A trivariate autoregressive model, that considers explicitly the influence of respiration, can subdivide overall, lumped, arterial pressure-heart period baroreflex gain, into two separate components, alphaart and alphacp. Only the latter is reduced by active orthostatism.

Smokers appeared characterized by a complex disruption of peripheral microcirculatory regulation, including inappropriate resting vasodilation, impaired endothelium-dependent and independent vasodilation, paradoxical recovery of endothelium-dependent vasodilation in response to acute smoking.

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Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is increasingly recognized as an effective and safe treatment option in patients with acute cholecystitis (AC) who are deemed unfit for cholecystectomy. Recent studies suggest that an endoscopic approach to biliary decompression may reduce patient discomfort and procedure-related costs compared with the standard percutaneous transhepatic GBD, while maintaining high rates of technical and clinical success. Here we present a case of a EUS-GBD in an elderly patient with AC and with altered anatomy due to a previous partial gastrectomy with Roux-en-Y reconstruction for gastric cancer. The linear array echoendoscope was carefully advanced within the afferent limb until EUS gallbladder visualization was achieved. Transmural GBD was then performed by placement of an electrocautery-enhanced lumen-apposing metal stent. If alternative treatments are precluded, EUS-GBD in patients with AC and altered anatomy is a feasible and effective therapeutic option when performed by experienced endoscopists.

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