Matrices based on lineal and star fumarate-metha/acrylate copolymers for bone tissue engineering: Characterization and biocompatibility studies.

This article presents the preparation of matrices from two new families of fumaric copolymers and the effect of structural differences on their physicochemical and biological behavior. Diisopropyl fumarate (DIPF) and poly(ethylene glycol) methyl ether methacrylate (OEGMA) or N-isopropylacrylamide (NIPAM) were copolymerized by conventional radical and RAFT polymerization to obtain lineal or start architectures, respectively. These copolymers were characterized by spectroscopic (FTIR and 1 H-NMR) and chromatographic methods. The thermal stability was studied by thermal gravimetric analysis, showing some differences in relation to the architecture and chemical nature of copolymers. SEM morphological analysis demonstrated that the surface of the matrices derived from OEGMA exhibited an irregular and rough surface, while DIPF-NIPAM copolymers presented smooth surface with nearly no significant porosity. The matrix obtained of both kinds of copolymers presented no cytotoxicity as it was evaluated using a model of macrophages on culture. Moreover, cell growth was better on the surfaces of the DIPF-NIPAM matrices, suggesting a good interaction with this matrix and its potential application as matrices for tissue engineering. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 195-203, 2019.

Resolution of subchorionic hematoma and symptoms of threatened miscarriage using vaginal alpha lipoic acid or progesterone: clinical evidences.

OBJECTIVE: Alpha Lipoic Acid (ALA) is a safe natural molecule that exerts a selective immunomodulating activity with antioxidant and anti-inflammatory properties. This randomized controlled clinical trial (RCT) tested the effect of the vaginal administration with ALA or Progesterone, in subchorionic hematoma resorption in women with threatened miscarriage. PATIENTS AND METHODS: 400 mg of vaginal Progesterone or 10 mg of vaginal ALA were administered to sixty-two pregnant women, in the first trimester of gestation with threatened miscarriage and subchorionic hematoma. Controls were patients who chose not to receive any treatment. RESULTS: In the ALA group the subchorionic hematoma was reabsorbed more quickly in comparison with the progression detected in Progesterone group (p ≤ 0.05). The other parameters checked (pelvic pain and vaginal bleeding) did not show any significant difference and a smaller number of miscarriages was recorded in the ALA group, compared to Progesterone group. CONCLUSIONS: Our data provides the first evidence of the efficacy of ALA, administered by vaginal route, in the healing process of patients with threatened miscarriage, thus supporting the normal course of pregnancy. CLINICAL TRIAL REGISTRATION NUMBER: NCT02601898 (ClinicalTrials.gov registry).

[Use of alpha-lipoic acid and omega-3 in postpartum pain treatment]. / [Acido alfa-lipoico e omega-3 nel trattamento del dolore nel postpartum.

Postpartum pain is a frequent condition that negatively affects women's quality of life, interferring with everyday life. Analgesic drugs and surgery are often contraindicated in pregnancy and during breast feeding. This review of the literature aims to evaluate the rational of the association of lipoic acid and omega-3 employ in the management of postpartum pain. Lipoic acid is a cofactor essential in mitochondrial metabolism with antioxidant and anti-inflammatory activity. Lipoic acid has been shown to be effective in neuropatic pain treatment in patients with sciatica, carpal tunnel syndrome and diabetic neuropathy. Omega-3 are known for their anti-inflammatory and neurotrophic activity. The peripheral and central activity of both substances allows to act on neuroinflammation mechanisms thus reducing cronicization of pain and also determining a potential improvement of women's emotional status. The preliminary data here presented confirm the positive effect of this association on the treatment of postpartum perineal pain. The supplementation of lipoic acid in association with omega-3 seems effective and safe for the treatment of chronic postpartum pain, allowing a pathogenetic approach to neuroinflammation, thus reducing the consumption of analgesic drugs, often contraindicated during breast-feeding.

[Effects of drinking spa therapy on oxidative stress]. / Effetti della creno-terapia idropinica sullo stress ossidativo.

OBJECTIVES: Data of literature have shown the correlation between oxidative stress and some diseases of gastrointestinal and metabolic relevance such as diabetes mellitus, gastric cancer, gastritis, etc.. Studies have also shown that sulfurous mineral water may be useful in the treatment of gastrointestinal diseases. The aim of our research was to evaluate the antioxidant effect of sulphurous mineral water, administered by drinking method, in type 2 diabetes mellitus, a chronic disease with a high social and economic impact. PATIENTS AND METHODS: The study has been performed on 57 subjects (25% women and 75% males; mean age: 60 ± 1.1 years; BMI: 27 ± 0.4) affected by type 2 Diabetes Mellitus. The subjects were divided in four groups: A (subjected to glucose-lowering diet therapy), B (subjected to antihyperglycaemic therapy), C (exposed to glucose-lowering diet therapy + drinking SPA therapy) and D (exposed to antihyperglycaemic therapy + drinking SPA therapy). Drinking SPA treatment was effected with sulphurous mineral water from Terme of Telese SpA (Benevento - Italy) and the pharmacological treatment provided the use of hypoglycemic drugs normally used in diabetic disease. After two weeks of therapy with treatments considered were evaluated fasting blood glycaemia and plasma concentration of ROMs (reactive oxygen metabolites) (d-ROMs test-Diacron International srl®-Grosseto - Italy). RESULTS: The results of our study have shown a significant (p<0.05) reduction of the fasting blood glycaemia when to hypoglycemic drugs or diet therapy was associated the sulphurous drinking SPA therapy. It was also observed a reduction of plasma ROMs levels, significant (p <0.05) in group D versus group B. CONCLUSIONS: The data from this preliminary investigation suggest that the drinking SPA therapy with sulphurous mineral water, especially in combination with antidiabetic drug treatment, may be useful in type 2 diabetes mellitus for the improvement redox state of the organism.

[The rhinogenic deafness and SPA therapy: clinical-experimental study]. / Sordità rinogena e terapia termale: studio clinico-sperimentale.

OBJECTIVES: The sulphur SPA inhalation therapy is useful in respiratory and otolaryngologic chronic inflammatory diseases in adult subjects and children. The therapeutic action relies on anti-inflammatory, mucolytic and trophic effects. Particularly in children, the sulphur SPA inhalation therapy, using endotympanic ventilation or Politzer method, would be suitable in the treatment of the rhinogenic deafness. Several reports have demonstrated the effectiveness of endotympanic ventilation while the results on the Politzer method are inconclusive. On the basis of these considerations, aim of our study was to analyze the effectiveness and the safety of the aerosol+Politzer with a sulphur mineral water in children affected by rhinogenic deafness or chronic inflammatory processes responsible for the onset or persistence of rhinogenic deafness. PATIENTS AND METHODS: The study has been performed on 23 subjects in pediatric age (61% women and 39% males; mean age: 6+/-2.4 years; age range: 3-14 years) affected by chronic catarrhalis otitis, chronic rhino-pharyngitis inflammations, chronic or recurrent adenoiditis with dysfunction of the Eustachian Tube. The investigated subjects underwent 12 consecutive days sulphur SPA inhalation therapy (aerosol+Politzer) at the Terme of Stabia in Castellammare (Naples, Italy). At the beginning and at the end of the SPA cycle the functionality of the middle ear and the tolerability were evaluated. RESULTS: The results have shown an increase of the impedance curves that correspond to the normal ventilation of the tympanic box (type A (13% before therapy and of 57% post-therapy) and a decrease of the pathological curves of type B and type C (87% pre-therapy and of 43% post-therapy); a significant increase of compliance (p 0.05) in pathological curves of type B and C. No adverse reaction to the SPA inhalation therapy has been reported during the study. CONCLUSIONS: In concordance with the literature our data demonstrated that the sulphur SPA inhalation treatment induce a improvement of middle ear function of the subjects examined with good local and systemic tolerability.

An electrodeless system for measurement of liquid sample dielectric properties in radio frequency band.

An electrodeless measurement system based on a resonant circuit is proposed for the measurement of dielectric properties of liquid samples at RF (radio frequency). Generally, properties as dielectric constant, loss factor and conductivity are measured by parallel plate capacitor cells: this method has several limitations in the case of particular liquid samples and in the range of radiofrequencies. Our method is based on the measurements of resonance frequency and quality factor of a LC resonant circuit in different measuring conditions, without and with the liquid sample placed inside a test tube around which the home made coil is wrapped. The measurement is performed using a network analyzer and a dual loop probe, inductively coupled with the resonant circuit. One of the advantages of this method is the contactless between the liquid sample and the measurement electrodes. In this paper the measurement system is described and test measurements of conventional liquids dielectric properties are reported.

A mechanical model lung for hydraulic testing of total liquid ventilation circuits.

A new model lung (ML), designed to reproduce the tracheal pressure vs. fluid flow relationship in animals undergoing total liquid ventilation (TLV) trials, was developed to be used as a mock bench test for neonatal TLV circuits. The ML is based on a linear inertance-resistance-compliance (LRC) lumped-parameter model of the respiratory system with different resistance values for inspiration (R insp ) or expiration (R exp ). The resistant element was set up using polypropylene hollow fibres packed inside a tube. A passive one-way valve was used to control the resistance cross-section area provided for the liquid to generate different values for R insp or R exp , each adjustable by regulating the active length of the respective fibre pack. The compliant element consists of a cylindrical column reservoir, in which bars of different diameter were inserted to adjust compliance (C). The inertial phenomena occurring in the central airways during TLV were reproduced by specifically dimensioned conduits into which the endotracheal tube connecting the TLV circuit to the ML was inserted. A number of elements with different inertances (L) were used to simulate different sized airways. A linear pressure drop-to-flow rate relationship was obtained for flow rates up to 5 l/min. The measured C (0.8 to 1.3 mL cmH2O (-1) kg(-1)), R insp (90 to 850 cmH2O s l(-1)), and R exp (50 to 400 cmH2O s l(-1)) were in agreement with the literature concerning animals weighing from 1 to 12 kg. Moreover, features observed in data acquired during in vivo TLV sessions, such as pressure oscillations due to fluid inertia in the upper airways, were similarly obtained in vitro thanks to the inertial element in the ML.

Botulinum toxin injection versus laparoscopic myotomy for the treatment of esophageal achalasia: economic analysis of a randomized trial.

BACKGROUND: The treatment of esophageal achalasia is still controversial: current therapies are palliative and aim to relieve dysphagia by disrupting or relaxing the lower esophageal sphincter muscle fibers with botulinum toxin. The aim of this study was to compare the clinical and economic results of two such treatments: laparoscopic myotomy and botulinum toxin injection. METHODS: A total of 37 patients with esophageal achalasia were randomly assigned to receive laparoscopic myotomy (20) or two Botox injections 1 month apart (17). All patients were treated at the same hospital and were part of a larger multicenter study. Symptom score, lower esophageal sphincter pressure, and esophageal diameter at barium swallow were compared. The economic analysis was performed considering only the direct costs (cost per treatment and cost effectiveness, i.e., cost per patient healed). RESULTS: Mortality and morbidity were nil in both groups. The actuarial probability of being asymptomatic at 2 years was 90% for surgery and 34% for Botox (p < 0.05). The initial cost was lower for Botox (1,245 Euros) than for surgery (3,555 Euros), but when cost effectiveness at 2 years was considered, this difference nearly disappeared: Botox 3,364 Euros, surgery 3,950 Euros. CONCLUSION: Botox is still the least costly treatment, but the minimal difference in the longer term does not justify its use, given that surgery is a risk-free, definitive treatment.

Tailored approach to Zenker's diverticula.

BACKGROUND: Zenker's diverticula (ZD) can be treated by diverticulostomy or open surgery (upper esophageal sphincter myotomy and diverticulectomy or diverticulopexy). The aim of this study was to compare the outcome of the two alternative treatments. METHODS: Fifty eight patients were scored for symptoms and upper esophageal sphincter (UES) pressure; relaxations and intrabolus pressures were recorded by manometry. Treatment depended on operative risk and ZD size. Twenty four patients with high surgical risk and/or a <3-cm or >5-cm pouch underwent diverticulostomy; the other 34 had open surgery. RESULTS: Mortality was nil. Five patients had postoperative complications after open surgery (p<0.05). Hospital stay was shorter after diverticulostomy (p<0.001). Follow-up (41 months; range, 1-101) was obtained in 53 patients. Postoperative manometry showed a UES pressure reduction, improved UES relaxation, and lower intrabolus pressure in both groups (p<0.05). In the diverticulostomy group, three patients complained of severe dysphagia. vs none in the open surgery group (p<0.05). CONCLUSION: Diverticulostomy is safe, quick, and effective for most patients with medium-sized ZD, but open surgery offers better long-term results and should be recommended for younger, healthy patients with small or very large diverticula.

Role of acid and bile reflux in development of specialised intestinal metaplasia in distal oesophagus.

BACKGROUND: Barrett's oesophagus is defined as specialised intestinal metaplasia in the distal oesophagus, regardless of extension. AIM: To study distal oesophagus function, and acid and bile exposure in patients with Long Segment (>3 cm), Short Segment (1 to 2 cm) and Ultra-short Segment (<1 cm) Barrett's Oesophagus, and in patients with gastro-oesophageal reflux disease without intestinal metaplasia. PATIENTS: Study population comprised 17 patients with Long, 8 with Short, 9 with Ultra-Short Segment Barrett's oesophagus, 32 with reflux disease and 12 healthy volunteers. METHODS: Patients were evaluated by manometry and by 24-hour pH and bile monitoring. RESULTS: Patients with intestinal metaplasia had greater acid exposure of the distal oesophagus than healthy volunteers. Patients with Long Segment Barrett's oesophagus had a longer history of symptoms, worse lower oesophageal sphincter pressures and longer bile and acid exposure than the other patients. Long Segment Barrett's oesophagus was predicted by low oesophageal pressure and increased bile exposure, age and male sex. CONCLUSION: Acid exposure in the distal oesophagus is probably the aetiological factor behind intestinal metaplasia, but a severely damaged antireflux barrier and bile in the refluxate are necessary for Long Segment Barrett's Oesophagus to develop.

Minimally invasive surgery for esophageal achalasia.

BACKGROUND: Esophageal achalasia is characterized by loss of peristaltic activity and failure of relaxation of the lower esophageal sphincter (LES). The characteristic dysphagia may be alleviated by surgery, dilations, or botulinum toxin injections. Video-endoscopic surgery is used increasingly. PATIENTS AND METHODS: This paper reports our experience with 142 consecutive achalasia patients treated by laparoscopic Heller myotomy and Dor antireflux fundoplication and followed for a median 26 months. RESULTS: Overall, the actuarial lifetable analysis showed a 90% probability of a patient's being symptom free over a 5-year period. Radiologic assessment showed a significant reduction in esophageal diameter and manometry a significant reduction in the resting tone and residual pressure of the LES. Twenty-four-hour pH monitoring showed postoperative reflux in 6.7% of patients. Persistent dysphagia or chest pain (i.e., failure of treatment) were reported by 15 patients (10.6%): 14 of them were subsequently treated with multiple pneumatic dilations, which were successful in 12 cases. CONCLUSION: Laparoscopic Heller myotomy with Dor fundoplication is a feasible and effective treatment for achalasia, with an actuarial success rate of 90% at 5 years. With additional dilation, a 98% success rate can be achieved.

Liquid ventilation: a mathematical model of gas diffusion in the premature lung.

The liquid ventilation (LV) technique was previously demonstrated to be a valuable alternative to ordinary gas ventilation, particularly for newborn patients with severely distressed lungs. This work describes a mathematical model of gas transfer phenomena occurring within the lungs of a preterm newborn baby ventilated with liquid perfluorocarbon (PFC) RM-101. The model was conceived in order to perform computer simulations of LV treatments. Its input parameters are tidal volume, respiratory frequency, oxygen and carbon dioxide tension in inlet PFC; its output data are the partial pressures of respiratory gases in the alveolar environment. Such values may be evaluated at any instant from the beginning of the treatment, in order to judge whether the therapy is able to meet the necessary conditions to arterialize properly the patient's venous blood. The model also enables optimisation procedures to be defined and performed. Quantitative results and graphs are supplied, with reference to the simulation of LV applied to a preterm newborn of 28 gestational weeks. The main results point out that a relatively short duration of initial transients is attainable (200 to 240 s) and that blood arterialization is possible even with low oxygen tension in inlet PFC (29.7 kPa (223 mmHg)).

K+ channels and guinea-pig trachea: a possible functional modulation by GABAB receptors.

K+ channel activators represent a novel class of smooth muscle relaxant agents. There is now much evidence demonstrating that K+ channels, localized to prejunctional neurons and post-junctional smooth muscle membranes, can regulate airway smooth muscle activity, inducing smooth muscle cell membrane hyperpolarization. K+ channel activity may be influenced by some neurotransmitters, such as adenosine, serotonin and noradrenaline. More recently, it has been observed that the stimulation of GABAB receptors influences K+ channels in the hippocampus, dorsal rafe and spinal cord neurons. The aim of this study was to investigate the effects of levcromakalim in guinea-pig trachea at pre- and post-junctional sites and to evaluate whether GABAB receptors may modulate K+ channel activation. Levcromakalim (from 1 nM to 1 microM) relaxed guinea-pig trachea (IC50 10 +/- 0.9 nM) previously contracted by KCl (30 mM). This effect was reversed by a pretreatment with tetraethylammonium (10 mM) (IC50 120 +/- 0.7 nM). A 30-min pretreatment with baclofen (1 microM) or phaclofen (1 microM) failed to modify the effects of levcromakalim (IC50 18 +/- 1.0 nM and 14 +/- 0.6 nM, respectively). The contractile responses to electrical field stimulation (71.20 +/- 5.12% of acetylcholine--100 microM--contraction) was significantly (P < 0.05) reduced by a pretreatment with levcromakalim (10 nM) (54.00 +/- 6.68%). This reduction was antagonized by tetraethylammonium (10 nM) (72.20 +/- 14.27%).(ABSTRACT TRUNCATED AT 250 WORDS)

Recurrent aortic graft infection following descending thoracic aorta to femoral artery bypass. A case report and review.

This paper presents a patient who developed a recurrent aortic graft infection after a descending thoracic aorta to femoral artery bypass. The patient had previously undergone successful management of an infected aortobifemoral bypass by removal of the graft and revascularization of the lower extremities with axillofemoral bypasses. A general discussion of the management of infected aortic grafts is presented and a discussion of the management of this particular patient is presented in detail.

Impending aortoenteric hemorrhage: the effect of early recognition on improved outcome.

Aortoenteric hemorrhage is the result of enteric erosion and necrosis of aortic wall or anastomotic site. Mechanical or bacteriologic causes may occur singly or in combination. The temporal sequence is such that warning symptoms, often including back pain, fever, hemotochezia, and anemia, are present long before exsanguinating hemorrhage occurs. Vigorous diagnostic efforts, including gallium-67 citrate nuclear scan and computerized axial tomography, lead to a correct diagnosis. This allows planned semielective corrective operation before severe hemorrhage begins. The ideal operation consists of extra-anatomic revascularization, excision of the infected prosthesis, bowel repair with decompression, and sump drainage. Appropriate antimicrobial therapy should be continued until healing is complete. With aggressive diagnostic and therapeutic intervention according to this plan, marked improvement in survival and limb preservation can be anticipated in patients having this complication of aortic surgery. In this series, 15 of 18 patiets having operation recovered, though delayed limb loss occurred in two.