Hellenic karst waters: geogenic and anthropogenic processes affecting their geochemistry and quality.

Karst hydrosystems represent one of the largest global drinking water resources, but they are extremely vulnerable to pollution. Climate change, high population density, intensive industrial, and agricultural activities are the principal causes of deterioration, both in terms of quality and quantity, of these resources. Samples from 172 natural karst springs were collected in the whole territory of Greece. To identify any geogenic contamination and/or anthropogenic pollution, analyses of their chemical compositions, in terms of major ions and trace elements, were performed and compared to the EU limits for drinking water. Based on chloride content, the collected karst springs were divided into two groups: low-chloride (< 100 mg L-1) and high-chloride content (> 100 mg L-1). An additional group of springs with calcium-sulfate composition was recognised. Nitrate concentrations were always below the EU limit (50 mg L-1), although some springs presented elevated concentrations. High contents in terms of trace elements, such as B, Sr, As, and Pb, sometimes exceeding the limits, were rarely found. The Greek karst waters can still be considered a good quality resource both for human consumption and for agriculture. The main issues derive from seawater intrusion in the aquifers along the coasts. Moreover, the main anthropogenic pollutant is nitrate, found in higher concentrations mostly in the same coastal areas where human activities are concentrated. Finally, high levels of potentially harmful trace elements (e.g. As, Se) are very limited and of natural origin (geothermal activity, ore deposits, etc.).

Scientific response to the 2021 eruption of Nyiragongo based on the implementation of a participatory monitoring system.

The development of a resilient society is a major challenge for growing human population faced with abundant natural hazards. During and after the May 22, 2021 eruption of Nyiragongo, the local population was surprised and scared by the subsequent seismicity and associated surface fracturing, coupled with the alert of a possible new eruptive vent opening in Goma (Democratic Republic of Congo) and/or Gisenyi (Rwanda). The creation of a toll-free phone number enabled the population to record fractures and gas/thermal anomalies affecting the area. Such work was fundamental in enabling scientists and authorities to assess the associated risks. Crucially, gas data showed that the degassing through fractures did not represent direct transfer of magmatic volatiles but was more likely of superficial origin. Surprisingly, this participatory work revealed that the first fractures appeared several weeks before the eruption and their opening was not detected by the monitoring system. This firmly underlines the need for scientists to anchor citizen science in monitoring strategies.

Impact of the medicalization of labor on mode of delivery.

AIMS: To evaluate whether routine medical interventions during labor (oxytocin augmentation, induction, amniotomy, epidural analgesia) condition the outcome of delivery independently of each other and of obstetric risk (calculated in an objective manner). Moreover, to evaluate whether there is an ideal window for initiating such interventions. METHODS: Prospective, observational study with 1,047 patients enrolled. RESULTS: Medical interventions were high, whether in low-, medium- or high-risk pregnancies. Oxytocin augmentation (odds ratio 4.678) labour induction (odds ratio 1.717) amniotomy (odds ratio 1.403) and obstetric risk (intermediate-risk odds ratio 1.889, high-risk odds ratio 2.008) increase the probability of an operative delivery. Oxytocin augmentation increases both the probability of a Cesarean delivery and vacuum extraction. Epidural analgesia reduces the probability of cesarean delivery and increases the probability of vacuum extraction. The greater the cervical dilation when oxytocin infusion is initiated, the lower the probability of an operative delivery. The more advanced the cervical dilation and the lower the station when amniotomy or epidural analgesia are carried out, the lower the probability of an operative delivery. Obstetric risk and oxytocin augmentation appear to increase the probability of operative delivery in patients who have undergone amniotomy or epidural analgesia. In addition, labor induction in patients who undergo epidural analgesia increases the risk of operative delivery. CONCLUSIONS: Medical interventions during labor are high and cause a rise in operative delivery. Therefore, practitioners should defer it as much as possible. The exception is epidural analgesia because it seems to reduce the number of cesarean sections.

[Histopathology of retrocorneal membranes after keratoplasty]. / Histopathologische Untersuchung von retrokornealen Membranen bei irreversiblem Transplantatversagen.

BACKGROUND: This retrospective study examines the histopathological changes, especially the occurrence of retrocorneal membranes, in irreversible graft failure after penetrating keratoplasty. PATIENTS/MATERIALS AND METHODS: 371 corneas of 308 patients were examined. The examination was carried out using a light microscope. RESULTS: 45% of the corneas (167/371) showed a retrocorneal membrane with a thickness of 2-520 micrometers. Re-endothelialisation was detected in 75 cases. In 74% (124/167) cellular infiltration into the stroma could be observed. In 32% (119/371) the graft-host border was visible. CONCLUSIONS: Retrocorneal membranes are a frequent finding in irreversible graft failure after penetrating keratoplasty. Aetiologically the graft-host border as well as the formation of connective tissue seem to play a key role.

Addition of sirolimus to cyclosporine in long-term kidney transplant recipients to withdraw steroid.

The aim of this study was to evaluate the feasibility of a steroid-free maintenance immunosuppression regimen in long-term renal transplant (KTx) recipients after addition of sirolimus (SRL) to cyclosporine (CsA)-based immunosuppression. A multicenter, prospective pilot study of steroid withdrawal (SW) was initiated for KTx patients. SW was divided into three phases: (A) conversion to a SRL + CsA + steroid regimen; (B) steroid tapering and withdrawal; and (C) maintenance with SRL + CsA. Primary endpoints of the study were incidence of acute biopsy-proven rejection (AR) and safety. In the A and B phases of the study 42 KTx patients (132 +/- 75 months post-Tx) were entered into the study, 18 of 42 (43%) with severe, acute side effects due to the CsA + SRL combination. These side effects were reversible with reduction of CsA or with suspension of the SRL/CsA combination. An amendment was introduced in the protocol to drastically reduce the CsA exposure to <50 ng/mL (trough) at the time of SRL addition. After this amendment, 39 other KTx patients entered the study and only 3 of 39 (8%) were discontinued because of toxic side effects. In the overall cohort of 81 KTx patients, the incidence of AR after SW was low (n = 5, 6.1%), all occurring within the first 3 months after SW. These findings indicate: (1) addition of SRL to very low-maintenance CyA exposure allows safe SW in KTx; (2) with the SRL + CsA combination, the incidence of AR after SW is low in long-term KTx patients; and (3) in the first 3 months after SW strict monitoring for early diagnosis and treatment of AR is mandatory.

Characterization of the Etna volcanic emissions through an active biomonitoring technique (moss-bags): part 2--morphological and mineralogical features.

Volcanic emissions were studied at Mount Etna (Italy) by using moss-bags technique. Mosses were exposed around the volcano at different distances from the active vents to evaluate the impact of volcanic emissions in the atmosphere. Morphology and mineralogy of volcanic particulate intercepted by mosses were investigated using scanning electron microscopy (SEM) equipped with energy dispersive spectrometer (EDS). Particles emitted during passive degassing activity from the two active vents, Bocca Nuova and North East Crater (BNC and NEC), were identified as silicates, sulfates and halide compounds. In addition to volcanic particles, we found evidences also of geogenic, anthropogenic and marine spray input. The study has shown the robustness of this active biomonitoring technique to collect particles, very useful in active volcanic areas characterized by continuous degassing and often not easily accessible to apply conventional sampling techniques.

Characterization of the Etna volcanic emissions through an active biomonitoring technique (moss-bags): part 1--major and trace element composition.

Active biomonitoring using moss-bags was applied to an active volcanic environment for the first time. Bioaccumulation originating from atmospheric deposition was evaluated by exposing mixtures of washed and air-dried mosses (Sphagnum species) at 24 sites on Mt. Etna volcano (Italy). Concentrations of major and a large suite of trace elements were analysed by inductively coupled mass and optical spectrometry (ICP-MS and ICP-OES) after total acid digestion. Of the 49 elements analysed those which closely reflect summit volcanic emissions were S, Tl, Bi, Se, Cd, As, Cu, B, Na, Fe, Al. Enrichment factors and cluster analysis allowed clear distinction between volcanogenic, geogenic and anthropogenic inputs that affect the local atmospheric deposition. This study demonstrates that active biomonitoring with moss-bags is a suitable and robust technique for implementing inexpensive monitoring in scarcely accessible and harsh volcanic environments, giving time-averaged quantitative results of the local exposure to volcanic emissions. This task is especially important in the study area because the summit area of Mt. Etna is visited by nearly one hundred thousand tourists each year who are exposed to potentially harmful volcanic emissions.

Atherosclerosis and inflammation. Patterns of cytokine regulation in patients with peripheral arterial disease.

Inflammatory phenomena at sites of atherosclerotic plaques are increasingly thought to be major determinants of the progression and clinical outcome of atherosclerotic disease. Therefore, attention is being paid to systemic markers/mediators which may reflect the inflammatory activity in the plaques. This study evaluates the pattern of the main proinflammatory cytokines tumor necrosis factor-alpha (TNFalpha), interleukin-1beta (IL-1beta), and interleukin-6 (IL-6), their soluble receptors/antagonist, and a variety of inflammatory markers, in patients with peripheral arterial disease (PAD). Eight patients with PAD suffering from claudicatio intermittens (CI), eight with critical limb ischemia (CLI) and eight controls (C) were studied. Blood samples were collected at baseline in all groups and. for C and CI, immediately after and 4 h after a 30-min treadmill test. Baseline: no differences in cytokine plasma levels were detected among the three groups. In contrast, soluble receptors of TNF (type I and II) and of IL-6, and IL-1beta receptor antagonist (IL-1ra) were increased in CI and CLI patients, as compared to C. Of note, IL-Ira correlated with the occurrence and stage of the disease in a highly significant proportion of the patients, reaching a predictive value for the disease of P < 0.0001. The opposite trend was observed for the soluble receptor of IL-1beta. Notably, in the patients no alterations could be found in white blood cell counts, expression of CD11c adherence molecule by circulating monocytes or, in vitro. O2- release from zymosan-activated neutrophils. Moreover, plasma levels of platelet activating factor (PAF), of neutrophil elastase and of the acute phase reactants C-reactive protein (CRP) and alpha1-acid glycoprotein were not found to be significantly altered. In contrast, the acute-phase proteins alpha1-antitrypsin (alpha1AT) and haptoglobin (HG) were found to be increased. Effect of treadmill: IL-1beta and TNFalpha remained at baseline levels following exercise, and IL-6 dropped to undetectable levels. Among cytokine antagonists, again the most relevant changes concerned the IL-1ra, which was significantly increased immediately after the treadmill test, both in CI and C, and returned to baseline levels after 4 h. In contrast, soluble TNFalpha, IL-1beta and IL-6 receptors, PAF, and the other markers of leukocyte activation were not found to be altered. Soluble TNFalpha and IL-6 receptors were shown to inhibit the biological effects of their ligands. Similarly, IL-1ra and the acute phase proteins alpha1AT and HG have been reported to exert anti-inflammatory functions. The increased plasma levels of these agents, together with low levels of inflammatory cytokines and other pro-inflammatory mediators such as PAF and alpha1-acid glycoprotein, appear to draw an undescribed picture, so far, of upregulation of a composite systemic anti-inflammatory mechanism in atherosclerotic patients. IL-1ra appears to be a reliable marker of the state of activation of this mechanism. These results may provide a basis for developing new insights into the pathogenesis of the atherosclerotic disease.

Fibrinogen, D-dimer and thrombin-antithrombin complexes in a random population sample: relationships with other cardiovascular risk factors.

Fibrinogen is an independent risk factor for cardiovascular disease and both D-Dimer and Thrombin-Antithrombin complexes may be suitable as laboratory markers of deep venous thrombosis and are becoming more widespread in clinical practice. The aim of our study was to evaluate their normal range and to examine their correlation with various cardiovascular risk factors. Fibrinogen, D-Dimer and Thrombin-Antithrombin complexes were assessed in 516 normal subjects randomly selected from the National Health Service register of Trieste (Italy). In our community the mean value of fibrinogen was 283 +/- 71 mg/dl. Fibrinogen increases with age in males and was significantly higher in male smokers. In non-smokers, females had significantly higher fibrinogen values than males. The mean value of D-Dimer was 306 +/- 130 ng/ml. In females it is significantly higher. The fibrinogen and D-Dimer correlation coefficient was 0.20 (p < 0.001). The mean level of Thrombin-Antithrombin complexes was 6.25 +/- 6.8 ng/ml with a distribution markedly skewed towards the left; males had lower concentration than females (p = 0.047). Multiple regression analysis for fibrinogen as a dependent variable showed that D-Dimer, LDL-cholesterol, Body-Mass Index and Thrombin-Antithrombin complexes were poor predictors for fibrinogen plasma levels (R2 = 0.23) and that fibrinogen, ApoA1 and age can explain only about 10% of the observed variability in D-Dimer.

Activation of coagulation by a LDL-apheresis device.

LDL-apheresis often induces an almost constant and progressive increase of the differential pressure of plasma flowing through the dextran sulphate cellulose column, reducing the efficacy of the treatment. On two occasions we were able to identify a fibrin plug by immunofluorescence. Our aim was to verify the modification of some coagulation indicators in patients undergoing LDL-apheresis and whether an activation of coagulation occurs in the LDL-apheresis device. Blood samples were obtained from six patients with familial hypercholesterolaemia who were undergoing LDL-apheresis. During the same session further blood/ plasma samples were taken from the LDL-apheresis device at different sites and at different volumes of filtered blood. In patients after LDL-apheresis the following modifications were found: a 25% decrease of fibrinogen and a slight increase in F1 + 2 plasma levels. No relevant changes in thrombin-antithrombin complexes and fibrinopeptide A plasma levels were noted. In the LDL-apheresis device the main results were: (a) fibrinogen was trapped in the dextran sulphate cellulose column in the early phases; (b) activation of coagulation was recognisable in the plasma separator during the procedure and progressively increased with duration of LDL-apheresis; (c) thrombin-antithrombin complexes, formed in the plasma separator, were retained by the dextran sulphate cellulose column. In conclusion, LDL-apheresis activates coagulation in the device. Shortening cycle time or using nafamostat mesilate as an anticoagulant, could be interesting alternatives for improving the procedure.

Platelet function and clotting parameters of vibration-exposed foundry workers.

Platelet aggregation and blood clotting parameters were studied in 22 workers (84 %) using pneumatic riveting and grinding hand tools and in 20 workers (90 %) not exposed to vibration but comparable with respect to age, anthropometric data, smoking and drinking habits, and atherogenic risk factors. The weighted acceleration levels of the vibrating tools are reported. According to Taylor's grading system for vibration-induced white fingers, 15 exposed workers (57 %) were in stage OT, 9 (34 %) in stage 0N, and 1 (4 %) in stage 1. Between the reference and the vibration-exposed groups no differences in the platelet aggregation indices both "in vitro" (adenosine-diphosphate, epinephrine, threshold adenosine-diphosphate concentration) and "in vivo" (platelet factor four, beta-thromboglobulin) were found. In addition the clotting parameters (prothrombin index, activated partial thromboplastin time, fibrinogen, antithrombin III) and the immunoglobulins G, A, and M were normal in the two groups. The measurement of skin temperature of the third right finger before and after the cold provocation test showed that the vibration exposed workers experienced a stronger vasoconstriction of the digital vessels than the referents. It is concluded that, in the early stages of vasospastic disorders, segmental vibration can induce peripheral vascular hyperreactivity without changes in the platelet function and clotting parameters.

Design of a trial comparing sirolimus plus mycophenolate mofetil versus sirolimus plus cyclosporine.

We present the study design of a prospective, multicenter, randomized trial aimed at comparing the effects of two different combinations of sirolimus. Renal transplant recipients will be allocated to receive either sirolimus and mycophenolate mofetil (group A) or sirolimus and cyclosporine (group B). The primary endpoint will be the graft function at 3, 6, 12, 24, 36, 48, and 60 months. A number of secondary endpoints will also be considered. To obtain a significant difference in the primary endpoint 180 patients will be enrolled.

Selection and evaluation of blood- and tribologically compatible journal bearing materials.

A critical issue in the Cleveland Clinic Foundation (CCF) Innovative Ventricular Assist System (IVAS) blood pump is the selection of materials for the blood-lubricated journal bearing. Under normal operating conditions, the journal bearing geometry creates a thick blood film that separates the rotating and stationary surfaces. However, since start-up and certain transients could cause temporary contact, the material pair selected for these surfaces must be both tribologically and blood compatible. Combinations of two biocompatible alloys were tested: a titanium-zirconium-niobium alloy (Ti-13Zr-13Nb) and a zirconium-niobium alloy (Zr-2.5Nb). A standard pin-on-disk tester was used, with the contact surfaces lubricated by glycerol/saline mixtures simulating the viscosity range of blood. One test series evaluated start-up conditions; the other modeled a high-speed rub that might occur if the fluid film broke down. Results showed that the preoxidized Zr-2.5Nb pin/Ti-13Zr-13Nb disk combination was superior at all sliding velocities; a self-mated Zr-2.5Nb pair also showed promise. The oxide film on a self-mated Ti-13Zr-13Nb pair, and a Ti-13Zr-13Nb pin and Zr-2.5Nb disk combination did not show adequate wear life. More work remains to explain distinct performance differences of certain combinations, with more data needed on mechanical properties of thin, hard coatings on softer metal substrates.

[Effects of cyclosporin A on various indices of cholestasis in kidney transplant recipients]. / Effetti della ciclosporina A su alcuni indici di colestasi nei trapiantati renali.

A cholestatic syndrome has been reported as one of the main side effects of CyA therapy. The aim of the present study was to evaluate frequency and degree of severity of the cholestatic syndrome in a group of patients with renal transplant treated with CyA. In 55 patients we evaluated both clinical: jaundice, pruritus, presence of biliary lithiasis and biochemical parameters: total serum biliary salts (TBS), total bilirubin (TB), alkaline phosphatase (AP), gammaglutamyl transpeptidase (GGT), transaminase (AST, ALT), cholesterol (CT), triglycerides (TG), HDL-cholesterol (HDL-C) and compared them with a control group matched for sex and age. In the transplant patients significantly higher values of TBS, TB, AP (p < 0.05) were found; 55% of the patients had above mean values of at least one of the classical parameters of liver function and an higher frequency of biliary lithiasis was also found, in the absence of the classical risk factors. However, none of the patients presented severe signs of hepatic disease and to date it has never been necessary to stop treatment. In conclusion, our study shows that the dosage of CyA used at present is quite safe; however, it is necessary to monitor in these patients some parameters of liver function to prevent the minor side effects we observed from progressing into more serious damage.

Treatment of intermittent claudication with antiplatelet agents.

In a double-blind study, 296 patients with intermittent claudication (Fontaine stage II) were treated with 250 mg ticlopidine twice daily, 500 mg aspirin every third day plus 75 mg dipyridamole three times daily, or 300 mg xanthinol nicotinate three times daily for 6 months. Ticlopidine and aspirin/dipyridamole, but not xanthinol nicotinate, improved platelet aggregation, reduced beta-thromboglobulin, platelet factor IV and fibrinopeptide A concentrations, and increased antithrombin III concentrations and red blood cell filterability. No changes in lipid profiles, platelet count or fibrinogen were recorded following any treatment. The doppler systolic blood pressure ratio was improved in patients treated with ticlopidine or aspirin/dipyridamole, but not with xanthinol nicotinate. It is concluded that antiplatelet treatment is useful for the treatment of limb arteriopathy.

[Platelet aggregation and various coagulation parameters in liver cirrhosis]. / L'aggregabilità piastrinica ed alcuni parametri coagulativi nella cirrosi epatica.

Twenty eight patients affected by liver cirrhosis were studied in comparison with 44 control subjects, matched for age. The following parameters were carried out: a) platelet aggregation (by Born's method) induced by increasing concentrations of ADP and epinephrine; b) PF3 ( Spaet - Cintron method) and antithrombin III, aPTT, prothrombin ratio, fibrinogen, platelet count. Platelet aggregation and availability of PF3 are lower in cirrhotic patients, suggesting an intrinsic defect of platelets. Moreover prolongation of aPTT and prothrombin ratio, lower levels of antithrombin III, fibrinogen and platelet count were detected.

[Evaluation of platelet function and coagulation in deafness and sudden vestibular disorders]. / Valutazione della funzionalità piastrinica e della coagulazione nella sordità e nelle turbe vestibolari improvvise.

Thirty-five patients affected by acute vestibular dysfunction (A.V.D.) and/or sudden deafness (S.D.) were studied. Twenty-seven of them presented, as major component of the clinical disorder, a vestibular dysfunction, eight a sudden deafness. The control group was matched for sex, age, smoking habit and family history of diabetes and myocardial infarction. In all the subjects the following tests were carried out: platelet aggregation (Born's method), PF3 (Spaet and Cintron), PF4 and BTg (RIA), aPTT, AT III, cholesterol and triglycerides. The results indicate in the patients group increase of P.A.: SAV = 27 vs 43% (p = 0.03) at 1.2 X 10(-6) M ADP, a larger availability of PF3 in PPP and PRP, increase of PF4: 7.2 vs 17.2 (p = 0.01) and BTg: 32.4 vs 49.1 (p = 0.009). The data indicate in A.V.D. and S.D. a platelet hyperactivity; if so, an antiplatelet therapy may be reasonable.

[Platelet factor 3 and 4 in juvenile diabetes and in children of diabetic mothers]. / I fattori piastrinici 3 (PF3) e 4 (PF4) nel diabete giovanile e nei figli di madre diabetica.

We studied 91 children, distributed, as follows, in four groups: Group A, including 24 children (average age 11.4 +/- 0.7) with juvenile onset diabetes (duration less than 4 years), without any clinically apparent vascular disorder. Group B: 22 matched controls (average age 11.5 +/- 0.53). Group C: 25 newborns (average age 3.7 +/- 0.3) of diabetic mothers (B Group in P. White classification). Group D: 20 matched controls (average age 2.8 +/- 0.3). All were tested for total, HDL, LDL-cholesterol, triglycerides, fasting blood sugar, systolic and diastolic blood pressure. In all the subjects we performed: -- PF4 (by H.T.C.H., according O'Brien et al., 1975) on PPP and on PRP (300,000-350,000 platelets/microliters) after platelet aggregation with 4.0 10(-6)M epinephrine (Born's method). -- PF3 (b a Stypven time) on frozen-thawed (three times) PRP and on PRP after p.a. with 4.0 10(-6)M epinephrine. No statistically significant difference was noted in PF3 values between A-C groups and their respective control groups (B-D). PF4 was more represented on diabetic's PPP (group A), whilst no difference was noted after aggregation. This increase suggests in early juvenile onset diabetes, without any clinically apparent disease, an "in vivo" platelet activation, which may be important in thromboembolic disorders of diabetics.

[Platelet aggregation in hyperlipoproteinemias]. / L'aggregabilità piastrinica nelle iperlipoproteinemie.

The Authors studied platelet aggregation in 42 hyperlipoproteinemic patients (10 with type IIA familiar, 7 with type IIA, 7 with type IIB, 18 with type IV and V). None of them suffered from clinically detectable vascular complications. The control group included 42 normolipoproteinemic subjects, closely matched for age and sex. Platelet aggregation, according Born's method, was statistically increased in hyperlipoproteinemia type IIA, but only when induced by epinephrine as aggregating agent. No statistical significance was demonstrated when hyperlipoproteinemic smokers and no smokers were compared. A positive family history of myocardial infarction and/or diabetes mellitus could be demonstrate affect on platelet aggregation.