Management of acute stroke. Specific nursing care and treatments in the stroke unit

OBJECTIVE

This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care.

METHODS

We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification.

RESULTS

The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital.

CONCLUSIONS

These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.

Dynamical imaging of local photovoltage at semiconductor surface by photo-assisted ultrafast scanning electron microscopy

Photo-assisted Ultrafast Scanning Electron Microscopy (USEM) maps the dynamics of surface photovoltages and local electric fields in semiconducting samples. Photovoltages and their gradients close to surface affect the emission yield and the detection efficiency of secondary electrons (SE), leading to photoexcited SE 2D patterns. In this work, we present a method to characterize the evolution of the patterns up to ultrafast regime. These results reveal the role of surface states in affecting the external field dynamics at picoseconds. Moreover, we show that tiny changes in surface preparation express deeply different photoexcited voltage signals. We investigate the relation between the surface chemistry of Si and photo-induced SE contrast.

Lupus anticoagulant and mortality in patients hospitalized for COVID-19

Coronavirus disease 2019 (COVID-19) is characterized by a procoagulant state that can lead to fatal thromboembolic events. Several studies have documented a high prevalence of lupus anticoagulant that may at least partially explain the procoagulant profile of COVID-19. However, the association between lupus anticoagulant and thrombotic complications in COVID-19 is controversial and no study has specifically evaluated the impact of lupus anticoagulant on mortality. The aim of our study was to investigate the association between lupus anticoagulant and mortality in a large group of 192 consecutive patients hospitalized for COVID-19. Lupus anticoagulant was found in 95 patients (49.5%). No difference in the percentage of patients with lupus anticoagulant was observed between 130 survivors and 62 non-survivors (47.7 versus 53,2%; p = 0.4745). When the combined outcome of death or need for mechanical ventilation in survivors was taken into account, the difference in the prevalence of patients with lupus anticoagulant between the patients with the combined outcome (n = 76) and survivors who did not require mechanical ventilation (n = 116) was not significant (52.6% versus 47.4%; p = 0.4806). In multivariate analysis predictors of mortality or need for mechanical ventilation in survivors were obesity, low oxygen saturation and elevated troponin levels measured on admission. In conclusion, our study did not show any association of lupus anticoagulant with mortality and with need for mechanical ventilation in survivors. The role of obesity, low SaO2 and elevated troponin levels as predictors of a worse prognosis in patients hospitalized for COVID-19 was confirmed.

Management of acute stroke. Specific nursing care and treatments in the stroke unit

OBJECTIVE

This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care.

METHODS

We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification.

RESULTS

The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital.

CONCLUSIONS

These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.

Lyme borreliosis incidence in Lombardy, Italy (2000-2015): Spatiotemporal analysis and environmental risk factors

Lyme borreliosis cases have been reported from Lombardy in northern Italy, where Ixodes ricinus is the main vector of Borrelia burgdorferi sensu lato. However, spatial and temporal variation in the incidence of Lyme borreliosis is not well understood. In the present study, based on new notified cases of Lyme borreliosis from 2000 to 2015, an average of 1.24 new cases per million residents per year was documented. New cases, georeferenced at the municipal level, were analyzed by retrospective space-time analysis (using SaTScan v. 9.3.1); and land cover, extrapolated from a Corine Land Cover dataset (using QGIS 2.8.1), was used to implement an environmental risk factor analysis. Firstly, a temporal high-risk cluster was detected in Lombardy: the relative risk of Lyme borreliosis was 3.73 times higher during 2008-2015 compared with the entire study period. Moreover, in a spatiotemporal high-risk cluster with a circular base, land cover consisting of wildland-urban interface, meadow, forest and meadow-forest transition were significantly higher compared to low-risk areas. Results of the present study demonstrate that the incidence of Lyme borreliosis is increasing in Lombardy and that environmental conditions are suitable for I. ricinus ticks infected with B. burgdorferi s.l.: citizens and health systems should be aware of Lyme borreliosis to reduce tick bites with personal protective behaviors and to avoid misdiagnosis, particularly within the area including the observed high-risk cluster. Economic resources should be invested to inform about methods to prevent tick bites, how to check people and pets after frequenting risk areas, and ways of removing the biting ticks when they are found.

Risk prioritization as a tool to Guide Veterinary Public Health activities at the regional level in Italy

In this study we developed a model for risk prioritisation and characterisation focused on zoonoses and food safety for diseases of interest in veterinary public health at a regional level in Italy. A previous model (Discontools) based on scorecards was used as a basis to develop the new model. A Formalised Consensus Process approach involving academics and veterinary officers was used to develop scorecards and relative form and guidelines. Scorecards include several areas of interest, with different categories and coefficient of importance. The following areas were identified: relevance of the disease, socio-economic impact, impact on public health, impact on trade, impact on animal welfare, control tools. A guide and a form were finalised in order to fill scorecards. Scorecards were filled by consulting available data, literature, and expert opinions. Among bovine diseases, mastitis (Salmonella aureus) showed the highest score; Q fever was the highest among small ruminants; among swine diseases the highest was salmonellosis; while among other animal diseases, toxoplasmosis had the highest score. The approach described in this study is designed to aid professionals in risk prioritisation, decision-making, and to improve disease control systems at a regional level in Italy. It also facilitates risk characterisation in different backgrounds and the identification of data holes in specific areas of interest for the diseases considered. This approach is conceived to aid professionals in risk prioritization, decision-making and to improve disease control systems at a regional level. It also allows to perform risk characterization in different backgrounds and to identify lacks of data in specific areas of interest for the diseases considered.

Imaging photoinduced surface potentials on hybrid perovskites by real-time Scanning Electron Microscopy

We introduce laser-assisted Time-Resolved SEM (TR-SEM), joining Scanning Electron Microscopy and laser light excitation, to probe the long-term temporal evolution of optically excited charge distributions at the surface of Metal Ammonium Lead Triiodide (MAPbI₃) hybrid perovskite thin films. Laser-assisted TR-SEM relies on the optically induced local modification of Secondary Electron (SE) detection yield to provide mapping of photoexcited potentials and charge dynamics at surfaces, and qualifies as a complementary approach to near-field probe microscopies and nonlinear photoemission spectroscopies for photovoltage measurements. Real-time imaging of evolving field patterns are provided on timescales compatible with SEM scanning rates, so that temporal resolution in the millisecond range can be ultimately envisaged. MAPbI₃ is an outstanding light-sensitive material candidate for applications in solar light harvesting and photovoltaics, also appealing as an active system for light generation. In this work, the real time temporal evolution of optically induced SE contrast patterns in MAPbI₃ is experimentally recorded, both under illumination by a 405 nm blue laser and after light removal, showing the occurrence of modifications related to photoinduced positive charge fields at surface. The long term evolution of these surface fields are tentatively attributed to ion migration within the film, under the action of the illumination gradient and the hole collecting substrate. This optical excitation is fully reversible in MAPbI₃ over timescales of hours and a complete recovery of the system occurs within days. Permanent irradiation damage of the material is avoided by operating the SEM at 5 keV of energy and 1-10 pA of primary current. Optical excitation is provided by intense above-bandgap illumination (up to 50 W/cm²). TR-SEM patterns show a strong dependence on the geometry of SE collection. Measurements are taken at different axial orientations of the sample with respect to the entrance of the in-column detection system of the SEM and compared with numerical modeling of the SE detection process. This enables to single out the information regarding the local potential distribution. Results are interpreted by combining data about the spectral distribution of emitted SEs with the configuration of the electric and magnetic fields in the specimen chamber. The present modeling sets a robust basis for the understanding of photoinduced SE electron contrast.

The effect of anaerobic digestion and storage on indicator microorganisms in swine and dairy manure

The aim of this experimental study was to evaluate the influence of anaerobic digestion and storage on indicator microorganisms in swine and dairy excreta. Samples were collected every 90 days for 15 months at eight farms, four pig, and four dairy farms, four of them having a biogas plant. Moreover, to evaluate storage effects on samples, 20 l of manure and slurry taken at each farm (digested manure only in farms with a biogas plant) were stored in a controlled climatic chamber at 18 °C, for 6 months. The bacterial load and the chemical-physical characteristics of excreta were evaluated at each sampling time, stored slurry, and manure were sampled and analyzed every 2 months. A high variability of the concentration of bacteria in the different excreta types was observed during the experiment, mainly depending on the type and time of treatment. No sample revealed either the presence of Escherichia coli O157:H7 or of Salmonella, usually linked to the temporary rearing of infected animals in facilities. Anaerobic digestion and storage affected in a significant way the reduction of indicator bacteria like lactobacilli, coliforms, and streptococci. Anaerobic digestion lowered coliforms in pig slurry (- 2.80 log, P < 0.05), streptococci in dairy manure (- 2.44 log, P < 0.001) and in pig slurry (- 1.43 log, P < 0.05), and lactobacilli in pig slurry (- 3.03 log, P < 0.05). Storage lowered coliforms and the other indicators counts, in particular in fresh wastes, while clostridia did not show a reduction in concentration.

Functional and quality of life evaluation after single level cervical discectomy and fusion or cervical artificial disc replacement

PURPOSE

To evaluate and compare clinical, functional and quality of life (QOL) outcomes after two types of surgical approach for single level cervical disc herniation: anterior cervical discectomy andfusion (ACDF) with cage and cervical artificial disc replacement (C-ADR).

METHOD

119 patients with cervical disc herniation underwent surgery from January 2007 to December 2010; 55 patients were included in the study (27 ACDF, 28 C-ADR). We performed: a pre and postoperative clinical evaluation of cervicobrachial pain, motor and sensory deficit in the upper limbs; a functional and QOL evaluation with self assessment scales (VAS, NPNQ, SF-36); a postoperative instrumental evaluation of cervical ROM and pain. Mean follow-up period was 24 months.

RESULTS

After surgery both groups showed clinical, functional and QOL improvement. No pre and postoperative differences were found between the groups. The postoperative instrumental evaluation showed a globally reduced cervical ROM and a decreased pain threshold in comparison with normal values in both groups.

CONCLUSION

Our results demonstrate the clinical equivalence of the two surgical techniques and the satisfaction of the two groups of patients two years after surgery. Although functional changes persist after surgery they do not affect quality of life.

Agonist antibodies activating the Met receptor protect cardiomyoblasts from cobalt chloride-induced apoptosis and autophagy

Met, the tyrosine kinase receptor for hepatocyte growth factor (HGF), mainly activates prosurvival pathways, including protection from apoptosis. In this work, we investigated the cardioprotective mechanisms of Met activation by agonist monoclonal antibodies (mAbs). Cobalt chloride (CoCl₂), a chemical mimetic of hypoxia, was used to induce cardiac damage in H9c2 cardiomyoblasts, which resulted in reduction of cell viability by (i) caspase-dependent apoptosis and (ii) – surprisingly – autophagy. Blocking either apoptosis with the caspase inhibitor benzyloxycarbonyl-VAD-fluoromethylketone or autophagosome formation with 3-methyladenine prevented loss of cell viability, which suggests that both processes contribute to cardiomyoblast injury. Concomitant treatment with Met-activating antibodies or HGF prevented apoptosis and autophagy. Pro-autophagic Redd1, Bnip3 and phospho-AMPK proteins, which are known to promote autophagy through inactivation of the mTOR pathway, were induced by CoCl₂. Mechanistically, Met agonist antibodies or HGF prevented the inhibition of mTOR and reduced the flux of autophagosome formation. Accordingly, their anti-autophagic function was completely blunted by Temsirolimus, a specific mTOR inhibitor. Targeted Met activation was successful also in the setting of low oxygen conditions, in which Met agonist antibodies or HGF demonstrated anti-apoptotic and anti-autophagic effects. Activation of the Met pathway is thus a promising novel therapeutic tool for ischaemic injury.

Protective effect of oral administration of transgenic tobacco seeds against verocytotoxic Escherichia coli strain in piglets

The use of transgenic plants as delivery system for antigenic proteins is attractive for its simplicity and increases likelihood for local immune response at sites of infection. The aim of this study was to evaluate the protective effect of oral administration of tobacco seeds, expressing the FedA, the major protein of the F18 adhesive fimbriae, and B subunit of verocytotoxin, against verocytotoxin-producing E. coli (VTEC) strain in piglets. Forty-three early weaned piglets, were randomly divided into 4 experimental groups: 3 test groups and a control. Treatment groups orally received a bolus, with different dose of tobacco seeds on 0, 1, 2, 14 days post primary administration. After challenge, with 1*10(10) CFU of O138 Escherichia coli strain, piglets showed clinical scores significantly higher in the control group compared to orally immunized groups (P < 0.05) and the latter showed a faster recovery than in CG. In conclusion, oral administration of recombinant tobacco seeds expressing antigenic proteins against VTEC strains can induce a protective effect against challenger strain in piglets.

Effects of disinfectant fogging procedure on dust, ammonia concentration, aerobic bacteria and fungal spores in a farrowing-weaning room

INTRODUCTION AND OBJECTIVE

In the last decades, large-scale swine production has led to intensive rearing systems in which air quality can be easily degraded by aerial contaminants that can pose a health risk to the pigs and farm workers. This study evaluated the effects of fogging disinfectant procedure on productive performance, ammonia and dust concentration, aerobic bacteria and fungal spores spreading in the farrowing-weaning room.

MATERIALS AND METHOD

This trial was conducted in 2 identical farrowing-weaning rooms of a piggery. In both rooms, 30 pregnant sows were lodged in individual cages. At 75 days of age, the piglets were moved to the fattening room. In the treated room, with the birth of the first suckling-pig, the fogging disinfection with diluted Virkon S was applied once a day in the experimental room per 15 minutes at 11:00. The fogging disinfectant treatment was switched between rooms at the end of the first trial period. Temperature, relative humidity, dust (TSP-RF fractions and number of particles), ammonia concentration and aerial contaminants (enterococci, Micrococcaeae and fungal spores) were monitored in both rooms.

RESULTS

Ammonia concentration reduction induced by fogging disinfection was estimated 18%, total suspended particles and the respirable fraction were significantly lower in the experimental room. Fungal spores resulted in a significant reduction by the fogging procedure, together with dust respirable fraction and fine particulate matter abatement.

CONCLUSIONS

The fogging disinfection procedure improved air quality in the piggery, thereby enhancing workers and animals health.

MicroRNAs in myocardial ischemia: identifying new targets and tools for treating heart disease. New frontiers for miR-medicine

MicroRNAs (miRNAs) are natural, single-stranded, small RNA molecules which subtly control gene expression. Several studies indicate that specific miRNAs can regulate heart function both in development and disease. Despite prevention programs and new therapeutic agents, cardiovascular disease remains the main cause of death in developed countries. The elevated number of heart failure episodes is mostly due to myocardial infarction (MI). An increasing number of studies have been carried out reporting changes in miRNAs gene expression and exploring their role in MI and heart failure. In this review, we furnish a critical analysis of where the frontier of knowledge has arrived in the fields of basic and translational research on miRNAs in cardiac ischemia. We first summarize the basal information on miRNA biology and regulation, especially concentrating on the feedback loops which control cardiac-enriched miRNAs. A focus on the role of miRNAs in the pathogenesis of myocardial ischemia and in the attenuation of injury is presented. Particular attention is given to cardiomyocyte death (apoptosis and necrosis), fibrosis, neovascularization, and heart failure. Then, we address the potential of miR-diagnosis (miRNAs as disease biomarkers) and miR-drugs (miRNAs as therapeutic targets) for cardiac ischemia and heart failure. Finally, we evaluate the use of miRNAs in the emerging field of regenerative medicine.

Expression of verocytotoxic Escherichia coli antigens in tobacco seeds and evaluation of gut immunity after oral administration in mouse model

Verocytotoxic Escherichia (E.) coli strains are responsible for swine oedema disease, which is an enterotoxaemia that causes economic losses in the pig industry. The production of a vaccine for oral administration in transgenic seeds could be an efficient system to stimulate local immunity. This study was conducted to transform tobacco plants for the seed-specific expression of antigenic proteins from a porcine verocytotoxic E. coli strain. Parameters related to an immunological response and possible adverse effects on the oral administration of obtained tobacco seeds were evaluated in a mouse model. Tobacco was transformed via Agrobacteium tumefaciens with chimeric constructs containing structural parts of the major subunit FedA of the F18 adhesive fimbriae and VT2e B-subunit genes under control of a seed specific GLOB promoter. We showed that the foreign Vt2e-B and F18 genes were stably accumulated in storage tissue by the immunostaining method. In addition, Balb-C mice receiving transgenic tobacco seeds via the oral route showed a significant increase in IgA-positive plasma cell presence in tunica propria when compared to the control group with no observed adverse effects. Our findings encourage future studies focusing on swine for evaluation of the protective effects of transformed tobacco seeds against E. coli infection.

Emergence and re-emergence of zoonoses. Context and consequences

Zoonoses have been and are still considered merely a "veterinary problem". Instead, the understanding of their emergence, re-emergence and persistence is more effectively addressed in the context of a "struggle" between pathogens, animals and man. The expression properties of pathogens are related with three interfaces: human-environment, environment-animal and human-animal. Animals and man can be either reservoirs or vectors of pathogens, while interfaces can amplify the clinical impact in all the species involved. The disease course is similar in animals and humans in terms of infection, clinical approach and control. Thus, this "epidemiological model" may be the key to an "updated" interpretation of infectious diseases involving humans and animals. Control and prevention should be carried out in an interdisciplinary context, without separating the medical and veterinary domains, in light of the fact that the activity of pathogenic microorganisms is not species-dependent. Finally, if human public health and veterinary public health are closely linked, knowledge and information can be pooled and used for mutual benefit.

Hypertension, prehypertension, and transient elevated blood pressure in children: association with weight excess and waist circumference

BACKGROUND

To assess the prevalence of hypertension (H), prehypertension (PH), and transient elevated blood pressure (TH) and their relationship with weight class and waist circumference (WC) in an unselected population of Northern Italian children.

METHODS

A cross-sectional study was conducted in 5,131 children (5-11 years). Weight class was defined according to the International Obesity Task Force references, H and PH according to the National High Blood Pressure Education Program. A child was classified as having PH or H when systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) at first screening were > or =90th percentile and the mean of three subsequent measures was between the 90th and 95th or > or =95th percentile, respectively. When BP values at the first screening were > or =90th percentile but the mean of three subsequent measures was <90th percentile the child was classified as having TH.

RESULTS

A proportion of 3.4% presented H, 2.7% PH, and 10.4% TH, 20% overweight, and 6% obesity. Weight class and WC were significantly associated to an increased risk of falling into any of the hypertensive categories. In children with TH BP z-scores of the mean of the three subsequent measurements following the first screening were significantly higher than BP z-scores observed in normotensive children (P value <0.001).

CONCLUSIONS

Weight class and WC are associated with BP. This is observed not only for H but also for PH, and for nonsustained forms of H. Prospective studies are needed to assess whether children with PH and TH will develop sustained H.

Pneumonia Disease Assessment using a Slaughterhouse Lung-Scoring Method

The aims of this study were the evaluation of a quantitative method for the assessment of pneumonia lesions applied to heavy-weight slaughtered pigs, the identification of risk factors connected with the increase in the prevalence and severity of the lesions and the evaluation of a possible correlation between the presence of pneumonia lesions and the decrease in the carcass quality. The lungs of 10 041 pigs (109 slaughtered batches) coming from 91 farms located in Northern Italy were examined. Lung lesions were scored using the method developed by Madec and Kobisch (Journ. Rech. Porc. Fr., 14, 1982, 405). Before the scoring, anamnestic information regarding the farm of origin of each batch were collected. For 41 batches (3603 pigs), information about carcass quality were also collected. Pneumonia lesions were found in 59.6% of the lungs (range 3-91%), and the average batch score was 2.11 (range 0.03-7.15). We identified as farm risk factors those related to an increase in the severity of the lung lesions, the presence of breeders within the herd, the starting of a growing cycle during the winter season and the lack of vaccination programmes to Mycoplasma hyopneumoniae. Moreover, we also found a statistically significant association between the increase in the mean lung score of the batch and the decrease of the carcass quality.

Pixantrone (BBR2778) reduces the severity of experimental allergic encephalomyelitis

Pixantrone is less cardiotoxic and is similarly effective to mitoxantrone (MTX) as an antineoplastic drug. In our study, pixantrone reduced the severity of acute and decreased the relapse rate of chronic relapsing experimental allergic encephalomyelitis (EAE) in rats. A marked and long-lasting decrease in CD3+, CD4+, CD8+ and CD45RA+ blood cells and reduced anti-MBP titers were observed with both pixantrone and MTX. In vitro mitogen- and antigen-induced T-cell proliferation tests of human and rodents cells evidenced that pixantrone was effective at concentrations which can be effectively obtained after i.v. administration in humans. Cardiotoxicity was present only in MTX-treated rats. The effectiveness and the favorable safety profile makes pixantrone a most promising immunosuppressant agent for clinical use in multiple sclerosis (MS).

Effects of naftopidil on some urodynamic parameters and arterial blood pressure in comparison with prazosin in conscious rats

Naftopidil, an alpha 1-adrenergic antagonist, was orally tested in comparison with prazosin, in a rat cystomanometric model to evaluate the effect on the bladder volume capacity (BVC), the micturition pressure (MP) and the mean arterial blood pressure (MAP), contemporaneously recorded to evaluate the selectivity of action. Naftopidil induced a clearcut increase of BVC and a decrease of MP without lowering MAP at 6.25 mg kg-1 p.o.. Prazosin was inactive on BVC, decreased MP and induced a significant decrease of MAP at 1.56 mg kg-1 p.o. Naftopidil could offer an advantage when compared with prazosin.

Clinical and anatomo-histopathological features of experimental infection by DF-2 in rabbits

Clinical and anatomo-histopathological features of experimental infection by DF-2 in rabbits are described. Hyperthermy, sensory reduction, diarrhoea, weight loss and catarrhal nasal discharge are reported. PTT and PT are shown to increase and number of platelets diminish markedly. Considerable haemorrhagic diathesis is reported for several organs. Several clots (especially in pulmonary vessels), serious alterations in kidney glomeruli, degeneration of hepatocytes and disseminated necrosis foci are also reported. Lesions are stated as being very similar to those observed in man.