Effect of remote ischemic conditioning on the immune-inflammatory profile in patients with traumatic hemorrhagic shock in a randomized controlled trial.

Resuscitation induced ischemia/reperfusion predisposes trauma patients to systemic inflammation and organ dysfunction. We investigated the effect of remote ischemic conditioning (RIC), a treatment shown to prevent ischemia/reperfusion injury in experimental models of hemorrhagic shock/resuscitation, on the systemic immune-inflammatory profile in trauma patients in a randomized trial. We conducted a prospective, single-centre, double-blind, randomized, controlled trial involving trauma patients sustaining blunt or penetrating trauma in hemorrhagic shock admitted to a Level 1 trauma centre. Patients were randomized to receive RIC (four cycles of 5-min pressure cuff inflation at 250 mmHg and deflation on the thigh) or a Sham intervention. The primary outcomes were neutrophil oxidative burst activity, cellular adhesion molecule expression, and plasma levels of myeloperoxidase, cytokines and chemokines in peripheral blood samples, drawn at admission (pre-intervention), 1 h, 3 h, and 24 h post-admission. Secondary outcomes included ventilator, ICU and hospital free days, incidence of nosocomial infections, 24 h and 28 day mortality. 50 eligible patients were randomized; of which 21 in the Sham group and 18 in the RIC group were included in the full analysis. No treatment effect was observed between Sham and RIC groups for neutrophil oxidative burst activity, adhesion molecule expression, and plasma levels of myeloperoxidase and cytokines. RIC prevented significant increases in Th2 chemokines TARC/CCL17 (P < 0.01) and MDC/CCL22 (P < 0.05) at 24 h post-intervention in comparison to the Sham group. Secondary clinical outcomes were not different between groups. No adverse events in relation to the RIC intervention were observed. Administration of RIC was safe and did not adversely affect clinical outcomes. While trauma itself modified several immunoregulatory markers, RIC failed to alter expression of the majority of markers. However, RIC may influence Th2 chemokine expression in the post resuscitation period. Further investigation into the immunomodulatory effects of RIC in traumatic injuries and their impact on clinical outcomes is warranted.ClinicalTrials.gov number: NCT02071290.

Two case reports of fetal alcohol syndrome: broadening into the spectrum of cardiac disease to personalize and to improve clinical assessment.

BACKGROUND: Fetal alcohol spectrum disorder (FASD) refers to a broad spectrum of disabilities, in infants and children, resulting from moderate to excessive prenatal alcohol exposure. Significant associations with alcohol exposure were already reported with congenital structural heart defects: i.e. ventricular septal defects, atrial septal defects, conotruncal defects. CASES PRESENTATION: We describe two cases of children with FASD, both admitted to the Center for Rare Diseases and Birth Defects of Policlinico Universitario Agostino Gemelli, in whom asymptomatic cardiac rhythm alterations were detected in absence of structural cardiovascular system anomalies or cardiac channelopathies. CONCLUSIONS: No other reports about cardiac rhythm anomalies in individuals affected by FASD are actually available from the literature. We would like to make an alert for clinician, given the possibility of finding anomalies of heart conduction and rhythm in children affected by FASD even without structural congenital heart disease.

Human parvovirus B 19 and Epstein-Barr virus co-infection in a child with hereditary spherocytosis.

BACKGROUND: In patients with chronic congenital haemolytic disorders, human Parvovirus B19 (HPV B19) is frequently involved in pure red-cell aplastic crises. Furthermore, it may inhibit three-lineage haematopoiesis in the bone marrow, causing severe pancytopenia. In such patients, Epstein Barr virus (EBV) infection also seems to share the same mechanism as HPV B19 in inducing bone marrow aplasia, but at present the clinical effect of an infection sustained by both viruses is unknown. CLINICAL REPORT: We present a 7-year-old boy affected by hereditary spherocytosis (HS) who suffered from transient aplastic crisis, in whom laboratory findings revealed a double HPV B19 and EBV infection. CONCLUSIONS: To our knowledge, this is the first report of a case of HPV B19 and EBV co-infection diagnosis in a paediatric patient. Despite underlying HS, no signs of haemolytic anaemia were detected, but the infection only produced transient pancytopenia. Nevertheless, the reason why there was no additive effect of the two viruses on the aplastic crisis is still unclear.

Phase I safety and pharmacokinetic study of SU-014813 in combination with docetaxel in patients with advanced solid tumours.

BACKGROUND: In pre-clinical models enhanced anti-tumour activity was observed when SU-014813, an oral multi-targeted tyrosine kinase inhibitor was combined with docetaxel. This synergy might be explained by improvement of the penetration of cytotoxic agents into tumours as a result of both VEGFR and PDGFR inhibition. We assessed the maximal tolerated dose (MTD), evaluated the pharmacokinetics and preliminary anti-tumour efficacy of oral SU-014813 administered continuously in combination with docetaxel to patients with advanced solid tumours. METHODS: In this phase I study successive patient cohorts received docetaxel 60 or 75mg/m(2) every 3weeks in combination with chronic daily dosing of SU-014813. Dose limiting toxicity was assessed both in the first and second treatment cycle. RESULTS: Twenty-five patients were entered on study of which 24 started treatment. Dose limiting toxicities were prolonged neutropenia, neutropenic fever, fatigue and diarrhoea. Other toxicities included fatigue, alopecia, nausea, vomiting, anorexia, rash, hypertension and hair discolouration. The recommended phase II dose was determined to be docetaxel 75mg/m(2) in combination with SU-014813 50mg/day. There was no clinically relevant pharmacokinetic drug-drug interaction. Two patients (8%) achieved a partial response (PR) and 7 patients (29%) had stabilisation of their disease (SD) >6months, for a clinical benefit rate of 37.5%. The activity observed in patients with melanoma and sunitinib refractory gastrointestinal stromal tumours (GIST) was particularly noteworthy. CONCLUSIONS: Oral SU-014813 50mg/day with docetaxel 75mg/m(2) is a clinically feasible regimen with a manageable safety profile and anti-tumour activity. Further development is warranted in patients with melanoma and GIST.

[Papular purpuric gloves and socks syndrome. A case report]. / Sindrome papulo-purpurea a guanto ed a calza e parvovirus B19: un ulteriore contributo.

Papulo-purpuric gloves and socks syndrome, a typical maculopurpuric exanthema limited to hands and feet, mainly associated with Parvovirus B19 infection, has not, until now been reported in the literature in relation to pediatric cases in Italy. The case of a 10-year old girl with all the characteristics of the papulo-purpuric gloves and socks syndrome, as well as being IgM positive anti Parvovirus B19, is reported. This syndrome, despite its spontaneous remission, should be included in the differential diagnosis of maculopurpuric exanthemas.

[Characteristics of Italian thermal parks and gardens: explorative study; therapeutic possibilities. I]. / Entità e caratteristiche di parchi e giardini termali italiani: censimento esplorativo; possibilità in terapia. Parte I.

There are reported the results of a research about thermal parks and thermal gardens own to 27 italian Spas. The considerable areas of green around Spas, the correct ratio with the number of subjects in thermal treatment and others arguments represent favourable elements for italian Medical Hydrology. The importance of green around Spas in Thermal Medicine and in Ecology il stressed.

[Extension and features of parks and gardens around spas in Italy: explorative census; possible therapeutic usefulness II]. / Entità e caratteristiche di parchi e giardini termali italiani: censimento esplorativo; possibilità in terapia. Parte II.

There are described the results of a census about parks and gardens own to 27 italian Spas. The considerable areas of green around Spas, the correct ratio whith the number of subjects in thermal treatment and other arguments represent favourable elements for italian medical Hydrology. In our census the found plants generally are in conformity with their correct geographical placing. Moreover they are in order to cause favourable effects for environmental Psychology and Therapeutics. The species of recommended plants for the increase and for improvement of green around italian Spas are mentioned. The importance of green around Spas in thermal Medicine and in Ecology is stressed.

[Thermal-spring parks within the ambit of protected areas: general trends in morphology and botany]. / Parchi termali nell'ambito delle aree protette: orientamenti generali di morfologia e botanica.

It is remembered that, in contemporary era, the thermal parks arose in U.S.A. and in Canada: they represent the first example of national parks in the world. Are described legislation, classifications and various types of protected areas. The species of recommended plants for the formation, increase and/or improvement of italian thermal are mentioned.

Malignant granular cell tumor mimicking herniated nucleus pulposus.

Peripheral nerve tumors may arise in any nerve, large or small. Their presence is readily apparent when they are superficial, but when they are located in a deep nerve, symptoms can mimic+ the nerve root pain of herniated nucleus pulposus. This case of malignant granular cell tumor, probably of Schwann cell origin, involved the sciatic and tibial nerves in the popliteal fossa. Originally the pain was assumed to be produced by a herniated nucleus pulposus. The discovery of the mass thus +was delayed. The mass gave a heterogeneous signal on magnetic resonance imaging studies. A peripheral origin of nerve pain should be considered whenever pain radiates to a limb. A complete physical examination that includes palpation of the nerve to which pain is referred gives the best clue as to the true cause of pain when a peripheral nerve tumor is present.

Relationship between nutritional status and tumor growth in humans.

AIMS AND BACKGROUND: There is considerable evidence from studies on tumor-bearing animals that nutritional support aimed at maintaining a good nutritional status can indeed promote tumor growth. Experience in humans, however, is scanty and controversial, this issue never having been extensively investigated. The purpose of this study was to analyze whether there exists a relationship between nutritional status and tumor growth in patients with non-Hodgkin's lymphoma. The hypothesis behind it was that if it is true than an abundant availability of substrates promotes tumoral growth, then the better the nutritional status the higher the tumor cell proliferation. METHODS: Two hundred and forty six adult patients with non-Hodgkin's lymphoma were characterized according to nutritional status (percent of weight loss as compared to usual body weight, serum albumin, serum cholinesterase, number of lymphocytes) and rate of incorporation of 3H thymidine labelling index in the tumor tissue. The values of serum albumin, serum cholinesterase and lymphocytes were subdivided into three classes adopting as cut-off points the tertile values of their distribution, while weight loss was scored as a "no" and a "yes". The association between nutritional parameters and labelling index was evaluated by a univariate analysis (X2 test and Mantel-Haenszel X2 test and the odds ratio) and by a logistic multiple regression model. RESULTS: Results of the univariate analysis show a statistically significant association between "poor" nutritional status (depressed nutritional indexes) and "high" labelling index (increased tumoural growth), while the multiple regression analysis found that the only significant association was that between low serum cholinesterase and high labelling index. CONCLUSIONS: These data demonstrate for the first time in a large series of patients that maintenance of a good nutritional status does not have any deleterious effect on the tumor growth.

When the media comes to call.

In most communities, the hospital administrator no longer has the luxury of choosing between standing in the limelight and melding into the background. If newspaper and broadcast reporters have not turned up at your hospital doorstep, they will.

Emergency care. Texas hospitals to the rescue.

An average of 17 Texans die every day as a result of accidental injuries. Our ability to respond to trauma in Texas will be a high priority issue in the upcoming Legislative session. In the meantime, metropolitan areas and remote rural locations across Texas have had to come up with ways to handle what is often a trauma crisis. Efforts are also underway to reduce the number of accidents and injuries in the first place. This month, HealthTexas takes a look at these trauma issues.

Complications of biopsy of the cervical lymph node.

The incidence of injury to the accessory nerve after biopsy of the cervical lymph nodes is difficult to ascertain. The deficits in trapezius muscle function can result in marked disability to the patient. We have presented the results of surgical exploration and repair in eight patients with injury to the accessory nerve during biopsy of the cervical lymph node. External and internal fascicular neurolysis and fascicle suturing when indicated were performed. Four patients received significant improvement in accessory nerve function and four had no improvement. Our findings agree with those reported in the literature that early recognition of accessory nerve dysfunction after biopsy of the posterior cervical lymph node with appropriate surgical therapy can yield excellent results in trapezius muscle function.