Rift Valley fever MP-12 vaccine elicits an early protective immune response in mice.

Rift Valley fever virus (RVFV) is an important mosquito-borne pathogen that causes outbreaks of severe disease in people and livestock throughout Africa and the Arabian Peninsula. The development of an effective veterinary and human vaccine to protect against Rift Valley fever (RVF) disease remains a high priority. The live attenuated RVFV MP-12 is a promising vaccine candidate for the prevention of RVF in both human and domestic ruminants. The aim of this study was to determine the onset of protective immunity elicted in mice by a single dose of this vaccine. Groups of CD-1 mice were vaccinated intraperitoneally with RVFV MP-12 vaccine and challenged on days 2, 5, 6 and 7 post-vaccination (PV) with a lethal dose of virulent RVFV. The mice were observed once daily for terminal morbidity and blood samples were obtained from the retro-orbital sinus complex on days 23 and 28 PV of surviving mice to determine RVFV neutralizing antibody titers. In one test, 2 of 3 mice challenged on day 2 PV survived and all 3 mice challenged at days 5 and 7 PV also survived. A second test of 10 mice per group was performed, and half (5) of those challenged at day 2 PV survived while all (10) survived challenge at day 4 and 6 PV. All surviving animals develop antibody that ranged from 1:80 to 1:1,280 PV. In a separate experiment, RVFV MP-12 vaccinated CD-1 mice, but not challenged developed a low viremia for the first 3 days PV and neutralzing antibody was detected on days 5 through day 28 PV. These findings demonstrated that the RVFV MP-12 vaccine elicited a rapid protective immune response in mice as early as 2 days PV, thus further supporting the effectiveness of this vaccine candidate for preventing RVF among humans and domestic ruminants.

A prospective study of the effects of carbocysteine lysine salt on frequency of exacerbations in COPD patients treated with or without inhaled steroids.

OBJECTIVE: COPD is one of the major causes of morbidity and mortality worldwide and represents one of the most important issues for public health. Frequent exacerbations induce a faster decline in lung function and poorer quality of life, increase mortality, and have a socio-economic impact with a high burden in terms of resources and healthcare costs. The clinical trials evaluated the effect of mucolytics in COPD and showed that the long-term carbocysteine, associated with bronchodilators, anticholinergics, and steroids, reduces the frequency of exacerbations and improves the quality of life. PATIENTS AND METHODS: The aim of this prospective real-life study was to evaluate the long-term impact on exacerbations (at 1 year) in COPD patients treated with carbocysteine lysine salt (single dose of 2.7 g once a day) in addition to background therapy with or without inhaled steroids. RESULTS: In a total of 155 evaluable patients, our study showed that the addition of a single dose of carbocysteine lysine salt to background therapy determines a statistically significant reduction of the average number of exacerbations vs. the number observed in the previous year (from 1.97±0.10 to 1.03±0.11; p<0.01), irrespective of treatment with or without inhaled steroids. In particular, in patients with ≥2 exacerbations in the previous year, the addition of carbocysteine lysine salt resulted in a statistically significant reduction in the exacerbations rate from 69% to 33% and from 58% to 25%, respectively (p<0.01) in patients with or without inhaled steroids. CONCLUSIONS: In summary, our data highlighted the efficacy of long-term administration of a single daily dose of carbocysteine lysine salt (2.7 g/day) in reducing the number and rate of exacerbations in COPD patients, independently from the use of inhaled steroids.

Chinese IUD removal techniques in a Chinese population in central Italy.

OBJECTIVE: To describe routine techniques and a newly developed approach to the removal of Chinese intrauterine devices (IUs). METHODS: Office records regarding women of Chinese nationality who presented to a tertiary care hospital for IUD removal between January 2007 and March 2012 were retrieved. Their demographic data were reviewed and menstrual/obstetric history, IUD type, and reasons given for removal were recorded. All underwent pelvic transvaginal ultrasound scanning. RESULTS: Of 134 Chinese IUDs, 18 (13.4%) were removed successfully in an office setting using a hook or uterine curette without general anesthesia or cervical dilation. Extraction under brief general anesthesia was performed in 55 (41.0%) cases. A further 61 (45.5%) Chinese IUDs were successfully removed in an office setting using a miniature resectoscope. Four types of Chinese IUDs were removed, the most common being the stainless steel ring (55.7%). CONCLUSIONS: All removal procedures were effective and safe. The mini-resectoscope appears to be a safe and effective tool enabling minimally invasive surgery.

Leiomyosarcoma: a rare malignant transformation of a uterine leiomyoma.

The malignant transformation of a uterine leiomyoma is still debated and, if it occurs, it is very rare. The case of a patient affected by one small leiomyoma is described. Diagnosis was made postoperatively on histopathological examination. The case reported here is meant to underline the need to keep all uterine myomas in check since the transition into leiomyosarcomas (LMSs) may occur with an evolution over a time period which has not been established so far. Specific receptors for luteinizing hormone/human chorionic gonadotropin (LH/hCG) have also been identified in the myometrium of several animal species, including humans. Conventional LMSs express estrogen receptors (ER), progesterone receptors (PR), and androgen receptors (AR) in 30-40% of cases. In comparison with other more common uterine malignancies, uterine LMSs bear some resemblance to type 2 endometrial carcinomas and high-grade serous carcinomas of ovary/fallopian tube origin, based on their genetic instability, frequent p53 abnormalities, aggressive behavior, and resistance to chemotherapy. It could be useful to understand with further researches if hormonal stimulation could be a contributing factor of uterine leiomyoma transformation into LMS. Until today the oncogenic mechanisms underlying the development of uterine LMSs remain elusive.

Spontaneous rupture of splenic hemangioma in puerperium.

Atraumatic splenic rupture is a rare clinical entity and in the absence of trauma, the diagnosis and treatment are often delayed. In this article the authors discuss a case of a 45-year-old woman, gravida 5, para 4, with spontaneous splenic rupture on her second postpartum day. The rupture was related to a splenic hemangioma that is a vascular malformation and the most common neoplasm of the spleen. Despite the fact that hemangiomas are the most common primary neoplasms of the spleen, only few cases of splenic rupture have been described in pregnancy or puerperium. However, spontaneous splenic rupture is a rare event and the rupture should be suspected in woman with unexplained abdominal pain or with clear signs of haemorrhage.

A decrease in sex ratio at birth nine months after the earthquake in L'Aquila.

INTRODUCTION: Multiple factors influence the secondary sex ratio (SSR) including stress, which appears to affect mainly the males born. OBJECTIVE: We evaluate the effects of the earthquake in L'Aquila on the SSR. MATERIALS AND METHODS: The SSR for the first six months of 2010 was compared to that of the same period of 2008. The chi-square test and Fisher's test were used for the statistical analysis. RESULTS: Nine months after the earthquake, an important reduction in the SSR was recorded: January 2010 versus January 2008 =0.62 versus 0.96. An overall fall in the SSR was also recorded when the first 3 months of 2010 were compared to the first three months of 2008: 0,82 versus 1,11. When the first three months of 2010 were compared with the second three months of 2010, a statistically significant increase of the sex ratio at birth was noted (0,82 versus 1,27).

[Asbestos risk: risk assessment and prevention]. / Rischio amianto: valutazione del rischio e prevenzione.

Asbestos is a very relevant medical and social issue, because of its potential dangerous effects on human health. It's present indeed in different environments, because it was widely used in the past. Asbestos is classified as first-class carcinogen, and so labelled with R 45 risk phrase. Exposure to asbestos fibers (both occupational and not) can cause diseases involving mainly the respiratory system. We point out the methods for a correct assessment of the risk from asbestos, with particular reference to current legislation and to the main preventive measures that have to be taken in case of presence of asbestos in a building. A correct prevention has to be carried out through education and information of workers and the use of specific check-lists.

The optical trocar in gynecological surgery: clinical and technical outcomes.

Optical trocars have been introduced as an alternative technique for obtaining access to the peritoneal cavity. The advantage is that each layer of the abdominal wall can be identified avoiding inadvertent injuries due to a lack of vision. From March 2010 to March 2011, 138 women underwent laparoscopy for benign diseases. They were submitted to gynecological laparoscopy for direct optical access. There was no evidence of vascular injuries. This study confirms that the optical trocar is a safe, rapid, and effective method, that offers a real perception of the safety of the entrance into the abdomen.

Leiomyosarcoma after hysteroscopic myomectomy: a case report.

OBJECTIVES: The aim of this study was to illustrate the importance of hysteroscopy in the evolution of mitotically active leiomyoma to leiomyosarcoma (LMS). Uterine sarcomas are rare tumors. The three microscopic criteria are: 1) the presence of coagulative tumor necrosis, 2) high mitotic index (exceeding 15 x 10 catabolite gene activator (CGA) and 3) occurrence of moderate to severe cytologic atypia. The authors report a case of a 52-year-old nulliparous woman with a LMS detected two months after a hysteroscopic resection of a mitotically active leiomyoma. After the first hysteroscopic resection the diagnosis was atypical leiomyoma with a mitotic index of two per ten high-power field (hpf) in the absence of coagulation necrosis. After two months, a new myoma was detected and another hysteroscopic resection was performed: the microscopic diagnosis was LMS and a total abdominal hysterectomy with bilateral salpingo-oophorectomy (BSO) was performed. CONCLUSION: The patient must undergo close clinical and instrumental follow-up procedures. Hysteroscopy plays an important role in the evaluation and evolution of both recurrent and de novo disease.

Subtle ultrasonographic appearance of Down's syndrome: a case report of prenatal diagnosis of isolated simple fetal syndactyly.

Syndactyly is an unusual condition in humans where two or more digits are fused together. In our report we present a case of prenatal diagnosis of simple, complete, bilateral syndactyly as the only ultrasonographic anomaly in a fetus with Down's syndrome. The mother, a 30-year-old, gravida 2, was referred to our hospital with an abnormal triple-test at 17 weeks of gestation, with a final biochemical risk for Down's syndrome more than 1:50. In this pregnancy neither the NT test nor early morphological exam showed typical findings of any chromosomal disorder. The patient underwent amniocentesis. We performed an accurate second level scan at 21 weeks while waiting for genetic results, and we suspected simple, complete, bilateral syndactyly between the third and fourth finger of the hands (rapper sign). The result of the invasive test was 47,XY,+21 and the mother opted for termination of pregnancy; the baby showed simple, complete, bilateral syndactyly of the two digits as suspected during sonography. In presenting our case report, we want to stress the importance of the accuracy of observation of fetal hand morphology, attitude, movements and reactivity. When the observation of fetal hands is not satisfactory (e.g., when the fetus does not open the fist), we recommend external stimulation of fetal reactivity through probe movements on the maternal abdomen (dynamic scan). This approach can make the identification of subtle hand anomalies easier and improve the detection rate of both structural and genetic fetal disorders.

Endometrial tuberculosis: a clinical case.

Genital tuberculosis is a bacterial infection still frequent in less developed countries where lots of cases are not diagnosed nor treated. In this work we describe a rare case of primary endometrial tuberculosis in a woman of 50 years old. The diagnosis was confirmed by an ultrasonography of the pelvis and an endometrial biopsy followed by a histological examination. The patient after the diagnosis was put under antiturbecular treatment for six months with complete healing.

[Urban stressors and thyroid hormones]. / Stressor urbani e ormoni tiroidei.

OBJECTIVES: The aim of the study is to evaluate whether occupational exposure to urban stressors could cause alterations in thyroid hormones plasma levels (TSH, FT3 and FT4) in female outdoor workers vs. administrative. MATERIALS AND METHODS: The study has been performed on an initial sample of 198 female subjects divided in two groups (occupationally exposed and not exposed to urban stressors). After excluding the subjects with the main confounding factors, female outdoor workers and administrative staff were matched by age, working life and drinking habit. RESULTS: In 40 female outdoor workers mean plasma TSH levels were significantly higher compared to 40 administrative staff. The distribution of TSH values in outdoor workers and in administrative staff was significant. Plasma FT3 and FT4 levels were not significantly different in the two groups. Our results suggest that exposure to urban stressors (chemical, physical and psycho-social), can alter the plasma concentration of TSH. CONCLUSIONS: According to our previous research, plasma TSH levels may be used as an early biological marker of chronic exposure to urban stressors, in occupational set even before the onset of the related disorders.

[Cardiovascular parameters in workers exposed to urban pollutions]. / Parametri cardiovascolari in lavoratori esposti ad inquinamento urbano.

The aim of the study is to evaluate if "outdoor" workers exposed to chemical, physical and psycho-social urban stressors could have alterations of systolic and diastolic blood pressure at rest and heart disease investigated by electrocardiogram compared with a group of "indoor" workers not exposed. Among non-smoking, the mean values of systolic blood pressure at rest were significantly higher in exposed compared to non exposed (p = 0.002) and frequency of electrocardiographic abnormalities was significantly higher in exposed (20.8%) than not exposed (10.4%, p = 0.02). Among exposed, the values of systolic blood pressure at rest were significantly higher in smokers than non-smokers (p = 0.002). Among non-exposed, the frequency of electrocardiographic abnormalities was significantly higher in smokers than non-smokers (p = 0.002). The study results suggest that chronic exposure to chemical, physical and psycho-social stressors can be a cardiovascular risk factor in addition to cigarette smoking in a manner determined by the categories of outdoor workers.

Pulmonary nodules in workers exposed to urban stressor.

By multilayer spiral low-dose computed tomography (LD-CT) of the chest this study assesses the early detection of lung lesions on a sample of 100 traffic policemen of a big Italian city professionally exposed to urban pollutants and 100 controls non-occupationally exposed to urban pollutants matched by sex, age, length of service and cigarette smoking habit. Exposure to urban pollutants in traffic policemen was characterized using the annual average concentrations of PM(10), NO2 and benzene in the period 1998-2008 measured by fixed monitoring stations located in different areas of the city. A significant and increasing number of suspicious lung nodules with diameters between 5 and 10 mm was observed: in traffic policemen (including smokers and non-smokers) vs. controls (including smokers and non-smokers); in total smokers (including traffic policemen and controls) vs. total non-smokers (traffic policemen and controls); in smoker traffic policemen vs. smoker controls and vs. non-smoker traffic policemen; in non-smoker traffic policemen vs. non-smoker controls. The RR of finding cases with at least one lung nodule with diameters between 5 and 10mm in traffic policemen (including smokers and non-smokers) compared to controls (including smokers and non-smokers) is 1.94 (CI 1.13-3.31); in total smokers vs. non-smokers the RR is 1.96 (CI 1.20-3.19). The comparison between the interaction exposure and smoking shows an increase in smoker traffic policemen than in smoker controls (RR=2.14; CI 1.02-4.52). The RR for smoker traffic policemen was higher than in non-smoker traffic policemen (RR=2.09; CI 1.19-3.66). The results of our study show that: (1) while smoker workers have a higher risk for developing solid suspicious lung nodules, the simple routinely exposure to urban pollutants is unable to produce the same kind of increased risk; (2) the interaction of smoking and exposure to urban pollutants greatly increases the risk for the development of solid suspicious lung nodules. In conclusion, the use of chest LD-CT in workers at risk helps identify suspicious solid lung nodules at early stage.

[Meta-analysis: effectiveness of the preventive interventions in agriculture accidents]. / Meta-analisi: efficacia degli interventi preventivi negli infortuni in agricoltura.

The aim of our study is to determine the effectiveness in reducing workplace accidents in agriculture using preventive interventions including awareness and effective knowledge of hazards with workers who followed training-informative programs. On the basis of the data reported in the 11 studies three categories we identified: Reduction in the number of workplace accidents: comparison between groups; Reduction in the number of workplace accidents: before-after comparison; Self-rating of injuries risk reduction. The second category showed significant statistical differences in the subgroup who followed preventive intervention compared to subgroup who did not follow this intervention. The third category showed a significant statistical increase of the Consciousness Index of the agricultural workers who followed the training-informative programs. The results suggested the need to use assessment models more suitable to the nature of the examined variables. A promising area is the evaluation of knowledge of risks achieved by workers exposed to formative-informative programs.

[Phlebopathies and workers]. / Flebopatie e lavoratori.

The few studies in literature about the relationship between venous diseases and work show that the posture assumed while working could promote the occurrence of venous disease in lower limbs. We compared male workers belonging to different occupational categories, matched for age, BMI and traditional risk factors for venous diseases, in order to assess the prevalence of venous disease and occupational and not-occupational postural risk factors. We found that maintaining a standing position for more than 50% of the shift appears the most important occupational risk factor in provoking the observed higher prevalence of venous disease in the workers studied. It can be assumed the venous diseases are often determined by occupational factors which could be main or concomitant causes. The identification of preventive measures to apply in workplaces, such as better organization of work, targeted examinations and therapeutic indications as the prescription of elastic stockings, is very important.

Follicle-stimulating hormone levels in male workers exposed to urban chemical, physical, and psychosocial stressors.

The aim of this study is to evaluate whether occupational exposure to urban stressors could cause alterations in the follicle-stimulating hormone (FSH) levels in traffic policemen compared to a control group. After excluding the subjects with main confounding factors, traffic policemen and male controls were matched by age, working life, body mass index (BMI), drinking habit, cigarette smoking history, and daily consumption of Italian coffee, 166 traffic policemen and 166 controls were included into the study. FSH levels were significantly higher in traffic policemen compared to male controls (P < 0.05). The distribution of FSH values in traffic policemen and controls was significant (P < 0.05). Our results suggest that occupational exposure to low doses of chemical and psychosocial stressors may alter plasma levels of FSH in traffic policemen more than in the control group. If the results obtained are confirmed by further research, the plasma levels of FSH may be used as early biological markers, valuable for the group, used in occupational set even before the appearance of disorders of male fertility.

[Night workers and plasmatic cortisol]. / Lavoratori notturni e cortisolo plasmatico.

The aim of the study is to evaluate whether occupational exposure to night work could cause alterations in the levels of plasmatic cortisol. The interest toward this argument arises form several studies in scientific literature referring the presence of an alteration in the synthesis and release of cortisol in workers exposed to night work. We studied a population of workers employed in night security service and monitoring service of alarm systems in different museums compared to a control group not performing shift-work and/or night work. The exposed and control subjects were compared by age, length of service, smoking habit (n. cigarettes per day), habitual consumption of alcoholic drinks (n. glass of wine/beer per day). We evaluated the levels of plasmatic cortisol on 50 workers exposed to night work, all males of whom 30 smokers and 20 non-smokers and on 50 controls of whom 30 smokers and 20 non-smokers.

Management of ovarian cysts in pregnancy: a case report.

According to recent epidemiological studies on ovarian cysts during pregnancy one out of 600 are, in most cases, benign neoformations. The most frequent histological type reported is mature cystic teratoma (50% of the cases), followed by functional cysts (13%), benign cystadenomas (20%) and ovarian cancer (0.6%). Most adnexal masses are asymptomatic and spontaneously resolve before the 16th week of amenorrhoea. On the other hand, some cases are persistent forms which can cause complications for the mother and fetus. The objective of this work was to review the existing literature from an epidemiological point of view, with an emphasis on diagnostic and therapeutic management. We have paid particular attention in our review to the use of diagnostic techniques and non surgical therapies such as laparoscopy, which in expert hands and adopting particular skills, can be considered as on approach to ovarian cysts in pregnancy. We present the case of a patient with an ovarian cyst during pregnancy that was a successfully treated with laparoscopy.