Relative fibular strength and locomotor behavior in KNM-WT 15000 and OH 35.

Relative fibular/tibial strength has been demonstrated to vary with locomotor behavior among anthropoid primates. In this study fibular/tibial strength was determined in KNM-WT 15000, a juvenile Homo erectus individual (1.5 Ma), and in OH 35, a Homo habilis (or possibly Paranthropus boisei) individual (1.8 Ma), and compared to that of adult modern humans (n = 79), chimpanzees (n = 16), gorillas (n = 16) and orangutans (n = 11). Ontogenetic changes in fibular/tibial strength were also analyzed due to KNM-WT 15000's juvenile status. Cross-sectional properties at midshaft were derived from multi-plane radiography and external contours, or CT scanning. Comparisons of log-transformed fibular/tibial polar second moment of area and anteroposterior (A-P) and mediolateral (M-L) second moments of area were carried out between extant species. Fossil deviations from each extant taxon's mean proportion were calculated in standard deviation (SD) units for that taxon. Great apes differ significantly from modern humans, with relatively stronger fibulae, particularly in the M-L plane. KNM-WT 15000 is more than 2 SD from all great apes (≥3 SD in the M-L plane) and within 1 SD of modern humans for almost all variables. This is not a result of its age, as fibular/tibial strength slightly decreases with age (i.e., becomes less like that of great apes) in humans. OH 35 falls within 1 SD of chimpanzees and orangutans for the majority of cross-sectional proportions, but more than 1 SD from humans. KNM-WT 15000 is demonstrated to be fully modern, complimenting other indications of complete terrestrial bipedality and possibly showing adaptations for endurance running. OH 35 has some human-like features; however, the relative strength of the two bones aligns the specimen with great apes, consistent with a significant degree of arboreality, in particular, vertical climbing.

Non-nursing tasks as experienced by nurses: a descriptive qualitative study.

BACKGROUND: Different concepts have been used to date (e.g. non-nursing tasks, organizational work) to define tasks performed by clinical nurses other than nursing care. However, the true essence of nursing work is still poorly understood mostly because nurses are lacking an appropriate lexicon to describe their practice. AIMS: To describe non-nursing tasks as experienced by nurses, exploring antecedents and consequences as perceived in daily practice. METHODS: A descriptive qualitative study from 2015 to 2016. A purposeful sample of nurses was approached. Semi-structured interviews were used, and content analysis was performed on audio-recorded and verbatim-transcribed interviews. FINDINGS: A total of 22 nurses participated, the majority of whom were female (16; 72.7%) and their average age was 42.6 years. The concept of 'Non-nursing tasks' is limited in describing what nurses experience in daily practice; the concept of 'Being out of the nursing role' emerged as being fully descriptive of the nurses' experience and this can occur in two dimensions: outside and inside the role of other healthcare professions. The first dimension includes administrative work separating nurses from patients. The second dimension was reported to happen in proximity to patients but in three different directions towards professions requiring: (a) less education (e.g. healthcare assistants), (b) the same amount of education at university level (e.g. physiotherapists), and (c) higher education at university level as compared to nurses, thus performing activities expected by physicians. Antecedents of 'Being out of the nursing role' have been identified at the organizational, individual and educational levels; their consequences have been reported at the patient, professional and organizational levels. CONCLUSION: Nurses play various non-nursing roles, below, above and in the horizontal levels, both inside and outside other healthcare professionals' role, mainly as a result of their felt moral obligation to offer the best to their patients, the organization's demand to nurses and the imprinting of nursing education. IMPLICATIONS FOR NURSING/HEALTH POLICY: Strategies at the nursing professional and policy levels are needed aimed at (a) supporting nurses in optimizing their professional identity, (b) sharing their sense of moral obligation towards patients with other healthcare professionals, and (c) implementing models of care based on interprofessional cooperation.

Impact of increased visceral and cardiac fat on cardiometabolic risk and disease.

OBJECTIVE: Previous studies have highlighted the associations between abdominal, cardiac or total fat accumulation and cardiovascular disease. The aim of this study was to investigate the impact of different ectopic fat depots on measurements of metabolic dysfunction and cardiovascular disease risk. METHODS: Using magnetic resonance imaging in 113 subjects, we measured abdominal (visceral and subcutaneous) and cardiac (epicardial and extra-pericardial) fat depots and examined their association with overall (BMI) and abdominal obesity (waist circumference), dyslipidaemia (triglycerides, total and HDL cholesterol), glucose tolerance (by an oral glucose tolerance test) and insulin sensitivity, blood pressure and 10-year coronary heart disease risk by Framingham score. RESULTS: Fat accumulation was proportional to the degree of obesity, with body fat ranging from 14 to 33 kg, visceral fat from 0.8 to 1.8 kg and cardiac fat from 134 to 236 g. Most cardiac fat (70% on average) was extra-pericardial, with a wide variability for both cardiac depots (epicardial: 172-2008 mm(2); extra-pericardial: 100-5056 mm(2)). Only visceral and extra-pericardial fat, but not epicardial or subcutaneous fat, could discriminate between subjects with three or more factors of the metabolic syndrome or medium-to-high coronary heart disease risk score. Controlling for gender and BMI by multivariable analysis, the best marker of reduced insulin sensitivity was visceral fat (partial r = -0.35); extra-pericardial fat was the closest associate of increased blood pressure (partial r = 0.26) and both extra-pericardial and visceral fat clustered with hypertriglyceridaemia (partial r = 0.29 and 0.24; both P < 0.02). CONCLUSION: Increased epicardial fat per se does not necessarily translate into presence or prediction of disease. In contrast, increased deposition of visceral abdominal and extra-pericardial mediastinal fat are both associated with an enhanced cardiovascular disease risk profile.

Changes in skeletal robusticity in an iron age agropastoral group: the Samnites from the Alfedena necropolis (Abruzzo, Central Italy).

Cross-sectional geometrical (CSG) properties of an Iron Age Samnite group from the Alfedena necropolis (Abruzzo, Italy, 2600-2400 B.P.) are compared with a Ligurian Neolithic sample (6000-5500 B.P.). In the period under examination, Samnites were organized in a tribal confederation led by patrilinear aristocracies, indicating incipient social stratification. In comparison, Neolithic society lacked clear signs of social hierarchy. The subsistence of both groups was mainly based on pastoralism and agriculture, but changes in habitual behavior are expected due to the socio-economic transformations that characterized the Iron Age. The Samnites' warlike ideology suggests that unimanual weapon-use and training would have become frequent for males. The intensification of agriculture and the adoption of transhumant pastoralism, performed by a smaller subset of the population, likely led to a lower average level of logistic mobility. The strongly genderized ideology of the period suggests a strict sexual division of labor, with women primarily performing sedentary tasks. CSG properties based on periosteal contours were calculated for humeri, femora, and tibiae (N = 61). Results corroborated the expectations: Alfedena males show substantial humeral bilateral asymmetry, indicating prevalent use of one arm, likely due to weapon training. In both sexes lower limb results indicate reduced mobility with respect to the Neolithic group. Sexual dimorphism is significant in both humeral asymmetry and lower limb indicators of mobility. Although both groups could be broadly defined as agropastoral based on archeological and historical evidence, CSG analysis confirmed important differences in habitual behavior.

Noise correlations and SNR in phased-array MRS.

The acquisition of magnetic resonance spectroscopy (MRS) signals by multiple receiver coils can improve the signal-to-noise ratio (SNR) or alternatively can reduce the scan time maintaining a reliable SNR. However, using phased array coils in MRS studies requires efficient data processing and data combination techniques in order to exploit the sensitivity improvement of the phased array coil acquisition method. This paper describes a novel method for the combination of MRS signals acquired by phased array coils, even in presence of correlated noise between the acquisition channels. In fact, although it has been shown that electric and magnetic coupling mechanisms produce correlated noise in the coils, previous algorithms developed for MRS data combination have ignored this effect. The proposed approach takes advantage of a noise decorrelation stage to maximize the SNR of the combined spectra. In particular Principal Component Analysis (PCA) was exploited to project the acquired spectra in a subspace where the noise vectors are orthogonal. In this subspace the SNR weighting method will provide the optimal overall SNR. Performance evaluation of the proposed method is carried out on simulated (1)H-MRS signals and experimental results are obtained on phantom (1)H-MR spectra using a commercially available 8-element phased array coil. Noise correlations between elements were generally low due to the optimal coil design, leading to a fair SNR gain (about 0.5%) in the center of the field of view (FOV). A greater SNR improvement was found in the peripheral FOV regions.

Heat and chemical stress modulate the expression of the alpha-RYR gene in broiler chickens.

The biological cause of Pork Stress syndrome, which leads to PSE (pale, soft, exudative) meat, is excessive release of Ca(2+) ions, which is promoted by a genetic mutation in the ryanodine receptors (RyR) located in the sarcoplasmic reticulum of the skeletal muscle cells. We examined the relationship between the formation of PSE meat under halothane treatment and heat stress exposure in chicken alphaRYR hot spot fragments. Four test groups were compared: 1) birds slaughtered without any treatment, i.e., the control group (C); 2) birds slaughtered immediately after halothane treatment (H); 3) birds slaughtered immediately after heat stress treatment (HS), and 4) birds exposed to halothane and to heat stress (H+HS), before slaughtering. Breast muscle mRNA was extracted, amplified by RT-PCR, and sequenced. PSE meat was evaluated using color determination (L* value). The most common alteration was deletion of a single nucleotide, which generated a premature stop codon, resulting in the production of truncated proteins. The highest incidence of nonsense transcripts came with exposure to halothane; 80% of these abnormal transcripts were detected in H and H+HS groups. As a consequence, the incidence of abnormal meat was highest in the H+HS group (66%). In HS, H, and C groups, PSE meat developed in 60, 50, and 33% of the samples, respectively. Thus, halothane apparently modulates alphaRYR gene expression in this region, and synergically with exposure to heat stress, causes Avian Stress syndrome, resulting in PSE meat in broiler chickens.

A new training model for robot-assisted urethrovesical anastomosis and posterior muscle-fascial reconstruction: the Verona training technique.

A training model is usually needed to teach robotic surgical technique successfully. In this way, an ideal training model should mimic as much as possible the "in vivo" procedure and allow several consecutive surgical simulations. The goal of this study was to create a "wet lab" model suitable for RARP training programs, providing the simulation of the posterior fascial reconstruction. The second aim was to compare the original "Venezuelan" chicken model described by Sotelo to our training model. Our training model consists of performing an anastomosis, reproducing the surgical procedure in "vivo" as in RARP, between proventriculus and the proximal portion of the esophagus. A posterior fascial reconstruction simulating Rocco's stitch is performed between the tissues located under the posterior surface of the esophagus and the tissue represented by the serosa of the proventriculus. From 2014 to 2015, during 6 different full-immersion training courses, thirty-four surgeons performed the urethrovesical anastomosis using our model and the Sotelo's one. After the training period, each surgeon was asked to fill out a non-validated questionnaire to perform an evaluation of the differences between the two training models. Our model was judged the best model, in terms of similarity with urethral tissue and similarity with the anatomic unit urethra-pelvic wall. Our training model as reported by all trainees is easily reproducible and anatomically comparable with the urethrovesical anastomosis as performed during radical prostatectomy in humans. It is suitable for performing posterior fascial reconstruction reported by Rocco. In this context, our surgical training model could be routinely proposed in all robotic training courses to develop specific expertise in urethrovesical anastomosis with the reproducibility of the Rocco stitch.

The increasing incidence and prevalence of MS in a Sardinian province.

OBJECTIVE: To verify incidence rates and their temporal trend in a homogeneous, ethnically, and genetically distinct population of central Sardinia (the Nuoro province). BACKGROUND: Intensive epidemiologic studies carried out in Sardinia since the 1970s have suggested that the prevalence and incidence of MS are much higher in this Mediterranean island compared with those found on mainland Italy. METHODS: The study area had a population of approximately 274, 000 people in the 1991 census. The authors adopted a complete enumerative approach by reviewing all possible sources of case collection available in the investigative area. RESULTS: Based on 469 MS patients, the mean annual incidence for 1955 to 1995 was 4.18 per 100,000 (or 4.3 per 100,000 if age- and sex-adjusted to the European population). The incidence, averaging 1.95 per 100,000 during 1955 to 1959, rose progressively over time, reaching rates of 6.6 in the quinquiennium 1985 to 1989 and 6.4 per 100,000 in 1990 to 1995. On December 31, 1994, the crude prevalence, based on 415 MS patients alive in the study area, was 151.9 per 100,000 (156.6 if adjusted to the European population). CONCLUSION: These incidence and prevalence rates are the highest to date that have been estimated for a large community in southern Europe, and they constitute some of the highest rates in the world. Based on other surveys, these results reinforce the position of Sardinia as a higher and rising prevalence area for MS compared with other Mediterranean populations. Genetic and social-historic data strengthen the hypothesis of the environmental role and genetic factors among Sardinians in determining the notable difference in MS frequency between Sardinians and other Mediterraneans.

Aversive effects and retention impairment induced by acetoxycycloheximide in an instrumental task.

AXM, when subcutaneously injected during the first 3 min following the acquisition of a nondiscriminative instrumental learning task, induced an aversion for the food reinforcement which had been associated with the training situation and with the pharmacological treatment. The high number of nonreinforced responses preceding the first reinforced response(RR) that animals performed when tested 6 days after AXM treatment, was not due to forgetting of the lever significance, but to this aversion. Animals treated with AXM showed low levels of lever pressing response and long latencies for their first RR; this deficit did not seem only to be due to food reinforcement aversion; it disappeared, as well as food aversion, when food reinforcement which had been associated with the learning situation and to treatment, was added to the daily feeding regimen during treatment-test interval. It has been shown, moreover, that more than 90 percent of cerebral protein synthesis was inhibited during the 5 hr following subcutaneous AXM injection. These findings are interpreted as an indication that AXM does not affect memory consolidation of a non discriminative instrumental learning.

The skeletal biology of two Italian peninsular Magna Graecia necropoles, Timmari and Montescaglioso.

The aim of this work is to outline a general picture of life style and conditions of a population living in Magna Graecia between the 7th and the 4th c. BC by the study of human skeletal remains found in two necropoles from the Matera province, Timmari and Montescaglioso, neighbouring Metaponto, one of the main Ionian Greek colonies. The biological reconstruction was attempted by a holistic approach which foresees the use of anthropometric, anthroposcopic, palaeodemographic, palaeopathological data, the study of skeletal and dentoalveolar indicators of environmental stress and the integration with archaeological and historical information. Interpretation of the results was also based on comparisons with coeval sites from Central-Southern Italy, from Greece and with earlier and later sites from the same region. The two samples from Matera did not show appreciable differences with the other Southern Italian coeval series when compared on the basis of metric and morphometric traits. The comparison with Greek samples was hampered by the scarcity of pertinent data. A high level of muscular activity was observed in males and females, with males clearly more mobile than females. Sexual dimorphism and limb bone lateralisation were marked. Health conditions and nutritional status were good.

[Alpha-interferon in the treatment of chronic hepatitis C in children]. / L'interferone alfa nella terapia dell'epatite cronica C nel bambino.

The hepatitis C virus is the main causative agent for sporadic as well as parenteral cases of non-A non-B hepatitis. Alpha interferon is a biologically active protein produced by B lymphocytes and monocytes which can be manufactured by recombinant DNA technology. Treatment of chronic hepatitis C with interferon in adults is associated with a sustained response in 20-25% of treated cases. First studies provide encouraging results for the use of interferon in the treatment of chronic hepatitis C in children, but controlled trials using this drug in a larger population of children are needed.

[Prevalence of HCV antibodies and vertical transmission of hepatitis C virus]. / Prevalenza dell'anti-HCV e trasmissione verticale del virus C.

HCV infection is one of the most frequent causes of hepatitis in man. There are numerous means of infection, not all of which can be documented. In infancy HCV infection occurs particularly in children that have been multitransfused or are on dialysis. Vertical transmission of HCV infection is rare, and the times and means of occurrence are not as yet well defined. The present study sets out to establish the prevalence of HCV-Ab carriers within a population of 4,242 pregnant women in Verona (Italy). It also aims to assess the incidence of vertical transmission of HCV infection in a sample of newborns examined over a 15-months follow-up. Of the 4,242 pregnant women subjected to screening, 45 (1.06%) were HCV-Ab positive. In only 74% of the cases it was possible to identify an HCV infection risk factor. On the 45 children of the HCV positive mothers, at present 25 have completed the 15 months follow-up. Only one of these children has contracted the infection: the incidence of transmission is therefore 4%.

Boron nitride nanotubes for boron neutron capture therapy as contrast agents in magnetic resonance imaging at 3 T.

The applicability of boron nitride nanotubes (BNNTs) containing Fe paramagnetic impurities as contrast agents in magnetic resonance imaging (MRI) was investigated. The measurement of longitudinal and transverse relaxation times of water protons in homogeneous aqueous dispersions of BNNTs wrapped with poly(L-lysine) at different concentrations allowed longitudinal (r(1)) and transverse (r(2)) relaxivities to be determined at 3T. The r(2) value was comparable to those of commercial superparamagnetic iron oxide nanoparticles, indicating that Fe-containing BNNTs have the potential to be used as T(2) contrast-enhancement agents in MRI at 3T.

Left ventricular modelling: a quantitative functional assessment tool based on cardiac magnetic resonance imaging.

We present the development and testing of a semi-automated tool to support the diagnosis of left ventricle (LV) dysfunctions from cardiac magnetic resonance (CMR). CMR short-axis images of the LVs were obtained in 15 patients and processed to detect endocardial and epicardial contours and compute volume, mass and regional wall motion (WM). Results were compared with those obtained from manual tracing by an expert cardiologist. Nearest neighbour tracking and finite-element theory were merged to calculate local myocardial strains and torsion. The method was tested on a virtual phantom, on a healthy LV and on two ischaemic LVs with different severity of the pathology. Automated analysis of CMR data was feasible in 13/15 patients: computed LV volumes and wall mass correlated well with manually extracted data. The detection of regional WM abnormalities showed good sensitivity (77.8%), specificity (85.1%) and accuracy (82%). On the virtual phantom, computed local strains differed by less than 14 per cent from the results of commercial finite-element solver. Strain calculation on the healthy LV showed uniform and synchronized circumferential strains, with peak shortening of about 20 per cent at end systole, progressively higher systolic wall thickening going from base to apex, and a 10° torsion. In the two pathological LVs, synchronicity and homogeneity were partially lost, anomalies being more evident for the more severely injured LV. Moreover, LV torsion was dramatically reduced. Preliminary testing confirmed the validity of our approach, which allowed for the fast analysis of LV function, even though future improvements are possible.

Sudden Sensorineural Hearing Loss: MR Imaging.

Hearing loss greater than 30 dB over three contiguous pure-tone frequencies occurring within a three day period is defined as sudden hearing loss. It is usually sensorineural (SSNHL), unilateral and appears as an otologic emergency. SSNHL has many possibile etiologies such as: labyrinthine viral infection, ischemic or hemorrhagic illness, trauma, immuno-mediated inner ear disease, tumor, inner ear malformation, and an imbalance between perilymphatic and endolymphatic fluid pressure. Nevertheless in almost 80% of cases SSNHL belongs to the idiopathic category because the etiology is unknown. The aim of this study was to test the diagnostic impact of two MR devices. Fifteen cases of SSNHL studied with a 1.5 T unit in our hospital between January 2006 and December 2008 within two weeks of the onset were retrospectively evaluated. Since January 2009 three more patients affected by SSNHL have been scanned with a 3T MR unit. We discuss the diagnostic sensitivity, clinical usefulness and the cost-benefit ratio of the MR systems.

Evaluation of a web-based network for reproducible T2* MRI assessment of iron overload in thalassemia.

PURPOSE: To build and evaluate a national network able to improve the care of thalassemia, a genetic disorder in haemoglobin synthesis often associated with iron accumulation in a variety of organs, due to the continuous blood transfusions. METHODS: The MIOT (Myocardial Iron Overload in Thalassemia) network is constituted by thalassemia and magnetic resonance imaging (MRI) centers. Thalassemia centers are responsible for patient recruitment and collection of anamnestic and clinical data. MRI centers have been equipped with a standardized acquisition technique and an affordable workstation for image analysis. They are able to perform feasible and reproducible heart and liver iron overload assessments for a consistent number of thalassemia patients in a robust manner. All centers are linked by a web-based network, configured to collect and share patient data. RESULTS: On 30th March 2008, 695 thalassemia patients were involved in the network. The completion percentage of the patient records in the database was 85+/-6.5%. Six hundred and thirteen patients (88%) successfully underwent MRI examination. Each MRI center had a specific absorption capacity that remained constant over time, but the network was capable of sustaining an increasing number of patients due to continuous enrollment of new centers. The patient's comfort, assessed as the mean distance from the patient home locations to the MRI centers, significantly increased during the network's evolution. CONCLUSION: The MIOT network seems to be a robust and scalable system in which T2* MRI-based cardiac and liver iron overload assessment is available, accessible and reachable for a significant and increasing number of thalassemia patients in Italy (about 420 per year), reducing the mean distance from the patient locations to the MRI sites from 951km to 387km. A solid, wide and homogeneous database will constitute an important scientific resource, shortening the time scale for diagnostic, prognostic and therapeutical evidence-based research on the management of thalassemia disease.

Amino-terminal fragment of pro-brain natriuretic hormone identifies functional impairment and right ventricular overload in operated tetralogy of Fallot patients.

To evaluate the relationship between plasma concentration of amino-terminal fragment of pro-brain natriuretic peptide (NT-proBNP), functional capacity, and right ventricular overload in survivors of tetralogy of Fallot (TOF) repair, we prospectively studied 70 operated TOF patients (44 males, 21 +/- 1 years old; mean +/- SEM) who underwent, during the same day, echocardiography, cardiac magnetic resonance imaging, neurohormonal characterization (plasma NT-proBNP, catecholamines, plasma renin activity, and aldosterone assay), and cardiopulmonary exercise testing. Forty-eight age- and sex-matched healthy volunteers served as the control group. Compared to controls, maximal workload and peak oxygen consumption (VO2/kg) were lower in operated TOF patients (p < 0.001), whereas NT-proBNP concentration was elevated (p < 0.001). No difference was found among the other neurohormones. In operated TOF patients, NT-proBNP showed a significant positive correlation with right ventricular (RV) end systolic and end diastolic volumes and RV systolic pressure, and it showed a negative correlation with peak VO2/kg and RV ejection fraction. From multivariable analysis, NT-proBNP concentration was found to be an independent predictor of peak VO2/kg, RV end systolic volume, and RV systolic pressure. These results show an association among RV overload, decrease in functional capacity, and cardiac natriuretic peptide expression in operated TOF patients. NT-proBNP plasma assay may be a useful tool for diagnostic purposes and for decision making in this setting.

An epidemiological study of multiple sclerosis in central Sardinia, Italy.

OBJECTIVES: To verify morbidity estimates in central Sardinia, Italy. METHODS: A prevalence study was performed in the province of Nuoro, Central Sardinia, which has a population of 273,768 inhabitants (135,383 men and 138,385 women). A complete enumeration approach was adopted by using all possible case-collection sources. RESULTS: On prevalence day, December 31, 1993, 394 subjects (124 men and 270 women) living in the study area were known to suffer from definite and probable MS, giving a crude prevalence rate of 143.9 cases per 100,000 people, 91.6 for males and 195.11 for females. The crude prevalence estimated on December 31, 1985, based on 282 MS cases alive in the study area, was 102.94 per 100,000. CONCLUSION: This study reinforced central Sardinia's position as a high and rising prevalence area for MS.