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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The term HELLP syndrome (an acronym of haemolysis, elevated liver enzyme, and low platelets) represents a severe variant of preeclampsia-eclampsia. It was described in these last years. The interpretation of elevated liver enzymes, the presence of haemolysis, and the platelets consumption are clinical pictures of internal physician interest (represented by an emergentist). We describe a case report and revised the recent literature, particularly the therapeutic aspects on the role of steroids. They are still object of studies and their use is not unanimously shared

Emergency Wards since we do not have a Neurology Department. Since 1998 we have been registering every patient that has arrived in our hospital with an acute cerebrovascular accident. We retrospectively evaluated 1263 patients (628 men, 49.7%; mean age 76Ϯ13 years) with either an acute ischemic stroke (58.6%) or a transient ischemic attack (41.4%).A knowledge of dyslipidemic disorder was present in only 91 patients (7.2%). Of these patients, 42 (46.2%) were treated with lipid-lowering drugs; specifically, 36 patients were treated with statins (14ϭsimvastatin; 13ϭatorvastatin; 7ϭpravastatin; 1ϭfluva-statin; 1ϭcerivastatin) and 3 patients were treated with fibrates. In 3 patients the drug was not known.A total of 905 of the 1263 patients have been admitted in General Medicine or the Emergency Department; we collected the laboratory data in 382 (42.2%) of these patients, and total cholesterol and triglyceride levels were measured in 57.9% and 55.0% of these patients, respectively. Total cholesterol determinations varied between the departments, ranging from 33.3% to 89.0%.A total cholesterol level Ͼ200 mg/dL and a triglyceride level Ͼ150 mg/dL was present in 57.5% and 23.8% of patients, respectively.Among 161 patients in whom the total cholesterol level was not determined, 81.4% presented relevant atherosclerosis risk factors such as chronic coronary disease, arterial hypertension, carotid stenosis, or previous ischemic cerebrovascular accidents.Our data confirm that in general medical wards there still is not a deep knowledge of the role of lipid disorders in patients with acute ischemic stroke and transient ischemic attack. The lack of knowledge is probably the cause of the general low use of statins.We confirm that educational programs are necessary to improve the knowledge of guidelines and recommendations currently not adequately followed.