Comment on: "A novel approach to peatlands as archives of total cumulative spatial pollution loads from atmospheric deposition of airborne elements complementary to EMEP data: Priority pollutants (Pb, Cd, Hg)" by Ewa Miszczak, Sebastian Stefaniak, Adam Michczynski, Eiliv Steinnes and Irena Twardowska.

A recent paper by Miszczak et al. (2020) examines metal contamination of mires in Poland and Norway. The authors conclude that lead (Pb) records in ombrotrophic peatlands cannot be used to reconstruct the chronological history of anthropogenic activities due to post-depositional mobility of the metal. We contest this general conclusion which stands in contrast with a significant body of literature demonstrating that Pb is largely immobile in the vast majority of ombrotrophic peatlands. Our aim is to reaffirm the crucial contribution that peat records have made to our knowledge of atmospheric Pb contamination. In addition, we reiterate the necessity of following established protocols to produce reliable records of anthropogenic Pb contamination in environmental archives.

Heavy metal concentrations in soils as determined by laser-induced breakdown spectroscopy (LIBS), with special emphasis on chromium.

Soil is unanimously considered as one of the most important sink of heavy metals released by human activities. Heavy metal analysis of natural and polluted soils is generally conducted by the use of atomic absorption spectroscopy (AAS) or inductively coupled plasma optical emission spectroscopy (ICP-OES) on adequately obtained soil extracts. Although in recent years the emergent technique of laser-induced breakdown spectroscopy (LIBS) has been applied widely and with increasing success for the qualitative and quantitative analyses of a number of heavy metals in soil matrices with relevant simplification of the conventional methodologies, the technique still requires further confirmation before it can be applied fully successfully in soil analyses. The main objective of this work was to demonstrate that new developments in LIBS technique are able to provide reliable qualitative and quantitative analytical evaluation of several heavy metals in soils, with special focus on the element chromium (Cr), and with reference to the concentrations measured by conventional ICP spectroscopy. The preliminary qualitative LIBS analysis of five soil samples and one sewage sludge sample has allowed the detection of a number of elements including Al, Ca, Cr, Cu, Fe, Mg, Mn, Pb, Si, Ti, V and Zn. Of these, a quantitative analysis was also possible for the elements Cr, Cu, Pb, V and Zn based on the obtained linearity of the calibration curves constructed for each heavy metal, i.e., the proportionality between the intensity of the LIBS emission peaks and the concentration of each heavy metal in the sample measured by ICP. In particular, a triplet of emission lines for Cr could be used for its quantitative measurement. The consistency of experiments made on various samples was supported by the same characteristics of the laser-induced plasma (LIP), i.e., the typical linear distribution confirming the existence of local thermodynamic equilibrium (LTE) condition, and similar excitation temperatures and comparable electron number density measured for all samples. An index of the anthropogenic contribution of Cr in polluted soils was calculated in comparison to a non-polluted reference soil. Thus, the intensity ratios of the emission lines of heavy metal can be used to detect in few minutes the polluted areas for which a more detailed sampling and analysis can be useful.

Variability in As, Ca, Cr, K, Mn, Sr, and Ti concentrations among humic acids isolated from peat using NaOH, Na4P2O7 and NaOH+Na4P2O7 solutions.

Sphagnum peat has been found to efficiently remove heavy metals, oil, detergents, dyes, pesticides and nutrients from contaminated waters since its major constituents, i.e., unesterified polyuronic acids, cellulose, and fulvic and humic acids (HA), show functional groups (e.g., alcohols, aldehydes, carboxylic acids, ketones and phenolic hydroxides) which may adsorb pollutant species. The influence of the extractant on the analytical characteristics of HA is an old but still open topic that should be studied in relation to the nature of the matrix from which they originate. While a number of works have been published on the effects of different reagents on the extraction yields and structural properties of HA from soils, relatively little attention has been devoted to peat HA. In this work, the contents of some major and trace elements (As, Ca, Cr, K, Mn, Sr, and Ti) in five Sphagnum-peat samples and in their corresponding HA fractions isolated using three common extractant solutions, i.e., 0.5M NaOH, 0.1M Na(4)P(2)O(7), and 0.5M NaOH+0.1M Na(4)P(2)O(7), where investigated by X-ray fluorescence spectroscopy. In general, Cr, Mn, and Ti concentrations of bulk peat samples were higher than those of the corresponding HA fractions regardless of the extractant used. Arsenic, Ca, K, and Sr concentrations in the HA fractions were affected by the extraction procedure, although at different extents depending on the extractant utilized. In particular, compared to both NaOH and NaOH+Na(4)P(2)O(7), the Na(4)P(2)O(7) extractant yielded HA generally richer in As, Ca, K, and Sr, and poorer in Ti. These results may be related to both the nature of each HA fraction and the physical and chemical form of each element supplied to the studied bog via atmospheric deposition.

Influence of extractant on quality and trace elements content of peat humic acids.

Among several extractants used to isolate humic acids (HA) from terrestrial environments, sodium hydroxide (NaOH) and sodium pyrophosphate (Na(4)P(2)O(7)) are the most utilized. In order to evaluate the influence of these different extractant solutions on the HA quality and on their trace elements content, HA were isolated from five Sphagnum-peat samples using three different solutions: (a) 0.5M NaOH; (b) 0.1M Na(4)P(2)O(7); (c) 0.5M NaOH+0.1M Na(4)P(2)O(7). The obtained HA have been analyzed with respect to ash content, elemental composition, main atomic ratios and characterized by FT-IR and total luminescence (TL) spectroscopies. In addition, both raw peat and HA have been analyzed using X-ray fluorescence in order to determine the Br, Cu, Fe, Ni, Pb and Zn contents. Results showed that HA extracted with NaOH and NaOH+Na(4)P(2)O(7) are quite similar with respect to ash, elemental contents and spectroscopic characteristics, while Na(4)P(2)O(7) solution, which in general reduces the extraction yield, seems to affect the nature of HA, featuring a more complex and aromatic character. With respect to the contents in the corresponding raw peat samples, the HA fractions were richer in Br, Cu and Ni, regardless of the extractant used, and poorer in Fe, Pb and Zn. Further, Br, Cu, Ni and Zn were more concentrated in HA extracted with Na(4)P(2)O(7) than in those extracted with NaOH and NaOH+Na(4)P(2)O(7), probably because of the greater affinity of these elements for these more aromatic humic molecules.

Prevention of recurrent radicular pain after lumbar disc surgery: a prospective study.

BACKGROUND: Postoperative epidural fibrosis is a major causative factor of low-back pain even if microsurgical techniques are adopted to reduce this phenomenon. To prevent the recurrent radicular pain caused by this problem, we utilized adipose tissue drawn from the same patient; at the end of surgical procedure, the fat was placed around the spinal root or the dural sac. This procedure was evaluated by a prospective, randomised study. METHOD: From 180 patients operated on for lumbar discectomy between January 2000 to December 2001, 74 were enclosed in the study. In 37 patients, the spinal root was covered by autologous fat (group A), in the other 37 (control group, B), this procedure was not adopted. One year after surgery, all the patients were evaluated with clinical and radiological (Magnetic Resonance Imaging) follow-up. Only two patients were lost to follow-up. FINDINGS: 71% of the patients in group A had 100% of clinical and radiological post-operative outcome score; this result was obtained only in 35% of the patients in group B. A clinical score evaluating pain syndrome (from grade 0 to 5) and a radiological score evaluating postoperative fibrosis (from grade 0 to 4) was adopted. Therefore, group A had best outcome as compared to control group. CONCLUSIONS: The authors found a positive effect in the reconstruction of epidural fat with autograft of adipose tissue to prevent postoperative scarring and failed-back syndrome related to postoperative fibrosis.

Does the neuronal plasticity exist in elderly patients? report of an unusual clinical case.

STUDY DESIGN: Case report. OBJECTIVE: To report complete recovery after paraplegia in an elderly patient after removal of meningioma at C7-T1 level. SETTING: Department of Neurosurgery, Reggio Calabria, Italy. METHODS: An 82-year-old lady with 48 months of progressive weakness and numbness was admitted with complete paraplegia lasting 15 days. Investigations (magnetic resonance imaging (MRI)) demonstrated a meningioma at C7-T1. The tumour compressed the extremely thinned spinal cord. MRI after surgery showed no evidence of residual tumour and the spinal cord was of normal dimensions. The patient recovered fully and locomotion was restored. CONCLUSION: Surgical decompression gave an excellent result. The result raises the possibility of neuronal plasticity.

"Approaches and surgical results in the treatment of ventral thoracic meningiomas. Review of our experience with a postero-lateral combined transpedicular-transarticular approach.".

BACKGROUND: The surgical treatment of anterior thoracic meningiomas provides a set of technical difficulties: the access is obstructed by the spinal cord posteriorly, thoracic cage and musculature laterally, mediastinum and pleural cavity anteriorly. It is fundamental to avoid any manipulation of the compressed, but also undamaged spinal cord: this shows significant plastic capabilities. Any effort should be directed to maximizing the contribution of the plasticity in order to obtain a good functional recovery. METHOD: We have utilized a postero-lateral combined transpedicular-transarticular approach in order to obtain less invasiveness on the neural structures. Ten patients with ventral thoracic meningioma were operated in the last 5 years. The preoperative clinical evaluation, follow-up monitoring, timing of recovery, Clinical/Functional Grade change were analysed. FINDINGS: 8 Patients had significant neurological improvement, 2 were unchanged. Magnetic Resonance Imaging (MRI) was useful in preoperative planning. Radical excision was possible in all patients and the late postoperative MRI did not reveal recurrence of the lesions at this time. To date, there has been no evidence of clinical or radiological instability. INTERPRETATION: We found this surgical exposure very helpful in the treatment of anterior thoracic meningiomas. The related morbidity and risk of instability are minimal. The combined postero-lateral approach offers a good surgical access to ventral, lateral and dorsal aspects of the thoracic spinal canal without manipulation of the spinal cord. Exposure is obtained by avoiding damage to the pleura and manipulation of the lungs and mediastinum and may be a feasible alternative in elderly patients, too.

Intraoperative monitoring of cerebral blood flow during ventricular shunting in hydrocephalic pediatric patients.

Several studies have demonstrated lowered cerebral blood flow (CBF) in patients with hydrocephalus and symptoms of raised intracranial pressure. Ventricular shunting in such cases permits a sudden increase in CBF. The pathophysiology of functional brain deficit secondary to hydrocephalus is little understood. Improvement of the patient's clinical status after drainage of CSF suggests that cerebral dysfunction is not necessarily due to permanent brain damage. In fact, it improves rapidly after ventricular taps. In view of this it would be helpful to monitor cerebral perfusion. The transcranial Doppler (TCD) ultrasonography technique allows real-time monitoring of the intracranial circulation and makes it possible to evaluate the physiopathological correlation between ventricular dilatation and CBF. Continuous monitoring of the middle cerebral artery (MCA) by TCD was performed in three hydrocephalic children (2 months, 14 months, and 8 years old) during a ventricular-peritoneal shunt operative procedure. A TC-2000S device provided by an IMP-F fixed probe was utilized. In all patients, when the lateral ventricle was shunted and the CSF could flow away, a clear and sudden increase of flow velocity above 30% was detected. The pulsatility index (PI) was also pathologically increased in all patients. A gradual normalization of this index was revealed after the shunting procedure. Our experience has to be considered preliminary, but nonetheless, it suggests a clear correlation between hydrocephalic disease and concomitant CBF alterations.(ABSTRACT TRUNCATED AT 250 WORDS)

Spinal cord compression in homozygous beta-thalassemia intermedia.

Symptomatic spinal cord compression caused by an epidural mass of extramedullary hematopoietic tissue in patients with beta-thalassemia is a rare occurrence, that becomes exceptional in childhood and adolescence. The literature is not uniform about the optimal treatment of these patients and different modes of therapy have been proposed so far, including surgical excision or decompressing laminectomy followed by local irradiation and/or hypertransfusional regimens. We report the successful treatment of such a complication in an adolescent with homozygous beta-thalassemia by surgery followed by repeated blood transfusions aimed at maintaining hematocrit at normal levels.

Photofibrosis: a further histopathological change induced by PUVA therapy via the mast cell in guttate psoriasis. Preliminary report.

Twenty-five psoriatic patients were studied histologically before and after PUVA therapy in order to delineate the relationship between dermal mast cells, psoriasis healing process and collagen changes. A number of mast cells were found in the psoriatic changes. A number of mast cells were found in the psoriatic lesion both before PUVA and also after PUVA therapy in 22 of the 25 patients. Fibrosis of the papillary dermis and upper reticular dermis was found in 3 cases. Increased collagen deposition and increased numbers of fibroblasts were accompanied by verticalization of ectatic and elongated blood vessels, with an overall pattern of relatively recent scarring. Mast cells were no longer detectable in the fibrosis area. We cannot exclude the possibility that PUVA therapy exerts a further stimulus on mast cell histamine and heparin degranulation in this type of psoriasis, thus leading to dermal fibrosis and blood vessel neogenesis.

Intracranial pressure monitoring in children: comparison of external ventricular device with the fiberoptic system.

Several intracranial pressure monitoring devices have been developed in the past several years. We have recently adopted the Camino fiberoptic device that permits subdural, intraparenchymal, and intraventricular monitoring. In this report we compare experiences in monitoring a group of pediatric patients with severe craniocerebral trauma and coma, grouped according to severity of Glasgow Coma Scale score. Patient age ranged from 2 to 16 years. Twelve patients were monitored by a ventricular catheter and 37, treated more recently, by a Camino fiberoptic device. The study demonstrated that the fiberoptic device and the ventricular catheter have the same accuracy and reliability. The fiberoptic method correlates very closely with the ventriculostomy method, but the pressure values are always 3 +/- 2 mmHg lower than those obtained with the conventional pressure transducer system, especially in more critically ill patients. This new technique is also easier to implant, safer to use, has minimal drift, and is minimally invasive, which particularly speaks for its use in pediatric patients.

Intracranial solitary-type infantile myofibromatosis.

An unusual case of infantile myofibromatosis of the solitary type occurring in an intracranial location in a 48-day-old female infant is presented. To our knowledge, there are no other descriptions in the literature of infantile myofibromatosis with exclusively intracranial involvement. The immunohistochemical and electron microscopic findings confirm the myofibroblastic origin of the proliferation.

Bullous lesions in acrodermatitis enteropathica. Histopathologic findings regarding two patients.

Acrodermatitis enteropathica (AE) is an autosomic recessive disorder affecting early infancy. Two cases of infantile AE with low plasma zinc levels are reported in which unusually prominent bullous and vesicobullous lesions were seen on the hands and feet, in addition to the more typical erythematous and scaly patches. Both psoriasiform and bullous lesions responded dramatically to oral zinc-sulfate supplementation. The histopathologic features of the bullous lesions of AE have not previously been fully examined. Histologically, the bullous lesions were characterized by intraepidermal vacuolar changes with massive ballooning, leading to intraepidermal vesiculation and blistering, with prominent epidermal necrosis and with no acantholysis. The bullous lesions did not arise on erythematous patchy lesions, but developed ex novo on unaffected skin. The histopathologic differential diagnosis with other bullous conditions is discussed.

Evidence for CD8+ cell increase in long-term PUVA-treated psoriatic patients after PUVA discontinuation.

Long-term PUVA-treated psoriatic patients given maintenance therapy (UVA doses greater than 1,000 J/cm2) have been demonstrated to undergo lymphopenia and a decrease in the total number of circulating CD3+ and CD4+ T cells. The aim of this study was to assess whether the impairment of T cells is detectable also in psoriatic patients after long-lasting PUVA discontinuation. A group of 34 psoriatic patients (25 males, 9 females; mean age 52.7 +/- 12.82 years), who had previously been treated by PUVA therapy (average cumulative dose 1,898.48 +/- 1,207.12 J/cm2), was studied 1 year or more after discontinuation of PUVA therapy. The patients studied failed to show any impairment in CD3+ and CD4+ cells. Nevertheless, a significant increase (p less than 0.05) in circulating CD8+ cells (both in the percentage and the total number) was detectable in PUVA patients as compared to appropriate controls. The significance and implications of this finding are not known and need further investigations.

Lymphopenia and decrease in the total number of circulating CD3+ and CD4+ T cells during 'long-term' PUVA treatment for psoriasis.

The relationship between high-dose PUVA treatment in psoriatic patients and peripheral T lymphocyte subsets (total number and percentage) has been studied. Of the two groups of patients considered, the first included 19 patients, all affected by chronic, progressively worsening psoriasis; they had never been previously treated by photochemotherapy. The second group included 13 psoriatic patients, who had received an average cumulative dose of 2,007.69 +/- 1,191.05 J/cm2. The 'long-term' PUVA-treated group was assessed while undergoing maintenance therapy. No significant differences were found between untreated patients and healthy controls for any of the parameters considered. A significant reduction (p less than 0.05) in the total number of lymphocytes in long-term PUVA-treated patients both versus untreated patients and controls was found. Furthermore, long-term PUVA-treated patients showed a significant reduction (p less than 0.05) in the percentage of lymphocytes as compared with controls. The reduction in the total number of CD3+ and CD4+ T cells was, moreover, significant (p less than 0.05) as compared with untreated patients. The impairment of circulating CD3+ and CD4+ T cells (total number) was only on the borderline of statistical significance vis-à-vis controls. These findings suggest the usefulness of a careful assessment of circulating T lymphocyte subsets in patients who undergo long-term PUVA therapy.

[Necrobiosis lipoidica diabeticorum in children. Description of a case]. / Necrobiosis lipoidica diabeticorum nel bambino. Descrizione di un caso.

A case of necrobiosis lipoidica diabeticorum (NLD) in a 12-year-old male patient is described. Diabetes mellitus (DM) was diagnosed at the age of 1.5 years. The onset of the first NLD lesion had been previously observed at the age of 7, on the back of the left foot. Three new lesions appeared at the age of 8, one on the left leg, the others on the thighs. At the age of 12, four infiltrated, reddish patches, with slight central atrophy were evident on his lower extremities. Histopathological features showed foci of collagen degeneration with sclerosis, surrounded by a chronic, mainly perivascular, granulomatous infiltrate, made up of lymphocytes and histiocytes. The patient is now 19-year old, with no eye or kidney failure, owing to a constant metabolic control of DM. A constant follow-up of the patient demonstrated a self-resolution of NLD plaques, with no evidence of further lesions.

Outcome of craniocerebral trauma in infants and children.

The authors examined 927 patients affected by craniocerebral trauma and analyzed the neurological complications that occurred most frequently. The study confirmed that the percentage of craniocerebral trauma, gravity, and complications were different in relation to the sex and age of the patients. Based on this analysis, a correlation was made between the traumatic pathologies and socioeconomic-environmental conditions.

[Werner's syndrome and intracranial meningioma]. / Sindrome di Werner e meningioma intracranico.

A case of Werner's Syndrome in a 47-year-old man, with typical features of progeria associated with intracranial meningioma is described. A revision of the literature showed that meningioma is the most frequent benign neoplasm in Werner's Syndrome. Meningioma is a peculiar model of neoplasm, because of the frequency of cytogenetical aberrations concerning chromosome n. 22. Either chromosome n. 22 and other chromosomal alterations could be detected in peripheral blood lymphocytes of our patient. These findings suggest a correlation between chromosomal instability and the onset of neoplasms in Werner's Syndrome. Furthermore, the possibility of detecting chromosome n. 22 aberrations in peripheral blood lymphocytes of Werner's Syndrome patients could provide a clue to the presence of a meningioma at a preclinical stage.

Effects of medium-term PUVA therapy on peripheral T-lymphocyte subsets in psoriatic patients.

Three to four months' PUVA treatment is a widely-adopted procedure to induce psoriasis remission and for the purpose of this study is called "medium-term". The 32 psoriatic patients considered revealed a statistically significant baseline decrease in OKT3+ (p less than 0.001), OKT4+ (p less than 0.001) and OKT8+ (p less than 0.001) as compared with 40 healthy controls, while OKT4/OKT8 was normal. Variance analysis within the psoriatic group failed to reveal further significant variation in the immunological parameters during the 3 months under study. Nevertheless, there was a marked trend towards a reduction in OKT4+ cells and OKT4/OKT8 as compared with baseline values after 3 months. These results suggest that "medium-term" PUVA therapy does not statistically restore the pre-existing baseline changes in T-lymphocyte subsets of the psoriatic patients. The non-statistically significant effects as regards OKT4+ may be due to the small number of patients who reached 3 months' treatment (9 patients) but could be regarded as the first step towards the significant changes described here in long-term PUVA-treated psoriatic patients.