Does a short lingual frenulum affect body posture? Assessment of posture in the sagittal plane before and after laser frenulotomy: a pilot study.

The factors that characterize posture are neurophysiological, biomechanical, psychoemotional. Neurophysiological factors concern the modulation of tone, muscle tone is the result of a series of neuropsychological processes within the tonic-postural system. The tonic-postural system can become unbalanced for various reasons, including a tight lingual frenum. The aim of this pilot study was to evaluate the benefits of frenulectomy by laser on body posture and on the scapular (shoulders) anteroposterior movement. Twenty-four healthy subjects were selected, between the ages of 10 and 26 years (mean age 15.22) who presented a short lingual frenum and a low posture of the tongue and jaw. They were examined using the Marchesan Protocol for Lingual Frenum and the Spinometry® Formetric and underwent laser frenectomy by diode laser (Siro Laser Blu. 660 nm) without any post-surgery complications. The release of the frenulum immediately brought benefits to patients, reorganizing the physiological modulation, and the movement of the tongue within the normal parameters of temporomandibular kinematics which were within physiological parameters. Frenectomy improved the anterior-posterior flexion of the scapulas (shoulders) in the sagittal plane but a larger sample is required to have statistically significant results.

Ceftazidime-avibactam resistance and restoration of carbapenem susceptibility in KPC-producing Klebsiella pneumoniae infections: A case series.

OBJECTIVES: Since the introduction of the ß-lactam/ß-lactamase inhibitor ceftazidime-avibactam (CZA), rapid evolution of resistance has been reported in different KPC-producing Klebsiella pneumoniae isolates. In this multicenter retrospective study, we describe the emergence of CZA resistance and evaluate the mutations that might be responsible for the restoration of carbapenem susceptibility. METHODS: During a study period of 18 months, KPC-producing K. pneumoniae isolates of five hospitalized patients were collected with phenotypic development of CZA resistance. RESULTS: In vitro restoration of carbapenem susceptibility during treatment was observed in 3 isolates. Whole genome sequencing of these isolates showed a D179Y mutation in the KPC gene of 2 variants and a KPC-2 with a Δ242-GT-243 deletion (KPC-14). Two KPC-3 variants showed CZA resistance with sustained carbapenemase activity without genomic adaptations in the KPC gene. CONCLUSIONS: This study confirms the emergence of CZA resistance in KPC K. pneumoniae. The role of carbapenems in treating patients with these variants is unclear and combination therapies warrant further investigation.

Amplitude and phase modulation in microwave ring resonators by doped CVD graphene.

In this paper, we numerically and experimentally demonstrate how to modulate the amplitude and phase of a microwave ring resonator by means of few-layers chemical vapour deposition graphene. In particular, both numerical and experimental results show a modulation of about 10 dB and a 90 degrees-shift (quadrature phase shift) when the graphene sheet-resistance is varied. These findings prove once again that graphene could be efficiently exploited for the dynamically tuning and modulation of microwave devices fostering the realization of (i) innovative beam-steering and beam-forming systems and (ii) graphene-based sensors.

Optically transparent microwave screens based on engineered graphene layers.

We propose an innovative approach for the realization of a microwave absorber fully transparent in the optical regime. This device is based on the Salisbury screen configuration, which consists of a lossless spacer, sandwiched between two graphene sheets whose sheet resistances are different and properly engineered. Experimental results show that it is possible to achieve near-perfect electromagnetic absorption in the microwave X-band. These findings are fully supported by an analytical approach based on an equivalent circuital model. Engineering and integration of graphene sheets could facilitate the realization of innovative microwave absorbers with additional electromagnetic and optical functionalities that could circumvent some of the major limitations of opaque microwave absorbers.

Forkhead box protein 3(+) regulatory T cells and Helios(+) subset in perinatally acquired HIV.

Forkhead box protein 3 (FoxP3)(+) regulatory T cells (Tregs ) are important not only in regulating the development of autoimmune conditions, but also in chronic infectious diseases. Given their cardinal function in suppressing immune activation, research has focused upon whether they play a detrimental role in chronic infections, particularly HIV. While the role of Tregs in HIV has been investigated intensively, it remains an unresolved topic. However, it is generally accepted that Tregs are susceptible to HIV infection and are preferentially preserved over conventional CD4(+) T cells. It is unknown whether the peripheral-induced or the thymic-derived Tregs are more susceptible to HIV cytotoxicity. It has been recognized that Tregs can be segregated into two subsets based on Helios expression, with the vast majority being Helios(+) . This study examines the impact of HIV infection on total Tregs and their Helios subsets in a perinatal-acquired HIV-infected paediatric population. The finding indicates a selective expansion or survival of Tregs in association with CD4 depletion and increased viraemia. The Helios(+) and Helios(-) subsets within Tregs appear to be equally affected. However, the Helios(+) Tregs seem to be more preserved in patients with low CD4(+) ≤ 25% and detectable plasma HIV RNA >20 copies/ml. In this group, the frequencies of Tregs are increased, but their numbers appear insufficient to restrain immune activation. In conclusion, our findings suggest that both Helios subsets of Tregs are susceptible to HIV infection and are preferentially preserved compared to conventional CD4(+) T cells.

Graphene-based perfect optical absorbers harnessing guided mode resonances.

We investigate graphene-based optical absorbers that exploit guided mode resonances (GMRs) attaining theoretically perfect absorption over a bandwidth of few nanometers (over the visible and near-infrared ranges) with a 40-fold increase of the monolayer graphene absorption. We analyze the influence of the geometrical parameters on the absorption rate and the angular response for oblique incidence. Finally, we experimentally verify the theoretical predictions in a one-dimensional, dielectric grating by placing it near either a metallic or a dielectric mirror, thus achieving very good agreement between numerical predictions and experimental results.

Graphene-based absorber exploiting guided mode resonances in one-dimensional gratings.

A one-dimensional dielectric grating, based on a simple geometry, is proposed and investigated to enhance light absorption in a monolayer graphene exploiting guided mode resonances. Numerical findings reveal that the optimized configuration is able to absorb up to 60% of the impinging light at normal incidence for both TE and TM polarizations resulting in a theoretical enhancement factor of about 26 with respect to the monolayer graphene absorption (≈2.3%). Experimental results confirm this behavior showing CVD graphene absorbance peaks up to about 40% over narrow bands of a few nanometers. The simple and flexible design points to a way to realize innovative, scalable and easy-to-fabricate graphene-based optical absorbers.

Exploring and rationalising effective n-doping of large area CVD-graphene by NH3.

Despite the large number of papers on the NH3 doping of graphene, the achievement of stable n-doped large area CVD (chemical vapor deposition) graphene, which is intrinsically p-doped, is still challenging. A control of the NH3 chemisorption and of the N-bond configuration is still needed. The feasibility of a room temperature high pressure NH3 treatment of CVD graphene to achieve n-type doping is shown here. We use and correlate data for (a) sheet resistance, R(sh), and the Hall coefficient, R(H), in van der Pauw configuration, acquired in real time during the NH3 doping of CVD-graphene on a glass substrate, (b) optical measurements of the effect of doping on the graphene Van Hove singularity point at 4.6 eV in the dielectric function spectra by spectroscopic ellipsometry, and of (c) N-bond configuration by XPS to better understand and, finally, control the NH3 doping of graphene. The discussion is focused on the thermal and time stability of the n-doping after air exposure. A chemical rationale is provided for the NH3 n-doping based on the interaction of (i) NH3 with intrinsic oxygen functionalities and defects of CVD graphene and of (ii) C-NH2 doping centers with acceptor species present in the air.

Identification and management of subvesical bile duct leakage after laparoscopic cholecystectomy: A systematic review.

Bile leak is a rare complication after Laparoscopic Cholecystectomy. Subvesical bile duct (SVBD) injury is the second cause of minor bile leak, following the unsuccessful clipping of the cystic duct stump. The aim of this study is to pool available data on this type of biliary tree anatomical variation to summarize incidence of injury, methods used to diagnose and treat SVBD leaks after LC. Articles published between 1985 and 2021 describing SVBD evidence in patients operated on LC for gallstone disease, were included. Data were divided into two groups based on the intra or post-operative evidence of bile leak from SVBD after surgery. This systematic report includes 68 articles for a total of 231 patients. A total of 195 patients with symptomatic postoperative bile leak are included in Group 1, while Group 2 includes 36 patients describing SVBD visualized and managed during LC. Outcomes of interest were diagnosis, clinical presentation, treatment, and outcomes. The management of minor bile leak is controversial. In most of cases diagnosed postoperatevely, Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is the best way to treat this complication. Surgery should be considered when endoscopic or radiological approaches are not resolutive.

Endovascular therapy outcome in isolated posterior cerebral artery occlusion strokes: A multicenter analysis of the Swiss Stroke Registry.

PURPOSE: There is little data on the safety and efficacy of endovascular treatment (EVT) in comparison with intravenous thrombolysis (IVT) in acute ischemic stroke due to isolated posterior cerebral artery occlusion (IPCAO). We aimed to investigate the functional and safety outcomes of stroke patients with acute IPCAO treated with EVT (with or without prior bridging IVT) compared to IVT alone. METHODS: We did a multicenter retrospective analysis of data from the Swiss Stroke Registry. The primary endpoint was overall functional outcome at 3 months in patients undergoing EVT alone or as part of bridging, compared with IVT alone (shift analysis). Safety endpoints were mortality and symptomatic intracranial hemorrhage. EVT and IVT patients were matched 1:1 using propensity scores. Differences in outcomes were examined using ordinal and logistic regression models. FINDINGS: Out of 17,968 patients, 268 met the inclusion criteria and 136 were matched by propensity scores. The overall functional outcome at 3 months was comparable between the two groups (EVT vs IVT as reference category: OR = 1.42 for higher mRS, 95% CI = 0.78-2.57, p = 0.254). The proportion of patients independent at 3 months was 63.2% in EVT and 72.1% in IVT (OR = 0.67, 95% CI = 0.32-1.37, p = 0.272). Symptomatic intracranial hemorrhages were overall rare and present only in the IVT group (IVT = 5.9% vs EVT = 0%). Mortality at 3 months was also similar between the two groups (IVT = 0% vs EVT = 1.5%). CONCLUSION: In this multicenter nested analysis, EVT and IVT in patients with acute ischemic stroke due to IPCAO were associated with similar overall good functional outcome and safety. Randomized studies are warranted.

[Surgical risk scale in pediatric surgery]. / Escala de riesgo quirúrgico en cirugía pediátrica.

INTRODUCTION: The need to measure the level of surgical risk arises from its direct relationship with the development of postoperative complications and the use of hospital resources. The construction of a surgical risk scale (ERQ) for pediatric surgery should be based on a common language, by using a small number of easy to collect and reproduce variables. The objectives of this study were to construct an ERQ for pediatric patients and to analyze the surgical performance. MATERIALS AND METHODS: We retrospectively analyzed 105 primary surgical procedures under general anesthesia performed by liver transplantation service at Hospital Garrahan, between 29/6/08 and 25/3/10. Newborn patients were not considered. The ERQ was built by adding patient risk factors (PRL): weight (< o > 10 kg), co-morbidities (coagulopathy-obesity-diabetes) and life support; and the magnitude level of the surgical procedure (SPL): surgical time and requirement of blood transfusions. The surgical performance was considered as a relation between the level of surgical risk and the post-operative results, measured with the classification of surgical complications proposed by Clavien et al (STROC). The main end point of the study was the STROC > or = 3 (severe complications). The ERQ predictive power for serious complications was compared with the anaesthetic risk (ASA). Descriptive and analytical statistics took place. The predictive value for complications was calculated by means of a ROC curve. The estimation of the risk was calculated by relative risk. RESULTS: The ERQ was constituted on a continuum of 6 risk levels (2 to 7). The ROC's curve predictive power to determine the development of severe post-operative complications (STROC > or = 3) was 0.87 (CI 0,80-0,94) for the ERQ and 0.81 (CI 0,73-0,89) for the ASA. Level of > or = 5 of ERQ was the cut-off point that better predicted the development of STROC > or = 3. CONCLUSION: The ERQ is an easy tool, useful to quantify and compare surgical risks and results. It showed a high predictive power of postoperative complications.

TaTME approach as a rescue during a laparoscopic TME for high rectal cancer. A case report.

INTRODUCTION AND IMPORTANCE: In the last years, transanal total mesorectal excision (TaTME) has been described in rectal cancer treatment, especially in challenging patients, difficulties in pelvic exposure and limitations of instrumentation improving not only dissection but also the preservation of autonomic pelvic nerves and the achievement of a restorative procedure. Here we report a case report of anterior laparoscopic rectal resection for adenocarcinoma of the high-mid rectum converted to transanal approach. CASE PRESENTATION: A 69-year-old male presented hepatic nodules during radiological follow-up for prostate cancer treated with radical prostatectomy and adjuvant radiotherapy (70 Gy). The biopsy of the lesion demonstrated the presence of a metastatic lesion of an adenocarcinoma, with suspected intestinal origin. Then, we perform an endoscopic examination, which showed the presence of a rectal lesion, which cause a bowel stenosis extended from the middle part to the upper part of the rectum. After chemoradiotherapy, an anterior rectal resection was performed. During surgery we could not perform the resection of the rectum due the thickness and fibrosis of the tissue, despite we used different branded mechanical stapler. So, we decided to complete the surgical treatment starting a TaTME procedure with resolution of the problem. CLINICAL DISCUSSION: TaTME is a relatively new technique that had already become a valid option in the treatment of low rectal cancer, and, nowadays, also in the treatment of inflammatory bowel disease. As reported in literature, this technique has a number of advantages, especially in narrow pelvis and it is very useful in low rectal surgery. CONCLUSION: This case report aims to describe the possible use of TaTME procedure as a rescue also when this approach is not the first choice.

Integrating rapid diagnostics in Gram-negative bloodstream infections of patients colonized by carbapenemase-producing Enterobacterales.

We implemented a fast-track diagnostic approach for Gram-negative bloodstram infections (BSIs) among carbapenemase-producing Enterobacterales (CPE) carriers. Within a large cohort of patients with CPE rectal carriage, 18.1% developed Gram-negative BSIs, of which 69.5% were caused by CPE. Direct matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) analysis provided reliable identification in 97% and 53.8% of monomicrobical blood cultures positive to Enterobacterales and non-fermenting Gram-negative species, respectively. Overall, sensitivity and specificity of NG-Test Carba 5 compared with the composite reference method after discrepant analysis were 100%, in polimicrobial blood cultures too. The combined use of direct MALDI-TOF MS and NG-Test Carba 5 assay might be a reliable and cost-effective tool for accelerating the laboratory diagnosis of CPE BSI in cohorts of high-risk patients such as CPE carriers.

Discovery of the shape coexisting 0+ state in 32 Mg by a two neutron transfer reaction.

The "island of inversion" nucleus 32 Mg has been studied by a (t, p) two neutron transfer reaction in inverse kinematics at REX-ISOLDE. The shape coexistent excited 0+ state in 32 Mg has been identified by the characteristic angular distribution of the protons of the Δ L=0 transfer. The excitation energy of 1058 keV is much lower than predicted by any theoretical model. The low γ-ray intensity observed for the decay of this 0+ state indicates a lifetime of more than 10 ns. Deduced spectroscopic amplitudes are compared with occupation numbers from shell-model calculations.

Accuracy of the ELITe MGB assays for the detection of carbapenemases, CTX-M, Staphylococcus aureus and mecA/C genes directly from respiratory samples.

INTRODUCTION: Bacterial lower respiratory tract infections (BLRTI) may represent serious clinical conditions which can lead to respiratory failure, intensive care unit admission and high hospital costs. The detection of carbapenemase- and extended-spectrum ß-lactamase (ESBL)-producing Enterobacterales, as well as meticillin-resistant Staphylococcus aureus (MRSA), has become a major issue, especially in healthcare-associated infections. This study aimed to determine whether molecular assays could detect genes encoding carbapenemases, ESBL and MRSA directly from respiratory samples in order to expedite appropriate therapy and infection control for patients with BLRTI. METHODS: The carbapenem-resistant enterobacterales (CRE), ESBL and MRSA/SA ELITe MGB assays were performed directly on 354 respiratory specimens sampled from 318 patients admitted with BLRTI. Molecular results were compared with routine culture-based diagnostics results. RESULTS: Positive (PPV) and negative (NPV) predictive values of the CRE ELITe MGB kit were 75.9% [95% confidence interval (CI) 60.3-86.7] and 100%, respectively. PPV and NPV of the ESBL ELITe MGB kit were 80.8% (95% CI 63.6-91.0) and 99.1% (95% CI 96.6-99.8), respectively. PPV and NPV of the MRSA/SA ELITe MGB kit were 91.7% (95% CI 73.7-97.7)/100% and 98.3% (95% CI 89.8-99.3)/96.8% (95% CI 81.6-99.5), respectively. DISCUSSION: Validity assessment of molecular assays detecting the main antibiotic resistance genes directly from respiratory samples showed high accuracy compared with culture-based results. Molecular assays detecting the main carbapenemase, ESBL, S. aureus and meticillin resistance encoding genes provide an interesting tool with potential to expedite optimization of antibiotic therapy and infection control practices in patients with BLRTI.

RESIST-5 O.O.K.N.V. and NG-Test Carba 5 assays for the rapid detection of carbapenemase-producing Enterobacterales from positive blood cultures: a comparative study.

We prospectively compared the performance of RESIST-5 O.O.K.N.V. and NG-Test Carba 5 assays directly from blood cultures spiked with 130 characterized Enterobacterales isolates. Overall, both assays yielded 100% sensitivity to detect KPC-type carbapenemases and OXA-48-like carbapenemases. Both assays failed to detect KPC-31 and KPC-33, D179Y point mutation variants of KPC-3 and KPC-2, that are deprived of carbapenemase activity and confer resistance to ceftazidime-avibactam. On blood culture bacterial pellets, NDM- and VIM-type carbapenemases were detected in 50.0% and 52.2%, respectively, by RESIST-5 O.O.K.N.V. vs 100% by NG-Test Carba 5. The sensitivity of RESIST-5 O.O.K.N.V. improved to 100% and 95.6%, respectively, by performing the assay on 4-h early subculture.

Detection of antibiotic resistance genes from blood cultures: performance assessment and potential impact on antibiotic therapy management.

Molecular assays may constitute a valid method for timely prediction of antimicrobial resistance and optimization of empirical antibiotic therapies. This study assessed ELITe MGB assays of blood cultures to detect the main carbapenemase and extended-spectrum beta-lactamase (ESBL) genes, Staphylococcus aureus and mec genes in less than 3 h. Excellent agreement was found between the results of genotypic and conventional phenotypic approaches. Retrospective analysis of medical records revealed that approximately 50% of bloodstream infections caused by ESBL-producing Enterobacteriaceae, carbapenemase-producing Enterobacteriaceae or meticillin-resistant S. aureus were initially treated with inactive drugs. Overall, 36.3% of patients could have been treated with appropriate therapy at least 24 h earlier if molecular data had been used.

CO2 and N2O from water resource recovery facilities: Evaluation of emissions from biological treatment, settling, disinfection, and receiving water body.

Water resource recovery facilities (WRRFs) contribute to climate change and air pollution, as they are anthropogenic potential sources of direct and indirect emission of greenhouse gases (GHGs). Studies concerning the monitoring and accounting for GHG emissions from WRRFs are of increasing interest. In this study, the floating hood technique for gas collection was coupled with the off-gas method to monitor and apportion nitrous oxide (N2O) and carbon dioxide (CO2) emissions from both aerated and non-aerated tanks in a municipal water resource recovery facility, in order to investigate its carbon footprint (CFP). To our knowledge, this is the first time that the chamber technique was applied to evaluate gas fluxes from the settler, where an emission factor (EF) of 4.71 ∗ 10-5 kgCO2,eq kgbCOD-1 was found. Interesting results were found in the disinfection unit, which was the major contributor to direct N2O emissions (with a specific emission factor of 0.008 kgCO2,eq kgbCOD-1), due to the chemical interaction between hydroxylamine and the disinfectant agent (hypochlorite). The specific emission factor of the biological aerated tank was 0.00112 kgCO2,eq kgbCOD-1. The average direct CO2 emission was equal to 0.068 kgCO2 kgbCOD-1 from the activated sludge tank and to 0.00017 kgCO2 kgbCOD-1 from the secondary clarifier. Therefore, taking into account the contribution of both direct N2O and CO2 emissions, values of 0.069 kgCO2,eq kgbCOD-1, 0.008 kgCO2,eq kgbCOD-1 and 0.00022 kgCO2,eq kgbCOD-1, were found for the net CFP of the aerated compartment, the disinfection unit and the clarifier, respectively. The plant energy Footprint (eFP) was also evaluated, confirming that the aeration system is the major contributor to energy consumption, as well as to indirect CO2 emission, with a specific eFP of 1.49 kWh kgbCOD-1.

Evaluation of placental protein modifications in normotensive and spontaneously hypertensive rats.

Hypertension in pregnancy is often associated to placental deficiency. Therefore several physiopathological modifications occur to sustain fetal well-being through protective mechanisms. Here, we used spontaneously hypertensive rat (SHR) and normotensive Wistar-Kyoto (WKY) counterpart to evaluate in late gestation (d 20) modification of placental proteins involved in adaptation to hypertension. Placenta from WKY and SHR was excised for the evaluation of protein changes by Western blot analysis and zymography. In particular, we showed in SHR placentas an increase in angiotensin receptor type 1 and a decrease in angiotensin converting enzyme. Conversely, inducible nitric oxide synthase expression was increased, while constitutive endothelial nitric oxide synthase was similar in both groups. Placentas from SHR showed a reduced protein expression in both peroxisome proliferators-activated receptors-alpha and -gamma. Pro-metalloproteinase-9 activity was not significantly modified, whereas both pro-metalloproteinase-2 and its active form present a higher activity in SHR placentas. Moreover, at the end of pregnancy, cyclooxygenase-2 expression decreased in SHR placentas. These data may provide new insights into the placental adaptive mechanisms that take place during pregnancy in SHR.

Abdominal aortic aneurysm associated with renal ectopia.

This report describes a rare case of concurrent abdominal aortic aneurysm and bilateral renal ectopia. Preoperative work-up included intravenous pyelography and angiography to assess renal function, renal artery anatomy, and ureter position. Conventional surgery was performed without renal protection. No deterioration in postoperative renal function was observed.