Medical versus neurosurgical treatment in ICH patients: a single center experience.

BACKGROUND AND AIMS: The effect of surgical treatment for spontaneous intracerebral hemorrhage (ICH) remains uncertain. We conducted an observational retrospective cohort study on supra-centimeter spontaneous ICH treated with either neurosurgical or conservative management. The baseline demographics and risk factors were correlated with in-hospital mortality and 3 and 6-month survival rates stratified by management. METHODS: We included all patients with evidence of spontaneous ICH > 1 cm detected by CT and admitted between august 2020 and march 2021 to the "SMM" Hospital in Perugia. RESULTS: Onehundredandtwentytwo patients were included in the study, and 45% (n.55) were surgically treated. The mean age was 71.9 ± 15.3, and 61% (n.75) were males. Intra-hospital mortality ended up being 31% (n.38), 3 months-survival was 63% (n.77) and 6 months-survival was 60% (n.73). From the multivariate analysis of the surgical patients versus medical patient, we observed that the surgical patients were younger (67.5 ± 14.9 vs 75.5 ± 14.7 y; OR 0.87; Cl 95% 0.85-0.94; p 0.001), with greater ICH volume at the onset (61 ± 39.4 cc vs 51 ± 64 cc; OR 1.03; Cl 95% 1.005-1.07; p 0.05), more midline shift (7.61 ± 5.54 mm vs 4.09 ± 5.88 mm; OR 1.37; Cl 95% 1.045-1.79; p 0.023), and a higher ICH score (3 vs 2 mean ICH score; OR 21.12; Cl 95% 2.6-170.6; p 0.004). Intra-hospital mortality in the surgical group and in the conservative treatment group was respectively 33% vs 30%, 3 month-survival was 64% vs 63% and 6 month- survival were 60% in both groups. CONCLUSIONS: Our patient cohort shows no overall benefit from surgery over conservative treatment, but surgical patients were younger and had larger ICH volume.

Not all sales performance is created equal: personality and interpersonal traits in inbound and outbound marketing activities.

A long tradition of research has shown that personality traits, such as extraversion and agreeableness, and interpersonal constructs better predict job performance with a tacit but not explicit distinction in sales marketing activities. In this contribution, we aim to understand the role of job-related and interest data, interpersonal, and personality traits in affecting either inbound or outbound marketing activities and the overall sales performance. An original questionnaire integrates the interpersonal traits and personality factors reported in the literature in sales marketing activities (independent variables). The results were matched with the individual job-related and interest data (control variables) and sales performance (criterion variables) - expressed as the total number of closed contracts over the inbound/outbound related contacts of employees with responsibility in marketing activities for a large banking group. We are able to identify the relevant predictors of sales performance by creating full binary trees using control and independent variables in conditional inference forests and variable importance index measures. Higher performers in either inbound or outbound marketing activities rely on distinct personality sub-traits, which have fundamentally essential implications for interpersonal functioning, and personal data when agreeableness is central to the ability to function effectively in the interpersonal realm of sales activity.

Detection of Low-Molecular-Weight Mast Cell-Activating Factors in Serum From Patients With Chronic Spontaneous Urticaria.

BACKGROUND AND OBJECTIVES: Functionally active autoantibodies to IgE and to the high-affinity IgE receptor (FcεRI) can be detected in serum in about 40% of patients with chronic spontaneous urticaria (CSU). Recent studies showed that serum from patients with CSU can induce activation of mast cells, irrespective of whether they carry high-affinity IgE receptors. To evaluate mast cell activation induced by factors in the serum of CSU patients with a molecular weight lower than that of autoantibodies. METHODS: Eight CSU patients and 5 healthy controls were evaluated. Whole serum and serum fractionated at 100, 50, and 30 kDa were used to stimulate in vitro LAD2 mast cells. The enzymatic activity of ß-hexosaminidase was evaluated in supernatants and cell pellets as a measure of mast cell degranulation. RESULTS: Mean (SEM) release of mast cell ß-hexosaminidase induced by whole serum from CSU patients was higher than that induced by serum from the healthy controls (14.4 [2.7%] vs 5.1 [2.4%]; P=.027). In addition, serum fractions below 100 kDa and below 50 kDa from CSU patients induced mast cell degranulation that was significantly higher than that induced by the corresponding fractions in sera from healthy controls (10.2% [1.4%] vs 3.8% [1.9%] [P=.024] and 10.1% [1.2%] vs 3.9% [1.7%] [P=.012], respectively). In 4 CSU patients, we evaluated serum fractions <30 kDa, which retained their capacity to activate mast cells (11.0% [0.7%]). CONCLUSIONS: This study shows that sera from CSU patients may contain low-molecular-weight mast cell-activating factors other than autoantibodies. These factors could be an additional mechanism contributing to the pathogenesis of CSU.

Detection of low-molecular-weight mast cell-activating factors in serum from patients with chronic spontaneous urticaria

Background: Functionally active autoantibodies to IgE and to the high-affinity IgE receptor (FcεRI) can be detected in serum in about 40% of patients with chronic spontaneous urticaria (CSU). Recent studies showed that serum from patients with CSU can induce activation of mast cells, irrespective of whether they carry high-affinity IgE receptors. Objective: To evaluate mast cell activation induced by factors in the serum of CSU patients with a molecular weight lower than that of autoantibodies. Methods: Eight CSU patients and 5 healthy controls were evaluated. Whole serum and serum fractionated at 100, 50, and 30 kDa were used to stimulate in vitro LAD2 mast cells. The enzymatic activity of β-hexosaminidase was evaluated in supernatants and cell pellets as a measure of mast cell degranulation. Results: Mean (SEM) release of mast cell β-hexosaminidase induced by whole serum from CSU patients was higher than that induced by serum from the healthy controls (14.4 [2.7%] vs 5.1 [2.4%]; P =.027). In addition, serum fractions below 100 kDa and below 50 kDa from CSU patients induced mast cell degranulation that was significantly higher than that induced by the corresponding fractions in sera from healthy controls (10.2% [1.4%] vs 3.8% [1.9%] [P=.024] and 10.1% [1.2%] vs 3.9% [1.7%] [P=.012], respectively). In 4 CSU patients, we evaluated serum fractions <30 kDa, which retained their capacity to activate mast cells (11.0% [0.7%]). Conclusions: This study shows that sera from CSU patients may contain low-molecular-weight mast cell-activating factors other than autoantibodies. These factors could be an additional mechanism contributing to the pathogenesis of CSU (AU)

Introducción: Los autoanticuerpos IgE funcionalmente activos y los receptores de alta afinidad para la IgE (FcεRI) pueden ser detectados n el suero de aproximadamente un 40% de los pacientes con urticaria crónica espontánea (UCE). Estudios recientes muestran que el uero de estos pacientes puede inducir activación de mastocitos con o sin receptores de alta afinidad para la IgE. Objetivo: El objetivo de este estudio fue evaluar la actividad de los factores séricos de los sueros de pacientes con UCE con un peso molecular inferior al de los autoanticuerpos. Métodos: Para ello se estudiaron 8 pacientes con UCE y 5 controles sanos. El suero completo de cada uno de ellos y el fraccionado a 100,50 y 30 kDA se utilizó para estimular in vitro mastocitos LAD2. La actividad enzimática de la β-hexosaminidasa se determinó en los sobrenadantes y en el botón celular con el fin de cuantificar la degranulación mastocitaria. Resultados: En cuanto a los resultados obtenidos se observó una liberación de β-hexosaminidasa mastocitaria inducida por los sueros completos de los pacientes con UCE (14,4±2,7%, media ± EE de la media) significativamente mayor que la inducida por sueros de controles sanos (5,1±2,4%; p=0,027). Así mismo, las fracciones séricas inferiores a 100 kDa e inferiores a 50 kDa de los pacientes con UCE indujeron degranulación mastocitaria significativamente superior a la inducida por las fracciones correspondientes de sueros controles (10,2±1,4% vs 3,8±1,9% [p=0,024] and 10,1±1,2% vs 3,9±1,7% [p=0,012], respectivamente). En 4 pacientes con UCE observamos que las fracciones inferiores a 30 kDa mantenían la capacidad de activar a los mastocitos (11,0±0,7%). Conclusiones: En conclusión, este estudio muestra que el suero de los pacientes con UCE puede contener factores de bajo peso molecular diferentes a los autoanticuerpos que son capaces de activar a los mastocitos. Este hallazgo podría contribuir a conocer los mecanismos de la patogénesis de la UCE (AU)

Tanshinone VI inhibits the expression of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1.

This study investigated the possible antitumor mechanisms of action of Tanshinone VI, one of the components of Salvia miltiorrhiza Bunge, which is used in traditional Chinese herbal medicine. To this end, the expression of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1), were evaluated in-vitroin tumor necrosis factor-alpha (TNF-alpha)-stimulated endothelial cells, with, or without the addition of Tanshinone VI (10, 20, 30, or 40 mM) in the culture medium; the effects of Tanshinone VI on angiogenesis was also evaluated with an epithelial cell tube formation assay and its toxicity was evaluated with a colorimetric (MTT) cell viability assay. The results showed that the up-regulation of ICAM-1 and VCAM-1 induced by TNF-alpha was dose-dependently inhibited by Tanshinone VI, with restoration of control levels at the dose of 40 mM; Tanshinone VI also had a remarkable anti-angiogenesis effect, already at the dose of 10 mM, while none of the doses tested had significant effects on cell viability. These results indicate that the antitumor properties of Tanshinone VI can be ascribed to the inhibition of cell adhesion, due to blockage of the up-regulation of cell adhesion molecules, with the consequent inhibition of metastases formation and/or angiogenesis. The lack of toxic effects at the dosage used makes Tanshinone VI a good candidate for its therapeutic use in humans.

Collapse of granular-liquid mixtures over rigid, inclined beds.

This work deals with the propagation of granular-liquid waves over rigid beds, originated by the sudden removal of a sluice gate in a rectangular, inclined flume. In particular, we experimentally investigate the role of the initial volume ratio of granular material-monodispersed plastic cylinders-to water, the flume width, and the bed roughness on the time evolution of the granular front. Due to the presence of the interstitial liquid, we observed previously unreported types of collapse: (i) discontinuous flows, where the granular material stops after an initial spreading, and then flows again when the liquid, initially slower than the particles, reaches the front and remobilizes it; (ii) flows evolving into uniformly progressive waves at an angle of inclination of the flume well below the angle of repose of the dry granular material. We also noticed an unusual influence of the lateral confinement on the wave propagation. Indeed, the constant front velocity in the uniformly progressive state decreases when the channel width increases. We claim that the latter observation and the presence of discontinuous flows, strongly support the idea that only two-phase, stratified mathematical models can predict the behavior of unsteady, granular-liquid mixtures at high concentration, such as debris flows.

The complement system at the embryo implantation site: friend or foe?

An inflammatory-like process and vascular remodeling represent the main changes that occur in decidua in the early phase of pregnancy. These changes are partly induced by trophoblast cells that colonize the decidua and are also contributed by the complement system, which can easily be activated as a result of tissue remodeling. Local control by several complement regulators including surface-bound and soluble molecules is critical to prevent complement-mediated tissue damage in normal pregnancy. C7 expressed on the endothelial cells (ECs) surface has been recognized as a novel complement regulator involved in the control of the proinflammatory effect of the terminal complement complex. The protective role of placental complement regulators in pregnancy is underscored by the recent finding of an association of preeclampsia with mutations in the genes encoding for some of these proteins. Complement components produced at feto-maternal interface serve an important function in placental development. C1q synthesized by decidual ECs and expressed on the cell surface is particularly important in this regard because it acts as a molecular bridge between endovascular trophoblast and ECs. C1q is also produced by extravillous trophoblast and is used to favor trophoblast migration through the decidua. Defective expression of C1q by trophoblast is associated with impaired trophoblast invasion of decidua and may have important implications in pregnancy disorders such as preeclampsia characterized by reduced vascular remodeling.

Mast cells are critically involved in serum-mediated vascular leakage in chronic urticaria beyond high-affinity IgE receptor stimulation.

BACKGROUND: Chronic urticaria (CU) is one of the most common skin disorders whose pathogenic mechanisms are not fully clarified. Autoimmune aetiology can be ascribed to 45% of patients with CU, and basophil histamine release is positive in 40% of cases. Our aim was to use a novel approach to evaluate the serum permeabilizing effect to identify the mediators of endothelial cell (EC) leakage and to define the role of mast cells (MCs) in the process. METHODS: Permeabilizing activity of sera from 19 patients with CU and 11 healthy blood donors was evaluated by measuring serum-induced degranulation of two MC lines, expressing (LAD2) or lacking (HMC-1) the IgE receptor. Mast cell supernatant (SN) was then incubated with an EC monolayer, and endothelial permeability was evaluated by Fluorescein isothiocyanate-bovine serum albumin leakage in a transwell system. RESULTS: All 19 patient sera failed to induce direct EC leakage, but 15/19 and 17/19 promoted degranulation of HMC-1 and LAD2, respectively. Interestingly, 85% of autologous serum skin test-negative sera were able to cause MC degranulation. Also, 17/19 SNs from HMC-1 and all SNs from LAD2 incubated with CU sera increased endothelial permeability. Endothelial cell leakage remained unchanged after Ig depletion and was prevented by antihistamine, platelet-activating factor or leukotriene antagonist. CONCLUSIONS: Our study shows that CU sera are able to degranulate MCs through an IgE- and IgG-independent mechanism. The nature of histamine-releasing factors involved is still unclear, but our finding opens new ways to the understanding of the pathogenesis of CU, particularly in patients not showing circulating autoantibodies to FcεRI or IgE.

New topics in bradykinin research.

Bradykinin has been implicated to contribute to allergic inflammation and the pathogenesis of allergic conditions. It binds to endothelial B(1) and B(2) receptors and exerts potent pharmacological and physiological effects, notably, decreased blood pressure, increased vascular permeability and the promotion of classical symptoms of inflammation such as vasodilation, hyperthermia, oedema and pain. Towards potential clinical benefit, bradykinin has also been shown to exert potent antithrombogenic, antiproliferative and antifibrogenic effects. The development of pharmacologically active substances, such as bradykinin receptor blockers, opens up new therapeutic options that require further research into bradykinin. This review presents current understanding surrounding the role of bradykinin in nonallergic angioedema and other conditions seen by allergists and emergency physicians, and its potential role as a therapeutic target.

Test of "crab-waist" collisions at the DAPhiNE Phi factory.

The electron-positron collider DAPhiNE, the Italian Phi factory, has been recently upgraded in order to implement an innovative collision scheme based on large crossing angle, small beam sizes at the crossing point, and compensation of beam-beam interaction by means of sextupole pairs creating a "crab-waist" configuration in the interaction region. Experimental tests of the novel scheme exhibited an increase by a factor of 3 in the peak luminosity of the collider with respect to the performances reached before the upgrade. In this Letter we present the new collision scheme, discuss its advantages, describe the hardware modifications realized for the upgrade, and report the results of the experimental tests carried out during commissioning of the machine in the new configuration and standard operation for the users.

Mannose binding lectin and C3 act as recognition molecules for infectious agents in the vagina.

In our study we examined the early complement components in patients with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and in healthy controls. The levels of C1q, mannose-binding lectin (MBL) and C3 were measured by ELISA in the cervicovaginal lavage (CVL) from gynaecological patients and controls. No significant differences were observed in the levels of these proteins in the three study groups. Immunofluorescence analysis of the clue cells and Candida hyphae from BV and VVC patients for surface-bound complement components showed the presence of C3, while C1q was undetectable. MBL was revealed on clue cells but not on Candida. Binding of MBL to Candida, grown or cytocentrifuged from the CVL of VVC patients, was found to be pH dependent and occurred between pH 4.5 and pH 5.5. In conclusion, we demonstrated that MBL and C3 present in the vaginal cavity act as recognition molecules for infectious agents that colonize the cervicovaginal mucosa. Our finding that MBL, but not C1q, binds to bacteria and fungi in vagina suggests that the lectin and classical pathways of complement activation may play a different role in immune defence in the female genital tract.

Feto-maternal immune interaction at the placental level.

A special interaction is established during pregnancy between the maternal immune system and fetal cells to allow the survival and the normal growth of the fetus. Fetal cells expressing paternal alloantigens are not recognized as foreign by the mother because of an efficient anatomic barrier and a local immunosuppression determined by the interplay of locally produced cytokines, biologically active molecules and hormones. A special balance between TH1 and TH2 lymphocytes has also been observed at the feto-maternal barrier that contribute to control the immune response at this level. An important role is played by trophoblast cells that act as a physical barrier forming a continuous layer and exert immunomodulatory function. Trophoblast cells have also been shown to express regulators of the complement system and to downregulate the expression of HLA antigens. Dysfunction of these cells leads to morphological and functional alterations of the feto-maternal barrier as well as to hormonal and immune imbalance and may contribute to the development of pathologic conditions of pregnancy, such as recurrent spontaneous abortions. Efforts are still needed to better understand the physiology of the feto-maternal interaction and the pathogenetic mechanisms responsible for tissue damage in pathologic conditions of pregnancy.

[Earthenware and lead poisoning. Description of a case]. / Recipienti di terracotta e intossicazione da piombo. Descrizione di un caso.

A case of acute lead poisoning caused by drinking wine that had been kept in a decorative amphora is reported. Chomico-physical analysis of the internal surface of the recipient evidenced a layer of lead paint very soluble in wine. It is hoped that this report will draw the attention of the practising physician and Preventive Medicine Departments to this unusual cause of saturnism. The craft production of earthenware recipients that have been inadequately glazed and their improper use as containers of drings of foods could be commoner than might be thought on the basis of the sporadic reporting of such cases of lead poisoning.