Procto-Glyvenol© accelerates the natural healing process of wounds: a pre-clinical study.

OBJECTIVE: Hemorrhoids are a common anorectal disease that causes pain, itching, and burning. The prevalence of hemorrhoids is estimated to be as high as 36% in the general population, with approximately 50% of individuals experiencing symptomatic hemorrhoids at least once in their life. Middle age, obesity, and pregnancy are risk factors. The combination of tribenoside and lidocaine (Procto-Glyvenol©, Recordati) has been used for decades to treat low-grade hemorrhoids, and its efficacy and safety are well supported by clinical experience. Tribenoside has been shown to have an anti-inflammatory effect, ameliorate the local microcirculation and vascular tone, and promote the healing of basement membrane. However, the molecular mechanism behind its wound-healing properties is still unclear. MATERIALS AND METHODS: Human dermal fibroblasts were used to test the effect of tribenoside on cell proliferation, cell migration, and production of reactive oxygen species in vitro. Full-thickness excisional wound model in rats was used to test the wound-healing properties of Procto-Glyvenol© in vivo. RESULTS: Tribenoside has been found to increase the migration rate of fibroblasts in vitro and to improve the wound healing process by promoting re-epithelialization in rats. Furthermore, novel antioxidant activity of tribenoside has been reported, which may represent a further mechanism of action in wound healing. CONCLUSIONS: Procto-Glyvenol© improves the natural healing process of wounds by stimulating cell migration and protecting against the toxic effects of reactive oxygen species. Therefore, it may represent a first-line treatment for hemorrhoids, which are a significant medical and socioeconomic problem that can deteriorate the quality of life.

Comparison between single-step and balloon dilatational tracheostomy in intensive care unit: a single-centre, randomized controlled study.

BACKGROUND: Balloon dilatational tracheostomy using the Ciaglia Blue Dolphin device has recently been introduced as a modification of the Ciaglia technique. The aim of this study was to compare the new Dolphin system with the single-step dilatational tracheostomy (Ciaglia Blue Rhino) in intensive care unit (ICU) patients. METHODS: Consecutive patients admitted to the ICU of the Emergency Department (Careggi Teaching Hospital, Florence, Italy) from January 2009 to October 2009, aged >18 years and with an indication for percutaneous dilatational tracheostomy (PDT), were enrolled. Exclusion criteria were infection/injury/malignancy of the neck, thyroid gland hypertrophy, severe head injury with uncontrolled intracranial hypertension, and coagulopathy. Patients were randomly assigned to undergo PDT using either the Ciaglia Blue Rhino (n=35) or the Ciaglia Blue Dolphin technique (n=35). Groups were compared according to tracheal puncture, tracheal tube placement time, procedure-related complications, and bleeding. RESULTS: Baseline clinical data were comparable between the two groups. Median procedure time was significantly shorter in the Rhino group compared with the Dolphin group (1.5 vs 4 min, P = 0.035). The presence of limited intra-tracheal bleeding at bronchoscopy examination after 6 h from PDT was more frequent in the Dolphin group than in the Rhino group patients (68.6% vs 34.3%, respectively, P = 0.008). No major bleeding occurred in either group. CONCLUSIONS: PDT using the Ciaglia Blue Dolphin technique is a feasible and viable option in ICU patients, but the Rhino technique had a shorter execution time and seemed to be associated with fewer tracheal injuries.

The value of lung ultrasound monitoring in H1N1 acute respiratory distress syndrome.

We present the case of a healthy young male who developed acute respiratory failure as a result of infection with influenza A/H1N1 of swine-origin and in whom ventilatory support was optimised and recovery of lung function was monitored by the use of sequential chest ultrasound examinations. The potential pivotal role of bedside lung ultrasonography in H1N1-induced respiratory failure is discussed.

Methyl jasmonate differentially affects tocopherol content and tyrosine amino transferase activity in cultured cells of Amaranthus caudatus and Chenopodium quinoa.

Tocopherols are lipid-soluble compounds synthesised exclusively by photosynthetic organisms. In this study, in vitro callus cultures were established from two plants that are naturally rich in tocopherols, Amaranthus caudatus and Chenopodium quinoa, in order to examine whether callus cultures were able to produce these compounds at levels comparable to those observed in planta. In both species, cotyledon explants produced the best callus induction and, once established, callus cultures were grown under two different hormonal treatments to check for effects of growth and to induce chloroplast differentiation in the cells. A rapid differentiation of chloroplasts occurred only in C. quinoa cell aggregates grown in the presence of benzyladenine, leading to the production of a homogeneous green callus. In both species, only alpha-tocopherol was produced by callus cultures, although levels were much lower than in planta, and the production was not influenced by the hormonal conditions. Interestingly, cell cultures of the two species responded in different ways to methyl jasmonate (MJ). In A. caudatus cultures, treatment with 100 mum MJ increased the production of alpha-tocopherol up to fivefold, and the inductive effect was influenced by the hormonal composition of the medium. This increase in alpha-tocopherol was associated with a proportional increase in tyrosine aminotransferase (TAT) activity, one of the key enzymes involved in tocopherol biosynthesis. By contrast, in C. quinoa cultures, elicitation with MJ did not have any effect, neither on tocopherol production, nor on TAT activity. These results are discussed in relation to chloroplast differentiation and the interplay between jasmonates and phytohormones.

Liquid chromatography-tandem mass spectrometry for the simultaneous quantitation of enmetazobactam and cefepime in human plasma.

A simple ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was developed and validated for the simultaneous analysis enmetazobactam (also known as AAI101) and cefepime in human plasma. Sample preparation was based on protein precipitation with acetonitrile. Separation was performed on Acquity BEH HILIC column (50 mm × 2.1 mm, 1.7 µm) with a mobile phase containing ammonium formate in water and acetonitrile. The analytes were analyzed with the corresponding isotopically labeled internal standards and were detected in multiple reactions monitoring (MRM) using API 5000 triple-quadrupole mass spectrometer with electrospray (ESI) source operating in positive ion mode. The calibration curves were linear over the selected ranges (r > 0.9970 for both analytes). The intra and inter-assay precision of the Quality Control samples showed CV ≤ 15% and the accuracy was within 85 and 115% in all cases for both compounds. The lower limit of quantification was 0.05 µg/mL for enmetazobactam and 0.5 µg/mL for cefepime.

Visual outcome after excimer laser refractive surgery in adult patients with amblyopia.

PURPOSE: To evaluate the visual and refractive outcome in adult patients wi th refractive and anisometropic amblyopia treated with photorefractive keratectomy. METHODS: An interventional non-comparative study was performed on 50 consecutive patients with amblyopia treated with photorefractive keratectomy. Sixty-eight eyes of 18 participants with bilateral refractive amblyopia and 32 participants with unilateral anisometropic amblyopia were studied. The photorefractive keratectomy was performed with MEL 70 G-Scan excimer laser. Follow-up was 1, 3, 6, and 12 months after the treatment. The mean outcome measures were uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BCVA), refraction, and corneal transparency. RESULTS: In 64.7% of eyes, the UCVA at 12 months after the treatment was better than or equal to their preoperative BCVA. A total of 82.4% of eyes improved their BCVA one or more lines. No eye lost lines of BCVA, 17.6% remained unvaried, 50% gained one line, 20.6 % gained two lines, and 11.8% gained three lines of BCVA. The number of lines gained correlated strongly with diopters of anisometropia between eyes (p<0.01). The mean sphere changed from -5.62+/-3.37 D to -0.47+/-1 D, mean cylinder varied from -2.36+/-1.57 to -0.18+/-0.41 D, and the spherical equivalent varied from -6.82+/-3.1 to -0.45+/-1.08 D. No clinically significant haze was observed. CONCLUSIONS: Excimer laser refractive surgery appears to be a safe and efficient procedure in the treatment of ametropic and anisometropic amblyopia in adults. Adult patients with anisometropic and refractive amblyopia could benefit from the refractive treatment with significant improvement of the visual acuity.

Feasibility of a psychoeducational family intervention for people with bipolar I disorder and their relatives: Results from an Italian real-world multicentre study.

BACKGROUND: Despite several guidelines recommend the use of psychoeducational family interventions (PFIs) as add-on in the treatment of patients with bipolar I disorder, their implementation on a large scale remains limited. The aim of the present study is to identify obstacles for the feasibility of PFIs in routine care. METHODS: This was a multicentre, real-world, controlled, outpatient trial, carried out in 11 randomly recruited Italian mental health centres. Two mental health professionals from each center attended a modular training course on PFI and provided the intervention. Difficulties and benefits experienced by mental health professionals in implementing the intervention were assessed through the Family Intervention Schedule (FIS-R), which was administered six times. RESULTS: Sixteen out of the 22 recruited professionals completed the training and administered the PFI to 70 patients with bipolar I disorder and their relatives. The retention rate of families receiving the intervention was 93%. Mental health professionals reported high levels of organizational difficulties, several benefits in their daily clinical work and low levels of intervention-related difficulties. The most important organizational obstacles were related to the need to integrate the intervention with other work responsibilities and to the lack of time to carry out the intervention. These difficulties did not decrease over time. Intervention-related difficulties were rated as less problematic since the first time assessment and tended to improve over time. LIMITATIONS: Low number of recruited professionals; use of a not previously validated assessment instrument. CONCLUSIONS: PFIs are feasible in routine care for the treatment of patients with bipolar I disorder and their relatives, and main obstacles are related to the organization/structure of mental health centres, and not to the characteristics of the intervention itself.

Transglutaminase activity during senescence and programmed cell death in the corolla of tobacco (Nicotiana tabacum) flowers.

Corolla life span of undetached flowers of Nicotiana tabacum was divided into stages from the closed corolla (stage 1) through anthesis (stage 5) to death (stage 9). Senescence began around stage 6 in the proximal part, concomitantly with DNA laddering. Nuclear blebbing, DNA laddering, cell wall modification, decline in protein, water, pigment content and membrane integrity were observed during senescence and PCD. Transglutaminase activity was measured as mono- and bis-derivatives of putrescine (mono-PU; bis-PU) and bis-derivatives of spermidine (bis-SD). Bis-derivatives decreased with the progression of senescence, while mono-PU increased during early senescence; derivatives were present in different amounts in the proximal and distal parts of the corolla. In excised flowers, exogenous spermine delayed senescence and PCD, and caused an increase in free and acid-soluble conjugated PA levels. Bis-PU was the most abundant PA-derivative before DNA laddering stage; thereafter, bis-PU generally decreased and mono-PU became the most abundant derivative.

Effect of polyamine biosynthesis inhibitors on mycelial growth and concentrations of polyamines in Ophiostoma ulmi (Buism.) Nannf.

Several inhibitors of polyamine biosynthesis reduced mycelial growth of the fungus Ophiostoma ulmi (Buism.) Nannf. cultured on malt extract-agar medium. Growth inhibition was particularly evident when expressed in terms of fresh weight rather than colony diameter. Of the different drugs tested, the most effective was difluoromethylarginine (DFMA), while difluoromethylornithine (DFMO) and methylglyoxal(bis)guanyl-hydrazone (MGBG) plus cyclohexylamine (CHA) reduced growth only by 75 and 62% respectively. The growth inhibition by DFMO + DFMA, measured as colony diameter, was apparently reversed by putrescine (PUT), but not when expressed in terms of fresh weight. Spermidine (SPD) was the most abundant polyamine in control cultures, followed by PUT and spermine (SPM). PUT was no longer detectable 8 d after inoculation. On day 10, DFMO and DFMA, alone and in combination, caused a significant reduction in cellular SPD concentrations, while exogenously supplied PUT restored the levels of this polyamine to control values. MGBG + CHA caused a conspicuous accumulation of PUT and an approximately 50% reduction in SPD titres. DFMA, alone or in combination with DFMO and with or without PUT, led to increased cellular levels of SPM. The latter polyamine, but not PUT or SPD, strongly retarded growth when added to the growth medium. As suggested by the effectiveness of DFMA in inhibiting growth, arginine decarboxylase activity was shown to be prevalent over ornithine decarboxylase activity in this fungus.

Laryngeal cytological aspects in women with surgically induced menopause who were treated with transdermal estrogen replacement therapy.

OBJECTIVE: To investigate the effects of estrogen replacement therapy (ERT) on laryngeal cytology in postmenopausal women. DESIGN: Prospective open clinical trial. SETTING: Outpatient menopausal clinic in the Department of Gynecology, University of Catania, Catania, Italy. PATIENT(S): Eighty-four healthy, surgically postmenopausal women, of whom 48 were treated with ERT and 36 were considered as a control group. INTERVENTION(S): Transdermal E(2) treatment by patches or gel, evaluation of laryngeal cytology with cytobrush by indirect laryngoscopy, and questionnaire for the voice history. MAIN OUTCOME MEASURE(S): Changes in cytologic aspects of laryngeal cells with respect to vaginal cytology by hematoxylin and eosin staining; subjective voice changes. RESULT(S): Sixty-seven women completed the study. Ten women from the ERT group and five from the control group dropped out because of the invasive laryngoscope method; two subjects in the control group were excluded because of pathologies of the vocal cord. Hematoxylin and eosin staining confirmed similar superficial-intermediate aspects of the cells between the laryngeal and the vaginal smears in ERT-treated women. In the control group, both smears showed aspects of atrophy-dystrophy. The ERT group had a subjectively better quality of voice than the control group. CONCLUSION(S): Our study confirms that the larynx is an estrogen target, as are vaginal cells. ERT may provide prevention and treatment of dystrophic pathologies of the vocal cords in postmenopausal women.

Long-term visual results of bifocal intraocular lens implantation.

PURPOSE: To evaluate the long-term visual results and variability in contrast sensitivity in patients with heparin-surface-modified (HSM) diffractive bifocal intraocular lenses (IOLs). SETTING: Institute of Ophthalmology, University of Catania, Italy. METHODS: In this prospective study, visual acuity (distance and near) and contrast sensitivity were measured in 35 patients who had phacoemulsification with bifocal diffractive IOL (model 811E, Pharmacia) implantation. Patient satisfaction was also evaluated using a questionnaire. Mean follow-up was 20 months (range 18 to 24 months). RESULTS: At the last examination, mean distance visual acuity was 0.79 +/- 0.2 (SD) without correction and 1.0 +/- 0.15 with best correction. Mean uncorrected near visual acuity was J1.6 +/- J0.77 and with best distance correction, J1.19 +/- J0.49. No statistically significant changes in visual acuity were evident at the last follow-up (Student t test). No changes were found in contrast sensitivity reduction over time, nor were late postoperative complications noted. Overall patient satisfaction was rated as good by 94.3% of patients with best distance correction. CONCLUSIONS: The diffractive bifocal HSM IOL provided good visual performance for distance and near over time. In relation to the low rate of postoperative complications, the slight contrast sensitivity reduction was stable during follow-up.

Jasmonates induce over-accumulation of methylputrescine and conjugated polyamines in Hyoscyamus muticus L. root cultures.

Jasmonic acid (JA) and its methyl ester (MeJA) at concentrations ranging from 0.001 to 10 µM provoked large increases in methylputrescine levels in normal and hairy roots of Hyoscyamus muticus L.; generally, levels of free putrescine and perchloric acid-soluble conjugated putrescine, spermidine and spermine also increased dramatically. More 14C-putrescine was formed when hairy roots were incubated with labelled ornithine than with arginine; conjugated 14C-putrescine was also rapidly formed. In accord with these results, ornithine decarboxylase (EC 4.1.1.17) activity was higher than that of arginine decarboxylase (EC 4.1.1.19), and MeJA enhanced these activities about two- and fourfold, respectively. Although treatment of root cultures with jasmonates enhanced precursor (putrescine, methylputrescine) levels and accumulation of secondary metabolites such as acid-soluble conjugated di-/polyamines, it provoked only modest increases in tropane alkaloid tissue levels.

Presurgical antimicrobial prophylaxis: effect on ocular flora in healthy patients.

OBJECTIVE: Evaluation of presurgical antimicrobial prophylaxis for reduction of ocular flora. SETTING: Ophthalmology Section, Department of Medicine and Surgery, University of Catania, Italy. METHODS: Three days before photorefractive keratectomy (PRK), conjunctiva of 70 healthy patients (100 eyes) were swabbed. After 3 days of instillation of ofloxacin 0.3% (3 times daily), conjunctival swabs were taken again. Bacteria were isolated and identified from each swab. RESULTS: A total of 191 independent isolates were obtained prior to antimicrobial treatment. Bacteria were isolated from all 100 eyes sampled. Gram-positive species predominated, with Staphylococcus epidermidis and Staphylococcus aureus cultured from 69% and 25% of eyes sampled, respectively. Species of the anaerobic genera Peptococcus and Peptostreptococcus were found in 22% and 14% of eyes, respectively. After prophylaxis with ofloxacin, bacteria could be cultured from only 7% of eyes (10 independent isolates). All isolates were sensitive to ofloxacin except 5 strains of S. epidermidis, which displayed intermediate sensitivity. No infections occurred after PRK. CONCLUSION: Prophylaxis by instillation of ofloxacin 0.3% 3 times daily for 3 days substantially reduced the ocular flora of 100 healthy eyes prior to refractive surgery.

Prevalence of oesophagitis in patients with persistent upper respiratory symptoms.

A growing body of evidence suggests that a variety of upper respiratory symptoms (URS) are associated with gastro-oesophageal reflux (GORD). The aim of this study was to determine the prevalence of endoscopic erosive, and non-erosive, oesophagitis among patients complaining of persistent URS, in the absence of typical GORD symptoms, and to compare them with a comparison group of similar age. A group of 110 patients aged 18-75, presenting with persistent URS with no suspicion of GORD symptoms, underwent upper flexible endoscopy, with biopsy sampling for histology, and was compared with a group of 117 patients of similar age undergoing endoscopy for reasons other than GORD. Patients affected with upper airway disorders, such as posterior laryngitis, chronic sinusitis and vocal fold nodules, had a significantly higher prevalence of oesophagitis of varying degrees (31 per cent) compared to the comparison population (15.4 per cent) (p < 0.01). These data suggest that in many patients with chronic URS occult gastro-oesophageal diseases are present.

[An unusual case of orbital cellulitis and perforating scleromalacia]. / Cas insolite de cellulite orbitaire et scléromalacie perforante.

We report the case of a diabetic patient with refractory anemia with excess blasts (RAEB) who developed bladder infection followed by orbital cellulitis and nodular skin lesions. After a short remission, the clinical aspect was complicated by corneal ulceration, scleromalacia, bulbar perforation and lens luxation.

[Fronto-lateral laryngectomy using a combined endolaryngeal external approach]. / Laringectomia fronto-laterale per via combinata, endolaringea ed esterna.

Functional laryngectomies-whether subtotal (with significant demolition) or conservative (with limited latero-frontal and frontal demolition)-can, at times, lead to significant post operative functional sequelae. Negative outcomes method proposed calls for an internal, endolaryngeal approach along with an external approach. The internal approach makes it possible to carefully delimit the posterior extension of the laryngeal neoplasm. The external approach, on the other hand, makes it possible to remove the anterior commissure and part of one or both vocal cords in a single unit together with a smaller portion of the thyroid cartilage. In particular, the endolaryngeal approach using suspension microlaryngoscopy makes it possible to section the laryngeal structures all the way up to the internal surface of the thyroid cartilage and, anteriorly, along the midline from the incision to the lower edge of the cartilage. From above the larynx is opened by means of a transfixed section of the thyroid membrane and of the epiglottis at the upper edge of the thyroid cartilage. The ends of the section are joined with the upper ends of the section prepared using the endolaryngeal approach. Cranio-caudal dissection of the internal perichondrium of the thyroid larynx is then performed, from behind, all the way to the endolaryngeal sections and, from below, to the point where the cord ligaments are inserted. The larynx is opened from below by means of a horizontal section in the crico-thyroid membrane at the upper edge of the cricoid cartilage. The trapezoidal section of the lower part of the protruding corner of the thyroid cartilage. After having joined the edges of the crico-thyroid section with the lower edge of the endolaryngeal sections, the entire piece is then removed in a single unit. This method, for treatment of carcinoma of the anterior commissure and of the anterior portion of one or both vocal cords (T1 and T2 N0 M0), must be used after accurate clinical evaluation; it is particularly appropriate for subjects with cordo-commissure carcinoma which was previously treated with radiotherapy. The method meets the requirements of oncological radicalness, permits one to perform both the external and internal sections under visual control and maintains the endolaryngeal diameters nearly intact.

[The senile voice]. / La voce senile.

Involutive processes which characterize aging induce substantial morphological and functional alteration in the pneumo-phono-articulatory system and thus bring about numerous effects on vocal quality. Fundamental frequency (Fo) variation, whose values increase in males and decrease in females, are found in voice patterns. Moreover, in literature many authors have described vocal substain intensity and timbre deficit in the elderly. Vocal emission of elderly people can become so peculiar that it may be possible to identify approximately the age and the sex of the speaker by merely hearing the voice. The aim of this work was to identify specific parameters of the senile voice using spectroacoustic digital analysis. The following points were considered in this study: the psychoacoustic perceptive evaluation of vocal samples in subjects of different ages in order to identify the sex and age of the speaker; the spectroacoustic digital analysis of the same vocal samples; the morphofunctional observation of the phono-articulatory apparatus. Our results confirmed the presence of peculiar electroacoustic characteristics in the senile voice (mean pitch value variation in males and in females, vocal substain deficit, decrease in vocal intensity, senile tremolo, cycle-to-cycle alteration of Fo and mean amplitude) due to morphofunctional changes of the pneumo-phono-articulatory system. In all the subjects we observed anatomo-functional changes at the glottic level. The presence of specific vocal patterns and the quality of speech play an important role in the processes of senile voice identification.

[Correlations between vocal qualities and mental retardation]. / Corrélation entre qualités vocales et retard mental.

This research is intended to verify the existence of vocal spectrographic alterations, with particular reference to the values of Fundamental Frequency, in patients with different levels of Mental Retardation. The results show the existence of a direct correspondence between the values of the Fundamental Frequency and the level of Mental Retardation: the spectrographic characteristics appear to be more altered in subjects with severe Mental Retardation. The spectrographics patterns are characterized by the presence of bi-phonation particularly at the onset time and at the end, and by a noise signal on constant frequency. The shifts of Fundamental Frequency and voice breakage are rarely detected.

Current trends in ß-lactam based ß-lactamases inhibitors.

The introduction of antibiotics to treat bacterial infections either by killing or blocking their growth has been accompanied by the development of resistance mechanism that allows the bacteria to survive and proliferate. In particular the successive series of ß-lactams have selected several generations of ß-lactamases including ESBLs, AmpC ß-lactamases, KPC carbapenamases in Enterobacteriaceae, the metallo ß-lactamases VIMs and IMPs, and very recently the threatening NDM-1 that confers resistance to virtually any clinically used antibiotic. The increasing use of carbapenems due to the spread of resistance to other existing antibacterial agents has facilitated the spread of resistance, especially in Acinetobacter spp. due to OXA- and metallo-carbapenemases. The pharmaceutical industry, that abandoned this field at the end of the nineties, is now trying to recover by developing some novel ß-lactam antibiotics and novel ß-lactamase-inhibitors, the latter to be used in combination with new as well as seasoned ß-lactam antibiotics. This article provides a survey of patent and scientific literature for ß-lactamase inhibitors discovered in the period 2006-2010.

Consistency of dosing with a thermal aerosol generation system: in vitro and in vivo correlation.

Dosing consistency and reproducibility are presented for a novel pharmaceutical inhaler technology based on a thermal condensation process. Two different device platforms producing thermally generated aerosols have been created and used in clinical studies with a number of different drug compounds. Because this approach does not rely on energy from the user to disperse the aerosol particles, aerosol production is reliable, reproducible and virtually user independent following actuation. Pharmacokinetic data from multiple clinical studies show rapid absorption, dose proportionality, and concentration levels and variability similar to intravenous injection. In addition, products used in clinical trials show excellent subject consistency with the vast majority of devices delivering greater than 90% of the loaded dose and little drug exhaled.