Golimumab improves health-related quality of life of patients with moderate-to-severe ulcerative colitis: Results of the go-care study.

BACKGROUND: In recent years, improvement of Health-Related Quality of Life (HRQoL) in Ulcerative colitis (UC) has become a relevant measure for treatment efficacy. METHODS: We report results from a multicenter prospective study in Italy investigating HRQoL in adult patients with UC treated with golimumab (GLM). Patients who had shown clinical response after a 6-week induction phase (w0), were followed for an additional 48 weeks (w48) (total 54-week treatment). RESULTS: Of the 159 patients enrolled 90 completed the study. Compared to values at the beginning of treatment (n = 137), significant improvements were observed for mean total Inflammatory Bowel Disease Questionnaire (IBDQ) scores at w0 (168.5) and w48 (181.7). Patients with baseline PMS above the median tended to have greater improvements in IBDQ at w0 (OR 2.037, p = 0.033) and w48 (OR 3.292, p = 0.027). Compared to beginning of GLM treatment, the mean Full Mayo Score (FMS) decreased by 5.9 points at w48, while mean Partial Mayo Score (PMS) decreased by 3.9 points at w0 and by 4.9 points at w48. CONCLUSIONS: GLM improved HRQoL, disease activity and inflammatory biomarkers in UC patients with moderate-to-severely active disease. The greater the burden of disease activity at baseline, the greater the improvement of HRQoL after 24 and 48 weeks of treatment.

Defining the Science of Learning: A scoping review.

BACKGROUND: Interest in research on the Science of Learning continues to grow. However, ambiguity about what this field is can negatively impact communication and collaboration and may inadequately inform educational training programs or funding initiatives that are not sufficiently inclusive in focus. METHODS: The present scoping review aimed to synthesize a working definition of the Science of Learning using Web of Science and ProQuest database searches. RESULTS: In total, 43 unique definitions were identified across 50 documents including journal articles, theses, conference papers, and book chapters. Definitions of the Science of Learning differed considerably when describing the fields thought to contribute to research on this topic. CONCLUSIONS: Based on findings, we propose a working definition of the Science of Learning for discussion and further refinement: the scientific study of the underlying bases of learning with the goal of describing, understanding, or improving learning across developmental stages and diverse contexts.

Diagnosis and management of fetal ductus arteriosus constriction-closure.

Pathognomonic features of in utero premature restriction/closure of the ductus arteriosus (DA) are increased right ventricular afterload, impaired right ventricular function, and consequently tricuspid regurgitation and right heart dilation. The most common reason for constriction-closure of DA is maternal administration of non-steroidal anti-inflammatory drugs (NSAIDs) during the 3rd trimester of gestation. The idiopathic form is a rare event and, maybe, an underestimated abnormality that, if it is not promptly recognized, may result in severe fetal-neonatal compromise. We describe a case of a 38-year-old woman presenting at 34+0 weeks of gestation with a normally grown male fetus whose fetal echocardiography had shown right ventricular hypertrophy, a tortuous S-shaped DA and a significant pulmonary hyperflow. All signs were consistent of an idiopathic severe constriction of DA with a significant fetal cardiac involvement. The patient was admitted to a tertiary care center equipped with Neonatal Intensive Care Unit (NICU), and delivered by cesarean section at 34+4 weeks with a good maternal and neonatal outcome. Based on our experience and a review of the Literature we propose a management algorithm to use when dealing with preterm or early term pregnancy complicated by this fetal hemodynamic malfunction.

Three-dimensional dynamics of a fermionic Mott wedding-cake in clean and disordered optical lattices.

Non-equilibrium quantum phenomena are ubiquitous in nature. Yet, theoretical predictions on the real-time dynamics of many-body quantum systems remain formidably challenging, especially for high dimensions, strong interactions or disordered samples. Here we consider a notable paradigm of strongly correlated Fermi systems, the Mott phase of the Hubbard model, in a setup resembling ultracold-gases experiments. We study the three-dimensional expansion of a cloud into an optical lattice after removing the confining potential. We use time-dependent density-functional theory combined with dynamical mean-field theory, considering interactions below and above the Mott threshold, as well as disorder effects. At strong coupling, we observe multiple timescales in the melting of the Mott wedding-cake structure, as the Mott plateau persist orders of magnitude longer than the band insulating core. We also show that disorder destabilises the Mott plateau and that, compared to a clean setup, localisation can decrease, creating an interesting dynamic crossover during the expansion.

Prognostic value of CD34+ peak in peripheral blood during mobilization in intermediate-risk AML patients treated in first CR by autologous or allogeneic transplantation.

Ninety-six AML patients in 1st CR were evaluated for peak CD34+ cell levels in peripheral blood (PB) during PBSC mobilization and harvest. Distribution of CD34+ cell peaks was determined and cases were grouped on the basis of 50th and 75th percentile: group A, those having a CD34+ cell peak ≤70 × 10(9)/L (n=48); group B, those having a CD34+ cell peak between 70 and 183 × 10(9)/L (n=24); group C, those having a CD34+ cell peak >183 × 10(9)/L (n=24). Irrespective of post-remission treatment received, group A had a disease free survival (DFS) of 73%, group B a DFS of 51% and group C of 30% (P=0.0003). In intermediate cytogenetic risk patients, those treated by autologous transplantation had a DFS of 68, 33 and 14% in the groups A, B and C, respectively, (P=0.01) whereas after allogeneic transplantation DFS was 87% in group A+B vs 50% in group C (P=0.009). The peak of CD34+ cells in PB, was an independent predictor for DFS in multivariate analysis.

High sacrectomy for locally recurrent rectal cancer: Can long-term survival be achieved?

BACKGROUND: Locally recurrent rectal cancer involving the upper sacrum is generally considered a contra-indication to curative surgery. The aim of this study was to determine if a survival benefit was seen in patients undergoing high sacrectomy. METHODS: All patients with locally recurrent rectal cancer involving the sacrum above the 3rd sacral body between 1999 and 2007 were retrospectively reviewed. Kaplan-Meier survival analysis was performed. RESULTS: Nine patients were identified with a median age of 63 years. The proximal extent of sacral resection was through S2 (n = 6), S1 (n = 2), and L5-S1 (n = 1). All patients had R0 negative-margin resection. Median operative time was 13.7 hr, and median operative blood transfusion was 3.7 L. Thirty-day mortality was nil. Postoperative complications requiring surgical intervention occurred in three patients. Local re-recurrence in the pelvis occurred in one patient. The overall median survival was 31 months (range, 2-39 months). Three patients still alive are free of disease after 40, 76, and 101 months, respectively. Ultimately, all deaths were due to metastatic disease. CONCLUSIONS: High sacrectomy that achieves clear margins in patients with recurrent rectal cancer is safe and feasible. A majority will die of metastatic disease, but long-term survival may be possible in some patients.

[Electrocardiography by the neonatologist]. / L'elettrocardiografia per il Neonatologo.

An electrocardiogram is a simple, non-invasive and inexpensive test, whose knowledge and interpretation should be an essential skill for neonatologists. It is a basic, easy and handy tool, very useful for the right approach to the child with suspected heart disease. The test provides important information on the heart rhythm and is essential to diagnose and therefore treat arrhythmic problems. It gives also information on the ventricular dimensions and volume and/or pressure overload of one or both ventricles. In case of malformative pathologies, the test enables to suspect the type of malformation. The aim of this report is to explain a normal electrocardiogram in a practical and simple way, through the definition of the necessary basic criteria to detect heart rate and rhythm, electrical axis of QRS complex, normal wave morphology in all leads and atrioventricular conduction (PR interval). Some basic information will also be provided on how to recognize a pathological electrocardiogram and heart rhythm disorders. Then we will use interactive methods to discuss some tracings through which it will be possible to reach a diagnostic orientation.

Day hospital for incisional hernia repair: selection criteria.

AIM: The authors report their experience with incisional hernia repair and set criteria for the safe performance of the procedure on a day hospital basis. MATERIALS AND METHODS: From January 1994 to July 2005, 29 day hospital procedures for incisional hernia were performed under local anaesthesia. Selection criteria included: a hernial defect < 10 cm, a reducible hernial sac and negative history for obstructive symptoms. The repair was achieved with a polypropylene plug in defects < 3 cm and a double layer mesh in larger defects. RESULTS: All patients were discharged within 7 hours of surgery. Postoperative pain was mild and required hospital analgesia in 30% of cases. Back at home analgesia was needed in only three patients (10%). Six patients (20%) developed a seroma that reabsorbed spontaneously. During a follow-up ranging 6 to 120 months (mean 75), no recurrence has been recorded. CONCLUSIONS: In selected patients, incisional hernia repair as day hospital procedure is feasible, safe and absolutely effective. The use of polypropylene plugs and meshes accounts for a sound repair with low risk of complications.

Adverse events after infusions of cryopreserved hematopoietic stem cells depend on non-mononuclear cells in the infused suspension and patient age.

BACKGROUND: Adverse events (AE) represent a significant clinical problem after infusion of cryopreserved HPC. However, the factors playing a role in the pathogenesis have not yet been fully established. METHODS: We prospectively collected data on AE that occurred with 179 HPC infusions performed on patients affected with hematologic neoplasm after high-dose chemotherapy. The stem cell source was hemopoietic progenitor cells aphaeresis (HPC-A) in 157 cases and hemopoietic progenitor cell BM (HPC-BM) in 22 cases. In all cases, an endotoxin-free DMSO was used. RESULTS: One or more AE were registered in 51/179 infusions (28.6%). The frequency of AE was higher after HPC-A than after HPC-BM (31.3% vs. 4.5%; chi(2) test, P =0.008). With univariate logistic regression, other factors found important for AE were age (P =0.028), number of total nucleated cells infused per kilogram (P =0.002), volume per kilogram infused (P =0.057), volume of packed RBC (P =0.019), a content of non-mononuclear cells >0.5 x 10(8)/kg (

0.5 x 10(8)/kg (P =0.0003) remained significant. A significant correlation existed between reduction of cardiac frequency both with volume per kilogram infused (r =0.221, P =0.02) and actual time of infusion (r =0.269, P =0.005). DISCUSSION: Cardiovascular changes are influenced by volume per kilogram infused and by actual time of infusion, while non-cardiovascular AE are dependent on patient age and contamination by non-mononuclear cells in apheretic harvests.

Characterisation of submarine groundwater discharge offshore south-eastern Sicily.

A complex approach in characterisation of submarine groundwater discharge (SGD) off south-eastern Sicily comprising applications of radioactive and non-radioactive tracers, direct seepage measurements, geophysical surveys and a numerical modelling is presented. SGD fluxes in the Donnalucata boat basin were estimated by direct seepage measurements to be from 4 to 12Ls(-1), which are comparable with the total SGD flux in the basin of 17Ls(-1) obtained from radon measurements. The integrated SGD flux over the Donnalucata coast estimated on the basis of Ra isotopes was around 60m(3)s(-1) per km of the coast. Spatial variations of SGD were observed in the Donnalucata boat basin, the average (222)Rn activity concentration in seawater varied from approximately 0.1kBqm(-3) to 3.7kBqm(-3) showing an inverse relationship with salinity. The continuous monitoring carried out at the site closest to the coast has revealed an inverse relationship of (222)Rn activity concentration on the tide. The (222)Rn concentrations in seawater varied from 2.3kBqm(-3) during high tides to 4.8kBqm(-3) during low tides, thus confirming an influence of the tide on submarine groundwater discharge. Stable isotopes (delta(2)H and delta(18)O) showed that SGD samples consist up to 50% of groundwater. Geo-electrical measurements showed a spatial variability of the salt/fresh water interface and its complex transformation in the coastal zone. The presented results imply that in the studied Donnalucata site there are at least two different sources of SGD, one superficial, represented by mixed fresh water and seawater, and the second one which originates in a deeper limestone aquifer.

Quantifying submarine groundwater discharge in the coastal zone via multiple methods.

Submarine groundwater discharge (SGD) is now recognized as an important pathway between land and sea. As such, this flow may contribute to the biogeochemical and other marine budgets of near-shore waters. These discharges typically display significant spatial and temporal variability making assessments difficult. Groundwater seepage is patchy, diffuse, temporally variable, and may involve multiple aquifers. Thus, the measurement of its magnitude and associated chemical fluxes is a challenging enterprise. A joint project of UNESCO and the International Atomic Energy Agency (IAEA) has examined several methods of SGD assessment and carried out a series of five intercomparison experiments in different hydrogeologic environments (coastal plain, karst, glacial till, fractured crystalline rock, and volcanic terrains). This report reviews the scientific and management significance of SGD, measurement approaches, and the results of the intercomparison experiments. We conclude that while the process is essentially ubiquitous in coastal areas, the assessment of its magnitude at any one location is subject to enough variability that measurements should be made by a variety of techniques and over large enough spatial and temporal scales to capture the majority of these changing conditions. We feel that all the measurement techniques described here are valid although they each have their own advantages and disadvantages. It is recommended that multiple approaches be applied whenever possible. In addition, a continuing effort is required in order to capture long-period tidal fluctuations, storm effects, and seasonal variations.

Male breast cancer: report of 2 cases and review of the literature.

Male breast cancer is rare and accounts for 1% of all breast cancers. The authors report two cases of male breast cancer at Stage III and review the literature. A Madden mastectomy with axillary clearance was performed. Patients were given adjuvant chemotherapy and started on tamoxifen. At one year follow-up the patients are alive and free from disease. Modified radical mastectomy is the preferred surgical approach for localized disease. Adjuvant hormonal therapy with tamoxifen is recommended as first-line treatment. Adjuvant chemotherapy has a role in node-positive cancer and locally advanced disease. Men should be made more aware of the disease and multicentric clinical trials encouraged to ensure an appropriate treatment on the basis of prospectively collected data.

Analogic evaluation of pain during inguinal hernioplasty under local anaesthesia.

OBJECTIVE: The authors evaluate intraoperative pain in patients undergoing tension-free inguinal hernioplasty under local anaesthesia. MATERIAL AND METHODS: One hundred and fourteen primary inguinal hernia repairs were carried out at the Department of General Surgery I of Catania University Polyclinic from January to September 2002. 2% Mepivacaine cloridrate was the local anesthetic of choice. Intraoperative pain was measured by a visual analog scale. RESULTS: A mean analogic score of 1.9 (range 0-2.9) was obtained. Intraoperative complications were recorded only in 2 patients (1.7%). There was no operative mortality. All patients were up and about straightaway after surgery, had a light meal two hours later and were discharged within one day of operation. CONCLUSIONS: Inguinal hernia repair under local anaesthesia is well tolerated and is associated with a low risk of complications.

Plug-technique for small incisional hernia.

OBJECTIVE: The authors report their experience with a new prosthetic technique for the repair of incisional hernia defects smaller than 3 cm. METHODS: From January 1995 to September 2002, 16 operations for small incisional hernias have been performed. Local anaesthesia was used in 12 out of 16 patients (75%). The repair was achieved by insertion of a polypropylene plug sutured to the margins of the hernial defect. RESULTS: All patients were discharged within 24 hours of surgery. Postoperative pain was mild and required hospital analgesia in 25% of cases. Back at home analgesia was needed in only 1 patient. During a follow-up ranging 3 to 91 months (mean 46), no recurrence has been recorded. CONCLUSION: The proposed technique allows a sound repair of small incisional hernias with minimal pain, quick rehabilitation and early return to unrestricted work.

[Tension-free prosthetic repair in the surgical treatment of epigastric hernia]. / La riparazione protesica tension-free per il trattamento chirurgico dell'ernia epigastrica.

From November 1994 to June 2001, the authors have performed 16 operations for epigastric hernia. Local anaesthesia was used in 8 patients with small hernias, in the remaining 8 general anaesthesia was preferred. In defects smaller than 4 cm, the repair was achieved by insertion of a polypropylene dart plug sutured to the margins of the hernial defect. In larger defects a double layer mesh placed in the pre-peritoneum was used. All patients were discharged within 24 hours of surgery. Postoperative pain was mild and required hospital analgesia in 25% of cases and domiciliary analgesia in 1 patient only. During a follow-up ranging 3 to 79 months (mean 31.2), no recurrence has been recorded. The proposed technique is simple, safe and absolutely effective, allows immediate rehabilitation with a low risk of complications.

[Plug-technique for umbilical hernia repair in the adult]. / La tecnica del piccolo plug nella riparazione dell'ernia ombelicale nell'adulto.

BACKGROUND: Umbilical hernia represents 6% of all abdominal wall hernias in the adult. Surgical repair should always be carried out due to possible occurrence of complications. Aim of this paper is to evaluate the efficacy of the plug-technique. METHODS: From October 1995 to April 2000, the authors performed 21 operations for acquired umbilical hernia with a defect smaller than 4 cm. Local anesthesia was used and a light intravenous sedation added in particularly anxious patients. The repair was achieved by insertion of a polypropylene dart plug sutured to the margins of the hernial defect. RESULTS: All patients were up and about straightaway and were discharged within 24 hours of surgery. Postoperative pain was mild and required hospital analgesia in only 19% of cases and domiciliary analgesia in 24%. During a follow-up ranging from 6 to 60 months (mean 30), only one recurrence has been recorded. CONCLUSIONS: This tension-free technique allows immediate rehabilitation, with few complications and a low recurrence rate.

[Current approach in the treatment of desmoid tumors of the abdominal wall]. / Attuali orientamenti nel trattamento dei desmoidi della parete addominale.

Desmoids of the abdominal wall are rare tumours with an incidence of 2-4 cases per million. From our experience which is reported here in detail (5 cases observed over the past 20 years), we draw the conclusion that the only completely reliable diagnosis is still histological, in spite of the use of ultrasound, CT scans and the new imaging possibilities afforded by NMR. After comprehensive excision of at least 2 cm of macroscopically healthy tissue from the tumour margins, reconstruction using prosthetic materials, such as Mersilene, PTFE or Prolene was performed. Neither radiotherapy nor chemotherapy were used, since there were doubts as to their usefulness. The functional and cosmetic results were satisfactory in all cases. Over follow-up periods ranging from 3 to 13 years, none of the patients has presented recurrences or incisional hernias.

rrn operons in Haemophilus parainfluenzae and mosaicism of conserved and species-specific sequences in the 16S-23S rDNA long spacer.

The mosaic organisation of short-sequence boxes was analysed in the cloned and sequenced long ribosomal spacer (547 bp) of Haemophilus parainfluenzae GR. Comparison and alignment of both the long and the short spacer were performed in H. parainfluenzae and H. influenzae Rd. The long spacer contained two tRNA genes (tRNA(Ala) and tRNA(Ile)) which are highly homologous to the corresponding genes found in the spacers of other species, such as Haemophilus spp., Actinobacillus spp., and Plesiomonas shigelloides. At the 3' end of tRNA(Ala) a putative ribosomal spacer loop was found, showing a strong secondary structure. Pulsed field gel electrophoresis (PFGE) analysis after restriction of the genome of H. parainfluenzae GR with I-Ceu I and subsequent polymerase chain reaction (PCR) analysis of PFGE-separated DNA fragments demonstrated that the H. parainfluenzae genome contained six operons and that the long spacer was present in three copies of them. Two short DNA segments were identified as being species-specific, allowing us to design PCR primers which were useful in the molecular identification of H. parainfluenzae isolates.