Implantation of a novel insertable cardiac monitor: preliminary multicenter experience in Europe.

BACKGROUND: The LUX-Dx™ is a novel insertable cardiac monitor (ICM) introduced into the European market since October 2022. PURPOSE: The aim of this investigation was to provide a comprehensive description of the ICM implantation experience in Europe during its initial year of commercial use. METHODS: The system comprises an incision tool and a single-piece insertion tool pre-loaded with the small ICM. The implantation procedure involves incision, creation of a device pocket, insertion of the ICM, verification of sensing, and incision closure. Patients receive a mobile device with a preloaded App, connecting to their ICM and transmitting data to the management system. Data collected at European centers were analyzed at the time of implantation and before patient discharge. RESULTS: A total of 368 implantation procedures were conducted across 23 centers. Syncope (235, 64%) and cryptogenic stroke (34, 9%) were the most frequent indications for ICM. Most procedures (338, 92%) were performed in electrophysiology laboratories. All ICMs were successfully implanted in the left parasternal region, oriented at 45° in 323 (88%) patients. Repositioning was necessary after sensing verification in 9 (2%) patients. No procedural complications were reported, with a median time from skin incision to suture of 4 min (25th-75th percentiles 2-7). At implantation, the mean R-wave amplitude was 0.39 ± 0.30 mV and the P-wave visibility was 91 ± 20%. Sensing parameters remained stable until pre-discharge and were not influenced by patient characteristics or indications. Procedural times were fast, exhibited consistency across patient groups, and improved after an initial experience with the system. Operator Operator feedback on the system was positive. Patients reported very good ease of use of the App and low levels of discomfort after implantation. CONCLUSIONS: LUX-Dx™ implantation appears efficient and straightforward, with favorable post-implantation sensing values and associated with positive feedback from operators and patients.

Legacy and emerging contaminants in the endangered filter feeder basking shark Cetorhinus maximus.

The status of contamination by chemical pollutants on large filter feeding sharks is still largely unknown. This study investigated for the first time the presence of legacy, emerging contaminants and trace elements in multiple tissues of basking sharks. In general, skin showed higher concentration of legacy and emerging contaminants probably due to pollutants being adsorbed onto the dermal denticles of the skin rather than accumulated in the tissue itself. Contaminants measured in both subcutaneous tissue and muscles appeared to strongly correlate with each other, indicating that the former might be a good proxy of muscle contamination in basking sharks. Considering the migratory nature of this species, longevity and feeding ecology, this species represents the perfect candidate to act as early warning bioindicator of regional contamination. In this context, non-lethal subcutaneous biopsies could allow the early detection of any temporal variation in the bioaccumulation of pollutants in the Mediterranean Sea.

Three-dimensional CAD/CAM reconstruction of the iliac bone following DCIA composite flap harvest.

This article reports a new technique to restore iliac bone integrity with a customized titanium device designed by CAD/CAM, in patients undergoing deep circumflex iliac artery (DCIA) composite flap harvest. Eight consecutive patients who underwent the repair of major head and neck defects with DCIA flaps were enrolled retrospectively. Computed tomography scans of the pelvis were obtained preoperatively. Starting from DICOM data, each personalized device was designed using modelling software and was finally made by additive manufacturing using a laser sintering machine. After surgery, the patients were followed up at 3-month intervals to evaluate the incidence of complications and the long-term outcome at the donor site. A subcutaneous seroma developed in one patient and an inguinal skin burn occurred in another. At a median follow-up of 12 months, the patients did not report pain, or any gait or sensory disturbance at the donor site. There was no occurrence of bulging, herniation, or instability or inflammation near the device for the entire follow-up duration. All patients were satisfied with the aesthetic result. In conclusion, reconstruction of the iliac bone with a customized device is safe and well tolerated. We recommend use of this device in patients deemed at high risk of herniation. Further studies are needed to confirm the stability of the device in the long term.

Odontomas: review of the literature and case reports.

Odontomas are one of the most common Odontogenic Tumors of the jaw. The exact etiology of odontomas is unknown. Histologically they are composed of various formations of dental tissue (enamel, dentin, cementum and sometimes pulp). In the WHO classification, they are divided into complex odontoma and compound odontoma. Clinically, odontomas are generally asymptomatic and only in rare cases cause swelling, pain, suppuration or bony expansion. Radiologically, the tumor is initially lucent, but with time, it develops small calcifications, which eventually coalesce to form a radiodense lesion with a lucent rim. Surgical resection is the treatment of choice and there is no recurrence. The aim of this paper is to define the principal characteristics and the treatment of these lesions, based on literature and personal experience.

Clam bioaccumulation of Alkylphenols and Polyciclic aromatic hydrocarbons in the Venice lagoon under different pressures.

Biota-Sediment Accumulation Factors (BSAFs) of nonylphenols (NPs) and polycyclic aromatic hydrocarbons (PAHs) in Ruditapes philippinarum from the Venice Lagoon (Italy) were determined with the aim to verify whether the routine biomonitoring studies are reliable in contaminated sites. Clams and sediments were collected in field campaigns (October 2003 to June 2004) in three sites of the Venice Lagoon. Results showed that Marghera and Campalto sediments were more contaminated by NPs and PAHs than Poveglia. Different trends were observed in the contamination of clams with the highest BSAFs found at Poveglia. BSAF trend appeared to be inversely related to the contaminant pressure on the sites. These results suggest that clam bioaccumulation is not always representative of the chemical pressure on aquatic biota. The direct correlation between sediment and biota concentrations in contaminated sites can be lost as a function of the site-specific conditions such as sediment toxicity and food availability.

Liquid chromatography mass spectrometry determination of perfluoroalkyl acids in environmental solid extracts after phospholipid removal and on-line turbulent flow chromatography purification.

An on-line TFC (Turbulent Flow Chromatography) clean up procedures coupled with UHPLC-MS/MS (Ultra High Performance Liquid Chromatography Mass Spectrometry) multi-residue method was developed for the simultaneous determination of 8 perfluroalkyl carboxylic acids (PFCA, from 5 to 12 carbon atoms) and 3 perfluoroalkyl sulfonic acids (PFSA, from 4 to 8 carbon atoms) in environmental solid matrices. Fast sample preparation procedure was based on a sonication-assisted extraction with acetonitrile. Phospholipids in biological samples were fully removed by an off-line SPE purification before injection, using HybridSPE(®) Phospholipid Ultra cartridges. The development of the on-line TFC clean-up procedure regarded the choice of the stationary phase, the optimization of the mobile phase composition, flow rate and injected volume. The validation of the optimized method included the evaluation of matrix effects, accuracy and reproducibility. Signal suppression in the analysis of fortified extracts ranged from 1 to 60%, and this problem was overcome by using isotopic dilution. Since no certified reference materials were available for PFAS in these matrices, accuracy was evaluated by recoveries on spiked clam samples which were 98-133% for PFCAs and 40-60% for PFSAs. MLDs and MLQs ranged from 0.03 to 0.3ngg(-1) wet weight and from 0.1 to 0.9ngg(-1) wet weight respectively. Repeatability (intra-day precision) and reproducibility (inter-day precision) showed RSD from 3 to 13% and from 4 to 27% respectively. Validated on-line TFC/UHPLC-MS/MS method has been applied for the determination of perfluoroalkyl acids in different solid matrices (sediment, fish, bivalves and bird yolk).

Osteopontin induces soluble urokinase-type plasminogen activator receptor production and release.

BACKGROUND: Osteopontin (OPN) and soluble urokinase plasminogen activator receptor (suPAR) have been proposed as markers of disease severity and risk-stratification in infection and inflammation. In breast cancer, OPN and the membrane bound form of urokinase plasminogen activator receptor (uPAR) are functionally related, as OPN-induced cell migration depends on uPAR triggering by urokinase plasminogen activator (uPA). The aim of this study was to prospectively evaluate the kinetic of OPN and suPAR blood levels in patients developing septic shock (SS) compared to those not developing SS, and to investigate the relationships between these two biomarkers in immune cells in vitro. METHODS: We measured the levels of OPN and suPAR for 15 days in forty-three patients, defined a priory as at risk to develop septic shock. Moreover, we investigated in vitro the effect of recombinant OPN on uPAR and suPAR expression in monocytes. RESULTS: We found that OPN and suPAR levels were directly correlated to each other both at intensive care unit admission and on the day patients met SIRS/sepsis or septic shock criteria. In patients developing septic shock, OPN increased prior to suPAR and was already detectable up to 4 days before the shock development. In vitro, OPN induced suPAR production in monocytes by increasing both uPAR gene expression, and suPAR release from the cell surface. CONCLUSION: These data suggest that OPN is partly responsible for the increased plasma levels of suPAR and might be a valuable tool to predict the occurrence of septic shock.

Evolutionary ecotoxicology of perfluoralkyl substances (PFASs) inferred from multigenerational exposure: a case study with Chironomus riparius (Diptera, Chironomidae).

A multigeneration toxicity test on Chironomus riparius was performed with the aim of investigating the evolutionary consequences of exposure to perfluoralkyl substances (perfluorooctane sulfonic acid, PFOS; perfluorooctanoic acid, PFOA; perfluorobutane sulfonate, PFBS). Six-hundred larvae were bred per treatment and per generation until emergence and egg deposition under a nominal concentration of 10µg/L of contaminants. Newborn larvae were used to start the next generation. Evolution of genetic variability was evaluated along a total of 10 consecutive generations based on 5 microsatellite loci. Analysis of life-history traits (survival, sex ratio and reproduction) was also carried out. Rapid genetic variability reduction was observed in all treatments, including controls, across generations due to the test conditions. Nevertheless, an increased mutation rate determined a stronger conservation of genetic variability in PFOS and, at minor extent, in PFBS exposed populations compared to controls. No significant effects were induced by exposure to PFOA. Direct mutagenicity or induced stress conditions may be at the base of increased mutation rate, indicating the potential risk of mutational load caused by exposure to PFOS and PFBS. The test provided the opportunity to evaluate the use of approximate Bayesian computation (ABC) and coalescent approaches in evolutionary ecotoxicology. A weak performance was evidenced for ABC, either in terms of bias or dispersion of effective population sizes and of estimates of mutation rate. On the contrary, coalescent simulations proved the sensitivity of traditional genetic endpoints (i.e. heterozygosity and number of alleles) to the alteration of mutation rate, but not to erosion of genetic effective size.

Effectiveness of maxillo-mandibular advancement in obstructive sleep apnea patients with and without skeletal anomalies.

This study evaluates the effectiveness of maxillo-mandibular advancement (MMA) in patients with obstructive sleep apnea syndrome (OSAS), even those without skeletal anomalies, indicating the possibility of extending this procedure to more patients. Two groups with different skeletal patterns were studied pre- and post-surgery. Group 1 (11 patients) had severe or moderate OSAS and maxillo-mandibular hypoplasia and/or mandibular deformities (SNA angle 78 degrees or less or SNA angle>78 degrees but with SNB<65 degrees and severe skeletal class II malocclusion). Group 2 (11 patients) had severe or moderate OSAS without maxillo-mandibular hypoplasia or deformity (SNA angle>80 degrees , dental class I occlusion). Analysis comprised: apnea hypopnea index (AHI), posterior airway space (PAS), SNA and SNB angles, Epworth sleepiness scale (ESS), body mass index (BMI), and a subjective standardized questionnaire about aesthetic appearance. All patients had increased PAS width and complete remission of objective and subjective OSAS symptoms evaluated by AHI and ESS. Results in both groups are comparable. Data were analysed using t-test; p<0.005 was statistically significant. All patients were satisfied with the functional and aesthetic results. MMA is effective in patients with severe or moderate OSAS, even in those without skeletal and/or occlusal anomalies and can be considered in more patients.

Uptake and elimination of 4-nonylphenol by the clam Tapes philippinarum.

The present study is the first dealing with the accumulation and elimination of 4-nonylphenol (NP) by the Manila clam, Tapes philippinarum. Specimens of T. philippinarum were exposed to NP-spiked seawater, and the NP contents in whole soft tissue, gills, digestive gland, and haemolymph were measured. Actual NP concentrations in seawater and microalgae (Isochrysis galbana) used for feeding were also determined, and the algal bioconcentration factor (BCF) value (640 ml/g) was calculated. Volatilisation was the main cause of dissipation of NP from experimental tanks, attaining up to 78% of the NP added. NP accumulated by algae used for feeding was negligible with respect to the total added NP, and we concluded that in our experiments, clams accumulated NP mainly from water and not food intake. Accumulation followed a two-compartment, first-order rate coefficient model, with an uptake rate coefficient of 13.8 +/- 0.6 mL g(-1)h(-1)(fresh weight [fw]) and an elimination coefficient of 0.0070 +/- 0.0005 h(-1). Ninety percent of the steady state was reached after 14 days of exposure, and the BCF value at the steady state was 1958 +/- 158 mL g(-1) fw (1.8 +/- 0.2 x 10(5) based on lipid weight). Slightly less than 50% of NP bioaccumulated through water was allocated into the gills, whereas the rest was found in the digestive gland. In the first 8 hours, clams eliminated 51% of the NP accumulated, and only 2% of the NP accumulated was detected in the clams at the end of the elimination phase (day 14). Two-compartment first-order decay model described the elimination of the accumulated NP by considering the clam as two compartments each with a different elimination rate. The sudden elimination of NP in the initial hours can be attributed to the elimination of NP accumulated into the gills and readily available for excretion (k ( e ) = 0.30 +/- 0.07 h(-1)). The slower step of the elimination process should be the mobilisation of NP accumulated in internal organs, which must be carried into the haemolymph for excretion (k(e) = 0.0091 +/- 0.0002 h(-1)). Because T. philippinarum has been demonstrated to accumulate NP dissolved in water, high NP levels can be hypothesised in clams from highly contaminated environments. This research was performed according to all national and international guidelines for animal welfare.

Determination of endocrine disrupting chemicals in environmental solid matrices by extraction with a non-ionic surfactant (Tween 80).

A readily applicable method based on extraction by aqueous non-ionic surfactant solutions (Tween 80) and RP-HPLC coupled to fluorescence detection, has been developed for the simultaneous determination of the phenolic endocrine disrupting chemicals (EDCs) nonylphenol (NP), nonylphenol monoethoxylate (NP1EO) and nonylphenol diethoxylate (NP2EO) and bisphenol A (BPA) in environmental solid matrices. Clean up of sample extracts was performed on Si-C18 solid phase extraction (SPE) cartridges. The overall Tween 80 extraction-SPE-RP-HPLC procedure was validated for accuracy and precision by analyzing sediment samples spiked with known amounts of EDCs. Recoveries for NP, NP1EO, NP2EO and BPA and limits of detection are in agreement with conventional extraction methods. The developed methodology was successfully applied to the analysis of target compounds in Italian river sediments, river suspended matter and benthonic macroinvertebrate organisms (oligochaetes Lumbriculus variegatus). Results confirmed that this relatively simple procedure performed satisfactorily in the determination of phenolic EDCs in environmental solid matrices of different complexity and that it can be a suitable alternative method to conventional systems even for routine analyses.

Fractures of the iliac crest following anterior and posterior bone graft harvesting. Review of the literature and case presentation.

Iliac crest is the most commonly used extra-oral donor site of autologous non-vascularized bone, because of the great amount of bone available and easy access. Bone grafting from the ileum, however, is not without complications. An extensive review of the literature focusing on fractures of the iliac crest and pelvic ring instability due to anterior and posterior bone graft harvesting is reported, and 1 case of anterior stress fracture of the iliac crest is described. Thirty-five of the 37 fractures described up to date in literature were divided in 2 groups depending on the region of bone graft harvesting. Twenty-four fractures - including our case - were related to bone graft harvesting from the anterior region, 12 were due to harvesting from the posterior region. Four out of 24 anterior fractures required further surgical treatment (16.6%). In 8 of the 12 fractures with pelvic ring instability due to posterior bone harvesting, 1 or more additional surgical procedures were performed in order to stabilize multiple fracture sites (66.6%). Anterior iliac crest fractures, even though painful, remain stable and heal spontaneously in most cases without further complications. On the contrary, fractures due to posterior iliac crest harvestings very often require complex surgical treatments and lead to significant disability, which can be permanent.

Recovery of 4-nonylphenol and 4-nonylphenol ethoxylates from river sediments by pressurised liquid extraction.

The pressurised liquid extraction (PLE) of 4-nonylphenol (4-NP) with methanol (100 degrees C and 100 atm) from river sediments was compared with methanolic Soxhlet extraction, the standard method for the sediment analysis. The PLE method showed a precision (average RSD ranged from 6 to 33%) and an accuracy (average recovery 85 and 87% for 4-NP and 4-NPE, respectively) comparable to those of Soxhlet. The extraction was performed on river sediments and no organic carbon content influence was found. The comparative study presented in this paper demonstrates that PLE is an alternative suitable extraction method for 4-nonylphenol and 4-nonylphenol ethoxylate determination in sediments.

Ion-chromatographic screening method for monitoring arsenate and other anionic pollutants in ground waters of Northern Italy.

A novel, rapid ion-chromatographic method for screening anionic pollutants in ground water, based on both conductivity and postcolumn spectrophotometric detection, has been developed. A relatively rapid separation of more than ten inorganic and polarizable anions was achieved by coupling an high capacity, hydroxide selective anion-exchange columns (Dionex IonPac AS16) supplied with an electrolytic eluent generator operating in gradient mode. The good control of the selectivity allowed the determination of polarizable anions including arsenate, thiocyanate, thiosulfate and perchlorate without interference from major components present at levels greater than 100 mg l(-1). This method was applied to the determination of arsenate in ground water samples collected in industrial and agricultural zones of Lombardia (Northern Italy). No traces of arsenate were detected in any sample, but added arsenate cannot be revealed by chromatographic analyses. This fact can be attributed to different causes, from reduction to the more reduced arsenic form to precipitation or dissolution in organic or inorganic based colloids. Oxidation with hydrogen peroxide seems to be useful for a partial recovery of added arsenate, but a stronger oxidation method, compatible with chromatographic separation, must be studied.

Electromagnetic interference by GSM cellular phones and UHF radios with intensive-care and operating-room ventilators.

The aim of this study was to evaluate the risks deriving from the interference by radio handsets (GSM cellular phones and UHF radios) with intensive-care and operating-room ventilators. Tests were conducted in three hospitals in Rome on 22 lung ventilators in accordance with the recommended practice ANSI C63.18-1997. When electromagnetic interference (EMI) effects occurred, the authors determined maximum interference distances. They also evaluated the distances at which the use of a given handset would result in a 5% and a 95% probability of interference. The degree of risk posed by each observed event was estimated, and safe distances are suggested. EMI events of varying degrees and natures were observed even with transmitters placed at a considerable distance. All observed effects were temporary. Only three ventilators of a certain model stopped working altogether and had to be reset.

Matrix effects in the determination of bromate in drinking water by ion chromatography.

Bromate is a well known by-product produced by the ozonation of drinking water; the allowed concentration for human consumption has to be regulated to low microgram l-1 range. By using a high-capacity anion-exchange column, it should be possible to determine bromate at this low concentration by direct injection of a very large volume (up to 1 ml) without any sample preconcentration and pretreatment. The feasibility of this technique for the determination of bromate in drinking water has been explored in our work. The experimental results showed that matrix effect, due to inorganic ions contained in drinking water, strongly influenced the chromatographic behaviour of the bromate peak. The increase of the total ion content led to a correlated decrease in the efficiency of the analyte peak so that effective detection limits depended on the matrix composition. In this work chromatographic parameters (efficiency, asymmetry and resolution) of bromate peak are discussed in relation to the concentration of the main inorganic anions, and the injection volume (from 250 microliters to 1 ml).

Analysis of inorganic species in environmental samples by capillary electrophoresis.

The use of capillary electrophoresis for the determination of inorganic species in environmental samples is reviewed. Topics covered include the separation of inorganic anions, inorganic cations, transition metal cations and organometals in different environmental matrices, such as atmospheric deposition, atmospheric aerosols, gases, natural waters, waste waters, soil, sediment and marine biological samples. Cited literature is gathered according to the type of matrix, so that the focus is on the discussion of matrix effects rather than on the method development for a single class of compounds. For each matrix, surveyed methods are tabulated in order to assist the method selection. Innovative applications of capillary electrophoresis to advanced environmental research are also emphasised.

Ion chromatography determination of trace level bromate by large volume injection with conductivity and spectrophotometric detection after post column derivatisation.

Bromate is a well known by-product produced by the ozonisation of drinking water; the allowed concentration for human consumption has to be regulated to the low microg l(-1) range. A direct injection, ion chromatographic method was developed using a tetraborate eluent with serially connected conductivity and spectrophotometric detection. Bromate was detected after post-column reaction with fuchsin at 520 nm. Sample capacity was investigated by injecting large volumes (up to 6 ml) using a high total hardness and chloride tap water. Linear correlation of bromate response with volumes from 1 ml to 6 ml was demonstrated, the main limitation being the overlapping of the chloride peak with bromate. Up to 1.5 ml sample can be injected without any pre-treatment. With more than 1.5 ml injection volume, a sample pre-treatment with a cartridge in Ag and H form, followed by a 10 min degassing in an ultrasonic bath, was needed. This method was validated by analysing secondary reference materials and real samples from a drinking water treatment plant. The method was linear from the limit of quantification to 20 microg l(-1). Reproducibilities in tap water were 18% (5 microg l(-1), n=12) and 21% (1 microg l(-1), n=4) respectively for 1.5 and 6 ml injection volumes with conductivity detection, and 17% at 0.5 microg l(-1) (n=9) with spectrophotometric detection. Calculated detection limits were 0.5 microg l(-1) (6 ml) ahd 2 microg l(-1) (1.5 ml) for conductivity detection and 0.3 microg l(-1) (1.5 ml) for spectrophotometric detection.