Risk factors for mortality and complications in peripheral venous catheter-associated Staphylococcus aureus bacteraemia: a large multicentre cohort study.

BACKGROUND: Peripheral venous catheter-associated Staphylococcus aureus bacteraemia (PVC-SAB) is a potentially life-threatening nosocomial infection. AIM: This cohort study aims to identify the risk factors associated with its mortality and complications. METHODS: Retrospective analysis of a prospective cohort study conducted at two tertiary-care hospitals in Spain. Adult patients admitted between January 2011 and July 2019 which developed PVC-SAB during their hospital stay were included. Primary outcome was all-cause 30- and 90-day mortality. Secondary outcomes were sepsis or septic shock at the onset of bacteraemia, metastatic infection and length of hospital stay. Univariate and multivariate analyses were performed. FINDINGS: A total of 256 PVC-SAB were diagnosed in 243 patients between 2011 and 2019. Thirty-day and 90-day all-cause mortality were 18.3% and 24.2%, respectively. Lack of susceptible antibiotic administration the day after blood culture collection (odds ratio: 4.14; 95% confidence interval: 1.55-11.03; P = 0.005), sepsis and complicated bacteraemia were identified as independent risk factors for 30- and 90-day mortality; meticillin-resistant S. aureus bacteraemia was identified as an independent risk factor only for 30-day mortality and functional dependence only for 90-day mortality. Persistent bacteraemia and sepsis were associated with septic metastases, which significantly increased hospital stay, and endocarditis. A greater proportion of patients experiencing septic shock were subsequently institutionalized compared to those without. CONCLUSION: PVC-SAB remains linked to high mortality rates. Prompt administration of appropriate antibiotics is crucial for lowering mortality. A comprehensive diagnostic approach is essential, especially in patients with persistent bacteraemia and implanted cardiovascular devices, to rule out metastatic complications and endocarditis.

Sol-gel synthesis and solar photocatalytic activity of Ca-alloyed ZnO nanoparticles elaborated using different precursors.

Ca-alloyed ZnO nanoparticles elaborated using different calcium precursors (CaSO4, CaCl2, Ca(NO3)2 and CaCO3) at different [Ca]/[Zn] ratios (0, 1, 5, 10, 15 and 20%) have been prepared by a sol-gel method followed by supercritical drying and annealing at 300 °C. The synthesized samples have been characterized by a number of techniques including Scanning Electron Microscopy (SEM), Transmission Electron Microscopy (TEM), Energy Dispersive X-ray Spectroscopy (EDS), X-ray Diffraction (XRD), Raman Spectroscopy and Electron Paramagnetic Resonance (EPR). SEM and TEM images reveal that the nanoparticles have a quasi-spherical shape with a grain size between 20 and 40 nm. The EDS results on chemical elementary compositions show that the Ca-alloyed ZnO with a CaCO3 precursor and [Ca]/[Zn] ratios of 5 and 10% are quasi-stoichiometric. The XRD results indicate that all the elaborated nanoparticles have a hexagonal wurtzite structure. Using Raman Spectroscopy a supplementary vibrational mode is detected in the case of CaSO4, CaCO3 and Ca(NO3)2 precursors. The intrinsic defect centers and defect number have been studied using EPR. Two intrinsic defects with different g factors are identified by EPR for which the spectral intensities change with calcium precursors. Furthermore, EPR reveals a correlation between the defect number and photocatalytic efficiency. The photocatalytic efficiency of the nanoparticles elaborated with different precursors and compositions has been studied for the solar photocatalytic degradation of pyrimethanil, using a solar simulator. The results show that the nanoparticles of Ca-alloyed ZnO elaborated with a CaCO3 precursor give promising results and enhance the photocatalytic efficiency in the solar field.

Physiological, biochemical and molecular responses to water stress and rehydration in Mediterranean adapted tomato landraces.

Mediterranean tomato landraces adapted to arid environments represent an option to counteract drought, and to address the complexity of responses to water deficit and recovery, which is a crucial component of plant adaptation mechanisms. We investigated physiological, biochemical and molecular responses of two Mediterranean tomato landraces, 'Locale di Salina' (Lc) and 'Pizzutello di Sciacca' (Pz) under two dehydration periods and intermediate rehydration in greenhouse pot experiments. Relationship between CO2 assimilation (A) and stomatal conductance under severe water stress (gs  < 0.05 mol·m-2 ·s-1 ) indicated the occurrence of stomatal and non-stomatal limitations of photosynthesis. Gas exchange promptly recovered within 2-3 days of rehydration. ABA and gs showed a strict exponential relationship. Both leaf ABA and proline peaked under severe water stress. Lc showed higher accumulation of ABA and higher induction of the expression of both NCED and P5CS genes than Pz. Poly(ADP-ribose) polymerase increased during imposition of stress, mainly in Lc, and decreased under severe water stress. The two landraces hardly differed in their physiological performance. Under severe water stress, gs showed low sensitivity to ABA, which instead controlled stomatal closure under moderate water stress (gs  > 0.15 mol·m-2 ·s-1 ). The prompt recovery after rehydration of both landraces confirmed their drought-tolerant behaviour. Differences between the two landraces were instead observed at biochemical and molecular levels.

Comparative Analysis of Short- and Long-Term Changes in Gene Expression Caused by Low Water Potential in Potato (Solanum tuberosum) Cell-Suspension Cultures.

To dissect the cellular response to water stress and compare changes induced as a generalized response with those involved in tolerance/acclimation mechanisms, we analyzed changes in two-dimensional electrophoretic patterns of in vivo [35S]methionine-labeled polypeptides of cultured potato (Solanum tuberosum) cells after gradual and long exposure to polyethylene glycol (PEG)- mediated low water potential versus those induced in cells abruptly exposed to the same stress intensity. Protein synthesis was not inhibited by gradual stress imposition, and the expression of 17 proteins was induced in adapted cells. Some polypeptides were inducible under mild stress conditions (5% PEG) and accumulated further when cells were exposed to a higher stress intensity (10 and 20% PEG). The synthesis of another set of polypeptides was up-regulated only when more severe water-stress conditions were applied, suggesting that plant cells were able to monitor different levels of stress intensity and modulate gene expression accordingly. In contrast, in potato cells abruptly exposed to 20% PEG, protein synthesis was strongly inhibited. Nevertheless, a large set of polypeptides was identified whose expression was increased. Most of these polypeptides were not induced in adapted cells, but many of them were common to those observed in abscisic acid (ABA)-treated cells. These data, along with the finding that cellular ABA content increased in PEG-shocked cells but not in PEG-adapted cells, suggested that this hormone is mainly involved in the rapid response to stress rather than long-term adaptation. A further group of proteins included those induced after long exposure to both water stress and shock. Western blot analysis revealed that osmotin was one protein belonging to this common group. This class may represent induced proteins that accumulate specifically in response to low water potential and that are putatively involved in the maintenance of cellular homeostasis under prolonged stress.

Potential role of protein kinase B in glucose transporter 4 translocation in adipocytes.

Phosphatidylinositol 3-kinase (PI 3-kinase) activation promotes glucose transporter 4 (Glut 4) translocation in adipocytes. In this study, we demonstrate that protein kinase B, a serine/threonine kinase stimulated by PI 3-kinase, is activated by both insulin and okadaic acid in isolated adipocytes, in parallel with their effects on Glut 4 translocation. In 3T3-L1 adipocytes, platelet-derived growth factor activated PI 3-kinase as efficiently as insulin but was only half as potent as insulin in promoting protein kinase B (PKB) activation. To look for a potential role of PKB in Glut 4 translocation, adipocytes were transfected with a constitutively active PKB (Gag-PKB) together with an epitope tagged transporter (Glut 4 myc). Gag-PKB was associated with all membrane fractions, whereas the endogenous PKB was mostly cytosolic. Expression of Gag-PKB led to an increase in Glut 4 myc amount at the cell surface. Our results suggest that PKB could play a role in promoting Glut 4 appearance at the cell surface following exposure of adipocytes to insulin and okadaic acid stimulation.

Potential role of 3-phosphoinositide-dependent protein kinase 1 (PDK1) in insulin-stimulated glucose transporter 4 translocation in adipocytes.

Insulin stimulation of Glut 4 translocation requires the activation of phosphatidylinositol 3-kinase (PI 3-kinase) but the downstream pathway remains ill-defined. We demonstrated that the overexpression of PDK1 (3-phosphoinositide-dependent protein kinase 1), a downstream effector of PI 3-kinase, stimulated Glut 4 translocation in adipocytes. This effect does not require the PH domain of PDK1, but expression of the pleckstrin homology domain-deleted PDK1 inhibits the effect of insulin, but not okadaic acid, on Glut 4 translocation. These results support a role of the PDK1 pathway in the transmission of insulin signal to Glut translocation.

Inotropic effects of calcitonin in man.

The Authors have studied th haemodynamic response of ten normal subjects to the intravenous administration of 160 MRC.U. of Calcitonin in 60 min, by serial measurement of the systolic time intervals. The analysis of results pointed out a minor inotropic effect starting from the 10th minute from the beginning of the infusion. Little but significant decrements (P less than 0.01) in the duration of the pre-ejection phase of the isovolumetric contraction time, as well as a significant increase (P less than 0.01) in the LVET/PEP ratio, have been noted. A negative chronotropic effect (P less than 0.05) has been noted starting from the 30th minute. The mechanism by which Calcitonin can modify the myocardial inotropism in the normal subject is till now unknown, and it could be related to the interference of this hormore on the endocellular movements of Calcium, and on the cellular levels of cyclic AMP.

[Periconceptual folic acid intake by Sicilian couples at a risk of recurrence of NTD]. / Assunzione periconcezionale di acido folico in coppie siciliane a rischio di ricorrenza di DTN.

BACKGROUND AND AIM: The authors aimed to evaluate the frequency with which pregnant Sicilian women with a high risk of recurring neural tube defects (NTD) attending the Ultrasonography and Prenatal Diagnosis Clinic in the Department of Diagnosis and Treatment at Ospedale S. Bambino in Catania were aware of the preventive effect of folic acid supplements during the periconceptional period and whether they therefore took folic acid supplements before the next pregnancy. METHODS: All pregnant women undergoing ultrasonography between January 1997 and December 1998 were interviewed. It was noted whether any earlier offspring had suffered from NTD or whether relatives (sisters, brothers, parents) had also suffered from the same experience. They were also asked whether they knew about the preventive effect of periconceptional folic acid supplements on the development of NTD, whether their pregnancy was planned and whether they had taken periconceptional folic acid supplements and, if so, at what dose. RESULTS: Eighteen couples were identified as being at risk for recurring NTD, in 3 cases owing to an earlier pregnancy resulting in NTD (2 cases of spina bifida and 1 case of anencephaly) with a negative family history for NTD; a further 15 couples showed a positive family history for NTD. None of the women were aware of the preventive effect of acid folic supplements during the periconceptional period on the development of NTD. Out of 11 programmed pregnancies, none of the pregnant women took folic acid during the periconceptional phase. CONCLUSIONS: Pregnant Sicilian women at risk for recurring NTD interviewed by the authors were not aware of the possible prevention of NTD using folic acid supplements during the periconceptional phase.

[Ultrasound in the study of gynecologic neoplasms]. / Gli ultrasuoni nello studio delle neoplasie ginecologiche.

The authors discuss the state-of-the-art of ultrasound diagnosis for pelvic swellings, with special reference to uterine and ovarian cancer. They review the applications of Eco colour Doppler in gynecological oncology and discuss the protocols for the prevention and/or early diagnosis of gynecological tumours.

[Mediterranean anemia in 124 Sicilian pregnant women]. / Informazione sull'anemia mediterranea in 124 puerpere siciliane.

INTRODUCTION AND AIMS: The aim of this study was to verify knowledge of beta-thalassemia in a group of Sicilian puerpere. METHODS: The study was performed in a group of 124 pregnant women chosen at random from 2769 who gave birth in 1995 in the third trimester of pregnancy at the Specialised Maternity Hospital of Santo Bambino in Catania. RESULTS: A total of 124 puerpere replied to the questionnaire out of 124 interviewed. Their age ranged from 15 to 46 years old; the most frequent age group was 20-35 years old (81 cases-65.4%). 69.3% (86 cases) were married, 5.6% (7 cases) were separated or divorced, 24.9% (31 cases) were single or living with partners. The level of education was mainly lower (39.6%-49 cases) and upper (26.6%-33 cases) secondary school; there were few cases of illiteracy (3.2%-4 cases). The women were predominantly workers (25%-31 cases), employees (37.1%-41 cases) and in 14.4% (18 cases) neither of the couple worked. 4% (5 cases) of women lived alone. 73.3% (91 cases) reported that they knew what Mediterranean anemia was, 85% (35 cases) had recently spoken about this pathology with their doctor, 57.2% (71 cases) with their gynecologist. 36.2% (45 cases) knew the meaning of hemoglobinophoresis. 25% (31 cases) replied in the affirmative to the question regarding the hemoglobinophoresis test, 28.5% (35 cases) were unable to answer and 46.7% (58 cases) replied negatively. 11.2% (14 cases) of the puerperae had been informed about this disease when they were under 20, 39.5% (49 cases) between 20 and 35 years old, and 0.80% (1 case) after 36 years old. 36.2% of those interviewed (45 cases) responded correctly to the question "when does a carrier of Mediterranean anemia risk producing children suffering from a severe blood pathology?".

[Preventive intervention during the planning of a new factory: contribution of an occupational medicine service on installation of a ceramic dye-producing plant]. / L'intervento preventivo nella fase di progettazione di un nuovo stabilimento industriale: contributo di un servizio di base per l'installazione di un colorificio ceramico.

The control during the planning of a factory is a sort of prevention. For instance, we suggested industrial hygiene standards for a new chemical plant, which have been into account. According to our suggestions they set up a closed factory process, a dust and fumes filtering plant and the water recycle. After some controls outside the factory, lead and dust concentrations were below the maximum allowed levels (30 and 5 mg/Nmc).

Chlamydia trachomatis diagnosis: a correlative study of pap smear and direct immunofluorescence.

From June 1989 to September 1990, 255 women with recurrent vaginitis, were evaluated, at the "Service of Precocious Diagnosis and Therapy of Gynecological Tumor" of the 1st Department of Obstetrics and Gynecology. They were compared with a control group of 255 women selected in the same time. All patients between the ages of 18-40 years, with normal sexual behaviour, had a negative colposcopy for HPV and HSV2 infections. The cervical smear with Papanicolaou technique and direct immunofluorescence (DIF) was performed in all patients. The specimens were examined with a fluorescence microscope (Leitz). Positive determinations were confined by examination a tha magnification of 600 X. Slides were scored as positive if at least 5 distinct apple-green fluorescence-stained elementary body per field was observed. The two groups were entirely comparable in age, parity, method of contraception, and number of sexual contacts over the preceding three months. Our data confirmed a higher incidence of Chlamydial infections in women with recurrent vaginitis (34.1%) than in control group (8.23%). In symptomatic women, more cases of metaplastic cells with cytoplasmic vacuolation, less inflammatory alteration and a lack of specific agents like CA and TV, were found than in the control group. The DIF positivity, in both groups, was connected with a cytological findings of metaplastic cells with cytoplasmic vacuolation in 72.3% and 50% respectively.

[Postoperative hypergastrinemia]. / Ipergastrinemie postoperatorie.

After reviewing the more recent acquisitions on the physiology and pathophysiology of gastrin, the authors concentrate on situations of hypergastrinemia, which they divide into a hyperhydrochloric and a hypohydrochloric variety. Among the former, which they subdivide into preoperative and postoperative, the authors discuss problems of differential diagnosis versus peptic ulcers in patients so afflicted. To that end they propose diagnostic policies comprising among other instrumental and laboratory tests the study of gastric secretion, blood gastrin levels in basal conditions and after stimulation by a protein meal, BBS, secretin, and calcium. From analysis of the results of such tests they were able to find a precise nosographic placement for postoperative hypergastrinemia, and from there they arrived at surgical programs aiming to correct postoperative peptic ulcers on the basis of their etiology and pathogenesis.

[Vascular changes in postmastectomy "thick arm"]. / Studio delle modificazioni vascolari nel "braccio grosso" postmastectomia.

The authors, after shortly outlining some pathogenetic theories about postmastectomy "big arm", especially dwell upon the theory of the hindered venous discharge. They, subsequently, through a clear and interesting phlebographic iconography, illustrate ten of the 41 cases suffering from such syndrome, they recently had the opportunity to observe. On the basis of their own experience, and according to part of the literature thereabout, the authors think very probably the postmastectomy "big arm" is to be ascribed to the hindered venous reflux of upper limb (for thrombosis or compression), due to the operation of mastectomy. As a conclusion, they suggest the improvement or recovery of this syndrome by stepping over the stenosed venous tract through a by-pass.

[Primary closure of the perineum after Miles's abdominoperineal amputation for carcinoma of the rectum (author's transl)]. / La chiusura primaria del perineo dopo amputazione addomino-perineale sec. Miles per cancro del retto.

In view of the results obtained in 32 cases of primary closure of the perineum after amputation of the rectum for cancer, the authors believe that this policy is best after removal of the malignancy by the abdominoperineal approach. Unquestionable advantages are shortening of the patient's hospital stay and a more rapid recovery; the possible disadvantages are relatively rare, from an uncommonly severe dysmetabolic situation to local disorders such as poor hemostasis, contamination of the operation site, inadequate preoperative antibacterial protection, or an unusually large tumor.

[Coloportal fistula in ulcerative colitis (massive penetration, through the splenic vein, of barium and air into the portal system during barium enema)]. / Fistola coloportale da colite ulcerosa (Penetrazione massiva attraverso la vena splenica di bario e aria nel sistema portale in corso di clisma opaco).

The authors describe one case of massive penetration of barium and air through the splenic vein into the portal system during administration of a radiopaque enema to a woman suffering from hemorrhagic proctitis in the florid phase. They provide a detailed description of this rare clinical case and discuss the possible etiology and pathophysiology of the observed event.

Impact of pre-hospital antibiotic use on community-acquired pneumonia.

Information on the influence of pre-hospital antibiotic treatment on the causative organisms, clinical features and outcomes of patients with community-acquired pneumonia (CAP) remains scarce. We performed an observational study of a prospective cohort of non-immunosuppressed adults hospitalized with CAP between 2003 and 2012. Patients were divided into two groups: those who had received pre-hospital antibiotic treatment for the same episode of CAP and those who had not. A propensity score was used to match patients. Of 2179 consecutive episodes of CAP, 376 (17.3%) occurred in patients who had received pre-hospital antibiotic treatment. After propensity score matching, Legionella pneumophila was more frequently identified in patients with pre-hospital antibiotic treatment, while Streptococcus pneumoniae was less common (p <0.001 and p <0.001, respectively). Bacteraemia was less frequent in pre-treated patients (p 0.01). The frequency of positive sputum culture and the sensitivity and specificity of the pneumococcal urinary antigen test for diagnosing pneumococcal pneumonia were similar in the two groups. Patients with pre-hospital antibiotic treatment were less likely to present fever (p 0.02) or leucocytosis (p 0.001). Conversely, chest X-ray cavitation was more frequent in these patients (p 0.04). No significant differences were found in the frequency of patients classified into high-risk Pneumonia Severity Index classes, in intensive care unit admission, or in 30-day mortality between the groups. In conclusion, L. pneumophila occurrence was nearly three times higher in patients who received pre-hospital antibiotics. After a propensity-adjusted analysis, no significant differences were found in prognosis between study groups. Pre-hospital antibiotic use should be considered when choosing aetiological diagnostic tests and empirical antibiotic therapy in patients with CAP.

Non-invasive infra-red therapy (1072 nm) reduces ß-amyloid protein levels in the brain of an Alzheimer's disease mouse model, TASTPM.

BACKGROUND: Alzheimer's disease (AD) is the most prevalent neurodegenerative disease and common cause of dementias in the Western world. This study investigated the expression profile of heat-shock proteins (HSPs) involved in maintaining healthy neurons in the TASTPM AD mouse model, and whether chronic treatment with 1072 nm infra-red (IR1072) modified the expression profiles of HSPs and amyloidopathy in female TASTPM mice. METHODOLOGY/PRINCIPAL FINDINGS: Quantitative immunoblotting and immunohistochemistry were used to examine the expression of proteins such as HSPs, phosphorylated tau (tau-P), amyloid precursor protein (APP), ß-amyloid1-40 (Aß), and Aß1-42. TASTPM mice at 3, 7 and 12 months were investigated as well as female TASTPM mice which had undergone a chronic, 5 month, IR1072 treatment. During the first 12 months of age, a critical period of AD progression, reduced HSP40 and HSP105 were observed. αB-crystallin, Aß1-42 and tau-P increased over this period, particularly between 3 and 7 months. Chronic IR1072 treatment of female TASTPM mice elicited significant increases in HSP60, 70 and 105 and phosphorylated-HSP27 (P-HSP27) (50-139%), together with a concomitant profound decrease in αB-crystallin, APP, tau-P, Aß1-40 and Aß1-42 (43-81%) protein levels at 7 months of age. Furthermore, IR1072 treatment elicited a modest, but significant, reduction in Aß1-42 plaques in the cerebral cortex. CONCLUSIONS/SIGNIFICANT FINDINGS: IR1072 treatment provides a novel non-invasive and safe way to upregulate a panel of stress response proteins in the brain, known to both reduce protein aggregation and neuronal apoptosis. This approach recently entered clinical trials for AD in the USA, and may provide a novel disease modifying therapy for a range of neuropathologies.