Serial scanning with 99mTc-3, 3-diphosphono-1, 2-propanodicarboxylic acid (99mTc-DPD) for early detection of cardiac amyloid deposition and prediction of clinical worsening in subjects carrying a transthyretin gene mutation.

BACKGROUND: To determine the capability of 99mTc-DPD scintigraphy to detect early cardiac involvement and predict clinical worsening in transthyretin (TTR) gene mutation patients. METHODS: Eleven mutated subjects with normal interventricular septum (IVS) thickness, NT-proBNP level and no cardiac symptoms underwent three seriate 99mTc-DPD scans (visually and semiquantitatively analyzed), and was followed-up for 5-8-years. RESULTS: Six patients showed no myocardial accumulation in all scans. Increased IVS thickness occurring in one patient 4 years after the last scan was the only abnormal finding in these patients; no cardiac symptoms developed during the follow-up. In three patients, cardiac radiotracer uptake was found at enrollment; other laboratory/instrumental abnormal findings occurred later and cardiac symptoms developed during the follow-up period. Two patients had a negative 99mTc-DPD scan at enrollment and showed cardiac uptake in the following scans. Increased mean left-ventricular (LV) wall thickness was found 3 years after positive scintigraphy; NT-proBNP increased later in one patient. These patients developed cardiac symptoms during the follow-up period. CONCLUSIONS: 99mTc-DPD scan detects cardiac involvement in subjects with TTR gene mutation earlier than ECG, echocardiography and biochemical markers, occurring some years before the fulfillment of current diagnostic criteria for cardiac amyloidosis. A positive 99mTc-DPD scan predicts cardiac symptoms onset.

Optimization of management choices of clariflocculation process by means of qualitative multi-criteria analysis.

Every year ship traffic produces tons of liquid waste mainly consisting of bilge water and of washing water of tankers' tanks. The latter are called slop waters and are characterized by high salinity and by the presence of recalcitrant pollutants mainly of hydrocarbon origin: these characteristics promote the use of chemical-physical rather than biological treatment. In particular, in the present study the slop waters were subjected to a clariflocculation treatment by means of batch tests. This treatment involves the dosage of specific chemical reagents (coagulants and flocculants) added to water at different stages of the process. In order to establish the optimal reagents' type and dose, also considering the operating costs, the proposed study presents a frequency analysis belonging to the family of multi-criteria exploration. The application of this methodology to examine the validity of the different process alternatives has allowed the inclusion of, in a single assessment, both economic and extra-economic (measurable only in qualitative terms) procedures. Thanks to this qualitative and quantitative method, it was therefore possible to order the different treatment alternatives analyzed, identifying the one that allows optimizing the wastewater management, for a conscious choice of the most suitable solution to the problem.

Start-up of two moving bed membrane bioreactors treating saline wastewater contaminated by hydrocarbons.

This work aims to assess the acclimation of microorganisms to a gradual increase of salinity and hydrocarbons, during the start-up of two moving bed membrane bioreactors (MB-MBRs) fed with saline oily wastewater. In both systems an ultrafiltration membrane was used and two types of carriers were employed: polyurethane sponge cubes (MB-MBRI) and polyethylene cylindrical carriers (MB-MBRII). A decreasing dilution factor of slops has been adopted in order to allow biomass acclimation. The simultaneous effect of salinity and hydrocarbons played an inhibitory role in biomass growth and this resulted in a decrease of the biological removal efficiencies. A reduction of bound extracellular polymeric substances and a simultaneous release of soluble microbial products (SMPs) were observed, particularly in the MB-MBRII system, probably due to the occurrence of a greater suspended biomass stress as response to the recalcitrance of substrate. On the one hand, a clear attachment of biomass occurred only in MB-MBRI and this affected the fouling deposition on the membrane surface. The processes of detachment and entrapment of biomass, from and into the carriers, significantly influenced the superficial cake deposition and its reversibility. On the other hand, in MB-MBRII, the higher production of SMPs implied a predominance of the pore blocking.

Rare cardiomyopathies: diagnostic features.

Cardiomyopathies (CM) are an important and heterogeneous group of diseases affecting the myocardium. They can induce mechanical and/or electrical disorders and are due to a variety of causes, they frequently are genetic. However, since their high number and their clinical complexity, the identification is still a challenge. Echocardiography is a very useful tool in the assessment of CM. In this review we aim to define the typical clinical features and to discuss the main diagnostic tool, above all echocardiography that can help physicians in the correct assessment of CM.

Hydrocarbons removal from real marine sediments: Analysis of degradation pathways and microbial community development during bioslurry treatment.

In this study, real marine sediments polluted by petroleum compounds were treated by means of a bioslurry pilot scale reactor. The treatment performance was evaluated by measuring the removal of total petroleum hydrocarbon (TPH), coupled to further analyses required to understand the mechanisms involved in the biodegradation process. The maximum TPH-removal efficiency reached 86 % at the end of experiments. Moreover, high throughput 16S RNA gene sequencing was used to describe the microbiome composition in sediment prior to, and after, bioslurry treatment, in order to identify the taxa mostly entailed in the TPH removal process. The raw sediment was mostly colonized by members of Sulfurimonas genus; after bioslurry treatment, it was noticed a shift in the microbial community composition, with Proteobacteria phylum dominating the remediation environment (high increase in terms of growth for Hydrogenophaga and Sphingorhabdus genera) along with the Phaeodactylibacter genus (Bacteroidetes). Furthermore, the assessment of gaseous emissions from the system allowed to quantify the volatile hydrocarbon component and, consequently, to obtain a more accurate evaluation of TPH-removal pathway by the bioslurry system. Finally, phytotoxicity tests on sediment samples highlighted an increase of the treated sample quality status compared to the untreated one.

Atrial lipomatous hypertrophy causing reduction in systemic venous return.

Lipomatous hypertrophy of the interatrial septum (LHIAS) is a benign condition characterized by an abnormal deposition of adipose tissue in the interatrial septum which appears as a pseudomass with a bilobed shape. We present the case of a 68-year-old obese female patient. LHIAS is an infrequent finding, but with recent improvements in imaging it is increasingly recognized. Cardiac MRI may prove useful in its diagnosis in terms of tissue characterization, as well as for the evaluation of disease extension and haemodynamic compromise.

Cardiac allograft vasculopathy : complications and imaging studies.

Cardiac allograft vasculopathy (CAV) is an accelerated form of coronary artery disease affecting both intramyocardial and epicardial coronary arteries and is observed in patients during long-term survival after cardiac transplantation. We report a case of CAV complicated with silent transmural myocardial infarction and massive left ventricular thrombus formation associated with silent pericarditis and with ischemic and non-ischemic scar tissue, as detected by cardiac magnetic resonance imaging (CMRI). The authors suggest CMRI as an additional technique along with echocardiography during follow-up of heart transplant recipients. CMRI may contribute to the early identification of areas of myocardial wall abnormalities suggestive of CAV, thus guiding diagnosis and prompt percutaneous treatment.

[Malnutrition in the elderly: clinical features, psychological and social determinants. Preliminary results]. / La malnutrizione in età geriatrica: caratteristiche cliniche e determinanti psico-sociali (MEG). Risultati preliminari.

In industrialized Countries malnutrition is a very frequent condition in frail groups of the population, people with low income and elderly subjects above all if institutionalized. The aim of the study is to: analyse the prevalence of malnutrition in a sample of elderly people located in different geographical areas in Italy; identify the psychological, social, economic, environmental, cultural and demographic determinants of malnutrition. The prevalence of malnutrition (estimated through the MNA) is high in both sexes (28% of F and 21.9% of M. Age, institutionalisation, health status, autonomy status, cognitive status and education level are some of the factors that correlate with the presence of malnutrition. Loneliness and poverty seem to have a negative impact on nutritional status but further data are needed to confirm this hypothesis. The data collected confirm the need to activate services dedicated to assess the nutritional status of elderly people, to implement campaigns in particular on food education for the elderly population, to set tools and guide lines for caregivers.

Does the feeding strategy enhance the aerobic granular sludge stability treating saline effluents?

The development and stability of aerobic granular sludge (AGS) was studied in two Sequencing Batch Reactors (SBRs) treating fish canning wastewater. R1 cycle comprised a fully aerobic reaction phase, while R2 cycle included a plug-flow anaerobic feeding/reaction followed by an aerobic reaction phase. The performance of the AGS reactors was compared treating the same effluents with variable salt concentrations (4.97-13.45 g NaCl/L) and organic loading rates (OLR, 1.80-6.65 kg CODs/(m3·d)). Granulation process was faster in R2 (day 34) than in R1 (day 90), however the granular biomass formed in the fully aerobic configuration was more stable to the variable feeding composition. Thus, in R1 solid retention times (SRT), up to 15.2 days, longer than in R2, up to 5.8 days, were achieved. These long SRTs values helped the retention of nitrifying organisms and provoked the increase of the nitrogen removal efficiency to 80% in R1 while it was approximately of 40% in R2. However, the presence of an anaerobic feeding/reaction phase increased the organic matter removal efficiency in R2 (80-90%) which was higher than in R1 with a fully aerobic phase (75-85%). Furthermore, in R2 glycogen-accumulating organisms (GAOs) dominated inside the granules instead of phosphorous-accumulating organisms (PAOs), suggesting that GAOs resist better the stressful conditions of a variable and high-saline influent. In terms of AGS properties an anaerobic feeding/reaction phase is not beneficial, however it enables the production of a better quality effluent.

Performances of a granular sequencing batch reactor (GSBR).

Aerobic granulation in sequencing batch reactors is widely reported in literature and in particular in SBAR (Sequencing batch airlift reactor) configuration, due to the high localised hydrodynamic shear forces that occur in this type of configuration. The aim of this work was to observe the phenomenon of the aerobic granulation and to confirm the excellent removal efficiencies that can be achieved with this technology. In order to do that, a laboratory-scale plant, inoculated with activated sludge collected from a conventional WWTP, was operated for 64 days: 42 days as a SBAR and 22 days as a SBBC (sequencing batch bubble column). The performances of the pilot plant showed excellent organics removal. COD and BOD removal efficiencies were respectively, 93 and 94%; on the contrary, N-removal efficiency was extremely low (5%-45%/o). The granules dimensions increased during the whole experimentation; change of reactor configuration contributed to further improve this aspect. The experimental work confirmed the essential role of hydraulic settling time in the formation of aerobic granules and in the sludge settleability and the need to find an optimum between granule size and oxygen supply to achieve good N-removal efficiency.

The role of fouling mechanisms in a membrane bioreactor.

The present study has aimed to quantify the role of pore blocking and cake layer in a laboratory scale hollow fibre membrane module in submerged configuration, The membrane reactor (MBR) was fed with raw wastewater, only screened with a 2-mm sieve, collected from the Palermo WWTP. The MBR was characterised by an operating volume of 190 L and equipped with an aeration system located on the bottom of the reactor. The MBR operated for 65 days. The permeate was extracted by imposing a constant flux through the membrane (21 Lh(-1) m(-2)). The results confirm the importance of pore blocking control during start-up. In particular, it provides a rapid irreversible fouling that takes place at the beginning of the filtration process, before the deposition mechanism. Therefore, low suspended solids concentration in the initial phase causes a fast irreversible fouling. This circumstance creates the need for more frequent chemical cleaning after start-up without inoculum. Finally, the results underline that the cake has a mainly reversible feature.

Levels and congener pattern of polychlorinated biphenyl and organochlorine pesticide residues in bluefin tuna (Thunnus thynnus) from the Straits of Messina (Sicily, Italy).

The aim of this study is to assess the accumulation of OCs and PCBs in Thunnus thynnus and to elucidate the suitability of this species as a bioindicator for monitoring contaminations of these compounds in the marine ecosystems of the Straits of Messina. This investigation was conducted on fat, liver and muscle samples of 14 T. thynnus collected during April 2004. Quantitative determination of OCs and PCBs in the various samples examined has been carried out using GC-ECD and GC-MS. The results obtained show the presence of low concentrations of p,p'-DDE and PCB congeners (138, 153 and 180) in all fat, liver and muscle samples caught in the Straits of Messina. Concentrations of p,p'-DDE and PCB congeners (138, 153 and 180) in all the samples examined were below MRLs (CE n. 97/41, 1999/65 and 1999/71).

Study of aerobic granular sludge stability in a continuous-flow membrane bioreactor.

A granular continuous-flow membrane bioreactor with a novel hydrodynamic configuration was developed to evaluate the stability of aerobic granular sludge (AGS). Under continuous-flow operation (Period I), AGS rapidly lost their structural integrity resulting in loose and fluffy microbial aggregates in which filamentous bacteria were dominant. The intermittent feeding (Period II) allowed obtaining the succession of feast and famine conditions that favored the increase in AGS stability. Although no further breakage occurred, the formation of new granules was very limited, owing to the absence of the hydraulic selection pressure. These results noted the necessity to ensure, on the one hand the succession of feast/famine conditions, and on the other, the hydraulic selection pressure that allows flocculent sludge washout. This preliminary study shows that the proposed configuration could meet the first aspect; in contrast, biomass selection needs to be improved.

Ischemic heart disease and early diagnosis. Study on the predictive value of 2D strain.

INTRODUCTION: Two-dimensional strain echocardiography (2D-SE) quantifies left ventricular global longitudinal strain (GLS) and global circumferential strain (GCS). Our aim was to test 2D-SE during dipyridamole stress echocardiography (Dipy-Stress) in patients with non-diagnostic result, checking by way of coronary CT angiography (CCTA) the possible presence of coronary artery disease (CAD). METHODS: Over twenty-four months 65 consecutive patients with non-diagnostic Dipy-Stress were studied by 2D-SE and by CCTA. GCS and GLS at rest and after stress were compared according to data derived from CCTA. CAD was graded as significant (stenosis ≥50%), mild (stenosis between 15 and 50%) or absent (stenosis <15%). CCTA was defined as "positive" in presence of mild CAD and "negative" in absence of stenoses. Furthermore, Δ strain was defined as follows: [(stressS-restS)/restS]×100. RESULTS: GCS at rest and after stress was similar in CCTA-positive (26±5% and 27±5% respectively) and CCTA-negative groups (27±3% and 28±3% respectively). GLS at rest was significantly reduced (P<0.0001) in CCTA-positive (23±3%) compared to CCTA-negative group (25±2%). GLS after stress was lower (P<0.0001) in CCTA-positive group (20±3%) than CCTA-negative one (26±2%). A significant reduction (P<0.0001) of GLS at rest versus after stress was found in positive-CCTA group. ΔGLS showed a significant decrease (P<0.0001) in CCTA-positive (-10±8%) compared to CCTA-negative (4.4±5.8%) group. ROC analysis of ΔGLS showed high accuracy (area under the ROC curve 0.916, 95% CI: 0.820-0.970) in distinguishing positive and negative CCTA groups. CONCLUSIONS: 2D-SE during Dipy-Stress allows, in case of non-diagnostic test, identification of mild-CAD with high sensitivity and specificity.

DNA damage and developmental defects after exposure to UV and heavy metals in sea urchin cells and embryos compared to other invertebrates.

The depletion of the stratospheric ozone layer and the resulting increase in hazardous ultraviolet-B (UV-B) radiation reaching the Earth are of major concern not only for terrestrial but also for aquatic organisms. UV-B is able to penetrate clear water to ecologically significant depths. This chapter deals with the effects of UV radiation on DNA integrity in marine benthic organisms, in particular sea urchins in comparison to other marine invertebrates (sponges and corals). These animals cannot escape the damaging effects of UV-B radiation and may be additionally exposed to pollution from natural or anthropogenic sources. Besides eggs and larvae that lack a protective epidermal layer and are particularly prone to the damaging effects of UV radiation, coelomocytes from the sea urchin Paracentrotus lividus were used as a "cellular sensor" to analyse the effects on DNA caused by UV-B, heavy metals (cadmium), and their combined actions. From our data we conclude that sea urchin coelomocytes as well as cells from other marine invertebrates are useful bioindicators of UV-B and heavy metal stress, responding to these stressors with different extents of DNA damage.

Speciation of inorganic arsenic in alimentary and environmental aqueous samples by using derivative anodic stripping chronopotentiometry (dASCP).

The purpose of this research was to develop a sensitive and accurate chronopotentiometric method at a gold film electrode, to determine trace and ultra trace levels of As(III) and As(V) in alimentary and environmental water systems. As(III) was directly determined in the aqueous matrix at a deposition potential of -300 mV for 180 s and at a constant anodic current of 2.5 microA, without any sample pre-treatment; moreover the chronopotentiometric method did not require a time-consuming de-oxygenation step prior to the analysis. A 3M HCl solution was chosen as the best stripping medium. The direct analysis of As(V) required the application of a high negative over-potential and, thus, measurements were characterized by poor reproducibility; therefore As(V) was determined after reduction to As(III) with KI in a strong hydrochloric acid solution. Under the optimised electrochemical conditions, detection limits of 0.08 microg As(III) l(-1) were achieved and no significant interferences from Cd, Cu, Pb, Zn and organic substances were observed. As(V) was the most abundant species in all the studied environmental and alimentary aqueous matrices. Amongst the beverages, tea and coffee presented the As(V) highest concentration ranges (934-1740 microg l(-1) and 850-1290 microg l(-1), respectively) while bottled mineral water the lowest (<1.61 microg l(-1)); whereas As(III) levels lower than 5.0 microg l(-1) were detected only in wine samples.

Pilot scale experiment with MBR operated in intermittent aeration condition: analysis of biological performance.

The effect of intermittent aeration (IA) on a MBR system was investigated. The study was aimed at analyzing different working conditions and the influence of different IA cycles on the biological performance of the MBR pilot plant, in terms of organic carbon and ammonium removal as well as extracellular polymeric substances (EPSs) production. The membrane modules were placed in a separate compartment, continuously aerated. This configuration allowed to disconnect from the filtration stage the biological phenomena occurring into the IA bioreactor. The observed results highlighted good efficiencies, in terms of organic carbon and ammonium removal. It was noticed a significant soluble microbial products (SMPs) release, likely related to the higher metabolic stress that anoxic conditions exerted on the biomass. However, the proposed configuration, with the membranes in a separate compartment, allowed to reduce the EPSs in the membrane tank even during the non-aerated phase, thus lowering fouling development.

Educating staff to manage threatening paranoid patients.

The threatening paranoid patient is one of the most frightening and difficult patients to treat. The author points out the need for all levels of hospital staff to become more adept at recognizing their own feelings, which often keep them from appropriately managing these patients. He summarizes several crucial points in teaching staff to cope successfully, dividing the process into diagnosis, management of one's emotions, and practice of appropriate therapeutic techniques.

Effects of chemically modified tetracyclines (CMTs) in sensitive, multidrug resistant and apoptosis resistant leukaemia cell lines.

Recently discovered chemically modified tetracyclines (CMTs) have shown in vitro and in vivo anti-proliferative and anti-tumour activities. Here, we evaluated in vitro the anti-proliferative and apoptotic activity of six different dedimethylamino chemically modified tetracyclines (CMT-1, CMT-3, CMT-5, CMT-6, CMT-7 and CMT-8) in sensitive and multidrug resistant myeloid leukaemia cells (HL60 and HL60R) in vitro. Three of these compounds (CMT-5, CMT-6, CMT-7) showed low cytotoxic activity both in sensitive and in resistant cells, CMT-3 was endowed with a high anti-proliferative activity only in sensitive cells and was moderately effective as apoptosis inducing agent, with an activity similar to that shown by doxycycline. On the contrary, CMT-1 and CMT-8 were very effective as programmed cell death inducing agents. The apoptotic pathway activated by these compounds involved the activation of caspases, especially caspase-9 and, for CMT-1, also the activation of FAS: Interestingly CMT-8, but not CMT-1, was able to induce apoptosis in multidrug resistant HL60R and in Fas-ligand resistant HUT78B1 cell lines. These properties, together with others previously described (e.g. anti-metastatic and anti-osteolytic activities), suggest that CMT-8 may have important applications in the clinical management of cancer. The comparative analysis of structure-activity relationship of CMT-8 and doxycycline suggests that the C-5 hydroxy moiety may play an important role in conferring activity in multidrug resistant cells. These findings appear to support the hypothesis that CMT-8 may represent an interesting lead for the development of a new class of potent apoptosis inducer agents active in multidrug resistant and Fas-ligand resistant malignancies.