Nitrous oxide and hypnotherapy in paediatric dentistry

AIM

Patient compliance is of paramount importance for proper dental treatment, which can be difficult to achieve in children due to anxiety and fear, hindering the therapeutic procedure. In addition to well-known sedation methods (pharmacological and nitrous oxide), further methods of approach are being tested, such as hypnotherapy.

MATERIALS

The sample consisted of 150 children (90 males, 60 females). Paper questionnaires, frequency meter, nitrous oxide dispenser in association with the use of the television were exploited. At the end of treatment, subjective pain was assessed using the VAS scale, while objective pain was assessed using the FLACC scale and heart rate. This made it possible to compare two experimental groups, one treated with nitrous oxide, and the other with hypnotherapy. The control group was treated with classic behavioural approach techniques. The results obtained were analysed by SPSS Software (Statistical Package for Social Science, version 27) and the inferences between the results were calculated for confirmation.

CONCLUSION

Hypnotherapy can be a valid substitute for nitrous oxide in paediatric dentistry.

Dim artificial light at night alters gene expression rhythms and growth in a key seagrass species (Posidonia oceanica)

Artificial light at night (ALAN) is a globally spreading anthropogenic stressor, affecting more than 20% of coastal habitats. The alteration of the natural light/darkness cycle is expected to impact the physiology of organisms by acting on the complex circuits termed as circadian rhythms. Our understanding of the impact of ALAN on marine organisms is lagging behind that of terrestrial ones, and effects on marine primary producers are almost unexplored. Here, we investigated the molecular and physiological response of the Mediterranean seagrass, Posidonia oceanica (L.) Delile, as model to evaluate the effect of ALAN on seagrass populations established in shallow waters, by taking advantage of a decreasing gradient of dim nocturnal light intensity (from < 0.01 to 4 lx) along the NW Mediterranean coastline. We first monitored the fluctuations of putative circadian-clock genes over a period of 24 h along the ALAN gradient. We then investigated whether key physiological processes, known to be synchronized with day length by the circadian rhythm, were also affected by ALAN. ALAN influenced the light signalling at dusk/night in P. oceanica, including that of shorter blue wavelengths, through the ELF3-LUX1-ZTL regulatory network, and suggested that the daily perturbation of internal clock orthologs in seagrass might have caused the recruitment of PoSEND33 and PoPSBS genes to mitigate the repercussions of a nocturnal stress on photosynthesis during the day. A long-lasting impairment of gene fluctuations in sites characterised by ALAN could explain the reduced growth of the seagrass leaves when these were transferred into controlled conditions and without lighting during the night. Our results highlight the potential contribution of ALAN to the global loss of seagrass meadows, posing questions about key interactions with a variety of other human-related stressors in urban areas, in order to develop more efficient strategies to globally preserve these coastal foundation species.

The connection between diverticulosis and colonic superficial neoplastic lesions in patients who underwent screening colonoscopy

PURPOSE

If could be a potential pathophysiological connection between colonic diverticula and colonic superficial neoplastic lesions, beyond the shared risk factors, has been a subject of debate in the last years. This study tries to evaluate the association between diverticulosis and colonic neoplastic lesions.

METHODS

This is a cross-sectional study including asymptomatic patients who underwent a screening colonoscopy (patients with a positive fecal occult blood test under the regional program of colorectal cancer (CRC) screening), surveillance after polypectomy resection, or familiarity (first-degree relatives) between 2020 and 2021 to evaluate the association between diverticula and colonic polyps. A multivariate analysis with multiple logistic regression and odds ratio (OR) to study the independent association between adenomas and adenocarcinomas was performed.

RESULTS

One thousand five hundred one patients were included. A statistically significant association between adenomas or CRC alone and colonic diverticula was found (p = 0.045). On a multivariate analysis of demographic (age, gender) and clinical parameters (familiarity for diverticula and adenoma/CRC), only age was significantly associated with the development of colorectal adenomas or cancer (OR 1.05, 95% CI 1.03-1.07, p < 0.0001).

CONCLUSIONS

This study showed a statistically significant association between diverticula and colonic adenomas. However, it is impossible to establish a cause-effect relationship due to the intrinsic characteristics of this study design. A study with a prospective design including both patients with diverticulosis and without colonic diverticula aimed at establishing the incidence of adenoma and CRC could help to answer this relevant clinical question, since a potential association could indicate the need for closer endoscopic surveillance.

Hydrothermal carbonization of the wet fraction from mixed municipal solid waste: Hydrochar characteristics and energy balance

Mixed municipal solid waste (MSW) may be pre-treated in a mechanical-biological treatment (MBT) plant to produce an exiting stream with improved combustible characteristics. The process also produces a second waste stream, which is generally separated on a size basis by industrial sieving equipment. It contains fractions with a high moisture content such as residual food waste, soiled paper and cardboard, and small fragments of other materials. Samples of this stream, collected at an existing plant, were characterized and processed by hydrothermal carbonization (HTC) at laboratory scale, at various temperatures (180, 200 and 220 °C), reaction times (1, 4 and 8 h) and solid to water ratios (0.15 and 0.07). The primary energy balance, on a hypothetical industrial scale, was performed. In brief, the results confirmed that the produced hydrochar was a brittle, hydrophobic, solid carbonaceous product which gave a better combustion performance as the residence time of the HTC process was increased. Moreover, the dewaterability of the carbonized waste was greatly improved when compared to raw, wet samples. The results of the primary energy balance confirmed that the energy contained in the produced hydrochar was higher than the energy consumption for the process itself, under all the HTC working conditions. The energy consumed in the process was in the range of 40-70 % of the energy content of the produced hydrochar.

Clowntherapy in paediatric dentistry: The psychological approach to the paediatric patient

AIM

Anxiety towards dental treatments and visits in children are often cause for the avoidance and/or failure of the treatment itself, as well as a reason for stress in both the patient and the orthodontist. The aim of the research is to understand if the use of clown therapy in dental waiting rooms is efficient in bringing down the level of preoperative anxiety in paediatric dental patients.

METHODS

Two psychometric tests were used: CFSS-DS (Dental Subscale of the Children's Fear Survey Schedule) and FIS (Facial Image Scale), after the translation of the original versions, to both the patients and their parents. The CFSS-DS is the most used instrument in order to assess dental fear in children, it is composed by 15 questions that outline situations which children and adolescents will have to face while on the dental chair. The FIS is a visual analogical scale that uses faces as indicators of anxiety.

CONCLUSION

Clowntherapy proves to be an efficient non-pharmacological method to reduce anxiety and dental fear in paediatric patients, offeringa valid and practical support for paediatric dentists.

Environmental Life Cycle Assessment of Hydrothermal Carbonization of Sewage Sludge and Its Products Valorization Pathways

ABSTRACT

This study is aimed at evaluating through Life Cycle Assessment (LCA) the environmental performances of an integrated system of an existing Water Resources Recovery Facility (WRRF) and a hypothetical hydrothermal carbonization (HTC) plant applied to the generated sewage sludge (SS). Beside the valorisation of the solid product (hydrochar, HC) as a fuel substituting lignite, the possibility to valorize also the liquid fraction (process water, PW) derived by the HTC, by anaerobic digestion to produce biogas, is here proposed and analysed. Additionally, phosphorus recovery from HC, prior its use, by acid leaching with nitric acid is also suggested and evaluated. Thus, four integrated scenarios, based on SS carbonization, are proposed and compared with the current SS treatment, based on composting outside of the WRRF (Benchmark scenario). The proposed scenarios, based on HTC, show improved performances with respect to the benchmark one, for thirteen of sixteen considered impact indicators. For the Climate Change (CC) indicator, the two HTC scenarios are able to reduce the impacts up to - 98%, with respect to the Benchmark. Further, the introduction of anaerobic digestion of PW proves to reduce impacts more than other configurations in eleven on sixteen impact categories. On the contrary, the introduction of phosphorus recovery process negatively affects the values for most of indicators. Thus, possible solutions to improve the integration of this process are outlined (e.g., the use of sulfuric acid instead of nitric one, or the application of a different ratio between solid and acidified solution during acid leaching of HC to recover phosphorus).

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12649-022-01821-x.

The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017

Introduction

Delirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium.

Methods

The analyses were conducted employing the cross-sectional “Delirium Day” initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses.

Results

A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09–2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001].

Discussion and conclusion

Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-01950-8.

Aspergillus fumigatus and aspergillosis: From basics to clinics

The airborne fungus Aspergillus fumigatus poses a serious health threat to humans by causing numerous invasive infections and a notable mortality in humans, especially in immunocompromised patients. Mould-active azoles are the frontline therapeutics employed to treat aspergillosis. The global emergence of azole-resistant A. fumigatus isolates in clinic and environment, however, notoriously limits the therapeutic options of mould-active antifungals and potentially can be attributed to a mortality rate reaching up to 100 %. Although specific mutations in CYP 51A are the main cause of azole resistance, there is a new wave of azole-resistant isolates with wild-type CYP 51A genotype challenging the efficacy of the current diagnostic tools. Therefore, applications of whole-genome sequencing are increasingly gaining popularity to overcome such challenges. Prominent echinocandin tolerance, as well as liver and kidney toxicity posed by amphotericin B, necessitate a continuous quest for novel antifungal drugs to combat emerging azole-resistant A. fumigatus isolates. Animal models and the tools used for genetic engineering require further refinement to facilitate a better understanding about the resistance mechanisms, virulence, and immune reactions orchestrated against A. fumigatus. This review paper comprehensively discusses the current clinical challenges caused by A. fumigatus and provides insights on how to address them.

Effect of extrudate swell on extrusion foam of polyethylene terephthalate

The effect of extrudate swell on extrusion foam of thermoplastic polymers is presented using an experimental approach supported by a modelling of the phenomenon. Its understanding is fundamental in designing the geometry of a die for extrusion foam and to predict foaming. The extrudate swell is the swelling of a viscoelastic material due to a fast elastic recovery after being subjected to stresses. We show that there exists a link between the extrudate swell and foaming, performing experiments with simple and complex extrusion dies to measure the expansion ratio. It was found that the expansion ratio is anisotropic and the anisotropy in the expansion of the foam is due to the extrudate swell that affects strongly the final shape of the product and it cannot be neglected in standard application for extrusion foam. A simple heuristic model was developed to predict the extrudate swell from geometrical parameters and rheological characterization of the fluid. It was found that the foaming mechanism of polyethylene terephthalate, blown with cyclopentane, changes as function of extrudate swell and the lowest density foam is achieved using the die that has the bigger extrudate swell.

Waste to energy efficiency improvements: Integration with solar thermal energy

Hybridisation of waste to energy with solar facility can take competing energy technologies and make them complementary. However, realising the benefits of solar integration requires careful consideration of the technical feasibility as well as the economic and environmental benefits of a proposed system. In this work, a solar-integrated waste-to-energy plant scheme is proposed and analysed from an energy, environmental and economic point of view. The new system integrates a traditional waste-to-energy plant with a concentrated solar power plant, by superheating the steam produced by the waste-to-energy flue gas boiler in the solar facility. The original waste-to-energy plant - that is, the base case before introducing the integration with concentrated solar power - has a thermal power input of 50 MW and operates with superheated steam at 40 bar and 400 °C; net power output is 10.7 MW, and the net energy efficiency is equal to 21.65%. By combining waste-to-energy plant with the solar facility, the power plant could provide higher net efficiency (from 1.4 to 3.7 p.p. higher), lower specific CO₂ emissions (from 69 to 180 kg MWh^-1 lower) and lower levellised cost of electricity (from 13.4 to 42.3 EUR MWh^-1 lower) comparing with the standalone waste to energy case. The study shows that: (i) in the integrated case and for the increasing steam parameters energy, economic and ecological performances are improved; (ii) increasing the solar contribution could be an efficient way to improve the process and system performances. In general, we can conclude that concentrated solar-power technology holds significant promise for extending and developing the waste to energy systems.

Tests of a novel imaging algorithm to localize hidden objects or cavities with muon radiography

A novel algorithm developed within muon radiography to localize objects or cavities hidden inside large material volumes was recently proposed by some of the authors (Bonechi et al. 2015 J. Instrum. 10, P02003 (doi:10.1088/1748-0221/10/02/P02003)). The algorithm, based on muon back projection, helps to estimate the three-dimensional position and the transverse extension of detected objects without the need for measurements from different points of view, which would be required to make a triangulation. This algorithm can now be tested owing to the availability of real data collected both in laboratory tests and from real-world measurements. The methodology and some test results are presented in this paper.This article is part of the Theo Murphy meeting issue 'Cosmic-ray muography'.

Short versus mid-long-term outcome of transanal irrigation in children with spina bifida and anorectal malformations

PURPOSE

We assessed short- and mid-long-term clinical efficacy of transanal irrigation (TAI) and its effect on the quality of life of children with spina bifida (SB) and anorectal malformations (ARM).

METHODS

Seventy-four pediatric patients (age 6-17 years) with SB and ARM with neurogenic bowel dysfunction were enrolled for a prospective and multicentric study. Patients were evaluated before the beginning of TAI (T0), after 3 months (T1) and after at least 2 years (range 24-32 months) (T2) using a questionnaire assessing bowel function, the Bristol scale, and two validated questionnaires on quality of life: the CHQ-PF50 questionnaire for the parents of patients aged 6-11 years and the SF36 questionnaires for patients aged between 12 and 18 years.

RESULTS

Seventy-two patients completed TAI program in T1, and 67 continued into T2. Bowel outcomes (constipation and fecal incontinence) improved in both the SB and the ARM groups in the short and mid-long term. In both groups at T1 and T2, parents and children reported an improvement in quality of life and there was a significant increase of stool form types 4 and 5 as described by the Bristol scale. Common adverse effects during the study were similar at T1 and T2 without serious complications.

CONCLUSIONS

We observed a sustained improvement in bowel management and quality of life in SB and ARM children during the study, more significant in the short term than in mid-long term. To maintain success rates in the mid-long term and to reduce the dropout rate, we propose patient training and careful follow-ups.

Polymicrobial antibiofilm activity of the membranotropic peptide gH625 and its analogue

This work illustrates a new role for the membranotropic peptide gH625 and its derivative gH625-GCGKKK in impairing formation of polymicrobial biofilms. Mixed biofilms composed of Candida and bacterial species cause frequently infections and failure of medical silicone devices and also show a major drug resistance than single-species biofilms. Inhibition and eradication of biofilms were evaluated by complementary methods: XTT-reduction, and crystal violet staining (CV). Our results indicate that gH625-GCGKKKK, better than the native peptide, strongly inhibited formation of mixed biofilms of clinical isolates of C. tropicalis/S. marcescens and C. tropicalis/S. aureus and reduced the biofilm architecture, interfering with cell adhesion and polymeric matrix, as well as eradicated the long-term polymicrobial biofilms on silicone surface.

Primary Mucoepidermoid Carcinoma of the Liver. A Case Report

The authors report a case of primary mucoepidermoid carcinoma of the liver in a 66-year-old woman. Electron microscopy findings suggest an origin from the biliary epithelium as well as cholangiocarcinoma, which clinical and prognostic features are similar to those of mucoepidermoid carcinoma.

Well-Differentiated Neuroendocrine Carcinoma of the Lung: A Clinicopathologic and Ultrastructural Study of 10 Cases

The clinico-pathologic characteristics of 10 resected pulmonary tumors, which proved to be well-differentiated neuroendocrine carcinomas (WDNC) on the basis of light microscopic, immunocytochemical, ultrastructural and immunoelectron microscopic investigations, were evaluated. The tumors showed a wide spectrum of histologic features that could be referred to three basic patterns: 1) a carcinoid-like pattern; 2) an organoid pattern characterized by palisading cells at the edge of cellular areas, and 3) a prevalent adenocarcinoma-like pattern. The second pattern was the most distinct even though it often mimicked the small cell/large cell subtype of small cell carcinoma (SCC) owing to its association with marked atypia and poor differentiation. All but one of the patients were males and smokers. The mean age was 58 years. Half of the tumors were centrally located including those showing the adenocarcinoma-like pattern. Disease-free and overall survival and type of tumor dissemination in four patients were similar to those of SCC. Five evaluable patients were alive and disease-free after a mean follow-up of 74 months. Two of these were initially diagnosed as SCC. We conclude that, because of its impact on prognosis, the diagnosis of WDNC appears to be relevant although other factors able to adversely affect the clinical course remain undefined.

A Light Microscopic and Ultrastructural Study of Two Cases of Fibrolamellar Hepatocellular Carcinoma

We describe two cases of fibrolamellar hepatocellular carcinoma of the liver in two young women. Both patients presented with diffuse intra-abdominal metastases; nevertheless they had a survival of 28 and 32 months, respectively, which sustains the better prognosis of this neoplasm. Electron microscopy of one case confirmed the oncocytic features of the neoplastic cells and showed intra- and intercellular duct-like vacuoles with numerous microvilli containing a microfilament core that terminated in a terminal web, which represents an unusual aspect in the spectrum of differentiation of fibrolamellar hepatocellular carcinoma.

A Clinico-Pathologic Study of Clear-Cell Hepatocellular Carcinoma

We reviewed the pathologic and clinical features of 7 cases of clear-cell hepatocellular carcinomas. Tumor cells had a typical clear, empty cytoplasm due to prominent accumulation of glycogen and lipid droplets, as demonstrated by ultrastructural study in one of our cases. Follow-up of the 7 patients did not confirm the better prognosis of this tumor reported by other investigators. The clinical course of our cases was more unfavorable than that of the other 130 cases of usual hepatocellular carcinomas treated at this Institute.

Nephroblastoma with Neuroendocrine Differentiation

A nephroblastoma (Wilms' tumor) with morphological, histochemical, immunohistochemical and ultrastructural evidence of neuroendocrine differentiation is described. Whereas areas of neural differentiation and occasional argyrophilic cells in cases of Wilms' tumor have been previously reported, the unique characteristic in this case was the extent of the neuroendocrine differentiation, as shown by a strong Grimelius stain of over 90 % of the blastematous cells. Immunoperoxidase studies employing antibodies to neuron-specific enolase and ultrastructural data were also in favor of the neuroendocrine differentiation and suggested the existence, in addition to the already reported variant of Wilms' tumor with neural differentiation, of a neuroendocrine variant which may be part of the histologic spectrum of this neoplasm.

Inflammatory Pseudotumor of the Liver: Report of Two Cases

Inflammatory pseudotumor of the liver is a very rare lesion. Herein we describe two cases of this entity which occurred in two women aged 22 and 49 years, respectively. Both cases were considered to be clinically malignant and only the histopathologic examination revealed the non-neoplastic nature of the disease. Ultrastructural and immunohistochemical studies further supported the evidence of a reactive disease.

Immunohistochemistry and Electron Microscopy of Intravascular Bronchioloalveolar Tumor of the Lung

We report on an intravascular bronchioloalveolar tumor (IVBAT) detected in the lungs of a 45-year-old female. The results of the immunohistochemical and ultrastructural investigations stress the already suggested endothelial origin of the tumor. The clinical and histopathologic differential diagnoses between IVBAT and other rare tumors of the lung are discussed. Similarities of IVBAT with other more or less recently described endothelial tumors of the liver, skin and soft tissues are pointed out.

Ileal Carcinoid Metastatic to the Breast. Report of a Case

We report a case of ileal carcinoid which clinically presented as a primary breast carcinoma. Review of the literature demonstrated only 9 cases of carcinoids metastatic to the breast. In spite of the rarity of this event, the differential diagnosis between primary and metastatic carcinoid of the breast should be considered in view of the different clinical management of these two settings.

Hairy Cell Leukemia: Enzyme-histochemical and Ultrastructural Investigation of one Case

The investigation was carried out on blood smears, bone marrow aspirates, one lymph node biopsy, and the surgically removed spleen of a 53-year-old man with hairy cell leukemia. In the blood smears stained with May-Grünwald-Giemsa, 60 to 70 % of the hairy cells contained tubular inclusions that corresponded to the ribosome-lamella complexes demonstrated at electron microscopy. In blood smears, imprints and cryostatic sections of the lymph node and of the spleen, hairy cells revealed tartrate-resistant acid phosphatase, beta-glucuronidase and adenosine-triphosphatase activity. In the spleen neutral esterase and alkaline phosphatase demonstrated the numerical increase of the histiocytes, which ultrastructurally displayed phagocytic activity. The presence in the spleen of pseudosinuses lined by hairy cells was confirmed by electron microscopy as well as by cytoenzymology.

Synchronous Triple Carcinoma of the Lung in One Patient

A case is reported of the simultaneous occurrence of a squamous cell carcinoma and a small cell carcinoma, both centrally located, in the right upper lobe and a peripheral adenocarcinoma in the right lower lobe. The simultaneous occurrence of three primary lung carcinomas is discussed in the light of a probable common cell origin.

The Ultrastructure of Malignant Fibrous Histiocytoma (Case Report)

A soft tissue malignant fibrous histiocytoma was studied by light and electron microscopy. The presence of fibroblast-like cells, histiocyte-like cells, undifferentiated stem cells, and xanthomatous cells was confirmed. Fibroblast- and histiocyte-like multinucleated giant cells were also observed. The observation of lysosomes in some fibroblast-like cells, the features of undifferentiated stem cells, and the presence of cells with intermediate characteristics common to xanthomatous, histiocytic, and stem cells suggest a strict relationship among these cellular types.

Unusual Morphologic Features of a Primary Liver Neoplasm

Light and electron microscopy study of an unusual primary liver neoplasm observed in a 36-year-old woman. By light microscopy the tumor, initially detected by a needle biopsy and later surgically removed, was mainly composed of spindle-shaped and multinucleated cells which were similar to rhabdomyoblasts. These cells, however, showed ultrastructural features of hepatocytes.

A Light Microscopic and Ultrastructural Study of Spindle-Shaped Hepatocellular Carcinoma

Spindle-cell hepatocellular carcinoma is an unusual morphologic variant of hepatocellular carcinoma with a typical sarcomatous appearance. The exact diagnosis of this tumor may be difficult when only small biopsies are available and in the absence of ultrastructural studies. We describe two cases of hepatocellular carcinoma: one was entirely composed of spindle-shaped cells, and the other was a typical hepatocellular carcinoma with only a small area of sarcomatous, fusiform cells. In the first case, ultrastructural studies demonstrated desmosomes and many Mallory bodies and confirmed the epithelial nature of the neoplasm. In the second case, no ultrastructural studies were available, but the presence of gradual transition from liver cell carcinoma to spindle-cell carcinoma excludede the diagnosis of carcino-sarcoma.

Electron Microscopy in an Oncologic Institution. Diagnostic Usefulness in Surgical Pathology

A retrospective survey of all electron microscopic (EM) examinations of surgical pathology specimens obtained at the Istituto Nazionale Tumori of Milan over a 5-year period (1981-1985) was carried out. During this time a total of 259 cases were examined: for 97 (38%) electron microscopy provided a substantial diagnostic contribution, whereas in 151 (58%) it confirmed the previous light microscopic diagnosis. In our experience, EM was most useful for diagnosing selected cases of cutaneous malignant melanoma predominantly metastatic, rhabdomyosarcoma, neuroblastoma and poorly differentiated neuroepithelial tumors and less helpful in the further analysis of cases of malignant mesothelioma, Ewing's sarcoma, leiomyosarcoma and fibrohistiocytic malignancies. In cases of well-differentiated neuroepithelial tumors, such as carcinoids, EM data was essentially confirmatory of (immuno)-histochemical findings.

Electron Microscopic Study of Viruses in Mouse Thymuses during Leukemogenesis by Urethan

A systematic search for viral particles was carried out in thymuses of C3Hf inbred mice treated with leukemogenic doses of urethan. Thymuses collected during the tumor latent period and thymic lymphosarcomas were examined. A group of 38 mice was treated, starting at 10 days of age, with 5 i.p. doses of urethan (lmg/g body weight) once every two days. This treatment induces approximately 30 per cent thymic lymphosarcomas in C3Hf mice, after an average period of 20 weeks, whereas no spontaneous thymic lymphosarcomas develop in untreated controls. Six animals with thymic lymphosarcoma were killed between 16–32 weeks of age; the others were sacrificed at 3,5,10 and 14 weeks of age when they did not have any recognizable thymic tumor either grossly or microscopically. As control, thymuses of a group of 28 untreated mice were examined. Mature and immature type C particles morphologically indistinguishable from the murine leukemogenic viruses and intracisternal A particles were observed. The immature C particles and intracisternal A particles were found in all the groups of treated and untreated mice. Intracisternal A particles were more numerous in the untreated than in the treated animals. The number of A particles in the neoplastic thymuses was far inferior than that observed in the treated animals killed before development of lymphoma. The amount of immature C particles was always much less than that of A particles. No significant difference in the number of immature C particles was observed in all experimental groups. Mature C particles were only seen in the thymus of a few treated or untreated mice, never in thymic lymphosarcomas. Within the limits of this investigation, the results presented are not consistent with the view that urethan may act by stimulating viral multiplication.

Production of a Monoclonal Antibody Directed against the High-Affinity Nerve Growth Factor Receptor

The high-affinity nerve growth factor receptor corresponds to the tyrosine protein kinase encoded by the proto-oncogene trkA. Different findings suggest that nerve growth factor (NGF) can be operative in the growth modulation of tumor cell lines possessing high-affinity binding sites for this molecule. Using as immunizing material the SKNBE neuroblastoma cell line transfected with proto-trkA we produced a monoclonal antibody (MAb) able to recognize the high-affinity nerve growth factor receptor. The selected MAb, designated MGR12, is directed against an epitope present on the extracellular domain of the receptor since it showed reactivity on living trkA-expressing cells and was able to immunoprecipitate the proto-trkA molecule. The MGR12 MAb is directed against a non-functional epitope since it neither inhibited NGF binding nor induced receptor internalization. This new reagent appears to be an appropriate tool for analyzing the expression of high-affinity nerve growth factor receptor in tumors of different origin and for elucidating its involvement in tumor progression.

Autosomal-dominant myopia associated to a novel P4HA2 missense variant and defective collagen hydroxylation

We recently described a complex multisystem syndrome in which mild-moderate myopia segregated as an independent trait. A plethora of genes has been related to sporadic and familial myopia. More recently, in Chinese patients severe myopia (MYP25, OMIM:617238) has been linked to mutations in P4HA2 gene. Seven family members complaining of reduced distance vision especially at dusk underwent complete ophthalmological examination. Whole-exome sequencing was performed to identify the gene responsible for myopia in the pedigree. Moderate myopia was diagnosed in the family which was associated to the novel missense variant c.1147A > G p.(Lys383Glu) in the prolyl 4-hydroxylase,alpha-polypeptide 2 (P4HA2) gene, which catalyzes the formation of 4-hydroxyproline residues in the collagen strands. In vitro studies demonstrated P4HA2 mRNA and protein reduced expression level as well as decreased collagen hydroxylation and deposition in mutated fibroblast primary cultures compared to healthy cell lines. This study suggests that P4HA2 mutations may lead to myopic axial elongation of eyeball as a consequence of quantitative and structural alterations of collagen. This is the first confirmatory study which associates a novel dominant missense variant in P4HA2 with myopia in Caucasian patients. Further studies in larger cohorts are advisable to fully clarify genotype-phenotype correlations.

Flat Panel Angiography in the Cross-Sectional Imaging of the Temporal Bone: Assessment of Image Quality and Radiation Dose Compared with a 64-Section Multisection CT Scanner

BACKGROUND AND PURPOSE

Cross-sectional imaging of the temporal bone is challenging because of the complexity and small dimensions of the anatomic structures. We evaluated the role of flat panel angiography in the cross-sectional imaging of the temporal bone by comparing its image quality and radiation dose with a 64-section multisection CT scanner.

MATERIALS AND METHODS

We retrospectively collected 29 multisection CT and 29 flat panel angiography images of normal whole-head temporal bones. Image quality was assessed by 2 neuroradiologists, who rated the visualization of 30 anatomic structures with a 3-point ordinal scale. The radiation dose was assessed with an anthropomorphic phantom.

RESULTS

Flat panel angiography showed better image quality than multisection CT in depicting the anterior and posterior crura of the stapes, the footplate of the stapes, the stapedius muscle, and the anterior ligament of the malleus (P < .05). In contrast, multisection CT showed better image quality than flat panel angiography in assessing the tympanic membrane, the bone marrow of the malleus and incus, the tendon of the tensor tympani, the interscalar septum, and the modiolus of the cochlea (P < .05). Flat panel angiography had a significantly higher overall image quality rating than multisection CT (P = .035). A reduction of the effective dose of approximately 40% was demonstrated for flat panel angiography compared with multisection CT.

CONCLUSIONS

Flat panel angiography shows strengths and weaknesses compared with multisection CT. It is more susceptible to artifacts, but due to the higher spatial resolution, it shows equal or higher image quality in assessing some bony structures of diagnostic interest. The lower radiation dose is an additional advantage of flat panel angiography.

The intriguing journey of gH625-dendrimers

The knowledge of the mechanism used by vectors to gain access to cell interiors is key to the development of effective drug delivery tools for different pathologies.

Experimental evaluation of two different types of reactors for CO2 removal from gaseous stream by bottom ash accelerated carbonation

Low methane content landfill gas may be enriched by removing carbon dioxide. An innovative process, based on carbon dioxide capture and storage by means of accelerated carbonation of bottom ash is proposed and studied for the above purpose. Within this research framework we devoted a preliminary research activity to investigate the possibility of improving the way the contact between bottom ash and landfill gas takes place: this is the scope of the work reported in this paper. Two different types of reactors - fixed bed and rotating drum - were designed and constructed for this purpose. The process was investigated at laboratory scale. As the aim of this phase was the comparison of the performances of the two different reactors, we used a pure stream of CO₂ to preliminarily evaluate the reactor behaviors in the most favorable condition for the process (i.e. maximum CO₂ partial pressure at ambient condition). With respect to the simple fixed bed reactor concept, some modifications were proposed, consisting of separating the ash bed in three layers. With the three layer configuration we would like to reduce the possibility for the gas to follow preferential paths through the ash bed. However, the results showed that the process performances are not significantly influenced by the multiple layer arrangement. As an alternative to the fixed bed reactor, the rotating drum concept was selected in order to provide continuous mixing of the solids. Two operating parameters were considered and varied during the tests: the filling ratio and the rotating speed. Better performances were observed for lower filling ratio while the rotating speed showed minor importance. Finally the performances of the two reactors were compared. The rotating drum reactor is able to provide improved carbon dioxide removal with respect to the fixed bed one, especially when the rotating reactor is operated at low filling ratio values and slow rotating speed values. Comparing the carbon dioxide specific removal obtained by using the rotating reactor (35-37g/kg_BA), in the best operating conditions, with that measured for the fixed bed reactor (21-23g/kg_BA), an increase of about 61-66% is observed.

Results of a 2-arm, phase 2 clinical trial using post-transplantation cyclophosphamide for the prevention of graft-versus-host disease in haploidentical donor and mismatched unrelated donor hematopoietic stem cell transplantation

BACKGROUND

High-dose, post-transplantation cyclophosphamide (PTCy) to prevent graft-versus-host disease (GVHD) has improved outcomes in haploidentical (HAPLO) stem cell transplantation (SCT). However, it remains unclear whether this strategy is effective in SCT from 1-antigen human leukocyte antigen (HLA)-mismatched unrelated donors (9/10 MUD) and how the outcomes of these patients compare with those of haploidentical transplantation recipients.

METHODS

A parallel, 2-arm, nonrandomized phase 2 clinical trial was conducted of melphalan-based reduced-intensity conditioning with PTCy, tacrolimus, and mycophenolate mofetil to prevent GVHD in patients with high-risk hematologic malignancies who underwent HAPLO (n = 60) or 9/10 MUD (n = 46) SCT.

RESULTS

The 1-year overall and progression-free survival rates were 70% and 60%, respectively, in the HAPLO arm and 60% and 47%, respectively, in the 9/10 MUD arm. The day +100 cumulative incidence of grade II to IV acute GVHD and grade III to IV acute GVHD was 28% and 3%, respectively, in the HAPLO arm and 33% and 13%, respectively, in the 9/10 MUD arm. The 2-year cumulative incidence of chronic GVHD was 24% in the HAPLO arm and 19% in the 9/10 MUD arm. The 1-year cumulative incidence of nonrelapse mortality was 21% in the HAPLO arm and 31% in the 9/10 MUD arm, and the 1-year relapse rate was 19% in the HAPLO arm and 25% in the 9/10 MUD arm.

CONCLUSIONS

Although this was a nonrandomized study and could not serve as a direct comparison between the 2 groups, the authors conclude that PTCy-based GVHD prophylaxis is effective for both HAPLO and 9/10 MUD SCTs. Prospective randomized trials will be required to compare the efficacies of alternative donor options for patients lacking HLA-matched donors. Cancer 2016;122:3316-3326. © 2016 American Cancer Society.

Solid recovered fuel: An experiment on classification and potential applications

The residual urban waste of Prato district (Italy) is characterized by a high calorific value that would make it suitable for direct combustion in waste-to-energy plants. Since the area of central Italy lacks this kind of plant, residual municipal waste is quite often allocated to mechanical treatment plants in order to recover recyclable materials (such as metals) and energy content, sending the dry fractions to waste-to-energy plants outside the region. With the previous Italian legislation concerning Refuse Derived Fuels, only the dry stream produced as output by the study case plant, considered in this study, could be allocated to energy recovery, while the other output flows were landfilled. The most recent Italian regulation, introduced a new classification for the fuel streams recovered from waste following the criteria of the European standard (EN 15359:2011), defining the Solid Recovered Fuel (SRF). In this framework, the aim of this study was to check whether the different streams produced as output by the study case plant could be classified as SRF. For this reason, a sampling and analysis campaign was carried out with the purpose of characterizing every single output stream that can be obtained from the study case mechanical treatment plant, when operating it in different ways. The results showed that all the output flows from the study case mechanical treatment plant were classified as SRF, although with a wide quality range. In particular, few streams, of rather poor quality, could be fed to waste-to-energy plants, compatibly with the plant feeding systems. Other streams, with very high quality, were suitable for non-dedicated facilities, such as cement plants or power plants, as a substitute for coal. The implementation of the new legislation has hence the potential for a significant reduction of landfilling, contributing to lowering the overall environmental impact by avoiding the direct impacts of landfilling and by exploiting the beneficial effects of energy recovery from waste.

Peristeen(®) transanal irrigation in paediatric patients with anorectal malformations and spinal cord lesions: a multicentre Italian study

AIM

In paediatric and adult patients with neurogenic bowel, transanal irrigation (TAI) of the colon has gained popularity due to the introduction of a specifically designed device. The aim of this pilot study was to present the results of TAI using the Peristeen(®) TAI system in a group of paediatric patients with anorectal malformation (ARM) and congenital or acquired spinal cord lesions (SCLs).

METHOD

Eight Italian paediatric surgery and spina bifida centres participated in the study. The inclusion criteria were age between 6 and 17 years, weight above 20 kg and unsatisfactory bowel management. Patients with chronic inflammatory bowel disease, mental disability and surgery within the previous 3 months were excluded. At the beginning of treatment (T0) and after 3 months (T1) the Bristol scale, a questionnaire assessing bowel function, and two questionnaires on quality of life (QoL) for patients aged 6-11 years (CHQ-pf50) and 12-17 years (SF36) were administered.

RESULTS

Eighty-three patients were enrolled, and seventy-eight completed the study (41 ARMs, 37 SCLs). At T1, constipation was reduced in ARMs from 69% to 25.6% and in SCLs from 92.7% to 41.5%, faecal incontinence in ARMs from 50% to 18.6% and in SCLs from 39% to 9.8% and flatus incontinence in ARMs from 20.9% to 9.8% and in SCLs from 31.7% to 10%. At T0, the Bristol Stool Scale types were 1-2 in 45% of ARMs and 77.5% of SCL patients, whereas at T1 types 1-2 were recorded in only 2.5% of SCL patients. QoL improved in both groups. In the younger group, a significant improvement in QoL was recorded in ARM patients for eight of nine variables and in SCL patients for seven of nine variables.

CONCLUSION

This study showed that Peristeen TAI resulted in a significant time reduction in colonic cleansing, increased independence from the carer and improved QoL in paediatric patients with ARMs and SCLs.

An overview of conditioning regimens for haploidentical stem cell transplantation with post-transplantation cyclophosphamide

Haploidentical related donors are an attractive alternative source of stem cells for allogeneic stem cell transplantation due to widespread availability and ease of stem cell procurement. Historically, haploidentical stem cell transplantation (HaploSCT) with extensive T-cell depletion has been associated with high rates of infectious complications and nonrelapse mortality (NRM). Post-transplantation cyclophosphamide (PTCy) has been shown to induce immune tolerance, effectively control graft-versus-host-disease (GVHD), and is associated with lower NRM, making it a preferred option for patients undergoing HaploSCT. Over the last decade, several groups investigated PTCy for GVHD prevention in HaploSCT; it is now successfully utilized with both myeloablative and nonmyeloablative conditioning regimens with survival comparable to HLA-matched transplantation. Future directions will focus on optimizing conditioning regimens by diagnosis, improving donor selection, and enhancing graft-versus-leukemia effect.

Spontaneous muscle haematomas: management of 10 cases

This is a retrospective study about the treatment of spontaneous muscle haematomas (SMH) that are an uncommon disease that occurs especially in elderly patients with acquired coagulopathy. We report the management of 10 cases admitted to our Emergency Surgical Unit (ESU) between March 2011 and October 2012. For this analysis we have considered some parameters such as age, drug history, current symptoms, location of the haematoma, cause, and imaging examination. Our attention focused on: clinical presentation, differential diagnosis, diagnostic imaging techniques and treatments.

Metalloproteinase-9 contributes to inflammatory glia activation and nigro-striatal pathway degeneration in both mouse and monkey models of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced Parkinsonism

Inflammation is a predominant aspect of neurodegenerative diseases, manifested by glia activation and expression of pro-inflammatory mediators. Studies on animal models of Parkinson's disease (PD) suggest that sustained neuroinflammation exacerbates degeneration of the dopaminergic (DA) nigro-striatal pathway. Therefore, insights into the inflammatory mechanisms of PD may help the development of novel therapeutic strategies against this disease. As extracellular matrix metalloproteinases (MMPs) could be major players in the progression of Parkinsonism, we investigated, in the substantia nigra and striatum of mice acutely injected with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), changes in mRNA expression, protein levels, and cell localization of MMP-9. This protease is mainly neuronal, but early after MPTP injection its mRNA and protein levels, as well as the number of MMP-9-expressing microglia and astrocytes, increase concomitantly to a prominent inflammation. Neuroinflammation and MMP-9(+) glia begin to decline within 2 weeks, although protein levels remain higher than control, in association with a partial recovery of DA nigro-striatal circuit. Comparable quantitative studies on MMP-9 knock-out mice, show a significant decrease in both glia activation and loss of DA neurons and fibers, with respect to wild-type. Moreover, in a parallel study on chronically MPTP-injected macaques, we observed that perpetuation of inflammation and high levels of MMP-9 are associated to DA neuron loss. Our data suggest that MMP-9 released by injured neurons favors glia activation; glial cells in turn reinforce their reactive state via autocrine MMP-9 release, contributing to nigro-striatal pathway degeneration. Specific modulation of MMP-9 activity may, therefore, be a strategy to ameliorate harmful inflammatory outcomes in Parkinsonism.

Pilot scale evaluation of the BABIU process--upgrading of landfill gas or biogas with the use of MSWI bottom ash

Biogas or landfill gas can be converted to a high-grade gas rich in methane with the use of municipal solid waste incineration bottom ash as a reactant for fixation of CO2 and H2S. In order to verify results previously obtained at a laboratory scale with 65-90 kg of bottom ash (BA), several test runs were performed at a pilot scale, using 500-1000 kg of bottom ash and up to 9.2 Nm(3)/h real landfill gas from a landfill in the Tuscany region (Italy). The input flow rate was altered. The best process performance was observed at a input flow rate of 3.7 Nm(3)/(htBA). At this flow rate, the removal efficiencies for H2S were approximately 99.5-99%.