Effects of a beaver dam on the benthic copepod assemblage of a Mediterranean river.

As known "ecosystem engineers", beavers influence river hydrology, geomorphology, biochemistry, and biological assemblages. However, there is a lack of research regarding the effects of beaver activities on freshwater meiofauna. In this study, we investigated the taxonomic and functional composition of the benthic copepod assemblage of a segment of the Tiber River (Italy) where a beaver dam, created about 7 weeks before our survey, had formed a semi-lentic habitat upstream and a lotic habitat downstream of the dam. We also analyzed the copepod assemblage before and after a flood event that destroyed the beaver dam, providing a unique opportunity to observe changes in a naturally reversing scenario. Our analyses revealed that, while the taxonomic composition and functional traits of the copepod assemblage remained largely unchanged across the recently formed semi-lentic and lotic habitats, substantial differences were evident between the dammed and undammed states. The dammed state showed lower copepod abundances, biomass, and functionality than the undammed one. These results highlight the role of beaver dams in changing the composition and functionality of meiofaunal assemblages offering insights into the dynamic interactions within aquatic ecosystems.

Biosorption of rare earth elements from luminophores by G. sulphuraria (Cyanidiophytina, Rhodophyta).

Lanthanides are indispensable constituents of modern technologies and are often challenging to acquire from natural resources. The demand for REEs is so high that there is a clear need to develop efficient and eco-friendly recycling methods. In the present study, freeze-dried biomass of the polyextremophile Galdieria sulphuraria was employed to recover REEs from spent fluorescent lamps (FL) luminophores by pretreating the freeze-dried biomass with an acid solution to favour ion exchange and enhance the binding sites on the cell surface available for the metal ions. Lanthanides were extracted from the luminophores using sulfuric acid solutions according to standardised procedures, and the effect of biosorbent dosage (0.5-5 mg/ml) and biosorption time (5-60 min) were evaluated. The content of individual REEs in the luminophores and the resulting algal biomass were determined using inductively coupled plasma mass spectrometry (ICP-MS). The most abundant REE in the luminophores was yttrium (287.42 mg/g dm, 91.60% of all REEs), followed by europium (20.98 mg/g, 6.69%); cerium, gadolinium, terbium and lanthanum was in trace. The best biosorption performances were achieved after 5 min and at the lowest biosorbent dosage (0.5 mg/mL). The highest total metal amount corresponded to 41.61 mg/g dried mass, and yttrium was the most adsorbed metal (34.59 mg/g dm, 82.88%), followed by cerium (4.01 mg/g); all other metals were less than 2 mg/g. The rapidity of the biosorption process and the low biosorbent dosage required confirmed this microalga as a promising material for creating an eco-sustainable protocol for recycling REEs.

Elective Treatment of Large-Bowel Obstruction in Asymptomatic Sigmoid Volvulus.

BACKGROUND: Sigmoid volvulus is an uncommon cause of intestinal obstruction representing the 5% of all Western cases, associated with old age and a history of neurological and psychiatric condition. Generally, its diagnosis is established by clinical and radiologic findings. It often represents an emergency and it is commonly associated with pain, vomit and abdominal tenderness. CASE PRESENTATION: We present a case of a 59 years old man, admitted to our emergency department, showing an abdominal X-Ray reporting a distention of large bowel,which was required due to presence of multiple diarrhea episodes during the previous 7 days. He had no significant past medical history and did not report constipation or subocclusive episode. CONCLUSIONS: Volvulus should be considered in the differential diagnosis in adult and healthy patients with bowel obstructions. Surgery is, in all cases, the radical and definitive treatment since there is a higher mortality in case of recurrent volvulus. Despite the massive bowel distention, our choice was the elective open surgery. Primary anastomosis is feasible and safe and did not lead to any complications. In case of unsuccessful colonic decompression, evidence to support or refute the safety and effectiveness of laparoscopic surgical resection for treatment of patients with sigmoid volvulus disease is not yet proven.

Accreditation for colorectal cancer surgery in Italy. Preliminary results of a new program in a district hospital.

Accreditation for colorectal (CR) cancer surgery has become a major issue in Italy. This study aimed to analyze the early results of a newly structured program for the treatment of CR cancer in a rural district hospital. Between 2017 and 2018, a total of 214 consecutive patients underwent a CR procedure for malignancy. There were 113 men and 101 women of a mean age of 74 years. Primary CR adenocarcinoma was diagnosed in 210 patients (98%). The incidence of stage I, II, III, and IV disease was 26%, 31%, 24%, and 19% respectively. Hospital volume increased tenfold compared to previous years. Anatomical resection was performed in 204 patients. Right-sided resection and resection of the transverse colon or left angle were performed in 76 (37%) and 14 (7%) patients, respectively. A restorative left sided CR resection was performed in 80 patients (39%), whereas Hartmann procedure and Miles abdominal-perineal resection were performed in 27 (13%) and 6 (3%) patients, respectively. Total colectomy with ileorectal anastomosis was performed in one patient, and two more patients underwent atypical resection. Emergency cecostomy was performed in 15 patients and a colic endoprosthesis was implanted in one patient for obstruction and seven underwent resection afterwards. Laparoscopic resection was performed in 118 patients (57.8%), and the conversion rate was 2%. Overall morbidity, reintervention, and mortality rates were 24.6%, 3,7%, and 3.2%, respectively. The incidence of AL was 4.6%, and two patients died of the consequences of it after right hemicolectomy. Five more elderly patients died for non-surgical related medical complications. The median hospital stay was ten days, and early unplanned readmission rate was 2%. Hospital and surgeon requirements, in terms of minimum volume, organization, and surgical outcome were fulfilled. A rural district hospital can become a tertiary referral center for the surrounding districts without imposing unreasonable travel burdens for patients. CR surgery represents a capital investment for the hospital administration since it shows the effectiveness and quality of care.

Association between Gallbladder Ultrasound Findings and Bacterial Culture of Bile in 70 Cats and 202 Dogs.

BACKGROUND: Bacterial cholecystitis often is diagnosed by combination of gallbladder ultrasound (US) findings and positive results of bile culture. The value of gallbladder US in determining the likelihood of bile bacterial infection in cats and dogs with suspected biliary disease is unknown. HYPOTHESIS/OBJECTIVES: To determine the value of gallbladder US in predicting bile bacterial culture results, identify most common bacterial isolates from bile, and describe complications after cholecystocentesis in cats and dogs with suspected hepatobiliary disease. ANIMALS: Cats (70) and dogs (202) that underwent an abdominal US and submission of bile for culture were included in the study. METHODS: A cross-sectional study design was used to determine the association of gallbladder US abnormalities and the results of bile cultures, and complications of cholecystocentesis. RESULTS: Abnormal gallbladder US had high sensitivity (96%) but low specificity (49%) in cats with positive and negative results of bile bacterial culture, respectively. Cats with normal gallbladder US findings were unlikely to have positive bile bacterial culture (negative predictive value of 96%). Gallbladder US had lower sensitivity (81%), specificity (31%), positive predictive value (20%), and negative predictive value (88%) in dogs. The most common bacterial isolates were of enteric origin, the prevalence being higher in cats. Incidence of complications after cholecystocentesis was 3.4%. CONCLUSIONS AND CLINICAL IMPORTANCE: Gallbladder US has a high negative predictive value for bile culture results in cats. This modality is less predictive of infection in dogs. Percutaneous US-guided cholecystocentesis has a low complication rate.

Ultrasound-guided synovial biopsy: a safe, well-tolerated and reliable technique for obtaining high-quality synovial tissue from both large and small joints in early arthritis patients.

OBJECTIVE: To determine the tolerability, safety and yield of synovial tissue in an early arthritis cohort using a minimally invasive, ultrasound (US)-guided, synovial biopsy technique in small, medium and large joints. METHODS: 93 sequential biopsy procedures were assessed from a total of 57 patients (baseline and 36 repeat biopsies at 6 months) recruited as part of the 'Pathobiology of Early Arthritis Cohort' study. Patients completed a tolerability questionnaire prior to and following the synovial biopsy procedure. The synovial biopsy was performed under US guidance with US images of the joint recorded prior to each procedure. Synovial tissue was harvested for immunohistochemistry and RNA extraction. RESULTS: Five different joint sites were biopsied (knee, elbow, wrist, metacarpal phalangeal and proximal interphalangeal). No significant complications were reported following the procedure. No difference in pain, swelling and stiffness of the biopsied joint from before and after the procedure was demonstrated. A median of 14 biopsy samples was retrieved from each procedure with 93% of biopsy procedures yielding good quality tissue. RNA yield was good in all joints and in repeat biopsies. Multivariant analysis demonstrated a significantly greater yield of RNA and graded tissue in relation to a high prebiopsy, grey-scale synovitis score (0-3, semiquantitative). CONCLUSIONS: A minimally invasive approach to synovial tissue harvesting, using US guidance, is both safe and well-tolerated by patients. Tissue quality/RNA yield is preserved in subsequent biopsies following therapeutic intervention. A high US grey-scale synovitis score is a predictor of good quality/quantity of tissue and RNA.

Alignment of small organic solutes in a nematic solvent: the effect of electrostatic interactions.

The origin of the alignment with respect to the director observed for solutes in a nematic host remains unclear, and various mechanisms ranging from steric repulsions to dispersive or electrostatic interactions have been invoked. Here we present atomistic molecular dynamics (MD) computer simulations of rigid solutes of small dimensions dissolved in a nematic liquid crystal solvent, 4-n-pentyl-4'cyanobiphenyl (5CB), that aim to quantitatively predict the orientational order. We have validated the results comparing the dipolar couplings obtained by atomistic simulation with their experimental NMR counterparts. To help assess the separate effect of the various types of anisotropic interactions on the orientational order of solutes, we have modeled solute molecules with their partial atomic charges present or absent (switching them to zero), finding that, at least for the cases studied, the alignment mechanism is largely dominated by steric and van der Waals dispersive forces rather than Coulomb ones. We have compared the anisotropic aligning potential with the predictions of the Maier-Saupe and surface tensor models and discussed their performance.

Risk factors for catheter-related thrombosis (CRT) in cancer patients: a patient-level data (IPD) meta-analysis of clinical trials and prospective studies.

BACKGROUND: Knowledge of independent, baseline risk factors for catheter-related thrombosis (CRT) may help select adult cancer patients who are at high risk to receive thromboprophylaxis. OBJECTIVES: We conducted a meta-analysis of individual patient-level data to identify these baseline risk factors. PATIENTS/METHODS: MEDLINE, EMBASE, CINAHL, CENTRAL, DARE and the Grey literature databases were searched in all languages from 1995 to 2008. Prospective studies and randomized controlled trials (RCTs) were eligible. Studies were included if original patient-level data were provided by the investigators and if CRT was objectively confirmed with valid imaging. Multivariate logistic regression analysis of 17 prespecified baseline characteristics was conducted. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. RESULTS: A total sample of 5636 subjects from five RCTs and seven prospective studies was included in the analysis. Among these subjects, 425 CRT events were observed. In multivariate logistic regression, the use of implanted ports as compared with peripherally implanted central venous catheters (PICCs), decreased CRT risk (OR, 0.43; 95% CI, 0.23-0.80), whereas past history of deep vein thrombosis (DVT) (OR, 2.03; 95% CI, 1.05-3.92), subclavian venipuncture insertion technique (OR, 2.16; 95% CI, 1.07-4.34) and improper catheter tip location (OR, 1.92; 95% CI, 1.22-3.02), increased CRT risk. CONCLUSIONS: CRT risk is increased with use of PICCs, previous history of DVT, subclavian venipuncture insertion technique and improper positioning of the catheter tip. These factors may be useful for risk stratifying patients to select those for thromboprophylaxis. Prospective studies are needed to validate these findings.

Agenesis of paranasal sinuses and nasal nitric oxide in primary ciliary dyskinesia.

Agenesis of paranasal sinuses has only been described in case reports of patients with primary ciliary dyskinesia (PCD). As agenesis of paranasal sinuses may contribute to low nasal nitric oxide levels, a common finding in PCD, we speculated that this condition might frequently occur in PCD patients. Patients referred for PCD evaluation were consecutively recruited for 30 months. In addition to standard diagnostic testing for PCD, a computed tomography (CT) scan of paranasal sinuses was performed in all subjects. 86 patients (46 children aged 8-17 yrs) were studied. PCD was diagnosed in 41 subjects and secondary ciliary dyskinesia (SCD) was diagnosed in the remaining 45 subjects. Frontal and/or sphenoidal sinuses were either aplastic or hypoplastic on CT scans in 30 (73%) out of 41 PCD patients, but in only 17 (38%) out of 45 with SCD (p = 0.002). There was a significant inverse correlation between the score for aplasia/hypoplasia of each paranasal sinus and nasal NO values in the PCD patients (p = 0.008, r = -0.432) but not in SCD (p = 0.07, r = -0.271). The findings of aplasia/hypoplasia of the frontal and or sphenoidal sinuses may be part of the spectrum of PCD and this finding should prompt exclusion of this condition.

Health-related quality of life and unmet needs in patients with primary ciliary dyskinesia.

Few studies have evaluated the quality of life of patients with primary ciliary dyskinesia (PCD). We sought to determine the health impact of the disease as well as the unmet needs in a large group of patients. Questionnaires were either posted or e-mailed to known patients with PCD and published online. Questionnaires included the St George's Respiratory Questionnaire, the Medical Outcomes Study Short Form-36 and a questionnaire that we produced to obtain information on age of diagnosis, symptoms and likely PCD-specific problems of these patients. 78 subjects (96% of those invited) answered all the questionnaires. Patients were diagnosed at a mean age of 9.4 yrs. Progressive worsening of the disease was observed and adherence to physiotherapy was found to be poor, particularly in adolescents and adults. Patients with the highest treatment burden had a worse quality of life. Over time patients become progressively less interested in treating their disease and adherence to treatment modalities decreases. PCD is associated with a progressive and continuous impact on the physical and mental health of the patients. Earlier identification of the patients and better strategies aimed at improving compliance with care are urgently needed.

Simplified cell culture method for the diagnosis of atypical primary ciliary dyskinesia.

BACKGROUND: The diagnosis of primary ciliary dyskinesia (PCD) can be challenging, and it may be particularly difficult to distinguish primary ciliary disease from the secondary changes after infections. OBJECTIVES: The purpose of the study was to evaluate if nasal epithelial cells, obtained with nasal brushing instead of a biopsy, could be used in a culture system for the diagnosis of PCD in difficult cases. METHODS AND MAIN RESULTS: Ciliary motion analysis (CMA) and transmission electron microscopy (TEM) were performed on 59 subjects with persistent or recurrent pneumonia. These investigations allowed the diagnosis of PCD in 13 (22%) patients while the defect of the cilia was considered secondary to infections in 37 (63%) subjects. In the remaining nine (15%) patients the diagnostic evaluation with CMA and TEM remained inconclusive. Ciliogenesis in culture allowed the diagnosis of PCD in four of these patients, it was indicative of a secondary defect in two subjects, and it was not helpful in the remaining three patients. CONCLUSIONS: Culture of cells obtained with brushing of the nasal turbinate is not a perfect test, nevertheless it may offer diagnostic help in doubtful cases of PCD.

Early and short-term acenocumarine or dalteparin for the prevention of central vein catheter-related thrombosis in cancer patients: a randomized controlled study based on serial venographies.

BACKGROUND: We evaluated efficacy and safety of early and short-term prophylaxis with acenocumarine or dalteparin in the prevention of non-occlusive or occlusive central vein catheter-related thrombosis (CVCrT). PATIENTS AND METHODS: Consecutive cancer patients scheduled for chemotherapy randomly received: acenocumarine 1 mg/day for 3 days before and 8 days after central vein catheter (CVC) insertion; dalteparin 5000 IU 2 h before and daily for 8 days after CVC insertion; no anticoagulant treatment (NT). All patients underwent venography on days 8 and 30, some of them on days 90, 150 and 210 after CVC. RESULTS: A total of 450 patients were randomized, 348 underwent at least two venography. Both acenocumarine and dalteparin reduced venography-detected CVCrT rate [21.9% acenocumarine versus 52.6% NT, odds ratio (OR) 0.3, P < 0.01; 40% dalteparin versus 52.6% NT, OR 0.6, P = 0.05]. Acenocumarine was more effective than dalteparin (OR 0.4, P = 0.01). The rate of occlusive CVCrT was not different in the three groups (0.9% acenocumarine, 3.3% dalteparin, 1.8% NT; P = 0.40). Most CVCrTs (95.6%) were observed on day 8 after CVC insertion and were non-occlusive. CONCLUSIONS: In this study of early and short-term prophylaxis, acenocumarine was more effective than dalteparin on non-occlusive and asymptomatic CVCrT events. The first days following CVC insertion represent the highest risk for CVCrT.

[Emergency Radiology layout]. / Risorse tecnologiche in radiologia d'emergenza.

The purpose of Radiologic Unit in Emergency is to reach diagnostic and therapeutic effectiveness in the best way and in less time possible. The Portable Ultrasound Device is an instrument necessary in Emergency Room and in ambulance/helicopter to evaluate the evidence of endoperitoneal bleeding. The CT is the radiologic methodic more fast that permits a complete evaluation of all body segments in traumatized patient in the famous "golden hour" after the trauma, therefore it would be placed in Emergency Area. The multislice CT brought to a reduction of morbidity and mortality, thanks to a quick acquisition, to a thin collimation, to a more spatial resolution and to an optimal vessel opacization, determining a saving of hospital global costs, therefore a reduction of percentage of not necessaries operations and permitting a more rapid diagnosis, obtaining a considerable reduction of waiting in Trauma Emergency Room with more rapid and aimed therapies and a consequent costs reduction. To satisfy a so wide question of radiologic exams necessaries devices are informatic systems completely connected between Radiology department and other departments. Main advantages of MR in Emergency are the use of non ionising radiations, the possibility to effect diffusion and perfusion studies and to evaluate spinal cord damage. Reduction of time of patient preparation and times of acquisition and elaboration of imagines by modern and performant devices is basic to make more rapid therapeutic decisions.

[Imaging in diagnosis of acute pancreatitis and its complications]. / Imaging nella diagnosi delle pancreatiti acute e delle loro complicanze.

Pancreatitis is a flogistic disease, caused by activation and digestion of pancreas by its enzymes. Diagnosis is based on integrated evaluation of clinical and laboratoristic data and morphological imaging. To evaluate the severity of pancreatitis there is a clinical classification in interstitial--mild pancreatitis and severe--necrotic one. The evaluation of severity is basic, because it is strictly correlated to the prognosis of the patient. CT has revealed the best method for diagnosis, staging and for evaluate the complications and follow-up and in some cases it is useful for therapeutic change.The abdomen X-Ray in orthostatism is performed in every situation suspected for acute abdominal disease, also if aspecific; the ultrasound can be used as first instance method in patient with clinical suspect of acute pancreatitis; the MR has actually a secondary role for the diagnosis, with only except for dubious cases to exclude primitive tumor of pancreas and pancreatic shock, but it represents, instead, first instance method in patients with adverse reaction to contrast medium. The CPRE has, like angiography, a selective indication.

A new dynamic endonasal stent for bilateral congenital choanal atresia.

The Authors describe a new dynamic endonasal Teflon stent, nick-named "little gun", used after the surgical transnasal endoscopic treatment of bilateral choanal atresia in a 4-day-old male. This Teflon stent, conceived to perfectly fit the new naso-choanal openings and to achieve an "orthopaedic" tutorial function, is made of three portions: "A", the barrel, "B", the breech, "C" the butt. The butt is the active part of the splint and must be rolled up around itself, in order to create a spiral tube, fitting to the new choanal openings, able to expand laterally on account of its intrinsic elastic resilience.

[Imaging of simple and complicated acute cholecystitis]. / Imaging delle colecistiti acute semplici e complicate.

Acute Cholecystitis is a common disease and it needs to be treated in emergency. In case of complication, surgery is mandatory in 48-72 hours. Ultrasonography (US) is the first diagnostic step in that it allows to identify the signs of major complications, not always visible. Spiral CT identifies complications misdiagnosed at US and allows a correct classification. However, spiral CT is able to depict fluid collections or gas in the wall or in the lumen of the gallbladder or free air in the peritoneum, signs not always depicted by US and which also needs surgical treatment in emergency. If one or more signs of complications are present, CT is mandatory to identify complicated cholecystitis (phlegmonous or empyematous cholecystitis, abscesses, emphysematous, gangrenous, hemorragic or perforated cholecystitis) and to indicate its urgent surgery.

Same-day endoscopic retrograde cholangiopancreatography after transduodenal endoscopic ultrasound-guided needle aspiration: do we need to be cautious?

Patients who are undergoing endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for suspected pancreatic tumors frequently undergo endoscopic retrograde cholangiopancreatography (ERCP) for palliation of their symptoms. Performing EUS-FNA and ERCP in tandem may be cost-effective and may reduce procedure time, but the potential risks associated with this approach have not been clearly defined in the literature. We report two patients who underwent same-day therapeutic ERCP after transduodenal EUS-FNA for pancreatic tumors. Endoscopic biliary manipulation during ERCP aggravated an inadvertent and subclinical needle puncture injury to the bile duct sustained during the preceding EUS-FNA. This resulted in leakage of bile into the retroperitoneal space, and both patients required laparotomy and surgical drainage. Additional clinical evidence is needed to clarify these issues and to determine whether it would be prudent to perform therapeutic ERCP prior to diagnostic transduodenal EUS-FNA when these two procedures are planned as sequential or same-day procedures.

Ultrasonographic and spiral CT evaluation of simple and complicated acute cholecystitis: diagnostic protocol assessment based on personal experience and review of the literature.

PURPOSE: The aim of this study was to identify and classify the ultrasonographic and computed tomography (CT) signs of simple and complicated acute cholecystitis and to define the correct diagnostic protocol. MATERIALS AND METHODS: We retrospectively reviewed 35 patients (23 men and 12 women; mean age 66.6 years) presenting with acute cholecystitis who were assessed by emergency ultrasonography (US) (30/35 cases) and spiral CT (12/35 cases); all patients underwent emergency surgery. The US signs were analysed and classified as major criteria (wall thickening and stratification, distension, Murphy's sign), minor criteria (bile stones, sludge, and biliary tract dilatation), and complication signs (gas collections, aerobilia, fluid collection, difficult or missed identification of the gallbladder). Imaging results were compared with histological findings (gold standard), and accuracy, sensitivity, specificity, and positive and negative predictive values (PPVs and NPVs) were assessed for each modality. Concordance between the US and CT findings was also evaluated for cases undergoing both examinations; additional findings provided by one or the other modality were also assessed. RESULTS: US had an accuracy of 66.6%, a sensitivity of 37.5%, a specificity of 70%, a PPV of 100%, and an NPV of 58.3%. CT had 100% accuracy, sensitivity, and specificity. Concordance between US and CT was observed for diagnosis of complications, but CT provided additional findings in all cases. The majority of complicated cases undergoing US examination (68.7%) revealed more than two major criteria and one minor criterion or at least one sign of complication. CONCLUSIONS: If more than two major signs associated with one minor sign or at least one sign of complication are present at US, CT is mandatory to recognise and thoroughly evaluate the type of complication and indicate appropriate treatment.

Hematocolpos in double vagina associated with uterus didelphus: US and MR findings.

The malformative syndrome of double vagina in association with uterus didelphus and kidney agenesis is a rare condition, often asymptomatic: if this condition is accompanied by imperforated obstructed hemivagina, the clinical manifestations depend on the presence of hematocolpos. MRI plays an important role for diagnosis because it allows to characterize the nature of the lesion and to evaluate the anatomical details of the uterine malformation. The authors describe this complex genital malformation and discuss the main US and MRI features.