[Safety and electromagnetic compatibility in sanitary field]. / Sicurezza e compatibilità elettromagnetica in ambito ospedaliero.

In sanitary field and especially in a hospital, multiple sources of non ionizing radiation are used for diagnostic and therapeutic aims. In sanitary sector both workers and users are present at the same time, and in some cases general population could need higher protection than workers in relationship to the exposition to electromagnetic fields. In order to protect health and safety of patients, general population and workers of hospitals and with the aim to identify, analyze, evaluate and study its level of significance, electrical, magnetic and electromagnetic sources Research Italian project Si.C.E.O. (Safety And Electromagnetic Compatibility In Sanitary Field) was instituted. Target of our research project was to deepen risk of exposition elements with analysis of outdoor (e.g. power lines, transmission cabinets) and indoor (e.g. equipment for physical therapy) sources, located in sanitary structures and to verify the level exposition of workers and common population end the respect of specific regulation, and finally to define technical and organizational measures really useful for protection and reduction of risk.

Real-World Evidence of Efficacy and Safety of Levonadifloxacin (Oral and IV) in the Management of Acute Bacterial Skin and Skin Structure Infections (ABSSSI): Findings of a Retrospective, Multi-Center Study.

Background Antimicrobial resistance by bacteria poses a substantial threat to the success in the treatment of acute bacterial skin and skin structure infections (ABSSSI). Levonadifloxacin is a novel benzoquinolizine subclass of quinolone which has a broad spectrum of activity, available in both oral and intravenous formulations for the treatment of skin structure infections caused by Gram-positive pathogens including methicillin-resistant Staphylococcus aureus (MRSA). Patients and methods This prescription event monitoring study captured data of 227 patients receiving levonadifloxacin (oral and/or IV) in a real-world setting to assess the safety and efficacy in the treatment of ABSSSI. Study outcomes were a clinical and microbial success at the end of therapy and safety was assessed based on adverse events reported. Results One hundred and forty patients received IV levonadifloxacin therapy, 76 patients received oral alalevonadifloxacin, and 11 received IV followed by oral therapy. The mean duration of therapy was 7.3 days. Out of 227 patients, MRSA isolates were identified in 79 patients. Clinical success rates with oral, IV, and IV followed by oral levonadifloxacin therapy were 97.3%, 97.8%, and 100% respectively. The overall microbial success rate was 99.2% and only two patients reported two adverse events. Conclusions The excellent safety and efficacy profile of levonadifloxacin on oral and/or intravenous therapy, makes it a desirable treatment modality for management of ABSSSI. Unique features of levonadifloxacin such as availability of both IV and oral form, minimal drug-drug interactions, exemption from dosage adjustment in renal and hepatic impaired patients and a broad spectrum of coverage, makes it a suitable agent meeting several unmet clinical needs in contemporary patients.

Performance of ophthalmic artery Doppler velocimetry in the complementary diagnosis of preeclampsia.

OBJECTIVES: To calculate the accuracy (A) and establish the best cutoff value for ophthalmic artery (OA) Doppler velocimetry indexes in patients diagnosed with preeclampsia (PE), compared with healthy pregnant women. METHODS: This prospective experimental study enrolled 268 women: 133 with PE and 135 healthy pregnant women. All patients were evaluated by OA Doppler sonography, bilaterally, to assess their pulsatility index (PI), resistance index (RI), peak systolic velocity (PVS), second peak systolic velocity (P2), end-diastolic velocity (EDV), and peak ratio (PR). Means were compared using Student's T-test. Receiver Operating Characteristics (ROC) curve was used to establish the cutoff value and estimate the sensitivity (S), specificity (Sp), accuracy (A) of all variables, and a significance of 95% was adopted. RESULTS: ROC curve analysis showed that P2 and PR were superior to the other parameters for PE diagnosis. We tested two cutoff values: (1) using PR ≥0.70, obtained A: 88.72%, S: 81.95%, and Sp: 95.48% and (2) using PR ≥0.75, and A: 86.24%, S: 74.43%, and Sp: 99.24%. By adopting P2 ≥ 21.5 cm/s, we obtained A: 87.59%, S: 84.96%, and Sp: 90.22% and when the cutoff point was P2 ≥ 22 cm/s, there was a slight decrease in A to 86.46% and S to 81.20%, with Sp: 91.89.3%. CONCLUSION: Ophthalmic artery Doppler demonstrated to be an effective and high-performance imaging method for the diagnosis of PE and the indexes P2 and PR demonstrated superior accuracy to the other Doppler parameters assessed. Higher performance occurred when the cutoff values with greater specificity were adopted, PR ≥ 0.75 and P2 ≥ 22 cm/s, considering that the proposed OA Doppler is to be a complementary method for preeclampsia.

Left atrial speckle tracking echocardiography in clinically healthy dogs: Variability and prediction intervals.

Left atrial (LA) speckle tracking echocardiography (STE) provides indices of LA deformation such as strain and strain rate. These variables offer useful clinical information in human and canine patients with cardiac disease. At present, reference ranges for LA STE variables in dogs are scarcely established and, due to variability among centers, they cannot be accepted worldwide. The present study aimed to provide normal ranges for LA strain and strain rate variables in clinically healthy dogs, and to evaluate the effect of clinical parameters such as bodyweight. Eighty clinically healthy dogs served as the study population. Left atrial STE was feasible in all dogs and agreement within and between observers was clinically acceptable for most of the variables, in particular strain variables. Age, sex, and heart rate did not affect LA STE. Bodyweight was negatively correlated with strain variables and positively correlated with diastolic strain rate variables and the relationship was allometric. Bodyweight-based vendor-dependent prediction intervals for LA STE variables in clinically healthy dogs could aid the evaluation of LA function in clinical practice.

Holocene evolution of Portus Pisanus, the lost harbour of Pisa.

The ancient harbour of Pisa, Portus Pisanus, was one of Italy's most influential seaports for many centuries. Nonetheless, very little is known about its oldest harbour and the relationships between environmental evolution and the main stages of harbour history. The port complex that ensured Pisa's position as an economic and maritime power progressively shifted westwards by coastal progradation, before the maritime port of Livorno was built in the late 16th century AD. The lost port is, however, described in the early 5th century AD as being "a large, naturally sheltered embayment" that hosted merchant vessels, suggesting an important maritime structure with significant artificial infrastructure to reach the city. Despite its importance, the geographical location of the harbour complex remains controversial and its environmental evolution is unclear. To fill this knowledge gap and furnish accurate palaeoenvironmental information on Portus Pisanus, we used bio- and geosciences. Based on stratigraphic data, the area's relative sea-level history, and long-term environmental dynamics, we established that at ~200 BC, a naturally protected lagoon developed and hosted Portus Pisanus until the 5th century AD. The decline of the protected lagoon started at ~1350 AD and culminated ~1500 AD, after which time the basin was a coastal lake.

[Pompe's disease: the role for early diagnosis and treatment]. / Malattia di Pompe: efficacia di una diagnosi precoce.

Pompe's disease (PD) is a glycogen storage disease characterized by the deposition of glycogen within body cells. This may lead to severe cardiac hypertrophy, with heart failure. The authors describe a female infant with PD, who developed severe cardiac hypertrophy, and was treated with recombinant human enzyme replacement therapy. This approach led to a progressive reduction of the heart hypertrophy, with improvement of the clinical condition.

Cation distribution in LiMgVO4 and LiZnVO4: structural and spectroscopic study.

The room temperature cation occupancy in LiMgVO(4) and LiZnVO(4) crystallographic sites is obtained by means of the combined use of X-ray powder diffraction (XRPD), (7)Li and (51)V magic angle spinning nuclear magnetic resonance (MAS NMR), and micro-Raman measurements. In the LiMgVO(4) Cmcm orthorhombic structure, the 4c (C(2)(v) symmetry) tetrahedral vanadium site is fully ordered; on the contrary, the Li 4c tetrahedral site and the 4b (C(2)(h) symmetry) Mg octahedral site display about 22% of reciprocal cationic exchange. Higher cationic disorder is observed in LiZnVO(4): the three cations can distribute on the three tetrahedral and distinct sites of the R-3 structure. XRPD and MAS NMR analysis results highly agree for what concerns vanadium ion distribution on the three cationic sites (about 25, 26, and 47%). From the full profile fitting of XRPD patterns with the Rietveld method, it is also obtained that Li(+) displays a slightly preferred occupation of the T1 position (approximately 55%) and Zn(2+) of the T2 position (approximately 46%). The vibrational spectra of the two compounds are characterized by different peak positions and broadening of the Raman modes, reflecting the cation distribution and the local vibrational unit distortion. A comparison is also made with recent Raman results on Li(3)VO(4). High temperature XRPD measurements rule out possible structural transitions up to 673 K for both compounds.

Structural and spectroscopic properties of pure and doped Ba6Ti2Nb8O30 tungsten bronze.

Pure and doped Ba(6)Ti(2)Nb(8)O(30) (BTN), obtained by substituting M = Cr, Mn, or Fe on the Ti site (Ba(6)Ti(2-x) M(x)Nb(8)O(30), x = 0.06 and 0.18) and Y and Fe on the Ba and Ti sites, respectively (Ba(6-x)Y(x)Ti(2-x)Fe(x)Nb(8)O(30), x= 0.18), are synthesized. The influence of cation doping on the local structure, the cation oxidation state, and the possible defect formation able to maintain the charge neutrality are investigated by spectroscopic (electron paramagnetic resonance (EPR) and micro-Raman), structural (X-ray powder diffraction) and transport (impedance spectroscopy, thermoelectric power) measurements, in the temperature range of 300-1200 K in air and N(2) flow. Starting from the valence state of the doping ions (Fe(3+), Cr(3+), and Mn(2+)), determined by EPR, and from thermoelectric power measurements, evidencing a negative charge transport, different charge-compensating defect equilibria, based on the creation of positive electron holes or oxygen vacancies and electrons, are discussed to interpret the conductivity results.

Transport and structural properties of pure and Cr doped Li3VO4.

This study deals with the effects of 5 and 10% chromium additions on the transport and structural properties of Li3VO4. The Cr substitution is easily obtained without impurity phases and does not affect the room- and high-temperature host crystal structure, as evidenced by X-ray powder diffraction and micro-Raman analysis. The EPR signals are interpreted in terms of quantified amounts of Cr ions in 5+ and 3+ valence states. Suitable 7Li and 51V MAS NMR spectra simulations agree with the EPR results about the relative amount of Cr5+ and Cr3+ ions substituted in V5+ and Li+ sites, respectively. The Cr3+ presence on Li site, also suggested by Raman results and Rietveld refinements, requires Li vacancies to maintain the charge neutrality. The p-type conductivity, suggested by the positive thermoelectric power coefficients, significantly increases by the cation doping up to an order of magnitude.

An electrical model of biological tissues undergoing hyperaemia.

Tissue hyperaemia is a physiological consequence of the temperature increase that follows, for example, the absorption of electromagnetic or ultrasound power in clinical diathermy. Diathermy, as well as other physical therapies (for example massotherapy), affects the local blood content of tissues through various mechanisms (vasoconstriction/dilatation, opening/closing of precapillary sphincters). A method for evaluating hyperaemia in superficial and medium-depth tissues has been recently proposed, which is based on four-electrode impedance measurements. A microcirculation model has also been developed to describe the hyperaemic effects of local diathermic therapy. This paper describes an electrical model of the tissues in hyperaemic conditions which allows us to correlate electrical impedance measurements to microcirculation modifications.

Hyperaemia evaluation in clinical diathermy by four-electrode impedance measurements.

The four-electrode electrical impedance measurement technique is proposed for the evaluation of the hyperaemia variation in tissues treated by diathermic therapy. An impedance meter suitable for such measurements is described, and an electrical model of the heated tissues, concerning the impedance variation during diathermy and its relation with hyperaemia, is presented. The occurrence of the substantial contribution of blood to the overall transverse impedance is demonstrated by comparing the experimental results with those arising from a 2D electrical/thermal model of the treated tissues. A two-admittance model is proposed to explain the electrical behaviour of the tissues treated by diathermy. The model allows us to separate the impedance violation due to the temperature dependence of tissue conductivity from that due to the change of tissue blood content. The results of preliminary measurements of tissue impedance on healthy volunteers treated by electromagnetic diathermy are presented and discussed, showing the feasibility of impedance detection of hyperaemia variations inside tissues.

Polymorphism of rac-5,6-diisobutyryloxy-2-methylamino-1,2,3,4-tetrahydro-naphthalene hydrochloride (CHF 1035). I. Thermal, spectroscopic, and X-ray diffraction properties.

The polymorphism of rac-5,6-diisobutyryloxy-2-methylamino-1,2,3,4-tetrahydro-naphthalene hydrochloride (CHF 1035) was investigated. Three different crystal forms (Form I, Form II, and Form III) were obtained by recrystallization procedures from common organic solvents. The polymorphs were characterized by Raman and carbon-13 nuclear magnetic resonance ((13)C NMR) spectroscopy, in solution and in solid state (cross polarization-magic angle spinning), powder X-ray diffractometry, and thermal methods (differential scanning calorimetry, hot stage microscopy, and thermogravimetry). Moreover, the diffraction patterns of Form I, collected at controlled temperatures, gave evidence of the presence of two reversible structural rearrangements at approximately 60 and approximately 75 degrees C. These structural variations were confirmed by the results obtained by differential scanning calorimetry and hot stage microscopy techniques. The analysis of the Raman spectra allowed the identification of peculiar absorption bands for each polymorph. Form III was the stable crystal form at room temperature as determined by the basis of slurry conversion method.

High permittivity patch radiator for single and multi-element hyperthermia applicators.

This paper describes a compact, low-profile patch radiator which is the base element for efficient, small-size applicators suitable for superficial hyperthermia. The design criteria and the technological processes involved are presented. The electromagnetic characteristics of the patch element are outlined, and possible application of the radiator are discussed.

Long-term outcome after senning operation for transposition of the great arteries.

BACKGROUND: The Senning operation for transposition of the great arteries (TGA) was first introduced by Senning in 1959 and was revived by Quaegebeur et al. in the late 1970s, thus becoming the intervention of choice for the correction of TGA in many centers. HYPOTHESIS: The purpose of this study was to evaluate the long-term follow-up of a group of patients undergoing surgery with the Senning procedure for TGA. METHODS: From November 1978 to November 1987, 73 consecutive patients underwent the Senning operation. The 70 survivors had an average follow-up of 19 years (16-25 years). RESULTS: (1) Cardiac rhythm: with time there was a progressive decrease in stable sinus rhythm (60% after 20 years) and a progressive increase of supraventricular tachyarrhythmias requiring therapy (10% after 20 years). (2) Right ventricular function: 20% of the patients had reduced ejection fraction. (3) Late mortality: in the last 12 years of follow-up years there were two sudden deaths (2.8%). (4) Functional status: 80% of patients were in NYHA class I, 17% in class II, and 3% in class III. CONCLUSIONS: Our results confirm that the patients who undergo the Senning procedure have a progressive loss of sinus rhythm, an increase in active arrhythmias, and other important adverse outcomes such as late sudden death and a decrease in right ventricular function; however, most patients (93% in our series) are alive and in good functional status.

Control of the physical parameters in local electromagnetic hyperthermia.

The evaluation of the clinical results in experimental applications of local electromagnetic hyperthermia requires strict control of the physical parameters of the treatment and adhesion to close medical protocols. Development and application processes in close cooperation between physicians and electromagnetic experts are reported and discussed, on the basis of experimental and theoretical research work. Attention is concentrated on a 434 MHz apparatus, where the fundamental physical limits have been identified and the operating features in the clinical practice have been evaluated. The cases eligible for treatment were chosen according basically to the limitations posed by depth, volume and steep temperature gradients. Several cases are reported mainly in association with radiotherapy. Lines of technical improvement are suggested, mainly based on the development and optimization of lower-frequency applicators.

Connective tissue regeneration after laser-CO2 therapy.

The ultrastructural pattern of fibroblasts involved in the healing process of laser-treated tissues has been investigated. This study has been performed on the uterine cervix, the epithelial abnormalities of which are frequently treated by laser. Observations carried out immediately and two and seven days after treatment, have demonstrated that: fibroblasts show an active and almost uniform pattern; myofibroblasts are not present; and macrophages are limited in number. This healing process is interpreted as a proliferative pattern of the connective tissue which differs from that of some benign tumors and of healing wounds.

[Evolution of pregnancy in 14 patients with lupus nephropathy]. / Evoluzione della gravidanza in 14 pazienti con nefropatia lupica.

Authors have examined 14 pregnant patients with renal involvement by systemic lupus erythematosus. Variations in blood creatinine, proteinuria and blood pressure were considered in the prepregnancy, pregnancy and postpartum periods in relation to the histologic results of renal biopsy and obstetric outcome.

Transcatheter closure of patent foramen ovale in patients with cryptogenic stroke.

BACKGROUND: About 50% of patients with cryptogenic stroke have a patent foramen ovale (PFO). The recurrence rate of paradoxical embolism is higher if a PFO is detected. METHODS: Thirty-five patients with PFO and > or = 1 thromboembolic event due to paradoxical embolism were included in the study (23 males, 12 females, mean age 47.8 +/- 14 years, mean weight 75 +/- 15 kg). Twenty-three patients had a transient ischemic attack whereas 12 experienced an ischemic stroke. Twenty-nine patients had one thromboembolic event, 4 patients had two thromboembolic events, and 2 patients had three thromboembolic events. The implantation procedure was performed, as previously reported, under general anesthesia, fluoroscopic guidance and during transesophageal echocardiography. RESULTS: The implantation procedure was successful in all patients. There were no complications related to the procedure. Four different devices were implanted (Amplatzer 3 patients; Cardioseal 12 patients; Starflex 12 patients, PFO Star 8 patients). The procedure time and fluoroscopic time were 50 +/- 21.8 and 12.2 +/- 8.3 min respectively. At transesophageal echocardiography performed after the procedure, 11 patients had a trivial shunt. None of the patients had a residual shunt at 1 month of follow-up. The mean follow-up was 12.3 +/- 8 months (median 11.0 months, range 3-37 months). In no patient did recurrence of a thromboembolic event occur during follow-up. CONCLUSIONS: Percutaneous PFO closure is a feasible and safe technique for the prevention of recurrent paradoxical embolism.

Electromagnetic field monitoring and control systems: state-of-the-art and work-in-progress.

The development of EMF monitoring and control systems unquestionably represents one of the major innovations in the range of methodologies for evaluating, through measurement, the so-called environmental electromagnetic pollution. The interest recently shown by ARPA and municipal and provincial councils for setting up electromagnetic field monitoring and control systems has created significant developments in the field under examination. This paper attempts to provide a complete overview of the technical possibilities provided by electromagnetic field monitoring and control systems in the environment and their possible applications. Equipment currently available and under development is described, as well as the most significant work-in-progress in this sector. In the near future, several monitoring systems will be proposed and set up by municipalities and provinces, or directly by telecommunications companies. For this reason, it is more than ever necessary that agreement be reached at a national level to define a unified methodological and operating approach to enable monitoring data from different sources to be compared.

[Peristomal laparocele: particular indications for the use of prosthetic materials]. / Il laparocele peristomale: una indicazione particolare all'utilizzazione di materiali protesici.

The authors report the case of a female patient suffering from colic neoplasm and a vast peristomal laparocele, the long-term outcome of a rectal amputation that the patient underwent at a young age. After colic resection, a vast area of surgical mesh in dacron was modelled and positioned in a retromuscular scat, thus allowing the hernia pathology to be resolved relatively simply, owing to its particular location-in correspondence with a preternatural anus-until not long ago this would have represented an absolute contraindication to the use of prosthetic materials. A precise surgical approach, marked by a scrupulous respect for aseptic conditions, is essential in these circumstances owing to the persistent risk of septic complications.