Cardiovascular risk and the COVID-19 pandemic: A retrospective observational study in a population of healthcare professionals.

BACKGROUND AND AIM: To contain the spread of COVID-19, many countries imposed several restrictive measures, leading to radical changes in daily life behaviors. Healthcare workers experienced additional stress due to the increased risk of contagion, possibly causing an increase in unhealthy habits. We investigated changes in cardiovascular (CV) risk assessed by the SCORE-2 in a healthy population of healthcare workers during the COVID-19 pandemic; an analysis by subgroups was also conducted (sportspeople vs sedentary subjects). METHODS AND RESULTS: We compared medical examination and blood tests in a population of 264 workers aged over 40, performed yearly before (T0) and during the pandemic (T1, T2). We found a significant increase in the average CV risk, according to SCORE-2, during the follow-up in our healthy population, with a shift from a mean low-moderate risk profile at T0 (2.35%) to a mean high-risk profile at T2 (2.80%). Furthermore, in sedentary subjects was observed a greater and early increase in SCORE-2 compared to sportspeople. CONCLUSIONS: Since 2019, we observed an increase in CV risk profile in a healthy population of healthcare workers, particularly in sedentary subjects, highlighting the need to reassess SCORE-2 every year to promptly treat high-risk subjects, according to the latest Guidelines.

Increased fibulin-1 plasma levels in polycystic ovary syndrome (PCOS) patients: possible contribution to the link between PCOS and cardiovascular risk.

PURPOSE: To investigate a possible relation between fibulin-1 plasma levels and PCOS. DESIGN: ELISA quantitative determination of human fibulin-1. METHODS: 50 women with PCOS and 40 control patients who attended the Unit of Human Reproductive Pathophysiology, Università Cattolica del Sacro Cuore, Rome, were enrolled. Ultrasonographic pelvic examinations, hormonal profile assays, oral tolerance test OGTT, lipid profile and ELISA quantitative determination of human fibulin-1 were performed. RESULTS: Fibulin-1 levels were found to be statistically significantly higher in PCOS patients than in matched control women. No statistically significant positive correlation was found between fibulin-1 and AUCi, HOMA-IR, total cholesterol, LDL, AMH, androstenedione and FAI, whereas a statistically significant positive correlation was found between fibulin-1 and 17OHP (p = 0.016) in the PCOS group. However, multivariable linear regression analysis showed that 17 OH P did not independently predict fibulin-1 levels (p = 0.089). CONCLUSIONS: Our data could contribute to explain the hypothesized increased cardiovascular risk and vascular damage in patients with PCOS. A better understanding of the cellular and molecular mechanisms involved in cardiometabolic disorders associated with PCOS is mandatory to identify new therapeutic strategies to eventually prevent the progression of cardiovascular diseases in these patients.

"Hormone of darkness" and human reproductive process: direct regulatory role of melatonin in human corpus luteum.

PURPOSE: To investigate the possible role of melatonin on human luteal cell function. METHODS: Corpora lutea were obtained from normally menstruating women (25-38 years old) in the midluteal phase (days 5-6 from ovulation) at the time of surgery for non-endocrine gynecologic diseases. The protocol was approved by the institutional review board of Università Cattolica del Sacro Cuore in Rome and all patients provided written informed consent. The corpora lutea were dated on the basis of the presumptive day of ovulation (day 0) , determined by urinary luteinizing hormone (LH) peak, ultrasound detection of corpus luteum or disappearance of the dominant follicle, and a rise in the plasma P concentration. ELISA or EIA kit and immunohistochemistry were performed. RESULTS: Melatonin was able to increase progesterone release and to influence the balance between luteotrophic and luteolityc factors. In addition, melatonin expression and MT2 receptor were detected, confirming the direct action of this indoleamine on CL. CONCLUSIONS: Melatonin may play an intriguing role in direct regulation of CL function and in establishing and maintaining of initial pregnancy. In conclusion, melatonin could become a relevant medication for improving ovarian and luteal function and in the early stages of pregnancy, opening new opportunities for the management of several ovarian-luteal and pregnancy diseases.

A cost-reducing extracorporeal membrane oxygenation (ECMO) program model: a single institution experience.

BACKGROUND: The worldwide demand for ECMO support has grown. Its provision remains limited due to several factors (high cost, complicated technology, lack of expertise) that increase healthcare cost. Our goal was to assess if an intensive care unit (ICU)-run ECMO model without continuous bedside perfusionists would decrease costs while maintaining patient safety and outcomes. METHOD: A new ECMO program was implemented in 2010, consisting of dedicated ICU multidisciplinary providers (ICU-registered nurses, mid-level providers and intensivists). In year one, we introduced an education platform, new technology and dedicated space. In year two, continuous bedside monitoring by perfusionists was removed and new management algorithms designating multidisciplinary providers as first responders were established. The patient safety and cost benefit from the removal of the continuous bedside monitoring of the perfusionists of this new ECMO program was retrospectively reviewed and compared. RESULTS: During the study period, 74 patients (28 patients in year 1 and 46 patients in year 2) were placed on ECMO (mean days: 8 ± 5.7). The total annual hospital expenditure for the ECMO program was significantly reduced in the new model ($234,000 in year 2 vs. $600,264 in year 1), showing a 61% decrease in cost. This cost decrease was attributed to a decreased utilization of perfusion services and the introduction of longer lasting and more efficient ECMO technology. We did not find any significant changes in registered nurse ratios or any differences in outcomes related to ICU safety events. CONCLUSION: We demonstrated that the ICU-run ECMO model managed to lower hospital cost by reducing the cost of continuous bedside perfusion support without a change in outcomes.

Could antispasmodic drug reduce pain during hysterosalpingo-contrast sonography (HyCoSy) in infertile patients? A randomized double-blind clinical trial.

OBJECTIVE: To assess the effectiveness of an antispasmodic drug, hyoscine-N-butylbromide, in reducing pain during hysterosalpingo-contrast sonography (HyCoSy). METHODS: Eight hundred and sixteen patients undergoing HyCoSy were randomized to receive 10 mg hyoscine-N-butylbromide (n = 408) or placebo (n = 408) per os, 30 min before the procedure, in a double-blind randomized controlled trial. Immediately after the procedure, the patient was asked to describe any pain experienced in comparison with pain usually suffered during the menstrual cycle, and the operator assigned a pain score between 0 and 4 as follows: 0 (no reaction or discomfort), 1 (slight pain, less than menstrual pain), 2 (moderate pain, exceeding menstrual cramps but no vasovagal reaction), 3 (vasovagal reaction or pain requiring observation in a hospital) and 4 (vasovagal reaction or pain requiring resuscitation). The primary aim was to estimate the difference in pain score, considered as a categorical value, between the active arm of the trial and the control group. The secondary aim was to evaluate if pain is related to tubal patency. RESULTS: There was no difference in pain score between the hyoscine-N-butylbromide group and the placebo group (P = 0.807). There was a negative correlation between pain and tubal patency, regardless of treatment group (P < 0.0001). CONCLUSIONS: Administration of 10 mg antispasmodic drug hyoscine-N-butylbromide does not reduce pain in patients undergoing HyCoSy.

Comparative FE biomechanical and microbial adhesion analyses on an implanted humerus.

Objective: In this study a multi fragment humeral fracture, treated with locking plate system implant, was investigate and compared with a healthy humerus by the mining of a Finite Element (FE) analysis. Locking plate implant, in this case AxSOS 3® Titanium produced by Stryker is the preferred solution in presence of multiple fracture or osteoporosis. Methods: Loading conditions were imposed by rotating of 52,5° respect the vertical axe, both the humeri (healthy and fractured), fixing distal end, and loading the top of bones with a vertical force of 543 N (Newton). This finite element analysis aimed to compare stability of implanted humerus, implant-bone interface, stress shielding, with those related to a healthy one. A microbial adhesion analysis was also performed on the implant's material. Results: Results obtained by FE analysis confirm a good agreement of the mechanical behavior of the models tested. The maximum values of the registered stressed, are of about 45 MPa (Mega Pascal) for the intact humerus and 113 MPa for the fractured one. Displacements, confirm higher values on the fractured humerus and no viable bacteria were found after microbial adhesion analyses.Conclusion: comparison between healthy and fractured humerus showed an optimal stability of the implant, when contact surfaces optimization and screws insertion are correctly performed.

[Laparoscopic treatment of abdominal wall hernias: prosthesis material comparison]. / Trattamento laparoscopico delle ernie della parete addominale: confronto fra i materiali protesici.

Hernia is due to abdominal wall weakening. This allows the contents of the abdomen to protrude from normal boundaries. Hernias are repaired by implanting a sterile surgical mesh to strengthen the weakened abdominal wall. Aim of this study is to compare the results obtained by bard Composix® L/P mesh or Dualmesh Plus Gore® implanting. The mesh has various beneficial characteristics. It is a reinforcing material for the abdominal wall, even when in the direct contact with the intestinal tract does not cause adhsion problems. The use of biocompatible materials is necessary in laparoscopic hernia repair. e-PTFE prosthesis and Dual Mesh® were the first to be used for laparoscopic treatment of the abdominal wall defects. These prosthesis are the result of many improvements, actually they are 1-mm thick and the two surfaces have different characteristics. Compound meshes are composed by e-PTFE and polypropylene with different percentage of the two materials and methods of interactions. The incidence of early complications were poor in relation to both types of implants, only seroma cases e-PTFE treated showed a prevalence of complication, in agreement with literature. About relapses in our experience we found that e-PTFE cases were predominantly. Dual Mesh® has better adaptability than Bard Composix®, which allows easier placement of the prosthesis as well as a better adaptation to the wall surface. The Bard Composix®, thanks to rigidity due to the polypropylene component has better handling than the Dual Mesh®, as it promotes a rapid and easy deployment of the prosthesis inside the abdominal cavity, favoring its positioning. The use of both prosthesis depends also on the experience specific to each operator, moreover, a rigorous surgical technique remains fundamental for the application of the mesh used.

[Management of early rectal cancer: our clinical experience]. / Trattamento dell'early rectal cancer: la nostra esperienza.

AIM: Patients with early rectal cancer (ERC) limited to the mucosa and submucosa does not present cytological or histological high risk features such as poorly differentiated cells, vascular and neural invasion, presence of mucinous histology and tumor ulceration. In these patients, local excision of rectal tumors preserves anal continence, bladder and sexual functions and achieves the same oncological results. In T1 patients, local excision is feasible because the curative rate is high (90/95%) and the risk of recurrence that is low ( 5/10%) as reported in the literature. Aim of this study is to carry out the best clinical choice in patients ERC affected. We have examined patologic, laboratory exams and surgical technique performed. PATIENTS AND METHODS: From January 2004 to July 2009, 16 patients with rectal cancer were studied at the General Surgery and Oncology Department of Catania University. The middle size of the cancers at the implantation site were 3,4 cm (range: 3-5). The average distance from the anus were 5,8 cm (range: 4,5-10). The cancers were presented vegetanting and movable on the muscle surfaces below. RESULTS: Istological exams pointed out pT1 neoplasia confined in submucosa in 13 patients, and in 3 patients pT2 neoplasia with a muscularis mucosae involvement. Istological grading found out G1 neoplasia in 9 cases and G2 in 7. Discussion. Low rectal cancers diagnosed in T1 stage necessitate an accurate preoperatory staging. Local exeresis can be a real alternative to traditional surgery. In these patients neoplasia exeresis can assure 5 years more survival in 85% of patients. CONCLUSION: Local exeresis is a validate surgical way but is however necessary that istological exam confirms surgical oncology criteria. Must be confirmed that neoplasia is T1 with 1mm resection margin at least,differentiation G1-G2 and no venous or lymphatic infiltrations.

Intra-Operative Contrast Cholangiography in Living Donor Liver Transplantation: The ISMETT Experience.

BACKGROUND: We evaluated the clinical impact of donor biliary anatomy discrepancies (DBAD) achieved by comparing pre-operative evaluation obtained with magnetic resonance (MR)/magnetic resonance cholangiopancreatography (MRCP) imaging, with intra-operative cholangiography (IOC) on the living related liver donor (LDLT) and recipient. METHODS: This single-center, retrospective study included 97 consecutive adult-to-adult (A2A) LDLT performed in our hospital in the last 12 years. Donor sex and age, living donors with biliary and/or vascular anomalies, recipient age, sex, primary etiology, re-transplantation, Model of End-Stage Liver Disease score, co-morbidities, arterial and biliary recipient complications assessed on the basis of clinical follow-up were collected and analyzed for significance through the use of a multivariate linear regression model. RESULTS: Biliary complications in the donor (DBC) were detected in 8 (8.2%) cases. Biliary complications in the recipients (RBC) were detected in 38 (39%) cases. DBADs were found in 32 (33%) cases and resulted strictly related to RBC (P = .05). CONCLUSIONS: After adjusting for co-variables, results of the linear regression analysis confirmed that DBAD is an independent predictor of RBC, but it is not significantly associated with vascular complications or patient survival. We showed that RBCs after LDLT were influenced by DBAD.

Effect of zinc supplementation on trace elements and intestinal metallothionein concentrations in experimental colitis in the rat.

BACKGROUND AND AIM: Zinc enhances cell protection against infection and injury and the healing processes themselves. We evaluated the effect of zinc supplementation at different doses on a model of experimental colitis in the rat. METHODS: Colitis, induced by intra-rectal instillation of dinitrobenzen-sulphonic acid, was assessed at 1 week by examining: general outcome and macroscopic damage, myeloperoxidase activity, mucosal zinc, iron and metallothionein concentrations. Rats received zinc sulphate, 2 mg/kg or 30 mg/kg, twice a day by gavage for 9 days, starting 3 days before the induction of colitis, or intrarectal instillation of zinc (20 mg/kg) once daily starting 8 hours after the induction of colitis and for 6 days thereafter RESULTS: Zinc-treated rats had less diarrhoea, higher body weight and lower colonic weight than untreated rats but no effect was observed on macroscopic inflammation, adhesions, colonic distension and neutrophil infiltration of the colonic mucosa. Zinc supplementation did not affect mucosal iron and zinc concentrations or plasma zinc levels in colitic rats. Metallothionein synthesis was induced in control rats and to a lesser extent in colitic rats. CONCLUSION: Zinc administration induces metallothionein synthesis but has little effect on the short-term course of experimental colitis.

The stenosis of the terminal esophagus after surgical repair of the hiatus hernia.

Eighty-two operations of hiatus hernia repair were performed at the General Surgery Department of the University of Padua from 1966 to 1975. Two cases of iatrogenic stenosis of the the terminal esophagus, whose correction required postoperative dilatations, occurred in this series. This complication should be separated from the transient dysphagia frequent occurring, without radiologia or endoscopic evidence of esophageal lesions, after hiatus hernia repair. The stenosis followed two different repair techniques but, at present time, it is impossible to establish a relationship between occurrence of the iatrogenic lesion and repair techniques used. Eventhough iatrogenic stenosis of the terminal esophagus does not occur frequently, it is a possible complication to keep in mind while performing hiatus hernia repair, because it is exclusively related to defects of the surgical technique.

[A clinical and instrumental study of the functionality of ileoanal "reservoirs"]. / Studio clinico e strumentale sulla funzionalità dei "reservoirs" ileo-anali.

Twenty-five patients with ileo-anal "reservoir" have been evaluated by clinical examination, manometry, proctography, endoscopy and biopsy, at least six months from the closure of ileostomy. 80% of them presented with a satisfactory condition, although only one third reached a normal function; 20% suffered for one or more dysfunctions which lead to a variable degree of social handicap. The most frequent dysfunctions were incontinence (13 patients), urgency (10), frequency (9), pouchitis (6), incapacity to evacuate (2). The mean values at manometry showed a halved anal tone, a slightly impaired external sphincter, a halved compliance of the pouch in comparison to normal rectum. Radiology demonstrated that half the patients with dysfunctions had a reduced motility of the pouch and anomalies in sphincter coordination. Endoscopy and biopsies demonstrated inflammation in 12 patients and 6 of them developed an acute pouchitis. From a general point of view, apart from particular conditions, it has been impossible to correlate clinical dysfunctions with a specific abnormality at the instrumental evaluation. Therefore, while good results are assumed to be due to a normally restored anatomical and motility condition, we must recognize that most clinical dysfunctions are not univocally correlated to abnormalities of the pouch or of the sphincteric apparatus.

[Notes on the embryology and anatomy of the diaphragm]. / Cenni di embriologia e di anatomia del diaframma

The main steps in the embryogenesis of the diaphragm are summarised, with particular reference to details of major importance in the formation of congenital hernias. Morphogenetic abnormalities of the diaphragm are described. Malformations occurring during the different stages of embryonal development (agenesia, total or partial aplasia or eventratio, restructuring defects) and their incidence are also illustrated. A personal view concerning the topography of congenital hernias of the diaphragm is expressed, with particular reference to those proceeding through incostant foramina.

[Acute complications of hernias caused by congenital defects of the diaphragm]. / Complicanze acute delle ernie da difetto congenito del diaframma

Following a classification of the various types of congenital hernia of the diaphragm, the acute complications that may be caused by such defects of diaphragmatic morphogenesis are reviewed. Relative physiopathology is considered, particularly as regards the thoracic dimension of large hernias of the cupola. As regards visceral hernia, the most typical pictures of the two commonest complications, volvulus and strangulation, are described among other aspects. The clinical situation is outlined bearing in mind the diversity of anatomoclinical pictures in relation to the age of the patient, the type of hernia involved, and the period in which the observation was made. The surgical problems involved in acute complications concern the approach--although agreement is almost unanimous depending on the type of hernia--viscous reduction modalities and the type of plastic surgery which is required on each occasion. Postoperative complications and the prognosis for these hernias are reviewed briefly.

[Pheochromocytoma. Diagnostic aspects and surgical treatment. Apropos of 20 operated cases]. / Il feocromocitoma. Aspetti diagnostici e trattamento chirurgico. A proposito di 20 casi operati.

Reference is made to 20 cases of pheochromocytoma operated at the surgical clinic of the University of Padua since 1963. Stress is laid on the importance of modern angiographic techniques in diagnosis and their attendant risks and the main aspects of surgical management are examined. The results show that success depends on careful preoperative localisation, choice of a suitable approach route, and correct technique coupled with suitable intraoperative management.

[Palliative treatment of esophageal and cardial carcinoma]. / La palliazione del carcinoma esofageo e cardiale.

Recent series reported increasing incidence of esophageal and cardial cancers with prognosis still severe in spite of surgical progress. The late diagnosis reduces the chance of radical surgery; on the other hand about 80-90% of patients develop local or distant recurrence. Therefore the treatment of esophageal and cardial cancer is often palliative: surgical resection is reserved only to selected cases. Endoscopic palliation was the treatment of choice in a total of 265 patients 174 of which received laser therapy and 91 prosthesis intubation. The results it good in about 80% of cases.

[Behavior of mast cells in experimental burns in rats]. / Osservazioni sul comportamento delle mastzellen nelle ustioni sperimentali nel ratto.

The Authors, using a personal dyeing method, specific for mast cells, that they described in a former work, (a modification of May-Gruenwald-Giemsa dye) observed crowd of mast cells in the subcutaneous tissue, below the site of thermal skin burns, in rats. They clearly demonstrate the phenomenon of mast cells degranulation. The granules are released in the subcutaneous tissue, then they go away along the limph vessels, and it is possible to follow them until the limph nodes. There is also crowd of limphocytes and plasma cells; nevertheless, there is evidence that mast cells are the early cells which react to burns in rats. Perhaps it should be possible that mast cells have some immunological function, owing to the contact their granules take with lymphocytes and plasma cells.

[Esophago-gastric lesions caused by caustics]. / Lesioni esofago-gastriche da caustici.

A wide range of lesions may occurs after accidental or voluntary ingestion of caustic substances including mild epithelial injury to whole thickness necrosis of the involved organs. The type of management varies according to the severity of the damage, medical therapy being indicated in the less severe cases while surgery is required in life threatering lesins or alternatively as elective treatment of trighly desabling sequelae last complications such as. From 1981 to 1989 we observed 20 patients with acute hastro-oesophageal lesions due to ingestion caustic substances 19 of then were successfully treated with medical therapy. Only 1 patient underwent surgery and died of oesophagus cardiac fistula with right atrium perforation (24 days following total gastrectomy). Based on either our own experience and the data reported in the literature we believe that the most adequate management of patients with lesions of the E.G. due to caustic agents tract must include: vital functions control maintenance intensive care treatment of shock endoscopic monitoring of E.G. lesions emergency surgical treatment where needed.

Combined microwave thermal ablation and liver resection for single step treatment of otherwise unresectable colorectal liver metastases; a monoistitutional experiences.

OBJECTIVE: Over half of colorectal cancer patients will develop liver metastases. BACKGROUND: Thermal ablation with or without associated liver resection for colorectal hepatic metastasis has been suggested as an alternative method to improve survival if radical surgical resection is not achievable. A retrospective case series of patients treated with microwave ablation(MWA) associated with hepatic resection in one step procedure, was reviewed to analyze the clinical outcome. MATERIALS AND METHODS: In a group of 40 patients surgically cured for liver tumors in our Department, 5 patients with technically unresectable disease underwent combined treatment LR-MWA. RESULTS: Four patients were treated with multiple segmentectomies and MWA and one patient received a left lobectomy (S2-S3) and MWA. Only 1 patient (20%) developed post surgical complication which was a liver abscess (grade II of Dindo classification). CONCLUSIONS: Hepatic resection combined with MWA expanded indications for operative treatment of multiple bilobar liver metastasis. This procedure promise to have good long-term outcomes.

Does the light influence astaxanthin production in Xanthophyllomyces dendrorhous?

Astaxanthin (C40H52O4) is an important natural pigment that has considerable promising applications in human health. Until now, many efforts were made aimed to develop economically sustainable bioprocesses alternative to the chemical synthesis, to satisfy the increasing demand of this ketocarotenoid from feed, food and cosmetic industries. The extraction of natural astaxanthin from the yeast Xanthophyllomyces dendrorhous till now seems to be rather expensive if compared with chemically synthesized astaxanthin. In this article, astaxanthin production by Xanthophyllomyces dendrorhous under two different conditions was studied: a first effort was made using a conventional reactor while a second using an enlightened one. This research was aimed also to optimise astaxanthin production by testing the influence of the light and of some nutrient sources. From fermentation tests, an astaxanthin yield ranging about 970 µg g(-1) was obtained after fed batch cultivation in the conventional reactor. In the enlightened reactor lower values, about 930 µg g(-1), were found.