surgery is frequently associated with abnormal perioperative bleeding, many authors have advocated prophylactic use of antifibrinolytic drugs to prevent hemorrhagic disorders. We compared the effects of tranexamic acid (a synthetic antifibrinolytic drug) with aprotinin (a natural derivative product with antifibrinolytic properties) on perioperative bleeding and the need for allogeneic transfusions., Methods: In a single-center prospective randomized unblinded trial, 1040 consecutive patients undergoing primary, elective cardiac operations with cardiopulmonary bypass received either high-dose aprotinin or tranexamic acid. The aprotinin group (518 patients) received 280 mg in 20 minutes before the skin incision, 280 mg in the priming solution of the extracorporeal circuit, and a continuous infusion of 70 mg/h throughout the operation. The tranexamic acid group (522 patients) received 1 g in 20 minutes before the skin incision, 500 mg in the priming solution of the extracorporeal circuit, and a continuous infusion of 400 mg/h during the operation. Postoperative bleeding, perioperative transfusions, and hematologic variables were evaluated at fixed times. Postoperative thrombotic complications, intubation time, intensive care unit stay, and hospital stay were recorded., Results: Postoperative bleeding was similar in the 2 groups: aprotinin 250 mL (150-400 mL) versus tranexamic acid 300 mL (200-450 mL) (median and 25th-75th quartiles), median difference of 50 mL (95% confidence intervals, 0-50 mL). The number of transfusions and the outcome did not differ., Conclusions: Tranexamic acid and aprotinin show similar clinical effects on bleeding and allogeneic transfusion in patients undergoing primary elective heart operations. Since tranexamic acid is about 100 times cheaper than aprotinin, its use is preferable in this type of patient.

Background: The effects of epsilon-aminocaproic acid (EACA) and tranexamic acid (TA) on bleeding and allogeneic transfusions, and the cost of pharmacological and transfusional treatment were compared to aprotinin (AP)., Methods: We randomized 210 patients subjected to elective cardiac surgery. Of these, 68 patients received EACA (a bolus of 5 g, an infusion of 2 g/h, and 2.5 g in the priming), 72 patients received TA (a bolus of 1 g, an infusion of 400 mg/h, and 500 mg in the priming), and 70 patients received AP (a bolus of 280 mg, an infusion of 70 mg/h, and 280 mg in the priming). Postoperative blood loss and homologous transfusions were collected and the cost of pharmacological treatment and homologous transfusions were calculated., Results: Bleeding but not allogeneic transfusions was significantly higher in the EACA group (467+/-234 versus TA, 311+/-231 versus AP, 283+/-233; p < 0.001). Costs of pharmacological and transfusional treatment were significantly lower in the TA group ($58.10+/-$105.10) versus the EACA group ($100.70+/-$158.60) versus the AP group ($432.60+/-$118.70) (p < 0.0001)., Conclusions: Compared to AP, TA has the same effects on bleeding and transfusions, but with a significant reduction of costs. Patients treated with EACA showed a significantly higher postoperative bleeding with an increased trend of transfusion requirement.