Improved chemometric approach for XRF data treatment: application to the reverse glass paintings from the Lipari collection

The Aeolian cultural heritage preserves hundreds of testimonies of the past that have passed through six millennia of history. Among these, the Archeological Park of the Aeolian Islands with the Museum Luigi Bernabò Brea (Italy) preserves a valuable set of artworks, which are related to a little-known 'popular' figurative heritage. It is an assemblage of small glass foils decorated using the technique of reverse painting, datable to between the end of the 17^th century and the end of the 18^th century, and actually under investigation by historians. Here, an X-ray fluorescence (XRF) spectroscopy study (performed with portable equipment) is combined with a multivariate approach that allows us to define the best way to process the data to detect compositional differences and similarities among the glass supports. The Principal Component Analysis (PCA) and Hierarchical Cluster Analysis (HCA) were applied both on normalized spectra and on normalized peak areas in order to establish the chemometric approach with the highest grouping ability. Results showed that the analysis of the normalized area provides the most reliable grouping based on the different elemental compositions, without problems coming from the background or peak-shape distortions. The obtained results can be used by researchers involved in the analysis of XRF data as a guideline to perform chemometrics. Furthermore, regarding the reverse glass, they can be divided into different typologies based on composition differences, providing a further discrimination criterion for historians involved in the study of the collection to determine the provenance and dating of the items.

[Gender Diversity and Impact on Work and Life Expectancy in Health Care. Results of a Survey Conducted in the Tuscany Region]

The percentage of female doctors employed in the health sector is constantly increasing both in Europe and in Italy with repercussions on organizational and socio-family models, currently not conceived in terms of equal opportunities, career and quality of life. The published studies have mainly taken into consideration economic and career disparities, (1) however, to date no study combined with surveys has highlighted criteria for evaluating the quality of work through the direct and sincere experience of workers. This reflection gave rise to the idea of a survey organized by the ANAAO Medical Women Group with the patronage of the Tuscan Medical Orders Federation organized on a homogeneous sample, i.e. female doctors from a single Region, Tuscany, in order to evaluate and new approaches in the management of human resources that take into account the delicate balance between the real possibilities available to the doctor and the complexities of experiential work that arise over the course of a lifetime. Empirical evidence deriving from specific investigations conducted at trade union and ordinistic level still document the existence of a gender gap between male and female doctors with respect to the reference parameters of quality work, such as the economic and ergonomic dimension, in relation to the physical and psychological aspects of people.

[Intestinal perforation due to accidental ingestion of foreign bodies]

Usually the ingested foreign bodies (IFB) pass the gastrointestinal tract making no lesions. Sometimes IFB could lead to a gastrointestinal perforation. The most frequently perforating IFB are chicken or fish bones and toothpicks, while risks factors are mental retardation, alcohol or drug abuse, denture usage, quick eating or habitual chewing of toothpicks. The accidentally ingestion in a high risk patient with unclear symptoms, added to a low sensitive diagnostic imaging, lead to intraoperative diagnosis in one half cases of gastrointestinal perforation by IFB. Furthermore the surgical treatment range between the less minimal invasive laparoscopic IFB extraction and intraabdominal hole suture to a laparotomic bowel or colic resection. Herein we describe our experience in 3 cases of gastrointestinal perforation by IFB have been diagnosed at surgery and treated by IFB extraction and hole suture (in 2 patients; 1 laparoscopy, 1 laparotomy) or open right emicolectomy (1 patient).

Tomato torrado virus is Transmitted by Bemisia tabaci and Infects Pepper and Eggplant in Addition to Tomato

Torrao or torrado is an emerging disease that is causing serious economic losses in tomato crops of southeastern Spain. The causal agent has been shown to be a new picorna-like plant virus, tentatively named Tomato torrado virus (ToTV) (4). By using trap tomato plants in a greenhouse affected by torrado located in the Murcia Region of Spain, we obtained a ToTV isolate (ToTV-CE) that we have biologically and molecularly characterized. Subtracted cDNA libraries (1) and expressed sequence tags sequencing were used to determine the partial nucleotide sequence of ToTV-CE. We covered ≈53% of the virus genome (GenBank Accession Nos. EU476181 and EU476182) and found that ToTV-CE RNAs 1 and 2 had a high nucleotide similarity (98 and 99%, respectively) with the ToTV published sequences (2,4). ToTV-CE sequences also showed a 70% nt similarity with those of Tomato apex necrosis virus, a newly identified virus in tomato crops of the Culiacan area (Sinaloa, Mexico) (3). To characterize the host range of ToTV-CE, 6 to 10 plants belonging to 14 species were mechanically inoculated with extracts from ToTV-CE-infected Nicotiana benthamiana plants. The presence of ToTV in these plants was analyzed at 3 and 6 weeks postinoculation (PI) by molecular hybridization in dot-blots. The determined host range was in agreement with that described earlier (2,4), but additional hosts and nonhosts were identified. Thus, the virus did not infect melon (Cucumis melo var. cantaloupe), cucumber (C. sativus cv. Marketmore), squash (Cucurbita pepo cv. Negro Belleza), Chenopodium album ssp. Amaranticolor, or Chenopodium quinoa. The virus infected systemically N. benthamiana, N. glutinosa, N. rustica, tobacco (N. tabacum cvs. Xanthi nc and Samsun), Physalis floridana, pepper (Capsicum annuum cv. Italian Long Sweet), tomato (Solanum lycopersicum cv. Boludo), and eggplant (S. melongena cv. Black Beauty). Pepper plants displayed severe symptoms of infection consisting of marked mosaics and stunting (but no necrosis), but eggplant remained asymptomatic for up to 6 weeks PI. A simple assay was devised to analyze whether ToTV can be transmitted by whiteflies. ToTV-CE-infected tomato plants were placed together with three to eight healthy tomato seedlings inside insect-proof glass boxes. Adult Bemisia tabaci (100 to 800 individuals in three replicates) or Trialeurodes vaporariorum (100 individuals in one replicate) were released into each box. For both treatments, symptoms typically induced by ToTV appeared in one to seven tomato seedlings by 1 week after the release of the whiteflies. ToTV infection was confirmed by molecular hybridization in tissue prints of petiole cross sections at 10 days PI. These data are in agreement with those reported by Pospieszny et al. (2) and strongly suggest that both B. tabaci and T. vaporariorum can transmit ToTV. References: (1) L. Diachenko et al. Proc. Natl. Acad. Sci. USA 93:6025, 1996. (2) H. Pospieszny et al. Plant Dis. 91:1364, 2007 (3) M. Turina et al. Plant Dis. 91:932, 2007. (4) M. Verbeek et al. Arch. Virol. 152:881, 2007.

[Biostatistical study on health surveillance of Military Navy personnel in Sicilia and Calabria regions]

The Maritime Military Health submit to periodic medical examination civilian employees exposed to health risks and all military personnel. The latest, because of particular use in operational duties, as well as the characteristic of seafarers employed, undergoes an extensive medical protocol. In 2006 there were around 3200 access to the Service of Medicine Labor Navy Hospital in Augusta (SR). We wanted then to make a collection of data with purpose to highlight the diseases that most often affect the area of military jurisdiction. The illnesses were divided into two main groups: those who did not produce any result on the job because of insignificant impact functional, and those for which they have been taken to unfitness, temporary or permanent. From a statistical evaluation of the acquired data, it results that most affected systems are the skeletical, hematologic, psychic, ENT, heart, the Body Mass Index.

Treatment of puborectalis syndrome with progressive anal dilation

PURPOSE

The aim of this study is to assess the ability of progressive anal dilations to improve frequency of spontaneous bowel movements in patients with puborectalis syndrome (PRS).

METHOD

Thirteen patients (9 females and 4 males; mean age, 37 years) with severe, chronic constipation caused by PRS were treated with daily, progressive anal dilation for a three-month period. Three dilators of 20, 23, and 27 mm in diameter were used. Dilators were inserted every day for 30 minutes (10 minutes each dilator). Patients were evaluated with anorectal manometry and defecography halfway through treatment, at the end of treatment, and six months after the end of treatment. At six months, patients also underwent physical examination.

RESULTS

There was a significant improvement of weekly mean spontaneous bowel movements from zero to six (P < 0.0001), and the need for laxatives decreased from 12 patients with a weekly mean of 4.6 to 2 patients once per week (P < 0.001). Enemas used before treatment by eight patients who had a weekly mean of 2.3 were, after treatment, needed only by three patients once per week (P < 0.01). During straining, tone measured with anorectal manometry decreased from 93 to 62 mmHg after six months of the end of therapy (F = 6.97; P < 0.01), and anorectal angle measured with defecography during the strain increased from 95 degrees to 110 degrees (P = not significant).

CONCLUSIONS

Daily progressive anal dilation should be considered as the first and most simple therapeutic approach in patients with PRS.

Botulinum toxin for chronic anal fissure

Botulinum toxin can chemically denervate striated muscle. Botulinum toxin A (15 U) was used to treat ten patients with chronic anal fissure by injection in the internal sphincter. In seven patients, the lesion healed at 2 months after treatment; one relapsed at 3 months. In one patient the lesion healed at 1 month, but partly relapsed a month later. Mild faecal incontinence lasting for 1 day was observed in one patient. We propose that botulinum toxin injections in the internal anal sphincter be considered an alternative approach to surgical therapy of anal fissure.

[Diagnostic and therapeutic update on primary duodenogastric reflux]

The authors, after some remarks on the pathophysiology of primary alkaline gastritis, analyze the main methods, available at present, for diagnosis; they particularly consider the importance of endoscopy and histology, gastroesophageal 24-hours pH-metry and 99mTc HIDA scintigraphy. Successively, they present the criteria for the identification of patients who will predictably benefit from surgical treatment, and examine advantages and limits of the two main corrective surgical techniques for the duodenogastric reflux in patients not previously operated on the gastrointestinal tract: duodenal extramucosal myotomy according to Mattioli, relatively easy to perform, and the "duodenal switch" according to De Meester, technically more complex, but pathophysiologically more acceptable, completely eliminating the duodenogastric reflux.

Results of 4 years of experience with bladder replacement using an ileocecal segment with multiple transverse teniamyotomies

Since 1987, 30 patients with bladder cancer underwent cystoprostatectomy with bladder replacement via ileocecourethrostomy. Multiple transverse teniamyotomies were made in the cecum to assure a large capacity reservoir with low pressures. The particular anatomy and physiology of the cecum, short length of the intestinal segment needed and teniamyotomies are the 3 factors that have allowed for good functional and metabolic results. All patients achieved daytime continence. After 3 years of followup 67% of the patients were continent at night if they voided every 3 or 4 hours and 22% if they voided every 2 or 3 hours, while 11% experienced enuresis. Urodynamic data after 1 year showed a mean capacity of 396 ml. for the new bladder, a mean full filling pressure of 28 cm. water and a mean maximum pressure of 55 cm. water. Post-micturition residual urine volume was consistently less than 55 ml. These results indicate that the ileocecal segment can be enlarged with myotomies through the tenia to produce an adequate capacity and a low pressure bladder replacement without the need for formal detubularization.

New grading and scoring for anal incontinence. Evaluation of 335 patients

A grading system of anal incontinence (AI) is described that takes into account both degree and frequency of symptoms. A, B, and C indicate AI for flatus/mucus, liquid stool, and solid stool, respectively; 1, 2, and 3 indicate occasional, weekly, and daily AI. A scoring system, ranging from 0 (continence) to 6 (severe AI, i.e., daily AI for solid stool or C3) also is reported. Three hundred thirty-five patients have been evaluated by this method in our institution: 30 percent had severe AI, graded as C3; only 9 percent had mild symptoms graded as A. Both males and females could not control diarrhea (Grade B) in 44 percent of cases. Nearly half of the 110 patients who underwent surgery had a C3 incontinence before treatment. Positive results were achieved in 75 percent of cases after surgery: e.g., AI score significantly improved from 4.2 +/- 1.6 to 1.5 +/- 1.9 (P less than 0.001) in those with AI and rectal prolapse. Most of the failures were the patients with idiopathic C3 incontinence. In conclusion, this grading and scoring system allowed a satisfactory assessment of patients' AI before and after treatment. It may also be used to achieve an objective comparison between different series.

Clinical and functional evaluation of the efficacy of otilonium bromide: a multicenter study in Italy

Seventy-two patients complaining of abdominal pain were studied in a double blind trial with otilonium bromide (OB) (40 mg tid or placebo). In our patients we performed, before and after the treatment, a clinical evaluation (symptom variations) and functional studies (sigmoid manometry during bowel distension). As regards clinical parameters, otilonium bromide significantly reduced abdominal pain and bloating and significantly increased (p less than 0.02) the pain threshold. However the comparison with the placebo group did not show any difference between the two groups. Sigmoid motility during distension was significantly reduced (p less than 0.05) in OB group, whereas it did not change in the placebo group. We can conclude that, in irritable bowel syndrome (IBS) patients, OB is able to improve symptoms and to reduce stimulated motor activity of the sigmoid.

Transanal electrostimulation for fecal incontinence: clinical, psychologic, and manometric prospective study

A prospective study was carried out to analyze the clinical, psychologic, and manometric short-term results of transanal electrostimulation (TES) in the treatment of fecal incontinence. Fifteen patients underwent TES. An initial clinical and manometric assessment was carried out before and 1 month after the procedure. A psychologic evaluation was also performed by means of interviews and appropriate tests. Early improvement of symptoms was noted in 10 patients. The nonresponders were women with gross daily incontinence to solid stool. At anal manometry, resting tone and rectal sensation remained unchanged, whereas a significant increase of voluntary contraction was observed following TES (from 48 +/- 26 to 59 +/- 39 mm Hg, P = 0.03). Psychologically, TES led to a significant decrease of both latent and paranoid anxiety related to symptoms (P = 0.02). At a clinical reassessment 6 months later, one of the nonresponders became continent after a further course of TES. In conclusion, TES is well accepted by the patients, is followed by positive emotional response, and, by improving striated sphincter function, seems to be effective in the treatment of partial fecal incontinence.

[Antibiotic prophylaxis with sulbactam/ampicillin in colon surgery]

We evaluated the effectiveness of sulbactam/ampicillin (S/A) as a perioperative prophylaxis regimen in elective colic surgery (procedures lasting less than 4 hours). We studied 18 patients (11 males, 7 females; mean age 46 yrs, range 21-72), by an open, non-comparative trial: S/A was given soon before anesthesia (1 g + 2 g) and the same dose was repeated every 6 hours, up to 5 doses. The drug was well tolerated, and there were no side effects requiring the interruption of the prophylaxis. Infection rate was low (only one case of evident suppuration of the wound).

Evaluation of in vivo morphological results of balloon mitral valvotomy

Percutaneous valvotomy is now more often considered for the treatment of mitral stenosis in poor risk patients. The aim of this study was the evaluation of the morphological changes produced by a similar procedure on the mitral valves of nine nonconsecutive patients undergoing a mitral valve replacement because of calcific isolated or prevalent mitral stenosis. The mitral valve was dilated through the left atriotomy before the valve excision with the same balloon catheter used in the percutaneous procedure. The pathological condition of the valve had been studied before dilatation by means of doppler echocardiography, cardiac catheterization and a visual examination performed by the surgeon before insertion of the balloon. At that time, the orifice area was measured with a Hegar dilator. A new measurement was performed after one or two dilatations performed at a balloon pressure of 2.7 atm. After excision, the valve was examined, photographed and X-rays were taken for evaluation of valve calcification. The pre-dilatation mean mitral valve orifice area was 1.3 +/- 0.4 cm2 and after the procedure was 2.8 +/- 0.3 cm2. In only one patient did the orifice area, originally 2.4 cm2, not increase. There was only one fused and calcified commissure, the other was normal. Before dilatation, the two commissures were fused in 17/18 cases and in 9/18, calcified. After dilatation, 5/17 commissures were completely open (not all were calcified), 10/17 incompletely opened and 2/17 remained fused (one in the above-mentioned patient).(ABSTRACT TRUNCATED AT 250 WORDS)

Anal manometry improves the outcome of surgery for fistula-in-ano

The aim of this prospective study is to investigate whether anal manometry is useful in orienting the surgical policy and improving the clinical and functional results following surgery for fistula-in-ano. Anal manometry was performed preoperatively and postoperatively in 96 patients. The results of surgery, in terms of both fecal soiling and recurrence rate, were analyzed and compared with those of another group of 36 subjects. Some operative maneuvers, such as internal sphincterotomy, laying open of the fistula with division of striated muscle, or use of a seton, were carried out according to the preoperative sphincter pattern as shown by anal manometry in the first group. A standard procedure was followed in the control group. The recurrence rate was 3 percent in the anal manometry group and 13 percent in the control group (P less than 0.01); postoperative soiling occurred in 14 percent of patients in the anal manometry group compared with 31 percent of patients in the control group (P less than 0.001). The functional results in transsphincteric and suprasphincteric fistulas, which are usually considered at higher risk for postoperative incontinence, were better in the anal manometry group, due to greater use of the seton. No increase in recurrence rate was observed in these complex fistulas after anal manometry. Internal sphincterotomy led to a disordered continence, mainly when associated with division of striated muscle; a significant decrease in resting tone from 56 +/- 22 to 47 +/- 50 and voluntary contraction from 114 +/- 30 to 85 +/- 28 mm Hg (mean +/- S) was found after surgery in patients with soiling. In conclusion, the routine use of anal manometry may be recommended in the management of patients with fistula-in-ano as it improves the clinical and functional outcome of surgery.