Model-based estimation of seasonal transport of macro-plastics in a marine protected area.

Management of plastic litter in Marine Protected Areas (MPAs) is expensive but crucial to avoid harms to critical environments. In the present work, an open-source numerical modelling chain is proposed to estimate the seasonal pathways and fates of macro-plastics, and hence support the effective planning and implementation of sea and beach cleaning operations. The proposed approach is applied to the nearshore region that includes the MPA of Capo Milazzo (Italy). A sensitivity analysis on the influence of tides, wind, waves and river floods over the year indicates that seasonality only slightly affects the location and extension of the macro-plastic accumulation zones, and that beach cleaning operations should be performed in autumn. Instead, the influence of rivers on plastic litter distribution is crucial for the optimal planning of cleaning interventions in the coastal area.

MRSA infections among patients in the emergency department: a European multicentre study.

BACKGROUND: MRSA is a therapeutic concern worldwide, and a major agent of community-acquired skin and soft tissue infections (CA-SSTIs). While the US epidemiology of MRSA in CA-SSTIs is well described and reports the high prevalence of the USA300 clone, data on the European situation are lacking. OBJECTIVES: To determine the prevalence and clonal characteristics of MRSA in CA-SSTIs in seven European emergency departments. PATIENTS AND METHODS: From April to June 2015, patients presenting to the tertiary hospital emergency department with a Staphylococcus aureus CA-SSTI were prospectively enrolled. S. aureus isolates were characterized by antimicrobial susceptibility testing, detection of Panton-Valentine leucocidin encoding genes and spa-typing, MLST and/or DNA microarray. RESULTS: Two-hundred and five cases of S. aureus-associated CA-SSTIs were included, comprising folliculitis, furuncles, abscesses, paronychia, impetigo, carbuncles and cellulitis. Of the 205 cases, we report an MRSA prevalence rate of 15.1%, with a north (0%) to south (29%) increasing gradient. Fifty-one isolates were Panton-Valentine leucocidin-positive (24.9%), whether MSSA or MRSA, with a heterogeneous distribution between countries. Clonal distribution of MSSA and MRSA showed high diversity, with no predominant circulating clone and no archetypical USA300 CA-MRSA clone. CONCLUSIONS: This original prospective multicentre study highlights stark differences in European MRSA epidemiology compared with the USA, and that the USA300 CA-MRSA clone is not predominant among community-infected patients in Europe.

Antibiotic susceptibility of respiratory pathogens recently isolated in Italy: focus on cefditoren.

The aim of this study was to evaluate the in vitro antibiotic susceptibility of respiratory pathogens recently isolated in Italy to commonly used antibiotics including cefditoren. Six clinical microbiological laboratories collected, between January and September 2009, a total of 2,510 respiratory pathogens from subjects with community-acquired respiratory tract infections (CARTI). Ceftditoren, out of all the beta-lactams studied, had the lowest MIC(90 )against 965 strains of Streptococcus pneumoniae examined, followed by cefotaxime and ceftriaxone (2% resistance in penicillin-resistant S. pneumoniae (PRSP)). Against 470 Haemophilus influenzae , independently of their production of beta-lactamases or ampicillin resistance, cefditoren was the oral cephalosporin with the best in vitro activity, comparable to that of the injectable cephalosporins and levofloxacin. Higher MIC(90)s were found for the macrolides (4 - 16 mg/l) and cefaclor (4 - 32 mg/l). As was foreseeable, Streptococcus pyogenes (225 strains) was uniformly sensitive to all the beta-lactam antibiotics, but the elevated MIC(90 )values reduced (<75%) susceptibility of this pathogen to macrolides. Beta-lactamase-negative Moraxella catarrhalis (100 strains) had reduced susceptibility only to the macrolides, while the 250 beta-lactamase-producing strains also had reduced susceptibility to cefuroxime. Levofloxacin showed the lowest MIC(50)/MIC(90 )values in the producing strains, whereas cefditoren, cefotaxime and ceftriaxone in the non-producers. As regards the enterobacteriaceae, cefditoren and levofloxacin had the lowest MIC(90)s against Klebsiella pneumoniae. Cefditoren and the third-generation injectable cephalosporins had the lowest MIC(90)s against Escherichia coli (100% susceptibility) while levofloxacin was less active (86% susceptibility).In conclusion, cefditoren's wide spectrum and high intrinsic activity, as well as its capacity to overcome most of the resistance that has become consolidated in some classes of antibiotics widely used as empiric therapy for CARTI, allows us to suggest that cefditoren might be included in the european guidelines as one of the first-choice antibiotics in the treatment of CARTI.

A nonrigid registration of MR breast images using complex-valued wavelet transform.

In this paper, a fast, slice-by-slice, nonrigid registration algorithm of dynamic magnetic resonance breast images is presented. The method is based on a multiresolution motion estimation of the breast using complex discrete wavelet transform (CDWT): the pyramid of oriented complex subimages is used to implement a hierarchical phase-matching-based motion estimation algorithm. The resulting motion estimate is nonrigid and pixel-independent. To assess the method performance, we computed the correlation coefficient and the normalized mutual information between pre- and postcontrast images with and without realignment. The indices increased after using our approach and the improvement was superior to rigid or affine registration. A set of clinical scores was also evaluated. The clinical validation demonstrated an increased readability in the subtraction images. In particular, CDWT registration allowed a best definition of breast and lesion borders and greater detail detectability.

Activity of Berberis aetnensis root extracts on Candida strains.

The antifungal activity of methanolic extract and alkaloidal fraction of Berberis aetnensis against Candida species was investigated. The crude extract was active against Candida species, this activity being higher than that of the alkaloidal fraction and berberine.

Antibacterial activity of propolis and its active principles alone and in combination with macrolides, beta-lactams and fluoroquinolones against microorganisms responsible for respiratory infections.

Propolis is produced by bees and is reported to have several pharmaceutical properties. Its antibacterial activity against strains causing upper respiratory tract infections is particularly important: propolis might be used as a therapeutic agent to prevent the bacterial infections that sometimes overlap viral infections. In this study the in vitro activity of both an alcoholic solution and a hydroglyceric extract of propolis, as well as its active principles, was tested against bacteria responsible for respiratory infections (Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis and Streptococcus pyogenes). We also evaluated the in vitro activity of a combination of propolis and its active principles and some beta-lactams, macrolides and fluoroquinolones. Our results, though not demonstrating a clearly synergistic activity between antibiotics and propolis and its constituents, show the possibility of using natural preparations, due to their antimicrobial and anti-inflammatory properties, to enhance antibacterial therapy.

Validation of an elastic matching algorithm based on complex wavelets for the realignment of dynamic MR breast images.

In this paper, a novel approach for the registration of dynamic magnetic resonance (MR) breast images is validated. The approach is fully automatic and it performs a multi-resolution motion field estimation based on complex discrete wavelets transform (CDWT). The validation was designed to assess the registration quality in patient breast data. A set of diagnostic features of MR breast image was defined and two expert radiologists were asked to score the capability to detect these features in the subtraction images. Two registration methods were compared: a rigid registration algorithm and the proposed approach. Results show that the novel approach is superior in terms of both lesion detectability and lesion definition.

Internalization-associated proteins among Streptococcus pyogenes isolated from asymptomatic carriers and children with pharyngitis.

Sixty-two strains of Streptococcus pyogenes isolated from 30 asymptomatic school children and 32 children with pharyngitis were characterized to analyze the involvement of 2 fibronectin-binding proteins (F/SfbI and PrtF2/PfbpI) in S. pyogenes colonizing asymptomatic carriers and to determine the possible association between these proteins and the genes associated with macrolide resistance. In this study, we demonstrated that the proportion of S. pyogenes strains carrying the pfbpI gene was significantly higher among asymptomatic carriers (80%) than among children with pharyngitis (53%; P<.05). With regard to the proportion of prtF1-positive strains, no significant differences were found between the 2 groups (70% vs. 69%, for asymptomatic carriers and children with pharyngitis, respectively). Another important finding is the significant association between macrolide resistance and protein F/SfbI (P<.001) in both groups. These results suggest that the presence of the pfbpI gene can be linked to the ability of S. pyogenes to persist in the throat of asymptomatic carriers.

Faropenem, a new oral penem: antibacterial activity against selected anaerobic and fastidious periodontal isolates.

The in vitro activity of faropenem, an oral penem, was compared with those of penicillin, co-amoxiclav, cefoxitin, clindamycin, erythromycin and metronidazole against 106 isolates of anaerobic pathogens involved in systemic infections. The organisms tested comprised Porphyromonas gingivalis (29), Prevotella spp. (eight), Prevotella melaninogenica (seven), Prevotella intermedia (five), Actinomyces spp. (25), Fusobacterium nucleatum (14), Peptostreptococcus spp. (11), Bacteroides ureolyticus (five) and Bacteroides forsythus (two). The antimicrobial properties of faropenem were investigated by studying MICs, MBCs, time-kill kinetics and post-antibiotic effect (PAE). Faropenem was highly active against all the anaerobes tested (MIC(90) < or = 0.5 mg/L) and was bactericidal against both beta-lactamase-positive and -negative anaerobes, with a maximum bactericidal effect at 10 x MIC at between 12 and 24 h. In addition, faropenem had an in vitro PAE on all the tested isolates and this was not influenced by beta-lactamase production. Faropenem may be useful for treating infections caused by periodontal bacteria or oral flora.

Antibacterial activity of moxifloxacin against periodontal anaerobic pathogens involved in systemic infections.

The in vitro activity of moxifloxacin was compared with that of penicillin G, amoxycillin/clavulanate, cefoxitin, erythromycin, clindamycin and metronidazole against 158 isolates associated with periodontal infections. MIC(50)/MIC(90) values of moxifloxacin were respectively 0.06/0.5 mg/l for Porphyromonas gingivalis (35), for Prevotella spp. (28) and Actinomyces spp. (35), 0.12/0.25 mg/l for Fusobacterium nucleatum (20) and 0.06/0.12 mg/l for Peptostreptococcus spp. (30). The minimum inhibitory concentration (MIC) range of moxifloxacin for Bacteroides forsythus (6) and Campylobacter rectus (4) was 0.06-0.12 mg/l. The minimum bactericidal concentrations were equal to or 2-4 times the MIC values. Moxifloxacin produced a bactericidal effect at 8 h. Our results show that moxifloxacin has good antibacterial activity against periodontal pathogens comparable with that of cefoxitin and amoxycillin/clavulanate, and better than that of clindamycin, metronidazole and penicillin.

Concurrent radiotherapy and weekly paclitaxel for locally advanced or recurrent squamous cell carcinoma of the uterine cervix. A pilot study with intensification of dose.

OBJECTIVE: This study included patients with inoperable primary or recurrent cervical cancer whose treatment plan called for exclusive radiotherapy. The endopoints of the study were to confirm the feasibility of concurrent radiotherapy and paclitaxel in relation to potential acute toxicity and to evaluate if an increase of complete local control might be obtained with the association of paclitaxel to radiotherapy as a radiosensitizer. METHODS: Twenty patients (13 new cases, stage IIB-III, and 7 with pelvic recurrences) were enrolled and, with exclusion of one recurrence, 19 were evaluable for acute toxicity and response. In new cases, radiotherapy was conventionally administered: 50.4 Gy/28 fractions by external beam (whole pelvis) followed by intracavitary cesium or reduced transcutaneous field. In recurrences, radiotherapy was performed with external beam only through individualized fields. Paclitaxel was administered weekly at the dose of 40 mg/m2 or 60 mg/m2 during the entire course of external radiotherapy. RESULTS: Complete regression (CR) as defined by clinical and imaging examinations was achieved in eight of the 13 new cases (62%) and in four of the six recurrences (66%), for a total complete response rate equal to 63%. Five patients (3 treated with 40 mg/m2 and 2 with 60 mg/m2) experienced grade 3 small bowel toxicity, one patient treated with 40 mg/m2 grade 3 bladder toxicity and one patient treated with 60 mg/m2 had grade 4 mucositis. Out of 12 CR patients at the end of treatment, ten maintain complete local remission for a median follow-up of 47 months but two have developed distant metastases. CONCLUSION: The results confirm that this approach is feasible and suggest the use of paclitaxel as radiosensitizer in locally advanced cervical cancer.

Minimal inhibitory concentrations and time-kill determination of moxifloxacin against aerobic and anaerobic isolates.

Moxifloxacin is a new oral 8-methoxy-quinolone with a wide spectrum of activity against Gram-negative and anaerobic bacteria, atypical micro-organisms and multi-resistant Gram-positive bacteria. This study was designed to assess the in vitro activity of moxifloxacin against Gram-positive bacteria with different resistance patterns, anaerobes and atypical micro-organisms such as Chlamydia and Mycoplasma. Moxifloxacin had good activity against Streptococcus pneumoniae with all strains inhibited by < or =0.12 mg/l. The minimal inhibitory concentrations (MICs) of moxifloxacin for Streptococcus pyogenes and Streptococcus agalactiae ranged from 0.03 to 0.5 mg/l while those of ciprofloxacin were about two- to four-fold higher (MICs=0.12-1 mg/l). Moxifloxacin was poorly active against enterococci but its activity against Clostridium and Bacteroides spp. was in the same range as that of metronidazole and superior to that of clindamycin. Moxifloxacin was substantially more active than both ciprofloxacin and sparfloxacin against Chlamydia.

BMRI in early detection of breast cancer in patients with increased genetic risk: our preliminary results.

Because of the higher risk of developing breast cancer and the early onset of the disease in women proved or suspected to be carriers of a breast cancer susceptibility gene, a dedicated screening should be offered as a less invasive approach with respect to the otherwise suggested prophylactic mastectomy. This should be optimized in order to overcome the limitations of conventional breast imaging with the application of new technologies such as Breast Magnetic Resonance Imaging (BMRI). A diagnostic protocol for routine control in patients with high risk for developing breast cancer has been prepared. Within a 7 months period, 23 patients suspected or proved to carry a breast cancer susceptibility gene underwent BMRI. Four breast cancers were identified with BMRI. In these cases mammography was negative because of the density of the parenchyma or for its fibroglandular pattern. US was negative in two cases, not specific for malignancy in one case and considered as only possibly malignant but with biopsy recommendation on the basis of MR findings in the last one. Clinic analysis was positive for mass in two cases. The accuracy of BMRI is known to be higher than that of conventional imaging in the study of breast parenchyma. High spatial resolution and no breast density influence can give more detailed information about smaller lesions and the right extent of the disease.

The Italian multi-centre project on evaluation of MRI and other imaging modalities in early detection of breast cancer in subjects at high genetic risk.

This report presents the preliminary results of the first phase (21 months) of a multi-centre, non-randomised, prospective study, aimed at evaluating the effectiveness of contrast-enhanced magnetic resonance imaging (MRI), X-ray mammography (XM) and ultrasound (US) in early diagnosis of breast cancer (BC) in subjects at high genetic risk. This Italian national trial (coordinated by the Istituto Superiore di Sanità, Rome) so far recruited 105 women (mean age 46.0 years; median age 51.0; age range 25-77 years), who were either proven BRCA1 or BRCA2 mutation carriers or had a 1 in 2 probability of being carriers (40/105 with a previous personal history of BC). Eight cases of breast carcinomas were detected in the trial (mean age 55.3 years, median age 52.5; age range 35-70 years; five with previous personal history of BC). All trial-detected BC cases (8/8) were identified by MRI, while XM and US correctly classified only one. MRI had one false positive case, XM and US none. Seven "MRI-only" detected cancers (4 invasive, 3 in situ) occurred in both pre- (n = 2) and post-menopausal (n = 5) women. With respect to the current XM screening programmes addressed to women in the age range 50-69 years, the global incidence of BC in the trial (7.6%) was over ten-fold higher. The cost per "MRI-only" detected cancer in this particular category of subjects at high genetic risk was substantially lower than that of an XM-detected cancer in the general women population. These preliminary results confirmed that MRI is a very useful tool to screen subjects at high genetic risk for breast carcinoma, not only in pre-, but also in post-menopausal age, with a low probability of false positive cases.

Lobular breast cancer: how useful is breast magnetic resonance imaging?

RATIONALE AND OBJECTIVES: To review magnetic resonance imaging (MRI) findings in lobular breast carcinoma, the in situ or infiltrating subtype, with special attention to the dynamic curves with the aim to evaluate possible differences with ductal carcinoma. METHODS: In 2 years, 27 patients with lobular and one with tubular carcinoma underwent MRI at the Istituto Nazionale Tumori of Milan. RESULTS: All lobular carcinomas demonstrated early or late enhancement (100% sensitivity), without significant differences in morphology compared with ductal carcinoma, but frequently with a different shape of the dynamic curves. CONCLUSIONS: Due to its infiltrative growth associated to only limited connective tissue reaction, lobular carcinoma often encounters difficulties in mammographic diagnosis. In contrast, MRI can be very helpful in evaluating the true extension of the disease, especially when breast conservation is considered. Due to a more consistent fibrotic stroma, these lesions sometimes show a delayed enhancement, which suggests that more than one set of subtracted images should be evaluated during MRI analysis.

Breast magnetic resonance imaging: a computer-based analysis of enhancement curves.

The aim of this work is to report our experience in contrast-enhanced magnetic resonance (MR) automatic analysis. This technique is usually used in our practice for the diagnosis of breast cancer. Study execution and semiautomatic data analysis require at least 1 hour of the radiologist. So, we decided to develop a tool that aids the radiologist in locating the regions of neoplastic angiogenesis and quickly plotting the enhancement curves. This is not a computer-aided diagnostic tool; of course, the curves are interpreting directly by the radiologist. We used a programmable graphical and calculus environment (Matlab, The Mathworks, Natick, MA) to develop a tool that interfaces directly with our picture archiving and communication system (PACS) via Digital Imaging and Communications in Medicine (DICOM), receives images, performs images subtraction, and shows some possible regions of interest (ROIs), each with an enhancement curve. The radiologist can also select other ROIs. The software shows a good performance (sensitivity, 100%). A low specificity (25%) is acceptable because the software allows the radiologist to save some time during each study.

A Java viewer to publish Digital Imaging and Communications in Medicine (DICOM) radiologic images on the World Wide Web.

The world wide web is an exciting service that allows one to publish electronic documents made of text and images on the internet. Client software called a web browser can access these documents, and display and print them. The most popular browsers are currently Microsoft Internet Explorer (Microsoft, Redmond, WA) and Netscape Communicator (Netscape Communications, Mountain View, CA). These browsers can display text in hypertext markup language (HTML) format and images in Joint Photographic Expert Group (JPEG) and Graphic Interchange Format (GIF). Currently, neither browser can display radiologic images in native Digital Imaging and Communications in Medicine (DICOM) format. With the aim to publish radiologic images on the internet, we wrote a dedicated Java applet. Our software can display radiologic and histologic images in DICOM, JPEG, and GIF formats, and provides a a number of functions like windowing and magnification lens. The applet is compatible with some web browsers, even the older versions. The software is free and available from the author.

A use of a neural network to evaluate contrast enhancement curves in breast magnetic resonance images.

For the diagnosis of breast cancer using magnetic resonance imaging (MRI), one of the most important parameters is the analysis of contrast enhancement. A three-dimensional MR sequence is applied before and five times after bolus injection of paramagnetic contrast medium (Gd-DTPA). The dynamics of absorption are described by a time/intensity enhancement curve, which reports the mean intensity of the MR signal in a small region of interest (ROI) for about 8 minutes after contrast injection. The aim of our study was to use an artificial neural network to automatically classify the enhancement curves as "benign" or "malignant." We used a classic feed-forward back-propagation neural network, with three layers: five input nodes, two hidden nodes, and one output node. The network has been trained with 26 pathologic curves (10 invasive carcinoma [K], two carcinoma-in-situ [DCIS], and 14 benign lesion [B]). The trained network has been tested with 58 curves (36 K, one DCIS, 21 B). The network was able to correctly identify the test curves with a sensitivity of 76% and a specificity of 90%. For comparison, the same set of curves was analyzed separately by two radiologists (a breast MR expert and a resident radiologist). The first correctly interpreted the curves with a sensitivity of 76% and a specificity of 90%, while the second scored 59% for sensitivity and 90% for specificity. These results demonstrate that a trained neural network recognizes the pathologic curves at least as well as an expert radiologist. This algorithm can help the radiologist attain rapid and affordable screening of a large number of ROIs. A complete automatic computer-aided diagnosis support system should find a number of potentially interesting ROIs and automatically analyze the enhancement curves for each ROI by neural networks, reporting to the radiologist only the potentially pathologic ROIs for a more accurate, manual, repeated evaluation.

[A visual displayer for publishing radiologic images on the World Wide Web]. / Un visualizzatore per la pubblicazione di immagini radiologiche su World Wide Web.

PURPOSE: To present a software suitable for publication of medical images on the World Wide Web and compatible with both the DICOM and other popular formats like GIF and JPEG. MATERIALS AND METHODS: DICOM viewer is a Java applet, written in Java 1.0. The tool offers the capability to publish medical images, to modify brightness and contrast (windowing) and to magnify the picture (magnification lens). Information related to the image is available for consultation only for DICOM images. RESULTS: The viewer was tested with many DICOM files, generated by our PACS or downloaded from Internet. It works well with the DICOM 3.0 file format, but correct functioning is not granted for previous releases. The software was compatible with all the most popular Web browsers (MS Internet Explorer 3.0 or newer, Netscape Navigator 4.5 or newer, Sun and HotJava) and it works well in Windows, Sun Solaris. Macintosh, Windows CE. A 512 kb image (a standard MR image) requires about 5 seconds to be shown on an Intel Pentium II PC with 32 Mbyte RAM connected on a 10 Mbit/s Ethernet network. About 3 seconds are needed to download the file and about 2 seconds to display the image. Windowing and zooming are quick enough. CONCLUSIONS: The applet allows to publish DICOM medical images directly on the World Wide Web, without converting them into another graphical format. Moreover, it supplies some image processing tools common in the radiological environment. The viewer characteristics make it suitable for preparing teaching radiology sites or clinical files on the Web. The viewer's performance is somewhat poor, particularly on the Internet. Better performances are achieved on local area network (intranet). To improve performance, we will introduce file compression and rewrite the software in Java 1.1. The software is available from the author free of charge.

Molecular mechanisms of resistance in Pseudomonas aeruginosa to fluoroquinolones.

Pseudomonas aeruginosa is important in the field of infectious disease especially with respect to its role in nosocomial infections. Infections with P. aeruginosa may be a problem as the organism has intrinsic resistance to several antibiotics and a capability in acquiring resistance during antibiotic therapy. Fluoroquinolones are sometimes used during antibiotic therapy of P. aeruginosa infections even though resistance to fluoroquinolones may develop. Six strains of P. aeruginosa were studied in an attempt to elucidate the mechanisms of resistance to fluoroquinolones. These included the electrophoresis patterns of the outer membrane proteins (OMPs), random amplified polymorphic DNA (RAPD) and polymerase chain reaction (PCR) analyses. A method is described that improved the clarity of the OMP gels. Resistance in these P. aeruginosa strains could depend not only on DNA-gyrase modifications but also on membranes alterations and on the presence (qualitative and quantitative) of the efflux pump formed by three subunits.