Modeling chronic oil pollution from ships.

Stochastic simulations of virtual oil spills from ships were performed for the Adriatic Sea over 2017-2020, applying the European Marine Observation and Data Network vessel densities as a proxy for starting locations of operational spillage. The MEDSLIK-II oil spill model was run using high-resolution currents provided by the Copernicus Marine Service and the European Centre for Medium-Range Weather Forecasts winds. Chronic exposure to operational oil spills was reported in terms of hazard indices for five vessel groups: pleasure and passenger ships, cargo and service vessels, the fishing fleet, tankers, and other ships. The northernmost Adriatic expectedly showed the highest hazard values, including the areas of Trieste and Venice, where cargo and service ships were the dominant polluters. The Croatian coastal waters were more chronically polluted than the Italian coastal waters; the predominant contribution was from coastwise pleasure and passenger ships.

Patent foramen ovale-mania: an unusual case of misdiagnosis.

Patent foramen ovale (PFO) is rapidly becoming in Europe, more than in the USA, a matter of over-diagnosis and over-treatment. A migrainous 34-year-old female with episodic hypostenia and even paralysis of the left arm was referred to a peripheral hospital for a complete neurological work-up. Being the Doppler ultrasound of carotid and vertebral arteries negative and angio-magnetic resonance imaging (MRI) positive for multiple white-matter lesions. A transthoracic echocardiography revealed a possible shunt through a patent foramen ovale with a right-to-left shunt and a mild buldging of interatrial septum, but the patient did not tolerate a further attempt of transesophageal echocardiography to confirm the diagnosis. Coagulation screening essay demonstrated a moderate hyperhomocisteinemia. In the hypothesis of embolic PFO mediated by a moderate prothrombotic state caused by hyperhomocisteinemia, the patient was referred to our attention for an attempt of PFO closure but on intracardiac echocardiography normal fossa ovalis without any shunt was revealed. One year later, during the follow-up, the patient became severely symptomatic for left arm hypostenia and parhestesia, both at rest and during efforts. Thus, the patient was submitted to a thoracic and upper limbs angio-MRI in order to exclude disease of the main arteries causing functional impotence. The MRI demonstrated thoracic outlet syndrome of both arms, more severe in the left arm with functional occlusion of the subclavian vein with abduction of the arm and possible cloth image at the subclavian vein next to the joint. The patient was referred to the thoracic surgeon for surgical repair.

ADQI 7: the clinical management of the Cardio-Renal syndromes: work group statements from the 7th ADQI consensus conference.

Many patients with heart failure have underlying renal dysfunction, and similarly, patients with kidney failure are prone to cardiac failure. This has led to the concept of cardio-renal syndromes, which can be an acute or chronic cardio-renal syndrome, when cardiac failure causes deterioration in renal function, or acute and/or chronic Reno-Cardiac syndrome, when renal dysfunction leads to cardiac failure. Patients who develop these syndromes have increased risk of hospital admission and mortality. Although there are clinical guidelines for managing both heart failure and chronic kidney disease, there are no agreed guidelines for managing patients with cardio-renal and/or Reno-Cardiac syndromes, as these patients have typically been excluded from clinical trials. We have therefore reviewed the currently available published literature to outline a consensus of current best clinical practice for these patients.

Safety and long-term results of patent foramen ovale transcatheter closure in patients with thrombophilia.

AIM: Trials on transcatheter closure of patent foramen ovale (PFO) in different settings attempted to exclude patients with thrombophilia for the risk of device thrombosis. Authors sought to retrospectively evaluate safety and results of transcatheter PFO closure in patients with confirmed coagulation abnormalities. METHODS: Between December 2006 and December 2008, 30 out of 98 consecutive patients (mean age 40+/-10.9 years, 23 females) referred to Rovigo General Hospital for transcatheter closure had coagulation abnormalities including mutations of factor V Leiden, factors X, VIII, protein C, S, MHFTR factors, and antiphospholipid and anticardiolipin antibodies, hyperhomocisteinimia. All patients underwent preoperative transesophageal echo and brain magnetic resonance imaging, and intra-cardiac echo-guided transcatheter PFO closure. RESULTS: Success rate was 100%; there was no difference in occlusion and complications rates between patients with and without thrombophilia: in particular no device thrombosis or recurrent cerebral ischemia or stroke were observed during the follow-up. Patients with thrombophilia had a higher incidence of atrial septal aneurysm, migraine with aura and deep venous thrombosis in the previous medical history compared to patients without. CONCLUSIONS: Despite its small sample, this study suggests that patients with coagulation abnormalities should not be excluded from the trial; they have potentially a higher risk of stroke through a PFO compared to other patients, and transcatheter closure is as safe and effective as in general population with almost no additional therapy rather than aspirin.

Integration of blood volume, blood pressure, heart rate and bioimpedance monitoring for the achievement of optimal dry body weight during chronic hemodialysis.

BACKGROUND: Achieving optimal dry body weight in hemodialysis is challenging. Clinical assessment alone is inadequate, and methods such as bioimpedance monitoring may be impractical for every patient treatment. Continuous blood volume monitoring, blood pressure and heart rate variability inform clinical decision-making, but integrated use of multiple methodologies to achieve dry weight and understand patient factors has not yet been described. METHODS: Nineteen chronic hemodialysis patients underwent thrice-weekly treatments for two weeks. Baseline hydration status and target weight were determined by bioimpedance. During subsequent treatments, ultrafiltration was adjusted and relative blood volume, blood pressure and pulse were recorded non-invasively. Bioimpedance was repeated to assess hydration. Response of variables to progressive change in weight was assessed and selected patients underwent additional autonomic function testing. RESULTS: Four distinct hemodynamic patterns emerged. Profile A: 4 patients demonstrated overhydration at baseline. With decreasing target, pulse and blood pressure remained stable while blood volume and bioimpedance demonstrated achievement of dry weight. Profile B: 8 patients demonstrated overhydration at baseline. With decreasing target, blood pressure remained stable while pulse increased. Profile C: 5 patients were overhydrated, but as weight decreased, blood pressure became unstable and heart rate failed to compensate. Further testing confirmed autonomic dysfunction. Profile D: 2 patients were dehydrated, and with increasing target demonstrated stable pulse and pressure, while blood volume and bioimpedance revealed achievement of dry weight. CONCLUSIONS: Integrating existing non-invasive, continuous monitoring during hemodialysis enabled achievement of dry weight and identified distinct profiles of the patients, some with autonomic dysfunction. This strategy may contribute to achieving optimum dry weight while improving cardiovascular tolerability of hemodialysis.

Management of fluid overload in congestive heart failure: learning from a case report.

A case of refractory fluid overload due to congestive heart failure and consequent renal insufficiency is reported. The case was approached multidisciplinarily, at the beginning with conservative and pharmacological therapy, subsequently with extracorporeal fluid removal in which a specific attention was payed to the maintenance of circulating blood volume and achievement of dry weight, and finally with chronic peritoneal dialysis as a maintenance therapy. The case seems to summarize the pathway of many patients seen initially in intensive care and cardiology departments and subsequently in nephrological wards.

Blood flow distribution in a polymyxin coated fibrous bed for endotoxin removal. Effect of a new blood path design.

The analysis of flow distribution in cartridges designed for hemoperfusion is extremely important. Taking advantage of a new imaging technique, based on the analysis of a helical scanner-generated imaging sequence, we studied the blood flow distribution in a series of cartridges for extracorporeal removal of endotoxin. Cartridges with improved design were compared to cartridges with a standard design. The improved design consists in a different structure of the holes of the distributor of the flow within the adsorbent unit. Cartridges were studied in vitro with human blood from voluntary donors at blood flows of 100 and 250 ml/min. The progression of density in specific regions of interest (ROI) was analyzed to detect the distribution of the dye injected in the blood circuit. The study demonstrates that both at 100 ml/min and at 250 ml/min of blood flow, the progression of flow appears more homogeneous in the devices with improved design. In detail, the flow distribution measured by the incremental density values detected in the ROIs of the proximal comers (close to the arterial port) and in the ROIs of the central region of the device (close to the inner wall of the case) displays a significant difference between the standard and the improved device. The ROIs studied in the standard devices display a slower increase in density and significantly lower absolute values expressed in Hounsfield units. The experimental method utilized to analyze flow distribution seems to represent an important means to study the performance and design of this type of device.

Artificial in vivo biofiltration: slow continuous intravenous plasmafiltration (SCIP) and artificial organ support.

An intravenous plasmafiltration (SCIP) catheter has been developed and is proposed for clinical investigation into the alleviation of acute fluid overload by SCUF of the extracted plasma. The system utilizes a unique backflushing technique, high intravenous shear flow rates and biocompatible polymers to minimize protein and platelet aggregation along the filter surfaces. The absence of platelets from the extracted plasma promotes the longevity of ultrafiltration cartridges, thus theoretically minimizing attendant labor associated with continuous renal replacement therapies. Clinical studies are currently being planned for the near future. Plasma SCUF is envisioned as a predecessor technology to future applications in therapeutic apheresis, tissue engineering, therapeutic sorbent technologies. Further, with improved longevity profiles, intravenous SCUF or dialysis and implantable or wearable artificial organs based upon artificial in vivo biofiltration are possible.

[Research on the psychological view of maternity in women in the puerperium]. / Indagine sul vissuto psicologico della maternità in donne in puerperio.

The aim of our research was to observe the ways in which the hospital and the social environment react towards delivery and birth and how pregnant women experience this event from the psychological point of view. A questionnaire was submitted to 58 puerperas at their third-fifth day. From the analysis of the results we can observe that the hospital structure tends to treat this experience as a mechanical and routinary event; this particularly jouful moment which should be a time of celebration is often undervalued. As a matter of fact the hospital does not create an atmosphere of joy which should accompany any event connected with birth and which should be transmitted to the child offering him a sense of confidence from the very first moment of his life. Women are generally the victims of a culture of terror, originated by an ideology of "institutionalism" which tends to regard the process of birth as a medical phenomenon and not as a natural one, and so they prefer to hand over all responsibility to the specialist, instead of taking charge of it themselves. We have also noticed that women very rarely undertake psycho-physical training before the delivery; the reasons may be the culture of terror or also because the training techniques are considered inadequate for the psychological aspects. We have observed that most of all, women are frightened by the delivery itself and of giving birth to a deformed child. Women lack an experience of psychological growth which would help them to reach an emotional maturity. This is necessary to help the child to develop his infinite potential and abilities which he already possesses from the moment he is born and which will help him to face whole heartedly the fascinating albeit painful adventure that is life.

Seroprevalence of antibodies to Neospora caninum in urban and rural dogs in north-west Italy.

Sera were collected from 490 dogs from north-west Italy. One hundred and eighty-eight dogs were urban, while 302 dogs were rural. Among the latter, 190 were shepherd dogs and 112 were cattle farm dogs. Sera were tested for the presence of antibodies against Neospora caninum using the Neospora agglutination test. Seroprevalence at 1/40, 1/80, 1/160 dilution titres was significantly higher in rural (36.4%, 19.5%, 9.9% respectively) than in urban dogs (20.2%, 10.6%, 4.8% respectively). Seroprevalence did not differ significantly in males and females. In shepherd dogs, prevalence increased according to dogs' age, thus suggesting a post-natal exposure by horizontal transmission. The observed higher seroprevalence in rural dogs suggests the importance of lifestyle and alimentary habits (i.e. aborted foetuses, placentas and small mammals) in the acquisition of N. caninum infection. Our results confirm that dogs are exposed to N. caninum and play an important role in the epidemiology of N. caninum.

[Color-Doppler ultrasonography and hypertension. Functional assessment of the renal region]. / Eco color Doppler e malattia ipertensiva. Valutazione funzionale del distretto renale.

Color-Doppler US can be used for the morphofunctional assessment of most arterial districts. In hypertension, color-Doppler US can be used to study the renal arteries for both the diagnosis of renovascular hypertension and better physiopathologic assessment of renal arterial blood flow in essential hypertension. To this purpose, we studied renal flow characteristics with the resistive index in both basal conditions and after pharmacologic stimulation with angiotensin-converting enzyme inhibitors. The resistive index was seen to rise in parallel with hypertension severity, as measured by mean arterial pressure; the change was statistically significant (p < 0.05). Values rose step by step from 57.4 (+/- 4.96) in the right renal artery and from 56.6 (+/- 4.18) in the left one in controls, up to 62.2 (+/- 6.6) in the right and 62.3 (+/- 7) in the left renal arteries of severe hypertensives. After pharmacologic stimulation in controls and in mild hypertensives, resistive index values rose significantly (+2.32 +/- 2.1 and +3.5 +/- 5.2, respectively), while in more advanced stages of the disease this index remained unvaried from a statistical point of view (+0.5 +/- 1.7 in moderate and -0.2 +/- 2.1 in severe hypertensives). These data can be explained by reduced capability of renal blood flow autoregulation, as a consequence of a defined vascular damage. In the follow-up of more severe stages of the disease, although pharmacologic treatment had been optimized and mean arterial pressure values reduced (109.08 vs. 118.25 mmHg), even after a prolonged therapeutic wash-out, an abnormal RI response persisted in controls (-1.79 +/- 2.62 vs. -0.94 +/- 1.64), due to persistent arteriolar damage. To date, it is still to be defined if our studies can be applied not only to populations but also to single patients.

Natural killer cell activity and T subpopulations in thalassemia major.

Natural killer (NK) cell activity against K562 cell targets and the distribution of T cell subpopulations were investigated in the peripheral blood of 25 patients affected by beta thalassemia major, 18 clinically healthy heterozygotes, and 25 age-matched normal subjects. It was found that thalassemia major patients display augmented levels of NK activity [specific lysis 41.9 +/- (se) 4.5%], while thalassemic carriers behave as normal controls [specific lysis 34.6 +/- (se) 3.5%]. The increase of NK function was neither related to the splenectomy nor to the siderosis, but rather to the age and the amount of blood units that the patients had received. An imbalance of circulating T subsets with the helper/suppressor cell ratio significantly diminished (p less than 0.001) was also detected in homozygotes but not in carriers. The finding that NK function is enhanced in homozygous beta thalassemia might be of clinical interest in assessing the risk of development of malignancies in these patients.

Phenotypic and genotypic switch in Philadelphia-positive, BCR-positive blast crisis of chronic myeloid leukemia.

We report a case of Ph1-positive, bcr-positive chronic myeloid leukemia blast crisis (CML-BC) which at presentation showed a mixed myeloid/B-lymphoid immunophenotype along with TdT positivity and, at the molecular level, an oligoclonal rearrangement of the immunoglobulin heavy chain (IgH) gene region. After obtaining a successful remission, at the time of relapse the patient underwent a phenotypic and genotypic switch from mixed to myeloid phenotype, characterized by the loss of the lymphoid markers and TdT expression and by a germline configuration of the IgH gene region. The same bcr rearrangement was, however, found in both phases of the disease, supporting the suggestion of a true phenotypic and genotypic conversion. This report confirms that the neoplastic event in CML may take place at an early multipotent stem-cell level, prior to a well-defined phenotypic and genotypic lineage expression. Moreover, it is suggested that different factors (chemotherapy? growth factors?) may have either eradicated the bcr+/IgH+ clone and promoted the growth of bcr+/IgH- leukemic cells or, alternatively, supported the lymphoid differentiation program and induced a myeloid lineage shift.

"In vitro" colony growth of blood T-lymphocytes from B-cell chronic lymphocytic leukemia.

T-lymphocyte colony formation in agar culture was investigated in 20 untreated B-cell Chronic Lymphocytic Leukemia (CLL) patients in stage O. As compared to the controls, colony growth was very poor when unseparated peripheral-blood lymphocytes from CLL-patients were seeded. The number of colonies was greatly higher when T-cell enriched fractions from CLL were plated; however, they failed to reach the normal range even in this experimental condition. The role of adherent cells in the colony growth was also investigated. Depletion of these cells resulted in impaired colony generation either in normals or in CLL-patients, which was subsequently restored by the addition of the same adherent cells. In the patients investigated in this study, an imbalance of T-subsets was found with increase of OKT8-positive cells (T-suppressors). When the number of colonies and the percentage of OKT8-positive cells were plotted, an inverse correlation was found. Conversely, a linear relationship was detected between the percentage of OKT4-positive cells (T-helpers) and the values of colonies. On the basis of the present experiments, it is suggested that the defective colony growth of T-cell fractions in B-cell CLL may be related to the low number of OKT4-positive cells plated, which are known to be mainly responsible for the colony generation in agar culture.

Ph1-negative T lymphocytic colonies in agar cultures of peripheral blood in chronic myeloid leukemia.

T lymphocytic colony formation by peripheral lymphocytes separated by discontinuous albumin gradient centrifugation was evaluated in 8 patients with Philadelphia (Ph1)-positive chronic myeloid leukemia (CML). Colonies were obtained using a liquid-on-agar culture system recently introduced (PHA overlayer-leukocyte feeder layer assay) which has been shown to be simple and reliable. The pattern of colony growth in CML and in normal controls was similar, the peak ranging from the 4th to the 6th day. Also the morphological aspects of colonies did not differ in the two groups. Cells recovered from CML lymphocytic colonies were shown to belong to T cell lineage, as they are able to form spontaneous E-rosettes and to respond to mitogenic stimulation in vitro. In contrast, cells recovered from all other cultured fractions failed to display these properties. Cytogenetic analysis showed that T colony cells were Ph1-negative whereas the chromosome anomaly was found in nonlymphoid colonies of the same patients, thus suggesting a nonclonal origin of T lymphocytes in CML.