Nitinol stents with polymer-free paclitaxel coating for stenosis of failing infrainguinal bypass grafts

AIM

This study was designed to investigate the immediate and one-year outcomes of polymer-free paclitaxel coated drug-eluting stent (DES) implantation in a consecutive series of patients presenting with stenosis of infrainguinal bypass grafts.

METHODS

Between January 2011 and January 2012, 11 patients with failing infrainguinal bypass grafts were treated in two institutions. Clinical status and Duplex scan parameters were recorded at baseline and over a follow-up period of one year.

RESULTS

DES implantation was successfully performed in all patients. Ten patients received a single stent and one patient received two stents. At one year, one patient showed total bypass graft occlusion (9%). In all the remaining patients, Duplex scan examination documented patency of the treated grafts.

CONCLUSION

DES implantation in failing infrainguinal bypass grafts can be safely performed and provides satisfactory clinical outcomes. The patency rate of 91% favourably compares with those obtained with other endovascular treatments such as plain balloon or cutting balloon angioplasty.

[Self expandable metal stent as bridge-to-surgery in acute bowel obstruction]

AIM

Self expandable metal stent (SEMS) can be used to relieve malignant colorectal obstruction. The stent serves as a palliative measure for high-risk patients or those with unresectable tumor on subsequent workup. For low-risk patients with resectable disease, SEMS serves as a safe and effective bridge to subsequent laparoscopic surgery.

METHODS

From August 2009 to April 2012 we have treated with SEMS 39 patients, 20 of whom with palliative purpose; 19 patients are treated with SEMS for bridge to surgery, out of these patients, 8 were women, 11 men with median age of 61.4 years (range 36-81 years). Technical success, defined as a successful stent placement and deployment in the stricture site, was achieved for 39/40 patients (97.5%). The average duration of the procedure was about 60 minutes (range 15-120).

RESULTS

Clinical success was achieved for all the 39 patients, 19 of these could be subjected to bowel preparation and colon resection after 25 days from the positioning. No colostomy was performed. Among patients undergoing the procedure, perforation occurred in 1 case.

CONCLUSION

In summary, the colonic stent placement is a complex method that needs qualified medical-nursing team, able to solve any difficult situation, such as the severe, irregular and distal obstruction. SEMS positioning guarantees a high percentage of clinical and technical success; however it is necessary to pay attention to the risk of complications like bowel perforation.

Detrimental effects of ocean acidification on the economically important Mediterranean red coral (Corallium rubrum)

The mean predicted decrease of 0.3-0.4 pH units in the global surface ocean by the end of the century has prompted urgent research to assess the potential effects of ocean acidification on the marine environment, with strong emphasis on calcifying organisms. Among them, the Mediterranean red coral (Corallium rubrum) is expected to be particularly susceptible to acidification effects, due to the elevated solubility of its Mg-calcite skeleton. This, together with the large overexploitation of this species, depicts a bleak future for this organism over the next decades. In this study, we evaluated the effects of low pH on the species from aquaria experiments. Several colonies of C. rubrum were long-term maintained for 314 days in aquaria at two different pH levels (8.10 and 7.81, pHT ). Calcification rate, spicule morphology, major biochemical constituents (protein, carbohydrates and lipids) and fatty acids composition were measured periodically. Exposure to lower pH conditions caused a significant decrease in the skeletal growth rate in comparison with the control treatment. Similarly, the spicule morphology clearly differed between both treatments at the end of the experiment, with aberrant shapes being observed only under the acidified conditions. On the other hand, while total organic matter was significantly higher under low pH conditions, no significant differences were detected between treatments regarding total carbohydrate, lipid, protein and fatty acid composition. However, the lower variability found among samples maintained in acidified conditions relative to controls, suggests a possible effect of pH decrease on the metabolism of the colonies. Our results show, for the first time, evidence of detrimental ocean acidification effects on this valuable and endangered coral species.

The Impact of Event Scale - Revised: psychometric properties of the Italian version in a sample of flood victims

BACKGROUND

This study aims to verify the main psychometric properties of the Italian version of the Impact of Event Scale - Revised (IES-R) in a sample of flood victims.

METHODS

The sample was composed of 262 subjects involved in the natural disaster of 2009 in the city of Messina (Italy). All participants completed the IES-R and the Dissociative Experiences Scale-II (DES-II) in order to verify some aspects of convergent validity.

RESULTS

THE EXPLORATORY AND CONFIRMATORY FACTOR ANALYSIS, USED TO VERIFY THE CONSTRUCT VALIDITY OF THE MEASURE, SHOWED A CLEAR FACTOR STRUCTURE WITH THREE INDEPENDENT DIMENSIONS: intrusion, avoidance, and hyper-arousal. The goodness-of-fit indices (non-normed fit index [NNFI] = 0.99; comparative fit index [CFI] = 0.99; standardized root mean square residual [SRMR] = 0.04; and root mean square error of approximation [RMSEA] = 0.02) indicated a good adaptation of the model to the data. The IES-R scales showed satisfactory values of internal consistency (intrusion, α = 0.78; avoidance, α = 0.72; hyper-arousal, α = 0.83) and acceptable values of correlation with the DES-II.

CONCLUSION

These results suggest that this self-reported and easily administered instrument for assessing the dimensions of trauma has good psychometric properties and can be adopted usefully, both for research and for practice in Italy.

Classification of Pecorino cheeses using electronic nose combined with artificial neural network and comparison with GC-MS analysis of volatile compounds

An electronic nose based on an array of 6 metal oxide semiconductor sensors was used, jointly with artificial neural network (ANN) method, to classify Pecorino cheeses according to their ripening time and manufacturing techniques. For this purpose different pre-treatments of electronic nose signals have been tested. In particular, four different features extraction algorithms were compared with a principal component analysis (PCA) using to reduce the dimensionality of data set (data consisted of 900 data points per sensor). All the ANN models (with different pre-treatment data) have different capability to predict the Pecorino cheeses categories. In particular, PCA show better results (classification performance: 100%; RMSE: 0.024) in comparison with other pre-treatment systems.

Multiple primary melanoma: the impact of atypical naevi and follow up

BACKGROUND

Patients with melanoma are especially encouraged to have regular follow- up visits with their dermatologist and to perform total-body skin examination on a routine basis to identify new pigmented lesions or detect significant changes in existing naevi.

OBJECTIVES

To identify main risk factors (sex, age, number of common and atypical naevi, family history, phototype) associated with multiple primary melanomas (MPM) and to investigate the association between regular follow up and tumour thickness of a second primary melanoma.

METHODS

We performed a retrospective analysis of patients with MPM in order to evaluate risk factors for developing a second primary melanoma. Medical records of patients with melanoma who developed a second primary melanoma were selected from a database of all patients with histopathologically confirmed melanoma treated at the dermatology clinic of the University of Florence, Italy, from 2000 to 2004. Medical data culled from the patient records were as follows: medical history, number of typical naevi, presence of atypical naevi, Breslow thickness, Clark level and histotype of the melanomas, site of the melanomas and patient adherence to 6-month follow-up examinations.

RESULTS

The presence of atypical naevi was associated with a higher risk of developing MPM (adjusted odds ratio 3·28, 95% confidence interval 1·35–7·44). Moreover, in the subjects who did not attend follow up, we noted that the thickness of the second melanoma was significantly higher, with a mean thickness of 1·22 mm, in comparison with patients with a careful adherence to follow up in whom the mean thickness was 0·36 mm (P = 0·0189).

CONCLUSIONS

For the first time, the validity of this clinical approach has been supported by real comparison of thickness levels of second melanoma in patients with or without periodical follow up. Results obtained from this analysis show that follow up is an effective method for early detection of melanoma.

Enteric neuropathy evoked by repeated cisplatin in the rat

BACKGROUND

Acute administration of the antitumoral drug cisplatin can induce nausea/emesis and diarrhea. The long-term effects of cisplatin on gastrointestinal motility, particularly after repeated administration, are not well known. Because cisplatin is highly neurotoxic, myenteric neurons can be affected. Our aim was to study the prolonged effects of repeated cisplatin administration in a rat model, focusing on gastrointestinal motor function and myenteric neurons.

METHODS

Rats received saline or cisplatin (1 or 3 mg kg(-1), i.p.) once weekly for 5 weeks. One week after treatment, both upper gastrointestinal transit and colonic activity were evaluated, and tissue samples from ileum, colon and rectum were processed for histological analysis. Intestinal transit was measured invasively (charcoal method). Colonic activity was determined electromyographically. The gut wall structure was evaluated in sections using conventional histology and immunohistochemistry. Whole-mount preparations from the distal colon were labeled for different markers, including nitric oxide synthase (NOS) and calcitonin-gene related peptide (CGRP) to determine relative proportions of myenteric neurons vs the total neuronal population labeled with HuC/D.

KEY RESULTS

One week after repeated cisplatin exposure, the upper gastrointestinal transit rate and colonic activity were dose-dependently reduced. The number of NSE- or HuC/D-immunoreactive myenteric neurons per ganglion was decreased; the proportion of CGRP-immunoreactive neurons was decreased, whereas that of NOS-immunoreactive cells was increased.

CONCLUSIONS & INFERENCES

Chronic cisplatin may induce an enteric neuropathy characterized by changes in myenteric neurons associated with marked gastrointestinal motor dysfunction.

Evaluation of glomerular filtration rate in HIV-1-infected patients before and after combined antiretroviral therapy exposure

BACKGROUND

The prevalence and factors associated with an increased risk of renal dysfunction in HIV-infected patients receiving or not receiving antiretroviral therapy (ART) have been poorly evaluated in observational settings.

METHODS

Patients in the ICONA Foundation cohort with at least two creatinine values available while still ART-naïve were enrolled in the study. A logistic regression analysis was performed to identify predictors of an estimated glomerular filtration rate (eGFR)<90 mL/min/1.73 m(2) at baseline. The incidence and predictors of a >20% reduction in eGFR from pre-combination ART (cART) levels (or a decrease from ≥90 to <90 mL/min/1.73 m(2) ) were evaluated by Poisson regression.

RESULTS

A total of 1505 patients were included in the study; 363 (24%) had eGFR<90 mL/min/1.73 m(2) at baseline. Older patients [odds ratio (OR) 1.58 per 10 years older; P<0.00001], female patients (OR 2.41 vs. male patients; P<0.00001), those who had diabetes and/or hypertension (OR 2.36 vs. neither; P<0.03) and patients with higher baseline CD4 count (OR 1.06 per 100 cells/μL higher; P<0.03) showed a greater risk of eGFR<90 mL/min/1.73 m(2) . Ninety-six patients experienced an eGFR decrease of >20% from pre-cART levels (6.8 per 100 person-years). Older age [relative risk (RR) 1.41 per 10 years older; P=0.005], female gender (RR 2.25 vs. male; P=0.003) and current exposure to didanosine (ddI), tenofovir and protease inhibitors were the major determinants.

CONCLUSIONS

We observed a relatively high rate of mild renal dysfunction in the absence of ART. In addition to traditional risk factors such as older age and diabetes/hypertension, female gender and current use of ddI, tenofovir and protease inhibitors were associated with a greater risk of decreased renal function as measured by eGFR.

Classification of Pecorino cheeses produced in Italy according to their ripening time and manufacturing technique using Fourier transform infrared spectroscopy

Fourier-transform infrared spectroscopy, followed by linear discriminant analysis of the spectral data, was used to classify Italian Pecorino cheeses according to their ripening time and manufacturing technique. The Fourier transform infrared spectra of the cheeses were divided into 18 regions and the normalized absorbance peak areas within these regions were used as predictors. Linear discriminant analysis models were constructed to classify Pecorino cheeses according to different ripening stages (hard and semi-hard) or according to their manufacturing technique (fossa and nonfossa cheeses). An excellent resolution was achieved according to both ripening time and manufacturing technique. Also, a final linear discriminant analysis model considering the 3 categories (hard nonfossa, hard fossa, and semi-hard nonfossa) was constructed. A good resolution among the 3 categories was obtained.

A severe complication of anti-TNF alfa treatment

The antitumor necrosis factor (TNF-alpha) drugs are increasingly used in treating skin diseases such as psoriasis. TNF-alpha is a proinflammatory cytokine with a key role in the pathogenesis of psoriasis but also in host defence against bacterial pathogens, especially against those that multiply inside host cells. The effectiveness of anti-TNF-alpha in the treatment of psoriasis is now widely recognized and has led to their increasingly wide use. Although these drugs are considered relatively safe, their use is associated with an increased incidence of serious infections even in patients treated. Have been described above numerous cases of tuberculosis but has also observed an increased incidence of granulomatous infections by intracellular bacteria such as Legionella pneumophila required. Infections due to this biotic agent, if not diagnosed early, are potentially fatal. We report the case of a patient, heavy smoker, suffering from severe skin psoriasis who after starting treatment with infliximab developed a pneumonia caused by Legionella pneumophila. Our aim is to draw the attention of specialists on increasing risk of granulomatous infections by intracellular agents in patients being treated with anti TNF-alpha.

Infliximab efficacy in nail psoriasis. A retrospective study in 48 patients

BACKGROUND

Nail psoriasis occurs in up to half of psoriatic patients and can lead to significant physical impairment and pain. To date, patients and clinicians are actually dissatisfied by current therapeutic approaches.

OBJECTIVE

Our main aim is to evaluate Infliximab efficacy in nail psoriasis.

METHODS

We performed an open-label and uncontrolled retrospective study considering all psoriatic patients presenting recalcitrant nail involvement and receiving Infliximab in our Department during the period between January 2008 and March 2009. We calculated nail psoriasis severity index (NAPSI) score at 0, 14, 22 and 38 weeks and percentage of patients achieving NAPSI-50,-75,-90 at 14, 22 and 38 weeks.

RESULTS

We observed a rapid nail improvement in most cases after 22 weeks of Infliximab therapy, but a complete nail clearing was reached in only five (10.4%) patients. We don't have a follow-up longer than 38 weeks to assess long-term efficacy of this treatment in nail psoriasis.

CONCLUSIONS

Infliximab, in our experience, has proved to be effective in reducing nail lesions and, in some cases, even clearing them. Our data demonstrate long-term efficacy of this biological agent in nail psoriasis.