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.

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.

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.

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.

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.

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.

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.

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.

[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.

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.

Determination of ascorbyl 6-palmitate in food matrices by amperometric flow injection analysis.

In this paper a rapid method based on a FIA (flow injection analysis) system with amperometric detection for the evaluation of ascorbyl 6-palmitate in foods is described. The selectivity of the proposed method is related to the low anodic potential applied to the working glassy carbon electrode (+0.1 V vs. Ag/AgCl) that leaves out interferences from ascorbic acid and phenolic compounds. By flow injection analysis, under optimised conditions, the calibration curve was linear in the range 0-20 mg l(-1) and the detection limit was 0.2 mg l(-1).

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.

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.

Rise and fall of asthma-related mortality in Italy and sales of beta2-agonists, 1980-1994.

We performed this study with the aims of describing the trend of asthma-related mortality in Italy between 1980 and 1994, and to evaluate the relationship between sale estimates of beta2-agonists drugs and mortality from asthma. For asthma mortality we used data provided by National Institute of Statistics, for sale estimates of beta2-agonists we used data provided by IMS HEALTH. We calculated the gender specific age-standardized incidence rates of asthma-related deaths for all ages and for age classes. We found that estimates for asthma-related mortality steadily increased between 1980 and 1987 in both sexes, and thereafter decreased. In people, aged between 34 and 64 and over 64, death rates in males were significantly higher than in females while the rates in those aged less than 34, were mostly similar in both gender. The overall exposure to beta2-agonists (alone and in combination) increased from 1980 to 1990, remained stable between 1990 and 1993, and increased steeply in 1994. We conclude that asthma-related death rates have declined since the mid-1980's. This decline has been more pronounced in males and in the older ages, while the rates in younger patients of both genders have remained nearly unchanged. Our data do not substantiate the hypothesis of an increased risk of asthma-related mortality associated to the use of inhaled beta2-agonists in general nor fenoterol or salbutamol in particular.

Chemical mechanism of DNA cleavage by the homing endonuclease I-PpoI.

Homing endonucleases are distinguished by their ability to catalyze the cleavage of double-stranded DNA with extremely high specificity. I-PpoI endonuclease, a homing endonuclease from the slime mold Physarum polycephalum, is a small enzyme (2 x 20 kDa) of known three-dimensional structure that catalyzes the cleavage of a long target DNA sequence (15 base pairs). Here, a detailed chemical mechanism for catalysis of DNA cleavage by I-PpoI endonuclease is proposed and tested by creating six variants in which active-site residues are replaced with alanine. The side chains of three residues (Arg61, His98, and Asn119) are found to be important for efficient catalysis of DNA cleavage. This finding is consistent with the proposed mechanism in which His98 abstracts a proton from an attacking water molecule bound by an adjacent phosphoryl oxygen, Arg61 and Asn119 stabilize the pentavalent transition state, and Asn119 also binds to the essential divalent metal cation (e.g., Mg(2+) ion), which interacts with the 3'-oxygen leaving group. Because Mg(2+) is required for cleavage of a substrate with a good leaving group (p-nitrophenolate), Mg(2+) likely stabilizes the pentavalent transition state. The pH-dependence of k(cat) for catalysis by I-PpoI reveals a macroscopic pK(a) of 8.4 for titratable groups that modulate product release. I-PpoI appears to be unique among known restriction endonucleases and homing endonucleases in its use of a histidine residue to activate the attacking water molecule for in-line displacement of the 3'-leaving group.

Evaluation of the 'antioxidant power' of olive oils based on a FIA system with amperometric detection.

A new method for the evaluation of the 'total antioxidant power' of olive oils, based on a flow injection analysis system with electrochemical detection, is described. It represents a attractive alternative to the mostly used Rancimat method since it is based on the chemical structure of antioxidants and does not require the manipulation of several parameters, such as temperature and oxygen pressure, to accelerate oil oxidation. The proposed procedure is simple, rapid, allows a throughput of 90 samples h-1 and provides a good precision: an RSD of 3.5% was obtained for caffeic acid at the concentration level of 5 mg L-1 (n = 12). A comparison of the proposed was obtained for caffeic acid at the concentration level of 5 mg L-1 (n = 12). A comparison of the proposed procedure with two other methods (Rancimat method and ABTS.+ decoloration assay) was performed to investigate the applicability and limitations of the proposed method.

Exposure to environmental tobacco smoke and the risk of adverse respiratory events in children receiving general anesthesia.

BACKGROUND: Exposure to environmental tobacco smoke is associated with detrimental effects on pulmonary function in children. The authors investigated the relation between airway complications in children receiving general anesthesia and the passive inhalation of tobacco smoke. METHODS: Six hundred two children scheduled to receive general anesthesia were enrolled in this prospective study. The anesthesiologist and the recovery room nurse, unaware of the smoke exposure history, recorded the occurrence of airway complications. A history of passive smoking was assessed by measuring the urinary concentration of the major nicotine metabolite cotinine and by questionnaire. RESULTS: Airway complications occurred in 42% of the patients with urinary concentrations of cotinine > or =40 ng/ml, in 33% of the patients with concentrations of cotinine between 10.0 and 39.9 ng/ml, and in 24% of the patients with concentrations of cotinine < 10 ng/ml (P = 0.01 for the trend among the three groups). The gender of the child (P = 0.001) and the educational level of the child's mother (P = 0.0008) significantly modified the effect of the concentration of cotinine on the incidence of adverse respiratory events. CONCLUSIONS: There is a strong association between passive inhalation of tobacco smoke and airway complications in children receiving general anesthesia. The relationship is greatest for girls and for those whose mothers have a lower level of education. Passive smoking should be regarded as a risk factor in children undergoing general anesthesia.