Electrocardiogram analysis in Anderson-Fabry disease: a valuable tool for progressive phenotypic expression tracking.

Background: Electrocardiogram (ECG) has proven to be useful for early detection of cardiac involvement in Anderson-Fabry disease (AFD); however, little evidence is available on the association between ECG alterations and the progression of the disease. Aim and Methods: To perform a cross sectional comparison of ECG abnormalities throughout different left ventricular hypertrophy (LVH) severity subgroups, providing ECG patterns specific of the progressive AFD stages. 189 AFD patients from a multicenter cohort underwent comprehensive ECG analysis, echocardiography, and clinical evaluation. Results: The study cohort (39% males, median age 47 years, 68% classical AFD) was divided into 4 groups according to different degree of left ventricular (LV) thickness: group A ≤ 9 mm (n = 52, 28%); group B 10-14 mm (n = 76, 40%); group C 15-19 mm (n = 46, 24%); group D ≥ 20 mm (n = 15, 8%). The most frequent conduction delay was right bundle branch block (RBBB), incomplete in groups B and C (20%,22%) and complete RBBB in group D (54%, p < 0.001); none of the patients had left bundle branch block (LBBB). Left anterior fascicular block, LVH criteria, negative T waves, ST depression were more common in the advanced stages of the disease (p < 0.001). Summarizing our results, we suggested ECG patterns representative of the different AFD stages as assessed by the increases in LV thickness over time (Central Figure). Patients from group A showed mostly a normal ECG (77%) or minor anomalies like LVH criteria (8%) and delta wave/slurred QR onset + borderline PR (8%). Differently, patients from groups B and C exhibited more heterogeneous ECG patterns: LVH (17%; 7% respectively); LVH + LV strain (9%; 17%); incomplete RBBB + repolarization abnormalities (8%; 9%), more frequently associated with LVH criteria in group C than B (8%; 15%). Finally, patients from group D showed very peculiar ECG patterns, represented by complete RBBB + LVH and repolarization abnormalities (40%), sometimes associated with QRS fragmentation (13%). Conclusions: ECG is a sensitive tool for early identification and long-term monitoring of cardiac involvement in patients with AFD, providing "instantaneous pictures" along the natural history of AFD. Whether ECG changes may be associated with clinical events remains to be determined.

The Erice 58 Charter on 'The health of migrants. An equity challenge for the public health system'.

Abstract: The Erice 58 Charter titled "The Health of Migrants: a Challenge of Equity for the Public Health System", was unanimously approved at the conclusion of the 58th Residential Course of the School of Epidemiology and Preventive Medicine 'Giuseppe D'Alessandro' entitled "The Health of Migrants: a Challenge of Equity for the Public Health System. Epidemiological, clinical-relational, regulatory, organisational, training and public communication aspects at international, national and local level', which took place from 28 March to 2 April 2022 in Erice (Sicily, Italy), at the 'Ettore Majorana' Foundation and Centre for Scientific Culture. The Course was promoted by the Italian Society of Migration Medicine (S.I.M.M.) and the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI), with the collaboration and patronage of the Istituto Superiore di Sanità (ISS). 72 learners participated (mainly resident doctors in 'Hygiene and Preventive Medicine' but also other health service professionals), whose average age was 37 years; on the basis of territorial origin, 13 of the 20 Italian regions were represented. During the intense learning experience, which consisted of 18 frontal lessons (with 20 lecturers from the bio-medical, socio-anthropological and journalistic fields) and 7 working group sessions (supported by 4 classroom tutors in addition to the lecturers) in 'blended learning' mode, the various dimensions and critical issues related to the possibility of guaranteeing truly inclusive health policies for foreigners/migrants, throughout the country, were identified and discussed from an 'Health Equity' perspective. This enabled a small editorial group to draw up the basic document that, in the last session of the Course, was discussed and modified by all participants into the version of the 'Erice 58 Charter' presented here.

Anatomical and biochemical studies of Spartium junceum infected by Xylella fastidiosa subsp. multiplex ST 87.

Spartium junceum L. is a typical species of Mediterranean shrubland areas, also grown in gardens and parks as an ornamental. In recent years in Europe, S. junceum has been recurrently found to be infected by different subspecies and genotypes of the quarantine regulated bacterium Xylella fastidiosa (Xf). This work presents for the first time the anatomy of S. junceum plants that we found, by means of genetic and immunochemistry analysis, to be naturally infected by Xf subsp. multiplex ST87 (XfmST87) in Monte Argentario (Grosseto, Tuscany, Italy), a new outbreak area within the EU. Our anatomical observations showed that bacteria colonized exclusively the xylem conductive elements and moved horizontally to adjacent vessels through pits. Interestingly, a pink/violet matrix was observed with Toluidine blue staining in infected conduits indicating a high content of acidic polysaccharides. In particular, when this pink-staining matrix was observed, bacterial cells were either absent or degenerated, suggesting that the matrix was produced by the host plant as a defense response against bacterial spread. In addition, a blue-staining phenolic material was found in the vessels and, at high concentration, in the pits and inter-vessels. SEM micrographs confirmed that polysaccharide and phenolic components showed different structures, which appear to be related to two different morphologies: fibrillary and granular, respectively. Moreover, our LM observations revealed bacterial infection in xylem conductive elements of green shoots and leaves only, and not in those of other plant organs such as roots and flowers.

First molecular evidence of frogs as a food source for sand flies (Diptera: Phlebotominae) in Brazilian caves.

Genus and species of phlebotomine sand flies have been recorded and described in caves in Brazil, but no study has provided the food source used by sand flies in these environments. Herein, we identified the blood source used by sand fly species in caves located at "Quadrilátero Ferrífero" (QF), Minas Gerais state. Specimens were manually collected near or on anurans inside ferruginous caves in Serra do Gandarela National Park and Serra do Rola Moça State Park. Males and females were placed in vials with 70% alcohol and stored at -10°C. Females engorged, after specific identification, had DNA extracted and followed for PCR amplification using specific primers. Sequencing was analyzed in the GenBank and Barcode of Life. A total of 198 specimens were collected (107 females and 91 males), all of them belonging to species Sciopemyia aff. microps (88.89%), Sciopemyia sordellii (10.61%), or Martinsmyia oliveirai (0.50%). When it comes to the females, 89 were S. aff. microps and 18 S. sordellii. Nineteen engorged females of S. aff. microps were analyzed and most of them (n=18) presented blood from Bokermannohyla martinsi and one contained blood from Scinax fuscovarius. The blood present in engorged females of S. sordellii (n=4) was from B. martinsi. Sciopemyia genus specimens are commonly found in collections carried out inside natural caves, but this was the first study to prove that females of this genus feed on cold-blooded animals in nature. HIGHLIGHTS: • Here we proved that sand flies feed in cold-blooded animals in in Brazilian caves. • Females of the Sciopemyia genus were for the first time found feeding in natural habitats. • Anurans of the family Hylidae were identified as source by molecular analyzes. • Insect bloodmeal identification can help assessing the fauna in several biomes. • This is the first record of S. aff. microps in caves of Brazil.

Influence of Incorporating Zirconium- and Barium-based Radiopaque Filler Into Experimental and Commercial Infiltrants.

OBJECTIVES: To evaluate how adding different concentrations of particles (barium or zirconium oxide 25%/45% by weight) to a commercial infiltrant (Icon) and an experimental infiltrant influences cohesive strength (CS), degree of conversion (DC), water sorption (WS), solubility (SL), radiopacity, and penetration depth. METHODS AND MATERIALS: Microtensile CS (n=10) was evaluated using a universal testing machine. DC (n=5) was evaluated in a Fourier-transform infrared spectrometer. Polymerized samples were dissected, weighed, and stored to obtain the final mass for WS and SL tests (n=10). Radiopacity analysis (n=5) was performed using a digital radiography system. Penetration depth analysis (n=5) was performed by confocal laser scanning microscopy. Analyses were performed using the R program, with a significance level of 5%, except for the penetration depth analyses, which were evaluated only qualitatively. RESULTS: The groups with 45% zirconium showed greater CS values, regardless of the infiltrant. Among the groups with no particle addition, those of the experimental infiltrant presented higher DC than those of Icon. The experimental infiltrant presented lower WS than Icon. All groups had SL below the ISO recommended levels. Radiopacity higher than 2.24 mmAl (enamel radiopacity) was observed only in the groups with 45% zirconium. All the groups achieved similar penetration depth, but the groups containing experimental infiltrant appear to have had longer tag extensions. CONCLUSIONS: Addition of 45% of zirconium presented good results for CS and WS, as well as SL below the ISO recommended standard, adequate radiopacity, and penetration depth similar to the other groups.

Structured report for chest high-resolution computed tomography in patients with connective tissue disease: Impact on the report quality as perceived by referring clinicians.

RATIONALE AND OBJECTIVES: To evaluate the impact on perceived report quality of referring rheumatologists for a chest high-resolution computed tomography (HRCT) structured report (SR) template for patients with connective tissue disease (CTD), compared to the traditional narrative report (NR). MATERIALS AND METHODS: We retrospectively considered 123 HRCTs in patients with CTD. Three radiologists, blinded to the original NRs they wrote during clinical routine, re-reported each HRCT using an SR dedicated template. We then divided all NR-SR couples into three groups (41 HRCT each). Each group was evaluated by one of three rheumatologists (R1, R2, R3), who expressed their perceived report quality for the respective pools of NRs and SRs in terms of completeness, clarity (both on a 10-points scale), and clinical relevance (on a 5-points scale). The Wilcoxon test and the McNemar test were used for statistical analysis. RESULTS: For each rheumatologist, SR received higher ratings compared to NR for completeness (median ratings: R1, 10 vs. 7; R2, 10 vs. 8; R3, 10 vs. 6, all p < 0.0001), clarity (median ratings: R1, 10 vs. 7; R2, 10 vs. 8; R3, 10 vs. 7, all p < 0.0001), and clinical relevance (median ratings: R1, 5 vs. 4; R2, 5 vs. 4; R3, 5 vs. 1, all p < 0.0001). After rating dichotomization, the use of SR led to a significant increase (p < 0.01) in completeness, clarity, and clinical relevance as compared to NR, except for clarity as perceived by R2 (p = 1). CONCLUSION: Referring rheumatologists' perceived report quality for structured reporting of HRCT in patients with CTD was superior to narrative reporting.

Oxidative stress biomarkers in Fabry disease: is there a room for them?

BACKGROUND: Fabry disease (FD) is an X-linked lysosomal storage disorder, caused by deficient activity of the alpha-galactosidase A enzyme leading to progressive and multisystemic accumulation of globotriaosylceramide. Recent data point toward oxidative stress signalling which could play an important role in both pathophysiology and disease progression. METHODS: We have examined oxidative stress biomarkers [Advanced Oxidation Protein Products (AOPP), Ferric Reducing Antioxidant Power (FRAP), thiolic groups] in blood samples from 60 patients and 77 healthy controls. RESULTS: AOPP levels were higher in patients than in controls (p < 0.00001) and patients presented decreased levels of antioxidant defences (FRAP and thiols) with respect to controls (p < 0.00001). In a small group of eight treatment-naïve subjects with FD-related mutations, we found altered levels of oxidative stress parameters and incipient signs of organ damage despite normal lyso-Gb3 levels. CONCLUSIONS: Oxidative stress occurs in FD in both treated and naïve patients, highlighting the need of further research in oxidative stress-targeted therapies. Furthermore, we found that oxidative stress biomarkers may represent early markers of disease in treatment-naïve patients with a potential role in helping interpretation of FD-related mutations and time to treatment decision.

Dermoscopy in the differential diagnosis between malar rash of systemic lupus erythematosus and erythematotelangiectatic rosacea: an observational study.

BACKGROUND: Malar rash is one of the three cutaneous diagnostic criteria of systemic lupus erythematosus (SLE). Although its clinical recognition is often straightforward, the differential diagnosis with erythematotelangiectatic rosacea may sometimes be challenging. OBJECTIVE: To describe dermoscopic features of SLE malar rash and investigate the accuracy of dermoscopy for the differential diagnosis with erythematotelangiectatic rosacea. METHODS: A representative dermoscopic image of target areas was evaluated for the presence of specific features. Fisher's test was used to compare their prevalence between the two cohorts, and accuracy parameters (specificity, sensitivity, and positive and negative predictive values) were evaluated. RESULTS: Twenty-eight patients were included in the analysis, of which 13 had SLE malar rash and 15 erythematotelangiectatic rosacea. The main dermoscopic features of malar rash were reddish/salmon-coloured follicular dots surrounded by white halos ('inverse strawberry' pattern), being present in 53.9% of the cases, while network-like vessels (vascular polygons) turned out to be the main feature of erythematotelangiectatic rosacea, with a prevalence of 93.3%. The comparative analysis showed that the 'inverse strawberry' pattern was significantly more common in SLE malar rash, with a specificity of 86.7%, while vascular polygons were significantly more frequent in rosacea, with a specificity of 92.3%. CONCLUSION: Dermoscopy may be a useful support to distinguish SLE malar rash and erythematotelangiectatic rosacea by showing peculiar features.

Discrimination between healthy and degenerated bovine articular cartilage with a fiber Bragg grating based microindenter.

OBJECTIVE: In this study we aim to show that an optical fiber Bragg grating-based microindentation system, which has the potential to be deployed arthroscopically, can differentiate between healthy and degenerated articular cartilage, which represents an important challenge in minimally-invasive surgery. DESIGN: Twenty bovine osteochondral cylinders, extracted from the patellar groove of ten 24 months old animals were subjected to stepwise in vitro stress-relaxation indentation measurements. The indentation procedure comprised 15 indentation steps of 20 µm each, reaching a total depth of 300 µm. Ten samples remained untreated and served as a control group for healthy cartilage. A second group of ten samples was treated for 12 h with an aqueous trypsin solution (concentration 2.5%) to deplete the proteoglycans. For both groups and all indentation depths deeper than 100 µm, the step response functions of a two elements Maxwell-Wiechert model fitted well to the measured relaxation curves. RESULTS: The standard deviations of the identified stiffness parameters within each group were much smaller than the difference of the average stiffness values between both groups. Based on the measured stiffness values, the system was capable to discriminate between healthy and degenerated cartilage with a high level of significance (p < 0.001). The experimental results are also discussed in terms of the biomechanical changes of cartilage under the action of trypsin. CONCLUSION: The fiber Bragg grating microindentation system showed the capability to differentiate intact and proteoglycan depleted cartilage with high significance.

Fiberoptic microindentation technique for early osteoarthritis diagnosis: an in vitro study on human cartilage.

In this study, the capability of a fiber optic microindenter sensor to discriminate between healthy and slightly degenerated human articular cartilage samples is demonstrated. The purely optical indenter sensor is characterized by extremely reduced dimensions (0.125 mm in diameter and 27 mm in length) in comparison to existing indenter probes offering advantages for endoscopic deployment. The indenter sensor is intended to assist the surgeon in the identification of damaged articular cartilage. From each of seven specimens of human tibia plateau three samples showing different Outerbridge grading were extracted. On each sample stress-relaxation measurements were performed with eight indentation steps, each step being 40 µm and the relaxation of the material was observed for 240 s after each step. A viscoelastic model was used to fit the relaxation and to extract the characteristic parameters according to the model. A highly significant difference in stiffness (p value <0.01) was observed between the native (grade 0) and early diseased (grade 1) human cartilage samples demonstrating the potential of the fiber optic indenter for the diagnosis of cartilage breakdown.

Effect of Cigarette Smoke on Resin Composite Bond Strength to Enamel and Dentin Using Different Adhesive Systems.

OBJECTIVE: To evaluate the microshear bond strength of composite resin restorations in dental blocks with or without exposure to cigarette smoke. METHOD: Eighty bovine dental blocks were divided into eight groups (n=10) according to the type of adhesive (Scotchbond Multi-Purpose, 3M ESPE, St Paul, MN, USA [SBMP]; Single Bond 2, 3M ESPE [SB]; Clearfil SE Bond, Kuraray Medical Inc, Okayama, Japan [CSEB]; Single Bond Universal, 3M ESPE [SBU]) and exposure to smoke (no exposure; exposure for five days/20 cigarettes per day). The adhesive systems were applied to the tooth structure, and the blocks received a composite restoration made using a matrix of perforated pasta. Data were statistically analyzed using analysis of variance and Tukey test (α<0.05). RESULTS: For enamel, there was no difference between the presence or absence of cigarette smoke (p=0.1397); however, there were differences among the adhesive systems (p<0.001). CSEB showed higher values and did not differ from SBU, but both were statistically different from SB. The SBMP showed intermediate values, while SB demonstrated lower values. For dentin, specimens subjected to cigarette smoke presented bond strength values that were lower when compared with those not exposed to smoke (p<0.001). For the groups without exposure to cigarette smoke, CSEB showed higher values, differing from SBMP. SB and SBU showed intermediary values. For the groups with exposure to cigarette smoke, SBU showed values that were higher and statistically different from SB and CSEB, which presented lower values of bond strength. SBMP demonstrated an intermediate value of bond strength. CONCLUSION: The exposure of dentin to cigarette smoke influenced the bonding strength of adhesives, but no differences were noted in enamel.

Optimizing the dose of mycophenolate mofetil for the maintenance treatment of lupus nephritis by therapeutic drug monitoring.

To evaluate the usefulness of monitoring the pharmacokinetic of mycophenolic acid (MPA) in lupus nephritis (LN), in order to optimize the mycophenolate mofetil (MMF) dose in the single patient. Five consecutive patients with active LN were studied. After standard induction therapy with MMF, MMF was titrated to achieve a stable target of MPA-AUC0-12h of 45-60 mg.h/l during the maintenance treatment. For MPA assays, blood samples were collected at 0, ½, 1 », 2, 4, 6, 8 and 12 h after the morning dose. Plasma MPA concentration was measured using a validated high-performance liquid chromatography. Treatment response was evaluated at baseline, i.e. at the end of the induction therapy and during maintenance therapy with MMF. The average whole follow-up was 21.4 months. At the last visit, a complete renal response was registered in all the five patients. No renal flares were observed. Glucocorticoids were suspended in all. The mean MPA-AUC0-12h of MMF at the last visit [56.74 (±2.9) mg.h/l] was significantly lower than MPA-AUC0-12h at baseline [98.7 (±24.6) mg.h/l] (p = 0.009), since the dose of MMF was significantly reduced in all the patients [from 2.8 g/day (±0.4) to 1.9 g/day (±0.4) (p = 0.018)] based on the target MPA-AUC. No severe adverse events were observed. Assessment of MPA pharmacokinetics may be useful to optimize the maintenance therapy of lupus nephritis with MMF, possibly improving the efficacy and minimizing the side effects.

Influence of an intermediary base on the microleakage of simulated class II composite resin restorations.

The aim of this in vitro study was to qualitatively and quantitatively evaluate the microleakage of Class II cavities restored with a methacrylate-based composite (Filtek Z250, 3M ESPE) or silorane-based composite (Filtek LS, 3M ESPE), varying the application of an intermediary base, using a low-viscosity composite resin (Filtek Z350 Flow, 3M ESPE) or resin-modified glass ionomer cement (RMGIC) (Vitrebond, 3M ESPE) and no intermediary base (control groups). Sixty cavities were prepared on the proximal surfaces of bovine teeth and were randomly divided according to the experimental groups (n=10). Following the restorative procedures and thermocycling, the samples were immersed in methylene blue for two hours. The qualitative evaluation was made using a stereomicroscope, whereby two observers analyzed the infiltration level of the dye within the tooth/filling. Microleakage scores among the groups were compared using the Kruskal-Wallis test followed by the Mann-Whitney test (p≤0.05). The samples were then ground and the powder was prepared for quantitative analysis in an absorbance spectrophotometer. The results were statistically analyzed by analysis of variance and the Tukey test (p≤0.05). Results from the quantitative analysis showed that LS presented higher values of microleakage than did Z250. There was a significant difference between both composites concerning the intermediary materials, with the lowest values obtained using RMGIC as an intermediary base. Results from the qualitative analysis showed that there were no statistically significant differences between composites; however, there were significant differences for both composites concerning the intermediary materials, with the lowest values obtained using RMGIC as an intermediary. It is possible to conclude that using RMGIC as an intermediary base provided lower microleakage, indicating better sealing of the tooth-restoration interface.

Open repair of isolated traumatic subscapularis tendon tears with a synthetic soft tissue reinforcement.

BACKGROUND: Missed or chronic subscapularis tendon ruptures may have muscle atrophy and tendon retraction resulting in a large defect with high risk of re-tear after a surgical repair. To improve the clinical results of this challenging surgery, the repaired tendon could be augmented with endogenous or exogenous materials. The purpose of this study was to evaluate the structural tendon integrity and clinical outcomes after an open subscapularis tendon repair with a synthetic soft tissue reinforcement. MATERIALS AND METHODS: Ten patients were managed with an open repair of the subscapularis tendon with augmentation by means of SportMesh, a readily available synthetic degradable poly(urethaneurea) scaffold. Clinical findings were assessed for all patients preoperatively and postoperatively with use of the visual analog scale for pain and the DASH scoring system. All patients had an ultrasonographic study at the latest follow-up. RESULTS: The visual analog scale for pain (mean ± standard deviation) improved significantly (P < 0.01) from 7.9 ± 1.1 preoperatively to 1.95 ± 1.85 at the latest clinical follow-up evaluation. The mean DASH score at the latest clinical follow-up was 12.63 %. Ultrasound imaging revealed a structural intact repair at follow-up in 9 shoulders (90 %) with average 5.4 mm in thickness (4.3 mm in the contralateral healthy side). CONCLUSIONS: At a median follow-up of 23 months, 80 % (8 of 10) of patients had a good or excellent result after an open subscapularis tendon repair with a soft tissue reinforcement. As a synthetic material, SportMesh Soft Tissue Reinforcement eliminates the risk of collagen reactions, which may result from collagen or dermis patches. Although the follow-up is relatively short, our series shows a promising durable repair with a 10 % re-tear rate at an average of 23 postoperative months. Level of evidence Case Series, Treatment Study, Level IV.

Neumonía eosinofílica aguda: reporte de un caso / Acute eosinophilic pneumonia: case report

Since the initial description as an independent entity in 1989, there are various patients reported in the literature as suffering acute eosinophilic pneumonia. Despite its recognition as etiology of acute respiratory insufficiency, at present still remains weak the ability for diagnosis and treatment, in the opportune moment. The clinical features of a patient that followed algorthms of diagnosis, for acute repiratory insufficiency, are presented. The treatment employed is describe in the article.

Neumonía eosinofílica aguda: reporte de un caso / Acute eosinophilic pneumonia: case report

Since the initial description as an independent entity in 1989, there are various patients reported in the literature as suffering acute eosinophilic pneumonia. Despite its recognition as etiology of acute respiratory insufficiency, at present still remains weak the ability for diagnosis and treatment, in the opportune moment. The clinical features of a patient that followed algorthms of diagnosis, for acute repiratory insufficiency, are presented. The treatment employed is describe in the article.(AU)

First Report of Knot Disease Caused by Pseudomonas savastanoi on Sweet Olive in Central Italy.

In April 2012 the presence of hyperplastic outgrowths on trunks, branches, and twigs of sweet olive plants, Osmanthus fragrans Lour (Fam. Oleaceae), was recorded in two ornamental hedges made up of five and four plants, respectively, in the city center of Montecatini (Pistoia-Italy). All sweet olive plants were seriously affected by the disease with outgrowths appearing either singly or close together, often forming a single mass that could extend up to 20 cm along the stems, occasionally surrounding the entire circumference. The symptoms observed on O. fragrans closely resembled those induced by the bacterium Pseudomonas savastanoi on Olea europea (common olive) and other plant species. Suspecting a bacterial origin of the disorder, young knots were collected from four diseased plants and used for bacterial isolation with standard techniques on nutrient sucrose agar medium (1). After 3 days of incubation at 26°C, non-levan forming colonies about 3 mm in diameter that were circular, convex, smooth, and cream colored with entire margins appeared on the surface of the agar medium. Purified isolates were gram negative, levan negative, oxidase negative, potato rot negative, arginine dihydrolase negative, showed a tobacco hypersensitive reaction, and tested positive to PCR screening for the presence of the iaaM (tryptophan-2-monooxygenase), iaaH (indoleacetamide hydrolase), ptz (isopentenyl transferase) (1) and iaaL (IAA-lysine synthethase) (3) genes. Three isolates were selected arbitrarily and further characterized by sequencing a fragment of the housekeeping genes rpoD (sigma factor 70) and pgi (phosphoglucose isomerase) (2). All sequenced gene fragments, of 620 bp and 552 bp for the rpoD and pgi genes, respectively, were identical to those of P. savastanoi pv. savastanoi strain NCPPB3335. The pathogenicity of the three isolates was verified on three O. fragrans plants and three Olea europea (cv. Frantoio) plants. Per each isolate, three 1-cm wounds were made on the branches of each plant using a sterile scalpel dipped in a bacterial suspension (1 × 108 CFU/ml). P. savastanoi pv. savastanoi PVFi-t2b isolated from olive was also inoculated as reference strain. After 30 days, all isolates including the reference strain induced typical knots on both plant species while no symptoms were observed on wounds inoculated with sterile water. Bacteria were reisolated from induced knots and Koch's postulates were confirmed. On the basis of biochemical tests, PCR screening, pathogenicity testing, and sequence analyses, the causal agent of knot disease on O. fragrans was identified as P. savastanoi. The potential susceptibility of O. aquifolium Sieb. to the causal agent of olive knot disease has been demonstrated in the past by means of artificial inoculations but interestingly, in the same trials, O. fragrans had tested negative (4). To the best of our knowledge, this is the world's first report of O. fragrans as natural host of P. savastanoi, which extends the growing list of cultivated and ornamental plant species affected by this phytopathogenic bacterium. References: (1) G. Marchi et al. Eur J. Plant Pathol. 112:101, 2005. (2) N. Parkinson et al. Plant Pathol. 60:338, 2011. (3) R. Penyalver et al. Appl. Environ. Microbiol. 66:2673, 2000. (4) C. O. Smith. Phytopathology 12:271, 1922.

Suprarenal inferior vena cava filter implantation.

PURPOSE: This study evaluated the feasibility, safety, and efficacy of the suprarenal implantation of a retrievable filter in patients with renal cell carcinoma (RCC) and renal vein thrombosis (RVT) [extending or not extending to the inferior vena cava (IVC)] undergoing surgery. MATERIALS AND METHODS: Between March 2005 and May 2010, 13 patients (eight men and five women; mean age 67.08 years, range 38-95) with RCC and RVT associated or not with IVC thrombosis underwent implantation of a retrievable suprarenal IVC filter. All patients underwent computed tomography angiography (CTA), which documented RVT and in some cases its extension to the IVC. The level of IVC involvement by the neoplastic thrombus was evaluated on the basis of the Oto classification. Cavography was performed before and after filter implantation. Surgical resection of RCC was performed in all patients. A CTA scan was performed 1 week before filter removal. RESULTS: The procedure had 100% feasibility. All filters were correctly deployed in the suprarenal tract of the IVC. There was no evidence of peri-or postprocedural complications. All patients were monitored for clinical symptoms of pulmonary embolism (PE). There was no evidence of PE in the 30 days after the procedure. All suprarenal IVC filters were removed from 30 to 60 days after surgery. CONCLUSIONS: Implantation of a temporary suprarenal IVC filter is an additional and feasible procedure that can prevent immediate and perioperative PE.

Predictors of clinical efficacy of 'Ablate and Pace' therapy in patients with permanent atrial fibrillation.

OBJECTIVE: To evaluate the 2-year clinical improvement after 'Ablate and Pace' therapy and to identify the variables able to influence the efficacy of this therapy in patients with permanent atrial fibrillation (AF). Design Prospective multicentre observational study. Setting Cardiology departments of 19 general hospitals in Italy, Spain and Greece. PATIENTS: 171 patients with drug-refractory severely symptomatic permanent AF considered for AV junction ablation. Interventions Patients underwent AV junction ablation, received a right ventricular (RV) pacing or echo-guided cardiac resynchronisation (CRT) pacing and were followed-up to 24 months. Main outcome measures Non-responders to Ablate and Pace therapy were defined those patients who, during the follow-up period had clinical failure (defined as death or hospitalisation due to heart failure, or worsening heart failure) or showed no improvement in their clinical condition. RESULTS: Responders were 63% of RV-paced patients and 83% of CRT-paced patients. Another 27% showed no clinical improvement (7%) or worsened (20%) (non-responders group). On multivariable Cox regression analysis, CRT mode and echo-optimised CRT were the only independent protective factors against non-response (HR=0.24, 95% CI 0.10-0.58, p=0.001 and HR=0.22, 95% CI 0.07-0.77, p=0.018 respectively). On comparing freedom from non-response, a trend in favour of echo-optimised CRT versus simultaneous biventricular pacing (p=0.077) was seen. CONCLUSIONS: In patients affected by severely symptomatic permanent AF, Ablate and Pace therapy yielded a clinical benefit in 63% of RV-paced patients and 83% of CRT-paced patients. CRT pacing and echo-optimised CRT were the only independent predictor of clinical benefit.

Quantitative evaluation on [9°Y] DOTATOC PET and SPECT imaging by phantom acquisitions and clinical applications in locoregional and systemic treatments.

AIM: The aim of this paper was to compare [9°Y]-PET and SPECT imaging quantification for dosimetric applications in targeted radionuclide therapy. METHODS: Imaging studies were carried out by SPECT-CT and PET equipment performing phantom tests first. [9°Y]-SPECT and PET scans were compared in terms of sensitivity, minimum detectable activity concentration, recovery coefficients (RCs) and system spatial resolution (FWHM). Quantitative evaluations by PET and SPECT acquisitions were then assessed in patients who received therapeutic activity of [9°Y]-DOTATOC directly injected into the surgical cavity by locoregional route in glioma treatment and by systemic route in neuroendocrine tumour patients who underwent intravenous infusion. Finally 3D-dose distributions by SPECT and PET images were obtained. RESULTS: Sensitivity was proven to be about fivefold higher for SPECT than for PET. To obtain a good-quality PET imaging, the minimum detectable activity concentration was determined to be equal to 1 MBq/mL compared with 0.05 MBq/mL that was sufficient to assess adequate SPECT imaging. RCs were 100% for volume ≥ 25.5 mL for PET and ≥ 110 mL for SPECT. FWHM was 7 mm for PET and 19 mm for SPECT scans. With regard to locoregional therapy, excellent imaging was obtained with both PET and SPECT. On the contrary, systemic administration did not permit us to obtain suitable PET imaging. PET and SPECT images were affected by considerable noise, whose influence is much more important in the quantitative evaluation of dose volume histograms rather than in the visual interpretation of images. CONCLUSION: [9°Y]-activity quantification is feasible by SPECT and PET imaging. For clinical applications, SPECT-CT is the best technique for visualizing the radiopharmaceuticals following systemic infusion, while both SPECT and PET scans are effective in analyzing locoregional distribution. Nevertheless PET study demonstrates the best spatial definition.