Key PointsQuestionWhat are the baseline characteristics and outcomes of patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to intensive care units (ICUs) in Lombardy, Italy?FindingsIn this retrospective case series that involved 1591 critically ill patients admitted from February 20 to March 18, 2020, 99% (1287 of 1300 patients) required respiratory support, including endotracheal intubation in 88% and noninvasive ventilation in 11%; ICU mortality was 26%.MeaningIn this case series of critically ill patients admitted to ICUs in Lombardy, Italy, with laboratory-confirmed coronavirus disease 2019 (COVID-19), a high proportion required mechanical ventilation and ICU mortality was 26% as of March 25, 2020.

Background The COVID-19 pandemic is challenging advanced health systems, which are dealing with an overwhelming number of patients in need of intensive care for respiratory failure, often requiring intubation. Prone positioning in intubated patients is known to reduce mortality in moderate-to-severe acute respiratory distress syndrome. We aimed to investigate feasibility and effect on gas exchange of prone positioning in awake, non-intubated patients with COVID-19-related pneumonia. MethodsIn this prospective, feasibility, cohort study, patients aged 18-75 years with a confirmed diagnosis of COVID-19related pneumonia receiving supplemental oxygen or non-invasive continuous positive airway pressure were recruited from San Gerardo Hospital, Monza, Italy. We collected baseline data on demographics, anthropometrics, arterial blood gas, and ventilation parameters. After baseline data collection, patients were helped into the prone position, which was maintained for a minimum duration of 3 h. Clinical data were re-collected 10 min after prone positioning and 1 h after returning to the supine position. The main study outcome was the variation in oxygenation (partial pressure of oxygen [PaO 2 ]/fractional concentration of oxygen in inspired air [FiO 2 ]) between baseline and resupination, as an index of pulmonary recruitment. This study is registered on ClinicalTrials.gov, NCT04365959, and is now complete. Findings Between March 20 and April 9, 2020, we enrolled 56 patients, of whom 44 (79%) were male; the mean age was 57•4 years (SD 7•4) and the mean BMI was 27•5 kg/m² (3•7). Prone positioning was feasible (ie, maintained for at least 3 h) in 47 patients (83•9% [95% CI 71•7 to 92•4]). Oxygenation substantially improved from supine to prone positioning (PaO 2 /FiO 2 ratio 180•5 mm Hg [SD 76•6] in supine position vs 285•5 mm Hg [112•9] in prone position; p<0•0001). After resupination, improved oxygenation was maintained in 23 patients (50•0% [95% CI 34•9-65•1]; ie, responders); however, this improvement was on average not significant compared with before prone positioning (PaO 2 /FiO 2 ratio 192•9 mm Hg [100•9] 1 h after resupination; p=0•29). Patients who maintained increased oxygenation had increased levels of inflammatory markers (C-reactive protein: 12•7 mg/L [SD 6•9] in responders vs 8•4 mg/L [6•2] in non-responders; and platelets: 241•1 × 10³/µL [101•9] vs 319•8 × 10³/µL [120•6]) and shorter time between admission to hospital and prone positioning (2•7 days [SD 2•1] in responders vs 4•6 days [3•7] in non-responders) than did those for whom improved oxygenation was not maintained. 13 (28%) of 46 patients were eventually intubated, seven (30%) of 23 responders and six (26%) of 23 non-responders (p=0•74). Five patients died during follow-up due to underlying disease, unrelated to study procedure. Interpretation Prone positioning was feasible and effective in rapidly ameliorating blood oxygenation in awake patients with COVID-19-related pneumonia requiring oxygen supplementation. The effect was maintained after resupina...

Frequent coffee consumption has been associated with a reduced risk of colorectal cancer in a number of case-control studies. Coffee is a leading source of methylxanthines, such as caffeine. The induction of vascular endothelial growth factor (VEGF) and interleukin-8 (IL-8) is an essential feature of tumor angiogenesis, and the hypoxia-inducible factor-1 (HIF-1) transcription factor is known to be a key regulator of this process. In this study, we investigated the effects of caffeine on HIF-1 protein accumulation and on VEGF and IL-8 expression in the human colon cancer cell line HT29 under hypoxic conditions. Our results show that caffeine significantly inhibits adenosineinduced HIF-1␣ protein accumulation in cancer cells. We show that HIF-1␣ and VEGF are increased through A 3 adenosine receptor stimulation, whereas the effects on IL-8 are mediated via the A 2B subtype. Pretreatment of cells with caffeine significantly reduces adenosine-induced VEGF promoter activity and VEGF and IL-8 expression. The mechanism of caffeine seems to involve the inhibition of the extracellular signal-regulated kinase 1/2 (ERK1/2), p38, and Akt, leading to a marked decrease in adenosine-induced HIF-1␣ accumulation, VEGF transcriptional activation, and VEGF and IL-8 protein accumulation. From a functional perspective, we observe that caffeine also significantly inhibits the A 3 receptor-stimulated cell migration of colon cancer cells. Conditioned media prepared from colon cells treated with an adenosine analog increased human umbilical vein endothelial cell migration. These data provide evidence that adenosine could modulate the migration of colon cancer cells by an HIF-1␣/VEGF/IL-8-dependent mechanism and that caffeine has the potential to inhibit colon cancer cell growth.Coffee and tea are the most commonly consumed beverages in the world (Fredholm, 1999). Results of epidemiological studies have not resolved whether coffee consumption is related to colorectal cancer risk. A report by the World Cancer Research Fund concluded that the available evidence was not sufficient to draw any firm conclusions about a decreased risk of colorectal cancer associated with coffee consumption (World Cancer Research Fund/American Institute for Cancer Research, 1997). However, some researchers contend that a link between high consumption of coffee and a low incidence Article, publication date, and citation information can be found at http://molpharm.aspetjournals.org. doi:10.1124/mol.106.032920.ABBREVIATIONS: IL-8, interleukin-8; Cl-IB-MECA, N 6 (3-iodobenzyl)2-chloroadenosine-5ЈN-methyluronamide; DPCPX, 1,3-dipropyl-8-cyclopentylxanthine; MRE 2029F20, N-benzo[1,3]dioxol-5-yl-2-[5-(2,6-dioxo-1,3-dipropyl-2,3,6,7-tetrahydro-1H-purin-8-yl)-1-methyl-1H-pyrazol-3-yloxy

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