Placebo and Nocebo Effects

Autori: Luana Colloca, M.D., Ph.D. Arthur J. Barsky, M.D.
Journal: N Engl J Med
Data Publication : 2020; 382:554-561
DOI1: https://www.nejm.org/doi/full/10.1056/NEJMra1907805

Placebo and nocebo effects are the effects of patients’ positive and negative expectations, respectively, concerning their state of health. These effects occur in many clinical contexts, including treatment with an active agent or a placebo in clinical practice or in a clinical trial, the informed-consent process, the provision of information about medical treatments, and public health campaigns. Placebo effects cause beneficial outcomes, and nocebo effects cause harmful and dangerous outcomes.

Variation in the ways that patients respond to treatments and experience symptoms is partly attributable to placebo and nocebo effects. The frequency and intensity of placebo effects in clinical practice are difficult to determine, and the range of effects in experimental settings is wide.

Baroreflex Dysfunction

Autori: Horacio Kaufmann, M.D., Lucy Norcliffe-Kaufmann, Ph.D., and Jose-Alberto Palma, M.D., Ph.D.
Journal: N Engl J Med
Data Publication : 2020;382:163-178
DOI1: https://www.nejm.org/doi/10.1056/NEJMra1509723

The autonomic nervous system innervates all body organs, including the cardiovascular system. Smooth muscle in arteries, arterioles, and veins and pericytes in capillaries receive autonomic innervation, which modulates vascular smooth-muscle tone and vessel diameter. Afferent sensory neurons with receptors monitoring local changes in the chemical and mechanical environment provide the information that allows the autonomic nervous system to regulate blood flow within every organ and redirect cardiac output to vascular beds as needed.

The autonomic nervous system provides moment-to-moment control of blood pressure and heart rate through baroreflexes.1 These negative-feedback neural loops regulate specific groups of both sympathetic neurons sending nerve impulses to the vasculature, the heart, and the kidney and parasympathetic neurons sending nerve impulses to the sinus node of the heart. We describe the main features of baroreflexes and the clinical phenotypes of baroreflex impairment.

Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery

Autori: Landoni G, Lomivorotov VV, Nigro Neto C, Monaco F, Pasyuga VV, Bradic N, Lembo R, Gazivoda G, Likhvantsev VV, Lei C, Lozovskiy A, Di Tomasso N, Bukamal NAR, Silva FS, Bautin AE, Ma J, Crivellari M, Farag AMGA, Uvaliev NS, Carollo C, Pieri M, Kunstýř J, Wa