Quantification of serum markers of hepatitis B (HBV) and Delta virus (HDV) infections in patients with chronic HDV infection.

The interplay between hepatitis B (HBV) and delta (HDV) viruses is complex and not always characterized during chronic HDV infection. We assessed the clinical usefulness of new quantitative assays for HBV and HDV serum markers in a retrospective cross-sectional study. Sera obtained from 122 HDV genotype 1 and HBV genotype D coinfected, anti-HIV-negative patients (71 males; median age 49.8 [21.7-66.9] years), recruited consecutively in two geographical areas (Italy 69 patients, Romania 53 patients) with different HBV and HDV epidemiology, were tested for HBsAg, HBV-DNA, HBcrAg, total anti-HBc, HDV-RNA, IgM and total anti-HDV using quantitative assays. Cirrhosis, which showed comparable prevalence in the two cohorts, was diagnosed in 97 of 122 (79.5%) patients. At multivariate analysis, cirrhosis was associated with lower total anti-HBc/IgM anti-HDV ratio (OR 0.990, 95% CI 0.981-0.999, P = .038), whereas disease activity was associated with higher total anti-HDV (OR 10.105, 95% CI 1.671-61.107, P = .012) and HDV-RNA levels (OR 2.366, 95% CI 1.456-3.844, P = .001). HDV-RNA serum levels showed a positive correlation with HBV-DNA (ρ = 0.276, P = .005), HBsAg (ρ = 0.404, P < .001) and HBcrAg (ρ = 0.332, P < .001). The combined quantitative profiling of HBV and HDV serum markers identifies specific patterns associated with activity and stage of chronic hepatitis D (CHD). HDV pathogenicity depends on the underlying active HBV infection in spite of the inhibition of its replication. HDV-RNA, IgM anti-HDV, total anti-HDV, total anti-HBc, HBsAg and HBcrAg serum levels qualify for prospective studies to predict progressive CHD and identify candidates to antiviral therapy.

Removal of organics and degradation products from industrial wastewater by a membrane bioreactor integrated with ozone or UV/H2O2 treatment.

The treatment of a pharmaceutical wastewater resulting from the production of an antibacterial drug (nalidixic acid) was investigated employing a membrane bioreactor (MBR) integrated with either ozonation or UV/H(2)O(2) process. This was achieved by placing chemical oxidation in the recirculation stream of the MBR. A conventional configuration with chemical oxidation as polishing for the MBR effluent was also tested as a reference. The synergistic effect of MBR when integrated with chemical oxidation was assessed by monitoring (i) the main wastewater characteristics, (ii) the concentration of nalidixic acid, (iii) the 48 organics identified in the raw wastewater and (iv) the 55 degradation products identified during wastewater treatment. Results showed that MBR integration with ozonation or UV/H(2)O(2) did not cause relevant drawbacks to both biological and filtration processes, with COD removal rates in the range 85-95%. Nalidixic acid passed undegraded through the MBR and was completely removed in the chemical oxidation step. Although the polishing configuration appeared to give better performances than the integrated system in removing 15 out of 48 secondary organics while similar removals were obtained for 19 other compounds. The benefit of the integrated system was however evident for the removal of the degradation products. Indeed, the integrated system allowed higher removals for 34 out of 55 degradation products while for only 4 compounds the polishing configuration gave better performance. Overall, results showed the effectiveness of the integrated treatment with both ozone and UV/H(2)O(2).

[Application medical history indicators and goals for the diagnosis of OSAS in a cohort of workers of the private car transportation: results of a year of health surveillance]. / Applicazione di indicatori anamnestici ed obiettivi per la diagnosi di OSAS in una coorte di lavoratori dell'auto-trasporto privato: risultati di un anno di sorveglianza sanitaria.

Even though Obstructive Sleep Apnea Syndrome (OSAS) is one of the main causes of daytime sleepiness with high subsequent risk for causing vehicle accidents, its evaluation is not usually included among the criteria used for the certification of job fitness among professional drivers. In order to assess the feasibility of a screening method that allows the occupational physician to identify the subjects at risk for OSAS which should undergo second level tests (cardiorespiratory monitoring), we recorded and subsequently processed appropriate subjective and objective indicators among 455 professional drivers employed in private transportation companies. Only 17 subjects (47%) out of 36 tested positive underwent cardiorespiratory monitoring (due to technical and organizational difficulties and to the poor compliance of workers). OSAS was confirmed in 15 subjects out of 17 showing an excellent positive predictive value of the screening. Risk management for OSAS is currently unavoidable yet not formally provided by law. Our results show the possibility of completing the health surveillance program with feasible and valuable screening tests. Difficulties (hardly compliant with a timely certification of the job fitness) arise instead as far as second level confirmatory procedures are involved.

Value of transthoracic echocardiography in the diagnosis of pulmonary embolism: results of a prospective study in unselected patients.

PURPOSE: Echocardiography is advocated by some as a useful diagnostic test for patients with suspected pulmonary embolism (PE), but its diagnostic accuracy is unknown. The present study was undertaken to determine prospectively the sensitivity and specificity of transthoracic echocardiography in the diagnosis of PE. SUBJECTS AND METHODS: We examined 110 consecutive patients with suspected PE. The study protocol included assessment of clinical probability, echocardiography, and perfusion lung scanning. Pulmonary angiography was performed in all patients with abnormal scans. As echocardiographic criteria to diagnose acute PE, we used the presence of any two of the following: right ventricular (RV) hypokinesis, RV end-diastolic diameter >27 mm (without RV wall hypertrophy), or tricuspid regurgitation velocity >2.7 m/sec. Clinical estimates of PE served as pretest probabilities in calculating, after echocardiography, the posttest probabilities of PE. RESULTS: Pulmonary angiography confirmed PE in 43 (39%) of 110 patients. Echocardiographic diagnostic criteria for PE yielded a sensitivity of 56% and a specificity of 90%. For pretest probabilities of 10%, 50%, and 90%, the posttest probabilities of PE conditioned by a positive echocardiogram were 38%, 85%, and 98%, respectively. The posttest probabilities of PE conditioned by a negative echocardiogram were 5%, 33%, and 81%, respectively. CONCLUSIONS: In unselected patients with suspected PE, transthoracic echocardiography fails to identify some 50% of patients with angiographically proven PE. Although echocardiographic findings of RV strain, paired with a high clinical likelihood, support a diagnosis of PE, the transthoracic echocardiography has to have a better sensitivity to be used as a screening test to rule out PE.

Pulmonary embolism: epidemiology.

Present evidence suggests that venous thromboembolism is the third most common acute cardiovascular disease after cardiac ischemic syndromes and stroke. The frequency of the diagnosis of pulmonary embolism (PE) at a given hospital greatly increases if a referral unit for PE is set up in the hospital. Pulmonary embolism is characterized by a continuous spectrum of severity, from 2 to 3 to 15 to 16 embolized pulmonary segments (over a total of 19). Morbidity from PE increases with age and male sex (males/females ratio: 1.24). In only a minority (10%) of patients with PE and/or deep-vein thrombosis (DVT), primary deficiencies of coagulation-inhibiting proteins have been shown. Primary abnormalities of the fibrinolytic system seem even more rare. On the basis of the clinical conditions preceding the embolic episode, patients may be divided into different groups: apparently primary or idiopathic PE (40%), surgery or trauma (43%), heart disease (12%), neoplastic disease (4%), and systemic disease (1%). Patients with apparently primary or idiopathic PE often develop subsequent clinically overt cancer (9.1%), whereas surgery or trauma patients rarely do (1.4%). Furthermore, the former exhibit a significantly shorter survival than the latter mostly for causes of death that reflect increased predisposition to thrombogenesis. Thus, as for DVT, it is convenient to consider a primary or idiopathic form also for PE.

Photoproduction of straight phi(1020) mesons on the proton at large momentum transfer

The cross section for straight phi meson photoproduction on the proton has been measured for the first time up to a four-momentum transfer -t = 4 GeV2, using the CLAS detector at the Thomas Jefferson National Accelerator Facility. At low four-momentum transfer, the differential cross section is well described by Pomeron exchange. At large four-momentum transfer, above -t = 1.8 GeV2, the data support a model where the Pomeron is resolved into its simplest component, two gluons, which may couple to any quark in the proton and in the straight phi.

Electrophoretic separation of A gamma and G gamma human globin chains in Nonidet P-40.

Electrophoresis in cellulose acetate in the presence of 3% Nonidet P-40 can resolve two neutral genetic variants, A gamma and G gamma human fetal globin chains. The ratio of these two chains, determined by densitometry of the electrophoretic strips, is in excellent agreement with the Gly-Ala ratio obtained by chemical analysis of the cyanogen bromide fragment gamma CB3. It is suggested that the detergent binds preferentially to the hydrophobic amino acid segment 133-141 in the A gamma chain, thus masking either a Lys or an Arg residue at the two extremes.

Pulmonary embolism in neurosurgical patients: diagnosis and treatment.

Pulmonary embolism was suspected in 45 neurosurgical patients who were treated between January, 1980, and December, 1981. Hypoxemia with respiratory alkalosis and sudden tachycardia gave rise to this suspicion more often than any other sign or symptom. Perfusion lung scanning confirmed the presence of pulmonary embolism in 23 of these cases. A retrospective analysis of the clinical course of these 23 patients suggested that one or more previous episodes of pulmonary embolism had occurred in 16 cases (69.6%), and had been either overlooked or misdiagnosed. Treatment was started immediately after diagnosis. Twenty-one patients were given heparin; however, two could not be treated because of contraindication to using anticoagulant drugs. Two patients died during treatment. The 21 surviving patients were assessed and 11 of them submitted again to perfusion lung scanning 1 week after diagnosis: 14 had improved, but seven did not show significant changes either clinically or on perfusion lung scanning. Nine treated patients developed hemorrhage, but it was readily controlled. In two of the nine patients, hemorrhage involved the surgical area. It is stressed that pulmonary embolism may be suspected and diagnosed in neurosurgical patients at an early stage. Heparin may be given and the survival rate appears to be better than previously reported figures.

Diagnostic value of gas exchange tests in patients with clinical suspicion of pulmonary embolism.

OBJECTIVE: To assess the value of parameters derived from arterial blood gas tests in the diagnosis of pulmonary embolism. METHOD: We measured alveolar-arterial partial pressure of oxygen [P(A-a)O2] gradient, PaO2 and arterial partial pressure of carbon diaxide (PaCO2) in 773 consecutive patients with suspected pulmonary embolism who were enrolled in the Prospective Investigative Study of Acute Pulmonary Embolism. DIAGNOSIS: The study design required pulmonary angiography in all patients with abnormal perfusion scans. RESULTS: Of 773 scans, 270 were classified as normal/near-normal and 503 as abnormal. Pulmonary embolism was diagnosed by pulmonary angiography in 312 of 503 patients with abnormal scans. Of 312 patients with pulmonary embolism, 12, 14 and 35% had normal P(A-a)O2, PaO2 and PaCO2, respectively. Of 191 patients with abnormal scans and negative angiograms, 11, 13 and 55% had normal P(A-a)O2, PaO2 and PaCO2, respectively. The proportions of patients with normal/near-normal scans who had normal P(A-a)O2, PaO2 and PaCO2 were 20, 25 and 37%, respectively. No differences were observed in the mean values of arterial blood gas data between patients with pulmonary embolism and those who had abnormal scans and negative angiograms. Among the 773 patients with suspected pulmonary embolism, 364 (47%) had prior cardiopulmonary disease. Pulmonary embolism was diagnosed in 151 (41%) of 364 patients with prior cardiopulmonary disease, and in 161 (39%) of 409 patients without prior cardiopulmonary disease. Among patients with pulmonary embolism, there was no difference in arterial blood gas data between patients with and those without prior CPD. CONCLUSION: These data indicate that arterial blood gas tests are of limited value in the diagnostic work-up of pulmonary embolism if they are not interpreted in conjunction with clinical and other laboratory tests.

Non-invasive diagnosis of pulmonary embolism.

Pulmonary embolism (PE) remains a challenging diagnostic problem because it mimics other cardiopulmonary disorders. Pulmonary angiography is still the reference standard for diagnosing PE but it is costly, invasive and not readily available. Non-invasive diagnostic strategies have therefore been developed to forego pulmonary angiography in patients suspected of having PE. Ventilation/perfusion lung scanning is, at present, the most widely used non-invasive diagnostic test for PE. A high probability ventilation/perfusion scan (segmental or greater perfusion defects with normal ventilation) warrants the institution of anticoagulant therapy especially when paired with high clinical suspicion of PE. Yet, only a minority of patients with confirmed PE have high probability ventilation/perfusion scans. Ventilation/perfusion abnormalities other than those of the high probability scan should be regarded as non-diagnostic. Under these circumstances, documentation of deep vein thrombosis by non-invasive leg testing warrants anticoagulation without the need for angiography. However, a single negative venous study result does not permit to rule out PE in patients with non-diagnostic ventilation/perfusion scans. Results of a recent prospective study indicate that accurate diagnosis or exclusion of PE is possible with perfusion lung scanning alone (without ventilation imaging). Combining perfusion lung scanning with clinical assessment helps to restrict the need for angiography to a minority of patients with suspected PE.

Use of the Oximeter-539 WTW, equipped with a sensor Trioxmatic-300, for the functional analysis of dilute solutions of human Hb-A.

Dissociation curves for oxygen of dilute samples of human adult Hb-A were evaluated on this occasion, by using the Oximeter-539 WTW with its sensor, and a suitable spectrophotometer. At this purpose, Hb samples were desaturated in oxygen upon given experimental conditions, by bubbling pure nitrogen in them, and their re-oxigenation in air was followed, step by step, by multiple oximetries. In addition, all the spectrophotometric measurements of the saturation of Hb-O2%, corresponding to each individual oximetry, were carried out parallely but separately. Dilution of Hb-A was maintained at 0.1 mM in heme. The p50 at pH 7.3 was 4.435 +/- 0.299 Torr, with the n-value of 2.7 +/- 0.2; Bohr effect was -0.55 +/- 0.08, within a pH range between 6.8, 7.3 and 7.8, whereas chloride and DPG effects at pH 7.3 (the most useful value) were 0.42 +/- 0.44 and 0.453 +/- 0.0187 respectively. In conclusion, these results are similar to those obtained with automated procedures, upon comparable experimental conditions, but do not require expensive and sophisticated instruments. Such a technique could be very useful in the hemoglobinopathies, which are common in Italy, and it could be easily adapted to perform comparative studies on animal hemoglobins not far from human species.

Hemoglobin Agenogi [beta 90 (F6) Glu-->Lys] found in Piedmont. Case report.

An electrophoretically slow-moving hemoglobin, with abnormal beta chains, has been found in a young woman and in three members of her family. This variant amounted to 41% of the total Hb, and did not cause important clinical manifestations, although characterized by decreased oxygen affinity. Structural and aminoacid analyses revealed the mutation of Hb-Agenogi: 90 (F6) Glu-->Lys, a rare variant so far detected in unrelated racial and ethnic groups. This is the first affected family of ascertained Piedmontese ancestry.

Studies on the oxygen transport in the clinical association between Hb-S and Hb-C.

The whole blood oxygen affinity of a Negro carrier of SC disease was found to be characterized by some right-shifted p50 and clearly increased Bohr effect, whereas the isolated and purified Hb-S and Hb-C exhibited slight deficiencies mainly of the Bohr effect. The right-shifted p50 from whole blood can be easily explained by the mild anemia with a parallel increase of 2,3-diphosphoglycerate (DPG), whereas the functional discrepancies between whole blood function and that of the purified Hb-S and C could be due, at least in part, to the presence in vivo of consistent amounts of hybrid Hb tetramers of the type alpha alpha beta S beta C. Unfortunately, the mechanism promoting the formation (or dissolution) of hybrids are fundamentally unknown; so, either their presence and functional properties are very difficult to be explored.

Perfusion lung imaging in the adult respiratory distress syndrome.

In 29 perfusion lung scans (PLS) of 19 patients with ARDS, 20 of which were obtained within six days from the onset of respiratory symptoms, perfusion abnormalities were the rule. These included focal, nonsegmental defects, mostly peripheral and dorsal, and perfusion redistribution away from the dependent lung zones. PLS were scored for the presence and intensity of perfusion abnormalities and the scores of perfusion redistribution were validated against numerical indices of blood flow distribution per unit lung volume. PLS scores were correlated with arterial blood gas values, hemodynamic parameters, and chest radiographic scores of ARDS. Arterial oxygen tension correlated with the scores of both perfusion defects and redistribution. Perfusion defects correlated better with the radiographic score of ARDS, and perfusion redistribution with PAP and vascular resistance. ARDS patients exhibit peculiar patterns of PLS abnormalities not observed in other disorders. Thus, PLS may help considerably in the detection and evaluation of pulmonary vascular injury in ARDS.

Factors affecting regional pulmonary blood flow in chronic ischemic heart disease.

To assess the effect of left heart disease on pulmonary blood flow distribution, we measured mean pulmonary arterial and wedge pressures, cardiac output, pulmonary vascular resistance, pulmonary blood volume, and arterial oxygen tension before and after treatment in 13 patients with longstanding ischemic heart failure and pulmonary edema. Pulmonary edema was evaluated by a radiographic score, and regional lung perfusion was quantified on a lung scan by the upper to lower third ratio (U:L ratio) of pulmonary blood flow per unit of lung volume. In all cases, redistribution of lung perfusion toward the apical regions was observed; this pattern was not affected by treatment. After treatment, pulmonary vascular pressures, resistance, and edema were reduced, while pulmonary blood volume did not change. At this time, pulmonary vascular resistance showed a positive correlation with the U:L ratio (r = 0.78; P less than 0.01), whereas no correlation was observed between U:L ratio and wedge pressure, pulmonary edema, or arterial oxygen tension. Hence, redistribution of pulmonary blood flow, in these patients, reflects chronic structural vascular changes prevailing in the dependent lung regions.

[Functional analysis of diluted solutions of human hemoglobin by using Oximeter-3000 WTW equipped with Trioxmatic-300 electrode]. / Analisi funzionale delle soluzioni diluite di emoglobina umana con l'Ossimetro-3000 WTW, munito di elettrodo Trioxmatic-300.

The oxygen carrying capacity of dilute solutions of hemoglobin from normal human adults was examined, by using the above indicated Oximeter. The results show that, if the pO2s are compared with those drawn from the Oximeter-539 WTW (a simpler instrument) carrying the same oxygen electrode, there is a good correspondence between the data drawn from both the instruments. The advantage of the former is that pO2s are measure in mBr, whereas the latter measures the oxygen of the aqueous solutions in mg/l; then mg must be converted into Torr pO2. Since both instruments are usually employed in the oxygen measurement of waste waters of earth, another conclusion is that their sensitivity also allows the use in the bio-medical (and zoological) field. In fact, the data obtained agree with those of recent literature on the subject, which are mainly drawn from automated and sophisticated apparatuses specifically built at this purpose.

[The acute treatment of supraventricular tachycardia with endovenous amiodarone]. / Trattamento acuto delle tachicardie sopraventricolari con amiodarone endovena.

In the present study we evaluated 35 patients of both sexes, aged 21-84, with newly occurring supraventricular tachyarrhythmias, 19 atrial fibrillation (AF), 6 atrial flutter (FL) and 10 paroxysmal supraventricular tachycardias (PSVT). They were treated with a single amiodarone infusion up to two hours after the restoration of a stable sinus rhythm or to a maximus dose of 2,400 mg (in 24 hours). Plasma amiodarone concentration and QTc were measured at the restoration of sinus rhythm and twelve hours after the amiodarone withdrawal. Amiodarone infusion restored a stable sinus rhythm in all 10 patients of the PSVT group (100%), in 5 of the FL group (83%) and in 16 of the AF group (84%). The average dose needed to stop PSVT was lesser than for AF and FL (M + SE: 473.3 +/- 36.88 vs 1842.1 + 259.6 vs 1548.8 +/- 345.5 mg; p less than 0.001). The average plasma amiodarone concentration at the restoration of sinus rhythm was 2450.4 +/- 175.9 SE ng/ml in all the tachyarrhythmias as a whole without any statistically significant difference among PSVT, FL and AF. Moreover no correlation exists between plasma amiodarone concentrations and the amount of amiodarone infused. QTc showed a statistically significant transient lengthening at the restoration of sinus rhythm, but not twelve hours after amiodarone withdrawal. In conclusion, a single dose of amiodarone is effective and safe in all newly occurring supraventricular tachyarrhythmias, without any important side effect and with a high therapeutic index in pharmacologic cardioversion as alternative treatment to cardioversion.

The updated BESGE spectrometer for pure beta activities in environmental matrices.

This work describes an updated version of a beta spectrometer that measures pure beta emitter activities. The detection system consists of a plastic scintillator surrounded in a 4 pi geometry by large anticoincidence NaI(Tl) scintillators. A thin silicon detector, inserted between the plastic and the sample, helps to reduce the gamma background. A Monte Carlo code, used to calculate the quite complex spectrometer response function to any isotope, is also described.

A beta spectrometer for monitoring environmental matrices.

In environmental matrices, pure beta emitters are often present with other beta-gamma emitters. This work describes a beta spectrometer that allows measurement of pure beta-emitter activities of about 10(-2) Bq. The detection system consists of a plastic scintillator surrounded in a 4 pi geometry by large anticoincidence NaI(Tl) scintillators. Solid, liquid, and gaseous samples can be analyzed, and no chemical separation is necessary. The system is particularly useful for 90Sr measurement.

Treatment options for tannery wastewater. I: Alkalinization with or without post-ozonation.

This is the first of two papers each dealing with a specific technological option for replacing the Fenton's reagent with simpler processes for treating industrial wastewater. In particular, the paper reports the results of an investigation aimed to check, at lab scale, the effectiveness of a chemical process (i.e., alkalinisation with or without post-ozonation) for treating tannery wastewater whose residual COD, measured after conventional biological treatment, result still higher than the Italian COD Maximum Allowable Concentration (MAC) value (i.e., 160 mgO2/L). The results have demonstrated that when the value of residual COD lies in the range 200 divided by 250 mgO2/L, a simple alkalinisation with NaOH, up to pH 12.5, allows to reach the MAC value with an alkali consumption equivalent to the acid consumption required by the Fenton treatment and with a chemical sludge production significantly lower, i.e. approximately 0.7 kg(dry)/m3 instead of approximately 1.5 kg(dry)/m3. Conversely, when the value of the residual COD lies in a higher range (i.e. 300 divided by 350 mgO2/L), in order to reach the COD MAC value, alkalinisation (from pH 8 to pH 12.5) must be followed by an ozonation post-treatment. From the chemical stand point, the paper clearly demonstrates that analyzing only simple "gross parameters" (i.e., TSS, TOC, COD, BOD5 and EC20) it is possible to get useful information about the chemical properties of the organic pollutants occurring in tannery wastewater.