Age and Vasodilator Response to Different Hyperemic Agents: Adenosine versus Contrast Medium.

Background: Age-related remodelling has the potential to affect the microvascular response to hyperemic stimuli. However, its precise effects on the vasodilatory response to adenosine and contrast medium, as well as its influence on fractional flow reserve (FFR) and contrast fractional flow reserve (cFFR), have not been previously investigated. We investigate the impact of age on these indices. Methods: We extrapolated data from the post-revascularization optimization and physiological evaluation of intermediate lesions using fractional flow reserve (PROPHET-FFR) and The Multi-center Evaluation of the Accuracy of the Contrast MEdium INduced Pd/Pa RaTiO in Predicting (MEMENTO) studies. Only lesions with a relevant vasodilatory response to adenosine and contrast medium were considered of interest. A total of 2080 patients, accounting for 2294 pressure recordings were available for analysis. The cohort was stratified into three age terciles. Age-dependent correlations with FFR, cFFR, distal pressure/aortic pressure (Pd/Pa) and instantaneous wave-free ratio (iFR) were calculated. The vasodilatory response was calculated in 1619 lesions (with both FFR and cFFR) as the difference between resting and hyperaemic pressure ratios and correlated with aging. The prevalence of FFR-cFFR discordance was assessed. Results: Age correlated positively to FFR (r = 0.062, p = 0.006), but not with cFFR (r = 0.024, p = 0.298), Pd/Pa (r = -0.015, p = 0.481) and iFR (r = -0.026, p = 0.648). The hyperemic response to adenosine (r = -0.102, p ≤ 0.0001) and to contrast medium (r = -0.076, p = 0.0023) showed a negative correlation with age. When adjusted for potential confounders, adenosine induced hyperaemia was negatively associated with age (p = 0.04 vs p = 0.08 for cFFR). Discordance decreased across age terciles (14.64% vs 12.72% vs 10.12%, p = 0.032). Conclusions: As compared to adenosine, contrast induced hyperaemia appeared to be less affected by age. cFFR may be considered a more stable and reproducible tool to assess epicardial stenosis in elderly patients. Clinical Trial Registration: PROPHET-FFR STUDY, Clinicaltrials.gov (NCT05056662).

Psychrobacter raelei sp. nov., isolated from a dog with peritonitis.

A strain belonging to the genus Psychrobacter, named PraFG1T, was isolated from the peritoneal effusion of a stray dog during necropsy procedures. The strain was characterized by the phylogenetic analyses based on the nucleotide sequences of 16S and 23S rRNA genes and of gyrB, which placed the strain in the genus Psychrobacter. The nucleotide sequence of the chromosome confirmed the placement, showing an average nucleotide identity of 72.1, 77.7, and 77.5 % with the closest related species, namely Psychrobacter sanguinis, Psychrobacter piechaudii, and Psychrobacter phenylpyruvicus, respectively, thus indicating a novel species. The polyphasic characterization by biochemical and fatty acid profiling as well as MALDI-TOF supported those findings. The strain was halotolerant, capable of growing within a temperature range between 4 and 37 °C, it was positive for catalase and oxidase, indole producing, nitrate reducing, and not able to use 5-keto-d-gluconic acid as a carbon source. Taken together, the data suggest that strain PraFG1T could be considered as representing a novel species, with the name Psychrobacter raelei sp. nov. (type strain PraFG1T=CIP 111873T=LMG 32233T).

An Outbreak of Human Systemic Anthrax, including One Case of Anthrax Meningitis, Occurred in Calabria Region (Italy): A Description of a Successful One Health Approach.

In this report, three cases of human cutaneous anthrax are described, one complicated by meningitis, and all were linked to a single infected bullock. A 41-year-old male truck driver, along with two male slaughterhouse workers, 45 and 42, were hospitalized for necrotic lesions of the arm associated with edema of the limb and high fever. All three patients were involved in transporting a bullock to the slaughterhouse. Microbiological examination on the prescapular lymph node and a piece of muscle from the bullock carcass showed the presence of Bacillus anthracis. The three patients underwent a biopsy of the affected tissues, and all samples tested positive for B. anthracis DNA using PCR. Furthermore, the truck driver also complained of an intense headache, and a CSF sampling was performed, showing him positive for B. anthracis by PCR, confirming the presumptive diagnosis of meningitis. Fast diagnosis and appropriate treatment are crucial for the management of human anthrax. Cooperation between human and veterinary medicine proved successful in diagnosing and resolving three human anthrax cases, confirming the reliability of the One Health approach for the surveillance of zoonoses.

Kinematic analysis of mandibular motion before and after orthognathic surgery for skeletal Class III malocclusion: A pilot study.

OBJECTIVES: The aim of the study was to detect the changes in 3D mandibular motion after orthognathic surgery for skeletal Class III malocclusion. METHOD: Using a 3D motion analyzer, free mandibular border movements were recorded in nine patients successfully treated for skeletal Class III malocclusion and in nine patients scheduled for orthognathic surgery. Data were compared using Mann-Whitney non-parametric U-test. RESULTS: The results showed no differences between the groups in the total amount of mouth opening, protrusion, and in lateral excursions, but the percentage of mandibular movement explained by condylar translation was significantly increased after surgery (20% vs. 23.6%). During opening, the post-surgery patients showed a more symmetrical mandibular interincisal point and condylar path than pre-surgery patients (p < 0.01). DISCUSSION: Patients treated with orthognathic surgery for skeletal Class III malocclusion recover a good and symmetric temporomandibular joint function.

Cinemática de variáveis de técnica-chave nos flic flacs de ginastas de elite / Kinematics of key technique variables in the backward handsprings of elite gymnasts

INTRODUÇÃO: A ginástica é o esporte de habilidades fechadas mais antigo e espetacular. Contudo, parâmetros técnicos de execução geralmente são somente ensinados por treinadores experientes. Desta maneira, existe uma lacuna de informações objetivas sobre o desempenho de ginastas (referências cinemáticas). OBJETIVO: No presente estudo, tentamos quantificar movimentos de inversão linear e de hiperextensão durante a execução de flic flacs. MÉTODOS: Foi efetuada uma detecção não invasiva de flic flacs com o auxílio de um instrumento óptico eletrônico 3D. Treze marcadores esféricos retrorreflexivos (1 cm de diâmetro) foram posicionados no corpo de 9 ginastas experientes: maléolos laterais direito e esquerdo, cabeça da fíbula, trocanter maior, acrômio, olecrano, processo estiloide da ulna e vértex. Na mesma sessão e após um período de aquecimento, cada participante executou 15 repetições de flic flacs. Dez repetições forma analisadas, e os trajetos 3D das 13 manobras medidos. RESULTADOS: Em média, os homens obtiveram altura vertical maior (mulheres, 62% da altura; homens, 58%). O alinhamento dos membros inferiores foi homogêneo entre os ginastas: ângulos posteriores de joelho variaram entre 80° e 118°. Nenhuma abdução de membro inferior foi observada: a largura de joelho foi 7 cm menor do que a largura intertrocanter; a largura de tornozelo foi 8 cm menor do que a largura de joelho. Na saída do movimento, o ângulo tronco-coxa apresentou excelente alinhamento corporal, com valores bem próximos de 180°. As mulheres executaram a fase de apoio das mãos com pulsos mais próximos do que os homens (homens, 134% de largura de ombro; mulheres, 121%). CONCLUSÃO: Os resultados podem fornecer informações para melhor conhecimento, definindo assim, a execução de padrão-ouro obtida de ginastas de elite com poucas lesões.

INTRODUCTION: Gymnastics is the most ancient and spectacular closed skills sport. Nonetheless, technical parameters of performance are often taught only by experienced trainers. Thus, there is a lack of objective data about gymnastics performance (kinematics references). OBJECTIVE: In the current study, we tried to quantify linear and hyperextension back movements during performance of backward handsprings. METHODS: A noninvasive detection of backward handsprings was made using a 3D optoelectronic instrument. Thirteen spherical retro-reflective markers (1-cm diameter) were positioned on the body of 9 experienced gymnasts: right and left lateral malleolus, fibular head, greater trochanter, acromion, olecranon, styloid process of the ulna; vertex. In the same session and after a warm-up period, each participant performed 15 repetitions of backward handsprings. Ten repetitions were analyzed, and the 3D tracks of the 13 landmarks measured. RESULTS: On average, men performed longer backward handsprings than women (men, 122% of height; women, 98%); women attained larger vertical height (women, 62% of height; men, 58%). Lower limb arrangement was homogenous among the gymnasts: posterior knee angles ranged between 80° and 118°. No lower limb abduction was observed: knee width was 7 cm smaller than intertrochanter width; ankle width was 8 cm smaller than knee width. At take-off, the trunk-thigh angle presented excellent body alignment, with values very close to 180°. Women performed the handstand phase with closer wrists than men (men, 134% of shoulder width; women, 121%). CONCLUSION: The results may offer data to improve understanding, defining gold-standard execution taken from high level gymnasts with few injuries.

Three-dimensional mandibular motion after closed and open reduction of unilateral mandibular condylar process fractures.

OBJECTIVE: To detect the changes in 3D mandibular motion after two types of condylar fracture therapies. MATERIALS AND METHODS: Using a 3D motion analyzer, free mandibular border movements were recorded in 21 patients successfully treated for unilateral fractures of the mandibular condylar process (nine patients: open reduction, rigid internal fixation, and functional treatment; 12 patients: closed reduction and functional treatment; follow-up: 6-66 months), and in 25 control subjects. RESULTS: No differences were found among the groups at maximum mouth opening (MO), protrusion and in lateral excursions. During opening, the patients had a larger maximal deviation to the fractured side than the controls (controls 2.3 mm, open treatment 3.9 mm, closed treatment 4.2 mm; Kruskal-Wallis test, p=0.014; closed treatment vs. controls, p=0.004), with a larger coronal plane angle (controls 2.4°, open treatment 3.6°, closed treatment 4.4°; p=0.016; closed treatment vs. controls, p=0.013). In the closed treatment patients, a longer follow-up was related to increased maximum MO (p=0.04), sagittal plane angle (p=0.03), and reduced lateral mandibular deviation during MO (p=0.03). CONCLUSION: Mandibular condylar fractures can recover good function; some kinematic variables of mandibular motion were more similar to the norm in the open treatment patients than in closed treatment patients.

Mandibular kinematics after orthognathic surgical treatment a pilot study.

We recorded three-dimensional mandibular movements, while the mouth was being opened and closed, using an optoelectronic motion analyser in 14 patients (5 skeletal Class II, 9 skeletal Class III) who were being assessed 7-49 months after orthognathic operations, and in 44 healthy subjects. All 14 patients had satisfactory healing on clinical examination, and function had been restored. Mandibular movement was divided into its rotational and translational components. On maximum mouth opening, the patients had significantly less total displacement of the mandibular interincisor point (p=0.05), and more mandibular movement that was explained by pure condylar rotation (p=0.006), than control subjects. There was no significant relation between maximum mouth opening and percentage rotation. While mandibular motion was well restored clinically by orthognathic surgery, the kinematics of the joint were modified. Larger studies and longitudinal investigations are necessary to appreciate the clinical relevance of the variations in condylar rotational and translational components.

A three-dimensional study of facial mimicry in healthy young adults.

To assess sex-related characteristics in facial movements, and to define a set of reference normal values, 20 healthy young adults (10 men, 10 women) performed six standardized facial movements (maximum smile; free smile; "surprise" with closed mouth; "surprise" with open mouth; right- and left-side eye closures). The three-dimensional coordinates of 21 soft-tissue facial landmarks were recorded by an optoelectronic motion analyzer, their movements computed, and standardized for facial dimensions. Asymmetry indices were calculated. The mouth area had the largest movements. Sex-related differences were found only for the superciliare landmark (men had larger movements than women, p<0.001). Asymmetries in the eyes, mouth and nose were similar in both sexes (p>0.01), with a significant effect of movement (p<0.001): eye and mouth asymmetry was larger during the asymmetric eye closures than during the symmetric movements. The right-side asymmetric movements were somewhat larger than the left-side ones. The total facial movement did not differ between sexes; the "surprise with mouth open" movement had the largest landmark displacements (p<0.001). In conclusion, normal young adult men and women had similar standardized facial movements, except in the forehead. Some individual asymmetry was found in symmetric facial animations; some synkinesis was found even in normal adults.

[Prevalence and risk factors for bacteriuria in patients with cirrhosis]. / Prevalenza e fattori di rischio della batteriuria in pazienti con cirrosi.

Bacterial infections occur frequently in patients with cirrhosis and may worsen the disease outcome. We investigated the prevalence of bacteriuria in 500 consecutive patients with cirrhosis, in different Child-Pugh stages (41.4% A; 40.8% B; 17% C) and analysed the associated risk factors. Most of the cirrhosis cases were virus related; alcohol abuse was recorded in 6.2% of the patients. Bacteriuria was detected in 139 (27.8%) cases: 32.4% were more than 100,000 cfu/ml; 7.9% between 100,000 and 1.000,000 cfu/ml and the remaining cases more than 1000,000 cfu/ml. Escherichia coli was the most frequent isolated agent (84.5%); Proteus spp. strains were detected only in bacteriuria with more than 100,000 cfu/ml. At univariate analysis, female gender, age and presence of diabetes were significantly associated to bacteriuria, while Child-Pugh stage and the presence of hepatocellular carcinoma were not. In a multivariate model, only female gender and diabetes were significantly associated to bacteriuria. These results indicate that advanced cirrhosis was not a risk for bacteriuria, that was associated rather to gender and diabetes, which are common risk factors for bacteriuria in non-cirrhotic patients.

Case report: effect of antileishmanial treatment on hepatitis C viraemia in a visceral leishmaniasis patient with chronic hepatitis C.

We describe a case of Mediterranean visceral leishmaniasis (VL) in a patient with pre-existing chronic hepatitis C, which caused high hepatitis C virus (HCV) plasma concentration and was followed by a rapidly growing hepatocellular carcinoma (HCC). The high HCV load was drastically and persistently reduced soon after treatment with liposomal amphotericin B suggesting a cause-effect interaction. Some data suggest that liposomal amphotericin B may have an immunomodulatory effect. VL may directly affect the liver function, but HCC has never been reported as a consequence of the disease. This case suggests that VL causes an increase in HCV replication, but, although the growth of the HCC can be defined as exceptional, a relationship with VL is not proven.