Improving venous symptoms in C0s-C1s patients after multicomponent diosmin-based preparation: Initial experience.

The use of drug therapies in patients with chronic venous disease (CVD) remains a topic of debate regarding safety, compliance, and effectiveness. Although the beneficial effects of molecules like diosmin have been established in patients with chronic venous insufficiency (CVI) of C3-C6 classes, the evidence for its use in C0-C1 patients is not well documented. This report aims to describe and analyze the positive impact of a new diosmin-based drug therapy on a population of C0-C1 patients in terms of relief of venous symptoms.

Methylene blue adsorption on thermo plasma expanded graphite in a multilayer column system.

The removal of dyes from wastewater is an important topic in environmental applications. Methylene blue (MB) is one of the most worrisome compounds, as it is widespread and used in many industrial activities. Adsorption represents an effective technique for the removal of this contaminant. Thermo plasma expanded graphite (TPEG) is an industrial material characterized by a fibrous morphology, a very low density and overlapped graphene layers. TPEG has a higher specific surface compared to conventional thermo-expanded graphite and it can establish effective attractive forces with charged pollutants. These properties make TPEG a very promising adsorbent material. In the present work, TPEG was tested in an innovative multilayer column system to treat MB contaminated solutions. Several batch experiments were carried out by varying pH, initial MB concentration and temperature. The optimal adsorption performance was assessed at pH 11, around which the TPEG assumed the maximum negative charge. Based on these results, the adsorption mechanism appeared to be related mainly to electrostatic interactions. At room temperature, the greatest amount of MB adsorbed on TPEG was detected by treating solutions with an initial concentration of 30 mgMB/L. The temperature increase from 20 to 40 °C caused an enhanced adsorption capacity when concentrations higher than 10 mgMB/L were treated. The adsorption trends were accurately described by a pseudo-second order kinetic law and the adsorption isotherms at 20 and 40 °C were found to follow both the features of Freundlich and Langmuir models. The adsorption capacity was estimated to reach threshold values around 95 mgMB/gTPEG and 265 mgMB/gTPEG at 20 and 40°C, respectively. The Gibbs energy change (ΔG°) was calculated to about -7.80 kJ/mol, which proved that the process is spontaneous from a thermodynamic point of view. Finally, it was verified that TPEG can be efficiently reused 5 times after a simple chemical regeneration phase with HCl.

Correlation Between Serum Activity of Muscle Enzymes and Stage of the Estrous Cycle in Italian Standardbred Horses Susceptible to Exertional Rhabdomyolysis.

Equine exertional rhabdomyolysis (ER) is a well-recognized clinical syndrome affecting racehorses. Prevalence analysis of ER showed that female sex was a significant risk factor. The aim of this research was to evaluate the differences and correlations in the serum activity of muscle enzymes and the stage of the estrous cycle in ER-susceptible and control (C) mares. Serum muscle enzyme activity before and after exercise and sex hormones were analyzed in the two groups of mares. Ten cyclic ER and 10 cyclic C mares were examined weekly for 4 weeks. During diestrus, ER horses had significantly higher resting and postexercise aspartate aminotransferase (AST) activity, but not creatine kinase (CK) activity, compared with controls; only postexercise AST activity was significantly higher during estrus compared with activity levels in controls. During estrus, 17ß-estradiol and AST activity were significantly negatively correlated in the control but not ER mares. Based on our results, further studies should be performed to characterize the presumptive different roles played by sexual hormones in horses susceptible to ER compared with healthy mares.

Ultrasonographic assessment of normal jugular veins in Standardbred horses.

BACKGROUND: Ultrasonography (US) is the recommended imaging technique to evaluate jugular veins. This prospective randomized clinical study was designed to collect a series of B-mode US measurements of manually distended jugular veins in healthy Italian Standardbreds and to find possible correlations between ultrasound measurements and animal morphometric characteristics. Forty-two horses, eight males and 34 females (range 3-22 years; bodyweight 494.4 ± 41.7 kg), were included in the study. The diameters and wall thicknesses of both jugular veins were measured at three different sites of the neck. The differences in ultrasound measurements based on scans, age, gender, side, and site of the neck were evaluated by ANOVA or by the Kruskal-Wallis test. The effects of the morphometric measures on each ultrasound parameter were evaluated by MANOVA (P < 0.05). RESULTS: The ultrasound measurements did not differ significantly between the three different sites or between genders; hence, they were pooled together in the results. On the transverse scan, the mean dorsoventral and lateromedial diameters were 1.58 ± 0.23 and 2.20 ± 0.25 cm, respectively; the mean superficial and deep wall thicknesses (SWT and DWT) were 0.07 ± 0.01 and 0.08 ± 0.01 cm, respectively. On the longitudinal scan, the mean dorsoventral diameter was 1.59 ± 0.26 cm, and the SWT and DWT were both 0.08 ± 0.01 cm. Neck length, from the caudal edge of the mandible to the thoracic inlet, was related to the dorsoventral diameter in both longitudinal and transverse scan and to the SWT and DWT in transverse scan, whereas height at the withers (measured with tape) and estimated weight were related to the wall thickness. Dividing the subjects into groups by age in years ("young" 3-7, "mature" 8-14, "old" > 14), differences were found for the lateromedial diameter in the transverse scan and the SWT on the longitudinal scan. The main limitation of this study was that only one operator performed the measurements. CONCLUSION: The US measurements of the jugular veins and their relationship with morphometric measures reported in this manuscript might be considered as guidelines both for early diagnosis and monitoring jugular vein abnormalities in healthy Italian Standardbred horses.

Single center evidence for the treatment of basal cell carcinoma of the head and neck.

AIM: Basal Cell Carcinoma (BCC) alone accounts for 80% of cases of non-melanoma skin cancer (NMSC), which characteristically develops on sun-exposed skin. Indeed the most common site of BCC is the head and neck region (80%). The purpose of this study to review the experience of our center with BCC in the head and neck region to report the sites of occurrence and treatment. MATERIALS AND METHOD: We retrospectively reviewed 77 patients with BCC of the head and neck, who revived surgical treatment within our plastic surgery division. Basic demographic data, cancer site and size, surgical treatment and histological data were collected. The mean follow-up period was 12 months. RESULTS: The study population included 37 males and 40 females, with a mean age of 74.12 years. The nasal unit was the main site of BCC (31.82%), followed by the periorbital (13.64%) and cervical (12.5%) units. Primary closure was the main surgical procedure performed (72.5%), followed by local flap (26.1%) and full-thickness skin grafts (1.4%). The safety resection margin ranged from 4.5 to 9 mm, with a 98.7% complete removal rate. Neither recurrence nor any newly-developed lesions were reported during follow-up in any patient. DISCUSSION: Our work reflects the shift in the incidence of BCC, which now seems to be more frequent in females. Furthermore, our data strengthens the association between UVR exposure and BCC, confirms its predilection to occur on the nasal unit and validates surgical excision as the gold standard treatment for skin cancer.

An Investigation on Pervasive Technologies for IoT-based Thermal Monitoring.

Indoor thermal monitoring is a crucial requirement for home automation, which fits inside the ever-growing Internet of Things (IoT) paradigm. The IoT ecosystem aims at connecting every device exploiting specific functions, deployed in a particular place, in order to give the chance to the users to monitor and/or control some aspects of their life, or to demand this task to a proper software. In the thermal monitoring context, IoT provides new opportunities for a dense and/or large-scale distribution of sensors, which have to gather data in order to effectively control the Heating, Ventilation and Air Conditioning (HVAC) system. Several wireless technologies can be exploited for this scope. However, they involve different benefits and drawbacks. In particular, this study is focused on Radio Frequency Identification (RFID) and Bluetooth®, which represent two well-known wireless technological standards used by commercial electronics but suitable also for pervasive IoT systems. These technologies are discussed and compared from several points of view, i.e., flexibility, reliability, battery life and cost of the system. A theoretical analysis highlights their benefits for the application context and evaluates their suitability to dense and large-scale monitoring systems. The theoretical results are supported by an experimental analysis based on the implementation and test of two different systems, one using RFID and the other using Bluetooth technology.

Removal of Hydrocarbons from Contaminated Soils by Using a Thermally Expanded Graphite Sorbent.

Lab-scale experiments on three soil matrices featured by increasing granulometry (sea sand, silica sand and gravel) were carried out in order to evaluate the adsorption capability and the removal efficiency of a new graphene-based material. Soil samples, firstly contaminated with different quantities of used lubricant oil up to final concentrations of 12.5, 25.0, 50.0 g kg-1, were treated with an opportune amount of thermally expanded graphite (TEG) (i.e. 1/10, 1/20, 1/40 as TEG/pollutant ratio). Results show that the removal efficiency of TEG is directly correlated to the contamination level of the soil. The best removal efficiency (87.04%) was obtained during the treatment of gravel samples at the maximum contamination level by using the highest dosage of TEG. A good removal efficiency (80.83%) was also achieved using lower TEG/pollutant ratio. Moreover, TEG at ratio 1/10 showed worse removal efficiencies in treating sea (81.17%) and silica sand (63.52%) than gravel. In this study, also the thermal regeneration was investigated in order to evaluate a possible reuse of TEG with subsequent technical and economic advantages. TEG-technique proves to be technologically and economically competitive with other currently used technologies, revealing the best choice for the remediation of hydrocarbon-contaminated soils.

1-D versus 2-D Entropy Velocity Law for Water Discharge Assessment in a Rough Ditch.

Water discharge assessment in open channel flow is one of the most crucial issues for hydraulic engineers in the fields of water resource management, river dynamics, ecohydraulics, irrigation, and hydraulic structure design, among others. Recent studies state that the entropy velocity law allows expeditive methodology for discharge estimation and rating curve development due to the simple mathematical formulation and implementation. Many works have been developed based on the one-dimensional (1-D) formulation of the entropy velocity profile, supporting measurements in the lab and the field for rating curve assessment, but in recent years, the two-dimensional (2-D) formulation was proposed and applied in studies of regular ditch flow, showing good performance. The present work deals with a comparison between the 1-D and 2-D approaches in order to give a general framework of threats and opportunities related to the robust operational application of such laws. The analysis was carried out on a laboratory ditch with regular roughness, under controlled boundary conditions, and in different stages, generating an exhaustive dashboard for better appraisal of the approaches.

Inflammatory Myopathy in Horses With Chronic Piroplasmosis.

Horses affected by chronic piroplasmosis may develop poor performance and muscle atrophy. Here we investigate the pathological and immunopathological aspects of myopathy occurring in chronic equine piroplasmosis. The study included 16 horses serologically positive for equine piroplasms presenting with clinical signs and supporting serum biochemical evidence of a myopathy. Skeletal muscle was evaluated by histopathology, immunohistochemistry, indirect immunofluorescence, and molecular detection of piroplasms and inflammatory cytokines in skeletal muscle. Histologic lesions included muscle fiber atrophy (100% of cases), degenerative changes (13/16, 81%), and perivascular perimysial and endomysial lymphocytic infiltrates (81% of cases). In 15 cases (94%), muscle fibers had strong immunostaining for major histocompatibility complex classes I and II. T lymphocyte populations were mainly CD3+, CD8+, and CD4+ in equal proportions, with a lower number of CD79α+ cells. The serum from affected horses was tested by indirect immunofluorescence for binding of IgG, IgM, or IgA to sections of normal equine muscle to detect circulating autoantibodies against muscle antigen(s). In all cases, distinct sarcolemmal staining was detected in sections incubated with serum from affected horses, in contrast to sections incubated with phosphate-buffered saline or equine control sera. Reverse transcription polymerase chain reaction (RT-PCR) testing of muscles from affected animals revealed a significant increase of interferon-γ, interleukin-12, and tumor necrosis factor-α gene expression compared to healthy controls. Theileria equi or Babesia caballi was not detected in samples of affected muscle by RT-PCR. Thus, inflammatory myopathy associated with equine piroplasmosis may involve an autoimmune pathogenesis with upregulation of inflammatory cytokines that may cause myofiber atrophy and degeneration.

Application of Metabolic Profiling to Abdominal Aortic Aneurysm Research.

Abdominal aortic aneurysm (AAA) is a complex disease posing diagnostic and therapeutic challenges. Metabonomics may aid in the diagnosis of AAA, determination of individualized risk, discovery of therapeutic targets, and improve understanding of pathogenesis. A systematic review of the diversity and outcomes of existing AAA metabonomic research has been performed. Original research studies applying metabonomics to human aneurysmal disease are included. Seven relevant articles were identified: four studies were based on plasma/serum metabolite profiling, and three studies examined aneurysmal tissue. Aminomalonic acid, guanidinosuccinic acid, and glycerol emerge as potential plasma biomarkers of large aneurysm. Lipid profiling improves predictive models of aneurysm presence. Patterns of metabolite variation associated with AAA relate to carbohydrate and lipid metabolism. Perioperative perturbations in metabolites suggest differential systemic inflammatory responses to surgery, generating hypotheses for adjunctive perioperative therapy. Significant limitations include small study sizes, lack of correction for multiple testing false discovery rates, and single time-point sampling. Metabolic profiling carries the potential to identify biomarkers of AAA and elucidate pathways underlying aneurysmal disease. Statistically and methodologically robust studies are required for validation, addressing the hiatus in understanding mechanisms of aneurysm growth and developing effective treatment strategies.

Spontaneous Subcapsular Renal Hematoma: Strange Case in an Anticoagulated Patient with HWMH after Aortic and Iliac Endovascular Stenting Procedure.

Spontaneous subcapsular renal hematoma is a rare condition in clinical practice. It is caused by renal cysts, benign and malignant renal tumors, vascular lesions, and antiplatelet or anticoagulant therapy. In this paper we report an unusual case of rupture of a renal cyst of a 66-year-old male patient during an aortic and iliac endovascular procedure for a massive calcified atheroma above the iliac bifurcation. We suspected that the bolus of high weight molecular heparin given during the procedure caused the rupture of the cyst. According to the literature, this is the first case of renal cyst rupture during an endovascular aortic procedure after administering a high weight molecular heparin bolus.

VAC therapy to promote wound healing after surgical revascularisation for critical lower limb ischaemia.

Vacuum-assisted closure (VAC) therapy is a new emerging non-invasive system in wound care, which speeds up wound healing by causing vacuum, improving tissue perfusion and suctioning the exudates, and facilitating the removal of bacteria from the wound. The application of sub-atmospheric pressure on the lesions seems to alter the cytoskeleton of the cells on the wound bed, triggering a cascade of intracellular signals that increase the rate of cell division and subsequent formation of granulation tissue. The aim of this study is to analyse the results of VAC therapy used as an adjuvant therapy for the treatment of foot wounds in patients affected by critical limb ischaemia (CLI) (Rutherford 6 class) after distal surgical revascularisation, to promote and accelerate the healing of ulcers. Twenty-nine patients (20 males, 9 females; mean age 68·4) affected by CLI of Rutherford 6 class, after surgical revascularisation of the lower limb, underwent VAC therapy in order to speed up wound healing. Complete wound healing was achieved in 19 patients (65·51%), in an average period of 45·4 ± 25·6 days. VAC therapy is a valid aid, after surgical revascularisation, to achieve rapid healing of foot lesions in patients with CLI.

Hybrid management of Paget-Schroetter syndrome due to thoracic outlet syndrome.

Paget-Schroetter syndrome due to thoracic outlet syndrome is a rare but potentially disabling condition that generally affects young patients otherwise healthy. The prompt diagnosis and treatment of Paget-Schroetter syndrome is necessary to avoid major morbidity and long-term disability. The more modern treatment paradigm reported in the current literature consists of hybrid procedures with surgical decompression of the thoracic outlet and endovascular techniques to potentially improve long-term vein patency. However, there seems to be no consensus in the literature with regard to the timing and precise nature of active management, and there is presently no agreed protocol for the optimum management of Paget-Schroetter syndrome. Controversy exists partly because no randomised controlled studies are present in literature. We present a case of Paget-Schroetter syndrome due to thoracic outlet syndrome in a young male patient submitted to a multimodal procedure.

Surgical Treatment of a Voluminous Infrarenal Abdominal Aortic Aneurysm with Horseshoe Kidney: Tips and Tricks.

Horseshoe kidney is a common urology anomaly, while its association with infrarenal abdominal aortic aneurysm represents a very rare condition. Surgical approach remains controversial however, we believe that the left retroperitoneal approach should be preferred in order to avoid isthmus resection with any subsequent renal infarction, urinary tract damage and to facilitate renal arteries reimplantation, when required. We present a case of voluminous infrarenal abdominal aortic aneurysm associated with horseshoe kidney, successfully treated through a left retroperitoneal approach on the retro-renal space.

Optimal time-points for minimal residual disease monitoring change on the basis of the method used in patients with acute myeloid leukemia who underwent allogeneic stem cell transplantation: a comparison between multiparameter flow cytometry and Wilms' tumor 1 expression.

Minimal residual disease (MRD) of 30 adult AML patients was monitored by multiparameter flow cytometry (MFC) and WT1 expression before and after allogeneic stem cell transplantation (allo-SCT). Diagnostic performance of pre-transplant MRD measured by MFC was higher than that obtained by WT1 expression. Comparable results were displayed at day +30 post-transplant, while better values by WT1 compared to MFC were found at day +90. Positive MRD by MFC predicted a shorter disease free survival (DFS) before and 1 month after transplant (p=0.006 and p=0.005), while only high WT1 levels at 1 month from the transplant significantly impacted on DFS (p=0.010). Our results support the idea that MRD monitoring by MFC should be suggested before and 30 days after the transplant, while WT1 expression should be preferred after this procedure. The assessment of MRD at day +30 from allo-SCT is recommended as post transplant check-point for the predictive role displayed, independently of the method used.

Minimal residual disease after allogeneic stem cell transplant: a comparison among multiparametric flow cytometry, Wilms tumor 1 expression and chimerism status (Complete chimerism versus Low Level Mixed Chimerism) in acute leukemia.

Relapse represents the main cause of treatment failure after allogeneic stem cell transplant (allo-SCT). The detection of minimal residual disease (MRD) by multiparametric flow cytometry (MFC), chimerism, cytogenetics and molecular analysis may be critical to prevent relapse. Therefore, we assessed the overall agreement among chimerism (low level mixed chimerism [LL-MC] vs. complete chimerism [CC]), MFC and Wilms tumor 1 (WT1) mRNA to detect MRD and investigated the impact of MRD obtained from the three methods on patient outcome. Sixty-seven fresh bone marrow (BM) samples from 24 patients (17 acute myeloid leukemia [AML], seven acute lymphoblastic leukemia [ALL]) in complete remission (CR) after allo-SCT were investigated at different time points. A moderate agreement was found among the three techniques investigated. A higher concordance between positive results from MFC (75.0% vs. 32.7%, p = 0.010) and WT1 (58.3% vs. 29.1%, p = 0.090) was detected among LL-MC rather than CC samples. Relapse-free survival (RFS) and overall survival (OS) were found to be higher in MRD negative patients than in MRD positive patients analyzed with MFC and WT1. Our results discourage the use of low autologous signals as the only marker of MRD, and suggest the usefulness of MFC and WT1 real-time quantitative polymerase chain reaction (RQ-PCR) in stratifying patients with respect to risk of relapse.

Sudden death due to a dissecting intramural hematoma of the esophagus (DIHE) in a woman with severe neurofibromatosis-related scoliosis.

Dissecting intramural hematoma of the esophagus (DIHE) is a rare condition in which intramural hemorrhage can lead to submucosal dissection of the esophageal wall. DIHE is generally considered a benign disease, and the only mortality associated with DIHE has been due to operative intervention or to the presence of another underlying, life-threatening condition. We report, however, a case of sudden death due to the spontaneous rupture of a DIHE that occurred in a 32-year-old woman, affected by neurofibromatosis type 1. She was admitted to the local emergency room, presenting a 24-hour history of sudden onset, severe central chest and interscapular pain associated with dysphagia, odynophagia and vomiting. Her condition worsened and proved fatal within a 6-hour period. A complete autopsy was then conducted, showing a complete dissecting intramural hematoma with laceration of the third superior of the esophagus. We can hypothesize that abnormal variations of gastro-esophageal pressure during ingurgitation and during bolus movement could be predisposing factors in the pathogenesis of the dissection. On the other hand angular kyphoscoliosis deformity may have had play a role as precipitating factor while vomiting in the subject's medical history can then be interpreted as the likely activation phenomenon.