Visual-spatial training in patients with sub-acute stroke without neglect: a randomized, single-blind controlled trial.

Many people who have suffered a stroke will experience sensorimotor impairments that disrupt their performance of motor skills, including balance and gait. Furthermore, stroke-induced brain damage can Result in visual disorders that may significantly impact performance of normal daily activities. The primary aim of this study was to investigate the effects, on balance, of visual-spatial training as an add-on intervention to conventional neurorehabilitation in patients with subacute stroke without neglect; secondarily, it aimed to assess the effects of this training on activities of daily living. Thirty inpatients (17 M, age: 57.3±12.9 years) with a diagnosis of subacute stroke (< 180 days) were enrolled in this study and randomized into two groups: the visual-spatial training group and a control group. All patients were evaluated, using the Tinetti Balance and Gait Scale (TBG), the Berg Balance Scale, computerized posturography, and the Barthel Index (BI), both before (T0) and after (T1) four weeks of training sessions. In addition to conventional neurorehabilitation, each group performed a total of twelve 20-minute rehabilitation sessions (3 times/week for 4 weeks). Significant TIME x GROUP interactions were recorded in the experimental group with respect to the control group for the TBG score [F (1,18) =15.59; p = 0.0004] and BI score [F (1,28) =6.35; p = 0.01]. Both groups recorded non-significant improvements on the instrumental postural assessment. These data suggest that visualspatial training as an add-on intervention to conventional neurorehabilitation could be an effective complementary strategy to improve balance and activities of daily living.

Identification and characterization of a new potyvirus infecting cucurbits.

A new potyvirus, tentatively named cucurbit vein banding virus (CVBV), was identified in crops of cucurbits in San Pedro (Buenos Aires, Argentina). The complete genome sequences of two isolates of CVBV were obtained by next-generation sequencing (Illumina). The genomic RNA consisted of 9968 and 9813 nucleotides, respectively, and displayed typical potyvirus organization. The percentage identity for these two genome sequences, using BLASTn, was 77% to sweet potato virus c and 73% to tomato necrotic stunt virus. BLASTx analysis of the complete polyprotein showed that the most closely related virus is plum pox virus, with 48% amino acid sequence identity for both isolates. Sequence comparisons and phylogenetic analyses indicate that CVBV belongs to a previously undescribed species in genus Potyvirus.

Endothelial Progenitor Cells in Sprouting Angiogenesis: Proteases Pave the Way.

Sprouting angiogenesis consists of the expansion and remodelling of existing vessels, where the vascular sprouts connect each other to form new vascular loops. Endothelial Progenitor Cells (EPCs) are a subtype of stem cells, with high proliferative potential, able to differentiate into mature Endothelial Cells (ECs) during the neovascularization process. In addition to this direct structural role EPCs improve neovascularization, also secreting numerous pro-angiogenic factors able to enhance the proliferation, survival and function of mature ECs, and other surrounding progenitor cells. While sprouting angiogenesis by mature ECs involves resident ECs, the vasculogenic contribution of EPCs is a high hurdle race. Bone marrowmobilized EPCs have to detach from the stem cell niche, intravasate into bone marrow vessels, reach the hypoxic area or tumour site, extravasate and incorporate into the new vessel lumen, thus complementing the resident mature ECs in sprouting angiogenesis. The goal of this review is to highlight the role of the main protease systems able to control each of these steps. The pivotal protease systems here described, involved in vascular patterning in sprouting angiogenesis, are the matrix-metalloproteinases (MMPs), the serineproteinases urokinase-type plasminogen activator (uPA) associated with its receptor (uPAR) and receptorassociated plasminogen/plasmin, the neutrophil elastase and the cathepsins. Since angiogenesis plays a critical role not only in physiological but also in pathological processes, such as in tumours, controlling the contribution of EPCs to the angiogenic process, through the regulation of the protease systems involved, could yield new opportunities for the therapeutic prospect of efficient control of pathological angiogenesis.

[Phlegmons of the neck: our experience with 7 cases]. / Flemmoni del collo: nostra esperienza su 7 casi clinici.

Phlegmons of the neck originate from infectious diseases of head and neck. Odontogeneous inflammation of the oral cavity is most frquently primary lesion, followed by sinusitis, otitis, as well as radiation therapy and surgical procedures. Phlegmons of head and neck can drain into the spaces among the muscles, aponevrosis, organs inside the neck like sublingual space, lateral pharyngeal space, retro-pharyngeal space or pre-vertebral space. We hereby report our experience with 7 patients treated from 2001 to 2005.

[Risk management in therapeutic procedures: the integrated flowsheet. Experience in a CQI context]. / La gestione del rischio nel processo terapeutico: la scheda di terapia integrata. Una esperienza in un'ottica di miglioramento continuo della qualità (MCQ).

UNLABELLED: Medication errors are an important problem in healthcare organizations. The Health Ministry and other government bodies have advised personnel directly involved in the care process as well as hospital management to adopt methods to prevent clinical risk. For this reason, the Sant'Andrea hospital of Rome , after analyzing the problem , decided to resolve it by introducing some corrective measures such as the integrated medication flowsheet. GOALS: To integrate the competence and knowledge necessary to fulfill patients' needs while safeguarding the different professional areas; to obtain better standards of quality , safety and patient satisfaction while enhancing job satisfaction and integration in all the professionals of the équipe.

[Process approach experience of university trust]. / L'importanza dell'approccio per processi: esperienza di una azienda universitaria.

This job has the scope to make to comprise the importance of the quality system applied to a complex organization describing the phases that have characterized the definition and the improvement of one organizational-managerial procedure for the prevention and the treatment of a problem of great importance in the within of the care process (ulcer pressure), demonstrating as the personnel involvement is one of change strategy used .

[Quality improvement: evolution and use of nursing records in a complex organization: the experience of Policlinico Umberto I of Rome - Italy]. / Miglioramento continuo della qualità: elaborazione ed applicazione della cartella infermieristica all'interno di un'organizzazione complessa. L'esperienza dell'azienda policlinico Unberto I di Roma.

Nursing documentation evolution is the result of an evolution of care and nurses like change of cultural and legislative type that has place, in way more growing, the patient to the center of nursing action. So it affirms that the nursing folder is the tool that allows to record, to plan, to appraise, to document and communicate patient care results, and of not smaller importance, to develop the search implementing nursing assistance turns to qualitative enhancement of the cares.

Hosts and distribution of Amblyomma auricularium (Conil 1878) and Amblyomma pseudoconcolor Aragão, 1908 (Acari: Ixodidae).

Collections of Amblyomma auricularium (Conil 1878) and A. pseudoconcolor Aragão, 1908 are discussed in relation to distribution and hosts. Three tick collections (two from Argentina and a third from the USA) house a total of 574 A. auricularium (307 males, 162 females, 73 nymphs and 32 larvae) and 179 A. pseudoconcolor (96 males, 74 females, 4 nymphs and 5 larvae). Apart from an adult A. pseudoconcolor found on a bird, Nothura maculosa Temminck, 1815, all ticks were found on mammals. The great majority of specimens of both ticks species were removed from the family Dasypodidae Gray, 1821 (84.9% and 93.8% of A. auricularium and A. pseudoconcolor, respectively). Amblyomma auricularium has also been found on wild hosts of the families Myrmecophagidae and occasionally Didelphidae, Caviidae, Chinchillidae, Hydrochaeridae, Muridae, Canidae, Mustelidae, Procyonidae and domestic animals (cattle, dogs, horses), while A. pseudoconcolor has also been found occasionally on wild hosts of the family Didelphidae and on domestic animals (cattle, dogs). Amblyomma pseudoconcolor appears to be restricted to the Neotropical region, covering northern Argentina and the eastern region of South America from Uruguay to Surinam, including south-eastern Paraguay, eastern Brazil and French Guiana. Amblyomma auricularium is distributed from northern Patagonia in Argentina throughout the Neotropics into the Nearctic region up to the southern USA (Texas, Florida), with collection localities also in Belize, Bolivia, Brazil, Colombia, Costa Rica, French Guiana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Trinidad & Tobago, Uruguay and Venezuela. It is not known whether A. auricularium is an established resident of the USA.

[Strategic planning: integration of training and quality. Experience at the Umberto I Polyclinic of Rome]. / Pianificazione strategica: integrazione fra formazione e qualità, l'esperienza dell'azienda policlinico umberto I di Roma.

This work shows how personnel involvement is one change strategy used in a complex organization making use of education and quality as main reorganization factors in a hospital system based on old management that didn't consider personnel as a strategy resource within a reorganizational change.

[Significance of health education in schools. Strategy for the prevention of cardiovascular diseases]. / L'importanza dell'educazione sanitaria nelle scuole. Una strategia per la prevenzione delle malattie cardiovascolari.

Cardiovascular diseases are the first cause of death in our Country. They mainly manifests in adult age but it is the result of initiated lesions since the young age and imputable often to errors of behaviours and to non appropriate styles of life. The knowledges related to the prevention of some illnesses, allows a reduction of the incidence of these, a reduction of the mortality, with consequent reduction of the health and social costs related to the care and to the rehabilitation. In our educational system, unlike what happens in the most greater part of the other European countries, these themes are only partially present and however treated in sporadic and insufficient way. For these raisons Pronto Cuore onlus Association has decided to start, in collaboration with the Regione Lazio, a project of health education to the high schools students considering that a more informed population has a longer expectancy of life and a better life quality. This job wants to underline the necessity to undertake a health education program to teach and inform students and teachers: to recognize some factors of risk as principal causes of cardiovascular diseases; to change life style; to recognize critical situations and behaviours to be adopted.

[Professional accreditation of emergency care services. Experience of the polyclinic "Umberto I" of Rome]. / L'accreditamento professionale dei servizi di Pronto Soccorso. Il percorso del Policlinico "Umberto 1o" di Roma.

Professional Accreditation can be seen as a Quality Improvement/Assurance Program for the delivery of Medical and Nursing Care, through organizational analysis to determine the level of compliance to specific criteria, correlated with satisfactory assistance processes. We report the experience of a professional accreditation process of an Emergency Department within a University Hospital in Rome, with high level assistance facilities. Voluntary interdisciplinary working groups were formed and working process was decomposed, as Quality Assurance Programs propose, so that critical points in each phase could be pointed out and hypothesis for improvements could be advanced for subsequent operative planning of changes. This method was used and applied to analyze the Emergency Department's "mission", clearing the goals of department, accordingly with the hospital's management mandate, and therefore permit the assessment of the level of compliance to quality indicators. Results of the different phases and critical analysis of all the steps are described.

[Acute myocardial infarct in HIV-positive patients in treatment with protease inhibitors]. / Infarto miocardico acuto in paziente HIV-positivo in trattamento con inibitori delle proteasi.

We report the case of a 40-year-old HIV-positive man, undergoing three-drug antiretroviral therapy for 2 years that included a protease inhibitor (ritonavir). The patient was admitted to our Coronary Care Unit with an acute anterior myocardial infarction. He smoked 20 cigarettes/day and had a family history of hypertension. At the time of hospitalization, triglyceride levels were found to be high (290 mg/dl). Metabolic alterations associated with the prolonged use of protease inhibitors, such as insulin resistance, dyslipidemia and lipodystrophy, have recently been described. This side effect may lead to premature coronary artery disease. Therefore it is mandatory to be aware that treatment with protease inhibitors in HIV-positive patients, despite survival prolongation and lowering of AIDS complications, may accelerate atherosclerosis and precipitate acute coronary events, especially in patients with pre-existing cardiovascular risk factors.

Amblyomma tigrinum (Acari: Ixodidae) in relation to phytogeography of central-northern Argentina with notes on hosts and seasonal distribution.

The findings of Amblyomma tigrinum in continental Argentina north of 40 degrees S are presented according to phytogeographic domains (Andean-Patagonic, Amazonian and Chaco) and the seasonal distribution is depicted on a monthly basis. A total of 718 adult ticks and four nymphs were found. A. tigrinum ticks were present in all domains. Adult ticks were found all year round but they were more abundant during the summer. Most ticks were found on domestic dogs but the survey has a bias to domestic hosts. It is speculated that the cycle of immature is bound to shelters that mitigate extreme climatic conditions, thus explaining the finding of this tick species in contrasting ecological areas.

[Bidimensional echocardiographic images of extracardiac tumors. Detection of mediastinal masses by the bidimensional echocardiographic Doppler technique]. / Immagini ecocardiografiche bidimensionali di tumori extracardiaci. Rilevamento di masse mediastiniche tramite tecnica ecocardiografica bidimensionale Doppler.

A mediastinal tumor might mimic tricuspid stenosis, pulmonary stenosis, constrictive pericarditis, producing symptoms and signs of a cardiologic illness. We report 2 cases of mediastinal masses (1 lymphoma and 1 pulmonary cancer) localized in the anterior mediastinum and compressing the cardiac silhouette. Bidimensional echocardiography and Doppler were used to differentiate masses of cardiac origin from extracardiac origin and to study the hemodynamic alterations; moreover these techniques allow to evaluate the efficacy of therapy.