Efficacy of non-invasive mechanical ventilation in the general ward in patients with chronic obstructive pulmonary disease admitted for hypercapnic acute respiratory failure and pH < 7.35: a feasibility pilot study.

AIM: To date non-invasive (NIV) mechanical ventilation use is not recommended in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) and pH < 7.30 outside a 'protected environment'. We assessed NIV efficacy and feasibility in improving arterial blood gases (ABG) and in-hospital outcome in patients with ARF and severe respiratory acidosis (RA) admitted to an experienced rural medical ward. METHODS: This paper is a prospective pilot cohort study conducted in the General Medicine Ward of Budrio's District Hospital. Two hundred and seventy-two patients with ARF were admitted to our Department, 112, meeting predefined inclusion criteria (pH < 7.35, PaCO2 > 45 mmHg). Patients were divided according to the severity of acidosis into: group A (pH < 7.26), group B (7.26 ≤ pH < 7.30) and group C (7.30 ≤ pH < 7.35). ABG were assessed at admission, at 2-6 h, 24 h, 48 h and at discharge. RESULTS: Group A included 55 patients (24 men, mean age: 80.8 ± 8.3 years), group B 31 (12 men, mean age: 80.3 ± 9.4 years) and group C 26 (15 men, mean age: 78.6 ± 9.9 years). ABG improved within the first hours in 92/112 (82%) patients, who were all successfully discharged. Eighteen percent (20/112) of the patients died during the hospital stay, no significant difference emerged in mortality rate (MR) within the groups (23%, 16% and 8%, for groups A, B and C, respectively) and between patients with or without pneumonia: 8/29 (27%) versus 12/83 (14%). On multivariable analysis, only age and Glasgow Coma Scale had an impact on the clinical outcome. CONCLUSION: In a non-'highly protected' environment such as an experienced medical ward of a rural hospital, NIV is effective not only in patients with mild, but also with severe forms of RA. MR did not vary according to the level of initial pH.

Insulin-like growth factor I: could it be a marker of prematurity in the foal?

Insulin-like growth factor (IGF)-I represents one of the most important growth regulators, playing a central role in fetal and neonatal growth. Plasma IGF-I levels increase rapidly after birth, and they are influenced by numerous factors, including sex, age, nutritional state, and premature birth. The aims of this study were: (1) to evaluate the IGF-I plasma profile in healthy newborn foals during the first 2 weeks of life; (2) to assess the possible influence of sex and birth weight on this hormone; (3) to analyze the percentage increment of IGF-I values in healthy foals; (4) to evaluate the influence of prematurity on IGF-I profile; (5) to verify the role of IGF-I as a diagnostic marker of prematurity; and (6) to analyze the percentage increment of IGF-I in premature foals. Thirty-four healthy term foals were enrolled as the control group and from each foal plasma was collected within 6 hours from birth, at 12 hours, daily from Day 1 to Day 7, and at Days 10 and 14 after birth. Eleven foals aged younger than 1 week and diagnosed as premature and hospitalized at a Equine Perinatology Unit were also enrolled; from each foal plasma was collected daily from the day of admission to discharge or death. Insulin-like growth factor I was analyzed by RIA. In the control group, an increasing trend of IGF-I concentrations was found, with higher values from Day 4 to 10 compared with data obtained at less than 6 hours of life, and from Day 5 to 10 compared with 12 and 24 hours and 3 days. No differences were found in healthy foals analyzed in relation to birth weight and sex. In premature foals an increasing trend was observed but no statistical differences were found among sampling times, and no differences were found between healthy and premature foals. The IGF value in premature foals at admission was always higher compared with the lowest recorded level in healthy age-matched foals, thus this parameter does not seem to have a diagnostic role for prematurity in foals. Finally, the evaluation of the percentage increment of IGF-I concentrations showed a significant increase in full-term foals on Day 5, 6, 7, and 10 compared with 12 and 24 hours, and no differences were observed in premature foals. In conclusion, prematurity in newborn foals seems to affect only partially IGF-I plasma concentrations and it does not seem to be a reliable marker for this pathological condition.

Acute effects of Microcystis aeruginosa from the Patos Lagoon estuary, southern Brazil, on the microcrustacean kalliapseudes schubartii (Crustacea: Tanaidacea).

Toxic blooms of the cyanobacterium Microcystis aeruginosa, a microcystin producer, have been observed in the past two decades in the Patos Lagoon estuary (southern Brazil). This cyanobacterium reaches the estuary from northern waters and accumulates as toxic blooms in the shallow margins of the environment. Microcystins are phosphatase (PP1 and PP2A) inhibitors and cause animal death via alteration of the liver cell cytoskeletons and intrahepatic hemorrhage. The massive accumulation of toxic material affects the survival of several benthonic estuarine local organisms. The tanaidacea Kalliapseudes schubartii is a benthonic estuarine species which occurs at high densities throughout the year in mixohaline areas of the Patos Lagoon. This microcrustacean is of high ecological relevance and plays an important role in the estuarine food web, as it is consumed on a large scale by estuarine fish. This work verifies the acute toxicity of aqueous extracts of M. aeruginosa RST9501 and of sediments spiked with lyophilized material of the same strain on K. schubartii; it also evaluates the sublethal effects on tanaidacean oxygen consumption rates and glycogen levels under acute exposure to M. aeruginosa aqueous extracts. The strain M. aeruginosa RST9501 was cultured in BGN/2 medium. The aqueous extracts were prepared using the lyophilized material from the strain cultures. Acute tests were performed over 96 h at a salinity of 15, at six toxic concentrations, and resulted in an average 96-h LC50 of 1.44 mg ml(-1). The spiked sediment tests were performed with a 10-day duration, using the lyophilized material in three proportions of powder/sediment and showed an average LC50 of 1.79 mg ml(-1). Oxygen consumption was determined after 24 and 48 h of incubation in adult organisms exposed to sublethal aqueous extract concentrations and showed a significant increase at the highest concentrations. This suggests alterations in the organism's metabolism by exposure to the cyanobacterium extract. The glycogen levels were determined with a commercial kit (Glicox 500; DOLES Ltd.); after 24 and 48 h the dosages were administered in the same organisms utilized in the oxygen consumption test and did not demonstrate significant differences. The results demonstrate the possible risks of intoxication to which the natural populations of K. schubartii were exposed in the environment and emphasize the importance of studies involving sublethal concentrations of M. aeruginosa to other organisms of the trophic web in this aquatic system.

Significance of selective carotid angiography during complete cardiac catheterization in patients candidates to combined aortic valve and carotid surgery.

AIM: Association of aortic valve stenosis (AVS) with carotid artery disease (CD) constitutes a high risk clinical setting for combined surgery. Carotid angiography is still considered the gold standard for carotid artery imaging, but its use is confined in cases of dubious or inconclusive sonographic examination. Despite the widespread use of ultrasonography, selective angiography may be practical in patients undergoing complete routine cardiac catheterization for AVS due to characteristic abnormalities in flow velocity pattern due to aortic valve stenosis. The present retrospective study aims to estimate the feasibility and role of carotid angiography during complete routine cardiac catheterization in the assessment of CD associated with AVS in patients candidates for combined surgery, in whom Doppler ultrasonography was inconclusive. METHODS: In agreement with cardiac and vascular surgeons, patients aged >60 years, presence of risk factors, and inconclusive Doppler ultrasonographic examination underwent selective carotid artery angiography during complete cardiac catheterization. The angiographic and clinical records of these patients were reviewed. RESULTS: Sixty patients (male/female 28/32, mean age 64.5+/-10.6 years) underwent carotid angiography during left and right catheterization. Optimal visualization of carotid trunk anatomy and morphology was achieved in all patients. Forty-one patients (68.3%) had no carotid artery atherosclerotic involvement, whereas 4 (6.6%) had low grade CD. Fifteen patients (8.3%, male/female: 7/8, mean age 70+/-10.4 years) were diagnosed with critical stenosis of one (14 patients) or both (1 patients) internal carotid arteries. The mean lesion degree was 77.1+/-2.1%. Culprit plaques, bifurcation lesion and occlusion have been discovered in 6.6%, 20%, and 26.6% of patients, respectively. Two arterial spasms (3.3%), and no intrahospital complications were observed. CONCLUSION: In highly selected patients with combined CD and AVS and inconclusive Doppler ultrasonographic examination, selective carotid angiography during heart catheterization is safe, acceptably time-consuming and it may give an optimal anatomical picture of CD.

Effects of ciprofloxacin and protamine sulfate combinations against catheter-associated Pseudomonas aeruginosa biofilms.

Infection is a common complication associated with the use of transcutaneous and implanted medical devices. These infections are generally difficult to treat and frequently require removal of the biomaterial before the infection can be completely eradicated. The presence of a bacterial biofilm recalcitrant to treatment often mediates these infections. We studied the influence of a polycationic protein, protamine sulfate, on the efficacy of the fluoroquinolone ciprofloxacin against a clinical isolate of Pseudomonas aeruginosa. A P. aeruginosa biofilm was developed on 1-cm sections of red rubber catheter material and then treated with various combinations of protamine sulfate and ciprofloxacin. The present work demonstrated that ciprofloxacin in combination with protamine was more effective against biofilms than was ciprofloxacin alone. Protamine sulfate at 50 micrograms/ml combined with antibiotic at 0.5 microgram/ml reduced the number of viable cells by an average of 98.97%, while protamine sulfate at 50 micrograms/ml alone resulted in an average 107.8% increase and antibiotic alone resulted in an average 58.6% reduction after 24 h. Furthermore, protamine sulfate, in combination with ciprofloxacin, inhibited P. aeruginosa in a dose-dependent fashion. It was further observed that treatment with the combination of protamine sulfate and ciprofloxacin had a more drastic effect on planktonic organisms as compared with the P. aeruginosa biofilms; the MBC was reduced to < 0.05 microgram/ml in the presence of 25 micrograms of protamine sulfate per ml. These findings were substantiated by ultrastructure studies of treated cells using scanning and transmission electron microscopy. The synergism between ciprofloxacin and protamine sulfate significantly enhanced the efficacy of ciprofloxacin against planktonic and biofilm P. aeruginosa.

Production of mouse monoclonal antibodies using a continuous cell culture fermenter and protein G affinity chromatography.

The production of anti-alpha-fetoprotein monoclonal antibodies for diagnostic use was carried out in a stirred tank fermenter equipped with a double membrane stirrer for bubble free aeration and continuous medium perfusion. A serum-free medium supplemented with 4 mM L-glutamine and 2.0 milligrams glucose with a protein content of only 780 micrograms/ml was used for the production process. The harvested antibodies were concentrated 50-fold using a tangential ultrafiltration system and were then purified in a one step purification process by protein G affinity chromatography. The purity of the final product (90%) was controlled by SDS-polyacrylamide gel electrophoresis, gel exclusion chromatography and isoelectric focussing. For further quality controls of the product the immunoglobulin subclass and the isoelectric point were determined and the specificity of the purified mAb was tested by RIA using 125I labelled alpha-fetoprotein. 1.87 g of purified monoclonal antibodies were produced (90% purity) within 2 weeks. It was found that the use of this type of stirred tank fermenter combined with a one step purification process using protein G affinity chromatography represents a suitable method for the fast production of medium scale quantities (500 mg-5 g) of monoclonal antibodies for diagnostic use.

Malignant eccrine spiradenoma of the hand.

A malignant eccrine spiradenoma (MES) of the hand is described in a patient who developed bilateral pulmonary metastasis more than 10 years later. A review of the literature including observations on clinical behavior and recommendations for treatment of this rare adnexal tumor is presented.

Eel calcitonin binding site distribution and antinociceptive activity in rats.

The distribution of binding site for [125I]-eel-calcitonin (ECT) to rat central nervous system, studied by an autoradiographic technique, showed concentrations of binding in the diencephalon, the brain stem and the spinal cord. Large accumulations of grains were seen in the hypothalamus, the amygdala, in the fasciculus medialis prosencephali, in the fasciculus longitudinalis medialis, in the ventrolateral part of the periventricular gray matter, in the lemniscus medialis and in the raphe nuclei. The density of grains in the reticular formation and in the nucleus tractus spinalis nervi trigemini was more moderate. In the spinal cord, grains were scattered throughout the dorsal horns. Binding of the ligand was displaced equally by cold ECT and by salmon CT(sCT), indicating that both peptides bind to the same receptors. Human CT was much weaker than sCT in displacing [125I]-ECT binding. The administration of ECT into the brain ventricles of rats dose-dependently induced a significant and long-lasting enhancement of hot-plate latencies comparable with that obtained with sCT. The antinociceptive activity induced by ECT is compatible with the topographical distribution of binding sites for the peptide and is a further indication that fish CTs are active in the mammalian brain.

[Interference of extraneous solutes in the iontophoresis of salicylic acid across the skin]. / Interferenza di soluti estranei nella iontoforesi dell'acido salicilico attraverso la pelle.

It has been analyzed the possibility to modify the cutaneous ionthophoresis of drugs by means of an original apparatus through which experiments are performed on isolated rat skin. The test drug employed as the salicylic acid (SA). The presence of parasite ions decreases the passage of SA through the skin with an effect which is proportional to the salt concentration. The sodium salicylate is transferred less than SA. It has been analyzed the effect of drugs increasing the skin permeability like dimethylsulfoxide (DMSO) and dimethylformamide (DMF). DMSO in combination with SA facilitates the SA cutaneous ionthophoresis, while DMF does not.

[Use of radioisotopes in the evaluation of coronary disease]. / Uso dei radioisotopi nella valutazione della cardiopatia coronarica.

A study on myocardial perfusion through scintigraphy with 201-Tl has been carried on in a group of 57 persons: among them 45 had myocardial infarction and 12 had myocardial ischemia in act. In consideration of this experience, the myocardial scintigraphy with 201-Tl seems to be a valid investigation method to support the electro-vectocardiography when evaluating, bloodlessly, ischemical cardiopathies. In general, the correlation between electro-vectorcardiographic and scintigraphic data has been satisfactory. Referring to stroken parts, we can say that also those cardiac sectors usually very difficult to be explored with other radio elements such as 131-CS and 42-K, have been adequately studied with 201-Tl. To sum up, we can say that scintigraphic investigation of myocardium with 201-Tl is certainly a valid blood-less method to diagnose ischemical cardiopathy with the advantage to be also a useful diagnostical element for the evaluation of the microcirculation.

[The significance of the radioimmunological of serum myoglobin in myocardial infarction]. / Significato della valutazione radioimmunologica della mioglobinemia in corso di infarto miocardico.

The Authors carried on a study in a group of 31 patients with acute myocardial infarction (AMI). The controled particularly the following dates: myoglobinemia (MG) with RIA and myocardial necrosis enzymes with traditional methods. Blood has been drawn from patients every 90 min, during the first 8 h of admission and every 4 h during the following 4 days. Important variations of MG have been detected in 80.6% of cases. These is an early increase in MG (within 4 h in 25.8% and within 8 h in 45.1% of cases) and normal values are reached in a time not longer the 72 h. The maximum value is reached in a shorter time than that creatine phosphokinase (CPK). We can therefore confirm that MG is a useful data in the early diagnosis of myocardial infarction in preenzymatic stage.

The sources of external work in level walking and running.

The work done at each step during level walking and running to lift the centre of mass of the body, Wv, and to increase its forward speed, Wf, and the total mechanical energy involved (potential + kinetic) Wext, have been measured at various 'constant' speeds (2-32 km/hr) with the technique described by Cavagna (1975). 2. At intermediate speeds of walking (about 4 km/hr) Wv = Wf and Wext/km is at a minimum, as is the energy cost. At lower speeds Wv greater than Wf whereas at higher speeds Wf greather than Wv: in both cases Wext/km increases. 3. The recovery of mechanical energy, through the pendular motion characteristic of walking, was measured as (/Wv/ + /Wf/ - Wext)/(/Wv/ + /Wf/): it attains a maximum (about 65%) at intermediate speeds. 4. A simple model, assuming that in walking the body rotates as an inverted pendulum over the foot in contact with the ground, fits the experimental data better at intermediate speeds but is no longer tenable above 7 km/hr. 5. In running the recovery defined above is minimal (0-4% independent of speed), i.e. Wext congruent to /Wv/ + /Wf/: potential and kinetic energy of the body do not interchange but are simultaneously taken up and released by the muscles with a rate increasing markedly with the speed (from about 1 to 4 h.p.). 6. Wext increases linearly with the running speed Vf from a positive y intercept owing to the fact that Wv is practically constant independent of Vf. On the contrary, Wf = aVf2/(1 + bVf), where b is the ratio between the time spent in the air and the forward distance covered while on the ground during each step.