The potential impact of acute coronary syndromes on automatic sensing system in Subcutaneous-ICDs.

BACKGROUND: The Subcutaneous-ICD (S-ICD) is emerging as a suitable option for most ICD candidates, however some open issues regarding the sensing algorithm still remain. OBJECTIVES: We aimed to examine the performance of the S-ICD sensing algorithm in patients hospitalized for ST elevation myocardial infarction (STEMI), non ST elevation acute coronary syndrome (NSTE-ACS) or chronic coronary syndrome (CCS), before and after revascularization. METHODS: We performed a S-ICD automated screening on 75 patients, 21 hospitalized for STEMI, 23 for NSTE-ACS and 31 for CCS, before and after percutaneous revascularization, regardless their eligibility to ICD implantation. RESULTS: Patients did not differ in clinical, electrocardiographic and echocardiographic parameters. Rates of screening pass were significantly lower in STEMI patients compared to NSTE-ACS and CCS (5% vs 56.7% vs 81% respectively, p < .0001). The viability of the primary vector was lower in STEMI patients compared to NSTE-ACS and CCS (33% vs 56% vs 71%, p .027 respectively). After revascularization, there were no more significant differences between groups. Pairing subjects at baseline and after revascularization, STEMI subjects percentages of screening success were respectively 5% and 81% (p < .001) and the rates of primary vector viability were 33% and 81% (p .002). STEMI was the only independent predictor of screening failure at multivariate logistic regression analysis (odds ratio 10.68 confidence interval 2.77-41.38, p = .001). CONCLUSION: The performance of the S-ICD and possible malfunction detections in the context of an acute ischemic event deserve further evaluation. Adequate patient selection and the development of dynamic device programming are warranted.

Kappa free light chains could predict early disease course in multiple sclerosis.

BACKGROUND: Cerebrospinal fluid (CSF) kappa free light chains (KFLC) have been suggested as quantitative alternative to oligoclonal bands (OB) in multiple sclerosis (MS) diagnosis. Despite OB have been associated to poor disease prognosis, little is known on KFLC in predicting MS early progression. Our aim is to evaluate the prognostic value of KFLC in a cohort of Italian MS patients. METHODS: 100 patients (64 females) underwent CSF analysis during their diagnostic MS work-up. We collected clinical/paraclinical features (gender, age at onset, clinical course, early MS treatments (within 1 year), gadolinium-enhancing (Gd+) lesions), calculated K index (ratio CSF-serum KFLC and albumin), and MS severity score (MSSS) at last follow up (minimum 1 year). Statistical analysis included Mann-Whitney descriptive analysis, Spearman correlation for independent samples, and linear regression for significant predictors. RESULTS: K index resulted a significant predictor for disability over time being higher in patients who developed greater MSSS. Accordingly, K index was also significantly increased in patients undergoing early versus delayed treatment (N = 50/100, p = 0.046). A similar role in predicting MS disability was confirmed for age at onset. No other factors were retained in our regression model. Of note, K index was not associated to known MS prognostic markers such as gender, age at onset, and Gd+ lesions (N = 31/96). CONCLUSION: Our study suggests KFLC as a CSF quantitative marker to predict early disability in MS (despite not being a substitute for OB).

Eigenstate thermalization hypothesis and quantum Jarzynski relation for pure initial states.

Since the first suggestion of the Jarzynski equality many derivations of this equality have been presented in both the classical and the quantum context. While the approaches and settings differ greatly from one another, they all appear to rely on the condition that the initial state is a thermal Gibbs state. Here, we present an investigation of work distributions in driven isolated quantum systems, starting from pure states that are close to energy eigenstates of the initial Hamiltonian. We find that, for the nonintegrable quantum ladder studied, the Jarzynski equality is fulfilled to a good accuracy.

The accuracy of digital infrared imaging for breast cancer detection in women undergoing breast biopsy.

BACKGROUND: Mammography has a lower sensitivity for breast cancer detection in younger women and those with dense breasts. Recent improvements in digital infrared breast imaging suggest there may be a role for this technology and we have studied its performance in 100 women prior to breast needle core biopsy (CB). METHODS: All patients were imaged using a digital infrared breast (DIB) scan (Sentinel BreastScan) prior to breast biopsy. Analysis of the infrared scans was performed, blinded to biopsy results, in four different ways: Sentinel screening report, Sentinel artificial intelligence (neural network), expert manual review and NoTouch BreastScan a novel artificial intelligence programme. RESULTS: Of 106 biopsies performed in 100 women, 65 were malignant and 41 were benign. Sensitivity of Sentinel screening (53%) and Sentinel neural network (48%) was low but analysis with NoTouch software (70%) was much closer to expert manual review (78%). Sensitivity (78%) and specificity (75%) using NoTouch BreastScan were higher in women under 50 and the combination of mammography and DIB, with NoTouch interpretation, in this age group resulted in a sensitivity of 89%. CONCLUSION: DIB using NoTouch is an effective adjunctive test for breast cancer detection in women under 70 and appears to be particularly effective in women under 50 where maximal sensitivity (78%) and specificity (75%) were observed. The combined sensitivity of NoTouch BreastScan and mammography in women under 50 was encouraging at 89%, suggesting a potential way forward for a dual imaging approach in this younger age group.

The response of intestinal mucous cells to the presence of enteric helminths: their distribution, histochemistry and fine structure.

Histochemical and ultrastructural investigations were conducted on the mucous cells of the intestine of brown trout, Salmo trutta L., naturally infected with the cestode Cyathocephalus truncatus (Pallas, 1781) and the acanthocephalan Echinorhynchus truttae Shrank, 1788. A subpopulation of 45 S. trutta were examined of which 15 specimens harboured E. truttae, 15 of which were infected with C. truncatus and 15 fish, the control group, were uninfected. In histological sections, hyperplasia and hypertrophy of the mucous cells were evident at the site of parasite infection. Enhanced mucus secretion was also recorded in infected fish. The number of mucous cells close to the site of parasite attachment within the intestine was significantly higher than the number detected in uninfected individuals and in infected individuals at sites 1 cm or greater from the point of parasite attachment. There were no significant differences between the number of mucous cells found at the latter two sites. Alcian blue and periodic acid-Schiff's staining of representative histological sections revealed a significant increase in the number of mucous cells staining positively for acid glycoconjugates compared to the number of cells found in the intestines of uninfected S. trutta. In transmission electron microscopy sections, each mucous cell typically possessed an elongated, basally positioned nucleus. The cytoplasm was observed to possess numerous electron dense and lucent vesicles, in addition to well-developed rough endoplasmic reticulum, Golgi apparatus and a few round mitochondria.

Effects of gamma-irradiation on trehalose-hydroxyethylcellulose microspheres loaded with vancomycin.

Ionizing radiation can be used as a drug sterilization technique, provided that the drug itself is not modified and that no toxic products are produced; moreover, if the irradiated product is a drug delivery system, the drug release characteristics must not be significantly altered by radiation. The aim of this work was to study the effects of sterilization by ionizing radiation on hydroxyethylcellulose/trehalose spherical micromatrices, containing the antibiotic vancomycin. Our experimental results showed that gamma-rays did not alter the chromophore groups of vancomycin (UV measurements), and did not modify the kinetic behavior of drug release from microspheres. Moreover, no significant changes in the shape and in the size distribution of microspheres were found after irradiation. The electron spin resonance (ESR) spectroscopy was proven to be a valid identification method of the executed radiation treatment, even after 5 years. The experimental results showed that the therapeutic application of the pharmacological system investigated was not compromised by irradiation, and that ESR spectroscopy can be used to distinguish irradiated from non-irradiated products.

Effects of naltrexone on the intake of ethanol and flavored solutions in rats.

It has been suggested that the endogenous opioid system may mediate the intake of preferred fluids, perhaps through an attenuation of reinforcement properties causing a subsequent shift in palatability. The purpose of the present study was to investigate the effects of the nonspecific opiate antagonist naltrexone on the intake of 10% ethanol, 0.1% saccharin, 0.0006% quinine, 0.4% saccharin + 10% ethanol, and 0.4% saccharin + 0.04% quinine solutions. Fluid intake was measured in male Long-Evans and Wistar rats under 24-h continuous and 30-min limited-fluid-access drinking paradigms. All rats received injections of naltrexone hydrochloride (10 mg/kg, i.p.) for 5 days after baseline intake measures and were monitored for a further 5 days (after-treatment phase). Results indicated that naltrexone did not affect intake of any solution when fluids were available over 24 h. However, under limited-access conditions, naltrexone caused a decrease in the intake of all fluids except quinine in both rat strains. On the basis of these findings, it is possible that the effects of this dose of naltrexone were not due to any true conditioning effect on the reinforcement properties of ethanol, but perhaps to some nonspecific effect of the drug, such as an alteration in palatability or an attenuation of locomotor activity. As well, due to the inconsistent results in fluid intake across drinking paradigms, the present findings do not provide evidence for an effective role for opiate mediation in ethanol intake as well as any ethanol-sweet fluid intake interactions.

A diary model for monitoring blood pressure in the elderly.

Activity can significantly change blood pressure. Twenty four hour ambulatory blood pressure monitoring (Holter method) was introduced to optimize diagnosis and the changes in blood pressure. It was flanked by the purpose to use diaries to correlate symptoms and pressure changes, pressure changes and psychophysical activity, life style and drugs. The diary model adopted by us for 380 elderly subjects between 65 and 85 years old is divided into four main sections: 1. general activities (8 items); 2. situational variations (7 items); 3. correlation between symptoms and pressure changes; 4. drug treatment and pressure changes. The aim of our study was to assess the compliance of the elderly to keeping a diary. Our results showed that compliance was satisfactory in 352/380 subjects (93%).

[Cranial injury in children]. / Traumi cranici pediatrici.

The Authors report personal experience in management of 23 children after severe head injury. All patients were submitted to TC scanning and their performance status was evaluated according to Glasgow Coma Scale (G.C.S.). All children were treated with hyperventilation, steroids, mannitol and, when necessary, Penthobarbital (TPS). Authors present the outcome at a distance of 6 months from trauma's beginning.

[Monitoring of intracranial pressure]. / In tema di monitorizzazione della pressione intracranica (PIC).

A very small fiberoptic catheter initially developed as an intravascular pressure sensor was incorporated into a system to be used as an intracranial pressure (ICP) monitor. 13 patients with intracranial hypertension have been studied with this probe. The clinical experience confirmed the safety, accuracy and reliability of the device. The monitor has functioned very well, and there have been no complications except for two breakages of optic fiber as a result of nursing manoeuvres. This new device can be placed into the ventricular, subdural and epidural space. Camino System appears to offer advantages over other monitors presently in use.