No abstract

For the first time fish RNases have been isolated and characterized. Their functional and structural properties indicate that they belong to the RNase A superfamily (or tetrapod RNase superfamily), now more appropriately described as the vertebrate RNase superfamily. Our findings suggest why previously repeated efforts to isolate RNases from fish tissues have met with no success; fish RNases have a very low ribonucleolytic activity, and their genes have a low sequence identity with those of mammalian RNases. The investigated RNases are from the bony fish Danio rerio (or zebrafish). Their cDNAs have been cloned and expressed, and the three recombinant proteins have been purified to homogeneity. Their characterization has revealed that they have indeed a very low RNA-degrading activity, when compared with that of RNase A, the superfamily prototype, but comparable with that of mammalian angiogenins; that two of them have angiogenic activity that is inhibited by the cytosolic RNase inhibitor. These data and a phylogenetic analysis indicate that angiogenic fish RNases are the earliest diverging members of the vertebrate superfamily, suggesting that ribonucleases with angiogenic activity were the ancestors of all ribonucleases in the superfamily. They later evolved into both mammalian angiogenins and, through a successful phylogenesis, RNases endowed with digestive features or with diverse bioactivities.One of the largest and most studied superfamilies of proteins is that of extracellular, pyrimidine-specific, animal RNases. It has been labeled with different names on different bases: the "RNase A superfamily," a mostly historical name, recognizes bovine pancreatic RNase A, one of the most successfully investigated proteins, as the superfamily prototype; the "pancreatictype RNase superfamily," which includes not only the large family of RNases isolated from the pancreas of many animals but also all other RNases phylogenetically related to them; or "the tetrapod RNase superfamily," as to date the investigated members of this superfamily comprise RNases from mammals, birds, reptiles, and amphibians but not from fish (1).Some of the tetrapod RNases have diverse bioactivities, distinct from the ribonucleolytic activity, but strictly dependent on it, including immunosuppressive, cytotoxic, microbicidal, and angiogenic activity (2). The RNases with angiogenic activity, the angiogenins, form a distinct family within the superfamily and are identified by their ability to stimulate the growth of blood vessels (3, 4). Angiogenins with confirmed angiogenic activity, investigated so far only in mammals, are RNases characterized by a very low catalytic activity, albeit essential to their angiogenic activity, and the presence in their structure of only three disulfides, compared with the four disulfide bridges of most mammalian RNases (3-5).Studies carried out mostly with human angiogenin (hANG) 2 have indicated that hANG is recognized by a putative 170-kDa receptor on endothelial cells (6) and is translocated to the cell nucleus (...

The outbreak of coronavirus disease 2019 (COVID-19) has created a global health crisis that has had a deep impact on the way we communicate with patients and their relatives in all the COVID-19 care settings, given the need to maintain isolation and social distancing [1]. To be highly effective, communication in medical encounters must capitalize on both verbal and nonverbal aspects. Both of these have been highly compromised in the COVID-19 experiences both in hotbed sites and in affected but more controlled settings. Loved ones of COVID-19 patients are suffering in unique ways as a result of adaptions in our communication. Dealing with emotion is as important as relaying information about diagnosis and prognosis, detecting and recognizing emotions as legitimate enables you to create trust and establish therapeutic alliance [2]. Nonverbal communication is established by eye contact, posture, tone of voice, head nods, gesture, and the postural position. Empathy is of great significance for better healthcare outcomes as part of a warm and friendly communication style. Communication between intensive care unit (ICU) staff and patients' families is essential in critical care medicine: relatives rate communication skills as just as valuable as clinical skills, or even more so (Fig. 1). The relatives of critically ill patients are at increased risk for traumatic stress symptoms (PTSS, 57%), anxiety

Background: A high incidence of venous thromboembolism (VTE) is reported in hospitalized COVID-19 patients, in particular in patients admitted to the intensive care unit (ICU). In patients with respiratory tract infections, including influenza A (H1N1), many studies have demonstrated an increased incidence of thromboses, but evidence is lacking regarding the risk difference (RD) of the occurrence of VTE between COVID-19 and non-COVID-19 patients. Methods: In this systematic review with meta-analysis, we evaluated the RD of the occurrence of VTE, pulmonary embolism (PE), and deep venous thrombosis (DVT) between COVID-19 and other pulmonary infection cohorts, in particular H1N1, and in an ICU setting. We searched for all studies comparing COVID-19 vs. non-COVID-19 regarding VTE, PE, and DVT. Results: The systematic review included 12 studies and 1,013,495 patients. The RD for VTE in COVID-19 compared to non-COVID-19 patients was 0.06 (95% CI 0.11–0.25, p = 0.011, I2 = 97%), and 0.16 in ICU (95% CI 0.045–0.27, p = 0.006, I2 = 80%). The RD for PE between COVID-19 and non-COVID-19 patients was 0.03 (95% CI, 0.006–0.045, p = 0.01, I2 = 89%). The RD for PE between COVID-19 and non-COVID-19 patients was 0.021 in retrospective studies (95% CI 0.00–0.04, p = 0.048, I2 = 92%) and 0.11 in ICU studies (95% CI 0.06–0.16, p < 0.001, I2 = 0%). Conclusions: The growing awareness and understanding of a massive inflammatory response combined with a hypercoagulable state that predisposes patients to thrombosis in COVID-19, in particular in the ICU, may contribute to a more appropriate strategy of prevention and earlier detection of the thrombotic events.

Burnout is one of the main chronic health problems with negative consequences on caregivers but also on the quality of care. This is a multidimensional occupational syndrome, characterized by three main criteria: emotional exhaustion (EE), depersonalization (DP), and low personal accomplishment (PA). Burnout is particularly identified in professionals working in caregiving and human services, especially the ones who are interpersonally stressed and emotionally vulnerable. Intensive care professionals seem to face a critical risk of burnout. This study aiming to evaluate the occurrence and the risk factors of burnout among Italian anesthesiologists and intensive care physicians. All members included in the mailing list of the Italian Society of Anesthesia, Analgesia, and Intensive Care were invited to participate in an online survey. An anonymous questionnaire was distributed via a specific website. Burnout was measured using the Maslach Burnout Inventory (MBI) questionnaire. All responses were evaluated through univariate and multivariable logistic regression. A total of 859 physicians out of 3,654 (23.5%) participated in this online survey. According to the MBI criteria for a high degree of burnout, 10.2% (88) of the respondents reported high EE, high DP, and low PA together; 79.9% (686) exhibited a moderate degree of burnout; and 9.9% (85) reported a low degree of burnout, with normal values in all three of the explored psychological dimensions. This study reported mostly a moderate level of burnout among Italian anesthesiologist and intensive care physicians since we found 10.2% incidence for high degree of burnout according to the MBI criteria.