Evaluation of fetal cardiac function in pregnancies with well-controlled gestational diabetes.

OBJECTIVE: To evaluate fetal ventricular diastolic function in pregnancies of women with gestational diabetes (GD), to determine whether minimal anomalies of glucose metabolism may influence fetal cardiac function. STUDY DESIGN: Fetal ventricular filling time was measured by transabdominal ultrasound in singleton pregnancies between 34 and 37 weeks of gestation. We used a measurement which consists in the ratio between the diastolic time and the whole cardiac cycle time. RESULTS: The study included 35 women with a GD and 217 non-diabetic. Right ventricular filling time (RVFT) was significantly lower in the GD group (mean of RVFT = 39.2 ± 4.4 vs 43.6 ± 4.6; p < 0.01). Likewise, left ventricular filling time (LVFT) was shorter in the GD group compared to the non-GD group, though the difference was not significant (mean of LVFT = 43.6 ± 4.6 vs 44.6 ± 5.5; p = 0.33). CONCLUSIONS: Fetal right cardiac function is altered also in pregnancies where gestational diabetes is well controlled.

Diabetes mellitus and the risk of bladder cancer: an Italian case­control study.

BACKGROUND: Diabetes mellitus has been associated with an increased risk of bladder cancer, although the evidence is still open to discussion. METHODS: We examined this association using data from a multicentre Italian case­control study, conducted between 2003 and 2014 on 690 bladder cancer cases and 665 frequency-matched hospital controls. Odds ratios (ORs) for diabetes were estimated by unconditional multiple logistic regression models, after allowance for major known risk factors for bladder cancer. RESULTS: One hundred and twelve (16.2%) cases and 57 (8.6%) controls reported a diagnosis of diabetes mellitus, corresponding to a multivariate OR of 2.09 (95% confidence interval (CI): 1.46­3.01). Bladder cancer risk increased with duration of diabetes (OR 1.92 for 1­ <5 years, 1.63 for 5­ <10 years, 2.39 for 10­ <15 years, and 2.58 for ≥15 years). The increased risk of bladder cancer was consistent in strata of age and education, whereas it was somewhat lower (although not significantly) in women (OR 1.18), in never (OR 1.31) and current (OR 1.42) smokers, and in subjects with a body mass index <25 kg m(-2) (OR 1.48). CONCLUSION: The present study provides further support of a role of diabetes in bladder cancer aetiology, although some residual confounding by tobacco, body mass index, or other unmeasured covariates may partly explain the association observed.

Viral and inflammatory markers in cerebrospinal fluid of patients with HIV-1-associated neurocognitive impairment during antiretroviral treatment switch.

OBJECTIVES: The aim of the study was to evaluate HIV-1 viral load (VL) and inflammatory markers in cerebrospinal fluid (CSF) and neurocognitive performance in patients with neurocognitive impairment (NCI) while they were receiving tenofovir (TDF)/ emtricitabine (FTC)/efavirenz (EFV) and after switching to a regimen with enhanced central nervous system (CNS) penetrability. METHODS: This was a prospective, single-arm pilot study. HIV-1-infected patients with plasma viral suppression and HIV-associated NCI on a regimen including TDF/FTC/EFV were switched to abacavir (ABC)/lamivudine (3TC)/maraviroc (MVC). The Global Deficit Score (GDS) was used to score cognitive function at baseline and 48 weeks after treatment switch. Both CSF and blood samples were taken at baseline and between weeks 24 and 36 after switching. HIV-1 RNA in plasma and CSF was determined by quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). Inflammatory biomarkers in CSF were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: A total of 71 patients receiving TDF/FTC/EFV were screened. Twelve of them (17%) had documented NCI, lacked the human leucocyte antigen (HLA)-B*57:01 haplotype and harboured Chemokine Receptor Type-5 (CCR5)-tropic virus. Eight patients had detectable HIV-1 RNA (between 2.7 and 41.6 HIV-1 RNA copies/mL) in CSF at baseline. All participants had elevated levels of neopterin and Monocyte Chemoattractant Protein 1 (MCP-1) in CSF at baseline. Eight out of 12 patients completed their follow-up assessment after treatment switch. The GDS decreased from 0.55 to 0.4 (P = 0.085). Median HIV-1 RNA in CSF decreased from 3.49 to 2.20 (P = 0.23). Among the inflammation markers in CSF, tumour necrosis factor (TNF)-α decreased significantly from median 0.51 to 0.35 pg/mL (P = 0.027), showing a correlation with the changes in neopterin, interferon (IFN)-γ and interleukin (IL)-6. CONCLUSIONS: Most patients with NCI receiving TDF/FTC/EFV had low-level viraemia and/or increased inflammatory markers in CSF. Treatment switching to an MVC-containing regimen with better CNS penetration resulted in a trend towards improvement in neurocognitive status and reduced TNF-α concentrations in CSF.

Testing the near field/far field model performance for prediction of particulate matter emissions in a paint factory.

A Near Field/Far Field (NF/FF) model is a well-accepted tool for precautionary exposure assessment but its capability to estimate particulate matter (PM) concentrations is not well studied. The main concern is related to emission source characterization which is not as well defined for PM emitters compared to e.g. for solvents. One way to characterize PM emission source strength is by using the material dustiness index which is scaled to correspond to industrial use by using modifying factors, such as handling energy factors. In this study we investigate how well the NF/FF model predicts PM concentration levels in a paint factory. PM concentration levels were measured during big bag and small bag powder pouring. Rotating drum dustiness indices were determined for the specific powders used and applied in the NF/FF model to predict mass concentrations. Modeled process specific concentration levels were adjusted to be similar to the measured concentration levels by adjusting the handling energy factor. The handling energy factors were found to vary considerably depending on the material and process even-though they have the same values as modifying factors in the exposure models. This suggests that the PM source characteristics and process-specific handling energies should be studied in more detail to improve the model-based exposure assessment.

Red meat and cancer risk in a network of case-control studies focusing on cooking practices.

BACKGROUND: Consumption of red meat has been related to increased risk of several cancers. Cooking methods could modify the magnitude of this association, as production of chemicals depends on the temperature and duration of cooking. METHODS: We analyzed data from a network of case-control studies conducted in Italy and Switzerland between 1991 and 2009. The studies included 1465 oral and pharyngeal, 198 nasopharyngeal, 851 laryngeal, 505 esophageal, 230 stomach, 1463 colon, 927 rectal, 326 pancreatic, 3034 breast, 454 endometrial, 1031 ovarian, 1294 prostate and 767 renal cancer cases. Controls included 11 656 patients admitted for acute, non-neoplastic conditions. Odds ratios (ORs) and confidence intervals (CIs) were estimated by multiple logistic regression models, adjusted for known confounding factors. RESULTS: Daily intake of red meat was significantly associated with the risk of cancer of the oral cavity and pharynx (OR for increase of 50 g/day = 1.38; 95% CI: 1.26-1.52), nasopharynx (OR = 1.29; 95% CI: 1.04-1.60), larynx (OR = 1.46; 95% CI: 1.30-1.64), esophagus (OR = 1.46; 95% CI: 1.23-1.72), colon (OR = 1.17; 95% CI: 1.08-1.26), rectum (OR = 1.22; 95% CI:1.11-1.33), pancreas (OR = 1.51; 95% CI: 1.25-1.82), breast (OR = 1.12; 95% CI: 1.04-1.19), endometrium (OR = 1.30; 95% CI: 1.10-1.55) and ovary (OR = 1.29; 95% CI: 1.16-1.43). Fried meat was associated with a higher risk of cancer of oral cavity and pharynx (OR = 2.80; 95% CI: 2.02-3.89) and esophagus (OR = 4.52; 95% CI: 2.50-8.18). Risk of prostate cancer increased for meat cooked by roasting/grilling (OR = 1.31; 95% CI: 1.12-1.54). No heterogeneity according to cooking methods emerged for other cancers. Nonetheless, significant associations with boiled/stewed meat also emerged for cancer of the nasopharynx (OR = 1.97; 95% CI: 1.30-3.00) and stomach (OR = 1.86; 95% CI: 1.20-2.87). CONCLUSIONS: Our analysis confirmed red meat consumption as a risk factor for several cancer sites, with a limited impact of cooking methods. These findings, thus, call for a limitation of its consumption in populations of Western countries.

Effects of low-protein diets and rumen-protected conjugated linoleic acid on production and carcass traits of growing double-muscled Piemontese bulls.

The effects of low-protein (LP) diets and rumen-protected CLA on DMI, ADG, carcass traits, and health status of double-muscled Piemontese young bulls were investigated. Forty-eight bull calves (BW = 237 ± 24 kg) were divided in 4 groups and housed in 12 fully slatted pens. Bulls were fed 2 diets differing in CP density [high-protein (HP) diet: CP = 145 g/kg of DM; LP diet: CP = 108 g/kg of DM] and top-dressed with 80 g/d of rumen-protected CLA or 65 g/d of hydrogenated soybean oil. Orts were collected weekly and feed intake was estimated on a pen basis, with 3 replicated pens for each treatment. Each bull was weighed monthly and examined for alterations of the locomotion system by using the locomotion score as an index of lameness and by counting the number of swollen joints. Carcass quality traits were measured at slaughter, after a feeding period of 332 d. Compared with HP, LP reduced ADG only during the first 4 mo of the trial (1.30 vs. 1.53 kg/d, P = 0.003). However, because of compensatory growth, over the whole trial, no significant effects attributable to CP or to additive were found on final BW (668 kg), ADG (1.19 kg/d), DMI (8.50 or 86 g/d per kg of BW(0.75)), dressing percentage (67.3%), carcass conformation (5.2 points), and carcass fat covering (1.87 points). Feed efficiency was affected by a CP × additive interaction (P = 0.030), with CLA improving feed efficiency when added to the LP diets, whereas feed efficiency was reduced with the HP diets. The addition of both LP and CLA reduced the number of bulls presenting swollen joints (P = 0.001), and LP improved the locomotion score (P = 0.021) compared with HP. It was concluded that 10.8 g/kg of CP density in the diet is sufficient for double-muscled Piemontese bulls. The reduction in CP density from 145 to 108 g/kg of DM, in addition to reducing the feeding cost, allows a strong reduction in N consumption without negative consequences on growth performance and carcass traits.

[The role of the hospital social work in the integration of health and social services. Survey on the social work at "Policlinico Umberto I Hospital"]. / Il ruolo del Servizio sociale ospedaliero nell'integrazione dei servizi socio-sanitari. Indagine conoscitiva presso il Servizio sociale dell'Azienda Policlinico Umberto I di Roma.

The research deals with the work done by the Social Services of the "Policlinico Umberto I of Rome" through the analysis of 814 social records and the data taken from them. These records refer to all the cases treated by the Social Work in the year 2008 and these cases represent 1.9% of the total admissions (regular admissions, DH admissions, infectious diseases A and B, DH admissions for the prevention and cure of liver damages caused by alcohol). The original objective was that of doing an in depth research of the activities done by the hospital's Social Services, through an analysis of the data, with the goal of underlining which role it has taken in the connection and the integration of the local, public Social health services and belonging to the third sector. The study was articulated in two essential phases: The first was collecting the data, taken from the social records that were present in the paper archive of the services, divided into three specific sectors, personal data, social data and the operations preformed. The second phase was elaborating the data during which the data obtained was organized in survey tables and then calculated statistically. The research shows how the relationship operation/execution time configures the activity of the hospital's Social Work as focused on emergency situations, and nevertheless as the hospital services takes the role of linking the hospital and the social health services system for the continuity of the social health welfare of the discharged patient.

PAP1 signaling involves MAPK signal transduction.

Pancreatitis-associated protein 1 (PAP1) belongs to the Reg family of secretory proteins. Several important biological roles have been attributed to PAP1 but the signaling pathways activated by this protein remain only partially understood. Here, we describe the intracellular pathways triggered by PAP1 in a pancreatic acinar cell line. Taking advantage of the fact that PAP1 induces its own transcription, we performed ChIP assays to analyze the recruitment of transcriptional factors on its promoter. Our results show that PAP1 increased the transactivation activity of pap1 and the binding on its promoter of the nuclear factors C/EBPbeta, P-CREB, P-ELK1, EGR1, STAT3, and ETS2, which are downstream targets of MAPK signaling. p44/42, p38, and JNK MAPKs activity increased after PAP1 treatment. In addition, pharmacological inhibition of these kinases markedly inhibited the induction of pap1 mRNA. Taken together, these results indicated that the mechanism of PAP1 action involves the activation of the MAPK superfamily.

Determination of isoprene and alpha-/beta-pinene oxidation products in boreal forest aerosols from Hyytiälä, Finland: diel variations and possible link with particle formation events.

Biogenic volatile organic compounds (VOCs), such as isoprene and alpha-/beta-pinene, are photo-oxidized in the atmosphere to non-volatile species resulting in secondary organic aerosol (SOA). The goal of this study was to examine time trends and diel variations of oxidation products of isoprene and alpha-/beta-pinene in order to investigate whether they are linked with meteorological parameters or trace gases. Separate day-night aerosol samples (PM(1)) were collected in a Scots pine dominated forest in southern Finland during 28 July-11 August 2005 and analyzed with gas chromatography/mass spectrometry (GC/MS). In addition, inorganic trace gases (SO(2), CO, NO(x), and O(3)), meteorological parameters, and the particle number concentration were monitored. The median total concentration of terpenoic acids (i.e., pinic acid, norpinic acid, and two novel compounds, 3-hydroxyglutaric acid and 2-hydroxy-4-isopropyladipic acid) was 65 ng m(-3), while that of isoprene oxidation products (i.e., 2-methyltetrols and C(5) alkene triols) was 17.2 ng m(-3). The 2-methyltetrols exhibited day/night variations with maxima during day-time, while alpha-/beta-pinene oxidation products did not show any diel variation. The sampling period was marked by a relatively high condensation sink, caused by pre-existing aerosol particles, and no nucleation events. In general, the concentration trends of the SOA compounds reflected those of the inorganic trace gases, meteorological parameters, and condensation sink. Both the isoprene and alpha-/beta-pinene SOA products were strongly influenced by SO(2), which is consistent with earlier reports that acidity plays a role in SOA formation. The results support previous proposals that oxygenated VOCs contribute to particle growth processes above boreal forest.

Microwave-assisted extraction of active pharmaceutical ingredient from solid dosage forms.

The microwave assisted extraction (MAE) technique has been evaluated for the extraction of active pharmaceutical ingredients (API) from various solid dosage forms. Using immediate release tablets of Compound A as a model, optimization of the extraction method with regards to extraction solvent composition, extraction time and temperature was briefly discussed. Complete recovery of Compound A was achieved when samples were extracted using acetonitrile as the extraction solvent under microwave heating at a constant cell temperature of 50 degrees C for 5 min. The optimized MAE method was applied for content uniformity (single tablet extraction) and potency (multiple tablets extraction) assays of release and stability samples of two products of Compound A (5 and 25mg dose strength) stored at various conditions. To further demonstrate the applicability of MAE, the instrumental extraction conditions (50 degrees C for 5 min) were adopted for the extraction of montelukast sodium (Singulair) from various solid dosage forms using methanol-water (75:25, v/v) as the extraction solvent. The MAE procedure demonstrated an extraction efficiency of 97.4-101.9% label claim with the greatest RSD at 1.4%. The results compare favorably with 97.6-102.3% label claim with the greatest RSD at 2.9% obtained with validated mechanical extraction procedures. The system is affordable, user-friendly and simple to operate and troubleshoot. Rapid extraction process (7 min/run) along with high throughput capacity (up to 23 samples simultaneously) would lead to reduced cycle time and thus increased productivity.

High natural aerosol loading over boreal forests.

Aerosols play a key role in the radiation balance of the atmosphere. Here, we present evidence that the European boreal region is a substantial source of both aerosol mass and aerosol number. The investigation supplies a straightforward relation between emissions of monoterpenes and gas-to-particle formation over regions substantially lacking in anthropogenic aerosol sources. Our results show that the forest provides an aerosol population of 1000 to 2000 particles of climatically active sizes per cubic centimeter during the late spring to early fall period. This has important implications for radiation budget estimates and relevancy for the evaluation of feedback loops believed to determine our future climate.

Computer-assisted method development and optimization in high-performance liquid chromatography.

This paper reports the use of DryLab, a computer simulation software package, to assist in the development and optimization of a reversed-phase high-performance liquid chromatographic (HPLC) method for the separation of a model drug candidate and its degradation products. Prior to the optimization process, columns with various bonded phases are evaluated for their chromatographic performance using the sample of interest. Simultaneous optimization of two separation variables and the use of resolution maps to predict the optimal conditions are illustrated. Options to optimize column conditions (column length and flow-rate) to further reduce run time are briefly discussed. The accuracy of DryLab-predicted retention times and resolution is compared with experimental values. The DryLab software used in this study provided satisfactory predictions for the selected model, with average errors of less than 3.5 and 11.8% for retention time and resolution, respectively.

Application of pressurized liquid extraction technology to pharmaceutical solid dosage form analysis.

The technique of pressurized liquid extraction has been evaluated for the extraction of active ingredients from pharmaceutical dosage forms using montelukast sodium oral chewable tablets as a model. The extraction method was optimized for the number of extraction cycles, extraction time, extraction solvent composition and temperature. Samples were extracted using two cycles of water for 2 min with a cell temperature of 40 degrees C and a pressure of 1.0 x 10(4) kPa, to disintegrate the tablet, followed by three cycles of methanol for 3 min at 70 degrees C and 1.0 x 10(4) kPa, to solubilize montelukast sodium. The method demonstrated an extraction efficiency of 98.2% of label claim and an RSD of 1.3% (n=10), as compared to 97.6% and an RSD of 0.9% obtained using a validated mechanical extraction method.

[Surgery of abdominal aortic aneurysms in octogenarians. Critical remarks on indications for surgical intervention in different age groups]. / La chirurgia degli aneurismi dell'aorta addominale negli ottuagenari. Riflessioni critiche sulla indicazione all'intervento chirurgico nelle varie fasce d'età.

Following the increased frequency of surgery for aortic abdominal aneurysm, due to increasing population age and to improved surgical and anaesthesiological techniques, results in octogenarians are presented and compared. The analysed data derive from 809 consecutive patients operated between January 1987 and December 1993. These have been divided into three age groups: group A = under 65 years, group B = from 65 to 79, group C = from 80 to 93. For each group surgery has been divided in planned operations (symptomatic and asymptomatic cases) and emergency operations (performed after aneurysm rupture) and results are compared. Surgery has been performed as an emergency in 8.6% of cases of group A, in 18.4% of group B and in 41.3% of cases of group C. Death rate in the three groups was respectively of 1.78%, 1.90% and 4.68% for planned operations and 12.50%, 32.63% and 46.67% for the emergency operations. These data confirm the experience of other Authors and indicate that age factor must not be considered a controindication for planned surgery. The importance of this factor in emergency surgery, the greater frequency of ruptures with increased age and the quality of the results in planned surgery suggest a widening of the indications for surgery: the aneurysm transverse diameter of 5 cm, as a minimal measure for planned surgery, must be reconsidered.

Immunocytologic analysis of nasal cells obtained by nasal lavage: a comparative study with a standard method of cell identification.

For evaluation of two methods of nasal cell identification, cell morphology and immunocytologic analysis, nasal lavage was performed in 16 healthy subjects and 29 patients suffering from rhinitis. Nasal lavage smears were stained with May-Grünwald-Giemsa (MGG), and cells were identified according to their structure as epithelial cells, neutrophils, lymphocytes, eosinophils, and metachromatic cells (basophils and mast cells). Immunocytologic analysis was performed with monoclonal antibodies by the immunoalkaline phosphatase method. The following monoclonal antibodies were used: CK1, EG2, and CD3, which identify epithelial cells, activated eosinophils, and T lymphocytes, respectively; CD15, which recognizes mature granulocytic cells; and CD14, which reacts with monocytes and macrophages. A significant difference was observed between the two methods in the number of identified epithelial cells, in both controls (64.6 +/- 7.8% with MGG, 14.2 +/- 3.5% with CK1 analysis) and patients with rhinitis (56.9 +/- 7.6% with MGG, 18.2 +/- 3.7% with CK1 analysis). In contrast, no significant differences were found in eosinophil and neutrophil counts when the two methods were compared. After nasal allergic provocation, a significant increase in the number of eosinophils was observed with both methods in seven patients with rhinitis. The results of this study indicate that: 1) MGG staining is a useful method to identify the cells obtained by nasal lavage, and 2) immunocytologic analysis with monoclonal antibodies accurately identifies granulocytic cells, while only a low proportion of epithelial cells are detected, probably because anticytokeratin monoclonal antibody reacts only with viable cells.

Speech intelligibility of children with cochlear implants, tactile aids, or hearing aids.

Speech intelligibility was measured in 31 children who used the 3M/House single-channel implant (n = 12), the Nucleus 22-Channel Cochlear Implant System (n = 15), or the Tactaid II + two-channel vibrotactile aid (n = 4). The subjects were divided into subgroups based on age at onset of deafness (early or late). The speech intelligibility of the experimental subjects was compared to that of children who were profoundly hearing impaired who used conventional hearing aids (n = 12) or no sensory aid (n = 2). The subjects with early onset of deafness who received their single- or multichannel cochlear implant before age 10 demonstrated the highest speech intelligibility, whereas subjects who did not receive their device until after age 10 had the poorest speech intelligibility. There was no obvious difference in the speech intelligibility scores of these subjects as a function of type of device (implant or tactile aid). On the average, the postimplant or tactile aid speech intelligibility of the subjects with early onset of deafness was similar to that of hearing aid users with hearing levels between 100 and 110 dB HL and limited hearing in the high frequencies. The speech intelligibility of subjects with late onset of deafness showed marked deterioration after the onset of deafness with relatively large improvements by most subjects after they received a single- or multichannel implant. The one subject with late onset of deafness who used a tactile aid showed no improvement in speech intelligibility.

Photoallergic contact dermatitis. Results of photopatch testing in New York, 1985 to 1990.

BACKGROUND: Over a 6-year period, 187 patients with a history of photosensitivity were photopatch tested using standard techniques. Seventy-six patients were male and 111 were female. Most patients were white (151 patients). Two thirds of the patients were between the ages of 31 and 60 years. OBSERVATION: Testing revealed a total of 63 positive reactions: 14 plain contact, 41 photocontact, and eight combined contact and photocontact in 37 (20%) patients. Careful history taking resulted in a diagnosis of clinically relevant photoallergic contact dermatitis in 54% of these 37 patients or 11% (20) of the total tested. Ten of the relevant responses were due to fragrance ingredients (musk ambrette and 6-methylcoumarin); 18 were due to sunscreen agents (nine to p-aminobenzoic acid and esters, nine to oxybenzone). The fragrance reactions occurred in the early years of the study (1985, 1986, and 1987) while the sunscreen agents accounted for all but two of the 14 positive reactions in the last 3 years of the study (1988, 1989, and 1990). CONCLUSION: These data suggest that the incidence of photoallergy due to fragrances is declining, while reactions to sunscreen agents, in particular oxybenzone, are increasing. This trend may reflect an altered use pattern by the general population for products containing these chemicals.