NIPSV proved to be equally effective in improving vital signs and ventilation without increasing acute myocardial infarction rate in patients with nonischemic acute pulmonary edema in comparison to CPAP alone. However, because the study lacked statistical power and excluded patients with acute coronary syndromes, caution is still advised when applying NIPSV to the latter subgroup of patients.

NIPSV proved as effective as CPAP in the treatment of patients with acute pulmonary edema and hypercapnia but did not improve resolution time.

EC was more effective in patients with acute AF and resulted in a shorter length of stay in the ED than PC. Adverse events were small in number and transient in both groups of patients. Clinical trials registration number NCT00933634.

While several papers support the physiological and clinical relevance of indices quantifying the sensitivity of spontaneous baroreflex control of heart rate (BRS), 1 Lipman et al 2 claim that they are unable to properly explore baroreflex function because spontaneous BRS was found to be quantitatively different from BRS values provided by the vasoactive drug injection technique and is unrelated to common carotid artery distensibility. We believe that this conclusion is not supported by Lipman's data, for the following reasons. Whether the origin of SBP ramps is spontaneous or by pharmacological means must be immaterial to the baroreceptors, with the partial physiological exception of spontaneous BP changes due to central influences simultaneously responsible also for arterial baroreflex resetting. 4. Spontaneous BRS assessment by the sequence and spectral method was validated not only by the drug injection approach, but also by surrogate data analysis 11 and for baroreceptor denervation in animals, which led to disappearance of baroreflex sequences 12 and to a marked reduction in the ␣ coefficient values. 13 5. The relation between carotid distensibility and BRS should be assessed in absence of diseases altering the baroreflex arch, while in some patients recruited in Lipman's study normal carotid distensibility coexisted with diseaseinduced alterations of BRS. Moreover, there is evidence, in absence of drug injection, of spontaneous low frequency oscillations in carotid diameter that are related with lowfrequency heart rate oscillations, further supporting the relevance of spontaneous methods to baroreflex physiology. 14 6. No BRS estimation technique, including drug injections, can produce stable numbers due to the physiological variability in BRS. [15][16][17][18][19] Thus BRS estimates provided by only a few drug injections may be less reliable than spontaneous estimates assessed by averaging data over a sufficiently long time period. 7. Lipman et al's paper also faces other methodological problems: patients selection criteria; 20 -22 excessive focus on subjects with low baroreflex gain in whom a decrease in the between-method correlation is mathematically expected given the larger bias of low BRS estimates; sequential performance of drug injections with insufficient time to resume baseline conditions; 3,4 use of different algorithms to derive pharmacological and spontaneous BRS values; 15,[22][23][24][25] and improper use of the Bland-Altman approach to assess between-method discrepancies. 26,27 The conclusions of Lipman et al should thus be carefully reconsidered and the finding of quantitative discrepancies between pharmacological and spontaneous BRS values should not be interpreted as a difference between "real" and "biased" BRS estimates but rather as the expected difference in result of methods that explore baroreflex function from different but complementary perspectives.

Blood pressure (BP) is characterized by continuous fluctuations, including fast changes lasting only a few seconds as well as slower and more prolonged variations, with a time constant of minutes or hours. Assessing the relative contribution of these different components to overall blood pressure variance is now possible through a number of mathematical approaches, either in the time or in the frequency domain (spectral analysis). Due to its complex nature, a precise and detailed assessment of blood pressure variability can be obtained only from the analysis of continuous, beat-by-beat, blood pressure recordings. Some information, however, can also be derived from analysis of discontinuous blood pressure tracings, such as those commonly performed in a clinical setting. This would require that attention is paid both to the quality of the recordings and to the selection of suitable analysis methods that should cope with the discontinuous nature of the measurements to be processed and to their intrinsic low sampling frequency.

The human brain can simulate motor actions without physically executing them, and there is a neuro-psychological relationship between imaging and performing a movement. These are shared opinions. In fact there is scientific evidence showing that the mental simulation of an action is correlated to a subliminal activation of the motor system. There is also evidence that virtual stimulation can enhance the acquisition of simple motor sequences. In some situations, virtual training was found to be as beneficial as real training and more beneficial than workbook and no training in teaching complex motor skills to people with learning disabilities. Moreover, studies of brain-injured hemiplegics patients suggest that these patients retain the ability to generate accurate motor images even of actions that they cannot perform. Combined with evidence indicating that motor imagery and motor planning share common neural mechanisms, these observations suggest that supporting mental imagery through non-immersive, low-cost virtual reality (VR) applications may be a potentially effective intervention in the rehabilitation of brain-injured patients. Starting from this background, our goal is to design and develop a new technique for the acquisition of new motor abilities- "imagery enhanced learning" (or I-learning)-to be used in neuro-psychological rehabilitation. A key feature of I-learning is the use of potentially low-cost, Virtual Reality enhanced technology to facilitate motor imagery creating a compelling sense of presence. This paper will discuss the rationale and a preliminary rehabilitation protocol for investigating mental imagery as a means of promoting motor recovery in patients with a neurological disorder. The treatment strategy aims at evoking powerful imaginative responses using an innovative technique which makes no attempt to simulate the real-world motor behavior, but draws the patient's attention to its underlying dynamic structure. This is done by displaying highly stylized sketches of the motor behavior on a computer screen and gradually increasing the perceptual realism of the visualization. This strategy assumes that optimal learning will be achieved when the patient is allowed to elaborate his own schema and sequences of movements, thereby constructing his own personal image of the motor behavior to be trained.

Low-dose fentanyl administration in healthy volunteers leads to sympathetic and overall ANS modulation decrease, with a trend toward vagal activation.

No abstract