Evaluation of point-of-care analysers for blood gas and clinical chemistry in Hermann's tortoises (Testudo hermanni).

OBJECTIVE: To assess the agreement between point-of-care and laboratory analysers in measuring biochemical and blood gas analytes in venous samples from tortoises and to define preliminary reference intervals for venous blood gas analysis in Hermann's tortoises (Testudo hermanni). MATERIALS AND METHODS: Jugular venous blood samples from 47 Hermann's tortoises underwent paired analysis with a portable gas analyser (i-STAT 1, Abaxis), a portable chemical analyser (VetScan VS2, Abaxis), and with the respective reference analysers. Agarose gel electrophoresis was used to determine albumin concentrations on 12 specimens. Agreement was evaluated with Bland-Altman plots and regression analysis using the Passing-Bablok method. RESULTS: Point-of-care analysers had variable agreement with the reference analysers, presenting constant or proportional bias depending on the analyte. Relevant analytes in reptiles, such as ionised and total calcium, had acceptable agreement. The method for determining albumin concentration currently available in both point-of-care and laboratory analysers significantly overestimated albumin concentrations as compared to protein electrophoresis. CLINICAL SIGNIFICANCE: While the use of POC analysers is extremely advantageous in small animal primary care facilities, agreement between point-of-care and laboratory analysers varies depending on the analyte. For certain analytes, interchangeability of results is limited and specific reference intervals for point-of-care analysers are required. Veterinarians should be aware of the size and the direction of the bias of each analyte.

Measured anatomical distributions of solar UVR on strawberry production workers in Italy.

The exposure of outdoor workers to solar ultraviolet radiation (UVR) has been known for some time. Measurements of erythemally weighted UVR are usually related to days of exposure and to the anatomical distribution of UVR on the human body. The aim of this research is to describe the UVR exposure of workers during a strawberry production cycle in order to assess the UVR hazard and to identify the highest exposure in the anatomical distribution of UVR on the body during an entire agricultural production cycle. This research was carried out on the experimental farm (Azienda Agraria Didattico-Sperimentale) of Università Politecnica delle Marche in Agugliano, Italy. A spectrometer was used to measure UVR, and electronic dosimeters were used to record UVR exposure. The measurements were carried out on all working days of the strawberry production cycle in 2012 during daily peak UVR levels. The daily UVR exposure geometric mean and the percentage ambient UVR in the strawberry production cycle were calculated and analyzed to assess the hazard for workers during the entire production cycle. The nape of the neck was the anatomical site most exposed to UVR. The mean daily UVR exposure on the nape of the neck was higher than 1.50 SED, the minimum value required to produce perceptible erythema in unacclimatized white skin, and a maximum value of 2.29 SED was measured. Real-time exposure data suggest that it may be useful to remind workers of the risks associated with UVR exposure.

Hypoglossal nerve paralysis in a burn patient following mechanical ventilation.

Traumatic injury resulting in isolated dysfunction of the hypoglossal nerve is relatively rare and described in few case reports. We present a patient with isolated unilateral palsy of the twelfth cranial nerve (CN XII) resulting from recurrent airway intervention following extensive burn injuries. The differential diagnosis for paralysis of the CN XII is also discussed herein. This case illustrates the significance of comprehensive diagnostic evaluation and the need for refined airway manipulation in patients that require multiple endotracheal intubations.

Une blessure traumatique résultant en un dysfonctionnement isolé du nerf hypoglosse est relativement rare et décrit dans quelques rapports de cas. Nous présentons un patient atteint de paralysie hypoglossal unilatérale isolée à la suite de l'intervention des voies respiratoires récurrentes après de brûlures extensives. Le diagnostic différentiel de la paralysie du nerf crânien (NC XII) est également discuté ici. Ce cas illustre l'importance de l'évaluation diagnostique complète et la nécessité pour la manipulation délicate des voies respiratoires chez les patients qui nécessitent de multiples intubations trachéales.

AlloDerm Sling for Correction of Synmastia After Immediate, Tissue Expander, Breast Reconstruction in Thin Women.

INTRODUCTION: Synmastia is a condition in which the breasts are conjoint and the natural intermammary sulcus is obliterated. It is the rarest type of breast implant malpositioning during breast augmentation; however, it is the most difficult one to correct. AlloDerm is an acellular dermal matrix that is assuming a major role in immediate breast reconstruction in recent years. METHODS: In the past 2 years, we have treated 3 thin women, a total of 6 breasts, for correction of synmastia after bilateral immediate breast reconstruction, using tissue expanders and skin sparing mastectomy. All of them suffered from synmastia, which manifested immediately after the mastectomy and accelerated during tissue expander inflation. We exchanged the expander into silicone implants, and during the same procedure we corrected the synmastia, using an AlloDerm sling. A thick sheet of AlloDerm (Life-Cell Corp, Branchbung, NJ) is used and the AlloDerm sheet is designed into a long narrow sling. Then, the sling is sutured into place. RESULTS: This technique successfully resolved the synmastia. CONCLUSION: The use of an AlloDerm sling to reinforce the capsule and the AlloDerm incorporation into it ensures a sound solution with a low recurrence rate.

Hyperhomocysteinaemia in HIV-infected patients: determinants of variability and correlations with predictors of cardiovascular disease.

OBJECTIVE: We evaluated hyperhomocysteinaemia (HHcy) in a cohort of HIV-infected patients in order to assess its relation to cardiovascular risk (CVR) and identify determinants of HHcy variability. METHODS: Cross-sectional observational study. HIV-infected patients on stable highly active antiretroviral therapy (ART) were evaluated for the presence of the metabolic syndrome, lipodystrophy and traditional CVR factors. Plasma homocysteine levels were measured using high-performance liquid chromatography. RESULTS: Five hundred and sixty-seven patients (38% female) with a median age of 44 years were included in the study. Homocysteine (Hcy) was significantly higher in patients with the metabolic syndrome and lipodystrophy. No significant association was found between Hcy levels and the use of ART. However, Hcy was associated with higher blood pressure, waist circumference and waist-to-hip ratio, total lean body mass, visceral adipose tissue (VAT), VAT/total adipose tissue, homeostasis model assessment of insulin resistance (HOMA-IR), triglycerides, high-density lipoprotein cholesterol, apolipoprotein A1, B, and creatinine. All 10-year CVR assessment scores were significantly associated with Hcy. In a multivariate regression model, systolic blood pressure, vitamin supplementation and HOMA-IR were significantly and independently related to Hcy. CONCLUSIONS: Hcy is elevated in HIV-infected patients and is significantly associated with increased CVR. Measurement of Hcy might be useful in identifying particularly high-risk populations at whom therapeutic interventions could be targeted.

Hepatitis C virus antibody-positive patients with HIV infection have a high risk of insulin resistance: a cross-sectional study.

OBJECTIVE: The aim of the study was to characterize and compare insulin resistance (IR) in hepatitis C virus (HCV)-antibody (Ab)-positive and HCV-Ab-negative patients with HIV infection. METHODS: This was a single-centre cross-sectional study of 1041 HIV-infected patients (373 HCV-Ab-positive; 167 with detectable plasma HCV RNA). Metabolic and anthropometric assessments were performed, including measurement of IR using the homeostasis model for assessment of insulin resistance (HOMA-IR). RESULTS: The prevalence of IR (i.e. a HOMA-IR score >or=3.8) was significantly higher in HCV-Ab-positive than in HCV-Ab-negative patients (47.7 vs. 32.7%; P<0.0001). On multivariable linear regression analysis, the following variables were associated with HOMA-IR score, expressed as an estimate of the percentage variation (Est.): high-density lipoprotein cholesterol (per 0.3 mmol/L increase: Est.-4.1; P=0.01), triglycerides (per 0.1 mmol/L increase: Est. 0.6; P<0.001), alcohol intake (Est. -12.4; P=0.002), sedentary lifestyle (Est. 14.7; P<0.001), CD4 T-cell count in the highest quartile, i.e. >or=690 cells/microL (Est. 20.7; P=0.002), body mass index in the highest quartiles, i.e. >or=22.54 kg/m2 (Est. 30.5-44.7; P<0.001), waist-to-hip ratio in the highest quartile, i.e. >1 (Est. 30.2; P<0.001) and HCV-Ab positivity (Est. 24.4; P<0.001). CONCLUSIONS: Our data confirm that HCV-Ab positivity is an independent risk factor for IR. Management aimed at correcting known risk factors for IR should be implemented.

Long-term psychometric outcomes of facial lipoatrophy therapy: forty-eight-week observational, nonrandomized study.

The aim of this observational, prospective, nonrandomized study was to assess long-term psychometric outcomes of surgical treatment of HIV-related facial lipoatrophy. Two hundred ninety-nine participants (70.8% male) consecutively attending the Metabolic Clinic of Modena and Reggio Emilia University from November 2005 to July 2006, undergoing surgical interventions for HIV-related facial lipoatrophy were enrolled. Fifty-four (18.1%) underwent facial lipofilling, which consists of the harvesting of a small, intact parcel of fatty tissue with processing that removes the nonviable components and of the transport of fatty parcels through a small cannula to implant the graft in a manner that provides nutrition and anchors the fat to the host tissue. After an initial lipofilling, 24 (8%) needed polylactic acid injections to correct cheek asymmetry, 91 (30.4%) received only polylactic acid infiltrations, and 130 (43.5%) polyacrylamide infiltrations only. Subjective outcome measures were face aesthetic satisfaction, body image perception, depression evaluated by a visual analogue scale (VAS), the Assessment of Body Change and Distress questionnaire (ABCD), and by the Beck Depression Inventory questionnaire, respectively. Objective measure was cheek thickness evaluated by a 7.5-MHz frequency ultrasound probe perpendicular to the skin surface at the nasolabial fold, the corner of the mouth, the zygomatic arch, and centrally between these points in the buccal fat pad area. Both subjective and objective variables were evaluated at baseline and 48 weeks after end of surgical treatment. All 299 participants had significant improvement of the aesthetic satisfaction for the face (VAS from 2.9 +/- 2.1 to 6.2 +/- 2.1, p < 0.0001), of body image satisfaction (ABCD question 7 from 3.8 +/- 1 to 3.1 +/- 1 p < 0.0001 and ABCD question 8 from 70.7 +/- 16.7 to 77.2 +/- 17.2 p < 0.0001), of depression score (Beck score from 11.4 +/- 8.3 to 9.4 +/- 7.8 p = 0.001). Participants experienced a significant augmentation of both cheeks' thickness (right cheek from 4.3 +/- 1.9 mm to 9.5 +/- 3 mm p < 0.0001, left cheek from 4.4 +/- 2 mm to 9.6 +/- 3.1 mm, p < 0.0001). Our data suggest that facial surgery is an important option in the treatment of HIV-related lipoatrophy as an integral part of the management of HIV infection, because of the important and lasting psychological benefits.

Quality of life and body image in the assessment of psychological impact of lipodystrophy: validation of the Italian version of assessment of body change and distress questionnaire.

Lipodystrophy (LD) includes morphologic changes that are distressing to patients with HIV. We tested the validity of an Italian version of the Assessment of Body Change and Distress (ABCD) questionnaire and analysed its relationship to physical and mental aspects of Health-Related Quality of Life. Two hundred and fifty-two patients completed the questionnaires. Construct validity of the ABCD was tested against the MOS-HIV Health Survey, body mass-index (BMI) and CD4+ T-lymphocyte counts. Cronbach's alpha for the ABCD total score was 0.94. The ABCD showed the hypothesized moderate correlations to MOS-HIV scales and clinical variables. Preliminary evidence supports the reliability and validity of the Italian version of the ABCD in people with HIV and LD. This questionnaire may be useful to identify people experiencing greater impact of LD, or to evaluate the impact of interventions to treat LD such as plastic surgery.

Hereditary inclusion body myopathy: the Middle Eastern genetic cluster.

BACKGROUND: Recessively inherited hereditary inclusion body myopathy (HIBM) with quadriceps sparing was initially described only in Jews originating from the region of Persia. The recent identification of the gene responsible for this myopathy and the common "Persian Jewish mutation" (M712T) enabled the re-evaluation of atypical phenotypes and the epidemiology of HIBM in various communities in the Middle East. OBJECTIVE: To test for the M712T mutation in the DNA from HIBM patients in the Middle East. METHODS: DNA from all suspected HIBM patients was tested for the M712T mutation. Unaffected members of families with genetically proven HIBM were studied too. In the majority of families, haplotype construction with markers spanning the 700-kb region of the HIBM gene was performed. RESULTS: One hundred twenty-nine HIBM patients of 55 families (Middle Eastern Jews, Karaites, and Arab Muslims of Palestinian and Bedouin origin) were homozygous for the M712T mutation, and all carried the same haplotype. Five clinically unaffected subjects were also homozygous for the common mutation and haplotype, including two older adults (ages 50 and 68 years). Atypical features with this same mutation were marked quadriceps weakness in five patients, proximal weakness only in two patients, facial weakness in three patients, and a muscle biopsy showing perivascular inflammation in one patient. CONCLUSIONS: The phenotypic spectrum of recessive HIBM is wider than previously described, and the diagnostic criteria for this myopathy must be changed. The Middle Eastern cluster is the result of a founder mutation, with incomplete penetrance, that is approximately 1,300 years old and is not limited to Jews.

The UDP-N-acetylglucosamine 2-epimerase/N-acetylmannosamine kinase gene is mutated in recessive hereditary inclusion body myopathy.

Hereditary inclusion body myopathy (HIBM; OMIM 600737) is a unique group of neuromuscular disorders characterized by adult onset, slowly progressive distal and proximal weakness and a typical muscle pathology including rimmed vacuoles and filamentous inclusions. The autosomal recessive form described in Jews of Persian descent is the HIBM prototype. This myopathy affects mainly leg muscles, but with an unusual distribution that spares the quadriceps. This particular pattern of weakness distribution, termed quadriceps-sparing myopathy (QSM), was later found in Jews originating from other Middle Eastern countries as well as in non-Jews. We previously localized the gene causing HIBM in Middle Eastern Jews on chromosome 9p12-13 (ref. 5) within a genomic interval of about 700 kb (ref. 6). Haplotype analysis around the HIBM gene region of 104 affected people from 47 Middle Eastern families indicates one unique ancestral founder chromosome in this community. By contrast, single non-Jewish families from India, Georgia (USA) and the Bahamas, with QSM and linkage to the same 9p12-13 region, show three distinct haplotypes. After excluding other potential candidate genes, we eventually identified mutations in the UDP-N-acetylglucosamine-2-epimerase/N-acetylmannosamine kinase (GNE) gene in the HIBM families: all patients from Middle Eastern descent shared a single homozygous missense mutation, whereas distinct compound heterozygotes were identified in affected individuals of families of other ethnic origins. Our findings indicate that GNE is the gene responsible for recessive HIBM.

Analysis of an accident at a solvent recovery plant.

An accident in a plant for solvent recovery from solvent-contaminated wastes was examined. An experimental investigation of the accident was carried out using calorimetric and thermogravimetric techniques. The immediate cause of the accident was an unforeseen exothermic decomposition reaction. The main underlying cause of the accident was the absence of safety culture in the plant management, that resulted in the lack of a testing procedure to evaluate the thermal stability of the process feed. A simplified screening procedure based on differential scanning calorimetry was used in order to test the thermal stability of the nonvolatile fraction of the solvent-contaminated wastes present on the plant in order to be processed. More than 75% of the samples examined showed exothermal decomposition phenomena starting at temperatures higher than 100 degrees C. These phenomena were common to solvent wastes that originated from a number of different industrial activities. Thus, the thermal instability of the process feed is one of the main problems in solvent recovery operations. Our analysis of the accident suggested that the safe operation of waste solvent recovery processes requires an accurate characterization of the thermal stability of the process feed. Process safety is also increased by an adequate emergency vent and an accurate control of operating temperature, that may be reduced operating under vacuum. Safety devices may also include a water supply for emergency quench.

Effects of home environment on respiratory symptoms and lung function in a general population sample in north Italy.

Effects of indoor pollution exposure were evaluated in a general population sample (n = 3,289) living in the Po River Delta area. Prevalence rates of chronic cough in men and dyspnoea in women were significantly higher in association with the use of bottled gas (propane) for cooking instead of natural gas (methane). Chronic cough and phlegm in men and dyspnoea in women were significantly associated with the use of a stove for heating. When combining type of heating and fuel used, in men a trend toward higher prevalence rates of chronic cough and phlegm was shown in those with stove or fan heating (regardless of the fuel); in women the trend reached statistical significance for dyspnoea. The relationship between stove (regardless of fuel) and decrease in forced expirograms was statistically significant only in women. In multiple logistic models, accounting for independent effects of age, smoking, pack-years, parents' smoking, socio-economic status, body mass index, significantly increased odds ratios were found in males for the associations of: bottled gas for cooking with cough (1.66) and dyspnoea (1.81); stove for heating with cough (1.44) and phlegm (1.39); stove fuelled by natural gas and fan or stove fuelled other than by natural gas with cough (1.54 and 1.66). In females, significantly increased odds ratios were found only for dyspnoea when associated with bottled gas for cooking (1.45), stove for heating (1.46), stove fuelled by natural gas (1.58), stove or fan fuelled other than by natural gas (1.73).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of caffeine and chlor-desmethyldiazepam on fighting behavior of mice with different reactivity baselines.

The effects of various doses of caffeine and of chlor-desmethyldiazepam on footshock-induced aggressive behavior were examined in mice with different baselines of aggressiveness. Caffeine significantly increased the number of fighting episodes with all the doses tested. This was more evident in mice with low rather than in those with high basal rates of agonistic response. Caffeine caused the appearance of minimal convulsive signs in mice subjected to a threshold electroshock which did not produce any seizure in the controls; it also increased metrazol toxicity. Chlor-desmethyldiazepam enhanced fighting behavior at doses of 0.04 and 0.08 mg/kg, but decreased it at 1.25 mg/kg. The first two doses produced the same effects as caffeine on electroshock test, but did not influence metrazol toxicity.

Interaction of caffeine with benzodiazepines: behavioral effects in mice.

Three series of behavioral experiments, i.e. hole-board, open-field and spontaneous motor activity test, were carried out on mice with the goal of determining the effects of the interaction between caffeine and two peculiar benzodiazepines (BDZ). The drugs, desmethyldiazepam (DMDZ) and chlor-desmethyldiazepam (Cl-DMDZ), were administered acutely by the intraperitoneal route. In preliminary experiments, the effects of several doses of caffeine were examined in the three in order to obtain some indication of the doses to use for interaction experiments. Therefore, stimulant doses of caffeine (5, 10 and 20 mg/kg) were associated with the two benzodiazepines. It was found that BDZ counteracted the effect of caffeine in the hole-board and in the spontaneous motor activity tests. By contrast, in the open-field situation, the association always gave rise to an increase in exploration activity. Furthermore, the present investigations showed, once again, that chlor-desmethyldiazepam is more active than the other benzodiazepine.