Nuove strategie terapeutiche nel trattamento delle ferite difficili

Introduzione. Il trattamento medico-chirurgico delle ferite difficili rappresenta un problema socio-sanitario in continua crescita, colpendo attualmente nel nostro Paese circa 2.000.000 di persone. La “ferita difficile” non è altro che una perdita di sostanza cutanea, a patogenesi multifattoriale, che non tende alla guarigione in modo spontaneo. Numerosi studi presenti in letteratura hanno evidenziato che l’uso delle medicazioni avanzate consente di raggiungere migliori risultati clinici ed economici nel processo di guarigione delle ferite difficili, assicurando sia una permanenza superiore sulla lesione che accorciando il tempo di trattamento, in quanto viene richiesto un minor numero di applicazioni rispetto alle medicazioni tradizionali. La Wound Bed Preparation (WBP) può essere definita come la gestione globale e coordinata della lesione cutanea atta a rimuovere le barriere locali alla guarigione o a promuovere l’efficacia di misure terapeutiche innovative. La medicazione avanzata non è altro che un materiale di copertura che possiede caratteristiche di biocompatibilità. Scopo della medicazione avanzata è quello di creare l’ambiente ideale per il processo di cicatrizzazione isolando la ferita da eventuali traumi ed infezioni esterne. Pazienti e metodi. Nell’Ambulatorio “Ferite Difficili” della Cattedra di Chirurgia Plastica e Ricostruttiva del Policlinico Umberto I di Roma, dal gennaio al dicembre 2006, sono stati trattati 570 pazienti (308 uomini – 262 donne), con un’età variabile dai 2 giorni agli 85 anni, affetti da ulcere di varia natura. Nell’ambito dei nostri casi clinici sono stati selezionati 200 soggetti divisi casualmente in due gruppi: gruppo A - 100 pazienti trattati unicamente con medicazioni tradizionali; gruppo B - 100 pazienti trattati unicamente con medicazioni avanzate. Ogni paziente è stato trattato localmente con medicazioni periodiche, specifiche a seconda del tipo di ferita difficile presentata. Inoltre si è proceduto all’individuazione ed alla cura dei fattori sistemici, concause dell’ulcera. Il nostro protocollo prevedeva medicazioni due o tre volte alla settimana a seconda che si trattasse di ferite infette o non infette, per un periodo cha poteva variare da un mese per i casi meno gravi ad un anno per le forme croniche. Risultati. È risultata evidente una più alta percentuale di guarigione ottenuta attraverso l’utilizzo delle medicazioni avanzate. Nel Gruppo A si sono ottenuti i seguenti risultati: la guarigione del 53% delle ferite; il restante 47% non è guarito, ma nel 17%, le medicazioni sono state di ausilio alla preparazione del letto vascolare per l’esecuzione di un intervento definitivo (applicazione di innesti o lembi locali); nel rimanente 30%, invece, è stato ottenuto solo un modestissimo miglioramento della lesione che è ancora in fase di trattamento. Nel Gruppo B si è ottenuta la guarigione del 65% delle ferite; nel restante 35% non guarito, nel 15% le medicazioni sono state di ausilio alla preparazione del letto vascolare per l’esecuzione di un intervento definitivo (applicazione di innesti o lembi locali) mentre nel rimanente 20% si è raggiunto comunque un notevole miglioramento della lesione (con riduzione delle dimensioni, scomparsa dell’infezione e miglioramento della qualità di vita del paziente). Discussione e conclusioni. In sintesi, emerge che le medicazioni avanzate, se correttamente impiegate, offrono vantaggi in termini di efficacia clinica (velocità di guarigione della lesione), di qualità della vita del paziente e di economicità. Non ultimo è da considerare che la ferita difficile è spesso l’epifenomeno di una malattia sistemica. La ferita difficile richiede, quindi, un trattamento multidisciplinare. difficile richiede, quindi, un trattamento multidisciplinare. Results. The results showed a higher percentage of recovery reached by using the advanced dressings. Group A showed the followings results: the 53% of patients recovered from wounds; the remaining 47% patients did’nt not recover but in 17% cases medications showed to be of some help in the preparation of the vascular bed for the execution of a definitive operation (application of grafts or local edges), while the remaining 30% has shown a scarce improvement of the injury and they are still under treatment. Group B showed the 65% of patients recovered from wounds; as for the remaining 35% not recovered patients, medications represented an auxiliary aid to the preparation of the vascular bed for the execution of a definitive operation (application of grafts or local edges) for the 15% of patients, while the remaining 20%, even if not completely recovered, showed a notable improvement of the injury (reduction of the dimensions and disappearance of the infection and improvement of the patient quality of life). Conclusions. In synthesis, it emerges that the advanced dressings, if correctly used, offer advantages in terms of clinical effectiveness (rapid recovery from the injury), patient quality of the life and cheapness. It has also to be considered that the difficult wound is often the epiphenomenon of a systemic illness. The difficult wound requires, therefore, a multidisciplinary treatment

Efficacy of a low-dose diosmin therapy on improving symptoms and quality of life in patients with chronic venous disease. Randomized, double-blind, placebo-controlled trial

Chronic Venous Disease (CVD) is a common medical condition affecting up to 80% of the general population. Clinical manifestations can range from mild to more severe signs and symptoms that contribute to the impairment of the quality of life (QoL) of affected patients. Among treatment options, venoactive drugs such as diosmin are widely used in the symptomatic treatment in all clinical stages. The aim of this study is to determine the effectiveness of a new formulated diosmin in relieving symptoms and improving QoL in patients suffering from CVD. In this randomized, double-blind, placebo-controlled, multicenter clinical study, CVD patients with a Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification system between C2 and C4 were randomized to receive a bioavailable diosmin (as μsmin® Plus) 450 mg tablet once daily or a placebo for 8 weeks. Clinical symptoms and QoL were monitored using the measurement of leg circumference, visual analogue scale (VAS) for pain, Global Index Score (GIS) and Venous Clinical Severity Score (VCSS). A total of 72 subjects completed the study. From week 4, leg edema was significantly decreased in the active group (p < 0.001). An improvement in the VAS score was observed in the active group compared to placebo at the end of treatment (p < 0.05). GIS and VCSS scores were significantly improved in the active group at week 8 (p < 0.001). No treatment related-side effects were recorded. The results of this study showed that the administration of low-dose μsmin® Plus was safe and effective in relieving symptoms and improving QoL in subjects with CVD

Peach [Prunus persica (L.) Batsch] KNOPE1, a class 1 KNOX orthologue to Arabidopsis BREVIPEDICELLUS/KNAT1, is misexpressed during hyperplasia of leaf curl disease

Class 1 KNOTTED-like (KNOX) transcription factors control cell meristematic identity. An investigation was carried out to determine whether they maintain this function in peach plants and might act in leaf curliness caused by the ascomycete Taphrina deformans. KNOPE1 function was assessed by overexpression in Arabidopsis and by yeast two-hybrid assays with Arabidopsis BELL proteins. Subsequently, KNOPE1 mRNA and zeatin localization was monitored during leaf curl disease. KNOPE1 and Arabidopsis BREVIPEDICELLUS (BP) proteins fell into the same phyletic group and recognized the same BELL factors. 35S:KNOPE1 Arabidopsis lines exhibited altered traits resembling those of BP-overexpressing lines. In peach shoot apical meristem, KNOPE1 was expressed in the peripheral and central zones but not in leaf primordia, identically to the BP expression pattern. These results strongly suggest that KNOPE1 must be down-regulated for leaf initiation and that it can control cell meristem identity equally as well as all class 1 KNOX genes. Leaves attacked by T. deformans share histological alterations with class 1 KNOX-overexpressing leaves, including cell proliferation and loss of cell differentiation. Both KNOPE1 and a cytokinin synthesis ISOPENTENYLTRANSFERASE gene were found to be up-regulated in infected curled leaves. At early disease stages, KNOPE1 was uniquely triggered in the palisade cells interacting with subepidermal mycelium, while zeatin vascular localization was unaltered compared with healthy leaves. Subsequently, when mycelium colonization and asci development occurred, both KNOPE1 and zeatin signals were scattered in sectors of cell disorders. These results suggest that KNOPE1 misexpression and de novo zeatin synthesis of host origin might participate in hyperplasia of leaf curl disease

Chi detta l’agenda? Le dichiarazioni pubbliche dei gruppi di interesse sul Recovery Fund

The so-called «Recovery Fund» represented a perhaps unrepeatable opportunity for Italian interest groups to see their own requests transformed into public policies. This article focuses on how the most important organized interests mobilized and contributed to the public debate on the Recovery Fund by attempting to answer three main research questions: which interests have received greater media visibility with respect to the RF? Which issues those same interest groups brought to the at-tention of public opinion? With what consequences (if any) to the main contents of the plan itself? We focus on the 20 most important Italian interest groups, recon-structing their lobbying activity and public frames through the coding of their media interventions and press coverage from September 2020 to the end of April 2021

Recipes for Inducing Cold Denaturation in an Otherwise Stable Protein

[Image: see text] Although cold denaturation is a fundamental phenomenon common to all proteins, it can only be observed in a handful of cases where it occurs at temperatures above the freezing point of water. Understanding the mechanisms that determine cold denaturation and the rules that permit its observation is an important challenge. A way to approach them is to be able to induce cold denaturation in an otherwise stable protein by means of mutations. Here, we studied CyaY, a relatively stable bacterial protein with no detectable cold denaturation and a high melting temperature of 54 °C. We have characterized for years the yeast orthologue of CyaY, Yfh1, a protein that undergoes cold and heat denaturation at 5 and 35 °C, respectively. We demonstrate that, by transferring to CyaY the lessons learnt from Yfh1, we can induce cold denaturation by introducing a restricted number of carefully designed mutations aimed at destabilizing the overall fold and inducing electrostatic frustration. We used molecular dynamics simulations to rationalize our findings and demonstrate the individual effects observed experimentally with the various mutants. Our results constitute the first example of rationally designed cold denaturation and demonstrate the importance of electrostatic frustration on the mechanism of cold denaturation

Recurrent cutaneous abscesses in two Italian family members

Environmental mycobacteria are the causative factors of an increasing number of infections worldwide. Cutaneous infections as a result of such mycobacteria are often misdiag-nosed, and their treatment is difficult since they can show in vivo and in vitro multidrug resistance. Absence of pathognomonic clinical signs and variable histological findings often delay diagnosis. We report a case of localized recurrent soft tissue swelling by Mycobacterium marinum in 2 members of the same family. The cases are being reported for their uncommon clinical presentation and the associated etiological agent. Patients recovered completely following therapy with rifampicin 600 mg plus isoniazide 300 mg daily for 45 days. © C Cantisani et al., 2010

Insomnia Prevalence among Italian Night-Shift Nurses

Background. Insomnia is one of the major health problems related with a decrease in quality of life (QOL) and also in poor functioning in night-shift nurses, that also may negatively affect patients’ care. The aim of this study is to evaluate the prevalence of insomnia in night shift nurses. This observational online web-based survey using Google®® modules specifically aimed to investigate the prevalence and risk factors for insomnia among Italian nurses. Methods. Data collection for this study lasted one month, with the questionnaire available from 1 March 2021 to 1 April 2021. Continuous variables were considered as either mean ± standard deviation (SD) or median and interquartile range (IQR) based on their distribution. Comparison among insomnia categories was assessed by one-way ANOVA or Kruskal–Wallis test according to variable distribution. Categorical variables were analyzed using chi-square test. Results. A total of 2355 responses were included in the final analysis, with 917 from the Northern zone, 815 from the Western zone, and 623 from the Southern zone of Italy. The prevalence of insomnia in the overall population was 65.4% (1524 out 2355 nurses suffered from insomnia). Conclusions. Nursing is a high-pressure profession, with heavy duties and high professional risks. We found an important prevalence of insomnia in night shift nurses, and we hope it may help to solicit further studies aimed to identify the risk factors for this working disorder among nurses

Recurrent cutaneous abscesses in two Italian family members

Environmental mycobacteria are the causative factors of an increasing number of infections worldwide. Cutaneous infections as a result of such mycobacteria are often misdiagnosed, and their treatment is difficult since they can show in vivo and in vitro multidrug resistance. Absence of pathognomonic clinical signs and variable histological findings often delay diagnosis. We report a case of localized recurrent soft tissue swelling by Mycobacterium marinum in 2 members of the same family. The cases are being reported for their uncommon clinical presentation and the associated etiological agent. Patients recovered completely following therapy with rifampicin 600 mg plus isoniazide 300 mg daily for 45 days