Diagnosis and treatment of chronic synovitis in patients with haemophilia: consensus statements from the Italian Association of Haemophilia Centres.

Although synovitis is recognized as a marker of joint disease activity, its periodic assessment is not included in routine clinical surveillance of patients with haemophilia (PwH). In order to evaluate the current knowledge and to identify controversial issues, a preliminary literature search by the Musculoskeletal Committee of the Italian Association of Haemophilia Centres (AICE) has been conducted. Statements have been established and sent to the Italian AICE members to collect their level of agreement or disagreement by a Delphi process. Thirty-seven consensus recommendations have been drafted. We found a general agreement on the indication to consider the presence of synovitis as a marker of joint disease activity in PwH. Accordingly, there was agreement on the indication to search for synovitis both in patients reporting joint pain and in asymptomatic ones, recognizing ultrasound as the most practical imaging technique to perform periodic joint screening. Interestingly, after detection of synovitis, there was agreement on the indication to modify the therapeutic approach, suggesting prophylaxis in patients treated on demand and tailoring treatment in patients already under prophylaxis. Whereas the need of an early consultation with a physiotherapist is recommended for PwH affected by chronic synovitis, the exact timing for an orthopaedic surgeon consultation is currently unknown.

Influence of the Use of an Ionic Liquid as Pre-Hydrodistillation Maceration Medium on the Composition and Yield of Cannabis sativa L. Essential Oil.

Cannabis sativa L. is a multi-purpose crop, whose resilience, adaptability and soil-enriching properties make it a low-impact production. In the last years, the cultivation of the "industrial" hemp varieties (THC < 0.2%) has been promoted by many Countries, opening a whole new market of hemp-derived products, such as its essential oil (EO). Its distillation might represent an effective method to exploit a residue of the hemp fiber production (flowers), complying with the guidelines of the circular economy. In the present work, different concentrations of an ionic liquid (IL; 1,3-dimethyl-1H-imidazol-3-ium dimethylphosphate) have been studied as a pre-hydrodistillation maceration medium. The EO yields have been evaluated, and their compositions have been analyzed by GC-EIMS. The use of 100% and 90% IL concentrations gave a hydrodistillation yield increment of 250% and 200%, respectively. The 200% yield increase was maintained when the 100% IL was recycled after the hydrodistillation. The lower IL concentrations incremented the cannabinoid and oxygenated sesquiterpene contents, while the opposite was true for sesquiterpene hydrocarbons. The proposed IL-enhanced hydrodistillation medium applied to hemp, studied for the first time in the present work, might be used to both (i) noteworthy increment the hydrodistillation yield and (ii) modulate the obtained EO composition based on the desired final product.

Standard and water rehabilitation: An analysis of over 14 years' experience in patients with haemophilia or other clotting factor disorders after orthopaedic surgery.

INTRODUCTION: In people with haemophilia (PWH) with severe arthropathy, total joint replacement (TJR) can be undertaken if conservative management fails. Post-operative rehabilitation treatment is an important part of the comprehensive management of patients undergoing TJR. AIM: To compare post-operative standard rehabilitation (SR) and SR plus water rehabilitation (WR) in PWH undergoing TJR. METHODS: PWH who were admitted to our centre between June 2003 and December 2016 for rehabilitation after TJR were included in the study. Rehabilitation included SR (ie, manual and mechanical mobilization, scar tissue massage, light muscle strengthening exercises and walking training with and without crutches) with or without WR. WR exercises with floats of different size and volume were performed when possible. Range of motion (ROM), muscle strength, pain level, perceived health status and length of hospital stay were analysed retrospectively. RESULTS: A total of 184 patients (233 rehabilitation programmes were enrolled in the study, corresponding to 160 after total knee replacement [TKR], 37 after total ankle replacement [TAR] and 36 after total hip replacement [THR]). Fifty-eight (25%) patients were treated with WR in addition to SR (32 for TKR, 19 for TAR and 7 for THR) with an average of 5.7 hours of WR. Muscle strength, pain and perceived health status improved significantly after rehabilitation. CONCLUSION: This non-randomized study seems to indicate that WR plus SR improves muscle strength, pain and perceived health status more than SR alone in PWH undergoing TJR. It would be necessary, however, to carry out randomized comparative studies to confirm these provisional conclusions.

[Primary cardiac angiosarcoma: an unexpected presentation]. / Angiosarcoma cardiaco primitivo: una manifestazione clinica inaspettata.

Among cardiac tumors, angiosarcoma is the most common primary malignancy, with a relatively higher prevalence in young male adults and a weak dominance in the right atrium as a primary site of growth. It is characterized by rapid infiltration of cardiac structures and possible metastasis to mediastinal and distant organs. The patient may be asymptomatic until advanced phases. It therefore has a poor prognosis. Diagnosis requires the use of multimodality imaging, including echocardiography, computed tomography (CT), cardiac magnetic resonance and positron emission tomography. The definitive diagnosis is based on histological examination. We report the case of a young male adult who was referred to the cardiology department for a syncopal event 5 h after cocaine assumption. During the diagnostic work-up, a chest X-ray was performed, showing multiple pulmonary lesions, which were evaluated with a chest CT highlighting the presence of a cardiac mass in the right atrium and ventricle. For this reason, a complete cardiological evaluation was performed. The clinical and instrumental suspicion of a malignant cardiac tumor was confirmed by multimodality imaging and finally by histological examination.

Improvement in fruit yield and tolerance to salinity of tomato plants fertigated with micronutrient amounts of iodine.

Iodine is an essential micronutrient for humans, but its role in plant physiology was debated for nearly a century. Recently its functional involvement in plant nutrition and stress-protection collected the first experimental evidence. This study wanted to examine in depth the involvement of iodine in tomato plant nutrition, also evaluating its potential on salt stress tolerance. To this end, iodine was administered at dosages effective for micronutrients to plants grown in different experimental systems (growth chamber and greenhouse), alone or in presence of a mild-moderate NaCl-salinity stress. Plant vegetative fitness, fruit yield and quality, biochemical parameters and transcriptional activity of selected stress-responsive genes were evaluated. In unstressed plants, iodine increased plant growth and fruit yield, as well as some fruit qualitative parameters. In presence of salt stress, iodine mitigated some of the negative effects observed, according to the iodine/NaCl concentrations used. Some fruit parameters and the expressions of the stress marker genes analyzed were affected by the treatments, explaining, at least in part, the increased plant tolerance to the salinity. This study thus reconfirms the functional involvement of iodine in plant nutrition and offers evidence towards the use of minute amounts of it as a beneficial nutrient for crop production.

Dose-Related Analysis in Percutaneous Central Venous Catheters Insertion: Experience of a Pediatric Interventional Radiology Center.

BACKGROUND: There are many techniques for long-term central venous catheter (CVC) placement, but none of them are specific for pediatric patients or focused on the delivered dose of ionizing radiation. MATERIALS AND METHODS: This retrospective study examined a sample of pediatric patients who received percutaneous long-term CVC positioning in a tertiary care pediatric hospital. Effective dose, dose-area product (DAP) and length of time of exposition during the procedure were determined, using an appropriate technical procedure, exam and program set of the angiograph, and compared with an unpaired t-test analysis. RESULTS: The study included 1410 enrolled patients, with a median age of 10 years (range 0.2-18 years), between 2016 and 2019. In 2016 (318 pts), the mean effective dose was 0.13 mSv and the mean DAP dose was 18.95 µGy/m2 In 2017 (353 pts), the mean effective dose was 0.11 mSv and the mean DAP dose was 17.26 µGy/m2. In 2018 (351 pts), the mean effective dose was 0.05 mSv and the mean DAP dose was 7.23 µGy/m2. In 2019 (388 pts), the mean effective dose was 0.02 mSv and the mean DAP dose was 3.10 µGy/m2. CONCLUSIONS: Medical and technical expertise led to a remarkable reduction in the radiation dose. Therefore, the authors' hypothesis is that US- and fluoroscopy-guided percutaneous long-term CVC insertion technique is safer, more cost-effective and lower in terms of radiation exposure if correctly applied, compared to surgical or percutaneous by direct puncture techniques.

Sustainable Valorisation and Efficient Downstream Processing of Giant Reed by High-Pressure Carbon Dioxide Pretreatment.

This work investigated the catalytic high-pressure CO2 pretreatment of giant reed. CO2 is a renewable resource; its use does not generate chemical wastes and it can be easily removed and recycled. The effect of the addition of low concentrations of FeCl3 (0.16 wt %) and PEG 400 (1.0 wt %) on the hemicellulose hydrolysis to xylose and xylo-oligosaccharides (XOS) is reported for the first time. Under the optimised pretreatment conditions, the xylan conversion of 82 mol % and xylose and XOS yields of 43 and 20 mol % were achieved, respectively. The solid residues obtained from different pretreatments were used as the substrate for the enzymatic hydrolysis to give glucose. The total glucose yield achieved under the optimised two-step process was 67.8 mol % with respect to the glucan units in the biomass. The results demonstrated that PEG-assisted FeCl3 -catalysed scCO2 pretreatment can produce xylose- or XOS-rich hydrolysates and improve the enzymatic hydrolysis of biomass.

A Review on the Bioactivity of Cannabinoids on Zebrafish Models: Emphasis on Neurodevelopment.

For centuries, the cannabis plant has been used as a source of food, fiber, and medicine. Recently, scientific interest in cannabis has increased considerably, as its bioactive compounds have shown promising potential in the treatment of numerous musculoskeletal and neurological diseases in humans. However, the mechanisms that underlie its possible effects on neurodevelopment and nervous-system functioning remain poorly understood and need to be further investigated. Although the bulk of research on cannabis and cannabinoids is based on in vitro or rodent models, the zebrafish has now emerged as a powerful in vivo model for drug-screening studies and translational research. We here review the available literature on the use of cannabis/cannabinoids in zebrafish, and particularly in zebrafish models of neurological disorders. A critical analysis suggests that zebrafish could serve as an experimental tool for testing the bioactivity of cannabinoids, and they could thus provide important insights into the safety and efficacy of different cannabis-extract-based products. The review showed that zebrafish exhibit similar behaviors to rodents following cannabinoid exposure. The authors stress the importance of analyzing the full spectrum of naturally occurring cannabinoids, rather than just the main ones, THC and CBD, and they offer some pointers on performing behavioral analysis in zebrafish.

Improving assessment and management of pain in hemophilia: an Italian Delphi consensus statement.

Comprehensive evidence-based guidelines and well-validated assessment scales for pain in people with hemophilia (PwH) are needed. Here, we report 28 statements covering five topics on pain assessment and management in pediatric and adult PwH that were developed by 60 Italian hemophilia specialists during a Delphi consensus process. Overall, a clear consensus was achieved for 19 of the 28 statements. Consensus was reached on all statements on the topic of pain assessment and quality of life (QoL), including the need for regular pain assessment on a quantitative scale, the importance of distinguishing between different pain types, and the need to evaluate the impact of pain on patient QoL. The other four topics concerned acute and chronic pain management in adults and in children. Consensus was reached on statements regarding non-pharmacologic treatment and the use of first-line paracetamol (acetaminophen). There was a lack of consensus regarding the use of non-steroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, or opioids.

In Vivo Evaluation of Cannabis sativa Full Extract on Zebrafish Larvae Development, Locomotion Behavior and Gene Expression.

Historically, humans have been using Cannabis sativa for both recreational and medical purposes. Nowadays, cannabis-based products have gained scientific interest due to their beneficial effects on several syndromes and illnesses. The biological activity of cannabinoids is essentially due to the interaction with the endocannabinoid system, and zebrafish (Danio rerio) is a very well-known and powerful in vivo model for studying such specific interactions. The aim of the study was to investigate the effects of different doses of a Cannabis sativa whole extract [dissolved in dimethyl sulfoxide (DMSO)] on zebrafish eggs' hatchability, embryo post-hatching survival, larvae locomotion behavior and mRNA gene expression. The results showed the absence of toxicity, and no significant differences were observed between treatments for both embryo hatching and survival rate. In addition, larvae exposed to the cannabis extract at the highest dose [containing 1.73 nM and 22.3 nM of ∆9-tetrahydrocannabinol (THC) and cannabidiol (CBD), respectively] showed an increased locomotion compared to the control and DMSO treated groups. Moreover, qRT-PCR analysis showed that the highest dosage of cannabis induced an over-expression of cnr1 and cnr2 cannabinoid receptors. In conclusion, the exposition of zebrafish larvae to the whole extract of Cannabis sativa showed no negative effects on embryo development and survival and enhanced the larvae's locomotor performances. These findings may open up possible Cannabis sativa applications in human pharmacology as well as in other animal sectors.

Small Functional Foods: Comparative Phytochemical and Nutritional Analyses of Five Microgreens of the Brassicaceae Family.

Microgreens are the seedlings of herbs and vegetables which are harvested at the development stage of their two cotyledonary leaves, or sometimes at the emergence of their rudimentary first pair of true leaves. They are functional foods, the consumption of which is steadily increasing due to their high nutritional value. The species of the Brassicaceae family are good sources of bioactive compounds, with a favorable nutritional profile. The present study analyzed some phytochemical compounds with nutritional values, such as chlorophylls, polyphenols, carotenoids, anthocyanins, ascorbic acid, total and reducing sugars, and the antioxidant activity of five Brassicaceae species: broccoli (Brassica oleracea L.), daikon (Raphanus raphanistrum subsp. sativus (L.) Domin), mustard (Brassica juncea (L.) Czern.), rocket salad (Eruca vesicaria (L.) Cav.), and watercress (Nasturtium officinale R.Br.). Broccoli had the highest polyphenol, carotenoid and chlorophyll contents, as well as a good antioxidant ability. Mustard was characterized by high ascorbic acid and total sugar contents. By contrast, rocket salad exhibited the lowest antioxidant content and activity. The essential oil (EO) composition of all of these species was determined in order to identify their profile and isothiocyanates content, which are compounds with many reported health benefits. Isothiocyanates were the most abundant group in broccoli (4-pentenyl isothiocyanate), mustard (allyl isothiocyanate), and watercress (benzyl isothiocyanate) EOs, while rocket salad and daikon exhibited higher contents of monoterpene hydrocarbons (myrcene) and oxygenated diterpenes (phytol), respectively. Broccoli microgreens exhibited the overall best nutritional profile, appearing as the most promising species to be consumed as a functional food among those analyzed.

Evidences for a Nutritional Role of Iodine in Plants.

Little is known about the role of iodine in plant physiology. We evaluated the impact of low concentrations of iodine on the phenotype, transcriptome and proteome of Arabidopsis thaliana. Our experiments showed that removal of iodine from the nutrition solution compromises plant growth, and restoring it in micromolar concentrations is beneficial for biomass accumulation and leads to early flowering. In addition, iodine treatments specifically regulate the expression of several genes, mostly involved in the plant defence response, suggesting that iodine may protect against both biotic and abiotic stress. Finally, we demonstrated iodine organification in proteins. Our bioinformatic analysis of proteomic data revealed that iodinated proteins identified in the shoots are mainly associated with the chloroplast and are functionally involved in photosynthetic processes, whereas those in the roots mostly belong and/or are related to the action of various peroxidases. These results suggest the functional involvement of iodine in plant nutrition.

Pain assessment and management in Italian Haemophilia Centres.

BACKGROUND: Although the widespread use of factor VIII/IX replacement therapy has significantly reduced the severity of arthropathy in persons with haemophilia (PWH), some develop degenerative joint changes, associated with significant pain. The aim of this survey was to investigate the management and perception of pain among Italian physicians who treat PWH. MATERIALS AND METHODS: Between September and October 2017, a questionnaire was distributed to 35 Italian haemophilia treatment centres (60 physicians). RESULTS: Fifty-three haemophilia specialists completed the survey. We found that there was good agreement (98.1%) on the need to investigate pain at each clinical visit, but there was heterogeneity in the opinions of haemophilia specialists with regards to the availability of validated guidelines (35.8%) and whether pain specialists should be a part of the comprehensive care team in daily clinical practice (58.5%). Haemophilia specialists also agreed pain should be evaluated using a rating scale validated in PWH (88.7%). Pain was mainly managed by the haemophilia specialists themselves, supported by a physiatrist and physiotherapist, while a pain specialist was only involved in 26.4% of cases. The combination of paracetamol with tramadol or codeine was the most common first-line treatment, while cyclo-oxygenase-2 inhibitors, non-steroidal anti-inflammatory drugs, and opioids were less commonly used. DISCUSSION: There are some unmet needs in Italy regarding pain management for PWH and the management of pain in these patients by haemophilia specialists. There is a lack of evidence-based guidelines for these specialists to use, as well as a reluctance to involve pain specialists. The lack of spontaneous reporting of pain by PWH, despite using pain relief, highlights the need for clinicians to actively ask patients about any pain they may be experiencing.

Correction: Effect of Iodine treatments on Ocimum basilicum L.: Biofortification, phenolics production and essential oil composition.

[This corrects the article DOI: 10.1371/journal.pone.0226559.].

Effect of Iodine treatments on Ocimum basilicum L.: Biofortification, phenolics production and essential oil composition.

Iodine biofortification has been gaining interest in recent years as a sustainable and innovative approach to eradicate iodine deficiency disorders. Studying the impact of iodine biofortification on plant phenotype, biochemical and physiological parameters is crucial to leverage the expertise and best practices for the agro-food industry and human health. The aim of this study was to evaluate iodine biofortification on the main quantitative and qualitative traits of basil (Ocimum basilicum L.) plants cultivated both in open field and in growth chamber. The impact of KI and KIO3 treatments was evaluated on biomass production, as well as on the synthesis of phenolic compounds, especially rosmarinic acid and other caffeic acid derivatives, and on the essential oil (EO) composition. These compounds are typically accumulated in basil leaves and strongly contribute to the plant nutraceutical value and aroma. In open field, the use of increasing concentrations of both iodine salts gradually enhanced iodine accumulation in leaves, also determining an increase of the antioxidant power, total phenolics, rosmarinic acid and cinnamic acid accumulation. The composition of EO was only slightly affected by the treatments, as all the samples were characterized by a linalool chemotype and a minor alteration in their relative content was observed. A growth chamber experiment was performed to test EO variation in controlled conditions, broadening the range of iodine concentrations. In this case, plant chemotype was significantly affected by the treatments and large EO variability was observed, suggesting that iodine form and concentration can potentially influence the EO composition but that in open field this effect is overcome by environmental factors.

Application of microwave irradiation for the removal of polychlorinated biphenyls from siloxane transformer and hydrocarbon engine oils.

The removal of polychlorinated biphenyls (PCBs) both from siloxane transformer oil and hydrocarbon engine oil was investigated through the application of microwave (MW) irradiation and a reaction system based on polyethyleneglycol (PEG) and potassium hydroxide. The influence of the main reaction parameters (MW irradiation time, molecular weight of PEG, amount of added reactants and temperature) on the dechlorination behavior was studied. Promising performances were reached, allowing about 50% of dechlorination under the best experimental conditions, together time and energy saving compared to conventional heating systems. Moreover, an interesting dechlorination degree (up to 32%) was achieved for siloxane transformer oil when MW irradiation was employed as the unique driving force. To the best of our knowledge, this is the first time in which MW irradiation is tested as the single driving force for the dechlorination of these two types of PCB-contaminated oils.

Reliability of the Handgrip Strength Test in Elderly Subjects With Parkinson Disease.

BACKGROUND: The handgrip strength test is widely used by clinicians; however, little has been investigated about its reliability when used in subjects with Parkinson disease (PD). The purpose of this study was to investigate the test-retest reliability of the handgrip strength test for subjects with PD. METHODS: The PD group consisted of 15 patients, and the control group consisted of 15 healthy subjects. Each patient performed 3 pain-free maximal isometric contractions on each hand on 2 occasions, 1 week apart. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and 95% limits of agreement (LOA) were calculated. The 2-way analysis of variance (ANOVA) was conducted to determine the differences between sides and groups. RESULTS: Test-retest reliability of measurements of grip strength was excellent for dominant (ICC = 0.97; P = .001) and non-dominant (ICC = 0.98; P = .001) hand of participant with PD and (ICC = 0.99; P = .001) and (ICC = 0.99; P = .001) respectively, of healthy group. CONCLUSIONS: The Jamar hand dynamometer had fair to excellent test-retest reliability to test grip strength in participants with PD.

Monitoring/characterization of stickies contaminants coming from a papermaking plant--Toward an innovative exploitation of the screen rejects to levulinic acid.

Recycled paper needs a lot of mechanical/chemical treatments for its re-use in the papermaking process. Some of these ones produce considerable rejected waste fractions, such as "screen rejects", which include both cellulose fibers and non-fibrous organic contaminants, or "stickies", these last representing a shortcoming both for the papermaking process and for the quality of the final product. Instead, the accepted fractions coming from these unit operations become progressively poorer in contaminants and richer in cellulose. Here, input and output streams coming from mechanical screening systems of a papermaking plant using recycled paper for cardboard production were sampled and analyzed directly and after solvent extraction, thus confirming the abundant presence of styrene-butadiene rubber (SBR) and ethylene vinyl acetate (EVA) copolymers in the output rejected stream and cellulose in the output accepted one. Despite some significant drawbacks, the "screen reject" fraction could be traditionally used as fuel for energy recovery within the paper mill, in agreement with the integrated recycled paper mill approach. The waste, which still contains a cellulose fraction, can be also exploited by means of the hydrothermal route to give levulinic acid, a platform chemical of very high value added.

BRAF(V599E) mutation is the leading genetic event in adult sporadic papillary thyroid carcinomas.

Activating mutations of BRAF have been identified in a variety of human cancers, most notably melanomas and papillary thyroid carcinomas (PTCs). The aim of the present study was to disclose the role of BRAF mutations in thyroid carcinoma development. Seventy-two thyroid tumors, including 60 PTCs, six follicular adenomas, five follicular carcinomas, and one anaplastic carcinoma, were studied. BRAF mutation screening focused on exon 15 and exon 11 of the gene by single-stranded conformational polymorphism and sequence analysis. Search of RET/PTC expression was conducted with the RT-PCR technique. The molecular genetic study of the BRAF gene showed the presence of a missense thymine to adenine transversion at nucleotide 1796, resulting in the V599E substitution, in 24 of 60 PTCs (40%), none of six follicular adenomas, and none of five follicular carcinomas or one anaplastic carcinoma. Moreover, nine of 60 PTCs (15%) presented RET/PTC expression. A genetico-clinical association analysis showed a statistically significant correlation between BRAF mutation and development of PTCs of the classic papillary histotype (P = 0.038). On the contrary, no link could be detected between expression of BRAF(V599E) and age at diagnosis, gender, dimension, and local invasiveness of the primary cancer, presence of lymph node metastases, tumor stage, and multifocality of the disease. These data clearly confirm that BRAF(V599E) is the more common genetic alteration found to date in adult sporadic PTCs, that it is unique for this thyroid cancer histotype, and that it might drive the development of PTCs of the classic papillary subtype.

Ret/PTC activation does not influence clinical and pathological features of adult papillary thyroid carcinomas.

OBJECTIVE: RET proto-oncogene rearrangements (ret/PTCs) represent the most common genetic alterations found in papillary thyroid carcinomas (PTCs). Correlation of ret/PTC expression with clinical outcome is controversial. The aim of the present study was to analyze the frequency of RET rearrangements in adult PTCs, and to investigate if ret/PTCs influence biological behavior and clinical features of the cancers. DESIGN: Ret/PTC rearrangements were looked for in tIssue samples of 48 PTCs collected at our institution. Data about clinical and pathological features of the tumors were also reviewed. Three separate association analyses were carried out on the cohort evaluating the effects of, respectively, ret/PTC positivity, preferential RET tyrosine kinase domain (RET-TK) expression, and ret/PTC plus RET-TK positivity, on age, sex, tumor size, staging, number of neoplastic foci, and histological subtype. METHODS: The genetic study was conducted with the RT-PCR-Southern blot technique. Standard Student's t-test and Fisher exact test were applied for the association analyses. RESULTS: The molecular genetic study demonstrated the positivity of ret/PTC1 and ret/PTC3 in 13 of 48 tumors (27.1%), and an exclusive or preferential RET-TK expression in 17 cases (35.4%). None of the three genetico-clinical analyses showed any significant association between ret/PTC expression and the clinical and pathological features of the cancers. CONCLUSIONS: These data indicate that RET rearrangements may not play any distinctive role in driving histotype development and cancer progression in these neoplasms. Moreover, they weaken the possibility of using ret/PTC as a prognostic marker for papillary thyroid carcinomas.