Sarcopenia and visceral fat in patients with incisional hernia after urgent laparotomy.

PURPOSE: Various risk factors have been associated with the development of incisional hernia (IH). Some recent papers underlined that visceral fat could be a reliable indicator. Another risk factor which is of increasing clinical interest is sarcopenia. Recent studies have identified it as an independent predictor of poor postoperative outcomes following abdominal surgery. We aimed to investigate the role of visceral fat and skeletal muscle as emerging risk factors for IH after urgent laparotomy. METHODS: Patients aged 18 years or older who underwent urgent median laparotomy and with continuous direct suturing of the laparotomy were included. They were categorized into two groups: those with a median IH and those without IH at 12-month follow-up. Demographic data were prospectively collected while CT scans were retrospectively reviewed. The data were compared among two groups. RESULTS: From January 2018 to May 2021, 364 patients underwent urgent surgery in our Department, of whom 222 were aged >18 years old and underwent median laparotomy. Forty-four patients had diagnosis of median IH, while 41 patients without IH were identified as the control group. Statistically significant differences emerged for BMI and for the area of visceral fat. The association with the presence/absence of sarcopenia was not significant. CONCLUSION: Even when surgery is performed in urgent settings, it could be important to identify patients at risk, especially as CT scans are generally available for all patients with urgent abdominal disease.

Effects of single rinse with three different types of mouthwashes on VSCs levels in morning breath: Randomized, double-blind, crossover clinical trial.

OBJECTIVE: Morning breath is a temporary and unpleasant malodour sourced from the mouth, which occurs upon awakening. This double-blind, crossover, randomized clinical trial aimed to evaluate the bad-breath suppression of three commercially available mouthwashes: Mentadent Professional® Chlorhexidine 0.05% with vitamin C (ChxC), Meridol Alito Sicuro® (SnF2 ) and CB12® (ZnChx) compared to a placebo (PbO) on morning halitosis. METHODS: Thirty-two subjects refraining from oral hygiene practices for 12 h before the evaluation, performed a 30-s rinse with 15 ml of mouthwash, followed by a 5-s gargle, in the evening before bedtime. In order to assess morning halitosis, visual inspection (Winkel Tongue Coating Index), organoleptic (Rosenberg index) and chromatographic measurements were used. Gas chromatography was carried out by means of a dedicated device, the Oral Chroma. The recorded measurements have to be considered solely after the rinse since no data about the pre-exposure were available. A washout period of 1 week passed between one administration and the next. RESULTS: The mean value of the organoleptic indices after administration of ChxC mouthwash is similar to ZnChx, SnF2 and PbO values. Thus, no statistically significant differences were recorded among the mouthwashes and PbO. Nevertheless, ChxC seems to be more efficient in comparison with the PbO regarding VSCs levels analysed with Oral Chroma, (CH3 SH; p = 0.0081) and [(CH3 )2 S; p = 0.0003]. CONCLUSION: Considering our limited sample, instrumental examination demonstrated that the use of the analysed mouthwashes can result in low VSCs levels after 12 h from a single rinse. Furthermore, the highest number of patients (n = 14) were proved to be free from bad smell after using a single administration of ChxC with respect to the other commercial products. The other tested mouthwashes did not show better performances with respect to the placebo after a single rinse.

Morphological and Biological Evaluations of Human Periodontal Ligament Fibroblasts in Contact with Different Bovine Bone Grafts Treated with Low-Temperature Deproteinisation Protocol.

Several types of deproteinised bovine bone mineral (DBBM) are available on the market, and each one is obtained with a thermic and chemical process that can differ, achieving different results. Currently, several protocols using low temperature are suggested to reduce the possible particle crystallisation during the production process. This study aimed to evaluate the biomorphological reaction of periodontal fibroblast cultures in contact with different DBBM particles treated with a low-temperature protocol (Thermagen®) and without exposure to sodium hydroxide (NaOH). Morphological evaluation was performed using light, confocal laser, and scanning electron microscopy, and the biological reaction in terms of proliferation was performed using an XTT proliferation assay at 24 h (T1), 72 h (T2), and 7 days (T3). The morphological analysis highlighted how the presence of the materials stimulated a change in the morphology of the cells into a polygonal shape, surface reactions with the thickening of the membrane, and expression of actin. In particular, the morphological changes were appreciable from T1, with a progressive increase in the considered morphological characteristics at T2 and T3 follow-ups. The proliferation assay showed a statistical significance between the different experimental materials and the negative control in T2 and T3 follow-ups. The post hoc analysis did not reveal any differences between the materials. In conclusion, the grafts obtained with the low-temperature extractions protocol and not exposed to NaOH solution showed positive morphological reactions with no differences in the sizes of particles.

Bio-Morphological Reaction of Human Periodontal Ligament Fibroblasts to Different Types of Dentinal Derivates: In Vitro Study.

Understanding the biological and morphological reactions of human cells towards different dentinal derivate grafting materials is fundamental for choosing the type of dentin for specific clinical situations. This study aimed to evaluate human periodontal ligament fibroblasts (hPLF) cells exposed to different dentinal derivates particles. The study design included the in vitro evaluation of mineralized dentine (SG), deproteinized and demineralized dentine (DDP), and demineralized dentine (TT) as test materials and of deproteinized bovine bone (BIOS) as the positive control material. The materials were kept with the hPLF cell line, and the evaluations were made after 24 h, 72 h, and 7 days of in vitro culture. The evaluated outcomes were proliferation by using XTT assays, the morphological characteristics by light microscopy (LM) and by the use of scanning electron microscopy (SEM), and adhesion by using confocal microscopy (CLSM). Overall, the experimental materials induced a positive response of the hPLFs in terms of proliferation and adhesion. The XTT assay showed the TT, and the SG induced significant growth compared to the negative control at 7 days follow-up. The morphological data supported the XTT assay: the LM observations showed the presence of densely packed cells with a modified shape; the SEM observations allowed the assessment of how fibroblasts exposed to DDP and TT presented cytoplasmatic extensions; and SG and BIOS also presented the thickening of the cellular membrane. The CLMS observations showed the expression of the proliferative marker, as well as and the expression of cytoskeletal elements involved in the adhesion process. In particular, the vinculin and integrin signals were stronger at 72 h, while the actin signal remained constantly expressed in all the follow-up of the sample exposed to SG material. The integrin signal was stronger at 72 h, and the vinculin and actin signals were stronger at 7 days follow-up in the sample exposed to DDP material. The vinculin and integrin signals were stronger at 72 h follow-up in the sample exposed to TT material; vinculin and integrin signals appear stronger at 24 h follow-up in the sample exposed to BIOS material. These data confirmed how dentinal derivates present satisfying biocompatibility and high conductivity and inductivity properties fundamental in the regenerative processes. Furthermore, the knowledge of the effects of the dentin's degree of mineralization on cellular behavior will help clinicians choose the type of dentine derivates material according to the required clinical situation.

Drain Amylase Levels in the Early Diagnosis of Gastric Leak after Laparoscopic Sleeve Gastrectomy.

OBJECTIVES: Laparoscopic sleeve gastrectomy is gaining popularity as a bariatric option. Gastric leak is the most dreaded septic complication after this procedure. This study investigated levels of drain amylase that could be useful for predicting gastric leak before its clinical presentation. SUBJECTS AND METHODS: This prospective observational study was carried out in 167 patients who underwent sleeve gastrectomy for morbid obesity between February 2014 and March 2020. Measurement of drain amylase levels (DALs) was adapted as a routine procedure. The results of the receiver operative characteristic (ROC) curve analysis revealed an optimal drain amylase levels cutoff point of 814.18 IU/L. Consequently, the DALs were classified as DALs <814.18 or DALs ≥814.18 for all subsequent analyses. RESULTS: Gastric leak occurred in 6 patients. Drain amylase levels of 167 patients were tested. The mean value for patients without leak was 71.13 ± 72.11 IU/L; for patients with leak, it was 4,687 ± 6,670 IU/L (p < 0.001). Using ROC curve analysis, the mean ± standard error of the area under the curve for DALs on postoperative day 1 was 0.9927 ± 0.0075, CI = 0.978-1.00, and a cutoff level at 814.18 IU/L for predicting gastric leak achieved 83.33% sensitivity and 100% specificity with positive predictive value of 100% and negative predictive value 99.38%. All patients with a leak, but one, had a drain amylase level >814.18 IU/L. CONCLUSION: The determination of drain amylase levels after sleeve gastrectomy is a significant indicator of gastric leak with high sensitivity and specificity.

[Working modes and evaluation of perceived stress during the Covid-19 pandemic]. / Modalità di lavoro e valutazione dello stress percepito durante la pandemia di Covid-19.

SUMMARY: Introduction. The global sanitary crisis due to covid 19 has had an unprecedent impact on human health and on the global economy creating unexpected challenges on work life. In Italy in order to limit the velocity of virus transmission, measures aimed towards social distancing were adopted by suspending all non essential working activities, with the recommendation of the maximum use of smart working (DPCM 01 MARCH 2020). Literature regarding precedent experiences worldwide on the impact of epidemic or pandemic flu viruses on the working enviroment report of a strong presence of correlated work stress. Objectives. The study is focalized in identifying the individual stress level correlated to work percieved in workers in the context of the unexpected scenario in adapting to work in a short time period relative to the emergency context. Materials and Methods. An epidemiological observational survey was conducted on the web during the months of May and June. The workers were invited in answering a questionnaire using a dedicated link. The questionnaire consisted in a introductive scheme(card) built ad hoc for the study containing information for the socio-demographic variables and work experience. The Evaluation Rapid Stress scale (VRS) was used for the rating of the subjective stress. The t Student test was used for the independant samples in the assay for the average scores of the VRS for sex and age. The ANOVA test was used in order to compare the various scores of the VRS in the three different working modes investigated (work on site, smart working or for both the modalities). A p0.05 was considered as level of significance. The statistical assay was conducted with the STATA software packet. Results. 337 workers answered the questionnaire. The rating of the VRS scores for sex highlighted significative differences between men and women in the levels of anxiety, depression, somatization and aggression showing higher values in women. The highest total scores of the VRS questionnaire and those related to the anxiety and somatization dimensions express higher levels of stress levels in response to the emergency situation in workers who carry out their activity in a on-site mode over the age of 40 and in parents. The comparison with the scores reported between the different working modes was resulted statistically significant. Conclusions. The results of our investigation are an expression of the perception of a widespread danger, linked to the threat of contracting the COVID-19 virus, whose mode and speed of transmission is surprising and for which therapy and in definitive treatment is not yet available. This leads to a series of emotional reactions in which stress is the main condition. The timely exploration aimed at the individuation of a stress problem in the working environment is extremely important especially in emergency situations in order to implement appropriate strategies of prevention.

Laparoscopic sleeve gastrectomy: A role of inflammatory markers in the early detection of gastric leak.

SETTING: Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as a bariatric option. Gastric leak (GL) is the most dreaded septic complication of LSG. Early detection and treatment of this complication may improve outcomes. OBJECTIVES: This study investigates biomarkers that might be useful to predict GL before its clinical presentation in patients who underwent LSG. PATIENTS AND METHODS: This study, prospective observational, was carried out in 151 patients, who underwent LSG for morbid obesity between February 2014 and October 2019. Blood samples were collected before the operation and on post-operative days one, three and five to dose serum C-reactive protein (CRP), pro-calcitonin (PCT), fibrinogen, white blood cells (WBCs) count and neutrophil-to-lymphocyte ratio (NLR). RESULTS: GL occurred in 6 patients (3.97%). According to the receiver operating characteristics curve, NLR detected leak with remarkably higher sensitivity (100%) and specificity (100%) than CRP, fibrinogen, WBC on all the days and higher than PCT in post-operative days 3 and 5. Moreover, the area under the curve (AUC) of NLR (AUC = 1) was higher than the AUC of CRP, fibrinogen, WBC on all the days and higher than PCT in post-operative days 3 and 5, suggesting important statistical significance. CONCLUSIONS: Because NLR and PCT detected GL with remarkably higher sensitivity and specificity than CRP, fibrinogen and WBC, these two markers seem to be more accurate for the early detection of this complication.

Analysis of Risk Factors Independently Associated with Cognitive Impairment in Patients with Permanent Atrial Fibrillation: A Cross-sectional Observational Study.

BACKGROUND AND OBJECTIVE: Atrial Fibrillation (AF) is associated with an increased risk of stroke and development of cognitive impairment. Our cross-sectional study aims to identify risk factors for cognitive impairment in patients with permanent AF. MATERIALS AND METHODS: 212 consecutive outpatients with history of permanent AF lasting more than 1 year were enrolled and the Short Portable Mental Status Questionnaire (SPMSQ) was used to assess cognitive impairment (number of errors ≥5). The type of antithrombotic therapy, the time in therapeutic range (TTR) in case of treatment with warfarin and the degree of heart rate (HR) control (upon Holter ECG monitoring) were also assessed. RESULTS: ROC curve analysis indicated that TTR was associated with cognitive impairment (AUC 0.85 ± 0.03; 95% CI 0.77-0.88; p < 0.0001). Multivariate logistic regression analysis showed an independent association of previous cerebrovascular or cardiovascular events (OR 7.24, 95% CI 1.37-38.25; p = 0.020), aspirin therapy instead of anticoagulant therapy (OR 24.74, 95% CI 1.27-482.12; p = 0.034), warfarin use with TTR ≤60% (OR 21.71 , 95%CI 4.35-108; p < 0.001) and an average daily HR either <60 bpm or >100 bpm (OR 6.04, 95% 1.09-33.29; p = 0.039) with cognitive impairment. CONCLUSION: Among patients with permanent AF, cognitive impairment is more frequent in those with inadequate antithrombotic therapy (aspirin therapy instead of anticoagulant therapy) and with suboptimal oral anticoagulation (TTR ≤60%) or heart rate control. Efforts should be made to optimize therapies related to these parameters.

Antifungal activity of diphenyl diselenide alone and in combination with itraconazole against Sporothrix brasiliensis.

Sporothrix brasiliensis is the main agent of feline and zoonotic sporotrichosis. Given the scarcity of options for sporotrichosis treatment and the promising activity of diphenyl diselenide (PhSe)2 against a diversity of fungal pathogens, this study aimed to evaluate the in vitro susceptibility of Sporothrix brasiliensis to (PhSe)2 alone and in combination with itraconazole (ITC). Forty clinical isolates of S. brasiliensis were subjected to broth microdilution method to evaluate their susceptibility to (PhSe)2 in concentrations ranging between 0.25 and 128 µg/ml, and to ITC (0.0313-16 µg/ml) following the protocol of the Clinical and Laboratory Standards Institute (CLSI, 2008). All of these isolates were also used to evaluate the interaction between these drugs by checkerboard technique. Geometric mean of (PhSe)2 MIC values was 12.12 µg/ml, ranging from 4 to 32 µg/ml, and for ITC was 0.37 µg/ml (0.125 to 1 µg/ml). Benefic effect (additive or synergistic) in the interaction test between (PhSe)2 and ITC occurs in 73% (29/40) of the isolates. The promising (PhSe)2in vitro activity against S. brasiliensis suggests that it may not only be a potential alternative therapy but also be used as a combination with ITC, which is the first choice of therapy to sporotrichosis.

Influence of the Menstrual Cycle Phase on Pain Perception and Analgesic Requirements in Young Women Undergoing Gynecological Laparoscopy.

CONTEXT: The influence of the gonadal hormones on some aspects of the human physiology has been studied with uncertain results. Still a confusion exists in relation to the real effects of the female hormones on the perception of pain. The existing data refer mainly to experimental studies and have provided results not always useful in the clinical practice. DATA SOURCE: This study was designed to detect whether there are differences in the perception of the postoperative pain in women, during two clearly defined phases of hormonal asset: luteal and follicular phases. CONCLUSION: The results of this study have demonstrated that in postoperative female patients pain is perceived significantly more in the luteal phase of the menstrual period, than in the follicular phase. This could suggest that female in child-bearing age should be scheduled for elective surgery preferentially during the follicular phase, unless differently necessary. It would guarantee a more comfortable postoperative period, with reduced necessity of analgesics.

Can sleep quality and burnout affect the job performance of shift-work nurses? A hospital cross-sectional study.

AIM: The aim of this study was to investigate any possible relationship between sleep disorders, burnout and job performance in a shift-work population of nurses. BACKGROUND: Sleep disorders and burnout can affect the job performance of nurses in terms of efficiency, productivity, task execution speed and supervision, which can be compromised when work shifts are organized on a 24-hour schedule and when the shift itself is irregular. DESIGN: A cross-sectional observational study was conducted from August 2014 - January 2015 on a sample of 315 shift-work nurses across 39 wards in seven central Italian hospitals. METHODS: The Pittsburgh Sleep Quality Index was used to detect the presence of sleep disorders, the Copenhagen Burnout Inventory was used to detect the presence of any possible type of burnout and the Job Performance Scale was used to measure job performance. Data analysis was mainly based on a multivariate logistic regression to identify variables significantly associated with investigated outcomes. RESULTS: On shift-work nurses' sleep quality and burnout correlated positively. The female gender and personal burnout were significantly associated with impaired sleep quality, while working in the psychiatric setting, working a long cycle shift pattern and experiencing daytime dysfunction were significantly associated with burnout. A significant negative association between patient-related burnout and job performance was observed. CONCLUSION: Specific characteristics of shift-work nurses can directly affect sleep quality and burnout and indirectly job performance. This evidence offers healthcare administrators opportunities to intervene with measures to promote nurse's health, well-being and safety.

Burnout among healthcare workers at L'Aquila: its prevalence and associated factors.

Burnout, which is now recognized as a real problem in terms of its negative outcome on healthcare efficiency, is a stress condition that can be increased by exposure to natural disasters, such as the 2009 L'Aquila earthquake. This study aims to evaluate burnout syndrome, its associated risk factors and stress levels, and the individual coping strategies among healthcare professionals at L'Aquila General Hospital. A cross-sectional study of 190 healthcare workers was conducted. There was a questionnaire for the collection of the socio-demographic, occupational and anamnestic data, and the Maslach Burnout Inventory, the General Health Questionnaire-12 items (GHQ-12) and the Brief COPE were used. The burnout dimensions showed high scores in Emotional Exhaustion (38.95%), in Depersonalization (23.68%) and in lack of Personal Accomplishment (23.16%), along with the presence of moderate to high levels of distress (54.21%). In addition to factors already known to be associated with burnout (job perception and high levels of distress) exposure to an earthquake emerged as a factor independently associated with the syndrome. Adaptive coping strategies such as religiosity showed a significant and negative relationship with burnout. Our research highlights the need for interventions directed at a reduction in workload and work-stressors and an improvement of adaptive coping strategies, especially in a post-disaster workplace.

Improving the outcome of fractional CO2 laser resurfacing using a probiotic skin cream: Preliminary clinical evaluation.

As known, fractional CO2 resurfacing treatments are more effective than non-ablative ones against aging signs, but post-operative redness and swelling prolong the overall downtime requiring up to steroid administration in order to reduce these local systems. In the last years, an increasing interest has been focused on the possible use of probiotics for treating inflammatory and allergic conditions suggesting that they can exert profound beneficial effects on skin homeostasis. In this work, the Authors report their experience on fractional CO2 laser resurfacing and provide the results of a new post-operative topical treatment with an experimental cream containing probiotic-derived active principles potentially able to modulate the inflammatory reaction associated to laser-treatment. The cream containing DermaACB (CERABEST™) was administered post-operatively to 42 consecutive patients who were treated with fractional CO2 laser. All patients adopted the cream twice a day for 2 weeks. Grades were given according to outcome scale. The efficacy of the cream containing DermaACB was evaluated comparing the rate of post-operative signs vanishing with a control group of 20 patients topically treated with an antibiotic cream and a hyaluronic acid based cream. Results registered with the experimental treatment were good in 22 patients, moderate in 17, and poor in 3 cases. Patients using the study cream took an average time of 14.3 days for erythema resolution and 9.3 days for swelling vanishing. The post-operative administration of the cream containing DermaACB induces a quicker reduction of post-operative erythema and swelling when compared to a standard treatment.

[Health status perception among the elderly of L'Aquila after the 2009 earthquake]. / Percezione dello stato di salute negli anziani della città dell'Aquila dopo il sisma del 2009.

OBJECTIVES: to evaluate the health status' perception in relation to the displacement in the over-65-year population of L'Aquila, about three years after the earthquake of April 6th, 2009. DESIGN: a cross-sectional observational study was performed using a structured interview with a questionnaire divided into 36 closed and multiple questions. SETTING AND PARTICIPANTS: interviews were conducted in the offices of general practitioners and at the Department of prevention - vaccinations service. The respondents were 569 elderly, equally represented by gender; 57% was 65-74 years old, 25% was 75-79 years old, and 18% was more than 80 years old. RESULTS: the study showed that the negative perception of health status is significantly associated with delocalization, female gender, more advanced age, low education, and living with a person not belonging to the family unit. Among people who perceive health in a negative way and live in temporary housing, the inability to perform daily activities, and therefore a lower degree of self-sufficiency, was detected more frequently. Even the presence of certain chronic degenerative diseases (even if self-reported) contributes to the negative perception. This is associated with a decrease in the ability to perform daily activities. CONCLUSIONS: the living conditions and the traditional determinants of old age negatively affect the perception of health status. Relocation and the absence of infrastructure change everyday life and affect judgment on one's health.

Well-being and perceived quality of life in elderly people displaced after the earthquake in L'Aquila, Italy.

On 6 April 2009, the city of L'Aquila was hit by a violent earthquake that destroyed almost all of its medieval centre, and the surviving inhabitants were evacuated and relocated in temporary quarters or undamaged homes. The aim of this study was to investigate the perceived quality of life of the elderly population 3 years after the earthquake in relation to the social and logistic issues of new housing. The study was carried out between October 2011 and March 2012, and involved 571 subjects aged over 65 years living in the municipality of L'Aquila. The interviews took place in the surgeries of general practitioners and the city's Department of Prevention and Vaccination in the anti-influenza immunisation period. The instrument used was a 36-item questionnaire with closed, multiple choice answers divided into the following sections: demographics, everyday activities, health and perceived health, and the quality of life in the city. The results show that, 3 years after the earthquake, the elderly population living in the new towns and temporary housing of L'Aquila have a worse perception of their quality of life than the others. They feel a certain social isolation and wish to live elsewhere. Governments faced with the problems arising from a natural calamity should take into account all of the elements making up a good quality of life and, before making choices whose impact cannot be changed, consider both their immediate and long-term social consequences.

Assessment of Executive Functions in Children with Sensorineural Hearing Loss and in Children with Specific Language Impairment: Preliminary Reports.

Executive functions (EFs) are related abilities, associated with the frontal lobes functions, that allow individuals to modify behavioral patterns when they become unsatisfactory. The aim of this study was to assess EFs in children with sensorineural hearing loss (SNHL) and in children with "specific language impairment" (SLI), compared with a control group of children with normal development, to identify specific skill deficits. Three groups of preschool children aged between 2 and 6 years were assessed: 19 children with normal hearing, cognitive, and language development, 10 children with SNHL, and 20 children with SLI. The FE-PS 2-6 Battery was used for the assessment of preschool EFs, supplemented with the Modified Bell Test for the analysis of selective attention. Statistically significant differences were found between the two experimental groups and the control one, regarding the investigated skills. Children with SNHL showed a clear deficit in flexibility, whereas children with SLI had greater problems in self-regulation and management of waiting for gratification. Selective attention was found to be deficient in all three groups, with no statistically significant differences. This study shows that the skills investigated were found to be deficient in both SNHL and SLI patients. It is essential to start targeted exercises based on specific deficient skills as part of the rehabilitation program. It is of great importance to understand the consequences of EF deficit in preschool children to achieve an accurate diagnosis and carry out customized rehabilitation programs.

New harmonic scalpel versus conventional hemostasis in right colon surgery: a prospective randomized controlled clinical trial.

BACKGROUND: The Harmonic Scalpel (HS) is a device that uses vibrations to coagulate and cut tissues simultaneously. Its advantages are represented by minimal lateral thermal tissue damage, less smoke formation, no neuromuscular stimulation and no transmission of electricity to the patient. METHODS: A total of 211 consecutive patients (113 men, 98 women; mean age 64 years) undergoing hemicolectomy for cancer of the right colon were divided into two groups, namely those in whom the operation was performed using a new HS handpiece (NHS; 108 patients) and those assigned to conventional hemostasis (CH; 103 patients). The two surgical groups were compared regarding patients' age and sex, tumor size, location, histotype and local invasiveness assessed by American Joint Cancer Committee stage, operative time, fluid content in the suction balloon (drainage volume) during the first 1-3 days after surgery, hospital stay and complications. RESULTS: Ultrasonic energy delivered through an HS has been shown to be safe and to produce minimal damage to the surrounding tissues because of its minimal heat production. Electrical devices allow hemostatic control in vessels up to 3 mm in diameter, while HS can coagulate vessels up to 5 mm in diameter; thus, HS allows not only better control of bleeding but also of lymphorrhea. In fact, the amount of fluid collected in the drainage was significantly lower in the NHS group compared to the CH group. Protein depletion influences the patient's regenerative capacity and thus also the occurrence of complications and recovery time. CONCLUSION: NHS is a useful device in colon surgery; it facilitates surgical maneuvers and reduces operative times and blood and lymphatic losses, allowing satisfactory maintenance of protein storage. This results in a lower incidence of complications and faster recovery by patients.

Ethical difficulties in nursing, educational needs and attitudes about using ethics resources.

Ethical difficulties arise in healthcare practices. However, despite extensive research findings that demonstrate that most nurses are involved in recurrent ethical problems, institutions are not always able to effectively support nursing care professionals. The limited availability of ethics consultation services and traditional nursing training fails to meet the frequent and strong requests by health workers to support their ethical dilemmas. A questionnaire was administered to 374 nurses attending a specialist training and a lifetime learning programme in Italy. The respondents reported a high frequency of ethically sensitive situations, and they described the poor development of ethics support and a scarcity of ethics training programmes. The results suggest the importance of promoting ethics services that include consultation and ethics training. A need for systematic ethics educational activities was identified for improving the capacity of nurses to manage ethical issues in patient care.

Clinical and mycological analysis of dog's oral cavity.

The oral microbiota of humans and animals is made up of a wide variety of yeasts and bacteria, but microbiota of dogs is not totally described. Although such identification is an important step to establish the etiopathogenesis and adequate therapy for the periodontal disease The aim of this study was to evaluate and correlate oral alterations with the presence of yeasts in oral cavity of female dogs. After clinical evaluation samples from healthy and from dogs with oral diseases were obtained from three different oral sites by swabs, curettes, millimeter periodontal probes and HA membrane tip in cellulose ester. Yeast identification was performed through macroscopic and microscopic colony features and biochemical tests. Dental calculus was the most prevalent occurrence in the oral cavity of 59 females. However, the isolation of yeasts was significantly higher (p < 0.05) in animals suffering from halitosis. Eleven yeast species were identified, namely: Malassezia pachydermatis, Rhodotorula spp., Candida albicans, C. catenulata, C. famata, C. guilliermondii, C. parapsilosis, C. intermedia, Trichosporon asahii, T. mucoides and Cryptococcus albidus. It could be concluded that the yeasts are part of the microbiota from the different sites of the oral cavity of the female canines studied without causing any significant alterations except halitosis.

Isolation of dermatophytes in wild felids from screening centers.

The aim of this study was detect the presence of dermatophyte fungi on wild felids from screening centers. Samples were taken from 30 animals, assembled in two groups: "free-ranging" and "transitory captivity". The dermatophytes (Trichophyton genus), isolated from two felids (6.6%), both of the group "free-ranging".