Severe renal failure and thrombotic microangiopathy induced by malignant hypertension successfully treated with spironolactone.

Malignant hypertension can cause thrombotic microangiopathy (TMA) characterized by hemolytic anemia and thrombocytopenia. On the other hand, severe hypertension is sometimes associated with hemolytic uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP). Distinguishing these entities is important because of therapeutic implications. Plasmapheresis should be initiated as soon as possible if we are dealing with TTP. We describe the case of a 30-year-old man referred to our hospital with malignant hypertension, severe renal failure and TMA: haemoglobin=9g/dL, total bilirubin=0.4mg/dL, haptoglobin≤10mg/dL, platelet count=59,000/µL and schistocytes on peripheral smear. He required initiation of hemodialysis. Additionally, we considered that the possible cause of TMA was malignant hypertension according to the presence of hypertensive retinopathy and thrombocytopenia which remitted only with blood pressure control, hence, plasmapheresis was not given. Renal function did not improve and the patient remained chronic hemodialysis. Intensive therapy for hypertension with a combination of antihypertensive drugs including spironolactone successfully lowered his blood pressure without developing hyperkalemia.

Observation of Localized Vibrational Modes of Graphene Nanodomes by Inelastic Atom Scattering.

Inelastic helium atom scattering (HAS) is suitable to determine low-energy (few meV) vibrations spatially localized on structures in the nanometer range. This is illustrated for the nanodomes that appear often on graphene (Gr) epitaxially grown on single crystal metal surfaces. The nature of the inelastic losses observed in Gr/Ru(0001) and Gr/Cu/Ru(0001) has been clarified by intercalation of Cu below the Gr monolayer, which decouples the Gr layer from the Ru substrate and changes substantially the out-of-plane, flexural phonon dispersion of epitaxial Gr, while maintaining the nanodomes and their localized vibrations. He diffraction proves that the Cu-intercalated Gr layer is well ordered structurally, while scanning tunneling microscopy reveals the persistence of the (slightly modified) periodic array of Gr nanodomes. A simple model explains the order of magnitude of the energy losses associated with the Gr nanodomes and their size dependence. The dispersionless, low-energy phonon branches may radically alter the transport of heat in intercalated Gr.

The thromboembolic risk in giant cell arteritis: a critical review of the literature.

Giant cell arteritis is a systemic vasculitis characterized by granulomatous inflammation of the aorta and its main vessels. Cardiovascular risk, both for arterial and venous thromboembolism, is increased in these patients, but the role of thromboprophylaxis is still debated. It should be suspected in elderly patients suffering from sudden onset severe headaches, jaw claudication, and visual disease. Early diagnosis is necessary because prognosis depends on the timeliness of treatment: this kind of arteritis can be complicated by vision loss and cerebrovascular strokes. Corticosteroids remain the cornerstone of the pharmacological treatment of GCA. Aspirin seems to be effective in cardiovascular prevention, while the use of anticoagulant therapy is controversial. Association with other rheumatological disease, particularly with polymyalgia rheumatica is well known, while possible association with antiphospholipid syndrome is not established. Large future trials may provide information about the optimal therapy. Other approaches with new drugs, such as TNF-alpha blockades, Il-6 and IL-1 blockade agents, need to be tested in larger trials.

Vectorial Kerr magnetometer for simultaneous and quantitative measurements of the in-plane magnetization components.

A vectorial magneto-optic Kerr effect (v-MOKE) setup with simultaneous and quantitative determination of the two in-plane magnetization components is described. The setup provides both polarization rotations and reflectivity changes at the same time for a given sample orientation with respect to a variable external magnetic field, as well as allowing full angular studies. A classical description based on the Jones formalism is used to calculate the setup's properties. The use of different incoming light polarizations and/or MOKE geometries, as well as the errors due to misalignment and solutions are discussed. To illustrate the capabilities of the setup a detailed study of a model four-fold anisotropy system is presented. Among others, the setup allows to study the angular dependence of the hysteresis phenomena, remanences, critical fields, and magnetization reversal processes, as well as the accurate determination of the easy and hard magnetization directions, domain wall orientations, and magnetic anisotropies.

Enhanced selectivity towards O2 and H2 dissociation on ultrathin Cu films on Ru(0001).

The reactivity of Cu monolayer (ML) and bilayer films grown on Ru(0001) towards O(2) and H(2) has been investigated. O(2) initial sticking coefficients were determined using the King and Wells method in the incident energy range 40-450 meV, and compared to the corresponding values measured on clean Ru(0001) and Cu(111) surfaces. A relative large O(2) sticking coefficient (~0.5-0.8) was measured for 1 ML Cu and even 2 ML Cu/Ru(0001). At low incident energies, this is one order of magnitude larger than the value observed on Cu(111). In contrast, the corresponding reactivity to H(2) was near zero on both Cu monolayer and bilayer films, for incident energies up to 175 meV. Water adsorption on 2 ML Cu/Ru(0001) was found to behave quite differently than on the Ru(0001) and Cu(111) surfaces. Our study shows that Cu/Ru(0001) is a highly selective system, which presents a quite different chemical reactivity towards different species in the same range of collision energies.

El tabaco en los establecimientos de hostelería de Zaragoza tras cuatro años de la Ley 28/2005 / The smoking ban in the hospitality sector in Zaragoza, four years after the new legislation 28/2005

Fundamento y objetivo. Estimar el grado de cumplimiento de la Ley 28/2005 en locales de restauración y hostelería de Zaragoza. Metodología. Estudio descriptivo de prevalencia, realizado durante el primer trimestre del año 2010. Muestreo aleatorio simple. Muestra: 801 locales clasificados en tres categorías: restaurantes, bares —tabernas, cafeterías y comida rápida— y locales de ocio. Las variables: superficie del local, local con o sin humo, separaciones de acuerdo con la ley y cartel visible. Análisis estadístico: prevalencias y sus intervalos de confianza poblacionales; para detectar diferencias entre proporciones se empleó la prueba de la X2. Resultados. En Zaragoza, se permitía fumar en el 92,63% (IC del 95%, 90,66-94,29) de los establecimientos, estaba prohibido el consumo de tabaco en un 4,24% (IC del 95%, 3-5,9), y en un 2,62% (IC del 95%, 1,67-3,91) existían zonas compartimentadas entre fumadores y no fumadores. En los locales de más de 100 m, en los bares en el 74% estaba permitido fumar. Los restaurantes representan el tipo de local en el que más se han compartimentado los espacios. No se encontró ningún local de ocio nocturno libre de humo, y sólo en un 3,4% de estos había zonas totalmente compartimentadas. Conclusiones. Tras 5 años de la ley 28/2005, no existe una protección efectiva de los fumadores pasivos que deciden acudir a estos establecimientos, ni del fumador pasivo laboral, ya que en el 92,63% de los establecimientos está permitido el consumo de tabaco (AU)

Background and objective. To estimate the level of compliance of the new smoke-free legislation in the hospitality sector in Zaragoza. Methods. We performed a descriptive prevalence study, carried out during the first trimester of 2010. Simple random sampling based on 801 premises, classified into three types: restaurants, bars —including taverns, coffee shops, fast food restaurants— and night clubs. Variables: area, smoking or non-smoking establishment, separation between areas following the current regulations and visible sign-posting. Statistical analysis: Prevalence and confidence intervals; ÷2 test was used to detect the differences between proportions. Results. In Zaragoza, smoking was allowed in 92.63% (95% CI, 90.66-94.29) of all establishments and was forbidden in 4.24% (95% CI, 3.00-5.9), and 2.62% (95% CI, 1.67-3.91) had separated smoking areas. In those places with an area exceeding 100 m2, 74% were allowed to smoke in bars. The restaurants had more separated areas. There are no night clubs for non-smokers and only 3.4% had separated areas. Conclusions. Four years after the introduction of the current law 28/2005, there is still no effective protection for those passive smokers who decide to visit these places, including passive-smoker employees, as 93.63% of the establishments allow smoking (AU)

West Nile Virus encephalitis in intensive care: a small mosquito, a tremendous danger.

The authors describe two of three cases of West Nile virus (WNV) meningoencephalitis admitted to ICU in Ferrara (south of Po River) underlying the main common features. They focus on the difficulties in diagnosis, with key-points including seasonality (late summer in Italy), unspecific flu-like symptoms at the beginning, as hyperpyrexia, myalgia and asthenia, followed by neurological impairment, and use of steroids in the patient clinical history. Special attention is deserved to the poor outcome at both short and long term.

Exploring the capacity of radar remote sensing to estimate wetland marshes water storage.

This paper focuses on the use of radar remote sensing for water storage estimation in wetland marshes of the Paraná River Delta in Argentina. The approach followed is based on the analysis of a temporal set of ENVISAT ASAR data which includes images acquired under different polarizations and incidence angles as well as different environmental conditions (water level, precipitation, and vegetation condition). Two marsh species, named junco and cortadera, were monitored. This overall data set gave us the possibility of studying and understanding the basic interactions between the radar, the soil under different flood conditions, and the vegetation structure. The comprehension of the observed features was addressed through electromagnetic models developed for these ecosystems. The procedure used in this work to estimate water level within marshes combines a direct electromagnetic model, field work data specifically obtained to feed the model, the actual ASAR measurements and a well known retrieval scheme based on a cost function. Results are validated with water level evaluations at specific points. A map showing an estimation of the water storage capacity and its error in junco and cortadera areas for the date where the investigation was done is also presented.

High Curie temperature for La(0.7)Sr(0.3)MnO(3) thin films deposited on CeO(2) /YSZ-based buffered silicon substrates.

Two kinds of epitaxial structures were grown by standard pulsed laser deposition on (001) Si, namely La(0.7)Sr(0.3)MnO(3)/Bi(4)Ti(3)O(12)/CeO(2) /YSZ/Si (BTO-based), and La(0.7)Sr(0.3)MnO(3)/SrTiO(3)/CeO(2) /YSZ/Si (STO-based) multilayers. The samples were investigated by means of x-ray diffraction, transmission electron microscopy, magnetic and transport measurements. The Curie temperature T(C) of the BTO-based samples was found to be higher (360 K) than for the typical reference epitaxial LSMO film grown on (001) SrTiO(3) single crystal (345 K), due to high compressive in-plane strain. The STO-based samples show high structural quality, low roughness and high T(C) (350 K), making them interesting candidates for use in innovative LSMO-based bolometers or spintronic devices operating at room temperature.

Experimental technique for reducing contact and background noise in voltage spectral density measurements.

Electric noise measurements can give useful information on the conduction mechanisms and the dynamic behaviors of the charge carriers in new materials. However, it is well known that not all the electronic fluctuations are originated from the material itself, but some noise sources depend on the experimental procedures used for the measurements. In this article, an experimental technique to reduce "external" noise components, not associated with the bulk system, is presented. The proposed method is based on measurements of the voltage spectral density, using in sequence a four- and a two-probe technique. From the measurements it is possible to evaluate the contact and the background noise contributions and to recover the real spectral trace of the sample. The proposed procedure is demonstrated to be valid in spectral density measurements performed on La(0.7)Sr(0.3)MnO(3) thin films.

High risk for microcarcinoma in thyroid benign diseases. Incidence in a one year period of total thyroidectomies.

Over the last few years, incidental thyroid microcarcinoma (TMC) has become a frequent disease and its incidence in some reports is considerable. The discovery of new cases depends on the progress of the diagnostics (US scan, fine needle biopsy and cytology, CT, MRI), on the extended indications to thyroidectomy for benign disease and on the attention in pathologic examination of the specimen. The clinical evolution of this disease is not well known: in spite of a high incidence reported in some autoptic series, suggesting that this tumour could have a good prognosis, some authors report an overall incidence of up to 11% of local recurrence, metastasis and mortality. For these reasons the treatment of TMC is still controversial today. Aim of this study was to estimate the incidence and the clinico-pathological findings of TMC over a one year period of total thyroidectomies for diffuse benign thyroid diseases, and to evaluate, on the basis of the frequency of incidental microcarcinoma, if the surgical procedure of complete removal of the gland should be adopted in any case. In this series no patient had pre-operative diagnosis or tentative diagnosis of carcinoma and the incidence of TMC at the final histologic examination was 27.4%. Total thyroidectomy confirmed to be the treatment of choice for diffuse benign diseases and appeared necessary to obtain both, diagnosis and treatment of incidental TMC.

Blood glucose pre-prandial baseline decreases from morning to evening in type 2 diabetes: role of fasting blood glucose and influence on post-prandial excursions.

BACKGROUND: To know the relationships between pre- and postprandial blood glucose (BG), i.e. BG profile shape, is a requisite for an appropriate therapy for type 2 diabetic patients. In non diabetic subjects, pre-breakfast, pre-lunch and pre-dinner BG are similar, so that BG postprandial excursions are superimposed on a stable BG preprandial baseline. We aimed to clarify: (a) whether BG preprandial baseline is stable also in type 2 diabetes and (b) whether fasting BG (FBG) influences the slope of BG preprandial baseline and the relationships between pre- and postprandial BG. DESIGN: We evaluated self-measured BG profiles of 237 type 2 diabetic patients on diet alone (M/F, 152/85; age 58.6 +/- 0.7 years; years from diagnosis 4.8 +/- 0.6; BMI 28.0 +/- 0.3 kg m-2): 536 profiles containing preprandial BG (corresponding HbA1c 6.8 +/- 0.06%) and 208 profiles containing both pre- and postprandial BG (corresponding HbA1c 6.8 +/- 0.09%). The profiles, measured by nurses, of 866 type 2 diabetic patients on diet alone were also considered (corresponding HbA1c 6.7 +/- 0.04%). RESULTS: In self-measured profiles containing only preprandial BG: (i) FBG (6.77 +/- 0.07 mmol L(-1)) is higher than pre-lunch BG (6.09 +/- 0.07 mmol L(-1)), P = 0.0001) and pre-dinner BG (5.84 +/- 0.06 mmol L(-1)), P =0.0001); (ii) the delta value between FBG and pre-dinner BG is correlated with FBG (r = 0.57, P = 0.0001), the highest FBG, the steepest the fall of BG preprandial baseline throughout the day. This trend is confirmed in profiles measured by nurses. In profiles containing both pre- and postprandial BG: (i) there is a trend to preprandial BG fall (P = 0.0001) and to postprandial BG increase (P = 0.0001) from morning to evening; (ii) postprandial excursions are influenced and sometimes masked by the slope of BG preprandial baseline, thus, in profiles with FBG < or = 6.7 mmol L(-1), all postprandial values are higher than FBG (P = 0.0001), whereas in profiles with FBG > 7.8 mmol L(-1), postprandial values are not significantly higher than FBG. CONCLUSION: In type 2 diabetes, the shape of BG profiles changes in relation to FBG, because it deeply influences the slope of BG preprandial baseline on which postprandial excursions are superimposed. Thus, before planning treatment policies, not only the extent of fasting and postprandial hyperglycaemia, but also the shape of profiles should be considered, to safely correct hyperglycaemia without inducing hypoglycaemia.

L-arginine modulates aggregation and intracellular cyclic 3,5-guanosine monophosphate levels in human platelets: direct effect and interplay with antioxidative thiol agent.

Platelet nitric oxide is involved in the control of aggregability via cyclic 3',5'-guanosine monophosphate synthesis. Since L-arginine provides a guanidino nitrogen group for nitric oxide synthesis through nitric oxide synthase activity, we tried to clarify whether an increased availability of this amino acid can directly modulate the response of human platelets. In our conditions, L-arginine (at 100-6000 micromol/L) was able to influence the response of human platelets stimulated with adenosine 5-diphosphate and collagen both in PRP and in whole blood. The anti-aggregating effect was not present when D-arginine was used. Permeabilized platelets exhibited an increased sensitivity to L-arginine. Also, an increased availability of Ca2+ enhanced L-arginine effect. L-arginine (at 120-500 micromol/L) increased cyclic 3',5'-guanosine monophosphate levels in resting platelets; the amino acid also determined an increase of cyclic 3',5'-guanosine monophosphate in platelets at the end of adenosine 5-diphosphate-induced aggregation. Nitric oxide synthase inhibitor N(G)-monomethyl-L-arginine prevented L-arginine effects on aggregation and cyclic 3',5'-guanosine monophosphate synthesis. Phosphodiesterase III inhibitor milrinone and antioxidative thiol N-acetyl-L-cysteine enhanced the effect of L-arginine on cyclic 3',5'-guanosine monophosphate. In conclusion, L-arginine exerts inhibitory effects on human platelet response through a nitric oxide-dependent synthesis of cyclic 3',5'-guanosine monophosphate. A positive interplay on platelet response between L-arginine and milrinone or antioxidative thiol N-acetyl-L-cysteine was evidenced.

Modulation of human platelet function by L-canavanine: differential effects of low and high concentrations.

L-Canavanine is a naturally occurring L-amino acid that interferes with L-arginine-utilizing enzymes owing to its structural analogy with this L-amino acid. In macrophages and polymorphonuclear leukocytes, which express inducible nitric oxide synthase (iNOS), L-canavanine is able to prevent the L-arginine-derived synthesis of nitric oxide (NO). Its effects on constitutive NOS (cNOS) are far less clear. Because human platelets synthesize NO from L-arginine through a cNOS and because intracellular NO levels modulate platelet function, we have investigated the effects of L-canavanine on parameters potentially influenced by NO, such as platelet levels of 3',5'-cyclic guanosine monophosphate (cGMP) and responses to different aggregating agents. In our experimental conditions, L-canavanine was able to influence the response of human platelets to different aggregating agents such as catecholamines, 5-hydroxytryptamine, and ADP. Low L-canavanine concentrations (10-100 micromol/l) decreased platelet responses, whereas a high concentration (1 mmol/l) was unable to exert antiaggregating effects. In resting platelets, L-canavanine reduced the levels of cGMP, starting from a concentration of 1 mmol/l; furthermore, at the same concentrations, it was able to reduce cGMP levels at the end of the aggregation induced by collagen. In conclusion, L-canavanine exerts differential effects on human platelets in relation to the concentrations: at low levels, it exerts antiaggregating effects by actions independent of NOS inhibition, whereas, at high levels, it inhibits NO synthesis and does not exert antiaggregating effects.

[Determination of urinary excretion of iodine in cordarone induced hyperthyroidism]. / Determinazione della ioduria negli ipertiroidismi da cordarone.

It is well known that amiodarone, an antiarrythmic drug containing iodine, can induce in some subjects thyroid function alterations: hyperthyroidism in patients resident in iodine-deficient areas and hypothyroidism in those with sufficient iodine intake. We attempted in this study to show the possibility to select the subjects at major risk of this iodine-induced hyperthyroidism, with a simple and inexpensive method such as urinary excretion iodine assay.

The start site of the Acanthamoeba castellanii ribosomal RNA transcription unit.

The 39S ribosomal RNA (rRNA) precursor has been isolated from Acanthamoeba castellanii. In vitro capping of the isolated RNA verified that it is the primary transcript and identified the 5' nucleotide as pppA. The position of the 5' coding nucleotide on the rRNA repeat unit sequence was identified using Northern blot, R-loop, and S1 nuclease mapping techniques. Dinucleotide priming of an in vitro transcription system stalled because of low initiating nucleotide concentration revealed that ApA maximally stimulates initiation of transcription. All of these results show that the underlined A in the sequence 5'-TATATATAAAGGGAC (RNA-like strand) coincides with the 5' nucleotide of the primary transcript. This identification is compatible with in vitro transcription experiments mapping the promoter for this transcription unit. The initiation sequences of rRNA genes from 14 species are compared, and a weak consensus for the initiator derived: [Formula; see text].

[Environmental contamination by iodine-131 and cancer of the thyroid gland]. / Contaminazione ambientale da iodio-131 e cancro della tiroide.

The biological effects of cosmic rays and ionising radiations on man are described. Particular attention is paid to the consequences of the environmental pollution caused by the Chernobyl accident and the relationship between I131 radiation and thyroid tumours is analysed.

Presence of endotoxemia and its relationship to liver dysfunction in patients with typhoid fever.

Twenty-one patients with typhoid fever were studied to evaluate the presence of endotoxin in peripheral blood and its relationship to the incidence and features of hepatic dysfunction which may occur during this disease. The limulus test for endotoxin was positive in the plasma samples of all patients prior to treatment. Liver dysfunction, as assessed by fasting and postprandial serum bile acid levels and by standard biochemical tests, occurred in 90% of patients. In seven, the injury was purely cholestatic (elevation of postprandial serum bile acid levels, alone); in 12, it was of mixed cholestatic-hepatocellular type (elevation of both serum bile acids and aminotransferase levels). After recovering, the limulus test was negative and liver function tests returned to normal values in all patients. The results demonstrate that endotoxemia is present in patients with typhoid fever. In addition, since endotoxin can impair bile secretion, our results suggest that endotoxin may have a pathogenetic role in the development of liver injury during typhoid fever.

Effect of beta-lactam antibiotics at subinhibitory concentrations on the phagocytosis of Staphylococcus aureus by the perfused rat liver.

We evaluated whether the exposure of Staphylococcus aureus to a subinhibitory concentration of penicillin and cefamandole could modify its susceptibility to rat serum factors and to the phagocytic activity of the isolated and perfused rat liver. Control or sub-MIC treated bacteria were added to the circulating medium which contained homologous serum, and the disappearance of bacteria from the perfusate and their recovery in the liver was determined during the 10 min experimental time. Sub-MIC treated bacteria were more susceptible to the bactericidal activity of serum present in the perfusate. However, the clearance rate of bacteria by the liver was decreased for penicillin-treated organisms and unchanged for cefamandole-treated bacteria. The data suggest that beta-lactam antibiotics at sub-MIC levels may modify S. aureus susceptibility to host defense mechanisms.