Electromyographic characterisation of abdominal wall trigger points developed after caesarean section and response to local anaesthesia: an observational study.

OBJECTIVE: This study examines the electromyography pattern of abdominal trigger points developed after a caesarean section, and the association between clinical response and local anaesthetic injection. DESIGN: Prospective cohort study. SETTING: A tertiary university hospital. POPULATION: Twenty-nine women with chronic pelvic pain associated with trigger points after a caesarean section were included in the study. METHODS: Participants received needle electromyography before treatment, then underwent a treatment protocol consisting of trigger-point injection of 2 ml of 1% lidocaine. The protocol was repeated once a week for 4 weeks. The clinical responses of the patients were compared 1 week after and 3 months after treatment. The clinical trial is registered with the Brazilian Clinical Trials Registry (REBEC) under RBR-42c6gz (www.ensaiosclinicos.gov.br/rg/RBR-42c6gz/). MAIN OUTCOME MEASURES: Needle electromyography and algometry results and pain reduction. RESULTS: Fifteen patients had abnormal electromyography findings; 14 had normal findings. The rates of response 1 week and 3 months after treatment within the abnormal electromyography group were 95 and 87%, respectively. In the normal group, the rate was 38% both 1 week after and 3 months after treatment. CONCLUSIONS: Trigger points developed after caesarean section, even without clinical symptoms or signs of neuralgia, may originate from neuropathies. Electromyographic abnormalities were associated with pain remission after anaesthesia injection; normal electromyography findings were associated with undiagnosed causes of pain, such as adhesions. TWEETABLE ABSTRACT: Trigger points developed after caesarean section are neuropathies, even in the absence of classical neuralgia.

Long-term investigation of methane and carbon dioxide emissions in two Italian landfills.

Landfills play a key role as greenhouse gas (GHGs) emitters, and urgently need assessment and management plans development to swiftly reduce their climate impact. In this context, accurate emission measurements from landfills under different climate and management would reduce the uncertainty in emission accounting. In this study, more than one year of long-term high-frequency data of CO2 and CH4 fluxes were collected in two Italian landfills (Giugliano and Case Passerini) with contrasting management (gas recovery VS no management) using eddy covariance (EC), with the aim to i) investigate the relation between climate drivers and CO2 and CH4 fluxes at different time intervals and ii) to assess the overall GHG balances including the biogas extraction and energy recovery components. Results indicated a higher net atmospheric CO2 source (5.7 ± 5.3 g m2 d-1) at Giugliano compared to Case Passerini (2.4 ± 4.9 g m2 d-1) as well as one order of magnitude higher atmospheric CH4 fluxes (6.0 ± 5.7 g m2 d-1 and 0.7 ± 0.6 g m2 d-1 respectively). Statistical analysis highlighted that fluxes were mainly driven by thermal variables, followed by water availability, with their relative importance changing according to the time-interval considered. The rate of change in barometric pressure (dP/dt) influenced CH4 patterns and magnitude in the classes ranging from -1.25 to +1.25 Pa h-1, with reduction when dP/dt > 0 and increase when dP/dt < 0, whilst a clear pattern was not observed when all dP/dt classes were analyzed. When including management, the total atmospheric GHG balance computed for the two landfills of Giugliano and Case Passerini was 174 g m2 d-1 and 79 g m2 d-1 respectively, of which 168 g m2 d-1 and 20 g m2 d-1 constituted by CH4 fluxes.

Addressing high cervical cancer rates in the Rio Grande Valley along the Texas-Mexico border: a community-based initiative focused on education, patient navigation, and medical provider training/telementoring.

AIMS: Cervical cancer incidence and mortality rates are approximately 55% higher in the Rio Grande Valley (RGV) along the Texas-Mexico border compared with the average rates in the US. Our aim was to improve cervical cancer prevention efforts in the RGV through a comprehensive multilevel intervention initiative focused on community education, patient navigation, and training of local providers. METHODS: We initiated a program in the RGV which consisted of (1) community education, (2) patient navigation, and (3) a training/mentoring program for local medical providers including hands-on training courses coupled with telementoring using Project ECHO® (Extension for Community Health Outcomes). We assessed the number of women undergoing cervical cancer screening, diagnosis, and treatment at three participating clinics caring for underserved women in the region. RESULTS: From November 2014 to October 2018, 14,846 women underwent cervical cancer screening. A total of 2030 (13.7%) women underwent colposcopy for abnormal results (179% increase over baseline) and 453 women underwent loop electrosurgical excision procedures (LEEPs) for treatment of cervical dysplasia. Invasive cancer was diagnosed in 39 women who were navigated to a gynecologic oncologist for treatment. Seven local medical providers were trained to perform colposcopy and/or LEEP. Project ECHO telementoring videoconferences were held every 2 weeks for a total 101 sessions with an average of 22 participants per session and a total of 180 patient cases presented and discussed. CONCLUSIONS: Our program led to a large number of women undergoing diagnosis and treatment of cervical dysplasia in the RGV. If sustained, we anticipate these efforts will decrease cervical cancer rates in the region. The program is currently being expanded to additional underserved areas of Texas and globally to low- and middle-income countries.

Clinical evaluation of temporomandibular disorders in children and adolescents: a review of the literature.

AIM: The abbreviation TMD (temporomandibular disorders) has been used to signify the variety of symptoms, signs and combinations that have often been assigned to the TMJ (temporomandibular joint) and its related structures (muscles, bone and facial structures). The prevalence of temporomandibular disorders in children and adolescents varies widely in literature. The most common signs and symptoms of TMD are: temporomandibular joint sounds, impaired movement of the mandible, limitation in mouth opening, preauricolar pain, facial pain, headaches and jaw tenderness on function. Many studies have shortcomings in their method of assessing or measuring TMD: the problem is probably due to the fact that temporomandibular disorders have multiple aetiological factors. The aim of this article is a review of the literature about the diagnostic procedures used to assess signs and symptoms of temporomandibular disorders in children and adolescents. MATERIALS AND METHODS: Literature was searched using Medline, Embase, and Cochrane Library from 1992 to February 2008. Only articles written in English were included in the study. The key words and mesh used were: temporomandibular disorders, mandibular dysfunction, children, adolescents. The inclusion criteria were: symptoms and signs of TMD, questionnaire, clinical protocol examination. Clinical studies as well as cross-sectional studies, longitudinal and epidemiological researches were considered. The articles reviewed were grouped according to the diagnostic procedure used. RESULTS: Out of the 37 articles selected, the Helkimo Clinical Dysfunction Index was used in 6 studies (16.22%), the CMI Index in 1 (2.70%), the RCD/TMD in 9 (24.33%) and a clinical protocol examination in 21 (56.75%) articles. CONCLUSION: The review of the literature shows that clinical examination protocols without reproducible items and a measurable and reproducible classification into diagnostic subgroups was the type of investigation used in most of the cases. This ended in a multitude of different results depending on the criteria used and the method of data collection. Such methodological problems should be acknowledged in studies relating to TMD in order to obtain a reliable diagnostic procedure.

Locating and quantifying multiple landfills methane emissions using aircraft data.

A mass balance approach to quantify methane (CH4) emission of four co-located landfills by means of airborne measurements and dispersion modelling was proposed and assessed. By flying grids at different heights above the landfills, atmospheric CH4 densities and wind components were measured along the edges and inside the study atmospheric volume, in order to calculate mass flows in the along- and across-wind directions. A steady-state Gaussian dispersion model was applied to build the concentration fields associated to unit emission from each landfill, while the contribution of each one to the total emission was assessed using a General Linear Model approach, minimizing the difference between measured and modeled mass flows. Results showed that wind spatial and temporal variability is the main factor controlling the accuracy of the method, as a good agreement between measured and modeled mass flows was mainly found for flights made in steady wind conditions. CH4 emissions of the entire area ranged from 213.5 ±â€¯33.5 to 317.9 ±â€¯90.4 g s-1 with a mean value of 252.5 ±â€¯54.2 g s-1. Contributions from individual sources varied from 17.5 to 40.1 g m-2 day-1 indicating a substantial heterogeneity of the different landfills, which differed in age and waste composition. The proposed method was validated against tower eddy covariance flux measurements made at one of the landfills, revealing an overall agreement within 20%.

Perspectives on cervical cancer screening and prevention: challenges faced by providers and patients along the Texas-Mexico border.

BACKGROUND: The Rio Grande Valley (RGV) and Laredo regions located along the Texas-Mexico border consist of seven counties with a population of approximately 1.5 million people and a high uninsured rate (33.5%). Cervical cancer mortality in these border counties is approximately 30% higher than the rest of Texas. The RGV and Laredo areas were studied to better understand the state of access to cervical cancer prevention services along the Texas-Mexico border. METHODS: Data on the population served and the services provided were analyzed to determine the gap between cervical cancer screenings recommended versus those received. Through interviews, we gathered the perspectives of 16 local stakeholders regarding cervical cancer screening for underserved individuals in the region. FINDINGS: It is estimated that 69,139 uninsured women aged 21-64 years in the RGV/Laredo per year are recommended to undergo cervical cancer screening with Papanicolaou (Pap) and/or human papillomavirus (HPV) testing, but only 8941 (12.9%) Pap tests are being performed by the Federally Qualified Health Center (FQHC) serving uninsured women in these regions. Systemic barriers identified include insufficient provider clinical capacity, the high cost of healthcare, and uncertainty about government funding sources. Patient barriers identified include inadequate knowledge on navigating the local healthcare system, low health literacy, lack of money and childcare, an inability to miss work, limited transportation, and fear of deportation. CONCLUSION: Decreasing the disparity between cervical cancer screening services provided and those recommended requires addressing the barriers, identified by local experts, which prevent uninsured women from accessing care. These challenges are being addressed through ongoing programs and collaborations.

Aflatoxin B1 contamination in maize in Europe increases due to climate change.

Climate change has been reported as a driver for emerging food and feed safety issues worldwide and its expected impact on the presence of mycotoxins in food and feed is of great concern. Aflatoxins have the highest acute and chronic toxicity of all mycotoxins; hence, the maximal concentration in agricultural food and feed products and their commodities is regulated worldwide. The possible change in patterns of aflatoxin occurrence in crops due to climate change is a matter of concern that may require anticipatory actions. The aim of this study was to predict aflatoxin contamination in maize and wheat crops, within the next 100 years, under a +2 °C and +5 °C climate change scenario, applying a modelling approach. Europe was virtually covered by a net, 50 × 50 km grids, identifying 2254 meshes with a central point each. Climate data were generated for each point, linked to predictive models and predictions were run consequently. Aflatoxin B1 is predicted to become a food safety issue in maize in Europe, especially in the +2 °C scenario, the most probable scenario of climate change expected for the next years. These results represent a supporting tool to reinforce aflatoxin management and to prevent human and animal exposure.

The synthesis of 2,3-dideoxy-2-fluoro-3-C-methylpentose-containing nucleosides via [3,3]-sigmatropic rearrangements.

[3,3]-Sigmatropic rearrangement of in situ-formed [O,O]-silyl ketene acetals of butenyl fluoroacetates was used as the key step in the synthesis of racemic 2,3-dideoxy-2-fluoro-3-C-methylpentofuranoses. The product pentofuranoses were transformed further into pyrimidine and purine nucleosides. The conformations of the synthetic carbohydrates were confirmed by single-crystal X-ray diffraction studies and indicated that previous structural assignments made by NMR were in error.

Allium chemistry: synthesis, natural occurrence, biological activity, and chemistry of Se-alk(en)ylselenocysteines and their gamma-glutamyl derivatives and oxidation products.

Syntheses are reported for gamma-glutamyl Se-methylselenocysteine (Sa), selenolanthionine (16), Se-1-propenylselenocysteine (Gd), Se-2-methyl-2-propenyl-L-selenocysteine (6e), and Se-2-propynyl-L-selenocysteine (6f). Oxidation of 8a and Se-methylselenocysteine (Ga) gives methaneseleninic acid (24), characterized by X-ray crystallography, and dimethyl diselenide (25). Oxidation of Se-2-propenyl-L-selenocysteine (6c) gives allyl alcohol and 3-seleninoalanine (22). Compound 22 is also formed on oxidation of 16 and selenocystine (4). Oxidation of 6d gives 2-[(E,Z)-1-propenylseleno]propanal (36). These oxidations occur by way of selenoxides, detected by chromatographic and spectroscopic methods. The natural occurrence of many of the Se-alk(en)ylselenocysteines and their gamma-glutamyl derivatives and oxidation products is discussed. Three homologues of the potent cancer chemoprevention agents 6a and 6c, namely 6d-f, were evaluated for effects on cell growth, induction of apoptosis, and DNA-damaging activity using two murine mammary epithelial cell lines. Although each compound displays a unique profile of activity, none of these compounds (Gd-f) is likely to exceed the chemopreventive efficacy of selenocysteine Se-conjugates Ga and 6c.

[Endoscopic study in reflux esophagitis. Our experience]. / L'indagine endoscopica nell'esofagite da reflusso. Nostra esperienza.

One hundred twenty one cases of oesophagitis by gastroesophageal reflux were observed through a retrospective study of 1250 endoscopies of the upper digestive tract. The oesophagitis was staged according to Savary-Miller classification. The prevalence (93.3%) of cases were in I and II stage. The Authors found that the most frequent associated diseases with oesophagitis by gastroesophageal reflux were: hiatal hernia, gastric and duodenal peptic disorders, gastric resection according Billroth II and biliary disorders. In 86.7% of cases, endoscopic diagnosis was confirmed by histological findings. From these data and from those reported in literature the authors can ascertain that endoscopy, associated with histological findings has an important role in diagnosing oesophagitis and in monitoring medical and surgical treatment used.

The personality to buffer burnout.

Critical care nurses encounter stressful events daily. What makes some nurses more apt to buffer such stressors and thus avoid the phenomenon known as burnout? This research study offers insight into burnout, hardiness, and intercorrelations between the two variables.

[Echographic study of cryptorchidism]. / L'indagine ecografica nel criptorchidismo.

The authors, after a nosologic review of cryptorchidism, illustrate their positive diagnostic experience with ultrasound. Limits as well as clinical advantages, in relation to the diagnosis and follow-up, are also described.

Methane and carbon dioxide fluxes and source partitioning in urban areas: the case study of Florence, Italy.

Long-term fluxes of CO(2), and combined short-term fluxes of CH(4) and CO(2) were measured with the eddy covariance technique in the city centre of Florence. CO(2) long-term weekly fluxes exhibit a high seasonality, ranging from 39 to 172% of the mean annual value in summer and winter respectively, while CH(4) fluxes are relevant and don't exhibit temporal variability. Contribution of road traffic and domestic heating has been estimated through multi-regression models combined with inventorial traffic and CH(4) consumption data, revealing that heating accounts for more than 80% of observed CO(2) fluxes. Those two components are instead responsible for only 14% of observed CH(4) fluxes, while the major residual part is likely dominated by gas network leakages. CH(4) fluxes expressed as CO(2) equivalent represent about 8% of CO(2) emissions, ranging from 16% in summer to 4% in winter, and cannot therefore be neglected when assessing greenhouse impact of cities.

Locating industrial VOC sources with aircraft observations.

Observation and characterization of environmental pollution, focussing on Volatile Organic Compounds (VOCs), in a high-risk industrial area, are particularly important in order to provide indications on a safe level of exposure, indicate eventual priorities and advise on policy interventions. The aim of this study is to use the Solid Phase Micro Extraction (SPME) method to measure VOCs, directly coupled with atmospheric measurements taken on a small aircraft environmental platform, to evaluate and locate the presence of VOC emission sources in the Marghera industrial area. Lab analysis of collected SPME fibres and subsequent analysis of mass spectrum and chromatograms in Scan Mode allowed the detection of a wide range of VOCs. The combination of this information during the monitoring campaign allowed a model (Gaussian Plume) to be implemented that estimates the localization of emission sources on the ground.

Reconstruction of the orbital floor with the muscle-bone flap (temporal muscle with coronoid process).

Various techniques for the reconstruction of the orbital floor are available when resecting the portion of the maxilla which includes the orbital floor. A composite muscle-bone flap of temporal muscle and coronoid process fills the defect satisfactorily and provides good support for the globe.