Effectiveness of a digital platform for sharing knowledge on headache management: a two-year experience.

It is crucial that all headache specialists receive adequate training. Considering the unsatisfactory results obtained with standard updating courses and the growing need for continuing professional education, a digital platform was developed as a training tool. The platform has been active since 1 October 2014. It is readily accessible to doctors by free registration. Users have access to all the material available on the platform, which includes scientific articles, e-books, presentations and images. Users can share their own material and clinical cases directly. At the time of this study, the platform had 37 users. In the second year following its launch 316 files were downloaded and five discussions were started. These saw 22 contributions. Fifteen of the 37 members did not perform any action on the platform. In total, 74 files were uploaded in the second year of activity, but 90% of the contributions came from a very small group of users. There were no significant differences in use of the platform between members of the Italian Society for the Study of Headache and other specialists. Even though the platform appears to be an easily accessible, interactive and inexpensive instrument, the higher number of downloads than uploads suggests that it is used passively.

Tryptophan-Mediated Interactions between Tristetraprolin and the CNOT9 Subunit Are Required for CCR4-NOT Deadenylase Complex Recruitment.

The zinc-finger protein tristetraprolin (TTP) binds to AU-rich elements present in the 3' untranslated regions of transcripts that mainly encode proteins of the inflammatory response. TTP-bound mRNAs are targeted for destruction via recruitment of the eight-subunit deadenylase complex "carbon catabolite repressor protein 4 (CCR4)-negative on TATA-less (NOT)," which catalyzes the removal of mRNA poly-(A) tails, the first obligatory step in mRNA decay. Here we show that a novel interaction between TTP and the CCR4-NOT subunit, CNOT9, is required for recruitment of the deadenylase complex. In addition to CNOT1, CNOT9 is now included in the identified CCR4-NOT subunits shown to interact with TTP. We find that both the N- and C-terminal domains of TTP are involved in an interaction with CNOT9. Through a combination of SPOT peptide array, site-directed mutagenesis, and bio-layer interferometry, we identified several conserved tryptophan residues in TTP that serve as major sites of interaction with two tryptophan-binding pockets of CNOT9, previously found to interact with another modulator GW182. We further demonstrate that these interactions are also required for recruitment of the CCR4-NOT complex and TTP-directed decay of an mRNA containing an AU-rich element in its 3'-untranslated region. Together the results reveal new molecular details for the TTP-CNOT interaction that shape an emerging mechanism whereby TTP targets inflammatory mRNAs for deadenylation and decay.

Treatment of chronic prostatitis/chronic pelvic pain syndrome category IIIA with Serenoa repens plus selenium and lycopene (Profluss) versus S. repens alone: an Italian randomized multicenter-controlled study.

OBJECTIVES: To evaluate the efficacy and safety of Serenoa repens + selenium and lycopene (Profluss) versus S. repens alone for the treatment of category IIIa chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). PATIENTS AND METHODS: 102 patients with IIIa CP/CPPS were enrolled and randomized into two groups each to receive Profluss or S. repens alone for 8 weeks. Evaluation was based on results of the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), IPSS, maximum peak flow rate (MPFR), and PSA measurements at baseline and at weeks 4, 8 and 8 after the end of treatment. The primary endpoint was a >50% reduction in NIH-CPSI score. Secondary endpoints evaluated were MPFR, IPSS, PSA and white blood cell count. RESULTS: No patients withdrew from the study. The mean NIH-CPSI score decreased significantly (p < 0.001) in both groups; we observed a decrease in the total score from 27.45 to 13.27 in group 1 (-51.64%) and from 27.76 to 20.62 in group 2 (-26.06%). IPSS improved significantly (p < 0.001) in both arms, but more in group 1. PSA and white blood cell count decreased significantly (p < 0.007) only in group 1. The MPFR improved more in group 1 (p < 0.005). CONCLUSION: Profluss is a triple therapy that is safe and well tolerated. It ameliorates symptoms associated with IIIa CP/CPPS.

[The demonstration of the connection of cause in the professional allergic pathology not tabulated. Utility and limits of the allergometric tests]. / La dimostrazione del nesso di causa nella patologia allergica professionale non tabellata. Utilità e limiti dei test allergometrici.

The Sentences of the Constitutional Court no 179/88 and 206/88 have of done modified the system insurance of the professional illnesses. To the old tabular system to the pathologies for which the legal conceitedness of origin is in force they are added those pathologies that need to be shown with burden of test of the applicant. And necessary to resort to the criterion pathogenetic for the geneses pathologies plurifactorialy or to non certain etiology. These innovations determine the necessity of a methodological iter forced for the recognition of the professional illness not table. The authors therefore they propose an iter diagnostic that passes through the recognition of the connection of cause. To such intention the authors examine meaning and limits of the suggested investigations.

[Work related disease in radiation exposed? Case report]. / Malattia professionale in radioesposto? Case report.

In the present work we analysed the possible recognition of professional disease in a subject exposed to ionizing radiation. Haematic parameters were evaluated during the working activity and after the risk's avoidance. Normal haematic values after the pathogenic noxa's avoidance exclude a chronic damage, which in an indispensable datum for professional disease recognition.

Effect of moderate red wine intake on cardiac prognosis after recent acute myocardial infarction of subjects with Type 2 diabetes mellitus.

BACKGROUND: Oxidative stress and increased inflammation have been reported to be increased in subjects with diabetes and to be involved in the pathogenesis of cardiovascular complications after myocardial infarction (MI). It is well recognized that red wine has antioxidant and anti-inflammatory activities. We examined the effects of moderate red wine intake on echocardiographic parameters of functional cardiac outcome in addition to inflammatory cytokines and nitrotyrosine (oxidative stress marker), in subjects with diabetes after a first uncomplicated MI. METHODS: One hundred and fifteen subjects with diabetes who had sustained a first non-fatal MI were randomized to receive a moderate daily amount of red wine (intervention group) or not (control group). Echocardiographic parameters of ventricular dys-synchrony, circulating levels of nitrotyrosine, tumour necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-18 (IL-18) and C-reactive protein (CRP) were investigated at baseline and 12 months after randomization. RESULTS: After 1 year of diet intervention, concentrations of nitrotyrosine (P < 0.01), CRP (P < 0.01), TNF-alpha (P < 0.01), IL-6 (P < 0.01) and IL-18 (P < 0.01) were increased in the control group compared with the intervention group. In addition, myocardial performance index (P < 0.02) was higher, and transmitral Doppler flow (P < 0.05), pulmonary venous flow analysis (P < 0.02) and ejection fraction (P < 0.05) were lower in the control group, indicating ventricular dys-synchrony. The concentrations of nitrotyrosine, CRP, TNF-alpha and IL-6 were related to echocardiographic parameters of ventricular dys-synchrony. CONCLUSIONS: In subjects with diabetes, red wine consumption, taken with meals, significantly reduces oxidative stress and pro-inflammatory cytokines as well as improving cardiac function after MI. Moderate red wine intake with meals may have a beneficial effect in the prevention of cardiovascular complications after MI in subjects with diabetes.

Gemcitabine and liposomal doxorubicin in biliary and hepatic carcinoma (HCC) chemotherapy: preliminary results and review of the literature.

BACKGROUND: Advanced biliary tract cancers have a poor prognosis. Gemcitabine (G) as a single agent or in combination represents an active treatment option. Systemic chemotherapy in hepatocellular carcinoma represents a palliative treatment. Gemcitabine in combination with Liposomal Doxorubicin (LD) may represent an active treatment option. PATIENTS AND METHODS: Clinical trials for biliary and hepatic carcinoma have been reviewed. RESULTS: We obtained RC (1 pt), RP (4 pts), SD (8 pts) and seven pts had PD (RR 25% and SD 40%). Our chemotherapy regimen was Gemcitabine 1000 mg/m(2) d 1 and 8, Liposomal Doxorubicin 30 mg d 1, q 28. Patients were 21 (17 M), aged 44 to 78 (median 63 yrs). Only in 8 pts we observed G 3-4 haematological toxicity, thrombocytopenia and neutropenia (7 G3, 1 G4).

Our experience with nifedipine and prednisolone as expulsive therapy for ureteral stones.

OBJECTIVES: We evaluated the effect of nifedipine associated with prednisolone in ureteral stone passage. MATERIAL AND METHODS: In our department we enrolled 50 patients with radiopaque ureteral stones. Stone size was 15 mm or less. The patients were divided into two groups: group I included 25 patients who received 30 mg oral treatment of slow-release nifedipine (for a maximum of 20 days) and 25 mg of prednisolone (for a maximum of 10 days) daily. Group II was made up of 25 patients who received 25 mg of prednisolone daily. On request, both groups could use non-steroidal anti-inflammatory drugs. RESULTS: The mean expulsion time was 6 days in group I and 10 days in group II. The average stone size was 12 mm in group I and 12.8 mm in group II. Six patients suspended therapy in group I (5 erythema, 1 stomachache), and seven in group II (3 because of intolerable pain, 4 stomachache). The expulsion success rates were 68% in group I and 81% in group II. CONCLUSIONS: For ureteral stones that do not cause an emergency situation, such as obstructive uropathy, infection or intolerable pain, we suggest expulsive medical treatment with nifedipine and prednisolone, if there are no contraindications to drug use.

[Environmental study on toxicity of water resulting from pesticide and biocide pollution]. / Etude ambiant de la toxicité des eaux due a la contamination des pesticides et biocides.

A chemical product has a level of danger or security which depends on the concentration and on the exposure time. The toxicity of the water is established by the answer (survival) of an animal organism in contact with a specific chemical product in short time. There are several reliable methods in the world; in any case the most significant aspect is given by the mortal concentration of the substance (mg/L) in connection with the organism dimensions. Among the methods we can point out:--% of mortality;--N.O.E.L. (No Observed Effect Level);--LC50. We must know the following data too:--responsable for the product;--registration of the pesticide/biocide;--risk valuation;--T.E.R. (Toxicity Exposure Ratio);--P.E.C. (Predicted Environmental Concentration); measures of detoxication;--ratio product toxicity/usage. The chronic effects concern the health the growth, the survival and the reproduction. These data are used for the management of the risk, the preparation of chemical substance in security, the treatment of accidental poisoning, the determination of TLV and safety level (LD50-LC50) of the substances (pesticide, biocide).

Role of Ca 15-3 in patients with biochemically suspected prostate cancer and multiple negative ultrasound-guided prostate biopsies.

Ca 15-3 is an aspecific tumor marker characteristic of cancer proliferation. Elevated serum levels seem to be closely correlated with cancer progression in non-urological tumors. This study assessed the role of Ca 15-3 as an aspecific tumor marker in patients with borderline prostate-specific antigen (PSA) biochemically suspected of prostate cancer (PCa) and with multiple negative prostate biopsies. The study is based on prospective analysis of 103 patients: (a) 33 patients (group A) presented lower urinary tract symptoms secondary to BPH with normal serum PSA values, DRE and TRUS negative for suspected PCa; (b) 31 patients (group B) with histologically diagnosed PCa; (c) 39 patients (group C) with borderline serum PSA values, DRE and TRUS normal, two ultrasound (US)-guided random prostate biopsies negative for PCa. Ca 15-3 was determined in the entire study series by the IRMA method, using as range the values proposed for the investigated non-urological tumors (38 UI/l).Ca 15-3 was within normal range in all group A patients (control), while the values were elevated in 27/31 of group B patients (PCa) and in 11/39 of group C (PCa suspected) patients. A third biopsy was performed in all 39 group C patients with borderline PSA and it was PCa-positive in 13 patients (33.3%, subgroup C3). In this series Ca 15-3 was increased in 9 of 13 patients (subgroup C3alpha), while the remaining four patients (subgroup C3beta) presented values within the normal range. On 26 group C patients who were negative for PCa to third biopsy (subgroup C4), 24 patients had Ca 15-3 levels within normal range (subgroup C4alpha) with histologic findings of BPH in 23 cases and granulomatous chronic prostatitis in one case, while two patients (subgroup C4beta) had elevated Ca 15-3 concentrations associated with lymphoplasmacytic chronic prostatitis. We hypothesize that Ca 15-3, as a specific tumor marker, could be an interesting and inexpensive second step diagnostic tool for PCa in patients with borderline PSA and multiple negative prostate biopsies, as it could indicate whether a repeated biopsy should be performed in a short time, having excluded other concomitant tumors. However, further prospective studies will be necessary to confirm this hypothesis.

[Test of pharmacologic bronchial stimulation in the assessment of work suitability]. / Il test di broncostimolazione farmacologica nella valutazione dell'idoneità al lavoro.

The suitability to the work is one of the main items of occupational medical doctor's activity, often developed with very few informations about the effective features a worker is about to carry out. Consequently, every appraisal of work suitability is based almost exclusively on clinical analysis. A peculiarity of the problem is the one strictly connected with the Allergic Pathology, since it brings a condition in which the subject under medical exams don't present any operative-limiting pathological condition; he could, anyway, presents a slight limitation connected to a subjective response toward a eventually workplace-based specific allergenic agent. It's important, therefore, the need to show, in case of workers exposed to potentially allergenic substances, that subjective conditions who could cause an abnormal reactivity in presence of a potentially efficient stimulation. The main intention of this piece of work is to develop a study about the utility of bronchial challenge with methacoline in a context of evaluation of work suitability for those allergenic substances exposed jobs.

Chemical technology for the toxic gas flow control through process water system.

The aim of this work is focused on the safety and toxicological aspects due to under-pressure industrial plant management, above all in the case which the gas is very dangerous for human health and environment. Here is illustrated the safe method of control of risks through specific choices of engineering devices and chemical process: in this way we have shown the mathematical calculation regarding the case of ammonia flow gas running in the piping and plant under-pressure. In this paper the Authors show the assessment of the technological solution for falling down of a toxic gas as NH3, which lets off from safety values facilities. The under pressure industrial plants with ammonia are protected through the safety valves, settled at 20 bar pressure. The out-let gas flow is capted by a tank of a water bulk of five time theoretical water amount necessary to the complete absorption of gas. In order to prevent any health risk and carry out a safety management, it needs to verify two basic aspects, with connected specific techniques: 1. The safety valves technology through the mathematical calculation of operating device; 2. The absorption process of the toxic agent for controlling of dangerous runaway of gas.

[Analysis of risk of biological accidents at a urban health area]. / Analisi del fenomeno infortunistico a rischio biologico in una azienda sanitaria cittadina.

The makers have examined 455 fingerprint cards of accidents at biologic risk needed in a sanitary structure from the month of november 1995 to the month of december 1998. After they have described the protocol of the sanitary supervision applied, the procedure of the accidents, the qualifications, and the departments mainly interested by the subject of study event, they have pointed out the need of a greater vaccinable covering against the virus B, parvying attention to the "non responders" subjects, thinking also it's necessary bigger resources for the personnel, training and information.

[Superparamagnetic iron oxide in the differential diagnosis of focal hepatic lesions using a 0.5-tesla magnetic resonance apparatus]. / Ossido di ferro superparamagnetico nella diagnosi differenziale delle lesioni focali epatiche con apparecchio di risonanza magnetica da 0.5 tesla.

INTRODUCTION: We investigated the efficacy of superparamagnetic iron oxide (SPIO) in the characterization of focal liver lesions on MR images by means of quantitative and qualitative analysis. MATERIAL AND METHODS: We examined 60 patients with at least one focal liver lesion on US images. Conventional T1-weighted spin echo (CSE), proton density and T2-weighted MR images were acquired before and after the injection of a SPIO agent (Endorem, slow infusion, 15 micromoles Fe/kg body weight). A qualitative and a quantitative analysis were performed calculating the contrast enhancement rate in different kinds of lesions; the differences were related to the type of sequence statistically using Student's t-test for coupled samples. RESULTS: Excellent correlation was found with biopsy findings in all but two patients who were false positive for hepatocellular carcinoma (scar on cirrhotic liver). T1-weighted sequences after AMI-25 injection were the most specific ones in hemangioma characterization; PD were the most sensitive sequences in the detection and characterization of liver metastases. T2-weighted sequences were helpful only in the detection of focal liver lesions but they were not specific. CONCLUSIONS: In conclusion, SPIO-enhanced MRI is an excellent imaging tool for the differential diagnosis of focal liver lesions, with a good specificity for the differential diagnosis of hemangioma and metastasis. It is also helpful to distinguish benign from malignant lesions.

[Aromatic polycyclic hydrocarbons: chemism, vehicles and technics for protection from toxicological risk]. / Idrocarburi Policiclici Aromatici: chimismo, veicolazione e tecniche di protezione dal rischio tossicologico.

In this work we take under examination the aromatic polycyclic hydrocarbons (APHs) as a class of organic micropolluting agents which have a considerable impact in the life and in the working environment of man. The authors decided to expressly start this study by proposing the changes pattern cause by APHs according to their chemical-physical reactivity characteristics, in order to realise a qualitative and quantitative evaluation of their toxicologic impact. Therefore, the specific aspects of chemism (reactions of substitution, aromatic electrophilia and addition) of these organic micropolluting agents are studied with particular reference to their chemical structure and to the properties which are the main important cause of every effect of diffusion both in productive environments and of toxicity in the human body. In this way, come toxicologic risk sources, responsible, within some technological cycles for the APHs emission in the working areas, are identified, shown and evaluated; carrying factors, not much investigated till now, which represent a synergic effect to the introduction and absorption of the APHs by the human body. For the necessity of a useful environmental monitoring which could be applied to different matrices, the techniques and the methods useful for carrying out sampling and analytical evaluation in a correct way, are introduced as well. Lastly, the Authors stress on the engagement and discuss the measures of prevention and protection, technically performable on the basis of the chemico-physical-granulometric properties of APHs, with the goal of safeguarding at best health of people occupationally exposed.

Occupational risk and toxicology evaluations of industrial water conditioning.

This study addresses the chemical and toxicological questions due to the wide use of chemical treatment programmes for industrial cooling water. First, natural problems encountered in cooling tower systems were presented and grouped into three categories: (i) scaling; (ii) corrosion and (iii) biofouling. Chemical solutions adopted in industrial plants were outlined for each one in order to minimize damage and categorized as shut-down, production loss, heat transfer reduction, upsets, etc. Above all, the purpose of the work was to identify the most dangerous chemicals normally used, which means sources of chemical risk for safety workers and their environment; thus, symptoms of exposure, prevention measures and protection tools are also described.

Tubercular epididymitis and orchitis: US patterns.

For several decades tuberculosis has been adequately under control in this country, but there has been recent concern that this disease might be coming back to the forefront, due to the influx of immigrants from developing countries where tuberculosis is still rampant. In the years to come we are expecting an increase in cases of genitourinary lesions of tubercular origin, a disease which had practically disappeared in the Western world. The aim of this pictorial essay is to provide an outline of the typical US images of tubercular epididymitis and orchitis.

[Multiple coronary aneurysms of an atherosclerotic nature in a patient with an abdominal aortic aneurysm: presentation of an anatomo-clinical case]. / Aneurismi coronarici multipli di natura aterosclerotica in soggetto con aneurisma dell'aorta addominale: presentazione di un caso anatomo-clinico.

We describe the case of a 71-year-old man with history of inferior wall myocardial infarction and abdominal aortic aneurysm surgically treated. The patient, admitted to hospital for chest pain, after 24 hours suddenly dead for ventricular fibrillation and cardiac arrest. Chest X Ray, echocardiogram and Computed Tomography had shown a very large paracardiac mass. At the autopsy, three large saccular aneurysms were found, one for each coronary artery and lumen completely filled with thrombi.

[X-syndrome: a pending problem]. / La sindrome X: un problema irrisolto.

The aim of the study was to evaluate the debated question of the pathogenesis of Syndrome X. Twelve consecutive patients with Syndrome X underwent high-dose dipyridamole echocardiographic test. Angina and ischaemic ST depression occurred in all patients, without impairment of regional wall-motion. Microvascular dysfunction probably is the cause of Syndrome X.

[Ventricular hyperkinetic arrhythmias: a current therapeutic problem. The possible greater use of beta blockers]. / Le aritmie ipercinetiche ventricolari: problema terapeutico attuale. Possibile maggiore impiego per i betabloccanti.

The therapeutic approach to cardiac arrhythmias is constantly evolving due to our improved understanding of their mechanisms and clinico-prognostic implications, even if uncertainties and controversies continue to be a marked feature of this sector, perhaps more than in any other field of medicine. The frequent finding of cardiac arrhythmias in the healthy and cardiopathic population justifies the importance which the question of the diagnosis and treatment of cardiac rhythm disorders has now assumed, even if, as far as the latter is concerned, the aggressive approach has been considerably modified over the past years. This has occurred in view of the still unproven value of indiscriminate anti-arrhythmic treatment for the purposes of prolonging life. This treatment has only been demonstrated to be of value in a few studies in selected subgroups of high-risk patients. In addition, it should be underlined that it has been reported that anti-arrhythmic drugs may possible aggravate or induce new arrhythmia. This potential pro-arrhythmic effect has become increasingly recurrent due to the widespread use and diffusion of this category of drugs. Such considerations should therefore encourage greater caution in the use of these drugs. Cardiac arrhythmias may be benign or life-threatening, symptomatic or asymptomatic; they may be a warning sign of sudden death, or be the cause or effect of heart failure, be the expression of an acute or chronic heart disease, or the clinical manifestation, at a cardiac level, of an extracardiac pathology. Within this broad-ranging clinical context, arrhythmia often gives rise to therapeutic dilemmas which must be resolved with extreme rationality, taking into account the results of all available clinical trials. The results of the Cardiac Arrhythmias Suppression Trial (CAST) showed that clinical judgements of therapeutic efficacy, made in the absence of carefully controlled studies, are often incorrect. On the basis of these findings beta-blocking drugs may find increasing use, since while they are not anti-arrhythmic drugs in the strict sense of the term, they are safer due to their negligible pro-arrhythmic effect, the lower incidence of collateral effects and their proven efficacy in post-infarction. The role of beta-blockers in the treatment of manifest heart failure should not be over-looked, since by countering the deleterious effect of increased catecholamines they may improve the prognosis, thus reducing the incidence of sudden death.