Primary urethral reconstruction results in penile fracture.

Objective This study assessed primary urethral reconstruction results in patients with a penile fracture. Materials and methods Between January 2005 and April 2016, patients who underwent primary urethral reconstruction due to penile fracture were called for a follow-up. Epidemiological and clinical presentation data and operative findings were reviewed retrospectively. Partial urethral lesions were primarily treated with interrupted absorbable sutures over urethral catheter. In cases of complete urethral lesion, tension-free end-to-end anastomosis was performed. From the third month after surgery, all patients were interviewed using the International Prostate Symptom Score questionnaire and uroflowmetry. Retrograde urethrocystography was used in patients with urinary symptoms or altered uroflowmetry to rule out or confirm urethral stenosis. Results Of 175 patients with penile fractures, 27 (15.4%) had associated urethral injury. All patients were diagnosed with penile fracture by means of clinical history and physical examination. No subsequent examinations were conducted. Ages varied from 30 years to 58 years old (mean 39.2 years). All fractures resulted from sexual activity. Reported sexual positions were 'doggy style' position in eight cases (61.5%) and with the 'man on top' in five cases (38.4%). Ten patients (76.9%) experienced haematuria, ten (76.9%) had urethral bleeding and four (30.7%) suffered urinary retention. Unilateral and bilateral injury of the corpus cavernosum was observed in four (30.7%) and nine (69.2%) patients, respectively; partial injury was found in nine cases (69.3%) and complete urethral injury was noticed in four cases (30.7%). All cases of complete urethral injury were associated with bilateral lesion of the corpus cavernosum. Six patients who had uroflowmetry with maximum urinary flow rate below 15 ml/s and/or had IPSS above 7 underwent retrograde urethrocystogram, and this was normal in all cases, excluding the possibility of urethral stenosis. Two patients (15.3%) experienced surgical postoperative complications represented by an urethrocutaneous fistula and a subcutaneous abscess adjacent to the end-to-end anastomosis area. Conclusions Penile fracture is a rare urological emergency, especially when it is associated with a urethral lesion. This must be suspected when the clinical picture is suggestive or in cases of high-energy trauma, especially in bilateral lesions of the corpus cavernosum. Complementary imaging methods are not needed in these cases and immediate exploration should not be delayed. Primary urethroplasty produces satisfactory results with low complication levels. Nonetheless, prospective studies with larger samples should be conducted.

Intima-media thickness in an Italian psoriatic population: correlation with lipidic serum levels, PASI and BMI.

BACKGROUND: Recent findings have shown that psoriasis is frequently associated with atherosclerosis. Intima-media thickness (IMT) is a surrogate marker of atherosclerosis damage. Psoriasis patients had impaired endothelial function and thicker IMT of the carotid artery, compared with the healthy control subjects. OBJECTIVES: The aim of our study is to evaluate the prevalence of subclinical atherosclerosis in patients affected by cutaneous psoriasis without arthritis, considering the IMT as a subclinical feature of atherosclerosis. METHODS: Intima-media thickness of the common carotid artery was measured using High-resolution B-mode ultrasound in 40 psoriasis patients and 40 control patients matched for age and gender. We also measured triglycerides, PASI, total cholesterol, LDL cholesterol and BMI. Pearson's partial correlation test was used to determine the correlation between each variable. RESULTS: Intima-media thickness in subjects with psoriasis was statistically higher than those in the control subjects (1.465 mm, P value < 0.001). A positive strong correlation between IMT and age (r = 0.464 P < 0.01), total cholesterol (r = 0.466 P < 0.01), LDL cholesterol (r = 0.518 P < 0.01), triglycerides (r = 0.285 P = 0.01) and PASI (r = 0.515 P < 0.01) was observed. There was no statistically significant correlation between IMT and BMI (r = 0.132 P = 0.244). CONCLUSIONS: Our study showed a significant increase in IMT in cutaneous psoriatic patients with moderate to severe psoriasis compared with a control group. IMT seems to be uncorrelated with BMI value. It can be assumed that the assessment of IMT, through a reliable and non-invasive technique such as ultrasound, appears particularly useful in the clinical evaluation of patients with psoriasis who may benefit from early intervention.

Interdigital psoriasis of the feet (psoriasis alba): not a distinct form of psoriasis.

BACKGROUND: Interdigital psoriasis (IP) of the feet is often missed and is commonly mistaken for interdigital fungal infection. OBJECTIVE: To assess the characteristics and the clinical presentation of IP, in order to better understand if IP should be considered a distinct form of psoriasis or not. METHODS: We performed a 1-year observational study on 164 psoriatic patients, affected by moderate to severe cutaneous psoriasis and undergoing systemic therapy, examining each patient between the digits of both feet. In every suspected case of IP, differential diagnosis with interdigital fungal infection was excluded by direct microscopic examination of skin scrapings, by culture and by skin biopsy. RESULTS: We suspected IP in 7 of the 164 patients. IP was confirmed in 6 patients and in the other one a diagnosis of tinea pedis was made. CONCLUSION: IP proved to be not rare or atypical since IP localized between the toes usually presents as characteristic whitish and sodden plaques or patches. Such a diagnosis should be considered in all patients presenting characteristic lesions especially if these have a negative fungal culture, are resistant to antimycotic treatment and involve patients with a history of psoriasis.

Optimization of systemic treatments for chronic plaque psoriasis. Recommendations for switching and transitioning.

AIM: The aim of this study was to provide practical recommendations for optimizing the use of conventional and biological systemic treatments for moderate-severe chronic plaque psoriasis, particularly in case of transitioning and switching. METHODS: A total number of 147 dermatologists from 33 different countries including Italy achieved consensus in providing practical recommendations for the use of conventional and biological treatments for moderate to severe psoriasis based on systematic literature review and/or expert opinion. RESULTS: In general, the continuous treatment regimen should be preferred in order to achieve a complete and long-term control of psoriasis. However, the treatment could be stopped or the dose reduced in case of complete disease clearance. A conventional drug could be associated to biological treatment in selected cases. Transitioning and/or switching could be considered in case of inefficacy or intolerance. A period of wash up is required if transitioning or switching is due to safety issues. CONCLUSION: This study provides practical suggestions for the optimal use of conventional and biological treatments for chronic plaque psoriasis.

Design of efficient methanol impermeable membranes for fuel cell applications.

In this paper, the design of efficient composite membranes based on sulfonated polysulfone and acidic silica material with characteristics and properties such as methanol barrier, high proton conductivity and suitable fuel cells performance is presented. A positive influence of nanosized acidic silica powders, used as an additive filler in the preparation of composite membranes, due to an efficient hydrophilic inter-distribution inside the membrane when compared to pure silica, is found. A series of different techniques such as XRF, FT-IR, TGA, DSC, IEC and conductivity measurements are used to highlight the properties of acidic silica material and composite membranes. The composite membrane based on acidic silica (SPSf-SiO(2)-S) shows the lowest crossover current (only 8 mA cm(-2)), which is 43% lower than that of a pure SPSf membrane and 33% lower compared to a composite membrane based on bare silica (SPSf-SiO(2)). These significant differences are attributed to the increasing diffusion path length of MeOH/H(2)O clusters in the composite membranes. The maximum DMFC performance at 30 °C is achieved with the SPSf-SiO(2)-S membrane (23 mW cm(-2)), whereas the MEAs based on SPSf-SiO(2) and pure SPSf membranes reached 21 and 16 mW cm(-2), respectively. These significant results of the composite SPSf-SiO(2)-S membrane are ascribed at a good compromise among high proton conductivity, low swelling and low methanol crossover compared to pure SPSf and (unmodified silica)-SPSf membranes. A preliminary short durability test of 100 h performed in a cell with the composite SPSf-SiO(2)-S membrane shows remarkable performance stability during chrono-voltammetric measurements (60 mA cm(-2)) at 30 °C.

Monitoring the dispersion process of SWNTs in aqueous solutions by UV-vis and Raman spectroscopies.

The current bottleneck to carbon nanotubes (CNT) application in composite materials field consists in the difficulty of dispersing them in solvents. As a result of strong van der Waals interactions, as produced CNTs are tightly bundled in ropes of several tubes, rendering the carbon-powder insoluble in aqueous and organic liquids and thus unprocessable. The interest in applications that require water-soluble CNTs is growing and much attention is being directed to the study of surfactant aqueous solutions. In a typical dispersion procedure, after the surfactant has been adsorbed on the nanotube surface by hydrophobic or pi-pi interactions, ultrasonication helps nanotubes debundling, providing a mechanical energy able to overcome van der Waals interactions in CNT bundles. The electrostatic repulsion between surfactant polar heads that remain in solution allows the colloidal stability. In this work the dispersibility of HiPCO Single Walled Carbon Nanotubes (SWNT) in different surfactant solutions has been evaluated by using UV-vis and Raman spectroscopies. UV absorbance as well as intensity of SWNTs characteristic Raman bands have been studied as a function of sonication time for each type of surfactant. Moreover the surface morphology of SWNTs films obtained by solutions drying has been observed by using Scanning Electron and Atomic Force Microscopies.

Chromatographic behavior of ion pair enantiomers of dansyl leucine cyclohexylammonium salt on a beta-cyclodextrin stationary phase and the effect of a competitive-binding mobile phase additive.

The separation of dansyl leucine enantiomers on a beta-cyclodextrin stationary phase is significantly complicated by the association of the amino acid with its cyclohexylammonium counter ion, in a mobile phase of 80:20 (v/v) methanol-water. This produces very unusual chromatography, with two partially superimposed peaks observed for each enantiomer at lower column temperatures. The peak shape is attributed to the irreversible, oncolumn conversion of the ion pair (I) to the free, protonated (neutral) dansyl amino acid (II+H). Increasing the ionic strength of the mobile phase greatly improves the chromatography by transforming the solute species to enantiomers of II (the anionic, free amino acid). Van't Hoff plots are constructed for both species I and II (under different mobile phase conditions) to provide thermodynamic insight into the major enantioselective driving forces of separation. The chiral discrimination of the stationary phase is found to be primarily enthalpically driven for both solutes. Finally, 1-adamantanecarboxylic acid (ACA) is investigated as a solute-competitive mobile phase additive to intentionally block the hydrophobic cyclodextrin cavities on the stationary phase. By varying the concentration of ACA additive in the mobile phase, control over the retention and chiral recognition of the stationary phase is demonstrated.

Development of a nanofiltration process to improve the stability of a novel anti-MRSA carbapenem drug candidate.

The benzenesulfonate salt of an anti-methicillin-resistant Staphylococcus aureus carbapenem antibiotic studied is a crystalline, nonhygroscopic powder which is stable at room temperature, making it an ideal compound for long-term storage. However, the limited aqueous solubility of this salt prohibits parenteral administration. Conversely, the chloride salt of this carbapenem demonstrates opposing characteristics; it is quantitatively soluble in water, however is amorphous and subject to significant hydrolytic degradation in the solid state. Given two such extreme alternatives for pharmaceutical salt selection, a common approach taken is to develop the bioavailable salt and devise manufacturing and storage conditions that minimize degradation. This report describes a different approach to this manufacturing dilemma via the application of a simple and efficient nanofiltration process to convert the benzenesulfonate salt (storage entity) to the chloride salt (formulated drug product). Such an approach combines the positive attributes of these two salt forms into a single scalable process that reduces processing cycle times via elimination of redundant unit operations, increases the flexibility in manufacturing schedule, and improves overall product quality.

Tautomer interconversion of 2,4-pentanedione during gas chromatography on an oxidized cyano-modified capillary column.

The tautomerization of 2,4-pentanedione (acetylacetone) is examined on a microbore column containing an acid-modified stationary phase made by oxidizing a commercially available cyano-modified column. This stationary phase is found to provide separation of the two tautomers, which allows the kinetic and thermodynamic properties of the on-column interconversion to be investigated. The enol-to-keto tautomerization is found to occur primarily in the stationary phase, being enthalpically driven. By treating the column as a reactor, the interconversion is investigated as a function of temperature. Monitoring the loss of the more gas-stable 'enol' tautomer makes it possible to extract an energy of activation for the net tautomerization (42.7 kj/mol), because the reaction is found to obey pseudo first-order kinetics. Simple peak-shape analysis of the major component (enol), which is used commonly in treatments of peak tailing, provides insight into the nature of the retention processes of the two tautomers as well as information on chromatographic optimization.

A simple quantitative FT-IR approach for the study of a polymorphic transformation under crystallization slurry conditions.

The pharmaceutical compound (2R,3S)-2-([(1R)-1-[3,5-bis(trifluoromethyl)phenyl]ethyl]oxy)-3-(4-fluorophenyl)morpholine hydrochloride (denoted here as Compound X), has been found to crystallize in at least two polymorphic forms. Using only two frequencies (1009 and 1058 cm(-1)) in the infrared, a linear (R=0.998) calibration plot, consisting of the ratio of the peak absorbances plotted against polymorph concentration, was constructed. This plot allowed the quantification of binary mixtures of polymorphs ranging from <3 to approximately 100 wt% Form II in Form I. Spectra were acquired in transmission mode using mineral oil (Nujol) mull sample preparation, for reasons of compatibility with wet cake and slurry samples. The transformation of the less thermodynamically stable polymorph (Form II) to the more stable form (Form I), in stirred methyl isobutyl ketone (MIBK) slurries, was monitored spectroscopically as a function of time. Performing the experiment at various temperatures allowed the energy of activation for the process to be estimated (42 kJ/mol).