Healthcare-acquired infections in rehabilitation units of the Lombardy Region, Italy.

BACKGROUND: Little data are available on the frequency and risk factors for infection in patients in rehabilitation units. METHODS: This was a 2-year retrospective cohort study conducted in 131 rehabilitation units (RUs) of the Lombardy Region, including those for patients requiring musculoskeletal, cardiac, respiratory, neurological and general geriatric rehabilitation. RUs were stratified into three groups by infection rate calculated from administrative data, and a random sample of RUs in each group was selected for analysis. Discharges from these RUs were randomly selected for chart review, and healthcare-acquired infection was confirmed using CDC/NHSN definitions. A logistic regression analysis explored the association among demographic variables of age, sex, type of rehabilitation unit, Charlson comorbidity score, and location prior to RU admission for selected infections. RESULTS: For the 3,028 discharges from 28 RUs, hospital administrative data had a sensitivity of 0.45 and a positive predictive value of 0.89 to identify infections in the chart review. At least one infection occurred in 14.9% of patient discharges, with 71% of infections being urinary, 8.0% respiratory, and 5% skin and soft tissue. Urinary infection was associated with female sex [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.13-1.93], age 75-85 years (OR 2.21, 95% CI 1.12-4.34), Charlson comorbidity score of ≥3 (OR 1.54, 95% CI 1.10-2.17), and the transfer from acute care (OR 1.45, 95% CI 1.04-2.02). For respiratory infection, male sex (OR 3.06, 95% CI 1.51-6.18), comorbidity score of 1 or 2 (OR 2.16, 95% CI 1.08-4.36), and transfer from a healthcare setting other than an acute care hospital were independent risks (OR 3.14, 95% CI 1.15-8.53). CONCLUSION: Infections are common in residents of these rehabilitation units, and risk factors may differ with type of infection. The proportion of infections which may be prevented and effective prevention strategies need to be determined.

Intratumoral vs systemic administration of meta-tetrahydroxyphenylchlorin for photodynamic therapy of malignant gliomas: assessment of uptake and spatial distribution in C6 rat glioma model.

Malignant gliomas, with an incidence of 5 cases per 100,000 population per year, represent the most common primary brain tumour. They have an overall survival length of less than 2 years. Many different adjuvant therapies have been developed. Among them, Photodynamic Therapy (PDT), that is based on photochemical reactions between light and tumoral tissue selectively labelled with exogenous photosensitizing agents. Among photosensitizers, m-THPC (Temoporfin), seems to be the most promising one for the treatment of brain tumors, but, unfortunately, it causes problems of high skin photosensitivity. To by-pass this problem, we devised an intratumoral route of administration of this photosensitizer. The aim of this study is to investigate and compare the uptake of m-THPC in brain tumor and normal tissue after systemic and intratumoral administration of the drug. 30 female Wistar rats received m-THPC 12 days after C6 tumor implantation. Temoporfin was administered intratumorally in 24 rats at two different concentrations. 6 rats constituted the control group and received m-THPC by means of an intraperitoneal injection. The brains were extracted at 4 h, 24 h and 96 h after Temoporfin injection. The samples were examined with a confocal laser scanning microscope. All samples showed high fluorescence emission exclusively in the tumour area, without appreciable differences between the samples taken at the different times of sacrifice and the two routes of administration. No fluorescence whatsoever was detected among normal brain tissue surrounding the tumour. The intratumoral route appears to give comparable results to the systemic one, regarding intracellular uptake efficiency and tumour--normal tissue ratio, with the advantage of a much shorter time needed to reach optimal intratumoural concentration--that is just four hours from m-THPC injection.

Binding of aflatoxin M1 to different protein fractions in ovine and caprine milk.

The affinity of aflatoxin M1 toward the main milk protein fractions in ewe and goat milk was investigated by using an ELISA. This study took into account the possible effects of common dairy processes such as ultrafiltration, acidic or rennet curding, and production of ricotta from acidic or rennet whey. Treatments that allowed the separation of casein from whey proteins under conditions that do not alter the physical or chemical status of the proteins (such as ultracentrifugation) were used as a reference. None of the treatments used in typical dairy processes caused significant release of the toxin, in spite of the relevant changes they induced in the interactions among proteins. Only the combined heat and acidic treatment used for production of ricotta cheese altered the structure of whey proteins to the point where they lost their ability to bind the toxin. This study also showed that, regardless of the physical state of the sample, a commercial electronic nose device, in combination with appropriate statistical tools, was able to discriminate among different levels of sample contamination.

Nanotechnology and food quality control.

The preparation and attractive performance of nanomaterials for innovative detection schemes of food related compounds are described. Nickel nanowires growths by the template procedure were used for magnetoswitchable control of electrochemical processes of sugar-like compounds at the electrode surface. Gold nanoparticles were also prepared by reducing a gold solution with different phenolic compounds. The different antioxidant power of these compounds allow to modulate the kinetic growth of gold nanoparticles. Finally, an index of the antioxidant power based on the growth of gold nanoparticle is reported.

Spontaneous haematoma of ligamentum flavum. Case report and literature review.

Spontaneous infarction of the ligamentum flavum is a very rare cause of mielo-radicular compression. In the literature only four cases are reported, all characterized by a clinical history of slowly progressive mielo-radiculopathy and good outcome after surgical treatment. A 70 year-old female patient presented with a four months clinical history of spontaneous, sub-continuous, progressive lumbar pain with bilateral irradiation to the L4-L5 dermatomers, right leg monoparesis and hypoaesthesia affecting tactile, thermal and pain sensivity, urinary incontinence and constipation. CT scan and MRI evidenced an extradural ovalar lesion in correspondence of the L1-L2 levels, that exerted compression over the dural sac, dislocating it anteriorly. The patient underwent a L1-L2 laminectomy and the lesion was totally resected. Rapid improvement of the patient's symptomatology has been noticed in the postoperative period, with complete recovery during the following month. Histologic examinations demonstrated that the mass was a haematoma of the ligamentum flavum. It's our opinion, that a picture of ligamentum flavum haematoma should be taken into account in differential diagnosis of posterior mielo-radicular compression. The progressive growth of the haematoma may explain the long clinical history of these patients and surgical treatment, even if delayed, permits an excel-lent clinical outcome.

Interleukin-6 modulates interferon-regulated gene expression by inducing the ISGF3 gamma gene using CCAAT/enhancer binding protein-beta(C/EBP-beta).

Although interleukin-6 (IL-6) alone does not induce the expression of IFN stimulated genes (ISG), a low dose priming of cells with IL-6 strongly enhances the cellular responses to interferon-alpha (IFN-alpha). This effect of IL-6 is not due to superstimulation of the JAK-STAT pathway. Rather, IL-6 induces expression of ISGF3 gamma (p48), a subunit of the multimeric transcription factor ISGF3. As a result IFN-alpha robustly activates gene transcription in IL-6 primed cells. We have shown earlier that the transcription of ISGF3 gamma gene is regulated through a novel element GATE (gamma-IFN activated transcriptional element). We show here IL-6 induces the ISGF3 gamma gene through GATE. Transcription factor C/EBP-beta is required for inducing ISGF3 gamma gene expression through GATE. A mutant C/EBP-beta inhibits the IL-6 inducible ISGF3 gamma gene expression through GATE. Together, these results establish a molecular basis for the synergy between IFNs and IL-6.

Head space sensor array for the detection of aflatoxin M1 in raw ewe's milk.

A novel screening method was developed for simple and rapid detection of aflatoxin M1 contamination in raw ewe's milk samples without the need for sample pretreatment. The method was based on the use of a commercial head space sensor array system constituted by 12 metal oxide semiconductor sensors, 10 metal oxide semiconductor field-effect transistor sensors, and a pattern recognition software. Twenty-four raw milk samples collected from two different groups of ewes fed with a formulated feed that contained increasing amounts of aflatoxin B1 and six noncontaminated ewe's milk samples were analyzed. The results obtained by using the head space sensor array, processed by statistical methods, made it possible to group the samples according to the presence or the absence of aflatoxin M1. Sample classification was in complete agreement with the aflatoxin M1 content measured by an enzyme-linked immunosorbent assay procedure. This is the first report, to our knowledge, of detection of aflatoxin M1 in ewe's milk by a multisensor array.

Transcriptional induction of genes by IFN-beta in mouse cells is regulated by a transcription factor similar to human ISGF-3.

Previous studies of IFN-stimulated transcription factors in murine cells have identified a variety of trans-acting factors that bind to the IFN-stimulated response element (ISRE) whose role in gene expression remain unclear. The present investigation was undertaken to delineate the signal transduction pathway as well as to identify the transcription factors regulated by murine IFN-beta in L929 cells. Tyrosine kinase inhibitor, Genistein, abrogated gene induction and activation of transcription factors by IFN-beta. As early as 5 min after IFN-beta treatment, a transcription factor was activated in the cytoplasm which subsequently migrated into the nucleus. Anti-phosphotyrosine antibodies detected a specific transcription factor induced by mIFN-beta. Antibodies raised against human ISGF-3 subunit proteins p48, p84, p91 and p113 recognized this factor in the cytoplasm as well as in the nucleus of IFN-beta-treated L929 cells. An antibody raised against an oligopeptide of human p113 (residues 435-450) recognized the ISGF-3 complexes both in human and murine cells. However, a different antibody against the C-terminus of human p113 (residues 671-806) did not recognize the ISGF-3 like complex in mouse cells, indicating differences in the primary sequence of these proteins.

Reversal of diet-induced changes in adenylate cyclase activity and fatty acid composition of rat submandibular salivary gland lipids.

This study sought to determine if the diet-induced changes in submandibular salivary glands can be reversed. Two groups of male weanling Sprague-Dawley rats were fed purified diets containing 9% butter + 1% corn oil (group I, control) or 9% ethyl ester concentrate of n-3 fatty acids + 1% corn oil (group II, experimental). After 5 weeks of feeding the respective diets, rats in group I were divided into two subgroups: Ia, which was maintained on the control diet, and Ib, which was shifted to the experimental diet for the reversal study. The rats in the experimental group were kept on their original diet. After five further weeks of feeding, the rats were killed, and membranes from submandibular glands were prepared and assayed for adenylate cyclase activity and for the fatty acid composition of total phospholipids. Changes characteristic of feeding n-3 fatty acids, including a significant increase in membrane fluidity as measured by the degree of unsaturation of fatty acids, were observed in the total phospholipids of membranes from the experimental group. The adenylate cyclase activity was two- to three-fold higher in membranes of rats fed the experimental diet (group II) than the control diet (group Ia). Whereas the diet-induced changes in fatty acid composition and membrane fluidity were largely reversed (group Ib, reversal study), changes in adenylate cyclase activity were only partially reversed. The results suggest that, in addition to the fatty acid composition and membrane fluidity, other factors may also be important in modifying adenylate cyclase activity.

Rapid electrochemical method for the evaluation of the antioxidant power of some lipophilic food extracts.

In this paper, a novel electrochemical method to evaluate the antioxidant power of lipophilic compounds present in vegetables, such as carotenoids, chlorophylls, tocopherols, and capsaicin, is reported. The method is based on a flow injection system with an electrochemical detector equipped with a glassy carbon working electrode operating amperometrically at a potential of + 0.5 V (vs Ag/AgCl). The proposed method is selective for lipophilic compounds having antioxidant power. When applied to pure compounds, the order of antioxidant power resulted as follows: lycopene > beta-carotene > zeaxanthin > alpha-carotene > beta-cryptoxanthin > lutein > alpha-tocopherol > capsaicin > chlorophyll a > chlorophyll b > astaxanthin > canthaxanthin. Results obtained on five vegetable and two fruit extracts were compared to those obtained by the 2,2'-azinobis(3-ethylbenz-thiazoline-6-sulfonic) acid (ABTS) radical cation decolorization assay, one of the most used methods to evaluate the total antioxidant capacity of foods. A good correlation between the two methods was found, except for spinach, because of the different antioxidant powers assigned by the two methods to chlorophylls. In conclusion, results suggest that the proposed electrochemical method can be successfully employed for the direct, rapid, and reliable monitoring of the antioxidant power of lipophilic food extracts.

[Development and validation of a questionnaire measuring hospital consumer satisfaction ]. / Sviluppo e validazione di un questionario di rilevazione della soddisfazione dell'utenza ospedaliera.

This study describes the process of development of a new instrument for measuring patient satisfaction with hospital care in Italy. The self-administered questionnaire included a total of 48 items, -contributing to the construction of 8 scales, each of them describing a specific area of interest such as medical care and nursing, several aspects of organisation, comfort and overall outcome of care. Psychometric characteristics of the questionnaire were in terms of acceptability, validity, reliability and the ability to discriminate different levels of satisfaction in various patient groups. Psychometric analyses resulted in a convincing construct validity and reliability, as described by the Cronbach Alpha coefficient estimates [range 0.73-0.95]. The high compliance obtained (67.3%) can be considered a sign of good acceptability of the questionnaire and of its mode of administration. These analyses demonstrate a good performance of the questionnaire in terms of both validity and reliability, suggesting that this instrument can represent a solid base for future applications.

Electrospinning of poly(vinyl alcohol) nanofibers loaded with hexadecane nanodroplets.

The feasibility of producing poly(vinyl alcohol) (PVA) nanofibers containing fine-disperse hexadecane droplets by electrospinning a blend of hexadecane-in-water emulsions and PVA was investigated. Hexadecane oil-in-water nanoemulsions (d(10)= 181.2 +/- 0.1 nm) were mixed with PVA at pH 4.5 to yield polymer-emulsion blends containing 0.5 to 1.5 wt% oil droplets and 8-wt% PVA. The solution properties of emulsions and emulsion-PVA blends (viscosity, conductivity, surface tension) were determined. Solutions were electrospun and the morphology and thermal properties of deposited fiber mats characterized by scanning electron microscopy and differential scanning calorimetry. Fiber mats were dissolved in buffer to liberate incorporated hexadecane droplets and the buffer solutions analyzed by optical microscopy, UV-spectroscopy, and light scattering. Analysis of dry fiber mats and their solutions showed that emulsion droplets were indeed part of the electrospun fiber structures. Depending on the concentration of hexadecane in the initial emulsion-polymer blends, droplets were dispersed in the fibers as individual droplets or in form of aggregated flocs of hexadecane droplets. Nanofibers with spindle-like perturbations or nanofibers containing bead-like structures with approximately 5 times larger than the size of droplets in the original nanoemulsion were obtained. Remarkably, incorporation of hexadecane droplets in fibers did not alter size of individual droplets, that is, no coalescence occurred. The manufacture of solid matrix containing nanodroplets could be of substantial interest for manufacturers wishing to develop encapsulation system for lipophilic functional compounds such as lipid-soluble flavors, antimicrobials, antioxidants, and bioactives with tailored release kinetics. Practical Applications: The paper describes the formation of electrospun nanofibers from hydrophilic polymers that contain fine-disperse emulsion droplets. By incorporating emulsion droplets, a large variety of lipophilic ingredients can be easily loaded into the fibers' hydrophilic polymer matrix. This is of practical importance as to date the only way to include a lipophilic ingredient in a nanofibers is by dissolving the lipophilic ingredient and polymer in an organic solvent followed by electrospinning. However, use of an organic solvent is (a) not feasible if one wants to electrospin hydrophilic polymers, and (b) use of organic solvents is generally highly undesirable in the food industry. Our results should be of interest to a number of industries such as the food, pharmaceutical, chemical, and personal care industries that are generally in need of novel matrices that can serve as carrier vehicles and release functional components such as flavors, antimicrobials, antioxidants, drugs, and bioactives.

Monitoring of autoxidation in LCPUFA-enriched lipid microparticles by electronic nose and SPME-GCMS.

Electronic nose and SPME-GCMS were used to monitor the autoxidation in long chain polyunsaturated fatty acid (LCPUFA)-enriched lipid microparticles produced by spray congealing with ultrasonic nebulization, during storage at 20 degrees C up to 6 weeks with sufficient air supply and limited air supply. Conjugated dienes and peroxide value as well as secondary lipid oxidation products were analysed to follow the course of autoxidation. Principal Component Analysis evidenced that only MOS sensors but not MOSFET sensors contributed to the discrimination of the samples and facilitated the ability of the electronic nose to distinguish the LCPUFA-enriched lipid microparticles into two groups according to the different oxidative status. The selected MOS sensor responses correlated well with quantitative dominating volatile compounds (propanal and hexanal) and with volatile compounds which have been associated with fishy and rancid off flavour (1-penten-3-one, 1-penten-3-ol, 2,4-heptadienal and 2,6-nonadienal). Bread mix supplemented with the LCPUFA-enriched microparticles was analysed as an example for a LCPUFA supplemented food. Data from the present study indicate that the electronic nose can be used as a sensitive tool to evaluate the lipid oxidative status of LCPUFA-enriched microparticles. In supplemented foods like bread mix, matrix-related changes, which occur in supplemented and non-supplemented samples, make a clear distinction more difficult.

Cationic liposomes, loaded with m-THPC, in photodynamic therapy for malignant glioma.

In this study we investigated the feasibility of mixed liposomes formed by dimyristoyl-sn-glycero-phosphatidylcholine (DMPC) and cationic gemini surfactant (Gemini 1) loaded with the chlorin m-tetrahydroxyphenylchlorin (m-THPC), in photodynamic therapy (PDT) for glioma. To this aim, an in vitro study was carried out by employing various human glioblastoma cell lines (A172, DBTRG, LN229, U118). The following liposomal formulations were tested: (i) DMPC and Gemini 1; (ii) m-THPC in DMPC in the absence or (iii) in the presence of Gemini 1 in the molar ratio 8:2; 7:3, and 6:4. The presence of Gemini 1 significantly increased the intracellular uptake of chlorin in all cell tested although with a different extent: LN229>U118>A172>DBTRG. The cytotoxicity of chlorin-loaded liposomes was then tested by cloning efficiency performed on different cultures, before and after irradiation with laser light at 652nm, at a Fluence Rate of 200mW/s for 100s, with a total Fluence of 20J/cm(-2). In the absence of irradiation, the different liposomal formulations induced a cytotoxicity in less than 30% of glioblastoma cells. On the contrary, irradiation induced total destruction of all cultures treated with m-THPC/DMPC+Gemini 1 in the ratios 8:2, or 7:3, or 6:4.

Intracranial meningiomas associated with non-traumatic chronic subdural hematoma.

BACKGROUND: Non-traumatic subdural hematomas are very rarely associated with intracranial meningiomas. Pathophysiological mechanisms of such an association are not yet fully understood. CASE DESCRIPTION: We report on two patients harboring an intracranial meningioma and ipsilateral non-traumatic chronic subdural hematoma. Their history was negative for risk factors for subdural hematoma. Both patients were submitted to surgery for evacuation of the subdural collection. The presence of the meningioma was discovered during surgery. A second operation was necessary in our first case. CONCLUSIONS: We retrospectively analyzed our radiological data and the literature to provide some features that may help in the pre-operative diagnosis of a meningioma in patients presenting with a chronic subdural hematoma. Furthermore the mechanisms responsible for this association are discussed on the basis of our pathological evidence.

Application of adsorptive stripping voltammetry to the speciation and determination of iron(III) and total iron in wines.

An analytical procedure for the determination of iron(III) and total iron in wines based on adsorptive stripping voltammetry is described. Iron(III) was determined by using Solochrome Violet Red as chelating agent while catechol was used for the determination of the total iron content. Each chelate was adsorbed on the hanging mercury electrode and the reduction current of the accumulated chelate was measured. The results obtained from the application of this procedure to wine samples are discussed.

Determination of ascorbic acid in foodstuffs by microdialysis sampling and liquid chromatography with electrochemical detection.

A method for the determination of ascorbic acid in foodstuffs utilising microdialysis sampling coupled with LC with electrochemical detection is described. The application of the method to liquid food samples such as milk, yoghurt and fruit juices was evaluated. Compared with the classical method, the proposed procedure features straightforward sample preparation and improved sensitivity and selectivity. A sampling rate of 20 h-1 is possible, depending on the particular sample under study.

Electrochemical sensor detecting free sulfhydryl groups: evaluation of milk heat treatment.

We describe a new and rapid method for the evaluation of reactive sulfhydryl groups in whey proteins obtained after precipitation of casein by acetic acid at pH 4.6. The procedure is based on the use of a wire tungsten electrode operating at -0.2 V versus saturated calomel electrode in flow injection analysis. The method was applied to raw milks and to commercial pasteurized and UHT milks. Results showed that the tungsten electrode constituted a robust amperometric sensor that could be used to differentiate milks that underwent different heat treatments. The decrease of thiol content in the whey proteins from samples was in agreement with the whey protein content found by HPLC. The procedure is suitable for on-line quality control of heat-treated milks.