Efficacy and safety of oral administration of a product based on hydroxytyrosol as preventive therapy for recurrent vulvo-vaginal candidosis: a prospective observational pilot study.

OBJECTIVE: The aim of the study is to evaluate the efficacy and safety of hydroxytyrosol for the prevention of the vulvar vaginal candida infections recurrence. PATIENTS AND METHODS: This study is a prospective observational pilot study. Eligible subjects were at least 18 years old, with at least 4 documented episodes of vulvovaginal candidiasis in the last 12 months. Patients were instructed to therapy (2 tabs daily for the first month and then 1 tab daily for 2 other months). Each capsule consists of hydroxytyrosol (HT) and other components: tea tree oil, tabebuia, juglans regia, and copper. Clinical and microbiological assessments took place at baseline and 12 weeks after. The impact on Quality of Life (QoL) was evaluated with the SF-36 and the Patient Global Impression of Improvement (PGI-I) after 3 months of treatment was calculated. RESULTS: Sixty patients were enrolled in the study. In the last 1 year the mean number of previous infections was 5.83 ± 2.76. Forty-nine patients (83%) did not have candida episodes during 3 months of treatment. A significant reduction in clinical symptoms, vaginal signs, such as pruritus, burning and vulvar erythema (< 0.0001). The SF-36 showed a significant change (55.67±8.43 vs. 84.56±11.56, p < 0.0001) and the total success at PGI-I was reported in 54 patients (90%). CONCLUSIONS: The HT-based product is effective and safe in preventing recurrent candida episodes and improves the quality of life and sexual function of treated women.

Dose-dense weekly chemotherapy in advanced ovarian cancer: An updated meta-analysis of randomized controlled trials.

OBJECTIVE: The use of dose-dense weekly chemotherapy in the management of advanced ovarian cancer (OC) remains controversial. The aim of this meta-analysis was to evaluate the efficacy of dose-dense regimen to improve clinical outcomes in OC patients with the inclusion of new trials. METHODS: For this updated meta-analysis, PubMed Medline and Scopus databases and meeting proceedings were searched for eligible studies with the limitation of randomized controlled trials, comparing dose-dense chemotherapy versus standard treatment. Trials were grouped in two types of dose-dense chemotherapy: weekly dose-dense (both paclitaxel and carboplatin weekly administration) and semi-weekly dose-dense (weekly paclitaxel and three weekly carboplatin administration). Data were extracted independently and were analyzed using RevMan statistical software version 5.3 (http://www.cochrane.org). Primary end-point was progression-free survival (PFS). RESULTS: Four randomized controlled trials comprising 3698 patients were identified as eligible. Dose-dense chemotherapy had not a significant benefit on PFS (HR 0.92, 95% CI 0.81-1.04, p = 0.20). When the analysis was restricted to both weekly and semi-weekly dose-dense data, a no significant interaction between dose-dense and standard regimen was confirmed (HR 1.01, 95% CI 0.93-1.10 and HR 0.82, 95% CI 0.63-1.08, respectively). CONCLUSIONS: In the absence of PFS superiority of dose-dense schedule, three weekly schedule should remain the standard of care for advanced OC.

Occurrence of hepatitis A and E and norovirus GI and GII in ready-to-eat vegetables in Italy.

Fresh vegetables and their ready-to-eat (RTE) salads have become increasingly recognized as potential vehicles for foodborne diseases. The EU Reg. 1441/2007 establishes microbiological criteria for bacterial pathogens for products placed on the market during their shelf-life (i.e. Salmonella spp., Listeria monocytogenes) for pre-cut fruits and vegetables (RTE) whilst it does not address the problem of contamination by enteric viruses. In this study we investigated the contamination by hepatitis A virus (HAV), hepatitis E virus (HEV) and norovirus (NoV) in 911 ready-to-eat vegetable samples taken from products at retail in Apulia and in Lombardia. The vegetable samples were tested using validated real-time PCR (RT-qPCR) assays, ISO standardized virological methods and ISO culturing methods for bacteriological analysis. The total prevalence of HAV and HEV was 1.9% (18/911) and 0.6% (6/911), respectively. None of the samples analysed in this study was positive for NoV, Salmonella spp. or Listeria monocytogenes. The detection of HAV and HEV in RTE salads highlights a risk to consumers and the need to improve production hygiene. Appropriate implementation of hygiene procedures is required at all the steps of the RTE vegetable production chain and this should include monitoring of emerging viral pathogens.

Outbreak of Hepatitis A in Italy Associated with Frozen Redcurrants Imported from Poland: A Case Study.

Hepatitis A virus (HAV) was detected in a batch of imported non-packaged frozen redcurrants purchased in a Bari grocery. Sequence and phylogenetic analysis showed the HAV strain clustered tightly with the HAV strain from the 2013 Italian epidemic, providing additional evidence that frozen redcurrants were the main vehicle of the HAV outbreak.

Detection of Vibrio parahaemolyticus in shellfish using polymerase chain reaction-enzyme-linked immunosorbent assay.

AIMS: This study evaluated the application of polymerase chain reaction-enzyme-linked immunosorbent assay (PCR-ELISA) for the detection of Vibrio parahaemolyticus in shellfish. METHODS AND RESULTS: The PCRs were selected to amplify a species-specific sequence region. In particular, internal tl biotin-labelled oligonucleotide probe was used to capture the DIG-labelled PCR products. Next, the probe PCR product hybrids, immobilized on a streptavidin-coated microtiter plate, were detected with peroxidase-conjugated anti-digoxigenin antibody (anti-DIG-POD) and the colorimetric peroxidase substrate ABTS [2,2'-azino-bis(3-ethylbenzthiazoline-6-sulphonic acid)] using an ELISA plate reader. CONCLUSIONS: The PCR-ELISA system described is a feasible, sensitive method for the direct and specific detection of V. parahaemolyticus in shellfish samples. Compared with gel-based detection methods, PCR-ELISA in this study increased sensitivity by 100-fold for V. parahaemolyticus. SIGNIFICANCE AND IMPACT OF THE STUDY: The PCR-ELISA described may be used for potential rapid detection in routine shellfish analysis for the seafood industry. The sector requires simultaneous large-scale sample screenings to monitor contamination levels in processing plants and evaluate the performance of the hazard analysis and critical control point (HACCP) system. PCR-ELISA also proved to be economical, with a cost of about 9 Euros per sample, and the quick assay taking 8 h to complete starting from DNA extraction.

Activated sludge diffusion for odour removal --effects of H2S on the biomass.

The removal of odours from wastewater treatment plants through diffusion of odour-containing air volumes into the aerated basins was investigated in a bench scale experimental campaign which lasted more than 200 days. Hydrogen sulphide was selected as a model odorous compound and its removal efficiencies were experimentally evaluated along with its effects on the biomass and on the main biochemical processes. Two bench scale sequencing batch reactors were fed in parallel on real primary sewage and monitored for chemical oxygen demand removal, nitrification and denitrification. The balance of H2S was also monitored after adding to one of them a Na2S liquid solution of 17 mgS l(reactor)(-1) d(-1), corresponding to a gas-phase concentration of 240 mgS (Nm3)(-1). Results showed an average sulphide removal of 94% in the reactor supplied with Na2S. Moreover, microbial composition did not show relevant variations after the addition of sulphide, and the good features of activated sludge flocs were maintained also in terms of sludge settleability. No relevant effects of sulphide were detected on carbon and nitrogen metabolism and chemical oxygen demand removal, nitrification and denitrification efficiencies were always above 75%, 95%, and 50% respectively, and comparable across the two reactors.

Updated perspectives on emerging vibrios associated with human infections.

This review describes the ecological, clinical and epidemiological features of emerging vibrios and discusses what laboratory methods are being used for the detection of pathogenic vibrios in clinical, environmental and food samples. After selecting articles illustrative of the current scientific research on pathogenic vibrios, the review focuses on the need for better insight into the risk factors of emerging infections to establish adequate prevention procedures.

A comparison of RT-PCR-based assays for the detection of HAV from shellfish.

The hepatitis A virus (HAV) is the most common cause of viral infection linked to shellfish consumption. The lack of correlation between the fecal coliform indicators and the presence of enteric viruses in shellfish and their harvesting waters points to the need for molecular methods to detect viruses. We compared two RT-PCR based techniques currently available for the detection of the hepatitis A virus (HAV) in shellfish. Both approaches involve extraction of viral particles by glycine buffer and concentration of virus particles by one or two PEG precipitation steps. One procedure involves as RNA extraction method the use of oligo (dT) cellulose to select poly (A) RNA, and the other uses a system in which total RNA is bound on silica membrane. Comparison of the two RT-PCR based methods highlighted the efficiency of the first approach which is less time-consuming and technically demanding than the second.

Detection of hepatitis A virus in shellfish (Mytilus galloprovincialis) with RT-PCR.

A PCR assay for the detection of hepatitis A virus (HAV) in shellfish is described. The procedure involves the concentration of viral particles with the use of polyethylene glycol (PEG), followed by viral RNA extraction and purification with oligo(dT) cellulose. Reverse transcriptase-PCR detection was accomplished in a single step with the use of primers specific for the VP3-VP1 region of the genome. The procedure detected one 50% tissue culture infective dose (0.6 PFU) per 25 g of shellfish homogenate. Heminested PCR was then carried out to verify the specificity of the PCR products. The method was used to detect HAV in shellfish samples from EU categories B and C and to evaluate the quality of shellfish in routine monitoring for HAV in view of the relevant public health implications of this foodborne disease.

Direct detection of Cryptosporidium parvum oocysts by immunomagnetic separation-polymerase chain reaction in raw milk.

Cryptosporidium parvum is an emerging protozoan parasite responsible for several serious outbreaks of cryptosporidiosis, an enteric infection characterized by severe intestinal distress. This parasite can be transmitted through contaminated water and raw food in the oocyst form, which is resistant to many environmental stresses and food processes. C. parvum is also commonly found on dairy farms and could be transmitted to humans through contaminated raw milk and dairy products. Thus, an immunomagnetic separation-polymerase chain reaction assay for direct detection of C. parvum oocysts in milk was developed. The procedure was able to detect < 10 C. parvum oocysts. Thus, it could be used for monitoring milk samples.

Combined chemical and biological degradation of tannery wastewater by a periodic submerged filter (SBBR).

The paper reports on the results of an investigation aimed to evaluate the performances of an innovative tannery wastewater process based on the combining biological degradation, carried out in a sequencing batch biofilm reactor, with chemical oxidation, performed by ozone. The combined treatment was carried out at the laboratory scale on real primary effluent coming from a centralised plant treating the wastewater from a large tanning district in Northern Italy. SBBR performances with and without ozonation were compared resulting to be very satisfactory only in the latter instance where recorded COD, NH4-N and TSS average removals were 97%, 98% and 99.9%, respectively. Such efficiencies correspond to specific concentrations in treated effluent well below the limit values fixed by the in-force Italian regulations. Furthermore, it was proved that the combined process is characterised by a very low sludge production. In fact, the measured specific sludge production (0.03 kg TSS/kg COD(removed)) resulted unexpectedly much more lower than the value reported for conventional biological systems (i.e., 0.3-0.5 kg TSS/kg COD(removed)).

Bacteriocin-producing Lactobacillus sake as starter culture in dry sausages.

One hundred and fifty-two strains of Lactobacillus spp and Micrococcus spp, isolated from dry sausages, were screened for inhibitory activity. Two of the strains assayed of the genus Lactobacillus showed bactericidal activity. They were able to inhibit Listeria monocytogenes, Listeria seeligeri, Listeria innocua, Lactobacillus alimentarius and Lactobacillus bavaricus. The strains of Escherichia coli, Salmonella bradford and Salmonella newlands, Staphylococcus aureus, Bacillus cereus, Pseudomonas aeruginosa, Serratia marcescens were resistant. Their antimicrobial activity was due to peptides detectable in the culture broths and inactivated by treatment with proteolytic enzymes. Using bacteriocin-producing Lactobacillus sake as starter cultures in dry sausages could be promising in the food industry.

Sludge incineration tests on circulating fluidised bed furnace.

Results of sludge incineration tests on a demonstrative fluidised bed furnace are reported and discussed. They show that particulate, heavy metals and acidic compounds in the emissions can be easily controlled both when sludge is spiked with chlorinated hydrocarbons up to a chlorine concentration in the feed of 5%, and when the afterburner is switched off. As for organic micropollutants, polynuclear aromatic hydrocarbons (PAH) were much lower than the Italian limits of 10 microg/m3 (no limits are at present considered in the European Directives). Dioxins (PCDDs) and furans (PCDFs) in some tests exceeded the limit of 0.1 ng/m3 (TE) but the concentrations in the fly ashes were much lower, thus evidencing a possible presence of contaminants in gas phase. PAHs and PCDD/PCDFs were not depending on the afterburning operation, the presence of organic chlorine in the feed sludge and the copper addition to sewage sludge.

Inhibiting effects of chloroform on anaerobic microbial consortia as monitored by the Rantox biosensor.

The Rantox biosensor was designed for anaerobic wastewater treatment process control, and detects modifications of the feed based on the response of the acetoclastic methanogens contained in the sensor to periodic pulses of a concentrated organic substrate. The biosensor was tested under various operating conditions at the laboratory scale, in parallel with a digester under control fed on the same substrate. The aim was to evaluate the response of the biosensor in the presence of an incoming organic toxic compound (CHCl3). The experimental set-up, i.e. the biosensor and the digester, was connected to an automated control system developed under LabVIEW environment for data acquisition and operational sequence programming (the Rantox Virtual Instrument). Biomasses with different activities were used as inocula, and inhibition was induced by dosing chloroform according to two different procedures. The results showed good sensitivity and rapid response of the biosensor to feed intoxication. The presence of chloroform was detected by the Rantox with a rapid and visible response, and well in advance with respect to the digester.

Polymerase chain reaction for the direct detection of Brucella spp. in milk and cheese.

A polymerase chain reaction test was developed to detect Brucella spp. directly in milk and cheese and optimized using primers for the BSCP-31 gene. A total of 46 cheese samples produced with sheep and goats milk were assayed, and Brucella spp. was detected in 46% of them, especially in cheese made from sheep milk. This method is of remarkable epidemiologic interest because it is an indirect test indicating the sanitary quality of milk used in dairy industries. The method showed good sensitivity and specificity. It is faster and less expensive than the conventional bacteriological assays.

[Flexible mini-ureteroscopy in diseases of the upper urinary tract: our experience]. / Mini-ureteroscopia flessibile nelle malattie dell'apparato urinario alto: la nostra esperienza.

OBJECTIVE: The aim of our work is to present our experience about the use of flexible mini-ureteroscope in the diagnosis and therapy of some upper urinary tract diseases. METHODS: We evaluated the data of 52 mini-ureteroscopy performed with 7.4 Fr instrument. The indications for ureteroscopy were: kidney stones (25 cases, 48.1%), filling defects (12 cases, 23.1%), positive cytology (5 cases, 9.6%), lateralising haematuria (8 casi, 15.4%), ureteropelvic junction obstruction (2 cases, 3.8%). RESULTS: There were no major complications during procedure. The stones were fragmented by 1.9 Fr electrohydraulic probe, by 200 and 365 m Holmium: YAG laser fiber or extracted by 0-Tip 3 Fr nitinol basket. The found papillary neoplasms were removed by basket or grasper and coagulated by laser fiber or 2 Fr electrode. The angiomas were coagulated by laser or 2 Fr electrode. The ureteropelvic junction was incised laterally by 365 m laser fiber or 3 Fr Rite-Cut. We interrupted the procedure only in 2 (3.8%) cases of lower pole kidney stones, because of lack of access with the laser fiber or other instruments. CONCLUSION: Today, the flexible mini-ureteroscopy is the gold standard in the diagnosis of filling defects and lateralising haematurias. This technique can be therapeutic also for the angiomas and the low grade tumours. In case of kidney stones, this technique is a less invasive alternative compared to percutaneous nephrolithotomy in the treatment of caliceal stones resistant to SWL and is the only therapy for the extremely obese patients with bleeding diathesis.

Monitoring toxicity in anaerobic digesters by the rantox biosensor: theoretical background.

Process control of anaerobic reactors is difficult due to the complexity of the methabolic pathways in the microbial consortium and to the difficulty of detecting and monitoring process instability in short time, before the biomass is poisoned by incoming toxicants. Process control based on the Rantox biosensor is based on the following principle: the wastewater that can potentially induce an overload or contains a toxicant is first tested on a small "upstream" digester (the Rantox). This reactor makes possible to detect the potential instability and, if necessary, to divert the concentrated and/or contaminated wastewater to a buffer tank and consequently to protect the active biomass of the full-scale reactor. It is generally accepted that methanogens are the most sensitive microorganisms in anaerobic digestion. Among these bacteria, the acetoclastic methanogens are of primary importance because some 70% of the converted chemical oxyen demand (COD) mass flow passes through acetic acid. Therefore the first objective in the development of the Rantox biosensor has been to monitor the metabolism of acetoclastic methanogens in the presence of toxicants. This article presents the theoretical background required to evaluate the toxicity effects by determining the kinetic constants of the considered microorganisms from experimental data. The results of two series of calibration tests, performed in order to obtain a preliminary evaluation of the biosensor response to overload and toxicity conditions, are reported. In a second article, calibration tests will be described which refer to two prototypes of the biosensor tested in different operating conditions. The crucial point related to the Rantox, i.e., its comparison with a "normal" laboratory-scale digester to simulate a full-scale plant, will be the subject of the third (and last) article, which is planned to describe the development of this instrument.

Three consecutive cases of adenomatoid tumour of the epididymis: histological considerations and therapeutical implications. Review of the literature.

Adenomatoid tumour is an uncommon neoplasm of the male genital tract. The Authors report their recent observation of three consecutive cases of adenomatoi tumour of the epididymis. In all cases the diagnosis was difficult and done only by an accurate histological examination. The treatment was conservative, consisting in the removal of the neoplasm. After a follow up of at least two years the patients do not show any sign of relapses confirming the validity of the surgical therapeutical approach performed. Because of the unfrequent observation of these forms and the difficulty in the diagnosis, the Authors stress the necessity of the surgical exploration with an accurate microscopic examination of the specimens. Moreover a review of the literature from a histological and therapeutical point of view was done and reported.

Should venous surgery be still proposed or neglected?

Forty-four men aged 20-56 years (mean 42) complaining a venous erectile dysfunction underwent penile venous surgery. Fifteen patients (34.1%) were treated by DDVL, 29 cases (65.9%) underwent DDVL + corporopexy. All patients were followed-up at short and long-term periods. In short-term follow-up, eight patients (57.2%) of 15 treated by DDVL showed spontaneous erection, six patients (42.8%) showed persistent erectile dysfunction. In long-term follow-up, four patients of this group (28.6%) showed spontaneous erection. The others, 10 patients (71.4%), were then treated by other therapeutical alternatives. Twenty-two patients (75.8%) of 29 operated with DDVL + corporopexy showed spontaneous erection in short-term follow-up. After one year, in long-term follow-up, whereas total 15 patients (51.7%) of them were obtaining full erection, the others required other forms of treatments. In both groups in a long-term follow-up, total 19 patients of 43 (44.2%) showed full spontaneous erection, four patients (9.3%) needed intracavernous injection and six patients (13.9%) were treated with penile prosthetic implants. A total of 29 patients (67.4%) were able to have acceptable sexual intercourse. We concluded that venous surgery is still useful in selected patients having no better therapeutical alternatives.