A geo-chemo-mechanical study of a highly polluted marine system (Taranto, Italy) for the enhancement of the conceptual site model.

The paper presents the results of the analysis of the geo-chemo-mechanical data gathered through an innovative multidisciplinary investigation campaign in the Mar Piccolo basin, a heavily polluted marine bay aside the town of Taranto (Southern Italy). The basin is part of an area declared at high environmental risk by the Italian government. The cutting-edge approach to the environmental characterization of the site was promoted by the Special Commissioner for urgent measures of reclamation, environmental improvements and redevelopment of Taranto and involved experts from several research fields, who cooperated to gather a new insight into the origin, distribution, mobility and fate of the contaminants within the basin. The investigation campaign was designed to implement advanced research methodologies and testing strategies. Differently from traditional investigation campaigns, aimed solely at the assessment of the contamination state within sediments lying in the top layers, the new campaign provided an interpretation of the geo-chemo-mechanical properties and state of the sediments forming the deposit at the seafloor. The integrated, multidisciplinary and holistic approach, that considered geotechnical engineering, electrical and electronical engineering, geological, sedimentological, mineralogical, hydraulic engineering, hydrological, chemical, geochemical, biological fields, supported a comprehensive understanding of the influence of the contamination on the hydro-mechanical properties of the sediments, which need to be accounted for in the selection and design of the risk mitigation measures. The findings of the research represent the input ingredients of the conceptual model of the site, premise to model the evolutionary contamination scenarios within the basin, of guidance for the environmental risk management. The study testifies the importance of the cooperative approach among researchers of different fields to fulfil the interpretation of complex polluted eco-systems.

Diversity of spore-forming bacteria and identification of Bacillus amyloliquefaciens as a species frequently associated with the ropy spoilage of bread.

This study examines the diversity of spore-forming bacteria isolated from raw materials/bread using molecular methods along with a rapid and innovative technology, the FT-NIR spectroscopy. Microbiological analysis showed that 23% of semolina and 42% of other raw materials (including grain, brewer yeast, improvers) contained more than 100 spores/g and more than 50% of each kind of sample was contaminated at a level ranging from 1 to 100 spores/g. A high bacterial diversity characterized raw materials. In total 176 isolates were collected and characterized: 13 bacterial species belonging to Bacillus (10) and Paenibacillus (3) genera were identified by sequencing of 16S rRNA, gyrA or gyrB genes. The two closely related species Bacillus amyloliquefaciens (strain N45.1) and Bacillus subtilis (strain S63) were also analyzed by the spectroscopic technique FT-NIR. This analysis gave clear discrimination between the strains in the score plot obtained by the PCA and allowed to identify the spectral region 5600-4000 cm(-1) as the information-rich region for discrimination. B. amyloliquefaciens, possibly misidentified as B. subtilis in previous studies, was recognized as the most frequent species, found also in ropy bread. Moreover, the screening test for rope production indicated that mainly B. amyloliquefaciens, together with B. subtilis and Bacillus pumilus, could cause spoilage in bread, even if the last two species were represented by a low number of isolates. The Bacillus cereus group and Bacillus megaterium showed a lower percentage (30-70%) of isolates potentially able to cause the rope, but considering the high number of B. cereus group isolates detected in this study, this bacterial group should also be considered important in rope spoilage. In conclusion, results demonstrate that raw materials used to produce bread represent a rich source of spore-forming bacteria, therefore their microbiological quality should be monitored before use. Moreover, this study highlights for the first time the importance of the species B. amyloliquefaciens in rope spoilage and indicates that other species may also cause this alteration although strains of the same species may behave differently.

Distinct immunomodulatory properties of Lactobacillus paracasei strains.

AIMS: This study was performed to ascertain the immunomodulatory effect of Lactobacillus paracasei strains. These strains were also genetically characterized. METHODS AND RESULTS: The strains were genetically differentiated by using the fluorescent-amplified fragment length polymorphism technique, which led to the identification of several molecular markers unique to each strain. To determine the immunomodulatory properties, we evaluated the effect of strains on dendritic cell maturation, dextran uptake, ability to induce proliferation of allogenic T cells and cytokine secretion. The results indicated that all the strains stimulated phenotypic maturation of dendritic cells (DCs), but they acted differently on DCs in relation to the other tested properties; notably, a different effect on cytokine secretion was detected. CONCLUSIONS: The results of this study revealed different immunomodulatory properties of strains of the species Lact. paracasei. Strain IMPC 4.1 showed an interesting anti-inflammatory ability. Probiotic strains IMPC 2.1 and LMG P-17806 were characterized by a similar and intermediate ability to induce cytokine secretion in contrast to the very low ability of strain LMG 23554. SIGNIFICANCE AND IMPACT OF STUDY: Our results confirm that each single strain of a bacterial species appears to influence the immune system in a peculiar manner. The evaluation of the different types and/or levels of cytokines whose secretion is induced by each strain could be relevant to define its pro- or anti-inflammatory properties and its more appropriate clinical use.

Role of the probiotic strain Lactobacillus paracasei LMGP22043 carried by artichokes in influencing faecal bacteria and biochemical parameters in human subjects.

AIMS: To evaluate the positive influence of the probiotic strain Lactobacillus paracasei LMGP22043 carried by artichokes into the human gut with special reference to faecal bacterial balance, short-chain fatty acid concentrations and enzyme activities in a randomized, double-blind human trial in comparison with probiotic-free artichokes (control). METHODS: Twenty subjects were randomized into two groups, which consumed daily 180 g of the artichoke product (probiotic or control) during two 15-day study periods (periods 1 and 2) separated by a 15-day washout in a crossover manner. Faecal samples were subjected to microbiological and biochemical analyses, and a strain-specific PCR was performed to monitor the probiotic strain. RESULTS: The probiotic strain, transported by the vegetable matrix, transiently colonized the gut of 17/20 subjects (median 6·87 log CFU g⁻¹ faeces), antagonized Escherichia coli and Clostridium spp. and increased the genetic diversity of lactic population based on REP-PCR profiles, mainly after period 1. CONCLUSIONS: The probiotic L. paracasei LMGP22043 successfully colonized the human gut and positively influenced faecal bacteria and biochemical parameters. SIGNIFICANCE AND IMPACT OF THE STUDY: The association of the probiotic L. paracasei with a food carrier rich in fibre can represent a new strategy for favouring a daily supply of probiotics and attracting more consumers to vegetable food fortified with probiotic strains.

Treatment of iatrogenic and traumatic tracheal disruptions.

BACKGROUND AND AIM: The optimal management of tracheal disruptions is still controversial. It is usually postulated that lesions wider than 1 or 2 centimetres and/or lesions of full-thickness should be treated by surgery at an early stage. Such a statement is not supported by any proven evidence. On the contrary, the conservative management of such injuries has also produced very good results according to recent reports. The aim of this study is to investigate whether conservative treatment can be safely used for wide tracheal lacerations and to assess any possible association between clinical features and modality of treatment. METHODS: Records of all patients with iatrogenic and traumatic tracheal disruptions observed between January 1992 and December 2006 were collected and retrospectively reviewed. Data regarding mechanism of injury, clinical and morphological features and modalities of treatment were registered. All possible associations between clinical features and modalities of treatment were investigated. RESULTS: 23 patients were observed overall. There were 6 males and 17 females with a median age of 58 years (range 20-84 yrs). 15 patients had undergone single tube intubation. One patient had his trachea injured during an esophagectomy. Ruptures were secondary to blunt (n = 5) and open (n = 2) trauma in 7 patients. Lesions varied in length between 1 and 7 centimetres (median length 3 centimetres) and all were full-thickness. The time interval until diagnosis varied between 0 and 72 hours (median 6 hours). Respiratory failure was evident in 7 patients. 16 patients (69.5%) with lacerations ranging in length between 1 and 5.5 centimetres (median length 2.75 cm) underwent conservative treatment. Seven patients (30.5%) underwent surgery. The follow up was completed for 16 patients and varied between 15 and 105 months (median 22.5). One patient died after surgical treatment. No mortality or late major sequelae were registered after conservative treatment. Female sex, absence of respiratory failure and delayed diagnosis was associated with the conservative treatment. CONCLUSIONS: Conservative treatment can play a major role even in cases of wide tracheal lacerations. Clinical rather than morphological features should be regarded as main criteria for treatment. The conservative treatment is particularly indicated in the case of stable respiratory parameters independent of the size and the depth of the lesion.

High epidural thoracic anesthesia for pericardial surgery.

Here are reported three cases involving patients (77, 61 and 58 years-old) with recurrent pericardial effusion who underwent pleuropericardial window using thoracic epidural anesthesia (T1-T2 o T2-T3) while fully awake, without endotracheal intubation. The operative and postoperative courses were uneventful. During the pneumothoracic phase the vital parameters and spontaneous ventilation patterns remained the same compared to the basic ones. Pain control was excellent. On the basis of this early experience the authors conclude that thoracotomy in awake patients to reach the cardiac structures is a reproducible technique.

The 'real' woman with heart failure. Impact of sex on current in-hospital management of heart failure by cardiologists and internists.

AIM: To identify differences between sexes in the clinical profile, use of resources, management and outcome in a large population of 'real world' patients with heart failure (HF). METHODS: A prospective cross-sectional survey was conducted on 2127 consecutive patients (47% women) admitted with HF to 167 cardiology and 250 internal medicine departments between February 14 and 25, 2000. RESULTS: Women were older, had a higher prevalence of atrial fibrillation, and more frequently a hypertensive or valvular aetiology. Females were admitted more frequently in Medical than in Cardiology Departments. The rate of invasive and non-invasive procedures was lower in women than in men, slightly higher if managed by cardiologists. Women were less frequently prescribed ACE-inhibitors, amiodarone, and spironolactone, and more frequently prescribed digoxin. In-hospital mortality was similar, without difference between health-care providers. A 6-month follow-up was performed in 56.4% of the cases in both setting, but less frequently in women. Event rates were similar with nearly half of patients re-hospitalised at least once. CONCLUSION: The 'real' HF woman has generally a more severe disease; she is an old lady who is more frequently hospitalised in a medical unit, receives few diagnostic, and cardiovascular procedures and pharmacological therapy, has a relatively low probability of dying in hospital, but a high likelihood of requiring readmission.

High-dose fluconazole therapy in Intensive Care Unit.

AIM: Fungal infections have become one of the emerging complications in intensive care patients and the morbidity and mortality linked to these infections underlines the importance of managing these pathologies. METHODS: The clinical and laboratory difficulties of diagnosing candidiasis prompted us to identify patients at risk and to intervene as soon as possible, where there was the "suspicion" of active infection, using adequate, so-called "empiric" treatment. The major risk factors include the use of invasive devices (central venous catheters), the administration of multiple antibiotic treatment and parenteral nutrition. In our Intensive Care ward (multi-purpose), we examined 1933 patients who had undergoing 1211 urine cultures (following consolidated clinical criteria). "Empiric treatment" was used in 378 high-risk patients with unstable clinical symptoms and positive urinary fungal colonisations using high-dose fluconazole (800 mg/die) according to the guidelines set down by BSAC. The mean duration of treatment was 12+2 days and urine cultures became negative in all patients after 1 or 2 weeks of treatment. RESULTS: We observed that fluconazole was generally well tolerated: only 10% of patients presented augmented hepatic transaminase. This phenomenon was always transient. Renal function remained unchanged (creatinine clearance). A severe infection with hematogenous dissemination was reported in 6 cases: "empiric treatment" was used in 5 cases with 800 mg/die of fluconazole and 1 case received amphotericin B 1 mg/kg/die (because no clinical improvement was observed after 48-72 hours of fluconazole treatment). Three of these 6 cases died, 2 of which were not directly linked to fungal infection, and 3 patient were discharged from the ward. CONCLUSIONS: We found that fluconazole offers a treatment option that is less toxic, less expensive and equally effective for these infections, provided that it is used at an adequate dose and that high-risk patients are identified for "empiric treatment". No significant increases in resistance were noted, as is demonstrated by the fact that only 1 case of candidemia required conversion to amphotericin B.

[Experience with remifentanil in the ICU]. / Esperienza con remifentanil in Terapia Intensiva.

BACKGROUND: Analgesia and sedation are indispensable in patients admitted to intensive care for the following, principal reasons: to control their state of anxiety, induce amnesia, improve their adaptation to mechanical ventilation, make invasive manoeuvres tolerable. The purpose of the present retrospective analysis is to assess the effectiveness of remifentanil in a total of 1085 patients admitted to our Resuscitation and Intensive Care Department in 1997-2001. METHODS: A sample of 60 adults was taken from these patients. The group was homogeneous in terms of age (67.3+/-10.2 kg), weight (66.7+/-10.2 kg), duration of sedation (6.8+/-1.6 days) and index of gravity (SAPS 30.1+/-4.4). The patients were suffering from chronic obstructive bronchopneumopathy, subjected to mechanical ventilation and sedated with remifentanil. The sample was then compared with another 2 groups (homogeneous with the first) of 20 patients each, treated with propofol and midazolam as the only drug. Following an initial bolus of 2 mg/kg (+/-0.04) for propofol and 0.15 mg/kg (+/-0.03) for midazolam (no bolus for remifentanil), the doses of subsequent continuous infusion (initial doses in the case of remifentanil) were: 0.05 mcg/kg/m (+/-0.01) for remifentanil; 1 mg/kg/h (+/-0.04) for propofol; 0.03 mg/kg/h (+/-0.006) for midazolam. In order to assess the level and quality of sedation, 2 subjective evaluation scales (Ramsey score and the Sedation-Agitation Score: SAS) and one system of objective evaluation (Bispectral Index; BIS) were employed. The BIS is a direct measure of the effects of anaesthetics on the brain. It is represented by a single digit (between 100, state of arousal, and zero, EEG flat), derived statistically and empirically from the EEG. RESULTS: No significant differences were encountered as regards quality of sedation among the 3 groups but there was a significant difference in negative cardiovascular activity in patients treated with propofol (12% reduction in Cl, 13.8% reduction in SVR). A significant accumulation of the drug was observed in cases treated with midazolam, whereas there was no accumulation for remifentanil and propofol in relation to the duration of the infusion. CONCLUSIONS: Of the various sedation modalities employed, we prefer the one which uses remifentanil as the sole drug because a good level of sedation is obtained, there is no accumulation, little interference with cardiovascular parameters and lower costs in comparison with the others.

Growth interactions during bacterial colonization of seedling rootlets.

Rootlet elongation and bacterial growth on rootlets were determined after inoculation of cucumber and spinach seedlings with Pseudomonas strains differing in production of siderophores and HCN. Siderophore producers grew more profusely than nonproducers on both species and promoted rootlet elongation on cucumber. Coinoculation of siderophore producers and nonproducers resulted in restricted growth of the latter. The total populations of nonproducers of HCN in the presence of HCN producers were not decreased, but the tenacity of their association with the rootlet surface was altered.

[Targets and prevention of complications in nursing of subarachnoid hemorrhage]. / Compiti assistenziali e preventivi del nursing nell'ESA.

A qualified nursing care is mandatory in patients after SAH. Clinical and instrumental monitoring are basilar to assure the rapid control of dangerous ICP or CPP changes and of epileptic crisis. Prophylaxis of infections is greatly minimized when coherent treatments are applied to any invasive devices, patient body, patient bed and UTI area. Many drugs can be useful to avoid ICP increases by tracheal suctioning and other sensorial stimulations. Having a trained staff, patient outcome can be improved.

[Foreign body inhalation in children. Report of a case]. / Inalazione di corpo estraneo in età pediatrica. Descrizione di un caso.

A case of inhalation of a foreign body in a child is reported. The case was recalcitant to treatment (antibiotics, bronchodilators, corticosteroids) and long-term follow-up is recommended.

Unexplained bilateral occipital calcification and reduced vision.

An eight year-old girl, investigated because of convulsions, was found to have isolated bilateral presumably cortical and subcortical calcification, reduced visual acuity and prolonged visual evoked response latencies. There were no clinical manifestations of a phakomatosis.

[Althesin in endocranial surgery of long duration]. / L'althesin nella chirurgia endocranica di lunghissima durata.

The results of personal experience of Althesin in long-duration (from 4 to 11 hours) neurosurgery are presented. The drug was used as an induction agent and for maintaining anaesthesia in continuous perfusion. Considering the good results obtained, the simplicity of the technique and the lack of side effects, it is concluded that Althesin is useful in this type of surgery, particular stress being laid on the speed and quality of arousal, and the excellent tolerance assessed by exploring secretory and excretory function of the liver with enzymatic tests.

[Althesin in surgery of the eyeball]. / L'althesin nella chirurgia del bulbo oculare.

Evaluation of Althesin in open eyeball surgery is reported. The anaesthetic gave surgically very useful and stable hypotonia, comparable with that offered by pentothal. Its is felt that steroid anaesthesia is excellent for surgical purposes and that Althesin is ideal on account of its overall features: lack of toxicity, high therapeutic index, tranquil induction, rapid return to consciousness, excellent quality, absence of carryover effects, and easy regulation. It is, moreover, rarely responsible for coughing and vomiting. It is preferable in eye surgery to "heavy" anaesthetics, such as barbiturates and volatile halogenates, particularly in the aged.