"Time is on my side". Disease trajectory of vulvodynia: a systematic review with a narrative synthesis.

PURPOSE: The aim of this systematic review was to shed light on the disease-trajectory of vulvodynia and identify potential risk factors which may affect such trajectory. METHODS: We searched Pubmed to identify articles providing evidence on vulvodynia trajectory (i.e., remission, relapse or persistence rates) with a minimum follow-up of 2 years. A narrative approach was used for data synthesis. RESULTS: Four articles were included (total participants: 741 women with vulvodynia; 634 controls). At a 2-year follow-up, 50.6% of women reported remission, remission with relapse was observed in 39.7% and persistence throughout time occurred in 9.6%. A decrease in pain was observed in 71.1% of patients at a 7-year follow-up. Mean pain scores and depressive symptoms resulted lower at 2-year follow-up, whereas sexual function and satisfaction were increased. Factors associated with remission of vulvodynia were greater couple cohesion, decreased reporting of pain after intercourse and lower levels of worst pain. Risk factors for symptom persistence included marriage, more severe pain ratings, depression, pain with partner touch, interstitial cystitis, pain with oral sex, fibromyalgia, older age and anxiety. Recurrence was associated with: longer duration of pain, more severe ratings of the worst pain ever and pain described as provoked. CONCLUSIONS: Symptoms of vulvodynia seem to improve over time, regardless of treatment. This finding contains a key message for patients and their physicians, considering the deleterious consequences of vulvodynia on women's lives.

Topical estrogens for the treatment of superficial dyspareunia related to genitourinary syndrome of menopause in women with a history of endometriosis: A clinical dilemma.

Estrogen withdrawal, which occurs with the cessation of ovulation, causes genitourinary syndrome of menopause in up to 50-85% of women. Symptoms may profoundly impact quality of life and sexual function, interfering with enjoyment of sex in up to three out of four individuals. Topical estrogens have been found to provide symptom relief with minimal systemic absorption and appear to be superior to systemic therapy as what regards genitourinary symptoms. However, conclusive data on their appropriateness in postmenopausal women with a history of endometriosis is not available and the hypothesis that exogenous estrogen stimulation may reactivate endometriotic foci or even promote their malignant transformation is still open. On the other hand, endometriosis affects around 10% of premenopausal women, many of which may be exposed to an acute hypoestrogenic depletion even before spontaneous menopause occurs. This considered, excluding on principle patients with a history of endometriosis from first-line treatment for vulvovaginal atrophy would mean excluding a considerable percentage of the population from adequate care. More robust evidence is urgently needed in these regards. Meanwhile, it would appear reasonable to tailor the prescription of topical hormones in these patients, taking into account the entity of symptoms and the impact such symptoms have on patients' quality of life, as well as the form of endometriosis and the possible risks hormonal may entail. Moreover, the application of estrogens on the vulva instead of the vagina could be efficacious, while outweighing the possible biological cost of hormonal treatment in women with a history of endometriosis.

Haemodynamically unstable pelvic trauma: initial validation of a dedicated protocol by a retrospective cohort study with historical controls

Background: We present our experience after the introduction of Advanced Trauma Life Support (ATLS)©, Trauma Team (TT) and Preperitoneal Pelvic Packing (PPP) protocols for the treatment of hemodynamically unstable pelvic blunt trauma.Methods: This is a retrospective study with historical controls: before (Control Group, CG) and after (Study Group SG) the introduction of the protocol. A single physician managed the CG and angiography was the emergency manoeuvre. A team with ATLS guidelines and PPP as an emergency manoeuvre managed the SG. Data were collected retrospectively. Patients were divided into two groups: before and after the introduction of protocols.Results: From January 2007 to October 2014, 36 patients were treated at our Centre. We consider patients from January 2007 to August 2011 (19 patients, CG) and from September 2011 to October 2014 (17 patients, SG). Median age was 54 years (43­69) in the CG vs. 47 (40­63) in the SG (p = 0.43), median initial SBP 90 mmHg (85­103) in the CG 94 (69­103) in the SG, (p = 0.60), heart rate was 90 (80­110) in the CG and 110 (95­130) in the SG, (p = 0.09). Median Injury Severity Score was 33 (21­41) in the CG and 34 (26­41) in the SG (p = 0.29). Time from arrival in the Emergency Department to first therapeutic manoeuvre was 132 minutes (109­180) in the CG and 87 minutes (51­204) in the SG (p = 0.4). The difference in mortality was statistically significant: 64.7% (11/17) in the CG and 23.5% (4/17) in the SG (p = 0.02).Conclusions: The introduction of protocols changed our approach in hemodynamically unstable pelvic trauma, achieving a remarkable improvement in early mortality

Comparison of adsorption of Remazol Black B and Acidol Red on microporous activated carbon felt.

The adsorption of two anionic dyes, Remazol Black B (RB5) and Acidol Red 2BE-NW (AR42), onto a microporous activated carbon felt was investigated. The characterization of carbon surface chemistry by X-ray microanalysis, Boehm titrations, and pH-PZC measurements indicates that the surface oxygenated groups are mainly acidic. The rate of adsorption depends on the pH and the experimental data fit the intraparticle diffusion model. The pore size distribution obtained by DFT analysis shows that the mean pore size is close to 1nm, which indicates that a slow intraparticle diffusion process control the adsorption. The adsorption isotherms were measured for different pH values. The Khan and the Langmuir-Freundlich models lead to the best agreement with experimental data for RB5 and AR42, respectively. These isotherm simulations and the pH dependence of adsorption show that the adsorption capacity is mainly controlled by nondispersive electrostatic interactions for pH values below 4. The adsorption kinetics, the irreversibility of the process, and the influence of the pH indicate that the rate of adsorption in this microporous felt proceeds through two steps. The first one is fast and results from direct interaction of dye molecules with the external surface of the carbon material (which account for 10% of the whole surface area); in the second, slow step, the adsorption rate is controlled by the slow diffusion of dye molecules into the narrow micropores. The influence of temperature on the adsorption isotherms was studied and the thermodynamic parameters were obtained. They show that the process is spontaneous and exothermic.

Experimental validation of a model describing the cycle of nitrogen in a step sludge recirculation activated sludge system with denitrification.

In this paper, a model describing the cycle of nitrogen in a Step Sludge Recirculation (SSR) reactor, was developed. The SSR reactor is a multistage, continuous stirred tank reactor where the recycled biomass is distributed over all stages. The SSR system provides a uniform treatment of the wastewater and high purification efficiency for both carbon and nitrogen removal. The objective of this work was to develop a mathematical model of the SSR system, based on the analysis of various parameters that are present in the system. The simplified form of the IWA-ASM model was adapted to include the carbon removal, nitrification and denitrification processes. For model validation, a SSR pilot plant fed with synthetic wastewater was operated for approximately four months. The experimental results show that the SSR system seems to be appropriate to attain maximum TOC and nitrogen removal with minimum sludge production. The proposed model seems to be capable of expressing the behavior of carbon removal, nitrification, denitrification and various microorganism species in a SSR configuration of a nitrogen cycle. When the experimental results were compared with those estimated by the proposed model, the model predictions matched well with the experimental results.

Effect of ethanol on the oxidation of atrazine in the remediation of contaminated soil.

The oxidation of an atrazine solution obtained from a flushing treatment of a contaminated soil was investigated. Experimental tests were performed on an artificially contaminated standard soil. Atrazine was removed from the soil by flushing with an aqueous solution at 5% volume of ethanol. Oxidative Fenton-type treatment on the extracted solution was then performed in order to transform atrazine into its by-products. The influence of different concentration of ethanol on atrazine oxidation was studied. Results show that the oxidative treatment is strongly affected by the ethanol residual amount. The degradation mechanism of atrazine during oxidation with Fenton's reagent in the presence of ethanol was also investigated.

Italian guidelines for intestinal transplantation: potential candidates among the adult patients managed by a medical referral center for chronic intestinal failure.

In 2002, the Italian guidelines for eligibility of patients for intestinal transplantation (ITx) were defined as: life-threatening complications of home parenteral nutrition (HPN), lack of venous access for HPN, locally invasive tumors of the abdomen, Chronic intestinal failure (CIF) with a high risk of mortality, primary disease-related poor quality of life (QoL) despite optimal HPN. Our aim was to identify potential candidates for ITx according to these national guidelines among patients managed by a medical referral center for CIF. Records of patients who received HPN were reviewed. CIF was considered reversible or irreversible (energy by HPN <50% or >50% basal energy expenditure). Patients with irreversible CIF were considered eligible for ITx in the absence of a contraindication, as are used for solid organs Tx. From 1986 to 2003 among 64 patients who met the entry criteria 23 showed reversible and 41 irreversible, CIF. Twenty-one patients with irreversible CIF had an indication for ITx, but eight had also contraindications; thus 13 were eligible, including intestinal pseudo-obstruction (n = 6), mesenteric ischemia (n = 3), Crohn's (n = 2), radiation enteritis (n = 1), and desmoid (n = 1). Indications for ITx included HPN liver failure (n = 2), lack of venous access (n = 2), CIF with high risk of mortality (n = 3), very poor QoL (n = 6 including 5 with pseudo-obstruction). According to the Italian guidelines for ITx, 31% of patients with irreversible CIF managed by a medical referral center were eligible for ITx. Primary disease-related poor QoL was the indication in half of them. Studies on the QoL after ITx are required to allow patients to make an educated decision.

The SF-36 instrument for the follow-up of health-related quality-of-life assessment of patients undergoing home parenteral nutrition for benign disease.

INTRODUCTION: The non-disease-specific SF-36 instrument was applied to detect changes in quality of life among patients at a single center who were receiving home parenteral nutrition (HPN) for intestinal failure. METHODS: All HPN patients completed the questionnaire during routine visits. The SF-36 examines eight domains (scores: 0% to 100%): physical functioning (PF), role-functioning physical (RP), body pain (BP), general health (GH), vitality (VT), social functioning (SF), as well as role-functioning emotional (RE) and mental health (MH). Patient responses were standardized for the sex- and age-matched group scores of the healthy population by calculating the Z-score: (healthy population mean score - patient raw score)/healthy population standard deviation (reduced value: Z-score < -1). A difference in a domain score was considered significant in the individual patient if it was greater than the 90% confidence interval for healthy subjects and if it produced a change in Z-score category. General, sociodemographic, underlying disease and HPN-related factors were collected. RESULTS: For 31 enrolled adult patients, the baseline mean Z-score was reduced in five domains: PF, RP, BP, GH and SF. Twenty patients underwent a second SF-36 assessment 10 +/- 2 months later: the HRQOL worsened in eight and improved in 10 (no. worsened domains > no. improved or vice versa). The worsened subgroup showed a decrease in body mass index (P =.104), an increase in the number of HPN infusions per week (P =.065), and a greater incidence of intestinal motility disorders (P =.161), of liquid oral diet (P =.027), and of nycturia (P =.028). CONCLUSIONS: The SF-36 instrument reflecting the generic HRQOL assessment may be a suitable tool for patients on HPN.

Recovery of EDTA and metal precipitation from soil flushing solutions.

This work studies the effectiveness of a process proposed for the recovery of ethylenediaminetetraacetic acid (EDTA) and metal precipitation from soil flushing solutions. Two series of experimental tests were carried out on two samples of a soil artificially contaminated with copper or lead. The metals were extracted from the soil by flushing with a 0.05 M aqueous solution of EDTA sodium salt (E-Na(2)). Cu or Pb extraction efficiencies of about 95 and 98% were observed, respectively. The two extracted solutions were then treated to obtain EDTA recovery and metal precipitation from the aqueous solution. EDTA recovery was achieved in two steps. An initial evaporation treatment lead to reduce the solution volume by about 75%. This was followed by the acidification of the residue solution, which precipitated more than 93% of the used EDTA. The precipitated EDTA was removed by filtration, and was suitable for reuse after adding an alkaline agent. Metal precipitation from the filtered solution was performed using two different methods: an almost total (99.5%) Pb precipitation in alkaline conditions was achieved after complex destabilization through the sequential addition of ferric ions and sodium phosphate, while 93.6% copper precipitation was achieved with ferrous sulfate as a destabilization agent.

Safety and efficacy of home parenteral nutrition for chronic intestinal failure: a 16-year experience at a single centre.

BACKGROUND: Comparisons between safety and efficacy of home parenteral nutrition and of intestinal transplantation for treatment of chronic intestinal failure derived from observational studies. AIMS: To present the 16-year experience of home parenteral nutrition by the Chronic Intestinal Failure Centre of Bologna University. PATIENTS: A total of 40 adult patients were enrolled between 1986 and 2001. METHODS: Safety indices: survival and cause of death, catheter-related bloodstream infection, deep vein thrombosis, liver disease. Efficacy indices: nutritional and rehabilitation status, quality of life (SF36 instrument), re-hospitalisation rate. STATISTICS: Kaplan-Maier analysis and Cox model for survival probability and risk factors; logistic regression for catheter-related bloodstream infection risk factors. RESULTS: Survival rates at 1, 3 and 5 years were 97, 82 and 67% respectively. Survival was higher in patients < or = 40 years. One death was home parenteral nutrition-related. Incidence of catheter-related bloodstream infection: 0.30/year home parenteral nutrition, was lower in patients treated by a specialized nursing protocol. Incidence of deep vein thrombosis was 0.05/year home parenteral nutrition. Hepatosteatosis occurred in 55%. Body weight remained stable or increased in 80%. Rehabilitation was total or partial in 74%. Re-hospitalisation rate was 0.70/year home parenteral nutrition. Quality of life scored significantly lower than in healthy populations in six out of eight domains. CONCLUSIONS: Home parenteral nutrition is a safe and efficacious therapy for chronic intestinal failure. Survival compares favourably with survival after intestinal transplantation.

A steady-state model for the evaluation of disk rotational speed influence on RBC kinetic: model presentation.

The physical and biological mechanisms of attached-biomass growth were analyzed and a steady-state model was proposed to determine the soluble carbonaceous removal in an RBC unit for different organic loading rates in the reactor. The objective of the model was the prediction of the organic loading rate corresponding to the maximum removal capacity in the system. A system of equations was solved where the influent soluble carbonaceous substrate concentration was the main variable. Monod's rate law was used for the growth of microorganism: the soluble carbonaceous substrate was the limiting substrate. Endogenous decay was neglected. The influence of disk rotational speed on the RBC removal capacity was investigated, the disk rotational speed being a parameter acting on oxygen transfer in the biofilm. The criteria for the evaluation of the kinetic parameter in the model were proposed.

Sarcoidosis preceding chronic myelomonocytic leukemia. Report of two cases.

We report 2 patients who had sarcoidosis with skin involvement associated with bilateral anterior uveitis. During the follow-up, they developed chronic myelomonocytic leukemia. This association is of particular interest as sarcoidosis and chronic myelomonocytic leukemia may be considered as disorders of a common monocyte-macrophage cell lineage.

Severe lower limbs lymphedema of late onset revealing polysplenia syndrome--a case report.

Polysplenia syndrome includes a group of congenital abnormalities involving the spleen, gastrointestinal tract, liver, and cardiovascular system. A case of severe lower limbs lymphedema occurring in a young woman with polysplenia, azygous continuation of the inferior vena cava, short pancreas, and preduodenal portal vein is reported. Lower limb lymphedema could represent a new clinical manifestation associated with polysplenia syndrome. Lymphedema could be the result of a primary anomaly of the lymphatic system or be induced by high pressure in the venous system or by compression of the lymphatic circulation by the hypertrophic azygous vessels in the posterior mediastinum.

Innovative methods for removing phosphorus from wastewaters.

Wastewater containing a mixture of hypophosphites and phosphites was treated in order to assess the possibility of attaining high levels of phosphorus oxidation to phosphate. An initial series of tests based on chemical oxidation by means of Fenton's reagent demonstrated the feasibility of this process for solutions containing 250-750 mg/l of phosphorus. Removal yields of up to 98% were attained at pH 3.5 by using variable ratios of [H2O2]/[Fe2+]. The second series involved the electrolytic generation of Fenton's reagent at pH 2-2.5 through cathodic oxygen reduction. This demonstrated the possibility of obtaining quantitative yields for solutions containing 80-160 mg/l P with a constant [H2O2]/[Fe2+] ratio of 3.94. Economic comparison of the two processes showed that the operative cost of the electrochemical treatment is comparable to that of the chemical process.

[Stevens-Johnson syndrome followed by Gougerot-Sjögren syndrome]. / Syndrome de Stevens-Johnson suivi d'un syndrome de Gougerot-Sjögren.

BACKGROUND: Sicca syndrome after Stevens-Johnson syndrome is classically described. However, to our knowledge, authentic Sjögren's syndrome following epidermal necrolysis has not been described previously. CASE REPORT: A 36-year-old woman with Steven-Johnson syndrome developed transient hepatitis and a persistent sicca syndrome. Fourteen years later an authentic Sjögren's syndrome was identified with presence of antinuclear and anti-SSA antibodies and lymphocytes infiltration of the accessory salivary glands, i.e. grade IV disease in the Chisholm classification. DISCUSSION: The initial mucosal destruction observed in our patients may have laid the ground for Sjögren's syndrome via abnormal antigen presentation in a predisposed dysimmune context.