Controlled processing of a full-sized porcine liver to a decellularized matrix in 24 h.

The generation of full-sized humanized organs based on animal matrix scaffolds is a promising approach to overcome the shortage of transplant organs. Recent decellularization methods are mostly time-consuming and associated with large rinsing volumes and poorly standardized procedures. In this study we developed an optimized rapid and standardized decellularization method to obtain a functional porcine liver matrix within 24 h. Full porcine livers (n = 10) were decellularized by flushing with 3 L of an isotonic sodium chloride solution and controlled portal perfusion (20 mmHg) with 2 × 10 L of a 1% sodium dodecyl sulphate (SDS) solution at 37°C and a final perfusion with DNase (n = 5). Protein concentrations were continuously monitored by optical density (280 nm). DNA, glycosaminoglycans, and collagen contents were assessed and a haematoxylin and eosin (H&E) staining was performed. After 24 h of perfusion, the liver had a white and translucent appearance, and no further protein was eluted. Histological staining showed an intact extracellular matrix with no nuclear residuals. Moreover, only trace amounts of DNA were detectable in the decellularized tissue (p < 0.001), while glycosaminoglycans and about 60% of collagen levels could be preserved. Thus, we demonstrate that human-scale porcine livers can be successfully decellularized with small volumes of an SDS solution and DNase in a standardized process within 24 h to obtain a clinically relevant organ scaffold suitable for further tissue engineering.

Two cases of imported malaria in Western Romania, 2010-2011.

Malaria is a major problem for European travelers to endemic regions. In Romania during 1980-2007 approximately 20 imported cases were detected annually. The aim of our short communication is to present 2 interesting cases of imported malaria detected in Western Romania. The first patient was a 20-year female who traveled to India and acquired an infection with Plasmodium vivax (P. vivax). The second patient, a 60-year female, contracted an infection with Plasmodium falciparum (P. falciparum) during a trip to Ghana; the evolution of the disease was severe with many complications and the patient finally died. The cases presented revealed the difficulties in establishing a correct diagnosis of malaria in a non-endemic country, consequences of an incomplete taken anamnesis. Travel history should always represent a mandatory part of a well conducted investigation. At the same time, we must underline the importance of a correct and complete prophylaxis prior to every departure to tropical countries.

Chronic pain in a sample of nursing home residents: prevalence, characteristics, influence on quality of life (QoL).

Chronic pain is common in the elderly, but it is often under-estimated and under-treated. The aim of this study was to evaluate the prevalence and characteristics of chronic pain in nursing home residents and to analyze its influence on patient's QoL and functional status. We studied 105 patients (mean age 82.2+/-9 years), living in two nursing homes in Torino, Italy. The McGill Pain Questionnaire (MGPQ), the Visual Analogical Scale (VAS) and the Face Pain Scale (FPS) were used to test pain. Depression, functional and cognitive status were also evaluated by using specific instruments, such as the Geriatric Depression Scale (GDS), Instrumental Activities of Daily Living (IADL), Activities of Daily Living (ADL) and the Mini-Mental State Examination (MMSE). Pharmacological and non-pharmacological treatments were documented. It was found that chronic pain was present in 82.9% of the sample; it lasted over 24 months and it was persistent in half of them (49.4%). We observed that chronic pain in the elderly has a strong affective component and its intensity influences older patients' mood, nutrition, sleep and QoL. Our study showed that chronic pain was under-treated. We conclude that chronic pain in institutionalized elderly is common and worsens patients' QoL. It is important to assess and manage pain as a relevant problem in particular for the population at increased risk for under-recognition and under-treatment.

Vegetable and synthetic tannins induce hormesis/toxicity in sea urchin early development and in algal growth.

Mimosa tannin and phenol-based synthetic tannin (syntan) were tested for toxicity to sea urchin (Paracentrotus lividus and Sphaerechinus granularis) early development and to marine algal growth (Dunaliella tertiolecta). Sea urchin embryogenesis was affected by vegetable tannin and syntan water extracts (VTWE and STWE) at levels >or=1mg/L. Developmental defects were significantly decreased at VTWE and STWE levels of 0.1 and 0.3mg/L when control cultures displayed suboptimal quality, i.e. <70% "viable" (normal or retarded) larvae. Fertilization success of sea urchin sperm was increased up to 0.3 mg/L STWE or VTWE, then was inhibited by increasing tannin levels (1-30 mg/L). Offspring abnormalities, following sperm exposure to VTWE or STWE, showed the same shift from hormesis to toxicity. Cell growth bioassays in D. tertiolecta exposed to VTWE or STWE (0.1-30 mg/L) showed non-linear concentration-related toxicity. Novel criteria are suggested in defining control quality that should reveal hormetic effects.

Toxicity of leather tanning wastewater effluents in sea urchin early development and in marine microalgae.

This study was designed to investigate the composition and the toxicity of leather tanning wastewater and conditioned sludge collected at the leather tanning wastewater treatment plant (CODISO) located in Solofra, Avellino (Southern Italy). Samples were analyzed for their conventional parameters (COD, TSS, chromium and ammonia) and for metal content. Effluent samples included raw wastewater, and samples collected following coagulation/flocculation process and biological treatment. A set of toxicity endpoints were tested using sea urchin and marine microalgal bioassays by evaluating acute embryotoxicity, developmental defects, changes in sperm fertilization success and transmissible damage from sperm to the offspring, and changes in algal growth rate. Dose-related toxicity to sea urchin embryogenesis and sperm fertilization success was exerted by effluent or sludge samples according to the following rank: conditioned sludge > coagulated effluent > or = raw influent >> effluent from biological treatment. Offspring quality was not affected by sperm exposure to any wastewater or to sludge samples. Algal growth was inhibited by raw or coagulated effluent to a similar extent and, again, the effluent from the biological treatment resulted in a decreased toxicity. The results suggest that coagulated effluent and conditioned sludge result in higher toxicity than raw influent in sea urchin embryos and sperm, whereas the biological wastewater treatment of coagulated effluent, in both sea urchins and algae, cause a substantial improvement of wastewater quality. Hence a final biological wastewater treatment should be operated to minimize any environmental damage from tannery wastewater.

[Comorbidity in the elderly: a sample of 2373 hospitalized elderly patients]. / La comorbilità nell'anziano: studio in 2373 pazienti ricoverati in una Divisione per acuti.

The aim of this study was to discuss about prevalence and clinical rilevance of comorbidity in the elderly patients. Our sample included 2373 (mean age 77.8 +/- 8.5; 1302 men and 1071 woman) consecutively admitted to the University Department of Geriatric Medicine of Torino. We examined some demographic variables, cognitive and functional status, main pathologies. Severity of illness was assessed using the C.I.R.S. The coexistence of two or more diseases was 83%: cardiovascular and chronic pulmonary diseases were the most frequently recorded (respectively 68% and 27%). The comorbidity and severity indexes of C.I.R.S. were associated respectively with mortality (O.R. 1.78; C.I. 1.36 - 2.33) and length of hospital staying (O.R. 2.35; C.I. 1.19 - 4.65). Comorbidity is an important specific prognostic indicator for reliable risk stratification of older patients.

Gender- and age-related distinctions for the in vivo prooxidant state in Fanconi anaemia patients.

Some selected oxidative stress parameters were measured in 56 Fanconi anaemia (FA) patients (42 untransplanted and 14 transplanted), 54 FA heterozygotes (parents) and 173 controls. Untransplanted FA patients showed a highly significant increase in leukocyte 8-hydroxy-2'-deoxyguanosine (8-OHdG) (P = 0.00003) and a borderline increase (P = 0.076) in urinary levels of 8-OHdG versus child controls. These increases were more pronounced in female FA patients (P = 0.00005 for leukocyte 8-OHdG and P = 0.021 for urinary 8-OHdG). Female FA patients also displayed a highly significant excess of spontaneous chromosomal breaks versus male patients (P = 0.00026), in the same female:male ratio ( approximately 1.4) as detected for both leukocyte and urine 8-OHdG levels. Plasma methylglyoxal (MGlx) levels were increased in untransplanted FA patients versus child controls (P = 0.032). The increases in leukocyte and urinary 8-OHdG and in MGlx levels were detected in young FA patients (< or =15 years), whereas patients aged 16-29 years failed to display any differences versus controls in the same age group. A significant increase in oxidized:reduced glutathione (GSSG:GSH) ratio was observed (P = 0.046) in the FA patients aged < or =15 years, whereas those aged 16-29 years, both untransplanted and transplanted, displayed a decrease (P = 0.06) in the GSSG:GSH ratio versus the controls of the respective age groups. No significant changes were detected in plasma levels of vitamin C, vitamin E or uric acid. Transplanted FA patients showed lesser alterations in leukocyte 8-OHdG and in GSSG:GSH ratio versus untransplanted patients. The parents of FA patients displayed a significant increase in plasma MGlx levels (P = 0.0014) versus adult controls. The results suggest a gender- and age-related modulation of oxidative stress in FA patients. The observed increase in urinary 8-OHdG in untransplanted FA patients suggests a proficient removal of oxidized DNA bases.

[Falls in hospitalized elderly patients: incidence and risk factors]. / Le cadute nell'anziano ospedalizzato: incidenza e fattori di rischio.

Aim of the study was to determine the incidence and risk factors for falls in hospitalized elderly patients. In a prospective observational study we investigated the characteristics of 620 elderly patients. We examined demographic variables, cognitive and functional status, main pathologies and drugs. Balance and gait were evaluated by Tinetti's scale. Seventy patients (11.3%) fell during hospitalization. The incidence rate of first falls was 5.2 per 1000 patient-days. Five independent variables were significantly and independently associated to falls: age, balance impairment, acute cognitive impairment, diabetes, and use of tricyclic antidepressants. Falls are common in hospitalized elderly patients and risk factors identification can be useful for a targeted multiple intervention falls prevention programme.

Multidimensional assessment and risk factors for prolonged hospitalization in the elderly.

BACKGROUND AND AIMS: Frailty, multiple pathologies, functional impairment and socioeconomic conditions can prolong the length of hospitalization in the elderly. The aim of our study was to analyze risk factors for prolonged hospitalization. METHODS: Our sample included 1054 patients consecutively admitted to the University Department of Geriatric Medicine of Torino, Italy. We examined some demographic variables (age, sex, socioeconomic conditions), affective, cognitive and functional status, main pathologies, and blood pressure and some hematological parameters (hemoglobin, creatinine, albumin, sodium). RESULTS: The number of functions lost to IADL and ADL, DMI (Dependent Medical Index) dependence, high levels of creatinine and low blood levels of albumin and sodium were associated with longer hospitalization, as also were the following clinical diagnoses: tumor, chronic obstructive pulmonary disease (COPD), hip fractures, peripheral arterial disease (PAD), and pressure sores. Independent predictors of prolonged hospitalization were: the number of functions lost to the ADL index, pressure sores, hip fracture, peripheral arterial disease with critical ischemia, and low levels of sodium. CONCLUSIONS: Multidimensional assessment is essential to identify medical, functional and socioeconomic problems, and can highlight risk factors for prolonged hospitalization.

Post-hospitalization mortality in the elderly.

The level of disability and polypathology in hospitalized elderly is usually high. Multidimensional and functional assessment allows to identify risk factors for clinical and functional failure of patients. Many studies point out that identifying predictors of high-risk patients is a necessary step in accurate targeting. We evaluated 395 subjects (175 women, 202 men, mean age 77.9 year) during their hospitalization in our Geriatric ward. Baseline data included: demographics variables, medical diagnosis, functional evaluation, and laboratory values. After a 6-month follow up 80 (20.2%) subjects died. In our study, male gender, dependence at the Dependence Medical Index (DMI), low serum albumin (< 2.8 g/dl), impaired score at the Instrumental Activities of Daily Living scale (IADL), score lower than 13.7 at the acute physiology and chronic health evaluation (APACHE II) and neoplasm were independent predictors of 6-month post-hospitalization mortality. The high mortality rate of our sample could be a marker of considerable frailty among elderly patients. Our study shows that a poor functional status is a more reliable prognostic factor than type and number of admitting diagnosis. Clinical evaluation, improved with information about functional status, is a feasible and practical way of detecting risk of short term post-hospitalization mortality of elderly subjects.

[Chronic pain in the elderly]. / Il dolore cronico nell'anziano.

Chronic pain is a common problem for the aged. Aim of the study was to evaluate prevalence, characteristics and influence on functional parameters of chronic pain in the elderly. Our study included 105 patients (mean age 82.2 +/- 9 yr). Chronic pain, tested by using the McGill Pain Questionnaire, was present in 87 patients (82.9%); it lasted more than 2 years and it was continuous in half of them (49.4%). Our study shows that chronic pain in the elderly has a strong affective component. Its intensity, evaluated by specific tests such as analogical visual and verbal scales, influences old patient's quality of life.